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 26-year-old woman comes to the physician because she has not had a menstrual period for 5 weeks. Menarche was at the age of 14 years and menses occurred at regular 30-day intervals. She reports having unprotected sexual intercourse 3 weeks ago. A urine pregnancy test is positive. Which of the following best describes... | Neural crest has formed, but limb buds have not yet formed | {
"A": "Sexual differentiation has begun, but fetal movement has not started",
"B": "Fetal heart is beating, but cardiac activity is not yet visible on ultrasound",
"C": "Limb buds have formed, but fetal movements have not begun",
"D": "Neural crest has formed, but limb buds have not yet formed"
} | step1 | D | [
"year old woman",
"physician",
"not",
"menstrual period",
"weeks",
"Menarche",
"age",
"years",
"menses occurred",
"regular 30 day intervals",
"reports",
"unprotected sexual intercourse",
"weeks",
"urine pregnancy test",
"positive",
"following best",
"stage",
"development",
"embry... |
A 3-month-old boy is brought to the emergency department by his mom for breathing difficulty after a recent fall. His parents say that he rolled off of the mattress and landed on the hard wood floor earlier today. After an extensive physical exam, he is found to have many purplish bruises and retinal hemorrhages. A non... | Inform child protective services | {
"A": "Inform child protective services",
"B": "Provide parents with anticipatory guidance",
"C": "Reassurance that accidents are common",
"D": "Referral to genetics for further testing"
} | step2&3 | A | [
"3 month old boy",
"brought",
"emergency department",
"mom",
"breathing difficulty",
"recent fall",
"parents",
"rolled",
"mattress",
"landed",
"hard wood floor earlier today",
"extensive physical exam",
"found to",
"bruises",
"retinal hemorrhages",
"non contrast shows",
"subdural hem... |
A 23-year-old man presents to the office complaining of weight loss and fatigue for the past 2 months. He states that he has been experiencing foul-smelling, light-colored stools but thinks it is because he hasn’t been eating well, recently. He has a past medical history significant for cystic fibrosis, which is well-c... | Pancreatic insufficiency | {
"A": "Damage to intestinal brush border",
"B": "Chronic damage to intestinal mucosa",
"C": "Decreased recycling of bile acids",
"D": "Pancreatic insufficiency"
} | step1 | D | [
"23 year old man presents",
"office",
"of weight loss",
"fatigue",
"past",
"months",
"states",
"experiencing foul-smelling",
"light-colored stools",
"thinks",
"hasnt",
"eating well",
"recently",
"past medical history significant",
"cystic fibrosis",
"well-controlled",
"denies",
"sh... |
A clinical diagnosis of abruptio placentae is suspected. Which of the following is the most appropriate next step in the management of this patient? | Administration of intravenous fluids | {
"A": "Administration of intravenous fluids",
"B": "Vaginal delivery",
"C": "Administration of intramuscular betamethasone",
"D": "Administration of intravenous tranexamic acid"
} | step2&3 | A | [
"clinical diagnosis of",
"placentae",
"suspected",
"following",
"most appropriate next step",
"management",
"patient"
] |
A researcher is studying the effects of a new antihypertensive medication on urine osmolality. She first measures urine osmolality in different parts of the nephron of a healthy human control. The findings are shown below:
Portion of nephron Urine osmolality (mOsmol/kg)
Proximal convoluted tubule 300
Loop of Henle, des... | Impermeability to water | {
"A": "Increased transcription of water channels",
"B": "Impermeability to sodium",
"C": "Increased bicarbonate reabsorption",
"D": "Impermeability to water"
} | step1 | D | [
"researcher",
"studying",
"effects",
"new antihypertensive medication",
"urine osmolality",
"first measures urine osmolality",
"different parts of",
"nephron",
"healthy human control",
"findings",
"shown",
"Portion nephron Urine",
"mOsmol/kg",
"Proximal convoluted tubule 300 Loop of Henle"... |
A 59-year-old woman with a history of chronic kidney disease comes to the physician for a 3-month history of easy fatiguability. Physical examination shows subconjunctival pallor. Her hemoglobin concentration is 8.9 g/dL, mean corpuscular volume is 86 μm3, and serum ferritin is 225 ng/mL. Treatment with erythropoietin ... | Ribosomal RNA | {
"A": "Ribosomal RNA",
"B": "Denatured globin chains",
"C": "Remnants of the nucleus",
"D": "Mitochondria"
} | step1 | A | [
"59 year old woman",
"history of chronic kidney disease",
"physician",
"3 month history",
"easy fatiguability",
"Physical examination shows subconjunctival pallor",
"hemoglobin concentration",
"g/dL",
"mean corpuscular volume",
"m3",
"serum ferritin",
"ng/mL",
"Treatment",
"erythropoietin"... |
A 45-year-old woman presents with recent onset movement abnormalities. She says that she noticeably blinks, which is out of her control. She also has spasms of her neck muscles and frequent leg cramps. Past medical history is significant for ovarian cancer, currently being treated with an antineoplastic agent that disr... | Benztropine | {
"A": "Physostigmine",
"B": "Benztropine",
"C": "Clozapine",
"D": "Bethanechol"
} | step1 | B | [
"year old woman presents",
"recent onset movement abnormalities",
"blinks",
"out",
"control",
"spasms",
"neck muscles",
"frequent leg cramps",
"Past medical history",
"significant",
"ovarian cancer",
"currently",
"treated with",
"antineoplastic agent",
"disrupts microtubule function",
... |
Serum studies show a troponin T concentration of 6.73 ng/mL (N < 0.01), and fingerstick blood glucose concentration of 145 mg/dL. The cardiac catheterization team is activated. Treatment with unfractionated heparin, aspirin, ticagrelor, and sublingual nitroglycerin is begun, and the patient's pain subsides. His tempera... | Oral atorvastatin | {
"A": "Intravenous morphine",
"B": "Oral atorvastatin",
"C": "Intravenous insulin",
"D": "Intravenous nitroglycerin"
} | step2&3 | B | [
"Serum studies show",
"troponin T concentration",
"ng/mL",
"N",
"0.01",
"fingerstick blood glucose concentration",
"mg/dL",
"cardiac catheterization team",
"activated",
"Treatment",
"unfractionated heparin",
"aspirin",
"ticagrelor",
"sublingual nitroglycerin",
"begun",
"patient's pain"... |
A 55-year-old woman presents with fatigue, shortness of breath during ordinary activities, and occasional fluttering in her chest. She denies chest pain or lower extremity edema. She has no prior medical history. She does not smoke but drinks alcohol socially. Her blood pressure is 110/70 mm Hg, her temperature is 36.9... | ACE inhibitors, beta-blockers, diuretics, and surgery | {
"A": "Emergency surgery",
"B": "Angiotensin-converting enzyme (ACE) inhibitors and beta-blockers",
"C": "ACE inhibitors, beta-blockers, diuretics, and surgery",
"D": "Observation and echocardiographic followup"
} | step2&3 | C | [
"55 year old woman presents",
"fatigue",
"shortness of breath",
"activities",
"occasional fluttering",
"chest",
"denies chest pain",
"lower extremity edema",
"prior medical history",
"not smoke",
"drinks alcohol",
"blood pressure",
"70 mm Hg",
"temperature",
"36",
"98 4F",
"radial pu... |
A 2-month-old boy is brought to the emergency department by his mother because of an 8-hour history of difficulty feeding and decreased arousability. His mother says that the symptoms began after he rolled over and fell from the bed. His vital signs are within normal limits. Examination shows regions of purple discolor... | Subdural hematoma | {
"A": "Epidural hematoma",
"B": "Bacterial meningitis",
"C": "Periventricular hemorrhage",
"D": "Subdural hematoma"
} | step1 | D | [
"2 month old boy",
"brought",
"emergency department",
"mother",
"8-hour history",
"difficulty feeding",
"decreased",
"mother",
"symptoms began",
"rolled over",
"fell from",
"bed",
"vital signs",
"normal limits",
"Examination shows regions",
"purple discoloration",
"dermatomes",
"te... |
A 15-year-old teenager presents to the emergency department via emergency medical service (EMS) after a motor vehicle accident. The patient is in critical condition and is hemodynamically unstable. It becomes apparent that the patient may require a blood transfusion, and the parents are approached for consent. They are... | Give the patient the blood transfusion. | {
"A": "Give the patient the blood transfusion.",
"B": "Do not give blood transfusion due to the parents’ refusal.",
"C": "Consult the hospital ethics committee.",
"D": "Obtain a court order to give blood products."
} | step1 | A | [
"year old teenager presents",
"emergency department",
"emergency medical service",
"motor vehicle accident",
"patient",
"critical condition",
"unstable",
"apparent",
"patient",
"blood transfusion",
"parents",
"approached",
"consent",
"Witnesses",
"deny",
"blood transfusion",
"beliefs... |
A 6-hour-old newborn male is noted to have a “lump on his head” by his mother. She denies that the lump was present at birth and is concerned about an infection. The child was born at 39 weeks gestation to a 34-year-old gravida 2 by vacuum-assisted vaginal delivery after a prolonged labor. The child’s birth weight was ... | Observation only | {
"A": "Incision and drainage",
"B": "Neurosurgical decompression",
"C": "Red blood cell transfusion",
"D": "Observation only"
} | step2&3 | D | [
"6-hour old newborn male",
"noted to",
"lump on",
"head",
"mother",
"denies",
"lump",
"present at birth",
"concerned",
"infection",
"child",
"born",
"weeks gestation",
"year old gravida 2",
"vacuum assisted vaginal delivery",
"prolonged labor",
"childs birth weight",
"3",
"kg",
... |
A 48-year-old man presents with chronic uncontrolled hypertension for the past 12 years. He smokes approx. 3 packs of cigarettes per day and have consumed 2 alcohol drinks per day for the past 10 years. Which of the following pathologic changes would occur in the bronchial epithelium? | Metaplasia | {
"A": "Atrophy",
"B": "Dysplasia",
"C": "Hypertrophy",
"D": "Metaplasia"
} | step1 | D | [
"48 year old man presents",
"chronic uncontrolled hypertension",
"past",
"years",
"smokes",
"packs",
"cigarettes",
"day",
"2 alcohol drinks per day",
"past 10 years",
"following pathologic changes",
"occur",
"bronchial epithelium"
] |
An 87-year-old man with glioblastoma multiforme is informed that the size and location of the tumor make operative resection impossible, and he has a prognosis of between 3-6 months. The patient then asks whether it would be possible to get a prescription for lethal medications so that he would be able to end his life ... | Non-maleficence | {
"A": "Autonomy",
"B": "Distributive justice",
"C": "Formal justice",
"D": "Non-maleficence"
} | step1 | D | [
"87 year old man",
"glioblastoma multiforme",
"informed",
"size",
"location",
"tumor make operative resection",
"prognosis",
"3",
"months",
"patient then",
"possible to",
"prescription for lethal medications so",
"able to end",
"life",
"deteriorated further",
"physician",
"unable to"... |
A 66-year-old woman presents to her primary care physician for a wellness exam. She noticed mild spotting a few days prior to presentation. Her last menstrual period was when she was 53 years of age, and she denies any trauma to the area. She is sexually active with one male partner and does not use condoms. Medical hi... | Megestrol acetate | {
"A": "Anastrozole",
"B": "Estrogen-progestin contraceptives",
"C": "Megestrol acetate",
"D": "Nafarelin"
} | step2&3 | C | [
"66 year old woman presents",
"primary care physician",
"wellness exam",
"mild spotting",
"few days prior to presentation",
"last menstrual period",
"years",
"age",
"denies",
"trauma",
"area",
"sexually active",
"one male partner",
"not use condoms",
"Medical history",
"significant",
... |
A 62-year-old woman with a history of hypertension, hyperlipidemia, and rheumatoid arthritis presents for evaluation of elevated serum liver chemistries. She has had three months of intense, unremitting itching. Current medications include chlorthalidone, atorvastatin, and ibuprofen. Physical exam is unremarkable. Labo... | Intrahepatic bile duct destruction | {
"A": "Intrahepatic and extra hepatic bile duct destruction",
"B": "Intrahepatic bile duct destruction",
"C": "Granulomas in portal tracts",
"D": "Bile plugging of hepatocytes and bile ducts"
} | step1 | B | [
"62 year old woman",
"history of hypertension",
"hyperlipidemia",
"rheumatoid arthritis presents",
"evaluation",
"elevated serum liver chemistries",
"three months",
"intense",
"itching",
"Current medications include chlorthalidone",
"atorvastatin",
"ibuprofen",
"Physical exam",
"unremarkab... |
A 65-year-old man presents to a clinic after 2 days of pain just below the right nipple. The pain radiates to the scapula. The rash was preceded by a burning and tingling pain in the affected region. His medical history is relevant for hypertension and hypercholesterolemia. He does not recall his vaccination status or ... | Famciclovir | {
"A": "Prednisone",
"B": "Famciclovir",
"C": "Valganciclovir",
"D": "Gabapentin"
} | step1 | B | [
"65 year old man presents",
"clinic",
"2 days",
"pain",
"right nipple",
"pain radiates",
"scapula",
"rash",
"preceded",
"burning",
"tingling pain",
"affected region",
"medical history",
"relevant",
"hypertension",
"hypercholesterolemia",
"not recall",
"vaccination status",
"child... |
A 5-year-old boy is brought to his neurologist for continued treatment of muscle spasms. His past medical history is significant for a brain abnormality that was detected neonatally when it presented with an enlarged posterior fossa as well as a malformed cerebellar vermis. Since birth, he has had developmental delay, ... | Hydrocephalus | {
"A": "Hydrocephalus",
"B": "Polyhydramnios",
"C": "Syringomyelia",
"D": "Vocal cord paralysis"
} | step1 | A | [
"5 year old boy",
"brought",
"neurologist",
"continued treatment of muscle spasms",
"past medical history",
"significant",
"brain abnormality",
"detected",
"presented",
"enlarged posterior fossa",
"malformed cerebellar vermis",
"birth",
"developmental delay",
"high muscle tone",
"difficu... |
A 47-year-old man presents to his primary care physician for headaches. The patient states that he typically has headaches in the morning that improve as the day progresses. Review of systems reveals that he also experiences trouble focusing and daytime fatigue. The patient drinks 2 to 3 alcoholic beverages daily and s... | Weight loss | {
"A": "Continuous positive airway pressure",
"B": "Ibuprofen and follow up in 2 weeks",
"C": "Uvulopalatopharyngoplasty",
"D": "Weight loss"
} | step2&3 | D | [
"year old man presents",
"primary care physician",
"headaches",
"patient states",
"headaches",
"morning",
"day progresses",
"Review of systems reveals",
"experiences trouble focusing",
"daytime fatigue",
"patient drinks 2",
"3 alcoholic beverages daily",
"smokes",
"cigarettes",
"day",
... |
A 48-year-old man presents with a productive cough and occasional dyspnea on exertion. He has experienced these symptoms for the past 6 years. Patient denies weight loss, night sweats, or hemoptysis. Past medical history is significant for arterial hypertension, diagnosed 3 years ago, and diabetes mellitus type 2, diag... | Smoking cessation | {
"A": "Smoking cessation",
"B": "Identifying and avoiding contact with an allergen",
"C": "Increasing physical activity",
"D": "Discontinuing lisinopril"
} | step2&3 | A | [
"48 year old man presents",
"productive cough",
"occasional dyspnea on exertion",
"experienced",
"symptoms",
"past",
"years",
"Patient denies weight loss",
"night sweats",
"hemoptysis",
"Past medical history",
"significant",
"arterial hypertension",
"diagnosed 3 years",
"diabetes mellitu... |
A 26-year-old woman presents with a 3-month history of progressive muscle weakness and dysphagia. She reports choking on her food several times a day and has difficulty climbing the stairs at work. She denies any changes in her routine, diet or muscle pain. Her vital signs include: blood pressure 110/70 mm Hg, pulse 70... | Methotrexate | {
"A": "Rituximab",
"B": "Methotrexate",
"C": "Tacrolimus",
"D": "Intravenous immunoglobulin"
} | step2&3 | B | [
"year old woman presents",
"month history",
"progressive muscle weakness",
"dysphagia",
"reports choking on",
"food",
"times",
"day",
"difficulty climbing",
"stairs",
"work",
"denies",
"changes in",
"routine",
"diet",
"muscle pain",
"vital signs include",
"blood pressure",
"70 mm... |
A 20-year-old man is brought to the emergency department 20 minutes after he sustained a stab wound to his back during an altercation. He reports weakness and numbness of the lower extremities. He has no history of serious illness. On arrival, he is alert and cooperative. His pulse is 90/min, and blood pressure is 100/... | Brown-Sequard syndrome | {
"A": "Anterior cord syndrome",
"B": "Brown-Sequard syndrome",
"C": "Posterior cord syndrome",
"D": "Central cord syndrome"
} | step2&3 | B | [
"20 year old man",
"brought",
"emergency department 20 minutes",
"sustained",
"stab",
"back",
"altercation",
"reports weakness",
"numbness",
"lower extremities",
"history",
"serious illness",
"arrival",
"alert",
"cooperative",
"pulse",
"90 min",
"blood pressure",
"100 65 mm Hg",
... |
A 56-year-old woman with rheumatoid arthritis comes to the physician for a follow-up examination. She has no other history of serious illness. Menopause occurred 1 year ago. Current medications include antirheumatic drugs and hormone replacement therapy. She exercises regularly. A DEXA scan shows a T-score of -1.80, in... | Prednisone | {
"A": "Medroxyprogesterone acetate",
"B": "Naproxen",
"C": "Prednisone",
"D": "Adalimumab"
} | step1 | C | [
"year old woman",
"rheumatoid arthritis",
"physician",
"follow-up examination",
"history",
"serious illness",
"Menopause occurred 1 year",
"Current medications include antirheumatic drugs",
"hormone replacement therapy",
"exercises",
"DEXA scan shows a T score",
"1 80",
"decreased bone densi... |
A 70-year-old retired police officer is being evaluated for fatigue. A peripheral smear shows extremely elevated numbers of immature myeloid cells, which are positive for myeloperoxidase and a translocation t(15,17). Which of the following statements is true regarding his condition? | The patient can be treated with a vitamin A derivative. | {
"A": "This condition is also developed early in life in patients with Down syndrome.",
"B": "Myelodysplastic syndromes may give rise to the condition.",
"C": "The patient can be treated with a vitamin A derivative.",
"D": "Auer rods are responsible for gum hyperplasia and bleeding."
} | step1 | C | [
"70 year old retired police officer",
"evaluated",
"fatigue",
"peripheral smear shows extremely elevated numbers",
"immature myeloid cells",
"positive",
"myeloperoxidase",
"translocation",
"following statements",
"true",
"condition"
] |
A 12-year-old boy is brought by his mother to a neurologist for continuing evaluation of seizures. His seizures were previously well-controlled on medication but over the last month he has been having seizures several times per week. The boy is non-verbal and has had severe developmental delays and cognitive disability... | Abnormally decreased expression of the gene from the maternal chromosome | {
"A": "Abnormally decreased expression of the gene from both chromosomes",
"B": "Abnormally decreased expression of the gene from the maternal chromosome",
"C": "Abnormally decreased expression of the gene from the paternal chromosome",
"D": "Abnormally increased expression of the gene from the maternal chromo... | step1 | B | [
"year old boy",
"brought",
"mother",
"neurologist",
"continuing evaluation",
"seizures",
"seizures",
"well",
"medication",
"last month",
"seizures",
"times",
"week",
"boy",
"non-verbal",
"severe developmental delays",
"cognitive disability",
"birth",
"exam",
"boy",
"found to"... |
A 61-year-old woman is brought to the emergency department because of fever, chills, and flank pain for 8 hours. Her temperature is 39.1°C (102.4°F). Physical examination shows right costovertebral angle tenderness. Urine dipstick is positive for nitrites. Urinalysis shows gram-negative rods. The patient is admitted to... | Cleaving DNA to relieve supercoils | {
"A": "Cleaving DNA to relieve supercoils",
"B": "Excising RNA fragments in 5' to 3' direction",
"C": "Unwinding DNA at replication fork",
"D": "Binding to single-stranded DNA to prevent reannealing"
} | step1 | A | [
"61 year old woman",
"brought",
"emergency department",
"fever",
"chills",
"flank pain",
"8 hours",
"temperature",
"4F",
"Physical examination shows right costovertebral angle tenderness",
"Urine dipstick",
"positive",
"nitrites",
"Urinalysis shows gram-negative rods",
"patient",
"admi... |
An exclusively breast-fed, 5-day-old boy is brought to the physician by his mother for a routine examination. He was born at term and delivery was uncomplicated. He received all standard treatment and testing prior to being discharged from the hospital 3 days ago. Examination shows no abnormalities. Without receiving a... | Rickets | {
"A": "Scaly dermatitis",
"B": "Intracranial bleed",
"C": "Microcytic anemia",
"D": "Rickets"
} | step1 | D | [
"breast-fed",
"5 day old boy",
"brought",
"physician",
"mother",
"routine examination",
"born",
"term",
"delivery",
"uncomplicated",
"received",
"standard treatment",
"testing prior to",
"discharged from",
"hospital",
"days",
"Examination shows",
"abnormalities",
"receiving addit... |
A 59-year-old woman presents to her primary care provider with a 6-month history of progressive left-arm swelling. Two years ago she had a partial mastectomy and axillary lymph node dissection for left breast cancer. She was also treated with radiotherapy at the time. Upon further questioning, she denies fever, pain, o... | Vascularized lymph node transfer | {
"A": "Diethylcarbamazine",
"B": "Endovascular stenting",
"C": "Vascularized lymph node transfer",
"D": "Antibiotics"
} | step2&3 | C | [
"59 year old woman presents",
"primary care provider",
"month history of progressive left-arm swelling",
"Two years",
"partial mastectomy",
"axillary lymph node dissection",
"left breast cancer",
"treated with radiotherapy",
"time",
"further questioning",
"denies fever",
"pain",
"skin change... |
A 29-year-old woman with hypothyroidism comes to her primary care physician for advice on a health insurance plan. She works as a baker and owns a small bakery. The patient explains that she would like to have affordable monthly premiums. She would be willing to make additional payments to be able to see providers outs... | Point of service | {
"A": "Preferred provider organization",
"B": "Medicare",
"C": "Medicaid",
"D": "Point of service"
} | step1 | D | [
"29 year old woman",
"hypothyroidism",
"primary care physician",
"advice",
"health insurance plan",
"works",
"baker",
"small bakery",
"patient",
"to",
"affordable monthly",
"willing to make additional payments to",
"able to see providers outside",
"network",
"to",
"specialist care",
... |
A 76-year-old woman presents to the office with a generalized weakness for the past month. She has a past medical history significant for uncontrolled hypertension and type 2 diabetes mellitus. Her temperature is 37.0°C (98.6°F), blood pressure is 135/82 mm Hg, pulse is 90/min, respiratory rate is 17/min, and oxygen s... | Increased PTH, decreased calcium, increased phosphate | {
"A": "Increased PTH, decreased calcium, increased phosphate",
"B": "Increased PTH, decreased calcium, decreased phosphate",
"C": "Increased PTH, increased calcium, increased phosphate",
"D": "Normal PTH, increased calcium, normal phosphate"
} | step1 | A | [
"76 year old woman presents",
"office",
"generalized weakness",
"past month",
"past medical history significant",
"uncontrolled hypertension",
"type 2 diabetes mellitus",
"temperature",
"98",
"blood pressure",
"mm Hg",
"pulse",
"90 min",
"respiratory rate",
"min",
"oxygen saturation",
... |
A 27-year-old G3P2002 presents to the clinic for follow up after her initial prenatal visit. Her last period was 8 weeks ago. Her medical history is notable for obesity, hypertension, type 2 diabetes, and eczema. Her current two children are healthy. Her current pregnancy is with a new partner after she separated from ... | Colposcopy and biopsy now | {
"A": "Colposcopy and biopsy after delivery",
"B": "Colposcopy and biopsy now",
"C": "Loop electrosurgical excision procedure (LEEP)",
"D": "Repeat Pap smear"
} | step2&3 | B | [
"27 year old",
"presents",
"clinic",
"follow up",
"initial prenatal visit",
"last period",
"weeks",
"medical history",
"notable",
"obesity",
"hypertension",
"type 2 diabetes",
"eczema",
"current two children",
"healthy",
"current pregnancy",
"new partner",
"separated",
"previous ... |
A 17-year-old girl is brought to the physician because she has never menstruated. She is at the 15th percentile for weight and 45th percentile for height. Vital signs are within normal limits. Examination shows facial hair, clitoromegaly, and coarse, curly pubic hair that extends to the inner surface of both thighs. Sh... | 5-α reductase deficiency | {
"A": "Sex chromosome monosomy",
"B": "Complete androgen insensitivity",
"C": "Aromatase deficiency",
"D": "5-α reductase deficiency"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"never",
"percentile",
"weight",
"percentile",
"height",
"Vital signs",
"normal limits",
"Examination shows facial hair",
"clitoromegaly",
"coarse",
"curly pubic hair",
"extends",
"inner surface of",
"thighs",
"glandular breast",
"Ultrasou... |
A 35-year-old man comes to the Veterans Affairs hospital because of a 2-month history of anxiety. He recently returned from his third deployment to Iraq, where he served as a combat medic. He has had difficulty readjusting to civilian life. He works as a taxi driver but had to take a leave of absence because of difficu... | Cognitive behavioral therapy | {
"A": "Motivational interviewing",
"B": "Prazosin therapy",
"C": "Venlafaxine therapy",
"D": "Cognitive behavioral therapy"
} | step2&3 | D | [
"35 year old man",
"Veterans",
"hospital",
"2 month history",
"anxiety",
"recently returned",
"third deployment",
"Iraq",
"difficulty",
"civilian life",
"works",
"taxi driver",
"to take",
"leave of absence",
"of difficulties",
"driving",
"Last week",
"hit",
"stop sign",
"out",
... |
A 60-year-old man visits his primary care doctor after being discharged from the hospital 3 weeks ago. He presented to the hospital with chest pain and was found to have ST elevations in leads I, aVL, and V6. He underwent cardiac catheterization with balloon angioplasty and was discharged on appropriate medications. At... | Aspirin | {
"A": "Aspirin",
"B": "Atorvastatin",
"C": "Furosemide",
"D": "Lisinopril"
} | step2&3 | A | [
"60 year old man visits",
"primary care doctor",
"discharged from",
"hospital",
"weeks",
"presented",
"hospital",
"chest pain",
"found to",
"ST elevations",
"leads I",
"aVL",
"V6",
"cardiac catheterization",
"balloon angioplasty",
"discharged",
"appropriate medications",
"visit",
... |
An 18-year-old woman presents for a routine check-up. She is a college student with no complaints. She has a 2 pack-year history of smoking and consumes alcohol occasionally. Her sexual debut was at 15 years of age and has had 2 sexual partners. She takes oral contraceptives and uses barrier contraception. Her family h... | The patient should undergo screening every 3 years after she turns 21 years of age. | {
"A": "The patient requires annual Pap testing due to her family history of cervical cancer.",
"B": "The patient does not require Pap testing as long as she uses barrier contraception.",
"C": "The patient should undergo screening every 3 years after she turns 21 years of age.",
"D": "HPV testing is more prefer... | step2&3 | C | [
"year old woman presents",
"routine check-up",
"college student",
"complaints",
"2 pack-year history of smoking",
"alcohol occasionally",
"sexual",
"years",
"age",
"2 sexual partners",
"takes oral contraceptives",
"uses barrier contraception",
"family history",
"significant",
"cervical c... |
A 53-year-old man comes to the emergency department for severe left knee pain for the past 8 hours. He describes it as an unbearable, burning pain that woke him up from his sleep. He has been unable to walk since. He has not had any trauma to the knee. Ten months ago, he had an episode of acute pain and swelling of the... | Arthrocentesis | {
"A": "Serum uric acid level",
"B": "Arthrocentesis",
"C": "Oral colchicine",
"D": "Oral methotrexate"
} | step2&3 | B | [
"year old man",
"emergency department",
"severe left knee pain",
"past 8 hours",
"burning pain",
"woke",
"sleep",
"unable to walk since",
"not",
"trauma",
"knee",
"Ten months",
"episode of acute pain",
"swelling",
"right great toe",
"after treatment",
"indomethacin",
"hypertension"... |
A 23-year-old man presents to his primary care physician for a runny nose, sneezing, and coughing that has persisted for a few months. He denies feeling weak or tired, but states that his symptoms have disrupted his every day life. The patient has no significant past medical history. He drinks alcohol occasionally on t... | Intranasal steroid | {
"A": "Amoxicillin",
"B": "Intranasal saline",
"C": "Intranasal steroid",
"D": "Loratadine"
} | step2&3 | C | [
"23 year old man presents",
"primary care physician",
"runny nose",
"sneezing",
"coughing",
"months",
"denies feeling weak",
"tired",
"states",
"symptoms",
"disrupted",
"day life",
"patient",
"significant past medical history",
"drinks alcohol occasionally",
"weekends",
"temperature"... |
A 47-year-old man presents to his primary care physician complaining of pain and stiffness in his right index finger and left knee. The past medical history is remarkable for severe dandruff and an episode of apparent gout in the left 1st toe 6 months ago, which never resolved. The physical examination confirms dactyli... | Psoriatic arthritis | {
"A": "Rheumatoid arthritis",
"B": "Psoriatic arthritis",
"C": "Osteoarthritis",
"D": "Reactive arthritis"
} | step2&3 | B | [
"year old man presents",
"primary care physician",
"pain",
"stiffness",
"right index finger",
"left knee",
"past medical history",
"severe dandruff",
"episode of apparent gout",
"left 1st toe",
"months",
"never resolved",
"physical examination confirms dactylitis",
"right index finger",
... |
A 28-year-old man presents with visual disturbances. He says that he is having double vision since he woke up this morning. His past medical history is insignificant except for occasional mild headaches. The patient is afebrile and his vitals are within normal limits. On physical examination of his eyes, there is paral... | Abducens nerve | {
"A": "Optic nerve",
"B": "Trigeminal nerve",
"C": "Oculomotor nerve",
"D": "Abducens nerve"
} | step1 | D | [
"year old man presents",
"visual disturbances",
"double vision",
"woke up",
"morning",
"past medical history",
"occasional mild headaches",
"patient",
"afebrile",
"normal limits",
"physical examination",
"eyes",
"paralysis",
"left lateral gaze",
"rest",
"esotropia of",
"left eye",
... |
A 6-month-old male presents with a painless, enlarged left scrotum. After examining the patient, you suspect this enlargement is secondary to serous fluid entering and accumulating in the scrotum through a patent processus vaginalis. Which of the following would be the most useful next step in confirming the diagnosis ... | Transillumination test followed by scrotal ultrasound | {
"A": "Measurement of AFP and hCG levels",
"B": "Transillumination test followed by scrotal ultrasound",
"C": "Evaluation of cremasteric reflex on physical exam",
"D": "Standard urinalysis"
} | step1 | B | [
"month old male presents",
"painless",
"enlarged left scrotum",
"examining",
"patient",
"suspect",
"enlargement",
"secondary to serous fluid entering",
"scrotum",
"patent processus vaginalis",
"following",
"most useful next step",
"confirming",
"diagnosis",
"patients condition"
] |
A 46-year-old woman presents to your medical office complaining of ‘feeling tired’. The patient states that she has been having some trouble eating because her ‘tongue hurts’, but she has no other complaints. On examination, the patient has pale conjunctiva and skin and also appears tired. She has a smooth, red tongue ... | Pernicious anemia | {
"A": "Herpes simplex virus-1 infection",
"B": "Pernicious anemia",
"C": "Plummer-Vinson syndrome",
"D": "Kawasaki disease"
} | step1 | B | [
"year old woman presents",
"medical office",
"feeling tired",
"patient states",
"trouble eating",
"tongue",
"complaints",
"examination",
"patient",
"pale conjunctiva",
"skin",
"appears tired",
"smooth",
"red",
"tender",
"touch",
"tongue depressor",
"patients hands",
"feet feel co... |
A 52-year-old man presents to the emergency department with severe pain of the left first metatarsophalangeal joint. He says that the pain started 3 hours ago and describes it as sharp in character. The pain has been so severe that he has not been able to tolerate any movement of the joint. His past medical history is ... | Negatively birefringent crystals in the joint | {
"A": "Fractures with bony consolidations",
"B": "Negatively birefringent crystals in the joint",
"C": "Positively birefringent crystals in the joint",
"D": "Subchondral sclerosis and osteophyte formation"
} | step1 | B | [
"year old man presents",
"emergency department",
"severe pain",
"left first metatarsophalangeal joint",
"pain started 3 hours",
"sharp",
"character",
"pain",
"so severe",
"not",
"able to",
"movement",
"joint",
"past medical history",
"significant",
"hypertension",
"takes",
"thiazid... |
A 29-year-old woman comes to the office with the complaints of severe bleeding after a dental extraction which required local hemostatic therapy. She has a long-term excessive menstrual bleeding and iron-deficiency anemia that required treatment with iron supplement since the age of 17. In addition, she states that her... | Von Willebrand disease | {
"A": "Hemophilia A",
"B": "Systemic lupus erythematosus",
"C": "Sideroblastic anemia",
"D": "Von Willebrand disease"
} | step1 | D | [
"29 year old woman",
"office",
"complaints",
"severe bleeding",
"dental extraction",
"required local hemostatic therapy",
"long-term excessive menstrual bleeding",
"iron-deficiency anemia",
"required treatment",
"iron supplement",
"age",
"addition",
"states",
"mother",
"history",
"freq... |
A 23-year-old woman presents with flatulence and abdominal cramping after meals. For the last year, she has been feeling uneasy after meals and sometimes has severe pain after eating breakfast in the morning. She also experiences flatulence and, on rare occasions, diarrhea. She says she has either cereal or oats in the... | Magnesium hydroxide | {
"A": "Cimetidine",
"B": "Magnesium hydroxide",
"C": "Sucralfate",
"D": "Loperamide"
} | step1 | B | [
"23 year old woman presents",
"flatulence",
"abdominal cramping",
"meals",
"last year",
"feeling uneasy",
"meals",
"sometimes",
"severe pain",
"eating breakfast",
"morning",
"experiences flatulence",
"rare occasions",
"diarrhea",
"either cereal",
"oats",
"morning",
"usually",
"gl... |
A 21-year-old man is brought to the office by his parents due to concerns about his behavior. They describe their son as aloof and a loner who earns average to below average grades in school. Today, his heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 36.8°C (98.2°F).... | Schizoid personality disorder | {
"A": "Avoidant personality disorder",
"B": "Schizoid personality disorder",
"C": "Schizotypal personality disorder",
"D": "Autism spectrum disorder"
} | step1 | B | [
"21-year-old man",
"brought",
"office",
"parents due to concerns",
"behavior",
"son",
"aloof",
"earns average",
"grades",
"school",
"Today",
"heart rate",
"90 min",
"respiratory rate",
"min",
"blood pressure",
"65 mm Hg",
"temperature",
"36",
"98",
"physical examination",
"... |
A 38-year-old woman is brought to the emergency department because of left lower leg pain after tripping on the stairs in her house. She reports that she has become a vegetarian and has been avoiding sunlight exposure for the last 2 years after watching a TV program on how to reduce the risk of malignancies. Physical e... | Synthesis of cholecalciferol | {
"A": "25-hydroxylation of cholecalciferol",
"B": "Synthesis of 7-dehydrocholesterol",
"C": "Synthesis of cholecalciferol",
"D": "Synthesis of ergocalciferol"
} | step1 | C | [
"year old woman",
"brought",
"emergency department",
"of left",
"tripping",
"stairs",
"house",
"reports",
"vegetarian",
"sunlight exposure",
"years",
"watching",
"TV program",
"to",
"risk",
"malignancies",
"Physical examination shows tenderness",
"left proximal shin",
"x-ray of",... |
A 37-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He suffered multiple deep lacerations and experienced significant blood loss during transport. In the emergency department, his temperature is 98.6°F (37°C), blood pressure is 102/68 mmHg, pulse is 112/min, and respira... | Increased cardiac output and increased right atrial pressure | {
"A": "Decreased cardiac output and decreased right atrial pressure",
"B": "Decreased cardiac output and increased right atrial pressure",
"C": "Increased cardiac output and decreased right atrial pressure",
"D": "Increased cardiac output and increased right atrial pressure"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"ambulance",
"motor vehicle accident",
"suffered multiple deep lacerations",
"significant blood loss",
"transport",
"emergency department",
"temperature",
"98",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"respirations",
"min",
"l... |
A 5-day-old male is brought to your office by his mother. The infant is experiencing bilious vomiting, abdominal distension, and overall failure to thrive. A contrast enema shows a transition point at the transverse colon between dilated ascending colon and non-distended distal portion of the colon. Which of the follow... | Failure of neural crest cell migration | {
"A": "Muscle hypertrophy",
"B": "CFTR gene mutation",
"C": "Meiotic nondisjunction",
"D": "Failure of neural crest cell migration"
} | step1 | D | [
"5 day old male",
"brought",
"office",
"mother",
"infant",
"experiencing bilious vomiting",
"abdominal distension",
"overall failure to thrive",
"contrast enema shows a transition point",
"transverse colon",
"dilated ascending colon",
"non distended distal portion",
"colon",
"following",
... |
A 62-year-old woman presents to her physician because she has been feeling increasingly fatigued over the last several months. In addition, she says that she has woken up at night several times and found herself completely covered in sweat. Finally, she says that she has lost 20 pounds despite no changes in her daily r... | Retinal hemorrhage | {
"A": "Calcitriol secretion",
"B": "Jaw lesion",
"C": "Retinal hemorrhage",
"D": "Sjogren syndrome"
} | step1 | C | [
"62 year old woman presents",
"physician",
"feeling",
"fatigued",
"months",
"addition",
"woken up",
"night",
"times",
"found",
"completely covered",
"sweat",
"lost 20 pounds",
"changes",
"daily routine",
"presentation",
"temperature",
"3C",
"blood pressure",
"83 mmHg",
"pulse... |
A 70-year-old man presents to an urgent care clinic with bilateral flank pain for the past 2 days. During the last week, he has been experiencing some difficulty with urination, which prevented him from leaving his home. Now, he has to go to the bathroom 4–5 times per hour and he wakes up multiple times during the nigh... | 5-alpha reductase inhibitor | {
"A": "Alpha-1-adrenergic antagonists",
"B": "Anticholinergic",
"C": "5-alpha reductase inhibitor",
"D": "Phosphodiesterase-5 inhibitors"
} | step1 | C | [
"70 year old man presents",
"urgent care clinic",
"bilateral flank pain",
"past 2 days",
"last week",
"experiencing",
"difficulty",
"urination",
"prevented",
"leaving",
"home",
"Now",
"to go",
"bathroom",
"times",
"hour",
"wakes up multiple times",
"night to",
"straining",
"dif... |
A 13-month-old female infant is brought to the pediatrician by her stepfather for irritability. He states that his daughter was crying through the night last night, but she didn’t want to eat and was inconsolable. This morning, she felt warm. The father also notes that she had dark, strong smelling urine on the last di... | Renal ultrasound | {
"A": "Prophylactic antibiotics",
"B": "Renal ultrasound",
"C": "Repeat urine culture in 3 weeks",
"D": "Voiding cystourethrogram"
} | step2&3 | B | [
"month old female infant",
"brought",
"pediatrician",
"stepfather",
"irritability",
"states",
"daughter",
"crying",
"night",
"to eat",
"morning",
"felt warm",
"father",
"notes",
"dark",
"strong smelling urine",
"diaper change",
"patients temperature",
"3C",
"blood pressure",
... |
A 4-year-old girl is brought to the emergency department by her father for the evaluation of abdominal pain for 1 hour after drinking a bottle of rust remover. The father reports that she vomited once on the way to the hospital and that her vomit was not bloody. The patient has pain with swallowing. She appears uncomfo... | Esophageal strictures | {
"A": "Esophageal webs",
"B": "Esophageal strictures",
"C": "Mallory-Weiss tears",
"D": "Oral cavity cancer"
} | step1 | B | [
"4 year old girl",
"brought",
"emergency department",
"father",
"evaluation",
"abdominal",
"1 hour",
"drinking",
"bottle",
"rust remover",
"father reports",
"vomited",
"hospital",
"vomit",
"not bloody",
"patient",
"pain with swallowing",
"appears",
"Oral examination shows mild er... |
A clinical trial investigating a new biomedical device used to correct congenital talipes equinovarus (club foot) in infants has recently been published. The study was a preliminary investigation of a new device and as such the sample size is only 20 participants. The results indicate that the new biomedical device is ... | Mode | {
"A": "Mean",
"B": "Median",
"C": "Mode",
"D": "Standard deviation"
} | step1 | C | [
"clinical trial investigating",
"new biomedical device used",
"correct congenital talipes equinovarus",
"club foot",
"infants",
"recently",
"published",
"study",
"preliminary investigation",
"new device",
"sample size",
"only 20 participants",
"results",
"new biomedical device",
"less ef... |
A 38-year-old man comes to the physician because of a 2-week history of severe pain while passing stools. The stools are covered with bright red blood. He has been avoiding defecation because of the pain. Last year, he was hospitalized for pilonidal sinus surgery. He has had chronic lower back pain ever since he had an... | Sitz baths and topical nifedipine | {
"A": "Botulinum toxin injection",
"B": "Tract curettage",
"C": "Sitz baths and topical nifedipine",
"D": "Colonoscopy"
} | step2&3 | C | [
"year old man",
"physician",
"2-week history",
"severe pain",
"stools",
"stools",
"covered",
"bright red blood",
"defecation",
"pain",
"year",
"hospitalized",
"pilonidal sinus surgery",
"chronic lower back pain ever",
"accident",
"workplace 10 years",
"patient's father",
"diagnosed... |
A 4-month-old girl with Down syndrome is brought into the pediatrician’s office by her father for her first well-child visit. The father states she was a home birth at 39 weeks gestation after an uneventful pregnancy without prenatal care. The child has not received any routine immunizations. The father states that som... | Indomethacin | {
"A": "Antibiotics",
"B": "Indomethacin",
"C": "PGE2",
"D": "Heart transplant"
} | step1 | B | [
"4 month old girl",
"Down syndrome",
"brought",
"pediatricians office",
"father",
"first well-child visit",
"father states",
"home birth",
"weeks gestation",
"pregnancy",
"prenatal",
"child",
"not received",
"routine immunizations",
"father states",
"sometimes",
"crying",
"nursing"... |
A 45-year-old woman comes to the emergency department because of severe pain in both of her wrist joints and her fingers for the past 24 hours. She has a 6-month history of similar episodes, which are often associated with stiffness for about 90 minutes when she wakes up in the morning. She has hyperlipidemia and hyper... | Prednisolone | {
"A": "Indomethacin",
"B": "Prednisolone",
"C": "Vitamin D and calcium supplements",
"D": "Sulfasalazine"
} | step2&3 | B | [
"year old woman",
"emergency department",
"of severe",
"wrist joints",
"fingers",
"past 24 hours",
"month history of similar episodes",
"often associated with stiffness",
"about 90 minutes",
"wakes up",
"morning",
"hyperlipidemia",
"hypertension",
"Two years",
"diagnosed",
"peptic ulce... |
A 35-year old Caucasian woman visits a community clinic and is presenting with a long history of early satiety, diarrhea, fatigue, hair loss, and brittle nails. Her family history is insignificant. Her personal history is relevant for iron deficiency anemia and vitamin B12 deficiency, as seen in her lab reports a few m... | Anti-parietal cell antibodies | {
"A": "Anti-Helicobacter pylori antibodies",
"B": "Anti-Saccharomyces cerevisiae antibodies (ASCAs)",
"C": "Anti-parietal cell antibodies",
"D": "Anti-neutrophil cytoplasmic antibodies (ANCAs)"
} | step2&3 | C | [
"35 year old Caucasian woman visits",
"community clinic",
"presenting",
"long history",
"early satiety",
"diarrhea",
"fatigue",
"hair loss",
"brittle nails",
"family history",
"personal history",
"relevant",
"iron deficiency anemia",
"vitamin B12 deficiency",
"seen",
"lab reports",
"... |
A 14-year-old boy presents with abdominal pain and diarrhea after returning from an East Asian vacation. Stool sample reveals the presence of red and white blood cells. Stool culture shows growth of immobile, non-lactose fermenting gram-negative rods. The attending physician explains to the medical students that the ba... | Shigella dysenteriae | {
"A": "Escherichia coli",
"B": "Salmonella enteritidis",
"C": "Shigella dysenteriae",
"D": "Helicobacter pylori"
} | step1 | C | [
"year old boy presents",
"abdominal pain",
"diarrhea",
"returning",
"East Asian vacation",
"Stool sample reveals",
"presence",
"red",
"white blood cells",
"Stool culture shows growth",
"immobile",
"non lactose fermenting gram-negative rods",
"attending physician",
"medical students",
"ba... |
A previously healthy 37-year-old woman, gravida 3, para 2, at 29 weeks' gestation comes to the physician because of colicky postprandial abdominal pain. Her vital signs are within normal limits. Physical examination shows a uterus consistent in size with a 29-week gestation. Ultrasonography of the abdomen shows multipl... | Increased secretion of cholesterol
" | {
"A": "Accelerated gallbladder emptying",
"B": "Increased secretion of bile acids",
"C": "Overproduction of bilirubin",
"D": "Increased secretion of cholesterol\n\""
} | step1 | D | [
"healthy",
"year old woman",
"gravida 3",
"para 2",
"29 weeks",
"gestation",
"physician",
"colicky postprandial abdominal pain",
"vital signs",
"normal limits",
"Physical examination shows",
"uterus consistent",
"size",
"29 week gestation",
"Ultrasonography of",
"abdomen shows multiple... |
A 4-year-old boy is brought to a pediatrician with a history of repeated episodes of right-ear symptoms, including irritability, fever, ear pain, and pulling at the ear, for the last 2 years. Each episode has been treated with an appropriate antibiotic for the recommended duration of time as prescribed by the pediatric... | Myringotomy with insertion of a tympanostomy tube | {
"A": "Antibiotic prophylaxis with subtherapeutic dose of sulfonamide",
"B": "Adenoidectomy",
"C": "Myringotomy without insertion of a tympanostomy tube",
"D": "Myringotomy with insertion of a tympanostomy tube"
} | step2&3 | D | [
"4 year old boy",
"brought",
"pediatrician",
"history of repeated episodes",
"right-ear symptoms",
"including irritability",
"fever",
"ear pain",
"pulling at",
"ear",
"last",
"years",
"episode",
"treated with",
"appropriate antibiotic",
"recommended duration",
"time",
"prescribed",... |
A 47-year-old man is brought to the emergency room by his wife. She states that they were having dinner at a restaurant when the patient suddenly became out of breath. His past medical history is irrelevant but has a 20-year pack smoking history. On evaluation, the patient is alert and verbally responsive but in modera... | Urgent needle decompression | {
"A": "Chest X-ray",
"B": "Urgent needle decompression",
"C": "D-dimer levels",
"D": "Nebulization with albuterol"
} | step2&3 | B | [
"year old man",
"brought",
"emergency room",
"wife",
"states",
"dinner",
"restaurant",
"patient",
"out of breath",
"past medical history",
"20 year pack smoking history",
"evaluation",
"patient",
"alert",
"responsive",
"moderate respiratory distress",
"temperature",
"98",
"blood ... |
A 56-year-old man comes to the emergency department complaining of substernal chest pain that radiates to the left shoulder. Electrocardiogram (EKG) demonstrates ST-elevations in leads II, III, and aVF. The patient subsequently underwent catheterization with drug-eluting stent placement with stabilization of his condit... | Aspirin | {
"A": "Aspirin",
"B": "Atorvastatin",
"C": "Lisinopril",
"D": "Surgery"
} | step1 | A | [
"year old man",
"emergency department",
"substernal chest pain",
"radiates",
"left shoulder",
"Electrocardiogram",
"EKG",
"demonstrates ST-elevations",
"leads",
"III",
"aVF",
"patient",
"catheterization",
"drug-eluting stent placement",
"stabilization",
"condition",
"post-operative d... |
A 2-year-old boy presents for a routine checkup. The patient’s mother says that he has been ‘under the weather’ for the past few days. She did not measure his temperature at home but states that he has felt warm. She denies any episodes of diarrhea or vomiting. No significant past medical history or current medications... | Administer the hepatitis A vaccine | {
"A": "Delay the hepatitis A immunization until next visit",
"B": "Administer the hepatitis A vaccine",
"C": "Strep rapid antigen detection test",
"D": "Order liver function tests"
} | step2&3 | B | [
"2 year old boy presents",
"routine checkup",
"patients mother",
"weather",
"past",
"days",
"not measure",
"temperature at home",
"states",
"felt warm",
"denies",
"episodes of diarrhea",
"vomiting",
"significant past medical history",
"current medications",
"patient attends daycare",
... |
A 10-year-old boy is brought to the emergency department by his mother due to frequent vomiting, abdominal pain, and weakness. Over the last 5 days, has been noted to have polydipsia and polyuria. Family history is irrelevant. His temperature is 37.1°C (98.7°F), blood pressure is 100/70 mm Hg, and pulse is 110/min. Phy... | Immune-mediated destruction of pancreatic beta cells | {
"A": "Insulin resistance",
"B": "Immune-mediated destruction of pancreatic beta cells",
"C": "Salicylate poisoning",
"D": "Defective synthesis or release of arginine vasopressin"
} | step2&3 | B | [
"A 10 year old boy",
"brought",
"emergency department",
"mother due to frequent vomiting",
"abdominal pain",
"weakness",
"last",
"days",
"noted to",
"polydipsia",
"polyuria",
"Family history",
"temperature",
"98",
"blood pressure",
"100 70 mm Hg",
"pulse",
"min",
"Physical examin... |
A 29-year-old woman came to the emergency department due to severe symptoms of intoxication and unexplained convulsions. She is accompanied by her husband who reports that she takes disulfiram. There is no prior personal and family history of epilepsy. She shows signs of confusion, hyperirritability, and disorientation... | B6 | {
"A": "B9",
"B": "B12",
"C": "B2",
"D": "B6"
} | step1 | D | [
"29 year old woman",
"emergency department due to severe symptoms",
"intoxication",
"unexplained convulsions",
"husband",
"reports",
"takes disulfiram",
"prior personal",
"family history of epilepsy",
"shows signs",
"confusion",
"hyperirritability",
"disorientation",
"further evaluation",
... |
A 58-year-old woman presents to her primary care provider complaining fatigue and a vague muscle pain in her limbs. She always seems tired and has difficulty getting through her workday and doing chores around the house. This has been going on for several months and her symptoms seem to be getting worse. She also admit... | Hyperparathyroidism | {
"A": "Hepatic encephalopathy",
"B": "Hyperparathyroidism",
"C": "Septic shock secondary to pyelonephritis",
"D": "Urinary tract infection (UTI)"
} | step1 | B | [
"58 year old woman presents",
"primary care provider",
"fatigue",
"vague muscle pain in",
"limbs",
"always",
"tired",
"difficulty getting",
"workday",
"chores",
"house",
"several months",
"symptoms",
"to",
"getting worse",
"admits",
"long bouts",
"constipation",
"Past medical his... |
A 31-year-old man is brought to the emergency department because of fever and increasing confusion for the past day. He has bipolar disorder with psychotic features and hypothyroidism. Current medications are lithium, haloperidol, and levothyroxine. He drinks one beer with dinner every night. His speech is confused and... | Neuroleptic malignant syndrome | {
"A": "Delirium tremens",
"B": "Herpes simplex encephalitis",
"C": "Bacterial meningitis",
"D": "Neuroleptic malignant syndrome"
} | step2&3 | D | [
"31 year old man",
"brought",
"emergency department",
"fever",
"increasing confusion",
"past day",
"bipolar disorder",
"psychotic features",
"hypothyroidism",
"Current medications",
"lithium",
"haloperidol",
"levothyroxine",
"drinks one beer",
"dinner",
"night",
"speech",
"confused... |
A 56-year-old woman comes to the physician because she palpated a mass in her right breast during self-examination a week ago. Menarche was at the age of 14, and her last menstrual period was at the age of 51. Vital signs are within normal limits. Examination shows a nontender, firm and hard mass in the upper outer qua... | Nodal status | {
"A": "Age",
"B": "Nodal status",
"C": "HER2 receptor status",
"D": "Hormone receptor status"
} | step2&3 | B | [
"year old woman",
"physician",
"palpated",
"mass in",
"right breast",
"self-examination",
"week",
"Menarche",
"age",
"last menstrual period",
"age",
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"normal limits",
"Examination shows",
"nontender",
"firm",
"hard mass",
"the upper outer quadrant of",
"breast",
"... |
A 14-year-old boy comes to the physician for a follow-up after a blood test showed a serum triglyceride level of 821 mg/dL. Several of his family members have familial hypertriglyceridemia. The patient is prescribed a drug that increases his risk of gallstone disease. The expected beneficial effect of this drug is most... | Increased lipoprotein lipase activity | {
"A": "Increased lipoprotein lipase activity",
"B": "Decreased lipolysis in adipose tissue",
"C": "Increased PPAR-gamma activity",
"D": "Increased bile acid sequestration"
} | step1 | A | [
"year old boy",
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"follow-up",
"blood test showed",
"serum",
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"family members",
"familial hypertriglyceridemia",
"patient",
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"drug",
"increases",
"risk",
"gallstone",
"expected beneficial effect",
"drug",
"most likely due to",
"following actions"
] |
A 9-year-old boy is brought to the psychiatrist due to unusual behavior over the past several months. His mother reports that he has started to blink more frequently than usual. His parents initially attributed this behavior to attention-seeking but he has not stopped despite multiple disciplinary efforts and behaviora... | Guanfacine | {
"A": "Guanfacine",
"B": "Lithium",
"C": "Fluoxetine",
"D": "Venlafaxine"
} | step1 | A | [
"year old boy",
"brought",
"psychiatrist due to unusual behavior",
"past",
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"mother reports",
"started to blink more frequently",
"usual",
"parents initially attributed",
"behavior",
"attention-seeking",
"not stopped",
"multiple",
"efforts",
"behavioral therapy",
"clinical psy... |
A newborn infant is resuscitated and transferred to the neonatal intensive care unit. The infant has notable limb deformities as well as low-set ears and a flattened nose. He was born at 34 weeks gestation to a healthy mother who received regular obstetric follow-up. Resuscitation was notable for difficulty maintaining... | Cystic dilation of the collecting ducts in the kidney | {
"A": "Chromosomal abnormality",
"B": "Cystic dilation of the collecting ducts in the kidney",
"C": "Failure to administer betamethasone",
"D": "PKD1 gene mutation"
} | step2&3 | B | [
"newborn infant",
"resuscitated",
"transferred",
"neonatal intensive care unit",
"infant",
"notable limb deformities",
"low-set ears",
"flattened nose",
"born",
"weeks gestation",
"healthy mother",
"received regular obstetric follow-up",
"Resuscitation",
"notable",
"difficulty maintainin... |
A researcher is studying the effects of various substances on mature B-cells. She observes that while most substances are only able to promote the production of antibodies when the B-cells are co-cultured with T-cells, a small subset of substances are able to trigger antibody production even in the absence of T-cells. ... | Requires mitogens | {
"A": "Produces memory",
"B": "Results in affinity maturation",
"C": "Requires mitogens",
"D": "Requires a peptide antigen"
} | step1 | C | [
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"various substances",
"mature B-cells",
"observes",
"substances",
"only able to promote",
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"co-cultured",
"T-cells",
"small subset",
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"absence",
"cells",
... |
An 81-year-old man is brought to the physician by his daughter after he was found wandering on the street. For the last 3 months, he often has a blank stare for several minutes. He also claims to have seen strangers in the house on several occasions who were not present. He has hypertension and hyperlipidemia, and was ... | Lewy body dementia | {
"A": "Lewy body dementia",
"B": "Vascular dementia",
"C": "Normal pressure hydrocephalus",
"D": "Frontotemporal dementia"
} | step1 | A | [
"81 year old man",
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"daughter",
"found wandering",
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"last",
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"often",
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"minutes",
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"house",
"several occasions",
"not present",
"hypertension",
"hyperlipidemia",
"diagnosed",
"Parkinson disease 8 mont... |
A 75-year-old female presents to your office with her daughter. The patient states that she feels perfectly well and that she does not know why she is present. The daughter states that over the last several years, the patient has become forgetful and recently forgot her grandchild's name, along with the groceries she w... | MRI scan of head | {
"A": "MRI scan of head",
"B": "CT scan of head",
"C": "PET scan of head",
"D": "CT angiography of head"
} | step2&3 | A | [
"75 year old female presents",
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"daughter",
"patient states",
"feels",
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"not",
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"daughter states",
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"grandchild's name",
"buy",
"found lost 10 miles",
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"daughter",
"states",
... |
A 26-year-old female medical student presents to occupational health after sustaining a needlestick injury. She reports that she was drawing blood from an HIV-positive patient when she stuck herself percutaneously while capping the needle. She immediately washed the puncture wound with betadine. The medical student has... | Draw her repeat HIV serology and immediately initiate three-drug antiretroviral therapy | {
"A": "Perform genotype testing on source patient and initiate antiretroviral therapy tailored to results",
"B": "Draw her repeat HIV serology and initiate three-drug antiretroviral therapy if negative",
"C": "Draw her repeat HIV serology and initiate three-drug antiretroviral therapy if positive",
"D": "Draw ... | step2&3 | D | [
"year old female medical student presents",
"occupational health",
"sustaining",
"needlestick injury",
"reports",
"drawing blood",
"HIV-positive patient",
"stuck",
"capping",
"needle",
"immediately washed",
"puncture wound",
"betadine",
"medical student",
"negative HIV serology",
"begi... |
A 50-year-old man presents to the office for a routine health check-up. Managing his weight has been his focus to improve his overall health. The doctor discusses his weight loss goals and overall health benefits from weight loss, including better blood pressure management and decreased insulin resistance. The national... | 145 kg (320 lb) | {
"A": "63 kg (140 lb)",
"B": "145 kg (320 lb)",
"C": "118 kg (260 lb)",
"D": "172 kg (380 lb)"
} | step1 | B | [
"50 year old man presents",
"office",
"routine health check-up",
"Managing",
"weight",
"focus to",
"overall health",
"doctor discusses",
"weight loss goals",
"overall health benefits",
"weight loss",
"including better blood",
"decreased insulin resistance",
"national average weight",
"ma... |
An 18-month-old boy is brought to the physician for a well-child examination. His mother is concerned because he is unable to walk on his own. He has been increasingly irritable over the past month, has been feeding poorly, and has had multiple episodes of vomiting. His immunizations are up-to-date. He is at the 50th p... | Ventriculoperitoneal shunt | {
"A": "Cerebral aqueductoplasty",
"B": "Ventriculoperitoneal shunt",
"C": "Furosemide therapy",
"D": "Acetazolamide therapy"
} | step2&3 | B | [
"month old boy",
"brought",
"physician",
"well",
"mother",
"concerned",
"unable to walk",
"irritable",
"past month",
"feeding poorly",
"multiple episodes of vomiting",
"immunizations",
"date",
"50th percentile",
"height",
"percentile",
"weight",
"percentile",
"head circumference"... |
An investigator for a nationally representative health survey is evaluating the heights and weights of men and women aged 18–74 years in the United States. The investigator finds that for each sex, the distribution of heights is well-fitted by a normal distribution. The distribution of weight is not normally distribute... | 99.7% of heights in women are likely to fall between 63.7 and 64.3 inches. | {
"A": "68% of weights in women are likely to fall between 153 and 155 pounds.",
"B": "99.7% of heights in women are likely to fall between 63.7 and 64.3 inches.",
"C": "99.7% of heights in men are likely to fall between 68.8 and 69.2 inches.",
"D": "95% of heights in men are likely to fall between 68.85 and 69... | step1 | B | [
"investigator",
"representative health survey",
"evaluating",
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"weights",
"men",
"women aged",
"years",
"United States",
"investigator finds",
"sex",
"distribution",
"heights",
"well fitted",
"normal distribution",
"distribution",
"weight",
"not",
"distributed",
"Resu... |
A 23-year-old female college senior comes to the physician with a 1-year history of recurrent palpitations accompanied by sweating, facial blushing, and sometimes nausea. The symptoms are worse during class when she is occasionally called out to speak, which causes her to feel embarrassed. She has been skipping class o... | Social anxiety disorder
" | {
"A": "Schizotypal personality disorder",
"B": "Avoidant personality disorder",
"C": "Generalized anxiety disorder",
"D": "Social anxiety disorder\n\""
} | step2&3 | D | [
"23 year old female college senior",
"physician",
"year history of recurrent palpitations",
"sweating",
"facial blushing",
"sometimes nausea",
"symptoms",
"worse",
"class",
"occasionally called out",
"speak",
"causes",
"to feel embarrassed",
"skipping class",
"discussion days",
"concer... |
A 37-year-old man presents to the clinic because of painful, severe blistering over his buttocks for the past week. About a year ago, he noticed a similar outbreak on his inner thighs, but it receded within a few days on its own. Physical examination shows the blisters are tense, and rubbing the affected skin does not ... | Hemidesmosomes | {
"A": "Gap junctions",
"B": "Hemidesmosomes",
"C": "Lamellar bodies",
"D": "Zonula occludens"
} | step1 | B | [
"year old man presents",
"clinic",
"of painful",
"severe blistering",
"buttocks",
"past week",
"year",
"similar outbreak",
"inner thighs",
"days",
"Physical examination shows",
"blisters",
"tense",
"affected skin",
"not result",
"popping",
"blisters",
"biopsy shows",
"entire epid... |
A 32-year-old man comes to the emergency department because of nausea and vomiting for the past 2 hours. The patient has neither had diarrhea nor fever. Four hours ago he ate some leftover Indian rice dish he had ordered the night before. There is no history of serious illness. He immigrated from India 8 years ago with... | Bacillus cereus | {
"A": "Bacillus cereus",
"B": "Staphylococcus aureus",
"C": "Shigella dysenteriae",
"D": "Enterohemorrhagic Escherichia coli"
} | step2&3 | A | [
"year old man",
"emergency department",
"nausea",
"vomiting",
"past",
"hours",
"patient",
"diarrhea",
"fever",
"Four hours",
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"Indian rice dish",
"ordered",
"night",
"history",
"serious illness",
"India",
"years",
"family",
"now works",
"butcher",
"appears ill",
"te... |
A 40-year-old man presents with multiple episodes of sudden-onset severe pain in his right side of the face lasting for only a few seconds. He describes the pain as lancinating, giving the sensation of an electrical shock. He says the episodes are precipitated by chewing or touching the face. Which of the following sid... | Syndrome of inappropriate ADH | {
"A": "Alopecia",
"B": "Pinpoint pupils",
"C": "Gingival hyperplasia",
"D": "Syndrome of inappropriate ADH"
} | step1 | D | [
"40 year old man presents",
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"only",
"few seconds",
"pain",
"lancinating",
"giving",
"sensation",
"electrical shock",
"episodes",
"precipitated",
"chewing",
"touching",
"face",
"following side effects",
"chara... |
A 66-year-old man comes to the emergency department because of shortness of breath. His temperature is 37.2°C (99°F) and pulse is 105/min. When the blood pressure cuff is inflated to 140 mm Hg, the patient's pulse is audible and regular. However, upon inspiration, the pulse disappears and does not reappear until expira... | Asthma | {
"A": "Lobar pneumonia",
"B": "Hypertrophic cardiomyopathy",
"C": "Congestive heart failure",
"D": "Asthma"
} | step1 | D | [
"66 year old man",
"emergency department",
"of shortness",
"breath",
"temperature",
"pulse",
"min",
"blood pressure cuff",
"mm Hg",
"patient's pulse",
"regular",
"inspiration",
"pulse",
"not",
"expiration",
"Only",
"blood pressure cuff",
"mm Hg",
"pulse",
"entire respiratory cy... |
A 20-year-old woman presents with nausea, fatigue, and breast tenderness. She is sexually active with two partners and occasionally uses condoms during intercourse. A β-hCG urinary test is positive. A transvaginal ultrasound reveals an 8-week fetus in the uterine cavity. The patient is distressed by this news and reque... | Explain the risk and potential harmful effects of the procedure. | {
"A": "Ask the patient to reconsider and refer her to a social worker.",
"B": "Ask the patient to obtain consent from legal guardians.",
"C": "Explain the risk and potential harmful effects of the procedure.",
"D": "Ask the patient to obtain consent from the baby’s father."
} | step1 | C | [
"20 year old woman presents",
"nausea",
"fatigue",
"breast tenderness",
"sexually active",
"two partners",
"occasionally uses condoms",
"intercourse",
"hCG urinary test",
"positive",
"transvaginal ultrasound reveals",
"week fetus",
"uterine cavity",
"patient",
"distressed",
"news",
"... |
A previously healthy 5-year-old boy is brought to the emergency department 15 minutes after sustaining an injury to his right hand. His mother says that she was cleaning the bathroom when he accidentally knocked over the drain cleaner bottle and spilled the liquid onto his hand. On arrival, he is crying and holding his... | Irrigate with water | {
"A": "Apply mineral oil",
"B": "Apply silver sulfadiazine",
"C": "Apply split-thickness skin graft",
"D": "Irrigate with water"
} | step2&3 | D | [
"healthy",
"year old boy",
"brought",
"emergency department 15 minutes",
"sustaining",
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"right hand",
"mother",
"cleaning",
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"drain cleaner bottle",
"liquid",
"hand",
"arrival",
"crying",
"right hand",
"flexed position",
"temperature",
"99",
"pulse",
"min"... |
A 67-year-old man with hypertension comes to the emergency department because of progressively worsening abdominal pain that started 1 week ago. The pain is localized to the right upper quadrant. He has also noticed yellowing of his eyes and skin during this time period. Physical examination shows jaundice, a distended... | Hepatic vein obstruction | {
"A": "Hepatic vein obstruction",
"B": "Thickened pericaridium",
"C": "Increased iron absorption",
"D": "Hepatic steatosis"
} | step1 | A | [
"67 year old man",
"hypertension",
"emergency department",
"worsening abdominal pain",
"started 1 week",
"pain",
"localized",
"right upper quadrant",
"yellowing",
"eyes",
"skin",
"time period",
"Physical examination shows jaundice",
"distended abdomen",
"tender hepatomegaly",
"jugular ... |
A 15-year-old boy comes to the physician because of skin changes on his face, chest, and back over the past year. Treatment with over-the-counter benzoyl peroxide has been ineffective. Physical examination shows numerous open comedones, inflammatory papules, and pustules on his face, chest, and back. Which of the follo... | Excess androgen production | {
"A": "Hyperplasia of pilosebaceous glands",
"B": "Formation of superficial epidermal inclusion cyst",
"C": "Excess androgen production",
"D": "Type IV hypersensitivity reaction"
} | step1 | C | [
"year old boy",
"physician",
"skin changes",
"face",
"chest",
"back",
"the past",
"Treatment",
"over",
"counter benzoyl peroxide",
"ineffective",
"Physical examination shows numerous open comedones",
"inflammatory papules",
"pustules",
"face",
"chest",
"back",
"following",
"most ... |
A 22-year-old woman comes to the physician for a follow-up examination. She had a spontaneous abortion 3 months ago. Her last menstrual period was 3 weeks ago. She reports feeling sad occasionally but has continued working and attending social events. She does not have any suicidal ideation or tendencies. She does not ... | Hypertension | {
"A": "Functional ovarian cysts",
"B": "Acne",
"C": "Endometriosis",
"D": "Hypertension"
} | step2&3 | D | [
"year old woman",
"physician",
"follow-up examination",
"spontaneous abortion",
"months",
"last menstrual period",
"3 weeks",
"reports feeling sad occasionally",
"continued working",
"attending social events",
"not",
"suicidal ideation",
"not smoke",
"Vital signs",
"normal",
"Physical ... |
A 28-year-old man comes to the physician because of progressively worsening fatigue, nausea, and right upper quadrant pain. He has a history of intravenous heroin use. Both serum Anti-HBe and Anti-HBc are positive. Further analysis of the Anti-HBc immunoglobulin is most likely to show which of the following properties? | Forms a pentamer when secreted | {
"A": "Activates eosinophils",
"B": "Forms a pentamer when secreted",
"C": "Protects against gastrointestinal infections",
"D": "Crosses the placenta"
} | step1 | B | [
"year old man",
"physician",
"worsening fatigue",
"nausea",
"right upper quadrant pain",
"history of intravenous heroin use",
"serum Anti-HBe",
"Anti-HBc",
"positive",
"Further analysis",
"Anti-HBc immunoglobulin",
"most likely to show",
"following properties"
] |
A 27-year-old young man presents to his primary care physician for weakness and tingling in his hand. The patient is an avid bodybuilder and has noticed that his grip strength has gradually worsened in both hands with symptoms worse at the end of a long workout. The patient has a past medical history of anabolic steroi... | Cubital tunnel compression | {
"A": "Cubital tunnel compression",
"B": "Guyon's canal compression",
"C": "Carpal tunnel syndrome",
"D": "Posterior interosseous nerve compression"
} | step2&3 | A | [
"27 year old young man presents",
"primary care physician",
"weakness",
"tingling",
"hand",
"patient",
"avid",
"grip strength",
"worsened",
"hands",
"symptoms worse",
"end",
"long workout",
"patient",
"past medical history of anabolic steroid use",
"high school",
"current medications... |
A 69-year-old woman is brought to the physician by her daughter because of increasing forgetfulness and generalized fatigue over the past 4 months. She is unable to remember recent events and can no longer recognize familiar people. She lives independently, but her daughter has hired a helper in the past month since th... | Elevated serum TSH | {
"A": "Diffuse cortical atrophy on brain MRI",
"B": "Ventriculomegaly on CT scan of the head",
"C": "Elevated serum WBC count",
"D": "Elevated serum TSH"
} | step2&3 | D | [
"69 year old woman",
"brought",
"physician",
"daughter",
"increasing forgetfulness",
"generalized fatigue",
"past",
"months",
"unable",
"remember recent events",
"longer",
"familiar people",
"lives",
"daughter",
"hired",
"past month",
"patient",
"found",
"difficult to shop",
"d... |
A stool sample was taken from a 19-year-old male who presented with profuse watery diarrhea. He recently returned from a trip to Central America. A microbiologist identified the causative agent as a gram-negative, oxidase-positive, comma-shaped bacteria that is able to grow well in a pH > 8. Which of the following is a... | Overactivation of adenylate cyclase by activation of Gs subunit by ADP-ribosylation | {
"A": "Overactivation of adenylate cyclase by activation of Gs subunit by ADP-ribosylation",
"B": "Overactivation of adenylate cyclase by inhibition of Gi subunit by ADP-ribosylation",
"C": "Inactivation of the 60S ribosomal subunit by cleaving an adenine from the 28S rRNA",
"D": "Overactivation of guanylate c... | step1 | A | [
"stool sample",
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"year old male",
"presented",
"watery diarrhea",
"recently returned",
"trip",
"Central America",
"microbiologist identified",
"causative agent",
"gram negative",
"oxidase positive",
"shaped bacteria",
"able to",
"well",
"pH",
"following",
"mechanism of acti... |
An investigator is attempting to assess the glomerular filtration rate (GFR) of a healthy adult volunteer. The volunteer's inulin clearance is evaluated under continuous inulin infusion and urine collection and compared to the creatinine clearance. It is found that the estimated GFR based on the volunteer's creatinine ... | Creatinine is actively secreted | {
"A": "Creatinine is not freely filtered",
"B": "Inulin is not freely filtered",
"C": "Creatinine is passively reabsorbed",
"D": "Creatinine is actively secreted"
} | step1 | D | [
"investigator",
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"evaluated",
"continuous inulin infusion",
"urine collection",
"compared",
"creatinine clearance",
"found",
"estimated GFR based",
"volunteer's creatinine clearance",
... |
A 30-year-old man is brought into the emergency room for complaints of acute onset chest pain and shortness of breath. He has a history of mental retardation and lives at home with his adoptive parents. His parents inform you that he has not seen a doctor since he was adopted as child and that he currently takes no med... | Serum blood test | {
"A": "Chest radiograph",
"B": "Angiogram",
"C": "Electrocardiogram",
"D": "Serum blood test"
} | step2&3 | D | [
"30 year old man",
"brought",
"emergency room",
"complaints of acute onset chest pain",
"shortness of breath",
"history",
"mental retardation",
"lives at home",
"adoptive parents",
"parents inform",
"not seen",
"doctor",
"adopted",
"child",
"currently takes",
"medications",
"patients... |
A 34-year-old gravida 5, para 4 presents to the physician for prenatal care at 32 weeks of pregnancy. She comes from a rural region of Ethiopia and did not have appropriate prenatal care during previous pregnancies. She has no complaints of swelling, contractions, loss of fluid, or bleeding from the vagina. During her ... | The patient should receive at least 2 doses of tetanus toxoid within the 4-week interval to ensure that she and her baby will both have immunity against tetanus. | {
"A": "The patient does not need vaccination because she has developed natural immunity against tetanus and will pass it to her baby.",
"B": "The patient is protected against tetanus due to her past medical history, so only the child is at risk of developing tetanus after an out-of-hospital delivery.",
"C": "The... | step1 | C | [
"year old gravida 5",
"para 4 presents",
"physician",
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"weeks",
"pregnancy",
"rural region",
"Ethiopia",
"not",
"appropriate prenatal care",
"previous pregnancies",
"complaints",
"swelling",
"contractions",
"loss of fluid",
"bleeding from",
"vagina",
"current pregna... |
A 62-year-old man presents with multiple episodes of hemoptysis for a week. It is associated with generalized weakness, decreased appetite, and a 5.4 kg (12 lb) weight loss in 2 months. He has a smoking history of a pack a day for the last 47 years. Physical examination reveals pallor, while the rest of the results are... | Small cell carcinoma of the lung | {
"A": "Tuberculoma",
"B": "Small cell carcinoma of the lung",
"C": "Squamous cell carcinoma of the lung",
"D": "Adenocarcinoma of the lung"
} | step1 | B | [
"62 year old man presents",
"multiple episodes of hemoptysis",
"week",
"associated with generalized weakness",
"decreased appetite",
"5.4 kg",
"weight loss",
"months",
"smoking history of",
"pack",
"day",
"years",
"Physical examination reveals pallor",
"rest",
"results",
"normal limits... |
An 84-year-old man is brought to the physician by the staff of a group home where he resides because of worsening confusion and decreased urinary output. His nurse reports that the patient has not been drinking much for the last 3 days. Examination shows a decreased skin turgor and dry oral mucosa. His pulse is 105/min... | Denudation of tubular basement membrane | {
"A": "Leukocytic infiltration of renal interstitium",
"B": "Disruption of glomerular podocytes",
"C": "Denudation of tubular basement membrane",
"D": "Immune complex deposition in mesangium"
} | step1 | C | [
"84 year old man",
"brought",
"physician",
"staff",
"group home",
"resides",
"worsening confusion",
"decreased urinary output",
"nurse reports",
"patient",
"not",
"drinking much",
"3 days",
"Examination shows",
"decreased skin turgor",
"dry oral",
"pulse",
"min",
"blood pressure"... |
A 47-year-old Caucasian woman presents with a 2-month history of general fatigue, slight jaundice, and mild itching. She has also noticed that her urine has been darker and stools have been lighter in color recently. She denies any fevers, chills, or alcohol use. She has no significant past medical or surgical history ... | Anti-mitochondrial antibody | {
"A": "Anti-neutrophilic cytoplasmic antibodies (ANCA)",
"B": "Rheumatoid factor",
"C": "Anti-centromere antibody",
"D": "Anti-mitochondrial antibody"
} | step1 | D | [
"year old Caucasian woman presents",
"month history",
"general",
"slight jaundice",
"mild itching",
"urine",
"darker",
"stools",
"lighter",
"color recently",
"denies",
"fevers",
"chills",
"alcohol use",
"significant past medical",
"surgical history",
"not taking",
"medications",
... |
A 44-year-old man, with a history of intravenous (IV) drug use, presented to the emergency department due to worsening non-productive cough, exertional dyspnea, and night sweats. His cough started 3 weeks ago and progressively worsened. He is homeless and well-known by the hospital staff. He was previously admitted to ... | Trimethoprim-sulfamethoxazole | {
"A": "Isoniazid, rifabutin, pyrazinamide and ethambutol",
"B": "Intravenous liposomal amphotericin B with flucytosine",
"C": "Fluconazole with flucytosine",
"D": "Trimethoprim-sulfamethoxazole"
} | step2&3 | D | [
"year old man",
"history",
"intravenous",
"drug use",
"presented",
"emergency department",
"worsening non-productive cough",
"exertional dyspnea",
"night sweats",
"cough started 3 weeks",
"worsened",
"homeless",
"well known",
"hospital staff",
"admitted",
"hospital",
"overdose",
"o... |
A 33-year-old woman comes to the physician because of vision impairment in her right eye for the past 2 weeks. During this period, she was unable to distinguish colors with her right eye. She also reports pain with eye movement. She has no double vision. She occasionally has headaches that are relieved by ibuprofen. On... | Optic neuritis
" | {
"A": "Retinal detachment",
"B": "Narrow-angle glaucoma",
"C": "Macular degeneration",
"D": "Optic neuritis\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"of vision impairment",
"right eye",
"past 2 weeks",
"period",
"unable to",
"colors",
"right",
"reports pain",
"eye movement",
"double vision",
"occasionally",
"headaches",
"relieved by ibuprofen",
"One year ago",
"similar episode",
"affected",
"lef... |
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