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 55-year-old woman comes to your office because she noticed the growth of unwanted hair on her upper lip, chin, and chest. She has also noticed an increase in blackheads and pimples on her skin. Her female partner has also recently brought to her attention the deepening of her voice, weight gain, and changes in her ex... | Sertoli-Leydig cell tumour | {
"A": "Thecoma",
"B": "Sertoli-Leydig cell tumour",
"C": "Adrenocortical carcinoma",
"D": "Granulosa cell tumour"
} | step1 | B | [
"55 year old woman",
"office",
"growth",
"hair",
"upper lip",
"chin",
"chest",
"increase",
"blackheads",
"pimples",
"skin",
"female partner",
"recently brought",
"attention",
"deepening",
"voice",
"weight gain",
"changes",
"external genitalia",
"generated",
"personal",
"pat... |
A 44-year-old female presents to her primary care physician with complaints of headache, fatigue, muscle weakness, and frequent urination. These issues have developed and worsened over the past month. She has no significant prior medical or surgical history other than cholecystitis managed with cholecystectomy 5 years ... | Metabolic alkalosis, hypernatremia, hypokalemia | {
"A": "Metabolic acidosis, hypernatremia, hyperkalemia",
"B": "Metabolic acidosis, hyponatremia, hyperkalemia",
"C": "Metabolic acidosis, hypernatremia, hypokalemia",
"D": "Metabolic alkalosis, hypernatremia, hypokalemia"
} | step2&3 | D | [
"year old female presents",
"primary care physician",
"complaints",
"headache",
"fatigue",
"muscle weakness",
"frequent urination",
"issues",
"worsened",
"past month",
"significant prior medical",
"surgical history",
"cholecystitis managed",
"cholecystectomy",
"years",
"vital signs",
... |
A 58-year-old woman comes to the physician because of a 6-month history of difficulty walking, clumsiness of her arms and legs, and slurred speech. Physical examination shows masked facies and a slow, shuffling gait. When her ankles are passively flexed, there is involuntary, jerky resistance. Treatment is initiated wi... | Orthostatic hypotension | {
"A": "Resting tremor",
"B": "Orthostatic hypotension",
"C": "Visual hallucinations",
"D": "Dyskinesia"
} | step1 | B | [
"58 year old woman",
"physician",
"month history",
"difficulty walking",
"clumsiness",
"arms",
"legs",
"slurred speech",
"Physical examination shows masked facies",
"slow",
"shuffling",
"ankles",
"flexed",
"involuntary",
"jerky resistance",
"Treatment",
"initiated",
"combination",
... |
A 12-month-old boy is brought to the pediatrician for a routine examination. Past medical history is significant for a pyloric myomectomy at 2 months of age after a few episodes of projectile vomiting. He has reached all appropriate developmental milestones. He currently lives with his parents and pet cat in a house bu... | Decreased hemoglobin | {
"A": "Decreased vitamin B12 levels",
"B": "Increased Hb S levels",
"C": "Decreased hemoglobin",
"D": "Metabolic alkalosis"
} | step2&3 | C | [
"month old boy",
"brought",
"pediatrician",
"routine examination",
"Past medical history",
"significant",
"pyloric myomectomy",
"months",
"age",
"few episodes of projectile vomiting",
"reached",
"appropriate developmental milestones",
"currently lives with",
"parents",
"pet cat",
"hous... |
A 47-year-old woman presents to a local medical shelter while on a mission trip with her church to help rebuild homes after a hurricane. She has been experiencing severe nausea, vomiting, and diarrhea for the last 2 days and was feeling too fatigued to walk this morning. On presentation, her temperature is 99.2°F (37.3... | Increased adenylyl cyclase activity | {
"A": "Activation of receptor tyrosine kinase",
"B": "Decreased ribosomal activity",
"C": "Increased adenylyl cyclase activity",
"D": "Increased membrane permeability"
} | step1 | C | [
"year old woman presents",
"local medical shelter",
"mission trip",
"church to help",
"homes",
"hurricane",
"experiencing severe nausea",
"vomiting",
"diarrhea",
"2 days",
"feeling",
"fatigued to walk",
"morning",
"presentation",
"temperature",
"99",
"3C",
"blood pressure",
"95 6... |
A 48-year-old woman with alpha-1-antitrypsin deficiency undergoes a lung transplant. She tolerates the surgery well, but 3 years later develops inflammation and fibrosis in her terminal bronchioles. Which of the following best describes the pathophysiology of this patient's deterioration? | Lymphocytic inflammation of the bronchiolar wall | {
"A": "Staphylocuccus aureus pneumonia",
"B": "Lymphocytic inflammation of the bronchiolar wall",
"C": "T-cell mediated vascular damage",
"D": "Proliferation of grafted immunocompetent T cells"
} | step1 | B | [
"48 year old woman",
"alpha-1-antitrypsin deficiency",
"lung transplant",
"surgery well",
"3 years later",
"inflammation",
"fibrosis",
"terminal bronchioles",
"following best",
"pathophysiology",
"patient's deterioration"
] |
A 8-month-old girl is brought to her pediatrician because her mom is concerned that she may have a "lazy eye". She was born prematurely at 33 weeks and was 3 pounds at birth. Her mother also says that there is a history of visual problems that run in the family, which is why she wanted to make sure that her daughter wa... | Asymmetric corneal light reflex | {
"A": "Asymmetric corneal light reflex",
"B": "Bitemporal hemianopsia",
"C": "Increased intraocular pressure",
"D": "Nystagmus"
} | step1 | A | [
"month old girl",
"brought",
"pediatrician",
"mom",
"concerned",
"lazy eye",
"born",
"weeks",
"3 pounds",
"birth",
"mother",
"history",
"visual problems",
"run in",
"family",
"wanted to make sure",
"daughter",
"evaluated early",
"presentation",
"found to",
"eyes",
"misalign... |
A 13-year-old teenage girl was brought to the emergency department by her mom after she collapsed. Her mom reports that she was at a birthday party when all of a sudden she fell. She reported left foot weakness and has been limping ever since. The patient has been healthy and had an uncomplicated birth history, though ... | Conversion disorder | {
"A": "Cerebral vascular accident",
"B": "Conversion disorder",
"C": "Guillain-Barre syndrome",
"D": "Multiple sclerosis"
} | step1 | B | [
"year old teenage girl",
"brought",
"emergency department",
"mom",
"collapsed",
"mom reports",
"party",
"sudden",
"fell",
"reported left",
"limping ever",
"patient",
"healthy",
"uncomplicated birth history",
"mom reports",
"recovered",
"cold",
"currently lives",
"younger sister",... |
A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having di... | Buspirone | {
"A": "Buspirone",
"B": "Bupropion",
"C": "Desensitization therapy",
"D": "Relaxation training"
} | step2&3 | A | [
"30 year old woman presents",
"family doctor requesting sleeping pills",
"graduate student",
"worry",
"getting worse",
"months",
"due date",
"final paper",
"approaching",
"time",
"feels more",
"edge",
"irritable",
"difficulty sleeping",
"employing good sleep hygiene practices",
"includ... |
A 25-year-old woman presents to the emergency department with nausea and vomiting. She denies any recent illnesses, sick contacts, or consumption of foods outside of her usual diet. She reports smoking marijuana at least three times a day. Her temperature is 97.7°F (36.5°C), blood pressure is 90/74 mmHg, pulse is 100/m... | Administer ondansetron and isotonic saline with potassium | {
"A": "Obtain an urine toxin screen",
"B": "Administer ondansetron per oral and provide oral rehydration solution",
"C": "Administer ondansetron and isotonic saline with potassium",
"D": "Administer ondansetron and 1/2 normal saline with dextrose"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"nausea",
"vomiting",
"denies",
"recent illnesses",
"sick contacts",
"consumption",
"foods",
"usual diet",
"reports smoking marijuana",
"three times",
"day",
"temperature",
"97",
"36",
"blood pressure",
"90 74 mmHg",
"pulse",
"... |
A 34-year-old male is brought to the emergency department by fire and rescue following a motor vehicle accident in which the patient was an unrestrained driver. The paramedics report that the patient was struck from behind by a drunk driver. He was mentating well at the scene but complained of pain in his abdomen. The ... | Decreased pulmonary capillary wedge pressure | {
"A": "Decreased systemic vascular resistance",
"B": "Decreased pulmonary capillary wedge pressure",
"C": "Increased mixed venous oxygen saturation",
"D": "Increased right atrial pressure"
} | step2&3 | B | [
"year old male",
"brought",
"emergency department",
"fire",
"following",
"motor vehicle accident",
"patient",
"driver",
"paramedics report",
"patient",
"struck",
"drunk driver",
"well",
"pain",
"abdomen",
"patient",
"known past medical history",
"trauma bay",
"temperature",
"98... |
A 26-year-old Caucasian G1 presents at 35 weeks gestation with mild vaginal bleeding. She reports no abdominal pain or uterine contractions. She received no prenatal care after 20 weeks gestation because she was traveling. Prior to the current pregnancy, she used oral contraception. At 22 years of age she underwent a c... | Smoking | {
"A": "Intake of oral contraceptives",
"B": "Nulliparity",
"C": "Smoking",
"D": "White race"
} | step2&3 | C | [
"year old Caucasian G1 presents",
"35 weeks gestation",
"mild vaginal",
"reports",
"abdominal pain",
"uterine contractions",
"received",
"prenatal care",
"20 weeks gestation",
"traveling",
"current pregnancy",
"used oral contraception",
"years",
"age",
"cervical polypectomy",
"5 smokin... |
A 7-year-old girl is brought to the physician by her father because of a dry cough, nasal congestion, and intermittent wheezing during the past 2 months. Since birth, she has had four upper respiratory tract infections that resolved without treatment and one episode of acute otitis media treated with antibiotics. She h... | Spirometry | {
"A": "Arterial blood gas analysis",
"B": "Chest x-ray",
"C": "Serum IgE levels",
"D": "Spirometry"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"father",
"dry cough",
"nasal congestion",
"intermittent wheezing",
"past",
"months",
"birth",
"four upper respiratory tract infections",
"resolved",
"treatment",
"one episode of acute otitis media treated with antibiotics",
"history of eczema",
... |
A 42-year-old man comes to the physician for 1 month of worsening right knee pain. He has not had any trauma other than stubbing his toe 3 days ago at the garage where he works as a mechanic. Examination of the right knee shows swelling and erythema with fluctuance over the inferior patella. There is tenderness on palp... | Inflammation of periarticular fluid-filled sac | {
"A": "Noninflammatory degeneration of the joint",
"B": "Infection of the joint",
"C": "Deposition of crystals in the joint",
"D": "Inflammation of periarticular fluid-filled sac"
} | step1 | D | [
"year old man",
"physician",
"1 month",
"worsening right knee pain",
"not",
"trauma",
"toe 3 days",
"garage",
"works",
"mechanic",
"Examination",
"right knee shows swelling",
"erythema",
"fluctuance",
"inferior patella",
"tenderness",
"palpation",
"patella",
"joint line tendernes... |
A 17-year-old man presents to his primary care physician with a bilateral tremor of the hands. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months... | Mineral accumulation in the basal ganglia | {
"A": "Mineral accumulation in the basal ganglia",
"B": "Central nervous system demyelination",
"C": "Autosomal dominant, trinucleotide repeat disorder",
"D": "Autoimmune process following infection with group A streptococci"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"bilateral tremor of",
"hands",
"senior",
"high school",
"year",
"grades",
"point",
"failing",
"memory",
"now poor",
"trouble focusing",
"tasks",
"behavior",
"changed",
"past 6 months",
"frequent episodes of depression",
"separat... |
A 4-year-old boy presents to the emergency department with a 1 hour history of severe knee pain after he bumped his knee against a door. He has no past medical history though his parents say that he seems to bruise fairly easily. His parents say that they are afraid he may have accidentally taken his grandfather's warf... | Production of an autoantibody | {
"A": "Deficiency in a coagulation factor",
"B": "Deficiency of von Willebrand factor",
"C": "Production of an autoantibody",
"D": "Warfarin toxicity"
} | step1 | C | [
"4 year old boy presents",
"emergency department",
"hour history",
"severe knee",
"knee",
"door",
"past medical history",
"parents",
"to bruise",
"easily",
"parents",
"afraid",
"taken",
"grandfather's warfarin medication",
"presentation",
"found to",
"erythematous",
"warm",
"swol... |
A 40-year-old man comes to the physician for a follow-up examination. He feels well. He has no urinary urgency, increased frequency, dysuria, or gross hematuria. He has a history of recurrent urinary tract infections. His last urinary tract infection was 3 months ago and was treated with ciprofloxacin. Current medicati... | CT urography
" | {
"A": "Transrectal ultrasound",
"B": "Voided urine cytology",
"C": "Reassurance",
"D": "CT urography\n\""
} | step2&3 | D | [
"40 year old man",
"physician",
"follow-up examination",
"feels well",
"urinary urgency",
"increased frequency",
"dysuria",
"gross hematuria",
"history of recurrent urinary tract infections",
"last urinary tract infection",
"3 months",
"treated with ciprofloxacin",
"Current medications inclu... |
A 40-year-old man presents with severe fatigue, dyspnea on exertion, and weight loss. He reports a weight loss of 15 kg (33.0 lb) over the past 3 months and feels full almost immediately after starting to eat, often feeling nauseous and occasionally vomiting. Past medical history is not significant. However, the patien... | Ligament of Treitz | {
"A": "Ligament of Treitz",
"B": "Hepatoduodenal ligament",
"C": "Ampulla of Vater",
"D": "Portal vein"
} | step1 | A | [
"40 year old man presents",
"severe fatigue",
"dyspnea on exertion",
"weight loss",
"reports",
"weight loss of",
"kg",
"0",
"past 3 months",
"feels full almost immediately",
"starting",
"eat",
"often feeling nauseous",
"occasionally vomiting",
"Past medical history",
"not significant",... |
A 33-year-old man with a history of alcohol abuse and cirrhosis presents to the emergency department with profuse vomiting. The patient is aggressive, combative, emotionally labile, and has to be chemically restrained. The patient continues to vomit and blood is noted in the vomitus. His temperature is 99.2°F (37.3°C),... | Transmural tear | {
"A": "Dilated and tortuous veins",
"B": "Mucosal tear",
"C": "Pericardial fluid accumulation",
"D": "Transmural tear"
} | step2&3 | D | [
"year old man",
"history of alcohol abuse",
"cirrhosis presents",
"emergency department",
"vomiting",
"patient",
"aggressive",
"combative",
"emotionally labile",
"to",
"chemically restrained",
"patient continues to vomit",
"blood",
"noted",
"vomitus",
"temperature",
"99",
"3C",
"... |
A 74-year-old male is brought to the emergency department 1 hour after he fell from the top of the staircase at home. He reports pain in his neck as well as weakness of his upper extremities. He is alert and immobilized in a cervical collar. He has hypertension treated with hydrochlorthiazide. His pulse is 90/min and r... | MRI of the cervical spine without contrast | {
"A": "CT angiography of the neck",
"B": "Cervical myelography",
"C": "X-ray of the cervical spine",
"D": "MRI of the cervical spine without contrast"
} | step2&3 | D | [
"74 year old male",
"brought",
"emergency department",
"hour",
"fell",
"top of",
"staircase at home",
"reports pain in",
"neck",
"weakness",
"upper extremities",
"alert",
"immobilized",
"cervical collar",
"hypertension treated with",
"pulse",
"90 min",
"regular",
"respirations",
... |
A 36-year old pregnant woman (gravida 4, para 1) presents at week 11 of pregnancy. Currently, she has no complaints. She had an uncomplicated 1st pregnancy that ended in an uncomplicated vaginal delivery at the age of 28 years. Her male child was born healthy, with normal physical and psychological development over the... | Recommend chorionic villus sampling with subsequent cell culturing and karyotyping | {
"A": "Offer a blood test for rubella virus, cytomegalovirus, and toxoplasma IgG",
"B": "Perform an ultrasound examination with nuchal translucency and crown-rump length measurement",
"C": "Recommend chorionic villus sampling with subsequent cell culturing and karyotyping",
"D": "Schedule a quadruple test at t... | step2&3 | C | [
"36 year old pregnant woman",
"gravida 4",
"para 1",
"presents",
"week",
"pregnancy",
"Currently",
"complaints",
"uncomplicated 1st pregnancy",
"ended",
"uncomplicated vaginal",
"age",
"years",
"male child",
"born healthy",
"normal physical",
"psychological development",
"years",
... |
A 63-year-old man is brought to the emergency department by the police after he was found in the streets lying unconscious on the ground. Both of his pupils are normal in size and reactive to light. There are no obvious signs of head trauma. The finger prick test shows a blood glucose level of 20 mg/dL. He has been bro... | Macrocytosis MCV > 100fL | {
"A": "Hypersegmented neutrophils",
"B": "Sickle cells",
"C": "Macrocytosis MCV > 100fL",
"D": "Howell-Jolly bodies"
} | step2&3 | C | [
"63 year old man",
"brought",
"emergency department",
"police",
"found",
"streets lying unconscious",
"pupils",
"normal",
"size",
"reactive to light",
"signs",
"head trauma",
"finger shows",
"blood glucose level",
"20 mg/dL",
"brought",
"emergency department",
"acute alcohol intoxi... |
A 65-year-old man comes to his primary care physician with a 6-month history of bilateral calf pain. The pain usually occurs after walking his dog a few blocks and is more severe on the right side. He has coronary artery disease, essential hypertension, and type 2 diabetes mellitus. He has smoked two packs of cigarette... | Graded exercise therapy | {
"A": "Graded exercise therapy",
"B": "Propranolol therapy",
"C": "Spinal cord stimulation",
"D": "Vascular bypass surgery"
} | step2&3 | A | [
"65 year old man",
"primary care physician",
"month history of bilateral calf pain",
"pain usually occurs",
"walking",
"dog",
"few blocks",
"more severe",
"right side",
"coronary artery disease",
"essential hypertension",
"type 2 diabetes mellitus",
"smoked two packs",
"cigarettes daily",
... |
A previously healthy 25-year-old man comes to the physician because of a 1-week history of fever and fluid release from painful lumps in his right groin. He had an atraumatic ulceration of his penis about 1 month ago that was not painful and resolved on its own within 1 week. He works at an animal shelter for abandoned... | Chlamydia trachomatis | {
"A": "Bartonella henselae",
"B": "Treponema pallidum",
"C": "Chlamydia trachomatis",
"D": "Haemophilus ducreyi"
} | step1 | C | [
"healthy",
"year old man",
"physician",
"1-week history",
"fever",
"fluid release",
"painful lumps",
"right groin",
"ulceration",
"penis",
"1 month",
"not painful",
"resolved",
"1 week",
"works",
"animal shelter",
"abandoned pets",
"sexually active",
"multiple male partners",
"... |
A 67-year-old man comes to the physician because of numbness and burning sensation of his legs for the past week. He also complains that his stools have been larger and rougher than usual. He has non-Hodgkin lymphoma and is currently receiving chemotherapy with prednisone, vincristine, rituximab, cyclophosphamide, and ... | Adverse effect of vincristine | {
"A": "Adverse effect of vincristine",
"B": "Spinal cord compression",
"C": "Paraneoplastic autoantibodies",
"D": "Charcot–Marie–Tooth disease"
} | step2&3 | A | [
"67 year old man",
"physician",
"numbness",
"burning sensation of",
"legs",
"past week",
"stools",
"larger",
"usual",
"non-Hodgkin lymphoma",
"currently receiving chemotherapy",
"prednisone",
"vincristine",
"rituximab",
"cyclophosphamide",
"doxorubicin",
"received 4 cycles",
"chemo... |
A 76-year-old Japanese man is admitted to the hospital because of a 3-month history of loose stools and worsening peripheral edema. He also reports fatigue, a 10-pound weight loss over the past 6 weeks, and a tingling sensation in his hands and feet over the same time period. Aside from the family dog, he has not had c... | Bacterial overgrowth | {
"A": "Neoplastic growth",
"B": "Increased intestinal motility",
"C": "Bacterial overgrowth",
"D": "Anastomotic stricture"
} | step2&3 | C | [
"76 year old Japanese man",
"admitted",
"hospital",
"3 month history",
"loose stools",
"worsening peripheral edema",
"reports fatigue",
"a 10 pound weight loss",
"past",
"weeks",
"tingling",
"hands",
"feet",
"same time period",
"family dog",
"not",
"contact with animals",
"over",
... |
A 7-week-old male presents to the pediatrician for vomiting. His parents report that three weeks ago the patient began vomiting after meals. They say that the vomitus appears to be normal stomach contents without streaks of red or green. His parents have already tried repositioning him during mealtimes and switching hi... | Intravenous hydration | {
"A": "Abdominal ultrasound",
"B": "Intravenous hydration",
"C": "Pyloromyotomy",
"D": "Thickening feeds"
} | step2&3 | B | [
"week old male presents",
"pediatrician",
"vomiting",
"parents report",
"three weeks",
"patient began vomiting",
"meals",
"vomitus appears to",
"normal stomach contents",
"streaks",
"red",
"green",
"parents",
"repositioning",
"mealtimes",
"switching",
"formula to",
"cows milk",
"... |
An investigator is studying nutritional deficiencies in humans. A group of healthy volunteers are started on a diet deficient in pantothenic acid. After 4 weeks, several of the volunteers develop irritability, abdominal cramps, and burning paresthesias of their feet. These symptoms are fully reversed after reintroducti... | Alpha-ketoglutarate dehydrogenase | {
"A": "Methionine synthase",
"B": "Dopamine beta-hydroxylase",
"C": "Glutathione reductase",
"D": "Alpha-ketoglutarate dehydrogenase"
} | step1 | D | [
"investigator",
"studying nutritional deficiencies",
"humans",
"A group",
"healthy volunteers",
"started",
"diet deficient",
"pantothenic acid",
"4 weeks",
"several",
"volunteers",
"irritability",
"abdominal cramps",
"burning paresthesias",
"feet",
"symptoms",
"reversed",
"reintrod... |
A 64-year-old man presents to his primary care physician's office for a routine check-up. His past medical history is significant for type 2 diabetes mellitus, hypertension, chronic atrial fibrillation, and ischemic cardiomyopathy. On his last visit three months ago, he was found to have hyperkalemia, at which time lis... | Renal tubular acidosis | {
"A": "Furosemide",
"B": "Chronic renal failure",
"C": "Renal tubular acidosis",
"D": "Amlodipine"
} | step2&3 | C | [
"64 year old man presents",
"primary care physician's office",
"routine check-up",
"past medical history",
"significant",
"type 2 diabetes mellitus",
"hypertension",
"chronic atrial fibrillation",
"ischemic cardiomyopathy",
"last visit three months",
"found to",
"hyperkalemia",
"time lisinop... |
A 17-year-old boy comes to the physician because of a 3-month history of pain in his right shoulder. He reports that he has stopped playing for his high school football team because of persistent difficulty lifting his right arm. Physical examination shows impaired active abduction of the right arm from 0 to 15 degrees... | Suprascapular nerve | {
"A": "Suprascapular nerve",
"B": "Long thoracic nerve",
"C": "Axillary nerve",
"D": "Upper subscapular nerve"
} | step1 | A | [
"year old boy",
"physician",
"3 month history",
"pain",
"right shoulder",
"reports",
"stopped playing",
"high school football team",
"persistent difficulty lifting",
"right arm",
"Physical examination shows impaired active abduction",
"right arm",
"0",
"15 degrees",
"passive abduction",
... |
A 72-year-old man is brought to the physician by his son because of gradually progressive yellow discoloration of his skin and generalized pruritus for the past 2 weeks. During this period, his appetite has decreased and he has had a 6.3-kg (14-lb) weight loss. He reports that his stool appears pale and his urine is ve... | Pancreatic adenocarcinoma | {
"A": "Pancreatic adenocarcinoma",
"B": "Choledocholithiasis",
"C": "Alcoholic hepatitis",
"D": "Cholecystitis"
} | step2&3 | A | [
"72 year old man",
"brought",
"physician",
"son",
"progressive yellow discoloration",
"skin",
"generalized pruritus",
"past 2 weeks",
"period",
"appetite",
"decreased",
"6.3 kg",
"weight loss",
"reports",
"stool appears pale",
"urine",
"very dark",
"Three years",
"episode of acut... |
A 2-day-old infant dies of severe respiratory distress following a gestation complicated by persistent oligohydramnios. Upon examination at autopsy, the left kidney is noted to selectively lack cortical and medullary collecting ducts. From which of the following embryological structures do the cortical and medullary co... | Ureteric bud | {
"A": "Mesonephros",
"B": "Paramesonephric duct",
"C": "Metanephric mesenchyme",
"D": "Ureteric bud"
} | step1 | D | [
"2-day old infant",
"severe respiratory distress following",
"gestation complicated",
"persistent oligohydramnios",
"examination",
"autopsy",
"left kidney",
"noted to",
"lack cortical",
"medullary collecting ducts",
"following embryological structures",
"cortical",
"medullary collecting duct... |
A 2-year-old child is brought to the emergency department with rapid breathing and a severe cyanotic appearance of his lips, fingers, and toes. He is known to have occasional episodes of mild cyanosis, especially when he is extremely agitated. This is the worst episode of this child’s life, according to his parents. He... | Boot-shaped heart | {
"A": "Egg on a string",
"B": "Boot-shaped heart",
"C": "Displaced tricuspid valve",
"D": "Atrial septal defect"
} | step2&3 | B | [
"2 year old child",
"brought",
"emergency department",
"rapid breathing",
"severe cyanotic appearance of",
"lips",
"fingers",
"toes",
"known to",
"occasional episodes of mild cyanosis",
"extremely agitated",
"worst episode of",
"childs life",
"parents",
"born",
"APGAR score",
"8",
... |
An 11-year-old boy is brought to a pediatrician by his parents with the complaint of progressive behavioral problems for the last 2 years. His parents report that he always looks restless at home and is never quiet. His school teachers frequently complain that he cannot remain seated for long during class, often leavin... | Past history of Kawasaki disease | {
"A": "Past history of Kawasaki disease",
"B": "Past history of recurrent fractures",
"C": "Past history of idiopathic thrombocytopenic purpura",
"D": "Past history of Guillain-Barré syndrome"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"parents",
"complaint",
"progressive behavioral problems",
"last",
"years",
"parents report",
"always looks restless",
"home",
"never quiet",
"school teachers frequently",
"seated",
"long",
"class",
"often",
"to move",
"classroom",
"de... |
A 2-year-old boy with a history of recurrent respiratory infections is brought to the physician for a follow-up examination. His height and weight are both at the 20th percentile. Crackles are heard in both lower lung fields. Cardiac auscultation shows a grade 3/6 holosystolic murmur over the left lower sternal border ... | Digital clubbing | {
"A": "Thrombocytosis",
"B": "Secondary hypertension",
"C": "Aortic dissection",
"D": "Digital clubbing"
} | step1 | D | [
"2 year old boy",
"history",
"recurrent respiratory infections",
"brought",
"physician",
"follow-up examination",
"height",
"weight",
"percentile",
"Crackles",
"heard",
"lower lung fields",
"Cardiac auscultation shows",
"grade",
"6 holosystolic murmur",
"left lower sternal border",
"... |
A previously healthy 57-year-old man comes to the emergency department because of acute retrosternal chest pain that radiates to his back. The pain started suddenly while he was having dinner. A few moments prior to the onset of the pain, he experienced discomfort when trying to eat or drink anything. On the way to the... | Esophageal manometry shows simultaneous multi-peak contractions | {
"A": "Esophageal manometry shows simultaneous multi-peak contractions",
"B": "Endoscopy shows multiple mucosal erosions",
"C": "Serology shows elevated CK-MB levels",
"D": "Esophageal manometry shows hypertensive contractions"
} | step2&3 | A | [
"healthy 57 year old man",
"emergency department",
"acute retrosternal",
"radiates",
"back",
"pain started",
"dinner",
"few",
"prior to",
"onset",
"pain",
"experienced discomfort",
"to eat",
"drink",
"hospital",
"took",
"sublingual nitrate tablet",
"at home",
"helped relieve",
... |
A 24-year-old woman presents with fever, abdominal pain, and bloody bowel movements. She says her symptoms onset 2 days ago and have not improved. She describes the abdominal pain as moderate, cramping in character, and poorly localized. 1 week ago, she says she was on a camping trip with her friends and had barbecued ... | Guillain-Barré syndrome | {
"A": "Typhoid",
"B": "Appendicitis",
"C": "Toxic megacolon",
"D": "Guillain-Barré syndrome"
} | step1 | D | [
"year old woman presents",
"fever",
"abdominal pain",
"bloody bowel movements",
"symptoms onset",
"days",
"not improved",
"abdominal pain",
"moderate",
"cramping",
"character",
"poorly localized",
"1 week",
"camping trip",
"friends",
"chicken",
"thought tasted",
"patient denies",
... |
A 17-year-old female presents to her pediatrician due to lack of menstruation. She states that she developed breasts 4 years ago but has not experienced menses yet. The patient denies abdominal pain and has no past medical history. Her mother underwent menarche at age 13. The patient is a volleyball player at school, i... | Gonadectomy | {
"A": "Gonadectomy",
"B": "Estrogen replacement therapy",
"C": "Vaginoplasty",
"D": "ACTH stimulation test"
} | step2&3 | A | [
"year old female presents",
"pediatrician due to lack of menstruation",
"states",
"breasts",
"years",
"not",
"menses",
"patient denies abdominal pain",
"past medical history",
"mother",
"menarche at age",
"patient",
"volleyball",
"school",
"single",
"never attempted intercourse",
"vi... |
A 60-year-old man comes to the physician because of a 6-month history of progressively worsening urinary frequency. He feels the urge to urinate every hour or two, which restricts his daily activities and interferes with his sleep. He has no fever, hematuria, or burning pain on micturition. He has hypertension and type... | Urinalysis | {
"A": "Urinalysis",
"B": "Urine cytology",
"C": "Serum prostate-specific antigen level",
"D": "Uroflowmetry"
} | step2&3 | A | [
"60 year old man",
"physician",
"month history",
"worsening urinary frequency",
"feels",
"to",
"hour",
"two",
"restricts",
"daily activities",
"interferes with",
"sleep",
"fever",
"hematuria",
"burning pain on micturition",
"hypertension",
"type 2 diabetes mellitus",
"Current medic... |
A 5-year-old boy is brought to the pediatric clinic for evaluation of fever, pain, swelling in the left leg, and limping. Review of systems and history is otherwise unremarkable. The vital signs include: pulse 110/min, temperature 38.1°C (100.6°F), and blood pressure 100/70 mm Hg. On examination, there is a tender swel... | X-ray showing lytic bone lesion with periosteal reaction | {
"A": "Mixed lytic and blastic appearance in the X-ray",
"B": "X-ray showing lytic bone lesion with periosteal reaction",
"C": "X-ray showing broad-based projections from the surface of the bone",
"D": "X-ray showing deep muscle plane displacement from the metaphysis"
} | step2&3 | B | [
"5 year old boy",
"brought",
"pediatric clinic",
"evaluation",
"fever",
"pain",
"swelling",
"left",
"limping",
"Review of systems",
"history",
"unremarkable",
"vital signs include",
"pulse",
"min",
"temperature",
"100",
"blood pressure 100 70 mm Hg",
"examination",
"tender swel... |
A 25-year-old homeless woman presents to an urgent care clinic complaining of vaginal bleeding. She also has vague lower right abdominal pain which started a few hours ago and is increasing in intensity. The medical history is significant for chronic hepatitis C infection, and she claims to take a pill for it ‘every no... | Surgery | {
"A": "Surgery",
"B": "IV fluids, then surgery",
"C": "Methotrexate",
"D": "Tubal ligation"
} | step2&3 | A | [
"year old homeless woman presents",
"urgent care clinic",
"vaginal bleeding",
"vague lower right abdominal pain",
"started",
"few hours",
"increasing",
"intensity",
"medical history",
"significant",
"chronic",
"to take",
"pill",
"now",
"then",
"temperature",
"36",
"98",
"blood pr... |
A 29-year-old man presents to the primary care clinic in June for post-discharge follow-up. The patient was recently admitted to the hospital after a motor vehicle collision. At that time he arrived at the emergency department unconscious, hypotensive, and tachycardic. Abdominal CT revealed a hemoperitoneum due to a la... | 13-valent pneumococcal conjugate vaccine | {
"A": "13-valent pneumococcal conjugate vaccine",
"B": "Inactivated (intramuscular) influenza vaccine",
"C": "Measles-mumps-rubella vaccine",
"D": "Tetanus booster vaccine"
} | step2&3 | A | [
"29 year old man presents",
"primary care clinic",
"June",
"post-discharge follow-up",
"patient",
"recently admitted",
"hospital",
"motor vehicle collision",
"time",
"arrived",
"emergency department unconscious",
"hypotensive",
"tachycardic",
"Abdominal CT revealed",
"hemoperitoneum due ... |
A 4-year-old boy is brought to the emergency department by his mother after cutting his buttock on a piece of broken glass. There is a 5-cm curvilinear laceration over the patient's right buttock. His vital signs are unremarkable. The decision to repair the laceration is made. Which of the following will offer the long... | Bupivacaine with epinephrine | {
"A": "Bupivacaine",
"B": "Bupivacaine with epinephrine",
"C": "Lidocaine",
"D": "Lidocaine with epinephrine"
} | step2&3 | B | [
"4 year old boy",
"brought",
"emergency department",
"mother",
"cutting",
"buttock",
"piece",
"glass",
"5 cm",
"laceration",
"patient's right buttock",
"vital signs",
"unremarkable",
"decision to repair",
"laceration",
"made",
"following",
"longest anesthesia",
"laceration repair... |
A 58-year-old woman comes to the emergency department because of a 2-day history of worsening upper abdominal pain. She reports nausea and vomiting, and is unable to tolerate oral intake. She appears uncomfortable. Her temperature is 38.1°C (100.6°F), pulse is 92/min, respirations are 18/min, and blood pressure is 132/... | Endoscopic retrograde cholangiopancreatography
" | {
"A": "Abdominal CT scan",
"B": "Laparoscopic cholecystectomy",
"C": "Extracorporeal shock wave lithotripsy",
"D": "Endoscopic retrograde cholangiopancreatography\n\""
} | step2&3 | D | [
"58 year old woman",
"emergency department",
"2-day history",
"worsening upper abdominal pain",
"reports nausea",
"vomiting",
"unable to",
"oral intake",
"appears",
"temperature",
"100",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"85 mm Hg",
"Examination shows",
"di... |
A 49-year-old woman presents to the office because of tremors for 2 months. She says that her hands have been shaking a lot, especially when she feels stressed. In addition, she has been sweating more than usual and has lost 8 kg (17.6 lb) in the last 2 months. She has a past medical history of vitiligo. Her vital sign... | Low TSH, high free T4, and high free T3 | {
"A": "High TSH, high freeT4, and high free T3",
"B": "High TSH, low free T4, and low free T3",
"C": "Low TSH, high free T4, and high free T3",
"D": "Low TSH, normal free T4, and normal free T3"
} | step1 | C | [
"year old woman presents",
"office",
"of tremors",
"months",
"hands",
"shaking",
"lot",
"feels stressed",
"addition",
"sweating more",
"usual",
"lost",
"kg",
"last",
"months",
"past medical vitiligo",
"vital signs",
"heart rate",
"98 min",
"respiratory rate",
"min",
"temper... |
A 14-year-old boy is brought to the emergency department because of acute left-sided chest pain and dyspnea following a motor vehicle accident. His pulse is 122/min and blood pressure is 85/45 mm Hg. Physical examination shows distended neck veins and tracheal displacement to the right side. The left chest is hyperreso... | 2nd left intercostal space along the midclavicular line | {
"A": "2nd left intercostal space along the midclavicular line",
"B": "8th left intercostal space along the posterior axillary line",
"C": "Subxiphoid space in the left sternocostal margin",
"D": "5th left intercostal space along the midclavicular line"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"acute left-sided chest pain",
"dyspnea following",
"motor vehicle accident",
"pulse",
"min",
"blood pressure",
"85",
"mm Hg",
"Physical examination shows distended neck",
"tracheal displacement",
"right side",
"left chest",
"hyperreso... |
Five days after undergoing an open colectomy and temporary colostomy for colon cancer, a 73-year-old man develops severe pain and swelling of the left calf. He was diagnosed with colon cancer 3 months ago. He has hypothyroidism and hypertension. His father died of colon cancer at the age of 68. He does not smoke. Prior... | Switch from unfractionated heparin to argatroban therapy | {
"A": "Switch from unfractionated heparin to warfarin therapy",
"B": "Switch from unfractionated heparin to argatroban therapy",
"C": "Administer vitamin K",
"D": "Transfuse platelet concentrate"
} | step2&3 | B | [
"Five days",
"open colectomy",
"temporary colostomy",
"colon cancer",
"year old man",
"severe pain",
"swelling of",
"left calf",
"diagnosed",
"colon cancer",
"months",
"hypothyroidism",
"hypertension",
"father died of colon cancer",
"age",
"68",
"not smoke",
"admission",
"medicat... |
A previously healthy 13-year-old boy is brought to the physician because of a lump beneath his right nipple that he discovered 1 week ago while showering. He has allergic rhinitis treated with cetirizine. He is at the 65th percentile for height and 80th percentile for weight. Examination shows a mildly tender, firm, 2-... | Normal development | {
"A": "Leydig cell tumor",
"B": "Adverse effect of medication",
"C": "Invasive ductal carcinoma",
"D": "Normal development"
} | step1 | D | [
"healthy",
"year old boy",
"brought",
"physician",
"of",
"lump",
"right nipple",
"discovered 1 week",
"showering",
"allergic rhinitis treated with cetirizine",
"percentile",
"height",
"80th percentile",
"weight",
"Examination shows",
"mildly tender",
"firm",
"2",
"subareolar mass... |
A 23-year-old female presents with a seven-day history of abdominal pain, and now bloody diarrhea that brings her to her primary care physician. Review of systems is notable for a 12-pound unintentional weight loss and intermittent loose stools. She has a family history notable for a father with CAD and a mother with p... | Continuous progression beginning in the rectum | {
"A": "Perianal disease",
"B": "Continuous progression beginning in the rectum",
"C": "Fistulae and stricture formation",
"D": "Cobblestoning and skip lesions"
} | step2&3 | B | [
"23 year old female presents",
"seven-day history",
"abdominal pain",
"now bloody diarrhea",
"primary care physician",
"Review of systems",
"notable",
"pound unintentional weight loss",
"intermittent loose stools",
"family history notable",
"father",
"CAD",
"mother",
"primary sclerosing ch... |
A 42-year-old man comes to the physician for a routine health maintenance examination. He feels well but has had several episodes of “finger pallor” over the past 4 months. During these episodes, the 4th finger of his left hand turns white. The color usually returns within 20 minutes, followed by redness and warmth of ... | Serologic testing | {
"A": "Discontinue lansoprazole",
"B": "Oral aspirin",
"C": "Digital subtraction angiography",
"D": "Serologic testing"
} | step2&3 | D | [
"year old man",
"physician",
"routine health maintenance examination",
"feels well",
"several episodes of finger pallor",
"past",
"months",
"episodes",
"4th finger of",
"left hand turns white",
"color usually returns",
"20 minutes",
"followed by redness",
"warmth",
"finger",
"episodes"... |
A 7-year-old boy presents to your office with facial eczema. He has a history of recurrent infections, including multiple episodes of pneumonia that lasted several weeks and otitis media. Laboratory measurements of serum immunoglobulins show increased IgE and IgA but decreased IgM. Which of the following additional abn... | Thrombocytopenia | {
"A": "Thrombocytopenia",
"B": "Leukopenia",
"C": "Anemia",
"D": "NADPH oxidase deficiency"
} | step1 | A | [
"year old boy presents",
"office",
"facial eczema",
"history",
"recurrent infections",
"including multiple episodes of pneumonia",
"lasted",
"weeks",
"otitis media",
"Laboratory measurements",
"serum immunoglobulins show increased IgE",
"IgA",
"decreased IgM",
"following additional abnorma... |
A 26-year-old student arrives to student health for persistent diarrhea. She states that for the past 2 months she has had foul-smelling diarrhea and abdominal cramping. She also reports increased bloating, flatulence, and an unintentional 4 lb weight loss. Prior to 2 months ago, she had never felt these symptoms befor... | Disulfiram-like reaction | {
"A": "Disulfiram-like reaction",
"B": "Osteoporosis",
"C": "Photosensitivity",
"D": "Tendon rupture"
} | step2&3 | A | [
"year old student",
"student health",
"persistent diarrhea",
"states",
"past",
"months",
"smelling diarrhea",
"abdominal cramping",
"reports increased bloating",
"flatulence",
"unintentional",
"weight loss",
"2 months",
"never felt",
"symptoms",
"denies",
"extra gastrointestinal symp... |
A 71-year-old man with hypertension comes to the physician for a follow-up examination. Cardiovascular exam shows the point of maximal impulse to be in the mid-axillary line. A transthoracic echocardiogram shows concentric left ventricular hypertrophy with a normal right ventricle. Which of the following is the most li... | Accumulation of sarcomeres in parallel | {
"A": "Accumulation of glycogen",
"B": "Accumulation of protein fibrils",
"C": "Accumulation of sarcomeres in parallel",
"D": "Infiltration of T lymphocytes"
} | step1 | C | [
"71 year old man",
"hypertension",
"physician",
"follow-up examination",
"Cardiovascular exam shows",
"point",
"maximal impulse to",
"mid-axillary line",
"transthoracic echocardiogram shows concentric left ventricular hypertrophy",
"normal right ventricle",
"following",
"most likely underlying... |
A 62-year-old man comes to the physician because of increased frequency of urination. He also says that he needs to urinate 4 to 5 times nightly and has difficulty initiating a urinary stream. He has had several episodes of acute cystitis treated with ciprofloxacin during the past year. Digital rectal examination shows... | Inflammation of the renal interstitium | {
"A": "Abscess formation in the prostate",
"B": "Irreversible decrease in renal function",
"C": "Impaired intracavernosal blood flow",
"D": "Inflammation of the renal interstitium"
} | step1 | D | [
"62 year old man",
"physician",
"of increased frequency",
"urination",
"needs to",
"4 to 5 times",
"difficulty initiating",
"urinary stream",
"several episodes of acute cystitis treated with ciprofloxacin",
"past year",
"Digital rectal examination shows",
"firm",
"enlarged",
"non-tender pr... |
A 9-year-old boy is brought to a psychologist by his mother because his teachers frequently complain about his behavioral problems at school. The patient’s mother reports that his concerning behavior started at a young age. She says he is disrespectful to family members and to his teachers at school. He also talks back... | Blaming others for his own misbehavior | {
"A": "Blaming others for his own misbehavior",
"B": "Staying out of home at nights despite restrictions",
"C": "Fights at school",
"D": "Frequently leaving his seat during class despite instructions by the teacher"
} | step2&3 | A | [
"year old boy",
"brought",
"psychologist",
"mother",
"teachers frequently",
"behavioral problems",
"school",
"patients mother reports",
"concerning behavior started",
"young age",
"disrespectful",
"family members",
"teachers",
"school",
"talks back",
"limiting",
"freedom",
"not imp... |
A 42-year-old woman comes to the physician because of stiffness and pain in multiple joints. She says that the fingers on both of her hands have become increasingly stiff and difficult to move over the past 8 months. She also complains of nails that break easily and look spotty as well as chronic back pain. She had a u... | Psoriatic arthritis
" | {
"A": "Secondary syphilis",
"B": "Ankylosing spondylitis",
"C": "Systemic lupus erythematosus",
"D": "Psoriatic arthritis\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"stiffness",
"pain in multiple joints",
"fingers",
"of",
"hands",
"stiff",
"difficult to move",
"past",
"months",
"nails",
"break easily",
"look spotty",
"chronic back pain",
"urinary tract infection",
"year",
"treated with antibiotics",
"sexually a... |
A 70-year-old women presents to her primary care physician with sudden episodes of dizziness that resolve in certain positions. On further questioning she describes a false sense of motion with occasional spinning sensation consistent with vertigo. She denies any recent illnesses or hearing loss aside from presbycusis.... | Benign Paroxysmal Positional Vertigo (BPPV) | {
"A": "Vestibular migraine",
"B": "Labyrinthitis",
"C": "Benign Paroxysmal Positional Vertigo (BPPV)",
"D": "Vestibular neuritis"
} | step2&3 | C | [
"70 year old women presents",
"primary care physician",
"sudden episodes of dizziness",
"resolve",
"certain positions",
"further questioning",
"false sense",
"motion",
"occasional spinning sensation consistent with vertigo",
"denies",
"recent illnesses",
"hearing loss",
"presbycusis",
"vit... |
A 6-year-old girl is brought to the physician by her father because of a 3-day history of sore throat, abdominal pain, nausea, vomiting, and high fever. She has been taking acetaminophen for the fever. Physical examination shows cervical lymphadenopathy, pharyngeal erythema, and a bright red tongue. Examination of the ... | Erythrogenic toxin-induced cytokine release | {
"A": "Subepithelial immune complex deposition",
"B": "Erythrogenic toxin-induced cytokine release",
"C": "Bacterial invasion of the deep dermis",
"D": "Paramyxovirus-induced cell damage"
} | step1 | B | [
"year old girl",
"brought",
"physician",
"father",
"3-day history",
"sore throat",
"abdominal pain",
"nausea",
"vomiting",
"high fever",
"taking acetaminophen",
"fever",
"Physical examination shows cervical lymphadenopathy",
"pharyngeal erythema",
"bright",
"Examination of",
"skin sh... |
A 37-year-old woman is being evaluated for difficulty with swallowing for the past few months. She explains that she experiences difficulty swallowing solid foods only. Her medical history is relevant for hypothyroidism and migraines. Her current medications include daily levothyroxine and acetaminophen as needed for p... | Mitral valve stenosis | {
"A": "Mitral valve stenosis",
"B": "Aortic valve stenosis",
"C": "Aortic valve regurgitation",
"D": "Mitral valve prolapse"
} | step1 | A | [
"year old woman",
"evaluated",
"difficulty",
"swallowing",
"past",
"months",
"experiences difficulty swallowing solid foods only",
"medical history",
"relevant",
"hypothyroidism",
"migraines",
"current medications include daily levothyroxine",
"acetaminophen as needed",
"pain",
"vital si... |
In a lab experiment, a researcher treats early cells of the erythrocyte lineage with a novel compound called Pb82. Pb82 blocks the first step of heme synthesis. However, the experiment is controlled such that the cells otherwise continue to develop into erythrocytes. At the end of the experiment, the cells have develop... | The cells will not produce heme since they lack mitochondria | {
"A": "The cells will now produce heme",
"B": "The cells will not produce heme since they lack mitochondria",
"C": "The cells will not produce heme because they lack cytosol",
"D": "The cells will not produce heme because they lack nucleoli"
} | step1 | B | [
"lab experiment",
"researcher treats early cells",
"erythrocyte lineage",
"novel compound called",
"blocks",
"first step",
"heme synthesis",
"experiment",
"controlled",
"cells",
"continue to",
"erythrocytes",
"end",
"experiment",
"cells",
"normal erythrocytes except",
"heme",
"seco... |
A 47-year-old man presents with upper GI (upper gastrointestinal) bleeding. The patient is known to have a past medical history of peptic ulcer disease and was previously admitted 4 years ago for the same reason. He uses proton-pump inhibitors for his peptic ulcer. Upon admission, the patient is placed on close monitor... | Clean-based ulcer | {
"A": "Gastric ulcer with arteriovenous malformations",
"B": "Visible bleeding vessel",
"C": "Adherent clot on ulcer",
"D": "Clean-based ulcer"
} | step1 | D | [
"year old man presents",
"upper GI",
"upper gastrointestinal",
"bleeding",
"patient",
"known to",
"past medical",
"admitted 4 years",
"same reason",
"uses proton-pump inhibitors",
"peptic ulcer",
"admission",
"patient",
"placed",
"close monitoring",
"8 hours",
"hematocrit",
"unchan... |
A study is conducted to find an association between serum cholesterol and ischemic heart disease. Data is collected, and patients are classified into either the "high cholesterol" or "normal cholesterol" group and also into groups whether or not the patient experiences stable angina. Which type of data analysis is most... | Chi-squared | {
"A": "Attributable risk",
"B": "Chi-squared",
"C": "Pearson correlation",
"D": "T-test"
} | step2&3 | B | [
"study",
"conducted to find",
"association",
"serum cholesterol",
"ischemic heart disease",
"Data",
"collected",
"patients",
"classified",
"high cholesterol",
"normal cholesterol",
"group",
"groups",
"not",
"patient experiences stable angina",
"type",
"data",
"most appropriate",
... |
A 42-year-old man is brought to the emergency department by his wife because of a 1-day history of progressive confusion. He recently lost his job. He has a history of chronic alcoholism and has been drinking 14 beers daily for the past week. Before this time, he drank 6 beers daily. He appears lethargic. His vital sig... | Osmotic myelinolysis | {
"A": "Wernicke encephalopathy",
"B": "Cerebral edema",
"C": "Osmotic myelinolysis",
"D": "Hyperglycemia"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"wife",
"of",
"1-day history",
"progressive confusion",
"recently lost",
"job",
"history of chronic alcoholism",
"drinking",
"beers daily",
"past week",
"time",
"drank",
"beers daily",
"appears lethargic",
"vital signs",
"normal ... |
A 25-year-old man presents to his primary care physician for trouble with focus and concentration. The patient states that he has lived at home with his parents his entire life but recently was able to get a job at a local factory. Ever since the patient has started working, he has had trouble focusing at his job. He i... | Bright light therapy | {
"A": "Polysomnography",
"B": "Bright light therapy",
"C": "Modafinil",
"D": "Zolpidem"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"focus",
"concentration",
"patient states",
"lived at home",
"parents",
"entire life",
"recently",
"able to",
"job",
"local factory",
"patient",
"started working",
"trouble focusing",
"job",
"unable to",
"focused",
"task",
"bos... |
A 7-year-old boy is brought to the physician because of a 4-day history of fever, headache, earache, and sore throat that is worse when swallowing. He has not had a runny nose or cough. He had a similar problem 1 year ago for which he was prescribed amoxicillin, but after developing a skin rash and facial swelling he w... | Erythromycin | {
"A": "Penicillin V",
"B": "Total tonsillectomy",
"C": "Fluconazole",
"D": "Erythromycin"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"4-day history",
"fever",
"headache",
"earache",
"sore throat",
"worse",
"swallowing",
"not",
"runny nose",
"cough",
"similar problem",
"year",
"prescribed amoxicillin",
"skin rash",
"facial swelling",
"switched",
"different medication",
... |
A 24-year-old male medical student presents into the university clinic concerned about his stool. He has admitted to spending a great deal of time looking back down into the toilet bowl after he has had a bowel movement and even more time later thinking about all the ways his stool is abnormal. A stool sample was colle... | Tourette syndrome | {
"A": "Tourette syndrome",
"B": "Obsessive-compulsive personality disorder",
"C": "Major depression",
"D": "Coprophilia"
} | step1 | A | [
"year old male medical student presents",
"university clinic concerned",
"stool",
"admitted",
"spending",
"great",
"time looking back",
"toilet bowl",
"bowel movement",
"time later thinking",
"stool",
"abnormal",
"stool sample",
"collected",
"reported to",
"normal",
"patient understa... |
A 28-year-old woman G1P0 presents at 38 weeks of gestation for a standard prenatal visit. She endorses occasional mild lower back pain but otherwise remains asymptomatic. Her past medical history is significant for HIV for which she is treated with azidothymidine (AZT). Her vital signs and physical exam are unremarkabl... | Urge the patient to have a cesarean section delivery | {
"A": "Increase AZT dose",
"B": "Add nevirapine to the patient’s AZT",
"C": "Treat the newborn with AZT following delivery",
"D": "Urge the patient to have a cesarean section delivery"
} | step2&3 | D | [
"year old woman",
"presents",
"weeks of gestation",
"standard prenatal visit",
"occasional mild lower back pain",
"asymptomatic",
"past medical history",
"significant",
"HIV",
"treated with azidothymidine",
"vital signs",
"physical exam",
"unremarkable",
"current HIV viral titer level",
... |
A 52-year-old man comes to the physician because of right knee pain and swelling for 2 days. Four days ago, he tripped at home and landed on his knees. He reports an episode of diarrhea 3 weeks ago that resolved after 4 days without treatment. He has a history of hypertension and hypercholesterolemia, and was recently ... | Hyperparathyroidism | {
"A": "Dyslipidemia",
"B": "Local skin abrasion",
"C": "Hyperparathyroidism",
"D": "Recent gastrointestinal infection"
} | step2&3 | C | [
"year old man",
"physician",
"right",
"swelling",
"2 days",
"Four",
"tripped at home",
"landed",
"knees",
"reports",
"episode of diarrhea",
"weeks",
"resolved",
"4 days",
"treatment",
"history of hypertension",
"hypercholesterolemia",
"recently diagnosed",
"parathyroid disease",
... |
A 24-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has type 1 diabetes mellitus. His only medication is insulin. He immigrated from Nepal 2 weeks ago . He lives in a shelter. He has smoked one pack of cigarettes daily for the past 5 years. He has not received any ro... | Obtain a chest x-ray | {
"A": "Perform interferon-γ release assay",
"B": "Obtain a chest x-ray",
"C": "Administer isoniazid for 9 months",
"D": "Collect sputum sample for culture"
} | step2&3 | B | [
"year old man",
"physician",
"routine health maintenance examination",
"feels well",
"type 1 diabetes mellitus",
"only medication",
"insulin",
"Nepal 2 weeks",
"lives",
"shelter",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"not received",
"routine childhood vaccinations",
... |
A 38-year-old man is brought to the emergency department after losing consciousness upon rising from his chair at work. The patient has had progressive cough, shortness of breath, fever, and chills for 6 days but did not seek medical attention for these symptoms. He appears distressed, flushed, and diaphoretic. He is 1... | Chest X-ray | {
"A": "Echocardiogram",
"B": "Bronchoscopy",
"C": "CT scan of the chest",
"D": "Chest X-ray"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"consciousness",
"rising",
"chair",
"work",
"patient",
"progressive cough",
"shortness of breath",
"fever",
"chills",
"6 days",
"not",
"medical attention",
"symptoms",
"appears distressed",
"flushed",
"diaphoretic",
"5 ft",
"... |
A scientist is studying mechanisms by which cancer drugs work to kill tumor cells. She is working to optimize the function of a drug class in order to reduce toxicity and increase potency for the target. After synthesizing a variety of analogs for the drug class, she tests these new pharmacologic compounds against a pa... | Chronic myeloid leukemia | {
"A": "Brain tumors",
"B": "HER2 negative breast cancer",
"C": "Chronic myeloid leukemia",
"D": "Non-Hodgkin lymphoma"
} | step1 | C | [
"scientist",
"studying mechanisms",
"cancer drugs work to kill tumor cells",
"working to",
"function",
"drug class",
"order to",
"toxicity",
"increase potency",
"target",
"variety",
"analogs",
"drug class",
"tests",
"new pharmacologic compounds",
"panel",
"potential targets",
"Assa... |
A pharmaceutical company conducts a randomized clinical trial in an attempt to show that their new anticoagulant drug, Aclotsaban, prevents more thrombotic events following total knee arthroplasty than the current standard of care. However, a significant number of patients are lost to follow-up or fail to complete trea... | Intention-to-treat analysis | {
"A": "Per-protocol analysis",
"B": "Intention-to-treat analysis",
"C": "Sub-group analysis",
"D": "Non-inferiority analysis"
} | step1 | B | [
"pharmaceutical company conducts",
"randomized clinical trial",
"attempt to show",
"new anticoagulant drug",
"prevents more thrombotic events following total knee arthroplasty",
"the current standard of care",
"significant number of patients",
"lost to follow-up",
"fail to complete treatment accordi... |
A 56-year-old woman with a history of alcoholic cirrhosis and recurrent esophageal varices who recently underwent transjugular intrahepatic portosystemic shunt (TIPS) placement is brought to the emergency room by her daughter due to confusion and agitation. Starting this morning, the patient has appeared sleepy, diffic... | Lactulose | {
"A": "Ciprofloxacin",
"B": "Lactulose",
"C": "Nadolol",
"D": "Protein-restricted diet"
} | step2&3 | B | [
"year old woman",
"history",
"alcoholic cirrhosis",
"recurrent esophageal varices",
"recently",
"transjugular intrahepatic portosystemic shunt",
"placement",
"brought",
"emergency room",
"daughter due to confusion",
"agitation",
"Starting",
"morning",
"patient",
"appeared sleepy",
"dif... |
A 28-year-old man comes to the physician because of a 1-week history of weakness in the fingers of his right hand. One week ago, he experienced sudden pain in his right forearm during weight training. He has no history of serious illness. Physical examination shows impaired flexion of the proximal interphalangeal joint... | Flexor digitorum superficialis | {
"A": "Flexor carpi radialis",
"B": "Flexor carpi ulnaris",
"C": "Flexor digitorum superficialis",
"D": "Flexor digitorum profundus"
} | step1 | C | [
"year old man",
"physician",
"1-week history",
"weakness",
"fingers of",
"right hand",
"One week",
"experienced sudden pain in",
"right forearm",
"weight training",
"history",
"serious illness",
"Physical examination shows impaired flexion",
"proximal interphalangeal joints",
"flexion",
... |
A 45-year-old homeless man is brought to the emergency department by the police. He was found intoxicated and passed out in a library. The patient has a past medical history of IV drug abuse, diabetes, alcohol abuse, and malnutrition. The patient has been hospitalized previously for multiple episodes of pancreatitis an... | Fulminant liver failure | {
"A": "Recovery from acute alcoholic liver disease",
"B": "Recovery from ischemic liver disease",
"C": "Acute renal failure",
"D": "Fulminant liver failure"
} | step2&3 | D | [
"year old homeless man",
"brought",
"emergency department",
"police",
"found",
"passed out",
"library",
"patient",
"past medical history of IV drug abuse",
"diabetes",
"alcohol abuse",
"malnutrition",
"patient",
"hospitalized",
"multiple episodes of pancreatitis",
"sepsis",
"Currentl... |
A 68-year-old man comes to the emergency department because of sudden onset abdominal pain for 6 hours. On a 10-point scale, he rates the pain as a 8 to 9. The abdominal pain is worst in the right upper quadrant. He has atrial fibrillation and hyperlipidemia. His temperature is 38.7° C (101.7°F), pulse is 110/min, and ... | Proceed with additional surgery without obtaining consent | {
"A": "Decrease the patient's sedation until he is able to give consent",
"B": "Proceed with additional surgery without obtaining consent",
"C": "Ask the patient's brother in the waiting room to consent",
"D": "Contact the patient's healthcare POA to consent"
} | step2&3 | B | [
"68 year old man",
"emergency department",
"of sudden abdominal",
"hours",
"a point scale",
"rates",
"pain",
"abdominal pain",
"worst",
"right upper quadrant",
"atrial fibrillation",
"hyperlipidemia",
"temperature",
"pulse",
"min",
"blood pressure",
"mm Hg",
"patient appears",
"i... |
A 35-year-old woman, gravida 2, para 2, comes to the physician with intermenstrual bleeding and heavy menses for the past 4 months. She does not take any medications. Her father died of colon cancer at the age of 42 years. A curettage sample shows dysplastic tall, columnar, cells in the endometrium without intervening ... | Instability of short tandem DNA repeats | {
"A": "Accumulation of double-stranded DNA breaks",
"B": "Defective checkpoint control transitions",
"C": "Inability to excise bulky DNA adducts",
"D": "Instability of short tandem DNA repeats"
} | step1 | D | [
"35 year old woman",
"gravida 2",
"para 2",
"physician",
"intermenstrual bleeding",
"heavy menses",
"past",
"months",
"not take",
"medications",
"father died of colon cancer",
"age",
"years",
"curettage sample shows dysplastic tall",
"columnar",
"cells",
"endometrium",
"stroma",
... |
A 45-year-old woman presents with heavy menstrual bleeding between her periods. The patient also complains of experiencing an irregular menstrual cycle, weight loss, bloating, and constipation. She has had 3 uncomplicated pregnancies, all of which ended with normal vaginal deliveries at term. She has never taken oral c... | Mismatch repair | {
"A": "Nucleotide-excision repair",
"B": "Base-excision repair",
"C": "Mismatch repair",
"D": "Non-homologous end joining"
} | step1 | C | [
"year old woman presents",
"heavy",
"periods",
"patient",
"experiencing",
"irregular menstrual cycle",
"weight loss",
"bloating",
"constipation",
"3 uncomplicated pregnancies",
"ended",
"normal vaginal deliveries",
"term",
"never taken oral contraception",
"not take",
"medication",
"... |
A 29-year-old woman comes to the clinic for complaints of fatigue and palpitations for the past 3 days. She reports that even standing up and walking around takes “a lot of energy.” She was forced to call in sick today to her work as a kindergarten teacher. She denies any previous episodes but does endorse symmetric jo... | Mutation of ankyrin | {
"A": "Anemia of chronic disease",
"B": "Infection with Ebstein-Barr virus",
"C": "Mutation of ankyrin",
"D": "Rheumatoid arthritis"
} | step1 | C | [
"29 year old woman",
"clinic",
"complaints",
"fatigue",
"palpitations",
"past 3 days",
"reports",
"standing up",
"walking",
"takes",
"lot",
"energy",
"forced to call",
"sick today",
"work",
"kindergarten teacher",
"denies",
"previous episodes",
"symmetric joint pain of",
"hands... |
A research lab is investigating the rate of replication of a variety of human cells in order to better understand cancer metastasis. The cell shown in the image is of particular interest and is marked with a high concern for malignant potential. Which of the following is most closely associated with an increased potent... | Euchromatin | {
"A": "Euchromatin",
"B": "Nucleosomes",
"C": "H1 protein",
"D": "Methylated DNA"
} | step1 | A | [
"research lab",
"investigating",
"rate",
"replication",
"variety",
"human",
"order",
"better understand cancer metastasis",
"cell shown",
"image",
"interest",
"marked",
"high concern",
"malignant potential",
"following",
"most",
"associated with",
"increased potential",
"malignan... |
A 6-year-old boy is brought in for evaluation by his adopted mother due to trouble starting 1st grade. His teacher has reported that he has been having trouble focussing on tasks and has been acting out while in class. His family history is unknown as he was adopted 2 years ago. His temperature is 36.2°C (97.2°F), puls... | Holosystolic murmur | {
"A": "Holosystolic murmur",
"B": "Limb hypoplasia",
"C": "Cataracts",
"D": "Congenital deafness"
} | step2&3 | A | [
"year old boy",
"brought",
"evaluation",
"adopted mother",
"starting 1st grade",
"teacher",
"reported",
"focussing",
"tasks",
"acting out",
"class",
"family history",
"unknown",
"adopted 2 years",
"temperature",
"36",
"97",
"pulse",
"80 min",
"respirations",
"20 min",
"bloo... |
A 36-year-old woman with a past medical history of diabetes comes to the emergency department for abdominal pain. She reports that a long time ago her gynecologist told her that she had “some cysts in her ovaries but not to worry about it.” The pain started last night and has progressively gotten worse. Nothing seems t... | Ascending infection of the urinary tract | {
"A": "Ascending infection of the urinary tract",
"B": "Cessation of venous drainage from the ovaries",
"C": "Inflammation of the appendix",
"D": "Vesicoureteral reflex"
} | step1 | A | [
"36 year old woman",
"past medical history of diabetes",
"emergency department",
"abdominal pain",
"reports",
"long time",
"gynecologist",
"cysts",
"ovaries",
"not",
"worry",
"pain started last night",
"gotten worse",
"to make",
"better",
"worse",
"denies headache",
"dizziness",
... |
A 71-year-old African American man diagnosed with high blood pressure presents to the outpatient clinic. In the clinic, his blood pressure is 161/88 mm Hg with a pulse of 88/min. He has had similar blood pressure measurements in the past, and you initiate captopril. He presents back shortly after initiation with extrem... | Initiate a thiazide diuretic | {
"A": "Reinitiate captopril",
"B": "Initiate an ARB ",
"C": "Initiate a beta-blocker",
"D": "Initiate a thiazide diuretic"
} | step2&3 | D | [
"71 year old African American man diagnosed",
"high blood pressure presents",
"outpatient clinic",
"clinic",
"blood pressure",
"88 mm Hg",
"pulse",
"min",
"similar blood pressure measurements",
"past",
"initiate captopril",
"presents back",
"initiation",
"extremely swollen lips",
"tongue... |
A 61-year-old white man presents to the emergency department because of progressive fatigue and shortness of breath on exertion and while lying down. He has had type 2 diabetes mellitus for 25 years and hypertension for 15 years. He is taking metformin and captopril for his diabetes and hypertension. He has smoked 10 c... | Presence of symptoms of left ventricular dysfunction | {
"A": "Old age",
"B": "Long history of systemic hypertension",
"C": "Presence of symptoms of left ventricular dysfunction",
"D": "Ejection fraction > 55%"
} | step2&3 | C | [
"61 year old white man presents",
"emergency department",
"progressive fatigue",
"shortness of breath",
"exertion",
"lying",
"type 2 diabetes mellitus",
"years",
"hypertension",
"years",
"taking metformin",
"captopril",
"diabetes",
"hypertension",
"smoked 10 cigarettes",
"day",
"past... |
A 50-year-old woman presents with a severe headache and vomiting. She says that symptoms onset after attending a wine tasting at the local brewery. She says that her headache is mostly at the back of her head and that she has been nauseous and vomited twice. Past medical history is significant for depression diagnosed ... | Blood pressure | {
"A": "Serum creatinine",
"B": "Temperature",
"C": "Creatine phosphokinase",
"D": "Blood pressure"
} | step1 | D | [
"50 year old woman presents",
"severe headache",
"vomiting",
"symptoms onset",
"attending",
"wine tasting",
"local brewery",
"headache",
"mostly",
"back of",
"head",
"nauseous",
"vomited twice",
"Past medical history",
"significant",
"depression diagnosed 20 years",
"now well",
"me... |
A 45-year-old man undergoes a parathyroidectomy given recurrent episodes of dehydration and kidney stones caused by hypercalcemia secondary to an elevated PTH level. He is recovering on the surgical floor on day 3. His temperature is 97.6°F (36.4°C), blood pressure is 122/81 mmHg, pulse is 84/min, respirations are 12/m... | Calcium gluconate | {
"A": "Calcium gluconate",
"B": "Observation",
"C": "Potassium",
"D": "Vitamin D"
} | step2&3 | A | [
"year old man",
"parathyroidectomy",
"recurrent episodes of dehydration",
"kidney stones caused",
"hypercalcemia secondary to",
"elevated",
"level",
"recovering",
"surgical floor",
"day 3",
"temperature",
"97",
"36 4C",
"blood pressure",
"81 mmHg",
"pulse",
"84 min",
"respirations"... |
A 51-year-old woman comes to the physician because of daytime sleepiness and dry mouth for one month. She says her sleepiness is due to getting up to urinate several times each night. She noticed increased thirst about a month ago and now drinks up to 20 cups of water daily. She does not feel a sudden urge prior to uri... | Mood stabilizer intake | {
"A": "Hypothalamic injury",
"B": "Paraneoplastic syndrome",
"C": "Primary hyperaldosteronism",
"D": "Mood stabilizer intake"
} | step2&3 | D | [
"year old woman",
"physician",
"daytime sleepiness",
"dry mouth",
"one month",
"sleepiness",
"due to getting",
"several times",
"night",
"increased thirst",
"month",
"now drinks",
"20 cups",
"water daily",
"not feel",
"sudden",
"prior to",
"not",
"dysuria",
"history of multiple... |
A 61-year-old man with hypertension and hyperlipidemia comes to the physician for a 4-month history of recurrent episodes of retrosternal chest pain, shortness of breath, dizziness, and nausea. The episodes usually start after physical activity and subside within minutes of resting. He has smoked one pack of cigarettes... | Intimal migration of smooth muscles cells | {
"A": "Increased expression of vascular cell-adhesion molecules",
"B": "Calcification of the atherosclerotic plaque core",
"C": "Intimal migration of smooth muscles cells",
"D": "Ingestion of cholesterol by mature monocytes"
} | step1 | C | [
"61 year old man",
"hypertension",
"hyperlipidemia",
"physician",
"month history of recurrent episodes",
"retrosternal chest pain",
"shortness of breath",
"dizziness",
"nausea",
"episodes usually start",
"physical activity",
"minutes",
"resting",
"smoked one pack",
"cigarettes daily",
... |
A 62-year-old man presents with dry and brittle toenails for the past couple of years. Past medical history is significant for diabetes mellitus type 2, diagnosed 30 years ago, managed with metformin and sitagliptin daily. He is an office clerk and will be retiring next year. On physical examination, his toenails are s... | Hepatitis | {
"A": "Chronic renal failure",
"B": "Chronic depression",
"C": "Pancytopenia",
"D": "Hepatitis"
} | step1 | D | [
"62 year old man presents",
"dry",
"brittle toenails",
"past couple of years",
"medical",
"significant",
"diabetes mellitus type 2",
"diagnosed 30 years",
"managed",
"metformin",
"sitagliptin daily",
"office clerk",
"retiring next year",
"physical examination",
"toenails",
"shown",
"... |
A 7-year-old boy is brought to the physician by his mother because of a limp for the last 3 weeks. He has also had right hip pain during this period. The pain is aggravated when he runs. He had a runny nose and fever around a month ago that resolved with over-the-counter medications. He has no history of serious illnes... | Avascular necrosis of the femoral head | {
"A": "Unstable proximal femoral growth plate",
"B": "Viral infection",
"C": "Immune-mediated synovial inflammation",
"D": "Avascular necrosis of the femoral head"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"mother",
"limp",
"last",
"weeks",
"right hip pain",
"period",
"pain",
"aggravated",
"runs",
"runny nose",
"fever",
"month",
"resolved",
"over-the-counter medications",
"history",
"serious illness",
"development",
"adequate",
"age",
... |
A 30-year-old woman, gravida 2, para 1, comes for a prenatal visit at 33 weeks' gestation. She delivered her first child spontaneously at 38 weeks' gestation; pregnancy was complicated by oligohydramnios. She has no other history of serious illness. Her blood pressure is 100/70 mm Hg. On pelvic examination, uterine siz... | Serial nonstress tests | {
"A": "Reassurance only",
"B": "Serial nonstress tests",
"C": "Weekly fetal weight estimation",
"D": "Amnioinfusion"
} | step2&3 | B | [
"30 year old woman",
"gravida 2",
"para 1",
"prenatal visit",
"weeks",
"gestation",
"delivered",
"first child",
"weeks",
"gestation",
"pregnancy",
"complicated",
"oligohydramnios",
"history",
"serious illness",
"blood pressure",
"100 70 mm Hg",
"pelvic examination",
"uterine size... |
A 24-year-old newly immigrated mother arrives to the clinic to discuss breastfeeding options for her newborn child. Her medical history is unclear as she has recently arrived from Sub-Saharan Africa. You tell her that unfortunately she will not be able to breastfeed until further testing is performed. Which of the foll... | Human Immunodeficiency Virus (HIV) | {
"A": "Hepatitis B",
"B": "Hepatitis C",
"C": "Latent tuberculosis",
"D": "Human Immunodeficiency Virus (HIV)"
} | step2&3 | D | [
"year old newly",
"mother",
"clinic to discuss breastfeeding options",
"newborn child",
"medical history",
"recently arrived",
"Sub-Saharan Africa",
"not",
"able to breastfeed",
"further testing",
"performed",
"following infections",
"absolute contraindication",
"breastfeeding"
] |
A 32-year-old man presents with a 1-week history of progressive diplopia followed by numbness and tingling in his hands and feet, some weakness in his extremities, and occasional difficulty swallowing. He was recently diagnosed with Hodgkin's lymphoma and started on a chemotherapeutic regimen that included bleomycin, d... | Vincristine | {
"A": "Cyclophosphamide",
"B": "Doxorubicin",
"C": "Prednisone",
"D": "Vincristine"
} | step2&3 | D | [
"year old man presents",
"1-week history",
"progressive diplopia followed by numbness",
"tingling",
"hands",
"feet",
"weakness",
"extremities",
"occasional difficulty swallowing",
"recently diagnosed",
"Hodgkin's lymphoma",
"started",
"chemotherapeutic regimen",
"included bleomycin",
"do... |
A 72-year-old Caucasian woman presents with three months of progressive central vision loss accompanied by wavy distortions in her vision. She has hypertension controlled with metoprolol but has no other past medical history. Based on this clinical history she is treated with intravitreal injections of a medication. Wh... | Inhibit choroidal neovascularization | {
"A": "Decrease ciliary body production of aqueous humor",
"B": "Crosslink corneal collagen",
"C": "Inhibit choroidal neovascularization",
"D": "Pneumatic retinopexy"
} | step1 | C | [
"72 year old Caucasian woman presents",
"three months of progressive central vision loss",
"wavy distortions",
"vision",
"hypertension controlled",
"metoprolol",
"past medical history",
"Based",
"clinical history",
"treated with",
"injections of",
"medication",
"mechanism of action",
"trea... |
A 19-year-old South Asian male presents to the family physician concerned that he is beginning to go bald. He is especially troubled because his father and grandfather "went completely bald by the age of 25," and he is willing to try anything to prevent his hair loss. The family physician prescribes a medication that p... | 5-alpha-reductase | {
"A": "Desmolase",
"B": "Aromatase",
"C": "5-alpha-reductase",
"D": "Cyclooxygenase 2"
} | step1 | C | [
"year old South Asian male presents",
"family physician concerned",
"beginning to go bald",
"father",
"grandfather",
"completely bald",
"age",
"willing to",
"to prevent",
"hair loss",
"family physician",
"medication",
"prevents",
"conversion",
"testosterone",
"dihydrotestosterone",
"... |
A 24-year-old woman presents to her primary care physician’s office complaining of right foot pain for the last week. She first noticed this pain when she awoke from bed one morning and describes it as deep at the bottom of her heel. The pain improved as she walked around her apartment but worsened as she attended ball... | Resting of the foot | {
"A": "Orthotic shoe inserts",
"B": "Glucocorticoid injection",
"C": "Plain radiograph of the foot",
"D": "Resting of the foot"
} | step2&3 | D | [
"year old woman presents",
"primary care physicians office",
"right",
"last week",
"first",
"pain",
"awoke",
"bed one morning",
"deep",
"bottom",
"heel",
"pain improved",
"walked",
"apartment",
"worsened",
"attended ballet practice",
"patient",
"professional",
"frequently",
"10... |
A 35-year-old man presents with acute onset of chest pain, trouble breathing, and abdominal pain. He says he had recently been training for a triathlon competition when, over the past week, he noticed that he was getting more tired than usual. He figured that it was due to his age since most of the people training with... | Flow cytometry | {
"A": "Peripheral blood smear",
"B": "Flow cytometry",
"C": "Hemoglobin electrophoresis",
"D": "Sucrose hemolysis test"
} | step2&3 | B | [
"35 year old man presents",
"acute onset of chest pain",
"trouble breathing",
"abdominal pain",
"recently",
"training",
"competition",
"past week",
"getting more tired",
"usual",
"due to",
"age",
"most",
"people training",
"20s",
"completing",
"difficult workout",
"weekend",
"lef... |
A 32-year-old man comes to the physician because of a 3-week history of recurrent thumb pain that worsens with exposure to cold temperatures. Examination shows a 6-mm, blue-red papule under the left thumbnail. The overlying area is extremely tender to palpation. The thumbnail is slightly pitted and cracked. This lesion... | Modified smooth muscle cells | {
"A": "Dysplastic melanocytes",
"B": "Modified smooth muscle cells",
"C": "Injured nerve cells",
"D": "Basal epidermal cells"
} | step1 | B | [
"year old man",
"physician",
"3 week history",
"recurrent thumb pain",
"worsens",
"exposure",
"cold temperatures",
"Examination shows",
"6-mm",
"blue-red papule",
"left thumbnail",
"area",
"extremely tender",
"palpation",
"thumbnail",
"slightly pitted",
"cracked",
"lesion",
"like... |
A 25-year-old man presents to his primary care physician with a chief complaint of "failing health." He states that he typically can converse with animals via telepathy, but is having trouble right now due to the weather. He has begun taking an assortment of Peruvian herbs to little avail. Otherwise he is not currently... | Schizotypal personality disorder | {
"A": "Schizotypal personality disorder",
"B": "Schizophrenia",
"C": "Schizophreniform disorder",
"D": "Brief psychotic disorder"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"chief complaint",
"failing health",
"states",
"animals",
"telepathy",
"right now due to",
"weather",
"begun taking",
"assortment",
"Peruvian herbs",
"little",
"not currently taking",
"medications",
"patient lives alone",
"works",
... |
An 18-month-old boy is brought in to the pediatrician by his mother for concerns that her child is becoming more and more yellow over the past two days. She additionally states that the boy has been getting over a stomach flu and has not been able to keep down any food. The boy does not have a history of neonatal jaund... | Missense mutation in the UGT1A1 gene | {
"A": "Deletion in the SLCO1B1 gene",
"B": "Mutation in the promoter region of the UGT1A1 gene",
"C": "Missense mutation in the UGT1A1 gene",
"D": "Nonsense mutation in the UGT1A1 gene"
} | step1 | C | [
"month old boy",
"brought",
"pediatrician",
"mother",
"concerns",
"child",
"more",
"more yellow",
"past two days",
"states",
"boy",
"getting",
"stomach flu",
"not",
"able to keep",
"food",
"boy",
"not",
"history of neonatal jaundice",
"exam",
"patient appears slightly sluggis... |
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