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 33-year-old woman presents to her primary care provider for a normal check-up. She reports she has been feeling intermittently fatigued over the past 3 months, but she attributes it to her work as a corporate lawyer and balancing family life. She is otherwise healthy and takes no medications. She was adopted and has ... | Loss-of-function mutation in the calcium-sensing receptor | {
"A": "Decreased sensitivity to parathyroid hormone",
"B": "Impaired tubular calcium reabsorption",
"C": "Loss-of-function mutation in the calcium-sensing receptor",
"D": "Over-secretion of parathyroid hormone"
} | step1 | C | [
"year old woman presents",
"primary care provider",
"normal check-up",
"reports",
"feeling",
"fatigued",
"past 3 months",
"attributes",
"work",
"corporate lawyer",
"balancing family life",
"healthy",
"takes",
"medications",
"adopted",
"information",
"biological family",
"has",
"c... |
Six days after undergoing an elective hip replacement surgery, a 79-year-old man develops dysuria, flank pain, and fever. His temperature is 38.5°C (101.3°F). Examination shows marked tenderness in the right costovertebral area. Treatment with an antibiotic is begun, but his symptoms do not improve. Further evaluation ... | Aminoglycosides | {
"A": "Aminoglycosides",
"B": "Glycopeptides",
"C": "Fluoroquinolones",
"D": "Macrolides"
} | step1 | A | [
"Six days",
"elective hip replacement surgery",
"year old man",
"dysuria",
"flank pain",
"fever",
"temperature",
"Examination shows marked tenderness",
"right",
"area",
"Treatment",
"antibiotic",
"begun",
"symptoms",
"not",
"Further evaluation shows",
"causal organism",
"enzyme",
... |
A 48-year-old man comes to the emergency department because of a 2-hour history of severe left-sided colicky flank pain that radiates towards his groin. He has vomited twice. Last year, he was treated with ibuprofen for swelling and pain of his left toe. He drinks 4-5 beers most days of the week. Examination shows left... | Rhomboid-shaped crystals | {
"A": "Red blood cell casts",
"B": "Rhomboid-shaped crystals",
"C": "Wedge-shaped crystals",
"D": "Coffin-lid-like crystals"
} | step1 | B | [
"48 year old man",
"emergency department",
"2-hour history",
"severe left-sided colicky flank",
"radiates",
"groin",
"vomited twice",
"year",
"treated with ibuprofen",
"swelling",
"pain",
"left toe",
"drinks 4-5 beers",
"days of the week",
"Examination shows left costovertebral angle ten... |
A 40-year-old woman visits your office with her pathology report after being subjected to total abdominal hysterectomy a month ago. She explains that she went through this procedure after a long history of lower abdominal pain that worsened during menses and heavy menstrual bleeding. She is a mother of 5 children, and ... | Uterine adenomyosis | {
"A": "Endometrial carcinoma",
"B": "Uterine leiomyoma",
"C": "Uterine adenomyosis",
"D": "Endometrial hyperplasia"
} | step1 | C | [
"40 year old woman visits",
"office",
"pathology report",
"subjected",
"total abdominal hysterectomy",
"month",
"procedure",
"long history",
"lower abdominal pain",
"worsened",
"menses",
"heavy menstrual bleeding",
"mother",
"children",
"delivered",
"cesarean section",
"pathology gro... |
A 31-year-old male traveler in Thailand experiences fever, headache, and excessive sweating every 48 hours. Peripheral blood smear shows trophozoites and schizonts indicative of Plasmodia infection. The patient is given chloroquine and primaquine. Primaquine targets which of the following Plasmodia forms: | Hypnozoite | {
"A": "Trophozoite",
"B": "Schizont",
"C": "Sporozoite",
"D": "Hypnozoite"
} | step1 | D | [
"31 year old male traveler",
"Thailand experiences fever",
"headache",
"excessive sweating",
"48 hours",
"Peripheral blood smear shows trophozoites",
"schizonts",
"Plasmodia infection",
"patient",
"given chloroquine",
"primaquine",
"Primaquine targets",
"following Plasmodia forms"
] |
A 45-year-old woman presents to the emergency department after sustaining a gunshot wound to her shoulder. During the course of the physical exam, the physician notes her spleen is palpable 10 cm below the left costal margin. Additionally, radiography of her shoulder showed several 'punched-out' areas of lytic bone. Wh... | Multiple myeloma | {
"A": "Multiple myeloma",
"B": "Infectious mononucleosis",
"C": "Beta-thalassemia",
"D": "Myelofibrosis"
} | step1 | A | [
"year old woman presents",
"emergency department",
"sustaining",
"gunshot wound",
"shoulder",
"course",
"physical exam",
"physician notes",
"spleen",
"palpable 10 cm",
"left costal margin",
"radiography of",
"shoulder showed several",
"punched out",
"areas",
"lytic bone",
"considered... |
A 17-year-old girl comes to the physician because of a 4-month history of fatigue. She has not had any change in weight. She had infectious mononucleosis 4 weeks ago. Menses occur at regular 28-day intervals and last 5 days with moderate flow. Her last menstrual period was 3 weeks ago. Her mother has Hashimoto thyroidi... | Ferritin levels | {
"A": "Direct Coombs test",
"B": "Ferritin levels",
"C": "Peripheral blood smear",
"D": "Bone marrow biopsy"
} | step1 | B | [
"year old girl",
"physician",
"4 month history",
"fatigue",
"not",
"change in weight",
"infectious mononucleosis",
"weeks",
"Menses occur",
"regular",
"day intervals",
"last 5",
"moderate flow",
"last menstrual period",
"3 weeks",
"mother",
"Hashimoto thyroiditis",
"Examination sho... |
A 55-year-old woman presents to the physician because of a fever 4 days after discharge from the hospital following induction chemotherapy for acute myeloid leukemia (AML). She has no other complaints and feels well otherwise. Other than the recent diagnosis of AML, she has no history of a serious illness. The temperat... | Imipenem | {
"A": "Caspofungin",
"B": "Ciprofloxacin",
"C": "Imipenem",
"D": "Valacyclovir"
} | step2&3 | C | [
"55 year old woman presents",
"physician",
"of",
"fever",
"days",
"discharge from",
"hospital following induction chemotherapy",
"acute myeloid leukemia",
"complaints",
"feels well",
"Other",
"recent diagnosis",
"AML",
"history",
"serious illness",
"temperature",
"blood pressure",
... |
A 65-year-old man is brought to the emergency department with central chest pain for the last hour. He rates his pain as 8/10, dull in character, and says it is associated with profuse sweating and shortness of breath. He used to have heartburn and upper abdominal pain associated with food intake but had never experien... | Stop exercise and order a coronary angiography | {
"A": "Continue exercise since ECG does not show ischemic changes",
"B": "Repeat exercise tolerance testing after one month",
"C": "Stop exercise and order a coronary angiography",
"D": "Stop exercise and order a pharmacological stress test"
} | step2&3 | C | [
"65 year old man",
"brought",
"emergency department",
"central chest pain",
"hour",
"rates",
"pain",
"8/10",
"dull",
"character",
"associated with profuse sweating",
"shortness of breath",
"used to",
"heartburn",
"upper abdominal pain associated with food intake",
"never",
"chest",
... |
A 27-year-old woman G2P1 at 34 weeks estimated gestational age presents with bouts of sweating, weakness, and dizziness lasting a few minutes after lying down on the bed. She says symptoms resolve if she rolls on her side. She reports that these episodes have occurred several times over the last 3 weeks. On lying down,... | Aortocaval compression | {
"A": "Aortocaval compression",
"B": "Increase in plasma volume",
"C": "Peripheral vasodilation",
"D": "Renin-angiotensin system activation"
} | step1 | A | [
"27 year old woman",
"weeks estimated gestational age presents",
"bouts",
"sweating",
"weakness",
"dizziness lasting",
"few minutes",
"lying",
"bed",
"symptoms resolve",
"side",
"reports",
"episodes",
"occurred several times",
"weeks",
"lying",
"blood pressure",
"90 50 mm Hg",
"p... |
A 22-year-old man comes to the physician because of a 3-week history of abdominal pain, loose, non-bloody stools, and intermittent nausea. He also reports intermittent fever. He has not had vomiting, tenesmus, or rectal pain. He has no history of serious illness and takes no medications. His vital signs are within norm... | Non-caseating granulomas | {
"A": "Neutrophilic inflammation of the crypts",
"B": "Inflammation of the terminal ileum",
"C": "Intranuclear and cytoplasmic inclusion bodies",
"D": "Non-caseating granulomas"
} | step2&3 | D | [
"year old man",
"physician",
"3 week history",
"abdominal pain",
"loose",
"non bloody stools",
"intermittent nausea",
"reports intermittent fever",
"not",
"vomiting",
"tenesmus",
"rectal pain",
"history",
"serious illness",
"takes",
"medications",
"vital signs",
"normal limits",
... |
A 57-year-old nulliparous woman comes to the physician 2 weeks after noticing a lump in her right breast. Her last mammogram was performed 4 years ago and showed no abnormalities. Menopause began 2 years ago, during which time the patient was prescribed hormone replacement therapy for severe hot flashes and vaginal dry... | Core needle biopsy
" | {
"A": "Bone scan",
"B": "Measurement of serum CA 15–3",
"C": "Mastectomy",
"D": "Core needle biopsy\n\""
} | step2&3 | D | [
"57 year old nulliparous woman",
"physician 2 weeks",
"lump in",
"right breast",
"last mammogram",
"performed 4 years",
"showed",
"abnormalities",
"Menopause began 2 years",
"time",
"patient",
"prescribed hormone replacement therapy",
"severe hot flashes",
"vaginal dryness",
"Vital signs... |
An investigator studying mechanisms of acquired antibiotic resistance in bacteria conducts a study using isolated strains of Escherichia coli and Staphylococcus aureus. The E. coli strain harbors plasmid pRK212.1, which conveys resistance to kanamycin. The S. aureus strain is susceptible to kanamycin. Both bacterial st... | Conjugation | {
"A": "Transformation",
"B": "Conjugation",
"C": "Transposition",
"D": "Transduction"
} | step1 | B | [
"investigator studying mechanisms",
"acquired antibiotic resistance",
"bacteria conducts",
"study using isolated strains",
"Escherichia coli",
"Staphylococcus aureus",
"E",
"coli strain harbors plasmid",
"resistance to kanamycin",
"The",
"aureus strain",
"susceptible",
"kanamycin",
"bacter... |
A 57-year-old woman comes to the clinic complaining of decreased urine output. She reports that over the past 2 weeks she has been urinating less and less every day. She denies changes in her diet or fluid intake. The patient has a history of lupus nephritis, which has resulted in end stage renal disease. She underwent... | Start intravenous steroids | {
"A": "Add ceftriaxone",
"B": "Add diltiazem",
"C": "Nephrectomy",
"D": "Start intravenous steroids"
} | step2&3 | D | [
"57 year old woman",
"clinic",
"decreased urine output",
"reports",
"past 2 weeks",
"less",
"less",
"day",
"denies changes in",
"diet",
"fluid intake",
"patient",
"history of lupus nephritis",
"resulted",
"end stage renal disease",
"renal transplant",
"months",
"then",
"mycopheno... |
A 47-year-old homeless man is brought to the emergency department by police, who found him sleeping by the side of the street. He is somnolent and confused and is unable to give a reliable history. His medical history is unobtainable. Vital signs include: temperature 36.9°C (98.4°F), blood pressure 112/75 mm Hg, and pu... | Vitamin B1 deficiency | {
"A": "Delirium tremens",
"B": "Miller-Fisher syndrome",
"C": "Vitamin B1 deficiency",
"D": "Ethylene glycol intoxication"
} | step2&3 | C | [
"year old homeless man",
"brought",
"emergency department",
"police",
"found",
"sleeping",
"side",
"street",
"somnolent",
"confused",
"unable to give",
"reliable history",
"medical history",
"Vital signs include",
"temperature 36",
"98 4F",
"blood pressure",
"75 mm Hg",
"pulse 85... |
An 8-year-old boy is brought to the hospital because of blurred vision and headache for 3 months. During this period, the father has noticed that the child has been tilting his head back to look straight ahead. The patient has also had difficulty falling asleep for 2 months. He has had a 3.5 kg (7.7 lb) weight loss ove... | Precocious puberty | {
"A": "Blindness",
"B": "Subarachnoid hemorrhage",
"C": "Precocious puberty",
"D": "Diabetic ketoacidosis"
} | step2&3 | C | [
"year old boy",
"brought",
"hospital",
"blurred vision",
"headache",
"months",
"period",
"father",
"child",
"tilting",
"head back to look straight",
"patient",
"difficulty falling asleep",
"months",
"3.5 kg",
"7.7",
"weight loss",
"past 6 months",
"temperature",
"99",
"pulse"... |
A 6-year-old girl is brought to the emergency department with difficulty in breathing. Her parents mention that the child has been experiencing an increasing difficulty in breathing over the past few weeks. It is more prominent when she plays outside in the garden. She has similar episodes about twice a week. She has h... | 12% | {
"A": "12%",
"B": "9%",
"C": "50%",
"D": "75%"
} | step2&3 | A | [
"year old girl",
"brought",
"emergency department",
"difficulty",
"breathing",
"parents",
"child",
"experiencing",
"increasing difficulty",
"breathing",
"past",
"weeks",
"more prominent",
"plays outside",
"garden",
"similar episodes",
"twice",
"week",
"slight difficulty",
"brea... |
A 55-year-old man presents to the emergency department with a 3-week history of shortness of breath. It started as exertional only, but progressed and is now present at rest. He says it's worse when he lies down; he has had a couple of episodes of waking up because of this shortness of breath with a choking sensation. ... | Vitamin B1 | {
"A": "Vitamin B1",
"B": "Vitamin B2",
"C": "Vitamin B3",
"D": "Vitamin B12"
} | step2&3 | A | [
"55 year old man presents",
"emergency department",
"3 week history of shortness",
"breath",
"started",
"exertional only",
"progressed",
"now present",
"rest",
"orse ",
"ouple f episodes ",
"aking ",
"f ",
"hortness ",
"reath ",
"hoking sensation.",
"ot ",
"ever,",
"ough,",
"h... |
A 38-year-old woman presents to the clinic complaining of fatigue and recurrent stomach pain for the past 3 years. She reports an intermittent, dull ache at the epigastric region that is not correlated with food intake. Antacids seem to help a little, but the patient still feels uncomfortable during the episodes. She r... | Intrinsic factor | {
"A": "Helicobacter pylori",
"B": "Intrinsic factor",
"C": "Lactase",
"D": "Lipase"
} | step1 | B | [
"year old woman presents",
"clinic",
"fatigue",
"recurrent stomach pain",
"past",
"years",
"reports",
"intermittent",
"dull ache",
"epigastric",
"not correlated",
"food intake",
"Antacids",
"to help",
"little",
"patient",
"feels",
"episodes",
"reports",
"getting",
"tired",
... |
A 42-year-old woman presents to the emergency department complaining of abdominal pain, nausea, and vomiting for the last 4 hours. She says that symptoms onset right after she had 2 generous portions of pizza. She notes that she had prior similar episodes which resolved spontaneously within an hour. However, the pain t... | The phrenic nerve | {
"A": "Lumbar plexus and greater splanchnic nerves to the spinal cord",
"B": "The pain endings of the visceral peritoneum",
"C": "Left greater splanchnic nerve",
"D": "The phrenic nerve"
} | step1 | D | [
"year old woman presents",
"emergency department",
"abdominal pain",
"nausea",
"vomiting",
"hours",
"symptoms onset right",
"2",
"portions",
"pizza",
"notes",
"prior similar episodes",
"resolved",
"hour",
"pain today",
"hours",
"much",
"severe",
"pain",
"right upper quadrant of... |
A 44-year-old woman comes to the physician because of progressively worsening shortness of breath with exertion and intermittent palpitations over the last 2 months. She has had neither chest pain nor a cough. Her pulse is 124/min and irregular. Physical examination shows a grade 4/6 high-pitched holosystolic murmur th... | Dilation of left atrium on echocardiogram | {
"A": "Pulmonary artery thrombus on computed tomography scan",
"B": "Obstruction of the right marginal artery on coronary angiogram",
"C": "Reversible area of myocardial ischemia on nuclear stress test",
"D": "Dilation of left atrium on echocardiogram"
} | step1 | D | [
"year old woman",
"physician",
"worsening shortness of breath",
"exertion",
"intermittent palpitations",
"months",
"chest pain",
"cough",
"pulse",
"min",
"irregular",
"Physical examination shows",
"grade",
"6 high-pitched holosystolic murmur",
"best heard",
"apex",
"radiates",
"bac... |
A 41-year-old woman comes to the physician because of bleeding from the nipple of her right breast for 3 months. There is no bleeding from the other breast. Menses occur at regular 30-day intervals and lasts for 5 days with moderate flow. Her last menstrual period was 1 week ago. Her mother died of breast cancer at the... | Intraductal papilloma | {
"A": "Invasive ductal carcinoma",
"B": "Paget disease of the breast",
"C": "Papillary carcinoma",
"D": "Intraductal papilloma"
} | step2&3 | D | [
"year old woman",
"physician",
"of bleeding",
"nipple",
"right breast",
"3 months",
"bleeding",
"breast",
"Menses occur",
"regular 30 day intervals",
"lasts",
"5 days",
"moderate flow",
"last menstrual period",
"1 week",
"mother died of breast cancer",
"age",
"years",
"not smoke"... |
A 32-year-old man comes to the emergency department for acute pain in the left eye. He reports having awoken in the morning with a foreign body sensation. He had forgotten to remove his contact lenses before sleeping. Following lens removal, he experienced immediate pain, discomfort, and tearing of the left eye. He rep... | Fluorescein examination | {
"A": "Fluorescein examination",
"B": "Ocular ultrasonography",
"C": "Gonioscopy",
"D": "CT scan of the orbit"
} | step2&3 | A | [
"year old man",
"emergency department",
"acute pain in",
"left eye",
"reports",
"awoken in",
"morning",
"foreign body sensation",
"forgotten to remove",
"contact lenses",
"sleeping",
"Following lens removal",
"experienced immediate pain",
"discomfort",
"tearing",
"left",
"reports",
... |
A 3-year-old male child is found to have a disease involving DNA repair. Specifically, he is found to have a defect in the endonucleases involved in the nucleotide excision repair of pyrimidine dimers. Which of the following is a unique late-stage complication of this child's disease? | Malignant melanoma | {
"A": "Colorectal cancer",
"B": "Endometrial cancer",
"C": "Lymphomas",
"D": "Malignant melanoma"
} | step1 | D | [
"3 year old male",
"found to",
"disease involving DNA repair",
"found to",
"defect",
"endonucleases involved",
"nucleotide excision repair",
"pyrimidine dimers",
"following",
"unique late-stage complication of",
"child's disease"
] |
A 58-year-old man comes to the physician because of a 3-month history of intermittent pain in his right calf that occurs after walking up more than 2 flights of stairs. He reports that the pain is associated with a tingling sensation and lasts for about 10 minutes. He is otherwise healthy. He has smoked 2 packs of ciga... | Clopidogrel therapy | {
"A": "Pentoxifylline therapy",
"B": "Clopidogrel therapy",
"C": "Percutaneous transluminal angioplasty",
"D": "Graded exercise therapy"
} | step2&3 | B | [
"58 year old man",
"physician",
"3 month history",
"intermittent pain",
"right calf",
"occurs",
"walking",
"more",
"flights",
"stairs",
"reports",
"pain",
"associated with",
"tingling sensation",
"lasts",
"10 minutes",
"healthy",
"smoked 2 packs",
"cigarettes daily",
"30 years"... |
A 36-year-old woman comes to the emergency department because of an itchy lesion on her skin. The rash developed shortly after she took an antibiotic for a urinary tract infection. Her temperature is 37.5°C (99.3°F), pulse is 99/min, and blood pressure is 100/66 mm Hg. Physical examination shows swelling of the face an... | Release of a vasoactive amine | {
"A": "Deficiency of C1 inhibitor",
"B": "Activation of complement cascade",
"C": "Release of a vasoactive amine",
"D": "Deposition of immune complexes"
} | step1 | C | [
"36 year old woman",
"emergency department",
"of",
"itchy lesion",
"skin",
"rash",
"took",
"antibiotic",
"urinary tract infection",
"temperature",
"99",
"pulse",
"99 min",
"blood pressure",
"100 66 mm Hg",
"Physical examination shows swelling of",
"face",
"raised",
"erythematous ... |
A 10-year-old boy is brought to the physician because of recurring episodes of achy muscle pain in his legs. He has a history of poor school performance despite tutoring and has been held back two grades. He is at the 40th percentile for height and 30th percentile for weight. Examination shows ptosis, a high-arched pal... | CTG trinucleotide expansion in the DMPK gene | {
"A": "Apoptosis of lower motor neurons",
"B": "Complete impairment of the dystrophin protein",
"C": "Humoral immune attack against the endomysial blood vessels",
"D": "CTG trinucleotide expansion in the DMPK gene"
} | step1 | D | [
"A 10 year old boy",
"brought",
"physician",
"of recurring episodes",
"achy muscle pain",
"legs",
"history",
"poor school performance",
"tutoring",
"held back two grades",
"percentile",
"height",
"percentile",
"weight",
"Examination shows ptosis",
"high-arched palate",
"muscle weakne... |
An 80-year-old woman is brought to the emergency department for left hip pain 30 minutes after she fell while walking around in her room. Examination shows left groin tenderness. The range of motion of the left hip is limited because of pain. An x-ray of the hip shows a linear fracture of the left femoral neck with sli... | Medial circumflex femoral | {
"A": "Deep femoral artery",
"B": "Medial circumflex femoral",
"C": "Obturator",
"D": "Superior gluteal artery"
} | step1 | B | [
"80 year old woman",
"brought",
"emergency department",
"left 30 minutes",
"fell",
"walking",
"room",
"Examination shows left",
"range of motion",
"left hip",
"limited",
"pain",
"x-ray",
"hip shows",
"linear fracture",
"left femoral neck",
"slight posterior displacement",
"femur",
... |
A 68-year-old woman comes to the physician for evaluation of diminished vision for several months. Twenty-eight years ago, she was diagnosed with systemic lupus erythematosus, which has been well controlled with hydroxychloroquine. Fundoscopic examination shows concentric rings of hypopigmentation and hyperpigmentation... | Paracentral scotoma | {
"A": "Bitemporal hemianopia",
"B": "Right monocular blindness",
"C": "Paracentral scotoma",
"D": "Binasal hemianopia"
} | step1 | C | [
"68 year old woman",
"physician",
"evaluation",
"diminished vision",
"several months",
"Twenty-eight years",
"diagnosed",
"systemic lupus erythematosus",
"well controlled",
"hydroxychloroquine",
"Fundoscopic examination shows concentric rings",
"hypopigmentation",
"hyperpigmentation surround... |
A 54-year-old woman presents for follow-up care for her type 2 diabetes mellitus. She was diagnosed approximately 2 years ago and was treated with dietary modifications, an exercise regimen, metformin, and glipizide. She reports that her increased thirst and urinary frequency has not improved with her current treatment... | Sodium-glucose co-transporter-2 inhibitor | {
"A": "Alpha-glucosidase inhibitor",
"B": "Dipeptidyl peptidase-4 inhibitor",
"C": "Peroxisome proliferator-activated receptor activator",
"D": "Sodium-glucose co-transporter-2 inhibitor"
} | step1 | D | [
"54 year old woman presents",
"follow-up care",
"type 2 diabetes mellitus",
"diagnosed approximately",
"years",
"treated with dietary modifications",
"exercise regimen",
"metformin",
"glipizide",
"reports",
"increased thirst",
"urinary frequency",
"not improved",
"current",
"hemoglobin A... |
A 65-year-old woman presents to a dermatology clinic complaining about a couple of well-demarcated, dark, round skin lesions on her face. She claims she has had these lesions for 3 or 4 years. The lesions are painless, not pruritic, and have never bled. However, she is moderately distressed about the potential malignan... | Reassure the patient and provide general recommendations | {
"A": "Excisional biopsy",
"B": "Reassure the patient and provide general recommendations",
"C": "Shave excision",
"D": "Topical fluorouracil"
} | step2&3 | B | [
"65 year old woman presents",
"dermatology clinic",
"couple",
"well",
"dark",
"round",
"face",
"lesions",
"4 years",
"lesions",
"painless",
"not",
"never bled",
"moderately distressed",
"potential malignancy",
"lesions",
"heard",
"close friend",
"diagnosed",
"melanoma",
"medi... |
A 38-year-old woman comes to the physician because of a 1-month history of progressively worsening dyspnea, cough, and hoarseness of voice. Her pulse is 92/min and irregularly irregular, respirations are 20/min, and blood pressure is 110/75 mm Hg. Cardiac examination shows a rumbling mid-diastolic murmur that is best h... | Antibody cross-reactivity | {
"A": "Myxomatous degeneration",
"B": "Hematogenous spread of bacteria",
"C": "Antibody cross-reactivity",
"D": "Congenital valvular defect"
} | step1 | C | [
"year old woman",
"physician",
"month history",
"worsening dyspnea",
"cough",
"hoarseness of voice",
"pulse",
"min",
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"respirations",
"20 min",
"blood pressure",
"75 mm Hg",
"Cardiac examination shows",
"rumbling mid-diastolic murmur",
"best heard",
"apex",
"left latera... |
A group of scientists developed a mouse model to study nondisjunction in meiosis. Their mouse model produced gametes in the following ratio: 2 gametes with 24 chromosomes each and 2 gametes with 22 chromosomes each. In which of the following steps of meiosis did the nondisjunction occur? | Anaphase I | {
"A": "Metaphase I",
"B": "Metaphase II",
"C": "Anaphase I",
"D": "Anaphase II"
} | step1 | C | [
"A group",
"scientists",
"mouse model to study nondisjunction",
"meiosis",
"mouse model",
"gametes",
"following ratio",
"2 gametes",
"chromosomes",
"2 gametes",
"22 chromosomes",
"following steps",
"meiosis",
"nondisjunction occur"
] |
A 29-year-old homeless man visits his local walk-in-clinic complaining of shortness of breath, fatigability, malaise, and fever for the past month. His personal history is significant for multiple inpatient psychiatric hospitalizations for a constellation of symptoms that included agitation, diarrhea, dilated pupils, a... | Chemical endothelial damage | {
"A": "Myxomatous degeneration",
"B": "Chemical endothelial damage",
"C": "Fibrillin 1 (FBN1) mutations",
"D": "Failed delamination"
} | step1 | B | [
"29 year old homeless man visits",
"local walk-in-clinic",
"of shortness",
"breath",
"fatigability",
"malaise",
"fever",
"past month",
"personal history",
"significant",
"multiple inpatient psychiatric hospitalizations",
"symptoms",
"included agitation",
"diarrhea",
"dilated pupils",
"... |
A 72-year-old woman comes to the emergency department because of a 2-week history of worsening shortness of breath, lower extremity swelling, and a 3-kg (6.6-lb) weight gain. Crackles are heard on auscultation of the chest. Cardiac examination shows a dull, low-pitched early diastolic sound at the 5th left intercostal ... | Increased left ventricular end-systolic volume | {
"A": "Decreased left myocardial compliance",
"B": "Increased ventricular contractility",
"C": "Increased left ventricular end-systolic volume",
"D": "Decreased left-ventricular filling pressure"
} | step1 | C | [
"72 year old woman",
"emergency department",
"of",
"2-week history",
"worsening shortness",
"breath",
"lower extremity swelling",
"3 kg",
"6.6",
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"heard",
"auscultation of",
"chest",
"Cardiac examination shows",
"dull",
"low-pitched early diastolic sound",
... |
A 27-year-old woman comes to the physician because of a 2-month history of palpitations, diaphoresis, and a 5-kg (11-lb) weight loss. Her pulse is 101/min and blood pressure is 141/84 mm Hg. Physical examination shows a fine tremor when the fingers are outstretched. After confirmation of the diagnosis, treatment is beg... | Inhibition of iodide ion oxidation | {
"A": "Suppression of thyroid-stimulating hormone release",
"B": "Inhibition of thyroid hormone release",
"C": "Inhibition of iodide ion oxidation",
"D": "Inhibition of peripheral conversion of T4 to T3"
} | step1 | C | [
"27 year old woman",
"physician",
"of",
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"palpitations",
"diaphoresis",
"5 kg",
"weight loss",
"pulse",
"min",
"blood pressure",
"84 mm Hg",
"Physical examination shows",
"fine tremor",
"fingers",
"confirmation of",
"diagnosis",
"treatment",
"begun",
"antithyr... |
An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture... | Treat boyfriend with rifampin | {
"A": "Add ampicillin, dexamethasone, and rifampin to treatment regimen",
"B": "Add ampicillin to treatment regimen",
"C": "Treat boyfriend with ceftriaxone and vancomycin",
"D": "Treat boyfriend with rifampin"
} | step2&3 | D | [
"year old female college student",
"brought",
"emergency department",
"ambulance",
"headache",
"altered mental status",
"patient lives",
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"not",
"feeling well",
"past day",
"vomited",
"times",
"past 12 hours",
"Lumbar puncture",
"performed",
"em... |
A concerned mother presents to clinic stating that her 14-year-old son has not gone through his growth spurt. She states that, although shorter, he had been growing at the same rate as his peers until the past year. There is no evidence of delayed puberty in the mother, but the father's history is unknown. The patient ... | Constitutional growth delay | {
"A": "Constitutional growth delay",
"B": "Familial short stature",
"C": "Celiac disease",
"D": "Growth hormone deficiency"
} | step2&3 | A | [
"mother presents",
"clinic stating",
"year old son",
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"delayed puberty",
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"unknown",
"patient",
"complaints",
"physical exam",
"patient",
"healthy appearing",
... |
A 41-year-old man comes to the emergency department because of fatigue, worsening abdominal discomfort, and progressive swelling of his legs for 3 months. The swelling is worse in the evenings. His only medication is ibuprofen for occasional joint pain. The patient does not smoke and drinks 2–3 beers each weekend. His ... | Impaired relaxation of the right ventricle | {
"A": "Impaired relaxation of the right ventricle",
"B": "Reduced glomerular filtration rate",
"C": "Dermal deposition of glycosaminoglycans",
"D": "Macrovesicular steatosis of the liver"
} | step2&3 | A | [
"year old man",
"emergency department",
"fatigue",
"worsening abdominal discomfort",
"progressive swelling of",
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"3 months",
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"only medication",
"ibuprofen",
"occasional joint pain",
"patient",
"not smoke",
"drinks 23 beers",
"weekend",
"tempe... |
A 19-year-old Caucasian male collapsed from sudden cardiac arrest while playing in a college basketball game. Attempts at resuscitation were unsuccessful. Post-mortem pathologic and histologic examination found asymmetric left ventricular hypertrophy and myocardial disarray. Assuming this was an inherited condition, th... | Cardiac cell sarcomere proteins | {
"A": "Cardiac cell sarcomere proteins",
"B": "Membrane potassium channel proteins",
"C": "Ryanodine receptors",
"D": "Membrane sodium channels"
} | step1 | A | [
"year old Caucasian male collapsed",
"sudden cardiac arrest",
"playing",
"college basketball game",
"Attempts",
"resuscitation",
"unsuccessful",
"Post-mortem pathologic",
"histologic examination found asymmetric left",
"myocardial",
"inherited condition",
"relevant gene",
"likely affects",
... |
A 1-year-old infant is brought to the emergency department by his parents because of fever and rapid breathing for the past 2 days. He had a mild seizure on the way to the emergency department and developed altered sensorium. His mother states that the patient has had recurrent respiratory infections since birth. He wa... | Aplastic thymus | {
"A": "Hypertrophy of Hassall's corpuscles",
"B": "Aplastic thymus",
"C": "Absent follicles in the lymph nodes",
"D": "Accessory spleen"
} | step1 | B | [
"year old infant",
"brought",
"emergency department",
"parents",
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"emergency department",
"altered sensorium",
"mother states",
"patient",
"recurrent respiratory infections",
"birth",
"delivered",
"term",
"complications",
"d... |
A 62-year-old man is brought to the emergency department because of a 4-hour history of abdominal pain, nausea, vomiting, and confusion. His wife reports that he had blurry vision on the way to the hospital. Two weeks ago, he lost his job and since then has been extremely worried about their financial situation and fut... | Inhibition of Na+/K+-ATPase | {
"A": "Inhibition of funny channels",
"B": "Inhibition of Na+-K+-2Cl--cotransporters",
"C": "Inhibition of Na+/K+-ATPase",
"D": "Blockade of beta-adrenergic receptors"
} | step1 | C | [
"62 year old man",
"brought",
"emergency department",
"4-hour history",
"abdominal pain",
"nausea",
"vomiting",
"confusion",
"wife reports",
"blurry vision",
"hospital",
"Two weeks",
"lost",
"job",
"since then",
"extremely worried",
"financial",
"future",
"congestive heart failur... |
A 3-month-old girl is brought to the physician because of poor feeding, irritability and vomiting for 2 weeks. She was born at 36 weeks' gestation and pregnancy was uncomplicated. She is at 5th percentile for length and at 3rd percentile for weight. Her temperature is 36.8°C (98.2°F), pulse is 112/min and respirations ... | Inability of the distal tubule to secrete H+ | {
"A": "Impaired metabolism of branched-chain amino acids",
"B": "Impaired CFTR gene function",
"C": "Inability of the distal tubule to secrete H+",
"D": "Deficiency of ornithine transcarbamylase"
} | step2&3 | C | [
"3 month old girl",
"brought",
"physician",
"poor feeding",
"irritability",
"vomiting",
"2 weeks",
"born",
"36 weeks",
"estation ",
"regnancy ",
"ncomplicated.",
"th ercentile ",
"ength ",
"rd ercentile ",
"eight.",
"emperature ",
"6.",
"8.",
"ulse ",
"in ",
"espirations ... |
A 35-year-old woman presents to the emergency room with fever, diarrhea, and dysuria for the past day. She also complains of palpitations, poor concentration, and severe anxiety. She was diagnosed with Graves disease 6 months ago but admits that she has missed some doses of her prescribed medications in the past couple... | Propanolol | {
"A": "Lithium",
"B": "Methimazole",
"C": "Nitrofurantoin",
"D": "Propanolol"
} | step1 | D | [
"35 year old woman presents",
"emergency room",
"fever",
"diarrhea",
"dysuria",
"past day",
"palpitations",
"poor concentration",
"severe anxiety",
"diagnosed",
"Graves disease",
"months",
"admits",
"missed",
"doses",
"prescribed medications",
"past couple",
"months",
"stress",
... |
A 9-year-old boy is brought to the emergency department because of progressively worsening shortness of breath for 3 days. He has had fever and malaise for the past 5 days. He had a sore throat 3 weeks ago that resolved without treatment. He appears ill. His temperature is 38.6°C (101.5°F), pulse is 98/min and blood pr... | Acute rheumatic fever | {
"A": "Acute rheumatic fever",
"B": "Viral myocarditis",
"C": "Systemic lupus erythematosus",
"D": "Infection with Borrelia burgdorferi"
} | step2&3 | A | [
"year old boy",
"brought",
"emergency department",
"worsening shortness of breath",
"3 days",
"fever",
"malaise",
"past 5 days",
"sore throat",
"weeks",
"resolved",
"treatment",
"appears ill",
"temperature",
"pulse",
"98 min",
"blood pressure",
"84 62 mm Hg",
"Pulse oximetry",
... |
A 52-year-old woman with type 2 diabetes mellitus comes to the physician because of a 2-day history of blisters on her forearms and pain during sexual intercourse. Her only medications are metformin and glyburide. Examination reveals multiple, flaccid blisters on the volar surface of the forearms and ulcers on the bucc... | Pemphigus vulgaris | {
"A": "Pemphigus vulgaris",
"B": "Behcet disease",
"C": "Dermatitis herpetiformis",
"D": "Toxic epidermal necrolysis"
} | step1 | A | [
"year old woman",
"type 2 diabetes mellitus",
"physician",
"2-day history",
"blisters",
"forearms",
"pain",
"sexual intercourse",
"only medications",
"metformin",
"glyburide",
"Examination reveals multiple",
"flaccid blisters",
"volar surface of",
"forearms",
"ulcers",
"buccal",
"g... |
A 37-year-old woman, gravida 4, para 3, at 35 weeks' gestation is admitted to the hospital in active labor. Her three children were delivered by Cesarean section. One hour after vaginal delivery, the placenta is not delivered. Manual separation of the placenta leads to profuse vaginal bleeding. Her pulse is 122/min and... | Defective decidual layer of the placenta | {
"A": "Impaired uterine contractions",
"B": "Consumption of intravascular clotting factors",
"C": "Rupture of the uterine wall",
"D": "Defective decidual layer of the placenta"
} | step1 | D | [
"year old woman",
"gravida 4",
"para 3",
"35 weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"three children",
"delivered",
"Cesarean section",
"One hour",
"vaginal delivery",
"placenta",
"not delivered",
"Manual separation",
"placenta leads to profuse vaginal bleeding",... |
A 4-year old boy is brought to the emergency department with fever, painful swallowing, headache, and neck spasm that began shortly after waking up. He has had a sore throat over the last week that acutely worsened this morning. He has no history of serious illness and takes no medications. He lives at home with his mo... | Endotracheal intubation | {
"A": "Endotracheal intubation",
"B": "IV antibiotics",
"C": "Blood cultures",
"D": "IV corticosteroids"
} | step2&3 | A | [
"4 year old boy",
"brought",
"emergency department",
"fever",
"painful swallowing",
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"began",
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"worsened",
"morning",
"history",
"serious illness",
"takes",
"medications",
"lives at home",
"mother",
"older brother",
"as... |
A 65-year-old woman is brought to the emergency department by her daughter for fever and cough. She just returned from a cruise trip to the Bahamas with her family 5 days ago and reports that she has been feeling ill since then. She endorses fever, productive cough, and general malaise. Her daughter also mentions that ... | Gram-negative on silver stain | {
"A": "Broad-based budding on fungal sputum culture",
"B": "Gram-negative rod on chocolate agar with factors V and X",
"C": "Gram-negative on silver stain",
"D": "Gram-positive diplococci on Gram stain"
} | step1 | C | [
"65 year old woman",
"brought",
"emergency department",
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"trip",
"Bahamas",
"family 5 days",
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"then",
"fever",
"productive cough",
"general malaise",
"daughter",
"patient",
"diarrhea",
"reports",
"rest",
"fam... |
A 26-year-old G1P0 woman presents for her first prenatal visit. Past medical history reveals the patient is blood type O negative, and the father is type A positive. The patient refuses Rho(D) immune globulin (RhoGAM), because it is derived from human plasma, and she says she doesn’t want to take the risk of contractin... | She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization | {
"A": "Rho(D) immune globulin is needed both before and immediately after delivery to protect this baby from developing the condition",
"B": "She should receive Rho(D) immune globulin to prevent the development of Rh(D) alloimmunization",
"C": "The Rho(D) immune globulin will also protect the baby against other ... | step1 | B | [
"year old",
"woman presents",
"first prenatal visit",
"Past medical history reveals",
"patient",
"blood type O negative",
"father",
"type A positive",
"patient refuses Rho(D",
"immune globulin",
"RhoGAM",
"derived",
"human plasma",
"to take",
"risk",
"contracting HIV",
"following",
... |
An otherwise healthy 18-year-old girl comes to the physician because of a 1-year history of severe acne vulgaris over her face, upper back, and arms. Treatment with oral antibiotics and topical combination therapy with benzoyl peroxide and retinoid has not completely resolved her symptoms. Examination shows oily skin w... | Endometrial cancer | {
"A": "Endometrial cancer",
"B": "Deep vein thrombosis",
"C": "Malignant melanoma",
"D": "Hepatic adenoma"
} | step2&3 | A | [
"healthy",
"year old girl",
"physician",
"year history",
"severe acne vulgaris",
"face",
"upper back",
"arms",
"Treatment",
"oral antibiotics",
"topical combination therapy",
"benzoyl peroxide",
"retinoid",
"not completely resolved",
"symptoms",
"Examination shows oily skin",
"numero... |
A 25-year-old man presents to the emergency department complaining of palpitations, lightheadedness, and sweating. He just started working at an investment firm and has been working long hours to make a good impression. Today, he had a dozen cups of espresso to keep himself awake and working. He has never had such an e... | Valsalva maneuver | {
"A": "Adenosine infusion",
"B": "Dipping his face in warm water",
"C": "Synchronized cardioversion",
"D": "Valsalva maneuver"
} | step1 | D | [
"year old man presents",
"emergency department",
"palpitations",
"lightheadedness",
"sweating",
"started working",
"investment firm",
"working long hours to make",
"good impression",
"Today",
"cups",
"to keep",
"awake",
"working",
"never",
"episode",
"past medical history",
"unrema... |
An 80-year-old African American male presents complaining of worsening shortness of breath that occurs during his weekly round of golf. He also notes he has been waking up at night "choking and gasping for air", though he has been able to gain some relief by propping his head on a stack of pillows before he goes to bed... | Left ventricular eccentric hypertrophy | {
"A": "Right atrial hypertrophy",
"B": "Left atrial hypertrophy",
"C": "Left ventricular eccentric hypertrophy",
"D": "Mitral stenosis"
} | step1 | C | [
"80 year old African American male presents",
"of worsening shortness",
"breath",
"occurs",
"weekly round",
"golf",
"notes",
"waking up",
"night",
"choking",
"gasping for air",
"able to gain",
"relief",
"head",
"stack",
"pillows",
"goes",
"bed",
"auscultation",
"low frequency",... |
A 25-year-old primigravida woman at 35 weeks estimated gestational age presents with a headache for the past 5 hours. She describes the headache as severe and incapacitating and showing no response to acetaminophen. In the emergency department, her blood pressure is found to be 150/100 mm Hg, pulse is 88/min, respirato... | Preeclampsia with severe features | {
"A": "HELLP syndrome",
"B": "Preeclampsia with severe features",
"C": "Eclampsia",
"D": "Gestational hypertension"
} | step1 | B | [
"year old primigravida woman",
"35 weeks estimated gestational age presents",
"headache",
"past",
"hours",
"headache",
"severe",
"showing",
"response to acetaminophen",
"emergency department",
"blood pressure",
"found to",
"100 mm Hg",
"pulse",
"88 min",
"respiratory rate",
"30/min",... |
A 47-year-old taxi driver visits an ophthalmologist after failing a routine eye test for his driver’s license renewal. The patient reports a slight blurring of his vision, headaches, and occasional dizziness for the past month. On further questioning, he admits to feeling tired and out of sorts most of the time. He att... | Hypopituitarism | {
"A": "Hypothyroidism",
"B": "Adrenal insufficiency",
"C": "Hypopituitarism",
"D": "Functional pituitary macroadenoma"
} | step2&3 | C | [
"year old taxi driver visits",
"ophthalmologist",
"routine eye test",
"drivers license",
"patient reports",
"slight blurring of",
"vision",
"headaches",
"occasional dizziness",
"past month",
"further questioning",
"admits",
"feeling tired",
"out",
"sorts",
"time",
"attributes",
"wo... |
A 75 year-old gentleman presents to the primary care physician with a 2 week history of right sided achilles tendon pain. He states that the pain has had a gradual onset and continues to worsen, now affecting the left side for the past 2 days. He denies any inciting event. Of note the patient performs self-catheterizat... | Switch medication and avoid exercise | {
"A": "Refer patient to an orthopedic surgeon",
"B": "Switch medication and avoid exercise",
"C": "Perform MRI",
"D": "Perform CT scan"
} | step1 | B | [
"75 year old",
"presents",
"primary care physician",
"2 week history",
"right sided achilles tendon pain",
"states",
"pain",
"gradual onset",
"continues to worsen",
"now affecting",
"left side",
"past 2 days",
"denies",
"event",
"note",
"patient performs self catheterization",
"episo... |
A 30-year-old man comes to the clinic with complaints of increased frequency of urination, especially at night, for about a month. He has to wake up at least 5-6 times every night to urinate and this is negatively affecting his sleep. He also complains of increased thirst and generalized weakness. Past medical history ... | Water deprivation test | {
"A": "CT thorax",
"B": "Chest X-ray",
"C": "Water deprivation test",
"D": "Serum ADH level"
} | step2&3 | C | [
"30 year old man",
"clinic",
"complaints of increased frequency",
"urination",
"night",
"about",
"month",
"to wake up",
"times",
"night to",
"affecting",
"sleep",
"increased thirst",
"generalized weakness",
"Past medical history",
"significant",
"bipolar disorder",
"lithium",
"ta... |
A 32-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a prenatal visit. She feels well. Her first pregnancy was uncomplicated and the child was delivered vaginally. Medications include folic acid and an iron supplement. Her temperature is 37°C (98.6°F), pulse is 98/min, respirations ... | Mefloquine | {
"A": "Doxycycline",
"B": "Mefloquine",
"C": "Primaquine",
"D": "Proguanil"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 1",
"20 weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"first pregnancy",
"uncomplicated",
"child",
"delivered",
"Medications include folic acid",
"iron supplement",
"temperature",
"98",
"pulse",
"98 min",
"respirations",
... |
A 38-year-old man comes to the physician because of white lesions in his mouth for 4 days. He also has intense pain while chewing food. He was diagnosed with non-Hodgkin lymphoma around 8 months ago. He is undergoing chemotherapy and is currently on his fourth cycle. He was treated for herpes labialis 4 months ago with... | Topical nystatin | {
"A": "Culture of the lesions",
"B": "Topical nystatin",
"C": "Biopsy of a lesion",
"D": "Topical corticosteroids"
} | step2&3 | B | [
"year old man",
"physician",
"of white lesions",
"mouth",
"4 days",
"intense pain",
"chewing food",
"diagnosed",
"non-Hodgkin lymphoma",
"months",
"chemotherapy",
"currently",
"fourth cycle",
"treated",
"herpes labialis",
"months",
"acyclovir",
"smoked half",
"pack",
"cigarette... |
A 20-year-old man comes to the physician because of a 2-day history of a pruritic rash on both arms. He returned from a 2-week hiking trip in North Carolina 1 day ago. He has ulcerative colitis. He works as a landscape architect. His only medication is a mesalazine suppository twice daily. He has smoked a pack of cigar... | Apply topical calamine preparation | {
"A": "Administer oral ivermectin",
"B": "Counsel patient on alcohol intake",
"C": "Apply topical calamine preparation",
"D": "Administer oral prednisone"
} | step2&3 | C | [
"20 year old man",
"physician",
"2-day history",
"pruritic rash",
"arms",
"returned",
"2-week hiking trip",
"North Carolina",
"day",
"ulcerative colitis",
"works",
"landscape architect",
"only medication",
"mesalazine suppository twice daily",
"smoked",
"pack",
"cigarettes daily",
... |
A 24-year-old man comes to the emergency department because of progressive shortness of breath and intermittent cough with blood-tinged sputum for the past 10 days. During this time, he had three episodes of blood in his urine. Six years ago, he was diagnosed with latent tuberculosis after a positive routine tuberculin... | Goodpasture syndrome | {
"A": "Goodpasture syndrome",
"B": "Granulomatosis with polyangiitis",
"C": "Reactivated tuberculosis",
"D": "Microscopic polyangiitis"
} | step2&3 | A | [
"year old man",
"emergency department",
"of progressive shortness",
"breath",
"intermittent cough",
"blood-tinged sputum",
"past 10 days",
"time",
"three episodes of blood",
"urine",
"Six years",
"diagnosed",
"latent tuberculosis",
"positive routine tuberculin skin test",
"treated",
"m... |
A 24-year-old male presents to the emergency room with a cough and shortness of breath for the past 3 weeks. You diagnose Pneumocystis jiroveci pneumonia (PCP). An assay of the patient's serum reveals the presence of viral protein p24. Which of the following viral genes codes for this protein? | gag | {
"A": "gag",
"B": "env",
"C": "tat",
"D": "rev"
} | step1 | A | [
"year old male presents",
"emergency room",
"cough",
"shortness of breath",
"past",
"weeks",
"diagnose Pneumocystis jiroveci pneumonia",
"PCP",
"assay",
"patient's serum reveals",
"presence of viral protein p24",
"following viral genes codes",
"protein"
] |
A 40-year-old South Asian male presents to a primary care provider complaining of a chronic cough that is worse at night. Through a translator, he reports that he has had the cough for several years but that it has been getting worse over the last few months. He recently moved to the United States to work in constructi... | Upper endoscopy | {
"A": "Helicobacter pylori stool antigen test",
"B": "Barium swallow",
"C": "Upper endoscopy",
"D": "Colonoscopy"
} | step2&3 | C | [
"40 year old South Asian male presents",
"primary care provider complaining of",
"chronic cough",
"worse",
"night",
"translator",
"reports",
"cough",
"years",
"getting worse",
"months",
"recently moved to",
"United States to work",
"construction",
"attributes",
"weight loss of ten poun... |
A 46-year-old man is brought to the emergency department for the onset of severe pain in his right knee that occurred when he tripped while descending a staircase. As he landed, he heard and felt an immediate popping sensation in his right knee. His medical history is positive for obesity, hypertension, type 2 diabetes... | Quadriceps tendon tear | {
"A": "Meniscal tear",
"B": "Femoral fracture",
"C": "Quadriceps tendon tear",
"D": "Avascular necrosis of the femur"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"onset",
"severe",
"right knee",
"occurred",
"tripped",
"descending",
"staircase",
"landed",
"heard",
"felt",
"immediate popping sensation",
"right knee",
"medical history",
"positive",
"obesity",
"hypertension",
"type 2 diabet... |
A 32-year-old man presents with hypertension that has been difficult to control with medications. His symptoms include fatigue, frequent waking at night for voiding, and pins and needles in the legs. His symptoms started 2 years ago. Family history is positive for hypertension in his mother. His blood pressure is 160/1... | Primary aldosteronism | {
"A": "Essential hypertension",
"B": "Coarctation of aorta",
"C": "Primary aldosteronism",
"D": "Renal artery stenosis"
} | step2&3 | C | [
"year old man presents",
"hypertension",
"difficult",
"control",
"medications",
"symptoms include fatigue",
"frequent waking",
"night",
"voiding",
"pins",
"needles",
"legs",
"symptoms started 2 years",
"Family history",
"positive",
"hypertension",
"mother",
"blood pressure",
"100... |
A 16-year-old girl is brought to the physician because of a 6-month history of menstrual cramps, heavy menstrual flow, and fatigue; she has gained 5 kg (11 lb) during this period. Menses occur at regular 30-day intervals and last 8 to 10 days; during her period she uses 7 tampons a day and is unable to participate in a... | Elevated TSH | {
"A": "Elevated TSH",
"B": "Elevated midnight cortisol",
"C": "Elevated LH:FSH ratio",
"D": "Elevated androgens"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"month history",
"menstrual",
"heavy menstrual flow",
"fatigue",
"gained 5 kg",
"period",
"Menses occur",
"regular 30 day intervals",
"last",
"10 days",
"period",
"uses",
"tampons",
"day",
"unable to",
"physical activities",
"cramping",
... |
A 74-year-old man comes to the physician for evaluation of a skin lesion on his right arm. The lesion first appeared 3 months ago and has since been slowly enlarging. Physical examination shows a 1.5-centimeter, faintly erythematous, raised lesion with irregular borders on the dorsum of the right forearm. A biopsy spec... | Irreversible nuclear changes in the stratum basale | {
"A": "Pleomorphism of cells in the stratum corneum",
"B": "Irreversible nuclear changes in the stratum basale",
"C": "Increased nuclear to cytoplasmic ratio in the stratum spinosum",
"D": "Presence of epithelial cells in the dermis"
} | step1 | B | [
"74 year old man",
"physician",
"evaluation",
"skin",
"right arm",
"lesion first appeared 3 months",
"since",
"slowly enlarging",
"Physical examination shows",
"centimeter",
"erythematous",
"raised lesion",
"irregular borders",
"dorsum",
"right forearm",
"biopsy specimen",
"obtained"... |
An 8-year-old boy presents to his primary care pediatrician for routine check-up. During the visit, his mom says that she has noticed yellow bumps on his eyelids and was concerned about whether they were a problem. Upon hearing this concern, the physician inquires about parental health studies and learns that both pare... | LDL receptor | {
"A": "Lipoprotein lipase",
"B": "LDL receptor",
"C": "VLDL receptor",
"D": "Apoprotein E"
} | step1 | B | [
"year old boy presents",
"primary care pediatrician",
"routine check-up",
"visit",
"mom",
"yellow bumps",
"eyelids",
"concerned",
"problem",
"hearing",
"concern",
"physician",
"parental health studies",
"learns",
"parents",
"high cholesterol",
"adhering",
"statin regimen",
"famil... |
A 6-year-old boy is brought to a primary care provider by his adoptive parents for evaluation of a 3-month history of jaw swelling. He has a travel history of recent immigration from equatorial Africa where his deceased mother was positive for HIV and died from related complications. On physical exam, extensive lymph n... | Recent immigration from equatorial Africa | {
"A": "Infected ulcer",
"B": "Close family member with HIV",
"C": "Recent immigration from equatorial Africa",
"D": "Gender of the patient"
} | step1 | C | [
"year old boy",
"brought",
"primary care provider",
"adoptive parents",
"evaluation",
"month history",
"jaw swelling",
"travel history of recent immigration",
"Africa",
"deceased mother",
"positive",
"HIV",
"died",
"related complications",
"physical exam",
"extensive lymph node swellin... |
A 34-year-old woman visits a fertility clinic with her husband with concerns about their inability to conceive their first child. Originally from India, she met her present husband during a humanitarian mission in Nepal 10 years ago. In addition, she reports a long history of vague lower abdominal pain along with chang... | Mycobacterium tuberculosis | {
"A": "Neisseria gonorrhoeae",
"B": "Streptococcus agalactiae",
"C": "Mycoplasma genitalium",
"D": "Mycobacterium tuberculosis"
} | step1 | D | [
"year old woman visits",
"fertility clinic",
"husband",
"concerns",
"to",
"first child",
"India",
"met",
"present husband",
"mission",
"Nepal 10 years",
"addition",
"reports",
"long history",
"vague lower abdominal pain",
"changes",
"menstrual",
"spotting",
"irregular vaginal ble... |
A 78-year-old woman is brought to the emergency department after she fell while gardening and experienced severe pain in her right arm. She has a history of well controlled hypertension and has been found to have osteoporosis. On presentation she is found to have a closed midshaft humerus fracture. No other major findi... | Wrist drop | {
"A": "Elbow flexion deficits",
"B": "Flattened deltoid",
"C": "Hypothenar atrophy",
"D": "Wrist drop"
} | step1 | D | [
"year old woman",
"brought",
"emergency department",
"fell",
"gardening",
"severe pain in",
"right arm",
"history of well controlled hypertension",
"found to",
"osteoporosis",
"presentation",
"found to",
"closed",
"humerus fracture",
"major findings",
"discovered",
"trauma survey",
... |
A 17-year-old girl is brought to her pediatrician by her mother for a wellness checkup. The patient states she is doing well in school and has no concerns. She has a past medical history of anxiety and is currently taking clonazepam as needed. Her family history is remarkable for hypertension in her mother and father a... | Bulimia nervosa | {
"A": "Anorexia nervosa",
"B": "Bulimia nervosa",
"C": "Diuretic abuse",
"D": "Gitelman syndrome"
} | step2&3 | B | [
"year old girl",
"brought",
"pediatrician",
"mother",
"wellness checkup",
"patient states",
"well",
"school",
"concerns",
"past medical anxiety",
"currently taking clonazepam as needed",
"family history",
"hypertension",
"mother",
"father",
"renal disease",
"grandparents",
"aunt",
... |
A 2-year-old girl is brought to the emergency department in the middle of the night because of difficulties breathing. Her parents say that the breathing noises have become progressively worse throughout the day and are mainly heard when she inhales. They say that a change in posture does not seem to have any effect on... | Nebulized epinephrine | {
"A": "Noninvasive ventilation",
"B": "Nebulized epinephrine",
"C": "Albuterol and ipratropium inhaler",
"D": "Reassurance"
} | step2&3 | B | [
"2 year old girl",
"brought",
"emergency department",
"middle",
"night",
"difficulties breathing",
"parents",
"breathing noises",
"worse",
"day",
"heard",
"inhales",
"change",
"posture",
"not",
"to",
"effect",
"breathing",
"last three days",
"runny nose",
"harsh cough",
"no... |
A 25-year-old male presents to his primary care physician with a chief complaint of anxiety and fatigue. The patient states that during this past week he has had final exams and has been unable to properly study and prepare because he is so exhausted. He states that he has been going to bed early but has been unable to... | Sleep hygiene education | {
"A": "Zolpidem",
"B": "Alprazolam",
"C": "Melatonin",
"D": "Sleep hygiene education"
} | step2&3 | D | [
"year old male presents",
"primary care physician",
"chief complaint",
"anxiety",
"fatigue",
"patient states",
"past week",
"final exams",
"unable",
"study",
"prepare",
"so exhausted",
"states",
"bed early",
"unable to",
"good nights sleep",
"patient admits",
"occasional cocaine",
... |
A 51-year-old woman comes to the physician because of a persistent cough and a 5-kg (11-lb) weight loss over the past 2 months. Yesterday, she coughed up bloody sputum. She does not smoke. Pulmonary examination shows decreased breath sounds over the right upper lobe. A CT scan of the chest shows a mass in the periphery... | ALK | {
"A": "ALK",
"B": "APC",
"C": "SMAD4 (DPC4)",
"D": "MYCL1"
} | step1 | A | [
"year old woman",
"physician",
"persistent cough",
"5 kg",
"weight loss",
"past",
"months",
"coughed up bloody sputum",
"not smoke",
"Pulmonary examination shows decreased breath sounds",
"right upper lobe",
"CT scan of",
"chest shows",
"mass",
"periphery",
"right upper lobe",
"Histo... |
A 26-year-old woman is brought to the ED by her fiance with cyanosis and shortness of breath. Gradually over the last few days she has also experienced headaches, fatigue, and dizziness. Her past medical history is significant only for mild anemia attributed to menorrhagia, for which she takes an iron supplement. Per h... | Methylene blue | {
"A": "Pralidoxime",
"B": "Deferoxamine",
"C": "Dimercaprol",
"D": "Methylene blue"
} | step1 | D | [
"year old woman",
"brought",
"ED",
"fiance",
"cyanosis",
"shortness of breath",
"last",
"days",
"headaches",
"fatigue",
"dizziness",
"past medical history",
"significant only",
"mild anemia attributed",
"menorrhagia",
"takes",
"iron supplement",
"fiance",
"recently",
"very exci... |
A 45-year-old woman comes to the clinic for complaints of abdominal pain and repeated watery stools for the past 2 days. She has a history of bowel complaints for the past 2 years consisting of periods of intermittent loose stools followed by the inability to make a bowel movement. Her past medical history is significa... | mu-opioid receptor agonist | {
"A": "D2 receptor antagonist",
"B": "PGE1 analog",
"C": "Substance P antagnoist",
"D": "mu-opioid receptor agonist"
} | step1 | D | [
"year old woman",
"clinic",
"complaints",
"abdominal pain",
"repeated watery stools",
"past 2 days",
"history",
"bowel complaints",
"past",
"years consisting",
"periods",
"intermittent loose stools followed by",
"to make",
"bowel movement",
"past medical history",
"significant",
"dia... |
A 37-year-old woman presents to the clinic to discuss various options for contraception. The patient has a past medical history of hypertension, Wilson’s disease, and constipation-dominant irritable bowel syndrome. The patient takes rivaroxaban and polyethylene glycol. The blood pressure is 152/98 mm Hg. On physical ex... | Levonorgestrel | {
"A": "Levonorgestrel",
"B": "Ethinyl estradiol",
"C": "Copper IUD",
"D": "Depot-medroxyprogesterone acetate"
} | step2&3 | A | [
"year old woman presents",
"clinic to discuss various options",
"contraception",
"patient",
"past medical",
"Wilsons disease",
"constipation dominant irritable bowel syndrome",
"patient takes rivaroxaban",
"polyethylene glycol",
"blood pressure",
"98 mm Hg",
"physical examination",
"patient ... |
A 21-year-old college student comes to the physician for intermittent palpitations. She does not have chest pain or shortness of breath. The symptoms started 2 days ago, on the night after she came back to her dormitory after a 4-hour-long bus trip from home. A day ago, she went to a party with friends. The palpitation... | Measure TSH levels | {
"A": "Measure TSH levels",
"B": "Observe and wait",
"C": "Measure D-Dimer levels",
"D": "Send urine toxicology"
} | step2&3 | A | [
"21-year-old college student",
"physician",
"intermittent palpitations",
"not",
"chest pain",
"shortness of breath",
"symptoms started 2 days",
"night",
"back",
"dormitory",
"4-hour long bus trip",
"home",
"day",
"party",
"friends",
"palpitations",
"gotten worse",
"then",
"occur ... |
A 58-year-old man with a 10-year history of type 2 diabetes mellitus and hypertension comes to the physician for a routine examination. Current medications include metformin and captopril. His pulse is 84/min and blood pressure is 120/75 mm Hg. His hemoglobin A1c concentration is 9.5%. The physician adds repaglinide to... | Glyburide | {
"A": "Linagliptin",
"B": "Glyburide",
"C": "Pioglitazone",
"D": "Miglitol"
} | step1 | B | [
"year old man",
"10",
"history of type 2 diabetes mellitus",
"hypertension",
"physician",
"routine examination",
"Current medications include metformin",
"captopril",
"pulse",
"84 min",
"blood pressure",
"75 mm Hg",
"hemoglobin concentration",
"9.5",
"physician adds repaglinide",
"trea... |
A 27-year-old woman with a past medical history of rheumatoid arthritis and severe anemia of chronic disease presents to the emergency department for nausea, vomiting, and abdominal pain that started this morning. She has been unable to tolerate oral intake during this time. Her blood pressure is 107/58 mmHg, pulse is ... | Repeat beta-hCG in 2 days | {
"A": "CT scan of the abdomen",
"B": "Repeat beta-hCG in 2 days",
"C": "Salpingectomy",
"D": "Salpingostomy"
} | step2&3 | B | [
"27 year old woman",
"past medical history of rheumatoid arthritis",
"severe anemia of chronic disease presents",
"emergency department",
"nausea",
"vomiting",
"abdominal pain",
"started",
"morning",
"unable to",
"oral intake",
"time",
"blood pressure",
"58 mmHg",
"pulse",
"min",
"re... |
A 21-year-old male presents to the emergency department with generalized weakness and fatigue. His past medical history is significant for hypertension refractory to several medications but is otherwise unremarkable. He is afebrile,his pulse is 82/min, respirations are 18/min, and blood pressure is 153/94 mmHg. Labs ar... | Amiloride | {
"A": "Amiloride",
"B": "Loop diuretics",
"C": "Mannitol",
"D": "Thiazide diuretics"
} | step1 | A | [
"21-year-old male presents",
"emergency department",
"generalized weakness",
"fatigue",
"past medical history",
"significant",
"hypertension refractory",
"medications",
"unremarkable",
"afebrile",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mmHg",
"Labs",
"follows",
... |
A 69-year-old woman comes to the clinic for an annual well exam. She reports no significant changes to her health except for an arm fracture 3 weeks ago while she was lifting some heavy bags. Her diabetes is well controlled with metformin. She reports some vaginal dryness that she manages with adequate lubrication. She... | Estrogen antagonist in breast and agonist in bone | {
"A": "Estrogen agonist in bone and breast",
"B": "Estrogen antagonist in breast and agonist in bone",
"C": "Estrogen antagonist in cervix and agonist in bone",
"D": "Partial estrogen agonist in bone and antagonist in cervix"
} | step1 | B | [
"69 year old woman",
"clinic",
"annual well exam",
"reports",
"significant changes",
"health",
"arm fracture",
"weeks",
"lifting",
"heavy bags",
"diabetes",
"well controlled",
"metformin",
"reports",
"vaginal dryness",
"adequate lubrication",
"denies",
"weight changes",
"fevers",... |
A 35-year-old female comes to the physician because of a 2-year history of progressive fatigue and joint pain. She has a 1-year history of skin problems and a 4-month history of episodic pallor of her fingers. She reports that the skin of her face, neck, and hands is always dry and itchy; there are also numerous “red s... | Lung cancer | {
"A": "Dental caries",
"B": "Antiphospholipid syndrome",
"C": "Lung cancer",
"D": "Urolithiasis"
} | step2&3 | C | [
"35 year old female",
"physician",
"2 year history",
"progressive fatigue",
"joint pain",
"year history",
"skin problems",
"4 month history of episodic pallor",
"fingers",
"reports",
"the skin of",
"face",
"neck",
"hands",
"always dry",
"itchy",
"numerous red",
"face",
"more clum... |
A 45-year-old man comes to the physician because of bright red blood in his stool for 5 days. He has had no pain during defecation and no abdominal pain. One year ago, he was diagnosed with cirrhosis after being admitted to the emergency department for upper gastrointestinal bleeding. He has since cut down on his drink... | Superior rectal vein | {
"A": "Superior rectal vein",
"B": "Inferior mesenteric artery",
"C": "Inferior rectal vein",
"D": "Internal iliac vein"
} | step1 | A | [
"year old man",
"physician",
"of bright red blood in",
"stool",
"5 days",
"pain",
"defecation",
"abdominal pain",
"One year ago",
"diagnosed",
"cirrhosis",
"admitted",
"emergency department",
"upper gastrointestinal bleeding",
"since cut down",
"drinking",
"bottles",
"beer daily",
... |
An 11-year-old girl presents to her primary care physician because she has been having difficulty hearing her teachers at school. She says that the difficulty hearing started about a year ago, and it has slowly been getting worse. Her past medical history is significant for multiple fractures in both her upper and lowe... | Type 1 collagen | {
"A": "Fibroblast growth factor receptor",
"B": "Type 1 collagen",
"C": "Type 3 collagen",
"D": "Type 4 collagen"
} | step1 | B | [
"year old girl presents",
"primary care physician",
"difficulty hearing",
"teachers",
"school",
"difficulty hearing started",
"year",
"slowly",
"getting worse",
"past medical history",
"significant",
"multiple fractures",
"upper",
"lower extremities",
"recently",
"growth spurt",
"fri... |
A 28-year-old woman gives birth to a male infant. During her third-trimester antenatal sonogram, the radiologist noted a suspected congenital heart defect, but the exact nature of the defect was not clear. The pediatrician orders an echocardiogram after making sure that the baby’s vital signs are stable. This reveals t... | Bluish discoloration of lips | {
"A": "Hepatomegaly",
"B": "Bluish discoloration of lips",
"C": "Diaphoresis while sucking",
"D": "Clubbing of finger nails"
} | step2&3 | B | [
"year old woman gives birth",
"male infant",
"third-trimester antenatal sonogram",
"radiologist noted",
"suspected congenital heart defect",
"exact nature",
"defect",
"not clear",
"pediatrician orders",
"echocardiogram",
"making sure",
"vital signs",
"stable",
"reveals",
"following findi... |
Four days after being hospitalized, intubated, and mechanically ventilated, a 30-year-old man has no cough response during tracheal suctioning. He was involved in a motor vehicle collision and was obtunded on arrival in the emergency department. The ventilator is at a FiO2 of 100%, tidal volume is 920 mL, and positive ... | Remove the ventilator | {
"A": "Ethics committee consultation",
"B": "Court order for further management",
"C": "Remove the ventilator",
"D": "Repeat CT scan of the head"
} | step2&3 | C | [
"Four days",
"hospitalized",
"intubated",
"ventilated",
"30 year old man",
"cough response",
"tracheal suctioning",
"involved",
"motor vehicle collision",
"obtunded",
"arrival",
"emergency department",
"ventilator",
"FiO2",
"100",
"tidal volume",
"mL",
"positive end-expiratory pres... |
A 55-year-old woman with a 1-year history of left-sided tinnitus is diagnosed with a tumor of the left jugular fossa. Sialometry shows decreased production of saliva from the left parotid gland. The finding on sialometry is best explained by a lesion of the nerve that is also responsible for which of the following? | Afferent limb of the gag reflex | {
"A": "Protrusion of the tongue",
"B": "Afferent limb of the gag reflex",
"C": "Afferent limb of the cough reflex",
"D": "Equilibrium and balance"
} | step1 | B | [
"55 year old woman",
"history",
"left-sided tinnitus",
"diagnosed",
"tumor",
"left jugular fossa",
"shows decreased production",
"saliva",
"left parotid gland",
"finding",
"best",
"lesion",
"nerve",
"responsible"
] |
A 67-year-old man is brought to the emergency department because of the sudden onset of severe substernal chest pain at rest. He has a history of hypertension, type 2 diabetes mellitus, and alcohol use disorder. He is diaphoretic and appears anxious. The lungs are clear to auscultation. An ECG shows ST-segment elevatio... | Transudation of plasma into the alveoli | {
"A": "Transudation of plasma into the alveoli",
"B": "Localized constriction of the pulmonary vasculature",
"C": "Bacterial infiltration into the pulmonary parenchyma",
"D": "Increased permeability of pulmonary vascular endothelial cells"
} | step1 | A | [
"67 year old man",
"brought",
"emergency department",
"sudden onset",
"severe substernal chest pain",
"rest",
"history of hypertension",
"type 2 diabetes mellitus",
"alcohol use disorder",
"diaphoretic",
"appears anxious",
"lungs",
"clear",
"auscultation",
"ECG shows ST-segment elevation... |
A 67-year-old woman is brought by ambulance from home to the emergency department after she developed weakness of her left arm and left face droop. According to her husband, she has a history of COPD, hypertension, and hyperlipidemia. She takes hydrochlorothiazide, albuterol, and atorvastatin. She is not on oxygen at h... | Intubate the patient | {
"A": "Intubate the patient",
"B": "Obtain non-contrast enhanced CT of brain",
"C": "Obtain an MRI of brain",
"D": "Start tissue plasminogen activator (tPA)"
} | step2&3 | A | [
"67 year old woman",
"brought",
"ambulance",
"home",
"emergency department",
"weakness of",
"left arm",
"left face droop",
"husband",
"history",
"COPD",
"hypertension",
"hyperlipidemia",
"takes hydrochlorothiazide",
"albuterol",
"atorvastatin",
"not",
"oxygen at home",
"active sm... |
A 3-week-old firstborn baby girl is brought to the pediatric emergency room with projectile vomiting. She started vomiting while feeding 12 hours ago and has been unable to keep anything down since then. After vomiting, she appears well and hungry, attempting to feed again. The vomitus has been non-bloody and non-bilio... | Hypertrophic muscularis externa | {
"A": "Failure of duodenal lumen recanalization",
"B": "Failure of neural crest cell migration into the rectum",
"C": "Hypertrophic muscularis externa",
"D": "Telescoping of the small bowel into the large bowel"
} | step1 | C | [
"3 week old",
"baby girl",
"brought",
"pediatric emergency room",
"projectile vomiting",
"started vomiting",
"feeding 12 hours",
"unable to keep",
"since then",
"vomiting",
"appears well",
"hungry",
"attempting to feed",
"vomitus",
"non bloody",
"non",
"last wet diaper",
"10 hours"... |
A 64-year-old woman is brought to the emergency department 1 hour after the onset of acute shortness of breath and chest pain. The chest pain is retrosternal in nature and does not radiate. She feels nauseated but has not vomited. She has type 2 diabetes mellitus, hypertension, and chronic kidney disease. Current medic... | Pericardiocentesis | {
"A": "Pericardiocentesis",
"B": "Hemodialysis",
"C": "Furosemide therapy",
"D": "Norepinephrine infusion"
} | step2&3 | A | [
"64 year old woman",
"brought",
"emergency department",
"hour",
"onset of acute shortness",
"breath",
"chest pain",
"chest pain",
"retrosternal",
"nature",
"not radiate",
"feels nauseated",
"not vomited",
"type 2 diabetes mellitus",
"hypertension",
"chronic kidney disease",
"Current ... |
A 7-year-old boy with a history of cystic fibrosis is brought to the physician for evaluation of recurrent episodes of productive cough, wheezing, and shortness of breath over the past month. Physical examination shows coarse crackles and expiratory wheezing over both lung fields. Serum studies show elevated levels of ... | Monomorphic, septate hyphae that branch at acute angles | {
"A": "Monomorphic, septate hyphae that branch at acute angles",
"B": "Dimorphic, cigar-shaped budding yeast",
"C": "Monomorphic, narrow budding encapsulated yeast",
"D": "Monomorphic, broad, nonseptate hyphae that branch at wide angles"
} | step1 | A | [
"year old boy",
"history",
"cystic fibrosis",
"brought",
"physician",
"evaluation of recurrent episodes",
"productive cough",
"wheezing",
"shortness of breath",
"past month",
"Physical examination shows coarse crackles",
"expiratory wheezing",
"lung fields",
"Serum studies show elevated le... |
A 45-year-old man comes to the physician because of persistent reddening of the face for the past 3 months. During this period he also had difficulty concentrating at work and experienced generalized fatigue. He has fallen asleep multiple times during important meetings. His mother has rheumatoid arthritis. He has hype... | Increased EPO production | {
"A": "Increased EPO production",
"B": "Increased serotonin levels",
"C": "Delayed-type hypersensitivity",
"D": "Increased cortisol levels"
} | step2&3 | A | [
"year old man",
"physician",
"persistent",
"face",
"past 3 months",
"period",
"difficulty concentrating",
"work",
"experienced generalized fatigue",
"fallen asleep multiple times",
"important meetings",
"mother",
"rheumatoid arthritis",
"hypertension",
"asthma",
"smoked one pack",
"c... |
The police are called to investigate a domestic disturbance. The neighbors report hearing a man shouting "I'm gonna kill you" for the past 30 minutes followed by occasional screaming. The house was only recently occupied by its new owner, a middle-aged lawyer. The police were greeted at the door by a man holding a broo... | Cognitive behavioral therapy | {
"A": "Cognitive behavioral therapy",
"B": "Anxiolytics",
"C": "Antidepressants",
"D": "Beta-blockers"
} | step1 | A | [
"police",
"called to investigate",
"domestic disturbance",
"neighbors report hearing",
"man shouting",
"I",
" ",
"ill ",
"ast 0 minutes ollowed by ccasional creaming.",
"ouse ",
"nly ecently ccupied ",
"ew wner,",
"iddle-aged awyer.",
"olice ",
"reeted ",
"oor ",
"an olding ... |
A 22-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious illness. Pelvic examination shows a pink, 2 x 2-cm, fluctuant swelling at the right posterior vaginal introitus. The swelling is most likely derived from which of the following structures? | Greater vestibular glands | {
"A": "Paraurethral glands",
"B": "Greater vestibular glands",
"C": "Mesonephric duct remnants",
"D": "Sebaceous glands"
} | step1 | B | [
"year old woman",
"physician",
"routine health maintenance examination",
"history",
"serious illness",
"Pelvic examination shows",
"pink",
"2",
"2",
"fluctuant swelling",
"right posterior vaginal introitus",
"swelling",
"most likely derived",
"following structures"
] |
A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is calle... | Autism spectrum disorder | {
"A": "Attention deficit hyperactivity disorder",
"B": "Bipolar disorder",
"C": "Obsessive-compulsive disorder",
"D": "Autism spectrum disorder"
} | step2&3 | D | [
"mother",
"year old son",
"doctor",
"worried",
"constantly",
"head",
"wall",
"exhibiting",
"behavior",
"months",
"worried",
"started",
"speak less than",
"used",
"not",
"name",
"called",
"aloof",
"children",
"to",
"lost interest",
"toys",
"most likely diagnosis"
] |
A 59-year-old man with chronic hepatitis C infection comes to the physician because of a 2-week history of ankle pain and nonpruritic skin lesions on his legs. He does not recall recent trauma or injury. He has not received treatment for hepatitis. Examination shows diffuse, violaceous lesions on both lower extremities... | Purpura | {
"A": "Hemangioma",
"B": "Purpura",
"C": "Petechiae",
"D": "Spider angioma"
} | step1 | B | [
"A 59 year old man",
"chronic hepatitis C infection",
"physician",
"2-week history",
"ankle pain",
"nonpruritic skin lesions",
"legs",
"not recall recent trauma",
"injury",
"not received treatment",
"hepatitis",
"Examination shows diffuse",
"violaceous lesions",
"lower extremities",
"les... |
A 62-year-old man comes to the office complaining of dysphagia that started 4-5 months ago. He reports that he initially he had difficulty swallowing only solid foods. More recently, he has noticed some trouble swallowing liquids. The patient also complains of fatigue, a chronic cough that worsens at night, and burning... | Adenocarcinoma | {
"A": "Adenocarcinoma",
"B": "Nutcracker esophagus",
"C": "Small cell carcinoma",
"D": "Squamous cell carcinoma"
} | step2&3 | A | [
"62 year old man",
"office",
"dysphagia",
"started 4-5 months",
"reports",
"initially",
"difficulty swallowing only solid foods",
"recently",
"swallowing liquids",
"patient",
"fatigue",
"chronic cough",
"worsens",
"night",
"burning chest pain",
"occurs",
"eats",
"used over-the-coun... |
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