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 comes to the physician because of a 1-month history of fever and poor appetite. Five weeks ago, he underwent molar extraction for dental caries. His temperature is 38°C (100.4°F). Cardiac examination shows a grade 2/6 holosystolic murmur heard best at the apex. A blood culture shows gram-positive, cat... | Production of dextrans | {
"A": "Replication in host macrophages",
"B": "Formation of germ tubes at body temperature",
"C": "Production of dextrans",
"D": "Conversion of fibrinogen to fibrin"
} | step1 | C | [
"year old man",
"physician",
"month history",
"fever",
"poor appetite",
"Five weeks",
"molar extraction",
"dental caries",
"temperature",
"100 4F",
"Cardiac examination shows",
"grade",
"6 holosystolic murmur heard best",
"apex",
"blood culture shows gram",
"catalase negative",
"Tran... |
A 55-year-old man presents to his primary care physician with complaints of fluctuating mood for the past 2 years. He feels great and full of energy for some months when he is very creative with tons of ideas just racing through his mind. He is noted to be very talkative and distracted by his different ideas. During th... | Cyclothymic disorder | {
"A": "Cyclothymic disorder",
"B": "Bipolar II disorder",
"C": "Persistent depressive disorder",
"D": "Dysthymic disorder"
} | step1 | A | [
"55 year old man presents",
"primary care physician",
"complaints",
"fluctuating mood",
"past",
"years",
"feels great",
"full of energy",
"months",
"very",
"tons",
"ideas",
"racing",
"mind",
"noted to",
"very talkative",
"different ideas",
"times",
"very productive",
"able to",... |
A 24-year-old woman presents with a 3-month history of worsening insomnia and anxiety. She says that she has an important college exam in the next few weeks for which she has to put in many hours of work each day. Despite the urgency of her circumstances, she states that she is unable to focus and concentrate, is anxio... | Dose titration of mirtazapine | {
"A": "Psychotherapy only",
"B": "Initiation of risperidone",
"C": "Dose titration of mirtazapine",
"D": "Phototherapy"
} | step2&3 | C | [
"year old woman presents",
"month history",
"worsening insomnia",
"anxiety",
"important college exam",
"next",
"weeks",
"to put",
"hours",
"work",
"day",
"urgency",
"states",
"unable to focus",
"concentrate",
"anxious",
"irritable",
"lost interest",
"almost",
"activities",
"t... |
A 39-year-old man comes to the physician for preoperative evaluation. He is scheduled for a right inguinal hernia repair the following day. He has a history of polycystic kidney disease and hypertension. His medications include lisinopril and vitamin D3 supplements. His father had the same kidney condition and died of ... | Perform hemodialysis | {
"A": "Perform hemodialysis",
"B": "Restrict salt and potassium intake",
"C": "Administer sodium bicarbonate",
"D": "Packed red blood cell transfusion"
} | step2&3 | A | [
"year old man",
"physician",
"preoperative evaluation",
"scheduled",
"right inguinal hernia repair",
"following day",
"history of polycystic kidney disease",
"hypertension",
"medications include lisinopril",
"vitamin D3 supplements",
"father",
"same kidney condition",
"died",
"intracerebra... |
A 32-year-old nulligravid woman comes to the physician because of 2 weeks of postcoital pain and blood-tinged vaginal discharge. She has been sexually active with one male partner for the past 3 months. They do not use condoms. Her only medication is a combined oral contraceptive that she has been taking for the past 2... | Chlamydia infection | {
"A": "Cervix trauma",
"B": "Uterine leiomyomas",
"C": "Early uterine pregnancy",
"D": "Chlamydia infection"
} | step2&3 | D | [
"year old nulligravid woman",
"physician",
"2 weeks",
"pain",
"blood-tinged vaginal discharge",
"sexually active",
"one male partner",
"past 3 months",
"not use condoms",
"only medication",
"combined oral contraceptive",
"taking",
"past",
"years",
"states",
"takes",
"medication",
"... |
A 55-year-old male presents to his primary care physician for a normal check-up. He has a history of atrial fibrillation for which he takes metoprolol and warfarin. During his last check-up, his international normalized ratio (INR) was 2.5. He reports that he recently traveled to Mexico for a business trip where he dev... | Trimethoprim-sulfamethoxazole | {
"A": "Rifampin",
"B": "Trimethoprim-sulfamethoxazole",
"C": "Griseofulvin",
"D": "Phenobarbital"
} | step1 | B | [
"55 year old male presents",
"primary care physician",
"normal check-up",
"history of atrial fibrillation",
"takes metoprolol",
"warfarin",
"last check-up",
"international normalized ratio",
"2.5",
"reports",
"recently traveled",
"Mexico",
"business trip",
"painful red rash",
"leg",
"p... |
A 4-year-old boy is brought to the physician by his parents for bedwetting. He went 3 months without wetting the bed but then started again 6 weeks ago. He has been wetting the bed about 1–2 times per week. He has not had daytime urinary incontinence or dysuria. His teachers report that he is attentive in preschool and... | Reassurance | {
"A": "Enuresis alarm",
"B": "Bladder ultrasound",
"C": "Reassurance",
"D": "IQ testing"
} | step2&3 | C | [
"4 year old boy",
"brought",
"physician",
"parents",
"bedwetting",
"3 months",
"wetting",
"bed",
"then started",
"weeks",
"wetting",
"bed",
"times",
"week",
"not",
"daytime urinary incontinence",
"dysuria",
"teachers report",
"attentive",
"preschool",
"plays well",
"peers",... |
An 8-year-old girl is brought to the physician because of a progressive swelling of her neck for the past 6 months. She has no pain, dyspnea, or dysphagia. She is at the 60th percentile for height and the 55th percentile for weight. Vital signs are within normal limits. Examination shows a 3-cm cystic, nontender swelli... | Ultrasonography of the neck | {
"A": "Excision of the cyst, track and hyoid bone",
"B": "Ultrasonography of the neck",
"C": "CT scan of the neck",
"D": "Excision of the cyst"
} | step2&3 | B | [
"year old girl",
"brought",
"physician",
"progressive swelling",
"neck",
"past 6 months",
"pain",
"dyspnea",
"dysphagia",
"percentile",
"height",
"percentile",
"weight",
"Vital signs",
"normal limits",
"Examination shows",
"3",
"cystic",
"nontender swelling",
"the midline of",
... |
A 76-year-old woman presents to the physician for a follow-up examination. She had a hemoglobin level of 10.5 g/dL last month. She complains of mild dyspnea with exercise. She reports exercising daily for the past 30 years. She is relatively healthy without any significant past medical history. She occasionally takes i... | Annual follow-up with laboratory tests | {
"A": "Annual follow-up with laboratory tests",
"B": "Check beta-2 microglobulin",
"C": "Referral for radiation therapy",
"D": "No further steps are required at this time"
} | step2&3 | A | [
"76 year old woman presents",
"physician",
"follow-up examination",
"a hemoglobin level",
"10.5 g",
"month",
"mild dyspnea",
"exercise",
"reports exercising daily",
"past 30 years",
"relatively healthy",
"significant past medical history",
"occasionally takes ibuprofen",
"knee pain",
"de... |
A 52-year-old man presents to his primary care physician for a yearly checkup complaining of recent weight gain. The patient states that he has noticed that, regardless of his diet, his midsection has gotten increasingly larger and his old clothes no longer fit. The patient has a 2-year history of left hip arthritis fr... | Bilateral adrenal atrophy | {
"A": "Bilateral adrenal atrophy",
"B": "Bilateral adrenal hyperplasia",
"C": "Unilateral adrenal atrophy",
"D": "Unilateral adrenal hyperplasia"
} | step1 | A | [
"year old man presents",
"primary care physician",
"yearly checkup",
"recent weight gain",
"patient states",
"diet",
"midsection",
"gotten",
"larger",
"old clothes",
"longer fit",
"patient",
"2 year history of left hip arthritis",
"car accident",
"prednisone",
"history of migraine head... |
A 35-year-old woman comes to the physician with right-sided flank pain and blood in her urine for 1 day. She does not have fever or dysuria. She had similar symptoms several weeks ago but did not seek medical care at the time. Physical examination shows right costovertebral angle tenderness. Her serum uric acid level i... | Chlorthalidone | {
"A": "Low-potassium diet",
"B": "Amoxicillin with clavulanic acid",
"C": "Allopurinol",
"D": "Chlorthalidone"
} | step1 | D | [
"35 year old woman",
"physician",
"right-sided flank pain",
"blood in",
"urine",
"1 day",
"not",
"fever",
"dysuria",
"similar symptoms",
"weeks",
"not",
"medical care",
"time",
"Physical examination shows right costovertebral angle tenderness",
"serum uric acid level",
"6.9 mg/dL",
... |
A 24-year-old man presents to the emergency department after a motor vehicle accident. The patient was at a stop when he was rear-ended from behind by a vehicle traveling at 11 miles per hour. The patient complains of severe back pain but states he otherwise feels well. The patient is currently seeing a physical therap... | Vertebral fracture | {
"A": "Herniated nucleus pulposus",
"B": "Malingering",
"C": "Spondylolisthesis",
"D": "Vertebral fracture"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"motor vehicle accident",
"patient",
"stop",
"rear-ended",
"vehicle traveling",
"miles per hour",
"patient",
"severe back pain",
"states",
"feels well",
"patient",
"currently seeing",
"physical therapist",
"giving",
"exercises to",
"... |
A 58-year-old male with a history of congestive heart failure and hypertension comes to you with the chief complaint of new-onset cough as well as increased serum potassium in the setting of a new medication. Which of the following medications is most likely responsible for these findings? | Lisinopril | {
"A": "Furosemide",
"B": "Amiodarone",
"C": "Digoxin",
"D": "Lisinopril"
} | step1 | D | [
"58 year old male",
"history of congestive heart failure",
"hypertension",
"chief complaint",
"new-onset cough",
"increased serum potassium",
"setting",
"new medication",
"following medications",
"most likely responsible",
"findings"
] |
An 11-year-old boy is brought to his pediatrician by his parents for the routine Tdap immunization booster dose that is given during adolescence. Upon reviewing the patient’s medical records, the pediatrician notes that he was immunized according to CDC recommendations, with the exception that he received a catch-up Td... | A single dose of Td vaccine at 18 years of age | {
"A": "A single dose of Tdap vaccine now",
"B": "A single dose of Tdap vaccine at 18 years of age",
"C": "A single dose of Td vaccine now",
"D": "A single dose of Td vaccine at 18 years of age"
} | step2&3 | D | [
"year old boy",
"brought",
"pediatrician",
"parents",
"routine Tdap dose",
"given",
"adolescence",
"reviewing",
"patients medical records",
"pediatrician notes",
"according",
"CDC recommendations",
"exception",
"received",
"catch",
"Tdap immunization",
"age",
"years",
"pediatrici... |
A 64-year-old woman with a past medical history of poorly managed diabetes presents to the emergency department with nausea and vomiting. Her symptoms started yesterday and have been progressively worsening. She is unable to eat given her symptoms. Her temperature is 102°F (38.9°C), blood pressure is 115/68 mmHg, pulse... | Trimethoprim-sulfamethoxazole | {
"A": "Amoxicillin",
"B": "Meropenem",
"C": "Nitrofurantoin",
"D": "Trimethoprim-sulfamethoxazole"
} | step2&3 | D | [
"64 year old woman",
"past medical history of poorly managed diabetes presents",
"emergency department",
"nausea",
"vomiting",
"symptoms started",
"worsening",
"unable to eat given",
"symptoms",
"temperature",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxyge... |
A 58-year-old woman with New York Heart Association Class III heart failure, atrial fibrillation, and bipolar disorder presents to the urgent care center with nausea, vomiting, abdominal pain, double vision, and describes seeing green/yellow outlines around objects. Her current medications include ramipril, bisoprolol,... | Digoxin | {
"A": "Digoxin",
"B": "Amiodarone",
"C": "Lithium",
"D": "Bisoprolol"
} | step2&3 | A | [
"58 year old woman",
"New York Heart Association Class III",
"failure",
"atrial fibrillation",
"bipolar disorder presents",
"urgent care center",
"nausea",
"vomiting",
"abdominal pain",
"double vision",
"seeing green/yellow outlines",
"objects",
"current medications include ramipril",
"bis... |
A 7-year-old boy is brought in to clinic by his parents with a chief concern of poor performance in school. The parents were told by the teacher that the student often does not turn in assignments, and when he does they are partially complete. The child also often shouts out answers to questions and has trouble partici... | Decreases synaptic reuptake of norepinephrine and dopamine | {
"A": "Increases the duration of GABAa channel opening",
"B": "Antagonizes NMDA receptors",
"C": "Decreases synaptic reuptake of norepinephrine and dopamine",
"D": "Blockade of D2 receptors"
} | step1 | C | [
"year old boy",
"brought",
"clinic",
"parents",
"concern",
"poor performance in school",
"parents",
"teacher",
"student often",
"not turn",
"assignments",
"complete",
"child",
"often shouts out answers",
"questions",
"participating",
"class sports",
"not follow",
"rules",
"pare... |
A 54-year-old woman comes to the emergency department because of two episodes of bright red blood per rectum within the past day. She has a history of migraine, which is treated prophylactically with verapamil. She appears well and is hemodynamically stable. Cardiac exam reveals a regular heart rate without any murmurs... | Observation | {
"A": "Observation",
"B": "Synchronized cardioversion",
"C": "Metoprolol therapy",
"D": "Pacemaker placement"
} | step2&3 | A | [
"54 year old woman",
"emergency department",
"two episodes",
"bright red blood per rectum",
"past day",
"history of migraine",
"treated",
"verapamil",
"appears well",
"hemodynamically stable",
"Cardiac exam reveals",
"regular heart rate",
"murmurs",
"Lungs",
"clear",
"auscultation",
... |
A 28-year-old male intern is currently on a trauma surgery service. After a busy overnight shift, the intern did not have enough time to prepare to present all of the patients on the team’s list. At morning rounds, the chief resident made a sarcastic comment that the intern “really put a lot of effort into preparing fo... | Displacement | {
"A": "Displacement",
"B": "Passive aggression",
"C": "Projection",
"D": "Reaction formation"
} | step1 | A | [
"year old male intern",
"currently",
"trauma surgery service",
"overnight shift",
"intern",
"not",
"time to prepare to present",
"patients",
"teams list",
"morning rounds",
"resident made",
"comment",
"intern",
"put",
"lot",
"effort",
"preparing",
"rounds",
"rounds",
"managing"... |
A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he ... | Valproic acid | {
"A": "Valproic acid",
"B": "Antidepressants",
"C": "Haloperidol",
"D": "Clozapine"
} | step2&3 | A | [
"35 year old man",
"brought",
"emergency department",
"wife",
"called",
"coworkers to",
"pick",
"work",
"barged",
"board meeting",
"very disruptive",
"great ideas",
"company",
"to reason",
"hostile",
"CEO",
"best",
"future",
"company",
"patients wife",
"noted",
"husband",
... |
An 82-year-old man is brought to the emergency department because of severe pain and joint stiffness in his right knee. The pain started 3 days ago and has worsened despite acetaminophen intake. He has benign prostatic hyperplasia and hypertension. One week ago, he had a urinary tract infection and was treated with nit... | IV cefepime | {
"A": "IV nafcillin",
"B": "IV cefepime",
"C": "IV ceftazidime and gentamicin",
"D": "IV vancomycin"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"severe pain",
"joint stiffness in",
"right knee",
"pain started 3 days",
"worsened",
"acetaminophen intake",
"benign prostatic hyperplasia",
"hypertension",
"One week",
"urinary tract infection",
"treated with nitrofurantoin",
"not smok... |
A 27-year-old female ultramarathon runner presents to the physician with complaints of persistent knee pain. She describes the pain to be located in the anterior area of her knee and is most aggravated when she performs steep descents down mountains, though the pain is present with running on flat roads, walking up and... | Pain upon compression of the patella while the patient performs flexion and extension of the leg | {
"A": "Excessive anterior displacement of the tibia",
"B": "Excessive posterior displacement of the tibia",
"C": "Pain upon compression of the patella while the patient performs flexion and extension of the leg",
"D": "Pain upon pressure placed on the medial aspect of the knee"
} | step2&3 | C | [
"27 year old female",
"presents",
"physician",
"complaints",
"persistent knee pain",
"pain to",
"anterior area",
"knee",
"most aggravated",
"performs",
"descents",
"mountains",
"pain",
"present",
"running",
"flat roads",
"walking",
"down stairs",
"squatting",
"following",
"mo... |
A 17-year-old high school student comes to the physician because of a 6-month history of insomnia. On school nights, he goes to bed around 11 p.m. but has had persistent problems falling asleep and instead studies at his desk until he feels sleepy around 2 a.m. He does not wake up in the middle of the night. He is worr... | Delayed sleep-wake disorder | {
"A": "Delayed sleep-wake disorder",
"B": "Psychophysiologic insomnia",
"C": "Advanced sleep-wake disorder",
"D": "Irregular sleep-wake disorder"
} | step2&3 | A | [
"year old high school student",
"physician",
"month history",
"insomnia",
"school nights",
"goes",
"bed",
"m",
"persistent problems falling asleep",
"studies",
"feels sleepy",
"m",
"not wake up",
"middle",
"night",
"worried",
"not",
"sleep",
"significant difficulties waking up",
... |
A 45-year-old woman from Mexico comes to your office due to recent shortness of breath. The patient states that she has recently started having trouble breathing when she is working out, but this resolves when she rests for a while. She states that she has no history of diabetes, heart disease, or hypertension, but doe... | Percutaneous valve commissurotomy | {
"A": "Diuretics",
"B": "Valve replacement",
"C": "Percutaneous valve commissurotomy",
"D": "Open valve commissurotomy"
} | step2&3 | C | [
"year old woman",
"Mexico",
"office due to recent shortness of breath",
"patient states",
"recently started",
"trouble breathing",
"working out",
"resolves",
"rests",
"states",
"history",
"diabetes",
"heart disease",
"hypertension",
"state",
"several colds",
"treated with antibiotics... |
A 37-year-old woman comes to the physician because of a 10-month history of excessive daytime sleepiness and fatigue. She says she has difficulty concentrating and has fallen asleep at work on numerous occasions. She also reports having frequent headaches during the day. She has no difficulty falling asleep at night, b... | Diurnal alveolar hypoventilation
" | {
"A": "Apneic episodes with obstructed upper airways",
"B": "Drug-induced respiratory depression",
"C": "Chronic inflammatory airflow limitation",
"D": "Diurnal alveolar hypoventilation\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"a 10 month history",
"excessive daytime sleepiness",
"fatigue",
"difficulty concentrating",
"fallen asleep",
"work",
"numerous occasions",
"reports",
"frequent headaches",
"day",
"difficulty falling asleep",
"night",
"wakes up gasping",
"breath",
"alwa... |
A 77-year-old female comes to a medical school's free clinic for follow-up examination after a urinary tract infection (UTI) and is seen by a fourth year medical student. The clinic serves largely uninsured low-income patients in a New York City neighborhood with a large African American and Latino population. Two week... | Low external validity | {
"A": "Low internal validity",
"B": "Poor reliability",
"C": "Low external validity",
"D": "Selection bias"
} | step2&3 | C | [
"year old female",
"medical school's free clinic",
"follow-up examination",
"urinary tract infection",
"seen by",
"fourth year medical student",
"clinic",
"uninsured low-income patients",
"New York City neighborhood",
"large African American",
"Latino population",
"Two weeks",
"patient",
"... |
An investigator is studying the biology of human sperm cells. She isolates spermatogonia obtained on a testicular biopsy from a group of healthy male volunteers. She finds that the DNA of spermatogonia obtained from these men show a large number of TTAGGG sequence repeats. This finding can best be explained by increase... | RNA-dependent synthesis of DNA | {
"A": "Ligation of Okazaki fragments",
"B": "Hemimethylation of DNA strand",
"C": "RNA-dependent synthesis of DNA",
"D": "Production of short RNA sequences"
} | step1 | C | [
"investigator",
"studying",
"biology",
"human sperm cells",
"isolates spermatogonia obtained",
"testicular biopsy",
"a group",
"healthy male volunteers",
"finds",
"DNA",
"spermatogonia obtained",
"men show",
"large number",
"sequence repeats",
"finding",
"best",
"increased",
"enzym... |
A 44-year-old woman with high blood pressure and diabetes presents to the outpatient clinic and informs you that she is trying to get pregnant. Her current medications include lisinopril, metformin, and sitagliptin. Her blood pressure is 136/92 mm Hg and heart rate is 79/min. Her physical examination is unremarkable. W... | Discontinue lisinopril and initiate labetalol | {
"A": "Continue her current regimen",
"B": "Discontinue lisinopril and initiate labetalol",
"C": "Continue her current regimen and add a beta-blocker for increased control",
"D": "Discontinue lisinopril and initiate candesartan"
} | step2&3 | B | [
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"high blood pressure",
"diabetes presents",
"outpatient clinic",
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"current medications include lisinopril",
"metformin",
"sitagliptin",
"blood pressure",
"mm Hg",
"heart rate",
"min",
"physical examination",
"unremarkable",
"medication",
... |
A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drin... | """I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about?""" | {
"A": "\"\"\"I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships.\"\"\"",
"B": "\"\"\"I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health.\"\"\"",
"C": "\"\"\"I'm sorry... | step1 | C | [
"67 year old man",
"physician",
"routine examination",
"not take",
"medications",
"drinks",
"bottles",
"beer",
"night",
"often",
"shot",
"whiskey",
"morning",
"headache",
"recently fired",
"job",
"late",
"wrong",
"drinking",
"frustration",
"best friend",
"longer returning",... |
A 42-year-old woman comes to the physician because of a 5-day history of intermittent palpitations. She has no history of syncope or chest pain. She had similar symptoms 1 year ago and following workup has been treated with daily flecainide since then. She drinks one to two glasses of wine on the weekends. She does not... | Pulmonary vein openings | {
"A": "Basal interventricular septum",
"B": "Pulmonary vein openings",
"C": "Atrioventricular node",
"D": "Bundle of Kent"
} | step2&3 | B | [
"year old woman",
"physician",
"of",
"5-day history",
"intermittent palpitations",
"history of syncope",
"chest pain",
"similar symptoms",
"year",
"following workup",
"treated with daily flecainide",
"then",
"drinks one",
"two glasses",
"wine",
"weekends",
"not smoke",
"pulse",
"... |
A 51-year-old woman with hyperlipidemia comes to the physician because of weakness for one month. At the end of the day, she feels too fatigued to cook dinner or carry a laundry basket up the stairs. She also complains of double vision after she reads for long periods of time. All of her symptoms improve with rest. Her... | Type II hypersensitivity reaction | {
"A": "Type II hypersensitivity reaction",
"B": "Impaired acetylcholine release",
"C": "Adverse drug effect",
"D": "Anterior horn cell destruction"
} | step1 | A | [
"year old woman",
"hyperlipidemia",
"physician",
"of weakness",
"one month",
"end",
"day",
"feels",
"fatigued to cook dinner",
"carry",
"laundry",
"stairs",
"double vision",
"reads",
"long periods",
"time",
"symptoms",
"rest",
"only medication",
"pravastatin",
"Physical exami... |
A 65-year-old man comes to the physician because of increasing swelling of the legs and face over the past 2 months. He has a history of diastolic heart dysfunction. The liver and spleen are palpable 4 cm below the costal margin. On physical examination, both lower limbs show significant pitting edema extending above t... | AL amyloidosis | {
"A": "AL amyloidosis",
"B": "Smoldering multiple myeloma",
"C": "Symptomatic multiple myeloma",
"D": "Waldenstrom’s macroglobulinemia"
} | step2&3 | A | [
"65 year old man",
"physician",
"of increasing swelling",
"legs",
"face",
"past 2 months",
"history",
"diastolic heart",
"liver",
"spleen",
"palpable",
"costal margin",
"physical examination",
"lower limbs show significant pitting extending",
"knees",
"pelvic area",
"Laboratory studi... |
A 45-year-old woman comes to the physician because of early satiety and intermittent nausea for 3 months. During this period she has also felt uncomfortably full after meals and has vomited occasionally. She has not had retrosternal or epigastric pain. She has longstanding type 1 diabetes mellitus, diabetic nephropathy... | Metoclopramide | {
"A": "Omeprazole",
"B": "Metoclopramide",
"C": "Ondansetron",
"D": "Calcium carbonate\n\""
} | step2&3 | B | [
"year old woman",
"physician",
"early satiety",
"intermittent nausea",
"months",
"period",
"felt",
"full",
"meals",
"vomited occasionally",
"not",
"retrosternal",
"epigastric pain",
"type 1 diabetes mellitus",
"diabetic nephropathy",
"generalized anxiety disorder",
"Current medicatio... |
Fluorescein is an artificial dark orange colored organic molecule used in the diagnosis of corneal ulcers and herpetic corneal infections. It is observed that, in experimental animals, the fluorescein binds to receptors on certain B cells, but it does not stimulate them to produce fluorescein specific antibodies unless... | Hapten | {
"A": "Carrier",
"B": "Hapten",
"C": "Adjuvant",
"D": "Immunogen"
} | step1 | B | [
"Fluorescein",
"artificial dark orange colored organic molecule used",
"diagnosis of corneal ulcers",
"herpetic corneal",
"observed",
"experimental animals",
"fluorescein binds",
"receptors",
"certain B cells",
"not",
"to",
"fluorescein specific antibodies",
"first attached",
"larger molec... |
A 65-year-old male is evaluated in clinic approximately six months after resolution of a herpes zoster outbreak on his left flank. He states that despite the lesions having resolved, he is still experiencing constant burning and hypersensitivity to touch in the distribution of the old rash. You explain to him that this... | Post-herpetic neuralgia | {
"A": "Ramsay-Hunt syndrome",
"B": "Acute herpetic neuralgia",
"C": "Post-herpetic neuralgia",
"D": "Secondary bacterial infection"
} | step2&3 | C | [
"65 year old male",
"evaluated in clinic approximately six months",
"resolution",
"herpes zoster outbreak",
"left flank",
"states",
"lesions",
"resolved",
"experiencing constant burning",
"hypersensitivity",
"touch",
"distribution",
"old rash",
"complication",
"occur",
"20-30",
"pati... |
An 11-year-old boy who recently emigrated from Nigeria is brought to the physician for evaluation of jaw swelling. He has no history of serious illness and takes no medications. Examination shows a 5-cm solid mass located above the right mandible and significant cervical lymphadenopathy. A biopsy specimen of the mass s... | t(8;14) | {
"A": "t(11;22)",
"B": "t(11;14)",
"C": "t(8;14)",
"D": "t(15;17)"
} | step1 | C | [
"year old boy",
"recently",
"Nigeria",
"brought",
"physician",
"evaluation",
"jaw swelling",
"history",
"serious illness",
"takes",
"medications",
"Examination shows",
"5",
"solid mass",
"right mandible",
"significant cervical lymphadenopathy",
"biopsy",
"mass shows sheets",
"lym... |
A 53-year-old man comes to the physician because of a 3-month history of a nonpruritic rash. He has been feeling more tired than usual and occasionally experiences pain in his wrists and ankles. He does not smoke or drink alcohol. His temperature is 37.6°C (99.7°F), pulse is 98/min, respirations are 18/min, and blood p... | Hepatitis C serology | {
"A": "Rapid plasma reagin test",
"B": "Hepatitis C serology",
"C": "pANCA assay",
"D": "Bence Jones protein test\n\""
} | step2&3 | B | [
"year old man",
"physician",
"3 month history",
"nonpruritic rash",
"feeling more tired",
"usual",
"occasionally experiences pain in",
"wrists",
"ankles",
"not smoke",
"drink alcohol",
"temperature",
"99",
"pulse",
"98 min",
"respirations",
"min",
"blood pressure",
"75 mm Hg",
... |
A 65-year-old African-American woman comes to the physician because of severe lower back pain. She has had dull lower back pain for several months, which suddenly become sharp in nature after lifting a heavy bucket of water 2 days ago. The pain is midline and does not radiate. She has had frequent vaginal dryness and h... | Smoking history | {
"A": "Age at menopause",
"B": "Exercise activity",
"C": "Smoking history",
"D": "Ancestry"
} | step2&3 | C | [
"65 year old African-American woman",
"physician",
"severe lower back pain",
"dull lower back pain",
"months",
"sharp",
"nature",
"lifting",
"heavy",
"water 2 days",
"pain",
"midline",
"not radiate",
"frequent vaginal dryness",
"hot flashes",
"menopause at",
"age",
"55 years",
"h... |
A 5-year-old girl is brought to the hospital by her parents with a persistent fever of 41°C (105.8°F), which is not relieved by tylenol. Her birth history is unremarkable. On general examination, the child is agitated and looks ill. Her heart rate is 120/min and the respiratory rate is 22/min. The parents told the phys... | Echocardiography | {
"A": "Rapid direct fluorescent antigen testing",
"B": "Tzanck smear",
"C": "Coronary angiography",
"D": "Echocardiography"
} | step1 | D | [
"5 year old girl",
"brought",
"hospital",
"parents",
"persistent fever",
"not relieved by tylenol",
"birth history",
"unremarkable",
"general examination",
"child",
"agitated",
"looks ill",
"heart rate",
"min",
"respiratory rate",
"min",
"parents",
"physician",
"rash",
"started... |
A 7-year-old boy is brought to the emergency department with a high fever and oxygen desaturation. He had a tracheostomy placed as an infant and has been placed on mechanical ventilation intermittently. Since then, he has had several bouts of pneumonia similar to his current presentation. In addition, he has been deaf ... | Branchial arch 1 | {
"A": "Branchial arch 1",
"B": "Branchial arch 2",
"C": "Branchial cleft 1",
"D": "Branchial pouch 3"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"high fever",
"oxygen desaturation",
"tracheostomy placed",
"infant",
"placed",
"mechanical ventilation",
"then",
"several bouts",
"pneumonia similar to",
"current presentation",
"In addition",
"deaf",
"birth",
"able to communicate",... |
A 31-year-old man comes to the physician because of a 9-month history of increasing fatigue and recurrent nausea. During this period, he has had a 3.8 kg (8.3 lb) weight loss. He also reports feeling lightheaded when he stands up suddenly. He was diagnosed with alopecia areata 1 year ago and was treated with monthly in... | Autoimmune destruction of the adrenal gland | {
"A": "Amyloid deposition within the adrenal gland",
"B": "Granulomatous inflammation of the adrenal gland",
"C": "Autoimmune destruction of the adrenal gland",
"D": "Suppression of pituitary corticotrophic activity"
} | step2&3 | C | [
"31 year old man",
"physician",
"month history",
"increasing fatigue",
"recurrent nausea",
"period",
"3",
"kg",
"weight loss",
"reports feeling lightheaded",
"stands up",
"diagnosed",
"alopecia areata 1 year",
"treated with monthly intralesional triamcinolone injections",
"3 months",
"... |
A 49-year-old woman presents to the clinic for a routine exam. She recently quit smoking after a 30 pack-year history and started exercising a little. Past medical history is noncontributory. She takes no medication. Her mother died at 65 from lung cancer. She rarely drinks alcohol and only uses nicotine gum as needed.... | Maintenance | {
"A": "Relapse",
"B": "Maintenance",
"C": "Contemplation",
"D": "Action"
} | step1 | B | [
"year old woman presents",
"clinic",
"routine exam",
"recently quit smoking",
"30 pack-year history",
"started exercising",
"little",
"Past medical history",
"takes",
"medication",
"mother died",
"65",
"lung cancer",
"rarely drinks alcohol",
"only uses nicotine gum as needed",
"admits ... |
A 43-year-old woman presents for a routine checkup. She says she has been uncontrollably grimacing and smacking her lips for the past 2 months, and these symptoms have been getting progressively worse. Past medical history is significant for schizophrenia, managed medically with clozapine. Which of the following is the... | Tardive dyskinesia | {
"A": "Torticollis",
"B": "Oculogyric crisis",
"C": "Tourette’s syndrome",
"D": "Tardive dyskinesia"
} | step1 | D | [
"year old woman presents",
"routine checkup",
"grimacing",
"smacking",
"lips",
"past",
"months",
"symptoms",
"getting",
"worse",
"Past medical history",
"significant",
"schizophrenia",
"managed",
"clozapine",
"following",
"most likely diagnosis",
"patient"
] |
A 58-year-old woman with type 2 diabetes mellitus comes to the physician because of generalized pain and muscle weakness. She suffered a nondisplaced left ulnar fracture 3 months ago after lifting a heavy crate of books. She has had progressively worsening renal function over the past 2 years but has not yet started he... | 1,25-dihydroxycholecalciferol | {
"A": "1,25-dihydroxycholecalciferol",
"B": "Ergosterol",
"C": "Cholecalciferol",
"D": "7-dehydrocholesterol"
} | step1 | A | [
"58 year old woman",
"type 2 diabetes mellitus",
"physician",
"generalized pain",
"muscle weakness",
"suffered",
"nondisplaced left ulnar fracture",
"months",
"lifting",
"heavy",
"books",
"worsening renal function",
"past",
"years",
"not",
"started hemodialysis",
"x-ray of",
"left ... |
A 46-year-old man presents to the emergency department with confusion, lacrimation, salivation, nausea, vomiting, abdominal pain, and diarrhea. He developed these symptoms 30 minutes after he finished treating his garden with the insecticide malathion. His vital signs are as follows: blood pressure is 85/50 mm Hg, hear... | The patient’s symptoms result from the formation of covalent bonds between malathion and the affected enzyme. | {
"A": "The patient’s symptoms are caused by reversible enzyme inhibition.",
"B": "Maximum reaction rate (Vmax) of the affected enzyme is not changed in this patient.",
"C": "The patient’s symptoms result from the formation of covalent bonds between malathion and the affected enzyme.",
"D": "Malathion activates... | step1 | C | [
"year old man presents",
"emergency department",
"confusion",
"lacrimation",
"salivation",
"nausea",
"vomiting",
"abdominal pain",
"diarrhea",
"symptoms 30 minutes",
"finished treating",
"garden",
"insecticide malathion",
"vital signs",
"follows",
"blood pressure",
"85 50 mm Hg",
"... |
An 8-year-old boy is brought to his pediatrician by his mother because she is worried about whether he is becoming ill. Specifically, he has been sent home from school six times in the past month because of headaches and abdominal pain. In fact, he has been in the nurse's office almost every day with various symptoms. ... | Play therapy | {
"A": "Clonidine",
"B": "Methylphenidate",
"C": "Play therapy",
"D": "Succimer"
} | step1 | C | [
"year old boy",
"brought",
"pediatrician",
"mother",
"worried",
"ill",
"sent home",
"school six times",
"past month",
"headaches",
"abdominal pain",
"nurse's office almost every day",
"various symptoms",
"symptoms started",
"family moved to",
"old house",
"state",
"months",
"take... |
A 62-year-old man comes to the physician for the evaluation of lower back pain and tingling and numbness in his legs for the past 6 months. The pain radiates bilaterally to his buttocks and legs gets worse while standing or walking downhill. Two weeks ago, he had an upper respiratory tract infection that resolved spont... | Leaning forward relieves the pain | {
"A": "Positive HLA-B27",
"B": "Albuminocytologic dissociation on CSF analysis",
"C": "Leaning forward relieves the pain",
"D": "Decreased ankle-brachial index"
} | step2&3 | C | [
"62 year old man",
"physician",
"evaluation of lower back pain",
"tingling",
"numbness in",
"legs",
"past 6 months",
"pain radiates",
"buttocks",
"legs gets worse",
"standing",
"walking",
"Two weeks",
"upper respiratory tract infection",
"resolved",
"hypertension",
"hypercholesterole... |
A 62-year-old woman comes to the physician because of a 2-month history of a rash on her ankles with intermittent itching. After the rash developed, she started applying a new scented lotion to her legs daily. She works as a cashier at a grocery store. She has type 2 diabetes mellitus and hypertension. Current medicati... | Dermal deposition of hemosiderin
" | {
"A": "Bacterial spread through the superficial dermis",
"B": "Contact of antigen with pre-sensitized T lymphocytes",
"C": "Infection with dermatophyte",
"D": "Dermal deposition of hemosiderin\n\""
} | step1 | D | [
"62 year old woman",
"physician",
"2 month history",
"rash",
"ankles",
"intermittent itching",
"rash",
"started applying",
"new scented lotion",
"legs daily",
"works",
"grocery store",
"type 2 diabetes mellitus",
"hypertension",
"Current medications include metformin",
"enalapril",
"... |
A 65-year-old patient comes to the physician because of a 6-month history of persistent dry cough and shortness of breath with mild exertion. He reports feeling too weak to leave the house on most days. He has a history of hypertension and chronic atrial fibrillation. He has smoked a pack of cigarettes daily for 45 yea... | Excess collagen deposition in the extracellular matrix of the lung | {
"A": "Excess collagen deposition in the extracellular matrix of the lung",
"B": "Chronic airway inflammation",
"C": "Pleural scarring",
"D": "Increased pressure in the pulmonary arteries"
} | step2&3 | A | [
"65 year old patient",
"physician",
"month history",
"persistent dry cough",
"shortness of breath",
"mild exertion",
"reports feeling",
"weak to leave",
"house",
"days",
"history of hypertension",
"chronic atrial fibrillation",
"smoked",
"pack",
"cigarettes daily",
"years",
"medicati... |
A 40-year-old man presents with problems with his vision. He says he has been experiencing blurred vision and floaters in his left eye for the past few days. He denies any ocular pain, fever, or headaches. Past medical history is significant for HIV infection a few years ago, for which he is noncompliant with his antir... | Nucleic acid synthesis | {
"A": "Viral penetration into host cells",
"B": "Nucleic acid synthesis",
"C": "Progeny virus release",
"D": "Viral uncoating"
} | step1 | B | [
"40 year old man presents",
"problems",
"vision",
"experiencing blurred vision",
"floaters in",
"left eye",
"past",
"days",
"denies",
"ocular pain",
"fever",
"headaches",
"Past medical history",
"significant",
"HIV infection",
"few years",
"noncompliant",
"antiretroviral medication... |
On a medical trip to Nicaragua, you observe a sweet odor in the cerumen of 12-hour female newborn. Within 48 hours, the newborn develops ketonuria, poor feeding, and a sweet odor is also noticed in the urine. By 96 hours, the newborn is extremely lethargic and opisthotonus is observed. In order to prevent a coma and su... | Valine | {
"A": "Phenylalanine",
"B": "Valine",
"C": "Tyrosine",
"D": "Methionine"
} | step1 | B | [
"medical trip",
"Nicaragua",
"observe",
"sweet odor",
"cerumen",
"12-hour female newborn",
"48 hours",
"newborn",
"ketonuria",
"poor feeding",
"sweet odor",
"urine",
"96 hours",
"newborn",
"extremely lethargic",
"opisthotonus",
"observed",
"order to prevent",
"coma",
"subsequen... |
A 77-year-old man with refractory shock has been under treatment in an intensive care unit for last 7 days. Despite the best possible management by the team of physicians and intensivists, he fails to show improvement. After discussion with his relatives and obtaining informed consent from them, the team administers to... | Cyclic adenosine monophosphate (cAMP) | {
"A": "Cyclic adenosine monophosphate (cAMP)",
"B": "Calcium ion",
"C": "Inositol 1,4,5-triphosphate (IP3)",
"D": "Cyclic guanosine monophosphate (cGMP)"
} | step1 | A | [
"year old man",
"refractory shock",
"under treatment",
"intensive care unit",
"last",
"days",
"best possible management",
"team",
"physicians",
"fails to show improvement",
"discussion",
"relatives",
"obtaining informed consent",
"team administers",
"novel drug",
"adrenergic agonist",
... |
A 35-year-old man presents to pulmonary function clinic for preoperative evaluation for a right pneumonectomy. His arterial blood gas at room air is as follows:
pH: 7.34
PaCO2: 68 mmHg
PaO2: 56 mmHg
Base excess: +1
O2 saturation: 89%
What underlying condition most likely explains these findings? | Chronic obstructive pulmonary disease | {
"A": "Acute respiratory distress syndrome",
"B": "Chronic obstructive pulmonary disease",
"C": "Cystic fibrosis",
"D": "Obesity"
} | step2&3 | B | [
"35 year old man presents",
"pulmonary function clinic",
"preoperative evaluation",
"right pneumonectomy",
"arterial blood gas",
"room air",
"follows",
"pH",
"68 mmHg PaO2",
"mmHg Base excess",
"1 O2 saturation",
"underlying condition",
"likely",
"findings"
] |
An 18-year-old girl comes to the clinic because she is concerned about her weight. She states that she is on her school’s cheerleading team and is upset because she feels she is the “fattest” girl on the team despite her healthy diet. She says that in the last 2 weeks since practice began, she has lost 2 lbs. The patie... | Oral contraception-induced | {
"A": "Familial hyperthyroidism",
"B": "Hypocholesterolemia",
"C": "Lithium",
"D": "Oral contraception-induced"
} | step2&3 | D | [
"year old girl",
"clinic",
"concerned",
"weight",
"states",
"schools cheerleading team",
"upset",
"feels",
"fattest girl",
"team",
"healthy diet",
"last 2 weeks",
"practice began",
"lost 2 lbs",
"patient",
"bipolar disorder I",
"medications include lithium",
"combined oral contrace... |
A 35-year-old woman comes to the physician for evaluation of a 6-month history of persistent rhinorrhea and nasal congestion. She works in retail and notices her symptoms worsen anytime she is exposed to strong perfumes. Her symptoms have worsened since winter began 2 months ago. She has not had fever, nausea, wheezing... | Intranasal azelastine | {
"A": "Oral phenylephrine",
"B": "Oral diphenhydramine",
"C": "Intranasal azelastine",
"D": "Percutaneous allergy testing"
} | step2&3 | C | [
"35 year old woman",
"physician",
"evaluation",
"month history",
"persistent rhinorrhea",
"nasal congestion",
"works",
"retail",
"symptoms worsen",
"exposed",
"strong perfumes",
"symptoms",
"worsened",
"winter began 2 months",
"not",
"fever",
"nausea",
"wheezing",
"itching",
"r... |
A 32-year-old woman is hospitalized after developing an allergic reaction to the contrast medium used for a cerebral angiography. The study was initially ordered as part of the diagnostic approach of a suspected case of pseudotumor cerebri. Her medical history is unremarkable. On physical examination she has stable vit... | Hyperkalemia | {
"A": "Hyperkalemia",
"B": "Uremic pericarditis",
"C": "Anemia",
"D": "Platelet dysfunction"
} | step2&3 | A | [
"year old woman",
"hospitalized",
"allergic reaction",
"contrast medium used",
"cerebral angiography",
"study",
"initially ordered",
"part of",
"diagnostic approach",
"suspected case",
"pseudotumor cerebri",
"medical history",
"unremarkable",
"physical examination",
"stable vital signs",... |
A 5-year-old patient presents to the pediatrician’s office with fatigue and swollen lymph nodes. Extensive work-up reveals a diagnosis of acute lymphoblastic leukemia. In an effort to better tailor the patient’s treatments, thousands of genes are arranged on a chip and a probe is made from the patient’s DNA. This probe... | Single nucleotide polymorphisms | {
"A": "Large scale chromosomal deletions",
"B": "Frame-shift mutations",
"C": "Single nucleotide polymorphisms",
"D": "Trisomies"
} | step1 | C | [
"5 year old patient presents",
"pediatricians office",
"fatigue",
"swollen lymph nodes",
"Extensive work-up reveals",
"diagnosis",
"acute lymphoblastic leukemia",
"effort",
"better tailor",
"patients treatments",
"thousands",
"genes",
"arranged",
"chip",
"probe",
"made",
"patients DN... |
A 53-year-old man is brought into the emergency department by ambulance. He was found stumbling in the street. He smells of alcohol and has difficulty answering any questions are giving any history about recent events. He is diagnosed with acute ethanol intoxication. After a night of IV fluid and sleep, he recovers and... | Anterograde amnesia | {
"A": "Anterograde amnesia",
"B": "Ataxia",
"C": "Ophthalmoplegia",
"D": "Confusion"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department",
"ambulance",
"found stumbling",
"street",
"smells",
"alcohol",
"difficulty answering",
"questions",
"giving",
"history",
"recent events",
"diagnosed",
"acute ethanol intoxication",
"night",
"IV fluid",
"sleep",
"recovers",
"tal... |
A 34-year-old man with worsening refractory epigastric pain secondary to long-standing gastroesophageal reflux disease presents for endoscopic evaluation. Past medical history is also significant for type 2 diabetes mellitus that was diagnosed 3 years ago, managed medically. Current medications are metformin, metoclopr... | Metaplasia of the esophageal mucosa | {
"A": "Esophageal smooth muscle atrophy",
"B": "Hypertrophy of the esophageal mucosa protruding into the lumen of the lower esophagus",
"C": "Metaplasia of the esophageal mucosa",
"D": "A malignant proliferation of squamous cells"
} | step1 | C | [
"year old man",
"worsening refractory epigastric secondary to long standing gastroesophageal reflux disease presents",
"endoscopic evaluation",
"Past medical history",
"significant",
"type 2 diabetes mellitus",
"diagnosed 3 years",
"managed",
"Current medications",
"metformin",
"metoclopramide",... |
A clinical trial is conducted to determine the efficacy of ginkgo biloba in the treatment of Parkinson disease. A sample of patients with major depression is divided into two groups. Participants in the first group are treated with ginkgo biloba, and participants in the other group receive a placebo. A change in the Mo... | Pygmalion effect | {
"A": "Pygmalion effect",
"B": "Hawthorne effect",
"C": "Effect modification",
"D": "Procedure bias"
} | step1 | A | [
"clinical trial",
"conducted to",
"efficacy",
"ginkgo biloba",
"treatment",
"Parkinson disease",
"sample",
"patients",
"major depression",
"divided",
"two groups",
"Participants",
"first group",
"treated with ginkgo biloba",
"participants",
"group receive",
"placebo",
"change",
"... |
A 4-month-old boy is brought to the physician by his parents because of fever for the past 3 days. They also state that he has been less active and has been refusing to eat. The patient has had two episodes of bilateral otitis media since birth. He was born at term and had severe respiratory distress and sepsis shortly... | Defective beta-2 integrin | {
"A": "Defective IL-2R gamma chain",
"B": "Defective beta-2 integrin",
"C": "Defective NADPH oxidase",
"D": "WAS gene mutation\n\""
} | step2&3 | B | [
"4 month old boy",
"brought",
"physician",
"parents",
"fever",
"past",
"days",
"state",
"less active",
"refusing to eat",
"patient",
"two episodes of bilateral otitis media",
"birth",
"born",
"term",
"severe respiratory distress",
"sepsis",
"birth",
"treated with antibiotics",
... |
A 10-year-old boy is brought to the clinic by his mother with complaints of cough productive of yellow sputum for the past couple of weeks. This is the 4th episode the boy has had this year. He has had recurrent episodes of cough since childhood, and previous episodes have subsided with antibiotics. There is no family ... | Dynein | {
"A": "Dynein",
"B": "Kinesin",
"C": "Microfilaments",
"D": "Neurofilaments"
} | step1 | A | [
"A 10 year old boy",
"brought",
"clinic",
"mother",
"complaints",
"cough productive",
"yellow",
"past couple",
"weeks",
"4th episode",
"boy",
"year",
"recurrent episodes of cough",
"childhood",
"previous episodes",
"antibiotics",
"family history of respiratory disorders",
"vaccinat... |
A 49-year-old man presents to his primary care physician for leg pain. He states that when he goes for walks with his dog, he starts feeling calf pain. He either has to stop or sit down before the pain resolves. He used to be able to walk at least a mile, and now he starts feeling the pain after 8 blocks. His medical h... | Clopidogrel | {
"A": "Angioplasty",
"B": "Bed rest",
"C": "Clopidogrel",
"D": "Electromyography"
} | step2&3 | C | [
"year old man presents",
"primary care physician",
"leg pain",
"states",
"goes",
"walks",
"dog",
"starts feeling calf pain",
"either",
"to stop",
"sit down",
"pain resolves",
"used to",
"able to walk",
"mile",
"now",
"starts feeling",
"pain",
"blocks",
"medical history includes... |
A 67-year-old woman comes to the physician with a 6-month history of pain and swelling of both legs. The symptoms are worst at the end of the day and are associated with itching of the overlying skin. Physical examination shows bilateral pitting ankle edema. An image of one of the ankles is shown. This patient is at gr... | Ulceration of the cutis | {
"A": "Thrombosis of a deep vein",
"B": "Malignant transformation of lymphatic endothelium",
"C": "Biliverdin accumulation in the epidermis",
"D": "Ulceration of the cutis"
} | step1 | D | [
"67 year old woman",
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"swelling of",
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"associated with itching of",
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"Physical examination shows bilateral pitting ankle edema",
"image",
"one",
"ankles",
"shown",
"patient",
"greatest risk",
... |
A 64-year-old woman presents to the physician with fever and sore throat for 2 days. She was diagnosed with rheumatoid arthritis 15 years ago. She has had several flares necessitating admission to the hospital in recent years. She has developed deformity in her joints despite aggressive therapy. She is a candidate for ... | Felty syndrome | {
"A": "Diffuse large B cell lymphoma",
"B": "Felty syndrome",
"C": "Sarcoidosis",
"D": "T cell large granular lymphocytic leukemia"
} | step2&3 | B | [
"64 year old woman presents",
"physician",
"fever",
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"2 days",
"diagnosed",
"rheumatoid arthritis",
"years",
"several flares",
"admission to",
"hospital",
"recent years",
"deformity",
"joints",
"aggressive therapy",
"candidate",
"surgical correction",
"temperature",
... |
A 48-year-old man comes to the physician for evaluation of an intensely pruritic skin rash on his arms and legs for 12 hours. Two days ago, he returned from an annual camping trip with his son. The patient takes no medications. A photograph of the skin lesions on his left hand is shown. Activation of which of the follo... | T cells | {
"A": "T cells",
"B": "Neutrophils",
"C": "B cells",
"D": "Eosinophils\n\""
} | step1 | A | [
"48 year old man",
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"medications",
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"skin lesions",
"left hand",
"shown",
"Activation of",
"following cell types",
"most likely caus... |
A 25-year-old man presents to the emergency department with the sudden onset of neck pain and a severe spinning sensation for the last 6 hours. The symptoms initially began while he was lifting weights in the gym. He feels the room is spinning continuously, and he is unable to open his eyes or maintain his balance. The... | Past-pointing | {
"A": "Expressive aphasia",
"B": "Hemiplegia",
"C": "Past-pointing",
"D": "Sensory aphasia"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"sudden onset",
"neck pain",
"severe spinning sensation",
"hours",
"symptoms initially began",
"lifting weights",
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"spinning",
"unable to open",
"eyes",
"maintain",
"balance",
"dizziness",
"pain",
"associated with nau... |
A 30-year-old man presents to clinic. He was born in southeast Asia and immigrated to the US three years ago. He has a history of chronic hepatitis C which he contracted from intravenous drug use. He reports that he has continued to take ribavirin, but unfortunately has started using heroin again. The patient was seen ... | Vaccinate the patient for Hepatitis B | {
"A": "Obtain a PSA",
"B": "Write a prescription for a fecal ocult blood test",
"C": "Write a prescription for a colonoscopy",
"D": "Vaccinate the patient for Hepatitis B"
} | step1 | D | [
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"three years",
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"continued to take ribavirin",
"started using heroin",
"patient",
"seen",
"clinic",
"week",
"blood work",
"results",
"fo... |
A 74-year-old man presents to the emergency department with shortness of breath that started about 30 mins ago. He is also experiencing chest pain on deep inspiration. He has several significant medical conditions including obstructive pulmonary disease, hypertension, and dyslipidemia. He used to smoke about 3 packs of... | Greenfield filter | {
"A": "Greenfield filter",
"B": "Unfractionated heparin",
"C": "Subcutaneous fondaparinux",
"D": "Warfarin"
} | step2&3 | A | [
"74 year old man presents",
"emergency department",
"shortness of breath",
"started",
"30 mins",
"experiencing chest pain",
"deep inspiration",
"several significant medical conditions including obstructive pulmonary disease",
"hypertension",
"dyslipidemia",
"used to smoke",
"packs",
"cigaret... |
A 22-year-old man presents to the emergency department after being tackled in a game of football. The patient was hit from behind and fell to the ground. After the event, he complained of severe pain in his knee. The patient has a past medical history of anabolic steroid use. His current medications include whey protei... | A palpable click with passive motion of the knee | {
"A": "A palpable click with passive motion of the knee",
"B": "Anterior displacement of the tibia relative to the femur",
"C": "Laxity to varus stress",
"D": "Severe pain with compression of the patella"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"game",
"football",
"patient",
"hit",
"fell",
"event",
"severe pain",
"knee",
"patient",
"past medical history of anabolic steroid use",
"current medications include whey protein supplements",
"multivitamins",
"fish oil",
"temperature",
... |
A research group from a small outpatient clinic is investigating the health benefits of a supplement containing polyphenol-rich extract from pomegranate, as several studies have suggested that pomegranate juice may have antiatherogenic, antihypertensive, and anti-inflammatory effects. Two researchers involved in the st... | Design bias | {
"A": "Confounding bias",
"B": "Design bias",
"C": "Late-look bias",
"D": "Proficiency bias"
} | step1 | B | [
"A research group",
"small outpatient clinic",
"investigating",
"health benefits",
"supplement containing polyphenol rich extract",
"pomegranate",
"several studies",
"suggested",
"pomegranate juice",
"antihypertensive",
"anti-inflammatory effects",
"Two researchers involved",
"study",
"to ... |
A 47-year-old woman with chronic epigastric pain comes to the physician because of a 1-month history of intermittent, loose, foul-smelling stools. She has also had a 6-kg (13-lb) weight loss. She has consumed 9–10 alcoholic beverages daily for the past 25 years. Seven years ago, she traveled to Mexico on vacation; she ... | Pancreatic calcifications | {
"A": "Trophozoites on stool microscopy",
"B": "Pancreatic calcifications",
"C": "Villous atrophy of duodenal mucosa",
"D": "Positive lactulose breath test"
} | step1 | B | [
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"Seven",
"traveled",
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"vacation",
"not",
"outside",
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"res... |
A 38-year-old, working, first-time mother brings her 9-month-old male infant to the pediatrician for "wounds that simply won't heal" and bleeding gums. She exclaims, "I have been extra careful with him making sure to not let him get dirty, I boil his baby formula for 15 minutes each morning before I leave for work to g... | Conversion of dopamine to norepinephrine | {
"A": "Conversion of pyruvate to acetyl-CoA",
"B": "Conversion of pyruvate to oxaloacetate",
"C": "Conversion of homocysteine to methionine",
"D": "Conversion of dopamine to norepinephrine"
} | step1 | D | [
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"aregiver,",
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A 20-year-old man comes to the physician because of a 3-day history of fever, myalgia, and swelling in his left groin after a recent camping trip in northern California. He appears acutely ill. Physical examination shows tender, left-sided inguinal lymphadenopathy and an enlarged, tender lymph node in the right axilla ... | Squirrels | {
"A": "Deer",
"B": "Birds",
"C": "Squirrels",
"D": "Dogs"
} | step1 | C | [
"20 year old man",
"physician",
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"recent camping trip",
"northern California",
"appears",
"ill",
"Physical examination shows tender",
"left-sided inguinal lymphadenopathy",
"enlarged",
"tender lymph node",
"right axilla",
"drain... |
An investigator is measuring the blood calcium level in a sample of female cross country runners and a control group of sedentary females. If she would like to compare the means of the two groups, which statistical test should she use? | t-test | {
"A": "t-test",
"B": "Linear regression",
"C": "Chi-square test",
"D": "F-test"
} | step1 | A | [
"investigator",
"measuring",
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"sample",
"female cross country",
"a control group",
"sedentary females",
"to compare",
"means",
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] |
A 16-year-old boy presents with acute left-sided weakness. The patient is obtunded and can not provide any history other than his stomach hurts. The patient’s friend states that the patient has had episodes like this in the past and that “he has the same weird disease as his mom”. On physical examination, strength is 1... | Conversion of pyruvate to oxaloacetate | {
"A": "Extracellular potassium homeostasis",
"B": "Conversion of pyruvate to oxaloacetate",
"C": "Synthesis of globin chains of hemoglobin",
"D": "Creation of exogenous reactive oxygen species"
} | step1 | B | [
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"acute left-sided weakness",
"patient",
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"not provide",
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"patients friend states",
"patient",
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"past",
"same",
"disease",
"mom",
"physical examination",
"strength",
"1 out of 5",
"left upper",
"lower extremities"... |
A 54-year-old female presents to her primary care physician with recurrent episodes of flushing. At first she attributed these symptoms to hormonal changes. However, lately she has also been experiencing episodes of explosive, watery diarrhea. She has also noticed the onset of heart palpitations. Her vital signs are wi... | Octreotide | {
"A": "Octreotide",
"B": "Metoclopramide",
"C": "Ondensatron",
"D": "Promethazine"
} | step2&3 | A | [
"54 year old female presents",
"primary care physician",
"recurrent episodes of flushing",
"first",
"attributed",
"symptoms",
"hormonal changes",
"experiencing episodes of explosive",
"watery diarrhea",
"onset",
"heart palpitations",
"vital signs",
"normal limits",
"physical exam",
"nota... |
A 7-year-old boy is brought to the physician by his mother because his teachers have noticed him staring blankly on multiple occasions over the past month. These episodes last for several seconds and occasionally his eyelids flutter. He was born at term and has no history of serious illness. He has met all his developm... | Ethosuximide | {
"A": "Carbamazepine",
"B": "Ethosuximide",
"C": "Phenytoin",
"D": "Levetiracetam"
} | step2&3 | B | [
"year old boy",
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"physician",
"mother",
"teachers",
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"episodes last",
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"eyelids flutter",
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"term",
"history",
"serious illness",
"met",
"developmental milestones",
"appears healthy",
"Neuro... |
A 64-year-old woman comes to the physician for a follow-up examination. She has had difficulty reading for the past 6 months. She tried using multiple over-the-counter glasses with different strengths, but they have not helped. She has hypertension and type 2 diabetes mellitus. Current medications include insulin and e... | Open-angle glaucoma | {
"A": "Age-related macular degeneration",
"B": "Diabetic retinopathy",
"C": "Open-angle glaucoma",
"D": "Optic neuritis\n\""
} | step2&3 | C | [
"64 year old woman",
"physician",
"follow-up examination",
"difficulty reading",
"past 6 months",
"using multiple over-the-counter glasses",
"different strengths",
"not helped",
"hypertension",
"type 2 diabetes mellitus",
"Current medications include insulin",
"enalapril",
"temperature",
"... |
A 65-year-old male presented to his primary care physician with exertional dyspnea. The patient had a 30-year history of smoking one pack of cigarettes per day. Physical examination reveals a barrel-chested appearance, and it is noted that the patient breathes through pursed lips. Spirometry shows decreased FEV1, FVC, ... | Centriacinar emphysema | {
"A": "Centriacinar emphysema",
"B": "Calcified nodule",
"C": "Hypersensitivity pneumonitis",
"D": "Uncalcified nodule"
} | step1 | A | [
"65 year old male presented",
"primary care physician",
"exertional dyspnea",
"patient",
"30 year history of smoking one pack",
"cigarettes",
"day",
"Physical examination reveals",
"barrel-chested appearance",
"noted",
"patient",
"pursed lips",
"Spirometry shows decreased FEV1",
"FVC",
"... |
A 30-year-old woman presents to a medical clinic for a routine check-up. She gained about 5 kg (11 lb) since the last time she weighed herself 3 months ago. She also complains of constipation and sensitivity to cold. She also noticed her hair appears to be thinning. The patient started to use combined oral contraceptiv... | Inhibition of hormones in the pituitary gland | {
"A": "Inhibition of hormones in the pituitary gland",
"B": "Inhibition of hormones in hypothalamus",
"C": "Increase the thickness of cervical mucus secretions",
"D": "Inducing endometrial atrophy"
} | step1 | A | [
"30 year old woman presents",
"medical clinic",
"routine check-up",
"gained",
"kg",
"last time",
"3 months",
"constipation",
"sensitivity to cold",
"hair appears to",
"thinning",
"patient started to use combined oral contraceptives",
"few months",
"compliant",
"physical examination",
"... |
A 31-year-old woman is brought to the emergency department for a severe throbbing headache, nausea, and photophobia for the past 3 hours. She has severe occipital pain and chest tightness. Prior to the onset of her symptoms, she had attended a networking event where she had red wine and, shortly after, a snack consisti... | Phenelzine | {
"A": "Phenelzine",
"B": "Sertraline",
"C": "Sumatriptan",
"D": "Topiramate"
} | step2&3 | A | [
"31 year old woman",
"brought",
"emergency department",
"severe throbbing",
"nausea",
"photophobia",
"past",
"hours",
"severe occipital pain",
"chest tightness",
"Prior to",
"onset",
"symptoms",
"attended",
"networking event",
"red wine",
"snack consisting",
"salami",
"dried frui... |
Shortly after delivery, a female newborn develops bluish discoloration of the lips, fingers, and toes. She was born at term to a 38-year-old primigravid woman. Pregnancy was complicated by maternal diabetes mellitus. Pulse oximetry on room air shows an oxygen saturation of 81%. Echocardiography shows immediate bifurcat... | Spiraling of aorticopulmonary septum | {
"A": "Separation of tricuspid valve tissue from myocardium",
"B": "Fusion of endocardial cushion",
"C": "Division of aorta and pulmonary artery",
"D": "Spiraling of aorticopulmonary septum"
} | step1 | D | [
"delivery",
"female newborn",
"discoloration",
"lips",
"fingers",
"toes",
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"term",
"year old primigravid woman",
"Pregnancy",
"complicated",
"maternal diabetes mellitus",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"81",
"Echocardiography shows immediate bifurcati... |
A thymidine kinase-deficient varicella-zoster virus strain has been isolated at a retirement home. Many of the elderly had been infected with this strain and are experiencing shingles. Which of the following would be the best antiviral agent to treat this population? | Cidofovir | {
"A": "Acyclovir",
"B": "Famciclovir",
"C": "Cidofovir",
"D": "Amantadine"
} | step1 | C | [
"thymidine kinase deficient varicella-zoster virus strain",
"isolated",
"retirement home",
"elderly",
"infected",
"strain",
"experiencing shingles",
"following",
"best antiviral agent to treat",
"population"
] |
A worried mother brings her 12-day-old son to the emergency room concerned that his body is turning "yellow". The patient was born at 39 weeks via spontaneous vaginal delivery without complications. The mother received adequate prenatal care and has been breastfeeding her son. The patient has had adequate urine and sto... | Reassure mother that jaundice will remit, advise her to continue breastfeeding | {
"A": "Phenobarbitol",
"B": "Phototherapy",
"C": "Exchange transfusion",
"D": "Reassure mother that jaundice will remit, advise her to continue breastfeeding"
} | step2&3 | D | [
"worried mother",
"day old son",
"emergency room concerned",
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"turning",
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"patient",
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"weeks",
"spontaneous vaginal delivery",
"complications",
"mother received adequate prenatal care",
"breastfeeding",
"son",
"patient",
"adequate urine",
"stool output",
"Phy... |
A 27-year-old man interested in pre-exposure therapy for HIV (PrEP) is being evaluated to qualify for a PrEP study. In order to qualify, patients must be HIV- and hepatitis B- and C-negative. Any other sexually transmitted infections require treatment prior to initiation of PrEP. The medical history is positive for a p... | It is a qualitative test used for screening purposes. | {
"A": "It is a quantitative test used for screening purposes.",
"B": "It is a qualitative test used for screening purposes.",
"C": "An unknown antigen binds to the known serum.",
"D": "A known antigen binds to the patient’s serum."
} | step1 | B | [
"27 year old man interested",
"pre exposure",
"HIV",
"PrEP",
"evaluated to",
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"order to",
"patients",
"HIV",
"hepatitis B",
"negative",
"sexually transmitted infections",
"treatment prior to initiation",
"PrEP",
"medical history",
"positive",
"prior syphilis infection",
... |
A 59-year-old man comes to the physician for the evaluation of generalized fatigue, myalgia, and a pruritic skin rash for the past 5 months. As a child, he was involved in a motor vehicle accident and required several blood transfusions. Physical examination shows right upper abdominal tenderness, scleral icterus, and ... | Viral RNA polymerase lacks proofreading ability | {
"A": "Viral RNA polymerase lacks proofreading ability",
"B": "Incorporation of envelope proteins from a second virus",
"C": "Integration of viral genes into host cell genome",
"D": "Infection with multiple viral genotypes"
} | step1 | A | [
"59 year old man",
"physician",
"evaluation",
"generalized fatigue",
"myalgia",
"skin rash",
"past",
"months",
"child",
"involved",
"motor vehicle accident",
"required",
"blood transfusions",
"Physical examination shows right upper abdominal tenderness",
"scleral icterus",
"well",
"p... |
A 58-year-old man presents to the emergency department with severe right leg pain accompanied by tingling and weakness. His condition started suddenly 3 hours ago when he was watching a movie. His medical history is remarkable for type 2 diabetes mellitus and hypertension. He has been smoking 20–30 cigarettes per day f... | Acute limb ischemia | {
"A": "Leriche syndrome",
"B": "Buerger's disease",
"C": "Acute limb ischemia",
"D": "CREST syndrome"
} | step2&3 | C | [
"58 year old man presents",
"emergency department",
"severe right leg pain",
"tingling",
"weakness",
"condition started",
"hours",
"watching",
"movie",
"medical history",
"type 2 diabetes mellitus",
"hypertension",
"smoking",
"cigarettes",
"day",
"past 35 years",
"vital signs include... |
A 15-day-old girl presents to the pediatrician for a well visit. Her mother reports that she has been exclusively breastfeeding since birth. The patient feeds on demand every one to two hours for 10-15 minutes on each breast. The patient’s mother reports that once or twice a day, the patient sleeps for a longer stretch... | Observe the patient during a feeding | {
"A": "Observe the patient during a feeding",
"B": "Recommend modification of mother’s diet",
"C": "Recommend waking the patient to feed",
"D": "Supplement breastfeeding with conventional formula"
} | step2&3 | A | [
"day old girl presents",
"pediatrician",
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"mother reports",
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"birth",
"patient feeds on demand",
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"two hours",
"10 15 minutes",
"breast",
"patients mother reports",
"twice a day",
"patient sleeps",
"longer stretch",
"three hours",
"waking",
"patie... |
A 36-year-old man presents to the physician with a cough accompanied by expectoration and recurrent wheezing, for the last 2 years. He says that his symptoms have progressed slowly in severity and frequency over this period. There is no history of rhinorrhea, nasal congestion, or high fever. He has been a smoker for th... | Serum α1-antitrypsin level | {
"A": "Serum total IgE level",
"B": "Skin prick test for aero-allergens",
"C": "Serum α1-antitrypsin level",
"D": "Sweat chloride levels"
} | step2&3 | C | [
"36 year old man presents",
"physician",
"cough",
"expectoration",
"recurrent wheezing",
"last",
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"symptoms",
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"severity",
"frequency",
"period",
"history",
"rhinorrhea",
"nasal congestion",
"high fever",
"smoker",
"years",
"environmental history",
"... |
A 30-year-old man who recently emigrated from Southeast Asia presents with heartburn and a bad taste in his mouth. He says the symptoms have been present for the last 6 months and are much worse at night. He describes the pain as moderate to severe, burning in character, and localized to the epigastric region. He menti... | Gastroesophageal reflux disease | {
"A": "Gastric MALT (mucosa-associated lymphoid tissue) lymphoma",
"B": "Duodenal ulcer disease",
"C": "Peptic ulcer disease",
"D": "Gastroesophageal reflux disease"
} | step1 | D | [
"30 year old man",
"recently",
"Southeast Asia presents",
"heartburn",
"bad taste",
"mouth",
"symptoms",
"present",
"months",
"much worse",
"night",
"pain",
"moderate",
"severe",
"burning",
"character",
"localized",
"epigastric region",
"1 month",
"tested",
"Helicobacter pylo... |
A 45-year-old man in respiratory distress presents to the emergency department. He sustained a stab to his left chest and was escorted to the nearest hospital. The patient appears pale and has moderate difficulty with breathing. His O2 saturation is 94%. The left lung is dull to percussion. CXRs are ordered and confirm... | Chest tube insertion | {
"A": "Chest tube insertion",
"B": "ABG",
"C": "Thoracotomy",
"D": "CT scan "
} | step2&3 | A | [
"year old man",
"respiratory distress presents",
"emergency department",
"sustained",
"stab",
"left chest",
"escorted",
"nearest hospital",
"patient appears pale",
"moderate",
"breathing",
"O2 saturation",
"left lung",
"dull",
"percussion",
"CXRs",
"ordered",
"confirm",
"likely d... |
A 32-year-old woman complains of fatigue and pallor. She says symptoms that started several months ago and have been becoming more serious with time. She reports that she has been exercising regularly and has been adhering to a strict vegan diet. The patient has no significant past medical history and takes no current ... | Iron deficiency anemia | {
"A": "Hemolytic anemia",
"B": "Glucose-6-phosphate dehydrogenase deficiency",
"C": "Lead poisoning",
"D": "Iron deficiency anemia"
} | step1 | D | [
"year old woman",
"fatigue",
"pallor",
"symptoms",
"started several months",
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"time",
"reports",
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"adhering",
"vegan diet",
"patient",
"significant past medical history",
"takes",
"current medications",
"denies",
"smoking history",
"alcohol use",
"recr... |
A 12-year-old girl with an autosomal dominant mutation in myosin-binding protein C is being evaluated by a pediatric cardiologist. The family history reveals that the patient's father died suddenly at age 33 while running a half-marathon. What was the likely finding on histological evaluation of her father's heart at a... | Myocyte disarray | {
"A": "Myocyte disarray",
"B": "Amyloid deposits",
"C": "Eosinophilic infiltration",
"D": "Wavy myocytes"
} | step1 | A | [
"year old girl",
"autosomal dominant mutation",
"myosin-binding protein C",
"evaluated",
"pediatric cardiologist",
"family history reveals",
"patient's father died",
"age",
"running",
"half marathon",
"likely finding",
"histological evaluation",
"father's heart",
"autopsy"
] |
A 25-year-old female comes to the clinic complaining of fatigue and palpitations. She has been undergoing immense stress from her thesis defense and has been extremely tired. The patient denies any weight loss, diarrhea, cold/heat intolerance. TSH was within normal limits. She reports a family history of "blood disease... | Introns | {
"A": "3'-poly(A) tail",
"B": "Exons",
"C": "Introns",
"D": "snRNPs"
} | step1 | C | [
"year old female",
"clinic",
"fatigue",
"palpitations",
"stress",
"thesis defense",
"extremely tired",
"patient denies",
"weight loss",
"diarrhea",
"cold heat",
"normal limits",
"reports",
"family history of",
"blood disease",
"later confirmed positive",
"thalassemia minor",
"abnor... |
A 35-year-old patient with a history of diabetes presents to the ED with a myriad of systemic complaints. An arterial blood gas shows serum pH = 7.3, HCO3- = 13 mEq/L, PCO2 = 27 mmHg. Which of the following would you LEAST expect to observe in this patient? | Decreased respiratory rate | {
"A": "Increased anion gap",
"B": "Increased serum ketones",
"C": "Decreased respiratory rate",
"D": "Increased serum potassium"
} | step1 | C | [
"35 year old patient",
"history",
"diabetes presents",
"ED",
"systemic complaints",
"arterial blood gas shows serum pH",
"HCO3",
"mEq/L",
"PCO2",
"27 mmHg",
"following",
"LEAST",
"to observe",
"patient"
] |
A 20-year-old woman is brought to the physician by her mother because she has been worried about her daughter's strange behavior for the past 2 years. She does not have any friends and spends most of her time alone in her room. She usually wears a long, black, hooded cloak. She is anxious at college because she is unco... | Schizotypal personality disorder | {
"A": "Social anxiety disorder",
"B": "Schizotypal personality disorder",
"C": "Paranoid personality disorder",
"D": "Schizophrenia"
} | step1 | B | [
"20 year old woman",
"brought",
"physician",
"mother",
"worried",
"daughter's strange behavior",
"past",
"years",
"not",
"friends",
"spends most of",
"time alone",
"room",
"usually",
"long",
"black",
"hooded",
"anxious",
"college",
"people",
"academic performance",
"poor",
... |
A 60-year-old African American woman presents to her family physician with shortness of breath on exertion. She also describes shortness of breath when she lies down to go to bed at night, as well as recent swelling in her ankles. Past medical history is significant for long-standing hypertension, for which she takes a... | Intimal thickening and medial hypertrophy | {
"A": "Intimal thickening and medial hypertrophy",
"B": "Thinning of the intima and media",
"C": "Fibrinoid necrosis",
"D": "Onion-skinning"
} | step2&3 | A | [
"60 year old African American woman presents",
"family physician",
"shortness of breath",
"exertion",
"shortness of breath",
"to go",
"bed",
"night",
"recent swelling",
"ankles",
"Past medical history",
"significant",
"long standing hypertension",
"takes amlodipine",
"lisinopril",
"tem... |
A 6-year-old boy is brought to the physician by his mother who is concerned about his early sexual development. He has no history of serious illness and takes no medications. He is at the 99th percentile for height and 70th percentile for weight. His blood pressure is 115/78 mm Hg. Examination shows greasy facial skin ... | Deficiency of 21β-hydroxylase | {
"A": "Deficiency of 21β-hydroxylase",
"B": "Idiopathic overproduction of GnRH",
"C": "Deficiency of 17α-hydroxylase",
"D": "Deficiency of 11β-hydroxylase"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
"concerned",
"early sexual development",
"history",
"serious illness",
"takes",
"medications",
"99th percentile",
"height",
"percentile",
"weight",
"blood pressure",
"mm Hg",
"Examination shows greasy facial skin",
"cystic acne",
... |
A 52-year-old man comes to to the emergency department with fatigue and shortness of breath that has become progressively worse over the past week. He had an upper respiratory tract infection 2 weeks ago, for which he was given an antibiotic. He has hypertension, type 2 diabetes mellitus, and colonic polyps diagnosed o... | Mechanical destruction of erythrocytes | {
"A": "Autoimmune destruction of erythrocytes",
"B": "Occult blood loss",
"C": "Erythrocyte enzyme defect",
"D": "Mechanical destruction of erythrocytes"
} | step2&3 | D | [
"year old man",
"to",
"emergency department",
"fatigue",
"shortness of breath",
"worse",
"past week",
"upper respiratory tract infection",
"weeks",
"given",
"antibiotic",
"hypertension",
"type 2 diabetes mellitus",
"colonic polyps diagnosed",
"screening colonoscopy",
"years",
"mother... |
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