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 22-year-old woman presents to the emergency department because of agitation and sweating. History shows she is currently being treated for depression with citalopram. She also takes tramadol for back pain. Her temperature is 38.6°C (97.9°F), the pulse is 108/min, the respirations are 18/min, and the blood pressure is... | Discontinue tramadol and citalopram | {
"A": "Cyproheptadine",
"B": "Diazepam",
"C": "Discontinue tramadol and citalopram",
"D": "Selegiline"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"agitation",
"sweating",
"History shows",
"currently",
"treated",
"depression",
"citalopram",
"takes tramadol",
"back pain",
"temperature",
"97 9F",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Physical ex... |
A 54-year-old female presents to her primary care physician with complaints of fatigue, constipation, and what the patient describes as "aching in her bones." Her medical history is significant for hypertension, well-controlled on lisinopril, and two prior kidney stones that both passed spontaneously without need for s... | Subperiosteal cortical thinning | {
"A": "Joint space narrowing at the proximal and distal interphalangeal joints",
"B": "Osteoid matrix accumulation around bony trabeculae",
"C": "Subperiosteal cortical thinning",
"D": "Dense bone filling the medullary cavity of the phalanges and metacarpals"
} | step1 | C | [
"54 year old female presents",
"primary care physician",
"complaints",
"fatigue",
"constipation",
"patient",
"aching",
"bones",
"medical history",
"significant",
"hypertension",
"well-controlled",
"lisinopril",
"two prior kidney stones",
"passed",
"need",
"surgery",
"Vital signs",
... |
A 55-year-old woman presents with acute onset abdominal pain radiating to her back, nausea, and vomiting. CT scan suggests a diagnosis of acute pancreatitis. The pathogenesis of acute pancreatitis relates to inappropriate activation of trypsinogen to trypsin. Which of the following activates trypsin in normal digestion... | Enterokinase | {
"A": "Lipase",
"B": "Cholecystokinin",
"C": "Enterokinase",
"D": "Secretin"
} | step1 | C | [
"55 year old woman presents",
"acute onset abdominal pain radiating",
"back",
"nausea",
"vomiting",
"CT scan suggests",
"diagnosis",
"acute pancreatitis",
"pathogenesis",
"acute pancreatitis relates",
"inappropriate activation",
"trypsinogen",
"trypsin",
"following activates trypsin",
"n... |
A mutant stem cell was created by using an inducible RNAi system, such that when doxycycline is added, the siRNA targeting DNA helicase is expressed, effectively knocking down the gene for DNA helicase. Which of the following will occur during DNA replication? | DNA is not unwound | {
"A": "DNA is not unwound",
"B": "DNA supercoiling is not relieved",
"C": "The two melted DNA strands reanneal",
"D": "The RNA primer is not created"
} | step1 | A | [
"mutant stem cell",
"created by using",
"inducible RNAi system",
"doxycycline",
"added",
"siRNA targeting DNA helicase",
"knocking down",
"gene",
"DNA helicase",
"following",
"occur",
"DNA replication"
] |
A 52-year-old man is on a week-long cruise vacation with his family to celebrate his mother's 80th birthday. He has a very important presentation at work to give in one month, which will in part determine whether he receives a promotion. He decides to focus on enjoying the vacation and not to worry about the presentati... | Suppression
" | {
"A": "Isolation of affect",
"B": "Introjection",
"C": "Regression",
"D": "Suppression\n\""
} | step2&3 | D | [
"year old man",
"week long",
"vacation",
"family to",
"mother's 80th",
"very important presentation",
"work to give",
"one month",
"part",
"receives",
"promotion",
"focus",
"vacation",
"not",
"worry",
"presentation",
"over",
"following psychological defense mechanisms"
] |
A 16-year-old boy comes to the physician because of painless enlargement of his left testis for the past 2 weeks. The patient reports that the enlargement is worse in the evenings, especially after playing soccer. He has not had any trauma to the testes. There is no personal or family history of serious illness. Vital ... | Infertility | {
"A": "Bowel strangulation",
"B": "Testicular torsion",
"C": "Testicular tumor",
"D": "Infertility"
} | step2&3 | D | [
"year old boy",
"physician",
"painless enlargement",
"left testis",
"past 2 weeks",
"patient reports",
"enlargement",
"worse",
"evenings",
"playing soccer",
"not",
"trauma",
"testes",
"personal",
"family history of serious illness",
"Vital signs",
"normal limits",
"Examination show... |
Two months after giving birth to a boy, a 27-year-old woman comes to the physician with her infant for a well-child examination. She was not seen by a physician during her pregnancy. Physical examination of the mother and the boy shows no abnormalities. Laboratory studies show elevated titers of hepatitis B surface ant... | Significant elevation of transaminases is not expected | {
"A": "Hepatitis B e antigen titer is likely undetectable",
"B": "Chronic infection is unlikely",
"C": "Lifetime risk of hepatocellular carcinoma is low",
"D": "Significant elevation of transaminases is not expected"
} | step1 | D | [
"Two months",
"giving birth",
"boy",
"27 year old woman",
"physician",
"infant",
"well child examination",
"not seen by",
"physician",
"pregnancy",
"Physical",
"mother",
"boy shows",
"abnormalities",
"Laboratory studies show elevated titers",
"hepatitis B surface antigen",
"mother",
... |
An experiment to determine the effects of gravity on blood pressure is conducted on 3 individuals of equal height and blood pressure oriented in different positions in space. Participant A is strapped in a supine position on a bed turned upside down in a vertical orientation with his head towards the floor and his feet... | Participant A: at the level of the feet | {
"A": "Participant A: at the level of the head",
"B": "Participant C: at the level of the heart",
"C": "Participant A: at the level of the feet",
"D": "Participant B: at the level of the head"
} | step1 | C | [
"experiment to",
"effects",
"gravity",
"blood pressure",
"conducted",
"3 individuals",
"equal height",
"blood pressure oriented",
"different positions",
"space",
"Participant",
"strapped",
"supine position",
"bed turned",
"down",
"vertical orientation",
"head",
"floor",
"feet",
... |
A new study is investigating the effects of an experimental drug, Exerzisin, on the duration and intensity of exercise. In the treatment group participants are given daily Exerzisin at the main treatment facility and instructed to exercise as much as they would like on the facility's exercise equipment. Due to an insuf... | Hawthorne effect | {
"A": "Selection bias",
"B": "Hawthorne effect",
"C": "Recall bias",
"D": "Lead time bias"
} | step1 | B | [
"new study",
"investigating",
"effects of",
"experimental drug",
"duration",
"intensity",
"exercise",
"treatment group participants",
"given daily",
"main treatment facility",
"to exercise",
"facility's exercise equipment",
"Due to",
"insufficient number of exercise units",
"main treatme... |
A 13-year-old Hispanic boy is brought to the physician by his mother because of left groin pain for 1 month. The pain radiates to his left knee and is aggravated on walking. He fell during soccer practice 5 weeks ago but did not see a doctor about it and does not recall any immediate and persistent pain after the event... | Slipped capital femoral epiphysis | {
"A": "Septic arthritis of the left hip",
"B": "Slipped capital femoral epiphysis",
"C": "Osteomyelitis of the left hip",
"D": "Developmental dysplasia of the left hip"
} | step2&3 | B | [
"year old Hispanic boy",
"brought",
"physician",
"mother",
"left",
"1 month",
"pain radiates",
"left knee",
"aggravated",
"walking",
"fell",
"soccer practice",
"weeks",
"not see",
"doctor",
"not recall",
"immediate",
"persistent pain",
"event",
"hypothyroidism",
"only medicat... |
A 38-year-old woman presents with generalized weakness and dizziness for the past 3 weeks. Past medical history is significant for systemic lupus erythematosus diagnosed 15 years ago, for which she takes hydroxychloroquine and methotrexate. No significant family history. Her vital signs include: temperature 37.1°C (98.... | IgG-mediated hemolysis | {
"A": "Red cell membrane defect",
"B": "IgG-mediated hemolysis",
"C": "IgM-mediated hemolysis",
"D": "Chronic inflammation"
} | step2&3 | B | [
"year old woman presents",
"generalized",
"dizziness",
"past",
"weeks",
"medical history",
"significant",
"systemic lupus erythematosus diagnosed",
"years",
"takes hydroxychloroquine",
"methotrexate",
"significant family history",
"vital signs include",
"temperature",
"98",
"blood pres... |
A 46-year-old man presents after he accidentally got splashed with a liquid insecticide that was stored in a bucket in the storeroom one hour ago. He says that he can’t stop coughing and is having problems breathing. He also says he has a pain in his thighs which is unbearable, and his vision is blurry. His temperature... | Bronchospasm | {
"A": "Bronchospasm",
"B": "Tachycardia",
"C": "Muscle cramps",
"D": "Pallor"
} | step1 | A | [
"year old man presents",
"got splashed",
"liquid insecticide",
"stored",
"storeroom one hour",
"cant stop coughing",
"problems breathing",
"pain in",
"thighs",
"vision",
"blurry",
"temperature",
"36",
"98",
"pulse",
"min",
"blood pressure",
"mm Hg",
"respiratory rate",
"20 min"... |
A female infant is born with a mutation in PKD1 on chromosome 16. An abdominal ultrasound performed shortly after birth would most likely reveal which of the following? | Normal kidneys | {
"A": "Bilateral kidney enlargement",
"B": "Microscopic cysts",
"C": "Adrenal atrophy",
"D": "Normal kidneys"
} | step1 | D | [
"female infant",
"born",
"mutation",
"PKD1",
"chromosome 16",
"abdominal ultrasound performed",
"birth",
"most likely reveal",
"following"
] |
A 28-year-old man is admitted to the hospital for the evaluation of symmetric, ascending weakness that started in his feet and has become progressively worse over the past 5 days. A lumbar puncture is performed to confirm the diagnosis. As the needle is advanced during the procedure, there is resistance just before ent... | Ligamentum flavum | {
"A": "Ligamentum flavum",
"B": "Superficial fascia",
"C": "Interspinous ligament",
"D": "Supraspinous ligament"
} | step1 | A | [
"year old man",
"admitted",
"hospital",
"evaluation",
"symmetric",
"ascending weakness",
"started",
"feet",
"worse",
"past 5 days",
"lumbar puncture",
"performed to confirm",
"diagnosis",
"needle",
"advanced",
"procedure",
"resistance",
"before entering",
"epidural space",
"res... |
A 32-year-old woman comes to the emergency department because of a 5-day history of anxiety, irritability, insomnia, and abdominal pain that began after a weekend of partying. She also reports “bloody” urine as well as a tingling sensation in her hands and feet. She has never experienced similar symptoms. She does not ... | Porphobilinogen deaminase | {
"A": "Homogentisic acid dioxygenase",
"B": "Aminolevulinic acid synthase",
"C": "Ferrochelatase",
"D": "Porphobilinogen deaminase"
} | step1 | D | [
"year old woman",
"emergency department",
"5-day history",
"anxiety",
"irritability",
"insomnia",
"abdominal pain",
"began",
"weekend",
"partying",
"reports bloody urine",
"tingling",
"hands",
"feet",
"never experienced similar symptoms",
"not smoke",
"to drink too much",
"5",
"m... |
A 26-year-old immigrant from Mexico presents to your clinic for a physical. He tells you that several weeks ago, he noticed a lesion on his penis which went away after several weeks. It was nontender and did not bother him. He currently does not have any complaints. His temperature is 97.9°F (36.6°C), blood pressure is... | Penicillin | {
"A": "Acyclovir",
"B": "Azithromycin and ceftriaxone",
"C": "No treatment indicated",
"D": "Penicillin"
} | step2&3 | D | [
"year old immigrant",
"Mexico presents",
"clinic",
"physical",
"several weeks",
"lesion",
"penis",
"weeks",
"nontender",
"not",
"currently",
"not",
"complaints",
"temperature",
"97 9F",
"36",
"blood pressure",
"mmHg",
"pulse",
"87 min",
"respirations",
"min",
"oxygen satu... |
A 10-year-old male presents with his mother with multiple complaints. A few weeks ago, he had a sore throat for several days that improved without specific therapy. Additionally, over the past several days he has experienced pain in his ankles and wrists and, more recently, his left knee. His mother also noted several ... | Interstitial myocardial granulomas containing plump macrophages with nuclei incorporating central wavy ribbons of chromatin | {
"A": "Atypical lymphocytes noted on peripheral blood smear with an initial positive heterophil antibody test",
"B": "Plasmodium falciparum ring forms in red blood cells on peripheral blood smear",
"C": "Needle-shaped, negatively birefringent crystal deposits surrounded by palisading histiocytes in the synovial ... | step1 | D | [
"A 10 year old male presents",
"mother",
"multiple complaints",
"few weeks",
"sore throat",
"days",
"improved",
"specific therapy",
"past",
"days",
"pain in",
"ankles",
"wrists",
"more recently",
"left knee",
"mother",
"noted several",
"elbows",
"pain",
"center",
"chest",
"... |
A 75-year-old man is brought to the emergency department by his son. He is suffering from left-sided weakness. The symptoms started 2 hours ago with sudden left-sided weakness. The patient is a known hypertensive, who is inconsistently compliant with his 2 antihypertensive medications and a heavy smoker, with a 40 pack... | Positive Babinski sign | {
"A": "Flaccid paresis",
"B": "Fasciculations",
"C": "Muscle atrophy",
"D": "Positive Babinski sign"
} | step1 | D | [
"75 year old man",
"brought",
"emergency department",
"son",
"suffering",
"left-sided weakness",
"symptoms started 2 hours",
"sudden left-sided weakness",
"patient",
"known hypertensive",
"compliant",
"antihypertensive medications",
"heavy smoker",
"40 pack year history",
"Physical exami... |
A 32-year-old woman, gravida 2, para 2, comes to the physician for the evaluation of a palpable mass in her right breast that she first noticed 1 week ago. She has no associated pain. She has never had a mammogram previously. She has type II diabetes mellitus treated with metformin. She has no family history of breast ... | Mammography | {
"A": "MRI scan of the breast",
"B": "Mammography",
"C": "BRCA gene testing",
"D": "Monthly self-breast exams"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 2",
"physician",
"evaluation",
"palpable mass",
"right breast",
"first",
"1 week",
"associated pain",
"never",
"mammogram",
"type II diabetes mellitus treated with metformin",
"family history of breast cancer",
"smoked half",
"pack",
"cigarettes d... |
A 70-year-old female presents to you for an office visit with complaints of forgetfulness. The patient states that over the last several years, the patient has stopped cooking for herself even though she lives alone. Recently, she also forgot how to drive back home from the grocery store and has difficulty paying her b... | Rivastigmine | {
"A": "Bromocriptine",
"B": "Pramipexole",
"C": "Rivastigmine",
"D": "Memantine"
} | step2&3 | C | [
"70 year old female presents",
"office visit",
"complaints",
"forgetfulness",
"patient states",
"last",
"years",
"patient",
"stopped cooking",
"lives alone",
"Recently",
"forgot",
"to drive back home",
"grocery store",
"difficulty paying",
"bills",
"patient",
"healthy",
"whole li... |
A 62-year-old man presents to the emergency department with hematuria and hemoptysis that started in the morning. He notes that he has had frequent lung infections throughout his adult life, the most recent being 2 weeks ago. He also mentions that he has had hematuria twice before but never as severe as he is having cu... | Granulomatosis with polyangiitis | {
"A": "Post-streptococcal glomerulonephritis",
"B": "IgA nephropathy",
"C": "Goodpasture syndrome",
"D": "Granulomatosis with polyangiitis"
} | step2&3 | D | [
"62 year old man presents",
"emergency department",
"hematuria",
"hemoptysis",
"started",
"morning",
"notes",
"frequent lung infections",
"adult life",
"most recent",
"2 weeks",
"hematuria twice",
"never",
"severe",
"currently",
"medical history",
"non significant",
"only medicatio... |
A 57-year-old man presents to the ED complaining of back and left leg pain. He was lifting heavy furniture while helping his daughter move into college when all of sudden he felt a sharp pain at his back. The pain is described as severe, worse with movement, and shoots down his lateral thigh. The patient denies any bow... | Disc herniation at the L3/L4 vertebra | {
"A": "Disc herniation at the L3/L4 vertebra",
"B": "Disc herniation at the L4/L5 vertebra",
"C": "Spinal metastasis from lung cancer",
"D": "Vertebral compression fracture"
} | step1 | A | [
"57 year old man presents",
"ED",
"of back",
"left leg pain",
"lifting heavy furniture",
"helping",
"daughter move",
"college",
"sudden",
"felt",
"sharp",
"back",
"pain",
"described",
"severe",
"worse",
"movement",
"shoots",
"lateral thigh",
"patient denies",
"bowel urinary",... |
A 20-year-old man presents to his primary care provider with a history of recurrent cough, wheezing, and breathlessness since early childhood. He previously diagnosed with allergic rhinitis and bronchial asthma. For his allergic rhinitis, he uses intranasal fluticasone. For his asthma, he uses an albuterol inhaler as a... | Mitogen-activated protein (MAP) kinase phosphatase-1 expression is upregulated by inhaled corticosteroids. | {
"A": "β2-agonists reverse bronchoconstriction but do not control the underlying inflammation.",
"B": "Antileukotrienes (such as montelukast and zafirlukast) exert their beneficial effects in bronchial asthma by blocking CysLT2-receptors.",
"C": "Omalizumab acts by blocking both circulating and mast cell-bound I... | step1 | D | [
"20 year old man presents",
"primary care provider",
"history",
"recurrent cough",
"wheezing",
"breathlessness",
"early childhood",
"diagnosed",
"allergic rhinitis",
"bronchial asthma",
"allergic rhinitis",
"uses intranasal fluticasone",
"asthma",
"uses",
"albuterol inhaler",
"to initi... |
A 24-year-old woman comes to the physician for a routine pelvic examination. She feels well. Menses occur at 30-day intervals and last 7 days. Her last menstrual period was 6 days ago. She has no history of abnormal Pap smears; her last Pap smear was 13 months ago. She is sexually active with three male partners and us... | HPV vaccination | {
"A": "HPV vaccination",
"B": "Syphilis testing",
"C": "Mammography",
"D": "HPV testing"
} | step2&3 | A | [
"year old woman",
"physician",
"routine pelvic examination",
"feels well",
"Menses occur",
"30 day intervals",
"last 7 days",
"last menstrual period",
"6 days",
"history",
"abnormal Pap smears",
"last Pap smear",
"months",
"sexually active",
"three male partners",
"uses condoms",
"ne... |
Two weeks after being hospitalized for acute pancreatitis, a 36-year-old man comes to the physician for a follow-up examination. Multiple family members have coronary artery disease. Physical examination shows multiple, yellow papular lesions on both upper eyelids. Fasting serum lipid studies show:
Total cholesterol 28... | Upregulation of lipoprotein lipase | {
"A": "Inhibition of intestinal cholesterol absorption",
"B": "Deactivation of peroxisome proliferator-activated receptors",
"C": "Upregulation of lipoprotein lipase",
"D": "Formation of bile acid complex"
} | step1 | C | [
"Two weeks",
"hospitalized",
"acute pancreatitis",
"36 year old man",
"physician",
"follow-up examination",
"Multiple family members",
"coronary artery disease",
"Physical examination shows multiple",
"yellow papular lesions",
"upper eyelids",
"Fasting serum lipid studies show",
"Total chole... |
A 57-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up evaluation. He was recently diagnosed with hyperlipidemia, for which he takes several medications. His serum total cholesterol concentration is 295 mg/dL and serum high-density lipoprotein concentration is 19 mg/dL (N: > 40 mg/dL). T... | Take aspirin shortly before taking the new drug to reduce pruritus | {
"A": "Take aspirin shortly before taking the new drug to reduce pruritus",
"B": "Schedule a follow-up appointment in 2 weeks to check serum creatine kinase levels",
"C": "Avoid smoking because of the new drug's increased risk of thrombosis",
"D": "Check blood glucose levels after taking the new drug to detect... | step1 | A | [
"57 year old man",
"type 2 diabetes mellitus",
"physician",
"follow-up evaluation",
"recently diagnosed",
"hyperlipidemia",
"takes several medications",
"serum total cholesterol concentration",
"mg/dL",
"serum high-density lipoprotein concentration",
"mg/dL",
"N",
"40 mg/dL",
"physician",
... |
A 69-year-old smoker presents to physician after noticing that his face seems to be more swollen than usual. Upon further questioning, he reports increasing shortness of breath and cough over the past 6 months. On exam, his physician notices venous distention in his neck and distended veins in the upper chest and arms.... | Cardinal veins | {
"A": "Bulbis cordis",
"B": "Primitive ventricle",
"C": "Left horn of sinus venosus",
"D": "Cardinal veins"
} | step1 | D | [
"69 year old smoker presents",
"physician",
"face",
"to",
"more swollen",
"usual",
"further questioning",
"reports increasing shortness of breath",
"cough",
"past 6 months",
"exam",
"physician",
"venous distention",
"neck",
"distended veins",
"upper chest",
"arms",
"Chest radiograp... |
A 57-year-old man comes to the emergency department for the evaluation of worsening fatigue, urinary frequency, and constipation over the past 5 days. He was recently diagnosed with metastatic bladder cancer and is currently awaiting treatment. He has smoked 1 pack of cigarettes daily for 35 years. Physical examination... | ↑ ↓ ↓ ↓ | {
"A": "↑ ↑ ↓ ↑",
"B": "↑ ↑ ↑ ↓",
"C": "↑ ↓ ↑ ↑",
"D": "↑ ↓ ↓ ↓"
} | step1 | D | [
"57 year old man",
"emergency department",
"evaluation",
"worsening fatigue",
"urinary frequency",
"constipation",
"past 5 days",
"recently diagnosed",
"metastatic bladder cancer",
"currently",
"treatment",
"smoked 1 pack",
"cigarettes daily",
"35 years",
"Physical examination shows dry ... |
A 2-year-old boy had increased bleeding during a circumcision. His birth and delivery were uncomplicated, and his mother had no issues with prolonged bleeding during labor. Of note, his maternal grandfather has a history of bleeding complications. The boy's vital signs are stable and physical examination is notable for... | Hemophilia A | {
"A": "Von Willebrand disease",
"B": "Glanzmann thrombasthenia",
"C": "Bernard-Soulier syndrome",
"D": "Hemophilia A"
} | step1 | D | [
"2 year old boy",
"increased bleeding",
"circumcision",
"birth",
"delivery",
"uncomplicated",
"mother",
"issues",
"prolonged bleeding",
"labor",
"note",
"maternal grandfather",
"history",
"bleeding complications",
"boy's vital signs",
"stable",
"physical examination",
"notable",
... |
A 52-year-old woman is brought to the emergency department for a severe, sudden-onset headache, light-sensitivity, and neck stiffness that began 30 minutes ago. A CT scan of the head shows hyperdensity between the arachnoid mater and the pia mater. The patient undergoes an endovascular procedure. One week later, she fa... | Nimodipine | {
"A": "Enalapril",
"B": "Nimodipine",
"C": "Fosphenytoin",
"D": "Nitroglycerin"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"severe",
"sudden-onset headache",
"light-sensitivity",
"neck stiffness",
"began 30 minutes",
"CT scan of",
"head shows",
"arachnoid mater",
"pia mater",
"patient",
"endovascular procedure",
"One week later",
"falls",
"returning",
... |
An experimental compound added to a protein disrupts both alpha helices as well as beta-pleated sheets. Which of the following has the experimental compound affected? | Hydrogen bonds between amino acids | {
"A": "Hydrogen bonds between amino acids",
"B": "Covalent peptide bonds between amino acids",
"C": "Ionic bonds between amino acids",
"D": "Disulfide bonds between amino acids"
} | step1 | A | [
"experimental compound added",
"a protein disrupts",
"alpha helices",
"beta-pleated sheets",
"following",
"experimental compound affected"
] |
A 28-year-old woman and her husband are admitted to the office due to difficulties conceiving a child for the past year. Her menarche was at the age of 15 years, and her periods have been regular since then. Her medical history is positive for an abortion with curettage 5 years ago. A spermogram on the partner is perfo... | Type 1 collagen | {
"A": "Type 1 collagen",
"B": "Type 2 collagen",
"C": "Type 3 collagen",
"D": "Type 4 collagen"
} | step1 | A | [
"year old woman",
"husband",
"admitted",
"office",
"difficulties conceiving",
"child",
"past year",
"menarche",
"age",
"years",
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"regular",
"then",
"medical history",
"positive",
"abortion",
"curettage",
"years",
"partner",
"performed",
"shows motile sperm cells",
... |
A 36-year-old woman is brought to the emergency room by her husband for “weird behavior" for the past several weeks. He reports that her right arm has been moving uncontrollably in a writhing movement and that she has been especially irritable. She has a history of depression, which was diagnosed 4 years ago and is cur... | CAG triplet expansion on chromosome 4 | {
"A": "CAG triplet expansion on chromosome 4",
"B": "Frontotemporal lobe degeneration",
"C": "GAA triplet expansion on chromosome 9",
"D": "Presence of misfolded proteins in the brain"
} | step1 | A | [
"36 year old woman",
"brought",
"emergency room",
"husband",
"behavior",
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"weeks",
"reports",
"right arm",
"moving",
"movement",
"irritable",
"history of depression",
"diagnosed 4 years",
"currently",
"treated with sertraline",
"denies",
"recent fever",
"trauma",
"infect... |
A 55-year-old Caucasian man is referred to a gastroenterologist for difficulty in swallowing. He has been cutting his food into much smaller pieces when he eats for a little over a year. Recently, he has been having difficulty with liquid foods like soup as well. His past medical history is irrelevant, but he has notic... | Acid reflux | {
"A": "Diet",
"B": "Smoking",
"C": "Dysplasia",
"D": "Acid reflux"
} | step2&3 | D | [
"55 year old Caucasian man",
"referred",
"gastroenterologist",
"difficulty in swallowing",
"cutting",
"food",
"smaller pieces",
"eats",
"little",
"year",
"Recently",
"difficulty",
"liquid foods",
"soup",
"well",
"past medical history",
"4 kg",
"8.8",
"weight loss",
"past",
"m... |
A 45-year-old man with asthma comes to the physician because of a 1-month history of progressively worsening shortness of breath and cough. He also has a history of chronic sinusitis and foot drop. Current medications include an albuterol inhaler and inhaled corticosteroid. Physical examination shows diffuse wheezing o... | Eosinophilic granulomatosis with polyangiitis | {
"A": "Granulomatosis with polyangiitis",
"B": "Eosinophilic granulomatosis with polyangiitis",
"C": "Microscopic polyangiitis",
"D": "Polyarteritis nodosa"
} | step1 | B | [
"year old man",
"asthma",
"physician",
"month history",
"worsening shortness of breath",
"cough",
"history",
"chronic sinusitis",
"foot drop",
"Current medications include",
"albuterol inhaler",
"inhaled corticosteroid",
"Physical examination shows diffuse wheezing",
"lung fields",
"tend... |
A 58-year-old man presents to the emergency department with a 1-day history of difficulty swallowing. He also mentions that he has been frequently experiencing moderate to severe burning pain localized to the epigastric region for the last 3 weeks. The patient denies any history of vomiting, hematemesis, or black-color... | Upper gastrointestinal endoscopy | {
"A": "Ambulatory 24-hour pH monitoring",
"B": "Esophageal manometry",
"C": "Intraluminal impedance monitoring",
"D": "Upper gastrointestinal endoscopy"
} | step2&3 | D | [
"58 year old man presents",
"emergency department",
"1-day history",
"difficulty swallowing",
"frequently experiencing moderate to severe burning pain localized",
"epigastric region",
"last",
"weeks",
"patient denies",
"history",
"vomiting",
"hematemesis",
"black-colored stools",
"past med... |
A 60-year-old woman presents to the emergency room with chest pain that started 20 minutes ago while watching television at home. The pain is substernal and squeezing in nature. She rates the pain as 6/10 and admits to having similar pain in the past with exertion. Her past medical history is significant for diabetes m... | aPTT and platelet count | {
"A": "Prothrombin time and platelet count",
"B": "Prothrombin time alone",
"C": "aPTT and platelet count",
"D": "Platelet count alone"
} | step1 | C | [
"60 year old woman presents",
"emergency room",
"chest pain",
"started 20 minutes",
"watching television at home",
"pain",
"squeezing",
"nature",
"rates",
"pain",
"6/10",
"admits",
"similar pain",
"past",
"exertion",
"past medical history",
"significant",
"diabetes mellitus",
"co... |
A 67-year-old woman who was recently diagnosed with Crohn disease comes to the physician for evaluation of her immunosuppressive therapy. She has had recurrent flares since her diagnosis. Physical examination shows two shallow ulcers on her oral mucosa. The physician considers adding azathioprine to her medication regi... | Hypoxanthine-guanine phosphoribosyl transferase | {
"A": "Xanthine oxidase",
"B": "Thymidylate synthase",
"C": "Phosphoribosyl pyrophosphate synthetase",
"D": "Hypoxanthine-guanine phosphoribosyl transferase"
} | step1 | D | [
"67 year old woman",
"recently diagnosed",
"Crohn disease",
"physician",
"evaluation",
"immunosuppressive",
"recurrent flares",
"diagnosis",
"Physical examination shows two shallow ulcers",
"oral",
"physician considers adding azathioprine",
"medication regimen",
"deficiency",
"following en... |
A 26-year-old woman is brought to the emergency department after a motor vehicle accident. She was driving on the highway when she was struck by a van. At the hospital she was conscious but was bleeding heavily from an open wound in her left leg. Pulse is 120/min and blood pressure is 96/68 mm Hg. She receives 3 L of i... | A patient history of frequent sinopulmonary infections | {
"A": "A patient history of cardiovascular disease",
"B": "Facial twitching when the patient's cheek is tapped",
"C": "A patient history of frequent sinopulmonary infections",
"D": "Unsanitary blood product storage practices in the hospital"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"motor vehicle accident",
"driving",
"highway",
"struck by",
"van",
"hospital",
"conscious",
"bleeding",
"open wound",
"left leg",
"Pulse",
"min",
"blood pressure",
"96 68 mm Hg",
"receives 3",
"intravenous saline",
"pulse sl... |
A 33-year-old man presents to the emergency department acutely confused. The patient was found down at a local construction site by his coworkers. The patient has a past medical history of a seizure disorder and schizophrenia and is currently taking haloperidol. He had recent surgery 2 months ago to remove an inflamed ... | Exertional heat stroke | {
"A": "Exertional heat stroke",
"B": "Heat exhaustion",
"C": "Malignant hyperthermia",
"D": "Neuroleptic malignant syndrome"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"confused",
"patient",
"found",
"local construction site",
"coworkers",
"patient",
"past medical",
"seizure disorder",
"schizophrenia",
"currently taking haloperidol",
"recent surgery 2 months",
"to remove",
"inflamed appendix",
"tempera... |
A 50-year-old man is brought to the emergency department because of severe headache over the past hour. He also reports nausea and one episode of non-bloody vomiting. He has a history of hypertension and type 2 diabetes mellitus. He does not smoke or drink alcohol. Medications include enalapril and metformin, but he st... | Rupture of a small penetrating artery | {
"A": "Rupture of a small penetrating artery",
"B": "Rupture of bridging veins",
"C": "Rupture of a saccular aneurysm",
"D": "Rupture of an arteriovenous malformation"
} | step2&3 | A | [
"50 year old man",
"brought",
"emergency department",
"of severe headache",
"past hour",
"reports nausea",
"one episode of non bloody vomiting",
"history of hypertension",
"type 2 diabetes mellitus",
"not smoke",
"drink alcohol",
"Medications include enalapril",
"metformin",
"states",
"n... |
A 65-year-old man comes to the emergency department 1 hour after a loss of consciousness. His wife said he suddenly fainted while she was adjusting his necktie. He regained consciousness within 30 seconds and was fully alert and oriented. He has had two similar episodes in the last year. He has anxiety and takes alpraz... | Carotid sinus hypersensitivity | {
"A": "Structural cardiac abnormality",
"B": "Orthostatic syncope",
"C": "Carotid sinus hypersensitivity",
"D": "Panic attack"
} | step2&3 | C | [
"65 year old man",
"emergency department",
"hour",
"loss of consciousness",
"wife",
"fainted",
"regained consciousness",
"30 seconds",
"alert",
"oriented",
"two similar episodes",
"year",
"anxiety",
"takes alprazolam as needed",
"smokes half",
"pack",
"cigarettes daily",
"drinks tw... |
A 7-year-old boy is brought to the pediatrician by his parents for concern of general fatigue and recurrent abdominal pain. You learn that his medical history is otherwise unremarkable and that these symptoms started about 3 months ago after they moved to a different house. Based on clinical suspicion labs are obtained... | Inhibition of ALA dehydratase and ferrochelatase | {
"A": "Chronic loss of blood through GI tract",
"B": "X-linked mutation of ALA synthetase",
"C": "Inflammation due to occult abdominal malignancy",
"D": "Inhibition of ALA dehydratase and ferrochelatase"
} | step1 | D | [
"year old boy",
"brought",
"pediatrician",
"parents",
"concern",
"general fatigue",
"recurrent abdominal pain",
"learn",
"medical history",
"unremarkable",
"symptoms started",
"months",
"moved to",
"different house",
"Based",
"clinical suspicion labs",
"obtained",
"reveal",
"micr... |
A 3175-g (7-lb) female newborn is delivered at 37 weeks to a 26-year-old primigravid woman. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. The pregnancy had been uncomplicated. The mother had no prenatal care. She immigrated to the US from Brazil 2 years ago. Immunization records are not available. One day ... | Congenital rubella infection | {
"A": "Congenital parvovirus B19 infection",
"B": "Congenital syphilis",
"C": "Congenital rubella infection",
"D": "Congenital CMV infection"
} | step2&3 | C | [
"g",
"female newborn",
"delivered",
"weeks",
"year old primigravid woman",
"Apgar scores",
"5 minutes",
"pregnancy",
"uncomplicated",
"mother",
"prenatal care",
"Brazil",
"years",
"Immunization records",
"not available",
"One day",
"delivery",
"newborn's temperature",
"99",
"pu... |
A 61-year-old woman presents to the emergency room with left leg pain and swelling. She recently returned to the United States from a trip to India. Her past medical history is notable for osteoarthritis in both hips, lumbar spinal stenosis, and hypertension. She takes lisinopril. Her temperature is 99°F (37.2°C), bloo... | Direct thrombin inhibitor | {
"A": "Anti-thrombin III activator",
"B": "Cyclooxygenase inhibitor",
"C": "Direct thrombin inhibitor",
"D": "Vitamin K epoxide reductase inhibitor"
} | step1 | C | [
"61 year old woman presents",
"emergency room",
"left leg pain",
"swelling",
"recently returned",
"United States",
"trip",
"India",
"past medical history",
"notable",
"osteoarthritis",
"hips",
"lumbar spinal stenosis",
"hypertension",
"takes lisinopril",
"temperature",
"blood pressur... |
A newborn male is evaluated 30 minutes after birth. He was born at 38 weeks gestation to a 39-year-old gravida 3 via vaginal delivery. The pregnancy was complicated by gestational diabetes, and the patient’s mother received routine prenatal care. The family declined all prenatal testing, including an anatomy ultrasound... | Complete atrioventricular septal defect | {
"A": "Aortic root dilation",
"B": "Bicuspid aortic valve",
"C": "Coarctation of the aorta",
"D": "Complete atrioventricular septal defect"
} | step2&3 | D | [
"newborn male",
"evaluated 30 minutes after birth",
"born",
"weeks gestation",
"year old gravida 3",
"vaginal delivery",
"pregnancy",
"complicated",
"gestational diabetes",
"patients mother received routine prenatal care",
"family",
"prenatal testing",
"including",
"anatomy ultrasound",
... |
A 24-year-old Asian woman comes to the office complaining of fatigue. She states that for weeks she has noticed a decrease in her energy. She is a spin instructor, and she has been unable to teach. She said that when she was bringing groceries up the stairs yesterday she experienced some breathlessness and had to rest ... | C | {
"A": "B",
"B": "C",
"C": "D",
"D": "E"
} | step2&3 | B | [
"year old Asian woman",
"office",
"fatigue",
"states",
"weeks",
"decrease",
"energy",
"spin instructor",
"unable",
"teach",
"stairs",
"experienced",
"breathlessness",
"to rest",
"ascending",
"flight",
"denies chest pain",
"palpitations",
"dyspnea at rest",
"occasional constipat... |
A 29-year-old man presents to the emergency room with facial weakness. He first noticed that he was having trouble smiling normally while at dinner with friends the night before. He also noticed that his food had less taste than usual during the dinner. He woke up on the day of presentation with a complete inability to... | Stylomastoid foramen | {
"A": "Inferior orbital fissure",
"B": "Petrotympanic fissure",
"C": "Superior orbital fissure",
"D": "Stylomastoid foramen"
} | step1 | D | [
"29 year old man presents",
"emergency room",
"facial weakness",
"first",
"smiling",
"dinner",
"friends",
"night",
"food",
"less taste than usual",
"dinner",
"woke up",
"day",
"presentation",
"complete",
"to move",
"right side of",
"face",
"recently returned",
"extended camping... |
A 21-year-old college student comes to the emergency department because of a two-day history of vomiting and epigastric pain that radiates to the back. He has a history of atopic dermatitis and Hashimoto thyroiditis. His only medication is levothyroxine. He has not received any routine vaccinations. He drinks 1–2 beers... | Measure serum lipid levels | {
"A": "Perform a pilocarpine-induced sweat test",
"B": "Measure serum mumps IgM titer",
"C": "Obtain an upright x-ray of the abdomen",
"D": "Measure serum lipid levels"
} | step2&3 | D | [
"21-year-old college student",
"emergency department",
"two day history",
"vomiting",
"epigastric pain",
"radiates",
"back",
"history",
"atopic dermatitis",
"Hashimoto thyroiditis",
"only medication",
"levothyroxine",
"not received",
"routine vaccinations",
"drinks",
"beers",
"weeken... |
A 2600-g (5-lb 8-oz) male newborn is delivered at 34 weeks' gestation to a 22-year-old woman. The mother did not have prenatal care. Upon examination in the delivery room, the newborn's skin appears blue. He is gasping and breathing irregularly. The ears are low-set with broad auricles, and the nasal tip is flattened. ... | Posterior urethral valve | {
"A": "Pulmonary hypoplasia",
"B": "Esophageal atresia",
"C": "Anencephaly",
"D": "Posterior urethral valve"
} | step1 | D | [
"g",
"8 oz",
"male newborn",
"delivered",
"weeks",
"gestation",
"year old woman",
"mother",
"not",
"prenatal care",
"examination",
"delivery",
"newborn's skin appears blue",
"gasping",
"breathing",
"ears",
"low-set",
"broad auricles",
"nasal tip",
"flattened",
"lower jaw",
... |
An 11-year-old boy with HIV and esophageal candidiasis is being treated with caspofungin. What is the mechanism of action of this drug? | Inhibition of 1,3-Beta-glucan synthase | {
"A": "Pore formation in cell membranes",
"B": "Inhibition of ergosterol synthesis",
"C": "Inhibition of squalene epoxidase",
"D": "Inhibition of 1,3-Beta-glucan synthase"
} | step1 | D | [
"year old boy",
"HIV",
"esophageal candidiasis",
"treated with caspofungin",
"mechanism of action",
"drug"
] |
A 42-year-old woman presents to the clinic for a recurrent rash that has remitted and relapsed over the last 2 years. The patient states that she has tried multiple home remedies when she has flare-ups, to no avail. The patient is wary of medical care and has not seen a doctor in at least 15 years. On examination, she ... | Cutaneous lupus erythematosus (CLE) | {
"A": "Systemic lupus erythematosus (SLE)",
"B": "Cutaneous lupus erythematosus (CLE)",
"C": "Dermatomyositis",
"D": "Tinea capitis"
} | step1 | B | [
"year old woman presents",
"clinic",
"recurrent rash",
"remitted",
"relapsed",
"years",
"patient states",
"multiple home remedies",
"flare-ups",
"patient",
"wary",
"medical care",
"not seen",
"doctor",
"years",
"examination",
"multiple disc-shaped",
"erythematous lesions",
"neck"... |
A 61-year-old man presents with back pain and hematuria. The patient says his back pain gradually onset 6 months ago and has progressively worsened. He describes the pain as moderate, dull and aching, and localized to the lower back and right flank. Also, he says that, for the past 2 weeks, he has been having intermitt... | 20-pack-year smoking history | {
"A": "History of obstructive nephrolithiasis",
"B": "Family history of renovascular hypertension",
"C": "Peripheral vascular disease",
"D": "20-pack-year smoking history"
} | step2&3 | D | [
"61 year old man presents",
"back pain",
"hematuria",
"patient",
"back pain",
"onset",
"months",
"worsened",
"pain",
"moderate",
"dull",
"aching",
"localized",
"lower back",
"right flank",
"past 2 weeks",
"intermittent episodes of hematuria",
"patient denies",
"recent history",
... |
A 56-year-old man comes to the physician for a 5-month history of progressive bilateral ankle swelling and shortness of breath on exertion. He can no longer walk up the stairs to his bedroom without taking a break. He also constantly feels tired during the day. His wife reports that he snores at night and that he somet... | Chronic hypoxia | {
"A": "Ischemic heart disease",
"B": "Chronic hypoxia",
"C": "Chronic kidney damage",
"D": "Alveolar destruction"
} | step2&3 | B | [
"year old man",
"physician",
"5 month history",
"progressive bilateral ankle swelling",
"shortness of breath",
"exertion",
"longer walk",
"stairs",
"bedroom",
"break",
"constantly feels tired",
"day",
"wife reports",
"snores",
"night",
"sometimes chokes",
"sleep",
"patient",
"smo... |
You are seeing a 4-year-old boy in clinic who is presenting with concern for a primary immune deficiency. He has an unremarkable birth history, but since the age of 6 months he has had recurrent otitis media, bacterial pneumonia, as well as two episodes of sinusitis, and four episodes of conjunctivitis. He has a matern... | Abnormally low number of B cells | {
"A": "Abnormally low number of B cells",
"B": "Abnormally high number of B cells",
"C": "Abnormally high number of T cells",
"D": "Elevated immunoglobulin levels"
} | step1 | A | [
"seeing",
"4 year old boy in clinic",
"presenting",
"concern",
"primary immune deficiency",
"unremarkable birth history",
"since",
"age",
"months",
"recurrent otitis media",
"bacterial pneumonia",
"two episodes of sinusitis",
"four episodes of conjunctivitis",
"maternal uncle",
"died",
... |
A 37-year-old woman comes for a follow-up prenatal visit at 18 weeks' gestation. At 12 weeks' gestation, ultrasonography showed increased nuchal translucency and pregnancy-associated plasma protein A (PAPP-A) was decreased by 2 standard deviations. Chorionic villus sampling showed a 47, XX karyotype. During this visit,... | ↓ ↓ ↑ ↑ | {
"A": "↓ ↓ ↓ normal",
"B": "↓ ↓ ↑ ↑",
"C": "Normal normal normal normal",
"D": "↓ ↓ ↓ ↓"
} | step1 | B | [
"year old woman",
"follow-up prenatal visit",
"weeks",
"gestation",
"weeks",
"gestation",
"ultrasonography showed increased nuchal translucency",
"pregnancy-associated plasma protein A",
"decreased",
"standard deviations",
"Chorionic villus sampling showed",
"XX karyotype",
"visit",
"ultra... |
A 9-year-old boy is brought to your office due to nausea and vomiting. He had 4 episodes of non-bloody and non-bilious emesis over the last 24 hours. He denies any diarrhea or changes in his diet; however, his best friend at school recently had viral gastroenteritis and his mother is concerned that he has the same bug.... | HLA-DR3 | {
"A": "HLA-B8",
"B": "HLA-DR2",
"C": "HLA-DR3",
"D": "No association with HLA system"
} | step1 | C | [
"year old boy",
"brought",
"office",
"nausea",
"vomiting",
"4 episodes of non bloody",
"non bilious emesis",
"24 hours",
"denies",
"diarrhea",
"changes in",
"diet",
"best friend",
"school recently",
"viral gastroenteritis",
"mother",
"concerned",
"same bug",
"notes",
"drinking ... |
Two days after hospital admission and surgical treatment for a cut on his right thigh from a sickle, a 35-year-old man has fever, chills, and intense pain. The wound is swollen. He had a similar injury 4 months ago that resolved following treatment with bacitracin ointment and daily dressings. He works on a farm on the... | Clostridium perfringens | {
"A": "Clostridium perfringens",
"B": "Pseudomonas aeruginosa",
"C": "Rhizopus oryzae",
"D": "Staphylococcus aureus"
} | step2&3 | A | [
"Two days",
"hospital admission",
"surgical treatment",
"cut",
"right thigh",
"35 year old man",
"fever",
"chills",
"intense pain",
"wound",
"swollen",
"similar injury 4 months",
"resolved following treatment",
"bacitracin ointment",
"daily dressings",
"works",
"farm",
"city",
"a... |
A 32-year-old woman is admitted to the emergency department for 36 hours of intense left-sided back pain that extends into her left groin. She reports that the pain started a day after a charitable 5 km (3.1 mi) marathon. The past medical history is relevant for multiple complaints of eye dryness and dry mouth. Physica... | Decreased renal excretion of hydrogen ions (H+) | {
"A": "Decreased bicarbonate renal absorption",
"B": "Carbonic acid accumulation",
"C": "Decreased renal excretion of hydrogen ions (H+)",
"D": "Decreased synthesis of ammonia (NH3)"
} | step1 | C | [
"year old woman",
"admitted",
"emergency department",
"36 hours of intense left-sided back pain",
"extends",
"left groin",
"reports",
"pain started",
"day",
"5 km",
"3.1 mi",
"marathon",
"past medical history",
"relevant",
"multiple complaints of eye dryness",
"dry mouth",
"Physical ... |
A 61-year-old man comes to the emergency department because of shortness of breath and right-sided chest pain for 3 days. The pain is sharp and worsens with deep inspiration. He has also had a fever and a cough productive of yellow sputum for 5 days. His temperature is 38.1°C (100.5°F), pulse is 85/min, respirations ar... | Chest tube placement | {
"A": "Intrapleural administration of deoxyribonuclease",
"B": "Pleural decortication",
"C": "Chest tube placement",
"D": "Thoracoscopic debridement"
} | step2&3 | C | [
"61 year old man",
"emergency department",
"of shortness",
"breath",
"right-sided chest pain",
"days",
"pain",
"sharp",
"worsens",
"deep inspiration",
"fever",
"cough productive",
"yellow",
"5 days",
"temperature",
"100",
"pulse",
"85 min",
"respirations",
"min",
"blood press... |
A 23-year-old primipara with no co-morbidities presents at 34 weeks gestation with edema and a moderate headache. Her vital signs are as follows: blood pressure, 147/90 mm Hg; heart rate, 82/min; respiratory rate, 16/min; and temperature, 36.6℃ (97.9℉). The physical examination is significant for a 2+ pitting edema. Th... | Liver transaminases | {
"A": "Hemoglobin",
"B": "Hematocrit",
"C": "Liver transaminases",
"D": "Creatinine"
} | step2&3 | C | [
"23 year old primipara",
"co-morbidities presents",
"weeks gestation",
"edema",
"moderate headache",
"vital signs",
"follows",
"blood pressure",
"90 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"97",
"physical examination",
"significant",
"2",
"p... |
An investigator is processing a blood sample from a human subject. A reagent is added to the sample and the solution is heated to break the hydrogen bonds between complementary base pairs. This solution is then cooled to allow artificial DNA primers in the solution to attach to the separated strands of the sample DNA m... | Polymerase chain reaction | {
"A": "Polymerase chain reaction",
"B": "Immunohistochemistry",
"C": "Northern blot",
"D": "Western blot"
} | step1 | A | [
"investigator",
"processing",
"blood sample",
"human subject",
"reagent",
"added",
"sample",
"solution",
"heated to break",
"hydrogen bonds",
"base pairs",
"solution",
"then cooled to allow artificial DNA primers",
"solution",
"attach",
"separated strands",
"sample DNA molecules",
... |
A 23-year-old woman presents to the emergency department complaining of nausea, vomiting, and abdominal pain. She has a 10-year history of type I diabetes mellitus treated with lispro and glargine. Upon questioning, she mentions that she stopped taking her insulin 3 days ago due to recent malaise and decreased appetite... | Total body potassium depletion | {
"A": "Signs of hypocalcemia",
"B": "Normal-to-high phosphate levels",
"C": "Total body potassium depletion",
"D": "Loss of sodium in urine is greater than free water loss"
} | step2&3 | C | [
"23 year old woman presents",
"emergency department",
"nausea",
"vomiting",
"abdominal pain",
"a 10 year history of type I diabetes mellitus treated with lispro",
"glargine",
"questioning",
"stopped taking",
"insulin 3 days",
"due to recent malaise",
"decreased appetite",
"denies recent weig... |
A newborn male is evaluated one minute after birth. He was born at 38 weeks gestation to a 28-year-old gravida 3 via vaginal delivery. The patient’s mother received sporadic prenatal care, and the pregnancy was complicated by gestational diabetes. The amniotic fluid was clear. The patient’s pulse is 70/min, and his bre... | Positive pressure ventilation and reassessment of Apgar score at 5 minutes | {
"A": "Chest compressions and bag-mask ventilation",
"B": "Positive pressure ventilation and reassessment of Apgar score at 5 minutes",
"C": "Supplemental oxygen via nasal cannula and reassessment of Apgar score at 5 minutes",
"D": "Endotracheal intubation and mechanical ventilation"
} | step2&3 | B | [
"newborn male",
"evaluated one minute after birth",
"born",
"weeks gestation",
"year old gravida 3",
"vaginal delivery",
"patients mother received sporadic prenatal care",
"pregnancy",
"complicated",
"gestational diabetes",
"amniotic fluid",
"clear",
"patients pulse",
"70 min",
"breathin... |
A 49-year-old male presents to his primary care physician for the first time in twelve years. His chief complaint is a new onset of diarrhea, which nothing seems to improve. He first noticed this diarrhea about a month ago. He complains of greasy stools, which leave a residue in his toilet bowl. Review of systems is no... | CT abdomen with IV contrast | {
"A": "d-Xylose absorption test",
"B": "CT abdomen with IV contrast",
"C": "EGD with biopsy of gastric mucosa",
"D": "Somatostatin receptor scintigraphy"
} | step2&3 | B | [
"year old male presents",
"primary care physician",
"first time",
"twelve years",
"chief complaint",
"new onset",
"diarrhea",
"to",
"first",
"diarrhea",
"month",
"greasy stools",
"leave",
"residue",
"toilet bowl",
"Review of systems",
"notable",
"alcohol consumption",
"cans",
"... |
A 13-year-old girl is referred to an oral surgeon after complaining of tooth pain, especially in the upper jaw. A review of her medical history reveals status post-surgical repair of a patent ductus arteriosus when she was 6 years old. At the clinic, her temperature is 37.0ºC (98.6°F), pulse is 90/min, respirations are... | Fibrillin-1 | {
"A": "Caveolin and the sarcoglycan proteins",
"B": "Emerin",
"C": "Lamin A",
"D": "Fibrillin-1"
} | step2&3 | D | [
"year old girl",
"referred",
"oral surgeon",
"tooth pain",
"upper jaw",
"review of",
"medical history reveals status post surgical repair of",
"patent ductus arteriosus",
"years old",
"clinic",
"temperature",
"98",
"pulse",
"90 min",
"respirations",
"min",
"blood pressure",
"mm Hg"... |
A 43-year-old type 1 diabetic woman who is poorly compliant with her diabetes medications presented to the emergency department with hemorrhage from her nose. On exam, you observe the findings shown in figure A. What is the most likely explanation for these findings? | Rhizopus infection | {
"A": "Cryptococcal infection",
"B": "Candida infection",
"C": "Rhizopus infection",
"D": "Gram negative bacterial infection"
} | step1 | C | [
"year old type 1 diabetic woman",
"poorly compliant",
"diabetes medications presented",
"emergency department",
"hemorrhage from",
"nose",
"exam",
"observe",
"findings shown",
"most likely explanation",
"findings"
] |
A 64-year-old man presents to the emergency department with the complaints of nausea and muscle weakness for the past 24 hours. He further adds that he is significantly aware of his heartbeat. He was diagnosed with type II diabetes mellitus 20 years ago and hypertension 15 years ago for which he is taking metformin and... | Decreased aldosterone secretion | {
"A": "Decreased aldosterone secretion",
"B": "Impaired distal tubule acidification in the kidneys",
"C": "Decreased bicarbonate reabsorption in the proximal tubules",
"D": "Metformin overdose"
} | step1 | A | [
"64 year old man presents",
"emergency department",
"complaints",
"nausea",
"muscle weakness",
"past 24 hours",
"further adds",
"aware of",
"heartbeat",
"diagnosed",
"type II diabetes mellitus 20 years",
"hypertension",
"years",
"taking metformin",
"captopril",
"occasionally takes napr... |
A 56-year-old woman is admitted to the hospital for progressive bilateral lower extremity weakness and absent deep tendon reflexes. Cerebrospinal fluid analysis shows an elevated protein concentration and a normal cell count. Treatment with plasmapheresis is initiated, after which her symptoms start to improve. Four we... | Increase in length constant | {
"A": "Increase in length constant",
"B": "Decrease in transmembrane resistance",
"C": "Increase in axonal capacitance",
"D": "Increase in axial resistance"
} | step1 | A | [
"year old woman",
"admitted",
"hospital",
"progressive bilateral lower extremity weakness",
"absent deep tendon reflexes",
"Cerebrospinal fluid analysis shows",
"elevated",
"normal cell count",
"Treatment",
"plasmapheresis",
"initiated",
"symptoms start to",
"Four weeks",
"initial presenta... |
A medical research study is beginning to evaluate the positive predictive value of a novel blood test for non-Hodgkin’s lymphoma. The diagnostic arm contains 700 patients with NHL, of which 400 tested positive for the novel blood test. In the control arm, 700 age-matched control patients are enrolled and 0 are found po... | 400 / (400 + 0) | {
"A": "700 / (700 + 0)",
"B": "700 / (400 + 400)",
"C": "400 / (400 + 300)",
"D": "400 / (400 + 0)"
} | step2&3 | D | [
"medical",
"beginning to evaluate",
"positive predictive value of",
"novel blood test",
"non-Hodgkins lymphoma",
"diagnostic arm contains 700 patients",
"NHL",
"400 tested positive",
"novel blood test",
"control arm",
"700 age matched control patients",
"enrolled",
"0",
"found positive",
... |
A 2-month-old boy is brought to his pediatrician’s office to be evaluated for new onset seizures and poor weight gain. The patient’s father says he is unable to track with his eyes and is unresponsive to verbal stimuli. The patient is hypotonic on physical exam. Further studies show elevated serum lactate levels and el... | Leucine | {
"A": "Methionine",
"B": "Isoleucine",
"C": "Arginine",
"D": "Leucine"
} | step1 | D | [
"2 month old boy",
"brought",
"pediatricians office to",
"evaluated",
"new onset seizures",
"poor weight gain",
"patients father",
"unable to track",
"eyes",
"unresponsive to verbal stimuli",
"patient",
"hypotonic",
"physical exam",
"Further studies show elevated serum lactate levels",
"... |
A previously healthy 3-year-old girl is brought to the physician by her parents for the evaluation of recurrent episodes of pain in her left wrist and right knee for 4 months. She has not had any trauma to the knee or any previous problems with her joints. She attends daycare. Her mother has rheumatoid arthritis. Her v... | Blindness | {
"A": "Airway obstruction",
"B": "Inflammation of sacroiliac joints",
"C": "Coronary artery aneurysm",
"D": "Blindness"
} | step2&3 | D | [
"healthy",
"year old girl",
"brought",
"physician",
"parents",
"evaluation of recurrent episodes",
"pain",
"left wrist",
"right knee",
"months",
"not",
"trauma",
"knee",
"previous problems",
"joints",
"attends daycare",
"mother",
"rheumatoid arthritis",
"vital signs",
"normal l... |
A 2-month study is conducted to assess the relationship between the consumption of natural licorice and the development of hypokalemia. A total of 100 otherwise healthy volunteers are enrolled. Half of the volunteers are asked to avoid licorice and the other half are asked to consume licorice daily, along with their re... | Mode | {
"A": "Mode",
"B": "Standard error",
"C": "Variance",
"D": "Mean"
} | step1 | A | [
"2 month study",
"conducted to assess",
"relationship",
"consumption",
"natural licorice",
"development",
"hypokalemia",
"total",
"100",
"healthy volunteers",
"enrolled",
"Half",
"volunteers",
"to",
"licorice",
"half",
"to",
"licorice daily",
"regular diet",
"volunteers",
"mo... |
A previously healthy 23-year-old African-American man comes to the physician because of a painless swelling on the left side of his jaw for 2 months. It has been progressively increasing in size and is draining thick, foul-smelling fluid. He does not have fever or weight loss. He had a molar extracted around 3 months a... | Doxycycline | {
"A": "Surgical resection of the mass",
"B": "Doxycycline",
"C": "Trimethoprim-sulfamethaxazole",
"D": "Cephalexin\n\""
} | step2&3 | B | [
"healthy 23 year old African-American man",
"physician",
"of",
"painless swelling",
"left side",
"jaw",
"2 months",
"increasing in size",
"draining thick",
"smelling fluid",
"not",
"fever",
"weight loss",
"molar extracted",
"months ago",
"One year",
"generalized rash",
"receiving a... |
A 69-year-old man presents to the emergency department with shortness of breath that has been worsening over the past month. The patient states that he has had worsening shortness of breath that has progressed to shortness of breath with simple activities and minor exertion. When he was unable to climb the stairs to hi... | Hypertension | {
"A": "Hypertension",
"B": "Hyperkalemia",
"C": "Hypokalemia",
"D": "Visual halos"
} | step2&3 | A | [
"69 year old man presents",
"emergency department",
"shortness of breath",
"worsening",
"past month",
"patient states",
"worsening shortness of breath",
"progressed to shortness of breath",
"simple activities",
"minor exertion",
"unable to climb",
"stairs",
"house today",
"to",
"emergenc... |
A 35-year-old woman, gravida 1, para 1, who gave birth at 39 weeks' gestation via cesarean section under general anesthesia 2 days ago presents with acute chest pain and difficulty breathing. The pregnancy was complicated by hypothyroidism and treated with L-thyroxine. The patient has a history of mild asthma. There is... | Collapse of alveoli | {
"A": "Bacterial blood infection",
"B": "Chronic inflammation of the respiratory system",
"C": "Collapse of alveoli",
"D": "Bacterial infection of the alveolar space"
} | step2&3 | C | [
"35 year old woman",
"gravida 1",
"para 1",
"gave birth",
"weeks",
"gestation",
"cesarean section",
"general anesthesia 2 days",
"presents",
"acute chest pain",
"difficulty breathing",
"pregnancy",
"complicated",
"hypothyroidism",
"treated with",
"thyroxine",
"patient",
"history of... |
A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations ... | Sertraline | {
"A": "Lithium",
"B": "Olanzapine",
"C": "Quetiapine",
"D": "Sertraline"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"found naked",
"square",
"patient stated",
"people",
"material desires",
"found destroying objects",
"temperature",
"99",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"98",
"room ai... |
A 26-year-old woman presents to your clinic with complaints of increasing muscle fatigue that worsens after periods of sustained activity. She also reports both ptosis and diplopia that make reading in the late afternoon and evenings difficult. An edrophonium test is performed and is positive, demonstrating resolution ... | 3rd branchial pouch | {
"A": "1st branchial pouch",
"B": "2nd branchial cleft",
"C": "3rd branchial pouch",
"D": "4th branchial pouch"
} | step1 | C | [
"year old woman presents",
"clinic",
"complaints",
"increasing muscle fatigue",
"worsens",
"periods",
"sustained activity",
"reports",
"ptosis",
"diplopia",
"make reading",
"late afternoon",
"evenings difficult",
"edrophonium test",
"performed",
"positive",
"resolution",
"patient's... |
A 33-year-old man living in the United States recently consumed a meal mostly consisting of raw shellfish that his girlfriend brought on her trip to Asia. After 2 days, he experienced a sudden onset of diarrhea and vomiting with severe abdominal cramps while his girlfriend developed mild diarrhea just several hours lat... | Comma-shaped rods | {
"A": "Comma-shaped rods",
"B": "Seagull-shaped rods",
"C": "Spiral-shaped rods",
"D": "Corkscrew-shaped rods"
} | step1 | A | [
"year old man living",
"United States recently",
"meal mostly consisting",
"raw shellfish",
"girlfriend brought",
"trip",
"Asia",
"2 days",
"experienced",
"sudden onset",
"diarrhea",
"vomiting",
"severe abdominal cramps",
"girlfriend",
"mild diarrhea",
"hours later",
"diarrhea",
"l... |
A 5-year-old boy presents to the emergency department with sudden onset nausea and vomiting that started 2 hours ago. The patient's parents can not recall any inciting event and state that he very suddenly started acting irritable, started vomiting, and experienced 1 episode of diarrhea. His temperature is 98.7°F (37.1... | Deferoxamine | {
"A": "Deferoxamine",
"B": "Dialysis",
"C": "Fomepizole",
"D": "Sodium bicarbonate"
} | step2&3 | A | [
"5 year old boy presents",
"emergency department",
"sudden onset nausea",
"vomiting",
"started 2 hours",
"patient's parents",
"not recall",
"event",
"state",
"very",
"started acting irritable",
"started vomiting",
"experienced 1 episode of diarrhea",
"temperature",
"98",
"blood pressur... |
A 43-year-old man is referred by his family physician because his urine dipstick reveals 3+ protein and urinalysis reveals 1-2 red cells/high power field, but is otherwise negative. He does not have any current complaints. His family history is irrelevant. He denies smoking and alcohol use. His temperature is 36.7°C (9... | Repeat the urine dipstick test | {
"A": "24-hour urine collection",
"B": "Repeat the urine dipstick test",
"C": "Urine culture",
"D": "Reassurance"
} | step2&3 | B | [
"year old man",
"referred by",
"family physician",
"urine dipstick reveals 3",
"protein",
"urinalysis reveals 1-2 red cells/high power field",
"negative",
"not",
"current complaints",
"family history",
"denies smoking",
"alcohol use",
"temperature",
"36",
"98",
"blood pressure",
"mm ... |
A 5-year-old boy is brought to the emergency room by his parents due to worsening cough, fever, and difficulty breathing in the past 2 days. Physical exam reveals a barking cough and use of accessory muscles for breathing. After a full clinical workup, he is diagnosed with an upper respiratory infection caused by a par... | Chest radiograph showing narrowing of upper trachea and subglottis | {
"A": "Chest radiograph showing narrowing of upper trachea and subglottis",
"B": "Inflammation and swelling of the parotid glands and testes",
"C": "Photophobia, hypersalivation, and dysphagia",
"D": "Postauricular lymphadenopathy and rash starting on the face"
} | step1 | A | [
"5 year old boy",
"brought",
"emergency room",
"parents due to worsening cough",
"fever",
"difficulty breathing",
"past 2 days",
"Physical exam reveals",
"barking cough",
"use of accessory muscles",
"breathing",
"full clinical workup",
"diagnosed",
"upper respiratory infection caused",
"... |
A 35-year-old man comes to the physician because of fatigue and generalized weakness for the past year. He has noticed he has been having fewer bowel movements. He has had pain with defecation and small amounts of blood when wiping. He has not lost weight despite increased efforts to diet and exercise. He has had no fe... | Elevated serum low-density lipoprotein | {
"A": "Elevated serum low-density lipoprotein",
"B": "Hyperglycemia",
"C": "Decreased serum creatinine",
"D": "Decreased serum creatine kinase\n\""
} | step2&3 | A | [
"35 year old man",
"physician",
"fatigue",
"generalized weakness",
"past year",
"fewer bowel movements",
"pain",
"defecation",
"small amounts",
"blood",
"wiping",
"not lost",
"increased efforts",
"diet",
"exercise",
"fever",
"throat pain",
"difficulty swallowing",
"temperature",
... |
A 31-year-old nurse presents to the emergency department with palpitations, sweating, and jitteriness. She denies chest pain, shortness of breath, and recent illness. She states that she experienced weakness in her arms and legs and a tingling sensation in her fingers before the palpitations occurred. Medical and surgi... | Fingerstick blood glucose | {
"A": "TSH levels",
"B": "Urine metanephrines",
"C": "Fingerstick blood glucose",
"D": "Echocardiogram"
} | step2&3 | C | [
"31 year old nurse presents",
"emergency department",
"palpitations",
"sweating",
"jitteriness",
"denies chest pain",
"shortness of breath",
"recent illness",
"states",
"experienced weakness",
"arms",
"legs",
"tingling sensation in",
"fingers",
"palpitations occurred",
"Medical",
"su... |
A cardiologist is studying how a new virus that infects the heart affects the electrical conduction system of the cardiac myocytes. He decides to obtain electrocardiograms on patients with this disease in order to see how the wave patterns and durations change over time. While studying these records, he asks a medical ... | Normal duration defined as less than 120 milliseconds | {
"A": "Becomes prominent in states of hypokalemia",
"B": "Elevated in patients with full thickness ischemic injury of the heart",
"C": "Normal duration defined as less than 120 milliseconds",
"D": "Normal duration defined as less than 200 milliseconds"
} | step1 | C | [
"cardiologist",
"studying",
"new virus",
"infects",
"heart affects",
"electrical conduction system",
"cardiac myocytes",
"to obtain electrocardiograms",
"patients",
"disease",
"order to see",
"wave patterns",
"durations change",
"time",
"studying",
"records",
"medical student",
"wo... |
During a study on chronic obstructive pulmonary disease (COPD), researchers discovered an agent that markedly inhibits the carbon dioxide-carrying capacity of the venous blood. Which of the following is the most likely mechanism underlying this agent’s effects? | Inhibition of erythrocyte carbonic anhydrase | {
"A": "Decreased capillary permeability to carbon dioxide",
"B": "Decreased amount of dissolved plasma carbon dioxide",
"C": "Inhibition of erythrocyte carbonic anhydrase",
"D": "Increased solubility of carbon dioxide in plasma"
} | step1 | C | [
"study",
"chronic obstructive pulmonary disease",
"researchers discovered",
"agent",
"markedly inhibits",
"carbon dioxide carrying capacity",
"venous blood",
"following",
"most likely mechanism",
"agents effects"
] |
A 38-year-old female presents to her primary care physician with complaints of several episodes of palpitations accompanied by panic attacks over the last month. She also is concerned about many instances over the past few weeks where food has been getting stuck in her throat and she has had trouble swallowing. She den... | Multiple endocrine neoplasia (MEN) IIa | {
"A": "Familial medullary thyroid cancer (FMTC)",
"B": "Li-Fraumeni syndrome",
"C": "Multiple endocrine neoplasia (MEN) IIa",
"D": "Multiple endocrine neoplasia (MEN) IIb"
} | step1 | C | [
"year old female presents",
"primary care physician",
"complaints of",
"episodes",
"palpitations",
"panic attacks",
"last month",
"concerned",
"instances",
"past",
"weeks",
"food",
"getting",
"throat",
"swallowing",
"denies",
"prior medical problems",
"reports",
"family history o... |
A 55-year-old woman presents to her family physician with a 1-week history of dizziness. She experiences spinning sensations whenever she lies down and these sensations increase when she turns her head to the right. These episodes are transient, intermittent, last for less than a minute, occur multiple times in a day, ... | Reassurance and vestibular suppressants | {
"A": "Broad-spectrum antibiotics",
"B": "High dose steroids",
"C": "MRI of the brain with gadolinium",
"D": "Reassurance and vestibular suppressants"
} | step2&3 | D | [
"55 year old woman presents",
"family physician",
"1-week history",
"dizziness",
"experiences spinning sensations",
"sensations increase",
"turns",
"head",
"right",
"episodes",
"transient",
"intermittent",
"minute",
"occur multiple times",
"day",
"associated with nausea",
"episodes",... |
A 53-year-old white man presents to the emergency department because of progressive fatigue, shortness of breath on exertion, and a sensation of his heart pounding for the past 2 weeks. He has had high blood pressure for 8 years for which he takes hydrochlorothiazide. He denies any history of drug abuse or smoking, but... | Congestive heart failure | {
"A": "Arrhythmias",
"B": "Congestive heart failure",
"C": "Infective endocarditis",
"D": "Sudden death"
} | step2&3 | B | [
"year old white man presents",
"emergency department",
"progressive fatigue",
"shortness of breath",
"exertion",
"sensation",
"heart pounding",
"past 2 weeks",
"high blood pressure",
"years",
"takes hydrochlorothiazide",
"denies",
"history of drug abuse",
"smoking",
"drinks alcohol",
"... |
A 16-year-old girl comes to the physician for a regular health visit. She feels healthy. She lives with her parents at home. She says that the relationship with her parents has been strained lately because they ""do not approve"" of her new boyfriend. She recently became sexually active with her boyfriend and requests ... | Discuss all effective contraceptive options | {
"A": "Conduct HIV screening",
"B": "Discuss all effective contraceptive options",
"C": "Ask patient to obtain parental consent before discussing any contraceptive options",
"D": "Recommend an oral contraceptive pill"
} | step2&3 | B | [
"year old girl",
"physician",
"regular health visit",
"feels healthy",
"lives with",
"parents at home",
"relationship",
"parents",
"strained",
"not approve",
"new boyfriend",
"recently",
"sexually active",
"boyfriend",
"requests",
"prescription for",
"oral contraception",
"not",
... |
A 76-year-old man is brought to his geriatrician by his daughter, who reports that he has been "losing his memory." While the patient previously performed all household duties by himself, he has recently had several bills that were unpaid. He also called his daughter several instances after getting lost while driving a... | Lumbar puncture | {
"A": "Memantine",
"B": "Lumbar puncture",
"C": "Carbidopa/Levodopa",
"D": "Warfarin"
} | step2&3 | B | [
"76 year old man",
"brought",
"geriatrician",
"daughter",
"reports",
"memory",
"patient",
"performed",
"household",
"recently",
"several bills",
"called",
"daughter",
"instances",
"getting lost",
"driving",
"accidents",
"getting",
"toilet",
"exam",
"patient",
"alert",
"pe... |
A 63-year-old man comes to the physician because of increasing generalized fatigue for 3 months. He is having more difficulty with keeping up with his activities of daily living and has lost 2.5 kg (5.5 lb) over the past month. He has hypertension and hyperlipidemia. He does not smoke and drinks two to three beers on w... | Acute myeloid leukemia | {
"A": "Acute myeloid leukemia",
"B": "Hairy cell leukemia",
"C": "Chronic lymphocytic leukemia",
"D": "Acute lymphoblastic leukemia"
} | step2&3 | A | [
"63 year old man",
"physician",
"of increasing generalized fatigue",
"months",
"more difficulty",
"keeping",
"activities of daily living",
"lost 2.5 kg",
"5.5",
"past month",
"hypertension",
"hyperlipidemia",
"not smoke",
"drinks two",
"three beers",
"weekends",
"medications include ... |
A 37-year-old woman presents with an inability to void in the hours after giving birth to her first child via vaginal delivery. Her delivery involved the use of epidural anesthesia as well as pelvic trauma from the use of forceps. She is currently experiencing urinary leakage and complains of increased lower abdominal ... | Urethral catheterization | {
"A": "Antimuscarinic drugs",
"B": "Pelvic floor muscle strengthening",
"C": "Pessary insertion",
"D": "Urethral catheterization"
} | step2&3 | D | [
"year old woman presents",
"void",
"hours",
"giving birth",
"first child",
"vaginal delivery",
"delivery involved",
"use of epidural anesthesia",
"pelvic trauma",
"use of forceps",
"currently experiencing urinary leakage",
"increased lower abdominal",
"following",
"most appropriate treatme... |
A 45-year-old woman comes to the physician because of a 5-kg (11-lb) weight loss and difficulty swallowing. She is able to swallow liquids without difficulty but feels like solid foods get stuck in her throat. Physical examination shows taut skin and limited range of motion of the fingers. There are telangiectasias ove... | Arteriolar wall thickening in the kidney | {
"A": "Amyloid deposits in the liver",
"B": "Budding yeasts on the oral mucosa",
"C": "Parasite nests in the myocardium",
"D": "Arteriolar wall thickening in the kidney"
} | step1 | D | [
"year old woman",
"physician",
"5 kg",
"weight loss",
"difficulty swallowing",
"able to swallow liquids",
"difficulty",
"feels",
"solid foods",
"throat",
"Physical examination shows taut skin",
"limited range of motion of",
"fingers",
"telangiectasias",
"cheeks",
"esophageal motility s... |
A 5-year-old girl presents to the emergency room with acute airway obstruction. Physical examination shows cough, episodic wheezing, and excess mucus production. Increased quantities of which of the following would predispose the child to extrinsic asthma: | Th2 lymphocytes | {
"A": "Treg lymphocytes",
"B": "Th1 lymphocytes",
"C": "Th2 lymphocytes",
"D": "Kupffer cells"
} | step1 | C | [
"5 year old girl presents",
"emergency room",
"acute airway",
"Physical examination shows cough",
"episodic wheezing",
"excess mucus production",
"Increased quantities",
"following",
"child",
"extrinsic asthma"
] |
A 68-year-old man, with a recent ischemic stroke due to a right middle cerebral artery thromboembolism, presents for evaluation. In addition to the abnormal neurologic findings, there are significant hepatosplenomegaly and multiple lymphadenopathies. Laboratory findings are significant for the following:
Hemoglobin 9.... | Hepatitis C virus | {
"A": "Hepatitis C virus",
"B": "Human herpesvirus 8",
"C": "Human immunodeficiency virus (HIV)",
"D": "Epstein-Barr virus"
} | step1 | A | [
"68 year old man",
"recent ischemic stroke due to",
"right middle cerebral artery thromboembolism",
"presents",
"evaluation",
"abnormal neurologic findings",
"significant hepatosplenomegaly",
"multiple lymphadenopathies",
"Laboratory findings",
"significant",
"following",
"Hemoglobin",
"9.5 ... |
A 78-year-old woman presents with difficulty swallowing and retrosternal chest pain for the past couple of weeks. She says the pain radiates to the epigastric region and increases whenever she eats or drinks anything. She says the pain is not aggravated by exertion, and she denies any shortness of breath, nausea or vom... | Start esomeprazole, temporarily stop risedronate | {
"A": "Refer her for an upper GI endoscopy",
"B": "Start her on ranitidine",
"C": "Start esomeprazole, temporarily stop risedronate",
"D": "Start triple therapy with esomeprazole, metronidazole, and clarithromycin"
} | step1 | C | [
"year old woman presents",
"difficulty swallowing",
"retrosternal",
"past couple of weeks",
"pain radiates",
"epigastric region",
"increases",
"eats",
"drinks",
"pain",
"not aggravated by exertion",
"denies",
"shortness of breath",
"nausea",
"vomiting",
"cough",
"sore throat",
"wei... |
Three days after delivering a baby at 36 weeks' gestation by lower segment transverse cesarean section due to abruptio placentae, a 29-year-old primigravid woman develops fever, chills, and a heavy feeling in her breasts. She also has nausea and abdominal pain. Her temperature is 39.3°C (102.7°F), pulse is 101/min, and... | IV clindamycin and gentamicin | {
"A": "Hysterectomy",
"B": "Dilation and curettage",
"C": "IV clindamycin and gentamicin",
"D": "Heparin infusion"
} | step2&3 | C | [
"Three days",
"delivering",
"baby",
"36 weeks",
"estation ",
"ower egment ransverse esarean ue to bruptio placentae,",
"9- ear- ld rimigravid oman ",
"ever,",
"hills,",
"eavy feeling ",
"reasts.",
"ausea ",
"bdominal pain.",
"emperature ",
"C ",
"ulse ",
"in,",
"lood pressur... |
A 25-year-old man is admitted to the intensive care unit with confusion and severe dyspnea at rest which started 3 hours ago. The symptoms worse when the patient lies down and improve in the sitting position. The patient has a history of cocaine abuse. The patient’s blood pressure is 75/50 mm Hg, the heart rate is 95/m... | Ventricular arrhythmias | {
"A": "Supraventricular arrhythmia",
"B": "Ventricular arrhythmias",
"C": "Third grade AV-blockade",
"D": "QT-prolongation"
} | step1 | B | [
"year old man",
"admitted to",
"intensive care unit",
"confusion",
"severe dyspnea at rest",
"started 3 hours",
"symptoms worse",
"patient",
"sitting position",
"patient",
"history of cocaine abuse",
"patients blood pressure",
"75 50 mm Hg",
"heart rate",
"95 min",
"respiratory rate",
... |
A previously healthy 55-year-old man comes to the physician because of a 5-month history of progressively worsening substernal chest pain after meals. The pain occurs almost daily, is worst after eating spicy food or drinking coffee, and often wakes him up from sleep at night. He has not had any weight loss. He has smo... | Esophageal stricture | {
"A": "Esophageal squamous cell carcinoma",
"B": "Esophageal stricture",
"C": "Sliding hiatal hernia",
"D": "Pyloric stenosis"
} | step2&3 | B | [
"healthy 55 year old man",
"physician",
"5 month history",
"worsening substernal chest pain",
"meals",
"pain occurs almost daily",
"worst",
"eating spicy food",
"drinking coffee",
"often wakes",
"sleep",
"night",
"not",
"weight loss",
"smoked 1 pack",
"cigarettes daily",
"35 years",
... |
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