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 21-year-old woman comes to the physician because of a 4-day history of abdominal cramps and bloody diarrhea 5 times per day. Her symptoms began after she ate an egg sandwich from a restaurant. Her vital signs are within normal limits. Physical examination shows diffuse abdominal tenderness. Stool culture shows gram-n... | Prolonged fecal excretion of the pathogen | {
"A": "Self-limiting systemic inflammatory response",
"B": "Thrombocytopenia and hemolytic anemia",
"C": "Orange discoloration of bodily fluids",
"D": "Prolonged fecal excretion of the pathogen"
} | step1 | D | [
"21-year-old woman",
"physician",
"4-day history",
"abdominal cramps",
"bloody diarrhea",
"times per day",
"symptoms began",
"ate",
"egg sandwich",
"restaurant",
"vital signs",
"normal",
"Physical examination shows diffuse abdominal tenderness",
"Stool culture shows gram-negative rods",
... |
A 30-year-old woman comes to the physician because of difficulty sleeping. She is afraid of falling asleep and gets up earlier than desired. Four months ago, she was the driver in a car accident that resulted in the death of her unborn child. She has vivid nightmares of the event and reports that she frequently re-expe... | Post-traumatic stress disorder | {
"A": "Acute stress disorder",
"B": "Major depressive disorder",
"C": "Post-traumatic stress disorder",
"D": "Adjustment disorder"
} | step1 | C | [
"30 year old woman",
"physician",
"difficulty sleeping",
"afraid",
"falling asleep",
"gets",
"earlier",
"desired",
"Four months",
"driver",
"car",
"resulted",
"death of",
"unborn child",
"vivid nightmares",
"event",
"reports",
"frequently re experiences",
"accident",
"blames",
... |
A 38-year-old woman is diagnosed with a stage IIIa infiltrating ductal carcinoma involving the left breast. The tumor is ER/PR positive, HER-2 negative, poorly differentiated Bloom-Richardson grade 3. 4/20 regional nodes are positive. The patient undergoes a lumpectomy with axillary lymph node dissection, followed by c... | Doxorubicin | {
"A": "Doxorubicin",
"B": "Radiation therapy",
"C": "Cyclophosphamide",
"D": "Myocarditis"
} | step1 | A | [
"year old woman",
"diagnosed",
"stage IIIa infiltrating ductal carcinoma involving",
"left breast",
"tumor",
"ER PR positive",
"HER-2 negative",
"poorly differentiated",
"Richardson grade",
"4 20 regional nodes",
"positive",
"patient",
"lumpectomy",
"axillary lymph node dissection",
"fol... |
A 4-day-old male newborn delivered at 39 weeks' gestation is evaluated because of poor feeding, recurrent vomiting, and lethargy. Physical examination shows tachypnea with subcostal retractions. An enzyme assay performed on a liver biopsy specimen shows decreased activity of carbamoyl phosphate synthetase I. This enzym... | Aspartate
" | {
"A": "N-acetylglutamate",
"B": "Homocysteine",
"C": "Phenylalanine",
"D": "Aspartate\n\""
} | step1 | D | [
"4 day old male newborn delivered",
"weeks",
"gestation",
"evaluated",
"poor feeding",
"recurrent vomiting",
"lethargy",
"Physical examination shows tachypnea",
"subcostal retractions",
"enzyme assay performed",
"liver biopsy specimen shows decreased activity",
"carbamoyl phosphate synthetase ... |
A 60-year-old patient is at his physician’s office for a routine health maintenance exam. The patient has a past medical history of osteoarthritis in his right knee and GERD that is well-controlled with over the counter medication. On a fasting lipid profile, he is found to have high cholesterol. The patient is started... | Apolipoprotein B-100 | {
"A": "Apolipoprotein A-I",
"B": "Apolipoprotein B-48",
"C": "Apolipoprotein B-100",
"D": "Apolipoprotein C-II"
} | step1 | C | [
"60 year old patient",
"physicians office",
"routine health maintenance exam",
"patient",
"past medical",
"right knee",
"GERD",
"well-controlled",
"over the counter medication",
"fasting lipid profile",
"found to",
"high cholesterol",
"patient",
"started",
"daily atorvastatin to",
"ris... |
A 19-year-old girl comes to the physician for evaluation after a minor motor vehicle collision. While driving down a residential street, a young boy ran out in front of her, chasing after a ball. She applied the brakes of her vehicle and avoided hitting the boy, but then she suddenly experienced generalized weakness th... | Sodium oxybate | {
"A": "Guanfacine",
"B": "Sodium oxybate",
"C": "Amphetamine",
"D": "Fluoxetine"
} | step1 | B | [
"year old girl",
"physician",
"evaluation",
"minor motor vehicle collision",
"driving",
"residential street",
"young boy ran out",
"front",
"ball",
"applied",
"brakes",
"vehicle",
"hitting",
"boy",
"then",
"experienced generalized weakness",
"unable to operate",
"vehicle",
"low s... |
A 55-year-old man presents to the emergency department complaining of mild vision changes, dizziness, and severe pain in the chest for the past hour. He has also been experiencing nausea since this morning and has already vomited twice. Past medical history includes poorly controlled type 2 diabetes and end-stage renal... | Diagram B | {
"A": "Diagram A",
"B": "Diagram B",
"C": "Diagram C",
"D": "Diagram E"
} | step1 | B | [
"55 year old man presents",
"emergency department",
"mild vision changes",
"dizziness",
"severe pain in the chest",
"past hour",
"experiencing nausea",
"morning",
"vomited twice",
"Past medical history includes poorly controlled type 2 diabetes",
"end-stage renal disease requiring dialysis",
"... |
A 21-year-old woman comes to the physician because of multiple painful, purulent ulcers she noticed on her vulva 2 days ago. The patient has not had fever or burning with urination. She has no history of similar lesions. She had a chlamydial infection at 17 years of age that was treated with antibiotics. Her immunizati... | Chancroid | {
"A": "Chancroid",
"B": "Genital herpes",
"C": "Chancre",
"D": "Lymphogranuloma venereum"
} | step2&3 | A | [
"21-year-old woman",
"physician",
"multiple painful",
"purulent ulcers",
"vulva 2 days",
"patient",
"not",
"fever",
"burning",
"urination",
"history",
"similar lesions",
"chlamydial infection",
"years",
"age",
"treated with antibiotics",
"immunizations",
"date",
"sexually active"... |
A 55-year-old woman presents to the clinic with joint pain and swelling of her hands. She reports that the pain lasts for about an hour in the morning and improves as her joints ‘loosen up’. This condition has been bothering her for about 2 years but has recently been impacting her daily routine. She has not seen a doc... | Ragocytes | {
"A": "Ragocytes",
"B": "Monosodium urate crystals",
"C": "Calcium pyrophosphate",
"D": "High lymphocyte count"
} | step2&3 | A | [
"55 year old woman presents",
"clinic",
"joint pain",
"swelling of",
"hands",
"reports",
"pain",
"hour",
"morning",
"improves",
"joints loosen",
"condition",
"about",
"years",
"recently",
"impacting",
"daily routine",
"not seen",
"doctor",
"years",
"Past medical history",
"... |
A 17-year-old girl is brought to the emergency department by her father with fever, chills, and a body rash. Her father reports that 3 days ago, his daughter underwent surgery for a deviated nasal septum. Since then, she has been "sleepy" and in moderate pain. When the patient’s father came home from work today, he fou... | Polyclonal T-cell activation | {
"A": "Bacterial lysis",
"B": "Circulating endotoxin",
"C": "Opioid receptor stimulation",
"D": "Polyclonal T-cell activation"
} | step1 | D | [
"year old girl",
"brought",
"emergency department",
"father",
"fever",
"chills",
"body rash",
"father reports",
"3 days",
"daughter",
"surgery",
"deviated nasal septum",
"Since then",
"sleepy",
"moderate pain",
"patients father",
"home",
"work today",
"found",
"patient",
"shi... |
A 3-year-old girl is brought to the emergency department because of chest pain for 2 hours. Eight days ago, she was admitted to the hospital for treatment of low-grade fever, malaise, and sore throat. The hospitalization was complicated by pharyngitis with pseudomembrane formation and severe cervical lymphadenopathy br... | Immunoglobulin that targets circulating proteins | {
"A": "Denatured bacterial toxin that contains an intact receptor binding site",
"B": "Electrolyte that reduces cardiomyocyte excitability",
"C": "Antibiotic that binds to penicillin-binding protein 3",
"D": "Immunoglobulin that targets circulating proteins"
} | step1 | D | [
"3 year old girl",
"brought",
"emergency department",
"of chest pain",
"2 hours",
"Eight days",
"admitted",
"hospital",
"treatment",
"low-grade fever",
"malaise",
"sore throat",
"hospitalization",
"complicated",
"pharyngitis",
"pseudomembrane formation",
"severe cervical lymphadenopa... |
A 59-year-old man comes to the clinic for an annual well-exam. He was lost to follow-up for the past 3 years due to marital issues but reports that he feels fine. The patient reports, “I feel tired but it is probably because I am getting old. I do feel a little feverish today - I think I got a cold.” His past medical h... | Leukocyte alkaline phosphatase | {
"A": "C-reactive protein",
"B": "Erythrocyte sedimentation rate",
"C": "Leukocyte alkaline phosphatase",
"D": "Magnetic resonance imaging of the chest"
} | step1 | C | [
"59 year old man",
"clinic",
"annual well exam",
"lost to follow-up",
"past",
"years",
"marital issues",
"reports",
"feels fine",
"patient reports",
"I feel tired",
"probably",
"I",
"getting old",
"I",
"feel",
"little feverish today",
"I think I got",
"cold",
"past medical hist... |
Which of the following cells in the body depends on dynein for its unique functioning? | Fallopian tube mucosal cell | {
"A": "Lower esophageal mucosal cell",
"B": "Fallopian tube mucosal cell",
"C": "Small intestinal mucosal cell",
"D": "Adipocyte"
} | step1 | B | [
"following cells",
"body depends",
"dynein",
"unique functioning"
] |
A 36-year-old man comes to the clinical for “bumps under his nipples.” He is anxious that this could be breast cancer as his sister was just recently diagnosed. Past medical history is unremarkable except for an appendectomy at age 13. He currently works as a personal trainer and reports a diet that consists mainly of ... | Testicular atrophy | {
"A": "Fluid wave",
"B": "Palmar erythema",
"C": "Spider angiomas",
"D": "Testicular atrophy"
} | step1 | D | [
"36 year old man",
"clinical",
"nipples",
"anxious",
"breast cancer",
"sister",
"recently diagnosed",
"Past medical history",
"unremarkable",
"appendectomy",
"age",
"currently works",
"personal trainer",
"reports",
"diet",
"consists",
"meat",
"patient reports drinking 1-2 beers",
... |
A 60-year-old man comes to the emergency department because of recurrent episodes of fatigue, palpitations, nausea, and diaphoresis over the past 6 months. The episodes have become more frequent in the last 2 weeks and he has missed work several times because of them. His symptoms usually improve after he drinks some j... | 72-hour fasting test | {
"A": "Oral glucose tolerance test",
"B": "24-hour urine catecholamine test",
"C": "72-hour fasting test",
"D": "Water deprivation test"
} | step2&3 | C | [
"60 year old man",
"emergency department",
"of recurrent episodes",
"fatigue",
"palpitations",
"nausea",
"diaphoresis",
"past 6 months",
"episodes",
"more frequent",
"2 weeks",
"missed work several times",
"symptoms usually",
"drinks",
"juice",
"rests",
"2 kg",
"4.5",
"weight gai... |
A 75-year-old woman is brought to the emergency department by her daughter because of shortness of breath and a productive cough with blood-tinged sputum for the past 24 hours. Five days ago, she developed muscle aches, headache, fever, and clear rhinorrhea. These symptoms lasted 3 days. She lives in a house with her d... | Staphylococcus aureus | {
"A": "Mycobacterium tuberculosis",
"B": "Staphylococcus aureus",
"C": "Legionella pneumoniae",
"D": "Streptococcus agalactiae"
} | step1 | B | [
"75 year old woman",
"brought",
"emergency department",
"daughter",
"of shortness",
"breath",
"productive cough",
"blood-tinged sputum",
"past 24 hours",
"Five days",
"muscle aches",
"headache",
"fever",
"clear rhinorrhea",
"symptoms lasted 3 days",
"lives",
"house",
"daughter",
... |
An 11-year-old boy is brought to the emergency department with sudden and severe pain in the left scrotum that started 2 hours ago. He has vomited twice. He has no dysuria or frequency. There is no history of trauma to the testicles. The temperature is 37.7°C (99.9°F). The left scrotum is swollen, erythematous, and ten... | Testicular torsion | {
"A": "Epididymitis",
"B": "Germ cell tumor",
"C": "Mumps orchitis",
"D": "Testicular torsion"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"sudden",
"severe pain in",
"left scrotum",
"started 2 hours",
"vomited twice",
"dysuria",
"frequency",
"history",
"trauma",
"testicles",
"temperature",
"99 9F",
"left scrotum",
"swollen",
"erythematous",
"tender",
"left testis... |
A 65-year-old woman who lives in New York City presents with headache, fever, and neck stiffness. She received a diagnosis of HIV infection 3 years ago and has been inconsistent with her antiretroviral medications. Recent interferon-gamma release assay testing for latent tuberculosis was negative. A computed tomography... | Cryptococcus neoformans | {
"A": "Blastomyces dermatitidis",
"B": "Coccidioides immitis",
"C": "Cryptococcus neoformans",
"D": "Mycobacterium tuberculosis"
} | step2&3 | C | [
"65 year old woman",
"lives",
"New York City presents",
"headache",
"fever",
"neck stiffness",
"received",
"diagnosis",
"HIV infection 3 years",
"inconsistent",
"medications",
"interferon-gamma release assay testing",
"latent tuberculosis",
"negative",
"computed tomography of",
"head",... |
An 11-year-old boy is brought to the clinic by his parents for poor academic performance. The patient’s parents say that his teacher told them that he may have to repeat a grade because of his lack of progress, as he does not pay attention to the lessons, tends to fidget about in his seat, and often blurts out comments... | Atomoxetine | {
"A": "Diazepam",
"B": "Atomoxetine",
"C": "Methylphenidate",
"D": "Olanzapine"
} | step1 | B | [
"year old boy",
"brought",
"clinic",
"parents",
"poor academic performance",
"patients parents",
"teacher",
"to repeat",
"grade",
"of",
"lack",
"progress",
"not pay attention",
"to fidget",
"often",
"out comments",
"turn",
"speak",
"school karate coach",
"patient",
"longer li... |
A 4-year-old girl presents with recurrent abdominal pain and a low-grade fever for the past 2 months. The patient’s mother says that she has lost her appetite which has caused some recent weight loss. She adds that the patient frequently plays outdoors with their pet dog. The patient is afebrile and vital signs are wit... | Toxocara canis | {
"A": "Toxocara canis",
"B": "Ancylostoma braziliense",
"C": "Ascaris lumbricoides",
"D": "Toxocara cati"
} | step1 | A | [
"4 year old girl presents",
"recurrent abdominal pain",
"low-grade fever",
"past",
"months",
"patients mother",
"lost",
"appetite",
"caused",
"recent weight loss",
"adds",
"patient frequently plays outdoors",
"pet dog",
"patient",
"afebrile",
"vital signs",
"normal limits",
"physic... |
A 69-year-old man is brought to the emergency room by his daughter due to confusion. She reports that her father did not remember who she was yesterday, and his refrigerator was completely empty when she tried to make him lunch. She states that he was acting like himself when she visited him last week. She also notes t... | Slow initiation of total parenteral nutrition (TPN) | {
"A": "Slow initiation of total parenteral nutrition (TPN)",
"B": "Use of enteral nutrition",
"C": "Initiation of furosemide",
"D": "Use of low-sugar TPN"
} | step2&3 | A | [
"69 year old man",
"brought",
"emergency room",
"daughter due to confusion",
"reports",
"father",
"not remember",
"refrigerator",
"completely empty",
"to make",
"lunch",
"states",
"acting",
"visited",
"last week",
"notes",
"alcoholism",
"years",
"not seen",
"doctor",
"two dec... |
A 75-year-old gentleman is brought to the ED with confusion that started earlier this morning. His family notes that he was complaining of feeling weak last night and also had a slight tremor at the time. He is afebrile and he has no known chronic medical conditions. Physical exam reveals a cooperative but confused gen... | Small cell lung cancer | {
"A": "Esophageal squamous cell carcinoma",
"B": "Gastric adenocarcinoma",
"C": "Rib osteosarcoma",
"D": "Small cell lung cancer"
} | step1 | D | [
"75 year old",
"brought",
"ED",
"confusion",
"started earlier",
"morning",
"family notes",
"feeling weak",
"night",
"slight tremor",
"time",
"afebrile",
"known chronic medical conditions",
"Physical exam reveals",
"cooperative",
"confused",
"mucous membranes",
"moist",
"focal neu... |
A 19-year-old woman presents to an outpatient psychiatrist after 2 weeks of feeling “miserable.” She has been keeping to herself during this time with no desire to socialize with her friends or unable to enjoy her usual hobbies. She also endorses low energy, difficulty concentrating and falling asleep, and decreased ap... | Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks | {
"A": "Auditory hallucinations, paranoia, and disorganized speech for 2 weeks",
"B": "Elevated mood, insomnia, distractibility, and flight of ideas for 5 days",
"C": "Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks",
"D": "Insomnia, anxiety, nightmares, and flashb... | step1 | C | [
"year old woman presents",
"outpatient psychiatrist",
"2 weeks",
"feeling miserable",
"keeping",
"time",
"desire to socialize",
"friends",
"unable to",
"usual hobbies",
"low energy",
"difficulty concentrating",
"falling asleep",
"decreased appetite",
"diagnose",
"major depressive episo... |
A 13-year-old girl is brought to the physician by her parents for the evaluation of progressive hair loss over the past 2 months. The parents report that they have noticed increased number of hairless patches on their daughter's head. The patient denies any itching. There is no personal or family history of serious ill... | Trichotillomania | {
"A": "Scarring alopecia",
"B": "Telogen effluvium",
"C": "Alopecia areata",
"D": "Trichotillomania"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"parents",
"evaluation of progressive hair loss",
"past",
"months",
"parents report",
"increased number",
"patches",
"daughter's head",
"patient denies",
"itching",
"personal",
"family history",
"serious illness",
"patient states",
"feeling ... |
A 58-year-old woman visits a physician because of fever, chills, dry cough, and a few enlarging masses on her cheeks and neck. Wart-like lesions are present on the nose as shown in the photograph. She reports that she visited the Mississippi area a few months before on a business trip. Her temperature is 38.1°C (100.6°... | Blastomyces dermatitidis | {
"A": "Blastomyces dermatitidis",
"B": "Malassezia furfur",
"C": "Histoplasma capsulatum",
"D": "Coccidioides immitis"
} | step2&3 | A | [
"58 year old woman visits",
"physician",
"fever",
"chills",
"dry cough",
"few enlarging masses",
"cheeks",
"neck",
"Wart",
"lesions",
"present",
"nose",
"shown",
"photograph",
"reports",
"visited",
"Mississippi area",
"few months",
"business trip",
"temperature",
"100",
"pu... |
A 34-year-old woman comes to the emergency department because of a 2-hour history of abdominal pain, nausea, and vomiting that began an hour after she finished lunch. Examination shows abdominal guarding and rigidity; bowel sounds are reduced. Magnetic resonance cholangiopancreatography shows the dorsal pancreatic duct... | Fusion of the pancreatic buds | {
"A": "Fusion of the pancreatic buds",
"B": "Rotation of the midgut",
"C": "Proliferation of mesenchyme in the dorsal mesentery",
"D": "Differentiation of the proximal hepatic diverticulum"
} | step1 | A | [
"year old woman",
"emergency department",
"2-hour history",
"abdominal pain",
"nausea",
"vomiting",
"began",
"hour",
"finished lunch",
"Examination shows abdominal guarding",
"rigidity",
"bowel sounds",
"reduced",
"Magnetic resonance cholangiopancreatography shows",
"dorsal pancreatic du... |
A 14-year-old boy who has been otherwise healthy presents to his doctor complaining of feeling easily winded and light-headed at basketball practice. He has never felt this way before and is frustrated because he is good enough to make varsity this year. He denies smoking, alcohol, or recreational drug use. His mother ... | Mitral regurgitation | {
"A": "Systolic ejection murmur that radiates to the carotids",
"B": "Tricuspid regurgitation",
"C": "Mitral regurgitation",
"D": "Systolic ejection murmur that improves with the Valsalva maneuver"
} | step2&3 | C | [
"year old boy",
"healthy presents",
"doctor",
"feeling easily winded",
"light-headed",
"basketball practice",
"never felt",
"frustrated",
"good",
"to make",
"year",
"denies smoking",
"alcohol",
"recreational drug use",
"mother",
"very worried",
"oldest son",
"brother",
"died",
... |
A 26-year-old G1P0 presents to her first obstetric visit after having a positive urine pregnancy test at home. Her last menstrual period was 9 weeks ago. She has no past medical history, but her mother has rheumatoid arthritis. The patient states that for several weeks, she has felt especially warm, even when her co-wo... | Propylthiouracil | {
"A": "Radioactive thyroid ablation (I-31)",
"B": "Propylthiouracil",
"C": "Prednisone",
"D": "Intravenous immunoglobulin"
} | step2&3 | B | [
"year old",
"presents",
"first obstetric visit",
"positive urine at home",
"last menstrual period",
"weeks",
"past medical history",
"mother",
"rheumatoid arthritis",
"patient states",
"several weeks",
"felt",
"warm",
"co workers",
"not",
"muscle weakness",
"mood swings",
"fatigue"... |
A 3-day-old female newborn is brought to the emergency department because of fever, poor feeding, and irritability for 6 hours. She was delivered at home at 39 weeks' gestation and delivery was uncomplicated. The mother had no prenatal care. Her temperature is 39.8°C (103.6°F), pulse is 172/min, respirations are 58/min... | Increased release of fibrinogen | {
"A": "Decreased expression of MHC class II",
"B": "Increased production of IgE",
"C": "Increased classical activation of macrophages",
"D": "Increased release of fibrinogen"
} | step1 | D | [
"3 day old female newborn",
"brought",
"emergency department",
"fever",
"poor feeding",
"irritability",
"hours",
"delivered",
"home",
"weeks",
"gestation",
"delivery",
"uncomplicated",
"mother",
"prenatal care",
"temperature",
"pulse",
"min",
"respirations",
"58 min",
"blood ... |
A 47-year-old man visits the outpatient clinic with complaints of heartburn and chest pain for the past 6 months. His pain is retrosternal and was initially only associated with intake of solid foods, but it now occurs with liquids as well. Antacids do not relieve his pain anymore. He is worried about the pain as it is... | Adenocarcinoma | {
"A": "Squamous cell carcinoma",
"B": "Achalasia",
"C": "Gastric ulcers",
"D": "Adenocarcinoma"
} | step1 | D | [
"year old man visits",
"outpatient clinic",
"complaints",
"heartburn",
"chest pain",
"past 6 months",
"pain",
"retrosternal",
"initially only associated with intake",
"solid",
"now occurs",
"liquids",
"well",
"Antacids",
"not relieve",
"pain",
"worried",
"pain",
"getting worse",
... |
A 27-year-old woman presents to the clinic with severe pain in her left knee of 1-day duration. Physical examination reveals a red, swollen, warm, and tender left knee with a decreased range of motion. The patient affirms that she has been sexually active with several partners over the last year and that 1 of her partn... | It selectively grows on Thayer-Martin medium | {
"A": "It produces a heat-labile toxin that prevents protein synthesis",
"B": "It ferments maltose",
"C": "It causes the Jarisch-Herxheimer reaction when treated with penicillin",
"D": "It selectively grows on Thayer-Martin medium"
} | step1 | D | [
"27 year old woman presents",
"clinic",
"severe pain in",
"left knee",
"1-day",
"Physical examination reveals",
"red",
"swollen",
"warm",
"tender left knee",
"decreased range of motion",
"patient",
"sexually active",
"partners",
"last year",
"1",
"partners",
"dysuria",
"yellow ur... |
A 14-year-old boy is brought to the physician by his mother because of a 1-month history of pain in his right leg. His mother has been giving him ketorolac at night to improve his sleep, but the pain has not improved. Physical examination shows marked tenderness along the right mid-femur. An x-ray of the right lower ex... | Ewing sarcoma | {
"A": "Ewing sarcoma",
"B": "Chondroblastoma",
"C": "Osteochondroma",
"D": "Osteoid osteoma"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
"month history",
"pain",
"right leg",
"mother",
"giving",
"ketorolac",
"night to",
"sleep",
"pain",
"not improved",
"Physical examination shows marked tenderness",
"right",
"femur",
"x-ray of",
"right lower extremity shows several... |
A 4-year-old Caucasian male suffers from cyanosis and dyspnea relieved by squatting. Which of the following abnormalities is most likely present? | Ventricular septal defect | {
"A": "Left ventricular hypertrophy",
"B": "Atrial septal defect",
"C": "Ventricular septal defect",
"D": "Coarctation of the aorta"
} | step1 | C | [
"4 year old Caucasian male suffers",
"cyanosis",
"dyspnea relieved by squatting",
"following abnormalities",
"most likely present"
] |
A 55-year-old man presents with burning and shooting in his feet and lower legs, which becomes more severe at night. In the past 6 months, the pain has become much worse and disturbs his sleep. He has a history of type 2 diabetes mellitus and essential hypertension. Which of the following best represent the etiology of... | Distal symmetric sensorimotor polyneuropathy | {
"A": "Isolated cranial nerve neuropathy",
"B": "Isolated peripheral nerve neuropathy",
"C": "Distal symmetric sensorimotor polyneuropathy",
"D": "Radiculopathy"
} | step2&3 | C | [
"55 year old man presents",
"burning",
"shooting",
"feet",
"lower legs",
"more severe",
"night",
"past 6 months",
"pain",
"worse",
"sleep",
"history of type 2 diabetes mellitus",
"essential hypertension",
"following best represent",
"etiology",
"patients condition"
] |
A 51-year-old gentleman presents with new onset bilateral paresthesias of his feet. He also admits that he has not been able to exercise as much as previously and his friends have commented that he looks pale. Upon physical exam you find that he has conjunctival pallor and mildly decreased sensation and proprioception ... | Pernicious anemia | {
"A": "Insufficient vitamin intake",
"B": "Pancreatic insufficiency",
"C": "Pernicious anemia",
"D": "Overgrowth of intestinal bacterial"
} | step1 | C | [
"year old",
"presents",
"new onset bilateral paresthesias of",
"feet",
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"able to exercise",
"friends",
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"conjunctival pallor",
"mildly decreased sensation",
"proprioception",
"feet",
"Based",
"suspicions",
"to obt... |
A 51-year-old homeless man presents to the emergency department with severe abdominal pain and cramping for the past 3 hours. He endorses radiation to his back. He adds that he vomited multiple times. He admits having been hospitalized repeatedly for alcohol intoxication and abdominal pain. His temperature is 103.8° F ... | Pancreatitis | {
"A": "Cholecystitis",
"B": "Pancreatitis",
"C": "Choledocholithiasis",
"D": "Duodenal peptic ulcer"
} | step2&3 | B | [
"year old homeless man presents",
"emergency department",
"severe abdominal",
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"radiation",
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"admits",
"hospitalized repeatedly",
"alcohol intoxication",
"abdominal pain",
"temperature",
"8 F",
"8",
"respiratory r... |
A previously healthy 24-year-old woman comes to the physician because of recurrent episodes of a choking sensation, palpitations, diffuse sweating, and shortness of breath over the past 3 months. These episodes occur without warning and last for about 10 minutes before gradually resolving. One episode occurred while at... | Prescribe fluoxetine | {
"A": "Prescribe fluoxetine",
"B": "D-dimer measurement",
"C": "Echocardiography",
"D": "Administer lorazepam\n\""
} | step2&3 | A | [
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"year old woman",
"physician",
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"palpitations",
"diffuse sweating",
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"warning",
"last",
"10 minutes",
"resolving",
"One episode occurred",
"shopping center",
"now",
"areas",
"f... |
A 22-year-old woman presents to an outpatient clinic complaining of an increasing vaginal discharge over the last week. The discharge is foul-smelling. The menstrual cycles are regular and last 4–5 days. The patient denies postcoital or intermenstrual bleeding. The last menstrual period was 2 weeks ago. She mentions th... | Trichomonas vaginalis infection | {
"A": "Latex allergy",
"B": "Physiologic leukorrhea",
"C": "Candida vaginitis",
"D": "Trichomonas vaginalis infection"
} | step2&3 | D | [
"year old woman presents",
"outpatient clinic",
"increasing vaginal discharge",
"last week",
"discharge",
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"menstrual cycles",
"regular",
"last",
"days",
"patient denies",
"intermenstrual bleeding",
"last menstrual period",
"2 weeks",
"sexually active",
"new partners",
"pa... |
A 57-year-old woman presents to her primary care physician with a chief complaint of epigastric pain that has worsened over the past three weeks. She describes it as sudden “gnawing” sensations that last for up to half a minute before subsiding. She finds some relief after a glass of water, but does not associate relie... | "Intestinal metaplasia and gastric dysplasia are reversible, requiring immediate medical therapy." | {
"A": "\"Intestinal metaplasia is reversible, but gastric dysplasia is irreversible, requiring immediate surgery.\"",
"B": "\"Intestinal metaplasia and gastric dysplasia are irreversible; there is no cure.\"",
"C": "\"Intestinal metaplasia and gastric dysplasia are reversible, requiring immediate medical therapy... | step1 | C | [
"57 year old woman presents",
"primary care physician",
"chief complaint",
"epigastric pain",
"worsened",
"past three weeks",
"sudden gnawing sensations",
"last",
"half",
"minute",
"finds",
"relief",
"glass",
"water",
"not associate relief",
"exacerbation",
"mealtimes",
"patient de... |
A 14-year-old girl presents with pain in her right lower abdomen. She says the pain is sudden, severe, colicky, and associated with nausea and vomiting. Physical examination reveals tachycardia, point tenderness, and rebound tenderness in the right iliac region. Emergency laparotomy reveals an inflamed appendix. Her bl... | Phagocytosis | {
"A": "Phagocytosis",
"B": "Allergic reaction",
"C": "Blood clotting",
"D": "Antigen presentation"
} | step1 | A | [
"year old girl presents",
"pain",
"right lower abdomen",
"pain",
"sudden",
"severe",
"colicky",
"associated with nausea",
"vomiting",
"Physical examination reveals tachycardia",
"point tenderness",
"rebound tenderness",
"right iliac region",
"Emergency laparotomy reveals",
"inflamed appe... |
A 42-year-old man comes to the physician because of fatigue and decreased urination for the past 3 days. His creatinine is 2.5 mg/dL. A photomicrograph of a biopsy specimen of the right kidney is shown. Which of the following mechanisms most likely contributed to this patient's biopsy findings? | Fibrin formation in Bowman space | {
"A": "Fibrin formation in Bowman space",
"B": "Segmental collapse of glomerular capillaries",
"C": "Effacement of podocyte foot processes",
"D": "Deposition of immunoglobulin light chains"
} | step1 | A | [
"year old man",
"physician",
"fatigue",
"decreased urination",
"past 3 days",
"creatinine",
"2.5 mg/dL",
"photomicrograph",
"biopsy specimen",
"right kidney",
"shown",
"following mechanisms",
"likely contributed",
"patient's biopsy findings"
] |
An immunologist is studying the stages of development of T lymphocytes in the thymus. He knows that double-negative T cells do not express CD4 or CD8 molecules. After undergoing development within the subcapsular zone in the thymus, double-negative T cells begin to move towards the medulla. While en route within the ou... | CD3 | {
"A": "CD3",
"B": "CD10",
"C": "CD32",
"D": "CD44"
} | step1 | A | [
"immunologist",
"studying",
"stages",
"development",
"T lymphocytes",
"thymus",
"double negative T cells",
"not",
"CD4",
"CD8 molecules",
"development",
"subcapsular zone",
"thymus",
"double negative T cells begin to move",
"medulla",
"en route",
"outer cortex",
"CD4",
"CD8 molec... |
An otherwise healthy 66-year-old man comes to the physician for evaluation of rough skin over his forehead and the back of his hands. He has tried applying different types of moisturizers with no improvement. He has worked on a farm all his life. Physical examination shows two erythematous papules with a gritty texture... | Keratin pearls | {
"A": "Keratin pearls",
"B": "Atypical melanocytes",
"C": "Noncaseating granulomas",
"D": "Intraepidermal acantholysis"
} | step1 | A | [
"healthy 66 year old man",
"physician",
"evaluation",
"skin",
"forehead",
"back of",
"hands",
"applying different types",
"moisturizers",
"improvement",
"worked",
"farm",
"life",
"Physical examination shows two erythematous papules",
"gritty texture",
"central scale",
"left temple",
... |
A neurology resident sees a stroke patient on the wards. This 57-year-old man presented to the emergency department after sudden paralysis of his right side. He was started on tissue plasminogen activator within 4 hours, as his wife noticed the symptoms and immediately called 911. When the resident asks the patient how... | Temporal lobe | {
"A": "Caudate nucleus",
"B": "Cuneus gyrus",
"C": "Broca’s area",
"D": "Temporal lobe"
} | step2&3 | D | [
"neurology resident sees",
"stroke patient",
"wards",
"57 year old man presented",
"emergency department",
"sudden paralysis",
"right",
"started",
"tissue plasminogen activator",
"4 hours",
"wife",
"symptoms",
"immediately called",
"resident",
"patient",
"apartment",
"Main St",
"no... |
A 1-week-old male newborn is brought to the physician for the evaluation of persistent irritability and crying. He was born at 36 weeks' gestation. Pregnancy was complicated by polyhydramnios. His mother reports that she nurses him frequently and changes his diapers 18–20 times per day. He is at the 5th percentile for ... | Bumetanide | {
"A": "Triamterene",
"B": "Bumetanide",
"C": "Tolvaptan",
"D": "Acetazolamide"
} | step1 | B | [
"week old male newborn",
"brought",
"physician",
"evaluation",
"persistent irritability",
"crying",
"born",
"36 weeks",
"estation.",
"regnancy ",
"omplicated ",
"olyhydramnios.",
"other eports ",
"urses ",
"requently ",
"hanges ",
"iapers ",
"imes per day.",
"th ercentile ",
... |
A 78-year-old woman is brought to the physician by her son because of progressive memory loss for the past year. She feels tired and can no longer concentrate on her morning crossword puzzles. She has gained 11.3 kg (25 lb) in the last year. Her father died from complications of Alzheimer disease. She has a history of ... | Autoimmune thyroid disease | {
"A": "Thiamine deficiency",
"B": "Autoimmune thyroid disease",
"C": "Normal pressure hydrocephalus",
"D": "Alzheimer disease"
} | step1 | B | [
"year old woman",
"brought",
"physician",
"son",
"progressive memory loss",
"past year",
"feels tired",
"longer concentrate",
"morning",
"gained",
"kg",
"last year",
"father died",
"complications of",
"disease",
"history",
"drinking alcohol excessively",
"not",
"alcohol",
"past... |
A 22-year-old man presents with abdominal cramps and diarrhea over the last few weeks. He notes that several of his bowel movements have a small amount of blood. Past medical history is significant for an intermittent cough that has been persistent since returning from Mexico last month. The patient takes no current me... | Ivermectin | {
"A": "Mebendazole",
"B": "Ivermectin",
"C": "Albendazole",
"D": "Praziquantel"
} | step1 | B | [
"year old man presents",
"abdominal cramps",
"diarrhea",
"weeks",
"notes",
"several",
"bowel movements",
"small amount of blood",
"Past medical",
"significant",
"intermittent cough",
"persistent",
"returning",
"Mexico",
"month",
"patient takes",
"current medications",
"physical exa... |
You are called to a hemodialysis suite. The patient is a 61-year-old man with a history of hypertension, hypercholesterolemia, and type-2 diabetes mellitus-induced end-stage renal disease who has required hemodialysis for the past year. His current hemodialysis session is nearing the end when the nurse notices that his... | Stop ultrafiltration and decrease blood flow into the machine | {
"A": "Stop ultrafiltration and decrease blood flow into the machine",
"B": "Infuse 1 liter of 0.9% saline",
"C": "Administer intravenous calcium gluconate",
"D": "Transfuse the patient with 1 unit of packed red blood cells"
} | step2&3 | A | [
"called",
"hemodialysis suite",
"patient",
"61 year old man",
"history of hypertension",
"hypercholesterolemia",
"type-2 diabetes mellitus induced end-stage renal disease",
"required hemodialysis",
"past year",
"current hemodialysis session",
"nearing",
"end",
"nurse",
"blood pressure",
... |
A 49-year-old man with hypertension comes to the hospital because of 4 days of left-sided chest pain, cough, and fever. The chest pain worsens upon inspiration and coughing. His temperature is 38.5°C (101.3° F), pulse is 110/min, respirations are 29/min. There is dullness to percussion at the left base of the lung. An ... | Decreased glucose concentration | {
"A": "Increased lymphocyte concentration",
"B": "Decreased glucose concentration",
"C": "Increased pH",
"D": "Increased triglyceride concentration"
} | step1 | B | [
"year old man",
"hypertension",
"hospital",
"4 days",
"left-sided chest pain",
"cough",
"fever",
"chest pain worsens",
"inspiration",
"coughing",
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"F",
"pulse",
"min",
"respirations",
"29 min",
"dullness",
"percussion",
"left base of",
"lung",
"x-ray of",
"che... |
A 17-year-old boy presents to the emergency department of a hospital located in the town of Recuay (which is situated at 3,400 meters above mean sea level [MAMSL]) in the Ancash Region (Peru), 48 hours after returning from a 21-day stay in Lima (the capital city of Peru at 0 MAMSL). The patient has no previous medical ... | Marked increase in pressure gradient can lead to tissue hypoxia | {
"A": "Following a rapid and sustained increase in altitude, decreased sympathetic activity transiently increases cardiac output, blood pressure, heart rate, and venous tone",
"B": "Marked increase in pressure gradient can lead to tissue hypoxia",
"C": "The net change in response to hypoxia results in decreased ... | step2&3 | B | [
"year old boy presents",
"emergency department",
"hospital",
"town",
"3 400 meters",
"mean sea level",
"Region",
"Peru",
"48 hours",
"returning",
"day",
"Lima",
"capital city",
"Peru",
"0 MAMSL",
"patient",
"previous medical history",
"current complaints include cough",
"dyspnea ... |
A 45-year-old woman presents to her primary care physician with complaints of muscle pains, poor sleep, and daytime fatigue. When asked about stressors she states that she "panics" about her job, marriage, children, and finances. When asked to clarify what the "panics" entail, she states that it involves severe worryin... | Generalized anxiety disorder | {
"A": "Generalized anxiety disorder",
"B": "Social phobia",
"C": "Panic disorder",
"D": "Obsessive-compulsive disorder"
} | step1 | A | [
"year old woman presents",
"primary care physician",
"complaints",
"muscle pains",
"poor sleep",
"daytime fatigue",
"stressors",
"states",
"panics",
"job",
"marriage",
"children",
"finances",
"to clarify",
"panics",
"states",
"severe worrying",
"symptoms",
"last saw",
"one year... |
A 17-year-old is brought to his primary care provider by his mother. They are concerned that his acne is getting worse and may leave scars. They have tried several over the counter products without success. He is otherwise healthy and without complaint. The boy was born at 39 weeks gestation via spontaneous vaginal del... | 47 XYY | {
"A": "45 X0",
"B": "47 XXY",
"C": "47 XYY",
"D": "46 XY"
} | step2&3 | C | [
"year old",
"brought",
"primary care provider",
"mother",
"concerned",
"acne",
"getting worse",
"leave scars",
"several over the counter products",
"success",
"healthy",
"complaint",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"delay",
... |
A 53-year-old man is brought to the emergency department by his wife because of a 1-day history of headache, blurry vision, and confusion. His wife also says that he hasn't urinated in the past 24 hours. Despite appropriate measures, the patient dies shortly after admission. A photomicrograph of a section of the kidney... | Severe hypertension | {
"A": "Mycotic aneurysm",
"B": "Severe hypertension",
"C": "Necrotizing vasculitis",
"D": "Atherosclerotic plaque rupture"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"wife",
"of",
"1-day history",
"headache",
"blurry vision",
"confusion",
"wife",
"past 24 hours",
"appropriate measures",
"patient",
"admission",
"photomicrograph",
"section",
"kidney obtained",
"autopsy",
"shown",
"following",... |
A 37-year-old woman with a history of anorectal abscesses complains of pain in the perianal region. Physical examination reveals mild swelling, tenderness, and erythema of the perianal skin. She is prescribed oral ampicillin and asked to return for follow-up. Two days later, the patient presents with a high-grade fever... | Production of beta-lactamase enzyme | {
"A": "Drug efflux pump",
"B": "Production of beta-lactamase enzyme",
"C": "Intrinsic absence of a target site for the drug",
"D": "Altered structural target for the drug"
} | step1 | B | [
"year old woman",
"history",
"anorectal abscesses",
"pain",
"perianal region",
"Physical examination reveals mild swelling",
"tenderness",
"erythema of",
"perianal skin",
"prescribed oral ampicillin",
"to return",
"follow-up",
"Two days later",
"patient presents",
"high-grade fever",
"... |
An 18-year-old woman comes to see her primary care physician for a physical for school. She states she has not had any illnesses last year and is on her school's volleyball team. She exercises daily, does not use any drugs, and has never smoked cigarettes. On physical exam you note bruising around the patients neck, an... | Sexual masochism | {
"A": "Dependent personality disorder",
"B": "Avoidant personality disorder",
"C": "Sexual masochism",
"D": "Sexual sadism"
} | step2&3 | C | [
"year old woman",
"to see",
"primary care physician",
"physical",
"school",
"states",
"not",
"illnesses last year",
"school's volleyball team",
"exercises daily",
"not use",
"drugs",
"never smoked cigarettes",
"physical exam",
"note bruising",
"patients neck",
"to",
"burn marks",
... |
A 25-year-old man comes to the physician because of a 4-day history of bloody stools. During this time, he has not had nausea, vomiting, abdominal cramps, or pain while defecating. He has had recurrent episodes of non-bloody diarrhea for the past 6 months. His father died of colon cancer at the age of 39 years. His vit... | Gardner syndrome | {
"A": "Cronkhite-Canada syndrome",
"B": "Peutz-Jeghers syndrome",
"C": "Gardner syndrome",
"D": "Cowden syndrome"
} | step2&3 | C | [
"year old man",
"physician",
"4-day history",
"bloody stools",
"time",
"not",
"nausea",
"vomiting",
"abdominal cramps",
"pain",
"recurrent episodes of non bloody diarrhea",
"past 6 months",
"father died of colon cancer",
"age",
"years",
"vital signs",
"normal",
"Physical examinatio... |
A 14-year-old boy is brought to the office by his step-parents because he was recently caught beating a stray cat in an alley near his home. He has a police record which includes vandalism, shoplifting, and running away on two occasions. He has also received several detentions and threats of expulsion from school due t... | Conduct disorder | {
"A": "Antisocial personality disorder",
"B": "Attention deficit hyperactivity disorder",
"C": "Conduct disorder",
"D": "Schizoid personality disorder"
} | step1 | C | [
"year old boy",
"brought",
"office",
"step-parents",
"recently caught beating",
"cat",
"home",
"police record",
"includes vandalism",
"shoplifting",
"running away",
"two occasions",
"received several",
"threats",
"expulsion",
"school due to bullying",
"too aggressive",
"younger stu... |
A group of investigators discovers a novel monomeric enzyme that cleaves glutamate-valine bonds in a bacterial exotoxin. The substrate binding site of the enzyme is rich in aspartate. A sample of the enzyme is added to two serum samples containing the bacterial exotoxin. One sample is assigned a test condition while th... | Increased enzyme concentration | {
"A": "Increased serum pH",
"B": "Increased enzyme concentration",
"C": "Presence of a reversible competitive inhibitor",
"D": "Presence of an irreversible competitive inhibitor\n\""
} | step1 | B | [
"A group",
"investigators discovers",
"novel monomeric enzyme",
"glutamate valine",
"bacterial exotoxin",
"substrate binding site of",
"enzyme",
"rich",
"aspartate",
"sample",
"enzyme",
"added",
"two serum samples containing",
"bacterial exotoxin",
"One sample",
"assigned",
"test con... |
A 27 year-old-male presents to the Emergency Room as a code trauma after being shot in the neck. En route, the patient’s blood pressure is 127/73 mmHg, pulse is 91/min, respirations are 14/min, and oxygen saturation is 100% on room air with GCS of 15. On physical exam, the patient is in no acute distress; however, ther... | CT angiography | {
"A": "MRI",
"B": "Plain radiography films",
"C": "CT angiography",
"D": "Bedside neck exploration"
} | step2&3 | C | [
"27 year old male presents",
"Emergency Room",
"code trauma",
"shot",
"neck",
"En route",
"patients blood pressure",
"mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"100",
"room air",
"GCS",
"physical exam",
"patient",
"acute distress",
"entry point",
"blo... |
A 53-year-old woman presents to the physician with palpitations and increasing swelling of the legs over the past 3 months. During this time, she has also had generalized pruritus. She has dyspnea on exertion. She has no history of asthma. She occasionally takes ibuprofen for chronic headaches she has had for several y... | Hypereosinophilic syndrome | {
"A": "Drug rash with eosinophilia and systemic symptoms (DRESS)",
"B": "Eosinophilic granulomatosis with polyangiitis",
"C": "Hypereosinophilic syndrome",
"D": "Strongyloidiasis eosinophilia"
} | step2&3 | C | [
"year old woman presents",
"physician",
"palpitations",
"increasing swelling of",
"legs",
"past 3 months",
"time",
"generalized pruritus",
"dyspnea on exertion",
"history of asthma",
"occasionally takes ibuprofen",
"chronic headaches",
"several years",
"not smoke",
"drink alcohol",
"pu... |
A 69-year-old man is scheduled to undergo radical retropubic prostatectomy for prostate cancer in 2 weeks. He had a myocardial infarction at the age of 54 years. He has a history of GERD, unstable angina, hyperlipidemia, and severe osteoarthritis in the left hip. He is unable to climb up stairs or walk fast because of ... | Radionuclide myocardial perfusion imaging | {
"A": "24-hour ambulatory ECG monitoring",
"B": "Radionuclide myocardial perfusion imaging",
"C": "No further testing",
"D": "Treadmill stress test"
} | step2&3 | B | [
"69 year old man",
"scheduled to",
"radical retropubic prostatectomy",
"prostate cancer",
"2 weeks",
"myocardial infarction",
"age",
"54 years",
"history",
"GERD",
"unstable angina",
"hyperlipidemia",
"severe osteoarthritis",
"left",
"unable to climb",
"stairs",
"walk fast",
"pain"... |
A 33-year-old man is brought to the emergency department 20 minutes after he fell from the roof of his house. On arrival, he is unresponsive to verbal and painful stimuli. His pulse is 72/min and blood pressure is 132/86 mm Hg. A CT scan of the head shows a fracture in the anterior cranial fossa and a 1-cm laceration i... | Astrocytes | {
"A": "Schwann cells",
"B": "Astrocytes",
"C": "Microglia",
"D": "Oligodendrocytes"
} | step1 | B | [
"year old man",
"brought",
"emergency department 20 minutes",
"fell from",
"roof",
"house",
"arrival",
"unresponsive",
"verbal",
"painful stimuli",
"pulse",
"72 min",
"blood pressure",
"mm Hg",
"CT scan of",
"head shows",
"fracture",
"anterior fossa",
"laceration",
"left anteri... |
A 58-year-old woman comes to the physician because of an itchy rash on her leg 3 days after she returned from a camping trip with her grandchildren. Examination shows a linear, erythematous, maculopapular rash on the left lower extremity. Treatment with a drug is begun that is also effective for motion sickness. One ho... | Antagonism at acetylcholine receptors | {
"A": "Antagonism at serotonin receptors",
"B": "Antagonism at acetylcholine receptors",
"C": "Agonism at β-adrenergic receptors",
"D": "Antagonism at α-adrenergic receptors"
} | step1 | B | [
"58 year old woman",
"physician",
"of",
"itchy",
"leg 3 days",
"returned",
"camping trip",
"grandchildren",
"Examination shows",
"linear",
"erythematous",
"maculopapular rash",
"left lower extremity",
"Treatment",
"drug",
"begun",
"effective",
"motion sickness",
"One hour later",... |
A 52-year-old man is brought to the emergency department after being found by police confused and lethargic in the park. The policemen report that the patient could not recall where he was or how he got there. Medical history is significant for multiple prior hospitalizations for acute pancreatitis. He also has schedul... | Transketolase | {
"A": "Methionine synthase",
"B": "Transketolase",
"C": "Pyruvate carboxylase",
"D": "Dopamine-ß-hydroxylase"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"found",
"police confused",
"lethargic",
"park",
"policemen report",
"patient",
"not recall",
"got",
"Medical history",
"significant",
"multiple prior hospitalizations",
"acute pancreatitis",
"scheduled visits",
"psychiatrist",
"ma... |
A 7-year-old boy is rushed to the urgent care department from a friend’s birthday party with breathing trouble. He is immediately placed on supplemental oxygen therapy. The patient’s father explains that peanut butter treats were served at the event, but he reported not having witnessed his son actually eat one. During... | Type 1–anaphylactic hypersensitivity reaction | {
"A": "Type 1–anaphylactic hypersensitivity reaction",
"B": "Type 3–immune complex-mediated hypersensitivity reaction",
"C": "Type 4–cell-mediated (delayed) hypersensitivity reaction",
"D": "Mixed anaphylactic and cytotoxic hypersensitivity reaction"
} | step2&3 | A | [
"year old boy",
"rushed",
"urgent care department",
"friends",
"party",
"breathing trouble",
"immediately placed",
"supplemental oxygen therapy",
"patients father",
"peanut butter treats",
"event",
"reported not",
"witnessed",
"son",
"eat one",
"party",
"patient approached",
"fathe... |
A 27-year-old man is brought to the emergency department 45 minutes after being involved in a motor vehicle collision. He is agitated. He has pain in his upper right arm, which he is cradling in his left arm. His temperature is 36.7°C (98°F), pulse is 135/min, respirations are 25/min, and blood pressure is 145/90 mm Hg... | Intubation with positive pressure ventilation | {
"A": "Intubation with positive pressure ventilation",
"B": "Bedside thoracotomy",
"C": "CT scan of the chest",
"D": "Surgical fixation of right third to sixth ribs"
} | step2&3 | A | [
"27 year old man",
"brought",
"emergency department 45 minutes",
"involved",
"motor vehicle collision",
"agitated",
"pain in",
"upper right arm",
"left arm",
"temperature",
"36",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"90 mm Hg",
"breathing",
"shallow",
"Pulse... |
A 76-year-old man comes to the emergency department because of an episode of seeing jagged edges followed by loss of central vision in his right eye. The episode occurred 6 hours ago and lasted approximately 5 minutes. The patient has no pain. He has a 3-month history of intermittent blurriness out of his right eye and... | Carotid duplex ultrasonography | {
"A": "Echocardiography",
"B": "Fluorescein angiography",
"C": "Reassurance and follow-up",
"D": "Carotid duplex ultrasonography"
} | step2&3 | D | [
"76 year old man",
"emergency department",
"of",
"episode",
"seeing",
"edges followed by loss of central vision",
"right eye",
"episode occurred 6 hours",
"lasted approximately",
"minutes",
"patient",
"pain",
"3 month history",
"intermittent blurriness",
"right eye",
"reports a 10 minu... |
A 34-year-old man presents to a clinic with complaints of abdominal discomfort and blood in the urine for 2 days. He has had similar abdominal discomfort during the past 5 years, although he does not remember passing blood in the urine. He has had hypertension for the past 2 years, for which he has been prescribed medi... | Autosomal dominant polycystic kidney disease (ADPKD) | {
"A": "Autosomal dominant polycystic kidney disease (ADPKD)",
"B": "Autosomal recessive polycystic kidney disease (ARPKD)",
"C": "Medullary cystic disease",
"D": "Acquired cystic kidney disease"
} | step1 | A | [
"year old man presents",
"clinic",
"complaints",
"abdominal discomfort",
"blood in",
"urine",
"2 days",
"similar abdominal discomfort",
"past",
"years",
"not remember",
"blood in",
"urine",
"hypertension",
"past",
"years",
"prescribed medication",
"history of weight loss",
"skin ... |
A 15-year-old boy is brought to the physician because his urine has been pink since that morning. During the past 2 days, he has had a sore throat and difficulty swallowing. He also reports having a low-grade fever. He has no pain with urination or changes in urinary frequency. He has had 2 similar episodes involving a... | IgA mesangial deposition | {
"A": "Splitting of the glomerular basement membrane",
"B": "Crescents of fibrin and plasma proteins",
"C": "IgA mesangial deposition",
"D": "Granular deposits of IgG, IgM, and C3 complement\n\""
} | step2&3 | C | [
"year old boy",
"brought",
"physician",
"urine",
"pink",
"morning",
"past 2 days",
"sore throat",
"difficulty swallowing",
"reports",
"low-grade fever",
"pain",
"urination",
"changes",
"urinary frequency",
"2 similar episodes involving",
"sore throat",
"pink urine",
"past",
"ye... |
A 49-year-old man presents to your clinic with “low back pain”. When asked to point to the area that bothers him the most, he motions to both his left and right flank. He describes the pain as deep, dull, and aching for the past few months. His pain does not change significantly with movement or lifting heavy objects. ... | Chromosome 16 | {
"A": "Chromosome 4",
"B": "Chromosome 7",
"C": "Chromosome 15",
"D": "Chromosome 16"
} | step1 | D | [
"year old man presents",
"clinic",
"low back pain",
"to point",
"area",
"most",
"motions",
"left",
"right flank",
"pain",
"deep",
"dull",
"aching",
"past",
"months",
"pain",
"not change",
"movement",
"lifting heavy objects",
"noted dark colored urine",
"morning",
"history o... |
A 26-year-old woman, gravida 1, para 0, at 22 weeks' gestation is brought to the emergency department by her husband because of a 2-day history of confusion and falls. Pregnancy has been complicated by excessive vomiting and an 8-kg (17-lb) weight loss over the past 10 weeks. Physical examination shows vertical nystagm... | α-Ketoglutarate dehydrogenase | {
"A": "Pyruvate carboxylase",
"B": "Methionine synthase",
"C": "α-Ketoglutarate dehydrogenase",
"D": "Succinate dehydrogenase"
} | step1 | C | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"brought",
"emergency department",
"husband",
"of",
"2-day history",
"confusion",
"falls",
"Pregnancy",
"complicated",
"excessive vomiting",
"kg",
"weight loss",
"past 10 weeks",
"Physical examination shows vertical n... |
A 25-year-old professional surfer presents to the emergency room with leg pain and a headache. He recently returned from a surf competition in Hawaii and has been feeling unwell for several days. He regularly smokes marijuana and drinks 6-7 beers during the weekend. He is otherwise healthy and does not take any medicat... | Question mark-shaped bacteria on dark-field microscopy | {
"A": "Granulocytes with morulae in the cytoplasm",
"B": "Treponemes on dark-field microscopy",
"C": "Monocytes with morulae in the cytoplasm",
"D": "Question mark-shaped bacteria on dark-field microscopy"
} | step1 | D | [
"year old professional",
"presents",
"emergency room",
"leg pain",
"headache",
"recently returned",
"surf competition",
"Hawaii",
"feeling unwell",
"days",
"smokes marijuana",
"drinks",
"beers",
"weekend",
"healthy",
"not take",
"medications",
"temperature",
"blood pressure",
"... |
A 58-year-old man presents to the emergency department following a motor vehicle accident where he was an unrestrained passenger. On initial presentation in the field, he had diffuse abdominal tenderness and his blood pressure is 70/50 mmHg and pulse is 129/min. Following administration of 2 L of normal saline, his blo... | Muddy brown casts | {
"A": "WBC casts",
"B": "RBC casts",
"C": "Muddy brown casts",
"D": "Fatty casts"
} | step1 | C | [
"58 year old man presents",
"emergency department following",
"motor vehicle accident",
"passenger",
"initial presentation in the field",
"diffuse abdominal tenderness",
"blood pressure",
"70 50 mmHg",
"pulse",
"min",
"Following administration",
"normal saline",
"blood pressure",
"74 58 mm... |
A 69-year-old man presents with progressive malaise, weakness, and confusion. The patient’s wife reports general deterioration over the last 3 days. He suffers from essential hypertension, but this is well controlled with amlodipine. He also has type 2 diabetes mellitus that is treated with metformin. On physical exami... | Cardiac pump dysfunction | {
"A": "Loss of intravascular volume",
"B": "Failure of vasoregulation",
"C": "Barrier to cardiac flow",
"D": "Cardiac pump dysfunction"
} | step2&3 | D | [
"69 year old man presents",
"progressive malaise",
"weakness",
"confusion",
"patients wife reports general deterioration",
"3 days",
"suffers",
"essential hypertension",
"well controlled",
"amlodipine",
"type 2 diabetes mellitus",
"treated with metformin",
"physical examination",
"patient ... |
A graduate student in public health is conducting a study on population health and is comparing different demographic models. He is particularly interested in investigating health care interventions in societies with the demographic distribution shown. Which of the following measures is most likely to ensure a healthy ... | Invest in childhood immunization programs | {
"A": "Invest in workplace health and safety measures",
"B": "Invest in childhood immunization programs",
"C": "Invest in prostate cancer screening programs",
"D": "Invest in long-term care facilities"
} | step1 | B | [
"graduate student",
"public health",
"conducting",
"study",
"population",
"comparing different demographic models",
"interested",
"investigating health care interventions",
"societies",
"demographic distribution shown",
"following measures",
"most likely to ensure",
"healthy demographic tran... |
A 30-year-old woman presents to the office with chief complaints of skin pigmentation and fragility of the extensor sides of both hands for a month. The lesions are progressive and are not directly sensitive to light. The patient is otherwise healthy and only uses an oral contraceptive. There is no skin disease or simi... | Hepatocellular carcinoma | {
"A": "Hepatocellular carcinoma",
"B": "Fatty liver",
"C": "Alcoholic cirrhosis",
"D": "OCP related hepatitis"
} | step1 | A | [
"30 year old woman presents",
"office",
"chief complaints of skin pigmentation",
"fragility",
"extensor sides",
"hands",
"month",
"lesions",
"progressive",
"not directly sensitive to light",
"patient",
"healthy",
"only uses",
"oral contraceptive",
"skin disease",
"similar skin symptoms... |
In a routine medical examination, a young man is noted to be tall with slight scoliosis and pectus excavatum. He had been told that he was over the 95% percentile for height as a child. Auscultation reveals a heart murmur, and transthoracic echocardiography shows an enlarged aortic root and mitral valve prolapse. Blood... | Aortic dissection | {
"A": "Infertility",
"B": "Rupture of blood vessels or organs",
"C": "Aortic dissection",
"D": "Intravascular thrombosis"
} | step2&3 | C | [
"routine medical examination",
"young man",
"noted to",
"tall",
"slight scoliosis",
"pectus excavatum",
"over",
"95",
"percentile",
"height",
"child",
"Auscultation reveals",
"heart murmur",
"transthoracic echocardiography shows",
"enlarged aortic root",
"mitral valve prolapse",
"Blo... |
Four days after delivery, a 1400-g (3-lb 1-oz) newborn has a tonic seizure that lasts for 30 seconds. Over the past 24 hours, he has become increasingly lethargic. He was born at 31 weeks' gestation. Antenatal period was complicated by chorioamnionitis. Apgar scores were 4 and 5 at 1 and 5 minutes, respectively. He app... | Germinal matrix hemorrhage | {
"A": "Galactose-1-phosphate uridylyltransferase deficiency",
"B": "Congenital hydrocephalus",
"C": "Phenylalanine hydroxylase deficiency",
"D": "Germinal matrix hemorrhage"
} | step1 | D | [
"Four days",
"delivery",
"g",
"1 oz",
"newborn",
"tonic seizure",
"lasts",
"30 seconds",
"past 24 hours",
"lethargic",
"born",
"31 weeks",
"gestation",
"Antenatal period",
"complicated",
"chorioamnionitis",
"Apgar scores",
"5",
"5 minutes",
"appears ill",
"pulse",
"min",
... |
A 44-year-old woman presents with palpitations and lightheadedness. She says that symptoms onset 3 days ago and have not improved. She denies any similar episodes in this past. Her blood pressure is 140/90 mm Hg, heart rate is 150/min, respiratory rate is 16/min, and temperature is 36.6℃ (97.9℉). An ECG is performed an... | Flecainide | {
"A": "Flecainide",
"B": "Amiodarone",
"C": "Propranolol",
"D": "Verapamil"
} | step1 | A | [
"year old woman presents",
"palpitations",
"lightheadedness",
"symptoms onset",
"days",
"not improved",
"denies",
"similar episodes",
"past",
"blood pressure",
"90 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"97",
"ECG",
"performed",
"results"... |
Two days after undergoing left hemicolectomy for a colonic mass, a 62-year-old man develops shortness of breath. His temperature is 38.1°C (100.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 120/78 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Cardiopulmonary examination sh... | Decreased ratio of ventilated alveoli | {
"A": "Increased anatomic dead space",
"B": "Increased tidal volume",
"C": "Decreased ratio of ventilated alveoli",
"D": "Decreased chest wall compliance"
} | step1 | C | [
"Two days",
"left hemicolectomy",
"colonic mass",
"62 year old man",
"shortness of breath",
"temperature",
"100",
"pulse",
"80 min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen",
"88",
"Cardiopulmonary examination shows decreased br... |
A 45-year-old man is brought to the emergency department because of severe abdominal pain for the past 2 hours. He has a 2-year history of burning epigastric pain that gets worse with meals. His pulse is 120/min, respirations are 22/min, and blood pressure is 60/40 mm Hg. Despite appropriate lifesaving measures, he die... | Lesser curvature of the stomach | {
"A": "Anterior duodenum",
"B": "Posterior duodenum",
"C": "Greater curvature of the stomach",
"D": "Lesser curvature of the stomach"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"of severe abdominal",
"past",
"hours",
"2 year history",
"burning epigastric pain",
"gets worse",
"meals",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"60 40 mm Hg",
"appropriate lifesaving measures",
"autopsy",
"ex... |
A primigravida, 29-year-old woman presents in her 28th week of pregnancy for evaluation of 3 hours of vaginal bleeding and abdominal pain. She denies any trauma and states that this is the first time she has had such symptoms. Her prenatal care has been optimal and all of her antenatal screenings have been within norma... | Threatened abortion | {
"A": "Incomplete abortion",
"B": "Inevitable abortion",
"C": "Missed abortion",
"D": "Threatened abortion"
} | step2&3 | D | [
"primigravida",
"29 year old woman presents",
"week",
"pregnancy",
"evaluation",
"hours",
"vaginal bleeding",
"abdominal pain",
"denies",
"trauma",
"states",
"first time",
"symptoms",
"prenatal care",
"optimal",
"antenatal screenings",
"normal limits",
"vital signs",
"unremarkabl... |
A 36-year-old man presents to his primary care physician because of shortness of breath. He is an office worker who has a mostly sedentary lifestyle; however, he has noticed that recently he feels tired and short of breath when going on long walks with his wife. He also has had a hacking cough that seems to linger, tho... | Defective protein folding | {
"A": "Damage to kidney tubules",
"B": "Defective protein folding",
"C": "Excessive protease activity",
"D": "Hyperplasia of mucous glands"
} | step1 | B | [
"36 year old man presents",
"primary care physician",
"of shortness",
"breath",
"office worker",
"mostly sedentary lifestyle",
"recently",
"feels tired",
"short of breath",
"long walks",
"wife",
"hacking cough",
"to",
"attributes",
"upper respiratory tract infection",
"2 months",
"di... |
A 42-year-old man with a history of gout and hypertension presents to his family physician with a complaint of increased left knee pain over the past 2 days. He also reports swelling and redness of the left knee and is unable to bear weight on that side. He denies any prior surgery or inciting trauma to the knee. His t... | Vancomycin and ceftazidime | {
"A": "Ceftriaxone",
"B": "Indomethacin and colchicine",
"C": "Piperacillin-tazobactam",
"D": "Vancomycin and ceftazidime"
} | step2&3 | D | [
"year old man",
"history of gout",
"hypertension presents",
"family physician",
"complaint",
"increased left",
"past 2 days",
"reports swelling",
"redness",
"left knee",
"unable to bear weight",
"side",
"denies",
"prior surgery",
"trauma",
"knee",
"temperature",
"97",
"36",
"bl... |
A 72-year-old male presents to a cardiac surgeon for evaluation of severe aortic stenosis. He has experienced worsening dyspnea with exertion over the past year. The patient also has a history of poorly controlled hypertension, diabetes mellitus, and hyperlipidemia. An echocardiogram revealed a thickened calcified aort... | Femoral nerve | {
"A": "Sartorius muscle",
"B": "Femoral nerve",
"C": "Lymphatic vessels",
"D": "Pectineus muscle"
} | step1 | B | [
"72 year old male presents",
"cardiac surgeon",
"evaluation of severe aortic stenosis",
"experienced worsening dyspnea",
"exertion",
"past year",
"patient",
"history of poorly controlled hypertension",
"diabetes mellitus",
"hyperlipidemia",
"echocardiogram revealed",
"thickened calcified aorti... |
A 26-year-old woman presents to the medicine clinic with swelling around the right side of her chin and neck (Image A). She reports pain when moving her jaw and chewing. Her symptoms developed two days after receiving an uncomplicated tonsillectomy. She has been followed by a general medical physician since birth and h... | Acute bacterial parotitis | {
"A": "Mumps",
"B": "Sjogren's syndrome",
"C": "Acute bacterial parotitis",
"D": "Superior vena cava syndrome"
} | step2&3 | C | [
"year old woman presents",
"medicine clinic",
"swelling",
"right side of",
"chin",
"neck",
"Image",
"reports pain",
"moving",
"jaw",
"chewing",
"symptoms",
"two days",
"receiving",
"uncomplicated tonsillectomy",
"followed by",
"general medical physician",
"birth",
"received",
"... |
A 72-year-old man is brought to the emergency department from hospice. The patient has been complaining of worsening pain over the past few days and states that it is no longer bearable. The patient has a past medical history of pancreatic cancer which is being managed in hospice. The patient desires no "heroic measure... | Morphine and fentanyl patch | {
"A": "Morphine",
"B": "Morphine and fentanyl patch",
"C": "No intervention warranted",
"D": "Ketorolac and fentanyl"
} | step2&3 | B | [
"72 year old man",
"brought",
"emergency department",
"hospice",
"patient",
"worsening pain",
"past",
"days",
"states",
"longer",
"patient",
"past medical history of pancreatic cancer",
"managed",
"hospice",
"patient desires",
"heroic measures",
"to",
"made",
"treatment",
"resu... |
A 58-year-old woman comes to the physician for evaluation of vaginal dryness and pain during sexual intercourse with her husband. Four months ago, she was diagnosed with metastatic breast cancer and is currently undergoing chemotherapy. She has smoked one pack of cigarettes daily for 15 years but quit when she was diag... | Exemestane | {
"A": "Palbociclib",
"B": "Paclitaxel",
"C": "Tamoxifen",
"D": "Exemestane"
} | step1 | D | [
"58 year old woman",
"physician",
"evaluation",
"vaginal dryness",
"pain",
"sexual intercourse",
"husband",
"Four months",
"diagnosed",
"metastatic breast cancer",
"currently",
"chemotherapy",
"smoked one pack",
"cigarettes daily",
"years",
"quit",
"diagnosed",
"breast cancer",
"... |
An investigator is studying physiologic renal responses to common medical conditions. She measures urine osmolalities in different parts of the nephron of a human subject in the emergency department. The following values are obtained:
Portion of nephron Osmolality (mOsmol/kg)
Proximal convoluted tubule 300
Loop of Henl... | Dehydration | {
"A": "Dehydration",
"B": "Psychogenic polydipsia",
"C": "Furosemide overdose",
"D": "Diabetes insipidus"
} | step1 | A | [
"investigator",
"studying physiologic renal responses",
"common medical conditions",
"measures urine osmolalities",
"different parts of",
"nephron",
"human subject",
"emergency department",
"following values",
"obtained",
"Portion",
"nephron Osmolality",
"mOsmol/kg",
"Proximal convoluted t... |
A 76-year-old woman presents to the primary care physician for a regular check-up. History reveals that she has had episodes of mild urinary incontinence over the past 2 years precipitated by sneezing or laughing. However, over the past week, her urinary incontinence has occurred during regular activities. Her blood pr... | Urine culture | {
"A": "Ultrasound scan of the kidneys, urinary tract, and bladder",
"B": "Urine culture",
"C": "Pelvic floor muscle training",
"D": "Reassurance"
} | step2&3 | B | [
"76 year old woman presents",
"primary care physician",
"regular check-up",
"History reveals",
"episodes of mild urinary incontinence",
"past",
"years precipitated",
"sneezing",
"laughing",
"past week",
"urinary incontinence",
"occurred",
"regular activities",
"blood pressure",
"90 mm Hg... |
A 76-year-old man is admitted to the hospital for evaluation of sudden-onset chest pain. Three days after admission, he develops severe shortness of breath. Despite appropriate care, the patient dies. The heart at autopsy is shown. Which of the following most likely contributed to this patient's cause of death? | Occlusion of the posterior descending artery | {
"A": "Occlusion of the posterior descending artery",
"B": "Pseudoaneurysmatic dilation of the left ventricle",
"C": "Rupture of the interventricular septum",
"D": "Bacterial infection of the mitral valve endocardium"
} | step1 | A | [
"76 year old man",
"admitted",
"hospital",
"evaluation of sudden-onset chest pain",
"Three days",
"admission",
"severe shortness of breath",
"appropriate care",
"patient",
"heart",
"autopsy",
"shown",
"following most likely contributed",
"patient's cause of death"
] |
A 42-year-old woman comes to the physician with a rash on the dorsal surfaces of her hands and feet for the past month. The rash began as blisters that developed a few days after she had been sunbathing on the beach. Photographs of the rash are shown. She has no history of similar symptoms, takes no medications, and ha... | Phlebotomy | {
"A": "Afamelanotide",
"B": "Carbohydrate loading",
"C": "Intravenous hemin",
"D": "Phlebotomy"
} | step2&3 | D | [
"year old woman",
"physician",
"rash",
"dorsal surfaces",
"hands",
"feet",
"past month",
"rash began",
"blisters",
"few days",
"sunbathing",
"beach",
"Photographs",
"rash",
"shown",
"history",
"similar symptoms",
"takes",
"medications",
"history",
"recent travels",
"excess ... |
A 31-year old man presents to the emergency department for blood in his stool. The patient states that he saw a small amount of bright red blood on his stool and on the toilet paper this morning, which prompted his presentation to the emergency department. The patient denies any changes in his bowel habits or in his we... | Anoscopy | {
"A": "Anoscopy",
"B": "CT scan",
"C": "Mesalamine enema",
"D": "Stool culture and analysis for red blood cells and leukocytes"
} | step2&3 | A | [
"31 year old man presents",
"emergency department",
"blood in",
"stool",
"patient states",
"saw",
"small amount",
"bright red blood",
"stool",
"toilet paper",
"morning",
"prompted",
"presentation",
"emergency department",
"patient denies",
"changes in",
"bowel habits",
"weight",
... |
A 40-year-old woman comes to the physician with a 5-day history of mild shortness of breath with exertion. She has also had a cough for 5 days that became productive of whitish non-bloody sputum 3 days ago. Initially, she had a runny nose, mild headaches, and diffuse muscle aches. She has not had fevers or chills. Thre... | Supportive treatment only | {
"A": "Supportive treatment only",
"B": "Perform Bordetella pertussis PCR",
"C": "Conduct a high-resolution chest CT",
"D": "Administer clarithromycin"
} | step2&3 | A | [
"40 year old woman",
"physician",
"5-day history of mild shortness",
"breath",
"exertion",
"cough",
"5 days",
"productive of",
"non bloody sputum 3 days",
"Initially",
"runny nose",
"mild headaches",
"diffuse muscle aches",
"not",
"fevers",
"chills",
"Three weeks",
"year old son",
... |
A 42-year-old woman comes to the physician because of episodic abdominal pain and fullness for 1 month. She works as an assistant at an animal shelter and helps to feed and bathe the animals. Physical examination shows hepatomegaly. Abdominal ultrasound shows a 4-cm calcified cyst with several daughter cysts in the liv... | Echinococcus granulosus | {
"A": "Strongyloides stercoralis",
"B": "Schistosoma mansoni",
"C": "Clonorchis sinensis",
"D": "Echinococcus granulosus"
} | step1 | D | [
"year old woman",
"physician",
"episodic abdominal pain",
"fullness",
"month",
"works",
"assistant",
"animal shelter",
"helps to feed",
"bathe",
"animals",
"Physical examination shows hepatomegaly",
"Abdominal ultrasound shows",
"4",
"calcified cyst",
"daughter cysts",
"liver",
"CT... |
One day after giving birth to a 4050-g (8-lb 15-oz) male newborn, a 22-year-old woman experiences involuntary loss of urine. The urine loss occurs intermittently in the absence of an urge to urinate. It is not exacerbated by sneezing or coughing. Pregnancy was uncomplicated except for two urinary tract infections that ... | Inadequate intermittent catheterization | {
"A": "Current urinary tract infection",
"B": "Damage to nerve fibers",
"C": "Recurrent urinary tract infections",
"D": "Inadequate intermittent catheterization"
} | step2&3 | D | [
"One day",
"giving birth",
"g",
"8",
"oz",
"male newborn",
"year old woman experiences involuntary loss",
"urine",
"urine loss occurs",
"absence",
"to",
"not exacerbated",
"sneezing",
"coughing",
"Pregnancy",
"uncomplicated",
"two urinary tract infections",
"treated with nitrofuran... |
A 62-year-old man comes to the physician because of easy bruising and recurrent nosebleeds over the past 4 months. During the same time period, the patient has felt weak and has had a 10-kg (22-lb) weight loss. Physical examination shows mucosal pallor and bruising on the upper and lower extremities in various stages o... | Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase | {
"A": "Neoplastic granulocytes with low leukocyte alkaline phosphatase score",
"B": "Neoplastic lymphocytes that stain positive for tartrate-resistant acid phosphatase",
"C": "Neoplastic myeloid cells that stain positive for myeloperoxidase",
"D": "Neoplastic lymphoid cells that stain positive for terminal deo... | step1 | B | [
"62 year old man",
"physician",
"easy bruising",
"recurrent nosebleeds",
"past",
"months",
"same time period",
"patient",
"felt weak",
"a 10 kg",
"weight loss",
"Physical examination shows mucosal pallor",
"bruising",
"upper",
"lower extremities",
"various stages",
"healing",
"sple... |
A new mother brings in her 2-week-old son because of a painful itchy rash on his trunk. Vital signs are within normal limits. A basic chemistry panel reveal sodium 135 mmol/L, potassium 4.1 mmol/L, chloride 107 mmol/L, carbon dioxide 22, blood urea nitrogen 30 mg/dL, creatinine 1.1 mg/dL, and glucose 108 mg/dL. On phys... | Atopic dermatitis | {
"A": "Impetigo",
"B": "Atopic dermatitis",
"C": "Eczema herpeticum",
"D": "Staphylococcal scalded skin syndrome"
} | step2&3 | B | [
"new mother",
"her 2 week old son",
"of",
"painful itchy",
"trunk",
"Vital signs",
"normal limits",
"basic chemistry panel reveal sodium",
"mmol/L",
"potassium",
"mmol/L",
"chloride",
"mmol/L",
"carbon 22",
"blood urea nitrogen 30 mg/dL",
"creatinine",
"mg/dL",
"glucose",
"mg/dL"... |
Three days after being admitted to the hospital for an appendectomy, a 69-year-old woman develops cough and dyspnea. The cough is productive of small amounts of green sputum. Her temperature is 39.0°C (102.2°F), pulse is 107/min, respirations are 31/min, and blood pressure is 89/68 mm Hg. Pulse oximetry on room air sho... | Cefepime and vancomycin | {
"A": "Amoxicillin-clavulanate and clarithromycin",
"B": "Azithromycin and ceftriaxone",
"C": "Cefepime and vancomycin",
"D": "Ertapenem and gentamicin"
} | step2&3 | C | [
"Three days",
"admitted",
"hospital",
"appendectomy",
"69 year old woman",
"cough",
"dyspnea",
"cough",
"productive",
"small amounts",
"green sputum",
"temperature",
"pulse",
"min",
"respirations",
"31 min",
"blood pressure",
"68 mm Hg",
"Pulse oximetry",
"room air shows",
"o... |
A 55-year-old woman seeks evaluation of difficult and incomplete voiding and spontaneous urine leakage that occurs continuously during the day and night. The symptoms are not associated with physical exertion. She denies any urethral or vaginal discharge. She is menopausal and does not take hormone replacement therapy.... | Blockage of M-cholinoreceptors | {
"A": "Blockage of β-adrenoreceptors",
"B": "Urethral hypermobility",
"C": "Blockage of M-cholinoreceptors",
"D": "Activation of α1-adrenoceptors"
} | step2&3 | C | [
"55 year old woman",
"evaluation",
"difficult",
"incomplete voiding",
"spontaneous urine leakage",
"occurs",
"day",
"night",
"symptoms",
"not associated with physical exertion",
"denies",
"urethral",
"vaginal discharge",
"menopausal",
"not take hormone replacement therapy",
"years",
... |
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