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 45-year-old man presents to an ambulatory clinic for evaluation after feeling food stuck behind the sternum when he was eating a hamburger last night. He was not in pain. He had to drink a whole glass of water to get the food down; however, he did manage to finish his dinner without any further problems. He is concer... | Endoscopic dilation | {
"A": "Endoscopic dilation",
"B": "Laparoscopic myotomy",
"C": "Topical glucocorticoids 'per os'",
"D": "No management is indicated at this time"
} | step2&3 | A | [
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"water to",
"food",
"to finish",
"dinner",
"further problems",
"concerned",
"2 similar episodes",
"year",
"healthy",
"smoked 1 h... |
An 82-year-old male with congestive heart failure experiences rapid decompensation of his condition, manifesting as worsening dyspnea, edema, and increased fatigue. Labs reveal an increase in his serum creatinine from baseline. As part of the management of this acute change, the patient is given IV dobutamine to allevi... | Increased myocardial oxygen consumption | {
"A": "Slowed atrioventricular conduction velocities",
"B": "Increased myocardial oxygen consumption",
"C": "Increased systemic vascular resistance due to systemic vasoconstriction",
"D": "Decreased cardiac contractility"
} | step1 | B | [
"year old male",
"congestive heart failure experiences rapid decompensation",
"condition",
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"increased fatigue",
"Labs reveal",
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"serum creatinine",
"baseline",
"part of",
"management",
"acute change",
"patient",
"given IV dobutami... |
A neurophysiology expert is teaching his students the physiology of the neuromuscular junction. While describing the sequence of events that takes place at the neuromuscular junction, he mentions that as the action potential travels down the motor neuron, it causes depolarization of the presynaptic membrane. This resul... | Exocytosis of acetylcholine from the synaptic vesicles | {
"A": "Release of Ca2+ ions into the synaptic cleft",
"B": "Increased Na+ and K+ conductance of the motor end plate",
"C": "Exocytosis of acetylcholine from the synaptic vesicles",
"D": "Generation of an end plate potential"
} | step1 | C | [
"neurophysiology",
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"motor",
"causes depolarization",
"membrane",
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"opening",
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"leads",
"calci... |
A scientist is trying to determine the proportion of white-eyed fruit flies in the environment. The white-eyed allele was found to be dominant to the red-eyed allele. The frequency of the red-eyed allele is 0.1. What is the proportion of flies who have white-eyes if the population is in Hardy Weinberg Equilibrium? | 99% | {
"A": "1%",
"B": "18%",
"C": "81%",
"D": "99%"
} | step1 | D | [
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"0.1",
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"flies",
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"population",
"Equilibrium"
] |
An investigator is studying muscle contraction in tissue obtained from the thigh muscle of an experimental animal. After injection of radiolabeled ATP, the tissue is stimulated with electrical impulses. Radioassay of these muscle cells is most likely to show greatest activity in which of the following structures? | A band | {
"A": "H zone",
"B": "I band",
"C": "A band",
"D": "Z line"
} | step1 | C | [
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"radiolabeled ATP",
"tissue",
"stimulated",
"electrical impulses",
"Radioassay",
"muscle cells",
"most likely to show greatest activity",
"following structures"
] |
A 15-month-old boy presents to his family physician after being brought in by his mother. She is concerned that her son has been sick for more than 5 days, and he is not getting better with home remedies and acetaminophen. On examination, the child has a sore throat and obvious congestion in the maxillary sinuses. His ... | Hyper-IgM syndrome | {
"A": "Chédiak-Higashi syndrome",
"B": "Hyper-IgM syndrome",
"C": "C7 deficiency",
"D": "Bruton agammaglobulinemia"
} | step1 | B | [
"month old boy presents",
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"examination",
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"congestion",
"maxillary",
"temperature",
"99",
"infection",
"Haemophilus infl... |
Health officials are considering a change be made to the interpretation of the tuberculin skin test that will change the cut-off for a positive purified protein derivative (PPD) from 10 mm to 15 mm for healthcare workers. Which of the following can be expected as a result of this change? | Decrease the sensitivity | {
"A": "Decrease the sensitivity",
"B": "Decrease the specificity",
"C": "Increase the precision",
"D": "No change to the sensitivity or specificity"
} | step2&3 | A | [
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"10 mm",
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] |
A 54-year-old woman comes to the office complaining of increased urinary frequency and dysuria. She is accompanied by her husband. The patient reports that she goes to the bathroom 6-8 times a day. Additionally, she complains of pain at the end of her urinary stream. She denies fever, abdominal pain, vaginal discharge,... | Topical estrogen | {
"A": "Antibiotic prophylaxis",
"B": "Topical clobetasol",
"C": "Topical estrogen",
"D": "Venlafaxine"
} | step2&3 | C | [
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"dysuria",
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"denies fever",
"abdominal pain",
"vaginal discharge",
"hematuria",
"husband adds",
"sex",
"much",
"us... |
A 13-year-old boy is brought to the emergency department after being involved in a motor vehicle accident in which he was a restrained passenger. He is confused and appears anxious. His pulse is 131/min, respirations are 29/min, and blood pressure is 95/49 mm Hg. Physical examination shows ecchymosis over the upper abd... | Beneficence | {
"A": "Nonmaleficence",
"B": "Beneficence",
"C": "Informed consent",
"D": "Autonomy"
} | step1 | B | [
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"respirations",
"29 min",
"blood pressure",
"95",
"mm Hg",
"Physical examination shows ecchymosis",
"upper abdomen",
"tend... |
A 25 year-old woman is brought to the emergency department by her boyfriend after she cut her forearms with a knife. She has had multiple visits to the emergency department in the past few months for self-inflicted wounds. She claims that her boyfriend is the worst person in the world. She and her boyfriend have broken... | Borderline personality disorder | {
"A": "Histrionic personality disorder",
"B": "Cyclothymic disorder",
"C": "Dependent personality disorder",
"D": "Borderline personality disorder"
} | step2&3 | D | [
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... |
A 62-year-old man presents to the emergency department with acute pain in the left lower abdomen and profuse rectal bleeding. These symptoms started 3 hours ago. The patient has chronic constipation and bloating, for which he takes lactulose. His family history is negative for gastrointestinal disorders. His temperatur... | Volume replacement, analgesia, intravenous antibiotics, and endoscopic hemostasis | {
"A": "Dietary modification and antibiotic",
"B": "Volume replacement, analgesia, intravenous antibiotics, and endoscopic hemostasis ",
"C": "Reassurance and no treatment is required",
"D": "Elective colectomy"
} | step2&3 | B | [
"62 year old man presents",
"emergency department",
"acute pain",
"left lower abdomen",
"rectal bleeding",
"symptoms started 3 hours",
"patient",
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"bloating",
"takes lactulose",
"family history",
"negative",
"gastrointestinal disorders",
"temperature",
"100",
"bl... |
An investigator is studying the effects of different drugs on the contraction of cardiomyocytes. The myocytes are able to achieve maximal contractility with the administration of drug A. The subsequent administration of drug B produces the response depicted in the graph shown. Which of the following drugs is most likel... | Pindolol | {
"A": "Albuterol",
"B": "Propranolol",
"C": "Pindolol",
"D": "Phenoxybenzamine"
} | step1 | C | [
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"drug",
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"graph shown",
"following drugs",
"most likely to",
"response similar"... |
A 65-year-old woman comes to the physician for the evaluation of several episodes of urinary incontinence over the past several months. She reports that she was not able to get to the bathroom in time. During the past 6 months, her husband has noticed that she is starting to forget important appointments and family mee... | Inability to suppress voiding | {
"A": "Detrusor-sphincter dyssynergia",
"B": "Inability to suppress voiding",
"C": "Loss of sphincter function",
"D": "Impaired detrusor contractility"
} | step2&3 | B | [
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"past 6 months",
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"starting",
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"family meetings",
"type 2 diabetes mellitus treated wit... |
A 32-year-old man presents with a history of diarrhea several days after eating a hot dog at a neighborhood barbeque. He notes that the diarrhea is visibly bloody, but he has not experienced a fever. He adds that several other people from his neighborhood had similar complaints, many of which required hospitalization a... | Hemolytic uremic syndrome | {
"A": "Disseminated intravascular coagulation",
"B": "Hemolytic uremic syndrome",
"C": "Rotatory nystagmus",
"D": "Guillain-Barré syndrome"
} | step2&3 | B | [
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A 25-year-old man comes to the physician for severe back pain. He describes the pain as shooting and stabbing. On a 10-point scale, he rates the pain as a 9 to 10. The pain started after he lifted a heavy box at work; he works at a supermarket and recently switched from being a cashier to a storekeeper. The patient app... | """I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes at your job.""" | {
"A": "“Yes. Since work may worsen your condition, I would prefer that you stay home a few days. I will write a letter to your employer to explain the situation.”",
"B": "\"\"\"I understand that you are uncomfortable, but the findings do not match the severity of your symptoms. Let's talk about the recent changes ... | step2&3 | B | [
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"severe distress",
"Vital ... |
A 27-year-old female presents to her primary care physician with a chief complaint of pain in her lower extremity. The patient states that the pain has gradually worsened over the past month. The patient states that her pain is worsened when she is training. The patient is a business student who does not have a signifi... | Friction with the lateral femoral epicondyle | {
"A": "Friction with the lateral femoral epicondyle",
"B": "Cartilagenous degeneration from overuse",
"C": "Infection of the joint space",
"D": "Meniscal tear"
} | step2&3 | A | [
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"not",
"significant past medical history",
"cu... |
A 59-year-old man presents to his primary care physician for fatigue. In general, he has been in good health; however, he recently has experienced some weight loss, abdominal pain, and general fatigue. He has a past medical history of anxiety, diabetes, a fracture of his foot sustained when he tripped, and a recent col... | Leukemoid reaction | {
"A": "Acute lymphoblastic lymphoma",
"B": "Chronic myeloid leukemia",
"C": "Leukemoid reaction",
"D": "Multiple myeloma"
} | step2&3 | C | [
"59 year old man presents",
"primary care physician",
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"good health",
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"past medical anxiety",
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"foot sustained",
"tripped",
"recent cold",
"caused",
"to mis... |
A 17-year-old male comes to the physician because of painful genital sores, malaise, and fever for 3 days. He is sexually active with 3 female partners and does not use condoms consistently. His temperature is 38.3°C (101°F). Physical examination shows tender lymphadenopathy in the left inguinal region and multiple, pu... | Eosinophilic intranuclear inclusions | {
"A": "Eosinophilic intranuclear inclusions",
"B": "Basophilic intracytoplasmic inclusions",
"C": "Eosinophilic intracytoplasmic inclusions",
"D": "Basophilic intranuclear inclusions"
} | step1 | A | [
"year old male",
"physician",
"painful genital sores",
"malaise",
"fever",
"3 days",
"sexually active",
"female partners",
"not use condoms",
"temperature",
"3C",
"Physical examination shows tender lymphadenopathy",
"left inguinal region",
"multiple",
"punched out ulcers",
"penile shaf... |
A 31-year-old woman makes an appointment with a fertility specialist because she has not been able to conceive despite trying for over a year with her husband. She is concerned because her husband has 2 children from a previous marriage whereas she has no children. After obtaining a detailed history as well as lab test... | Visual disturbances | {
"A": "Deep venous thrombosis",
"B": "Osteoporosis",
"C": "Thrombophilia",
"D": "Visual disturbances"
} | step1 | D | [
"31 year old woman makes",
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"fertility specialist",
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"husband",
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"previous marriage",
"children",
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"detailed history",
"lab tests",
"specialist",
"certain drug",
"drug",
"able to",
... |
A 72-year-old man presents to his physician’s office with complaints of a cough and painful breathing for the last 2 months. He says that he has also observed a 5 kg (11 lb) weight loss during the past month. He is relatively healthy but the sudden change in his health worries him. Another problem that he has been faci... | Right upper lobe | {
"A": "Left upper lobe",
"B": "Central hilar region",
"C": "Right upper lobe",
"D": "Brain stem metastasis"
} | step2&3 | C | [
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"painful breathing",
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"face",
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"unusual times of",
"day",
... |
A 72-year-old man is brought to the physician by his wife for memory issues over the last 7 months. The patient's wife feels that he has gradually become more forgetful. He commonly misplaces his car keys and forgets his children's names. He seems to have forgotten how to make dinner and sometimes serves uncooked noodl... | MRI of the brain
" | {
"A": "Lumbar puncture",
"B": "Electroencephalography",
"C": "PET scan",
"D": "MRI of the brain\n\""
} | step2&3 | D | [
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"to make dinner",
"sometimes",
"noodles",
"raw meat",
"One night",
"parked",
"car",
"neig... |
A 4-month-old girl is brought to the office by her parents because they noticed a mass protruding from her rectum and, she has been producing green colored emesis for the past 24 hours. Her parents noticed the mass when she had a bowel movement while changing her diaper. She strained to have this bowel movement 24 hour... | Hirschsprung disease | {
"A": "Malnutrition",
"B": "Hirschsprung disease",
"C": "Myelomeningocele",
"D": "Cystic fibrosis"
} | step1 | B | [
"4 month old girl",
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"office",
"parents",
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"changing",
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"strained to",
"bowel movement 24 hours",
"3 episodes of",
"vomiting",
"past medical failure to pass ... |
A 44-year-old man comes to the physician for a pre-employment evaluation. On questioning, he reports a mild cough, sore throat, and occasional headaches for 1 week. He has not had fever or weight loss. Nine years ago, he was diagnosed with HIV. He has gastroesophageal reflux disease. He has a history of IV drug abuse b... | Reassurance | {
"A": "Chest x-ray",
"B": "Reassurance",
"C": "Interferon-γ release assay",
"D": "Repeat tuberculin skin test after 6–8 weeks"
} | step2&3 | B | [
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"not",
"fever",
"weight loss",
"Nine years",
"diagnosed",
"HIV",
"gastroesophageal reflux disease",
"history of IV drug abuse",
"quit",... |
A 40-year-old chronic smoker presents to the office complaining of a cough and pleuritic chest pain. He also has had pain in his right shoulder for the past 2 weeks. He denies fever, night sweats, but has noticed a 2.2 kg (5 lb) weight loss in the last month. He has no recent history of travel. Past medical history is ... | Histiocytosis X | {
"A": "Pancoast tumor",
"B": "Small cell carcinoma of the lung",
"C": "Histiocytosis X",
"D": "Pulmonary tuberculosis"
} | step2&3 | C | [
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"2.2 kg",
"5",
"weight loss",
"month",
"recent history",
"Past medical",
"unremarkable",
"cardiopulmonary exam... |
A 2-week-old boy has developed bilious vomiting. He was born via cesarean section at term. On physical exam, his pulse is 140, blood pressure is 80/50 mmHg, and respirations are 40/min. His abdomen appears distended and appears diffusely tender to palpation. Abdominal imaging is obtained (Figures A). Which of the follo... | Abnormal rotation of the midgut | {
"A": "Ischemia-reperfusion injury in premature neonate",
"B": "Telescoping segment of bowel",
"C": "Abnormal rotation of the midgut",
"D": "Partial absence of ganglion cells in large intestine"
} | step1 | C | [
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"80 50 mmHg",
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"appears",
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"palpation",
"Abdominal imaging",
"obtained",
"following",
"mechanism",
... |
A 57-year-old man comes to the emergency department because of pain in the sides of his abdomen and blood-tinged urine since the previous night. Over the last 2 days, he has also had progressive malaise, myalgia, and a generalized itchy rash. He has a history of gastroesophageal reflux that did not respond to ranitidin... | Elevated levels of eosinophils in urine | {
"A": "Elevated levels of eosinophils in urine",
"B": "Papillary calcifications on CT imaging",
"C": "Urinary crystals on brightfield microscopy",
"D": "Crescent-shape extracapillary cell proliferation\n\""
} | step2&3 | A | [
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"not",
"ranitidine",
"improved since taking pantoprazole",
"months",
"... |
A 46-year-old man is brought to the emergency department because of severe epigastric pain and vomiting for the past 4 hours. The pain is constant, radiates to his back, and is worse on lying down. He has had 3–4 episodes of greenish-colored vomit. He was treated for H. pylori infection around 2 months ago with triple-... | Crystalloid fluid infusion
" | {
"A": "Calcium gluconate therapy",
"B": "Fomepizole therapy",
"C": "Laparotomy",
"D": "Crystalloid fluid infusion\n\""
} | step2&3 | D | [
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"treated",
"H",
"pylori infection",
"2 months",
"triple regimen therapy",
"atrial fib... |
A 45-year-old woman presents with severe, acute-onset colicky abdominal pain and nausea. She also describes bone pain, constipation, headache, decreased vision, and menstrual irregularity. Past medical history is significant for surgical removal of an insulinoma one year ago. Two months ago, she was prescribed fluoxeti... | Decreased urine pH | {
"A": "Diagnosis confirmed with cyanide-nitroprusside test",
"B": "Imaging demonstrates staghorn calculi",
"C": "Decreased urine pH",
"D": "Hypokalemia and non-anion gap acidosis"
} | step2&3 | C | [
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"constipation",
"headache",
"decreased vision",
"menstrual irregularity",
"Past medical history",
"significant",
"surgical removal",
"insulinoma one year ago",
"Two months",
"prescribed fluo... |
A 38-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the physician because of a 1-day history of dyspnea and left-sided chest pain that is worse when she breathes deeply. One week ago, she returned from a trip to Chile, where she had a 3-day episode of flu-like symptoms that resolved without treatmen... | Noncompressible femoral vein on ultrasonography | {
"A": "Decreased fibrinogen levels on serum analysis",
"B": "Depression of the PR segment on electrocardiography",
"C": "Decreased myocardial perfusion on a cardiac PET scan",
"D": "Noncompressible femoral vein on ultrasonography"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
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"dyspnea",
"left-sided chest pain",
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"returned",
"trip",
"Chile",
"3-day episode of flu-like symptoms",
"resolved",
"treatment",
"Pregnancy",
"delivery",
... |
A 43-year-old gentleman with a history of intravenous drug use presents with general fatigue and weakness accompanied by swelling in his ankles and lower legs. Further questions elicit that he has had many infections due to his drug use but has not previously had any cardiac or pulmonary issues. Upon physical examinati... | Tricuspid regurgitation | {
"A": "Tricuspid stenosis",
"B": "Tricuspid regurgitation",
"C": "Mitral stenosis",
"D": "Mitral regurgitation"
} | step1 | B | [
"year old",
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"lower legs",
"Further questions elicit",
"infections due to",
"drug use",
"not",
"cardiac",
"pulmonary issues",
"physical examination",
"holosystolic blowing murmur radiating t... |
A 34 year-old-male with a previous diagnosis of Grave’s disease presents for a check-up. Since his diagnosis 4 months ago, the patient’s symptoms have been relatively well-controlled with medications since starting them 3 weeks ago after an initial unsuccessful course of radioiodine ablation. The patient’s complete blo... | Methimazole | {
"A": "Atenolol",
"B": "Levothyroxine",
"C": "Methimazole",
"D": "Perchlorate"
} | step1 | C | [
"year old male",
"previous diagnosis",
"Graves disease presents",
"check-up",
"diagnosis",
"months",
"patients symptoms",
"well controlled with medications",
"starting",
"3 weeks",
"initial unsuccessful course",
"radioiodine ablation",
"patients complete blood count reveals decreased absolut... |
A 60-year-old male presents to the emergency room with shortness of breath after waking up in the middle of the night with a "choking" sensation. The patient has a history of hypertension and MI. Physical examination reveals bibasilar inspiratory crackles and an S3 heart sound.
Which of the following drugs should be a... | A drug that acts on the Na/K/Cl symporter in the thick ascending limb of the loop of Henle | {
"A": "A drug that acts on the Na/Cl cotransporter in the distal convoluted tubule",
"B": "A drug that acts on the Na/K/Cl symporter in the thick ascending limb of the loop of Henle",
"C": "A drug that inhibits carbonic anhydrase",
"D": "A drug that competes for mineralocorticoid receptors in the collecting du... | step1 | B | [
"60 year old male presents",
"emergency room",
"shortness of breath",
"waking",
"middle",
"night",
"choking",
"sensation",
"patient",
"history of hypertension",
"MI",
"Physical examination reveals",
"inspiratory crackles",
"S3 heart sound",
"following drugs",
"administered",
"rapid",... |
An autopsy of a patient's heart who recently died in a motor vehicle accident shows multiple nodules near the line of closure on the ventricular side of the mitral valve leaflet. Microscopic examination shows that these nodules are composed of immune complexes, mononuclear cells, and thrombi interwoven with fibrin stra... | A 41-year-old female with a facial rash and nonerosive arthritis | {
"A": "A 71-year-old male with acute-onset high fever and nail bed hemorrhages",
"B": "A 41-year-old female with a facial rash and nonerosive arthritis",
"C": "A 62-year-old male with Cardiobacterium hominis bacteremia",
"D": "A 6-year-old female with subcutaneous nodules and erythema marginatum"
} | step1 | B | [
"autopsy",
"patient's heart",
"recently died",
"motor vehicle accident shows multiple nodules",
"line",
"closure",
"ventricular side of",
"mitral valve leaflet",
"Microscopic examination shows",
"nodules",
"immune complexes",
"mononuclear cells",
"thrombi",
"fibrin strands",
"nodules",
... |
A 50-year-old man presents with headache, chest discomfort, and blurred vision. His headache started 2 days ago and has not improved. He describes it as severe, throbbing, localized to the occipital part of the head and worse at the end of the day. He says he has associated nausea but denies any vomiting. Past medical... | Smooth muscle hyperplasia and duplication of the basement membrane | {
"A": "Smooth muscle hyperplasia and duplication of the basement membrane",
"B": "Cholesterol deposition in the vascular lumen",
"C": "Weakening of vessel wall following endothelial injury",
"D": "Protein deposition in the vascular lumen"
} | step1 | A | [
"50 year old man presents",
"headache",
"chest discomfort",
"blurred vision",
"headache started 2 days",
"not improved",
"severe",
"throbbing",
"localized",
"occipital part of",
"head",
"worse",
"end",
"day",
"associated nausea",
"denies",
"vomiting",
"Past medical history",
"sig... |
Forty minutes after undergoing nasal polypectomy for refractory rhinitis, a 48-year-old woman develops chest tightness and shortness of breath. The surgical course was uncomplicated and the patient was successfully extubated. She received ketorolac for postoperative pain. She has a history of asthma, hypertension, and ... | Pseudoallergic reaction | {
"A": "Type 1 hypersensitivity reaction",
"B": "Prinzmetal angina",
"C": "Pseudoallergic reaction",
"D": "Excessive beta-adrenergic blockade"
} | step1 | C | [
"Forty minutes",
"nasal polypectomy",
"refractory rhinitis",
"48 year old woman",
"chest tightness",
"shortness of breath",
"surgical course",
"uncomplicated",
"patient",
"extubated",
"received ketorolac",
"postoperative pain",
"history of asthma",
"hypertension",
"aspirin allergy",
"d... |
A 51-year-old man presents to his physician’s office with a persistent fever that started a week ago. He says that his temperature ranges between 37.8–39.1°C (100–102.5°F). He has also had a persistent cough productive of foul-smelling sputum. There is no significant medical history to report, but he does mention that ... | Clindamycin | {
"A": "Surgical drainage",
"B": "Metronidazole",
"C": "Bronchoscopy",
"D": "Clindamycin"
} | step2&3 | D | [
"year old man presents",
"physicians office",
"persistent fever",
"started",
"week",
"temperature ranges",
"persistent cough productive",
"foul-smelling sputum",
"significant medical history to report",
"suffering",
"dental caries",
"last month",
"meaning to see",
"dentist",
"blood press... |
An 11-year-old boy is brought to the emergency department because he was found to have severe abdominal pain and vomiting in school. On presentation, he is found to be lethargic and difficult to arouse. His parents noticed that he was eating and drinking more over the last month; however, they attributed the changes to... | E | {
"A": "A",
"B": "C",
"C": "D",
"D": "E"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"found to",
"severe abdominal",
"vomiting in school",
"presentation",
"found to",
"lethargic",
"difficult",
"parents",
"eating",
"drinking",
"last month",
"attributed",
"changes",
"entering",
"growth spurt",
"Physical exam reveal... |
A 55-year-old man comes to the physician because of a 6-month history of cough, breathlessness, and fatigue. He has also had an 8-kg (17.6-lb) weight loss and night sweats during this time. He appears pale. His vital signs are within normal limits. Physical examination shows hepatosplenomegaly. His leukocyte count is 7... | Leukemoid reaction | {
"A": "Acute myeloid leukemia",
"B": "Acute lymphoblastic leukemia",
"C": "Leukemoid reaction",
"D": "Tuberculosis\n\""
} | step2&3 | C | [
"55 year old man",
"physician",
"month history",
"cough",
"breathlessness",
"fatigue",
"kg",
"weight loss",
"night",
"time",
"appears pale",
"vital signs",
"normal",
"Physical examination shows hepatosplenomegaly",
"leukocyte count",
"mm3",
"peripheral blood smear shows",
"80",
"... |
A 46-year-old woman comes to the clinic complaining of right eye irritation. The eye is itchy and red. Discomfort has been relatively constant for the last 6 months, and nothing makes it better or worse. Past medical history is significant for hypertension, hyperlipidemia, and aggressive tooth decay, requiring several ... | Artificial tears | {
"A": "Artificial tears",
"B": "Fundoscopy",
"C": "Erythromycin ointment",
"D": "Retinoscopy"
} | step2&3 | A | [
"year old woman",
"clinic",
"right",
"eye",
"itchy",
"red",
"Discomfort",
"constant",
"months",
"makes",
"better",
"worse",
"Past medical history",
"significant",
"hypertension",
"hyperlipidemia",
"aggressive tooth decay",
"several root canals",
"removal",
"replacement",
"tee... |
A 20-year-old man presents to your office with dyspnea, reporting nocturnal cough. You note expiratory wheezing on auscultation. Chest x-ray reveals increased anteroposterior diameter. Past medical history is significant for multiple episodes of "bronchitis" as a child. Which of the following drugs would be most effect... | Fluticasone | {
"A": "Albuterol",
"B": "Fluticasone",
"C": "Theophylline",
"D": "Ipratroprium"
} | step1 | B | [
"20 year old man presents",
"office",
"dyspnea",
"reporting nocturnal cough",
"note expiratory wheezing",
"auscultation",
"Chest x-ray reveals increased",
"diameter",
"Past medical history",
"significant",
"multiple episodes of",
"bronchitis",
"child",
"following drugs",
"most effective"... |
A 75-year-old woman presents complaining of severe shortness of breath and peripheral edema. Her family reports that she has gained a significant amount of weight within the past week. Despite considerable efforts in the emergency department and ICU, she dies from sudden cardiac death overnight. The family requests an ... | Congestive heart failure | {
"A": "Budd-Chiari syndrome",
"B": "Congestive heart failure",
"C": "Hepatic metastasis",
"D": "Amebic liver abscess"
} | step1 | B | [
"75 year old woman presents",
"of severe shortness",
"breath",
"peripheral edema",
"family reports",
"gained",
"significant amount",
"weight",
"past week",
"efforts",
"emergency department",
"ICU",
"sudden cardiac death overnight",
"family requests",
"autopsy to",
"cause of death",
"... |
A 13-year-old girl is brought to the physician because of an itchy rash on her knee and elbow creases. She has had this rash since early childhood. Physical examination of the affected skin shows crusty erythematous papules with skin thickening. She is prescribed topical pimecrolimus. The beneficial effect of this drug... | Dephosphorylation of serine | {
"A": "Reduction of ribonucleotides",
"B": "Oxidation of dihydroorotic acid",
"C": "Synthesis of tetrahydrofolic acid",
"D": "Dephosphorylation of serine"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"of",
"itchy",
"knee",
"elbow creases",
"rash",
"early childhood",
"Physical examination of",
"affected skin shows crusty erythematous papules",
"skin",
"prescribed topical pimecrolimus",
"beneficial effect",
"drug",
"best",
"inhibition",
"f... |
A 46-year-old man comes to the physician for a follow-up examination. Two weeks ago, he underwent laparoscopic herniorrhaphy for an indirect inguinal hernia. During the procedure, a black liver was noted. He has a history of intermittent scleral icterus that resolved without treatment. Serum studies show:
Aspartate ami... | Dubin-Johnson syndrome | {
"A": "Type II Crigler-Najjar syndrome",
"B": "Dubin-Johnson syndrome",
"C": "Gilbert syndrome",
"D": "Type I Crigler-Najjar syndrome"
} | step1 | B | [
"year old man",
"physician",
"follow-up examination",
"Two weeks",
"laparoscopic",
"indirect hernia",
"procedure",
"black liver",
"noted",
"history",
"intermittent scleral",
"resolved",
"treatment",
"Serum studies show",
"Aspartate aminotransferase",
"IU/L Alanine aminotransferase",
... |
A 40-year-old woman comes to the physician because of a 6-day history of painless blisters on her hands, forearms, and face. Some of the blisters have popped and released a clear fluid. She is otherwise healthy. She had been working the night shift as a security guard for the past few years and switched to the day shif... | Increased urinary uroporphyrin | {
"A": "Elevated anti-Smith antibodies",
"B": "Elevated anti-varicella zoster virus antibodies",
"C": "Positive skin patch test",
"D": "Increased urinary uroporphyrin"
} | step2&3 | D | [
"40 year old woman",
"physician",
"6-day history",
"painless blisters",
"hands",
"forearms",
"face",
"blisters",
"popped",
"released",
"clear fluid",
"healthy",
"working",
"night shift",
"security guard",
"past",
"years",
"switched",
"day shift 2 weeks",
"started",
"new metal... |
A 2-month-old boy is brought to the emergency room by his mother who reports he has appeared lethargic for the past 3 hours. She reports that she left the patient with a new nanny this morning, and he was behaving normally. When she got home in the afternoon, the patient seemed lethargic and would not breastfeed as usu... | Crescent-shaped hematoma | {
"A": "Crescent-shaped hematoma",
"B": "Lens-shaped hematoma",
"C": "Blood in the basal cisterns",
"D": "Multiple cortical and subcortical infarcts"
} | step1 | A | [
"2 month old boy",
"brought",
"emergency room",
"mother",
"reports",
"appeared lethargic",
"past",
"hours",
"reports",
"left",
"patient",
"new nanny",
"morning",
"got home",
"afternoon",
"patient",
"lethargic",
"not breastfeed",
"usual",
"birth",
"child",
"Apgar score",
"... |
A 42-year-old man comes to his primary care physician complaining of abdominal pain. He describes intermittent, burning, epigastric pain over the past 4 months. He reports that the pain worsens following meals. He had an upper gastrointestinal endoscopy done 2 months ago that showed a gastric ulcer without evidence of ... | Smoking cessation | {
"A": "Celecoxib",
"B": "Increase milk consumption",
"C": "Low-fat diet",
"D": "Smoking cessation"
} | step1 | D | [
"year old man",
"primary care physician",
"abdominal pain",
"intermittent",
"burning",
"epigastric pain",
"past",
"months",
"reports",
"pain worsens following meals",
"upper gastrointestinal endoscopy",
"2 months",
"showed",
"gastric ulcer",
"evidence",
"malignancy",
"patient",
"pr... |
An newborn infant comes to the attention of the neonatal care unit because he started having heavy and rapid breathing. In addition, he was found to be very irritable with pale skin and profuse sweating. Finally, he was found to have cold feet with diminished lower extremity pulses. Cardiac auscultation reveals a harsh... | Prostaglandin E1 | {
"A": "Leukotriene E4",
"B": "Prostaglandin E1",
"C": "Prostaglandin E2",
"D": "Prostaglandin I2"
} | step1 | B | [
"newborn infant",
"attention",
"neonatal care unit",
"started",
"heavy",
"rapid breathing",
"addition",
"found to",
"very irritable",
"pale skin",
"profuse sweating",
"found to",
"cold feet",
"diminished lower extremity pulses",
"Cardiac auscultation reveals",
"harsh systolic murmur",
... |
A 50-year-old man with a history of stage 4 kidney disease was admitted to the hospital for an elective hemicolectomy. His past medical history is significant for severe diverticulitis. After the procedure he becomes septic and was placed on broad spectrum antibiotics. On morning rounds, he appear weak and complains of... | Send the patient for hemodialysis | {
"A": "Perform a STAT pericardiocentesis",
"B": "Treat the patient with cyclophosphamide and prednisone",
"C": "Send the patient for hemodialysis",
"D": "Prepare the patient for renal transplant"
} | step2&3 | C | [
"50 year old man",
"history of stage 4 kidney disease",
"admitted",
"hospital",
"elective hemicolectomy",
"past medical history",
"significant",
"severe diverticulitis",
"procedure",
"septic",
"placed",
"broad spectrum antibiotics",
"morning rounds",
"appear weak",
"fatigue",
"nausea",... |
A 56-year-old man comes to the physician for increasing shortness of breath and retrosternal chest pain on exertion. He has smoked 2 packs of cigarettes daily for 35 years. His blood pressure is 145/90 mm Hg. Cardiac examination is shown. Which of the following is the most likely cause of this patient's auscultation fi... | Left ventricular failure | {
"A": "Left ventricular failure",
"B": "Aortic valve sclerosis",
"C": "Right ventricular hypertrophy",
"D": "Mitral valve stenosis"
} | step1 | A | [
"year old man",
"physician",
"increasing shortness of breath",
"retrosternal chest pain on exertion",
"smoked 2 packs",
"cigarettes daily",
"35 years",
"blood pressure",
"90 mm Hg",
"Cardiac examination",
"shown",
"following",
"most likely cause",
"patient's auscultation findings"
] |
A 59-year-old man presents with fatigue and tingling in both feet and hands. Past medical history is significant for type 2 diabetes mellitus diagnosed 27 years ago, for which he takes metformin and gliclazide. He denies any smoking, alcohol, or illicit drug use. Physical examination is unremarkable. Laboratory results... | Impaired DNA synthesis of red cells | {
"A": "Impaired DNA synthesis of red cells",
"B": "Defect in heme synthesis",
"C": "Defect in globin chain synthesis",
"D": "Myelodysplastic syndrome"
} | step2&3 | A | [
"59 year old man presents",
"fatigue",
"tingling",
"feet",
"hands",
"Past medical history",
"significant",
"type 2 diabetes mellitus diagnosed 27 years",
"takes metformin",
"gliclazide",
"denies",
"smoking",
"alcohol",
"illicit drug use",
"Physical examination",
"unremarkable",
"Labo... |
A 19-year-old man presents to his primary care physician for evaluation before going off to college. Specifically, he wants to know how to stay healthy while living outside his home. Since childhood he has suffered severe sunburns even when he goes outside for a small period of time. He has also developed many freckles... | Recognition of chemically dimerized bases | {
"A": "Endonucleolytic removal of bases from backbone",
"B": "Recognition of chemically dimerized bases",
"C": "Recognition of mismatched bases",
"D": "Sister chromatid binding and recombination"
} | step1 | B | [
"year old man presents",
"primary care physician",
"evaluation",
"college",
"to",
"to",
"healthy",
"living outside",
"home",
"childhood",
"suffered severe sunburns",
"goes outside",
"small period",
"time",
"freckles",
"surfaced growths starting",
"same age",
"eyes",
"very sensiti... |
An 11-year-old boy presents to your clinic after 4 months of pain and swelling in his thigh. His mother states that at first she thought his condition was due to roughhousing, but it hasn’t gone away and now she’s concerned. You perform an X-ray that shows an ‘onion skin’ appearance on the diaphysis of the femur. You a... | t(11;22) translocation | {
"A": "Nonsense mutation to DMD gene",
"B": "Defective mitochondrial DNA",
"C": "t(11;22) translocation",
"D": "Rb loss of function mutation"
} | step1 | C | [
"year old boy presents",
"clinic",
"4 months",
"pain",
"swelling",
"thigh",
"mother states",
"first",
"thought",
"condition",
"due to",
"hasnt",
"now shes concerned",
"perform",
"X-ray",
"shows",
"onion skin appearance",
"diaphysis of",
"femur",
"concerned",
"malignancy",
"... |
A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The phys... | Acute tubular necrosis | {
"A": "Acute glomerulonephritis",
"B": "Chronic kidney disease",
"C": "Acute pyelonephritis",
"D": "Acute tubular necrosis"
} | step1 | D | [
"year old woman presents",
"physician",
"evaluation",
"sudden onset respiratory",
"past",
"hours",
"past medical history includes",
"myocardial infarction",
"years",
"vital signs include",
"blood pressure 70 40 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"room air",
"physical ... |
A 34-year-old man presents to the neurology clinic for an appointment after having been referred by his family physician. Four months earlier, he presented with worsening upper limb weakness. His primary complaint at that time was that he was unable to play badminton because of increasing difficulty in moving his shoul... | Spastic paralysis | {
"A": "Paresthesia",
"B": "Spastic paralysis",
"C": "Cape-like sensory loss",
"D": "Positive Romberg sign"
} | step2&3 | B | [
"year old man presents",
"neurology clinic",
"appointment",
"referred by",
"family physician",
"Four months earlier",
"presented",
"worsening upper limb weakness",
"primary complaint",
"time",
"unable to play badminton",
"increasing difficulty",
"moving",
"shoulders",
"arms",
"weakness... |
A 27-year-old woman with cystic fibrosis comes to the physician for a follow-up examination. She has been hospitalized frequently for pneumonia and nephrolithiasis and is on chronic antibiotic therapy for recurrent sinusitis. The patient and her husband would like to have a child but have been unable to conceive. She f... | """I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group.""" | {
"A": "\"\"\"I think it's really important that you talk to your family more about this. I'm sure they can help you out.\"\"\"",
"B": "\"\"\"I understand that living with cystic fibrosis is not easy. You are not alone in this. I would like to recommend a support group.\"\"\"",
"C": "\"\"\"I understand your frust... | step1 | B | [
"27 year old woman",
"cystic fibrosis",
"physician",
"follow-up examination",
"hospitalized frequently",
"pneumonia",
"nephrolithiasis",
"chronic antibiotic therapy",
"recurrent sinusitis",
"patient",
"husband",
"to",
"child",
"unable to",
"feels",
"never",
"full",
"happy due to",
... |
A 34-year-old male visits the clinic with complaints of intermittent diarrhea over the past 6 months. He has lost 6.8 kg (15 lb) over that time period. His frequent bowel movements are affecting his social life and he would like definitive treatment. Past medical history is significant for chronic type 2 diabetes that ... | Stimulation of lipolysis | {
"A": "Activation of glycogen synthase",
"B": "Inhibition of acetone production",
"C": "Inhibition of gluconeogenesis",
"D": "Stimulation of lipolysis"
} | step1 | D | [
"year old male visits",
"clinic",
"complaints",
"intermittent diarrhea",
"past 6 months",
"lost",
"kg",
"over",
"time period",
"frequent bowel movements",
"affecting",
"social life",
"definitive treatment",
"Past medical history",
"significant",
"chronic type 2 diabetes",
"well contr... |
A 15-year-old girl is brought to the clinic by her mother for an annual well-exam. She is relatively healthy with an unremarkable birth history. She reports no specific concerns except for the fact that her friends “already got their periods and I still haven’t gotten mine.” Her mom reports that she also had her menarc... | Raised areola | {
"A": "Coarse hair across pubis and medial thigh",
"B": "Flat chest with raised nipples",
"C": "Formation of breast mound",
"D": "Raised areola"
} | step1 | D | [
"year old girl",
"brought",
"clinic",
"mother",
"annual well exam",
"relatively healthy",
"unremarkable birth history",
"reports",
"specific concerns",
"fact",
"friends",
"got",
"periods",
"I",
"gotten",
"mom reports",
"menarche late",
"not",
"worry",
"alone",
"patient denies... |
A 55-year-old man with long-standing diabetes presents with a fragility fracture. He has chronic renal failure secondary to his diabetes. His serum parathyroid hormone concentration is elevated. You measure his serum concentration of 25(OH)-vitamin D and find it to be normal, but his concentration of 1,25(OH)-vitamin D... | Secondary hyperparathyroidism with low serum calcium | {
"A": "Primary hyperparathyroidism with elevated serum calcium",
"B": "Secondary hyperparathyroidism with elevated serum calcium",
"C": "Secondary hyperparathyroidism with low serum calcium",
"D": "Tertiary hyperparathyroidism with low serum calcium"
} | step1 | C | [
"55 year old man",
"long standing diabetes presents",
"fragility fracture",
"chronic renal failure secondary",
"diabetes",
"serum parathyroid hormone concentration",
"elevated",
"measure",
"serum concentration",
"OH",
"vitamin D",
"find",
"to",
"normal",
"concentration",
"OH",
"vitam... |
A 47-year-old man with bipolar I disorder and hypertension comes to the physician because of a 2-week history of increased thirst, urinary frequency, and sleep disturbance. He says that he now drinks up to 30 cups of water daily. He has smoked 2 packs of cigarettes daily for the past 20 years. Examination shows decreas... | Adverse effect of a medication | {
"A": "Adverse effect of a medication",
"B": "Tumor of the pituitary gland",
"C": "Paraneoplastic production of a hormone",
"D": "Tumor in the adrenal cortex"
} | step1 | A | [
"year old man",
"bipolar I disorder",
"hypertension",
"physician",
"2-week history",
"increased thirst",
"urinary frequency",
"sleep disturbance",
"now drinks",
"30 cups",
"water daily",
"smoked 2 packs",
"cigarettes daily",
"past 20 years",
"Examination shows decreased skin turgor",
"... |
A 23-year-old man comes to his primary care provider after having severe abdominal cramping and diarrhea beginning the previous night. He denies any fevers or vomiting. Of note, he reports that he works in a nursing home and that several residents of the nursing home exhibited similar symptoms this morning. On exam, hi... | Clostridium perfringens | {
"A": "Clostridium difficile",
"B": "Clostridium perfringens",
"C": "Listeria monocytogenes",
"D": "Streptococcus pneumoniae"
} | step1 | B | [
"23 year old man",
"primary care provider",
"severe abdominal cramping",
"diarrhea beginning",
"previous night",
"denies",
"fevers",
"vomiting",
"note",
"reports",
"works",
"nursing",
"several residents",
"nursing home exhibited similar symptoms",
"morning",
"exam",
"temperature",
... |
A 79-year-old man with a history of prostate cancer is brought to the emergency department because of lower abdominal pain for 1 hour. He has not urinated for 24 hours. Abdominal examination shows a palpable bladder that is tender to palpation. A pelvic ultrasound performed by the emergency department resident confirms... | “I would prefer that you obtain informed consent when you become available again.” | {
"A": "“I will make sure the patient reads and signs the informed consent form.”",
"B": "“I would be happy to obtain informed consent on your behalf, but I'm not legally allowed to do so during my residency.”",
"C": "“Suprapubic catheterization is not the treatment of choice for this patient.”",
"D": "“I would... | step1 | D | [
"year old man",
"history cancer",
"brought",
"emergency department",
"of lower abdominal pain",
"hour",
"not",
"24 hours",
"Abdominal examination shows",
"palpable bladder",
"tender",
"palpation",
"pelvic ultrasound performed by",
"emergency department resident confirms",
"diagnosis of a... |
A 45-year-old man with a body mass index of 45 kg/m^2 presents to his primary care doctor with right hip pain. He asserts that the pain is instigated by walking up and down stairs around a construction site which he oversees. On physical exam, his hips are symmetric and equal with no tenderness to palpation bilaterally... | Pes anserine bursitis | {
"A": "Lateral meniscus tear",
"B": "Medial meniscus tear",
"C": "Pes anserine bursitis",
"D": "Prepatellar bursitis"
} | step2&3 | C | [
"year old man",
"body mass index",
"kg/m",
"presents",
"primary care doctor",
"right hip pain",
"pain",
"walking",
"down stairs",
"construction site",
"physical exam",
"hips",
"symmetric",
"equal",
"tenderness",
"palpation",
"left lower extremity appears",
"normal",
"full range o... |
A 12-year-old girl with a recently diagnosed seizure disorder is brought to the physician by her mother for genetic counseling. She has difficulties in school due to a learning disability. Medications include carbamazepine. She is at the 95th percentile for height. Genetic analysis shows a 47, XXX karyotype. An error i... | Maternal meiosis, anaphase II | {
"A": "Maternal meiosis, metaphase II",
"B": "Maternal meiosis, anaphase II",
"C": "Maternal meiosis, telophase II",
"D": "Paternal meiosis, metaphase II"
} | step1 | B | [
"year old girl",
"recently diagnosed seizure disorder",
"brought",
"physician",
"mother",
"genetic counseling",
"difficulties in school due to",
"learning",
"Medications include carbamazepine",
"95th percentile",
"height",
"Genetic analysis shows",
"XXX karyotype",
"error",
"following st... |
A 27-year-old woman comes to the physician for a 1-week-history of painful urination and urinary frequency. She has no history of serious illness and takes no medications. She is sexually active with her boyfriend. Her temperature is 36.7°C (98.1°F). There is no costovertebral angle tenderness. Urine dipstick shows leu... | Chlamydia trachomatis | {
"A": "Neisseria gonorrhoeae",
"B": "Escherichia coli",
"C": "Chlamydia trachomatis",
"D": "Trichomonas vaginalis"
} | step1 | C | [
"27 year old woman",
"physician",
"1-week history",
"painful urination",
"urinary frequency",
"history",
"serious illness",
"takes",
"medications",
"sexually active",
"boyfriend",
"temperature",
"36",
"98",
"costovertebral angle tenderness",
"Urine dipstick shows leukocyte esterase",
... |
A 48-year-old man is brought to the emergency department 1 hour after the sudden onset of chest pain and shortness of breath. He describes the pain as severe and occasionally migrating to his left arm and back. He has hypertension treated with hydrochlorothiazide and lisinopril. He has smoked one pack of cigarettes dai... | Administer labetalol | {
"A": "Begin heparin therapy",
"B": "Administer labetalol",
"C": "Administer tissue plasminogen activator",
"D": "Administer aspirin"
} | step2&3 | B | [
"48 year old man",
"brought",
"emergency department",
"hour",
"sudden onset of chest pain",
"shortness of breath",
"pain",
"severe",
"occasionally migrating",
"left arm",
"back",
"hypertension treated with hydrochlorothiazide",
"lisinopril",
"smoked one pack",
"cigarettes daily",
"30 y... |
A 31-year-old G2P1001 presents to the labor floor for external cephalic version (ECV) due to breech presentation at 37 weeks gestation. Her pregnancy has been complicated by an episode of pyelonephritis at 14 weeks gestation, treated with intravenous ceftriaxone. The patient has not had urinary symptoms since that time... | Rhogam administration | {
"A": "Urinalysis",
"B": "Fibrinogen level",
"C": "Urine protein to creatinine ratio",
"D": "Rhogam administration"
} | step2&3 | D | [
"31 year old",
"presents",
"labor floor",
"external cephalic version",
"due to breech presentation",
"weeks gestation",
"pregnancy",
"complicated",
"episode of pyelonephritis",
"weeks gestation",
"treated with intravenous ceftriaxone",
"patient",
"not",
"urinary symptoms",
"time",
"pre... |
A 24-year-old college student consumed a container of canned vegetables for dinner. Fourteen hours later, he presents to the E.R. complaining of difficulty swallowing and double-vision. The bacterium leading to these symptoms is: | Rod-shaped | {
"A": "An obligate aerobe",
"B": "Gram-negative",
"C": "Rod-shaped",
"D": "Non-spore forming"
} | step1 | C | [
"year old college student",
"container",
"canned vegetables",
"dinner",
"Fourteen hours later",
"presents",
"R",
"difficulty swallowing",
"double-vision",
"bacterium leading",
"symptoms"
] |
A 9-year-old boy is brought to the emergency department by his mother. She says that he started having “a cold” yesterday, with cough and runny nose. This morning, he was complaining of discomfort with urination. His mother became extremely concerned when he passed bright-red urine with an apparent blood clot. The boy ... | Adenovirus infection | {
"A": "Adenovirus infection",
"B": "BK virus infection",
"C": "E. coli infection",
"D": "Toxin exposure"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"mother",
"started",
"cold",
"cough",
"runny nose",
"morning",
"discomfort",
"urination",
"mother",
"extremely concerned",
"passed bright-red urine",
"apparent blood clot",
"boy",
"healthy",
"following",
"most likely underlying c... |
A 33-year-old female comes to her primary care physician with complaints of fatigue and nausea. She has also noticed that her skin tone is darker than it used to be. On exam, the physician notes that the woman appears to be jaundiced and obtains liver enzymes which demonstrate an elevated AST and ALT. Further testing s... | I, II, III, IV | {
"A": "I only",
"B": "I, II, III, IV",
"C": "II, III",
"D": "I, II, III"
} | step1 | B | [
"year old female",
"primary care physician",
"complaints",
"fatigue",
"nausea",
"skin tone",
"darker",
"used to",
"exam",
"physician notes",
"woman appears to",
"jaundiced",
"obtains liver enzymes",
"elevated AST",
"ALT",
"Further testing",
"confirms",
"diagnosis",
"hepatitis B",... |
A 46-year-old man comes to the physician because of a 4-month history of progressively worsening fatigue and loss of appetite. Five years ago, he received a kidney transplant from a living family member. Current medications include sirolimus and mycophenolate. His blood pressure is 150/95 mm Hg. Laboratory studies show... | CD4+ T cell-mediated intimal smooth muscle proliferation | {
"A": "Donor T cell-mediated epithelial cell damage",
"B": "Donor endothelial cell damage by preformed host antibodies",
"C": "CD4+ T cell-mediated intimal smooth muscle proliferation",
"D": "Drug-induced tubular vacuolization"
} | step1 | C | [
"year old man",
"physician",
"4 month history",
"worsening fatigue",
"loss of appetite",
"Five years",
"received",
"kidney transplant",
"living family member",
"Current medications include sirolimus",
"mycophenolate",
"blood pressure",
"95 mm Hg",
"Laboratory studies show normocytic",
"n... |
A 27-year-old woman visits a psychiatrist expressing her feelings of sadness which are present on most days of the week. She says that she has been feeling this way for about 2 to 3 years. During her first pregnancy 3 years ago, the fetus died in utero, and the pregnancy was terminated at 21 weeks. Ever since then, she... | Persistent depressive disorder | {
"A": "Persistent depressive disorder",
"B": "Major depressive disorder",
"C": "Bipolar disorder",
"D": "Schizoaffective disorder"
} | step2&3 | A | [
"27 year old woman visits",
"psychiatrist",
"feelings of sadness",
"present",
"days of the week",
"feeling",
"3 years",
"first pregnancy 3 years",
"fetus died in utero",
"pregnancy",
"terminated",
"weeks",
"Ever",
"then",
"hasnt",
"able to sleep well",
"night",
"difficulty concentr... |
A 25-day-old newborn is brought to the pediatrician for lethargy, poor muscle tone, and feeding difficulty with occasional regurgitation that recently turned into projectile vomiting. The child was born via vaginal delivery without complications. On examination, the vital signs include: pulse 130/min, respiratory rate ... | Succinyl-CoA | {
"A": "Pyruvate",
"B": "Succinyl-CoA",
"C": "Methylmalonyl-CoA",
"D": "Acetyl-CoA"
} | step1 | B | [
"day old newborn",
"brought",
"pediatrician",
"lethargy",
"poor muscle tone",
"feeding difficulty",
"occasional regurgitation",
"recently turned",
"projectile vomiting",
"child",
"born",
"vaginal delivery",
"complications",
"examination",
"vital signs include",
"pulse",
"min",
"res... |
A 48-year-old woman comes to the emergency department because of increasingly severe right upper abdominal pain, fever, and nonbloody vomiting for 5 hours. The pain is dull and intermittent and radiates to her right shoulder. During the past 3 months, she had recurring abdominal discomfort after meals. She underwent an... | History of multiple past pregnancies | {
"A": "History of multiple past pregnancies",
"B": "History of recurrent sexually transmitted infections",
"C": "Frequent, high-pitched bowel sounds on auscultation",
"D": "Urine culture growing gram-negative rods"
} | step2&3 | A | [
"48 year old woman",
"emergency department",
"severe right upper",
"fever",
"vomiting",
"hours",
"pain",
"dull",
"intermittent",
"radiates",
"right shoulder",
"past 3 months",
"recurring abdominal discomfort",
"meals",
"appendectomy",
"age",
"years",
"patient",
"hypertension",
... |
A 2-day-old boy is examined on day of discharge from the newborn nursery. He was born at 39 weeks by vaginal delivery to a primigravid mother. The pregnancy and delivery were uncomplicated, and the baby has been stooling, urinating, and feeding normally. Both the patient’s mother and father have no known past medical h... | Decreased affinity for 2,3-bisphosphoglycerate | {
"A": "Lower affinity for binding oxygen",
"B": "More likely to form hexagonal crystals",
"C": "Decreased affinity for 2,3-bisphosphoglycerate",
"D": "Increased affinity for 2,3-bisphosphoglycerate"
} | step1 | C | [
"2-day old boy",
"examined",
"day",
"discharge",
"newborn nursery",
"born",
"weeks",
"vaginal delivery",
"primigravid mother",
"pregnancy",
"delivery",
"uncomplicated",
"baby",
"stooling",
"feeding",
"patients mother",
"father",
"known past medical history",
"found to",
"normal... |
An investigator is comparing DNA replication in prokaryotes and eukaryotes. He finds that the entire genome of E. coli (4 × 106 base pairs) is replicated in approximately 30 minutes. A mammalian genome (3 × 109 base pairs) is usually replicated within 3 hours. Which of the following characteristics of eukaryotic DNA re... | Simultaneous replication at multiple origins | {
"A": "Replication inhibition at checkpoint",
"B": "Simultaneous replication at multiple origins",
"C": "DNA compaction in chromatin",
"D": "More efficient DNA polymerase activity"
} | step1 | B | [
"investigator",
"comparing DNA replication",
"prokaryotes",
"eukaryotes",
"finds",
"entire genome",
"E",
"coli",
"4",
"base pairs",
"replicated",
"approximately 30 minutes",
"mammalian genome",
"3",
"base pairs",
"usually replicated",
"hours",
"following characteristics",
"eukary... |
A 23-year-old woman presents to the emergency department after fainting at a baseball game. The patient was using the bathroom and upon standing up, felt a warm and tingling sensation followed by an episode of syncope that lasted for about 5 seconds. While the patient was unconscious, bystanders observed twitching and ... | Discharge the patient with reassurance | {
"A": "Discharge the patient with reassurance",
"B": "Echocardiography",
"C": "EEG",
"D": "Serum toxicology"
} | step2&3 | A | [
"23 year old woman presents",
"emergency department",
"fainting",
"baseball game",
"patient",
"using",
"bathroom",
"standing up",
"felt",
"warm",
"tingling sensation followed by",
"episode of syncope",
"lasted",
"seconds",
"patient",
"unconscious",
"bystanders observed twitching",
... |
A 15-year-old girl is brought in by her parents to her pediatrician with concerns that their daughter still has not had her first menstrual cycle. The parents report that the patient has had no developmental issues in the past. She was born full term by vaginal delivery and has met all other milestones growing up. Base... | 46, XY | {
"A": "45, XO",
"B": "46, XY",
"C": "47, XXY",
"D": "47, XYY"
} | step1 | B | [
"year old girl",
"brought",
"parents",
"pediatrician",
"concerns",
"daughter",
"not",
"first menstrual cycle",
"parents report",
"patient",
"developmental issues",
"past",
"born full term",
"vaginal delivery",
"met",
"milestones",
"Based",
"chart review",
"patient",
"breast bud... |
A microbiologist is involved in research on the emergence of a novel virus, X, which caused a recent epidemic in his community. After studying the structure of the virus, he proposes a hypothesis: Virus X developed from viruses A and B. He suggests that viruses A and B could co-infect a single host cell. During the gro... | Phenotypic mixing | {
"A": "Genetic reassortment",
"B": "Complementation",
"C": "Phenotypic mixing",
"D": "Antigenic shift"
} | step1 | C | [
"microbiologist",
"involved",
"research",
"emergence",
"novel virus",
"caused",
"recent epidemic",
"community",
"studying",
"structure",
"virus",
"hypothesis",
"Virus",
"viruses",
"suggests",
"viruses",
"co infect",
"single host cell",
"growth cycles",
"viruses",
"cells",
"... |
A previously healthy 5-year-old boy is brought to the physician because of a 2-day history of itchy rash and swelling on his left lower leg. His mother says the boy complained of an insect bite while playing outdoors 3 days before the onset of the lesion. His immunizations are up-to-date. He is at the 50th percentile f... | Streptococcus pyogenes infection
" | {
"A": "Sporothrix schenckii infection",
"B": "Contact dermatitis",
"C": "Vasculitis",
"D": "Streptococcus pyogenes infection\n\""
} | step2&3 | D | [
"healthy",
"year old boy",
"brought",
"physician",
"2-day history",
"itchy rash",
"swelling",
"left",
"mother",
"boy",
"insect bite",
"playing outdoors 3 days",
"onset",
"lesion",
"immunizations",
"date",
"50th percentile",
"height",
"percentile",
"weight",
"known allergies",... |
A 52-year-old man presents to the emergency room after a syncopal episode. The patient is awake, alert, and oriented; however, he becomes lightheaded whenever he tries to sit up. The medical history is significant for coronary artery disease and stable angina, which are controlled with simvastatin and isosorbide dinitr... | Increased cGMP | {
"A": "Increased PDE-5",
"B": "Increased NO",
"C": "Increased cGMP",
"D": "Nitric oxide synthase inhibition"
} | step1 | C | [
"year old man presents",
"emergency room",
"syncopal episode",
"patient",
"awake",
"alert",
"oriented",
"lightheaded",
"to sit up",
"medical history",
"significant",
"coronary artery disease",
"stable angina",
"controlled",
"simvastatin",
"isosorbide dinitrate",
"blood pressure",
"... |
A 32-year-old woman is admitted to the hospital after undergoing an open cholecystectomy under general anesthesia. Preoperatively, the patient was administered a single dose of intravenous ceftriaxone. Now, the anesthetic effects have worn off, and her pain is well managed. The patient has a prior medical history of hy... | Halothane | {
"A": "Captopril",
"B": "Nitrous oxide",
"C": "Halothane",
"D": "Ceftriaxone"
} | step1 | C | [
"year old woman",
"admitted",
"hospital",
"open cholecystectomy",
"general anesthesia",
"patient",
"administered",
"single dose",
"intravenous ceftriaxone",
"Now",
"anesthetic effects",
"pain",
"well managed",
"patient",
"prior medical",
"well controlled by captopril",
"2 years",
"... |
A 2-month-old infant is brought to his pediatrician because of recurrent episodes of vomiting. Specifically, his parents say that he starts to vomit as soon as he is laid down after feeding. He was born at full term and had no complications in the perinatal period. Contrast radiograph reveals part of the stomach is wit... | Reflux | {
"A": "Cholecystitis",
"B": "Dyspnea",
"C": "Pancreatitis",
"D": "Reflux"
} | step1 | D | [
"2 month old infant",
"brought",
"pediatrician",
"of recurrent episodes",
"vomiting",
"parents",
"starts to vomit",
"feeding",
"born",
"full term",
"complications",
"perinatal period",
"Contrast radiograph reveals part",
"stomach",
"thoracic cavity",
"following symptoms",
"most likel... |
A 27-year-old man is brought to the emergency department from a homeless shelter because of bizarre behavior. He avoids contact with others and has complained to the supervising staff that he thinks people are reading his mind. Three days ago, he unplugged every electrical appliance on his floor of the shelter because ... | Intramuscular risperidone | {
"A": "Intravenous propranolol",
"B": "Oral haloperidol",
"C": "Oral diazepam",
"D": "Intramuscular risperidone"
} | step2&3 | D | [
"27 year old man",
"brought",
"emergency department",
"homeless shelter",
"bizarre behavior",
"contact with others",
"staff",
"thinks people",
"reading",
"mind",
"Three days",
"electrical appliance",
"floor",
"shelter",
"used to transmit messages",
"others",
"patient",
"schizophren... |
A 66-year-old woman presents to the emergency department complaining of palpitations. She says that she has been experiencing palpitations and lightheadedness for the past 6 months, but before this morning the episodes usually resolved on their own. The patient’s medical history is significant for a transient ischemia ... | Type II heparin-induced thrombocytopenia | {
"A": "Idiopathic thrombocytopenia purpura",
"B": "Type I heparin-induced thrombocytopenia",
"C": "Type II heparin-induced thrombocytopenia",
"D": "Warfarin toxicity"
} | step2&3 | C | [
"66 year old woman presents",
"emergency department",
"palpitations",
"experiencing palpitations",
"lightheadedness",
"past 6 months",
"morning",
"episodes usually resolved",
"patients medical history",
"significant",
"transient ischemia attack",
"months",
"hypertension",
"diabetes",
"ta... |
A 30-year-old man presents with dark urine and fatigue. The patient states that the symptoms started 2 days ago. Since yesterday, he also noticed that his eyes look yellow. The past medical history is significant for recent right ear pain diagnosed 3 days ago as acute otitis media, which he was prescribed trimethoprim-... | Increased serum lactate dehydrogenase (LDH) | {
"A": "Decreased reticulocyte count",
"B": "Decreased indirect bilirubin levels",
"C": "Increased serum lactate dehydrogenase (LDH)",
"D": "Decreased mean corpuscular volume"
} | step2&3 | C | [
"30 year old man presents",
"dark urine",
"fatigue",
"patient states",
"symptoms started 2 days",
"eyes look yellow",
"past medical history",
"significant",
"recent right diagnosed 3 days",
"acute otitis media",
"prescribed trimethoprim-sulfamethoxazole",
"currently",
"not take",
"medicati... |
A 72-year-old man presents to his primary care physician because he has been having flank and back pain for the last 8 months. He said that it started after he fell off a chair while doing yard work, but it has been getting progressively worse over time. He reports no other symptoms and denies any weight loss or tingli... | Renal arteries and common iliac arteries | {
"A": "Diaphragm and renal arteries",
"B": "Diaphragm and superior mesenteric artery",
"C": "Renal arteries and common iliac arteries",
"D": "Superior mesenteric artery and common iliac arteries"
} | step1 | C | [
"72 year old man presents",
"primary care physician",
"flank",
"back pain",
"months",
"started",
"fell",
"chair",
"yard work",
"getting",
"worse",
"time",
"reports",
"symptoms",
"denies",
"weight loss",
"tingling",
"extremities",
"medical history",
"significant",
"poorly cont... |
A 17-year-old girl is brought to the emergency department 6 hours after she attempted suicide by consuming 16 tablets of acetaminophen (500 mg per tablet). At present, she does not have any complaints or symptoms. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. La... | Promotes microcirculatory blood flow | {
"A": "Promotes glucuronidation of unmetabolized acetaminophen",
"B": "Promotes fecal excretion of unabsorbed acetaminophen",
"C": "Promotes microcirculatory blood flow",
"D": "Promotes oxidation of N-acetyl-p-benzoquinoneimine (NAPQI)"
} | step1 | C | [
"year old girl",
"brought",
"emergency department",
"hours",
"attempted suicide",
"tablets",
"acetaminophen",
"500 mg",
"tablet",
"present",
"not",
"complaints",
"symptoms",
"patient",
"afebrile",
"vital signs",
"normal",
"Physical examination",
"unremarkable",
"Laboratory find... |
A 70-year-old man comes to the physician because of a 2-month history of progressive shortness of breath and a dry cough. He has also noticed gradual development of facial discoloration. He has not had fevers. He has coronary artery disease, hypertension, and atrial fibrillation. He does not smoke or drink alcohol. He ... | Amiodarone | {
"A": "Lisinopril",
"B": "Warfarin",
"C": "Metoprolol",
"D": "Amiodarone"
} | step2&3 | D | [
"70 year old man",
"physician",
"of",
"2 month history",
"progressive shortness",
"breath",
"dry cough",
"gradual development",
"facial discoloration",
"not",
"fevers",
"coronary artery disease",
"hypertension",
"atrial fibrillation",
"not smoke",
"drink alcohol",
"not remember",
"... |
A 65-year-old man presents to the emergency department with vague, constant abdominal pain, and worsening shortness of breath for the past several hours. He has baseline shortness of breath and requires 2–3 pillows to sleep at night. He often wakes up because of shortness of breath. Past medical history includes conges... | Meandering mesenteric artery | {
"A": "Meandering mesenteric artery",
"B": "Right coronary artery",
"C": "Celiac artery and superior mesenteric artery",
"D": "Left colic artery"
} | step1 | A | [
"65 year old man presents",
"emergency department",
"vague",
"constant abdominal",
"worsening shortness of breath",
"past",
"hours",
"baseline shortness of breath",
"23 pillows to sleep",
"night",
"often wakes up",
"of shortness",
"breath",
"Past medical history includes congestive heart f... |
A 28-year-old man presents to the emergency department with diffuse abdominal pain and nausea for the past 5 hours. The pain started with a dull ache but is now quite severe. He notes that he “just doesn’t feel like eating” and has not eaten anything for almost a day. Although the nausea is getting worse, the patient h... | Increased acetyl CoA levels | {
"A": "Increased acetyl CoA levels",
"B": "Inadequate insulin production",
"C": "Increased osmolal gap",
"D": "Thiamine deficiency"
} | step1 | A | [
"year old man presents",
"emergency department",
"diffuse abdominal",
"nausea",
"past",
"hours",
"pain started",
"dull ache",
"now",
"severe",
"notes",
"feel",
"eating",
"not eaten",
"almost",
"day",
"nausea",
"getting worse",
"patient",
"not vomited",
"notes",
"medical iss... |
A 17-year-old girl presents to an urgent care clinic after waking up in the morning with a left-sided facial droop and an inability to fully close her left eye. Of note, she is currently on oral contraceptives and escitalopram and smokes half a pack of cigarettes per day. Her temperature is 98.2°F (36.8°C), blood press... | Prednisone alone | {
"A": "Head CT without contrast",
"B": "Implantation of gold weight for eyelid",
"C": "Intravenous immunoglobulin",
"D": "Prednisone alone"
} | step1 | D | [
"year old girl presents",
"urgent care clinic",
"waking",
"morning",
"left-sided facial droop",
"close",
"left eye",
"note",
"currently",
"oral contraceptives",
"escitalopram",
"smokes half",
"pack",
"cigarettes",
"day",
"temperature",
"98",
"36",
"blood pressure",
"68 mmHg",
... |
A 40-year-old sailor is brought to a military treatment facility 20 minutes after being involved in a navy ship collision. He appears ill. He reports a sensation that he needs to urinate but is unable to void. His pulse is 140/min, respirations are 28/min, and blood pressure is 104/70 mm Hg. Pelvic examination shows ec... | Tearing of the posterior urethra | {
"A": "Tearing of the anterior urethra",
"B": "Rupture of the corpus cavernosum",
"C": "Tearing of the posterior urethra",
"D": "Tearing of the ureter"
} | step2&3 | C | [
"40 year old sailor",
"brought",
"military treatment facility 20 minutes",
"involved",
"navy ship collision",
"appears ill",
"reports",
"sensation",
"needs to",
"unable to void",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"70 mm Hg",
"Pelvic examination shows ecchymoses... |
A 22-year-old woman presents with progressive hearing loss for the past 4 months. She says that she isn’t hearing high frequency sounds like she used to, especially in large rooms. Her past medical history shows significant bilateral lens dislocations 6 months ago. Family history reveals that her mother had chronic hem... | Skin biopsy | {
"A": "Skin biopsy",
"B": "Urinary creatinine (24-hour)",
"C": "Upright KUB radiograph",
"D": "Renal ultrasound"
} | step2&3 | A | [
"year old woman presents",
"progressive hearing loss",
"past",
"months",
"hearing high frequency sounds",
"used",
"large rooms",
"past medical history shows significant bilateral lens dislocations",
"months",
"Family history reveals",
"mother",
"chronic hematuria",
"grandfather suffered",
... |
A pregnant woman gives birth to her 1st child at the family farm. After delivery, the assisting midwife notices a triangular defect in the lower anterior abdominal wall of the baby. She clamps the umbilical cord with a cloth and urges the family to seek immediate medical care at the nearest hospital. Upon admission, th... | Bladder exstrophy | {
"A": "Urachal cyst",
"B": "Posterior urethral valves",
"C": "Cloacal exstrophy",
"D": "Bladder exstrophy"
} | step1 | D | [
"pregnant woman gives birth",
"1st child",
"family farm",
"delivery",
"assisting midwife",
"triangular defect",
"lower anterior abdominal wall",
"baby",
"clamps",
"umbilical cord",
"cloth",
"family to",
"immediate medical",
"nearest hospital",
"admission",
"attending pediatrician furth... |
A new drug has been shown to block epithelial sodium channels in the cortical collecting duct. Which of the following is most likely to be decreased upon drug administration? | Potassium secretion in the collecting tubules | {
"A": "Potassium secretion in the collecting tubules",
"B": "Sodium secretion in the collecting tubules",
"C": "Urea secretion in the collecting tubules",
"D": "Sodium chloride reabsorption in the distal tubule"
} | step1 | A | [
"new drug",
"shown to block epithelial sodium channels",
"cortical collecting duct",
"following",
"most likely to",
"decreased",
"drug administration"
] |
A 30-year-old G1P0 woman at 26 weeks gestation presents to the obstetric emergency room for an evaluation after being involved in a motor vehicle accident. She was in the passenger seat of her car when the car was hit on the side by a drunk driver. She is currently in no acute distress but is worried about her pregnanc... | Betamethasone administration | {
"A": "Betamethasone administration",
"B": "Emergent cesarean section",
"C": "Contraction stress test",
"D": "Immediate induction of labor"
} | step1 | A | [
"30 year old",
"woman",
"26 weeks gestation presents",
"obstetric emergency room",
"evaluation",
"involved",
"motor vehicle accident",
"passenger",
"car",
"car",
"hit",
"side",
"drunk driver",
"currently",
"acute distress",
"worried",
"pregnancy",
"patient attended",
"prenatal vi... |
A 56-year-old woman presents to the emergency department following a seizure episode. She has a remote history of tonic-clonic seizures; however, her seizures have been well-controlled on valproate, with no seizure episodes occurring over the past 12 years. She was weaned off of the valproate 4 months ago. Her temperat... | Observation | {
"A": "Intubation",
"B": "Normal saline",
"C": "Observation",
"D": "Sodium bicarbonate"
} | step2&3 | C | [
"year old woman presents",
"emergency department following",
"seizure episode",
"remote history",
"tonic-clonic seizures",
"seizures",
"well-controlled",
"valproate",
"seizure episodes occurring",
"past",
"years",
"weaned",
"valproate",
"months",
"temperature",
"97",
"36 4C",
"bloo... |
A 13-year-old girl is brought to the physician by her mother because of a 1-month history of abnormal movements of her muscles that she cannot control. She has a younger brother with cognitive disabilities and epilepsy. Examination shows frequent, brief, involuntary contractions of the muscle groups of the upper arms, ... | Defective oxidative phosphorylation | {
"A": "CTG trinucleotide repeat expansion",
"B": "Defective oxidative phosphorylation",
"C": "Autoimmune endomysial destruction",
"D": "Truncated dystrophin protein"
} | step1 | B | [
"year old girl",
"brought",
"physician",
"mother",
"month history",
"abnormal",
"muscles",
"control",
"younger brother",
"cognitive disabilities",
"epilepsy",
"Examination shows frequent",
"brief",
"involuntary contractions of",
"muscle groups",
"upper arms",
"legs",
"face",
"tri... |
A 70-year-old man with a history of chronic constipation presents to the emergency department with a two-day history of left lower quadrant abdominal pain. He is found to have a temperature of 100.8F, BP 140/90, HR 85, and RR 16. On physical examination, he is tender to light palpation in the left lower quadrant and ex... | Abdominal CT | {
"A": "Lipase",
"B": "Abdominal CT",
"C": "Left lower quadrant ultrasound",
"D": "Emergent colonoscopy"
} | step2&3 | B | [
"70 year old man",
"history",
"chronic constipation presents",
"emergency department",
"two day history",
"left lower quadrant abdominal pain",
"found to",
"temperature",
"100",
"BP",
"90",
"85",
"RR",
"physical examination",
"tender",
"light palpation",
"left lower quadrant",
"exh... |
A 28-year-old man presents to the clinic with increasing shortness of breath, mild chest pain at rest, and fatigue. He normally lives a healthy lifestyle with moderate exercise and an active social life, but recently he has been too tired to do much. He reports that he is generally healthy and on no medications but did... | Coxsackievirus infection | {
"A": "Acute myocardial infarction",
"B": "Unstable angina",
"C": "Coxsackievirus infection",
"D": "Cocaine abuse"
} | step2&3 | C | [
"year old man presents",
"clinic",
"increasing shortness of breath",
"mild chest pain at rest",
"fatigue",
"lives",
"healthy lifestyle",
"moderate exercise",
"active social life",
"recently",
"tired to",
"reports",
"healthy",
"medications",
"cold",
"weeks",
"not smoke",
"occasional... |
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