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 group of investigators is performing a phase I trial of a novel drug among patients with chronic right upper quadrant pain. Iminodiacetic acid labeled with technetium 99m is administered intravenously and subjects are subsequently imaged with a gamma camera. It is found that administration of the experimental drug in... | Jejunal I cells | {
"A": "Pancreatic D cells",
"B": "Antral G cells",
"C": "Duodenal S cells",
"D": "Jejunal I cells"
} | step1 | D | [
"A group",
"investigators",
"performing",
"phase I trial",
"novel drug",
"patients",
"chronic right upper quadrant pain",
"Iminodiacetic acid labeled",
"technetium 99m",
"administered",
"subjects",
"imaged",
"gamma camera",
"found",
"administration",
"experimental increases",
"amount... |
A 2-month-old infant boy is brought into the clinic for a well-child check. Mom reports a healthy pregnancy with no complications. Though she said the ultrasound technician saw “some white deposits in his brain” during a prenatal check, mom was not concerned. The baby was delivered at 38 weeks of gestation during a hom... | Sensorineural hearing loss | {
"A": "Continuous machine-like murmur",
"B": "Hutchinson teeth",
"C": "Sensorineural hearing loss",
"D": "Skin vesicles"
} | step1 | C | [
"2 month old infant boy",
"brought",
"clinic",
"well-child check",
"Mom reports",
"healthy pregnancy",
"complications",
"ultrasound technician saw",
"white deposits",
"brain",
"prenatal check",
"mom",
"not concerned",
"baby",
"delivered",
"weeks of gestation",
"home birth",
"proble... |
A 56-year-old man comes to the physician because of worsening double vision and drooping of the right eyelid for 2 days. He has also had frequent headaches over the past month. Physical examination shows right eye deviation laterally and inferiorly at rest. The right pupil is dilated and does not react to light or with... | Aneurysm of the posterior communicating artery | {
"A": "Aneurysm of the posterior communicating artery",
"B": "Demyelination of the medial longitudinal fasciculus",
"C": "Enlarging pituitary adenoma",
"D": "Infarction of the midbrain"
} | step1 | A | [
"year old man",
"physician",
"worsening double vision",
"drooping",
"right eyelid",
"2 days",
"frequent headaches",
"past month",
"Physical examination shows right",
"rest",
"right pupil",
"dilated",
"not react",
"light",
"accommodation",
"patient's diplopia improves slightly",
"look... |
A 76-year-old female with a past medical history of obesity, coronary artery disease status post stent placement, hypertension, hyperlipidemia, and insulin dependent diabetes comes to your outpatient clinic for regular checkup. She has not been very adherent to her diabetes treatment regimen. She has not been checking ... | Overflow incontinence | {
"A": "Stress incontinence",
"B": "Overflow incontinence",
"C": "Rectal prolapse",
"D": "Hemorrhoids"
} | step2&3 | B | [
"76 year old female",
"past medical",
"coronary artery disease status post stent placement",
"hypertension",
"hyperlipidemia",
"insulin dependent diabetes",
"outpatient clinic",
"regular checkup",
"not",
"very adherent",
"diabetes treatment regimen",
"not",
"checking",
"sugars",
"frequen... |
A 35-year-old woman comes to the physician because of recurring episodes of headache for the past 5 months. During this period, she has had headaches for approximately 20 days per month. The episodes last for about 2 hours each. She describes the headaches as dull, pressing, and non-pulsating holocranial pain. The symp... | Amitriptyline therapy | {
"A": "Amitriptyline therapy",
"B": "Ergotamine therapy",
"C": "Aspirin therapy",
"D": "Valproate therapy"
} | step2&3 | A | [
"35 year old woman",
"physician",
"of recurring episodes",
"headache",
"past",
"months",
"period",
"headaches",
"approximately 20 days",
"month",
"episodes last",
"hours",
"headaches",
"dull",
"non pulsating",
"pain",
"symptoms",
"not increase",
"exertion",
"vomiting",
"nause... |
A 7-year-old girl comes in to the emergency department with her mother for swelling of her left periorbital region. Yesterday morning she woke up with a painful, warm, soft lump on her left eyelid. Eye movement does not worsen the pain. Physical examination shows redness and swelling of the upper left eyelid, involving... | Hordeolum | {
"A": "Hordeolum",
"B": "Blepharitis",
"C": "Xanthelasma",
"D": "Chalazion"
} | step2&3 | A | [
"year old girl",
"emergency department",
"mother",
"swelling",
"left periorbital",
"morning",
"woke up",
"painful",
"warm",
"soft lump",
"left eyelid",
"Eye movement",
"not worsen",
"pain",
"Physical examination shows redness",
"swelling of",
"upper left",
"involving",
"hair foll... |
A 57-year-old female presents to general gynecology clinic for evaluation of a pelvic mass. The mass was detected on a routine visit to her primary care doctor during abdominal palpation. In the office, she receives a transvaginal ultrasound, which reveals a mass measuring 11 cm in diameter. In the evaluation of this m... | CA-125 | {
"A": "S-100",
"B": "CA-125",
"C": "Alpha fetoprotein",
"D": "CA-19-9"
} | step1 | B | [
"57 year old female presents",
"general gynecology clinic",
"evaluation",
"pelvic mass",
"mass",
"detected",
"routine visit",
"primary care doctor",
"abdominal palpation",
"office",
"receives",
"transvaginal ultrasound",
"reveals",
"mass measuring",
"diameter",
"evaluation",
"mass",
... |
A 23-year-old woman presents to her primary care physician for a wellness checkup. She has been treated for gonorrhea and chlamydia 3 times in the past 6 months but is otherwise healthy. She smokes cigarettes, drinks alcohol regularly, and wears a helmet while riding her bicycle. The patient is generally healthy and ha... | Condoms | {
"A": "Condoms",
"B": "Intrauterine device",
"C": "Pull out method",
"D": "Tubal ligation"
} | step2&3 | A | [
"23 year old woman presents",
"primary care physician",
"wellness checkup",
"treated",
"gonorrhea",
"chlamydia 3 times",
"past",
"healthy",
"smokes cigarettes",
"drinks alcohol",
"helmet",
"bicycle",
"patient",
"healthy",
"acute complaints",
"physical exam",
"unremarkable",
"reques... |
A 57-year-old woman is brought to the emergency department by her husband with complaints of sudden-onset slurring for the past hour. She is also having difficulty holding things with her right hand. She denies fever, head trauma, diplopia, vertigo, walking difficulties, nausea, and vomiting. Past medical history is si... | Dysarthria-clumsy hand syndrome | {
"A": "Dysarthria-clumsy hand syndrome",
"B": "Lateral medullary syndrome",
"C": "Parinaud’s syndrome",
"D": "Pure motor syndrome"
} | step2&3 | A | [
"57 year old woman",
"brought",
"emergency department",
"husband",
"complaints",
"sudden-onset slurring",
"past hour",
"difficulty holding things",
"right hand",
"denies fever",
"head trauma",
"diplopia",
"vertigo",
"walking difficulties",
"nausea",
"vomiting",
"Past medical history"... |
An 80-year-old man is brought to the emergency department from a nursing home because of a 2-day history of an increasing cough, fever, and dyspnea. He has type 2 diabetes mellitus, hypertension, and dementia. Current medications include insulin, enalapril, and donepezil. On arrival, he has dyspnea and is disoriented t... | Gram-positive diplococci | {
"A": "Gram-negative coccobacilli",
"B": "Gram-positive cocci in clusters",
"C": "Gram-positive diplococci",
"D": "Gram-negative rods"
} | step2&3 | C | [
"80 year old man",
"brought",
"emergency department",
"nursing home",
"of",
"2-day history",
"increasing cough",
"fever",
"dyspnea",
"type 2 diabetes mellitus",
"hypertension",
"dementia",
"Current medications include insulin",
"enalapril",
"donepezil",
"arrival",
"dyspnea",
"disor... |
A 60-year-old man comes to the physician because of a 2-month history of chest pain, dry cough, and shortness of breath. He describes two painless masses in his neck, which he says appeared 4 months ago and are progressively increasing in size. During this time, he has had week-long episodes of fever interspersed with ... | Excisional biopsy | {
"A": "Leukocyte count",
"B": "Sputum polymerase chain reaction test",
"C": "CT scan of the chest",
"D": "Excisional biopsy"
} | step2&3 | D | [
"60 year old man",
"physician",
"of",
"2 month history",
"chest pain",
"dry cough",
"shortness of breath",
"two painless",
"neck",
"appeared 4 months",
"increasing in size",
"time",
"week long episodes of fever",
"10 day periods",
"afebrile",
"reports",
"clothes",
"looser",
"past... |
A 36-year-old man comes to the physician for a 4-week history of swollen legs. He has difficulty putting on socks because of the swelling. Two years ago, he was diagnosed with sleep apnea. He takes no medications. He emigrated from Guatemala with his family when he was a child. He is 171 cm (5 ft 6 in) tall and weighs ... | Segmental sclerosis of the glomeruli | {
"A": "Segmental sclerosis of the glomeruli",
"B": "Fibrin crescents within the glomerular space",
"C": "Diffuse thickening of glomerular capillaries",
"D": "Amyloid deposition in the mesangium"
} | step1 | A | [
"36 year old man",
"physician",
"4 week history",
"swollen legs",
"difficulty putting",
"socks",
"swelling",
"Two years",
"diagnosed",
"sleep apnea",
"takes",
"medications",
"Guatemala",
"family",
"child",
"5 ft 6",
"tall",
"kg",
"BMI",
"kg/m2",
"pulse",
"min",
"blood pre... |
A 13-year-old girl is brought to the emergency department by her parents for 5 days of abdominal pain, fever, vomiting, and mild diarrhea. Her parents have been giving her acetaminophen in the past 3 days, which they stopped 24 hours ago when they noted blood in their daughter's urine. Upon admission, the patient has a... | Hemolytic uremic syndrome | {
"A": "Antiphospholipid syndrome",
"B": "Sickle cell disease",
"C": "Hemolytic uremic syndrome",
"D": "Nonsteroidal anti-inflammatory drugs (NSAIDs) nephropathy"
} | step1 | C | [
"year old girl",
"brought",
"emergency department",
"parents",
"5 days",
"abdominal pain",
"fever",
"vomiting",
"mild diarrhea",
"parents",
"giving",
"acetaminophen",
"past 3 days",
"stopped 24 hours",
"noted blood in",
"daughter's urine",
"admission",
"patient",
"fever",
"hemo... |
A 63-year-old man is brought to the emergency department for the evaluation of severe abdominal pain that started suddenly 1 hour ago while he was having a barbecue with his family. The pain is located in the middle of his abdomen and he describes it as 9 out of 10 in intensity. The patient feels nauseated and has vomi... | Balloon angioplasty and stenting | {
"A": "Anticoagulation with heparin",
"B": "Colonoscopy",
"C": "MR angiography",
"D": "Balloon angioplasty and stenting"
} | step2&3 | D | [
"63 year old man",
"brought",
"emergency department",
"evaluation",
"severe abdominal",
"started",
"hour",
"family",
"pain",
"middle",
"abdomen",
"out",
"10",
"intensity",
"patient feels nauseated",
"vomited twice",
"loose bowel movement",
"diagnosed",
"hypertension",
"years",
... |
A 68-year-old man presents to his primary care physician complaining of bulge in his scrotum that has enlarged over the past several months. He is found to have a right-sided inguinal hernia and proceeded with elective hernia repair. At his first follow-up visit, he complains of a tingling sensation on his scrotum. Whi... | L1-L2 | {
"A": "L1-L2",
"B": "L2-L3",
"C": "S1-S3",
"D": "S2-S4"
} | step1 | A | [
"68 year old man presents",
"primary care physician",
"bulge",
"scrotum",
"enlarged",
"past",
"months",
"found to",
"right-sided inguinal hernia",
"elective hernia repair",
"first follow-up visit",
"tingling sensation",
"scrotum",
"following nerve roots communicates",
"injured tissues"
] |
A group of investigators is studying a drug to treat refractory angina pectoris. This drug works by selectively inhibiting the late influx of sodium ions into cardiac myocytes. At high doses, the drug also partially inhibits the degradation of fatty acids. Which of the following is the most likely effect of this drug? | Increased oxygen efficiency | {
"A": "Increased oxygen efficiency",
"B": "Increased prolactin release",
"C": "Decreased uric acid excretion",
"D": "Decreased insulin release"
} | step1 | A | [
"A group",
"investigators",
"studying",
"drug to treat refractory",
"drug works",
"inhibiting",
"late",
"sodium ions",
"cardiac myocytes",
"high doses",
"drug",
"inhibits",
"degradation",
"fatty acids",
"following",
"most likely effect of",
"drug"
] |
A 31-year-old female presents to her gynecologist for a routine Pap smear. Her last Pap smear was three years ago and was normal. On the current Pap smear, she is found to have atypical squamous cells of unknown significance (ASCUS). Reflex HPV testing is positive. What is the best next step? | Colposcopy | {
"A": "Repeat Pap smear in 3 years",
"B": "Repeat Pap smear in 1 year",
"C": "Colposcopy",
"D": "Loop electrosurgical excision procedure (LEEP)"
} | step2&3 | C | [
"31 year old female presents",
"gynecologist",
"routine Pap smear",
"last Pap smear",
"three years",
"normal",
"current Pap smear",
"found to",
"atypical squamous cells",
"unknown significance",
"Reflex HPV testing",
"positive",
"best next step"
] |
A 42-year-old woman presents to the physician with symptoms of vague abdominal pain and bloating for several months. Test results indicate that she has ovarian cancer. Her physician attempts to reach her by phone but cannot. Next of kin numbers are in her chart. With whom can her doctor discuss this information? | The patient | {
"A": "The patient's husband",
"B": "The patient's brother",
"C": "The patient",
"D": "All of the above"
} | step1 | C | [
"year old woman presents",
"physician",
"symptoms",
"vague abdominal pain",
"bloating",
"months",
"Test results",
"ovarian cancer",
"physician attempts to reach",
"phone",
"Next of kin numbers",
"chart",
"doctor discuss",
"information"
] |
A 55-year old man living in Midwest USA comes in complaining of painless hematuria for the past week. He denies dysuria but complains of fatigue and lethargy at work. He has lost about 9.0 kg (20.0 lb) in the past 6 months. He drinks 1–2 beers on the weekends over the past 10 years but denies smoking. He has worked at ... | Aromatic amine exposure | {
"A": "Genetic predisposition",
"B": "Alcohol",
"C": "Vinyl chloride exposure",
"D": "Aromatic amine exposure"
} | step1 | D | [
"55 year old man living",
"USA",
"painless hematuria",
"past week",
"denies dysuria",
"fatigue",
"lethargy",
"work",
"lost",
"9.0 kg",
"20 0",
"past 6 months",
"drinks",
"beers",
"weekends",
"past 10 years",
"denies smoking",
"worked",
"plastic chemical plant",
"past 30 years",... |
Collagen is a very critical structural protein in many of our connective tissues. Defects in collagen produce diseases such as Ehlers-Danlos syndrome, where there is a defective lysyl hydroxylase gene, or osteogenesis imperfecta, where there is a defect in the production of type I collagen. Which of the following repre... | Gly-X-Y | {
"A": "Ser-X-Y",
"B": "Met-X-Y",
"C": "Gly-X-Y",
"D": "Glu-X-Y"
} | step1 | C | [
"Collagen",
"a very critical structural protein",
"connective tissues",
"Defects",
"collagen",
"diseases",
"Ehlers-Danlos syndrome",
"defective lysyl hydroxylase gene",
"osteogenesis imperfecta",
"defect",
"production",
"type I collagen",
"following represents",
"basic repeating",
"colla... |
A 28-year-old woman presents with a malodorous vaginal discharge and itchiness that have lasted for 15 days. She reports that the smell of the discharge is worse after intercourse and is accompanied by a whitish-gray fluid. She has no significant past medical or gynecological history. She is in a stable monogamous rela... | Vaginal fluid pH > 4.5, clue cells present on a saline smear of the vaginal secretions, along with a fishy odor on addition of KOH | {
"A": "Vaginal fluid pH > 5.0, motile flagellated pyriform protozoa seen on the microscopic examination of the vaginal secretions",
"B": "Vaginal fluid pH > 4.5, clue cells present on a saline smear of the vaginal secretions, along with a fishy odor on addition of KOH",
"C": "Vaginal fluid pH > 4.0, hyphae on th... | step1 | B | [
"year old woman presents",
"vaginal discharge",
"itchiness",
"lasted",
"days",
"reports",
"smell",
"discharge",
"worse",
"intercourse",
"gray fluid",
"significant past medical",
"gynecological history",
"stable monogamous relationship",
"never",
"pregnant",
"diagnosed",
"bacterial ... |
A 45-year-old man with a history of recurrent gouty arthritis comes to the physician for a follow-up examination. Four weeks ago, he was diagnosed with hyperuricemia and treatment with allopurinol was begun. Since then, he has had another acute gout attack, which resolved after treatment with ibuprofen. His temperature... | Probenecid | {
"A": "Rasburicase",
"B": "Probenecid",
"C": "Indomethacin",
"D": "Colchicine"
} | step1 | B | [
"year old man",
"history of recurrent gouty arthritis",
"physician",
"follow-up examination",
"Four weeks",
"diagnosed",
"hyperuricemia",
"treatment",
"allopurinol",
"begun",
"Since then",
"acute gout attack",
"resolved after treatment",
"ibuprofen",
"temperature",
"98",
"Physical ex... |
A 61-year-old woman comes to the physician because of a 5-day history of fever, headache, coughing, and thick nasal discharge. She had a sore throat and nasal congestion the week before that had initially improved. Her temperature is 38.1°C (100.6°F). Physical exam shows purulent nasal drainage and tenderness to percus... | Gram-positive, optochin-sensitive, lancet-shaped diplococci | {
"A": "Gram-negative, oxidase-positive, maltose-nonfermenting diplococci",
"B": "Gram-positive, optochin-sensitive, lancet-shaped diplococci",
"C": "Gram-negative, lactose-nonfermenting, blue-green pigment-producing bacilli",
"D": "Gram-positive, anaerobic, non-acid fast branching filamentous bacilli"
} | step1 | B | [
"61 year old woman",
"physician",
"5-day history",
"fever",
"headache",
"coughing",
"thick nasal discharge",
"sore throat",
"nasal congestion",
"week",
"initially improved",
"temperature",
"100",
"Physical exam shows purulent nasal drainage",
"tenderness",
"percussion",
"frontal sinu... |
A 57-year-old woman presents to her primary care physician with a concern for joint pain. She states that she often feels minor joint pain and morning stiffness in both of her hands every day, in particular in the joints of her fingers. Her symptoms tend to improve as the day goes on and she states they are not impacti... | Alendronate | {
"A": "Alendronate",
"B": "Ibuprofen",
"C": "Methotrexate",
"D": "Prednisone"
} | step2&3 | A | [
"57 year old woman presents",
"primary care physician",
"concern",
"joint pain",
"states",
"often feels minor joint pain",
"morning stiffness",
"hands",
"day",
"joints of",
"fingers",
"symptoms",
"to",
"day goes",
"states",
"not impacting",
"quality of",
"life",
"lives alone",
... |
A 70-year-old woman presents to her primary care doctor complaining of left knee pain. She states that she has noticed this more during the past several months after a fall at home. Previously, she was without pain and has no history of trauma to her knees. The patient states that the majority of her pain starts in the... | Marginal sclerosis | {
"A": "Association with HLA-DR4",
"B": "Heberden nodes",
"C": "Joint pannus",
"D": "Marginal sclerosis"
} | step1 | D | [
"70 year old woman presents",
"primary care doctor",
"left",
"states",
"more",
"past",
"months",
"fall",
"home",
"pain",
"history",
"trauma",
"knees",
"patient states",
"majority",
"pain starts",
"afternoon",
"active",
"time",
"pain resolves",
"rest",
"over-the-counter anal... |
A 27-year-old homeless man presents to the emergency department with abdominal pain and vomiting. He has a known history of intravenous drug use and has been admitted to the hospital several times before. On physical examination his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 90/min, respirati... | Buprenorphine | {
"A": "Buprenorphine",
"B": "Naltrexone",
"C": "Naloxone",
"D": "Buproprion"
} | step1 | A | [
"27 year old homeless man presents",
"emergency department",
"abdominal pain",
"vomiting",
"known history",
"intravenous drug use",
"admitted",
"hospital",
"times",
"physical examination",
"temperature",
"blood pressure",
"85 mmHg",
"pulse",
"90 min",
"respirations",
"min",
"pulse ... |
A 21-year-old gravida 1, para 0 woman presents to the family medicine clinic for her first prenatal appointment. She states that she has been taking folic acid supplements daily as directed by her mother. She smokes a few cigarettes a day and has done so for the last 5 years. Pediatric records indicate the patient is m... | MMR vaccine postpartum | {
"A": "MMR vaccine postpartum",
"B": "MMR vaccine during pregnancy",
"C": "Serology, then vaccine postpartum",
"D": "MMR vaccine and immune globulin postpartum"
} | step2&3 | A | [
"21-year-old gravida 1",
"para 0 woman presents",
"family medicine clinic",
"first prenatal appointment",
"states",
"taking folic acid supplements daily",
"directed",
"mother",
"smokes",
"few cigarettes",
"day",
"so",
"years",
"Pediatric records",
"patient",
"measles",
"mumps",
"ru... |
A 76-year-old woman with hypertension and coronary artery disease is brought to the emergency department after the sudden onset of right-sided weakness. Her pulse is 83/min and blood pressure is 156/90 mm Hg. Neurological examination shows right-sided facial drooping and complete paralysis of the right upper and lower ... | Contralateral lenticulostriate artery | {
"A": "Anterior spinal artery",
"B": "Contralateral middle cerebral artery",
"C": "Ipsilateral posterior inferior cerebellar artery",
"D": "Contralateral lenticulostriate artery"
} | step1 | D | [
"76 year old woman",
"hypertension",
"coronary artery disease",
"brought",
"emergency department",
"sudden onset",
"right-sided weakness",
"pulse",
"83 min",
"blood pressure",
"90 mm Hg",
"Neurological examination shows right-sided facial drooping",
"complete paralysis",
"right",
"lower ... |
A patient with history of hypertension and bipolar disorder is seen in your clinic for new-onset tremor, as well as intense thirst and frequent desire to urinate. Although her bipolar disorder was previously well-managed by medication, she has recently added a new drug to her regimen. Which of the following medications... | Hydrochlorothiazide | {
"A": "Furosemide",
"B": "Acetaminophen",
"C": "Hydrochlorothiazide",
"D": "Valproate"
} | step1 | C | [
"patient",
"history of hypertension",
"bipolar disorder",
"seen",
"clinic",
"new-onset tremor",
"intense thirst",
"frequent desire to",
"bipolar disorder",
"well managed",
"medication",
"recently added",
"new",
"regimen",
"following medications",
"likely start"
] |
A 70-year-old man presents with severe abdominal pain over the last 24 hours. He describes the pain as severe and associated with diarrhea, nausea, and vomiting. He says he has had a history of postprandial abdominal pain over the last several months. The patient denies any fever, chills, recent antibiotic use. Past me... | Atherosclerosis | {
"A": "Atherosclerosis",
"B": "Hypokalemia",
"C": "Bacterial infection",
"D": "Upper GI bleeding"
} | step1 | A | [
"70 year old man presents",
"severe abdominal",
"last 24 hours",
"pain",
"severe",
"associated with diarrhea",
"nausea",
"vomiting",
"history",
"postprandial abdominal pain",
"last",
"months",
"patient denies",
"fever",
"chills",
"recent antibiotic use",
"Past medical history",
"si... |
An investigator studying DNA mutation mechanisms isolates single-stranded DNA from a recombinant bacteriophage and sequences it. The investigator then mixes it with a buffer solution and incubates the resulting mixture at 70°C for 16 hours. Subsequent DNA resequencing shows that 3.7 per 1,000 cytosine residues have mut... | Creation of empty sugar-phosphate site | {
"A": "Cleavage of the phosphodiester bond 3' of damaged site",
"B": "Addition of free nucleotides to 3' end",
"C": "Connecting the phosphodiester backbone",
"D": "Creation of empty sugar-phosphate site"
} | step1 | D | [
"investigator studying DNA mutation mechanisms isolates single-stranded DNA",
"recombinant bacteriophage",
"sequences",
"investigator then mixes",
"buffer solution",
"incubates",
"resulting mixture",
"hours",
"Subsequent DNA resequencing shows",
"3",
"1",
"cytosine residues",
"mutated",
"u... |
A 72-year-old woman comes to the emergency department because of severe pain in her right lower leg for 3 hours. She has also had worsening tingling that started 3 hours before. She has never had such pain in her leg in the past. Over the last couple months, she has occasionally had episodes of palpitations. She has hy... | Synthesis of vitamin K-dependent factors | {
"A": "Voltage-gated cardiac potassium channels",
"B": "Receptors for platelet aggregation",
"C": "Synthesis of vitamin K-dependent factors",
"D": "Voltage-gated cardiac sodium channels"
} | step2&3 | C | [
"72 year old woman",
"emergency department",
"of severe pain in",
"right lower leg",
"3 hours",
"worsening tingling",
"started 3 hours",
"never",
"pain in",
"leg",
"past",
"last couple months",
"occasionally",
"episodes of palpitations",
"hypertension",
"type 2 diabetes mellitus",
"C... |
A healthy 20-year-old African American man presents to the clinic for pre-participation sports physical for college football. He has no health complaints at this time. He has no recent history of illness or injury. He denies chest pain and palpitations. He reports no prior syncopal episodes. He had surgery 2 years ago ... | Asymptomatic | {
"A": "Asymptomatic",
"B": "Infective endocarditis",
"C": "Atrial fibrillation",
"D": "Sudden cardiac death"
} | step2&3 | A | [
"healthy 20 year old African American man presents",
"clinic",
"pre participation sports physical",
"college football",
"health complaints",
"time",
"recent history",
"illness",
"injury",
"denies chest pain",
"palpitations",
"reports",
"prior syncopal episodes",
"surgery 2 years",
"appen... |
An 18-month-old boy is brought in by his parents because of failure to gain weight. This patient’s pregnancy and spontaneous transvaginal delivery were uneventful. His vital signs include: temperature 37.0°C (98.6°F), blood pressure 102/57 mm Hg, pulse 97/min. His height is at the 30th percentile and weight is at the 2... | Hemoglobin F | {
"A": "Hemoglobin Bart",
"B": "Hemoglobin F",
"C": "Hemoglobin A2",
"D": "Hemoglobin S"
} | step2&3 | B | [
"month old boy",
"brought",
"parents",
"failure to gain weight",
"patients pregnancy",
"spontaneous transvaginal delivery",
"vital signs include",
"temperature",
"98",
"blood pressure",
"57 mm Hg",
"pulse 97 min",
"height",
"percentile",
"weight",
"percentile",
"age",
"sex",
"Phy... |
A 3000-g (6-lb 10-oz) male newborn delivered at 38 weeks' gestation develops respiratory distress shortly after birth. Physical examination shows low-set ears, retrognathia, and club feet. Within a few hours, the newborn dies. Examination of the liver at autopsy shows periportal fibrosis. Which of the following is the ... | Cystic dilation of collecting duct | {
"A": "Bilateral hypoplasia of kidneys",
"B": "Mutation on the short arm of chromosome 16",
"C": "Valvular obstruction of urine outflow",
"D": "Cystic dilation of collecting duct"
} | step1 | D | [
"3000 g",
"10 oz",
"male newborn delivered",
"weeks",
"gestation",
"respiratory distress",
"birth",
"Physical examination shows low-set ears",
"retrognathia",
"club feet",
"few hours",
"newborn",
"Examination",
"liver",
"autopsy shows periportal fibrosis",
"following",
"most likely u... |
A 45-year-old bank manager presents emergency department with abdominal pain for the last 2 weeks. The patient also vomited a few times, and in the last hour, he vomited blood as well. His pain was mild in the beginning but now he describes the pain as 8/10 in intensity, stabbing, and relentless. Ingestion of food make... | Gastroduodenal artery | {
"A": "Right gastroepiploic artery",
"B": "Gastroduodenal artery",
"C": "Inferior pancreaticoduodenal artery",
"D": "Superior pancreaticoduodenal artery"
} | step1 | B | [
"year old bank manager presents emergency department",
"abdominal pain",
"last",
"weeks",
"patient",
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"few times",
"last hour",
"vomited blood",
"well",
"pain",
"mild",
"beginning",
"now",
"pain",
"8/10",
"intensity",
"stabbing",
"Ingestion",
"food makes",
"better",... |
A 2-year-old girl is brought to the doctor by her mother with persistent scratching of her perianal region. The patient’s mother says that symptoms started 3 days ago and have progressively worsened until she is nearly continuously scratching even in public places. She says that the scratching is worse at night and dis... | Enterobius vermicularis | {
"A": "Enterobius vermicularis",
"B": "Taenia saginata",
"C": "Ancylostoma duodenale",
"D": "Ascaris lumbricoides"
} | step1 | A | [
"2 year old girl",
"brought",
"doctor",
"mother",
"persistent scratching",
"perianal region",
"patients mother",
"symptoms started 3 days",
"worsened",
"nearly",
"scratching",
"public places",
"scratching",
"worse",
"night",
"sleep",
"anal swab",
"staining",
"lactophenol cotton b... |
A 29-year-old woman, gravida 2, para 1, at 17 weeks' gestation comes to the physician for a routine prenatal examination. A prenatal ultrasound at 10 weeks' gestation showed no abnormalities. Serum studies at 16 weeks' gestation showed an abnormally elevated α-fetoprotein level and normal beta human chorionic gonadotro... | Underestimation of gestational age | {
"A": "Robertsonian translocation",
"B": "Underestimation of gestational age",
"C": "Maternal hypothyroidism",
"D": "Gestational trophoblastic disease"
} | step1 | B | [
"29 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"routine prenatal examination",
"prenatal ultrasound",
"10 weeks",
"gestation showed",
"abnormalities",
"Serum studies",
"weeks",
"gestation showed",
"elevated",
"fetoprotein level",
"normal beta human cho... |
A 7-year-old boy is brought to the emergency department because of abdominal pain, nausea, and vomiting one day after he was a passenger in a low-velocity motor vehicle accident in which he was wearing an adult seatbelt. He has no personal or family history of serious illness. His temperature is 37.1°C (98.8°F), pulse ... | Nasogastric decompression and total parenteral nutrition | {
"A": "Oral rehydration therapy and early refeeding",
"B": "Esophagogastroduodenoscopy",
"C": "Focused assessment with sonography for trauma",
"D": "Nasogastric decompression and total parenteral nutrition"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"abdominal pain",
"nausea",
"vomiting one day",
"passenger",
"low velocity motor vehicle accident",
"adult seatbelt",
"personal",
"family history",
"serious illness",
"temperature",
"98",
"pulse",
"min",
"respirations",
"20 min",
... |
A 21-year-old woman presents for a routine check-up with a new primary care physician. She is concerned about a needle-stick that occurred 2 days ago while volunteering to clean a public park. She notes that she had about 8 drinks last night while celebrating her best friend's engagement. Otherwise she has been healthy... | Defective conjugation of bilirubin with glucuronic acid | {
"A": "Defective conjugation of bilirubin with glucuronic acid",
"B": "Defective secretion of bilirubin into the bile duct",
"C": "Excessive extravascular hemolysis",
"D": "Viral infection of hepatocytes"
} | step1 | A | [
"21-year-old woman presents",
"routine check-up",
"new primary care physician",
"concerned",
"needle-stick",
"occurred 2 days",
"volunteering to clean",
"public park",
"notes",
"about",
"drinks last night",
"best friend's engagement",
"healthy",
"past medical history",
"not smoke",
"dr... |
A 49-year-old woman is brought to the emergency department for a severe, sudden-onset generalized headache that began while she was riding an exercise bike at home that morning. After quickly getting off the bike and lying down, she lost consciousness. She was unconscious for a period of one minute. When she regained c... | Oral nimodipine | {
"A": "Intravenous fresh frozen plasma",
"B": "Intravenous sodium nitroprusside",
"C": "Oral nimodipine",
"D": "Oral aspirin and clopidogrel"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"severe",
"sudden-onset generalized headache",
"began",
"exercise bike at home",
"morning",
"getting",
"bike",
"lying",
"lost consciousness",
"unconscious",
"period",
"one minute",
"regained consciousness",
"neck stiffness",
"nau... |
A 28-year-old woman comes to the doctor with a sudden onset of edematous and hyperemic circular skin lesions all over her body. The lesions are not painful but are pruritic. She also complains of severe genital pruritus. The patient also reports that she ate peanut butter 15–20 minutes before the onset of symptoms. Her... | H1 receptor antagonists | {
"A": "One of the beta-lactam antibiotics",
"B": "No medications, just observation",
"C": "Corticosteroids",
"D": "H1 receptor antagonists"
} | step1 | D | [
"year old woman",
"doctor",
"sudden onset",
"edematous",
"hyperemic circular skin lesions",
"body",
"lesions",
"not painful",
"severe genital pruritus",
"patient",
"reports",
"ate peanut butter",
"minutes",
"onset",
"symptoms",
"blood pressure",
"76 mm Hg",
"heart rate",
"beats p... |
A 5-year-old girl with no significant medical history is brought to her pediatrician because her mother is concerned about her axillary hair development. She first noticed the hair growth a day prior as she was assisting her daughter in getting dressed. The girl has no physical complaints, and her mother has not notice... | Adrenal glands | {
"A": "Hypothalamus",
"B": "Pituitary",
"C": "Adrenal glands",
"D": "Neoplasm"
} | step2&3 | C | [
"5 year old girl",
"significant medical history",
"brought",
"pediatrician",
"mother",
"concerned",
"axillary hair development",
"first",
"hair growth",
"day prior",
"assisting",
"daughter",
"getting dressed",
"girl",
"physical complaints",
"mother",
"not",
"change in",
"behavior... |
While at the emergency room, a 43-year-old woman starts experiencing progressive chest pain, shortness of breath, dizziness, palpitations, bilateral arm numbness, and a feeling that she is choking. She originally came to the hospital after receiving the news that her husband was injured in a car accident. The symptoms ... | Administer clonazepam | {
"A": "Order D-dimers",
"B": "Order thyroid function tests",
"C": "Order echocardiogram",
"D": "Administer clonazepam"
} | step2&3 | D | [
"emergency room",
"year old woman starts experiencing progressive chest pain",
"shortness of breath",
"dizziness",
"palpitations",
"bilateral arm numbness",
"feeling",
"choking",
"hospital",
"receiving",
"news",
"husband",
"injured",
"car accident",
"symptoms began 5 minutes",
"patient... |
A 25-year-old previously healthy woman is admitted to the hospital with progressively worsening shortness of breath. She reports a mild fever. Her vital signs at the admission are as follows: blood pressure 100/70 mm Hg, heart rate 111/min, respiratory rate 20/min, and temperature 38.1℃ (100.6℉); blood saturation on ro... | FiO2 and PEEP | {
"A": "Tidal volume and respiratory rate",
"B": "Tidal volume and FiO2",
"C": "FiO2 and PEEP",
"D": "FiO2 and respiratory rate"
} | step2&3 | C | [
"year old",
"healthy woman",
"admitted",
"hospital",
"worsening shortness of breath",
"reports",
"mild fever",
"vital signs",
"admission",
"follows",
"blood pressure 100 70 mm Hg",
"heart rate",
"min",
"respiratory rate 20 min",
"temperature",
"100",
"blood saturation",
"room air",... |
A 23-year-old man comes to the emergency department because of a 2-day history of painful swelling of the right hand. There is no associated recent trauma. Physical examination shows a 3 × 3-cm area of induration that is fluctuant and warm to the touch, consistent with an abscess. The patient consents to incision and d... | Chloroprocaine | {
"A": "Mepivacaine",
"B": "Chloroprocaine",
"C": "Lidocaine",
"D": "Etidocaine"
} | step2&3 | B | [
"23 year old man",
"emergency department",
"of",
"2-day history",
"painful swelling",
"right hand",
"associated recent trauma",
"Physical examination shows",
"3",
"3",
"area of induration",
"fluctuant",
"warm",
"touch",
"consistent with",
"abscess",
"patient consents",
"incision",
... |
A 2-day-old boy, born at 38-weeks gestation, presents with jaundice and microcephaly. Social history reveals his mother is an animal caretaker. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 75/40 mm Hg, pulse 150/min, respiratory rate 40/min, and oxygen saturation 99% on room air. Physical examin... | CMV | {
"A": "CMV",
"B": "Varicella",
"C": "Toxoplasmosis",
"D": "Syphilis"
} | step2&3 | A | [
"2-day old boy",
"born",
"weeks gestation",
"presents",
"jaundice",
"microcephaly",
"Social history reveals",
"mother",
"animal caretaker",
"vital signs include",
"temperature",
"98",
"blood pressure 75 40 mm Hg",
"pulse",
"min",
"respiratory rate 40 min",
"oxygen 99",
"room air",
... |
A 72-year-old patient presents to the emergency department because of abdominal pain, diarrhea, and fever. He was started on levofloxacin for community-acquired pneumonia 2 weeks prior with resolution of his pulmonary symptoms. He has had hypertension for 20 years, for which he takes amlodipine. His temperature is 38.3... | Disruption of normal bowel flora and infection by spore-forming rods | {
"A": "Disruption of normal bowel flora and infection by spore-forming rods",
"B": "Autoimmune inflammation of the rectum",
"C": "Decreased blood flow to the gastrointestinal tract",
"D": "Presence of osmotically active, poorly absorbed solutes in the bowel lumen"
} | step2&3 | A | [
"72 year old patient presents",
"emergency department",
"abdominal pain",
"diarrhea",
"fever",
"started",
"levofloxacin",
"community-acquired pneumonia",
"weeks prior",
"resolution",
"pulmonary symptoms",
"hypertension",
"20 years",
"takes amlodipine",
"temperature",
"3C",
"pulse",
... |
A 31-year-old woman comes to the physician because of intermittent episodes of stabbing right lower jaw pain for 6 weeks. The pain is severe, sharp, and lasts for a few seconds. These episodes commonly occur when she washes her face, brushes her teeth, or eats a meal. She does not have visual disturbances, weakness of ... | Carbamazepine | {
"A": "Amoxicillin",
"B": "Carbamazepine",
"C": "Valacyclovir",
"D": "Doxepin"
} | step1 | B | [
"31 year old woman",
"physician",
"of intermittent episodes",
"stabbing right lower jaw pain",
"weeks",
"pain",
"severe",
"sharp",
"lasts",
"seconds",
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"occur",
"washes",
"face",
"brushes",
"teeth",
"eats",
"meal",
"not",
"visual disturbances",
"weakness",
"facia... |
A 2-year-old boy is brought to the physician because of fatigue and yellow discoloration of his skin for 2 days. One week ago, he had a 3-day course of low-grade fever and runny nose. As a newborn, he underwent a 5-day course of phototherapy for neonatal jaundice. His vital signs are within normal limits. Examination s... | Cholecystitis | {
"A": "Malaria",
"B": "Osteomyelitis",
"C": "Acute myelogenous leukemia",
"D": "Cholecystitis"
} | step2&3 | D | [
"2 year old boy",
"brought",
"physician",
"fatigue",
"yellow discoloration",
"skin",
"2 days",
"One week",
"3-day course",
"low-grade fever",
"runny nose",
"newborn",
"5-day course",
"phototherapy",
"neonatal jaundice",
"vital signs",
"normal limits",
"Examination shows jaundice",
... |
A 59-year-old woman presents to the emergency room with severe low back pain. She reports pain radiating down her left leg into her left foot. She also reports intermittent severe lower back spasms. The pain started after lifting multiple heavy boxes at her work as a grocery store clerk. She denies bowel or bladder dys... | S1 | {
"A": "L4",
"B": "L5",
"C": "S1",
"D": "S2"
} | step1 | C | [
"59 year old woman presents",
"emergency room",
"severe low back pain",
"reports pain radiating",
"left leg",
"left foot",
"reports intermittent severe lower back spasms",
"pain started",
"lifting multiple heavy boxes",
"work",
"grocery store clerk",
"denies bowel",
"bladder dysfunction",
... |
A 57-year-old man is brought to the emergency department by his wife 20 minutes after having had a seizure. He has had recurrent headaches and dizziness for the past 2 weeks. An MRI of the brain shows multiple, round, well-demarcated lesions in the brain parenchyma at the junction between gray and white matter. This pa... | Lung | {
"A": "Prostate",
"B": "Kidney",
"C": "Lung",
"D": "Skin"
} | step1 | C | [
"57 year old man",
"brought",
"emergency department",
"wife 20 minutes",
"seizure",
"recurrent headaches",
"dizziness",
"past 2 weeks",
"MRI of",
"brain shows multiple",
"round",
"well",
"lesions",
"brain parenchyma",
"junction",
"gray",
"white matter",
"patient's brain lesions",
... |
Two weeks after undergoing an emergency cardiac catheterization for unstable angina pectoris, a 65-year-old man has decreased urinary output. He takes naproxen for osteoarthritis and was started on aspirin, clopidogrel, and metoprolol after the coronary intervention. His temperature is 38.1°C (100.5°F), pulse is 96/min... | Cholesterol embolization | {
"A": "Allergic interstitial nephritis",
"B": "Cholesterol embolization",
"C": "Contrast-induced nephropathy",
"D": "Eosinophilic granulomatosis with polyangiitis"
} | step1 | B | [
"Two weeks",
"emergency cardiac catheterization",
"unstable angina pectoris",
"65 year old man",
"decreased urinary output",
"takes naproxen",
"osteoarthritis",
"started",
"aspirin",
"clopidogrel",
"metoprolol",
"coronary intervention",
"temperature",
"100",
"pulse",
"96 min",
"blood... |
A 25-year-old woman presents to an urgent care center following a bee sting while at a picnic with her friends. She immediately developed a skin rash and swelling over her arm and face. She endorses diffuse itching over her torso. Past medical history is significant for a mild allergy to pet dander and ragweed. She occ... | Type 1 - anaphylactic hypersensitivity reaction | {
"A": "Type 1 - anaphylactic hypersensitivity reaction",
"B": "Type 2 - cytotoxic hypersensitivity reaction",
"C": "Type 4 - cell mediated (delayed) hypersensitivity reaction",
"D": "Both A & B"
} | step2&3 | A | [
"year old woman presents",
"urgent care center following",
"bee sting",
"friends",
"immediately",
"skin rash",
"swelling",
"arm",
"face",
"diffuse itching",
"torso",
"Past medical history",
"significant",
"mild allergy",
"pet dander",
"ragweed",
"occasionally takes oral contraceptive... |
An investigator is studying the chemical structure of antibiotics and its effect on bacterial growth. He has synthesized a simple beta-lactam antibiotic and has added a bulky side chain to the molecule that inhibits the access of bacterial enzymes to the beta-lactam ring. The synthesized drug will most likely be approp... | Folliculitis | {
"A": "Nocardiosis",
"B": "Folliculitis",
"C": "Atypical pneumonia",
"D": "Otitis media"
} | step1 | B | [
"investigator",
"studying",
"chemical structure",
"antibiotics",
"effect",
"bacterial growth",
"synthesized",
"simple beta-lactam antibiotic",
"added",
"bulky side chain",
"molecule",
"inhibits",
"access",
"bacterial enzymes",
"beta-lactam ring",
"synthesized drug",
"most likely",
... |
A 31-year-old woman scrapes her finger on an exposed nail and sustains a minor laceration. Five minutes later, her finger is red, swollen, and painful. She has no past medical history and does not take any medications. She drinks socially with her friends and does not smoke. The inflammatory cell type most likely to be... | Segmented nuclei | {
"A": "Dark histamine containing granules",
"B": "Dramatically expanded endoplasmic reticulum",
"C": "Large cell with amoeboid movement",
"D": "Segmented nuclei"
} | step1 | D | [
"31 year old woman scrapes",
"finger",
"exposed nail",
"sustains",
"minor laceration",
"Five minutes later",
"finger",
"red",
"swollen",
"painful",
"past medical history",
"not take",
"medications",
"drinks",
"friends",
"not smoke",
"inflammatory cell type most likely to",
"promine... |
A 38-year-old woman presents to her surgeon 1 year after a surgery for Crohn disease involving the removal of much of her small bowel. She had no major complications during the surgery and recovered as expected. Since then, she has noticed bone pain and weakness throughout her body. She has also had several fractures s... | 7-dehydrocholesterol | {
"A": "7-dehydrocholesterol",
"B": "Alpha-tocopherol",
"C": "Calcium-sensing receptor",
"D": "Glutamyl carboxylase"
} | step1 | A | [
"year old woman presents",
"surgeon",
"year",
"surgery",
"Crohn disease involving",
"removal",
"small",
"major complications",
"surgery",
"recovered",
"expected",
"Since then",
"bone pain",
"weakness",
"body",
"several fractures",
"surgery",
"panel",
"labs relevant",
"bone phys... |
A 7-month-old girl is brought to the pediatrician by her parents with a mild, persistent fever for the past week. The patient’s mother also states she is feeding poorly and has become somewhat lethargic. The patient was born at term and the delivery was uncomplicated. The child’s birth weight was 3.5 kg (7.7 lb) and at... | Isoniazid alone | {
"A": "No medication is required",
"B": "Isoniazid alone",
"C": "Isoniazid and rifampicin",
"D": "Isoniazid, rifampicin, and pyrazinamide"
} | step1 | B | [
"month old girl",
"brought",
"pediatrician",
"parents",
"mild",
"persistent",
"past week",
"patients mother",
"states",
"feeding poorly",
"somewhat lethargic",
"patient",
"born",
"term",
"delivery",
"uncomplicated",
"childs birth weight",
"3.5 kg",
"7.7",
"months",
"0 kg",
... |
A 63-year-old man comes to the physician because of a 2-month history of progressive fatigue. He also has shortness of breath and palpitations, which worsen on physical exertion and improve with rest. He has had intermittent constipation, low-grade fever, and generalized myalgia for the past 3 months. He has had a 10.4... | A villous adenomatous polyp | {
"A": "A submucosal lipomatous polyp",
"B": "A villous adenomatous polyp",
"C": "A serrated hyperplastic polyp",
"D": "A tubular adenomatous polyp"
} | step2&3 | B | [
"63 year old man",
"physician",
"2 month history",
"progressive fatigue",
"shortness of breath",
"palpitations",
"worsen",
"physical exertion",
"rest",
"intermittent constipation",
"low-grade fever",
"generalized myalgia",
"past 3 months",
"a 10 kg",
"23",
"weight loss",
"past",
"m... |
A 51-year-old woman is brought into the emergency department following a motor vehicle accident. She is unconscious and was intubated in the field. Past medical history is unknown. Upon arrival, she is hypotensive and tachycardic. Her temperature is 37.2°C (99.1°F), the pulse is 110/min, the respiratory rate is 22/min,... | Hypovolemic shock | {
"A": "Neurogenic shock",
"B": "Cardiogenic shock",
"C": "Obstructive shock",
"D": "Hypovolemic shock"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department following",
"motor vehicle accident",
"unconscious",
"intubated in the field",
"Past medical history",
"unknown",
"arrival",
"hypotensive",
"tachycardic",
"temperature",
"99",
"pulse",
"min",
"respiratory rate",
"min",
"blood press... |
A 17-year-old girl comes to the emergency department because of a 6-day history of gradual onset abdominal pain, fever, vomiting, and decreased appetite. Her pain started as dull and diffuse over the abdomen but has progressed to a sharp pain on her right side. She has taken ibuprofen twice daily since the onset of sym... | Continue conservative management and schedule appendectomy in 6-8 weeks | {
"A": "Correct electrolyte imbalances and proceed to the operating room for urgent open laparotomy",
"B": "Continue conservative management and schedule appendectomy in 6-8 weeks",
"C": "Continue conservative management only",
"D": "Correct electrolyte imbalances and proceed to the operating room for laparosco... | step2&3 | B | [
"year old girl",
"emergency department",
"of",
"6-day history",
"gradual onset abdominal pain",
"fever",
"vomiting",
"decreased appetite",
"pain started",
"dull",
"diffuse",
"abdomen",
"progressed",
"sharp pain",
"right side",
"taken ibuprofen twice daily",
"onset",
"symptoms",
"... |
A 61-year-old woman presents to the urgent care unit with a 2-week history of abdominal pain after meals. The patient reports vomiting over the past few days. The past medical history is significant for osteoarthritis and systemic lupus erythematosus. She regularly drinks alcohol. She does not smoke cigarettes. The pat... | Acute pancreatitis | {
"A": "Acute liver failure",
"B": "Acute cholecystitis",
"C": "Acute pancreatitis",
"D": "Acute mesenteric ischemia"
} | step2&3 | C | [
"61 year old woman presents",
"urgent care unit",
"2-week history",
"abdominal pain",
"meals",
"patient reports vomiting",
"past",
"days",
"past medical history",
"significant",
"osteoarthritis",
"systemic lupus erythematosus",
"drinks alcohol",
"not smoke cigarettes",
"patient currently... |
A 65-year-old male engineer presents to the office with shortness of breath on exertion and a dry cough that he has had for about a year. He is a heavy smoker with a 25-pack-years history. His vitals include: heart rate 95/min, respiratory rate 26/min, and blood pressure 110/75 mm Hg. On examination, he presents with n... | Idiopathic pulmonary fibrosis | {
"A": "Pleuropulmonary fibroelastosis",
"B": "Pulmonary Langerhans cells histiocytosis",
"C": "Chronic hypersensitivity pneumonitis",
"D": "Idiopathic pulmonary fibrosis"
} | step1 | D | [
"65 year old male engineer presents",
"office",
"shortness of breath",
"exertion",
"dry cough",
"about",
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"heavy smoker",
"pack-years history",
"include",
"heart rate 95 min",
"respiratory rate",
"min",
"blood pressure",
"75 mm Hg",
"examination",
"presents",
"nail clubbing"... |
A 47-year-old patient returns to his primary care physician after starting aspirin two weeks ago for primary prevention of coronary artery disease. He complains that he wakes up short of breath in the middle of the night and has had coughing "attacks" three times. After discontinuing aspirin, what medication is most ap... | Montelukast | {
"A": "Tiotropium",
"B": "Prednisone",
"C": "Montelukast",
"D": "Fluticasone"
} | step1 | C | [
"year old patient returns",
"primary care physician",
"starting aspirin two weeks",
"primary of coronary artery disease",
"wakes up short",
"breath",
"middle",
"night",
"coughing",
"attacks",
"three times",
"discontinuing aspirin",
"medication",
"most appropriate",
"prevention",
"simil... |
A 54-year-old man with hypertension and congenital blindness comes to the physician because he is unable to recognize objects by touch with his right hand. The symptoms started about 2 hours ago. When given a house key, he can feel the object in his right hand but is not able to identify what it is. This patient's cond... | Contralateral superior parietal lobule | {
"A": "Ipsilateral inferior frontal gyrus",
"B": "Contralateral superior parietal lobule",
"C": "Contralateral precentral gyrus",
"D": "Ipsilateral cingulate gyrus"
} | step1 | B | [
"54 year old man",
"hypertension",
"congenital blindness",
"physician",
"unable to",
"objects",
"touch",
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"symptoms started",
"hours",
"given",
"house",
"feel",
"object",
"right hand",
"not able to",
"patient's condition",
"most likely caused",
"lesion",
"following... |
A 62-year-old man presents to his primary care physician because he is unhappy about his inability to tan this summer. He has been going to the beach with his family and friends, but he has remained pale. He has no other complaints except that he has been getting tired more easily, which he attributes to normal aging. ... | Aortic valve replacement | {
"A": "Aortic valve replacement",
"B": "Consumption of fava beans",
"C": "Infection of red blood cells",
"D": "Red urine in the morning"
} | step1 | A | [
"62 year old man presents",
"primary care physician",
"unhappy",
"to tan",
"summer",
"beach",
"family",
"friends",
"pale",
"complaints except",
"getting tired more easily",
"attributes",
"normal aging",
"Based",
"clinical suspicion",
"panel",
"tests",
"performed",
"following resu... |
A 37-year-old primigravid woman comes to the physician at 13 weeks' gestation for a prenatal visit. She feels well. Her only medication is folic acid. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 13-week gestation. Ultrasonography shows a nuchal translucency above th... | Chorionic villus sampling | {
"A": "Chorionic villus sampling",
"B": "Quadruple marker test",
"C": "Cell-free DNA testing",
"D": "Amniocentesis"
} | step2&3 | A | [
"year old primigravid woman",
"physician",
"weeks",
"gestation",
"prenatal visit",
"feels well",
"only medication",
"folic acid",
"Vital signs",
"normal limits",
"Pelvic examination shows",
"uterus consistent",
"size",
"week gestation",
"Ultrasonography shows",
"nuchal translucency",
... |
A 10-month-old boy with a seizure disorder is brought to the physician by his mother because of a 2-day history of vomiting and lethargy. Laboratory studies show a decreased serum glucose concentration. Further testing confirms a deficiency in an enzyme involved in lipid metabolism that is found in the liver but not in... | Glycerol kinase | {
"A": "Glycerol-3-phosphate dehydrogenase",
"B": "Glycerol kinase",
"C": "Acetyl-CoA carboxylase",
"D": "HMG-CoA reductase"
} | step1 | B | [
"10 month old boy",
"seizure disorder",
"brought",
"physician",
"mother",
"2-day history",
"vomiting",
"lethargy",
"Laboratory studies show",
"decreased serum glucose concentration",
"Further testing confirms",
"deficiency",
"enzyme involved",
"lipid metabolism",
"found",
"liver",
"n... |
A 38-year-old woman comes to the physician for the first time because of a 2-year history of lower back pain and fatigue. She also says that she occasionally feels out of breath. Her symptoms are not associated with physical activity. She has seen multiple physicians over the past year. Extensive workup including blood... | """I would like to assess your symptoms causing you the most distress and schedule monthly follow-up appointments.""" | {
"A": "\"\"\"I would like to investigate your shortness of breath by performing coronary artery catheterization.\"\"\"",
"B": "\"\"\"Your symptoms are suggestive of a condition called somatic symptom disorder.\"\"\"",
"C": "\"\"\"I would like to assess your symptoms causing you the most distress and schedule mon... | step1 | C | [
"year old woman",
"physician",
"first time",
"of",
"year history",
"lower back pain",
"fatigue",
"occasionally feels out of breath",
"symptoms",
"not associated with physical activity",
"seen multiple physicians",
"past year",
"Extensive workup including blood",
"urine tests",
"abdominal... |
A 24-year-old woman arrives to an urgent care clinic for "eye discoloration." She states that for the past 3 days she has had the “stomach flu” and has not been eating much. Today, she reports she is feeling better, but when she woke up "the whites of [her] eyes were yellow." She denies fever, headache, palpitations, a... | Rotor syndrome | {
"A": "Cholelithiasis",
"B": "Crigler-Najjar syndrome",
"C": "Dubin-Johnson syndrome",
"D": "Rotor syndrome"
} | step2&3 | D | [
"year old woman",
"urgent care clinic",
"eye discoloration",
"states",
"past 3 days",
"stomach flu",
"not",
"eating much",
"Today",
"reports",
"feeling better",
"woke up",
"whites",
"eyes",
"yellow",
"denies fever",
"headache",
"palpitations",
"abdominal pain",
"nausea",
"vom... |
A 16-year-old male presents to an ophthalmologist as a new patient with a complaint of blurry vision. He reports that over the past several months he has had increasing difficulty seeing the board from the back of the classroom at school. The patient is otherwise doing well in school and enjoys playing basketball. His ... | Mutation of gene on chromosome 15 | {
"A": "Defective metabolism of methionine",
"B": "Mutation of gene on chromosome 15",
"C": "Mutation of COL5A1 or COL5A2",
"D": "Mutation of RET proto-oncogene"
} | step2&3 | B | [
"year old male presents",
"ophthalmologist",
"new patient",
"complaint",
"blurry vision",
"reports",
"past",
"months",
"increasing difficulty seeing",
"board",
"back of",
"classroom",
"school",
"patient",
"well",
"school",
"playing basketball",
"past medical history",
"significan... |
An 11-year-old boy is brought to the physician by his mother because of teacher complaints regarding his poor performance at school for the past 8 months. He has difficulty sustaining attention when assigned school-related tasks, does not follow the teachers' instructions, and makes careless mistakes in his homework. H... | Elevated blood pressure | {
"A": "Serotonin syndrome",
"B": "Increased BMI",
"C": "Decreased perspiration",
"D": "Elevated blood pressure"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"mother",
"teacher complaints",
"poor performance",
"school",
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"months",
"difficulty sustaining attention",
"assigned school related tasks",
"not follow",
"teachers",
"instructions",
"makes",
"mistakes",
"homework",
"often",
"out ans... |
A 14-year-old boy is brought in to the clinic by his parents for weird behavior for the past 4 months. The father reports that since the passing of his son's pet rabbit about 5 months ago, his son has been counting during meals. It could take up to 2 hours for him to finish a meal as he would cut up all his food and ar... | Increased activity of the caudate | {
"A": "Atrophy of the frontotemporal lobes",
"B": "Decreased level of serotonin",
"C": "Enlargement of the ventricles",
"D": "Increased activity of the caudate"
} | step1 | D | [
"year old boy",
"brought",
"clinic",
"parents",
"behavior",
"past",
"months",
"father reports",
"son's pet rabbit",
"5 months",
"son",
"counting",
"meals",
"take",
"hours",
"to finish",
"meal",
"cut",
"food",
"certain",
"parents to leave",
"room",
"reason",
"behaviors",... |
A 2720-g (6-lb) female newborn is delivered at term to a 39-year-old woman, gravida 3, para 2. Examination in the delivery room shows micrognathia, prominent occiput with flattened nasal bridge, and pointy low-set ears. The eyes are upward slanting with small palpebral fissures. The fists are clenched with fingers tigh... | Trisomy 18 | {
"A": "Trisomy 18",
"B": "Fetal alcohol syndrome",
"C": "Deletion of Chromosome 5p",
"D": "Trisomy 13"
} | step1 | A | [
"g",
"female newborn",
"delivered",
"term",
"year old woman",
"gravida 3",
"para 2",
"Examination",
"delivery shows micrognathia",
"prominent",
"flattened",
"pointy low-set ears",
"eyes",
"upward slanting",
"small palpebral fissures",
"fists",
"clenched",
"fingers",
"flexed",
"... |
You are a resident on an anesthesiology service and are considering using nitrous oxide to assist in placing a laryngeal mask airway (LMA) in your patient, who is about to undergo a minor surgical procedure. You remember that nitrous oxide has a very high minimal alveolar concentration (MAC) compared to other anestheti... | decreased lipid solubility and decreased potency | {
"A": "decreased lipid solubility and decreased potency",
"B": "increased lipid solubility and decreased potency",
"C": "decreased lipid solubility and increased potency",
"D": "increased lipid solubility and increased potency"
} | step1 | A | [
"resident",
"anesthesiology service",
"considering using nitrous oxide to assist",
"placing",
"laryngeal mask airway",
"patient",
"to",
"minor surgical procedure",
"remember",
"nitrous oxide",
"very high minimal alveolar concentration",
"compared",
"anesthetics",
"means",
"nitrous oxide"... |
A 72-year-old man with congestive heart failure is brought to the emergency department because of chest pain, shortness of breath, dizziness, and palpitations for 30 minutes. An ECG shows a wide complex tachycardia with a P-wave rate of 105/min, an R-wave rate of 130/min, and no apparent relation between the two. Intra... | Quinidine
" | {
"A": "Carvedilol",
"B": "Flecainide",
"C": "Sotalol",
"D": "Quinidine\n\""
} | step1 | D | [
"72 year old man",
"congestive heart failure",
"brought",
"emergency department",
"chest pain",
"shortness of breath",
"dizziness",
"palpitations",
"30 minutes",
"ECG shows",
"wide complex tachycardia",
"P-wave rate",
"min",
"R rate",
"min",
"apparent relation",
"two",
"Intravenous... |
An 18-year-old woman comes to the physician because of worsening headache and exertional dyspnea for 6 days. Two months ago, she had a spontaneous abortion. Since then, she has had intermittent bloody vaginal discharge. Pelvic examination shows blood at the cervical os and a tender, mildly enlarged uterus. A urine preg... | Cytotrophoblasts and syncytiotrophoblasts without chorionic villi | {
"A": "Whorled pattern of smooth muscle fibers surrounded by a pseudocapsule",
"B": "Poorly differentiated glandular cells with myometrial invasion",
"C": "Cytotrophoblasts and syncytiotrophoblasts without chorionic villi",
"D": "Glomeruli-like central blood vessels enveloped by germ cells"
} | step1 | C | [
"year old woman",
"physician",
"worsening headache",
"exertional dyspnea",
"6 days",
"Two months",
"spontaneous abortion",
"then",
"intermittent bloody vaginal discharge",
"Pelvic examination shows blood",
"cervical os",
"tender",
"mildly enlarged uterus",
"urine pregnancy test",
"positi... |
A 22-year-old woman presents to the gynecologist for evaluation of amenorrhea and dyspareunia. The patient states that she recently got married and has been worried about getting pregnant. The patient states that she has never had a period and that sex has always been painful. On examination, the patient is Tanner stag... | Mullerian agenesis | {
"A": "Exposure to DES in utero",
"B": "Turner syndrome",
"C": "PCOS",
"D": "Mullerian agenesis"
} | step1 | D | [
"year old woman presents",
"gynecologist",
"evaluation",
"amenorrhea",
"dyspareunia",
"patient states",
"recently got married",
"worried",
"getting pregnant",
"patient states",
"never",
"period",
"sex",
"always",
"painful",
"examination",
"patient",
"Tanner stage 5",
"development... |
A previously healthy 61-year-old man comes to the physician because of bilateral knee pain for the past year. The pain is worse with movement and is relieved with rest. Physical examination shows crepitus, pain, and decreased range of motion with complete flexion and extension of both knees. There is no warmth, redness... | Naproxen | {
"A": "Naproxen",
"B": "Allopurinol",
"C": "Celecoxib",
"D": "Infliximab"
} | step1 | A | [
"healthy 61 year old man",
"physician",
"of bilateral knee pain",
"past year",
"pain",
"worse",
"movement",
"relieved with rest",
"Physical examination shows crepitus",
"pain",
"decreased range of motion",
"complete flexion",
"extension",
"knees",
"warmth",
"redness",
"swelling",
"... |
A researcher is studying how electrical activity propagates across the heart. In order to do this, he decides to measure the rate at which an action potential moves within various groups of cardiac muscle tissue. In particular, he isolates fibers from areas of the heart with the following characteristics:
A) Dysfuncti... | A > D > C > B | {
"A": "A > D > C > B",
"B": "B > C > D > A",
"C": "B > D > C > A",
"D": "D > C > A > B"
} | step1 | A | [
"researcher",
"studying",
"electrical activity",
"heart",
"order",
"to measure",
"rate",
"action potential moves",
"various groups",
"cardiac muscle tissue",
"isolates fibers",
"areas",
"heart",
"following characteristics",
"Dysfunction leads",
"fixed PR intervals",
"dropped beat",
... |
A 35-year-old nulligravid woman and her 33-year-old husband come to the physician for genetic counseling prior to conception. The husband has had severe psoriasis since adolescence that is now well-controlled under combination treatment with UV light therapy and etanercept. His father and two brothers also have this co... | Schizophrenia | {
"A": "Schizophrenia",
"B": "Alport syndrome",
"C": "Oculocutaneous albinism",
"D": "Familial hypercholesterolemia"
} | step1 | A | [
"35 year old nulligravid woman",
"year old husband",
"physician",
"genetic counseling prior to conception",
"husband",
"severe psoriasis",
"adolescence",
"now well-controlled",
"combination treatment",
"UV light therapy",
"etanercept",
"father",
"two brothers",
"condition",
"couple",
"... |
A 27-year old woman comes to the physician for a rash that began 5 days ago. The rash involves her abdomen, back, arms, and legs, including her hands and feet. Over the past month, she has also had mild fever, headache, and myalgias. She has no personal history of serious illness. She smokes 1 pack of cigarettes a day ... | PCR for C. trachomatis and N. gonorrhea | {
"A": "Lumbar puncture",
"B": "Blood cultures",
"C": "CT angiography of the chest",
"D": "PCR for C. trachomatis and N. gonorrhea"
} | step2&3 | D | [
"27 year old woman",
"physician",
"rash",
"began 5 days",
"rash",
"abdomen",
"back",
"arms",
"legs",
"including",
"hands",
"feet",
"past month",
"mild fever",
"headache",
"myalgias",
"personal history",
"serious illness",
"smokes 1 pack",
"cigarettes",
"day",
"binge drinks"... |
A 35-year-old woman seeks evaluation at a clinic with a complaint of right upper abdominal pain for greater than 1 month. She says that the sensation is more of discomfort than pain. She denies any history of weight loss, changes in bowel habit, or nausea. Her medical history is unremarkable. She takes oral contracepti... | Discontinue oral contraceptives | {
"A": "Discontinue oral contraceptives",
"B": "Radiofrequency ablation (RFA)",
"C": "CT-guided biopsy",
"D": "Referral for surgical excision"
} | step1 | A | [
"35 year old woman",
"evaluation",
"clinic",
"complaint",
"right upper",
"greater than",
"month",
"sensation",
"more",
"discomfort",
"pain",
"denies",
"history of weight loss",
"changes in bowel habit",
"nausea",
"medical history",
"unremarkable",
"takes oral contraceptive pills",
... |
A 30-year-old woman presents to her physician for a routine check-up. She says she is planning to get pregnant. Past medical history is significant for arterial hypertension. Current medications are enalapril. The physician explains that this medication can be teratogenic. He changes her antihypertensive medication to ... | Typical blood smear findings include spherocytes. | {
"A": "The direct Coombs test is positive if there are antibodies in the serum.",
"B": "Typical blood smear findings include spherocytes.",
"C": "The indirect Coombs test is positive if red blood cells are coated with antibody or complement.",
"D": "Heinz bodies are common findings in blood smear."
} | step1 | B | [
"30 year old woman presents",
"physician",
"routine check-up",
"planning to",
"pregnant",
"Past medical history",
"significant",
"arterial hypertension",
"Current medications",
"enalapril",
"physician",
"medication",
"teratogenic",
"changes",
"antihypertensive medication",
"methyldopa"... |
A 30-year-old woman comes to the primary care physician because she has felt nauseous and fatigued for 3 weeks. Menses occur at irregular 24- to 33-day intervals and last for 4–6 days. Her last menstrual period was 7 weeks ago. Her temperature is 37°C (98.6°F), pulse is 95/min, and blood pressure is 100/70 mm Hg. Pelvi... | Dichorionic-diamniotic twins | {
"A": "Abdominal pregnancy",
"B": "Dichorionic-diamniotic twins",
"C": "Partial hydatidiform mole",
"D": "Complete hydatid mole"
} | step2&3 | B | [
"30 year old woman",
"primary care physician",
"felt nauseous",
"fatigued",
"weeks",
"Menses occur",
"irregular",
"day intervals",
"last",
"days",
"last menstrual period",
"weeks",
"temperature",
"98",
"pulse",
"95 min",
"blood pressure",
"100 70 mm Hg",
"Pelvic examination shows... |
A 38-year-old primigravid woman at 34 weeks' gestation comes to the emergency department because of progressive shortness of breath for 3 hours. At a prenatal visit 2 weeks earlier, she was diagnosed with gestational hypertension. Amniocentesis with chromosomal analysis was performed at 16 weeks' gestation and showed n... | Pulmonary edema | {
"A": "Pulmonary edema",
"B": "Amniotic fluid embolism",
"C": "Pulmonary metastases",
"D": "Pulmonary thromboembolism"
} | step2&3 | A | [
"year old primigravid woman",
"weeks",
"gestation",
"emergency department",
"of progressive shortness",
"breath",
"3 hours",
"prenatal visit",
"weeks earlier",
"diagnosed",
"gestational hypertension",
"Amniocentesis",
"chromosomal analysis",
"performed",
"weeks",
"gestation",
"showed... |
A 12-year-old girl presents to a pediatrician because she fails to show signs of breast development. On physical examination, the pediatrician notes that her stature is shorter than expected for her age and sex. She has a webbed neck, a low posterior hairline, and a broad chest with widely spaced nipples. Non-pitting b... | A short systolic murmur along the left sternal border in the third and fourth intercostal spaces which radiates to the left infrascapular area | {
"A": "A short systolic murmur along the left sternal border in the third and fourth intercostal spaces which radiates to the left infrascapular area",
"B": "A continuous machine-like murmur over the second left intercostal space which radiates to the left clavicle",
"C": "A high-pitched holosystolic murmur over... | step2&3 | A | [
"year old girl presents",
"pediatrician",
"fails to show signs",
"breast development",
"physical examination",
"pediatrician notes",
"stature",
"shorter",
"expected",
"age",
"sex",
"webbed neck",
"low posterior hairline",
"broad chest",
"widely spaced nipples",
"Non-pitting bilateral p... |
A 56-year-old woman is one week status post abdominal hysterectomy when she develops a fever of 101.4°F (38.6°C). Her past medical history is significant for type II diabetes mellitus and a prior history of alcohol abuse. The operative report and intraoperative cystoscopy indicate that the surgery was uncomplicated. Th... | Wound infection | {
"A": "Surgical error",
"B": "Post-operative ileus",
"C": "Urinary tract infection",
"D": "Wound infection"
} | step2&3 | D | [
"year old woman",
"one week status post abdominal hysterectomy",
"fever",
"4F",
"past medical history",
"significant",
"type II diabetes mellitus",
"prior history of alcohol abuse",
"operative report",
"intraoperative cystoscopy",
"surgery",
"uncomplicated",
"nurse reports",
"surgery",
"... |
A 34-year-old man is admitted to the emergency department after a motor vehicle accident in which he sustained blunt abdominal trauma. On admission, he is conscious, has a GCS score of 15, and has normal ventilation with no signs of airway obstruction. Vitals initially are blood pressure 95/65 mmHg, heart rate 87/min, ... | Low-density areas within the splenic parenchyma | {
"A": "Irregular linear areas of hypoattenuation in the liver parenchyma",
"B": "Subdiaphragmatic air collection",
"C": "Low-density areas within the splenic parenchyma",
"D": "Herniation of the stomach into the thoracic cavity"
} | step2&3 | C | [
"year old man",
"admitted",
"emergency department",
"motor vehicle accident",
"sustained blunt abdominal trauma",
"admission",
"conscious",
"GCS score",
"15",
"normal ventilation",
"signs",
"airway obstruction",
"Vitals initially",
"blood pressure 95 65 mmHg",
"heart rate 87 min",
"res... |
A 23-year-old man comes to the physician because of a tremor in his right hand for the past 3 months. The tremor has increased in intensity and he is unable to perform his daily activities. When he wakes up in the morning, his pillow is soaked in saliva. During this period, he has been unable to concentrate in his coll... | Penicillamine | {
"A": "Penicillamine",
"B": "Deferoxamine",
"C": "Prednisone",
"D": "Levodopa\n\""
} | step2&3 | A | [
"23 year old man",
"physician",
"of",
"tremor",
"right hand",
"past 3 months",
"tremor",
"increased",
"intensity",
"unable to perform",
"daily activities",
"wakes up",
"morning",
"pillow",
"soaked",
"saliva",
"period",
"unable to concentrate",
"college classes",
"several falls"... |
A 30-year-old man returns to the hospital 3 weeks after open reduction and internal fixation of left tibia and fibula fractures from a motor vehicle accident. The patient complains that his surgical site has been draining pus for a few days, and his visiting nurse told him to go to the emergency room after he had a fev... | Toxic shock syndrome toxin 1 | {
"A": "Alpha toxin",
"B": "Endotoxin",
"C": "Pyogenic exotoxin A",
"D": "Toxic shock syndrome toxin 1"
} | step1 | D | [
"30 year old man returns",
"hospital 3 weeks",
"open reduction",
"internal fixation of left tibia",
"fibula fractures",
"motor vehicle accident",
"patient",
"surgical site",
"draining pus",
"days",
"visiting nurse",
"to go",
"emergency room",
"fever",
"morning",
"exam",
"temperature"... |
A 76-year-old woman comes to the physician because of a sudden loss of vision in her right eye for 10 minutes that morning, which subsided spontaneously. Over the past 2 months, she has had multiple episodes of left-sided headaches and pain in her jaw while chewing. Examination shows conjunctival pallor. Range of motio... | ↓ ↑ ↓ ↓ | {
"A": "↓ ↓ ↓ ↓",
"B": "↑ ↑ ↓ ↑",
"C": "↓ ↓ ↑ ↓",
"D": "↓ ↑ ↓ ↓"
} | step1 | D | [
"76 year old woman",
"physician",
"of",
"sudden loss",
"vision",
"right eye",
"10 minutes",
"morning",
"past",
"months",
"multiple episodes of left-sided headaches",
"pain in",
"jaw",
"chewing",
"Examination shows conjunctival pallor",
"Range of motion of",
"shoulders",
"hips",
"... |
A 32-year-old man with hypertension and gout comes to the physician with left flank pain and bloody urine for two days. He does not smoke cigarettes but drinks two beers daily. Home medications include hydrochlorothiazide and ibuprofen as needed for pain. Physical examination shows left costovertebral angle tenderness.... | Urinary tract infection | {
"A": "Urinary tract infection",
"B": "Uric acid precipitation",
"C": "Ethylene glycol ingestion",
"D": "Hereditary deficiency in amino acid reabsorption"
} | step1 | A | [
"year old man",
"hypertension",
"gout",
"physician",
"left flank pain",
"bloody urine",
"two days",
"not smoke cigarettes",
"drinks two beers daily",
"Home medications include hydrochlorothiazide",
"ibuprofen as needed",
"pain",
"Physical examination shows left costovertebral angle tendernes... |
A 25-year-old woman presents to the psychiatric emergency department in restraints. She was found trying to break into a deli at midnight. The patient claims that she has an idea that will revolutionize the shipping industry. The patient is not violent but seems highly agitated and is speaking very rapidly about her id... | Change diuretics | {
"A": "Change diuretics",
"B": "Increase captopril dose",
"C": "Increase chlorthalidone dose",
"D": "Ultrasound of the renal arteries"
} | step2&3 | A | [
"year old woman presents",
"psychiatric emergency department",
"restraints",
"found",
"to break",
"midnight",
"patient",
"idea",
"shipping industry",
"patient",
"not violent",
"highly agitated",
"speaking very rapidly",
"ideas",
"easily distractible",
"about",
"ideas",
"past medica... |
A 24-year-old man comes to the physician with his wife because of difficulty conceiving during the past year. He emigrated from rural Romania 2 years ago and has a history of recurrent respiratory infections since childhood for which he has not sought treatment. Physical examination shows mild hepatomegaly and clubbing... | Adenosine triphosphate | {
"A": "Adenosine triphosphate",
"B": "γ-aminobutyric acid",
"C": "N-methyl-D-aspartate",
"D": "Cyclic guanosine monophosphate\n\""
} | step1 | A | [
"year old man",
"physician",
"wife",
"difficulty conceiving",
"past year",
"rural Romania",
"years",
"history",
"recurrent respiratory infections",
"childhood",
"not",
"treatment",
"Physical examination shows mild hepatomegaly",
"clubbing of",
"nail beds",
"Serum alanine aminotransfera... |
You examine an infant in your office. On exam you observe hypotonia, as well as the findings shown in Figures A and B. You order laboratory testing, which demonstrates the findings shown in Figure C. Which of the following is the most likely pathologic mechanism involved? | Accumulation of sphingomyelin | {
"A": "Accumulation of galactocerebroside",
"B": "Accumulation of sphingomyelin",
"C": "Accumulation of GM2 ganglioside",
"D": "Accumulation of glucocerebroside"
} | step1 | B | [
"infant",
"office",
"exam",
"observe hypotonia",
"findings shown",
"order laboratory testing",
"demonstrates",
"findings shown",
"following",
"most likely pathologic mechanism involved"
] |
A research study is comparing 2 novel tests for the diagnosis of Alzheimer’s disease (AD). The first is a serum blood test, and the second is a novel PET radiotracer that binds to beta-amyloid plaques. The researchers intend to have one group of patients with AD assessed via the novel blood test, and the other group as... | Measurement bias | {
"A": "Measurement bias",
"B": "Confounding bias",
"C": "Recall bias",
"D": "Lead-time bias"
} | step2&3 | A | [
"research study",
"comparing 2 novel tests",
"diagnosis",
"Alzheimers disease",
"first",
"serum blood test",
"second",
"novel PET radiotracer",
"binds",
"beta",
"researchers",
"to",
"one group",
"patients",
"AD assessed",
"novel blood test",
"group assessed",
"novel PET examination... |
A 54-year-old man presents with fever, abdominal pain, nausea, and bloody diarrhea. He says that his symptoms started 36 hours ago and have not improved. Past medical history is significant for a left-leg abscess secondary to an injury he sustained from a fall 4 days ago while walking his dog. He has been taking clinda... | Vancomycin | {
"A": "Ciprofloxacin",
"B": "Vancomycin",
"C": "Erythromycin",
"D": "Trimethoprim-sulfamethoxazole"
} | step1 | B | [
"54 year old man presents",
"fever",
"abdominal pain",
"nausea",
"bloody diarrhea",
"symptoms started 36 hours",
"not improved",
"Past medical history",
"significant",
"left secondary to",
"injury",
"sustained",
"fall 4 days",
"walking",
"dog",
"taking clindamycin",
"infection",
"a... |
A 36-year-old man with a history of a stab wound to the right upper thigh one year previously presents to the emergency department with complaints of difficulty breathing while lying flat. Physical examination reveals an S3 gallop, hepatomegaly, warm skin and a continuous bruit over the right upper thigh. Which of the ... | Increased venous return | {
"A": "Decreased sympathetic output",
"B": "Increased venous return",
"C": "Decreased contractility",
"D": "Increased pulmonary resistance"
} | step1 | B | [
"36 year old man",
"history",
"stab",
"right one year",
"presents",
"emergency department",
"complaints",
"difficulty breathing",
"lying flat",
"Physical examination reveals",
"S3 gallop",
"hepatomegaly",
"warm skin",
"continuous bruit",
"right upper thigh",
"following",
"most likely... |
A 52-year-old man presents to the emergency department with sudden-onset dyspnea, tachycardia, tachypnea, and chest pain. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Tennessee. His medical history is significant for gout, hypertension, hypercholest... | Initiate heparin with a bridge to warfarin | {
"A": "Initiate warfarin anticoagulation",
"B": "Initiate heparin with a bridge to warfarin",
"C": "Tissue plasminogen activator (tPA)",
"D": "Consult interventional radiologist (IR) for IVC filter placement"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"sudden-onset dyspnea",
"tachycardia",
"tachypnea",
"chest pain",
"works",
"long",
"truck driver",
"informs",
"recently returned",
"west",
"trip",
"Tennessee",
"medical history",
"significant",
"gout",
"hypertension",
"hypercholest... |
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