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 girl presents to the office with her parents who are concerned about their daughter and slow, progressive changes in her behavior. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and was meeting all developmental milestones until about 2 years ago... | Rett syndrome | {
"A": "Autistic spectrum disorder",
"B": "Phenylketonuria",
"C": "Rett syndrome",
"D": "Tourette syndrome"
} | step1 | C | [
"4 year old girl presents",
"office",
"parents",
"concerned",
"daughter",
"slow",
"progressive changes in",
"behavior",
"girl",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"about",
"years",
"one point",
"... |
A 42-year-old man presents to clinic complaining of increasing difficulty climbing stairs and standing up from sitting in his chair. On exam you perceive that his strength to be 5/5 distally, but only 3/5 in proximal muscle groups bilaterally. There is a distinctive rash on his upper eyelids and around his eyes. Examin... | Violaceous papules over the MCP, PIP, and DIP | {
"A": "Dactylitis",
"B": "Enlargement of the PIP",
"C": "Ulnar deviation of the fingers",
"D": "Violaceous papules over the MCP, PIP, and DIP"
} | step1 | D | [
"year old man presents",
"clinic",
"increasing difficulty climbing stairs",
"standing up",
"sitting",
"chair",
"exam",
"strength to",
"5/5",
"only 3",
"proximal muscle groups",
"rash",
"upper",
"eyes",
"Examination of",
"fingers",
"most likely to reveal",
"following"
] |
A 42-year-old man presents to the emergency department with abdominal pain. The patient was at home watching television when he experienced sudden and severe abdominal pain that prompted him to instantly call emergency medical services. The patient has a past medical history of obesity, smoking, alcoholism, hypertensio... | Abdominal radiograph | {
"A": "Abdominal radiograph",
"B": "CT of the abdomen",
"C": "Urgent laparoscopy",
"D": "Urgent laparotomy"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"abdominal pain",
"patient",
"at home watching television",
"experienced sudden",
"severe abdominal",
"prompted",
"to",
"call emergency medical services",
"patient",
"past medical",
"smoking",
"alcoholism",
"hypertension",
"osteoarthriti... |
An 11-year-old boy is brought to the emergency room with acute abdominal pain and hematuria. Past medical history is significant for malaria. On physical examination, he has jaundice and a generalized pallor. His hemoglobin is 5 g/dL, and his peripheral blood smear reveals fragmented RBC, microspherocytes, and eccentro... | D-glucose-6-phosphate + NADP+ → 6-phospho-D-glucono-1,5-lactone + NADPH + H+ | {
"A": "Glucose-1-phosphate + UTP → UDP-glucose + pyrophosphate",
"B": "Glucose-6-phosphate + H2O → glucose + Pi",
"C": "D-glucose-6-phosphate + NADP+ → 6-phospho-D-glucono-1,5-lactone + NADPH + H+",
"D": "Glucose + ATP → Glucose-6-phosphate + ADP + H+"
} | step1 | C | [
"year old boy",
"brought",
"emergency room",
"acute abdominal pain",
"hematuria",
"Past medical history",
"significant",
"malaria",
"physical examination",
"jaundice",
"generalized pallor",
"hemoglobin",
"5 g/dL",
"peripheral blood smear reveals fragmented RBC",
"microspherocytes",
"ec... |
A 76-year-old woman comes to the physician for evaluation of a 3-month history of vulvar itching and pain. She was diagnosed with lichen sclerosus 4 years ago. She has smoked 1 pack of cigarettes daily for 35 years. Physical examination shows a 2.5-cm nodular, ulcerative lesion on the vaginal introitus and left labia m... | Superficial inguinal | {
"A": "Superficial inguinal",
"B": "Para-aortic",
"C": "Inferior mesenteric",
"D": "External iliac"
} | step1 | A | [
"76 year old woman",
"physician",
"evaluation of",
"month history",
"vulvar itching",
"pain",
"diagnosed",
"lichen sclerosus",
"years",
"smoked 1 pack",
"cigarettes daily",
"35 years",
"Physical examination shows",
"2.5",
"nodular",
"ulcerative",
"vaginal introitus",
"left labia mi... |
A prospective cohort study was conducted to assess the relationship between LDL and the incidence of heart disease. The patients were selected at random. Results showed a 10-year relative risk of 2.3 for people with elevated LDL levels compared to individuals with normal LDL levels. The 95% confidence interval was 1.05... | 0.04 | {
"A": "0.04",
"B": "0.08",
"C": "0.10",
"D": "0.20"
} | step1 | A | [
"prospective cohort study",
"conducted to assess",
"relationship",
"the incidence of heart disease",
"patients",
"selected",
"random",
"Results showed a 10 year relative risk",
"2",
"people",
"elevated",
"levels compared",
"individuals",
"normal",
"levels",
"95",
"confidence interval... |
A child is in the nursery one day after birth. A nurse notices a urine-like discharge being expressed through the umbilical stump. What two structures in the embryo are connected by the structure that failed to obliterate during the embryologic development of this child? | Bladder - yolk sac | {
"A": "Pulmonary artery - aorta",
"B": "Bladder - yolk sac",
"C": "Liver - umbilical vein",
"D": "Kidney - large bowel"
} | step1 | B | [
"child",
"nursery one after birth",
"nurse",
"urine",
"discharge",
"umbilical stump",
"two structures",
"embryo",
"connected",
"structure",
"failed to obliterate",
"embryologic",
"child"
] |
A 26-year-old medical student who is preparing for Step 1 exams is woken up by her friend for breakfast. She realizes that she must have fallen asleep at her desk while attempting to study through the night. While walking with her friend to breakfast, she realizes that she has not eaten since breakfast the previous day... | Liver and kidney | {
"A": "Liver and muscle",
"B": "Liver and kidney",
"C": "Liver, muscle, and kidney",
"D": "Muscle only"
} | step1 | B | [
"year old medical student",
"preparing",
"Step 1 exams",
"woken up",
"friend",
"breakfast",
"fallen asleep",
"attempting to study",
"night",
"walking",
"friend",
"breakfast",
"not eaten since breakfast",
"previous day",
"Using",
"motivation to review",
"biochemistry",
"pauses to co... |
A 16-year-old female is seen at her outpatient primary medical doctor's office complaining of a sore throat. Further history reveals that she has no cough and physical exam is notable for tonsillar exudates. Vitals in the office reveal HR 88, RR 16, and T 102.1. Using the Centor criteria for determining likelihood of G... | 41/50 = 82% | {
"A": "41/50 = 82%",
"B": "41/46 = 89%",
"C": "45/50 = 90%",
"D": "Not enough information has been provided"
} | step1 | A | [
"year old female",
"seen",
"outpatient primary medical doctor's office",
"of",
"sore throat",
"history reveals",
"cough",
"physical exam",
"notable",
"tonsillar exudates",
"office reveal",
"88",
"RR",
"T",
"Using",
"Centor criteria",
"determining likelihood",
"Group A beta-hemolyti... |
A 26-year-old woman presents to her physician with a complaint of milk reduction. 2 months ago, she delivered a healthy girl from an uncomplicated pregnancy. The baby was exclusively breastfed until 1.5 months when the patient had to return to the workforce. She cannot breastfeed her daughter at work so she had to leav... | Insufficient breast emptying | {
"A": "Insufficient amount of glandular breast tissue",
"B": "Suppression of lactation by the medications",
"C": "Insufficient breast emptying",
"D": "Failure of lactogenic ducts to develop"
} | step2&3 | C | [
"year old woman presents",
"physician",
"complaint",
"milk reduction",
"months",
"delivered",
"healthy girl",
"uncomplicated pregnancy",
"baby",
"breastfed",
"months",
"patient",
"to return",
"workforce",
"breastfeed",
"daughter",
"work",
"to leave",
"grandmother",
"baby",
"d... |
A 61-year-old man presents to the clinic because of sinus congestion, dyspnea, fatigue, and a productive cough. He returned from a trip to Wuhan, China 3 weeks ago. He says that he received his annual influenza vaccine approximately 2 months ago and was in otherwise good health prior to the recent onset of symptoms. Th... | RNA | single-stranded | envelope: yes | positive-sense, helical | {
"A": "DNA | double-stranded | envelope: yes | icosahedral",
"B": "DNA | single-stranded | envelope: no | icosahedral",
"C": "RNA | single-stranded | envelope: no | positive-sense, icosahedral",
"D": "RNA | single-stranded | envelope: yes | positive-sense, helical"
} | step1 | D | [
"61 year old man presents",
"clinic",
"sinus congestion",
"dyspnea",
"fatigue",
"productive cough",
"returned",
"trip",
"China",
"weeks",
"received",
"annual influenza vaccine approximately",
"months",
"good health prior to",
"recent onset",
"symptoms",
"heart rate",
"min",
"resp... |
A 75-year-old man comes to the physician because of abdominal pain and nausea over the past 2 weeks and a 1-month history of pain in his knees and hips. He has smoked one pack of cigarettes daily for 30 years. Physical examination shows decreased muscle strength. Laboratory studies show:
Hemoglobin 11.0 mg/dL
Serum
Cre... | Proximal convoluted tubules | {
"A": "Distal convoluted tubules",
"B": "Proximal convoluted tubules",
"C": "Glomerulus",
"D": "Renal pelvis"
} | step1 | B | [
"75 year old man",
"physician",
"abdominal pain",
"nausea",
"past 2 weeks",
"month history",
"pain",
"knees",
"hips",
"smoked one pack",
"cigarettes daily",
"30 years",
"Physical examination shows decreased muscle strength",
"Laboratory studies show",
"0",
"Serum Creatinine",
"Calciu... |
A 52-year-old woman presents with erosions in her mouth that are persistent and painful. She says that symptoms appeared gradually 1 week ago and have progressively worsened. She also notes that, several days ago, flaccid blisters appeared on her skin, which almost immediately transformed to erosions as well. Which of ... | Pemphigus vulgaris | {
"A": "Pemphigus vulgaris",
"B": "Psoriasis",
"C": "Molluscum contagiosum",
"D": "Staphylococcal infection (scalded skin syndrome)"
} | step1 | A | [
"year old woman presents",
"erosions",
"mouth",
"persistent",
"painful",
"symptoms appeared",
"week",
"worsened",
"notes",
"several days",
"flaccid blisters appeared",
"skin",
"almost immediately transformed",
"erosions",
"well",
"following",
"most likely diagnosis"
] |
A 33-year-old man comes to the physician because of gradually worsening bilateral foot pain for 2 months. The pain used to only occur after long walks and subside with rest. For the past week, the pain has been continuous and associated with burning sensations. He has also had transient painful nodules along the course... | Smoking cessation | {
"A": "Bypass grafting",
"B": "Smoking cessation",
"C": "Enoxaparin therapy",
"D": "Simvastatin therapy"
} | step2&3 | B | [
"year old man",
"physician",
"worsening bilateral foot pain",
"months",
"pain used to only occur",
"long walks",
"rest",
"past week",
"pain",
"continuous",
"associated with burning sensations",
"transient painful nodules",
"course",
"leg veins",
"4 months",
"resolve",
"patient",
"a... |
A 17-year-old woman presents to an OBGYN clinic for evaluation of primary amenorrhea. She is a well-developed well-nourished woman who looks at her stated age. She has reached Tanner stage IV breast and pubic hair development. The external genitalia is normal in appearance. She has an older sister who underwent menarch... | Failure of the paramesonephric duct to form | {
"A": "Failure of the mesonephric duct to degenerate",
"B": "Failure of the ovaries to produce estrogen",
"C": "Genotype 47 XXY",
"D": "Failure of the paramesonephric duct to form"
} | step1 | D | [
"year old woman presents",
"OBGYN clinic",
"evaluation",
"primary amenorrhea",
"well",
"nourished woman",
"looks",
"stated age",
"reached Tanner stage IV breast",
"pubic hair development",
"external genitalia",
"normal",
"appearance",
"older sister",
"menarche at",
"years",
"age",
... |
A 35-year-old man with no known past medical history presents to his physician because he is applying for a job as a healthcare worker, which requires screening for the hepatitis B virus (HBV). The patient states that he is in good health and denies any symptoms. His vital signs and physical exam are unremarkable. Labs... | Chronically infected, low infectivity | {
"A": "Immune due to previous infection",
"B": "Chronically infected, low infectivity",
"C": "Chronically infected, high infectivity",
"D": "Acutely infected"
} | step1 | B | [
"35 year old man",
"known past medical history presents",
"physician",
"applying",
"job",
"healthcare worker",
"screening",
"hepatitis B",
"patient states",
"good health",
"denies",
"symptoms",
"vital signs",
"physical exam",
"unremarkable",
"Labs",
"drawn",
"patient's HBV shows",
... |
Four days after undergoing an elective total hip replacement, a 65-year-old woman develops a DVT that embolizes to the lung. Along with tachypnea, tachycardia, and cough, the patient would most likely present with a PaO2 of what? | 60 mmHg | {
"A": "120 mmHg",
"B": "110 mmHg",
"C": "85 mmHg",
"D": "60 mmHg"
} | step1 | D | [
"Four days",
"elective total hip replacement",
"65 year old woman",
"DVT",
"lung",
"tachypnea",
"tachycardia",
"cough",
"patient",
"most likely present",
"PaO2"
] |
A randomized controlled trial was initiated to evaluate a novel DPP-4 inhibitor for blood glucose management in diabetic patients. The study used a commonly prescribed sulfonylurea as the standard of care treatment. 2,000 patients were enrolled in the study with 1,000 patients in each arm. One of the primary outcomes w... | 49% | {
"A": "23%",
"B": "33%",
"C": "49%",
"D": "59%"
} | step2&3 | C | [
"randomized controlled trial",
"initiated to evaluate",
"novel DPP-4 inhibitor",
"blood glucose management",
"diabetic patients",
"study used",
"prescribed sulfonylurea",
"standard of care treatment",
"patients",
"enrolled",
"study",
"1",
"patients",
"arm",
"One",
"primary outcomes",
... |
A 51-year-old man comes to the physician because of a 1-day history of progressive pain, excessive tearing, and blurry vision of his right eye. He first noticed his symptoms last evening while he was watching a movie at a theater. His left eye is asymptomatic. He wears contact lenses. He has atopic dermatitis treated w... | Topical ofloxacin | {
"A": "Topical ketorolac and artificial tears",
"B": "Topical ofloxacin",
"C": "Topical prednisolone",
"D": "Topical ganciclovir"
} | step2&3 | B | [
"year old man",
"physician",
"1-day history",
"progressive pain",
"excessive tearing",
"blurry vision",
"right eye",
"first",
"symptoms last evening",
"watching",
"movie",
"theater",
"left eye",
"asymptomatic",
"contact lenses",
"atopic dermatitis treated with topical hydrocortisone",
... |
A 54-year-old woman comes to the physician because of constant dull pain, swelling, and progressive stiffness of the right knee for 3 days. Use of over-the-counter analgesics has only provided minimal relief of her symptoms. She has not had any similar symptoms in the past. She takes hydrochlorothiazide for hypertensio... | Calcification of the meniscal cartilage | {
"A": "Human leukocyte antigen-B27 positivity",
"B": "Knee joint space narrowing with subchondral sclerosis",
"C": "Calcification of the meniscal cartilage",
"D": "Chalky nodules on the external ear"
} | step2&3 | C | [
"54 year old woman",
"physician",
"constant dull",
"swelling",
"progressive stiffness of",
"right knee",
"3 days",
"Use of over-the-counter analgesics",
"only provided minimal relief",
"symptoms",
"not",
"similar symptoms",
"past",
"takes hydrochlorothiazide",
"hypertension",
"Examinat... |
A 45-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. He has a history of hypertension that is controlled with enalapril. He does not smoke or use illicit drugs. He drinks 2–3 beers on the weekends. His vital... | Hepatocellular carcinoma | {
"A": "Non-Hodgkin lymphoma",
"B": "Hepatocellular carcinoma",
"C": "Progressive central obesity",
"D": "Pancreatic carcinoma"
} | step2&3 | B | [
"year old man",
"physician",
"month history",
"increasing fatigue",
"reduced libido",
"joint pain",
"hands",
"history of hypertension",
"controlled",
"enalapril",
"not smoke",
"use illicit",
"drinks 23 beers",
"weekends",
"vital signs",
"normal limits",
"Physical examination shows",
... |
A 36-year-old woman comes to the physician because of a 3-month history of intermittent cough productive of thick, yellow phlegm and increasing shortness of breath. She especially becomes short of breath while playing with her children. She has worked as a farmer for 18 years. She has asthma treated with a salbutamol i... | Alpha-1 antitrypsin deficiency | {
"A": "Alpha-1 antitrypsin deficiency",
"B": "Constrictive bronchiolitis obliterans",
"C": "Hypersensitivity pneumonitis",
"D": "Chronic obstructive lung disease"
} | step2&3 | A | [
"36 year old woman",
"physician",
"3 month history",
"intermittent cough productive",
"thick",
"yellow phlegm",
"increasing shortness of breath",
"short of breath",
"playing",
"children",
"worked",
"farmer",
"years",
"asthma treated with",
"salbutamol inhaler",
"smoked half",
"pack",... |
The occupational health department at a hospital implements new safety precautions to prevent laboratory-acquired infections. One of the new precautions includes disinfecting the microbiology laboratory benches with 70% ethanol before and after use. This measure is most likely to be effective in preventing the transmis... | Herpes simplex virus | {
"A": "Hepatitis A virus",
"B": "Parvovirus",
"C": "Polyomavirus",
"D": "Herpes simplex virus"
} | step1 | D | [
"occupational health",
"hospital",
"new safety to prevent laboratory acquired infections",
"One",
"new precautions includes",
"microbiology laboratory",
"70",
"ethanol",
"use",
"measure",
"most likely to",
"effective",
"preventing",
"transmission of",
"following viruses"
] |
A 36-year-old man is brought in by ambulance after being found down on the sidewalk. It is uncertain how long he was down before being found, and he did not have any forms of identification when he was found. On presentation, the man is found to still be unconscious with a disheveled and unkempt appearance. He is also ... | Decreased bicarbonate and increased carbon dioxide | {
"A": "Decreased bicarbonate and decreased carbon dioxide",
"B": "Decreased bicarbonate and increased carbon dioxide",
"C": "Increased bicarbonate and increased carbon dioxide",
"D": "Normal bicarbonate and normal carbon dioxide"
} | step1 | B | [
"36 year old man",
"brought",
"ambulance",
"found",
"sidewalk",
"uncertain",
"long",
"found",
"not",
"forms",
"identification",
"found",
"presentation",
"man",
"found to",
"unconscious",
"unkempt appearance",
"found to",
"taking slow",
"shallow",
"smell",
"alcohol",
"temp... |
A 72-year-old man comes to the physician for medical clearance for a molar extraction. He feels well. He reports he is able to climb 3 flights of stairs without experiencing any shortness of breath. He has hypertension, type 2 diabetes mellitus, and ischemic heart disease. He underwent an aortic valve replacement for s... | Administer oral amoxicillin 1 hour before the procedure | {
"A": "Administer oral amoxicillin 1 hour before the procedure",
"B": "Obtain echocardiography prior to procedure",
"C": "Avoid nitrous oxide during the procedure",
"D": "Discontinue aspirin and warfarin 72 hours prior to procedure"
} | step2&3 | A | [
"72 year old man",
"physician",
"medical clearance",
"molar extraction",
"feels well",
"reports",
"able to climb",
"flights",
"stairs",
"experiencing",
"shortness of breath",
"hypertension",
"type 2 diabetes mellitus",
"ischemic heart disease",
"aortic valve",
"severe",
"stenosis",
... |
A 63-year-old man is brought to the emergency department, 30 minutes after being involved in a high-speed motor vehicle collision. He is obtunded on arrival. He is intubated and mechanical ventilation is begun. The ventilator is set at a FiO2 of 60%, tidal volume of 440 mL, and positive end-expiratory pressure of 4 cm ... | Insertion of a chest tube | {
"A": "Administer levofloxacin",
"B": "Insertion of a chest tube",
"C": "CT scan of the chest",
"D": "Close observation\n\""
} | step2&3 | B | [
"63 year old man",
"brought",
"emergency department",
"30 minutes",
"involved",
"high speed motor vehicle collision",
"obtunded",
"arrival",
"intubated",
"mechanical ventilation",
"begun",
"ventilator",
"set",
"FiO2",
"60",
"tidal volume",
"440 mL",
"positive end-expiratory pressur... |
A 41-year-old woman comes to the emergency room because she has been taking phenelzine for a few years and her doctor warned her that she should not eat aged cheese while on the medication. That night, she unknowingly ate an appetizer at a friend's party that was filled with cheese. She is concerned and wants to make s... | Blood pressure | {
"A": "Oxygen saturation",
"B": "Creatine phosphokinase",
"C": "Blood pressure",
"D": "Temperature"
} | step2&3 | C | [
"year old woman",
"emergency room",
"taking phenelzine",
"years",
"doctor warned",
"not eat aged cheese",
"medication",
"night",
"ate",
"friend's party",
"filled",
"cheese",
"concerned",
"to make sure",
"right",
"vital sign",
"blood test",
"most important to monitor",
"patient"
] |
A 57-year-old man presents to the emergency department after a motor vehicle collision. The patient was the back seat restrained passenger in a vehicle that was rear ended at 25 miles/hour. The patient has a past medical history of diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). His temperatur... | Tamponade | {
"A": "Congestive heart failure",
"B": "Septic shock",
"C": "Tamponade",
"D": "Tension pneumothorax"
} | step2&3 | C | [
"57 year old man presents",
"emergency department",
"motor vehicle collision",
"patient",
"back",
"restrained passenger",
"vehicle",
"rear ended",
"miles hour",
"patient",
"past medical diabetes",
"hypertension",
"chronic obstructive pulmonary disease",
"temperature",
"97",
"36 4C",
... |
A medical student is sampling serum triglyceride values for a study on the effect of gemfibrozil on lipid levels. He draws blood from 6 different patients who have been fasting for a period of 9 hours. Laboratory results show:
Patient 1 175 mg/dL
Patient 2 150 mg/dl
Patient 3 196 mg/dL
Patient 4 160 mg/dL
Patient 5 170... | 172.5 mg/dL | {
"A": "172.5 mg/dL",
"B": "171.0 mg/dL",
"C": "175.0 mg/dL",
"D": "160.0 mg/dL\n\""
} | step2&3 | A | [
"medical student",
"sampling serum triglyceride values",
"study",
"effect",
"gemfibrozil",
"lipid levels",
"draws blood",
"different patients",
"fasting",
"period",
"hours",
"Laboratory results show",
"Patient",
"mg dL",
"160",
"following",
"median",
"serum triglyceride values"
] |
A 33-year-old woman presents to the urgent care center with 4 days of abdominal pain and increasingly frequent bloody diarrhea. She states that she is currently having 6 episodes of moderate volume diarrhea per day with streaks of blood mixed in. Her vital signs include: blood pressure 121/81 mm Hg, heart rate 77/min, ... | Campylobacter | {
"A": "Clostridium difficile",
"B": "Campylobacter",
"C": "Salmonella",
"D": "Shigella"
} | step2&3 | B | [
"year old woman presents",
"urgent care center",
"4 days",
"abdominal pain",
"frequent bloody diarrhea",
"states",
"currently",
"6 episodes of moderate volume diarrhea",
"day",
"streaks",
"blood mixed",
"vital signs include",
"blood pressure",
"81 mm Hg",
"heart rate",
"min",
"respir... |
Three days after undergoing laparoscopic colectomy, a 67-year-old man reports swelling and pain in his right leg. He was diagnosed with colon cancer 1 month ago. His temperature is 38.5°C (101.3°F). Physical examination shows swelling of the right leg from the ankle to the thigh. There is no erythema or rash. Which of ... | Compression ultrasonography | {
"A": "Transthoracic echocardiography",
"B": "CT pulmonary angiography",
"C": "Blood cultures",
"D": "Compression ultrasonography"
} | step1 | D | [
"Three days",
"laparoscopic colectomy",
"67 year old man reports swelling",
"pain in",
"right leg",
"diagnosed",
"colon cancer",
"month",
"temperature",
"Physical examination shows swelling of",
"right leg",
"ankle",
"thigh",
"erythema",
"rash",
"following",
"likely to",
"helpful",... |
A 45-year-old male is brought to the emergency department by emergency medical services after sustaining a gunshot wound to the abdomen. He is unresponsive. His temperature is 99.0°F (37.2°C), blood pressure is 95/58 mmHg, pulse is 115/min, and respirations are 20/min. Physical examination reveals an entry wound in the... | Descending colon | {
"A": "Descending colon",
"B": "Transverse colon",
"C": "Ascending colon",
"D": "Sigmoid colon"
} | step1 | A | [
"year old male",
"brought",
"emergency department",
"emergency medical services",
"sustaining",
"gunshot",
"abdomen",
"unresponsive",
"temperature",
"99",
"blood pressure",
"95 58 mmHg",
"pulse",
"min",
"respirations",
"20 min",
"Physical examination reveals",
"entry wound",
"lef... |
A previously healthy 22-year-old man presents to the university clinic with increasing scrotal pain and swelling over the past 5 days. He also has dysuria and urinary frequency. He has never felt this type of pain before. The young man considers himself generally healthy and takes no medications. He is sexually active ... | IV ceftriaxone and oral doxycycline | {
"A": "IV ceftriaxone and oral doxycycline",
"B": "Oral metronidazole for patient and sexual partner",
"C": "Radical orchiectomy",
"D": "Surgical exploration"
} | step2&3 | A | [
"healthy",
"year old man presents",
"university clinic",
"increasing scrotal pain",
"swelling",
"past 5 days",
"dysuria",
"urinary frequency",
"never felt",
"type",
"pain",
"young man considers",
"healthy",
"takes",
"medications",
"sexually active",
"one partner",
"uses condoms",
... |
A 21-year-old G3P2 woman presents to her obstetrician at 6 weeks gestation for routine prenatal care. Her past medical history includes obesity and gestational diabetes. She has had two spontaneous vaginal deliveries at term. One infant was macrosomic with hypoglycemia, but otherwise, she has had no complications. Her ... | Ectoderm | {
"A": "Notocord",
"B": "Mesenchyme",
"C": "Ectoderm",
"D": "Endoderm"
} | step1 | C | [
"21-year-old",
"woman presents",
"obstetrician",
"6 weeks",
"routine prenatal care",
"past medical history includes obesity",
"gestational diabetes",
"two spontaneous vaginal deliveries",
"term",
"One infant",
"hypoglycemia",
"complications",
"physician informs",
"start taking",
"multivi... |
A 49-year-old man presents to the clinic with skin lesions and chronic diarrhea. His wife also reports that he has become more irritable and forgetful in the past year. His medical history is significant for a gastroenterostomy performed 4 years ago due to gastric outlet obstruction caused by hyperplastic polyposis, wh... | NAD+ | {
"A": "Menaquinone",
"B": "Flavin mononucleotide",
"C": "Biotin",
"D": "NAD+"
} | step1 | D | [
"year old man presents",
"clinic",
"skin lesions",
"chronic diarrhea",
"wife",
"reports",
"more irritable",
"forgetful",
"past year",
"medical history",
"significant",
"gastroenterostomy performed 4 years",
"due to gastric outlet obstruction caused",
"hyperplastic polyposis",
"complicate... |
Cardiac surgery is consulted on a newborn with a large ventricular septal defect. The child has poor weight gain and feeding difficulties. He requires furosemide and captopril to avoid dyspnea. On physical examination his temperature is 36.9°C (98.4°F), pulse rate is 158/min, respiratory rate is 30/min, and blood press... | Surgical closure of the defect | {
"A": "Continue medical treatment and provide reassurance about spontaneous closure of the defect",
"B": "Addition of digoxin to the current medical regimen with regular follow-up until spontaneous closure occurs",
"C": "Surgical closure of the defect",
"D": "Transcatheter occlusion of the defect"
} | step2&3 | C | [
"Cardiac surgery",
"consulted",
"newborn",
"large ventricular septal defect",
"child",
"poor weight gain",
"feeding difficulties",
"furosemide",
"captopril to",
"dyspnea",
"physical examination",
"temperature",
"36",
"98 4F",
"pulse rate",
"min",
"respiratory rate",
"30/min",
"bl... |
A 15-year-old boy is brought to the physician with excessive daytime sleepiness over the past year. His parents are concerned with his below-average school performance over the last 3 months. He goes to bed around midnight and wakes up at 7 am on school days, but sleeps in late on weekends. He exercises regularly after... | Increase nighttime sleep hours | {
"A": "Decrease exercise intensity",
"B": "Increase nighttime sleep hours",
"C": "Take a nap in the afternoon",
"D": "Take melatonin before bedtime"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"excessive daytime sleepiness",
"past year",
"parents",
"concerned",
"average school performance",
"months",
"goes",
"bed",
"midnight",
"wakes up",
"school days",
"sleeps",
"late",
"weekends",
"exercises",
"school",
"usually",
"light sn... |
A 38-year-old man presents with sudden onset abdominal pain and undergoes an emergent laparoscopic appendectomy. The procedure is performed quickly, without any complications, and the patient is transferred to the post-operative care unit. A little while later, the patient complains of seeing people in his room and hea... | N-methyl-D-aspartate receptor antagonism | {
"A": "Increased duration of GABA-gated chloride channel opening",
"B": "N-methyl-D-aspartate receptor antagonism",
"C": "Stimulation of μ-opioid receptors",
"D": "Blocking the fast voltage-gated Na+ channels"
} | step1 | B | [
"year old man presents",
"sudden abdominal",
"emergent laparoscopic appendectomy",
"procedure",
"performed",
"complications",
"patient",
"transferred",
"post-operative care unit",
"little",
"later",
"patient",
"seeing people",
"room",
"hearing voices talking",
"patient",
"prior medic... |
A 15-year-old girl comes to the physician with her father for evaluation of her tall stature. She is concerned because she is taller than all of her friends. Her birth weight and height were within normal limits. Her father is 174 cm (5 ft 7 in) tall; her mother is 162 cm (5 ft 3 in) tall. She is at the 98th percentile... | Transsphenoidal adenomectomy | {
"A": "Transsphenoidal adenomectomy",
"B": "Letrozole therapy",
"C": "Methimazole therapy",
"D": "Caloric restriction"
} | step2&3 | A | [
"year old girl",
"physician",
"father",
"evaluation",
"tall stature",
"concerned",
"friends",
"birth weight",
"height",
"normal limits",
"father",
"5 ft",
"tall",
"mother",
"5 ft",
"tall",
"percentile",
"height",
"90th percentile",
"BMI",
"not",
"menstrual period",
"mothe... |
A 38-year-old woman comes to the physician because of a 3-week history of involuntary movements of her extremities. One year ago, she was fired from her position as an elementary school teacher because she had stopped preparing lessons and was frequently absent without notice. She now lives with her mother. She appears... | Dopamine | {
"A": "Gamma-aminobutyric acid",
"B": "Acetylcholine",
"C": "Dopamine",
"D": "N-acetyl aspartate"
} | step1 | C | [
"year old woman",
"physician",
"3 week history",
"involuntary",
"extremities",
"One year ago",
"fired",
"position",
"elementary school teacher",
"stopped preparing",
"frequently absent",
"now lives with",
"mother",
"appears emaciated",
"Examination shows rapid",
"jerks",
"limbs",
"... |
A 52-year-old man arrives to the clinic for arthritis and leg swelling. The patient reports that the joint pains began 8 months ago. He has tried acetaminophen and ibuprofen without significant improvement. He reports the leg swelling began within the past 2 months and has gotten progressively worse. The patient’s medi... | Alpha fetoprotein | {
"A": "Alpha fetoprotein",
"B": "Alkaline phosphatase",
"C": "CA 19-9",
"D": "Chromogranin"
} | step2&3 | A | [
"year old man",
"clinic",
"arthritis",
"leg swelling",
"patient reports",
"joint pains began",
"months",
"acetaminophen",
"ibuprofen",
"significant improvement",
"reports",
"leg swelling began",
"past",
"months",
"gotten",
"worse",
"patients medical history",
"significant",
"diab... |
A 20-year-old woman presents for a follow-up visit with her physician. She has a history of cystic fibrosis and is currently under treatment. She has recently been struggling with recurrent bouts of cough and foul-smelling, mucopurulent sputum over the past year. Each episode lasts for about a week or so and then subsi... | Pseudomonas | {
"A": "Histoplasmosis",
"B": "Mycobacterium avium",
"C": "Pneumococcus",
"D": "Pseudomonas"
} | step2&3 | D | [
"20 year old woman presents",
"follow-up visit",
"physician",
"history",
"cystic fibrosis",
"currently",
"treatment",
"recently",
"recurrent bouts",
"cough",
"foul-smelling",
"mucopurulent sputum",
"past year",
"episode",
"week",
"so",
"then",
"not",
"fever",
"chills",
"episo... |
A 24-year-old woman presents to the clinic with chronic abdominal discomfort and cramping. She seeks medical attention now as she is concerned about the diarrhea that she has developed that is occasionally mixed with tiny streaks of blood. Her medical history is significant for lactose intolerance and asthma. She has a... | Crohn’s disease | {
"A": "Irritable bowel syndrome",
"B": "Celiac disease",
"C": "Ulcerative colitis",
"D": "Crohn’s disease"
} | step2&3 | D | [
"year old woman presents",
"clinic",
"chronic abdominal discomfort",
"cramping",
"medical attention now",
"concerned",
"diarrhea",
"occasionally mixed",
"streaks",
"blood",
"medical history",
"significant",
"lactose intolerance",
"asthma",
"family history of wheat allergy",
"reports",
... |
An 8-year-old boy presents with a skin lesion on his back as shown in the picture. On physical examination, there are synchronous spasmodic movements of the neck, trunk, and extremities. The physician explains that this is likely due to a genetic condition, and further testing would be necessary to confirm the diagnosi... | TSC1 | {
"A": "TSC1",
"B": "NF1",
"C": "NF2",
"D": "VHL"
} | step1 | A | [
"year old boy presents",
"skin lesion",
"back",
"shown",
"picture",
"physical examination",
"synchronous spasmodic movements of",
"neck",
"trunk",
"extremities",
"physician",
"likely due to",
"genetic condition",
"further testing",
"to confirm",
"diagnosis",
"following genes",
"inv... |
A 42-year-old man with a history of tuberculosis presents to your office complaining of fatigue for two months. Serum laboratory studies reveal the following: WBC 7,000 cells/mm^3, Hb 9.0 g/dL, Hct 25%, MCV 88 fL, Platelet 450,000 cells/mm^3, Vitamin B12 500 pg/mL (200-800), and Folic acid 17 ng/mL (2.5-20). Which of t... | Iron studies | {
"A": "Iron studies",
"B": "Colonoscopy",
"C": "Bone marrow biopsy",
"D": "Observation"
} | step2&3 | A | [
"year old man",
"history of tuberculosis presents",
"office",
"fatigue",
"two months",
"Serum laboratory studies reveal",
"following",
"WBC",
"cells mm",
"Hb",
"0 g",
"Hct",
"MCV 88 fL",
"Platelet 450",
"cells mm",
"Vitamin B12 500 pg/mL",
"200 800",
"Folic acid",
"ng/mL",
"2.5... |
A 37-year-old man comes to the physician because of a 6-month history of progressive breast enlargement. Two years ago, he was diagnosed with HIV infection and started treatment with antiretroviral medications. Examination shows a soft, non-tender, ill-defined swelling at the nape of the neck. The cheeks appear hollowe... | Indinavir | {
"A": "Enfuvirtide",
"B": "Indinavir",
"C": "Raltegravir",
"D": "Abacavir"
} | step1 | B | [
"year old man",
"physician",
"month history",
"progressive breast enlargement",
"Two years",
"diagnosed",
"HIV infection",
"started treatment with antiretroviral medications",
"Examination shows",
"soft",
"non-tender",
"ill defined swelling",
"the nape of",
"neck",
"cheeks appear hollowe... |
A 21-year-old woman, gravida 1, para 0, at 39 weeks' gestation comes to the physician for a prenatal visit. She has some mild edema and tiredness but generally feels well. She recently had a nephew visiting for 1 week who became ill and was diagnosed with the chickenpox. She has no history of chickenpox and is not vacc... | Varicella zoster immune globulin | {
"A": "Varicella vaccine",
"B": "Reassurance",
"C": "Ganciclovir therapy",
"D": "Varicella zoster immune globulin"
} | step2&3 | D | [
"21-year-old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"physician",
"prenatal visit",
"mild edema",
"tiredness",
"feels well",
"recently",
"nephew visiting",
"1 week",
"ill",
"diagnosed",
"chickenpox",
"history of chickenpox",
"not vaccinated",
"varicella zoster virus"... |
A 4-year-old boy is brought to the emergency department by his parents after 10 days of fever, varying from 38.0–40.0°C (100.4–104.0°F). On physical examination, the child is ill-looking with an extensive rash over his trunk with patchy desquamation. His hands are swollen, and he also shows signs of a bilateral conjunc... | High-dose aspirin | {
"A": "Low-dose aspirin",
"B": "High-dose aspirin",
"C": "Corticosteroids",
"D": "Influenza vaccine"
} | step2&3 | B | [
"4 year old boy",
"brought",
"emergency department",
"parents",
"10 days",
"fever",
"100",
"physical examination",
"child",
"ill looking",
"extensive rash",
"trunk",
"patchy desquamation",
"hands",
"swollen",
"shows signs",
"bilateral conjunctivitis",
"laboratory test results",
"... |
A 45-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 2 diabetes mellitus. There is no family history of serious illness. He works as an engineer at a local company. He does not smoke. He drinks one glass of red wine every other day. He does not use illicit dr... | Nonalcoholic steatohepatitis | {
"A": "Primary biliary cirrhosis",
"B": "Viral hepatitis",
"C": "Nonalcoholic steatohepatitis",
"D": "Autoimmune hepatitis"
} | step2&3 | C | [
"year old man",
"physician",
"routine health maintenance examination",
"feels well",
"type 2 diabetes mellitus",
"family history",
"serious illness",
"works",
"engineer",
"local company",
"not smoke",
"drinks one glass",
"red wine",
"day",
"not use illicit drugs",
"only medication",
... |
A 49-year-old woman is admitted to the hospital for the evaluation of postprandial colicky pain in the right upper quadrant of the abdomen. Abdominal ultrasound shows multiple round, hyperechoic structures within the gallbladder lumen. She undergoes a cholecystectomy. A photograph of the content of her gallbladder is s... | Chronic hemolytic anemia | {
"A": "Primary hyperparathyroidism",
"B": "Chronic hemolytic anemia",
"C": "Menopausal symptoms",
"D": "Morbid obesity"
} | step1 | B | [
"year old woman",
"admitted",
"hospital",
"evaluation",
"postprandial colicky",
"right upper quadrant of",
"abdomen",
"ultrasound shows multiple round",
"hyperechoic structures",
"gallbladder lumen",
"cholecystectomy",
"photograph",
"content",
"gallbladder",
"shown",
"patient",
"most... |
A 42-year-old woman comes to the physician for a follow-up appointment. Two months ago, she was diagnosed with asthma after a 1-year history of a chronic cough and dyspnea with exertion. Her symptoms have improved since starting inhaled albuterol and beclomethasone, but she still coughs most nights when she is lying in... | Add a proton pump inhibitor | {
"A": "Add a salmeterol inhaler",
"B": "Add oral prednisone",
"C": "Add a proton pump inhibitor",
"D": "Order total serum IgE levels"
} | step2&3 | C | [
"year old woman",
"physician",
"follow-up appointment",
"Two months",
"diagnosed",
"asthma",
"1 year history",
"chronic cough",
"dyspnea",
"exertion",
"symptoms",
"improved since starting inhaled albuterol",
"beclomethasone",
"coughs",
"nights",
"lying in bed",
"past 2 weeks",
"occ... |
A 72-year-old man presents to his primary care physician for his annual exam. He has a very stoic personality and says that he is generally very healthy and has "the normal aches and pains of old age." On further probing, you learn that he does have pretty significant back and hip pain that worsens throughout the day. ... | Osteoarthritis | {
"A": "Gout",
"B": "Pseudogout",
"C": "Osteoarthritis",
"D": "Osteopaenia"
} | step1 | C | [
"72 year old man presents",
"primary care physician",
"annual exam",
"very",
"personality",
"very healthy",
"normal aches",
"pains",
"old age",
"further probing",
"learn",
"significant back",
"hip pain",
"worsens",
"day",
"physical exam",
"note bony enlargement",
"distal",
"joint... |
A 13-month-old girl is brought to the physician for a well-child examination. She was born at 38 weeks' gestation. There is no family history of any serious illnesses. She cannot pull herself to stand from a sitting position. She can pick an object between her thumb and index finger but cannot drink from a cup or feed ... | Fine motor: normal | Gross motor: delayed | Language: delayed | Social skills: normal | {
"A": "Fine motor: normal | Gross motor: delayed | Language: normal | Social skills: delayed",
"B": "Fine motor: delayed | Gross motor: normal | Language: normal | Social skills: delayed",
"C": "Fine motor: delayed | Gross motor: delayed | Language: normal | Social skills: normal",
"D": "Fine motor: normal | G... | step2&3 | D | [
"month old girl",
"brought",
"physician",
"well",
"born",
"weeks",
"gestation",
"family history",
"serious illnesses",
"pull",
"to stand",
"sitting position",
"pick",
"object",
"thumb",
"index finger",
"drink",
"cup",
"feed",
"using",
"spoon",
"called",
"name",
"willing... |
A 38-year-old man comes to the physician because of an 8-month history of upper abdominal pain. During this period, he has also had nausea, heartburn, and multiple episodes of diarrhea with no blood or mucus. He has smoked one pack of cigarettes daily for the past 18 years. He does not use alcohol or illicit drugs. Cur... | Fasting serum gastrin level | {
"A": "24-hour esophageal pH monitoring",
"B": "Fasting serum gastrin level",
"C": "Urine metanephrine levels",
"D": "Serum vasoactive intestinal polypeptide level"
} | step1 | B | [
"year old man",
"physician",
"month history",
"upper abdominal pain",
"period",
"nausea",
"heartburn",
"multiple episodes of diarrhea",
"blood",
"mucus",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"not use alcohol",
"illicit drugs",
"Current medications include",
"anta... |
A 23-year-old woman is brought to the emergency department by her friends because she thinks that she is having an allergic reaction. The patient is visibly distressed and insists on immediate attention as she feels like she is going to die. Her friends say they were discussing future plans while dining at a new seafoo... | Decreased alveolar pCO2 and increased alveolar pO2 | {
"A": "Decreased alveolar pCO2 and increased alveolar pO2",
"B": "Decreased alveolar pCO2 and decreased alveolar pO2",
"C": "Decreased alveolar pCO2 and unchanged alveolar pO2",
"D": "Increased alveolar pCO2 and decreased alveolar pO2"
} | step1 | A | [
"23 year old woman",
"brought",
"emergency department",
"friends",
"thinks",
"allergic reaction",
"patient",
"distressed",
"immediate attention",
"feels",
"to die",
"friends",
"discussing future plans",
"dining at a new seafood restaurant",
"symptoms started",
"patient",
"history of ... |
A 2-year-old girl is brought to the emergency department by her mother because the girl has had a cough and shortness of breath for the past 2 hours. Her symptoms began shortly after she was left unattended while eating watermelon. She appears anxious and mildly distressed. Examination shows intercostal retractions and... | Right intermediate bronchus | {
"A": "Left lower lobe bronchus",
"B": "Right middle lobe bronchus",
"C": "Right intermediate bronchus",
"D": "Left upper lobe bronchus"
} | step1 | C | [
"2 year old girl",
"brought",
"emergency department",
"mother",
"girl",
"cough",
"shortness of breath",
"past",
"hours",
"symptoms began",
"left",
"eating watermelon",
"appears anxious",
"mildly distressed",
"Examination shows intercostal retractions",
"unilateral diminished breath sou... |
A 77-year-old man with a history of hypertension and a 46 pack-year smoking history presents to the emergency department from an extended care facility with acute onset of headache, nausea, vomiting, and neck pain which started 6 hours ago and has persisted since. He is alert, but his baseline level of consciousness is... | Lumbar puncture | {
"A": "Ibuprofen, acetaminophen, metoclopramide, and diphenhydramine",
"B": "Lumbar puncture",
"C": "MRI",
"D": "Ultrasound"
} | step2&3 | B | [
"year old man",
"history of hypertension",
"pack-year smoking history presents",
"emergency department",
"extended care facility",
"acute",
"headache",
"nausea",
"vomiting",
"neck pain",
"started 6 hours",
"since",
"alert",
"baseline level of consciousness",
"slightly diminished",
"nur... |
A 65-year-old man comes to the clinic complaining of abdominal pain for the past 2 months. He describes the pain as a dull, aching, 6/10 pain that is diffuse but worse in the right upper quadrant (RUQ). His past medical history is significant for diabetes controlled with metformin and a cholecystectomy 10 years ago. He... | Prior occupation in a chemical plastics manufacturing facility | {
"A": "Heavy ingestion of acetaminophen",
"B": "Infection with the hepatitis B virus",
"C": "Obesity",
"D": "Prior occupation in a chemical plastics manufacturing facility"
} | step1 | D | [
"65 year old man",
"clinic",
"abdominal",
"past",
"months",
"pain",
"dull",
"aching",
"10 pain",
"diffuse",
"worse",
"right upper quadrant",
"past medical history",
"significant",
"diabetes controlled",
"metformin",
"cholecystectomy 10 years",
"reports fatigue",
"a 10",
"weight... |
A 61-year-old man comes to the physician because of fatigue and a 5-kg (11-lb) weight loss over the past 6 months. He experimented with intravenous drugs during his 20s and has hepatitis C. His father died of colon cancer. He has smoked one pack of cigarettes daily for 35 years. Physical examination shows scleral icter... | Elevated α-fetoprotein | {
"A": "Bacteremia",
"B": "Elevated antimitochondrial antibodies",
"C": "Elevated α-fetoprotein",
"D": "Elevated carcinoembryonic antigen"
} | step1 | C | [
"61 year old man",
"physician",
"fatigue",
"5 kg",
"weight loss",
"past 6 months",
"experimented",
"intravenous drugs",
"20s",
"hepatitis C",
"father died of colon cancer",
"smoked one pack",
"cigarettes daily",
"35 years",
"Physical examination shows scleral icterus",
"several telangi... |
A 70-year-old female with a history of congestive heart failure presents to the emergency room with dyspnea. She reports progressive difficulty breathing which began when she ran out of her furosemide and lisinopril prescriptions 1-2 weeks ago. She states the dyspnea is worse at night and when lying down. She denies an... | Basic metabolic panel | {
"A": "Basic metabolic panel",
"B": "Chest x-ray",
"C": "Brain natriuretic peptide",
"D": "Urinalysis"
} | step2&3 | A | [
"70 year old female",
"history of congestive heart failure presents",
"emergency room",
"dyspnea",
"reports progressive difficulty breathing",
"began",
"ran out",
"furosemide",
"lisinopril prescriptions",
"weeks",
"states",
"dyspnea",
"worse",
"night",
"lying",
"denies",
"fever",
"... |
A 26-year-old woman thinks poorly of herself and is extremely sensitive to criticism. She is socially inhibited and has never had a romantic relationship, although she desires one. Which of the following is the most likely diagnosis? | Avoidant personality disorder | {
"A": "Paranoid personality disorder",
"B": "Avoidant personality disorder",
"C": "Depression",
"D": "Dysthmia"
} | step1 | B | [
"year old woman thinks poorly",
"extremely sensitive to criticism",
"inhibited",
"never",
"romantic relationship",
"desires one",
"following",
"most likely diagnosis"
] |
A 19-year-old woman is brought to the emergency room by her mother. She found her daughter pale, cold to the touch, and collapsed next to her bed earlier this morning. The patient has no previous medical or psychiatric history, but the mother does report that her daughter has not had her periods for the last 3 months. ... | Bupropion | {
"A": "Bupropion",
"B": "Cognitive-behavioral therapy",
"C": "Selective serotonin reuptake inhibitors",
"D": "Olanzapine"
} | step2&3 | A | [
"year old woman",
"brought",
"emergency room",
"mother",
"found",
"daughter pale",
"cold to",
"touch",
"collapsed next to",
"bed earlier",
"morning",
"patient",
"previous medical",
"psychiatric history",
"mother",
"report",
"daughter",
"not",
"periods",
"months",
"emergency d... |
A 75-year-old woman presents with a sudden onset of weakness and difficulty walking. She also complains of nausea and palpitations. She was working in her garden about an hour ago when her problems started. The patient says she is feeling warm even though the emergency room is air-conditioned. Past medical history is s... | Missed dose of venlafaxine | {
"A": "Ischemic stroke",
"B": "Dehydration due to physical activity",
"C": "Aspirin overdose",
"D": "Missed dose of venlafaxine"
} | step1 | D | [
"75 year old woman presents",
"sudden onset",
"weakness",
"difficulty walking",
"nausea",
"palpitations",
"working",
"garden",
"hour",
"problems started",
"patient",
"feeling warm",
"emergency room",
"air conditioned",
"Past medical history",
"significant",
"major depressive disorder... |
A 80-year-old woman is brought to the emergency department from a senior living home with a chief complaint of acute onset and severe abdominal pain with 5 episodes of bloody diarrhea. She has a history of having chronic constipation, and postprandial abdominal pain which subsides after taking nitroglycerin. The abdomi... | Transmural infarction | {
"A": "Transmural infarction",
"B": "Mucosal infarct",
"C": "Toxic megacolon",
"D": "Adenocarcinoma"
} | step1 | A | [
"80 year old woman",
"brought",
"emergency department",
"senior living home",
"chief complaint",
"acute onset",
"severe abdominal pain",
"episodes of bloody diarrhea",
"history",
"chronic constipation",
"postprandial abdominal pain",
"taking nitroglycerin",
"abdominal pain",
"currently exp... |
A 27-year-old woman comes to the physician because of a 1-month history of progressive shortness of breath. She can no longer walk one block without stopping to catch her breath. Her last menstrual period was 3 months ago. Menarche occurred at the age of 12 years, and menses had occurred at regular 28-day intervals. Ca... | Increased intravascular volume | {
"A": "Decreased right ventricular preload",
"B": "Decreased minute ventilation",
"C": "Increased intravascular volume",
"D": "Increased right ventricular afterload"
} | step1 | C | [
"27 year old woman",
"physician",
"of",
"month history",
"progressive shortness",
"breath",
"longer walk one block",
"stopping to catch",
"breath",
"last menstrual period",
"3 months",
"Menarche occurred",
"age",
"years",
"menses",
"occurred",
"regular",
"day intervals",
"Cardiac... |
A 52-year-old obese man is brought to the emergency department 30 minutes after he was involved in a high-speed motor vehicle collision. He was the unrestrained driver. On arrival, he is lethargic. His pulse is 112/min, respirations are 10/min and irregular, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air... | Cricothyrotomy
" | {
"A": "Video laryngoscopy",
"B": "Comfort measures only",
"C": "Tracheostomy",
"D": "Cricothyrotomy\n\""
} | step2&3 | D | [
"year old obese man",
"brought",
"emergency department 30 minutes",
"involved",
"high speed motor vehicle collision",
"driver",
"arrival",
"lethargic",
"pulse",
"min",
"respirations",
"10/min",
"irregular",
"blood pressure",
"60 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen s... |
A 21-year-old man presents to the emergency room requesting surgery to remove "microchips," which he believes were implanted in his brain by "Russian spies" 6 months ago to control his thoughts. He also reports hearing the "spies" talk to each other through embedded "microspeakers." You notice that his hair appears unw... | Asociality, flat affect, and alogia | {
"A": "Amnesia, multiple personality states, and de-realization",
"B": "Anhedonia, guilty rumination, and insomnia",
"C": "Asociality, flat affect, and alogia",
"D": "Grandiose delusions, racing thoughts, and pressured speech"
} | step1 | C | [
"21-year-old man presents",
"emergency room requesting surgery to remove",
"microchips",
"implanted",
"brain",
"Russian",
"months",
"to control",
"thoughts",
"reports hearing",
"talk",
"embedded",
"hair appears",
"clothes",
"backward",
"Urine toxicology",
"negative",
"illicit drugs... |
A 41-year-old woman is brought to the emergency department by ambulance because of a sudden onset severe headache. On presentation, the patient also says that she is not able to see well. Physical examination shows ptosis of the right eye with a dilated pupil that is deviated inferiorly and laterally. Based on the clin... | Corticosteroids | {
"A": "Aldosterone",
"B": "Corticosteroids",
"C": "Erythropoietin",
"D": "Insulin"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"ambulance",
"sudden onset severe headache",
"presentation",
"patient",
"not able to see well",
"Physical examination shows ptosis",
"right eye",
"dilated pupil",
"deviated",
"Based",
"clinical presentation",
"neurosurgery",
"immedia... |
A 77-year-old woman, gravida 2, para 2, is brought to the physician by staff of the nursing home where she resides because of involuntary loss of urine and increased frequency of urination over the past 2 weeks. She reports that she has very little time to get to the bathroom after feeling the urge to urinate. “Acciden... | Urinalysis and culture | {
"A": "Vaginal estrogen cream",
"B": "Urinalysis and culture",
"C": "Pad test",
"D": "MRI of the pelvis"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 2",
"brought",
"physician",
"staff",
"nursing",
"resides",
"involuntary loss",
"urine",
"increased frequency of urination",
"past 2 weeks",
"reports",
"very little time to get",
"bathroom",
"feeling",
"to",
"Accidents",
"occurred",
"times",
... |
A 64-year-old woman with a history of rheumatic fever presents to her primary care clinician complaining of excessive fatigue with walking and difficulty lying flat. She had no prior physical limitations, but recently has been unable to walk more than 3 blocks without needing to stop and rest. Her cardiac exam is notab... | MItral Stenosis | {
"A": "Aortic Stenosis",
"B": "MItral Stenosis",
"C": "Aortic Regurgitation",
"D": "Tricuspid Regurgitation"
} | step1 | B | [
"64 year old woman",
"history of rheumatic fever presents",
"primary care clinician",
"excessive fatigue",
"walking",
"difficulty lying flat",
"prior physical limitations",
"recently",
"unable to walk more",
"blocks",
"needing to stop",
"rest",
"cardiac exam",
"notable",
"late diastolic ... |
A 62-year-old man comes to the physician because of progressive fatigue and dyspnea on exertion for 3 months. During this time, he has also had increased straining during defecation and a 10-kg (22-lb) weight loss. He has no personal or family history of serious medical illness. Physical examination shows conjunctival ... | KRAS | {
"A": "TP53",
"B": "MLH1",
"C": "APC",
"D": "KRAS"
} | step1 | D | [
"62 year old man",
"physician",
"progressive fatigue",
"dyspnea on exertion",
"3 months",
"time",
"increased straining",
"defecation",
"a 10 kg",
"weight loss",
"personal",
"family history of serious medical illness",
"Physical examination shows conjunctival pallor",
"Laboratory studies sh... |
A 67-year-old man presents to the emergency department for a headache. The patient states his symptoms started thirty minutes ago. He states he experienced a sudden and severe headache while painting his house, causing him to fall of the ladder and hit his head. He has also experienced two episodes of vomiting and diff... | Cerebellar hemorrhage | {
"A": "Cerebellar hemorrhage",
"B": "Pontine hemorrhage",
"C": "Thalamic hemorrhage",
"D": "Subarachnoid hemorrhage"
} | step2&3 | A | [
"67 year old man presents",
"emergency department",
"headache",
"patient states",
"symptoms started thirty minutes",
"states",
"experienced",
"sudden",
"severe headache",
"painting",
"house",
"causing",
"to fall",
"ladder",
"hit",
"head",
"experienced two episodes of vomiting",
"di... |
A 28-year-old G2P1 female is concerned that she may give birth to another child with Down syndrome. She states that she may not be able to take care of another child with this disorder. Which of the following tests can confirm the diagnosis of Down syndrome in utero? | Amniocentesis | {
"A": "Quadruple marker test",
"B": "Integrated test",
"C": "Ultrasound",
"D": "Amniocentesis"
} | step1 | D | [
"year old",
"female",
"concerned",
"give birth",
"child",
"Down syndrome",
"states",
"not",
"able to take care",
"child",
"disorder",
"following tests",
"confirm",
"diagnosis",
"Down syndrome in utero"
] |
A 9-year-old boy is brought to the physician by his mother to establish care after moving to a new city. He lives at home with his mother and older brother. He was having trouble in school until he was started on ethosuximide by a previous physician; he is now performing well in school. This patient is undergoing treat... | Frequent episodes of blank staring and eye fluttering | {
"A": "Overwhelming daytime sleepiness and hypnagogic hallucinations",
"B": "Episodic jerky movements of the arm and impaired consciousness",
"C": "Frequent episodes of blank staring and eye fluttering",
"D": "Recurrent motor tics and involuntary obscene speech"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"mother to establish care",
"moving",
"new city",
"lives at home",
"mother",
"older brother",
"in school",
"started",
"ethosuximide",
"previous physician",
"now performing well",
"school",
"patient",
"treatment",
"condition",
"most likely p... |
A 33-year-old man is brought to a psychiatric emergency room in St. Louis by policemen who report that they found him loitering at the main bus station. The patient is unable to recall why he was at the bus station, but he does have a bus ticket in his pocket from Chicago to St. Louis. When asked what his name is, he r... | Dissociative fugue disorder | {
"A": "Bipolar I disorder",
"B": "Depersonalization disorder",
"C": "Dissociative fugue disorder",
"D": "Dissociative identity disorder"
} | step1 | C | [
"year old man",
"brought",
"psychiatric emergency room",
"St",
"policemen",
"report",
"found",
"main bus station",
"patient",
"unable to recall",
"bus station",
"bus",
"Chicago",
"St",
"name",
"I",
"source",
"identification",
"recall",
"past medical history",
"medications",
... |
A 62-year-old female is brought to the hospital by her daughter. Six hours ago, she was at a wedding giving a speech when she suddenly experienced difficulty finding words and a right facial droop. She denies any extremity weakness, paresthesias, or sensory deficits. She has a history of hypertension and type 2 diabete... | Decreased serum uric acid | {
"A": "Increased hydrostatic pressure",
"B": "Decreased serum uric acid",
"C": "Increased serum bicarbonate",
"D": "Increased urinary frequency"
} | step2&3 | B | [
"62 year old female",
"brought",
"hospital",
"daughter",
"Six hours",
"wedding giving",
"speech",
"difficulty finding words",
"right facial droop",
"denies",
"extremity weakness",
"paresthesias",
"sensory deficits",
"history of hypertension",
"type 2 diabetes",
"takes hydrochlorothiazi... |
A 15-year-old boy is brought to the Emergency department by ambulance from school. He started the day with some body aches and joint pain but then had several episodes of vomiting and started complaining of a terrible headache. The school nurse called for emergency services. The boy was born at 39 weeks gestation via s... | Oxidase-positive and ferments glucose and maltose | {
"A": "Growth in anaerobic conditions",
"B": "No growth on Thayer-Martin medium",
"C": "Growth in colonies",
"D": "Oxidase-positive and ferments glucose and maltose"
} | step1 | D | [
"year old boy",
"brought",
"Emergency department",
"ambulance",
"school",
"started",
"day",
"body aches",
"joint pain",
"then",
"several episodes of vomiting",
"started complaining of a terrible headache",
"school nurse called",
"emergency services",
"boy",
"born",
"weeks gestation",... |
A medical student is reading about a specific type of T cells that plays an important role in immunologic tolerance. Most of these cells develop in the thymus, but some of them also develop in peripheral lymphoid organs. Usually, they are CD4+ cells and also express CD25 molecules. The functions of these cells are depe... | Interleukin-10 | {
"A": "Interleukin-2",
"B": "Interleukin-10",
"C": "Interleukin-12",
"D": "Interleukin-17"
} | step1 | B | [
"medical student",
"reading",
"specific type of",
"cells",
"plays",
"important role",
"immunologic",
"cells",
"thymus",
"peripheral lymphoid organs",
"Usually",
"CD4",
"cells",
"CD25 molecules",
"functions",
"cells",
"dependent",
"forkhead box P3",
"function",
"to block",
"ac... |
A 3-year-old boy is brought to the emergency department with a history of unintentional ingestion of seawater while swimming in the sea. The amount of seawater ingested is not known. There is no history of vomiting. On physical examination, the boy appears confused and is asking for more water to drink. His serum sodiu... | Increased ECF volume, decreased ICF volume, increased body osmolality | {
"A": "Decreased ECF volume, decreased ICF volume, increased body osmolality",
"B": "Increased ECF volume, unaltered ICF volume, unaltered body osmolality",
"C": "Increased ECF volume, increased ICF volume, decreased body osmolality",
"D": "Increased ECF volume, decreased ICF volume, increased body osmolality"... | step1 | D | [
"3 year old boy",
"brought",
"emergency department",
"history",
"unintentional ingestion",
"seawater",
"swimming",
"sea",
"amount",
"seawater ingested",
"not known",
"history",
"vomiting",
"physical examination",
"boy appears confused",
"water to drink",
"serum sodium",
"mmol/L",
... |
An 87-year-old male presents to his neurologist for a follow-up visit. He is being followed for an inoperable tumor near his skull. He reports that he recently noticed that food has started to lose its taste. He also notes increasing difficulty with swallowing. He has a history of myocardial infarction, diabetes mellit... | Parasympathetic innervation to the parotid gland | {
"A": "Parasympathetic innervation to the parotid gland",
"B": "Parasympathetic innervation to the submandibular gland",
"C": "Parasympathetic innervation to the trachea",
"D": "Somatic sensory innervation to the lower lip"
} | step1 | A | [
"87 year old male presents",
"neurologist",
"follow-up visit",
"followed",
"inoperable tumor",
"skull",
"reports",
"recently",
"food",
"started to",
"taste",
"notes increasing difficulty",
"swallowing",
"history of myocardial infarction",
"diabetes mellitus",
"hyperlipidemia",
"hyper... |
A 49-year-old woman with a history of intravenous drug use comes to the physician because of a 6-month history of fatigue, joint pain, and episodic, painful discoloration in her fingers when exposed to cold weather. She takes no medications. She has smoked one pack of cigarettes daily for the past 22 years. She appears... | Immune complex formation | {
"A": "Immune complex formation",
"B": "Spirochete infection",
"C": "Tobacco hypersensitivity",
"D": "Fibroblast proliferation"
} | step1 | A | [
"year old woman",
"history",
"intravenous drug use",
"physician",
"month history",
"fatigue",
"joint pain",
"episodic",
"painful discoloration in",
"fingers",
"exposed",
"cold weather",
"takes",
"medications",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"appears tired... |
A 38-year-old man presents to his physician for difficulty swallowing for 2 months. He describes food getting stuck down his windpipe and has been feeling very anxious around meal time because he is thinking that he may have esophageal cancer. He has had an influenza-like infection that lasted about 6 weeks in the past... | Subacute granulomatous thyroiditis | {
"A": "Lymphoma",
"B": "Chronic lymphocytic thyroiditis",
"C": "Subacute granulomatous thyroiditis",
"D": "Fibrous thyroiditis"
} | step2&3 | C | [
"year old man presents",
"physician",
"difficulty swallowing",
"months",
"food getting",
"windpipe",
"feeling very anxious",
"meal time",
"thinking",
"esophageal cancer",
"influenza",
"infection",
"lasted",
"weeks",
"past 3 months",
"exacerbated",
"asthma attacks",
"used",
"puffe... |
A 28-year-old man comes to the emergency department for an injury sustained while doing construction. Physical examination shows a long, deep, irregular laceration on the lateral aspect of the left forearm with exposed fascia. Prior to surgical repair of the injury, a brachial plexus block is performed using a local an... | Inactivation of sodium channels | {
"A": "Inactivation of sodium channels",
"B": "Activation of acetylcholine receptors",
"C": "Inactivation of ryanodine receptors",
"D": "Activation of GABA receptors"
} | step1 | A | [
"year old man",
"emergency department",
"injury sustained",
"construction",
"Physical examination shows",
"long",
"deep",
"irregular laceration",
"lateral aspect of",
"left forearm",
"exposed fascia",
"Prior to surgical",
"injury",
"brachial plexus block",
"performed using",
"local ane... |
A 67-year-old woman comes to the emergency department because of a 4-month history of fatigue, shortness of breath with exertion, and dizziness. She has a history of atrial fibrillation and had a single-chamber pacemaker placed five years ago after an episode of syncope. Her pulse is 66/min and blood pressure is 98/66 ... | Right ventricle | {
"A": "Superior vena cava",
"B": "Left ventricle",
"C": "Right ventricle",
"D": "Right atrium"
} | step1 | C | [
"67 year old woman",
"emergency department",
"4 month history",
"fatigue",
"shortness of breath",
"exertion",
"dizziness",
"history of atrial fibrillation",
"single-chamber pacemaker placed five years",
"episode of syncope",
"pulse",
"66 min",
"blood pressure",
"98 66 mm Hg",
"x-ray of",... |
A 21-year-old college student is admitted to the emergency department with complaints of pharyngitis, headache, and a persistent, non-productive, dry, hacking cough. The patient complains of feeling tired and fatigued and denies fever/chills. On physical examination, her mucosa is pale. A complete blood count is remark... | Red blood cells bind to IgM in cold temperatures < 37°C (98.6°F) | {
"A": "Red blood cells bind to IgG in warm temperatures > 37°C (98.6°F)",
"B": "It is similarly associated with systemic lupus erythematosus",
"C": "Red blood cells bind to IgM in cold temperatures < 37°C (98.6°F)",
"D": "The underlying mechanism is complement-independent."
} | step1 | C | [
"21-year-old college student",
"admitted",
"emergency department",
"complaints",
"pharyngitis",
"headache",
"persistent",
"non-productive",
"dry",
"cough",
"patient",
"feeling tired",
"fatigued",
"denies fever/chills",
"physical examination",
"mucosa",
"pale",
"complete blood count... |
A previously healthy 29-year-old Taiwanese woman comes to the emergency department with vaginal bleeding and pelvic pressure for several hours. Over the past 2 weeks, she had intermittent nausea and vomiting. A home urine pregnancy test was positive 10 weeks ago. She has had no prenatal care. Her pulse is 80/min and bl... | Suction curettage | {
"A": "Insulin therapy",
"B": "Serial beta-hCG measurement",
"C": "Suction curettage",
"D": "Methotrexate therapy"
} | step2&3 | C | [
"healthy 29 year old Taiwanese woman",
"emergency department",
"vaginal bleeding",
"pelvic pressure",
"hours",
"past 2 weeks",
"intermittent nausea",
"vomiting",
"home urine",
"positive 10 weeks",
"prenatal care",
"pulse",
"80 min",
"blood pressure",
"98 mm Hg",
"Physical examination s... |
A 10-year-old boy from Sri Lanka suffers from an autosomal dominant condition, the hallmark of which is hyperimmunoglobulinemia E and eosinophilia. He suffers from recurrent infections and takes antibiotic chemoprophylaxis. A STAT3 mutation analysis has been performed to confirm the diagnosis of Job syndrome.
Eosinophi... | I, II, V | {
"A": "I, II, III",
"B": "I, II, V",
"C": "I, II, IV, V",
"D": "IV, V, VI"
} | step1 | B | [
"A 10 year old boy",
"Sri Lanka suffers",
"autosomal dominant condition",
"hyperimmunoglobulinemia",
"eosinophilia",
"suffers",
"recurrent infections",
"takes antibiotic chemoprophylaxis",
"STAT3 mutation analysis",
"performed to confirm",
"diagnosis",
"Job syndrome",
"Eosinophilia Eczema Ha... |
A 5-day-old male presents to the pediatrician for a well visit. The patient has been exclusively breastfed since birth. His mother reports that he feeds for 30 minutes every two hours. She also reports that she often feels that her breasts are not completely empty after each feeding, and she has started using a breast ... | Continue current breastfeeding regimen | {
"A": "Continue current breastfeeding regimen",
"B": "Increase frequency of breastfeeding",
"C": "Offer stored breastmilk between feedings",
"D": "Supplement breastfeeding with conventional formula"
} | step2&3 | A | [
"5 day old male presents",
"pediatrician",
"well visit",
"patient",
"breastfed",
"birth",
"mother reports",
"feeds",
"30 minutes",
"two hours",
"reports",
"often feels",
"breasts",
"not completely empty",
"feeding",
"started using",
"breast pump to extract",
"residual milk",
"sto... |
A 56-year-old woman visits her primary care provider complaining of fatigue, weight gain, increased thirst, hair loss, and headaches. She has been perimenopausal for 3 years. She was diagnosed with rheumatoid arthritis 4 years ago and prescribed oral prednisolone. Currently, she takes prednisolone and omeprazole daily.... | Upon activation of intracellular corticosteroid receptors in hepatocytes, its DNA-binding domain binds to glucocorticoid response elements and triggers transcription of gluconeogenic enzymes. | {
"A": "Binding of glucocorticoids to surface G-protein-coupled corticosteroid receptors leads to activation of the inositol-3-phosphate pathway and consequent transcription of gluconeogenic enzymes.",
"B": "Upon activation of intracellular corticosteroid receptors in hepatocytes, its DNA-binding domain binds to gl... | step1 | B | [
"year old woman visits",
"primary care provider",
"fatigue",
"weight gain",
"increased thirst",
"hair loss",
"headaches",
"perimenopausal",
"years",
"diagnosed",
"rheumatoid arthritis",
"years",
"prescribed oral prednisolone",
"Currently",
"takes prednisolone",
"omeprazole daily",
"v... |
A 6-day-old newborn girl is brought into the hospital by her mother because of excessive vomiting and poor feeding. The mother did not have antenatal care. Her temperature is 36.8°C (98.2°F), blood pressure is 50/30 mm Hg, and pulse is 150/min. On examination, the infant is dehydrated and demonstrates signs of shock. H... | Deficiency of 21-hydroxylase | {
"A": "Deficiency of 21-hydroxylase",
"B": "Deficiency of 11-beta-hydroxylase",
"C": "Deficiency of 17-alpha-hydroxylase",
"D": "Deficiency of placental aromatase"
} | step2&3 | A | [
"day old newborn girl",
"brought",
"hospital",
"mother",
"excessive vomiting",
"poor feeding",
"mother",
"not",
"antenatal care",
"temperature",
"36",
"98",
"blood pressure",
"50 30 mm Hg",
"pulse",
"min",
"examination",
"infant",
"dehydrated",
"demonstrates signs",
"shock",
... |
A 29-year-old G1P0 female at 32 weeks gestation presents to the emergency department with vaginal bleeding. She has had minimal prenatal care to-date with only an initial visit with an obstetrician after a positive home pregnancy test. She describes minimal spotting that she noticed earlier today that has progressed to... | If mother is Rh-negative and father is Rh-positive then administer RhoGAM | {
"A": "If mother is Rh-negative and father is Rh-positive then administer RhoGAM",
"B": "If mother is Rh-positive and father is Rh-negative then administer RhoGAM",
"C": "If mother is Rh-negative and father is Rh-positive, RhoGAM administration is not needed",
"D": "After 28 weeks gestation, administration of ... | step2&3 | A | [
"29 year old",
"female",
"weeks presents",
"emergency department",
"vaginal bleeding",
"minimal prenatal care",
"date",
"only",
"initial visit",
"obstetrician",
"positive home",
"minimal spotting",
"earlier today",
"progressed",
"larger amounts",
"blood",
"estimates 30 mL of blood lo... |
A 29-year-old G2P1 in her 22nd week of pregnancy presents with a primary complaint of peripheral edema. Her first pregnancy was without any major complications. Evaluation reveals a blood pressure of 160/90 and urinalysis demonstrates elevated levels of protein; both of these values were within normal limits at the pat... | Seizures | {
"A": "Diabetes mellitus",
"B": "Seizures",
"C": "Myocardial infarction",
"D": "Tubulointerstitial nephritis"
} | step1 | B | [
"29 year old",
"week",
"pregnancy presents",
"primary complaint",
"peripheral",
"first pregnancy",
"major complications",
"Evaluation reveals",
"blood pressure",
"90",
"urinalysis demonstrates elevated levels",
"protein",
"values",
"normal limits",
"patient's last well check-up",
"year... |
A 12-year-old boy is brought to the physician for a well-child examination. He feels well. He has no history of serious illness. He has received all age-appropriate screenings and immunizations. His 7-year-old brother was treated for nephrotic syndrome 1 year ago. He is at 50th percentile for height and 60th percentile... | Repeat urine dipstick in 1 year | {
"A": "Repeat urine dipstick in 1 year",
"B": "Lipid profile",
"C": "24-hour urine protein collection",
"D": "Anti-nuclear antibody level"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"well",
"feels well",
"history",
"serious illness",
"received",
"age-appropriate screenings",
"immunizations",
"year old brother",
"treated",
"nephrotic syndrome",
"year",
"50th percentile",
"height",
"percentile",
"weight",
"temperature",
... |
A 6-year-old child presents for evaluation of a medical condition associated with recurrent infections. After reviewing all of the medical history, gene therapy is offered to treat a deficiency in adenosine deaminase (ADA). ADA deficiency is the most common autosomal recessive mutation in which of the following disease... | Severe Combined Immunodeficiency | {
"A": "Severe Combined Immunodeficiency",
"B": "Hyper-IgM Syndrome",
"C": "Wiskott-Aldrich Syndrome",
"D": "Bruton's Agammaglobulinemia"
} | step1 | A | [
"year old child presents",
"evaluation",
"medical condition associated with recurrent infections",
"reviewing",
"of",
"medical history",
"gene therapy",
"offered to treat",
"deficiency",
"adenosine deaminase",
"most common autosomal recessive mutation",
"following diseases"
] |
A 44-year-old man seeks evaluation at a clinic because he is experiencing a problem with his sexual health for the past month. He says he does not get erections like he used to, despite feeling the urge. In addition to heart failure, he has angina and hypertension. His regular oral medications include amlodipine, atorv... | Spironolactone | {
"A": "Atorvastatin",
"B": "Nitroglycerine",
"C": "Spironolactone",
"D": "Losartan"
} | step1 | C | [
"year old man",
"evaluation",
"clinic",
"experiencing",
"problem",
"sexual",
"past month",
"not",
"erections",
"used",
"feeling",
"heart failure",
"angina",
"hypertension",
"regular oral medications include amlodipine",
"atorvastatin",
"nitroglycerine",
"spironolactone",
"losarta... |
A previously healthy 2-year-old girl is brought to the physician because of a 1-week history of yellow discoloration of her skin, loss of appetite, and 3 episodes of vomiting. Her parents also report darkening of her urine and light stools. During the last 2 days, the girl has been scratching her abdomen and arms and h... | Biliary cyst | {
"A": "Biliary cyst",
"B": "Biliary atresia",
"C": "Hepatic abscess",
"D": "Pancreatic pseudocyst"
} | step2&3 | A | [
"healthy",
"year old girl",
"brought",
"physician",
"1-week history",
"yellow discoloration",
"skin",
"loss of appetite",
"3 episodes of vomiting",
"parents",
"report",
"urine",
"light stools",
"last 2 days",
"girl",
"scratching",
"abdomen",
"arms",
"crying excessively",
"born"... |
A previously healthy 26-year-old woman comes to the physician because of a 2-day history of pain with urination. She has been sexually active with two partners over the past year. She uses condoms for contraception. Vital signs are within normal limits. Physical examination shows suprapubic tenderness. Urinalysis shows... | Fimbriae | {
"A": "Lipoteichoic acid",
"B": "Fimbriae",
"C": "Biofilm production",
"D": "IgA protease"
} | step1 | B | [
"healthy",
"year old woman",
"physician",
"2-day history",
"pain",
"urination",
"sexually active",
"two partners",
"past year",
"uses condoms",
"contraception",
"Vital signs",
"normal",
"Physical examination shows suprapubic tenderness",
"Urinalysis shows neutrophils",
"positive nitrit... |
A 50-year-old man presents to the urgent care clinic for 3 hours of worsening cough, shortness of breath, and dyspnea. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Arkansas. His medical history is significant for gout, hypertension, hypercholesterol... | Chest radiographs | {
"A": "Arterial blood gas",
"B": "Pulmonary function tests",
"C": "Chest radiographs",
"D": "Chest computed tomography (CT) with contrast"
} | step2&3 | C | [
"50 year old man presents",
"urgent care clinic",
"3 hours",
"worsening cough",
"shortness of breath",
"dyspnea",
"works",
"long",
"truck driver",
"informs",
"recently returned",
"west",
"trip",
"Arkansas",
"medical history",
"significant",
"gout",
"hypertension",
"hypercholester... |
A 54-year-old man comes to the physician for the evaluation of difficulty swallowing of both solids and liquids for 1 month. During the past 5 months, he has also had increased weakness of his hands and legs. He sails regularly and is unable to hold the ropes as tightly as before. Ten years ago, he was involved in a mo... | Amyotrophic lateral sclerosis | {
"A": "Amyotrophic lateral sclerosis",
"B": "Inclusion-body myositis",
"C": "Subacute combined degeneration of spinal cord",
"D": "Cervical spondylosis with myelopathy\n\""
} | step2&3 | A | [
"54 year old man",
"physician",
"evaluation",
"difficulty swallowing",
"solids",
"liquids",
"month",
"past",
"months",
"increased weakness of",
"hands",
"legs",
"sails",
"unable to hold",
"ropes",
"before",
"Ten years",
"involved",
"motor vehicle collision",
"Examination shows ... |
A study is performed to determine whether cognitive behavioral therapy (CBT) increases compliance to dietary regimens. In order to test this hypothesis, a random group of volunteers who want to lose weight are selected from the community and subsequently randomized to no intervention and CBT groups. They are asked to r... | Hawthorne effect | {
"A": "Hawthorne effect",
"B": "Procedure bias",
"C": "Pygmalion effect",
"D": "Recall bias"
} | step1 | A | [
"study",
"performed to",
"cognitive behavioral therapy",
"increases compliance",
"dietary regimens",
"order to test",
"hypothesis",
"a random group",
"volunteers",
"to",
"weight",
"selected",
"community",
"randomized",
"intervention",
"CBT",
"to record",
"ate",
"day",
"food jou... |
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