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 4-year-old boy is brought to the emergency department by his mother with an itchy rash on his trunk, malaise, and fever with spikes up to 38.5°C (101.3°F) for the past 2 weeks. The patient’s mother says she tried giving him Tylenol with little improvement. Past medical history includes a spontaneous vaginal delivery ... | Coronary artery | {
"A": "Gallbladder",
"B": "Mitral valve",
"C": "Coronary artery",
"D": "Pylorus"
} | step2&3 | C | [
"4 year old boy",
"brought",
"emergency department",
"mother",
"itchy rash",
"trunk",
"malaise",
"fever",
"spikes",
"past 2 weeks",
"patients mother",
"giving",
"Tylenol",
"little improvement",
"Past medical history includes",
"spontaneous vaginal delivery",
"full term",
"patients ... |
A 45-year-old woman comes to the emergency department with recurrent episodes of shaking, sweating, and palpitations. The patient is confused and complains of hunger. One week ago, she had similar symptoms that improved after eating. She has hypertension and a history of biliary pancreatitis. She underwent cholecystect... | Surreptitious insulin use | {
"A": "Pancreatic neoplasm",
"B": "Grave's disease",
"C": "Type 1 diabetes mellitus",
"D": "Surreptitious insulin use"
} | step2&3 | D | [
"year old woman",
"emergency department",
"recurrent episodes of shaking",
"sweating",
"palpitations",
"patient",
"confused",
"hunger",
"One week",
"similar symptoms",
"improved",
"eating",
"hypertension",
"history of biliary pancreatitis",
"cholecystectomy",
"year",
"works",
"nurs... |
A randomized controlled trial is conducted to evaluate the relationship between the angiotensin receptor blocker losartan and cardiovascular death in patients with congestive heart failure (diagnosed as ejection fraction < 30%) who are already being treated with an angiotensin-converting enzyme (ACE) inhibitor and a be... | 10 | {
"A": "20",
"B": "10",
"C": "0.25",
"D": "0.05"
} | step1 | B | [
"randomized controlled trial",
"conducted to evaluate",
"relationship",
"angiotensin receptor",
"losartan",
"cardiovascular death",
"patients",
"congestive heart failure",
"diagnosed",
"ejection fraction",
"30",
"treated with",
"angiotensin-converting enzyme",
"inhibitor",
"beta blocker"... |
A 37-year-old man presents to an urgent care clinic with complaints of speech problems and yellowing of his eyes for a week. He admits to using illicit intravenous drugs. His vital signs include: blood pressure 110/60 mm Hg, pulse rate 78/min, and respiratory rate 22/min. On examination, the patient appears jaundiced, ... | Lymphocytic infiltrate at the dermalepidermal junction | {
"A": "Microabscesses with fibrin and neutrophils",
"B": "Lymphocytic infiltrate at the dermalepidermal junction",
"C": "Intraepithelial cleavage with acantholysis",
"D": "Noncaseating granulomas"
} | step1 | B | [
"year old man presents",
"urgent care clinic with complaints",
"speech problems",
"yellowing",
"eyes",
"week",
"admits to using illicit intravenous drugs",
"vital signs include",
"blood pressure",
"60 mm Hg",
"pulse rate",
"min",
"respiratory rate",
"min",
"examination",
"patient appea... |
A 4-year-old-female presents with a flattened, reddish 2 cm lump located at the base of the tongue. The patient's mother reports her having trouble swallowing, often leading to feeding difficulties. The mother also reports lethargy, constipation, dry skin, and hypothermia. Which of the following is the most appropriate... | Surgical excision of mass followed by levothyroxine administration | {
"A": "Combination therapy of methimazole and Beta-blockers",
"B": "Week-long course of penicillin",
"C": "Radioactive iodine ablation",
"D": "Surgical excision of mass followed by levothyroxine administration"
} | step1 | D | [
"4 year old female presents",
"flattened",
"lump",
"the base of",
"tongue",
"patient's mother reports",
"swallowing",
"often leading",
"feeding difficulties",
"mother",
"reports lethargy",
"constipation",
"dry skin",
"hypothermia",
"following",
"most appropriate management",
"patient... |
A 61-year-old man comes to the physician because of fatigue, diarrhea, and crampy abdominal pain for 3 weeks. The abdominal pain is worse after eating. During the past week, he has had up to 4 watery stools daily. He has also had pain in his mouth and gums for 6 days. He has not had nausea, vomiting, or fever. Four mon... | Crohn disease | {
"A": "Diverticulitis",
"B": "Tropical sprue",
"C": "Crohn disease",
"D": "Celiac disease"
} | step2&3 | C | [
"61 year old man",
"physician",
"fatigue",
"diarrhea",
"crampy abdominal pain",
"weeks",
"abdominal pain",
"worse after eating",
"past week",
"up to",
"watery stools daily",
"pain",
"mouth",
"gums",
"6 days",
"not",
"nausea",
"vomiting",
"fever",
"Four months",
"1 trip",
"D... |
A 48-year-old man is brought to the emergency department by his wife because of a 3-day history of increasing confusion and lethargy. He complains of decreased urine output and abdominal pain for the past month. Two months ago, he was hospitalized for pyelonephritis and treated with ceftriaxone. He has a history of chr... | Decreased renal perfusion | {
"A": "Renal interstitial inflammation",
"B": "Renal vein thrombosis",
"C": "Decreased renal perfusion",
"D": "Renal microvascular thrombi\n\""
} | step2&3 | C | [
"48 year old man",
"brought",
"emergency department",
"wife",
"of",
"3-day history",
"increasing confusion",
"lethargy",
"decreased urine output",
"abdominal pain",
"past month",
"Two months",
"hospitalized",
"pyelonephritis",
"treated with ceftriaxone",
"a history of chronic hepatitis... |
An 8-year-old male presents to his pediatrician for a follow-up appointment for persistent fatigue. His mother reports that the patient’s teacher called her yesterday to tell her that her son has been sitting out of recess every day for the past week. The patient first developed symptoms of fatigue and weakness several... | Vaccinations followed by splenectomy and penicillin for one year | {
"A": "Hydroxyurea",
"B": "Glucocorticoids",
"C": "Vaccinations followed by splenectomy",
"D": "Vaccinations followed by splenectomy and penicillin for one year"
} | step2&3 | D | [
"year old male presents",
"pediatrician",
"follow-up appointment",
"persistent fatigue",
"mother reports",
"patients teacher called",
"to",
"son",
"sitting out",
"day",
"past",
"patient first",
"symptoms",
"fatigue",
"weakness",
"years",
"returned",
"physician",
"similar episodes... |
A 34-year-old G3P3 woman with a history of migraines presents with several weeks of headaches. The headaches are unlike her usual migraines and are worse in the morning. This morning she had an episode of emesis prompting her to seek medical care. She also has some right sided weakness which she believes is related to ... | Oral contraceptive use | {
"A": "History of migraines",
"B": "Alcohol use",
"C": "Ibuprofen use",
"D": "Oral contraceptive use"
} | step1 | D | [
"year old",
"woman",
"history of migraines presents",
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"headaches",
"usual migraines",
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"morning",
"morning",
"episode of emesis prompting",
"to",
"medical care",
"right sided weakness",
"related",
"new exercise routine",
"mother",
"breast",
"medicati... |
A 37-year-old man presents with dull, continuous epigastric pain that radiates to the back in a circumscribing fashion. The history is significant for 3 episodes of acute pancreatitis that were managed conservatively. He reports no history of such episodes in his relatives and denies a family history of any cardiovascu... | Failure of fusion of dorsal and ventral pancreatic duct anlages | {
"A": "Duplication of the embryonic pancreatic duct",
"B": "Ectopy of the developing bile duct",
"C": "Failure of fusion of dorsal and ventral pancreatic duct anlages",
"D": "Improper rotation of the anterior pancreatic bud"
} | step1 | C | [
"year old man presents",
"dull",
"continuous epigastric",
"radiates",
"back",
"circumscribing",
"history",
"significant",
"episodes of acute pancreatitis",
"managed",
"reports",
"history of",
"episodes",
"relatives",
"denies",
"family",
"cardiovascular",
"gastrointestinal disorders... |
A 24-year-old woman, gravida 1, para 0, at 39 weeks' gestation, is admitted to the hospital in active labor. She currently has contractions occurring every 3–5 minutes. For the past 3 days, she has had burning pain in the vulvar area associated with intense itching. Her pregnancy has been uneventful. She has a history ... | Oral acyclovir therapy and cesarean delivery | {
"A": "Tocolytic therapy until lesions are crusted",
"B": "Oral acyclovir therapy and vaginal delivery",
"C": "Topical acyclovir and vaginal delivery",
"D": "Oral acyclovir therapy and cesarean delivery"
} | step2&3 | D | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"currently",
"contractions occurring",
"35 minutes",
"past",
"days",
"burning pain in",
"vulvar area associated with intense itching",
"pregnancy",
"history",
"genital herpes",
... |
A 27-year-old man is running on the treadmill at his gym. His blood pressure prior to beginning his workout was 110/72. Which of the following changes in his cardiovascular system may be seen in this man now that he is exercising? | Decreased systemic vascular resistance | {
"A": "Increased systemic vascular resistance",
"B": "Decreased stroke volume",
"C": "Decreased systemic vascular resistance",
"D": "Decreased blood pressure"
} | step1 | C | [
"27 year old man",
"running",
"treadmill",
"blood pressure prior to beginning",
"workout",
"72",
"following changes",
"cardiovascular system",
"seen",
"man now",
"exercising"
] |
A 45-year-old bank manager is brought to the emergency department by ambulance after vomiting bright red blood while at work. He is also complaining of abdominal pain that is 10/10 in intensity, stabbing, and relentless. He had a similar yet less severe abdominal pain off and on for the last 2 weeks. Eating food and dr... | Inferior pancreaticoduodenal artery | {
"A": "Inferior pancreaticoduodenal artery",
"B": "Greater pancreatic artery",
"C": "Left gastroepiploic artery",
"D": "Gastroduodenal artery"
} | step1 | A | [
"year old bank manager",
"brought",
"emergency department",
"ambulance",
"vomiting bright red blood",
"work",
"abdominal pain",
"10",
"intensity",
"stabbing",
"similar",
"severe abdominal",
"2",
"Eating food",
"drinking milk",
"to make",
"pain",
"little",
"tolerable",
"hospital... |
A 39-year-old man comes to the physician for evaluation of hearing loss. He reports difficulty hearing sounds like the beeping of the microwave or birds chirping, but can easily hear the pipe organ at church. He works as an aircraft marshaller. A Rinne test shows air conduction greater than bone conduction bilaterally.... | Destruction of the organ of Corti | {
"A": "Perforation of the tympanic membrane",
"B": "Immobility of the stapes",
"C": "Destruction of the organ of Corti",
"D": "Excess endolymphatic fluid pressure"
} | step1 | C | [
"year old man",
"physician",
"evaluation of hearing loss",
"reports difficulty",
"microwave",
"birds",
"easily hear",
"pipe organ",
"church",
"works",
"aircraft",
"Rinne test shows air conduction greater than bone conduction",
"Weber test",
"not",
"following",
"most likely underlying c... |
A 36-year-old primigravida presents to her obstetrician for antenatal care. She is at 24 weeks of gestation and does not have any current complaint except for occasional leg cramps. She does not smoke or drink alcohol. Family history is irrelevant. Her temperature is 36.9°C (98.42°F), blood pressure is 100/60 mm Hg, an... | Oral glucose tolerance test for gestational diabetes mellitus | {
"A": "Oral glucose tolerance test for gestational diabetes mellitus",
"B": "Fasting and random glucose testing for gestational diabetes mellitus",
"C": "Wet mount microscopy of vaginal secretions for bacterial vaginosis",
"D": "Complete blood count for iron deficiency anemia"
} | step2&3 | A | [
"36 year old primigravida presents",
"obstetrician",
"antenatal care",
"weeks of gestation",
"not",
"current complaint",
"occasional leg cramps",
"not smoke",
"drink alcohol",
"Family history",
"temperature",
"36",
"98",
"blood pressure",
"100 60 mm Hg",
"pulse",
"95 minute",
"body... |
A 25-year-old G1P0000 presents to her obstetrician’s office for her first prenatal visit. She had a positive pregnancy test 6 weeks ago, and her last period was about two months ago, though at baseline her periods are irregular. Aside from some slight nausea in the mornings, she feels well. Which of the following measu... | Crown-rump length | {
"A": "Biparietal diameter",
"B": "Femur length",
"C": "Serum beta-hCG",
"D": "Crown-rump length"
} | step2&3 | D | [
"year old",
"presents",
"obstetricians office",
"first prenatal visit",
"positive pregnancy test",
"weeks",
"last period",
"about two months",
"baseline",
"periods",
"irregular",
"slight nausea",
"mornings",
"feels well",
"following measurements",
"provide",
"most accurate dating",
... |
A 62-year-old man comes to the physician in May for a routine health maintenance examination. He feels well. He underwent a right inguinal hernia repair 6 months ago. He has hypertension and type 2 diabetes mellitus. There is no family history of serious illness. Current medications include metformin, sitagliptin, enal... | Influenza vaccine | {
"A": "Influenza vaccine",
"B": "Pneumococcal conjugate vaccine 13",
"C": "Abdominal ultrasound",
"D": "Colonoscopy"
} | step2&3 | A | [
"62 year old man",
"physician",
"May",
"routine health maintenance examination",
"feels well",
"right",
"months",
"hypertension",
"type 2 diabetes mellitus",
"family history",
"serious illness",
"Current medications include metformin",
"sitagliptin",
"enalapril",
"metoprolol",
"receive... |
A 14-year-old boy presents with a 1-month history of gradual onset of pain immediately below his right kneecap. He has recently started playing basketball for the junior varsity team at his school, and he is very excited for the season to begin. Unfortunately, the pain in his knee is exacerbated by all the jumping acti... | Osgood-Schlatter disease | {
"A": "Meniscal tear",
"B": "Osgood-Schlatter disease",
"C": "Patellofemoral syndrome",
"D": "Prepatellar bursitis"
} | step2&3 | B | [
"year old boy presents",
"month history of gradual onset",
"pain immediately",
"right kneecap",
"recently started playing basketball",
"junior",
"team",
"school",
"very excited",
"season to begin",
"the pain in",
"knee",
"exacerbated",
"jumping activity",
"practice",
"patient reports s... |
A 62-year-old man is brought to the emergency department with a sudden onset of severe chest pain, that he describes as tearing. The pain started 90 minutes back and is now referring to the upper back. There is a history of essential hypertension for the past 17 years. The patient has smoked 20–30 cigarettes daily for ... | Intravenous metoprolol | {
"A": "Intravenous metoprolol",
"B": "Intravenous hydralazine",
"C": "Oral aspirin",
"D": "D-dimer"
} | step2&3 | A | [
"62 year old man",
"brought",
"emergency department",
"sudden onset of severe chest pain",
"tearing",
"pain started 90 minutes back",
"now referring",
"upper back",
"history of essential hypertension",
"past",
"years",
"patient",
"smoked",
"cigarettes daily",
"past 27 years",
"Vital si... |
A 45-year-old man is brought to the physician by his wife because of difficulty sleeping and poor appetite for the past 4 weeks. During this period, he also has had persistent sadness and difficulty concentrating on tasks, because of which he has been reprimanded at work for poor performance. Over the past 3 years, he ... | Persistent depressive disorder | {
"A": "Persistent depressive disorder",
"B": "Adjustment disorder with depressed mood",
"C": "Major depressive disorder",
"D": "Persistent complex bereavement disorder"
} | step2&3 | A | [
"year old man",
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"physician",
"wife",
"difficulty sleeping",
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"tasks",
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"poor performance",
"past",
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"often",
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"maximum symptom free gap",
"one month",
... |
A 12-year-old boy is referred to a pediatric neurologist because of repetitive motions such as blinking or tilting his head. He is brought in by his mother who says that he also clears his throat and hums repeatedly. These actions have been happening for the past year and his mother is concerned. The boy was born at 39... | Coprolalia | {
"A": "3 Hz spike-wave pattern on EEG",
"B": "Coprolalia",
"C": "Severe atrophy of the caudate and putamen",
"D": "X-linked MECP2 mutation with female predominance"
} | step1 | B | [
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"actions",
"happening",
"past year",
"mother",
"concerned",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal del... |
A 27-year-old woman presents with painful swallowing for the past 2 days. She received a kidney transplant 3 months ago for lupus-induced end-stage renal disease. She takes tacrolimus, mycophenolate mofetil, prednisone, and calcium supplements. The blood pressure is 120/80 mm Hg, the pulse is 72/min, the respirations a... | Ganciclovir | {
"A": "Budesonide",
"B": "Fluconazole",
"C": "Ganciclovir",
"D": "Pantoprazole"
} | step2&3 | C | [
"27 year old woman presents with painful swallowing",
"past 2 days",
"received",
"kidney transplant",
"months",
"lupus induced end-stage renal disease",
"takes tacrolimus",
"mycophenolate mofetil",
"prednisone",
"calcium supplements",
"blood pressure",
"80 mm Hg",
"pulse",
"72 min",
"res... |
A 67-year-old man comes to the emergency department because of retrosternal chest pressure and shortness of breath for 4 hours. The symptoms started while he was walking to work and have only minimally improved with rest. He has a history of type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 35 ye... | Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus | {
"A": "Coronary artery occlusion due to transient increase in vascular tone",
"B": "Stable atherosclerotic plaque with 85% coronary artery occlusion",
"C": "Disruption of an atherosclerotic plaque with a non-occlusive coronary artery thrombus",
"D": "Atherosclerotic plaque thrombus with complete coronary arter... | step1 | C | [
"67 year old man",
"emergency department",
"retrosternal chest pressure",
"shortness of breath",
"4 hours",
"symptoms started",
"walking to work",
"only",
"improved",
"rest",
"history of type 2 diabetes mellitus",
"smoked one pack",
"cigarettes daily",
"35 years",
"appears",
"pulse",
... |
A 33-year-old nulliparous woman comes to the physician because of a 5-month history of increased flow and duration of her menses. Menses previously occurred at regular 32-day intervals and lasted 4 days with normal flow. They now last 10 days and the flow is heavy with the passage of clots. During this period, she has ... | Benign tumor of the myometrium | {
"A": "Benign tumor of the myometrium",
"B": "Malignant transformation of endometrial tissue",
"C": "Abnormal thickening of endometrial tissue",
"D": "Pedunculated endometrial mass"
} | step2&3 | A | [
"year old nulliparous woman",
"physician",
"5 month history",
"increased flow",
"duration",
"menses",
"occurred",
"regular",
"day intervals",
"lasted 4 days",
"normal flow",
"now last 10 days",
"flow",
"heavy",
"passage",
"clots",
"period",
"dyspareunia",
"cyclical lower abdomina... |
A group of investigators studying embryological defects in mice knock out a gene that is responsible for the development of the ventral wing of the third branchial pouch. A similar developmental anomaly in a human embryo is most likely to result in which of the following findings after birth? | White oral patches | {
"A": "White oral patches",
"B": "Conductive hearing loss",
"C": "Cleft palate",
"D": "Carpopedal spasm"
} | step1 | A | [
"A group",
"investigators studying embryological defects in mice knock out",
"gene",
"responsible",
"development",
"ventral wing",
"third branchial pouch",
"similar developmental anomaly",
"human embryo",
"most likely to result",
"following findings after birth"
] |
A 17-year-old male, accompanied by his uncle, presents to his family physician with his arm in a sling. There is blood dripping down his shirt. He pleads with the physician to keep this injury "off the books", offering to pay in cash for his visit, as he is afraid of retaliation from his rival gang. The physician exams... | Breach confidentiality and report the stab wound to the police | {
"A": "Maintain confidentiality, as retaliation may result in greater harm to the patient",
"B": "Maintain confidentiality, as reporting stab wounds is not required",
"C": "Maintain confidentiality and schedule a follow-up visit with the patient",
"D": "Breach confidentiality and report the stab wound to the p... | step1 | D | [
"year old male",
"uncle",
"presents",
"family physician",
"arm",
"sling",
"blood dripping",
"shirt",
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"cash",
"visit",
"afraid",
"gang",
"physician exams",
"wound",
"appears to",
"stabbing injury",
"left",
"physician best han... |
An otherwise healthy 27-year-old man presents to his dermatologist because of a rash over his knees. The rash has been present for 5 weeks and is moderately itchy. Physical examination reveals erythematous plaques covered with silvery scales over the extensor surface of the knees as shown in the image. Which of the fol... | Topical corticosteroids and/or topical vitamin D analog | {
"A": "Skin biopsy",
"B": "Oral corticosteroids",
"C": "Topical corticosteroids and/or topical vitamin D analog",
"D": "Oral methotrexate"
} | step2&3 | C | [
"healthy 27 year old man presents",
"dermatologist",
"of",
"rash",
"knees",
"rash",
"present",
"weeks",
"moderately itchy",
"Physical examination reveals erythematous plaques covered",
"silvery scales",
"extensor surface of",
"knees",
"shown",
"image",
"following",
"best initial step... |
A 34-year-old man with a 2-year history of rheumatoid arthritis is being evaluated on a follow-up visit. He is currently on methotrexate and celecoxib for pain management and has shown a good response until now. However, on this visit, he mentions that the morning stiffness has been getting progressively worse. On phys... | Methotrexate and Infliximab | {
"A": "Methotrexate and Corticosteroids",
"B": "Sulfasalazine",
"C": "Adalimumab monotherapy",
"D": "Methotrexate and Infliximab"
} | step2&3 | D | [
"year old man",
"history of rheumatoid arthritis",
"evaluated",
"follow-up visit",
"currently",
"methotrexate",
"celecoxib",
"pain management",
"shown",
"good response",
"now",
"visit",
"morning stiffness",
"getting",
"worse",
"physical examination",
"wrists",
"erythematous",
"sw... |
A man appearing to be in his mid-50s is brought in by ambulance after he was seen walking on railroad tracks. On further questioning, the patient does not recall being on railroad tracks and is only able to provide his name. Later on, he states that he is a railroad worker, but this is known to be false. On exam, his t... | Mammillary bodies | {
"A": "Cerebellar vermis",
"B": "Frontal eye fields",
"C": "Mammillary bodies",
"D": "Parietal-temporal cortex"
} | step1 | C | [
"man appearing to",
"mid",
"brought",
"ambulance",
"seen walking",
"railroad tracks",
"further questioning",
"patient",
"not recall",
"railroad tracks",
"only able to provide",
"name",
"Later",
"states",
"railroad worker",
"known to",
"false",
"exam",
"temperature",
"99 9F",
... |
A 36-year-old primigravid woman at 22 weeks' gestation comes to the physician for a routine prenatal visit. Her previous prenatal visits showed no abnormalities. She has hyperthyroidism treated with methimazole. She previously smoked one pack of cigarettes daily for 15 years but quit 6 years ago. She reports gaining we... | Maternal malnutrition | {
"A": "Maternal malnutrition",
"B": "Advanced maternal age",
"C": "Fetal aneuploidy",
"D": "History of tobacco use"
} | step2&3 | A | [
"36 year old primigravid woman",
"weeks",
"gestation",
"physician",
"routine prenatal visit",
"previous prenatal visits showed",
"abnormalities",
"hyperthyroidism treated with methimazole",
"smoked one pack",
"cigarettes daily",
"years",
"quit",
"years",
"reports gaining weight",
"quitti... |
A 22-year-old man comes to the emergency department because of several episodes of blood in his urine and decreased urine output for 5 days. His blood pressure is 158/94 mm Hg. Examination shows bilateral lower extremity edema. Urinalysis shows 3+ protein and red blood cell casts. Mass spectrometry analysis of the urin... | Nonselective glomerular | {
"A": "Tubular",
"B": "Overflow",
"C": "Postrenal",
"D": "Nonselective glomerular"
} | step1 | D | [
"year old man",
"emergency department",
"of several episodes",
"blood",
"urine",
"decreased urine output",
"5 days",
"blood pressure",
"mm Hg",
"Examination shows bilateral lower extremity edema",
"Urinalysis shows 3",
"protein",
"red blood cell casts",
"Mass spectrometry analysis of",
"... |
A 72-year-old woman comes to the emergency department 1 hour after the sudden onset of a diffuse, dull, throbbing headache. She also reports blurred vision, nausea, and one episode of vomiting. She has a history of poorly controlled hypertension. A photograph of her fundoscopic examination is shown. Which of the follow... | Hypertensive emergency | {
"A": "Giant cell arteritis",
"B": "Hypertensive emergency",
"C": "Epidural hematoma",
"D": "Transient ischemic attack"
} | step1 | B | [
"72 year old woman",
"emergency department",
"hour",
"sudden onset",
"diffuse",
"dull",
"throbbing headache",
"reports blurred vision",
"nausea",
"one episode of vomiting",
"history of poorly controlled hypertension",
"photograph",
"fundoscopic examination",
"shown",
"following",
"most... |
A 28-year-old woman comes to the emergency department for a rash that began 3 days ago. She has low-grade fever and muscle aches. She has no history of serious illness and takes no medications. She has had 5 male sexual partners over the past year and uses condoms inconsistently. Her temperature is 38.1°C (100.6° F), p... | Fluorescent treponemal antibody absorption test
" | {
"A": "Treponemal culture",
"B": "Intravenous penicillin G",
"C": "Oral doxycycline",
"D": "Fluorescent treponemal antibody absorption test\n\""
} | step2&3 | D | [
"year old woman",
"emergency department",
"rash",
"began 3 days",
"low-grade fever",
"muscle aches",
"history",
"serious illness",
"takes",
"medications",
"5 male sexual partners",
"past year",
"uses condoms",
"temperature",
"100",
"F",
"pulse",
"85 min",
"blood pressure",
"mm ... |
A 36-year-old man undergoes ileocecal resection after a gunshot injury. The resected ileocecal segment is sent for histological evaluation. One of the slides derived from the specimen is shown in the image. Which of the following statements regarding the structure marked within the red circle is correct? | This structure can become a site of entry of certain microorganisms including S. typhi. | {
"A": "This structure can be only found in the colon.",
"B": "This structure can become a site of entry of certain microorganisms including S. typhi.",
"C": "Infants have the largest amount of these structures within their intestinal wall.",
"D": "This structure only appears in case of bacterial infection."
} | step1 | B | [
"36 year old man",
"ileocecal resection",
"gunshot injury",
"resected ileocecal segment",
"sent",
"histological evaluation",
"One",
"slides derived",
"specimen",
"shown",
"image",
"following statements",
"structure marked",
"red circle",
"correct"
] |
A 30-year-old woman, gravida 2, para 1, at 42 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by gestational diabetes, for which she has been receiving insulin injections. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring f... | Lack of uterine muscle contraction | {
"A": "Lack of uterine muscle contraction",
"B": "Uterine inversion",
"C": "Adherent placenta to myometrium",
"D": "Uterine rupture"
} | step2&3 | A | [
"30 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"Pregnancy",
"complicated",
"gestational diabetes",
"receiving insulin injections",
"first child",
"delivered",
"lower segment transverse cesarean",
"fetal heart rate",
"pulse",
... |
One week after an aortic valve replacement surgery, a 55-year-old man is brought to the emergency room 30 minutes after the onset of severe, sharp chest pain. He appears pale and dyspneic but is alert, oriented, and speaks in full sentences. His temperature is 38°C (100.4°F), pulse is 192/min and thready, respirations ... | Synchronized cardioversion | {
"A": "Synchronized cardioversion",
"B": "Vagal maneuvers",
"C": "Administer magnesium sulfate",
"D": "Administer amiodarone"
} | step2&3 | A | [
"One week",
"aortic valve replacement surgery",
"55 year old man",
"brought",
"emergency room 30 minutes",
"onset of severe",
"sharp chest pain",
"appears pale",
"dyspneic",
"alert",
"oriented",
"speaks",
"full sentences",
"temperature",
"100 4F",
"pulse",
"min",
"thready",
"resp... |
A 33-year-old woman presents to the emergency department with a 3-day history of backache, progressive bilateral lower limb weakness, and a pins-and-needles sensation in both of her legs. She has not passed urine for the past 24 hours. Her medical history is unremarkable. Her blood pressure is 112/74 mm Hg, heart rate ... | Inflammation of the spinal cord | {
"A": "Demyelination of peripheral nerves",
"B": "Inflammation of the spinal cord",
"C": "Low serum potassium levels",
"D": "Nutritional deficiency"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"3-day history of backache",
"progressive bilateral lower limb weakness",
"pins",
"needles sensation",
"legs",
"not passed urine",
"past 24 hours",
"medical history",
"unremarkable",
"blood pressure",
"74 mm Hg",
"heart rate",
"min",
"... |
A 63-year-old man undergoes workup for nocturnal dyspnea and what he describes as a "choking" sensation while sleeping. He also endorses fatigue and dyspnea on exertion. Physical exam reveals a normal S1, loud P2, and a neck circumference of 17 inches (43 cm) (normal < 14 inches (< 35 cm)). His temperature is 98.8°F (3... | Right ventricular failure | {
"A": "Chronic obstructive pulmonary disease",
"B": "Left ventricular failure",
"C": "Pulmonary embolism",
"D": "Right ventricular failure"
} | step1 | D | [
"63 year old man",
"workup",
"nocturnal dyspnea",
"choking",
"sensation",
"sleeping",
"fatigue",
"dyspnea on exertion",
"Physical exam reveals",
"normal S1",
"loud P2",
"neck circumference of",
"inches",
"normal",
"inches",
"35",
"temperature",
"98",
"blood pressure",
"mmHg",
... |
A 4-year-old girl is brought to the pediatrician by her parents for a 1-year history of gradual loss of speech and motor skills. Pregnancy and delivery were uncomplicated, and development was normal until the age of 3 years. Her parents say she used to run and speak in short sentences but now is only able to walk slowl... | Microdeletion of methyl-CpG binding protein 2 on X-chromosome | {
"A": "Microdeletion of methyl-CpG binding protein 2 on X-chromosome",
"B": "CGG trinucleotide repeat in FMR1 gene on X-chromosome",
"C": "CTG trinucleotide repeat in DMPK gene on chromosome 19",
"D": "Partial deletion of long arm of chromosome 7"
} | step1 | A | [
"4 year old girl",
"brought",
"pediatrician",
"parents",
"year history of gradual loss",
"speech",
"motor skills",
"Pregnancy",
"delivery",
"uncomplicated",
"development",
"normal",
"age",
"years",
"parents",
"used to run",
"speak",
"short sentences",
"now",
"only able to walk ... |
A 57-year-old man presents to the emergency department because he has been having abdominal pain for the past several months. Specifically, he complains of severe epigastric pain after eating that is sometimes accompanied by diarrhea. He has also lost 20 pounds over the same time period, which he attributes to the fact... | CA-19-9 | {
"A": "Alpha-fetoprotein",
"B": "CA-19-9",
"C": "CEA",
"D": "PTHrP"
} | step1 | B | [
"57 year old man presents",
"emergency department",
"abdominal pain",
"past",
"months",
"severe epigastric",
"eating",
"sometimes",
"diarrhea",
"lost 20 pounds",
"same time period",
"attributes",
"fact",
"pain",
"stopping",
"eat",
"not recall",
"changes",
"urine",
"stool",
"P... |
A 26-year-old medical student comes to the physician with a 3-week history of night sweats and myalgias. During this time, he has also had a of 3.6-kg (8-lb) weight loss. He returned from a 6-month tropical medicine rotation in Cambodia 1 month ago. A chest x-ray (CXR) shows reticulonodular opacities suggestive of acti... | 0.25 | {
"A": "1.4",
"B": "0.25",
"C": "0.70",
"D": "0.88"
} | step1 | B | [
"year old medical student",
"physician",
"3 week history",
"night sweats",
"myalgias",
"time",
"3.6 kg",
"weight loss",
"returned",
"month tropical medicine rotation",
"Cambodia",
"month",
"chest x-ray",
"shows",
"opacities suggestive of active tuberculosis",
"student",
"curious",
... |
A 49-year-old man comes with odynophagia, abdominal pain, fatigue, headache, and fever for several weeks. The patient reports no chronic medical problems, no travel, and no recent sick exposures. Physical examination is significant only for an erythematous oral mucosa and cervical lymphadenopathy. His vital signs show ... | Primary HIV infection | {
"A": "Disseminated gonococci",
"B": "Primary syphilis",
"C": "Secondary syphilis",
"D": "Primary HIV infection"
} | step2&3 | D | [
"year old man",
"odynophagia",
"abdominal pain",
"fatigue",
"headache",
"fever",
"weeks",
"patient reports",
"chronic medical problems",
"travel",
"recent sick exposures",
"Physical examination",
"significant only",
"erythematous oral mucosa",
"cervical lymphadenopathy",
"vital signs s... |
A 65-year-old man comes to the physician for evaluation of severe pain in his left shoulder for several days. He did not fall or injure his shoulder. He has a history of osteoarthritis of both knees that is well-controlled with indomethacin. He spends most of his time at a retirement facility and does not do any sports... | Musculoskeletal ultrasound | {
"A": "Musculoskeletal ultrasound",
"B": "Surgical fixation",
"C": "Biopsy of the humerus",
"D": "Reassurance"
} | step2&3 | A | [
"65 year old man",
"physician",
"evaluation",
"severe",
"left shoulder",
"days",
"not fall",
"shoulder",
"history",
"knees",
"well-controlled",
"indomethacin",
"spends most of",
"time",
"retirement facility",
"not",
"sports",
"family history",
"serious illness",
"smoked one pac... |
A 27-year-old woman with no past medical history presents to her primary care provider because she has begun to experience color changes in her fingers on both hands in cold temperatures. She reports having had this problem for a few years, but with the weather getting colder this winter she has grown more concerned. S... | Amlodipine | {
"A": "Amlodipine",
"B": "Phenylephrine",
"C": "Propranolol",
"D": "Sildenafil"
} | step1 | A | [
"27 year old woman",
"past medical history presents",
"primary care provider",
"begun to experience color changes",
"fingers",
"hands",
"cold",
"reports",
"problem",
"years",
"weather getting colder",
"winter",
"more concerned",
"exposed",
"cold",
"fingers turn white",
"blue",
"red... |
A 68-year-old man presents to your office concerned about the frequency with which he wakes up in the middle night feeling out of breath. He has been required to use 3 more pillows in order to reduce the shortness of breath. In addition to this, he has noticed that he tires easily with minor tasks such as walking 1 blo... | Increased production of brain natriuretic peptide | {
"A": "Increased nitric oxide bioactivity",
"B": "Decreased collagen synthesis",
"C": "Increased production of brain natriuretic peptide",
"D": "Cardiomyocyte hyperplasia"
} | step1 | C | [
"68 year old man presents",
"office concerned",
"frequency",
"wakes up",
"middle night feeling out of breath",
"required to use 3 more pillows",
"order to",
"shortness of breath",
"tires easily",
"minor tasks",
"walking",
"block",
"more recently",
"dressing",
"mornings",
"Physical exam... |
A 69-year-old man with metastatic colon cancer is brought to the emergency department because of shortness of breath, fever, chills, and a productive cough with streaks of blood for the past 5 days. He has a history of emphysema. The patient does not have abdominal pain or headache. He receives chemotherapy with 5-fluo... | Voriconazole | {
"A": "Ceftriaxone and azithromycin",
"B": "Piperacillin-tazobactam",
"C": "Ceftazidime and levofloxacin",
"D": "Voriconazole"
} | step2&3 | D | [
"69 year old man",
"metastatic colon cancer",
"brought",
"emergency department",
"of shortness",
"breath",
"fever",
"chills",
"productive cough",
"streaks of blood",
"past",
"days",
"history of emphysema",
"patient",
"not",
"abdominal pain",
"headache",
"receives chemotherapy",
"... |
A 50-year-old man presents to a clinic with a skin lesion on his forearm, which recently changed in color from light brown to brown-black. The lesion was initially pinhead in size but now has grown to the size of a penny. On examination, there is a 3.5 x 2.5 cm irregularly-shaped lesion on his left forearm. A photograp... | B7 | {
"A": "MHC class II",
"B": "T cell receptor",
"C": "CD 28",
"D": "B7"
} | step1 | D | [
"50 year old man presents",
"clinic",
"skin",
"forearm",
"recently changed",
"color",
"light brown",
"black",
"lesion",
"initially",
"size",
"now",
"size",
"examination",
"3",
"2",
"cm",
"shaped lesion",
"left forearm",
"photograph",
"lesion",
"presented",
"biopsy",
"le... |
A 58-year-old man comes to the physician for the evaluation of intermittent dysphagia for 6 months. He states that he drinks a lot of water during meals to help reduce discomfort he has while swallowing food. He has hypertension and gastroesophageal reflux disease. He has smoked one half-pack of cigarettes daily for 32... | Mechanical dilation
" | {
"A": "Esophagectomy",
"B": "Iron supplementation",
"C": "Nissen fundoplication",
"D": "Mechanical dilation\n\""
} | step2&3 | D | [
"58 year old man",
"physician",
"evaluation",
"intermittent dysphagia",
"months",
"states",
"drinks",
"lot",
"water",
"meals to help",
"discomfort",
"swallowing food",
"hypertension",
"gastroesophageal reflux disease",
"smoked one half pack",
"cigarettes daily",
"years",
"not drink... |
A 43-year-old man presents to the emergency department following a work-related accident in which both arms were amputated. The patient lost a substantial amount of blood prior to arrival, and his bleeding is difficult to control due to arterial damage and wound contamination with debris. His complete blood count (CBC)... | Type 2 hypersensitivity reaction | {
"A": "Type 1 hypersensitivity reaction",
"B": "Type 2 hypersensitivity reaction",
"C": "Type 3 hypersensitivity reaction",
"D": "Type 4 hypersensitivity reaction"
} | step2&3 | B | [
"year old man presents",
"emergency department following",
"work accident",
"arms",
"amputated",
"patient lost",
"amount",
"blood",
"arrival",
"bleeding",
"difficult to control due",
"arterial damage",
"wound contamination",
"debris",
"complete blood count",
"CBC",
"significant",
"... |
A 37-year-old woman, gravida 2, para 1, at 35 weeks' gestation is brought to the emergency department for the evaluation of continuous, dark, vaginal bleeding and abdominal pain for one hour. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The pati... | Detachment of the placenta | {
"A": "Rupture of the uterus",
"B": "Placental tissue covering the cervical os",
"C": "Rupture of aberrant fetal vessels",
"D": "Detachment of the placenta"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
"35 weeks",
"gestation",
"brought",
"emergency department",
"evaluation",
"continuous",
"dark",
"vaginal bleeding",
"abdominal pain",
"one hour",
"first child",
"delivered",
"lower segment transverse cesarean",
"fetal heart rate",
"patient",... |
A 54-year-old African American man presents to the clinic for his first annual well-check. He was unemployed for years but recently received health insurance from a new job. He reports feeling healthy and has no complaints. His blood pressure is 157/90 mmHg, pulse is 86/min, and respirations are 12/min. Routine urinaly... | Lisinopril | {
"A": "Amlodipine",
"B": "Furosemide",
"C": "Lisinopril",
"D": "Metoprolol"
} | step1 | C | [
"54 year old African American man presents",
"clinic",
"first annual well check",
"unemployed",
"years",
"recently received health insurance",
"new job",
"reports feeling healthy",
"complaints",
"blood pressure",
"90 mmHg",
"pulse",
"min",
"respirations",
"min",
"Routine urinalysis",
... |
A 48-year-old man from Argentina presents to your office complaining of difficulty swallowing for the past few months. He is accompanied by his wife who adds that his breath has started to smell horrible. The patient says that he feels uncomfortable no matter what he eats or drinks. He also has lost 5 kg (11 lb) in the... | Trypanosoma cruzi infection | {
"A": "Food allergy",
"B": "Malignant proliferation of squamous cells",
"C": "Trypanosoma cruzi infection",
"D": "Pyloric stenosis"
} | step1 | C | [
"48 year old man",
"Argentina presents",
"office",
"difficulty swallowing",
"past",
"months",
"wife",
"adds",
"breath",
"started to smell",
"patient",
"feels",
"eats",
"drinks",
"lost 5 kg",
"last",
"months",
"patient",
"afebrile",
"vital signs",
"normal limits",
"Physical ... |
A 32-year-old man is brought to the emergency department after a skiing accident. The patient had been skiing down the mountain when he collided with another skier who had stopped suddenly in front of him. He is alert but complaining of pain in his chest and abdomen. He has a past medical history of intravenous drug us... | Emergency laparotomy | {
"A": "Close observation",
"B": "Upper gastrointestinal endoscopy",
"C": "Diagnostic peritoneal lavage",
"D": "Emergency laparotomy"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"skiing accident",
"patient",
"skiing",
"mountain",
"skier",
"stopped",
"front",
"alert",
"pain",
"chest",
"abdomen",
"past medical intravenous drug use",
"peptic ulcer disease",
"current smoker",
"temperature",
"97 4F",
"36 3C... |
An 8-month-old child presents with a history of poor growth and a chronic cough. He was born to a 21-year-old woman at 41 weeks of gestation. Soon after birth, he developed respiratory distress and was admitted to the neonatal intensive care unit where he was mechanically ventilated for 24 hours. He was initially breas... | Atrophy | {
"A": "Hyperplasia",
"B": "Dysplasia",
"C": "Hypertrophy",
"D": "Atrophy"
} | step1 | D | [
"month old child presents",
"history",
"poor growth",
"chronic cough",
"born",
"21-year-old woman",
"weeks of gestation",
"birth",
"respiratory distress",
"admitted to",
"neonatal intensive care unit",
"ventilated",
"24 hours",
"initially breastfed",
"due to frequent vomiting",
"loose ... |
A 40-year-old woman comes to the therapist for weekly psychotherapy. She was diagnosed with major depressive disorder and anxiety after her divorce 1 year ago. During last week's appointment, she spoke about her ex-husband's timidity and lack of advancement at work; despite her urging, he never asked for a raise. Today... | Transference | {
"A": "Transference",
"B": "Displacement",
"C": "Passive aggression",
"D": "Reaction formation"
} | step1 | A | [
"40 year old woman",
"therapist",
"weekly psychotherapy",
"diagnosed",
"major depressive disorder",
"anxiety",
"divorce",
"year",
"last week's appointment",
"spoke",
"husband's timidity",
"lack",
"advancement",
"work",
"never",
"Today",
"therapist",
"to",
"courage to",
"I",
"... |
A 55-year-old man is brought to the emergency department by his friends after he was found vomiting copious amounts of blood. According to his friends, he is a chronic alcoholic and lost his family and job because of his drinking. The admission vital signs were as follows: blood pressure is 100/75 mm Hg, heart rate is ... | Caput medusae | Caval (systemic): epigastric veins | Portal (hepatic): paraumbilical vein | {
"A": "Caput medusae | Caval (systemic): epigastric veins | Portal (hepatic): paraumbilical vein",
"B": "Anorectal varices | Caval (systemic): inferior rectal vein | Portal (hepatic): middle rectal vein",
"C": "Esophageal varices | Caval (systemic): azygos vein | Portal (hepatic): esophageal vein",
"D": "Inter... | step1 | A | [
"55 year old man",
"brought",
"emergency department",
"friends",
"found vomiting copious amounts",
"blood",
"friends",
"chronic alcoholic",
"lost",
"family",
"job",
"drinking",
"admission vital signs",
"follows",
"blood pressure",
"100 75 mm Hg",
"heart rate",
"95 min",
"respirat... |
A scientist in Boston is studying a new blood test to detect Ab to the parainfluenza virus with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After severa... | 90% | {
"A": "82%",
"B": "86%",
"C": "90%",
"D": "98%"
} | step2&3 | C | [
"scientist",
"Boston",
"studying",
"new blood test to detect Ab",
"parainfluenza virus",
"increased sensitivity",
"specificity",
"far",
"best attempt",
"creating",
"exam reached",
"sensitivity",
"88",
"specificity",
"hoping to increase",
"numbers",
"percent",
"value",
"several ye... |
A 55-year-old man with a history of congestive heart failure, hypertension, and hyperlipidemia presents to his primary care clinic. He admits he did not adhere to a low salt diet on a recent vacation. He now has progressive leg swelling and needs two pillows to sleep because he gets short of breath when lying flat. Cur... | Hypocalcemia | {
"A": "Hypocalcemia",
"B": "Hypouricemia",
"C": "Hypoglycemia",
"D": "Hypermagnesemia"
} | step1 | A | [
"55 year old man",
"history of congestive heart failure",
"hypertension",
"hyperlipidemia presents",
"primary care clinic",
"admits",
"not adhere",
"low salt diet",
"recent vacation",
"now",
"progressive leg swelling",
"needs two pillows to sleep",
"gets short of breath",
"lying flat",
"... |
A 60-year-old man presents with pain, swelling, and a purulent discharge from his left foot. He says that the symptoms began 7 days ago with mild pain and swelling on the medial side of his left foot, but have progressively worsened. He states that there has been a foul-smelling discharge for the past 2 days. The medic... | Presence of wet gangrene | {
"A": "Diminished peripheral pulses",
"B": "Positive blood cultures",
"C": "Presence of wet gangrene",
"D": "Smoking history"
} | step2&3 | C | [
"60 year old man presents",
"pain",
"swelling",
"purulent discharge",
"left foot",
"symptoms began 7 days",
"mild pain",
"swelling",
"medial of",
"left",
"worsened",
"states",
"smelling discharge",
"past 2 days",
"medical history",
"significant",
"type 2 diabetes mellitus",
"diagno... |
A 6-year-old girl is brought to your clinic by her mother with a high grade temperature associated with generalized weakness and lethargy. Her mother reports that she has had similar episodes, each last 3-4 days since she was an infant. These episodes would often lead to hospitalization where she would be found to be a... | Pyridoxine | {
"A": "Thiamine",
"B": "Folic acid",
"C": "Riboflavin",
"D": "Pyridoxine"
} | step1 | D | [
"year old girl",
"brought",
"clinic",
"mother",
"high temperature associated with generalized weakness",
"lethargy",
"mother reports",
"similar episodes",
"last 3-4 days",
"infant",
"episodes",
"often lead",
"hospitalization",
"found to",
"anemic",
"RBC transfusions",
"born",
"full... |
A 42-year-old woman presents with pruritus and progressive weakness for the past 3 months. She says she feels excessively tired during the daytime and is losing interest in activities that used to be fun. The patient reports a history of heavy alcohol use and drinks around 20 ounces per week. Laboratory studies show:
P... | Primary biliary cholangitis | {
"A": "Viral hepatitis",
"B": "Primary sclerosing cholangitis",
"C": "Primary biliary cholangitis",
"D": "Cardiac cirrhosis"
} | step1 | C | [
"year old woman presents",
"pruritus",
"progressive weakness",
"past 3 months",
"feels excessively tired",
"daytime",
"interest",
"activities",
"used to",
"patient reports",
"history of heavy alcohol use",
"drinks",
"20 ounces",
"week",
"Laboratory studies show",
"Proteins",
"4",
"... |
A 25-year-old female comes to her obstetrician’s office for a prenatal visit. She has a transvaginal ultrasound that correlates with her last menstrual period and dates her pregnancy at 4 weeks. She has no complaints except some nausea during the morning that is improving. She comments that she has had some strange foo... | Closure of the neural tube | {
"A": "Creation of the notochord",
"B": "Closure of the neural tube",
"C": "Movement of limbs",
"D": "Formation of male genitalia"
} | step1 | B | [
"year old female",
"obstetricians office",
"prenatal visit",
"transvaginal ultrasound",
"last menstrual period",
"dates",
"pregnancy",
"weeks",
"complaints",
"nausea",
"morning",
"improving",
"comments",
"food cravings",
"issues",
"eating",
"balanced diet",
"BMI",
"23 kg/m",
"g... |
A 32-year-old man comes to the physician because of a 3-week history of cough, weight loss, and night sweats. He migrated from Sri Lanka 6 months ago. He appears emaciated. His temperature is 38.1°C (100.5°F). Physical examination shows enlargement of the right supraclavicular lymph node. Chest and abdominal examinatio... | Medullary sinus | {
"A": "Germinal center",
"B": "Medullary sinus",
"C": "Paracortex",
"D": "Periarteriolar lymphatic sheath"
} | step1 | B | [
"year old man",
"physician",
"3 week history",
"cough",
"weight loss",
"night sweats",
"migrated",
"Sri Lanka",
"months",
"appears emaciated",
"temperature",
"100",
"Physical examination shows enlargement of",
"right supraclavicular lymph node",
"Chest",
"abdominal examination show",
... |
A 33-year-old woman presents with anxiety, poor sleep, and occasional handshaking and sweating for the past 10 months. She says that the best remedy for her symptoms is a “glass of a good cognac” after work. She describes herself as a “moderate drinker”. However, on a more detailed assessment, the patient confesses tha... | Naltrexone | {
"A": "Naltrexone",
"B": "Disulfiram",
"C": "Amitriptyline",
"D": "Topiramate"
} | step2&3 | A | [
"year old woman presents",
"anxiety",
"poor sleep",
"occasional",
"sweating",
"past 10 months",
"best",
"symptoms",
"glass",
"good cognac",
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"more detailed assessment",
"patient",
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"drinks",
"working day",
"35 drinks",
"days",
"partying",
"... |
A 26-year-old woman presents to the emergency department with confusion, severe myalgia, fever, and a rash over her inner left thigh. The patient was diagnosed with pharyngitis three days ago and prescribed antibiotics, but she did not take them. Her blood pressure is 90/60 mm Hg, heart rate is 99/min, respiratory rate... | Variable part of TCR β-chain | {
"A": "Variable part of TCR β-chain",
"B": "CD3",
"C": "Constant part of TCR α-chain",
"D": "CD4"
} | step1 | A | [
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"patient",
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"pharyngitis three days",
"prescribed antibiotics",
"not take",
"blood pressure",
"90 60 mm Hg",
"heart rate",
"99 min",
"respiratory rate",
"min... |
A pharmaceutical corporation is developing a research study to evaluate a novel blood test to screen for breast cancer. They enrolled 800 patients in the study, half of which have breast cancer. The remaining enrolled patients are age-matched controls who do not have the disease. Of those in the diseased arm, 330 are f... | 330 / (330 + 70) | {
"A": "370 / (30 + 370)",
"B": "370 / (70 + 370)",
"C": "330 / (330 + 70)",
"D": "330 / (330 + 30)"
} | step2&3 | C | [
"pharmaceutical corporation",
"research study to evaluate",
"novel blood test to screen",
"breast cancer",
"enrolled 800 patients",
"study",
"half",
"breast cancer",
"remaining enrolled patients",
"age matched controls",
"not",
"disease",
"arm",
"330",
"found positive",
"test",
"pati... |
A 23-year-old woman presents to the physician with complaints of pain and paresthesias in her left hand, particularly her thumb, index, and middle fingers. She notes that the pain is worse at night, though she still feels significant discomfort during the day. The patient insists that she would like urgent relief of he... | Splinting | {
"A": "Corticosteroid injection",
"B": "Nonsteroidal anti-inflammatory drugs",
"C": "Splinting",
"D": "Surgical decompression"
} | step2&3 | C | [
"23 year old woman presents",
"physician",
"complaints",
"pain",
"paresthesias",
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"thumb",
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"middle fingers",
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"feels significant discomfort",
"day",
"patient",
"urgent relief",
"symptoms",
"pain",
"keeping",
"carrying out",
... |
A previously healthy 45-year-old man comes to the physician for a routine health maintenance examination. He has been having recurrent headaches, especially early in the morning, and sometimes feels dizzy. There is no family history of serious illness. The patient runs 5 miles 3 days a week. He does not smoke or drink ... | Amlodipine | {
"A": "Losartan",
"B": "Prazosin",
"C": "Propranolol",
"D": "Amlodipine"
} | step2&3 | D | [
"healthy",
"year old man",
"physician",
"routine health maintenance examination",
"recurrent headaches",
"early",
"morning",
"sometimes feels dizzy",
"family history",
"serious illness",
"patient runs 5 miles",
"days",
"week",
"not smoke",
"drink alcohol",
"5 ft 10",
"tall",
"72 kg... |
A researcher measures action potential propagation velocity in various regions of the heart in a 42-year-old Caucasian female. Which of the following set of measurements corresponds to the velocities found in the atrial muscle, AV Node, Purkinje system, and venticular muscle, respectively? | 1.1 m/s, 0.05 m/s, 2.2 m/s, 0.3 m/s | {
"A": "2.2 m/s, 0.3 m/s, 0.05 m/s, 1.1 m/s",
"B": "1.1 m/s, 0.05 m/s, 2.2 m/s, 0.3 m/s",
"C": "0.5 m/s, 1.1 m/s, 2.2 m/s, 3 m/s",
"D": "0.05 m/s, 1.1 m/s, 2.2 m/s, 3.3 m/s"
} | step1 | B | [
"researcher measures action potential propagation velocity",
"various regions of",
"heart",
"year old Caucasian female",
"following set",
"measurements",
"velocities found",
"atrial muscle",
"AV Node",
"system",
"muscle"
] |
A 29-year-old woman presents to the emergency department with joint pain and a notable rash. She has had joint pain for the past 12 months but noticed the rash recently as well as generalized malaise. She states her joint pain is symmetric, in her upper extremities, and is worse in the morning. Her temperature is 97.6°... | Anti-dsDNA | {
"A": "Anti-CCP",
"B": "Anti-dsDNA",
"C": "Anti-nuclear antibody",
"D": "Rheumatoid factor"
} | step2&3 | B | [
"29 year old woman presents",
"emergency department",
"joint pain",
"notable rash",
"joint pain",
"past 12 months",
"rash recently",
"generalized malaise",
"states",
"joint pain",
"symmetric",
"upper extremities",
"worse",
"morning",
"temperature",
"97",
"36 4C",
"blood pressure",
... |
A healthy 30-year-old female has a measured creatinine clearance of 100 mL/min. She has a filtration fraction (FF) of 25%. Serum analysis reveals a creatinine level of 0.9 mg/dL and an elevated hematocrit of 0.6. Which of the following is the best estimate of this patient’s renal blood flow? | 1.0 L/min | {
"A": "400 mL/min",
"B": "600 mL/min",
"C": "800 mL/min",
"D": "1.0 L/min"
} | step1 | D | [
"healthy 30 year old female",
"measured creatinine clearance",
"100 mL/min",
"filtration fraction",
"of",
"Serum analysis reveals",
"creatinine level",
"0.9 mg/dL",
"elevated hematocrit",
"0.6",
"following",
"best estimate",
"patients renal blood flow"
] |
A 22-year-old female college student comes to your clinic to establish care. She has no significant past medical history and her only complaint today is that she has had trouble maintaining a consistent weight. Her temperature is 98.6°F (37.0°C), blood pressure is 100/65 mmHg, pulse is 62/min, and respirations are 12/m... | Decreased chloride, decreased potassium, increased bicarbonate | {
"A": "Decreased chloride, decreased potassium, decreased bicarbonate",
"B": "Decreased chloride, decreased potassium, increased bicarbonate",
"C": "Decreased chloride, increased potassium, increased bicarbonate",
"D": "Increased chloride, decreased potassium, decreased bicarbonate"
} | step2&3 | B | [
"year old female college student",
"clinic to establish care",
"significant past medical history",
"only complaint today",
"maintaining",
"consistent weight",
"temperature",
"98",
"blood pressure",
"100 65 mmHg",
"pulse",
"62 min",
"respirations",
"min",
"body mass index",
"physical ex... |
As part of a clinical research study, the characteristics of neoplastic and normal cells are being analyzed in culture. It is observed that neoplastic cell division is aided by an enzyme which repairs progressive chromosomal shortening, which is not the case in normal cells. Due to the lack of chromosomal shortening, t... | Telomerase | {
"A": "Protein kinase",
"B": "Reverse transcriptase",
"C": "Telomerase",
"D": "Topoisomerase"
} | step1 | C | [
"part of",
"clinical",
"characteristics",
"neoplastic",
"normal cells",
"analyzed",
"culture",
"observed",
"neoplastic",
"aided",
"enzyme",
"repairs progressive chromosomal shortening",
"not",
"case",
"normal cells",
"Due to",
"lack",
"chromosomal shortening",
"neoplastic cells d... |
A 5-year-old boy is brought in by his mother with reports of trouble at school. Teachers report that for the last 6 months he has been having difficulty finishing tasks, is easily distracted, frequently does not listen, commonly fails to finish schoolwork, has not been able to complete any of the class projects this ye... | Methylphenidate | {
"A": "Atomoxetine",
"B": "Methylphenidate",
"C": "Clonidine",
"D": "Guanfacine"
} | step2&3 | B | [
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"brought",
"mother",
"reports",
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"Teachers report",
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"fails to finish",
"not",
"able to complete",
"class projects",
"year",
"frequently",
"school books",
"supplies",... |
A 32-year-old male asks his physician for information regarding a vasectomy. On further questioning, you learn that he and his wife have just had their second child and he asserts that they no longer wish to have additional pregnancies. You ask him if he has discussed a vasectomy with his wife to which he replies, "Wel... | Explain the risks and benefits of the procedure and request signed consent from the patient | {
"A": "Insist that the patient first discuss this procedure with his wife",
"B": "Telephone the patient's wife to inform her of the plan",
"C": "Explain the risks and benefits of the procedure and request signed consent from the patient",
"D": "Refuse to perform the vasectomy"
} | step1 | C | [
"year old male",
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"information",
"vasectomy",
"further questioning",
"learn",
"wife",
"second child",
"longer wish to",
"additional pregnancies",
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"vasectomy",
"wife",
"Well",
"not",
"I",
" ure he'",
"ree.\"",
"xt a propriate s ep p ior t heduling t",
... |
A 16-year-old boy comes to the physician for the evaluation of fatigue over the past month. He reports that his energy levels are low and that he spends most of his time in his room. He also states that he is not in the mood for meeting friends. He used to enjoy playing soccer and going to the shooting range with his f... | Instruct parents to remove guns from the house | {
"A": "Recommend family therapy",
"B": "Recommend alcohol cessation",
"C": "Hospitalization",
"D": "Instruct parents to remove guns from the house"
} | step2&3 | D | [
"year old boy",
"physician",
"evaluation",
"fatigue",
"past month",
"reports",
"energy levels",
"low",
"spends most of",
"time",
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"states",
"not",
"mood",
"meeting friends",
"used",
"playing soccer",
"shooting range",
"father",
"recently stopped showing interest",
"act... |
A 24-year-old woman presents with blisters and erosions on her upper face, chest, and back. The blisters have erythema, scales, and crust formation. The lesions are aggravated, especially after sun exposure. Examination shows oromucosal involvement. Histopathologic evaluation reveals a tombstone arrangement at the base... | Pemphigus vulgaris | {
"A": "Pemphigus vulgaris",
"B": "Bullous pemphigoid",
"C": "Pemphigus foliaceus",
"D": "Linear immunoglobulin A (IgA) disease (LAD)"
} | step1 | A | [
"year old woman presents",
"blisters",
"erosions",
"upper face",
"chest",
"back",
"blisters",
"erythema",
"scales",
"crust formation",
"lesions",
"aggravated",
"sun exposure",
"Examination shows oromucosal involvement",
"Histopathologic evaluation reveals",
"arrangement",
"base",
"... |
A 3-year-old boy is brought to his pediatrician by his mother for a productive cough. His symptoms began approximately 3 days prior to presentation and have not improved. His mother also reports that he developed diarrhea recently and denies any sick contacts or recent travel. He has received all of his vaccinations. M... | NAPDH oxidase defect | {
"A": "LFA-1 integrin defect",
"B": "Lysosomal trafficking regulator gene defect",
"C": "NAPDH oxidase defect",
"D": "WASP gene mutation"
} | step1 | C | [
"3 year old boy",
"brought",
"pediatrician",
"mother",
"productive cough",
"symptoms began approximately 3 days prior to presentation",
"not improved",
"mother",
"reports",
"diarrhea recently",
"denies",
"sick contacts",
"recent travel",
"received",
"of",
"vaccinations",
"Medical his... |
A 28-year-old female presents to her primary care provider for headache. The patient reports that every few weeks she has an episode of right-sided, throbbing headache. The episodes began several years ago and are accompanied by nausea and bright spots in her vision. The headache usually subsides if she lies still in a... | Sumatriptan | {
"A": "Acetazolamide",
"B": "High-flow oxygen",
"C": "Verapamil",
"D": "Sumatriptan"
} | step2&3 | D | [
"year old female presents",
"primary care provider",
"headache",
"patient reports",
"few weeks",
"episode of right-sided",
"throbbing headache",
"episodes began several years",
"nausea",
"bright spots",
"vision",
"headache usually",
"dark",
"quiet room",
"hours",
"patient denies",
"w... |
A 19-year-old woman presents to her gynecologist’s office stating that she has never had a period. She is slightly alarmed because most of her friends in college have been menstruating for years. She is also concerned about her short stature. When she previously visited her family physician during early puberty, she wa... | Coarctation of aorta | {
"A": "Cystic medial necrosis",
"B": "Coarctation of aorta",
"C": "Intelligence disability",
"D": "Endocardial cushion defects"
} | step2&3 | B | [
"year old woman presents",
"gynecologists office stating",
"never",
"period",
"slightly alarmed",
"most",
"friends",
"college",
"years",
"concerned",
"short stature",
"visited",
"family physician",
"early puberty",
"gain",
"appropriate height",
"final teenage years",
"past",
"yea... |
A 25-year-old woman is brought to the physician by her mother because she refuses to get out of bed and spends most days crying or staring at the wall. Her symptoms started 3 months ago. The patient states that she is very sad most of the time and that none of the activities that used to interest her are interesting no... | Continue fluoxetine and add phenelzine | {
"A": "Continue fluoxetine and increase dosage",
"B": "Taper fluoxetine and switch to desipramine",
"C": "Continue fluoxetine and add bupropion",
"D": "Continue fluoxetine and add phenelzine"
} | step2&3 | D | [
"year old woman",
"brought",
"physician",
"mother",
"refuses to get out",
"bed",
"spends",
"days crying",
"staring",
"wall",
"symptoms started 3 months",
"patient states",
"very sad most",
"time",
"activities",
"used to interest",
"interesting now",
"sleeps more",
"10 hours",
"... |
A 19-year-old basketball player unexpectedly collapses on the court. Several minutes later he returns to consciousness and is able to continue playing. This has happened several times before with similar outcomes. He had no significant past medical history. Which of the following is most likely to be found in this pati... | Septal hypertrophy | {
"A": "Atheromatous plaque rupture",
"B": "Coagulation necrosis with loss of nuclei and striations",
"C": "Septal hypertrophy",
"D": "Cardiac myxoma"
} | step1 | C | [
"year old basketball",
"collapses",
"court",
"minutes later",
"returns",
"consciousness",
"able to continue playing",
"happened",
"times",
"similar outcomes",
"significant past medical history",
"following",
"most likely to",
"found",
"patient"
] |
A 27-year-old woman presents to her doctor complaining of pain in her neck that radiates to her left ear. The pain has been more or less constant for the last 3 weeks and increases when she chews and swallows. She was in her normal state of health before the pain started. She also mentions that she has been experiencin... | ↓ Serum TSH, ↑ Total T4, ↑ Free T4, ↓ I131 Uptake | {
"A": "Normal Serum TSH, ↑ Total T4, Normal Free T4, Normal I131 Uptake",
"B": "↓ Serum TSH, ↑ Total T4, ↑ Free T4, ↓ I131 Uptake",
"C": "Normal Serum TSH, ↓ Total T4, Normal Free T4, Normal I131 Uptake",
"D": "↑ Serum TSH, ↑ Total T4, ↑ Free T4, ↑ I 131 Uptake"
} | step1 | B | [
"27 year old woman presents",
"doctor",
"pain",
"neck",
"radiates",
"left ear",
"pain",
"less constant",
"weeks",
"increases",
"chews",
"swallows",
"normal state of health",
"pain started",
"experiencing palpitations",
"muscle weakness",
"increased sweating",
"2 weeks",
"Past med... |
Patient 1 – A 26-year-old woman presents to her primary care physician for an annual exam. She currently does not have any acute concerns and says her health has been generally well. Medical history is significant for asthma, which is managed with an albuterol inhaler. Her last pap smear was unremarkable. She is curren... | Patient 1 – BRCA testing. Patient 2 – Breast ultrasound | {
"A": "Patient 1 – BRCA testing. Patient 2 – Breast ultrasound",
"B": "Patient 1 – Breast ultrasound. Patient 2 – Return in 3 months for a clinical breast exam",
"C": "Patient 1 – Breast and ovarian ultrasound. Patient 2 – Mammography",
"D": "Patient 1 – CA-125 testing. Patient 2 – BRCA testing"
} | step2&3 | A | [
"Patient",
"year old woman presents",
"primary care physician",
"annual exam",
"currently",
"not",
"acute concerns",
"health",
"well",
"Medical history",
"significant",
"asthma",
"managed",
"albuterol inhaler",
"last pap smear",
"unremarkable",
"currently sexually active",
"one mal... |
A 67-year-old man with a past medical history of poorly-controlled type 2 diabetes mellitus (T2DM) is brought to the emergency department for acute onset nausea and vomiting. According to the patient, he suddenly experienced vertigo and began vomiting 3 hours ago while watching TV. He reports hiking in New Hampshire wi... | Thrombotic stroke at the anterior inferior cerebellar artery (AICA) | {
"A": "Embolic stroke at the posterior inferior cerebellar artery (PICA)",
"B": "Hypoperfusion of the anterior spinal artery (ASA)",
"C": "Labryrinthitis",
"D": "Thrombotic stroke at the anterior inferior cerebellar artery (AICA)"
} | step1 | D | [
"67 year old man",
"past medical history of poorly-controlled type 2 diabetes mellitus",
"brought",
"emergency department",
"acute onset nausea",
"vomiting",
"patient",
"vertigo",
"began vomiting 3 hours",
"watching TV",
"reports hiking",
"New Hampshire",
"wife",
"days",
"Past medical hi... |
A 27-year-old female is brought to the Emergency Department by Fire Rescue after participating in a physical altercation with several commuters on the subway. She appears to be responding to hallucinations and is diaphoretic. Her vitals are as follows: T 100.5F (38C), HR 115, BP 155/90, RR 17. Her past medical history ... | Prominent vertical nystagmus | {
"A": "Prominent vertical nystagmus",
"B": "Constricted but responsive pupils",
"C": "Dilated, minimally responsive pupils",
"D": "Conjunctival injection"
} | step1 | A | [
"27 year old female",
"brought",
"Emergency Department",
"Fire",
"participating",
"physical altercation",
"subway",
"appears to",
"hallucinations",
"diaphoretic",
"follows",
"T 100",
"BP",
"90",
"RR",
"past medical history",
"notable",
"previous ED visit",
"phencyclidine related ... |
A 25-year-old nulligravid female presents to clinic complaining of abnormal vaginal discharge and vaginal pruritis. The patient's past medical history is unremarkable and she does not take any medications. She is sexually active with 3 male partners and does not use condoms. Pelvic examination is notable for a thick, o... | Oral fluconazole for the patient | {
"A": "Oral clindamycin for the patient and her partner",
"B": "Oral clindamycin for the patient",
"C": "Oral fluconazole for the patient and her partner",
"D": "Oral fluconazole for the patient"
} | step2&3 | D | [
"year old nulligravid female presents",
"clinic",
"abnormal",
"vaginal pruritis",
"patient's past",
"unremarkable",
"not take",
"medications",
"sexually active",
"male partners",
"not use condoms",
"Pelvic examination",
"notable",
"thick",
"white discharge",
"marked erythema",
"edema... |
A 52-year-old female presents to her rheumatologist with complaints of fatigue, a sore mouth, and occasional nausea and abdominal pain over the past several months. Her medical history is significant for 'pre-diabetes' treated with diet and exercise, hypertension managed with lisinopril, and rheumatoid arthritis well-c... | Initiation of folinic acid | {
"A": "Discontinuation of lisinopril and initiation of triamterene for blood pressure control",
"B": "Administration of daily, high-dose PO vitamin B12",
"C": "Initiation of folinic acid",
"D": "Addition of metformin"
} | step2&3 | C | [
"year old female presents",
"rheumatologist",
"complaints",
"fatigue",
"sore mouth",
"occasional nausea",
"abdominal pain",
"past",
"months",
"medical history",
"significant",
"pre-diabetes",
"treated with diet",
"exercise",
"hypertension managed",
"lisinopril",
"rheumatoid arthritis... |
Cardiac muscle serves many necessary functions, leading to a specific structure that serves these functions. The structure highlighted is an important histology component of cardiac muscle. What would be the outcome if this structure diffusely failed to function? | Failure of propagation of the action potential from the conduction system | {
"A": "Inappropriate formation of cardiac valve leaflets",
"B": "Failure of propagation of the action potential from the conduction system",
"C": "Outflow tract obstruction",
"D": "Ineffective excitation-contraction coupling due to insufficient calcium ions"
} | step1 | B | [
"Cardiac muscle",
"functions",
"leading",
"specific structure",
"functions",
"structure",
"important histology component",
"cardiac",
"outcome",
"structure",
"failed to function"
] |
A 32-year-old primigravid woman with a history of seizures comes to the physician because she had a positive pregnancy test at home. Medications include valproic acid and a multivitamin. Physical examination shows no abnormalities. A urine pregnancy test is positive. Her baby is at increased risk for requiring which of... | Lower spinal surgery | {
"A": "Lower spinal surgery",
"B": "Kidney transplanation",
"C": "Respiratory support",
"D": "Arm surgery"
} | step1 | A | [
"year old primigravid woman",
"history",
"seizures",
"physician",
"positive",
"home",
"Medications include valproic acid",
"multivitamin",
"Physical examination shows",
"abnormalities",
"urine pregnancy test",
"positive",
"baby",
"increased risk",
"following interventions"
] |
An investigator is studying early post-mortem changes in the lung. Autopsies are performed on patients who died following recent hospital admissions. Microscopic examination of the lungs at one of the autopsies shows numerous macrophages with brown intracytoplasmic inclusions. A Prussian blue stain causes these inclusi... | Shortness of breath that worsens when supine | {
"A": "Diaphoresis that worsens at night",
"B": "Purulent expectoration that worsens in the lateral recumbent position",
"C": "Lower extremity swelling that worsens on standing",
"D": "Shortness of breath that worsens when supine"
} | step1 | D | [
"investigator",
"studying early post-mortem changes",
"lung",
"Autopsies",
"performed",
"patients",
"died following recent hospital admissions",
"Microscopic examination",
"lungs",
"one",
"autopsies shows numerous macrophages",
"brown",
"inclusions",
"Prussian blue stain causes",
"inclus... |
A 42-year-old woman presents to her primary care physician for a checkup. She has been trying to get pregnant with her husband for the past 7 months but has been unsuccessful. The patient states that they have been having unprotected intercourse daily during this time frame. She states that she experiences her menses e... | Decreased ovarian reserve | {
"A": "Decreased ovarian reserve",
"B": "Menopause",
"C": "Spermatogenesis defect",
"D": "Tubal scarring"
} | step2&3 | A | [
"year old woman presents",
"primary care physician",
"checkup",
"to",
"pregnant",
"husband",
"past",
"months",
"unsuccessful",
"patient states",
"unprotected intercourse daily",
"time frame",
"states",
"experiences",
"menses",
"days",
"husband",
"2 children",
"marriage",
"patie... |
A 48-year-old man comes to the physician because of increasing generalized fatigue for 1 month. He has been unable to do normal household duties or go for his evening walks during this period. He has hypertension, hyperlipidemia, and type 2 diabetes mellitus. His father died of liver cancer at the age of 60 years. He d... | Genetic testing | {
"A": "CT of the abdomen",
"B": "Abdominal ultrasonography",
"C": "Liver biopsy",
"D": "Genetic testing"
} | step2&3 | D | [
"48 year old man",
"physician",
"of increasing generalized fatigue",
"month",
"unable to do normal household",
"go",
"evening walks",
"period",
"hypertension",
"hyperlipidemia",
"type 2 diabetes mellitus",
"father died of liver cancer",
"age",
"60 years",
"not smoke",
"drinks one alcoh... |
A 50-year-old male presents to the emergency room complaining of fever, shortness of breath, and diarrhea. He returned from a spa in the Rocky Mountains five days prior. He reports that over the past two days, he developed a fever, cough, dyspnea, and multiple watery stools. His past medical history is notable for majo... | Charcoal yeast agar with iron and cysteine | {
"A": "Charcoal yeast agar with iron and cysteine",
"B": "Sorbitol-MacConkey agar",
"C": "Bordet-Gengou agar",
"D": "Thayer-Martin agar"
} | step1 | A | [
"50 year old male presents",
"emergency room",
"fever",
"shortness of breath",
"diarrhea",
"returned",
"spa",
"Rocky Mountains five days prior",
"reports",
"past two days",
"fever",
"cough",
"dyspnea",
"multiple watery stools",
"past medical history",
"notable",
"major depressive dis... |
A 56-year-old woman is brought to the emergency department by her family with altered mental status. Her husband says that she complained of fever, vomiting, and abdominal pain 2 days ago. She has a history of long-standing alcoholism and previous episodes of hepatic encephalopathy. Current vital signs include a temper... | Diagnostic paracentesis | {
"A": "Empiric antibiotics",
"B": "Non-selective beta-blockers",
"C": "Intravenous albumin",
"D": "Diagnostic paracentesis"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"family",
"altered mental status",
"husband",
"fever",
"vomiting",
"abdominal pain",
"days",
"history of long standing alcoholism",
"previous episodes of hepatic encephalopathy",
"Current vital signs include",
"temperature",
"3C",
"b... |
An investigator studying viral replication isolates the genetic material of an unidentified virus strain. After exposing a cell culture to the isolated, purified viral genetic material, the cells begin to produce viral polymerase and subsequently replicate the viral genome. Infection with the investigated strain is mos... | Poliomyelitis | {
"A": "Rotavirus infection",
"B": "Influenza",
"C": "Rabies",
"D": "Poliomyelitis"
} | step1 | D | [
"investigator studying viral replication isolates",
"genetic",
"unidentified virus strain",
"exposing",
"cell culture",
"isolated",
"purified viral genetic material",
"cells begin to",
"viral polymerase",
"replicate",
"viral",
"Infection",
"investigated strain",
"most likely to cause",
"... |
A 26-year-old woman presents to her primary care physician for 5 days of increasing pelvic pain. She says that the pain has been present for the last 2 months; however, it has become increasingly severe recently. She also says that the pain has been accompanied by unusually heavy menstrual periods in the last few month... | Ureter | {
"A": "Cardinal ligament of the uterus",
"B": "External iliac artery",
"C": "Ovarian ligament",
"D": "Ureter"
} | step1 | D | [
"year old woman presents",
"primary care physician",
"5 days",
"increasing pelvic pain",
"pain",
"present",
"months",
"severe recently",
"pain",
"heavy menstrual periods",
"last",
"months",
"Physical exam reveals",
"mass",
"right adnexa",
"ultrasonography reveals",
"right ovarian mas... |
A 46-year-old man with HIV infection comes to the physician because of a 1-week history of severe retrosternal pain while swallowing. He has not been compliant with his antiretroviral drug regimen. His CD4+ T-lymphocyte count is 98/mm3 (N ≥ 500). Endoscopy shows white plaques in the esophagus. The most appropriate imme... | Cytochrome p450 enzymes | {
"A": "DNA polymerase",
"B": "Hydrogen-potassium ATPase",
"C": "Phospholipase A2",
"D": "Cytochrome p450 enzymes"
} | step1 | D | [
"year old man",
"HIV infection",
"physician",
"1-week history",
"severe retrosternal",
"swallowing",
"not",
"compliant",
"antiretroviral drug regimen",
"CD4",
"lymphocyte count",
"98 mm3",
"N",
"500",
"Endoscopy shows white plaques",
"esophagus",
"most appropriate immediate treatment... |
A 62-year-old woman is evaluated for fatigue 6 months after placement of a mechanical valve due to aortic stenosis. She does not drink alcohol or smoke cigarettes. A complete blood count reports hemoglobin of 9.5 g/L and a reticulocyte percentage of 5.8%. Platelet and leukocyte counts are within their normal ranges. Th... | RBC fragments and schistocytes | {
"A": "Bite cells and Heinz bodies",
"B": "Sickle cells and target cells",
"C": "RBC fragments and schistocytes",
"D": "Round macrocytes and target cells"
} | step1 | C | [
"62 year old woman",
"evaluated",
"fatigue",
"months",
"placement",
"mechanical valve",
"aortic stenosis",
"not drink alcohol",
"smoke cigarettes",
"complete blood count reports hemoglobin",
"9.5 g/L",
"a reticulocyte percentage",
"Platelet",
"leukocyte counts",
"normal ranges",
"patie... |
A 36-year-old woman comes to the physician because of new onset limping. For the past 2 weeks, she has had a tendency to trip over her left foot unless she lifts her left leg higher while walking. She has not had any trauma to the leg. She works as a flight attendant and wears compression stockings to work. Her vital s... | Normal foot inversion | {
"A": "Decreased ankle jerk reflex",
"B": "Normal foot eversion",
"C": "Normal foot inversion",
"D": "Weak hip flexion"
} | step2&3 | C | [
"36 year old woman",
"physician",
"new onset limping",
"past 2 weeks",
"trip",
"left foot",
"lifts",
"left leg higher",
"walking",
"not",
"trauma",
"leg",
"works",
"flight attendant",
"compression stockings to work",
"vital signs",
"normal",
"Physical examination shows weakness of ... |
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