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 4-year-old boy is brought to the physician because of a 5-day history of sore throat and a painful swelling on the left side of his neck that has become progressively larger. He has had pain during swallowing and has refused to eat solid foods for the past 3 days. He immigrated to the United States one year ago from ... | Clindamycin therapy | {
"A": "Sulfadiazine and pyrimethamine therapy",
"B": "Incision and drainage",
"C": "Clindamycin therapy",
"D": "Immunoglobulin therapy"
} | step2&3 | C | [
"4 year old boy",
"brought",
"physician",
"5-day history",
"sore throat",
"painful swelling",
"the left side of",
"neck",
"larger",
"pain",
"swallowing",
"refused to eat solid foods",
"past 3 days",
"United States one year ago",
"India",
"immunization records",
"unavailable",
"fami... |
A 52-year-old man with a history of hypertension and hyperlipidemia comes to the physician because of a 10-month history of substernal chest pain on exertion that is relieved with rest. His pulse is 82/min and blood pressure is 145/82 mm Hg. He is prescribed a drug that acts by forming free radical nitric oxide. The pa... | Pulsating headaches | {
"A": "Pulsating headaches",
"B": "Hypertensive urgency",
"C": "Lower extremity edema",
"D": "Erectile dysfunction"
} | step1 | A | [
"year old man",
"history of hypertension",
"hyperlipidemia",
"physician",
"of a 10 month history",
"chest pain",
"exertion",
"relieved with rest",
"pulse",
"min",
"blood pressure",
"mm Hg",
"prescribed",
"drug",
"acts",
"forming free radical nitric oxide",
"patient",
"most likely t... |
A 26-year-old man is brought to the emergency department by ambulance after being involved in a motor vehicle collision. He does not open his eyes on command or respond to verbal cues. A CT scan of the head shows a hyperdense fluid collection in the right medial temporal lobe with medial displacement of the uncus and p... | Oculomotor | {
"A": "Facial",
"B": "Vagus",
"C": "Oculomotor",
"D": "Trigeminal"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"ambulance",
"involved",
"motor vehicle collision",
"not open",
"eyes",
"verbal cues",
"CT scan of",
"head shows",
"fluid collection",
"right medial temporal lobe",
"medial displacement",
"uncus",
"gyrus of",
"temporal lobe",
"foll... |
A 70-year-old male immigrant from Asia is brought to the emergency room with complaints of palpitations and light-headedness for 1 hour. The patient was sitting in his chair watching television when he felt his heart racing and became dizzy. He was unable to stand up from his chair because of weakness and light-headedn... | Increased QT interval | {
"A": "Decreased slope of phase 4",
"B": "Decreased calcium current",
"C": "Decreased conduction velocity",
"D": "Increased QT interval"
} | step1 | D | [
"70 year old male immigrant",
"Asia",
"brought",
"emergency room",
"complaints",
"palpitations",
"light-headedness",
"hour",
"patient",
"sitting",
"chair watching television",
"felt",
"heart racing",
"dizzy",
"unable to stand up",
"chair",
"weakness",
"light-headedness",
"past me... |
A 74-year-old woman is brought by ambulance to the emergency department and presents with a complaint of excruciating chest pain that started about 45 minutes ago. The patient was sitting in the garden when she 1st noticed the pain in the upper abdomen. The pain has persisted and now localizes underneath of the sternum... | Acute ventricular septal rupture complicating myocardial infarction | {
"A": "A new myocardial infarction (re-infarction)",
"B": "Acute pericarditis complicating myocardial infarction",
"C": "Acute ventricular septal rupture complicating myocardial infarction",
"D": "Aortic dissection complicating myocardial infarction"
} | step1 | C | [
"74 year old woman",
"brought",
"ambulance",
"emergency department",
"presents",
"complaint of excruciating chest pain",
"started",
"45 minutes",
"patient",
"sitting",
"garden",
"1st",
"pain",
"upper abdomen",
"pain",
"now localizes",
"sternum",
"left shoulder",
"Milk of magnesia... |
A 53-year-old male presents to his primary care provider for tremor of his right hand. The patient reports that the shaking started a few months ago in his right hand but that he worries about developing it in his left hand as well. He reports that the shaking is worse when he is sitting still or watching television an... | Anticholinergic | {
"A": "Anticholinergic",
"B": "Acetylcholinesterase inhibitor",
"C": "Beta-blocker",
"D": "Sodium channel antagonist"
} | step2&3 | A | [
"year old male presents",
"primary care provider",
"tremor of",
"right hand",
"patient reports",
"shaking started",
"few months",
"right hand",
"worries",
"left hand",
"well",
"reports",
"shaking",
"worse",
"sitting",
"watching television",
"improves",
"goes",
"daily activities",... |
A 45-year-old man presents with lethargy, muscle aches, and dry skin. He is underweight and has very particular eating habits. Physical examination reveals swollen bleeding gums, cracked lips, petechiae, perifollicular hemorrhage, and corkscrew hairs. Laboratory tests reveal a nutritional deficiency. Which of the follo... | Hydroxylation of lysine and proline residues in collagen synthesis | {
"A": "Precursor of serotonin",
"B": "Hydroxylation of lysine and proline residues in collagen synthesis",
"C": "Cofactor in carboxylase reactions",
"D": "Gamma-carboxylation of glutamate residues in clotting factors"
} | step1 | B | [
"year old man presents",
"lethargy",
"muscle aches",
"dry skin",
"underweight",
"very",
"eating habits",
"Physical examination reveals swollen bleeding",
"cracked lips",
"petechiae",
"perifollicular hemorrhage",
"corkscrew hairs",
"Laboratory tests reveal",
"nutritional deficiency",
"fol... |
A 24-year-old woman is brought to the emergency department after being assaulted. The paramedics report that the patient was found conscious and reported being kicked many times in the torso. She is alert and able to respond to questions. She denies any head trauma. She has a past medical history of endometriosis and a... | Fluid resuscitation | {
"A": "Abdominal radiograph",
"B": "Abdominal CT",
"C": "Emergency laparotomy",
"D": "Fluid resuscitation"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"assaulted",
"paramedics report",
"patient",
"found conscious",
"reported",
"times",
"torso",
"alert",
"able to",
"questions",
"denies",
"head trauma",
"past medical",
"tubo-ovarian abscess",
"removed surgically two years",
"on... |
A 59-year-old woman comes to the physician because of upper extremity weakness and fatigue for the past 4 months. She has had difficulty combing her hair and lifting objects. She has also had difficulty rising from her bed in the mornings for 2 months. Over the past month, she started using over-the-counter mouth rinse... | Autoimmunity | {
"A": "Metastasis",
"B": "Inflammation",
"C": "Autoimmunity",
"D": "Invasion"
} | step1 | C | [
"59 year old woman",
"physician",
"upper extremity weakness",
"fatigue",
"past",
"months",
"difficulty combing",
"hair",
"lifting objects",
"difficulty rising from",
"bed",
"mornings",
"months",
"past month",
"started using over-the-counter mouth",
"dry",
"smoked 1 pack",
"cigarett... |
A 75-year-old man comes to the emergency department because of fatigue and black sticky stools during the past 3 days. He also complains of nausea and has had a 2-kg (4.4-lb) weight loss over the past month. He has a history of polycystic kidney disease, hypertension, and hyperlipidemia. He does not smoke or drink alco... | Dysfunctional platelet aggregation | {
"A": "Inherited antithrombin deficiency",
"B": "Dysfunctional platelet aggregation",
"C": "Acquired factor VII deficiency",
"D": "Impaired production of thrombopoietin"
} | step2&3 | B | [
"75 year old man",
"emergency department",
"fatigue",
"black",
"stools",
"past 3 days",
"nausea",
"2 kg",
"4.4",
"weight loss",
"past month",
"history of polycystic kidney disease",
"hypertension",
"hyperlipidemia",
"not smoke",
"drink alcohol",
"Current medications include hydrochlo... |
A 56-year-old man with coronary artery disease agrees to participate in a pharmacological study. He takes an oral medication that leads to dephosphorylation of myosin light chains in venous smooth muscle cells. An investigator measures the plasma concentration of the drug over time after intravenous and then after oral... | Isosorbide mononitrate | {
"A": "Isosorbide mononitrate",
"B": "Nitroglycerine",
"C": "Nifedipine",
"D": "Nitroprusside"
} | step1 | A | [
"year old man",
"coronary artery disease agrees to",
"pharmacological study",
"takes",
"oral medication",
"leads",
"dephosphorylation",
"myosin light chains",
"venous smooth muscle cells",
"investigator measures",
"plasma concentration",
"drug",
"time",
"intravenous",
"then",
"oral adm... |
A 50-year-old woman presents with sudden onset right upper quadrant abdominal pain. She says her symptoms started 6 hours ago after she had dinner. She describes the pain as cramping, radiating to her shoulders. She had similar episodes in the past, but they were less severe and resolved with over-the-counter analgesic... | Hydrophilic bile acids | {
"A": "Hydrophilic bile acids",
"B": "No need for further treatment",
"C": "Initiate stronger analgesic medications such as morphine",
"D": "Re-evaluate after few hours and perform laparoscopic cholecystectomy"
} | step1 | A | [
"50 year old woman presents",
"sudden onset right upper quadrant abdominal pain",
"symptoms started 6 hours",
"dinner",
"pain",
"cramping",
"radiating to",
"shoulders",
"similar episodes",
"past",
"less severe",
"resolved",
"over-the-counter analgesics",
"medical history",
"significant",... |
A 33-year-old man comes to the emergency department because of repeated episodes of severe headache for the past 3 days. He is currently having his 2nd episode of the day. He usually has his first episode in the mornings. The pain is severe and localized to his right forehead and right eye. He had similar symptoms last... | Cluster headache | {
"A": "Migraine headache",
"B": "Cluster headache",
"C": "Giant cell arteritis",
"D": "Medication overuse headache"
} | step2&3 | B | [
"year old man",
"emergency department",
"of repeated episodes",
"severe headache",
"past",
"days",
"currently",
"2nd episode of",
"day",
"usually",
"first episode",
"mornings",
"pain",
"severe",
"localized",
"right forehead",
"right eye",
"similar symptoms last summer",
"works",
... |
A 7-year-old boy is brought to the clinic by his mother due to a sudden onset of puffiness of the eyes. His mother is also concerned about his abdominal distention which she first noticed 5 days ago. There is no history of a recent upper respiratory tract infection, decreased urination, or gross hematuria. His vaccinat... | Microcytic hypochromic anemia responding poorly to oral iron therapy | {
"A": "Spontaneous bacterial peritonitis caused by Haemophilus influenzae",
"B": "Prophylactic anticoagulation is indicated due to the risk of thromboembolism.",
"C": "Acute renal failure due to intrinsic renal failure",
"D": "Microcytic hypochromic anemia responding poorly to oral iron therapy"
} | step1 | D | [
"year old boy",
"brought",
"clinic",
"mother due to",
"sudden onset",
"puffiness",
"eyes",
"mother",
"concerned",
"abdominal distention",
"first",
"5 days",
"history",
"recent upper respiratory tract infection",
"decreased urination",
"gross hematuria",
"vaccinations",
"date",
"i... |
A 3-year-old patient is brought to the emergency department by her mother due to inability to walk. The child has been limping recently and as of this morning, has refused to walk. Any attempts to make the child walk or bear weight result in crying. She was recently treated for impetigo and currently takes a vitamin D ... | Synovial fluid analysis | {
"A": "Radiograph",
"B": "MRI",
"C": "Broad spectrum antibiotics",
"D": "Synovial fluid analysis"
} | step2&3 | D | [
"3 year old patient",
"brought",
"emergency department",
"mother due to",
"to walk",
"child",
"limping recently",
"as",
"morning",
"refused to walk",
"attempts to make",
"child walk",
"bear weight result",
"crying",
"recently treated",
"impetigo",
"currently takes",
"vitamin D supp... |
A 42-year-old man comes to the physician because he is concerned that he is balding. Over the past few months, he has noticed patchy areas of hair loss on his head. He also mentions that he has felt depressed since the death of his wife last year and has unintentionally lost about 18 kg (40 lbs). He is constantly fatig... | Zinc supplementation | {
"A": "Finasteride",
"B": "Griseofulvin",
"C": "Restriction of vitamin A-rich foods",
"D": "Zinc supplementation"
} | step2&3 | D | [
"year old man",
"physician",
"concerned",
"balding",
"past",
"months",
"patchy areas of hair loss",
"head",
"felt depressed",
"death",
"wife",
"year",
"lost",
"kg",
"40 lbs",
"constantly fatigued",
"little appetite",
"feels food",
"not taste",
"same",
"occasional episodes of ... |
A 62-year-old woman referred to the cardiology clinic for the evaluation of fatigue and dyspnea for 4 months. She also has loose stools (2–4 per day), palpitations, and non-pitting edema up to her mid-calf. On examination, vital signs are unremarkable, but she appears to be flushed with mild bilateral wheezes can be he... | Carcinoid tumor | {
"A": "Systemic mastocytosis",
"B": "Carcinoid tumor",
"C": "Whipple’s disease",
"D": "Irritable bowel syndrome"
} | step1 | B | [
"62 year old woman referred",
"cardiology clinic",
"evaluation",
"fatigue",
"dyspnea",
"months",
"loose stools",
"day",
"palpitations",
"non-pitting edema",
"calf",
"examination",
"vital signs",
"unremarkable",
"appears to",
"flushed",
"mild bilateral wheezes",
"heard",
"chest au... |
A 2-year-old boy is brought to the physician because of an increasing productive cough with a moderate amount of white phlegm for the past week. He has been treated for pneumonia with antibiotic therapy four times over the past year. A chest x-ray performed 3 months ago showed no anatomical abnormalities. He has had mu... | Sweat chloride test | {
"A": "X-ray of the chest",
"B": "Serum immunoglobulin level",
"C": "Sweat chloride test",
"D": "DNA phenotyping\n\""
} | step2&3 | C | [
"2 year old boy",
"brought",
"physician",
"increasing productive cough",
"moderate amount",
"white phlegm",
"past week",
"treated",
"pneumonia",
"antibiotic therapy four times",
"past",
"chest x-ray performed 3 months",
"showed",
"anatomical abnormalities",
"multiple episodes of bulky gr... |
A 25-year-old woman comes to the physician because of irregular menstrual bleeding. Menarche occurred at the age of 12 years and menses have occurred at 45 to 90-day intervals. Her last menstrual period was 8 weeks ago. She is not sexually active. Serum studies show:
Fasting glucose 178 mg/dL
Fasting insulin 29 mcIU/mL... | Enlarged ovaries on transvaginal ultrasound | {
"A": "Elevated serum beta-HCG level",
"B": "Adrenal tumor on abdominal MRI",
"C": "Enlarged ovaries on transvaginal ultrasound",
"D": "Intrasellar mass on cranial contrast MRI"
} | step1 | C | [
"year old woman",
"physician",
"irregular menstrual bleeding",
"Menarche occurred",
"age",
"years",
"menses",
"occurred",
"90 day intervals",
"last menstrual period",
"weeks",
"not sexually active",
"Serum studies show",
"Fasting glucose",
"mg/dL",
"insulin 29 mcIU/mL",
"N",
"mcIU/... |
A 77-year-old man with hypertension, type 2 diabetes mellitus, and atrial fibrillation is admitted to the hospital because of a 3-hour history of nausea and flank pain. Two days after admission, he suddenly develops aphasia and left-sided paralysis. Despite appropriate life-saving measures, he dies. A photograph of a s... | Coagulative necrosis | {
"A": "Coagulative necrosis",
"B": "Gangrenous necrosis",
"C": "Liquefactive necrosis",
"D": "Caseous necrosis\n\""
} | step1 | A | [
"year old man",
"hypertension",
"type 2 diabetes mellitus",
"atrial fibrillation",
"admitted",
"hospital",
"3 hour history",
"nausea",
"flank pain",
"Two days",
"admission",
"aphasia",
"left-sided paralysis",
"appropriate life saving measures",
"photograph",
"section",
"kidney obtain... |
A 38-year-old man presents with concerns after finding out that his father was recently diagnosed with colon cancer. Family history is only significant for his paternal grandfather who also had colon cancer. A screening colonoscopy is performed, and a polyp is found in the ascending (proximal) colon, which on biopsy sh... | DNA mismatch repair | {
"A": "Inhibitor of apoptosis",
"B": "Inhibits progression from G1 to S phase",
"C": "DNA mismatch repair",
"D": "RAS cycle transduction inhibitor"
} | step1 | C | [
"year old man presents",
"concerns",
"finding out",
"father",
"recently diagnosed",
"colon cancer",
"Family history",
"only significant",
"paternal grandfather",
"colon cancer",
"screening colonoscopy",
"performed",
"polyp",
"found",
"ascending",
"proximal",
"colon",
"biopsy shows ... |
A 57-year-old woman presents to an outpatient clinic with lower extremity weakness and lower back pain. The patient says that her symptoms began 2 weeks ago when she was working in her garden and have progressively worsened to the extent she currently is unable to walk on her own. She describes the pain as sharp, sever... | Immediate transfer to the emergency department for management | {
"A": "Outpatient management with a 3-day course of meloxicam and tolperisone and reassess",
"B": "Outpatient management with 3 days of strict bed rest and reassess",
"C": "Recommend non-emergent inpatient spinal manipulation program",
"D": "Immediate transfer to the emergency department for management"
} | step2&3 | D | [
"57 year old woman presents",
"outpatient clinic",
"lower extremity weakness",
"lower back pain",
"patient",
"symptoms began 2 weeks",
"working",
"garden",
"worsened",
"extent",
"currently",
"unable to walk",
"pain",
"sharp",
"severe",
"descending",
"lower back",
"lateral ankles",
... |
A 71-year-old man comes to the physician for a routine health maintenance examination. He has occasional fatigue but otherwise feels well. He has a history of hypertension and type 2 diabetes mellitus. He is a retired chemist. His only medication is ramipril. His temperature is 37.8°C (100°F), pulse is 72/min, respirat... | Smudge cells | {
"A": "Ringed sideroblasts",
"B": "Rouleaux formation",
"C": "Smudge cells",
"D": "Polycythemia\n\""
} | step2&3 | C | [
"71 year old man",
"physician",
"routine health maintenance examination",
"occasional fatigue",
"feels well",
"history of hypertension",
"type 2 diabetes mellitus",
"retired chemist",
"only medication",
"ramipril",
"temperature",
"pulse",
"72 min",
"respirations",
"min",
"blood pressur... |
A 64-year-old woman presents to an urgent care clinic with edema of her lips and difficulty breathing. She reports that she had multiple root canals performed earlier today, and she started to notice swelling of her lips 2 hours ago. The symptoms have now progressed to where she is having trouble breathing. She notes s... | Hereditary angioedema | {
"A": "Hereditary angioedema",
"B": "Contact dermatitis",
"C": "Drug-induced angioedema",
"D": "Allergic reaction"
} | step2&3 | A | [
"64 year old woman presents",
"urgent care clinic",
"edema",
"lips",
"difficulty breathing",
"reports",
"multiple root canals performed earlier today",
"started",
"swelling of",
"lips",
"hours",
"symptoms",
"now progressed",
"trouble breathing",
"notes similar episodes",
"past",
"min... |
A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper a... | Sorafenib | {
"A": "Daclizumab",
"B": "Palivizumab",
"C": "Abciximab",
"D": "Sorafenib"
} | step2&3 | D | [
"year old African American presents",
"emergency department",
"abdominal pain",
"fatigue",
"weight loss over",
"past 3 months",
"a long standing history of",
"hepatitis B virus infection complicated",
"cirrhosis",
"examination",
"jaundice",
"leg edema",
"palpable mass",
"right upper abdomi... |
A 29-year-old G1P1 woman presents to her primary care physician with unilateral breast pain. She is currently breastfeeding her healthy 3-month-old baby boy. She has been breastfeeding since her child's birth without any problems. However, 3 days prior to presentation, she developed left breast pain, purulent nipple di... | Staphylococcus aureus | {
"A": "Candida albicans",
"B": "Staphylococcus aureus",
"C": "Staphylococcus epidermidis",
"D": "Streptococcus pyogenes"
} | step1 | B | [
"29 year old G1P1 woman presents",
"primary care physician",
"unilateral breast",
"currently breastfeeding",
"healthy",
"month old baby boy",
"breastfeeding",
"child's birth",
"problems",
"3 days prior to presentation",
"left",
"purulent nipple discharge",
"malaise",
"past medical history"... |
A 61-year-old man is brought to the emergency department by ambulance because of severe retrosternal chest pain and shortness of breath for 30 minutes. Paramedics report that an ECG recorded en route to the hospital showed ST-segment elevation in I, aVL, and the precordial leads. On arrival, the patient is unresponsive... | Ventricular fibrillation | {
"A": "Left ventricular failure",
"B": "Ventricular aneurysm",
"C": "Cardiac free wall rupture",
"D": "Ventricular fibrillation"
} | step1 | D | [
"61 year old man",
"brought",
"emergency department",
"ambulance",
"severe retrosternal chest pain",
"shortness of breath",
"30 minutes",
"Paramedics report",
"ECG recorded en route",
"hospital showed ST-segment elevation",
"I",
"aVL",
"precordial leads",
"arrival",
"patient",
"unrespo... |
A 7-month-old Caucasian male presents with recurrent sinusitis and pharyngitis. The parents say that the child has had these symptoms multiple times in the past couple of months and a throat swab sample reveals the presence of Streptoccocus pneumoniae. Upon workup for immunodeficiency it is noted that serum levels of i... | CD19 | {
"A": "CD4",
"B": "CD8",
"C": "CD19",
"D": "NKG2D"
} | step1 | C | [
"month old Caucasian male presents",
"recurrent sinusitis",
"pharyngitis",
"parents",
"child",
"symptoms multiple times",
"past couple",
"months",
"throat swab sample reveals",
"presence",
"pneumoniae",
"workup",
"immunodeficiency",
"noted",
"serum levels",
"immunoglobulins",
"extrem... |
A 1-year-old boy is brought to the physician because of irritability and poor feeding that began 2 days ago. His mother reports that he has been crying more than usual during this period. He refused to eat his breakfast that morning and has not taken in any food or water since that time. He has not vomited. When changi... | Perform transurethral catheterization | {
"A": "Perform renal ultrasound",
"B": "Obtain clean catch urine sample",
"C": "Perform transurethral catheterization",
"D": "Administer cefixime"
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"irritability",
"poor feeding",
"began 2 days",
"mother reports",
"crying more",
"usual",
"period",
"refused to eat",
"breakfast",
"morning",
"not taken",
"food",
"water",
"time",
"not vomited",
"changing",
"boy's diapers",
"morning",
... |
A 55-year-old male with a 60 pack-year smoking history presents to his oncologist for ongoing management of his recently diagnosed small cell lung cancer. His oncologist discusses several options and decides to start the chemotherapeutic medication, etoposide. The patient is warned that one side effect of this drug is ... | Inhibition of supercoil relaxation | {
"A": "Alkylation of DNA",
"B": "Crosslinking of DNA",
"C": "Inhibition of supercoil relaxation",
"D": "Stabilization of microtubules"
} | step1 | C | [
"55 year old male",
"60 pack",
"smoking history presents",
"oncologist",
"ongoing management",
"recently diagnosed small cell lung cancer",
"oncologist discusses several options",
"to start",
"chemotherapeutic medication",
"etoposide",
"patient",
"warned",
"one",
"drug",
"myelosuppressio... |
A 40-year-old pregnant woman presents to the clinic at her 12th week of gestation. She does not have any complaints during this visit but comes to discuss her lab reports from her last visit. Her blood test results are within normal limits, but the abdominal ultrasound reports nuchal thickening with a septated cystic h... | Congenital lymphedema of the hands and feet | {
"A": "Congenital lymphedema of the hands and feet",
"B": "Anal atresia",
"C": "Port-wine stain on the forehead",
"D": "Microphthalmia"
} | step1 | A | [
"40 year old pregnant woman presents",
"clinic",
"week",
"gestation",
"not",
"complaints",
"visit",
"to discuss",
"lab reports",
"visit",
"blood test results",
"normal limits",
"abdominal ultrasound reports nuchal thickening",
"septated cystic hygroma",
"Chorionic villus sampling",
"pe... |
A 32-year-old man is brought to the physician by his wife for a 3-day history of fever, headaches, and myalgias. He returned from a camping trip in Oklahoma 10 days ago. He works as a computer salesman. His temperature is 38.1°C (100.6°F). Neurologic examination shows a sustained clonus of the right ankle following sud... | Ehrlichia chaffeensis | {
"A": "Coxiella burnetii",
"B": "Rickettsia rickettsii",
"C": "Anaplasma phagocytophilum",
"D": "Ehrlichia chaffeensis"
} | step1 | D | [
"year old man",
"brought",
"physician",
"wife",
"3-day history",
"fever",
"headaches",
"myalgias",
"returned",
"camping trip",
"Oklahoma 10 days",
"works",
"computer salesman",
"temperature",
"100",
"Neurologic examination shows",
"sustained clonus",
"right ankle following sudden p... |
A 34-year-old woman presents with blurred vision and ringing in her ears. She says she has a 6-month history of recurrent worsening bilateral pulsatile headaches that she manages with ibuprofen, which does very little to relieve the pain. For the past week, she says she has vomited nearly every morning and missed work ... | Acetazolamide | {
"A": "Furosemide",
"B": "Acetazolamide",
"C": "Optic nerve sheath fenestration",
"D": "Ventriculoperitoneal shunting"
} | step2&3 | B | [
"year old woman presents",
"blurred vision",
"ringing in",
"ears",
"month history of recurrent worsening bilateral pulsatile headaches",
"ibuprofen",
"very little to relieve",
"pain",
"past week",
"vomited nearly",
"morning",
"missed work due to",
"pain",
"head",
"first",
"vision probl... |
A 63-year-old man presents with a 2-month history of increasing sensation of fullness involving his left flank. The patient reports recent episodes of constant pain. The patient is hypertensive (145/90 mm Hg) and is currently on medications including losartan and hydrochlorothiazide. His past medical history is otherwi... | Renal cell carcinoma | {
"A": "Angiomyolipoma",
"B": "Renal cell carcinoma",
"C": "Transitional cell carcinoma",
"D": "Wilms tumor"
} | step2&3 | B | [
"63 year old man presents",
"month history",
"increasing sensation",
"fullness involving",
"left flank",
"patient reports recent episodes of constant pain",
"patient",
"hypertensive",
"90 mm Hg",
"currently",
"medications including losartan",
"hydrochlorothiazide",
"past medical history",
... |
A 25-year-old woman, gravida 2, para 1, at 24 weeks' gestation comes to the physician for a prenatal visit. She reports feeling fatigue and having swollen legs lately. One month ago, she had a low-grade fever, a runny nose, painful joints, and a sore throat that resolved spontaneously. Pregnancy and delivery of her fir... | Parvovirus B19 | {
"A": "Herpes simplex virus",
"B": "Parvovirus B19",
"C": "Listeria monocytogenes",
"D": "Toxoplasma gondii\n\""
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"prenatal visit",
"reports feeling fatigue",
"swollen legs",
"One month",
"low-grade fever",
"runny nose",
"painful joints",
"sore throat",
"resolved",
"Pregnancy",
"delivery",
"first child",
"uncomplicat... |
A 44-year-old man presents to a family medical center for evaluation of multiple, painful lesions on the lower lip. He says that the lesions appeared 1 day ago after spending a weekend vacation at the beach. He reports a tingling sensation after the 2nd day. This is the 3rd time in the past year that the lesions have o... | Penciclovir cream | {
"A": "Docosanol cream",
"B": "Imiquimod",
"C": "Oral cidofovir",
"D": "Penciclovir cream"
} | step2&3 | D | [
"year old man presents",
"family medical center",
"evaluation",
"multiple",
"painful lesions",
"lower",
"lesions appeared 1 day",
"spending",
"weekend vacation",
"beach",
"reports",
"tingling sensation",
"2nd day",
"3rd time",
"past",
"lesions",
"occurred",
"past medical conditions... |
One week after starting a new medication, a 16-year-old girl is brought to the emergency department by her mother because of a painful, blistering rash. She has a history of bipolar disorder. Her temperature is 39°C (102°F). Physical examination shows numerous coalescing bullae with epidermal detachment covering the fa... | Lamotrigine | {
"A": "Topiramate",
"B": "Valproic acid",
"C": "Lamotrigine",
"D": "Lithium"
} | step1 | C | [
"One week",
"starting",
"new medication",
"year old girl",
"brought",
"emergency department",
"mother",
"painful",
"blistering rash",
"history of bipolar disorder",
"temperature",
"Physical examination shows numerous",
"bullae",
"epidermal detachment covering",
"face",
"trunk",
"extr... |
A 61-year-old woman comes to the physician for evaluation of numbness and a burning sensation in her feet for the past 5 months. She has type 2 diabetes mellitus and hypercholesterolemia. Her blood pressure is 119/82 mm Hg. Neurologic examination shows decreased sensation to pinprick, light touch, and vibration over th... | Increased protein deposition in endoneural vessel walls | {
"A": "Accumulation of lipids and foam cells in arteries",
"B": "Increased protein deposition in endoneural vessel walls",
"C": "Osmotic damage to oligodendrocyte nerve sheaths",
"D": "Elevated hydrostatic pressure in arteriolar lumen"
} | step1 | B | [
"61 year old woman",
"physician",
"evaluation",
"numbness",
"burning sensation",
"feet",
"past",
"months",
"type 2 diabetes mellitus",
"hypercholesterolemia",
"blood pressure",
"mm Hg",
"Neurologic examination shows decreased sensation",
"light touch",
"vibration",
"soles of",
"feet"... |
A 45-year-old woman presents to the office because of shortness of breath and chest tightness on exertion which she noticed for the past 2 months. She was diagnosed with asthma 1 month ago but says that the asthma medication has not improved her breathing. She does not smoke and works as a hotel manager. Examination sh... | Alpha 1-antitrypsin deficiency | {
"A": "Alpha 1-antitrypsin deficiency",
"B": "Bilateral pneumothorax",
"C": "Pneumomediastinum",
"D": "Pulmonary hypertension"
} | step1 | A | [
"year old woman presents",
"office",
"of shortness",
"breath",
"chest tightness",
"exertion",
"past",
"months",
"diagnosed",
"asthma",
"month",
"asthma medication",
"not improved",
"breathing",
"not smoke",
"works",
"hotel",
"Examination shows mildly jaundiced conjunctivae",
"sev... |
A 15-year-old boy presents with a 3-month history of severe muscle cramps and pain. The patient first noticed these symptoms while attending tryouts for the high school football team. Following the tryout, he becomes easily fatigued and complains of severe muscle pain and swelling after 10 minutes of exercising. Howeve... | Myophosphorylase deficiency | {
"A": "Acid maltase deficiency",
"B": "Dystrophin gene mutation",
"C": "Medium chain acyl CoA dehydrogenase deficiency",
"D": "Myophosphorylase deficiency"
} | step2&3 | D | [
"year old boy presents",
"month history",
"severe muscle cramps",
"pain",
"patient first",
"symptoms",
"attending",
"high football team",
"Following",
"easily fatigued",
"severe muscle",
"swelling",
"10 minutes",
"exercising",
"brief period",
"rest",
"symptoms",
"able to return",
... |
A 56-year-old homeless male presents to a free clinic for a health evaluation. He states that he has not seen a physician in over 25 years but finally decided to seek medical attention after he noticed recent chronic fatigue and weight gain. Upon questioning, he endorses drinking 2 handles of whiskey per day. On exam, ... | Testicular atrophy | {
"A": "4-hertz hand tremor",
"B": "Direct hyperbiluribemia",
"C": "Microcytic anemia",
"D": "Testicular atrophy"
} | step2&3 | D | [
"year old homeless male presents",
"free clinic",
"health evaluation",
"states",
"not seen",
"physician",
"years",
"to",
"medical attention",
"recent chronic fatigue",
"weight gain",
"questioning",
"drinking 2 handles",
"whiskey",
"day",
"exam",
"physician observes",
"findings show... |
A previously healthy 20-year-old man comes to the physician because of a 6-month history of a painless mass in his left groin that has been gradually increasing in size. Physical examination shows a 3x3-cm oval, non-tender left inguinal mass and a fluctuant, painless left scrotal swelling that increase in size with cou... | Failure of processus vaginalis to close | {
"A": "Failure of processus vaginalis to close",
"B": "Obstruction of left spermatic vein",
"C": "Widening of femoral ring",
"D": "Weakening of transversalis fascia\n\""
} | step1 | A | [
"healthy 20 year old man",
"physician",
"month history",
"painless mass",
"left groin",
"increasing in size",
"Physical examination shows",
"oval",
"non-tender left inguinal mass",
"fluctuant",
"painless left scrotal swelling",
"increase in size",
"coughing",
"following",
"most likely ca... |
A 42-year-old homeless man presents to the emergency department complaining of pain in his right knee and fever. The patient is having difficulty walking and looks visibly uncomfortable. On examination, he is disheveled but his behavior is not erratic. The patient’s right knee is erythematous, edematous, and warm, with... | Vancomycin | {
"A": "Linezolid",
"B": "Penicillin G",
"C": "Vancomycin",
"D": "Gentamicin"
} | step1 | C | [
"year old homeless man presents",
"emergency department",
"pain",
"right knee",
"fever",
"patient",
"difficulty walking",
"looks",
"examination",
"behavior",
"not",
"patients right knee",
"erythematous",
"edematous",
"warm",
"evidence",
"wound",
"weeping purulent fluid",
"patient... |
A 58-year-old man presents to the emergency department following a fall while walking in a grocery store. He has a history of at least 6 previous collapses to the ground with no warning. When these episodes occur, he becomes pale, diaphoretic, and recovers quickly within a few seconds. These episodes always occur when ... | Erectile dysfunction | {
"A": "Amyotrophy",
"B": "Diplopia",
"C": "Erectile dysfunction",
"D": "Heat intolerance"
} | step2&3 | C | [
"58 year old man presents",
"emergency department following",
"fall",
"walking in",
"grocery store",
"history",
"previous collapses",
"warning",
"episodes occur",
"pale",
"diaphoretic",
"recovers",
"seconds",
"episodes always occur",
"standing",
"past medical history",
"significant",... |
An otherwise healthy 13-year-old boy is brought to the physician for the evaluation of severe acne for the last 3 years. Topical retinoic acid and oral tetracycline did not improve his symptoms. He shaves his chin and mustache area every few days. His parents report that he grew 5 cm (2 in) during the last year. The on... | 21β-hydroxylase deficiency | {
"A": "Leydig-cell tumor production of androgens",
"B": "21β-hydroxylase deficiency",
"C": "Constitutive activation of adenylyl cyclase",
"D": "17α-hydroxylase deficiency"
} | step2&3 | B | [
"healthy",
"year old boy",
"brought",
"physician",
"evaluation",
"severe acne",
"last",
"years",
"Topical retinoic acid",
"oral tetracycline",
"not",
"symptoms",
"shaves",
"chin",
"mustache area",
"few days",
"parents report",
"5",
"2",
"last year",
"onset of pubic hair growt... |
During the third week of development, the blastula undergoes a variety of differentiation processes responsible for the formation of the gastrula and, eventually, the embryo. This differentiation creates cell lineages that eventually become a variety of body systems. What cell lineage, present at this date, is responsi... | Endoderm | {
"A": "Syncytiotrophoblasts",
"B": "Endoderm",
"C": "Ectoderm",
"D": "Mesoderm"
} | step1 | B | [
"third week",
"development",
"blastula",
"variety",
"differentiation processes responsible",
"formation",
"gastrula",
"embryo",
"differentiation creates cell lineages",
"variety",
"body systems",
"cell lineage",
"present",
"date",
"responsible",
"formation",
"liver"
] |
A 34-year-old poultry worker presents to his physician with a sore throat and a non-productive cough for 2 weeks. His cough is associated with fever. The vital signs include: blood pressure 120/80 mm Hg, heart rate 67/min, respiratory rate 18/min, and temperature 37.6°C (98.0°F). Physical examination shows oropharyngea... | It primarily induces the Th1-cell response. | {
"A": "It activates TLR5 on the surface of macrophages.",
"B": "It primarily induces the Th1-cell response.",
"C": "Peptidoglycan is its major antigen that induces an immune response.",
"D": "This pathogen evades the immune response by encapsulation."
} | step1 | B | [
"year old poultry worker presents",
"physician",
"sore throat",
"non-productive cough",
"weeks",
"cough",
"associated with fever",
"vital signs include",
"blood pressure",
"80 mm Hg",
"heart rate 67 min",
"respiratory rate",
"min",
"temperature",
"98",
"Physical examination shows oroph... |
A 15-year-old boy is admitted to the emergency department with neck stiffness, maculopapular rash, fever, and a persistent headache. A blood culture shows encapsulated gram-negative diplococci. He has had this same infection before. Which of the following proteins is likely to be deficient in this patient? | C9 | {
"A": "Calcineurin",
"B": "C9",
"C": "CD55 (decay accelerating factor)",
"D": "CD4"
} | step1 | B | [
"year old boy",
"admitted",
"emergency department",
"neck stiffness",
"maculopapular rash",
"fever",
"persistent headache",
"blood culture shows encapsulated gram-negative diplococci",
"same infection",
"following proteins",
"likely to",
"deficient",
"patient"
] |
A 27-year-old man comes to the physician because of intermittent right shoulder pain for the past 2 weeks. The pain awakens him at night and is worse when he lies on the right shoulder. He does not have any paresthesia or numbness in the right arm. He is a painter, and these episodes of pain have not allowed him to wor... | Physical therapy | {
"A": "MRI of the shoulder",
"B": "Intraarticular glucocorticoids",
"C": "Physical therapy",
"D": "Thoracic outlet decompression"
} | step2&3 | C | [
"27 year old man",
"physician",
"of intermittent right shoulder pain",
"past 2 weeks",
"pain",
"night",
"worse",
"right shoulder",
"not",
"paresthesia",
"numbness",
"right arm",
"painter",
"episodes of pain",
"not allowed",
"to work",
"appears healthy",
"Vital signs",
"normal lim... |
One week after starting amoxicillin for sinusitis, a 4-year-old girl is brought to the emergency department with fever, rash, and myalgia. She has been hospitalized multiple times for recurrent streptococcal pneumonia and meningitis. She appears tired. Examination shows a diffuse urticarial rash. Her antibiotic is disc... | Impaired opsonization | {
"A": "Impaired leukocyte adhesion",
"B": "Defective superoxide production",
"C": "Impaired opsonization",
"D": "Absence of IgA antibodies"
} | step1 | C | [
"One week",
"starting amoxicillin",
"sinusitis",
"4 year old girl",
"brought",
"emergency department",
"fever",
"rash",
"myalgia",
"hospitalized multiple times",
"recurrent streptococcal",
"meningitis",
"appears tired",
"Examination shows",
"diffuse urticarial",
"antibiotic",
"discon... |
A 9-year-old boy presents with polydipsia, polyuria, and a serum osmolality of 325 mOsm/L. A neurologic examination reveals bitemporal hemianopia. The lesion is believed to be derived from Rathke's pouch remnants. Which of the following is the most likely histologic finding? | Cystic spaces | {
"A": "Liquefactive necrosis",
"B": "Cystic spaces",
"C": "Lymphocytic infiltrate",
"D": "Branching papillae"
} | step1 | B | [
"year old boy presents",
"polydipsia",
"polyuria",
"serum osmolality",
"325 mOsm/L",
"neurologic examination reveals bitemporal hemianopia",
"lesion",
"to",
"derived",
"Rathke's pouch remnants",
"following",
"most likely histologic finding"
] |
A 43-year-old man comes to the physician because of nasal congestion and fatigue for 12 days. During this period, he has had fevers and severe pain over his cheeks. His nasal discharge was initially clear, but it has turned yellowish over the last couple of days. He has no visual complaints. He has been taking an over-... | Oral amoxicillin-clavulanic acid | {
"A": "Intravenous amphotericin B",
"B": "Oral amoxicillin-clavulanic acid",
"C": "Oral levofloxacin",
"D": "Oral loratadine"
} | step2&3 | B | [
"year old man",
"physician",
"nasal congestion",
"fatigue",
"days",
"period",
"fevers",
"severe pain",
"cheeks",
"nasal discharge",
"initially clear",
"turned",
"couple",
"days",
"visual complaints",
"taking",
"over-the-counter nasal decongestant",
"acetaminophen",
"relief",
"t... |
A 67-year-old man is referred to a dermatologist after a reddish mole appears on his nose. The mole’s size has changed over the last 2 years, and occasional bleeding is noted. The man’s medical history is unremarkable, and he does not take any medications. He retired from his construction job 15 years ago. Physical exa... | Radiation therapy | {
"A": "Photodynamic therapy",
"B": "5-fluorouracil",
"C": "Radiation therapy",
"D": "Interferon"
} | step2&3 | C | [
"67 year old man",
"referred",
"dermatologist",
"mole appears",
"nose",
"moles size",
"changed",
"years",
"occasional bleeding",
"noted",
"mans medical history",
"unremarkable",
"not take",
"medications",
"retired",
"construction job 15 years",
"Physical examination",
"nose reveals... |
A 51-year-old woman with AIDS presents to her primary care physician with fatigue and weakness. She has a history of type 2 diabetes mellitus, hypertension, infectious mononucleosis, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and denies any illicit drug ... | Hemodialysis | {
"A": "Intravenous saline with mannitol with the goal of a daily urinary output above 2.5 L/day",
"B": "Hemodialysis",
"C": "Allopurinol 300 mg/day",
"D": "Intravenous recombinant uricase enzyme rasburicase"
} | step2&3 | B | [
"year old woman",
"AIDS presents",
"primary care physician",
"fatigue",
"weakness",
"history of type 2 diabetes mellitus",
"hypertension",
"infectious mononucleosis",
"hypercholesterolemia",
"currently smokes 1 pack",
"cigarettes",
"day",
"drinks",
"glass",
"wine",
"day",
"denies",
... |
A 13-month-old girl is brought to the pediatric clinic by her mother due to progressive abdominal distension, poor feeding, and failure to thrive. The perinatal history was uneventful. The family emigrated from Sudan 8 years ago. The vital signs include: temperature 36.8°C (98.2°F), blood pressure 100/55 mm Hg, and pul... | Beta-thalassemia major | {
"A": "Alpha-thalassemia major",
"B": "Glucose-6-phosphate dehydrogenase deficiency",
"C": "Sickle cell disease",
"D": "Beta-thalassemia major"
} | step2&3 | D | [
"month old girl",
"brought",
"pediatric clinic",
"mother due to progressive abdominal distension",
"poor feeding",
"failure to thrive",
"perinatal history",
"family",
"Sudan",
"years",
"vital signs include",
"temperature 36",
"98",
"blood pressure 100 55 mm Hg",
"pulse 99 min",
"physic... |
A 35-year-old man is admitted with an acute onset of dysphagia, odynophagia, slight retrosternal chest pain, hypersalivation, and bloody sputum. These symptoms appeared 3 hours ago during a meal when the patient ate fish. The patient’s past medical history is significant for repair of a traumatic esophageal rupture 5 y... | Emergency endoscopy | {
"A": "IV administration of glucagon",
"B": "Foley catheter removal",
"C": "Emergency endoscopy",
"D": "Removal with Magill forceps"
} | step2&3 | C | [
"35 year old man",
"admitted",
"acute onset",
"dysphagia",
"odynophagia",
"slight retrosternal chest pain",
"hypersalivation",
"bloody sputum",
"symptoms appeared 3 hours",
"meal",
"patient ate fish",
"patients past medical history",
"significant",
"repair",
"traumatic esophageal rupture... |
An 8-year-old boy presents to his pediatrician accompanied by his father with a complaint of chronic cough. For the past 2 months he has been coughing up yellow, foul-smelling sputum. He has been treated at a local urgent care center for multiple episodes of otitis media, sinusitis, and bronchitis since 2 years of age.... | Decreased motility of cilia | {
"A": "Decreased motility of cilia",
"B": "Defective maturation of B-lymphocytes",
"C": "Maldevelopment of pharyngeal pouches",
"D": "Transient bronchoconstriction"
} | step2&3 | A | [
"year old boy presents",
"pediatrician",
"father",
"complaint",
"chronic cough",
"past",
"months",
"coughing",
"yellow",
"foul-smelling sputum",
"treated",
"local urgent care center",
"multiple episodes of otitis media",
"sinusitis",
"bronchitis",
"years",
"age",
"family history",
... |
A researcher is studying physiologic and hormonal changes that occur during pregnancy. Specifically, they examine the behavior of progesterone over the course of the menstrual cycle and find that it normally decreases over time; however, during pregnancy this decrease does not occur in the usual time frame. The researc... | Thyroid gland | {
"A": "Adipocytes",
"B": "Adrenal gland",
"C": "Bones",
"D": "Thyroid gland"
} | step1 | D | [
"researcher",
"studying physiologic",
"hormonal changes",
"occur",
"pregnancy",
"behavior",
"progesterone",
"course",
"menstrual cycle",
"find",
"decreases",
"time",
"pregnancy",
"decrease",
"not occur",
"usual time frame",
"researcher",
"circulating factor",
"appears to",
"res... |
A 73-year-old woman comes to the physician because of recurrent episodes of losing consciousness for several seconds upon standing. She has a history of hypertension, which has been treated with hydrochlorothiazide. Her blood pressure is 130/87 mm Hg in the supine position and 100/76 mm Hg 30 seconds after standing up.... | ↓ ↓ ↓ | {
"A": "↓ ↓ ↓",
"B": "↑ ↑ ↑",
"C": "No change ↓ ↓",
"D": "↓ ↑ ↓"
} | step1 | A | [
"year old woman",
"physician",
"recurrent episodes",
"consciousness",
"several seconds",
"standing",
"history of hypertension",
"treated with hydrochlorothiazide",
"blood pressure",
"87 mm Hg",
"supine position",
"100 76 mm Hg 30 seconds",
"standing up",
"Cardiac examination shows",
"abn... |
A 27-year-old Caucasian female presents complaining of recent weight loss and weakness. She reports that she feels dizzy and lightheaded every morning when she gets out of bed, and often at work whenever she must rise from her desk. Physical exam reveals several areas of her skin including her elbows and knees are more... | Hyperkalemia | {
"A": "Hyperglycemia",
"B": "Hyperkalemia",
"C": "Hypernatremia",
"D": "Central obesity"
} | step1 | B | [
"27 year old Caucasian female presents",
"recent weight loss",
"weakness",
"reports",
"feels dizzy",
"lightheaded",
"morning",
"gets out",
"bed",
"often",
"work",
"rise",
"Physical exam reveals several areas",
"skin including",
"elbows",
"knees",
"more pigmented",
"areas",
"follo... |
A 52-year-old man comes to the physician because of a 1-month history of fatigue and blurry vision. Pulse oximetry on room air shows an oxygen saturation of 99%. Laboratory studies show a hemoglobin concentration of 17.5 g/dL, mean corpuscular volume of 88 μm3, red cell volume of 51.6 mL/kg, and plasma volume of 38 mL/... | Hepatocellular carcinoma | {
"A": "Polycythemia vera",
"B": "Excessive diuretic use",
"C": "Chronic myelogenous leukemia",
"D": "Hepatocellular carcinoma"
} | step1 | D | [
"year old man",
"physician",
"month history",
"fatigue",
"blurry vision",
"Pulse oximetry",
"room air shows",
"oxygen",
"99",
"Laboratory studies show a hemoglobin concentration",
"17",
"g dL",
"mean corpuscular volume",
"88 m3",
"red cell volume",
"mL/kg",
"plasma volume of",
"mL/... |
A recently deceased 92-year-old woman with a history of arrhythmia was discovered to have amyloid deposition in her atria upon autopsy. Upon further examination, there was no amyloid found in any other organs. The peptide at fault was identified and characterized by the pathologist performing the autopsy. Before its ev... | Vasodilation | {
"A": "Reduction of blood calcium concentration",
"B": "Vasodilation",
"C": "Slowing of gastric emptying",
"D": "Stimulation of lactation"
} | step1 | B | [
"recently deceased",
"year old woman",
"history",
"arrhythmia",
"discovered to",
"amyloid deposition",
"atria",
"autopsy",
"further examination",
"amyloid found",
"organs",
"peptide",
"fault",
"identified",
"characterized",
"pathologist performing",
"autopsy",
"deposition",
"card... |
A 26-year-old male engineer presents to a reproductive specialist due to the inability to conceive after 2 years of trying with his 28-year-old wife. He reports that he is healthy without any significant medical history, surgeries, or medications. He was adopted at 17 years-old. On exam, he is well appearing without dy... | Kallman Syndrome | {
"A": "Fragile X Syndrome",
"B": "Kallman Syndrome",
"C": "Kleinfelter Syndrome",
"D": "Primary Hypogonadism"
} | step2&3 | B | [
"year old male engineer presents",
"reproductive specialist",
"to",
"years",
"year old wife",
"reports",
"healthy",
"significant medical history",
"surgeries",
"medications",
"adopted",
"years old",
"exam",
"well appearing",
"dysmorphic features",
"high pitched voice",
"absent facial... |
A 4-year-old male is brought into your office because his mother states he has been fatigued. He has not been acting like himself and has been getting tired easily while running around and playing with other children. As of last week, he has also been complaining of being short of breath. His vitals are temperature 98.... | Ventricular septal defect (VSD) | {
"A": "Tetrology of Fallot",
"B": "Patent ductus arteriosus (PDA)",
"C": "Ventricular septal defect (VSD)",
"D": "Atrial septal defect (ASD)"
} | step2&3 | C | [
"4 year old male",
"brought",
"office",
"mother states",
"fatigued",
"not",
"acting",
"getting tired easily",
"running",
"playing with other children",
"last week",
"short of breath",
"temperature 98",
"deg F",
"blood pressure 100 75 mmHg",
"pulse 98 min",
"respirations",
"min",
... |
You are culturing bacteria on lactose-rich and glucose-free media. These bacteria regulate gene expression via the lac operon to ferment lactose into glucose and galactose for their metabolic needs. You add free glucose to the media. The addition of glucose reduces lactose fermentation secondary to which of the followi... | Decreased level of cAMP | {
"A": "Decreased binding by the repressor to the operator",
"B": "Increased binding to CAP",
"C": "Increased level of cAMP",
"D": "Decreased level of cAMP"
} | step1 | D | [
"culturing bacteria",
"lactose rich",
"glucose free media",
"bacteria",
"gene expression",
"lac operon",
"ferment lactose",
"glucose",
"galactose",
"metabolic needs",
"add free glucose",
"media",
"addition",
"glucose",
"lactose fermentation secondary to",
"following changes"
] |
A 71-year-old man arrives to the emergency room appearing cyanotic and having weak, shallow respirations. He is brought in by his home care nurse, who reports that the patient has a history of myasthenia gravis and frequent urinary tract infections. The patient was in his normal state of health until 5 days ago when he... | Plasmapheresis | {
"A": "Atropine",
"B": "Edrophonium",
"C": "Plasmapheresis",
"D": "Thymectomy"
} | step2&3 | C | [
"71 year old man",
"emergency room appearing cyanotic",
"weak",
"shallow",
"brought",
"home nurse",
"reports",
"patient",
"history",
"myasthenia gravis",
"frequent urinary tract infections",
"patient",
"normal state of health",
"5 days",
"urinary tract infection",
"prescribed gentamici... |
A 2720-g (6-lb) female newborn delivered at 35 weeks’ gestation starts vomiting and becomes inconsolable 48 hours after birth. The newborn has not passed her first stool yet. Examination shows abdominal distention and high-pitched bowel sounds. A water-soluble contrast enema study shows microcolon. Serum studies show i... | Increased sodium concentration in sweat | {
"A": "Decreased hydrogen ion concentration in renal collecting duct",
"B": "Increased serum calcium concentration",
"C": "Increased bicarbonate concentration in pancreatic secretions",
"D": "Increased sodium concentration in sweat"
} | step1 | D | [
"g",
"female newborn delivered",
"35 weeks gestation starts vomiting",
"48 hours after birth",
"newborn",
"not passed",
"first stool",
"Examination shows abdominal distention",
"high-pitched bowel sounds",
"water-soluble contrast enema study shows microcolon",
"Serum studies show increased level... |
Two weeks after undergoing allogeneic stem cell transplant for multiple myeloma, a 55-year-old man develops a severely pruritic rash, abdominal cramps, and profuse diarrhea. He appears lethargic. Physical examination shows yellow sclerae. There is a generalized maculopapular rash on his face, trunk, and lower extremiti... | Donor T cells in the graft | {
"A": "Donor T cells in the graft",
"B": "Newly formed anti-HLA antibodies",
"C": "Proliferating transplanted B cells",
"D": "Activated recipient T cells"
} | step1 | A | [
"Two weeks",
"allogeneic stem cell transplant",
"multiple myeloma",
"55 year old man",
"severely pruritic rash",
"abdominal cramps",
"diarrhea",
"appears lethargic",
"Physical examination shows yellow sclerae",
"generalized maculopapular rash on",
"face",
"trunk",
"lower extremities",
"des... |
A 28-year-old African American woman presents to her primary care physician with two weeks of nausea, abdominal pain, and increased urination. She states she has had kidney stones in the past and is concerned because her current pain is different in character from what she had experienced then. In addition she reports ... | Increased intestinal absorption of calcium | {
"A": "Osteoclast-driven bone resorption",
"B": "Increased production of parathyroid hormone",
"C": "Increased intestinal absorption of calcium",
"D": "Increased renal calcium reabsorption"
} | step1 | C | [
"year old African American woman presents",
"primary care physician",
"two weeks",
"nausea",
"abdominal pain",
"increased urination",
"states",
"kidney stones in",
"past",
"concerned",
"current pain",
"different",
"character",
"experienced then",
"addition",
"reports increasing weaknes... |
A 38-year-old man comes to the physician for a follow-up examination. He has quadriparesis as a result of a burst fracture of the cervical spine that occurred after a fall from his roof 1 month ago. He has urinary and bowel incontinence. He appears malnourished. His temperature is 37.1°C (98.8°F), pulse is 88/min, and ... | Damage to the anterior spinal artery | {
"A": "Cavitation within the spinal cord",
"B": "Occlusion of the posterior spinal artery",
"C": "Hemi-transection of the spinal cord",
"D": "Damage to the anterior spinal artery"
} | step2&3 | D | [
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"follow-up examination",
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"result of",
"burst fracture",
"cervical spine",
"occurred",
"fall",
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"month",
"urinary",
"bowel incontinence",
"appears malnourished",
"temperature",
"98",
"pulse",
"88 min",
"blood pressure",
"60 mm... |
A 55-year-old woman with poorly controlled type 2 diabetes mellitus comes to the emergency department because of a 5-day history of a severely painful, blistering rash. The rash began over the right forehead, and spread to the chest, back, and bilateral upper extremities over the next 2 days. She is diagnosed with diss... | Obstruction of renal tubule
" | {
"A": "Formation of anti-GBM antibodies",
"B": "Coagulative necrosis of renal papilla",
"C": "Deposition of glomerular immune complexes",
"D": "Obstruction of renal tubule\n\""
} | step2&3 | D | [
"55 year old woman",
"poorly controlled type 2 diabetes mellitus",
"emergency department",
"5-day history",
"severely painful",
"blistering rash",
"rash began",
"right forehead",
"spread",
"chest",
"back",
"bilateral upper extremities",
"next 2 days",
"diagnosed",
"disseminated cutaneous... |
A 32-year-old man is brought to the emergency department with fever, dyspnea, and impaired consciousness. His wife reports that he has also had an episode of dark urine today. Two weeks ago, he returned from a trip to the Republic of Congo. His temperature is 39.4°C (103°F), pulse is 114/min, and blood pressure is 82/5... | Artesunate | {
"A": "Proguanil",
"B": "Chloroquine",
"C": "Dapsone",
"D": "Artesunate"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"fever",
"dyspnea",
"impaired consciousness",
"wife reports",
"episode of dark urine today",
"Two weeks",
"returned",
"trip",
"the Republic of Congo",
"temperature",
"4C",
"pulse",
"min",
"blood pressure",
"mm Hg",
"Physical exam... |
A 39-year-old man is admitted to the hospital with profuse diarrhea. His wife says that it started yesterday and since then the patient has passed over 15 liters of watery stools which have become progressively clear and odorless. Over the past 2 days, the patient has only eaten homemade food. His wife and daughter do ... | Pantoprazole | {
"A": "Aspirin",
"B": "Pantoprazole",
"C": "Propranolol",
"D": "Levocetirizine"
} | step1 | B | [
"year old man",
"admitted",
"hospital",
"diarrhea",
"wife",
"started",
"since then",
"patient",
"passed",
"liters",
"watery stools",
"clear",
"past 2 days",
"patient",
"only eaten",
"food",
"wife",
"daughter",
"not",
"symptoms",
"wife",
"returned",
"trip",
"rural India ... |
A 36-year-old man is brought to the emergency department because of facial spasm and an inability to speak for 2 hours. He has had no loss of consciousness or rhythmic movements. He has a history of schizophrenia and was recently put on clozapine for resistant symptoms. He appears to be aware of his surroundings. At th... | Diphenhydramine | {
"A": "Calcium gluconate",
"B": "Diphenhydramine",
"C": "Labetalol",
"D": "Morphine"
} | step2&3 | B | [
"36 year old man",
"brought",
"emergency department",
"facial spasm",
"speak",
"hours",
"loss of consciousness",
"rhythmic movements",
"history of schizophrenia",
"recently put",
"clozapine",
"resistant symptoms",
"appears to",
"aware",
"surroundings",
"hospital",
"blood pressure",
... |
A 2-week-old boy is brought to the emergency department after he was found to have blood in his stool. The mother says the baby was born by home birth at 38 weeks without complications. The mother denies fever, vomiting, or rash but says the baby has been fussier recently. The mother denies a family history of any simi... | Vitamin K deficiency | {
"A": "Bacterial infection",
"B": "Factor IX deficiency",
"C": "Vitamin K deficiency",
"D": "Vitamin B12 deficiency"
} | step1 | C | [
"2 week old boy",
"brought",
"emergency department",
"found to",
"blood in",
"stool",
"mother",
"baby",
"born",
"home birth",
"weeks",
"complications",
"mother denies fever",
"vomiting",
"rash",
"baby",
"fussier recently",
"mother denies",
"family",
"similar problems",
"exam"... |
A 35-year-old G4P1 woman presents for follow-up after her 3rd miscarriage. All 3 miscarriages occurred during the 2nd trimester. Past medical history is significant for systemic lupus erythematosus (SLE) and a deep vein thrombosis (DVT) in her right lower leg 3 years ago. Her current medication is hydroxychloroquine. T... | Anti-phospholipid | {
"A": "Anti-centromere",
"B": "Anti-Scl-70",
"C": "Anti-Ro",
"D": "Anti-phospholipid"
} | step2&3 | D | [
"35 year old",
"woman presents",
"follow-up",
"3rd miscarriage",
"3 miscarriages occurred",
"2nd trimester",
"Past medical history",
"significant",
"systemic lupus erythematosus",
"deep vein thrombosis",
"right leg",
"years",
"current medication",
"hydroxychloroquine",
"patient denies",
... |
A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respi... | Dilation of the ventricular system | {
"A": "Dilation of the ventricular system",
"B": "Degeneration of the substantia nigra pars compacta",
"C": "Accumulation of Lewy bodies in cortical cells",
"D": "Caudate head atrophy"
} | step1 | A | [
"70 year old woman",
"brought",
"office",
"nurse",
"apathetic",
"easily",
"starting to",
"bed",
"medical history",
"relevant",
"hypertension",
"control",
"medication",
"Physical examination reveals",
"blood pressure",
"76 mm Hg",
"heart rate",
"70 min",
"respiratory rate",
"min... |
A previously healthy 49-year-old woman comes to the emergency department because of chest pain that radiates to her back. The pain started 45 minutes ago while she was having lunch. Over the past 3 months, she has frequently had the feeling of food, both liquid and solid, getting “stuck” in her chest while she is eatin... | Simultaneous multi-peak contractions on manometry | {
"A": "Simultaneous multi-peak contractions on manometry",
"B": "Elevated lower esophageal sphincter pressure on manometry",
"C": "Gastroesophageal junction mass on endoscopy",
"D": "Hypertensive contractions on manometry"
} | step1 | A | [
"healthy",
"year old woman",
"emergency department",
"chest pain",
"radiates",
"back",
"pain started 45 minutes",
"lunch",
"past 3 months",
"frequently",
"feeling",
"food",
"liquid",
"solid",
"getting",
"chest",
"eating",
"patient's vital signs",
"normal limits",
"ECG shows",
... |
A 65-year-old man presents to the emergency department due to an episode of lightheadedness. The patient was working at his garage workbench when he felt like he was going to faint. His temperature is 98.8°F (37.1°C), blood pressure is 125/62 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 98%... | A past medical history of repeat GI and respiratory infections | {
"A": "A past medical history of repeat GI and respiratory infections",
"B": "Autoimmune reaction against red blood cell antigens",
"C": "Diffuse whiting out of the lungs on chest radiograph",
"D": "Sudden rupture of a vessel"
} | step2&3 | A | [
"65 year old man presents",
"emergency department due to",
"episode of lightheadedness",
"patient",
"working",
"garage",
"felt",
"faint",
"temperature",
"98",
"blood pressure",
"62 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Laboratory ... |
An 84-year-old man presents to the emergency department for a loss of consciousness. The patient states that he was using the bathroom when he lost consciousness and fell, hitting his head on the counter. The patient has a past medical history of diabetes, hypertension, obesity, factor V leiden, constipation, myocardia... | Situational syncope | {
"A": "Postural hypotension",
"B": "Seizure",
"C": "Cardiac arrhythmia",
"D": "Situational syncope"
} | step2&3 | D | [
"84 year old man presents",
"emergency department",
"loss of consciousness",
"patient states",
"using",
"bathroom",
"lost consciousness",
"fell",
"hitting",
"head",
"counter",
"patient",
"past medical diabetes",
"hypertension",
"obesity",
"factor V leiden",
"constipation",
"myocard... |
A 50-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, the patient has also had a 5 kg (11-lb) weight loss. She has a history of Hashimoto thyroiditis. She is sexually active with her husband only. She does not smoke. She drinks one glass of wine per day. Sh... | Positive anti-smooth muscle antibodies | {
"A": "Positive anti-smooth muscle antibodies",
"B": "Positive anti-mitochondrial antibodies",
"C": "Positive HBV surface antigen",
"D": "Elevated serum transferrin saturation"
} | step2&3 | A | [
"50 year old woman",
"physician",
"evaluation",
"fatigue",
"past 6 months",
"period",
"patient",
"5 kg",
"weight loss",
"history",
"Hashimoto thyroiditis",
"sexually active",
"husband only",
"not smoke",
"drinks one glass",
"wine",
"day",
"not use illicit drugs",
"only medication... |
A 35-year-old woman from San Francisco has been refusing to vaccinate her children due to the claims that vaccinations may cause autism in children. Her 10-year-old male child began developing a low-grade fever with a rash that started on his face; as the rash began to spread to his limbs, it slowly disappeared from hi... | Enveloped, SS + nonsegmented RNA | {
"A": "Nonenveloped, SS linear DNA",
"B": "Enveloped, SS + nonsegmented RNA",
"C": "Enveloped, SS - nonsegmented RNA",
"D": "Nonenveloped, DS segmented RNA"
} | step1 | B | [
"35 year old woman",
"San Francisco",
"refusing to vaccinate",
"children due to",
"vaccinations",
"cause autism in children",
"10 year old male began",
"low-grade fever with",
"rash",
"started",
"face",
"rash began to spread",
"limbs",
"slowly",
"face",
"child",
"taken",
"clinic",
... |
A 6-year-old girl is brought to the emergency department because of abdominal pain, vomiting, and fatigue for the past 4 hours. Over the past month, she has had a 4-kg (8.8-lb) weight loss, increased thirst, and increased urinary frequency. Examination shows dry mucous membranes, decreased skin turgor, and hyperventila... | Polygenic | {
"A": "Mitochondrial",
"B": "X-linked recessive",
"C": "Imprinted",
"D": "Polygenic"
} | step1 | D | [
"year old girl",
"brought",
"emergency department",
"abdominal pain",
"vomiting",
"fatigue",
"past",
"hours",
"past month",
"4 kg",
"8.8",
"weight loss",
"increased thirst",
"increased urinary frequency",
"Examination shows dry mucous membranes",
"decreased skin turgor",
"hyperventil... |
A 69-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8... | Pamidronate | {
"A": "Calcitriol",
"B": "Fluoride",
"C": "Pamidronate",
"D": "Testosterone"
} | step2&3 | C | [
"69 year old African American man",
"brought",
"emergency department",
"sudden onset lower",
"back pain",
"generalized bone",
"months",
"history",
"severe illnesses",
"takes ibuprofen",
"pain",
"examination",
"pale",
"vital signs include",
"temperature",
"98",
"pulse 68 min",
"resp... |
A 5-week-old male infant is brought to the Emergency Department with the complaint of vomiting. His parents state he has been unable to keep normal feedings down for the past week and now has projectile non-bilious vomiting after each meal. He was given a short course of oral erythromycin at 4 days of life for suspecte... | Hypertrophic pyloric stenosis | {
"A": "Hypertrophic pyloric stenosis",
"B": "Milk-protein allergy",
"C": "Midgut volvulus",
"D": "Intussusception"
} | step2&3 | A | [
"5 week old male infant",
"brought",
"Emergency Department",
"complaint",
"vomiting",
"parents state",
"unable to keep normal feedings",
"past week",
"now",
"projectile non bilious vomiting",
"meal",
"given",
"short course",
"oral erythromycin",
"4 days",
"life",
"suspected bacterial... |
A 67-year-old gentleman with a history of poorly controlled diabetes presents to his primary care physician for a routine examination. He is found to be hypertensive on physical exam and is started on a medication that is considered first-line therapy for his condition. What should the physician warn the patient about ... | Hypotensive episodes | {
"A": "Hypotensive episodes",
"B": "Hyperthermic episodes",
"C": "Hypothermic episodes",
"D": "Anuric episodes"
} | step1 | A | [
"67 year old",
"history",
"poorly controlled diabetes presents",
"primary care physician",
"routine examination",
"found to",
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"physical exam",
"started",
"medication",
"considered first-line therapy",
"condition",
"physician warn",
"patient",
"takes",
"first dose",
"m... |
A 72-year-old man with chronic lymphocytic leukemia (CLL) comes to the physician with a 2-day history of severe fatigue and dyspnea. He regularly visits his primary care physician and has not required any treatment for his underlying disease. His temperature is 36.7°C (98.1°F), pulse is 105/min, respiratory rate is 22/... | Autoimmune hemolytic anemia | {
"A": "Autoimmune hemolytic anemia",
"B": "Bone marrow involvement",
"C": "Evan’s syndrome",
"D": "Splenomegaly"
} | step2&3 | A | [
"72 year old man",
"chronic lymphocytic leukemia",
"physician",
"2-day history",
"severe fatigue",
"dyspnea",
"visits",
"primary care physician",
"not required",
"treatment",
"underlying disease",
"temperature",
"36",
"98",
"pulse",
"min",
"respiratory rate",
"min",
"blood pressu... |
A 67-year-old man comes to the physician for a follow-up examination. He has had lower back pain for several months. The pain radiates down the right leg to the foot. He has no history of any serious illness and takes no medications. His pain increases after activity. The straight leg test is positive on the right. The... | Physical therapy | {
"A": "Dexamethasone",
"B": "Physical therapy",
"C": "Plasmapheresis",
"D": "Thalidomide"
} | step2&3 | B | [
"67 year old man",
"physician",
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"months",
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"right leg",
"foot",
"history",
"serious illness",
"takes",
"medications",
"pain increases",
"activity",
"straight leg test",
"positive",
"right",
"results",
"laboratory studies... |
A 3-week-old neonate in the neonatal intensive care unit (NICU) has bilious vomiting. He was born at 31 weeks gestation by cesarean section due to maternal preeclampsia. The birth weight was 1100 g (2.4 lb). Meconium was passed on the 2nd day after birth, and he had an adequate number of wet diapers. He is on continuou... | Air in the bowel wall on abdominal X-ray | {
"A": "Diffuse microcolon on barium enema",
"B": "No air in the rectum on abdominal X-ray",
"C": "Air in the bowel wall on abdominal X-ray",
"D": "Epigastric olive-shaped mass on abdominal sonography"
} | step2&3 | C | [
"3 week old neonate",
"neonatal",
"bilious vomiting",
"born",
"31 weeks gestation",
"cesarean section due to maternal preeclampsia",
"birth weight",
"g",
"Meconium",
"passed",
"2nd day after birth",
"adequate number",
"wet diapers",
"continuous nasogastric formula feeds",
"vital signs in... |
A patient is in the ICU for diabetic ketoacidosis and is currently on an insulin drip. His electrolytes are being checked every hour and his potassium is notable for the following measures:
1. 5.1 mEq/L
2. 5.8 mEq/L
3. 6.1 mEq/L
4. 6.2 mEq/L
5. 5.9 mEq/L
6. 5.1 mEq/L
7. 4.0 mEq/L
8. 3.1 mEq/L
Which of the following i... | 5.45 | {
"A": "3.10",
"B": "5.10",
"C": "5.16",
"D": "5.45"
} | step2&3 | D | [
"patient",
"ICU",
"diabetic ketoacidosis",
"currently",
"insulin drip",
"electrolytes",
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"hour",
"potassium",
"notable",
"following measures",
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"5",
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"5.8 mEq/L",
"6",
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"6",
"mEq",
"5",
"mEq/L 6",
"5",
"mEq/L",
"4 0 mEq/L 8",
"3.1 mEq/L",... |
A 66-year-old man was referred for endoscopic evaluation due to iron deficiency anemia. He has had anorexia and weight loss for two months. Three years ago, the patient had coronary artery bypass grafting and aortic mechanical valve replacement. He has a 12-year history of diabetes mellitus and hypertension. He takes w... | Warfarin to heparin | {
"A": "Aspirin to clopidogrel",
"B": "Lisinopril to losartan",
"C": "Metformin to empagliflozin",
"D": "Warfarin to heparin"
} | step2&3 | D | [
"66 year old man",
"referred",
"endoscopic evaluation",
"iron deficiency anemia",
"anorexia",
"weight loss",
"two months",
"Three years",
"patient",
"coronary artery bypass grafting",
"aortic mechanical valve replacement",
"year history of diabetes mellitus",
"hypertension",
"takes warfari... |
A 27-year-old woman gives birth to a boy at 36 weeks gestational age. The infant weighs 4022 grams at birth, is noted to have a malformed sacrum, and appears to be in respiratory distress. Apgar scores are 5 and 7 at 1 minute and 5 minutes respectively. Hours after birth, the infant is found to be irritable, bradycardi... | Hypoglycemia | {
"A": "Hypoinsulinemia",
"B": "Hypoglycemia",
"C": "Hypercalcemia",
"D": "Hypermagnesemia"
} | step1 | B | [
"27 year old woman gives birth",
"boy",
"36 weeks gestational age",
"infant",
"grams",
"birth",
"noted to",
"malformed sacrum",
"appears to",
"respiratory distress",
"Apgar scores",
"5",
"minute",
"5",
"Hours after birth",
"infant",
"found to",
"irritable",
"bradycardic",
"cyan... |
Two healthy adults have only one child. He has Friedrich ataxia (FA). They are considering having more children, but are uncertain of their risk of having another child with the condition. What should they do? | See a genetic counselor; risk of having another child with FA is 25% | {
"A": "See a genetic counselor; risk of having another child with FA is 25%",
"B": "See a genetic counselor; risk of having another child with FA is 66%",
"C": "Proceed with conception; risk of having another child with FA is 0%",
"D": "Proceed with conception; risk of having another child with FA is unpredict... | step1 | A | [
"Two healthy adults",
"only one child",
"Friedrich ataxia",
"considering",
"more children",
"uncertain",
"risk",
"child",
"condition"
] |
A 72-year-old man is brought in by ambulance to the hospital after being found down at home. On presentation, he appears cachectic and is found to be confused. Specifically, he does not answer questions appropriately and is easily distracted. His wife says that he has been losing weight over the last 3 months and he ha... | Demeclocycline | {
"A": "Antidiuretic hormone",
"B": "Demeclocycline",
"C": "Normal saline",
"D": "Renin"
} | step1 | B | [
"72 year old man",
"brought",
"ambulance",
"hospital",
"found",
"home",
"presentation",
"appears cachectic",
"found to",
"confused",
"not answer questions",
"easily",
"wife",
"weight",
"months",
"40 pack-year history of smoking",
"serum sodium",
"found to",
"mEq/L",
"urine osmo... |
A 5-year-old girl accompanied by her mother presents to the emergency department after suffering a fall on the elementary school playground. Her mother reports that a child on the playground pushed her daughter who fell on her right side, after which she screamed and was found clutching her right leg. The girl's past m... | Defective type I collagen production | {
"A": "Decreased cystathionine beta synthase activity",
"B": "Defective type I collagen production",
"C": "Fibrillin gene defect",
"D": "Type III collagen gene defect"
} | step1 | B | [
"5 year old girl",
"mother presents",
"emergency department",
"suffering",
"fall",
"elementary school playground",
"mother reports",
"child",
"playground pushed",
"daughter",
"fell",
"right side",
"screamed",
"found",
"right leg",
"girl's past medical history",
"significant",
"frac... |
A new imaging modality is being tested to study vitelline duct morphology. A fetus at 20 weeks' gestation is found to have partial obliteration of this duct. Which of the following is the most likely sequela of this condition? | Bleeding from the gastrointestinal tract
" | {
"A": "Swelling in the genital region",
"B": "Dilation of the descending colon",
"C": "Discharge of urine from the umbilicus",
"D": "Bleeding from the gastrointestinal tract\n\""
} | step1 | D | [
"new imaging modality",
"tested to study vitelline duct morphology",
"fetus",
"20 weeks",
"gestation",
"found to",
"partial obliteration",
"duct",
"following",
"most likely sequela",
"condition"
] |
A 15-year-old boy is brought to the emergency department by his parents because of lethargy, repeated vomiting, and abdominal pain for 6 hours. Over the past 2 weeks, he has reported increased urinary frequency to his parents that they attributed to his increased oral fluid intake. Examination shows dry mucous membrane... | Hepatocyte | {
"A": "Thrombocyte",
"B": "Neuron",
"C": "Hepatocyte",
"D": "Myocyte\n\""
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"parents",
"lethargy",
"repeated vomiting",
"abdominal pain",
"hours",
"past 2 weeks",
"reported increased urinary frequency",
"parents",
"attributed",
"increased oral",
"Examination shows dry mucous membranes",
"rapid",
"deep",
"Lab... |
A 45-year-old man comes to the physician because of worsening shortness of breath and dry cough for 6 months. The patient's symptoms get worse when he walks more than about 150 yards. He also reports fatigue and difficulty swallowing solid foods. In cold weather, his fingers occasionally turn blue and become painful. H... | Decreased diffusing capacity | {
"A": "Decreased right atrial pressure",
"B": "Increased lung compliance",
"C": "Decreased diffusing capacity",
"D": "Decreased A-a gradient"
} | step1 | C | [
"year old man",
"physician",
"of worsening shortness",
"breath",
"dry cough",
"months",
"patient's symptoms",
"worse",
"walks more",
"yards",
"reports fatigue",
"difficulty swallowing solid foods",
"cold weather",
"fingers occasionally turn blue",
"painful",
"occasionally smokes cigare... |
A 26-year-old female with AIDS (CD4 count: 47) presents to the emergency department in severe pain. She states that over the past week she has been fatigued and has had a progressively worse headache and fever. These symptoms have failed to remit leading her to seek care in the ED. A lumbar puncture is performed which ... | Serial lumbar punctures | {
"A": "Fluconazole",
"B": "Serial lumbar punctures",
"C": "Mannitol",
"D": "Acetazolamide"
} | step2&3 | B | [
"year old female",
"AIDS",
"CD4 count",
"presents",
"emergency department",
"severe pain",
"states",
"past week",
"fatigued",
"worse headache",
"fever",
"symptoms",
"failed to remit leading",
"to",
"care",
"ED",
"lumbar puncture",
"performed",
"demonstrates",
"opening pressure"... |
A 10-year-old boy is brought to the physician by his parents because they are concerned about his “strange behavior”. The parents state that he has always been a lonely kid without many friends, but recently he has been having behavioral problems that seem to be unprovoked and are occurring more frequently. The child t... | Autism spectrum disorder | {
"A": "Autism spectrum disorder",
"B": "Attention deficit hyperactivity disorder",
"C": "Tourette’s syndrome",
"D": "Obsessive-compulsive disorder"
} | step2&3 | A | [
"A 10 year old boy",
"brought",
"physician",
"parents",
"concerned",
"strange behavior",
"parents state",
"always",
"lonely kid",
"friends",
"recently",
"behavioral problems",
"to",
"occurring more frequently",
"child throws tantrums",
"reason",
"not",
"punishment",
"reward",
"... |
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