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 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to... | Schizophreniform disorder | {
"A": "Schizoaffective disorder",
"B": "Brief psychotic disorder",
"C": "Schizophreniform disorder",
"D": "Delusional disorder"
} | step2&3 | C | [
"23 year old man",
"brought",
"emergency department",
"girlfriend",
"acute agitation",
"bizarre behavior",
"girlfriend reports",
"past 3 months",
"patient",
"withdrawn",
"stopped",
"hobbies",
"used",
"One month",
"lost",
"job",
"stopped",
"to work",
"time",
"left",
"apartment... |
A 27-year-old G1P0 female presents for her first prenatal visit. She is in a monogamous relationship with her husband, and has had two lifetime sexual partners. She has never had a blood transfusion and has never used injection drugs. Screening for which of the following infections is most appropriate to recommend this... | Syphilis, HIV, and HBV | {
"A": "Syphilis and HIV",
"B": "Syphilis, HIV, and HBV",
"C": "Syphilis, HIV, HBV, and chlamydia",
"D": "No routine screening is recommended for this patient"
} | step2&3 | B | [
"27 year old",
"female presents",
"first prenatal visit",
"monogamous relationship",
"husband",
"two lifetime sexual partners",
"never",
"blood transfusion",
"never used injection drugs",
"Screening",
"of",
"following infections",
"most appropriate to recommend",
"patient"
] |
A 3-year-old boy presents to the emergency department with a fever and a rash. This morning the patient was irritable and had a fever which gradually worsened throughout the day. He also developed a rash prior to presentation. He was previously healthy and is not currently taking any medications. His temperature is 102... | Staphylococcal scalded skin syndrome | {
"A": "Staphylococcal scalded skin syndrome",
"B": "Toxic epidermal necrolysis",
"C": "Toxic shock syndrome",
"D": "Urticaria"
} | step2&3 | A | [
"3 year old boy presents",
"emergency department",
"fever",
"rash",
"morning",
"patient",
"irritable",
"fever",
"worsened",
"day",
"rash prior to presentation",
"healthy",
"not currently taking",
"medications",
"temperature",
"blood pressure",
"90 50 mmHg",
"pulse",
"min",
"res... |
A previously healthy 48-year-old man comes to the physician because of a 3-week history of progressively worsening jaundice, generalized itching, and epigastric discomfort. He also complains of nausea and loss of appetite. His stools have looked like clay for the past week. He has returned from a vacation in Thailand o... | Cancer antigen 19-9 | {
"A": "Anti-HBc immunoglobulin M",
"B": "Elevated anti-neutrophil cytoplasmic antibodies",
"C": "Cancer antigen 19-9",
"D": "Alpha-fetoprotein"
} | step2&3 | C | [
"healthy 48 year old man",
"physician",
"3 week history",
"worsening jaundice",
"generalized itching",
"epigastric discomfort",
"nausea",
"loss of appetite",
"stools",
"looked",
"clay",
"past week",
"returned",
"vacation",
"Thailand one week",
"got",
"new tattoo",
"sexually active"... |
A 24-year-old man is brought to the doctor’s office by his mother because the patient believes aliens have begun to read his mind and will soon have him performing missions for them. The patient’s mother says that the delusions have been intermittently present for periods of at least 1-month over the past year. When he... | Schizophrenia | {
"A": "Schizotypal personality disorder",
"B": "Schizophrenia",
"C": "Schizoaffective disorder",
"D": "Schizoid personality disorder"
} | step2&3 | B | [
"year old man",
"brought",
"doctors office",
"mother",
"patient",
"aliens",
"begun to read",
"mind",
"missions",
"patients mother",
"delusions",
"present",
"periods",
"month",
"past year",
"not",
"delusions",
"lacks expression",
"interest",
"socializing",
"friends",
"out",
... |
A 22-year-old female with no past medical history presents to her primary care physician with a 3-day history of knee pain. She denies any recent injury or trauma. On physical examination her knee is warm, erythematous, and has diminished range of movement. The patient reports to having multiple sexual partners over th... | Ceftriaxone monotherapy and joint aspiration | {
"A": "Nafcillin monotherapy and joint aspiration",
"B": "Oxacillin and ceftriaxone",
"C": "Vancomycin monotherapy",
"D": "Ceftriaxone monotherapy and joint aspiration"
} | step2&3 | D | [
"year old female",
"past medical history presents",
"primary care physician",
"3-day history",
"knee pain",
"denies",
"recent injury",
"trauma",
"physical examination",
"knee",
"warm",
"erythematous",
"diminished range",
"movement",
"patient reports to",
"multiple sexual partners",
"... |
A 43-year-old woman comes to the physician because of a 3-week history of progressive weakness. She has had increased difficulty combing her hair and climbing stairs. She has hypertension. She has smoked a pack of cigarettes daily for 25 years. She does not drink alcohol. Her mother had coronary artery disease and syst... | Anti-Jo-1 antibodies | {
"A": "Anti-centromere antibodies",
"B": "Anti-histone antibodies",
"C": "Voltage-gated calcium channel antibodies",
"D": "Anti-Jo-1 antibodies"
} | step2&3 | D | [
"year old woman",
"physician",
"3 week history",
"progressive weakness",
"increased difficulty combing",
"hair",
"climbing stairs",
"hypertension",
"smoked",
"pack",
"cigarettes daily",
"years",
"not drink alcohol",
"mother",
"coronary artery disease",
"systemic lupus erythematosus",
... |
A 55-year-old man presents to the emergency department with nausea and vomiting. The patient states that he has felt nauseous for the past week and began vomiting last night. He thought his symptoms would resolve but decided to come in when his symptoms worsened. He feels that his symptoms are exacerbated with large fa... | Adhesions | {
"A": "Adhesions",
"B": "Impacted stool",
"C": "Norovirus",
"D": "Twisting of the bowel"
} | step2&3 | A | [
"55 year old man presents",
"emergency department",
"nausea",
"vomiting",
"patient states",
"felt nauseous",
"past week",
"began vomiting last night",
"thought",
"symptoms",
"resolve",
"to",
"symptoms worsened",
"feels",
"symptoms",
"exacerbated",
"large",
"meals",
"drinks alcoho... |
A 55-year-old postmenopausal woman comes to the physician for a screening Pap smear. She has no history of serious illness. Her last Pap smear was 10 years ago and showed no abnormalities. She has smoked one-half pack of cigarettes daily for 20 years and drinks 3 bottles of wine per week. She is sexually active with mu... | Diethylstilbestrol exposure in utero | {
"A": "Alcohol consumption",
"B": "Cigarette smoking",
"C": "Family history of breast and ovarian cancer",
"D": "Diethylstilbestrol exposure in utero"
} | step2&3 | D | [
"55 year old postmenopausal woman",
"physician",
"screening Pap smear",
"history",
"serious illness",
"last Pap smear",
"10 years",
"showed",
"abnormalities",
"smoked one half pack",
"cigarettes daily",
"20 years",
"drinks 3 bottles",
"wine",
"week",
"sexually active",
"multiple male... |
A 53-year-old woman presents with a severe headache, nausea, and vomiting for the past 48 hours. Vitals show a blood pressure of 220/134 mm Hg and a pulse of 88/min. Urinalysis shows a 2+ proteinuria and RBC casts. Which of the following renal lesions is most likely to be seen in this patient? | Fibrinoid necrosis | {
"A": "Fibrinoid necrosis",
"B": "Acute pyelonephritis",
"C": "Acute interstitial nephritis (AIN)",
"D": "Papillary necrosis"
} | step1 | A | [
"year old woman presents",
"severe headache",
"nausea",
"vomiting",
"past 48 hours",
"show",
"blood pressure",
"mm Hg",
"pulse",
"88 min",
"Urinalysis shows",
"2",
"proteinuria",
"RBC casts",
"following renal lesions",
"most likely to",
"seen",
"patient"
] |
A 28-year-old woman presents with weakness, fatigability, headache, and faintness. She began to develop these symptoms 4 months ago, and their intensity has been increasing since then. Her medical history is significant for epilepsy diagnosed 4 years ago. She was prescribed valproic acid, which, even at a maximum dose,... | Phenytoin intake | {
"A": "Phenytoin intake",
"B": "Epilepsy",
"C": "Alcohol intake",
"D": "Vegan diet"
} | step1 | A | [
"year old woman presents",
"weakness",
"fatigability",
"headache",
"faintness",
"began to",
"symptoms",
"months",
"intensity",
"increasing since then",
"medical history",
"significant",
"epilepsy diagnosed 4 years",
"prescribed valproic acid",
"maximum dose",
"not control",
"seizures... |
A 17-year-old male presents to your office with right knee pain. He is the quarterback of his high school football team and developed the knee pain after being tackled in last night's game. He states he was running with the ball and was hit on the lateral aspect of his right knee while his right foot was planted. Now, ... | Valgus stress test | {
"A": "Anterior drawer test",
"B": "Lachman's test",
"C": "Pivot shift test",
"D": "Valgus stress test"
} | step2&3 | D | [
"year old male presents",
"office",
"right",
"high school football team",
"knee pain",
"night's game",
"states",
"running",
"ball",
"hit",
"lateral aspect of",
"right knee",
"right foot",
"planted",
"Now",
"tender",
"palpation",
"medial knee",
"unable to bear full weight",
"rig... |
A 12-year-old boy admitted to the intensive care unit 1 day ago for severe pneumonia suddenly develops hypotension. He was started on empiric antibiotics and his blood culture reports are pending. According to the nurse, the patient was doing fine until his blood pressure suddenly dropped. Vital signs include: blood pr... | Release of tumor necrosis factor (TNF) | {
"A": "Degradation of lecithin in cell membranes",
"B": "Inhibition of acetylcholine release",
"C": "Inhibition of GABA and glycine",
"D": "Release of tumor necrosis factor (TNF)"
} | step1 | D | [
"year old boy admitted to",
"intensive care unit 1 day",
"severe pneumonia",
"hypotension",
"started",
"empiric antibiotics",
"blood culture reports",
"nurse",
"patient",
"fine",
"blood pressure",
"dropped",
"Vital signs include",
"blood pressure",
"88 58 mm Hg",
"temperature",
"4C",... |
A 27-year-old man comes to the physician because of severe fatigue that started 1 week ago. Ten days ago, he finished a course of oral cephalexin for cellulitis. He does not take any medications. He appears tired. His temperature is 37.5°C (99.5°F), pulse is 95/min, and blood pressure is 120/75 mm Hg. Examination shows... | Oral prednisone | {
"A": "Splenectomy",
"B": "Oral prednisone",
"C": "Plasmapheresis",
"D": "Intravenous immune globulin"
} | step2&3 | B | [
"27 year old man",
"physician",
"severe fatigue",
"started 1 week",
"Ten days",
"finished",
"course",
"oral cephalexin",
"cellulitis",
"not take",
"medications",
"appears tired",
"temperature",
"99",
"pulse",
"95 min",
"blood pressure",
"75 mm Hg",
"Examination shows scleral icte... |
A 47-year-old man presents to you with gradual loss of voice and difficulty swallowing for the past couple of months. The difficulty of swallowing is for both solid and liquid foods. His past medical history is insignificant except for occasional mild headaches. Physical exam also reveals loss of taste sensation on the... | Jugular foramen | {
"A": "Foramen spinosum",
"B": "Foramen lacerum",
"C": "Jugular foramen",
"D": "Foramen rotundum"
} | step1 | C | [
"year old man presents",
"gradual loss of voice",
"difficulty swallowing",
"past couple",
"months",
"difficulty",
"swallowing",
"solid",
"liquid foods",
"past medical history",
"occasional mild headaches",
"Physical exam",
"reveals loss of sensation",
"posterior third of",
"tongue",
"p... |
A newborn whose mother had uncontrolled diabetes mellitus during pregnancy is likely to have which of the following findings? | Hypoglycemia | {
"A": "Atrophy of pancreatic islets cells",
"B": "Hypoglycemia",
"C": "Hyperglycemia",
"D": "Ketoacidosis"
} | step1 | B | [
"newborn",
"mother",
"uncontrolled diabetes mellitus",
"pregnancy",
"likely to",
"following findings"
] |
A 25-year-old man comes to the physician because of right wrist pain after a fall from a ladder. Physical examination shows decreased grip strength and tenderness between the tendons of extensor pollicis longus and extensor pollicis brevis. X-ray of the right wrist shows no abnormalities. This patient is at increased r... | Osteoarthritis of the radiocarpal joint | {
"A": "Paralysis of the abductor pollicis brevis muscle",
"B": "Osteoarthritis of the radiocarpal joint",
"C": "Avascular necrosis of the lunate bone",
"D": "Contracture of the palmar aponeurosis\n\""
} | step1 | B | [
"year old man",
"physician",
"of right wrist pain",
"fall",
"ladder",
"Physical examination shows decreased grip strength",
"tenderness",
"tendons of extensor pollicis longus",
"extensor pollicis brevis",
"X-ray of",
"right wrist shows",
"abnormalities",
"patient",
"increased risk",
"fol... |
A 28-year-old woman comes to the physician because of a 4-day history of lower abdominal pain and pain with urination. Five months ago, she was treated for gonococcal urethritis. She recently moved in with her newlywed husband. She is sexually active with her husband and they do not use condoms. Her only medication is ... | Escherichia coli | {
"A": "Neisseria gonorrhoeae",
"B": "Klebsiella pneumoniae",
"C": "Enterococcus faecalis",
"D": "Escherichia coli"
} | step2&3 | D | [
"year old woman",
"physician",
"4-day history",
"lower abdominal pain",
"pain",
"urination",
"Five months",
"treated",
"gonococcal urethritis",
"recently moved",
"husband",
"sexually active",
"husband",
"not use condoms",
"only medication",
"oral contraceptive",
"temperature",
"99"... |
A 1-month-old girl presents to her pediatrician with her mother. The patient was born at 38 weeks gestation via Caesarian section for cervical incompetence. The patient’s mother has no complaints, although she notes that the child had a runny nose and cough for a few days last week. The patient’s mother endorses decrea... | Obstruction of the extrahepatic biliary tree | {
"A": "Increased enterohepatic circulation of bilirubin",
"B": "Increased production of bilirubin",
"C": "Obstruction of the extrahepatic biliary tree",
"D": "Obstruction of the intrahepatic biliary tree"
} | step2&3 | C | [
"month old girl presents",
"pediatrician",
"mother",
"patient",
"born",
"weeks gestation",
"Caesarian section",
"cervical incompetence",
"patients mother",
"complaints",
"notes",
"child",
"runny nose",
"cough",
"days last week",
"patients mother",
"decreased appetite",
"illness",
... |
A 36-year-old man comes to the clinic for follow-up of his general anxiety disorder. He was diagnosed a year ago for excessive worry and irritability and was subsequently started on paroxetine. He demonstrated great response to therapy but is now complaining of decreased libido, which is affecting his marriage and qual... | Buspirone | {
"A": "Amitriptyline",
"B": "Buspirone",
"C": "Duloxetine",
"D": "Phenelzine"
} | step1 | B | [
"36 year old man",
"clinic",
"follow-up",
"general anxiety disorder",
"diagnosed",
"year",
"excessive worry",
"irritability",
"started",
"paroxetine",
"great response",
"therapy",
"now",
"decreased libido",
"affecting",
"marriage",
"quality of life",
"wishes to switch",
"differen... |
A 35-year-old man presents with large tense blisters on the flexor surfaces of the upper extremities and trunk. The histologic findings show subepidermal blisters with an eosinophil-rich infiltrate. What is the most likely underlying pathology? | Linear band of immunoglobulin G (IgG) in the epidermal basement membrane | {
"A": "Autoantibodies to desmoglein 3",
"B": "Granular deposits of immunoglobulin A (IgA) in the dermal papilla",
"C": "Linear band of immunoglobulin G (IgG) in the epidermal basement membrane",
"D": "Linear band of IgA in the basement membrane"
} | step1 | C | [
"35 year old man presents",
"large tense blisters",
"flexor surfaces",
"upper extremities",
"trunk",
"histologic findings show subepidermal blisters",
"eosinophil rich infiltrate",
"most likely underlying pathology"
] |
A public health campaign increases vaccination rates against human papillomaviruses 16 and 18. Increased vaccination rates would have which of the following effects on the Papanicolaou test? | Decreased positive predictive value | {
"A": "Increased true negative rate",
"B": "Decreased true positive rate",
"C": "Decreased positive predictive value",
"D": "Decreased negative predictive value"
} | step1 | C | [
"health campaign increases vaccination rates",
"human papillomaviruses 16",
"Increased vaccination rates",
"following effects",
"Papanicolaou test"
] |
A 39-year-old man presents to the emergency department with the complaint of ‘cola-colored’ urine that he noticed this morning. Additionally, he complains of malaise and reports that he has not been able to be productive at work since last week. Lab results revealed a hemoglobin of 6.7 g/dL, leukocyte total count of 1,... | ↑ activation of neutrophil adhesion molecules, ↓ release of neutrophils in the bone marrow, and ↑ destruction of neutrophils | {
"A": "↑ activation of neutrophil adhesion molecules, ↓ release of neutrophils in the bone marrow, and ↑ destruction of neutrophils",
"B": "↑ activation of neutrophil adhesion molecules, ↓ destruction of neutrophils, and ↓ production of neutrophils in the bone marrow",
"C": "↓ activation of neutrophil adhesion m... | step1 | A | [
"year old man presents",
"emergency department",
"complaint",
"cola colored urine",
"morning",
"malaise",
"reports",
"not",
"able to",
"productive at work",
"week",
"Lab results revealed a hemoglobin",
"g/dL",
"leukocyte total count",
"cells/mm3",
"reticulocyte count",
"Coomb test",
... |
A 31-year-old woman presents to her primary care physician with a 2-week history of diarrhea. She says that she has also noticed that she is losing weight, which makes her feel anxious since she has relatives who have suffered from anorexia. Finally, she says that she is worried she has a fever because she feels warm a... | Peroxidase | {
"A": "Cyclooxygenase",
"B": "Kinase",
"C": "Peroxidase",
"D": "Phosphatase"
} | step1 | C | [
"31 year old woman presents",
"primary care physician",
"2-week history",
"diarrhea",
"weight",
"makes",
"feel anxious",
"relatives",
"suffered",
"anorexia",
"worried",
"fever",
"feels warm",
"sweating",
"physical examination",
"found to",
"proptosis",
"fine tremor of",
"hands",
... |
A 45-year-old woman, gravida 3, para 2, at 18 weeks' gestation comes to the physician for a prenatal visit. Ultrasonography at a previous visit when she was at 12 weeks' gestation showed a hypoplastic nasal bone. Pelvic examination shows a uterus consistent in size with an 18-week gestation. Maternal serum studies show... | Single transverse palmar crease | {
"A": "Ambiguous external genitalia",
"B": "Extremity lymphedema",
"C": "Meningomyelocele",
"D": "Single transverse palmar crease"
} | step1 | D | [
"year old woman",
"gravida 3",
"para 2",
"weeks",
"gestation",
"physician",
"prenatal visit",
"Ultrasonography",
"previous visit",
"weeks",
"gestation showed",
"hypoplastic nasal bone",
"Pelvic examination shows",
"uterus consistent",
"size",
"week gestation",
"Maternal serum studies... |
A 21-year-old man presents to his physician for a routine checkup. His doctor asks him if he has had any particular concerns since his last visit and if he has taken any new medications. He says that he has not been ill over the past year, except for one episode of the flu. He has been training excessively for his inte... | Third heart sound (S3) | {
"A": "Opening snap",
"B": "Mid-systolic click",
"C": "Second heart sound (S2)",
"D": "Third heart sound (S3)"
} | step1 | D | [
"21-year-old man presents",
"physician",
"routine checkup",
"doctor",
"concerns",
"last visit",
"taken",
"new medications",
"not",
"ill",
"past year",
"except for one episode of",
"flu",
"training excessively",
"football",
"to",
"event",
"blood pressure",
"70 mm Hg",
"pulse",
... |
A 25-year-old man presents to the emergency department with sudden-onset severe pain in the right shoulder that occurred when he threw a bowling ball 2 hours ago. He has a history of dislocations in both shoulders and subluxation of the right knee and left wrist. There is no history of fractures. On physical examinatio... | Collagen | {
"A": "Collagen",
"B": "Elastin",
"C": "Fibrillin-1",
"D": "Tau"
} | step2&3 | A | [
"year old man presents",
"emergency department",
"sudden-onset severe pain in",
"right shoulder",
"occurred",
"threw",
"bowling ball",
"hours",
"history",
"dislocations",
"shoulders",
"subluxation",
"right",
"left wrist",
"history of fractures",
"physical examination",
"right arm",
... |
A 65-year-old woman presents with a complaint of a chronic, dry cough of insidious onset since working with her new primary care physician. She has a longstanding history of diabetes mellitus type 2, hypertension, and hyperlipidemia. She has a 10 pack-year smoking history, but does not currently smoke. What is the best... | Review medication list | {
"A": "Review medication list",
"B": "Monitor esophageal pH",
"C": "Trial of decongestant and first-generation histamine H1 receptor antagonist",
"D": "Spirometry"
} | step1 | A | [
"65 year old woman presents",
"complaint",
"chronic",
"dry",
"insidious onset",
"working",
"new primary care physician",
"history of diabetes mellitus type 2",
"hypertension",
"hyperlipidemia",
"a 10 pack-year smoking history",
"not currently smoke",
"best next step"
] |
An 8-year-old boy is brought to the emergency department by his parents because of vomiting, abdominal pain, and blurry vision for the past hour. The parents report that the boy developed these symptoms after he accidentally ingested 2 tablets of his grandfather’s heart failure medication. On physical examination, the ... | Hyperkalemia | {
"A": "Hypermagnesemia",
"B": "Hyperkalemia",
"C": "Hypokalemia",
"D": "Hypercalcemia"
} | step1 | B | [
"year old boy",
"brought",
"emergency department",
"parents",
"vomiting",
"abdominal pain",
"blurry vision",
"past hour",
"parents report",
"boy",
"symptoms",
"ingested 2 tablets",
"grandfathers heart failure medication",
"physical examination",
"child",
"drowsy",
"pulse",
"min",
... |
A 44-year-old man comes to the physician for a follow-up examination. Eight months ago, he was diagnosed with HIV infection and combined antiretroviral treatment was begun. He feels well. He does not smoke or drink alcohol. Current medications include lamivudine, zidovudine, atazanavir, and trimethoprim-sulfamethoxazol... | Nucleoside reverse transcriptase inhibitor | {
"A": "Entry inhibitor",
"B": "Integrase inhibitor",
"C": "Nucleoside reverse transcriptase inhibitor",
"D": "Dihyrofolate reductase inhibitor"
} | step1 | C | [
"year old man",
"physician",
"follow-up examination",
"Eight months",
"diagnosed",
"HIV infection",
"combined antiretroviral treatment",
"begun",
"feels well",
"not smoke",
"drink alcohol",
"Current medications include lamivudine",
"zidovudine",
"atazanavir",
"trimethoprim-sulfamethoxazo... |
A 52-year-old man comes to the physician because of a 3-week history of a cough and hoarseness. He reports that the cough is worse when he lies down after lunch. His temperature is 37.5°C (99.5°F); the remainder of his vital signs are within normal limits. Because the physician has recently been seeing several patients... | Availability | {
"A": "Confirmation",
"B": "Anchoring",
"C": "Framing",
"D": "Availability"
} | step1 | D | [
"year old man",
"physician",
"3 week history",
"cough",
"hoarseness",
"reports",
"cough",
"worse",
"lunch",
"temperature",
"99",
"vital signs",
"normal limits",
"physician",
"recently",
"seeing several patients",
"common cold",
"the diagnosis of",
"viral upper respiratory tract i... |
A researcher is studying the effects of 2 drugs, drug X, and drug Y. He is trying to measure the potential of each drug to achieve a certain response. The graphs in the images show some of his observations. He observes that when drug X acts on its own, it produces a much higher response compared to drug Y. When drug Y ... | Partial agonist | {
"A": "Agonist",
"B": "Inverse agonist",
"C": "Competitive antagonist",
"D": "Partial agonist"
} | step1 | D | [
"researcher",
"studying",
"effects of",
"drugs",
"drug",
"drug",
"to measure",
"potential",
"drug to",
"certain response",
"graphs",
"images show",
"observations",
"observes",
"drug",
"acts",
"much higher response compared",
"drug",
"drug",
"added",
"reaction",
"maximum eff... |
A 54-year-old man comes to the emergency department for nausea and vomiting for the past 2 days. The patient reports that he felt tired and weak for the past week without any obvious precipitating factors. Past medical history is significant for hypertension controlled with hydrochlorothiazide. He denies diarrhea, chan... | Chromogranin positive mass in the lung | {
"A": "Chromogranin positive mass in the lung",
"B": "Orphan Annie eyes and psammoma bodies in the thyroid",
"C": "Pituitary hypertrophy",
"D": "Venous congestion at the liver"
} | step1 | A | [
"54 year old man",
"emergency department",
"nausea",
"vomiting",
"past 2 days",
"patient reports",
"felt tired",
"weak",
"past week",
"precipitating factors",
"Past medical history",
"significant",
"hypertension controlled",
"hydrochlorothiazide",
"denies diarrhea",
"changes in diet",
... |
A 48-year-old man presents to the clinic with several weeks of watery diarrhea and right upper quadrant pain with fever. He also endorses malaise, nausea, and anorexia. He is HIV-positive and is currently on antiretroviral therapy. He admits to not being compliant with his current medications. His temperature is 37°C (... | Cryptosporidiosis | {
"A": "Cryptosporidiosis",
"B": "Irritable bowel syndrome",
"C": "Norovirus infection",
"D": "Traveler’s diarrhea due to ETEC"
} | step2&3 | A | [
"48 year old man presents",
"clinic",
"several weeks",
"watery diarrhea",
"right upper quadrant pain",
"fever",
"malaise",
"nausea",
"anorexia",
"HIV-positive",
"currently",
"antiretroviral therapy",
"admits to not",
"compliant",
"current medications",
"temperature",
"98",
"respira... |
Following a recent myocardial infarction, a 60-year-old woman has been started on multiple medications at the time of discharge from the hospital. After 10 days of discharge, she presents to the emergency department with a history of fever, headache, and dark colored urine for 2 days. Her husband mentions that she has ... | Plasma exchange | {
"A": "Renal dialysis",
"B": "Plasma exchange",
"C": "Intravenous immunoglobulin",
"D": "Rehydration"
} | step1 | B | [
"Following",
"recent myocardial infarction",
"60 year old woman",
"started",
"multiple medications",
"time",
"discharge",
"hospital",
"10 days",
"discharge",
"presents",
"emergency department",
"history",
"fever",
"headache",
"dark colored urine",
"2 days",
"husband",
"not passed... |
A 68-year-old man comes to the physician because of double vision and unilateral right eye pain that began this morning. His vision improves when he covers either eye. He has hypertension, mild cognitive impairment, and type 2 diabetes mellitus. The patient has smoked two packs of cigarettes daily for 40 years. His cur... | Ptosis | {
"A": "Ptosis",
"B": "Dilated and fixed pupil",
"C": "Miosis and anhidrosis",
"D": "Positive swinging-flashlight test\n\""
} | step2&3 | A | [
"68 year old man",
"physician",
"double vision",
"unilateral",
"began",
"morning",
"vision improves",
"covers either eye",
"hypertension",
"mild cognitive impairment",
"type 2 diabetes mellitus",
"patient",
"smoked two packs",
"cigarettes daily",
"40 years",
"current medications includ... |
An 82-year-old woman presents to the emergency department because of excruciating right flank pain and fever for the past 2 days. She states that she is having trouble urinating. Her past medical history is unremarkable. A urinalysis is performed and comes back positive for leukocytes and gram-negative bacilli. A contr... | Liposarcoma | {
"A": "Liposarcoma",
"B": "Rhabdomyosarcoma",
"C": "Teratoma",
"D": "Leiomyosarcoma"
} | step1 | A | [
"year old woman presents",
"emergency department",
"excruciating right flank pain",
"fever",
"past 2 days",
"states",
"past medical history",
"unremarkable",
"urinalysis",
"performed",
"back positive",
"leukocytes",
"gram-negative bacilli",
"contrast computed tomography of",
"abdomen",
... |
A 70-year-old woman, gravida 5, para 5, comes to the physician for the evaluation of sensation of vaginal fullness for the last six months. During this period, she has had lower back and pelvic pain that is worse with prolonged standing or walking. The patient underwent a hysterectomy at the age of 35 years because of ... | Enterocele | {
"A": "Bartholin gland cyst",
"B": "Atrophic vaginitis",
"C": "Infectious vulvovaginitis",
"D": "Enterocele"
} | step2&3 | D | [
"70 year old woman",
"gravida 5",
"para 5",
"physician",
"evaluation",
"sensation",
"vaginal fullness",
"last six months",
"period",
"lower back",
"pelvic pain",
"worse",
"prolonged standing",
"walking",
"patient",
"hysterectomy",
"age",
"35 years",
"severe dysmenorrhea",
"type... |
A 30-year-old woman, gravida 2 para 1, at 39 weeks gestation presents to the hospital with painful contractions and a rupture of membranes. She reports that the contractions started a couple hours ago and are now occurring every 4 minutes. She is accompanied by her husband who states, “her water broke an hour ago befor... | Cervix is 7 cm dilated and fetal head is at 0 station after 4 hours, with contractions every 2 minutes | {
"A": "Cervix is 7 cm dilated and fetal head is at 0 station after 1 hour, with contractions every 5 minutes",
"B": "Cervix is 7 cm dilated and fetal head is at -1 station after 2 hours with contractions every 7 minutes",
"C": "Cervix is 7 cm dilated and fetal head is at 0 station after 4 hours, with contraction... | step2&3 | C | [
"30 year old woman",
"gravida 2 para 1",
"weeks gestation presents",
"hospital",
"painful contractions",
"rupture of membranes",
"reports",
"contractions started",
"couple hours",
"now occurring",
"4 minutes",
"husband",
"states",
"water broke",
"hour",
"left",
"hospital",
"patient... |
A 3-year-old female is found to have unusual susceptibility to infections by catalase-producing organisms. This patient likely has a problem with the function of which of the following cell types? | Neutrophils | {
"A": "B cells",
"B": "T cells",
"C": "Neutrophils",
"D": "Eosinophils"
} | step1 | C | [
"3 year old female",
"found to",
"unusual susceptibility to infections",
"catalase",
"organisms",
"patient likely",
"problem",
"function of",
"following cell types"
] |
A 3-year-old child is brought to the pediatrician by his mother who states that he has been fussy for the past two days. She says that he has had a runny nose, a cough, a sore throat, and decreased appetite. Vital signs are within normal limits. Physical exam reveals a slightly erythematous oropharynx and clear nasal d... | Explain the reasoning as to why antibiotics are not indicated for the common cold | {
"A": "Prescribe antibiotics to the child",
"B": "Refer the mother to a nearby physician who will prescribe antibiotics",
"C": "Prescribe a placebo",
"D": "Explain the reasoning as to why antibiotics are not indicated for the common cold"
} | step1 | D | [
"3 year old child",
"brought",
"pediatrician",
"mother",
"states",
"fussy",
"past two days",
"runny nose",
"cough",
"sore throat",
"decreased appetite",
"Vital signs",
"normal limits",
"Physical exam reveals",
"slightly erythematous oropharynx",
"clear nasal discharge",
"mother state... |
One day after delivery, an African American female newborn develops yellow discoloration of the eyes. She was born at term via uncomplicated vaginal delivery and weighed 3.4 kg (7 lb 8 oz). Her mother did not receive prenatal care. Examination shows scleral icterus and mild hepatosplenomegaly. Laboratory studies show:
... | Transfer of Anti-A antibodies | {
"A": "Viral infiltration of the bone marrow",
"B": "Polymerization of deoxygenated hemoglobin",
"C": "Atresia of the bilary tract",
"D": "Transfer of Anti-A antibodies"
} | step1 | D | [
"One day",
"delivery",
"African American female newborn",
"yellow",
"eyes",
"born",
"term",
"uncomplicated vaginal",
"3.4 kg",
"oz",
"mother",
"not receive prenatal care",
"Examination shows scleral icterus",
"mild hepatosplenomegaly",
"Laboratory studies show",
"Hemoglobin 10",
"mg/... |
A 67-year-old man presents to the physician for a followup examination. He was diagnosed with hypertension 12 years ago. He had a coronary stent placement 2 years ago. His medications include aspirin, atorvastatin, lisinopril, hydrochlorothiazide, and carvedilol. Amlodipine was also added to his medication list 2 month... | Renal artery revascularization | {
"A": "Renal artery revascularization",
"B": "Enoxaparin",
"C": "Tissue plasminogen activator",
"D": "Maximizing the dose of antihypertensive medications"
} | step2&3 | A | [
"67 year old man presents",
"physician",
"followup examination",
"diagnosed",
"hypertension",
"years",
"coronary",
"years",
"medications include aspirin",
"atorvastatin",
"lisinopril",
"hydrochlorothiazide",
"carvedilol",
"Amlodipine",
"added",
"medication list 2 months",
"to control... |
A 68-year-old woman presents to the hospital for an elective right hemicolectomy. She is independently mobile and does her own shopping. She has had type 2 diabetes mellitus for 20 years, essential hypertension for 15 years, and angina on exertion for 6 years. She has a 30-pack-year history of smoking. The operation wa... | Sepsis | {
"A": "Non-infectious systemic inflammatory response syndrome (SIRS)",
"B": "Multiple organ dysfunction syndrome",
"C": "Sepsis",
"D": "Drug-induced fever"
} | step2&3 | C | [
"68 year old woman presents",
"hospital",
"elective right hemicolectomy",
"mobile",
"shopping",
"type 2 diabetes mellitus",
"20 years",
"essential hypertension",
"years",
"angina",
"exertion",
"years",
"30 pack-year history of smoking",
"operation",
"uncomplicated",
"post",
"day 5",
... |
A 35-year-old woman with a history of systemic lupus erythematosus (SLE) presents with worsening fatigue. She says her symptoms onset a few months ago and are significantly worse than experienced due to her SLE. Past medical history is significant for SLE diagnosed 3 years ago, managed with NSAIDs and hydroxychloroquin... | Prednisone | {
"A": "Splenectomy",
"B": "Prednisone",
"C": "Exchange transfusion",
"D": "Rituximab"
} | step2&3 | B | [
"35 year old woman",
"history of systemic lupus erythematosus",
"presents",
"worsening fatigue",
"symptoms onset",
"few months",
"worse",
"experienced due to",
"SLE",
"Past medical history",
"significant",
"SLE diagnosed 3 years",
"managed",
"NSAIDs",
"hydroxychloroquine",
"review of s... |
A 55-year-old male presents with left hip pain and stiffness. Radiographs are shown in Figures A and B. Serum alkaline phosphatase levels are elevated. A biopsy of the left femur is performed and shown in Figure C. Which of the following cells are initially responsible for this condition? | Osteoclasts | {
"A": "Osteoclasts",
"B": "Neutrophils",
"C": "T-Cells",
"D": "Fibroblasts"
} | step1 | A | [
"55 year old male presents",
"left",
"stiffness",
"Radiographs",
"shown",
"Serum alkaline phosphatase levels",
"elevated",
"biopsy of",
"left femur",
"performed",
"shown",
"following cells",
"initially responsible",
"condition"
] |
A 1-day-old infant in the general care nursery, born at full term by uncomplicated cesarean section delivery, is noted to have a murmur, but otherwise appears well. On examination, respiratory rate is 40/min and pulse oximetry is 96%. Precordium is normoactive. With auscultation, S1 is normal, S2 is single, and a 2/6 s... | The degree of right ventricular outflow tract obstruction | {
"A": "The degree of right ventricular outflow tract obstruction",
"B": "The ratio of reduced hemoglobin to oxyhemoglobin",
"C": "The size of ventricular septal defect",
"D": "The concentration of pulmonary surfactant"
} | step2&3 | A | [
"1-day old infant",
"general care nursery",
"born",
"full term",
"uncomplicated cesarean section delivery",
"noted to",
"murmur",
"appears well",
"examination",
"respiratory rate",
"40 min",
"pulse oximetry",
"96",
"Precordium",
"auscultation",
"S1",
"normal",
"S2",
"single",
"... |
An 8-year-old girl is brought to the physician by her parents because they are concerned with her behavior. She has temper outbursts six or seven times per week, which last anywhere between 5 minutes to half an hour or until she becomes tired. According to her father, she screams at others and throws things in anger “w... | Disruptive mood dysregulation disorder | {
"A": "Pediatric bipolar disorder",
"B": "Conduct disorder",
"C": "Disruptive mood dysregulation disorder",
"D": "Intermittent explosive disorder"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"parents",
"concerned",
"behavior",
"outbursts six",
"seven times",
"week",
"last",
"5 minutes",
"half",
"hour",
"tired",
"father",
"screams",
"others",
"throws things",
"anger",
"things",
"go",
"outbursts started",
"half years old... |
A healthy 29-year-old nulligravid woman comes to the physician for genetic counseling prior to conception. Her brother has a disease that has resulted in infertility, a right-sided heart, and frequent sinus and ear infections. No other family members are affected. The intended father has no history of this disease. The... | 0.2% | {
"A": "0.7%",
"B": "1%",
"C": "66%",
"D": "0.2%"
} | step1 | D | [
"healthy 29 year old nulligravid woman",
"physician",
"genetic counseling prior to conception",
"brother",
"disease",
"resulted",
"infertility",
"right-sided heart",
"frequent sinus",
"ear infections",
"family members",
"affected",
"intended father",
"history of",
"disease",
"populatio... |
A 79-year-old man with aortic stenosis comes to the emergency room because of worsening fatigue for 5 months. During this time, he has also had intermittent bright red blood mixed in with his stool. He has not had any abdominal pain or weight loss. Physical examination shows pale conjunctivae and a crescendo-decrescend... | Tortuous submucosal blood vessels | {
"A": "Thrombus in the superior mesenteric artery",
"B": "Atherosclerotic narrowing of the mesenteric arteries",
"C": "Tortuous submucosal blood vessels",
"D": "Inherited factor VIII deficiency"
} | step1 | C | [
"year old man",
"aortic stenosis",
"emergency room",
"of worsening fatigue",
"months",
"time",
"intermittent bright red blood mixed",
"stool",
"not",
"abdominal pain",
"weight loss",
"Physical examination shows pale conjunctivae",
"crescendo-decrescendo systolic murmur best heard",
"second... |
A 15-year-old boy is brought to the physician because of recurrent respiratory infections that cause him to miss several weeks of school each year. He also has bulky, foul-smelling stools that are difficult to flush. He has a good appetite and eats a variety of foods. His height and weight are below the 10th percentile... | Absence of the vas deferens | {
"A": "Antibodies to endomysium",
"B": "Absence of the vas deferens",
"C": "Positive methacholine challenge test",
"D": "Deficiency of immunoglobulin A"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"recurrent respiratory infections",
"cause",
"to miss several weeks",
"school",
"year",
"bulky",
"foul-smelling stools",
"difficult to flush",
"good appetite",
"eats",
"variety",
"foods",
"height",
"weight",
"percentile",
"Physical examinat... |
A 16-year-old girl is brought to the physician because she has not yet reached menarche. There is no personal or family history of serious illness. She is at the 20th percentile for weight and 50th percentile for height. Vital signs are within normal limits. Examination shows mild facial hair. There is no glandular bre... | 5-α reductase deficiency | {
"A": "5-α reductase deficiency",
"B": "Sex chromosome monosomy",
"C": "21-hydroxylase deficiency",
"D": "Complete androgen insensitivity"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"not",
"reached menarche",
"personal",
"family history",
"serious illness",
"percentile",
"weight",
"50th percentile",
"height",
"Vital signs",
"normal limits",
"Examination shows mild facial hair",
"glandular breast tissue",
"Pubic hair",
"... |
A 23-year-old woman with no significant past medical history currently on oral contraceptive pills presents to the emergency department with pleuritic chest pain. She states that it started today. Yesterday she had a trip and returned via plane. Her temperature is 98°F (36.7°C), blood pressure is 117/66 mmHg, pulse is ... | D-dimer | {
"A": "Chest radiograph",
"B": "CT angiogram",
"C": "D-dimer",
"D": "Ultrasound of the lower extremities"
} | step2&3 | C | [
"23 year old woman",
"significant past medical history currently",
"oral contraceptive pills presents",
"emergency department",
"pleuritic chest pain",
"states",
"started today",
"trip",
"returned",
"plane",
"temperature",
"36",
"blood pressure",
"66 mmHg",
"pulse",
"min",
"respirati... |
A 26-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and delivery of her first child were uncomplicated. Her temperature is 37.2°C (99°F) and blood pressure is 163/105 mm Hg. Her blood pressure 10 weeks ago was 128/84 mm Hg. At her last vi... | Hydralazine therapy | {
"A": "Magnesium sulfate therapy",
"B": "Lisinopril therapy",
"C": "Complete bed rest",
"D": "Hydralazine therapy"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"Pregnancy",
"delivery",
"first child",
"uncomplicated",
"temperature",
"blood pressure",
"mm Hg",
"blood pressure 10 weeks",
"84 mm Hg",
"last visit two weeks",
"blood pre... |
A 12-month-old child passed away after suffering from craniofacial abnormalities, neurologic dysfunction, and hepatomegaly. Analysis of the child’s blood plasma shows an increase in very long chain fatty acids. The cellular analysis demonstrates dysfunction of an organelle responsible for the breakdown of these fatty a... | Beta-oxidation | {
"A": "Beta-oxidation",
"B": "Transcription",
"C": "Translation",
"D": "Ubiquitination"
} | step1 | A | [
"month old child passed",
"suffering",
"craniofacial abnormalities",
"neurologic dysfunction",
"hepatomegaly",
"Analysis",
"childs blood plasma shows",
"increase",
"very long chain fatty acids",
"cellular analysis demonstrates dysfunction",
"organelle responsible",
"breakdown",
"fatty acids"... |
A 15-year-old boy is brought to the clinic by his father for difficulty in school. He reports that his son has been suspended several times over his high school career for instigating fights. Per the patient, he has always had trouble controlling his anger and would feel especially frustrated at school since he has dif... | XYY syndrome | {
"A": "Conduct disorder",
"B": "Down syndrome",
"C": "Klinefelter syndrome",
"D": "XYY syndrome"
} | step1 | D | [
"year old boy",
"brought",
"clinic",
"father",
"difficulty in school",
"reports",
"son",
"suspended",
"times",
"high school career",
"fights",
"patient",
"always",
"controlling",
"anger",
"feel",
"frustrated",
"school",
"difficulty keeping",
"past medical history",
"unremarka... |
A study on cholesterol levels of a town in rural Idaho is performed, of which there are 1000 participants. It is determined that in this population, the mean LDL is 200 mg/dL, with a standard deviation of 50 mg/dL. If the population has a normal distribution, how many people have a cholesterol less than 300 mg/dL? | 975 | {
"A": "680",
"B": "950",
"C": "975",
"D": "997"
} | step1 | C | [
"study",
"cholesterol levels",
"town",
"rural Idaho",
"performed",
"participants",
"population",
"mean",
"200 mg/dL",
"standard deviation",
"50 mg/dL",
"population",
"normal distribution",
"people",
"cholesterol",
"300 mg/dL"
] |
A 28-year-old patient presents to a medical office for a consultation regarding a mole on her nose that is increasing in size. She also complains of frequent headaches, which she associates with stress on the job. She works as a civil engineer and spends much of her time outside. Her past medical history is positive fo... | BRAF | {
"A": "c-MYC",
"B": "APC",
"C": "BRAF",
"D": "BCL-2"
} | step1 | C | [
"year old patient presents",
"medical office",
"consultation",
"mole",
"nose",
"increasing in size",
"frequent headaches",
"associates",
"stress",
"job",
"works",
"civil engineer",
"spends much",
"time outside",
"past medical history",
"positive",
"bronchial asthma",
"stable",
"m... |
A 33-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She was diagnosed with multiple sclerosis one year ago. She has had two exacerbations since then, each lasting about one week and each requiring hospitalization for corticosteroid treatment. Her most recent exacerba... | Interferon beta | {
"A": "Mitoxantrone",
"B": "Methylprednisolone",
"C": "Interferon beta",
"D": "Supportive therapy only as needed"
} | step2&3 | C | [
"year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"diagnosed",
"multiple sclerosis one year ago",
"two exacerbations",
"then",
"lasting",
"one week",
"hospitalization",
"corticosteroid treatment",
"most recent exacerbation",
"three weeks",
"episodes",... |
A 25-year-old woman comes to the physician because of vaginal discharge for 4 days. She has no pain or pruritus. Menses occur at regular 27-day intervals and last 5 days. Her last menstrual period was 2 weeks ago. She is sexually active with two male partners and uses a diaphragm for contraception. She had a normal pap... | Gardnerella vaginalis | {
"A": "Escherichia coli",
"B": "Neisseria gonorrhoeae",
"C": "Gardnerella vaginalis",
"D": "Candida albicans"
} | step2&3 | C | [
"year old woman",
"physician",
"of vaginal discharge",
"4 days",
"pain",
"pruritus",
"Menses occur",
"regular 27 day intervals",
"last 5 days",
"last menstrual period",
"2 weeks",
"sexually active",
"two male partners",
"uses",
"diaphragm",
"contraception",
"normal pap smear",
"mon... |
A 50-year-old man is brought to the emergency department 30 minutes after the sudden onset of severe pain in the middle of his chest. He describes the pain as tearing in quality; it radiates to his jaw. He is sweating profusely. He has a 5-year history of hypertension and was diagnosed with chronic bronchitis 3 years a... | Muffled heart sounds | {
"A": "Tactile crepitus over the neck",
"B": "Muffled heart sounds",
"C": "Early diastolic knocking sound",
"D": "Diminished breath sounds over the right lung base"
} | step2&3 | B | [
"50 year old man",
"brought",
"emergency department 30 minutes",
"sudden onset",
"severe pain",
"middle",
"chest",
"pain",
"tearing",
"quality",
"radiates",
"jaw",
"sweating",
"5 year history of hypertension",
"diagnosed",
"chronic bronchitis",
"years",
"smoked one pack",
"cigare... |
A 68-year-old woman is brought to the emergency department by her husband because of acute confusion and sudden weakness of her left leg that lasted for about 30 minutes. One hour prior to admission, she was unable to understand words and had slurred speech for about 15 minutes. She has type 2 diabetes mellitus and hyp... | Warfarin | {
"A": "Enalapril",
"B": "Warfarin",
"C": "Alteplase",
"D": "Aortic valve replacement"
} | step2&3 | B | [
"68 year old woman",
"brought",
"emergency department",
"husband",
"acute confusion",
"sudden weakness of",
"left leg",
"lasted",
"30 minutes",
"One hour",
"admission",
"unable to understand words",
"slurred speech",
"15 minutes",
"type 2 diabetes mellitus",
"hypertension",
"smoked 1... |
A 9-year-old girl is brought to the pediatrician by her father for dysuria, genital pruritus, and vaginal discharge. Cultures of the discharge are sent, revealing the causative agent to be a Gram-negative glucose-fermenting, non-maltose fermenting diplococci. Which of the following steps should the physician follow nex... | Contact Child Protective Services | {
"A": "Tell the father that the child needs antiobiotics to treat the bacterial infection",
"B": "Discuss with the father that the child is being sexually abused",
"C": "Contact Child Protective Services",
"D": "Treat the child with antibiotics and schedule a follow up"
} | step1 | C | [
"year old girl",
"brought",
"pediatrician",
"father",
"dysuria",
"genital pruritus",
"vaginal discharge",
"Cultures",
"sent",
"revealing",
"causative agent to",
"Gram negative glucose",
"non maltose",
"diplococci",
"following steps",
"physician follow next"
] |
A 20-year-old man presents with a painless neck mass that has gradually increased in size. The mass is anteromedial to the right sternocleidomastoid muscle and has been present for 3 years. The mass increased in size and became more tender following an upper respiratory infection. An ultrasound of the neck identifies a... | Second branchial cleft cyst | {
"A": "First branchial cleft cyst",
"B": "Ectopic thyroid tissue",
"C": "Second branchial cleft cyst",
"D": "Sternomastoid tumor"
} | step1 | C | [
"20 year old man presents",
"painless neck",
"increased in size",
"mass",
"anteromedial",
"right sternocleidomastoid muscle",
"present",
"years",
"mass increased in size",
"more tender following",
"upper respiratory infection",
"ultrasound of the neck",
"single",
"round cystic",
"uniform... |
Please refer to the summary above to answer this question
An 8-year-old boy is brought to the physician by his mother for a well-child examination at a clinic for low-income residents. Although her son's elementary school offers free afterschool programming, her son has not been interested in attending. Both the son's ... | High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults. | {
"A": "The patient's family history of psychiatric illness prevents any conclusions from being drawn from the study.",
"B": "High-quality afterschool programming would decrease this patient's risk of developing major depressive disorder.",
"C": "High-quality afterschool programming has a greater effect on reduci... | step2&3 | D | [
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A 19-year-old man is brought to the emergency department by the police. The officers indicate that he was acting violently and talking strangely. In the ED, he becomes increasingly more violent. On exam his vitals are: Temp 101.1 F, HR 119/min, BP 132/85 mmHg, and RR 18/min. Of note, he has vertical nystagmus on exam. ... | Phencyclidine | {
"A": "Phencyclidine",
"B": "Ketamine",
"C": "Dextromethorphan",
"D": "Mescaline"
} | step2&3 | A | [
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A researcher is investigating the behavior of two novel chemotherapeutic drugs that he believes will be effective against certain forms of lymphoma. In order to evaluate the safety of these drugs, this researcher measures the concentration and rate of elimination of each drug over time. A partial set of the results is ... | The half-life of drug A is constant but that of drug B is variable | {
"A": "The half-life of both drug A and drug B are constant",
"B": "The half-life of drug A is constant but that of drug B is variable",
"C": "The half-life of drug A is variable but that of drug B is constant",
"D": "The half-life of both drug A and drug B are variable"
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A 25-year-old man comes to the physician because of palpitations, sweating, and flushing. Since he was promoted to a manager in a large software company 6 months ago, he has had several episodes of these symptoms when he has to give presentations in front of a large group of people. During these episodes, his thoughts ... | Cognitive behavioral therapy | {
"A": "Olanzapine therapy",
"B": "Cognitive behavioral therapy",
"C": "Lorazepam therapy",
"D": "Buspirone therapy"
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An 18-year-old college student seeks evaluation at an emergency department with complaints of fevers with chills, fatigue, diarrhea, and loss of appetite, which have lasted for 1 week. He says that his symptoms are progressively getting worse. He was taking over-the-counter acetaminophen, but it was ineffective. The pa... | Lipid A - a toxic component present in the bacterial cell wall | {
"A": "Lipid A - a toxic component present in the bacterial cell wall",
"B": "Pili on the bacterial cell surface",
"C": "Flagella",
"D": "Outer capsule"
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A 34-year-old man presents to the emergency department by ambulance after being involved in a fight. On arrival, there is obvious trauma to his face and neck, and his mouth is full of blood. Seconds after suctioning the blood, his mouth rapidly fills up with blood again. As a result, he is unable to speak to you. An at... | Cricothyroidotomy | {
"A": "Endotracheal intubation",
"B": "Cricothyroidotomy",
"C": "Nasogastric tube",
"D": "Cardiopulmonary resusication"
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A 54-year-old man presents to the clinic for epigastric discomfort during the previous month. He states he has not vomited, but reports of having epigastric pain that worsens after most meals. The patient states that his stool “looks black sometimes.” The patient does not report of any weight loss. He has a past medica... | Endoscopy with biopsy | {
"A": "Serology for Helicobacter pylori",
"B": "Urea breath testing",
"C": "CT abdomen",
"D": "Endoscopy with biopsy"
} | step2&3 | D | [
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A 63-year-old man with a history of stage 4 chronic kidney disease (CKD) has started to develop refractory anemia. He denies any personal history of blood clots in his past, but he says that his mother has also had to be treated for deep venous thromboembolism in the past. His past medical history is significant for di... | ESAs should only be used with the hemoglobin level is < 10 g/dL | {
"A": "ESAs can improve survival in patients with breast and cervical cancers",
"B": "ESAs are utilized in patients receiving myelosuppressive chemotherapy with an anticipated curative outcome",
"C": "ESAs should only be used with the hemoglobin level is < 10 g/dL",
"D": "ESAs show efficacy with low iron level... | step2&3 | C | [
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A 48-year-old woman comes to the physician because of progressively worsening dyspnea on exertion and fatigue for the past 2 months. She had Hodgkin lymphoma as an adolescent, which was treated successfully with chemotherapy and radiation. Her father died from complications related to amyloidosis. She does not smoke or... | Chronic tachycardia | {
"A": "Amyloid deposition",
"B": "Acute psychological stress",
"C": "Chronic tachycardia",
"D": "Coronary artery occlusion"
} | step2&3 | C | [
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A 45-year-old man presents to a psychiatrist by his wife with recent behavioral and emotional changes. The patient’s wife says that her husband’s personality has completely changed over the last year. She also says that he often complains of unpleasant odors when actually there is no discernible odor present. The patie... | Olfactory hallucinations | {
"A": "Delusions of grandeur",
"B": "Thought broadcasting",
"C": "Olfactory hallucinations",
"D": "Echolalia"
} | step2&3 | C | [
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A scientist is studying the characteristics of a newly discovered infectious disease in order to determine its features. He calculates the number of patients that develop the disease over several months and finds that on average 75 new patients become infected per month. Furthermore, he knows that the disease lasts on ... | 0.24 | {
"A": "0.01",
"B": "0.02",
"C": "0.12",
"D": "0.24"
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An investigator is studying the function of the endoplasmic reticulum in genetically modified lymphocytes. A gene is removed that facilitates the binding of ribosomes to the endoplasmic reticulum. Which of the following processes is most likely to be impaired as a result of this genetic modification? | Production of secretory proteins | {
"A": "Production of secretory proteins",
"B": "Synthesis of ketone bodies",
"C": "α-Oxidation of fatty acids",
"D": "Ubiquitination of proteins"
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An 80-year-old man is admitted to the hospital after the sudden onset of sub-sternal chest pain and shortness of breath while sitting in a chair. He has hypertension and type 2 diabetes mellitus. He has smoked 1 pack of cigarettes daily for 42 years. Four days after admission, he becomes tachycardic and then loses cons... | Hyperemic granulation tissue with abundance of macrophages | {
"A": "Coagulative necrosis with dense neutrophilic infiltrate",
"B": "Wavy myocardial fibers without inflammatory cells",
"C": "Dense granulation tissue with collagenous scar formation",
"D": "Hyperemic granulation tissue with abundance of macrophages"
} | step1 | D | [
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An investigator is conducting a study on hematological factors that affect the affinity of hemoglobin for oxygen. An illustration of two graphs (A and B) that represent the affinity of hemoglobin for oxygen is shown. Which of the following best explains a shift from A to B? | Increased body temperature | {
"A": "Decreased serum 2,3-bisphosphoglycerate concentration",
"B": "Increased serum pH",
"C": "Increased body temperature",
"D": "Decreased serum pCO2"
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A 72-year-old female presents to the emergency department complaining of severe abdominal pain and several days of bloody diarrhea. Her symptoms began with intermittent bloody diarrhea five days ago and have worsened steadily. For the last 24 hours, she has complained of fevers, chills, and abdominal pain. She has a hi... | Plain abdominal radiograph | {
"A": "Abdominal CT with IV contrast",
"B": "Plain abdominal radiograph",
"C": "Colectomy",
"D": "Contrast enema"
} | step2&3 | B | [
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A 42-year-old woman comes to the physician because of a 2-month history of progressive muscular weakness. She has had difficulty climbing stairs, getting up from chairs, and brushing her hair. Her vital signs are within normal limits. Muscle strength is 2/5 with flexion of the hips and 3/5 with abduction of the shoulde... | Sarcolemmal MHC-I overexpression with CD8+ lymphocytic infiltration | {
"A": "Muscle fiber necrosis with rare inflammatory cells",
"B": "Sarcolemmal MHC-I overexpression with CD8+ lymphocytic infiltration",
"C": "Relative atrophy of type II muscle fibers with hypertrophy of type I muscle fiber",
"D": "Perimysial inflammation with perivascular CD4+ T lymphocytic infiltration"
} | step1 | B | [
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A neuroscientist is delivering a lecture on the electrophysiology of the brain. He talks about neuroreceptors which act as ion channels in the neurons. He mentions a specific receptor, which is both voltage-gated and ligand-gated ion channel. Which of the following receptors is most likely to be the one mentioned by th... | NMDA receptor | {
"A": "GABAA receptor",
"B": "Glycine receptor",
"C": "NMDA receptor",
"D": "Nicotinic acetylcholine receptor"
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A 57-year-old woman comes to the physician because of several years of recurrent pelvic pain and constipation. She has increased fecal urgency and a sensation of incomplete evacuation following defecation. She has had no problems associated with urination. Her last menstrual period was 6 years ago. She has had three un... | Rectovaginal fascia | {
"A": "Pubocervical fascia",
"B": "Rectovaginal fascia",
"C": "Uterosacral ligament",
"D": "Bulbospongiosus muscle"
} | step1 | B | [
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A 19-year-old male from rural West Virginia presents to his family medicine doctor to discuss why he is having trouble getting his wife pregnant. On exam, he is 6 feet 2 inches with a frail frame and broad hips for a male his size. He is noted to have mild gynecomastia, no facial hair, and small, underdeveloped testes.... | 47: XXY | {
"A": "Trisomy 13",
"B": "Trisomy 21",
"C": "47: XXY",
"D": "45: XO"
} | step1 | C | [
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A 62-year-old woman is hospitalized for an open reduction of a fracture of her right femur following a motor vehicle accident 2 hours prior. She has had rheumatoid arthritis for 12 years. She was hospitalized 1 month ago for an exacerbation of rheumatoid arthritis. Since then, she has been taking a higher dose of predn... | Replacing prednisone with hydrocortisone | {
"A": "Adding zinc supplementation",
"B": "Discontinuing steroids before surgery",
"C": "Increasing prednisone dose initially and tapering rapidly after 3 days",
"D": "Replacing prednisone with hydrocortisone"
} | step2&3 | D | [
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A 23-year-old woman presents to the outpatient OB/GYN clinic as a new patient who wishes to begin contraception. She has no significant past medical history, family history, or social history. The review of systems is negative. Her vital signs are: blood pressure 118/78 mm Hg, pulse 73/min, and respiratory rate 16/min.... | Intrauterine device (IUD) | {
"A": "Intrauterine device (IUD)",
"B": "NuvaRing",
"C": "Male condoms",
"D": "Diaphragm with spermicide"
} | step2&3 | A | [
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A 42-year-old man presents to his primary care provider for abdominal pain. He reports that for several months he has been experiencing a stabbing pain above the umbilicus during meals. He denies associated symptoms of nausea, vomiting, or diarrhea. The patient’s past medical history is significant for hypertension and... | Secretin stimulation test | {
"A": "Empiric triple therapy",
"B": "Secretin stimulation test",
"C": "Serum chromogranin A level",
"D": "Serum prolactin level"
} | step2&3 | B | [
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A patient is infected with a pathogen and produces many antibodies to many antigens associated with that pathogen via Th cell-activated B cells. This takes place in the germinal center of the lymphoid tissues. If the same patient is later re-infected with the same pathogen, the immune system will respond with a much st... | Affinity maturation | {
"A": "Affinity maturation",
"B": "Avidity",
"C": "Immunoglobulin class switching",
"D": "T cell negative selection"
} | step1 | A | [
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Physical exam of a 15-year-old female reveals impetigo around her mouth. A sample of the pus is taken and cultured. Growth reveals gram-positive cocci in chains that are bacitracin sensitive. Which of the following symptoms would be concerning for a serious sequelae of this skin infection? | Hematuria | {
"A": "Fever",
"B": "Myocarditis",
"C": "Hematuria",
"D": "Chorea"
} | step1 | C | [
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A 34-year-old woman comes to a physician for a routine health maintenance examination. She moved to Denver 1 week ago after having lived in New York City all her life. She has no history of serious illness and takes no medications. Which of the following sets of changes is most likely on analysis of a blood sample obta... | ↑ ↓ unchanged | {
"A": "Unchanged ↓ unchanged",
"B": "Unchanged unchanged ↓",
"C": "↑ unchanged unchanged",
"D": "↑ ↓ unchanged"
} | step1 | D | [
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A 19-year-old male is found to have Neisseria gonorrhoeae bacteremia. This bacterium produces an IgA protease capable of cleaving the hinge region of IgA antibodies. What is the most likely physiological consequence of such a protease? | Impaired mucosal immune protection | {
"A": "Membrane attack complex formation is impaired",
"B": "Opsonization and phagocytosis of pathogen cannot occur",
"C": "Impaired adaptive immune system memory",
"D": "Impaired mucosal immune protection"
} | step1 | D | [
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A 7-year-old girl is brought to the physician with complaints of erythema and rashes over the bridge of her nose and on her forehead for the past 6 months. She also has vesiculobullous and erythematous scaly crusted lesions on the scalp and around the perioral areas. Her parents report a history of worsening symptoms d... | Type III hypersensitivity | {
"A": "Type I hypersensitivity",
"B": "Type II hypersensitivity",
"C": "Type III hypersensitivity",
"D": "Type IV hypersensitivity"
} | step2&3 | C | [
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"exposure to sunligh... |
A graduate student at the biochemistry laboratory decides to research the different effects of vitamin deficiencies in mice by completely depriving the mice of one vitamin. The symptoms of this deficiency include posterior column and spinocerebellar tract demyelination, as well as hemolytic anemia. Further analysis is ... | High doses can increase the effects of warfarin | {
"A": "High doses can increase the effects of warfarin",
"B": "The vitamin facilitates iron absorption",
"C": "The vitamin controls serum calcium levels",
"D": "The vitamin is important in rod and cone cells for vision"
} | step1 | A | [
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A 58-year-old woman presents to the physician for a routine gynecological visit. She denies any acute issues and remarks that she has not been sexually active for the past year. Her last Pap test was negative for any abnormal cytology. A pelvic examination and Pap test is performed at the current visit with no remarkab... | Pap test and HPV test in 5 years | {
"A": "Colposcopy at the current visit to verify Pap test results",
"B": "Colposcopy in 3 years",
"C": "Pap test and HPV test in 5 years",
"D": "Pap test only in 5 years"
} | step2&3 | C | [
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A 15-month-old boy is brought to the pediatrician’s office by his mother due to abnormal muscle tone and an inability to walk. He was able to control his head at 5 months of age, roll at 8 months of age, sit at 11 months of age, and develop hand preference at 13 months of age. On physical exam, he is observed to asymme... | Prematurity | {
"A": "Multiparity",
"B": "Perinatal hypoxic injury",
"C": "Prematurity",
"D": "Stroke"
} | step2&3 | C | [
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A 65-year-old man presents with generalized edema and dyspnea on exertion. He also complains of easy bruising and nasal bleeding. Past medical history is significant for a right-sided myocardial infarction 4 years ago. Current medications are metoprolol, aspirin, and rosuvastatin. His vital signs are as follows: blood ... | Pericentral hepatocytes | {
"A": "Pericentral hepatocytes",
"B": "Ito cells",
"C": "Periportal hepatocytes",
"D": "Sinusoidal endothelial cells"
} | step1 | A | [
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An 82-year-old woman is brought to the emergency room after her neighbor saw her fall in the hallway. She lives alone and remarks that she has been feeling weak lately. Her diet consists of packaged foods and canned meats. Her temperature is 97.6°F (36.4°C), blood pressure is 133/83 mmHg, pulse is 95/min, respirations ... | Folate | {
"A": "Folate",
"B": "Thiamine",
"C": "Vitamin B12",
"D": "Zinc"
} | step2&3 | A | [
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"min",
... |
An otherwise healthy 10-day-old boy is brought to the physician by his parents because of progressively enlarging breasts bilaterally for the last 4 days. The parents report that they have sometimes noticed a discharge of small quantities of a white liquid from the left breast since yesterday. During pregnancy, the mot... | Reassurance | {
"A": "Reassurance",
"B": "Breast biopsy",
"C": "Serum gonadotropin measurement",
"D": "Chromosomal analysis"
} | step2&3 | A | [
"healthy 10 day old boy",
"brought",
"physician",
"parents",
"enlarging breasts",
"last",
"days",
"parents report",
"sometimes",
"discharge",
"small quantities",
"white liquid",
"left breast",
"pregnancy",
"mother",
"diagnosed",
"hypothyroidism",
"treated with",
"thyroxine",
"p... |
A 60-year-old man presents to the physician for a regular checkup. The patient has a history of osteoarthritis in his right knee and gastroesophageal reflux disease. His conditions are well controlled by medications, and he has no active complaints at the moment. He takes ibuprofen, omeprazole, and a multivitamin. Labo... | Bile acid production | {
"A": "Bile acid production",
"B": "HMG-CoA reductase activity",
"C": "Surface LDL-receptors",
"D": "Scavenger receptors"
} | step1 | A | [
"60 year old man presents",
"physician",
"regular checkup",
"patient",
"history of osteoarthritis",
"right knee",
"gastroesophageal reflux disease",
"conditions",
"well controlled by medications",
"active complaints",
"takes ibuprofen",
"omeprazole",
"multivitamin",
"Laboratory tests show"... |
A 19-year-old male college student presents to the clinic in the month of January with a 2-day history of watery diarrhea. The patient also complains of weakness, nausea, vomiting and abdominal cramps. He has no significant past medical history. He does not take any medication. He drinks socially on the weekends but do... | Norovirus | {
"A": "Norovirus",
"B": "Rotavirus",
"C": "Staphylococcus aureus",
"D": "Enterotoxigenic Escherichia coli"
} | step2&3 | A | [
"year old male college student presents",
"clinic",
"month",
"January",
"2-day history",
"watery diarrhea",
"patient",
"weakness",
"nausea",
"vomiting",
"abdominal cramps",
"significant past medical history",
"not take",
"medication",
"drinks",
"weekends",
"not smoke cigarettes",
"... |
An 8-year-old boy is brought to the physician by his mother because of a 3-week history of irritability and frequent bed wetting. She also reports that he has been unable to look upward without tilting his head back for the past 2 months. He is at the 50th percentile for height and weight. His vital signs are within no... | Dorsal midbrain | {
"A": "Cerebral falx",
"B": "Dorsal midbrain",
"C": "Sella turcica",
"D": "Cerebellar vermis"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"mother",
"week history",
"irritability",
"frequent bed wetting",
"reports",
"unable to look upward",
"tilting",
"head back",
"past",
"months",
"50th percentile",
"height",
"weight",
"vital signs",
"normal limits",
"Ophthalmological examina... |
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