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 17-year-old girl comes in to her primary care physician's office for an athletic physical. She is on her school’s varsity swim team. She states she is doing “ok” in her classes. She is worried about her upcoming swim meet. She states, “I feel like I’m the slowest one on the team. Everyone is way more fit than I am.” ... | Dental cavities | {
"A": "Dental cavities",
"B": "Galactorrhea",
"C": "Lanugo",
"D": "Metatarsal stress fractures"
} | step1 | A | [
"year old girl",
"primary care physician's office",
"athletic physical",
"schools",
"swim team",
"states",
"classes",
"worried",
"swim meet",
"states",
"I feel",
"slowest one",
"team",
"more fit",
"I",
"patient",
"polycystic ovarian syndrome",
"irregular menses",
"last menstrual ... |
After being warned by the locals not to consume the freshwater, a group of American backpackers set off on a week-long hike into a region of the Ecuadorean Amazon forest known for large gold mines. The group of hikers stopped near a small stream and used the water they filtered from the stream to make dinner. Within th... | Cytochrome c oxidase | {
"A": "NADH dehydrogenase",
"B": "Cytochrome bc1 complex",
"C": "Cytochrome c oxidase",
"D": "ATP synthase"
} | step1 | C | [
"warned",
"locals not to",
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"Ecuadorean Amazon forest known",
"large gold mines",
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"stopped",
"small stream",
"used",
"water",
"filtered",
"stream to make dinner",
"next half hour",
"began to experience hea... |
A 50-year-old woman comes to the emergency department because of fever and productive cough with blood in the sputum for 1 day. She also reports a sharp pain under her ribs that is worsened on taking deep breaths. Over the past 2 years, she has had repeated episodes of sinusitis, for which she used over the counter med... | Increased c-ANCA titers | {
"A": "Increased c-ANCA titers",
"B": "Decreased ADAMTS13 activity",
"C": "Increased p-ANCA titers",
"D": "Increased anti-GBM titers"
} | step2&3 | A | [
"50 year old woman",
"emergency department",
"fever",
"productive cough",
"blood",
"sputum",
"1 day",
"reports",
"sharp pain",
"ribs",
"worsened",
"taking deep breaths",
"past",
"years",
"repeated episodes of sinusitis",
"used over the counter medication",
"recently started",
"new ... |
A 52-year-old man presents with a 5-week history of multiple cutaneous ulcers on his left forearm and neck, which he first noticed after returning from a 2-month stay in rural Peru. He does not recall any trauma or arthropod bites. The lesions began as non-pruritic erythematous papules that became enlarged, ulcerated, ... | Cutaneous leishmaniasis | {
"A": "Cutaneous leishmaniasis",
"B": "Ecthyma",
"C": "Syphilis",
"D": "Cutaneous tuberculosis"
} | step1 | A | [
"year old man presents",
"week history of multiple cutaneous ulcers",
"left forearm",
"neck",
"first",
"returning",
"month",
"rural Peru",
"not recall",
"trauma",
"arthropod bites",
"lesions began",
"non-pruritic erythematous papules",
"enlarged",
"ulcerated",
"crusted",
"history",
... |
A 2-year-old boy is brought in to the pediatrician by his mother because she is concerned that he is not gaining weight. She reports that the patient has a good appetite, eats a varied diet of solid foods, and drinks 2 cups of milk a day. The patient’s mother also reports that he has foul-smelling stools over 6 times a... | Infertility | {
"A": "Inferior lens dislocation",
"B": "Infertility",
"C": "Lymphoma",
"D": "Meconium ileus"
} | step2&3 | B | [
"2 year old boy",
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"day",
"patient",
... |
A 42-year-old man comes to the physician because of a 2-month history of fatigue and increased urination. The patient reports that he has been drinking more than usual because he is constantly thirsty. He has avoided driving for the past 8 weeks because of intermittent episodes of blurred vision. He had elevated blood ... | ACE inhibitor therapy | {
"A": "Insulin therapy",
"B": "ACE inhibitor therapy",
"C": "Aspirin therapy",
"D": "Low-carbohydrate diet"
} | step2&3 | B | [
"year old man",
"physician",
"2 month history",
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"constantly thirsty",
"driving",
"past",
"weeks",
"intermittent episodes",
"blurred vision",
"elevated blood pressure",
"previous visit",
"healthy",
"work ... |
A 3-year-old girl with no significant past medical history presents to the clinic with a 4-day history of acute onset cough. Her parents have recently started to introduce several new foods into her diet. Her vital signs are all within normal limits. Physical exam is significant for decreased breath sounds on the right... | Rigid broncoscopy | {
"A": "Rigid broncoscopy",
"B": "Inhaled bronchodilators and oral corticosteroids",
"C": "Flexible broncoscopy",
"D": "Empiric antibiotic therapy"
} | step2&3 | A | [
"3 year old girl",
"significant past medical history presents",
"clinic",
"4-day history",
"acute onset cough",
"parents",
"recently started to introduce several new foods",
"diet",
"vital signs",
"normal limits",
"Physical exam",
"significant",
"decreased breath sounds",
"right",
"most ... |
A 14-year-old boy presents with his mother complaining of a swollen, red, painful left knee. His physician aspirates the joint and discovers frank blood. The patient denies a recent history of trauma to the knee. Upon further discussion, the mother describes that her son has had multiple swollen painful joints before, ... | Hemophilia A | {
"A": "Hemophilia A",
"B": "Hemophilia B",
"C": "Hemophilia C",
"D": "Child abuse"
} | step2&3 | A | [
"year old boy presents",
"mother",
"swollen",
"red",
"painful left knee",
"physician aspirates",
"joint",
"discovers frank blood",
"patient denies",
"recent history",
"trauma",
"knee",
"further discussion",
"mother",
"son",
"multiple swollen painful",
"often",
"evidence",
"trauma... |
A 25-year-old man comes to the emergency department with right knee pain. He was playing soccer when an opposing player tackled him from the side and they both fell down. He immediately heard a popping sound and felt severe pain in his right knee that prevented him from standing or walking. On physical examination, his... | Medial meniscus tear | {
"A": "Anterior cruciate ligament",
"B": "Posterior cruciate ligament",
"C": "Medial meniscus tear",
"D": "Lateral meniscus tear"
} | step1 | C | [
"year old man",
"emergency department",
"right",
"playing soccer",
"side",
"fell",
"immediately heard",
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"felt severe pain in",
"right knee",
"prevented",
"standing",
"walking",
"physical examination",
"right knee",
"swollen",
"local tenderness",
"mostly",
"medial... |
A 46-year-old man comes to the emergency department because of sharp pain in his left flank that began suddenly 30 minutes ago. Physical examination shows costovertebral angle tenderness on the left side. A photomicrograph of the urine is shown. The patient is most likely to benefit from an increase of which of the fol... | Citrate | {
"A": "Sodium",
"B": "Citrate",
"C": "Oxalate",
"D": "Phosphate"
} | step1 | B | [
"year old man",
"emergency department",
"of sharp pain",
"left flank",
"began",
"30 minutes",
"Physical examination shows costovertebral angle tenderness",
"left side",
"photomicrograph",
"urine",
"shown",
"patient",
"most likely to benefit",
"increase",
"following components",
"urine"... |
A 24-year-old man comes to the physician for a 1-week history of a painless swelling on the right side of his neck that he noticed while showering. He is 203 cm (6 ft 8 in) tall and weighs 85 kg (187 lb); BMI is 21 kg/m2. Physical examination shows long, thin fingers and an increased arm-length to body-height ratio. Ex... | Oral tumors | {
"A": "Gastric ulcers",
"B": "Oral tumors",
"C": "Recurrent hypoglycemia",
"D": "Kidney stones"
} | step1 | B | [
"year old man",
"physician",
"1-week history",
"painless swelling",
"right side of",
"neck",
"showering",
"6 ft 8",
"tall",
"85 kg",
"BMI",
"kg/m2",
"Physical examination shows long",
"thin fingers",
"increased arm-length",
"body-height ratio",
"Examination of",
"neck shows",
"si... |
A 2-day-old newborn boy is brought to the emergency department because of apnea, cyanosis, and seizures. He is severely hypoglycemic and does not improve with glucagon administration. His blood pressure is 100/62 mm Hg and heart rate is 75/min. Blood tests show high lactate levels. Physical examination is notable for h... | Glucose-6-phosphatase | {
"A": "Glucose-6-phosphatase",
"B": "Glucocerebrosidase",
"C": "Phenylalanine hydroxylase",
"D": "Sphingomyelinase"
} | step1 | A | [
"2-day old newborn boy",
"brought",
"emergency department",
"apnea",
"cyanosis",
"seizures",
"severely hypoglycemic",
"not",
"glucagon administration",
"blood pressure",
"100 62 mm Hg",
"heart rate",
"75 min",
"Blood tests show high lactate levels",
"Physical examination",
"notable",
... |
An American pediatrician travels to Bangladesh on a medical mission. While working in the local hospital's emergency room, she sees a 2-week-old boy who was brought in by his mother with muscle spasms and difficulty sucking. The mother gave birth at home at 38 weeks gestation and was attended to by her older sister who... | Blocking release of GABA and glycine | {
"A": "Binding to MHC II and the T cell receptor simultaneously",
"B": "Blocking release of acetylcholine",
"C": "Blocking release of GABA and glycine",
"D": "Blocking voltage-gated sodium channel opening"
} | step1 | C | [
"American pediatrician travels",
"Bangladesh",
"medical mission",
"working",
"local hospital's emergency room",
"sees",
"2 week old boy",
"brought",
"mother",
"muscle spasms",
"difficulty sucking",
"mother gave birth",
"home",
"weeks gestation",
"attended to",
"older sister",
"traini... |
A 12-year-old boy is brought to the physician because of increased frequency of micturition over the past month. He has also been waking up frequently during the night to urinate. Over the past 2 months, he has had a 3.2-kg (7-lb) weight loss. There is no personal or family history of serious illness. He is at 40th per... | Insulin deficiency | {
"A": "Insulin resistance",
"B": "Elevated thyroxine levels",
"C": "Infection of the urinary tract",
"D": "Insulin deficiency"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"of increased frequency",
"micturition",
"past month",
"waking up frequently",
"night to",
"past",
"months",
"3.2 kg",
"weight loss",
"personal",
"family history",
"serious illness",
"percentile",
"height",
"weight",
"Vital signs",
"norma... |
A 40-year-old man comes to his doctor because of 2 weeks of progressively worsening pain on the outer side of his right elbow. He does not recall any trauma to the area. The patient plays tennis recreationally and has recently gone from playing weekly to playing daily in preparation for a local tournament. He has had s... | Repeated wrist extension | {
"A": "Nerve compression at the elbow",
"B": "Bursal inflammation",
"C": "Excessive stress to bone",
"D": "Repeated wrist extension"
} | step2&3 | D | [
"40 year old man",
"doctor",
"2 weeks",
"worsening pain",
"outer side of",
"right elbow",
"not recall",
"trauma",
"area",
"patient plays tennis",
"recently",
"playing weekly",
"playing daily",
"preparation",
"local",
"pain relief",
"ibuprofen",
"physical examination",
"tenderness... |
A 3-week old boy is brought to the physician for the evaluation of lethargy, recurrent vomiting, and poor weight gain since birth. Physical examination shows decreased skin turgor and a bulging frontal fontanelle. Serum studies show an ammonia concentration of 170 μmol/L (N < 30) and low serum citrulline levels. The or... | Protein | {
"A": "Fructose",
"B": "Protein",
"C": "Vitamin A",
"D": "Gluten"
} | step1 | B | [
"3 week old boy",
"brought",
"physician",
"evaluation",
"lethargy",
"recurrent vomiting",
"poor weight gain",
"birth",
"Physical examination shows decreased skin turgor",
"bulging frontal",
"Serum studies show",
"ammonia concentration",
"mol/L",
"N",
"30",
"low serum citrulline levels"... |
A 57-year-old man presents for a regular check-up. He does not have any complaints at the time of presentation. He has a history of several episodes of acute non-necrotizing pancreatitis with the last episode being 2 years ago. Also, he was diagnosed with hypertension 5 years ago. Currently, he takes aspirin, atorvasta... | Add fenofibrate | {
"A": "Add simvastatin",
"B": "Add fenofibrate",
"C": "Add metformin",
"D": "Add aprotinin"
} | step1 | B | [
"57 year old man presents",
"regular check-up",
"not",
"complaints",
"time",
"presentation",
"history of",
"episodes",
"acute necrotizing pancreatitis",
"last episode",
"2 years",
"diagnosed",
"hypertension",
"years",
"Currently",
"takes aspirin",
"atorvastatin",
"enalapril",
"in... |
A 38-year-old woman comes to the physician because of a 4-day history of swelling and pain in her left knee. She has had similar episodes of swollen joints over the past 3 weeks. Two months ago, she had a rash on her upper back that subsided after a few days. She lives in Pennsylvania and works as a forest ranger. Her ... | Infection with spiral-shaped bacteria | {
"A": "Wearing down of articular cartilage",
"B": "Infection with round bacteria in clusters",
"C": "Postinfectious activation of innate lymphoid cells of the gut",
"D": "Infection with spiral-shaped bacteria"
} | step1 | D | [
"year old woman",
"physician",
"4-day history",
"swelling",
"pain in",
"left knee",
"similar episodes of swollen joints",
"past 3 weeks",
"Two months",
"rash",
"upper",
"days",
"lives",
"Pennsylvania",
"works",
"forest ranger",
"temperature",
"Physical examination shows",
"tender... |
A 65-year-old man is brought to the emergency department from his home. He is unresponsive. His son requested a wellness check because he had not heard from his father in 2 weeks. He reports that his father was sounding depressed during a telephone. The paramedics found a suicide note and a half-empty bottle of antifre... | Anion gap metabolic acidosis | {
"A": "Metabolic alkalosis",
"B": "Anion gap metabolic acidosis",
"C": "Mixed acid-base disorder",
"D": "Respiratory acidosis"
} | step1 | B | [
"65 year old man",
"brought",
"emergency department",
"home",
"unresponsive",
"son requested",
"wellness check",
"not heard",
"father",
"2 weeks",
"reports",
"father",
"sounding depressed",
"telephone",
"paramedics found",
"suicide note",
"half empty bottle",
"antifreeze",
"patie... |
A 24-year-old man presents to the postoperative unit after undergoing an appendectomy following 2 episodes of acute appendicitis. He complains of nausea and vomiting. On physical examination, his temperature is 36.9°C (98.4ºF), pulse rate is 96/minute, blood pressure is 122/80 mm Hg, and respiratory rate is 14/minute. ... | Inhibition of serotonin receptors on the vagal and spinal afferent nerves from the intestines | {
"A": "Inhibition of gastroesophageal motility",
"B": "Inhibition of dopamine receptors on chemoreceptor trigger zone (CTZ)",
"C": "Stimulation of intestinal and colonic motility",
"D": "Inhibition of serotonin receptors on the vagal and spinal afferent nerves from the intestines"
} | step1 | D | [
"year old man presents",
"postoperative unit",
"appendectomy following 2 episodes of acute appendicitis",
"nausea",
"vomiting",
"physical examination",
"temperature",
"36",
"98 4F",
"pulse rate",
"96 minute",
"blood pressure",
"80 mm Hg",
"respiratory rate",
"minute",
"abdomen",
"sof... |
A pharmaceutical company is studying a new drug that inhibits the glucose transporter used by intestinal enterocytes to absorb glucose into the body. The drug was designed such that it would act upon the glucose transporter similarly to how cyanide acts upon cytochrome proteins. During pre-clinical studies, the behavio... | Unchanged Km and decreased Vmax | {
"A": "Increased Km and decreased Vmax",
"B": "Increased Km and unchanged Vmax",
"C": "Unchanged Km and decreased Vmax",
"D": "Unchanged Km and unchanged Vmax"
} | step1 | C | [
"pharmaceutical company",
"studying",
"new drug",
"inhibits",
"glucose transporter used by intestinal enterocytes",
"glucose",
"body",
"drug",
"designed",
"act",
"glucose transporter",
"cyanide acts",
"cytochrome proteins",
"pre-clinical studies",
"behavior",
"drug",
"activity",
"g... |
A 28-year-old G1P1 woman is brought into the clinic by her concerned husband. The husband has noted that his wife is not behaving normally. She no longer enjoys his company or is not particularly happy around their newborn. The newborn was delivered 3 weeks ago via normal vaginal delivery with no complications. He also... | If symptoms present within a month after delivery and treatment occurs promptly, the prognosis is good | {
"A": "If symptoms present within a month after delivery and treatment occurs promptly, the prognosis is good",
"B": "Risk for this patient’s condition increases with each pregnancy",
"C": "This patient’s condition is self-limited",
"D": "Electroconvulsive therapy is the first-line therapy for this patient’s c... | step1 | A | [
"year old G1P1 woman",
"brought",
"clinic",
"husband",
"husband",
"noted",
"wife",
"not",
"longer",
"company",
"not",
"happy",
"newborn",
"newborn",
"delivered 3 weeks",
"normal vaginal",
"complications",
"notes",
"wife",
"to",
"world",
"thoughts",
"Overall",
"appears t... |
A 31-year-old man comes to the physician because of worsening abdominal pain, an inability to concentrate at work, and a general lack of motivation over the past several months. He has a history of spontaneous passage of two kidney stones. His father and uncle underwent thyroidectomy before the age of 35 for thyroid ca... | Urine metanephrines | {
"A": "Serum prolactin",
"B": "Serum aldosterone to renin ratio",
"C": "Urine 5-hydroxyindoleacetic acid",
"D": "Urine metanephrines"
} | step1 | D | [
"31 year old man",
"physician",
"worsening abdominal pain",
"to concentrate",
"work",
"general lack of motivation",
"past",
"months",
"history of spontaneous passage",
"two kidney stones",
"father",
"uncle",
"thyroidectomy",
"age",
"35",
"thyroid cancer",
"Physical examination shows ... |
A 45-year-old HIV-positive male presents to his primary care physician complaining of decreased libido. He reports that he has been unable to maintain an erection for the past two weeks. He has never encountered this problem before. He was hospitalized four weeks ago for cryptococcal meningitis and has been on long-ter... | Inhibition of ergosterol synthesis | {
"A": "Inhibition of pyrimidine synthesis",
"B": "Inhibition of beta-glucan synthesis",
"C": "Disruption of microtubule formation",
"D": "Inhibition of ergosterol synthesis"
} | step1 | D | [
"year old HIV-positive male presents",
"primary care physician",
"decreased libido",
"reports",
"unable to maintain",
"erection",
"past two weeks",
"never encountered",
"problem",
"hospitalized four weeks",
"cryptococcal meningitis",
"long-term antifungal therapy",
"then",
"CD4 count",
"... |
A 78-year-old right-handed man with hypertension and hyperlipidemia is brought to the emergency department for sudden onset of nausea and vertigo one hour ago. Physical examination shows 5/5 strength in all extremities. Sensation to light touch and pinprick is decreased in the right arm and leg. A CT scan of the brain ... | Right-sided homonymous hemianopia | {
"A": "Right-sided homonymous hemianopia",
"B": "Left-sided gaze deviation",
"C": "Prosopagnosia",
"D": "Right-sided superior quadrantanopia"
} | step1 | A | [
"year old right-handed man",
"hypertension",
"hyperlipidemia",
"brought",
"emergency department",
"sudden onset",
"nausea",
"vertigo one hour",
"Physical examination shows 5/5 strength",
"extremities",
"Sensation",
"light touch",
"decreased",
"right arm",
"leg",
"CT scan",
"brain sho... |
A 50-year-old man comes to the physician because of gradually worsening rhythmic movements of his right hand for the past 5 months. His symptoms worsen when he is in a meeting and he is concerned that people are noticing it more frequently. There is no personal or family history of serious illness, but the patient reca... | Trihexyphenidyl | {
"A": "Donepezil",
"B": "Trihexyphenidyl",
"C": "Propranolol",
"D": "Levodopa/carbidopa"
} | step2&3 | B | [
"50 year old man",
"physician",
"worsening rhythmic movements",
"right hand",
"past",
"months",
"symptoms worsen",
"meeting",
"concerned",
"people",
"more frequently",
"personal",
"family history",
"serious illness",
"patient recalls",
"father",
"bobbing",
"head",
"older age",
... |
A 71-year-old man comes to the physician for routine health maintenance examination. He feels well. He has hypertension and gastroesophageal reflux disease. Current medications include metoprolol and pantoprazole. He does not smoke or drink alcohol. Temperature is 37.3°C (99.1°F), pulse is 75/min, and blood pressure 13... | Observation and follow-up | {
"A": "Stem cell transplantation",
"B": "All-trans retinoic acid",
"C": "Observation and follow-up",
"D": "Fludarabine, cyclophosphamide, and rituximab"
} | step2&3 | C | [
"71 year old man",
"physician",
"routine health maintenance examination",
"feels well",
"hypertension",
"gastroesophageal reflux disease",
"Current medications include metoprolol",
"pantoprazole",
"not smoke",
"drink alcohol",
"Temperature",
"3C",
"99",
"pulse",
"75 min",
"blood pressu... |
29-year-old G2P2002 presents with foul-smelling lochia and fever. She is post-partum day three status-post cesarean section due to eclampsia. Her temperature is 101 F, and heart rate is 103. She denies chills. On physical exam, lower abdominal and uterine tenderness is present. Leukocytosis with left shift is seen in l... | Intravenous clindamycin and gentamicin treatment | {
"A": "Endometrial culture",
"B": "Intravenous clindamycin and gentamicin treatment",
"C": "Intramuscular cefotetan treatment",
"D": "Prophylactic intravenous cefazolin treatment"
} | step2&3 | B | [
"29 year old",
"presents",
"smelling lochia",
"fever",
"post day three status",
"cesarean section",
"eclampsia",
"temperature",
"F",
"heart rate",
"denies chills",
"physical exam",
"lower abdominal",
"uterine tenderness",
"present",
"Leukocytosis",
"left shift",
"seen",
"labs",
... |
A 23-year-old man presents with fatigue and increased daytime somnolence. He says his symptoms began gradually 6 months ago and have progressively worsened and have begun to interfere with his job as a computer programmer. He is also bothered by episodes of paralysis upon waking from naps and reports visual hallucinati... | Cardiac irregularities, nervousness, hallucinations | {
"A": "Cardiac irregularities, nervousness, hallucinations",
"B": "Parkinsonism and tardive dyskinesia",
"C": "Nephrogenic diabetes insipidus",
"D": "Weight gain and metabolic syndrome"
} | step1 | A | [
"23 year old man presents",
"fatigue",
"increased daytime somnolence",
"symptoms began",
"months",
"worsened",
"begun to interfere",
"job",
"computer programmer",
"episodes",
"paralysis",
"waking",
"naps",
"reports visual hallucinations",
"falling asleep",
"night",
"care",
"physici... |
Which of the following physiologic changes decreases pulmonary vascular resistance (PVR)? | Breath holding maneuver at functional residual capacity (FRC) | {
"A": "Inhaling the inspiratory reserve volume (IRV)",
"B": "Exhaling the expiratory reserve volume (ERV)",
"C": "Inhaling the entire vital capacity (VC)",
"D": "Breath holding maneuver at functional residual capacity (FRC)"
} | step1 | D | [
"following physiologic changes decreases pulmonary vascular resistance"
] |
A 37-year-old G2P1 woman presents to the clinic complaining of amenorrhea. She reports that she has not had a period for 2 months. A urine pregnancy test that she performed yesterday was negative. She is sexually active with her husband and uses regular contraception. Her past medical history is significant for diabete... | Intrauterine adhesions | {
"A": "Extreme weight loss",
"B": "Intrauterine adhesions",
"C": "Pregnancy",
"D": "Premature menopause"
} | step1 | B | [
"year old",
"woman presents",
"clinic",
"amenorrhea",
"reports",
"not",
"period",
"months",
"urine pregnancy test",
"performed",
"negative",
"sexually active",
"husband",
"uses regular contraception",
"past medical history",
"significant",
"diabetes",
"dilation",
"curettage proce... |
A 3-month old male infant with HIV infection is brought to the physician for evaluation. The physician recommends monthly intramuscular injections of a monoclonal antibody to protect against a particular infection. The causal pathogen for this infection is most likely transmitted by which of the following routes? | Aerosol inhalation | {
"A": "Aerosol inhalation",
"B": "Blood transfusion",
"C": "Skin inoculation",
"D": "Breast feeding"
} | step1 | A | [
"3 month old male infant",
"HIV",
"brought",
"physician",
"evaluation",
"physician recommends monthly intramuscular injections",
"monoclonal antibody to",
"infection",
"causal pathogen",
"infection",
"most likely transmitted by",
"following routes"
] |
A 67-year-old man presents to the emergency department with a 1-hour history of nausea and upper abdominal and substernal chest pain radiating to his lower jaw. He vomited several times before arriving at the hospital. His last visit to the primary care physician was 6 months ago during which he complained of fatigue, ... | Papillary muscle rupture leading to reflux of blood into left atrium | {
"A": "Scarring of mitral valve as a complication of childhood illness",
"B": "Age-related fibrosis and calcification of the aortic valve",
"C": "Aortic root dilation",
"D": "Papillary muscle rupture leading to reflux of blood into left atrium"
} | step1 | D | [
"67 year old man presents",
"emergency department",
"hour history",
"nausea",
"upper abdominal",
"substernal chest pain radiating to",
"lower jaw",
"vomited several times",
"hospital",
"last visit",
"primary care physician",
"months",
"fatigue",
"slowing",
"morning walks",
"abdominal p... |
A virology student is asked to identify a sample of virus. When subjected to a nonionic detergent, which disrupts lipid membranes, the virus was shown to lose infectivity. The student then purified the genetic material from the virus and subjected it to treatment with DNase, an enzyme that cleaves the phosphodiester li... | Togavirus | {
"A": "Herpesvirus",
"B": "Adenovirus",
"C": "Togavirus",
"D": "Calicivirus"
} | step1 | C | [
"virology student",
"to",
"sample",
"virus",
"subjected",
"nonionic detergent",
"disrupts lipid membranes",
"virus",
"shown to",
"infectivity",
"student then purified",
"genetic material",
"virus",
"subjected",
"treatment",
"DNase",
"enzyme",
"phosphodiester linkages",
"DNA backb... |
Two weeks after undergoing an allogeneic skin graft procedure for extensive full-thickness burns involving his left leg, a 41-year-old man develops redness and swelling over the graft site. He has not had any fevers or chills. His temperature is 36°C (96.8°F). Physical examination of the left lower leg shows well-demar... | Th1-induced macrophage activation | {
"A": "Immune complex-mediated complement activation",
"B": "Staphylococci-induced neutrophil activation",
"C": "Antibody-mediated complement activation",
"D": "Th1-induced macrophage activation"
} | step1 | D | [
"Two weeks",
"allogeneic skin graft procedure",
"extensive full-thickness burns involving",
"left leg",
"year old man",
"redness",
"swelling",
"graft site",
"not",
"fevers",
"chills",
"temperature",
"96",
"Physical examination of",
"left lower leg shows well",
"erythema",
"edema",
... |
A previously healthy 46-year-old woman comes to the physician because of a 3-month history of fatigue and progressive shortness of breath. She does not take any medications. Her pulse is 93/min and blood pressure is 112/80 mm Hg. Examination shows no abnormalities. Her hemoglobin concentration is 8 g/dL, leukocyte coun... | Left ventricular dysfunction | {
"A": "Bilateral tinnitus",
"B": "Gross hematuria",
"C": "Decreased diffusing capacity of of the lung for carbon dioxide",
"D": "Left ventricular dysfunction"
} | step2&3 | D | [
"healthy",
"year old woman",
"physician",
"3 month history",
"fatigue",
"progressive shortness of breath",
"not take",
"medications",
"pulse",
"min",
"blood pressure",
"80 mm Hg",
"Examination shows",
"abnormalities",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"mm3",
... |
A 32-year-old man is brought into the emergency department by his friends. The patient was playing soccer when he suddenly became short of breath. The patient used his albuterol inhaler with minimal improvement in his symptoms. He is currently struggling to breathe. The patient has a past medical history of asthma and ... | Intubation | {
"A": "Continue current management with close observation",
"B": "Begin IV steroids",
"C": "Terbutaline",
"D": "Intubation"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"friends",
"patient",
"playing soccer",
"short of breath",
"patient used",
"albuterol inhaler",
"minimal improvement",
"symptoms",
"currently",
"patient",
"past medical",
"pack-year smoking history",
"current medications include albute... |
A 28-year-old G1P0 woman at 16 weeks estimated gestational age presents for prenatal care. Routine prenatal screening tests are performed and reveal a positive HIV antibody test. The patient is extremely concerned about the possible transmission of HIV to her baby and wants to have the baby tested as soon as possible a... | Polymerase chain reaction (PCR) for HIV RNA | {
"A": "EIA for HIV antibody",
"B": "Antigen assay for p24",
"C": "Viral culture",
"D": "Polymerase chain reaction (PCR) for HIV RNA"
} | step1 | D | [
"year old",
"woman",
"weeks estimated gestational age presents",
"prenatal care",
"Routine",
"screening tests",
"performed",
"reveal",
"positive HIV antibody test",
"patient",
"extremely concerned",
"possible transmission",
"HIV",
"baby",
"to",
"baby tested",
"possible",
"delivery"... |
A 36-year-old man comes to the physician because of increasing back pain for the past 6 months. The pain is worse when he wakes up and improves throughout the day. He has problems bending forward. He has taken ibuprofen which resulted in limited relief. His only medication is a topical corticosteroid for two erythemato... | Etanercept | {
"A": "Leflunomide",
"B": "Etanercept",
"C": "Prednisolone",
"D": "Rituximab"
} | step2&3 | B | [
"36 year old man",
"physician",
"of increasing back pain",
"past 6 months",
"pain",
"worse",
"wakes up",
"improves",
"day",
"problems bending forward",
"taken ibuprofen",
"resulted",
"limited relief",
"only medication",
"topical corticosteroid",
"two erythematous",
"itchy patches of"... |
A 29-year-old, gravida 1 para 0, at 10 weeks' gestation comes to the physician for progressively worsening emesis, nausea, and a 2-kg (4.7-lb) weight loss over the past 2 weeks. The most recent bouts of vomiting occur around 3–4 times a day, and she is stressed that she had to take a sick leave from work the last 2 day... | Addition of doxylamine | {
"A": "IV fluid resuscitation",
"B": "Administration of supplemental oxygen",
"C": "Monitoring and stress counseling",
"D": "Addition of doxylamine"
} | step2&3 | D | [
"29 year old",
"gravida 1 para 0",
"10 weeks",
"estation ",
"hysician ",
"orsening mesis,",
"ausea,",
"- g ",
".",
"eight loss ",
"ast 2 weeks.",
"ost recent outs ",
"omiting ccur ",
"imes ",
"ay,",
"tressed ",
"o ake ",
"ick leave ",
"ork ",
"ast 2 days.",
"urrently aki... |
A 62-year-old female presents with complaint of chronic productive cough for the last 4 months. She states that she has had 4-5 month periods of similar symptoms over the past several years. She has never smoked, but she reports significant exposure to second-hand smoke in her home. She denies any fevers, reporting onl... | Decreased FEV1, Decreased FEV1/FVC ratio, Increased TLC, Normal DLCO | {
"A": "Decreased FEV1, Decreased FEV1/FVC ratio, Increased TLC, Decreased DLCO",
"B": "Decreased FEV1, Decreased FEV1/FVC ratio, Increased TLC, Normal DLCO",
"C": "Decreased FEV1, Normal FEV1/FVC, Decreased TLC, Decreased DLCO",
"D": "Decreased FEV1, Increased FEV1/FVC ratio, Decreased TLC, Normal DLCO"
} | step2&3 | B | [
"62 year old female presents",
"complaint",
"chronic productive cough",
"last",
"months",
"states",
"4-5 month periods of similar symptoms",
"past",
"years",
"never smoked",
"reports significant exposure to second-hand smoke",
"home",
"denies",
"fevers",
"reporting only occasional shortn... |
A 45-year-old woman comes to the physician because of a 5-month history of recurrent retrosternal chest pain that often wakes her up at night. Physical examination shows no abnormalities. Upper endoscopy shows hyperemia in the distal third of the esophagus. A biopsy specimen from this area shows non-keratinized stratif... | Proximal migration of the gastroesophageal junction | {
"A": "Increased lower esophageal sphincter tone",
"B": "Chronic gastrointestinal iron loss",
"C": "Proximal migration of the gastroesophageal junction",
"D": "Spread of neoplastic cells"
} | step1 | C | [
"year old woman",
"physician",
"of",
"5 month history",
"recurrent retrosternal chest pain",
"often wakes",
"night",
"Physical examination shows",
"abnormalities",
"Upper endoscopy shows hyperemia",
"distal third of",
"esophagus",
"biopsy specimen",
"area shows",
"keratinized stratified ... |
A 23-year-old gravida-1-para-1 (G1P1) presents to the emergency department with fever, malaise, nausea, and abdominal pain. She says her symptoms started 2 days ago with a fever and nausea, which have progressively worsened. 2 hours ago, she started having severe lower abdominal pain that is diffusely localized. Her pa... | Pelvic inflammatory disease | {
"A": "Vaginitis",
"B": "Cervicitis",
"C": "Pelvic inflammatory disease",
"D": "Urinary tract infection"
} | step1 | C | [
"23 year old gravida-1 para",
"presents",
"emergency department",
"fever",
"malaise",
"nausea",
"abdominal pain",
"symptoms started 2 days",
"fever",
"nausea",
"worsened",
"hours",
"started",
"severe lower abdominal pain",
"localized",
"past medical history",
"unremarkable",
"last ... |
Five minutes after arriving in the postoperative care unit following total knee replacement under general anesthesia, a 55-year-old woman is acutely short of breath. The procedure was uncomplicated. Postoperatively, prophylactic treatment with cefazolin was begun and the patient received morphine and ketorolac for pain... | Type I hypersensitivity reaction | {
"A": "Neuromuscular blockade",
"B": "Decreased central respiratory drive",
"C": "Bronchial hyperresponsiveness",
"D": "Type I hypersensitivity reaction"
} | step2&3 | D | [
"Five minutes",
"postoperative care unit following total knee replacement",
"general anesthesia",
"55 year old woman",
"short of breath",
"procedure",
"uncomplicated",
"prophylactic treatment",
"cefazolin",
"begun",
"patient received morphine",
"ketorolac",
"pain management",
"generalized ... |
A 59-year-old man presents with the persistent right-sided facial droop and slurred speech for the past 2 hours. He says he had similar symptoms 6 months ago which resolved within 1 hour. His past medical history is significant for long-standing hypertension, managed with hydrochlorothiazide. He reports a 10-pack-year ... | CT of the head without contrast | {
"A": "CT of the head without contrast",
"B": "T1/T2 MRI of the head",
"C": "CT angiography of the brain",
"D": "IV tPA"
} | step2&3 | A | [
"59 year old man presents",
"persistent right-sided facial droop",
"slurred speech",
"past",
"hours",
"similar symptoms",
"months",
"resolved",
"hour",
"past medical history",
"significant",
"long standing hypertension",
"managed",
"hydrochlorothiazide",
"reports a 10 pack-year smoking h... |
A 65-year-old man comes to the physician because he is worried about a mole on his right forearm. He has had the mole for several years, but it has grown in size in the past 3 months. Physical examination shows a hyperpigmented plaque with irregular borders and small area of ulceration. Histopathologic analysis of a fu... | Hypodermis | {
"A": "Stratum corneum",
"B": "Papillary dermis",
"C": "Hypodermis",
"D": "Stratum basale"
} | step1 | C | [
"65 year old man",
"physician",
"worried",
"mole",
"right forearm",
"mole",
"years",
"size",
"past 3 months",
"Physical examination shows",
"hyperpigmented plaque",
"irregular borders",
"small area",
"ulceration",
"Histopathologic analysis",
"full-thickness excisional biopsy confirms t... |
A 4-month-old girl is brought to the pediatric walk-in clinic by her daycare worker with a persistent diaper rash. The daycare worker provided documents to the clinic receptionist stating that she has the authority to make medical decisions when the child’s parents are not available. The patient’s vital signs are unrem... | Physicians are mandated to report | {
"A": "Physicians are mandated to report",
"B": "Physical abuse suspected",
"C": "The daycare worker failed to report the neglect",
"D": "The daycare worker has paperwork authorizing the physician to report"
} | step2&3 | A | [
"4 month old girl",
"brought",
"pediatric walk-in clinic",
"daycare worker",
"persistent diaper rash",
"daycare worker provided documents",
"clinic receptionist stating",
"authority to make medical decisions",
"childs parents",
"not available",
"patients vital signs",
"unremarkable",
"5th pe... |
A 55-year-old woman with diabetes presents to the emergency department due to swelling of her left leg, fever, and chills for the past 2 days. The woman’s maximum recorded temperature at home was 38.3°C (101.0°F). Her left leg is red and swollen from her ankle to the calf, with an ill-defined edge. Her vital signs incl... | PGE2 | {
"A": "LTB4",
"B": "PGE2",
"C": "Histamine",
"D": "Arachidonic acid"
} | step1 | B | [
"55 year old woman",
"diabetes presents",
"emergency department due to swelling of",
"left leg",
"fever",
"chills",
"past 2 days",
"maximum recorded temperature at home",
"3C",
"left leg",
"red",
"swollen",
"ankle",
"calf",
"ill defined edge",
"vital signs include",
"blood pressure",... |
A 57-year-old, multiparous, woman comes to the physician because of urinary leakage for the past 6 months. She involuntarily loses a small amount of urine after experiencing a sudden, painful sensation in the bladder. She has difficulty making it to the bathroom in time, and feels nervous when there is no bathroom near... | Increased detrusor muscle activity | {
"A": "Increased detrusor muscle activity",
"B": "Increased urine bladder volumes",
"C": "Trauma to urinary tract",
"D": "Decreased pelvic floor muscle tone\n\""
} | step2&3 | A | [
"57 year old",
"multiparous",
"woman",
"physician",
"of urinary leakage",
"past 6 months",
"small amount",
"urine",
"experiencing",
"sudden",
"painful sensation",
"bladder",
"difficulty making",
"bathroom",
"time",
"feels nervous",
"bathroom nearby",
"started",
"to",
"night",
... |
A 46-year-old male was found unconscious in the field and brought to the emergency department by EMS. The patient was intubated in transit and given a 2 liter bolus of normal saline. On arrival, the patient's blood pressure is 80/60 mmHg and temperature is 37.5C. Jugular veins are flat and capillary refill time is 4 se... | Hypovolemic shock | {
"A": "Septic shock",
"B": "Hypovolemic shock",
"C": "Neurogenic shock",
"D": "Cardiogenic shock"
} | step2&3 | B | [
"year old male",
"found unconscious",
"field",
"brought",
"emergency department",
"patient",
"intubated in transit",
"given",
"2 liter bolus",
"normal saline",
"arrival",
"patient's blood pressure",
"80 60 mmHg",
"temperature",
"Jugular veins",
"flat",
"capillary refill time",
"4 s... |
A 63-year-old woman with a past medical history significant for hypertension presents to the outpatient clinic for evaluation of vaginal dryness, loss of libido, and hot flashes. These symptoms have been progressively worsening over the past 3 months. Her vital signs are: blood pressure 131/81 mm Hg, pulse 68/min, and ... | Cessation of menses for at least 12 months | {
"A": "Cessation of menses for at least 12 months",
"B": "Increased serum follicle-stimulating hormone (FSH)",
"C": "Increased serum luteinizing hormone (LH)",
"D": "Increased total cholesterol"
} | step2&3 | A | [
"63 year old woman",
"past medical history significant",
"hypertension presents",
"outpatient clinic",
"evaluation",
"vaginal dryness",
"loss of libido",
"hot flashes",
"symptoms",
"worsening",
"past 3 months",
"vital signs",
"blood pressure",
"81 mm Hg",
"pulse 68 min",
"respiratory r... |
A 44-year-old male immigrant presents to his primary care physician for a new patient visit. The patient reports chronic fatigue but states that he otherwise feels well. His past medical history is not known, and he is not currently taking any medications. The patient admits to drinking 7 alcoholic beverages per day an... | Beta-thalassemia | {
"A": "B12 deficiency",
"B": "Beta-thalassemia",
"C": "Hemolytic anemia",
"D": "Iron deficiency"
} | step2&3 | B | [
"year old male immigrant presents",
"primary care physician",
"new patient visit",
"patient reports chronic fatigue",
"states",
"feels well",
"past medical history",
"not known",
"not currently taking",
"medications",
"patient admits",
"drinking",
"alcoholic",
"day",
"smoking",
"pack",... |
A 14-month-old boy is brought to the physician by his mother because of an abdominal bulge that has become more noticeable as he began to walk 2 weeks ago. The bulge increases on crying and disappears when he is lying down. He was born at 39 weeks' gestation by lower segment transverse cesarean section. He has met all ... | Reassurance and observation | {
"A": "Elective open repair",
"B": "Reassurance and observation",
"C": "Abdominal ultrasound",
"D": "CT scan of the abdomen"
} | step2&3 | B | [
"month old boy",
"brought",
"physician",
"mother",
"abdominal bulge",
"more",
"began to walk 2 weeks",
"bulge increases",
"crying",
"lying",
"born",
"weeks",
"gestation",
"lower segment transverse cesarean",
"met",
"developmental milestones",
"breast-fed",
"birth",
"appears healt... |
A 29-year-old G2P1 at 35 weeks gestation presents to the obstetric emergency room with vaginal bleeding and severe lower back pain. She reports the acute onset of these symptoms 1 hour ago while she was outside playing with her 4-year-old son. Her prior birthing history is notable for an emergency cesarean section duri... | Premature separation of a normally implanted placenta | {
"A": "Amniotic sac rupture prior to the start of uterine contractions",
"B": "Chorionic villi attaching to the decidua basalis",
"C": "Chorionic villi attaching to the myometrium",
"D": "Premature separation of a normally implanted placenta"
} | step1 | D | [
"29 year old",
"35 weeks gestation presents",
"obstetric emergency room",
"vaginal bleeding",
"severe lower back pain",
"reports",
"acute onset of",
"symptoms",
"hour",
"outside playing",
"year old son",
"prior",
"history",
"notable",
"emergency cesarean section",
"first pregnancy",
... |
To reduce the hemolysis that occurs with dialysis, researchers have developed an organic filtration membrane for dialysis that is believed to mimic the physiologic filtering apparatus of the human glomerulus. The permeability characteristics of this membrane are believed to be identical to those of the glomerular filte... | Albumin | {
"A": "Sodium",
"B": "Amino acids",
"C": "Urea",
"D": "Albumin"
} | step1 | D | [
"To",
"hemolysis",
"occurs",
"dialysis",
"researchers",
"organic filtration membrane",
"dialysis",
"to",
"physiologic filtering apparatus",
"human glomerulus",
"permeability characteristics",
"membrane",
"to",
"identical",
"glomerular filtering membrane",
"following substances",
"abs... |
A 5-year-old male is brought to the pediatrician by his mother, who relates a primary complaint of a recent history of five independent episodes of vomiting over the last 10 months, most recently 3 weeks ago. Each time, he has awoken early in the morning appearing pale, feverish, lethargic, and complaining of severe na... | Cyclic vomiting syndrome | {
"A": "Intracranial mass",
"B": "Cyclic vomiting syndrome",
"C": "Gastroesophageal reflux",
"D": "Intussusception"
} | step2&3 | B | [
"5 year old male",
"brought",
"pediatrician",
"mother",
"relates",
"primary complaint of",
"recent history",
"five independent episodes",
"vomiting",
"last 10 months",
"most recently",
"weeks",
"time",
"awoken early",
"morning appearing pale",
"feverish",
"lethargic",
"severe nause... |
A 78-year-old woman presents to the orthopedic department for an elective total left knee arthroplasty. She has had essential hypertension for 25 years and type 2 diabetes mellitus for 35 years. She has smoked 20–30 cigarettes per day for the past 40 years. The operation was uncomplicated. On day 3 post-surgery, she co... | Oral apixaban monotherapy | {
"A": "Oral dabigatran monotherapy",
"B": "Oral apixaban monotherapy",
"C": "Long-term aspirin",
"D": "Complete bed rest"
} | step2&3 | B | [
"year old woman presents",
"orthopedic department",
"elective total left knee arthroplasty",
"essential hypertension",
"years",
"type 2 diabetes mellitus",
"35 years",
"smoked",
"cigarettes",
"day",
"past 40 years",
"operation",
"uncomplicated",
"day 3 post-surgery",
"left leg pain",
"... |
A 40-year-old man presents to the office with complaints of epigastric discomfort for the past 6 months. He adds that the discomfort is not that bothersome as it does not interfere with his daily activities. He does not have any other complaints at the moment. The past medical history is insignificant. He is a non-smok... | Echinococcosis | {
"A": "Liver abscess",
"B": "Hepatocellular carcinoma",
"C": "Echinococcosis",
"D": "Hemangioma"
} | step1 | C | [
"40 year old man presents",
"office",
"complaints",
"epigastric discomfort",
"past 6 months",
"adds",
"discomfort",
"not",
"not interfere",
"daily activities",
"not",
"complaints",
"past medical history",
"non-smoker",
"not",
"alcohol",
"recently",
"back",
"trip",
"South Americ... |
A 40-year-old woman presents to her physician's home with a headache. She describes it as severe and states that her symptoms have not been improving despite her appointment yesterday at the office. Thus, she came to her physician's house on the weekend for help. The patient has been diagnosed with migraine headaches t... | Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office. | {
"A": "It sounds to me like you are in a lot of pain. Let me see how I can help you.",
"B": "Unfortunately, I cannot examine and treat you at this time. Please set up an appointment to see me in my office.",
"C": "You should go to the emergency department for your symptoms rather than coming here.",
"D": "Your... | step2&3 | B | [
"40 year old woman presents",
"physician's home",
"headache",
"severe",
"states",
"symptoms",
"not",
"improving",
"appointment",
"office",
"physician's house",
"weekend",
"help",
"patient",
"diagnosed",
"migraine headaches",
"past 6 months",
"states",
"current symptoms feel",
"... |
A 23-year-old woman presents to the emergency department with burning and increased urinary frequency. The patient states that her symptoms started yesterday and have been worsening despite hydrating well. The patient is generally healthy, does not smoke or drink alcohol, and is 10 weeks pregnant. She is currently taki... | Amoxicillin-clavulanate | {
"A": "Amoxicillin-clavulanate",
"B": "Ciprofloxacin",
"C": "Doxycycline",
"D": "Trimethoprim-sulfamethoxazole"
} | step2&3 | A | [
"23 year old woman presents",
"emergency department",
"burning",
"increased urinary frequency",
"patient states",
"symptoms started",
"worsening",
"hydrating well",
"patient",
"healthy",
"not smoke",
"drink alcohol",
"10 weeks pregnant",
"currently taking folate",
"iron",
"multivitamin... |
A 47-year-old man presents for a routine physical examination as part of an insurance medical assessment. He has no complaints and has no family history of cardiac disease or sudden cardiac death. His blood pressure is 120/80 mm Hg, temperature is 36.7°C (98.1°F), and pulse is 75/min and is regular. On physical examina... | Prolapse of a mitral valve leaflet of ≥2 mm above the level of the annulus in systole | {
"A": "Doming of the mitral valve leaflets in diastole",
"B": "High pressure gradient across the aortic valve",
"C": "Prolapse of a mitral valve leaflet of ≥2 mm above the level of the annulus in systole",
"D": "Left atrial mass arising from the region of the septal fossa ovalis"
} | step2&3 | C | [
"year old man presents",
"routine physical examination",
"part of",
"insurance medical assessment",
"complaints",
"family history of cardiac disease",
"sudden cardiac death",
"blood pressure",
"80 mm Hg",
"temperature",
"36",
"98",
"pulse",
"75 min",
"regular",
"physical examination",
... |
A 9-month-old boy is brought to a pediatrician by his parents for routine immunization. The parents say they have recently immigrated to the United States from a developing country, where the infant was receiving immunizations as per the national immunization schedule for that country. The pediatrician prepares a plan ... | IPV is known to produce higher titers of serum IgG antibodies than OPV | {
"A": "IPV is known to produce higher titers of serum IgG antibodies than OPV",
"B": "IPV is known to produce virus-specific CD8+ T cells that directly kills polio-infected cells",
"C": "IPV is known to produce virus-specific CD4+ T cells that produce interleukins and interferons to control polio viruses",
"D"... | step1 | A | [
"month old boy",
"brought",
"pediatrician",
"parents",
"routine immunization",
"parents",
"recently",
"United States",
"developing country",
"infant",
"receiving immunizations",
"national immunization schedule",
"country",
"pediatrician prepares",
"plan",
"infants immunizations",
"st... |
A 25-year-old G2P1 woman at 12 weeks gestational age presents to the office to discuss the results of her routine prenatal screening labs, which were ordered during her 1st prenatal visit. She reports taking a daily prenatal vitamin but no other medications. She complains of mild fatigue and appears pale on exam. Her c... | Iron deficiency anemia in the mother; normal Hb levels in the fetus | {
"A": "Folate deficiency anemia in both the mother and the fetus",
"B": "Iron deficiency anemia in the mother; normal Hb levels in the fetus",
"C": "Pernicious anemia in the mother; normal Hb levels in the fetus",
"D": "Physiologic anemia in the mother; normal Hb levels in the fetus"
} | step2&3 | B | [
"year old",
"woman",
"weeks presents",
"office to discuss",
"results",
"routine prenatal labs",
"ordered",
"1st prenatal visit",
"reports taking",
"daily prenatal vitamin",
"medications",
"mild fatigue",
"appears pale",
"exam",
"complete blood count",
"CBC",
"shows",
"following",
... |
A 34-year-old male is brought to the emergency department. He has prior hospitalizations for opiate overdoses, but today presents with fever, chills, rigors and malaise. On physical exam vitals are temperature: 100.5 deg F (38.1 deg C), pulse is 105/min, blood pressure is 135/60 mmHg, and respirations are 22/min. You n... | A water-hammer pulse when palpating the radial artery | {
"A": "A holosystolic murmur at the 4th intercostal midclavicular line",
"B": "A harsh crescendo-decrescendo systolic murmur in the right second intercostal space",
"C": "Decreased blood pressure as measured in the lower extremities compared to the upper extremities",
"D": "A water-hammer pulse when palpating ... | step2&3 | D | [
"year old male",
"brought",
"emergency department",
"prior hospitalizations",
"opiate overdoses",
"today presents",
"fever",
"chills",
"rigors",
"malaise",
"physical exam",
"temperature",
"100",
"deg F",
"pulse",
"min",
"blood pressure",
"60 mmHg",
"respirations",
"min",
"not... |
A 58-year-old woman is brought to the emergency department 1 hour after she accidentally spilled hot oil on her leg while cooking. The Venezuelan receptionist reports that the patient only speaks and understands Spanish. She is accompanied by her adult son, who speaks English and Spanish. Her vital signs are within nor... | Wait for a licensed Spanish interpreter to communicate the treatment plan | {
"A": "Wait for a licensed Spanish interpreter to communicate the treatment plan",
"B": "Communicate the treatment plan through the son",
"C": "Perform the treatment without prior communication",
"D": "Communicate the treatment plan through the receptionist"
} | step1 | A | [
"58 year old woman",
"brought",
"emergency department",
"hour",
"spilled hot oil",
"leg",
"cooking",
"Venezuelan receptionist reports",
"patient only speaks",
"understands Spanish",
"adult son",
"speaks English",
"Spanish",
"vital signs",
"normal",
"Physical examination shows a 10",
... |
A 47-year-old man presents to his primary care physician for fatigue. Over the past 3 months, his tiredness has impacted his ability to work as a corporate lawyer. He denies any changes to his diet, exercise regimen, bowel movements, or urinary frequency. His past medical history is notable for obesity, type II diabete... | Mismatch repair | {
"A": "Homologous recombination",
"B": "Mismatch repair",
"C": "Non-homologous end joining",
"D": "Nucleotide excision repair"
} | step1 | B | [
"year old man presents",
"primary care physician",
"fatigue",
"past 3 months",
"tiredness",
"impacted",
"ability to work",
"corporate lawyer",
"denies",
"changes",
"diet",
"exercise regimen",
"bowel movements",
"urinary frequency",
"past medical history",
"notable",
"obesity",
"typ... |
A 48-year-old female visits your office complaining that she has trouble swallowing solids and liquids, has persistent bad breath, and sometimes wakes up with food on her pillow. Manometry studies show an absence of functional peristalsis and a failure of the lower esophageal sphincter to collapse upon swallowing. The ... | Myenteric (Auerbach’s) plexus | {
"A": "Lamina propria",
"B": "Myenteric (Auerbach’s) plexus",
"C": "Submucosal (Meissner’s) plexus",
"D": "Muscularis mucosa"
} | step1 | B | [
"48 year old female visits",
"office",
"swallowing solids",
"liquids",
"persistent bad breath",
"sometimes wakes up",
"food",
"pillow",
"Manometry studies show",
"absence",
"functional peristalsis",
"failure",
"lower esophageal sphincter to collapse",
"swallowing",
"patients disorder",
... |
A 10-year-old girl is brought to the physician by her parents due to 2 months of a progressively worsening headache. The headaches were initially infrequent and her parents attributed them to stress from a recent move. However, over the last week the headaches have gotten significantly worse and she had one episode of ... | Pinealoma | {
"A": "Craniopharyngioma",
"B": "Pinealoma",
"C": "Ependymoma",
"D": "Pituitary Ademona"
} | step1 | B | [
"A 10 year old girl",
"brought",
"physician",
"parents due to",
"months",
"worsening headache",
"headaches",
"initially infrequent",
"parents attributed",
"stress",
"recent move",
"last week",
"headaches",
"gotten",
"worse",
"one episode of vomiting",
"morning",
"woke up",
"medic... |
A 32-year-old female presents with acute onset abdominal pain accompanied by nausea, vomiting, and hematuria. She is currently taking glipizide for type 2 diabetes mellitus. Past medical history is also significant for lactose intolerance. She has just started training for a marathon, and she drinks large amounts of sp... | Flank pain that does not radiate to the groin | {
"A": "Edema and anuria ",
"B": "Flank pain that does not radiate to the groin",
"C": "Colicky pain radiating to the groin",
"D": "Rebound tenderness, pain exacerbated by coughing"
} | step2&3 | B | [
"year old female presents",
"acute onset abdominal pain",
"nausea",
"vomiting",
"hematuria",
"currently taking glipizide",
"type 2 diabetes mellitus",
"Past medical history",
"significant",
"lactose intolerance",
"started training",
"marathon",
"drinks large amounts",
"sports drinks to",
... |
An investigator conducts a case-control study to evaluate the relationship between benzodiazepine use among the elderly population (older than 65 years of age) that resides in assisted-living facilities and the risk of developing Alzheimer dementia. Three hundred patients with Alzheimer dementia are recruited from assi... | A 86-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility | {
"A": "An 80-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an independent-living community",
"B": "A 64-year-old man with well-controlled hypertension and mild benign prostate hyperplasia who lives in an assisted-living facility",
"C": "A 73-year-old woman with ... | step1 | D | [
"investigator conducts",
"case-control study to evaluate",
"relationship",
"benzodiazepine use",
"elderly population",
"older",
"65 years",
"age",
"resides",
"assisted-living facilities",
"risk",
"Alzheimer dementia",
"Three hundred patients",
"Alzheimer dementia",
"assisted-living facil... |
A 29-year-old nulligravid woman comes to the physician for evaluation of infertility. She has been unable to conceive for 14 months. One year ago, she stopped taking the oral contraceptive pill, which she had been taking since she was 17. Her husband's semen analysis was normal. Four years ago, she had an episode of a ... | Loss of ciliary action | {
"A": "Insulin resistance",
"B": "Loss of ciliary action",
"C": "Adverse effect of oral contraceptive pill",
"D": "Primary ovarian insufficiency"
} | step1 | B | [
"29 year old nulligravid woman",
"physician",
"evaluation",
"infertility",
"unable to",
"months",
"One year ago",
"stopped taking",
"oral contraceptive pill",
"taking",
"husband's semen analysis",
"normal",
"Four years",
"episode of",
"pelvic tenderness",
"vaginal discharge",
"resolv... |
A 34-year-old woman visits an outpatient clinic with a complaint of pain in her left breast for the last few months. The pain worsens during her menstrual cycle and relieves once the cycle is over. She denies any nipple discharge, skins changes, warmth, erythema, or a palpable mass in the breast. Her family history is ... | Sclerosing adenosis | {
"A": "Fibroadenoma",
"B": "Infiltrating ductal carcinoma",
"C": "Sclerosing adenosis",
"D": "Ductal hyperplasia without atypia"
} | step1 | C | [
"year old woman visits",
"outpatient clinic",
"complaint",
"pain",
"left breast",
"months",
"pain worsens",
"menstrual cycle",
"relieves once",
"cycle",
"over",
"denies",
"nipple discharge",
"skins changes",
"warmth",
"erythema",
"palpable mass in",
"breast",
"family history",
... |
A randomized double-blind controlled trial is conducted on the efficacy of 2 different ACE-inhibitors. The null hypothesis is that both drugs will be equivalent in their blood-pressure-lowering abilities. The study concluded, however, that Medication 1 was more efficacious in lowering blood pressure than medication 2 a... | We can fail to accept the null hypothesis. | {
"A": "This trial did not reach statistical significance.",
"B": "There is a 0.1% chance that medication 2 is superior.",
"C": "We can fail to accept the null hypothesis.",
"D": "We can accept the null hypothesis."
} | step2&3 | C | [
"randomized double-blind controlled trial",
"conducted",
"efficacy",
"different ACE-inhibitors",
"null hypothesis",
"drugs",
"equivalent",
"blood-pressure-lowering abilities",
"study concluded",
"Medication 1",
"more efficacious",
"lowering blood pressure",
"medication 2",
"determined by",... |
A 60-year-old man presents to his physician as part of his routine annual medical check-up. He has no specific complaints but mentions that he has often experienced fatigue over the past few months. His past medical history is noncontributory. On physical examination, his temperature is 37.2°C (98.8°F), pulse rate is 8... | Chronic myeloid leukemia | {
"A": "Chronic myeloid leukemia",
"B": "Chronic myelomonocytic leukemia",
"C": "Transient myeloproliferative disorder",
"D": "Myelodysplastic syndrome/myeloproliferative neoplasm, unclassifiable"
} | step1 | A | [
"60 year old man presents",
"physician",
"part of",
"routine annual medical check-up",
"specific complaints",
"often",
"fatigue",
"past",
"months",
"past medical history",
"physical examination",
"temperature",
"98",
"pulse rate",
"84 min",
"blood pressure",
"mm Hg",
"respiratory r... |
A 59-year-old man presents to the emergency department with a complaint of palpitations for the last 30 minutes. He denies chest pain, breathlessness, and loss of consciousness. The medical history is negative for hypertension or ischemic heart disease. On physical examination, the temperature is 36.9°C (98.4°F), the p... | Prolongation of cardiac depolarization by blocking the potassium channels and activating the slow inward sodium current | {
"A": "Prolongation of action potential duration by blocking the rapid outward sodium current",
"B": "Prolongation of cardiac depolarization by blocking the potassium channels and activating the slow inward sodium current",
"C": "Slowing the rapid upstroke during phase 0 by blocking the calcium channels",
"D":... | step1 | B | [
"59 year old man presents",
"emergency department",
"complaint",
"palpitations",
"last 30 minutes",
"denies chest pain",
"breathlessness",
"loss of consciousness",
"medical history",
"negative",
"hypertension",
"ischemic heart disease",
"physical examination",
"temperature",
"36",
"98 ... |
A 58-year-old female presents to her primary care physician with complaints of chest pain and palpitations. A thorough past medical history reveals a diagnosis of rheumatic fever during childhood. Echocardiography is conducted and shows enlargement of the left atrium and narrowing of the mitral valve opening. Which of ... | Opening snap following the aortic component of the S2 heart sound | {
"A": "Holosystolic murmur that radiates to the axilla",
"B": "Opening snap following the aortic component of the S2 heart sound",
"C": "Continuous, machine-like murmur",
"D": "High-pitched, blowing decrescendo murmur in early diastole"
} | step1 | B | [
"58 year old female presents",
"primary care physician",
"complaints of chest pain",
"palpitations",
"past medical history reveals",
"diagnosis",
"rheumatic fever",
"childhood",
"Echocardiography",
"conducted",
"shows enlargement",
"left atrium",
"narrowing",
"mitral valve opening",
"fol... |
A pediatrician is investigating determinants of childhood obesity. He has been following a cohort of pregnant women with poorly controlled diabetes and comorbid obesity. In the ensuing years, he evaluated the BMI of the cohort's children. The results of the correlation analysis between mean childhood BMI (at 4 years of... | There is a positively correlated linear association between maternal BMI and childhood BMI | {
"A": "Maternal BMI is a stronger predictor of childhood BMI than maternal HbA1c",
"B": "Higher maternal HbA1c leads to increased childhood BMI",
"C": "The association between maternal BMI and childhood BMI has a steeper slope than maternal HbA1c and childhood BMI",
"D": "There is a positively correlated linea... | step2&3 | D | [
"pediatrician",
"investigating determinants",
"childhood obesity",
"following",
"cohort",
"pregnant women",
"poorly controlled diabetes",
"comorbid obesity",
"years",
"evaluated",
"BMI",
"cohort's children",
"results",
"correlation analysis",
"mean childhood BMI",
"4 years",
"age",
... |
Following a motor vehicle accident, a 63-year-old man is scheduled for surgery. The emergency physician notes a posture abnormality in the distal left lower limb and a fracture-dislocation of the right hip and acetabulum based on the radiology report. The senior orthopedic resident mistakenly notes a fraction dislocati... | Conducting a preoperative time-out | {
"A": "Conducting a preoperative time-out",
"B": "Implementing a checklist",
"C": "Performing screening X-rays",
"D": "Verifying the patient’s identity"
} | step2&3 | A | [
"Following",
"motor vehicle accident",
"63 year old man",
"scheduled",
"surgery",
"emergency physician notes",
"posture abnormality",
"distal left lower limb",
"fracture dislocation of the right hip",
"acetabulum based",
"radiology report",
"senior orthopedic resident",
"notes",
"fraction ... |
A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a signif... | Long-term lithium therapy | {
"A": "Long-term risperidone therapy",
"B": "Clonazepam therapy for one year",
"C": "Sertraline therapy for one year",
"D": "Long-term lithium therapy"
} | step2&3 | D | [
"year old woman",
"brought",
"physician",
"husband",
"concerned",
"ability to care",
"Three weeks",
"quit",
"marketing job to start",
"clothing company",
"then",
"not slept more",
"hours",
"night",
"working",
"business plans",
"used",
"significant portion",
"savings to fund busin... |
A 60-year-old man presents to the emergency department complaining of worsening exertional dyspnea over the last week. He denies chest pain and lightheadedness but reports persistent cough with white sputum. His past medical history includes hypertension and diabetes mellitus. He has a 50 pack-year history of smoking b... | Muscarinic blocker | {
"A": "Alpha-1 blocker",
"B": "Alpha-2 blocker",
"C": "Beta-2 blocker",
"D": "Muscarinic blocker"
} | step2&3 | D | [
"60 year old man presents",
"emergency department",
"worsening exertional dyspnea",
"last week",
"denies chest pain",
"lightheadedness",
"reports persistent cough",
"white sputum",
"past medical history includes hypertension",
"diabetes mellitus",
"50 pack-year history of smoking",
"denies",
... |
A 61-year-old man comes to the physician because of a 3-month history of fatigue and progressively worsening shortness of breath that is worse when lying down. Recently, he started using two pillows to avoid waking up short of breath at night. Examination shows a heart murmur. A graph with the results of cardiac cathet... | High-pitched, holosystolic murmur that radiates to the axilla | {
"A": "High-pitched, holosystolic murmur that radiates to the axilla",
"B": "Rumbling, delayed diastolic murmur heard best at the cardiac apex",
"C": "Blowing, early diastolic murmur heard best at the Erb point",
"D": "Harsh, late systolic murmur that radiates to the carotids"
} | step1 | A | [
"61 year old man",
"physician",
"3 month history",
"fatigue",
"worsening shortness of breath",
"worse",
"lying",
"Recently",
"started using two pillows to",
"waking",
"short of breath at night",
"Examination shows",
"heart murmur",
"graph",
"results",
"cardiac catheterization",
"show... |
A 63-year-old woman comes to the physician for evaluation of worsening fatigue and an unintentional 6.8-kg (15-lb) weight loss over the past 2 months. She also reports having had an unusual appetite for soil and clay for several months. She has a history of osteoarthritis of the knees, for which she takes acetaminophen... | Positive stool guaiac test | {
"A": "Positive stool guaiac test",
"B": "Elevated serum thyroid-stimulating hormone concentration",
"C": "Elevated serum lead concentration",
"D": "Decreased CD4+ T-lymphocyte count"
} | step2&3 | A | [
"63 year old woman",
"physician",
"evaluation",
"worsening fatigue",
"unintentional",
"kg",
"weight loss",
"past",
"months",
"reports",
"unusual appetite",
"soil",
"clay",
"months",
"history",
"knees",
"takes acetaminophen",
"pulse",
"minute",
"blood pressure",
"84 mm Hg",
... |
A 70-year-old man presents with a complaint of progressive dyspnea on minimal exertion. The patient reports being quite active and able to climb 3 flights of stairs in his building 10 years ago, whereas now he feels extremely winded when climbing a single flight. At first, he attributed this to old age but has more rec... | Toxic cardiomyopathy | {
"A": "Toxic cardiomyopathy",
"B": "Diastolic heart failure",
"C": "Ischemic cardiomyopathy",
"D": "Nephrotic syndrome"
} | step2&3 | A | [
"70 year old man presents",
"complaint",
"progressive dyspnea",
"minimal exertion",
"patient reports",
"active",
"able to climb",
"flights",
"stairs",
"building 10 years",
"now",
"feels extremely winded",
"climbing",
"single flight",
"first",
"attributed",
"old age",
"more recently... |
An unconscious middle-aged man is brought to the emergency department. He is actively bleeding from the rectum. He has no past medical history. At the hospital, his pulse is 110/min, the blood pressure is 90/60 mm Hg, the respirations are 26/min, and the oxygen saturation is 96% at room air. His extremities are cold. R... | Mesenteric angiography | {
"A": "Mesenteric angiography",
"B": "Colonoscopy",
"C": "Exploratory laparotomy with segmental bowel resection",
"D": "EGD"
} | step2&3 | A | [
"unconscious middle-aged man",
"brought",
"emergency department",
"bleeding",
"rectum",
"past medical history",
"hospital",
"pulse",
"min",
"blood pressure",
"90 60 mm Hg",
"respirations",
"min",
"oxygen saturation",
"96",
"room air",
"extremities",
"cold",
"Resuscitation",
"st... |
A 50-year-old woman presents to the clinic with joint pain that has persisted for the last 2 months. She reports having intermittently swollen, painful hands bilaterally. She adds that when she wakes up in the morning, her hands are stiff and do not loosen up until an hour later. The pain tends to improve with movement... | Methotrexate | {
"A": "Leflunomide",
"B": "Methotrexate",
"C": "Hydroxyurea",
"D": "Allopurinol"
} | step1 | B | [
"50 year old woman presents",
"clinic",
"joint pain",
"months",
"reports",
"swollen",
"painful hands",
"adds",
"wakes up",
"morning",
"hands",
"stiff",
"not loosen",
"hour later",
"pain",
"to",
"movement",
"Physical examination",
"significant",
"warm",
"swollen",
"tender pr... |
A 79-year-old man is brought to the emergency department after he noted the abrupt onset of weakness accompanied by decreased sensation on his left side. His symptoms developed rapidly, peaked within 1 minute, and began to spontaneously resolve 10 minutes later. Upon arrival in the emergency room 40 minutes after the i... | Carotid stenting | {
"A": "Aspirin and clopidogrel",
"B": "Warfarin",
"C": "Carotid stenting",
"D": "Hypercoagulability studies"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"noted",
"abrupt onset",
"weakness",
"decreased sensation",
"left side",
"symptoms",
"rapidly",
"peaked",
"minute",
"began to",
"resolve 10 minutes later",
"arrival",
"emergency room 40 minutes",
"initial onset",
"symptoms",
"res... |
A 19-year-old woman comes to the physician because of a 1-month history of mild fatigue and weakness. Physical examination shows no abnormalities. Her hemoglobin concentration is 11 g/dL and mean corpuscular volume is 74 μm3. Hemoglobin electrophoresis shows 10% HbA2 (normal < 3.5%). Which of the following is the most ... | Beta thalassemia minor | {
"A": "Beta thalassemia minor",
"B": "Hemoglobin Barts disease",
"C": "Alpha thalassemia minima",
"D": "Hemoglobin H disease"
} | step1 | A | [
"year old woman",
"physician",
"month history",
"mild fatigue",
"weakness",
"Physical examination shows",
"abnormalities",
"hemoglobin concentration",
"g/dL",
"mean corpuscular volume",
"74 m3",
"Hemoglobin electrophoresis shows 10",
"HbA2",
"normal",
"3.5",
"following",
"most likely... |
A 59-year-old man comes to the emergency department because of worsening nausea and reduced urine output for the past 3 days. One week ago he had a 4-day episode of abdominal pain, vomiting, and watery, nonbloody diarrhea that began a day after he returned from a trip to Mexico. He has not been able to eat or drink muc... | Hypovolemia | {
"A": "Hypovolemia",
"B": "Direct renal toxicity",
"C": "IgA glomerulonephritis",
"D": "Hemolytic uremic syndrome"
} | step2&3 | A | [
"59 year old man",
"emergency department",
"worsening nausea",
"reduced urine output",
"past 3 days",
"One week",
"4-day episode of abdominal pain",
"vomiting",
"watery",
"diarrhea",
"began",
"day",
"returned",
"trip",
"Mexico",
"not",
"able to eat",
"drink much",
"then",
"symp... |
A 27-year-old woman presents to the emergency department because of muscle tightness and pain. She says that she has experienced increasing tightness and cramping of the muscles on the left side of her neck. She also says that she has trouble looking downwards because her “eyes are stuck.” She has a history of schizoph... | Benztropine | {
"A": "Benztropine",
"B": "Dantrolene",
"C": "Haloperidol",
"D": "Propranolol"
} | step2&3 | A | [
"27 year old woman presents",
"emergency department",
"muscle tightness",
"pain",
"experienced increasing tightness",
"cramping",
"muscles",
"left side of",
"neck",
"looking downwards",
"eyes",
"stuck",
"history of schizophrenia",
"treated with haloperidol",
"temperature",
"98",
"pul... |
A 52-year-old man with stage IV melanoma comes to the physician with his wife for a routine follow-up examination. He was recently diagnosed with new bone and brain metastases despite receiving aggressive chemotherapy but has not disclosed this to his wife. He has given verbal consent to discuss his prognosis with his ... | """What is your understanding of your husband's current condition?""" | {
"A": "\"\"\"What is your understanding of your husband's current condition?\"\"\"",
"B": "\"\"\"Have you discussed a living will or goals of care together?\"\"\"",
"C": "\"\"\"We should talk about how we can manage his symptoms with additional chemotherapy.\"\"\"",
"D": "\"\"\"Your husband has end-stage cance... | step1 | A | [
"year old man",
"stage IV melanoma",
"physician",
"wife",
"routine follow-up examination",
"recently diagnosed",
"new bone",
"brain metastases",
"receiving aggressive chemotherapy",
"not",
"wife",
"given verbal consent to discuss",
"prognosis",
"wife",
"doctor to inform",
"condition",
... |
A 4-week-old infant is brought to the physician by his mother because of blood-tinged stools for 3 days. He has also been passing whitish mucoid strings with the stools during this period. He was delivered at 38 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. H... | Continue breastfeeding and advise mother to avoid dairy and soy products | {
"A": "Assess for IgA (anti‑)tissue transglutaminase antibodies (tTG)",
"B": "Continue breastfeeding and advise mother to avoid dairy and soy products",
"C": "Perform stool antigen immunoassay",
"D": "Stop breastfeeding and switch to soy-based formula"
} | step2&3 | B | [
"4 week old infant",
"brought",
"physician",
"mother",
"blood-tinged stools",
"3 days",
"passing",
"mucoid strings",
"stools",
"period",
"delivered",
"weeks",
"gestation",
"lower segment transverse cesarean",
"fetal heart rate",
"monitored",
"intensive care unit",
"day prior to",
... |
Two days after being admitted to the hospital because of severe peripartum vaginal bleeding during a home birth, a 40-year-old woman, gravida 3, para 3, has a 30-second generalized convulsive seizure followed by unconsciousness. Prior to the event she complained of acute onset of sweating and uncontrollable shivering. ... | Pituitary ischemia | {
"A": "Lactotrophic adenoma",
"B": "Hypoactive thyroid",
"C": "Pituitary ischemia",
"D": "Hypothalamic infarction\n\""
} | step2&3 | C | [
"Two days",
"admitted",
"hospital",
"of severe peripartum vaginal",
"home birth",
"40 year old woman",
"gravida 3",
"para 3",
"30 second generalized convulsive seizure followed by unconsciousness",
"event",
"acute onset",
"sweating",
"shivering",
"unstable",
"required",
"liters",
"in... |
A 26-year-old man presents with a 2-day history of worsening right lower leg pain. He states that he believes his right leg is swollen when compared to his left leg. Past medical history is significant for generalized anxiety disorder, managed effectively with psychotherapy. He smokes a pack of cigarettes daily but den... | Factor V Leiden | {
"A": "Factor V Leiden",
"B": "von Willebrand disease",
"C": "Vitamin K deficiency",
"D": "Hemophilia A"
} | step2&3 | A | [
"year old man presents",
"2-day history",
"worsening right lower leg pain",
"states",
"right leg",
"swollen",
"compared",
"left leg",
"Past medical history",
"significant",
"generalized anxiety disorder",
"managed",
"psychotherapy",
"smokes",
"pack",
"cigarettes daily",
"denies alcoh... |
A 63-year-old woman presents to your outpatient clinic complaining of headaches, blurred vision, and fatigue. She has a blood pressure of 171/91 mm Hg and heart rate of 84/min. Physical examination is unremarkable. Her lab results include K+ of 3.1mEq/L and a serum pH of 7.51. Of the following, which is the most likely... | Primary hyperaldosteronism (Conn’s syndrome) | {
"A": "Primary hyperaldosteronism (Conn’s syndrome)",
"B": "Pheochromocytoma",
"C": "Cushing’s syndrome",
"D": "Addison’s disease"
} | step2&3 | A | [
"63 year old woman presents",
"outpatient clinic",
"headaches",
"blurred vision",
"fatigue",
"blood pressure",
"mm Hg",
"heart rate of 84 min",
"Physical examination",
"unremarkable",
"lab results include K",
"3",
"serum",
"following",
"most likely diagnosis",
"patient"
] |
A 62-year-old woman with type 2 diabetes mellitus is brought to the emergency room because of a 3-day history of fever and shaking chills. Her temperature is 39.4°C (103°F). Examination of the back shows right costovertebral angle tenderness. Analysis of the urine shows WBCs, WBC casts, and gram-negative rods. Ultrasou... | Polymorphonuclear leukocytes in tubules | {
"A": "Polygonal clear cells filled with lipids and carbohydrates",
"B": "Polymorphonuclear leukocytes in tubules",
"C": "Cystic dilation of the renal medulla",
"D": "Tubular eosinophilic casts\n\""
} | step1 | B | [
"62 year old woman",
"type 2 diabetes mellitus",
"brought",
"emergency room",
"3-day history",
"fever",
"shaking chills",
"temperature",
"4C",
"Examination of",
"back shows right costovertebral angle tenderness",
"Analysis of",
"urine shows WBCs",
"WBC casts",
"gram-negative rods",
"Ul... |
A 39-year-old woman is brought to the emergency department following a stab wound to the neck. Per the patient, she was walking her dog when she got robbed and was subsequently stabbed with a knife. Vitals are stable. Strength examination reveals 2/5 right-sided elbow flexion and extension, wrist extension, and finger ... | Hemisection injury | {
"A": "Anterior cord syndrome",
"B": "Hemisection injury",
"C": "Posterior cord syndrome",
"D": "Syringomyelia"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department following",
"stab",
"neck",
"patient",
"walking",
"dog",
"got",
"stabbed",
"knife",
"stable",
"Strength examination reveals 2/5 right-sided elbow flexion",
"extension",
"wrist extension",
"finger motions",
"Babinski sign",
"upward"... |
A 32-year-old woman is brought to your office by her husband. The husband says that she had been acting strange lately. She has been forgetful, and she sometimes becomes angered for no reason, which is highly unusual for her. She has also been having random, uncontrollable movements, which are also new. On examination,... | Loss of neurons in the caudate nucleus and putamen | {
"A": "Alpha-synuclein intracellular inclusions",
"B": "Loss of neurons in the caudate nucleus and putamen",
"C": "Lipohyalinosis",
"D": "Beta-amyloid plaques"
} | step1 | B | [
"year old woman",
"brought",
"office",
"husband",
"husband",
"acting",
"forgetful",
"sometimes",
"angered",
"reason",
"highly unusual",
"random",
"movements",
"new",
"examination",
"appears withdrawn",
"flat",
"further questioning",
"reveals",
"father died",
"age",
"movemen... |
A previously healthy 27-year-old man is brought to the emergency department 35 minutes after being involved in a high-speed motor vehicle collision in which he was an unrestrained passenger. He was ambulatory at the accident scene, with stable vital signs and no major external injuries except abrasions to both upper ex... | Hospitalization and frequent ultrasounds | {
"A": "Laparoscopic splenectomy",
"B": "Hospitalization and frequent ultrasounds",
"C": "Exploratory laparotomy and splenectomy",
"D": "Coil embolization of short gastric vessels"
} | step2&3 | B | [
"healthy 27 year old man",
"brought",
"emergency department 35 minutes",
"involved",
"high speed motor vehicle collision",
"passenger",
"ambulatory",
"accident",
"stable vital signs",
"major external injuries",
"abrasions",
"upper extremities",
"arrival",
"alert",
"oriented",
"temperat... |
A 42-year-old man with chronic hepatitis C is admitted to the hospital because of jaundice and abdominal distention. He is diagnosed with decompensated liver cirrhosis, and treatment with diuretics is begun. Two days after admission, he develops abdominal pain and fever. Physical examination shows tense ascites and dif... | Inhibition of bacterial peptidoglycan crosslinking | {
"A": "Inhibition of bacterial RNA polymerase",
"B": "Free radical creation within bacterial cell",
"C": "Inhibition of bacterial 50S subunit",
"D": "Inhibition of bacterial peptidoglycan crosslinking"
} | step1 | D | [
"A",
"year old man",
"chronic hepatitis C",
"admitted",
"hospital",
"jaundice",
"abdominal distention",
"diagnosed",
"decompensated liver cirrhosis",
"treatment",
"diuretics",
"begun",
"Two days",
"admission",
"abdominal pain",
"fever",
"Physical examination shows tense ascites",
"... |
A 27-year-old woman visits her family physician complaining of the recent onset of an unpleasant fish-like vaginal odor that has started to affect her sexual life. She was recently treated for traveler’s diarrhea after a trip to Thailand. External genitalia appear normal on pelvic examination, speculoscopy shows a gray... | Clue cells on saline smear | {
"A": "Clue cells on saline smear",
"B": "Polymorphonuclear cells (PMNs) to epithelial cell ratio of 2:1",
"C": "Motile flagellates",
"D": "Hyphae"
} | step1 | A | [
"27 year old woman visits",
"family physician",
"recent onset",
"fish",
"vaginal odor",
"started to affect",
"sexual life",
"recently treated",
"travelers diarrhea",
"trip",
"Thailand",
"External genitalia appear normal",
"pelvic examination",
"speculoscopy shows",
"gray",
"thin",
"h... |
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