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 72-year-old man presents to the physician with a 3-month history of severe lower back pain and fatigue. The pain increases with activity. He has no history of any serious illness. He takes ibuprofen for pain relief. He does not smoke. His blood pressure is 105/65 mm Hg, pulse is 86/min, respiratory rate is 16/min, an... | Hypercalcemia | {
"A": "Amyloid deposits",
"B": "Hypercalcemia",
"C": "Infiltration of kidney by malignant cells",
"D": "Nonsteroidal antiinflammatory drugs (NSAIDs)"
} | step2&3 | B | [
"72 year old man presents",
"physician",
"3 month history of severe lower back pain",
"fatigue",
"pain increases",
"activity",
"history",
"serious illness",
"takes ibuprofen",
"pain relief",
"not smoke",
"blood pressure",
"65 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"temp... |
A 35-year-old man and his 9-year-old son are brought to the emergency department following a high-speed motor vehicle collision. The father was the restrained driver. He is conscious. His pulse is 135/min and his blood pressure is 76/55 mm Hg. His hemoglobin concentration is 5.9 g/dL. His son sustained multiple body co... | Transfuse packed red blood cells to the son but not to father | {
"A": "Consult hospital ethics committee for medical treatment of the son",
"B": "Proceed to surgery on the son without transfusion",
"C": "Seek a court order for medical treatment of the son",
"D": "Transfuse packed red blood cells to the son but not to father"
} | step2&3 | D | [
"35 year old man",
"year old son",
"brought",
"emergency department following",
"high speed motor vehicle collision",
"father",
"restrained driver",
"conscious",
"pulse",
"min",
"blood pressure",
"76 55 mm Hg",
"hemoglobin concentration",
"5",
"g/dL",
"son sustained multiple body contu... |
A 47-year-old woman presents to the emergency department with a fever and a headache. Her symptoms started yesterday and have rapidly progressed. Initially, she was experiencing just a fever and a headache which she was treating with acetaminophen. It rapidly progressed to blurry vision, chills, nausea, and vomiting. T... | Cavernous sinus thrombosis | {
"A": "Acute closed angle glaucoma",
"B": "Cavernous sinus thrombosis",
"C": "Periorbital cellulitis",
"D": "Intracranial hemorrhage"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"fever",
"headache",
"symptoms started",
"rapidly progressed",
"Initially",
"experiencing",
"fever",
"headache",
"treating",
"acetaminophen",
"rapidly progressed",
"blurry vision",
"chills",
"nausea",
"vomiting",
"patient",
"past... |
A 42-year-old woman comes to the physician for a routine health maintenance examination. She has generalized fatigue and has had difficulties doing her household duties for the past 3 months. She has eczema and gastroesophageal reflux disease. She has a history of using intravenous methamphetamine in her youth but has ... | Bariatric surgery | {
"A": "Liposuction",
"B": "Bariatric surgery",
"C": "Behavioral therapy",
"D": "Phentermine and topiramate therapy and follow-up in 3 months"
} | step2&3 | B | [
"year old woman",
"physician",
"routine health maintenance examination",
"generalized fatigue",
"difficulties",
"household",
"past 3 months",
"eczema",
"gastroesophageal reflux disease",
"history",
"using intravenous methamphetamine",
"youth",
"not used illicit drugs",
"23 years",
"medic... |
A 12-year-old girl is presented to the office by her mother with complaints of cola-colored urine and mild facial puffiness that began 5 days ago. According to her mother, she had a sore throat 3 weeks ago. Her immunization records are up to date. The mother denies fever and any change in bowel habits. The vital signs ... | Hypercellular and enlarged glomeruli | {
"A": "Wire looping of capillaries",
"B": "Hypercellular and enlarged glomeruli",
"C": "Segmental sclerosis and hyalinosis",
"D": "Mesangial proliferation"
} | step1 | B | [
"year old girl",
"presented",
"office",
"mother",
"complaints",
"cola colored urine",
"mild facial puffiness",
"began 5 days",
"mother",
"sore throat",
"weeks",
"immunization records",
"date",
"mother denies fever",
"change in bowel habits",
"vital signs include blood pressure",
"mm ... |
A 75-year-old male arrives by ambulance to the emergency room severely confused. His vitals are T 40 C, HR 120 bpm, BP 80/55 mmHg, RR 25. His wife explains that he injured himself about a week ago while cooking, and several days later his finger became infected, oozing with pus. He ignored her warning to see a doctor a... | Alpha 1, Alpha 2, Beta 1 | {
"A": "Alpha 1",
"B": "Alpha 2",
"C": "Alpha 1, Alpha 2, Beta 1",
"D": "Alpha 1, Beta 1, Dopamine 1"
} | step1 | C | [
"75 year old male",
"ambulance",
"emergency room severely confused",
"T 40",
"BP 80 55 mmHg",
"RR",
"wife",
"injured",
"about",
"week",
"cooking",
"several days later",
"finger",
"infected",
"pus",
"ignored",
"warning to see",
"doctor",
"refused",
"fever",
"chills",
"severe... |
A 74-year-old woman presents to the clinic for evaluation of an erythematous and edematous skin rash on her right leg that has progressively worsened over the last 2 weeks. The medical history is significant for hypertension and diabetes mellitus type 2. She takes prescribed lisinopril and metformin. The vital signs in... | Cellulitis | {
"A": "Cellulitis",
"B": "Irritant contact dermatitis",
"C": "Folliculitis",
"D": "Gas gangrene"
} | step2&3 | A | [
"74 year old woman presents",
"clinic",
"evaluation",
"erythematous",
"edematous skin rash",
"right leg",
"worsened",
"2 weeks",
"medical history",
"significant",
"hypertension",
"diabetes mellitus type 2",
"takes prescribed lisinopril",
"metformin",
"vital signs include",
"blood press... |
A 12-year-old girl presents to her physician for the evaluation of episodic shortness of breath and cough. These episodes occur more frequently in spring. Her mother has a history of similar complaints. The physical examination reveals bilateral wheezes on chest auscultation. The initial response to pollen consists of ... | Isotype switching | {
"A": "Junctional diversity",
"B": "Affinity maturation",
"C": "Somatic hypermutation",
"D": "Isotype switching"
} | step1 | D | [
"year old girl presents",
"physician",
"evaluation of episodic shortness",
"breath",
"cough",
"episodes occur more frequently",
"spring",
"mother",
"history",
"similar complaints",
"physical examination reveals bilateral wheezes",
"chest auscultation",
"initial response",
"pollen consists"... |
A 5-year-old boy is brought into your office by his mother. His father recently passed away, and his mother states she just lost her job. She has been unable to buy food regularly, and they have had to eat boiled and preserved vegetables. His mother denies that the boy has any prior medical conditions, but the patient ... | Vitamin C deficiency | {
"A": "Vitamin K deficiency",
"B": "Vitamin C deficiency",
"C": "Vitamin B12 deficiency",
"D": "Vitamin B3 deficiency"
} | step2&3 | B | [
"5 year old boy",
"brought",
"office",
"mother",
"father recently passed",
"mother states",
"lost",
"job",
"unable",
"buy food",
"to eat boiled",
"preserved vegetables",
"mother denies",
"boy",
"prior medical conditions",
"patient states",
"gums bleed",
"brushes",
"teeth",
"exa... |
A mother brings her 4-year-old son to his pediatrician. Over the last eight months, her son has been exhibiting several "odd" behaviors. Most importantly, he repeatedly says that he is playing games with a friend named "Steven," though she is certain that he does not exist. She has often found him acting out magical sc... | Normal development | {
"A": "Developmental delay",
"B": "Normal development",
"C": "Schizoid personality disorder",
"D": "Schizophreniform disorder"
} | step2&3 | B | [
"mother",
"4 year old son",
"pediatrician",
"last eight months",
"son",
"exhibiting several",
"odd",
"behaviors",
"Most",
"repeatedly",
"playing games",
"friend named",
"certain",
"not exist",
"often found",
"acting out magical scenarios",
"else",
"present",
"most likely diagnosi... |
A 29-year-old woman comes to the office with her husband because she has had 4 spontaneous abortions. Regarding her medical history, she was diagnosed with systemic lupus erythematosus 9 years ago, had a stroke 3 years ago, and was diagnosed with deep vein thrombosis in the same year. She has no relevant family history... | Antiphospholipid syndrome | {
"A": "Protein S deficiency",
"B": "Antiphospholipid syndrome",
"C": "Mutation of Leiden V factor",
"D": "Antithrombin deficiency"
} | step1 | B | [
"29 year old woman",
"office",
"husband",
"4 spontaneous abortions",
"medical history",
"diagnosed",
"systemic lupus erythematosus",
"years",
"stroke",
"years",
"diagnosed",
"deep vein thrombosis",
"same year",
"relevant family history",
"vital signs include",
"heart rate",
"min",
... |
A 59-year-old male with history of hypertension presents to your clinic for achy, stiff joints for the last several months. He states that he feels stiff in the morning, particularly in his shoulders, neck, and hips. Occasionally, the aches travel to his elbows and knees. His review of systems is positive for low-grade... | Corticosteroid | {
"A": "Nonsteroidal antiinflammatory agent",
"B": "Hyaluronic acid",
"C": "Bisphosphonate",
"D": "Corticosteroid"
} | step2&3 | D | [
"59 year old male",
"history of hypertension presents",
"clinic",
"achy",
"stiff joints",
"months",
"states",
"feels stiff",
"morning",
"shoulders",
"neck",
"hips",
"Occasionally",
"aches travel",
"elbows",
"knees",
"review of systems",
"positive",
"low-grade fever",
"tiredness... |
A 35-year-old woman comes to the physician because of a 3-month history of facial hair growth, acne, and irregular menses. Her friends have told her that her voice sounds lower than usual. Physical examination shows pustular acne and dark hair growth along the jawline. Serum studies show elevated testosterone levels an... | Theca interna cells | {
"A": "Granulosa cells",
"B": "Sertoli cells",
"C": "Theca interna cells",
"D": "Clue cells"
} | step1 | C | [
"35 year old woman",
"physician",
"3 month history",
"facial",
"acne",
"irregular menses",
"friends",
"voice sounds lower",
"usual",
"Physical examination shows pustular acne",
"dark hair growth",
"Serum studies show elevated testosterone levels",
"normal inhibin levels",
"ultrasound",
"... |
A group of gastroenterologists is concerned about low colonoscopy screening rates. They decide to implement a free patient navigation program to assist local residents and encourage them to obtain colonoscopies in accordance with U.S. Preventive Services Task Force (USPSTF) guidelines. Local residents were recruited at... | Hawthorne effect | {
"A": "Confirmation bias",
"B": "Hawthorne effect",
"C": "Sampling bias",
"D": "Recall bias\n\""
} | step2&3 | B | [
"A group",
"gastroenterologists",
"concerned",
"low colonoscopy screening rates",
"to",
"free patient navigation program to assist local residents",
"to obtain colonoscopies",
"U",
"Preventive Services Task Force",
"guidelines",
"Local residents",
"community centers",
"Participants attended ... |
A 32-year-old man is brought to the emergency department after he was found unresponsive on the street. Upon admission, he is lethargic and cyanotic with small, symmetrical pinpoint pupils. The following vital signs were registered: blood pressure of 100/60 mm Hg, heart rate of 70/min, respiratory rate of 8/min, and a ... | pH: decreased, HCO3- : increased, Pco2: increased | {
"A": "pH: increased, HCO3- : decreased, Pco2: decreased",
"B": "pH: decreased, HCO3- : increased, Pco2: increased",
"C": "pH: increased, HCO3- : increased, Pco2: increased",
"D": "pH: normal, HCO3- : increased, Pco2: increased"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"found unresponsive",
"street",
"admission",
"lethargic",
"cyanotic",
"small",
"symmetrical pinpoint pupils",
"following vital signs",
"registered",
"blood pressure",
"100 60 mm Hg",
"heart rate",
"70 min",
"respiratory rate",
"min... |
A 38-year-old woman applies a PABA sunscreen to her skin before going to the beach. Which type(s) of ultraviolet light will it protect her against? | UVB | {
"A": "UVB",
"B": "UVC",
"C": "UVA and UVB",
"D": "UVB and UVC"
} | step1 | A | [
"year old woman applies",
"PABA sunscreen",
"skin",
"beach",
"type s",
"ultraviolet light"
] |
An investigator studying the epidemiology of breast cancer finds that prevalence of breast cancer has increased significantly in the United States since the 1980s. After analyzing a number of large epidemiological surveillance databases, the epidemiologist notices that the incidence of breast cancer has remained relati... | Improved treatment of breast cancer | {
"A": "Increased awareness of breast cancer among clinicians",
"B": "Increased average age of population at risk for breast cancer",
"C": "Improved screening programs for breast cancer",
"D": "Improved treatment of breast cancer"
} | step1 | D | [
"investigator studying the epidemiology of breast cancer finds",
"prevalence of breast cancer",
"increased",
"United States",
"1980s",
"number",
"large epidemiological surveillance databases",
"epidemiologist",
"the incidence of breast cancer",
"stable",
"past 30 years",
"following best",
"e... |
A 37-year old man is being evaluated due to a recent history of fatigue that started 3 weeks ago. The patient presents with a history of HIV, which was first diagnosed 7 years ago. He has been on an antiretroviral regimen and takes it regularly. His CD4+ count is 350 cells/mm3. According to the patient, his partner pas... | Diffuse large B cell lymphoma | {
"A": "Burkitt’s lymphoma",
"B": "Diffuse large B cell lymphoma",
"C": "Follicular lymphoma",
"D": "Small lymphocytic lymphoma"
} | step1 | B | [
"year old man",
"evaluated due to",
"recent history",
"fatigue",
"started 3 weeks",
"patient presents",
"history",
"HIV",
"first diagnosed",
"years",
"antiretroviral regimen",
"takes",
"CD4",
"count",
"350 cells/mm3",
"patient",
"partner passed",
"blood cancer",
"worried",
"fat... |
A 67-year-old man presents to the emergency department with acute onset of shortness of breath of 30 minutes' duration. Initially, he felt faint but did not lose consciousness. He is complaining of left-sided chest pain that increases on deep inspiration. He has no history of cardiopulmonary disease. A week ago, he und... | Trapped thrombus in the pulmonary vasculature | {
"A": "Inflammation of the lung parenchyma",
"B": "Occluding thrombus in a coronary artery",
"C": "Accumulation of fluids in the pericardial sac",
"D": "Trapped thrombus in the pulmonary vasculature"
} | step2&3 | D | [
"67 year old man presents",
"emergency department",
"acute onset of shortness",
"breath",
"30 minutes",
"duration",
"Initially",
"felt faint",
"not",
"consciousness",
"left-sided chest pain",
"increases",
"deep inspiration",
"history of cardiopulmonary disease",
"week",
"total left hip... |
A 26-year-old nulligravid woman presents to her gynecologist after noticing a lump in her right breast while showering. She states that she first noticed the lump approximately 2 weeks ago, when the mass was slightly tender to touch. Since then, the lump has gotten slightly smaller and is now non-tender. The patient is... | Hypercellular stroma with overgrowth of fibrous and glandular tissues | {
"A": "Dilated glands with 2 cell layers present",
"B": "Hypercellular stroma with overgrowth of fibrous and glandular tissues",
"C": "Large, pleomorphic cells with associated central necrosis and microcalcifications",
"D": "Terminal duct lobular units surrounded by dense stroma"
} | step1 | B | [
"year old nulligravid woman presents",
"gynecologist",
"lump in",
"right breast",
"showering",
"states",
"first",
"lump approximately",
"weeks",
"mass",
"slightly tender",
"touch",
"then",
"lump",
"gotten slightly smaller",
"now non-tender",
"patient",
"healthy",
"not take oral c... |
A 58-year-old African-American man with a history of congestive heart failure presents to the emergency room with headache, frequent vomiting, diarrhea, anorexia, and heart palpitations. He is taking a drug that binds the sodium-potassium pump in myocytes. EKG reveals ventricular dysrhythmia. Which of the following is ... | Changes in color vision | {
"A": "Bronchoconstriction",
"B": "Changes in color vision",
"C": "Decreased PR interval",
"D": "Cough"
} | step1 | B | [
"58 year old African-American man",
"history of congestive heart failure presents",
"emergency room",
"headache",
"frequent vomiting",
"diarrhea",
"anorexia",
"heart palpitations",
"taking",
"drug",
"binds",
"sodium-potassium pump",
"myocytes",
"EKG reveals ventricular dysrhythmia",
"fol... |
A 59-year-old man comes to the physician because of a 3-month history of frequent urination. He has to urinate every 1–2 hours during the day and wakes up at least 2–3 times at night to urinate. He also reports that over the last 2 months, he has difficulty initiating micturition and the urinary stream is weak, with pr... | Terazosin therapy | {
"A": "Bladder catheterization",
"B": "Terazosin therapy",
"C": "Finasteride therapy",
"D": "Cystoscopy"
} | step2&3 | B | [
"59 year old man",
"physician",
"of",
"3 month history",
"frequent urination",
"to",
"hours",
"day",
"wakes up",
"23 times",
"night to",
"reports",
"last",
"months",
"difficulty initiating micturition",
"urinary stream",
"weak",
"prolonged terminal dribbling",
"pulse",
"72 min"... |
A 37-year-old man presents to the emergency department with rapid onset epigastric pain that started 4 hours ago. He describes the pain as severe, localized to the epigastric region and radiating to the back, which is partially relieved by leaning forward. He admits to binge drinking this evening at a friend’s party. H... | Bedside Index of Severity in Acute Pancreatitis (BISAP) score | {
"A": "Bedside Index of Severity in Acute Pancreatitis (BISAP) score",
"B": "Modified Glasgow Score",
"C": "C- reactive protein level",
"D": "Ranson´s criteria"
} | step1 | A | [
"year old man presents",
"emergency department",
"rapid onset epigastric pain",
"started 4 hours",
"pain",
"severe",
"localized",
"epigastric region",
"radiating to",
"back",
"relieved by",
"forward",
"admits to binge drinking",
"evening",
"friends party",
"nauseated",
"denies vomiti... |
A 23-year-old man presents to his primary care physician with complaints of fatigue and cheek pain that started a day ago. He notes that he has nasal discharge that is yellow/green as well. Otherwise, he feels well and is generally healthy. The patient has a past medical history of type I diabetes mellitus and occasion... | Pseudoephedrine and follow up in 1 week | {
"A": "Amoxicillin-clavulanate",
"B": "Amphotericin and debridement",
"C": "CT head",
"D": "Pseudoephedrine and follow up in 1 week"
} | step2&3 | D | [
"23 year old man presents",
"primary care physician",
"complaints",
"fatigue",
"cheek pain",
"started",
"day",
"notes",
"nasal discharge",
"yellow/green",
"well",
"feels well",
"healthy",
"patient",
"past medical history of type I diabetes mellitus",
"occasionally uses IV drugs",
"te... |
A 14-year-old boy is brought to the physician by his mother because of a 12-hour history of abdominal pain and dark urine. Three days ago, he developed a cough, sore throat, and rhinorrhea. Examination shows conjunctival pallor, scleral icterus, and mild splenomegaly. A peripheral blood smear shows small round inclusio... | Generation of superoxide | {
"A": "Biosynthesis of glutathione",
"B": "Generation of superoxide",
"C": "Anchoring proteins to cell surface",
"D": "Function of myeloperoxidase"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"mother",
"12-hour history",
"abdominal pain",
"dark urine",
"Three days",
"cough",
"sore throat",
"rhinorrhea",
"Examination shows conjunctival pallor",
"scleral icterus",
"mild splenomegaly",
"peripheral blood smear shows small round inclusions",... |
A 34-year-old female presents to her primary care physician with complaints of fevers, nausea/vomiting, and severe left flank pain that has developed over the past several hours. She denies any prior episodes similar to her current presentation. Physical examination is significant for a body temperature of 39.1 C and c... | Neutrophils filling the lumens of the renal tubules | {
"A": "Neutrophils filling the lumens of the renal tubules",
"B": "Thickening of the capillaries and glomerular basement membrane",
"C": "Scarring of the glomeruli",
"D": "Enlarged, hypercellular glomeruli with 'wire-looping' of capillaries"
} | step1 | A | [
"year old female presents",
"primary care physician",
"complaints",
"fevers",
"nausea/vomiting",
"severe left flank pain",
"past",
"hours",
"denies",
"prior episodes similar",
"current presentation",
"Physical examination",
"significant",
"body temperature",
"costovertebral angle tendern... |
A 19-year-old woman presents to the family medicine clinic for evaluation of a sore throat. The patient states that she does not have a runny nose, cough or itchy throat. The patient has no past medical history but she did have an appendectomy when she was 8 years old. She takes acetaminophen when she gets a headache a... | Rapid strep test | {
"A": "Antibiotics",
"B": "Rapid strep test",
"C": "Symptomatic treatment",
"D": "Ultrasound of neck"
} | step2&3 | B | [
"year old woman presents",
"family medicine clinic",
"evaluation",
"sore throat",
"patient states",
"not",
"runny nose",
"cough",
"itchy throat",
"patient",
"past medical history",
"appendectomy",
"years old",
"takes acetaminophen",
"gets",
"headache",
"not smoke cigarettes",
"incl... |
A 31-year-old woman visits her primary care physician with the complaint that over the past 6 months she has “felt out of breath and dizzy while walking, even after short distances.” She reports no other medical problems and denies taking any medications, vitamins, supplements, recreational drugs, alcohol or tobacco. H... | Right ventricular failure | {
"A": "Abdominal aortic aneurysm",
"B": "Right ventricular failure",
"C": "Pulmonary abscess",
"D": "Tension pneumothorax"
} | step1 | B | [
"31 year old woman visits",
"primary care physician",
"complaint",
"past 6 months",
"felt out of breath",
"dizzy",
"walking",
"short distances",
"reports",
"medical problems",
"denies taking",
"medications",
"vitamins",
"supplements",
"recreational drugs",
"alcohol",
"tobacco",
"BM... |
A 19-month-old girl is brought by her mother to the local walk-in clinic after noticing a mass protruding from her vagina. The mass had the appearance of "a bunch of grapes". She also says that she has been having a vaginal discharge for the past 6 months. Her family and personal history are not significant for maligna... | Sarcoma | {
"A": "Sarcoma",
"B": "Verrucous carcinoma",
"C": "Squamous cell carcinoma (SCC)",
"D": "Adenocarcinoma"
} | step1 | A | [
"month old girl",
"brought",
"mother",
"local walk-in clinic",
"mass protruding",
"vagina",
"mass",
"appearance",
"grapes",
"vaginal discharge",
"past 6 months",
"family",
"personal history",
"not significant",
"malignancies",
"inherited disorders",
"physical examination",
"unremar... |
A 78-year-old man receives chemotherapy for advanced hepatocellular carcinoma. Despite appropriate therapy, he dies 4 months later. Histopathological examination of the cancer cells shows the presence of a transmembrane efflux pump protein that is known to cause decreased intracellular concentrations of chemotherapeuti... | P-glycoprotein | {
"A": "P-glycoprotein",
"B": "Tyrosine receptor",
"C": "G protein",
"D": "Channel protein"
} | step1 | A | [
"year old man receives chemotherapy",
"advanced hepatocellular carcinoma",
"appropriate therapy",
"months later",
"Histopathological examination of",
"cancer cells shows",
"presence",
"a transmembrane efflux pump protein",
"known to cause decreased intracellular concentrations",
"chemotherapeutic ... |
A 65-year-old woman presents to her physician with chronic breathlessness. Her condition has been progressively worsening over the last 20 years despite treatment with inhaled salbutamol, inhaled corticosteroids, and multiple courses of antibiotics. She has a 30-pack-year smoking history but quit 20 years ago. Her puls... | Diminished surface area for gas exchange | {
"A": "Accumulation of fluid in the alveolar space",
"B": "Decreased partial pressure of alveolar oxygen",
"C": "Diminished surface area for gas exchange",
"D": "Inflammation of the pulmonary bronchi"
} | step1 | C | [
"65 year old woman presents",
"physician",
"chronic breathlessness",
"condition",
"worsening",
"20 years",
"treatment",
"inhaled salbutamol",
"inhaled corticosteroids",
"multiple courses",
"antibiotics",
"30 pack-year smoking history",
"quit 20 years",
"pulse",
"min",
"respirations",
... |
A 12-year-old boy is brought by his father to a pediatrician for evaluation of stiff jaw and swallowing difficulty. He has also developed painful body spasms triggered by loud noise, light, and physical touch. His father says that a few days ago, his son continued to play football, even after falling and bruising his a... | GABA (gamma-aminobutyric acid) | {
"A": "Norepinephrine",
"B": "Serotonin",
"C": "GABA (gamma-aminobutyric acid)",
"D": "Acetylcholine"
} | step1 | C | [
"year old boy",
"brought",
"father",
"pediatrician",
"evaluation",
"stiff jaw",
"swallowing difficulty",
"painful body spasms triggered by loud noise",
"light",
"physical touch",
"father",
"few days",
"son continued to play football",
"falling",
"bruising",
"arms",
"knees",
"examin... |
A 62-year-old Caucasian man visits his primary care provider with recurrent episodes of moderate to severe abdominal pain, nausea, and anorexia for the past 2 years. Additional complaints include constipation, steatorrhea, weight loss, polyphagia, and polyuria. His personal history is relevant for a 2-year period of ho... | Alcohol abuse | {
"A": "Alcohol abuse",
"B": "Cocaine abuse",
"C": "Obesity",
"D": "Hypercholesterolemia"
} | step2&3 | A | [
"62 year old Caucasian man visits",
"primary care provider",
"recurrent episodes of moderate",
"severe abdominal",
"nausea",
"anorexia",
"past",
"years",
"Additional complaints include constipation",
"steatorrhea",
"weight loss",
"polyphagia",
"polyuria",
"personal history",
"relevant",
... |
A 33-year-old male presents to his primary care physician with complaints of headaches and muscle weakness. His physical exam is entirely within normal limits except for a blood pressure of 150/95. Subsequent routine blood lab work showed a sodium level of 146 and potassium level of 3.0. What is the best pharmacologica... | Spironolactone | {
"A": "Hydrochlorthiazide",
"B": "Spironolactone",
"C": "Propanolol",
"D": "Lisinopril"
} | step1 | B | [
"year old male presents",
"primary care physician",
"complaints",
"headaches",
"muscle weakness",
"physical exam",
"normal limits except for",
"blood pressure",
"95",
"Subsequent routine",
"lab work showed",
"sodium level",
"potassium level",
"3.0",
"best pharmacological therapy",
"pat... |
A 43-year-old woman is hospitalized for chemotherapy following a local recurrence of breast cancer. Because the tumor responded well to the previous chemotherapy regimen, the ordering physician copies and pastes previous recommendations from her electronic health record into the patient’s new orders. Subsequently, the ... | Making copy and paste material readily identifiable | {
"A": "Avoiding copy and paste in electronic health records",
"B": "Making copy and paste material readily identifiable",
"C": "Preventing identification of authors",
"D": "Using copy and paste only for patient demographics"
} | step2&3 | B | [
"year old woman",
"hospitalized",
"chemotherapy following",
"local recurrence",
"breast cancer",
"tumor",
"well",
"previous chemotherapy regimen",
"ordering physician copies",
"pastes previous recommendations",
"electronic health record",
"patients new orders",
"patient",
"drug related tox... |
A 3-year-old boy presents with his mother to the family medicine clinic for an itchy rash on the face that started 3 days ago. The mother states that her son had a fever with a runny nose a little more than a week ago. There has been no sore throat or cough according to the mother. No significant medical conditions are... | Parvovirus B19 | {
"A": "Parvovirus B19",
"B": "Adenovirus",
"C": "Human herpesvirus 6 (HHV-6)",
"D": "Rubella virus"
} | step2&3 | A | [
"3 year old boy presents",
"mother",
"family medicine clinic",
"itchy rash",
"face",
"started 3 days",
"mother states",
"son",
"fever",
"runny nose",
"little",
"week",
"sore throat",
"cough according",
"mother",
"significant medical conditions",
"noted",
"medications",
"record",
... |
A 37-year-old G3P2 is referred to a gynecologist by her physician to follow-up on the results of some screening tests. She has a history of 1 medical abortion and 2 vaginal deliveries. The most recent labo, which occurred at 31 years of age, was induced at 41 weeks gestation with prostaglandin application to the cervix... | Cold-knife conization | {
"A": "Cryoablation of the lesion",
"B": "Laser ablation of the lesion",
"C": "Cold-knife conization",
"D": "Punch biopsy and subsequent management based on the results"
} | step2&3 | C | [
"year old",
"referred",
"gynecologist",
"physician to follow-up",
"results",
"screening tests",
"history of",
"medical abortion",
"2 vaginal deliveries",
"most recent",
"occurred",
"31 years",
"age",
"induced",
"weeks gestation",
"prostaglandin application",
"cervix",
"complicated"... |
A 40-year-old man presents with a painless firm mass in the right breast. Examination shows retraction of the nipple and the skin is fixed to the underlying mass. The axillary nodes are palpable. Which of the following statements is true regarding the above condition? | These are positive for estrogen receptor | {
"A": "Lobular cancer is the most common breast cancer in males",
"B": "These are positive for estrogen receptor",
"C": "BRCA analysis is not recommended in his family members",
"D": "Endocrine therapy has no role in the treatment"
} | step1 | B | [
"40 year old man presents",
"painless firm",
"right",
"Examination shows retraction of",
"nipple",
"skin",
"fixed",
"underlying mass",
"axillary nodes",
"palpable",
"following statements",
"true",
"above condition"
] |
A 56-year-old man presents to the emergency department with severe chest pain and a burning sensation. He accidentally drank a cup of fluid at his construction site 2 hours ago. The liquid was later found to contain lye. On physical examination, his blood pressure is 100/57 mm Hg, respiratory rate is 21/min, pulse is 8... | Surgical repair | {
"A": "Ceftriaxone",
"B": "Surgical repair",
"C": "Dexamethasone",
"D": "Nasogastric lavage"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"severe chest",
"burning sensation",
"drank",
"cup",
"fluid",
"construction site",
"hours",
"liquid",
"later found to contain lye",
"physical examination",
"blood pressure",
"100 57 mm Hg",
"respiratory rate",
"min",
"pulse",
"84 min... |
A 36-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision. On arrival, she is unconscious. Her pulse is 140/min, respirations are 12/min and shallow, and blood pressure is 76/55 mm Hg. 0.9% saline infusion is begun. A focused assessment with sonog... | Transfusion of packed red blood cells | {
"A": "Administer hydroxyethyl starch",
"B": "Transfusion of packed red blood cells",
"C": "Consult hospital ethics committee",
"D": "Proceed to surgery without transfusion"
} | step2&3 | B | [
"36 year old woman",
"brought",
"emergency department 20 minutes",
"involved",
"high speed motor vehicle collision",
"arrival",
"unconscious",
"pulse",
"min",
"respirations",
"min",
"shallow",
"blood pressure",
"76 55 mm Hg",
"0.9",
"saline infusion",
"begun",
"focused assessment",... |
A 26-year-old woman comes to the physician because of increasing pain and swelling in her right foot for the past 2 weeks. Initially, the pain was intermittent but it is now constant and she describes it as 8 out of 10 in intensity. She has not had any trauma to the foot or any previous problems with her joints. The pa... | Stress fracture | {
"A": "Acute osteomyelitis",
"B": "Stress fracture",
"C": "Plantar fasciitis",
"D": "Freiberg disease"
} | step2&3 | B | [
"year old woman",
"physician",
"increasing pain",
"swelling",
"right",
"past 2 weeks",
"Initially",
"pain",
"intermittent",
"now constant",
"out",
"10",
"intensity",
"not",
"trauma",
"foot",
"previous problems",
"joints",
"pain",
"not allowed",
"to continue training",
"mara... |
A 23-year-old man presents to student health for a cough. The patient states he has paroxysms of coughing followed by gasping for air. The patient is up to date on his vaccinations and is generally healthy. He states he has felt more stressed lately secondary to exams. His temperature is 101.0°F (38.3°C), blood pressur... | Azithromycin | {
"A": "Azithromycin",
"B": "Chest radiograph",
"C": "PCR for Bordetella pertussis",
"D": "Penicillin"
} | step2&3 | A | [
"23 year old man presents",
"student health",
"cough",
"patient states",
"paroxysms of coughing followed by gasping",
"air",
"patient",
"date",
"vaccinations",
"healthy",
"states",
"felt more stressed",
"secondary to exams",
"temperature",
"3C",
"blood pressure",
"65 mmHg",
"pulse"... |
A 4-year-old boy is brought to the physician because of frequent respiratory tract infections and chronic diarrhea. His stools are bulky and greasy, and he has around 8 bowel movements daily. He is at the 10th percentile for height and 25th percentile for weight. Chest examination shows intercostal retractions along wi... | Intracellular retention of misfolded proteins | {
"A": "Defective ciliary protein function",
"B": "Intracellular retention of misfolded proteins",
"C": "Altered configuration of a protease inhibitor",
"D": "Frameshift mutation of muscle-anchoring proteins\n\""
} | step1 | B | [
"4 year old boy",
"brought",
"physician",
"frequent infections",
"chronic diarrhea",
"stools",
"bulky",
"greasy",
"bowel movements daily",
"percentile",
"height",
"percentile",
"weight",
"Chest examination shows intercostal retractions",
"diffuse wheezing",
"expiratory rhonchi",
"fol... |
A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to sp... | Explore the reasoning behind the children's request | {
"A": "Deliver the information in Spanish",
"B": "Explore the reasoning behind the children's request",
"C": "Respect the children's wishes to hold prognosis information",
"D": "Tell the children that you are obligated to tell the father"
} | step2&3 | B | [
"year old man",
"admitted",
"hospital",
"jaundice",
"weight loss",
"immigrant",
"Dominican Republic",
"speaks little English",
"CT scan",
"performed showing",
"large mass",
"the head of",
"pancreas",
"enter",
"room to discuss",
"results",
"patient",
"daughter",
"son",
"speak",
... |
A 2-year-old girl presents to the emergency department with a 3-minute episode of a tonic-clonic seizure. The parents deny any previous history of seizure involving the patient or the family. Physical examination reveals an afebrile, well-groomed, and playful appearance, with normal vital signs. The patient carries a p... | Prominent intraparenchymal white matter calcification | {
"A": "A non-enhancing hemispheric lesion",
"B": "Intraparenchymal hemorrhage",
"C": "Prominent intraparenchymal white matter calcification",
"D": "Subependymal nodule"
} | step2&3 | C | [
"2 year old girl presents",
"emergency department",
"3 minute episode of",
"tonic-clonic seizure",
"parents deny",
"previous history",
"seizure involving",
"patient",
"family",
"Physical examination reveals",
"afebrile",
"well groomed",
"playful appearance",
"normal vital signs",
"patien... |
A 35-year-old woman comes to the physician accompanied by her husband after he started noticing strange behavior. He first noticed her talking to herself 8 months ago. For the past 6 months, she has refused to eat any packaged foods out of fear that the government is trying to poison her. She has no significant past me... | Dyslipidemia | {
"A": "Seizures",
"B": "Dyslipidemia",
"C": "Agranulocytosis",
"D": "Myoglobinuria\n\""
} | step2&3 | B | [
"35 year old woman",
"physician",
"husband",
"started",
"strange behavior",
"first",
"talking",
"months",
"past 6 months",
"refused to eat",
"packaged foods out",
"fear",
"government",
"to poison",
"significant past medical history",
"smoked marijuana",
"college",
"not smoked",
"... |
An investigator studying protein synthesis in human stem cells isolates tRNA molecules bound to mRNA molecules. The isolated tRNA molecules have inosine in the 5' position of the anticodon; of these, some are bound to adenine, some to cytosine, and some to uracil at the 3' position of the mRNA codon. Which of the follo... | Degeneracy | {
"A": "Specificity of the start codon",
"B": "Degeneracy",
"C": "Unambiguity",
"D": "Non-overlapping"
} | step1 | B | [
"investigator studying protein synthesis",
"human stem cells isolates tRNA molecules bound",
"mRNA molecules",
"isolated tRNA molecules",
"inosine",
"position",
"anticodon",
"bound",
"adenine",
"cytosine",
"uracil",
"3",
"position",
"mRNA codon",
"following properties",
"genetic code",... |
A 75-year-old man is evaluated in the emergency department for increasing shortness of breath for the last 8 months. He also complains of a dry cough for the last 6 months. Initially, his shortness of breath occurs with exertion, but now he feels it at rest as well. He has no other complaints. He has a sedentary lifest... | Idiopathic pulmonary fibrosis | {
"A": "Pulmonary embolism",
"B": "Idiopathic pulmonary fibrosis",
"C": "Chronic obstructive pulmonary disease",
"D": "Chlamydia pneumoniae"
} | step1 | B | [
"75 year old man",
"evaluated",
"emergency department",
"increasing shortness of breath",
"last",
"months",
"dry cough",
"last",
"months",
"Initially",
"shortness of breath occurs",
"exertion",
"now",
"feels",
"rest",
"well",
"complaints",
"sedentary lifestyle",
"hip surgery rece... |
A previously healthy 39-year-old man comes to the physician because of a 1-month history of fatigue and red-colored urine. His vital signs are within normal limits. Physical examination shows pallor and jaundice. His platelet count is 90,000/mm3 and creatinine concentration is 1.0 mg/dL. A direct Coombs test is negativ... | Venous thrombosis | {
"A": "Radiolucent gallstones",
"B": "Venous thrombosis",
"C": "Hepatocellular carcinoma",
"D": "Chronic lymphocytic leukemia"
} | step1 | B | [
"healthy",
"year old man",
"physician",
"month history",
"fatigue",
"red-colored urine",
"vital signs",
"normal",
"Physical examination shows pallor",
"jaundice",
"platelet count",
"90",
"mm3",
"creatinine concentration",
"1 0 mg/dL",
"direct Coombs test",
"negative",
"Flow cytomet... |
A 58-year-old man is brought to the emergency department by his wife 30 minutes after the sudden onset of severe retrosternal chest pain radiating to his back. He has a history of hyperlipidemia, hypertension, and type 2 diabetes mellitus. He has smoked one-half pack of cigarettes daily for 20 years. Medications includ... | Hypertension | {
"A": "Age",
"B": "Genetic collagen disorder",
"C": "Hypertension",
"D": "History of smoking"
} | step1 | C | [
"58 year old man",
"brought",
"emergency department",
"wife 30 minutes",
"sudden onset",
"severe retrosternal",
"back",
"history of hyperlipidemia",
"hypertension",
"type 2 diabetes mellitus",
"smoked one half pack",
"cigarettes daily",
"20 years",
"Medications include aspirin",
"captopr... |
A 5-year-old girl is brought to the emergency department after drinking a bottle of drain cleaner. It is unknown how much the child drank. She has a past medical history of Down syndrome and obesity. The patient's vitals are unremarkable. Physical exam is notable for a child in no acute distress. She is tolerating her ... | Endoscopy | {
"A": "Dilute hydrochloric acid",
"B": "Endoscopy",
"C": "Intubation",
"D": "Observation"
} | step2&3 | B | [
"5 year old girl",
"brought",
"emergency department",
"drinking",
"bottle",
"drain cleaner",
"unknown",
"child drank",
"past medical Down syndrome",
"obesity",
"patient's",
"unremarkable",
"Physical exam",
"notable",
"child",
"acute distress",
"oral secretions",
"interactive",
"I... |
A 38-year-old man presents to the emergency department with chest pain and difficulty breathing for the last 3 hours. He denies cough, nasal discharge or congestion, sneezing, and palpitations. There is no history of recent surgery or hospitalization but he mentions that he was diagnosed with a psychiatric disorder 6 m... | Chlorpromazine | {
"A": "Alprazolam",
"B": "Chlorpromazine",
"C": "Haloperidol",
"D": "Lithium"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"chest pain",
"difficulty breathing",
"hours",
"denies cough",
"nasal discharge",
"congestion",
"sneezing",
"palpitations",
"history of recent surgery",
"hospitalization",
"diagnosed",
"psychiatric disorder",
"months",
"on medication",
... |
A 62-year-old man comes to the physician because of a 1-day history of dull pain and stiffness of the right knee. He takes chlorthalidone for hypertension. Physical examination of the right knee shows a large effusion and mild erythema; range of motion is limited by pain. Arthrocentesis of right knee yields a cloudy as... | Calcification of the meniscal cartilage | {
"A": "Thickening of the synovia at the metacarpophalangeal joints",
"B": "Calcification of the meniscal cartilage",
"C": "Elevation of serum uric acid concentration",
"D": "Expression of human leukocyte antigen-B27"
} | step1 | B | [
"62 year old man",
"physician",
"1-day history",
"dull pain",
"stiffness of",
"right knee",
"takes chlorthalidone",
"hypertension",
"Physical examination",
"right knee shows",
"large effusion",
"mild erythema",
"range of motion",
"limited",
"pain",
"Arthrocentesis",
"right",
"cloud... |
A 29-year-old man from India seeks evaluation at a clinic with complaints of sore muscles and lethargy of several days duration. After the physical examination and laboratory testing, the patient is asked to stay for treatment and monitoring. Despite the physician’s warning, the patient leaves the hospital against medi... | Atovaquone-proguanil | {
"A": "Atovaquone-proguanil",
"B": "Primaquine",
"C": "Chloroquine",
"D": "Chloramphenicol"
} | step1 | A | [
"29 year old man",
"India",
"evaluation",
"clinic",
"complaints",
"sore muscles",
"lethargy",
"days duration",
"physical examination",
"laboratory testing",
"patient",
"to",
"treatment",
"monitoring",
"physicians warning",
"patient leaves",
"hospital",
"medical advice",
"difficul... |
A 57-year-old male is found to have an elevated prostate specific antigen (PSA) level on screening labwork. PSA may be elevated in prostate cancer, benign prostatic hypertrophy (BPH), or prostatitis. Which of the following best describes the physiologic function of PSA? | Liquefaction of semen | {
"A": "Sperm production",
"B": "Liquefaction of semen",
"C": "Maintains corpus luteum",
"D": "Regulation of transcription factors and phosphorylation of proteins"
} | step1 | B | [
"57 year old male",
"found to",
"elevated prostate specific antigen",
"level",
"screening",
"elevated",
"prostate cancer",
"benign prostatic hypertrophy",
"prostatitis",
"following best",
"physiologic function",
"PSA"
] |
An 18-year-old African-American woman comes to the physician for the evaluation of worsening fatigue that started 1 year ago. Physical examination shows mild jaundice and splenomegaly. Laboratory studies show:
Hemoglobin 10.4 g/dL
Mean corpuscular hemoglobin concentration 43% Hb/cell
Platelet count 220,000/mm3
Reticulo... | Replacement of glutamate by lysine in beta-globin chain | {
"A": "Decreased conversion of oxidized glutathione into its reduced form",
"B": "Replacement of glutamate by lysine in beta-globin chain",
"C": "Reduced production of beta-globin due to a mutation in the HbB gene",
"D": "Acquired mutation of membrane-bound glycosylphosphatidylinositol anchor"
} | step1 | B | [
"year old African-American woman",
"physician",
"evaluation",
"worsening fatigue",
"started 1 year",
"Physical examination shows mild jaundice",
"splenomegaly",
"Laboratory studies show",
"Hemoglobin 10.4 g/dL Mean corpuscular hemoglobin concentration",
"Hb cell Platelet",
"mm3 Reticulocyte",
... |
A 3-month-old girl with an immunodeficiency syndrome has been hospitalized for 1 month due to a severe pulmonary infection. Her family came to visit her daily in the beginning of her hospital stay; however, since their car broke down they have been unable to visit for the last 2 weeks. While the infection has now been ... | The condition is reversible | {
"A": "The condition can be diagnosed in adults if it lasts > 6 months",
"B": "The condition is significantly more common in boys",
"C": "The condition is reversible",
"D": "The condition should be reported to state authorities"
} | step1 | C | [
"3 month old girl",
"immunodeficiency",
"hospitalized",
"month",
"severe pulmonary infection",
"family",
"to visit",
"daily",
"beginning",
"hospital stay",
"car",
"unable to visit",
"2 weeks",
"infection",
"now",
"resolved",
"treatment",
"supportive care",
"girl's nurse",
"conc... |
A 6-year-old boy is brought to the emergency department because of colicky abdominal pain and vomiting for 1 day. He has a history of a sore throat 2 weeks ago. His temperature is 37°C (98.6°F), pulse is 100/min, blood pressure is 90/55, and respirations are 28/min. Examination of the lower extremities shows non-blanch... | Deposition of IgA immune complexes | {
"A": "P-ANCA vasculitis of small vessels",
"B": "Microthrombi occluding the vasculature",
"C": "Gram-negative cocci infection",
"D": "Deposition of IgA immune complexes"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"colicky abdominal pain",
"vomiting",
"1 day",
"history",
"sore throat 2 weeks",
"temperature",
"98",
"pulse",
"100 min",
"blood pressure",
"90 55",
"respirations",
"min",
"Examination of the lower extremities shows non blanching rai... |
During the course of investigation of a suspected abdominal aortic aneurysm in a 57-year-old woman, a solid 6 × 5 cm mass is detected in the right kidney. The abdominal aorta reveals no abnormalities. The patient is feeling well and has no history of any serious illness or medication usage. She is a 25-pack-year smoker... | Nephrectomy | {
"A": "Interferon-ɑ (IFN-ɑ)",
"B": "Interleukin 2 (IL-2)",
"C": "Nephrectomy",
"D": "Radiation"
} | step2&3 | C | [
"course of investigation",
"suspected abdominal aortic aneurysm",
"57 year old woman",
"solid",
"mass",
"detected",
"right kidney",
"abdominal aorta reveals",
"abnormalities",
"patient",
"feeling well",
"history",
"serious illness",
"medication usage",
"pack-year smoker",
"vital signs"... |
A 57-year-old man comes to the physician because of a 3-month history of fatigue, difficulty swallowing, and weight loss. He has smoked 1 pack of cigarettes daily for 30 years. He is 173 cm (5 ft 8 in) tall, and weighs 54 kg (120 lb); BMI is 18 kg/m2. Upper gastrointestinal endoscopy shows an exophytic tumor at the gas... | Decreased REM sleep latency | {
"A": "Increased spike-and-wave discharge",
"B": "Increased slow-wave sleep-cycle duration",
"C": "Increased periodic sharp-wave discharge",
"D": "Decreased REM sleep latency"
} | step1 | D | [
"57 year old man",
"physician",
"3 month history",
"fatigue",
"difficulty swallowing",
"weight loss",
"smoked 1 pack",
"cigarettes daily",
"30 years",
"5 ft 8",
"tall",
"54 kg",
"BMI",
"kg/m2",
"Upper gastrointestinal endoscopy shows",
"exophytic tumor",
"gastroesophageal junction",
... |
A 42-year-old woman, gravida 5, para 5, comes to the physician because of a 6-month history of occasional involuntary urine loss that is exacerbated by coughing, sneezing, and laughing. She has no urgency or dysuria. Physical examination shows normal appearing external genitalia, vagina, and cervix. There is a loss of ... | Levator ani | {
"A": "Compressor urethrae",
"B": "Internal urethral sphincter",
"C": "Levator ani",
"D": "Deep transverse perineal muscles"
} | step1 | C | [
"year old woman",
"gravida 5",
"para 5",
"physician",
"month history",
"occasional involuntary urine",
"exacerbated",
"coughing",
"sneezing",
"laughing",
"urgency",
"dysuria",
"Physical examination shows normal appearing external genitalia",
"vagina",
"cervix",
"loss",
"urine",
"Va... |
A 3-year-old boy presents with progressive lethargy and confusion over the last 5 days. He lives with his parents in a home that was built in the early 1900s. His parents report that "his tummy has been hurting" for the last 3 weeks and that he is constipated. He eats and drinks normally, but occasionally tries things ... | Succimer | {
"A": "Folic acid",
"B": "Docusate",
"C": "Succimer",
"D": "Psyllium"
} | step1 | C | [
"3 year old boy presents",
"progressive lethargy",
"confusion",
"5 days",
"lives with",
"parents",
"home",
"built",
"early 1900s",
"parents report",
"last",
"weeks",
"constipated",
"eats",
"drinks",
"occasionally",
"things",
"not food",
"Abdominal exam shows",
"focal tenderness... |
A 2-year-old boy is brought to the pediatrician with complaints of fever and a skin rash for the past 2 days. The boy was born by normal vaginal delivery at full term, and his neonatal period was uneventful. He has a history of severe pain in his legs and difficulty eating. His temperature is 38.6°C (101.4°F), pulse is... | Coxsackievirus | {
"A": "Coxsackievirus",
"B": "Herpes simplex virus",
"C": "Cytomegalovirus",
"D": "Parvovirus B19"
} | step2&3 | A | [
"2 year old boy",
"brought",
"pediatrician",
"complaints",
"fever",
"skin rash",
"past 2 days",
"boy",
"born by normal vaginal delivery",
"full term",
"neonatal period",
"history",
"severe pain",
"legs",
"difficulty eating",
"temperature",
"4F",
"pulse",
"min",
"respiratory rat... |
A 65-year-old man is brought into the emergency department by his wife for slurred speech and right-sided weakness. The patient has a significant past medical history of hypertension and hyperlipidemia. The wife reports her husband went to bed last night normally but woke up this morning with the symptoms mentioned. Ph... | Dejerine syndrome | {
"A": "Lateral pontine syndrome",
"B": "Dejerine syndrome",
"C": "Wallenberg syndrome",
"D": "Weber syndrome"
} | step1 | B | [
"65 year old man",
"brought",
"emergency department",
"wife",
"slurred speech",
"right-sided weakness",
"patient",
"significant past medical",
"hyperlipidemia",
"wife reports",
"husband",
"bed",
"night",
"woke up",
"morning",
"symptoms",
"Physical examination shows right-sided hemipa... |
A 29-year-old woman is brought to the emergency room for seizure-like activity. Her husband reports that they were in bed sleeping when his wife began complaining of “hot flashes.” Several minutes later, her right arm began to twitch, and she did not respond to his calls. The whole episode lasted for about 5 minutes. S... | Weeks 3-8 | {
"A": "Weeks 1-2",
"B": "Weeks 3-8",
"C": "Week 14",
"D": "Week 18"
} | step1 | B | [
"29 year old woman",
"brought",
"emergency room",
"seizure",
"activity",
"husband reports",
"bed sleeping",
"wife began",
"hot flashes",
"minutes later",
"right arm began to twitch",
"not",
"calls",
"whole episode lasted",
"5 minutes",
"denies",
"prior similar episodes",
"tongue bi... |
A 59-year-old man comes to the physician because of a 1-year history of progressive shortness of breath and nonproductive cough. Pulmonary examination shows bibasilar inspiratory crackles. An x-ray of the chest shows multiple nodular opacities in the upper lobes and calcified hilar nodules. Pulmonary functions tests sh... | Crystalline silica | {
"A": "Beryllium",
"B": "Crystalline silica",
"C": "Moldy hay",
"D": "Asbestos fibers"
} | step1 | B | [
"59 year old man",
"physician",
"of",
"year history",
"progressive shortness",
"breath",
"nonproductive cough",
"Pulmonary examination shows",
"inspiratory crackles",
"x-ray of",
"chest shows multiple nodular opacities",
"upper lobes",
"calcified hilar nodules",
"Pulmonary functions tests ... |
A 22-year-old man is brought to the emergency department after he was impaled by a metal rod during a work accident. The rod went into his back around the level of T9 but was removed before arrival. He has no past medical history and does not take any medications. On physical examination, he has significant muscle weak... | Left hemicord | {
"A": "Central cord",
"B": "Left hemicord",
"C": "Posterior cord",
"D": "Right hemicord"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"metal rod",
"work accident",
"rod",
"back",
"level",
"T9",
"removed",
"arrival",
"past medical history",
"not take",
"medications",
"physical examination",
"significant muscle weakness",
"entire left lower body",
"exhibits impaire... |
A 62-year-old woman comes to the physician for evaluation of a mole on her forearm that has increased in size over the last several months. Physical examination shows a 9-mm skin lesion on the right forearm with irregular borders. An excisional biopsy is performed, and genetic analysis shows a mutation in the gene that... | Formation of covalent bonds between adjacent pyrimidine bases | {
"A": "Double-strand breaks in DNA molecules",
"B": "Relocation of a chromosomal segment onto a nonhomologous chromosome",
"C": "Formation of covalent bonds between adjacent pyrimidine bases",
"D": "Deamination of cytosine, guanine, and adenine nucleotides"
} | step1 | C | [
"62 year old woman",
"physician",
"evaluation",
"mole",
"forearm",
"increased in size",
"last",
"months",
"Physical examination shows",
"mm skin lesion",
"right forearm",
"irregular borders",
"excisional biopsy",
"performed",
"genetic analysis shows",
"mutation",
"gene",
"encodes B... |
A 13-year-old girl presents with a 4-week history of unrelenting cough, night sweats, and fever. No known past medical history and no current medications. The patient recently immigrated to the country from a rural town in northern India. Vaccination status is unknown. Her temperature is 38.5°C (101.3°F), pulse is 115/... | Pyridoxine | {
"A": "Riboflavin",
"B": "Pyridoxine",
"C": "Niacin",
"D": "Folic acid"
} | step1 | B | [
"year old girl presents",
"week history",
"cough",
"night sweats",
"fever",
"known past medical history",
"current medications",
"patient recently",
"country",
"rural town",
"northern India",
"Vaccination status",
"unknown",
"temperature",
"pulse",
"min",
"blood pressure",
"95 65 m... |
A 59-year-old man presents to the emergency department with diffuse abdominal pain, nausea, and vomiting. Laboratory evaluation of admission is significant for serum glucose of 2410 mg/dL, AST of 321 IU/dL, and leukocytes of 21,200 /mL. Within 3 days of admission with supportive care in the intensive care unit, the pat... | 15% | {
"A": "15%",
"B": "40%",
"C": "80%",
"D": "100%"
} | step2&3 | A | [
"59 year old man presents",
"emergency department",
"diffuse abdominal",
"nausea",
"vomiting",
"Laboratory evaluation",
"admission",
"significant",
"serum glucose",
"mg dL",
"AST",
"IU/dL",
"leukocytes",
"200",
"mL",
"3 days",
"admission",
"supportive care",
"intensive",
"unit"... |
A 3-year-old boy is brought to the physician because of recurrent nosebleeds and fatigue for the past 2 months. He also frequently complains his head hurts. The patient has met all motoric milestones for his age but does not like to run because his legs start to hurt if he does. He is at the 40th percentile for both he... | Delayed pulse in lower extremities | {
"A": "Inferior rib notching",
"B": "Pulmonary valve stenosis",
"C": "Left-axis deviation on ECG",
"D": "Delayed pulse in lower extremities"
} | step1 | D | [
"3 year old boy",
"brought",
"physician",
"recurrent nosebleeds",
"fatigue",
"past",
"months",
"frequently",
"head",
"patient",
"met",
"motoric milestones",
"age",
"not",
"to run",
"legs start to",
"percentile",
"height",
"weight",
"temperature",
"98",
"pulse",
"min",
"... |
A gastroenterology fellow is interested in the relationship between smoking and incidence of Barrett esophagus. At a departmental grand rounds she recently attended, one of the presenters claimed that smokers are only at increased risk for Barrett esophagus in the presence of acid reflux. She decides to design a retros... | Confounding | {
"A": "Random error",
"B": "Effect modification",
"C": "Confounding",
"D": "Stratification"
} | step2&3 | C | [
"gastroenterology",
"interested",
"relationship",
"smoking",
"incidence",
"Barrett esophagus",
"departmental grand rounds",
"recently attended",
"one",
"smokers",
"only",
"increased risk",
"Barrett esophagus",
"presence",
"acid reflux",
"to design",
"retrospective cohort study to inv... |
An investigator is studying the interaction between a new drug B and an existing drug A. The results are recorded and plotted on the graph shown. Which of the following properties of drug B best explain the observed effect on the dose-response curve of drug A? | Competitive antagonist | {
"A": "Non-competitive antagonist",
"B": "Competitive antagonist",
"C": "Inverse agonist",
"D": "Functional antagonist"
} | step1 | B | [
"investigator",
"studying",
"interaction",
"new drug",
"drug",
"results",
"recorded",
"graph shown",
"following properties",
"drug",
"best",
"observed effect",
"dose-response curve of drug"
] |
A 30-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the hospital for regular, painful contractions that have been increasing in frequency. Her pregnancy has been complicated by gestational diabetes treated with insulin. Pelvic examination shows the cervix is 50% effaced and 4 cm dilated; the vertex ... | Routine monitoring | {
"A": "Routine monitoring",
"B": "Vibroacoustic stimulation",
"C": "Emergent cesarean delivery",
"D": "Administer tocolytics"
} | step2&3 | A | [
"30 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"hospital",
"regular",
"painful contractions",
"increasing",
"frequency",
"pregnancy",
"complicated",
"gestational diabetes treated with insulin",
"Pelvic examination shows",
"cervix",
"50",
"4",
"dilated",
"vertex... |
A 6-week-old boy is brought for routine examination at his pediatrician’s office. The patient was born at 39 weeks to a 26-year-old G1P1 mother by normal vaginal delivery. External cephalic version was performed successfully at 37 weeks for breech presentation. Pregnancy was complicated by gestational diabetes that was... | Pavlik harness | {
"A": "Closed reduction and spica casting",
"B": "Observation",
"C": "Pavlik harness",
"D": "Physiotherapy"
} | step2&3 | C | [
"week old boy",
"brought",
"routine examination",
"pediatricians office",
"patient",
"born",
"weeks",
"year old G1P1 mother",
"normal vaginal",
"External cephalic version",
"performed",
"weeks",
"breech presentation",
"Pregnancy",
"complicated",
"gestational diabetes",
"well-controll... |
A 25-year-old woman presents to the emergency department for the evaluation of a severe abdominal pain of 5 hours duration. The pain is colicky but is not localized. She also complains of nausea and an episode of vomiting. For the past 2 days, she has been constipated. She has had similar episodes of varying intensity ... | Porphobilinogen deaminase | {
"A": "Aminolevulinic acid dehydratase",
"B": "Porphobilinogen deaminase",
"C": "Uroporphyrinogen III synthase",
"D": "Uroporphyrinogen decarboxylase"
} | step1 | B | [
"year old woman presents",
"emergency department",
"evaluation",
"severe abdominal",
"hours duration",
"pain",
"colicky",
"not localized",
"nausea",
"episode of vomiting",
"past 2 days",
"constipated",
"similar episodes of",
"intensity",
"past",
"resolved",
"hours",
"Several labora... |
A 59-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has systemic lupus erythematosus and hypertension. She does not drink alcohol. Her current medications include lisinopril and hydroxychloroquine. She appears malnourished. Her vital signs are within normal limit... | Tenofovir therapy | {
"A": "Pegylated interferon alpha therapy",
"B": "Lamivudine therapy",
"C": "Tenofovir therapy",
"D": "Reassurance and follow-up"
} | step2&3 | C | [
"59 year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"systemic lupus erythematosus",
"hypertension",
"not drink alcohol",
"current medications include lisinopril",
"hydroxychloroquine",
"appears malnourished",
"vital signs",
"normal limits",
"Examination ... |
A 71-year-old man is brought in by his daughter for forgetfulness. The daughter finds herself repeating things she has already told him. She also reports that the patient recently missed a lunch date they had scheduled. She is worried that he may have Alzheimer's disease because her mother had it, and this is how it st... | Normal aging | {
"A": "Alzheimer disease",
"B": "Major depressive disorder",
"C": "Normal aging",
"D": "Vascular dementia"
} | step2&3 | C | [
"71 year old man",
"brought",
"daughter",
"forgetfulness",
"daughter finds",
"repeating things",
"reports",
"patient recently missed",
"lunch date",
"scheduled",
"worried",
"Alzheimer's disease",
"mother",
"started",
"patient states",
"sometimes forgets",
"puts",
"glasses",
"not ... |
A 4700-g (10.3-lb) male newborn is delivered at 37 weeks' gestation to a 30-year-old woman, gravida 2, para 1. Apgar scores are 7 and 8 at 1 and 5 minutes, respectively. The newborn appears pale. Temperature is 37°C (98.6°F), pulse is 180/min, and blood pressure is 90/60 mm Hg. Examination in the delivery room shows mi... | Serial abdominal ultrasonography | {
"A": "Serum IGF-1 measurement",
"B": "Serum 17-hydroxyprogesterone measurement",
"C": "Cranial MRI",
"D": "Serial abdominal ultrasonography"
} | step2&3 | D | [
"g",
"10.3",
"male newborn",
"delivered",
"weeks",
"gestation",
"30 year old woman",
"gravida 2",
"para 1",
"Apgar scores",
"8",
"1",
"5 minutes",
"newborn appears pale",
"Temperature",
"98",
"pulse",
"min",
"blood pressure",
"90 60 mm Hg",
"Examination",
"delivery shows",
... |
A 7-year-old girl presents for a follow-up visit after recent discharge from the hospital. She was admitted about 4 months ago for symptoms of seizures, altered mental status, and fever. She was diagnosed during that admission with herpes encephalitis and recovered well after being treated with acyclovir. However, at t... | Amygdala | {
"A": "Substantia nigra",
"B": "Lateral geniculate nucleus",
"C": "Amygdala",
"D": "Brainstem"
} | step1 | C | [
"year old girl presents",
"follow-up visit",
"recent discharge from",
"hospital",
"admitted",
"months",
"symptoms",
"seizures",
"altered mental status",
"fever",
"diagnosed",
"admission",
"herpes encephalitis",
"recovered well",
"treated with acyclovir",
"visit",
"parents",
"strang... |
A 32-year-old woman with a recurrent vesicular genital rash comes to the physician because of a 3-day history of a painful, pruritic rash that began on the extremities and has spread to her trunk. Her only medication is acyclovir. Her temperature is 38.1°C (100.6°F). Examination of the skin shows several reddish-purple... | Erythema multiforme | {
"A": "Erythema multiforme",
"B": "Urticaria",
"C": "Stevens-Johnson syndrome",
"D": "Dermatitis herpetiformis"
} | step1 | A | [
"year old woman",
"recurrent vesicular genital",
"physician",
"3-day history",
"painful",
"pruritic rash",
"began",
"extremities",
"spread",
"trunk",
"only medication",
"acyclovir",
"temperature",
"100",
"Examination of",
"skin shows several",
"purple papules",
"macules",
"dusky ... |
A 13-year-old male is admitted to the hospital for treatment of acute lymphoblastic leukemia. During his hospital course, he develops a fever of 39.0 degrees Celsius. A CBC demonstrates a leukocyte count of <500 /mm^3. Which of the following is the most appropriate initial management of this patient? | IV ceftazidime | {
"A": "Granulocyte colony-stimulating factor (G-CSF)",
"B": "IV ceftazidime",
"C": "Oral doxycycline",
"D": "Oral ciprofloxacin and amoxicillin/clavulanic acid"
} | step2&3 | B | [
"year old male",
"admitted",
"hospital",
"treatment",
"acute lymphoblastic leukemia",
"hospital course",
"fever",
"0 degrees Celsius",
"CBC demonstrates",
"leukocyte count",
"500",
"mm",
"following",
"most appropriate initial management",
"patient"
] |
A 25-year-old woman presents with a history of recurrent attacks of unprovoked fear, palpitations, and fainting. The attacks are usually triggered by entering a crowded place or public transport, so the patient tries to avoid being in public places alone. Besides this, she complains of difficulties in falling asleep, u... | Clonazepam | {
"A": "Bupropion",
"B": "Metoprolol",
"C": "Clonazepam",
"D": "Nifedipine"
} | step2&3 | C | [
"year old woman presents",
"history",
"recurrent attacks",
"fear",
"palpitations",
"fainting",
"attacks",
"usually triggered by entering",
"crowded place",
"public transport",
"patient",
"to",
"public places alone",
"difficulties",
"falling asleep",
"uncontrolled worry",
"job",
"he... |
Two weeks after undergoing low anterior resection for rectal cancer, a 52-year-old man comes to the physician because of swelling in both feet. He has not had any fever, chills, or shortness of breath. His temperature is 36°C (96.8°F) and pulse is 88/min. Physical examination shows a normal thyroid and no jugular venou... | Lipid-rich, protein-rich fluid | {
"A": "Acellular, protein-poor fluid",
"B": "Lymphocytic, hemosiderin-rich fluid",
"C": "Lipid-rich, protein-rich fluid",
"D": "Protein-rich, glycosaminoglycan-rich fluid"
} | step1 | C | [
"Two weeks",
"low anterior resection",
"rectal cancer",
"year old man",
"physician",
"of swelling",
"feet",
"not",
"fever",
"chills",
"shortness of breath",
"temperature",
"96",
"pulse",
"88 min",
"Physical examination shows",
"normal thyroid",
"jugular venous distention",
"Exami... |
A 6-year-old girl presents to the clinic for a general checkup before her last scheduled DTaP vaccination. Her mother is concerned about mild swelling and redness at the site of injection after her daughter’s previous DTaP administration. The patient has mild spastic cerebral palsy. She was diagnosed with epilepsy at t... | Signs of pneumonia | {
"A": "Epilepsy",
"B": "Mild swelling and redness at the site of injection after the previous vaccine administration",
"C": "Signs of pneumonia",
"D": "Penicillin allergy"
} | step1 | C | [
"year old girl presents",
"clinic",
"general checkup",
"scheduled DTaP vaccination",
"mother",
"concerned",
"mild swelling",
"redness",
"site of injection",
"daughters previous DTaP administration",
"patient",
"mild spastic cerebral palsy",
"diagnosed",
"epilepsy",
"age",
"well-control... |
A 25-year-old woman whose menses are 2 weeks late, presents to her physician for evaluation. She also complains of fatigue, morning nausea, and mood changes. She is a nulliparous with previously normal menstrual cycles and no known medical conditions. She had an intrauterine device (IUD) placed 6 months ago. The patien... | Incomplete Mullerian ducts fusion | {
"A": "Failure of the Wolffian duct regression",
"B": "Incomplete Mullerian ducts fusion",
"C": "Mullerian ducts duplication",
"D": "Cloacal membrane duplication"
} | step2&3 | B | [
"year old woman",
"menses",
"2 weeks late",
"presents",
"physician",
"evaluation",
"fatigue",
"morning nausea",
"mood changes",
"nulliparous",
"normal menstrual cycles",
"known medical conditions",
"intrauterine device",
"placed",
"months",
"patients vital signs",
"follows",
"blood... |
A 28-year-old woman comes to the physician because of a two-month history of fatigue and low-grade fevers. Over the past 4 weeks, she has had increasing shortness of breath, a productive cough, and a 5.4-kg (11.9-lb) weight loss. Three months ago, the patient returned from a two-month trip to China. The patient appears... | Administer isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months | {
"A": "Await culture results before initiating treatment",
"B": "Perform interferon-γ release assay",
"C": "Obtain CT scan of the chest",
"D": "Administer isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months, followed by isoniazid and rifampin for 4 months"
} | step2&3 | D | [
"year old woman",
"physician",
"two month history",
"fatigue",
"low-grade fevers",
"past 4 weeks",
"increasing shortness of breath",
"productive cough",
"5.4 kg",
"weight loss",
"Three months",
"patient returned",
"two month trip",
"China",
"patient appears thin",
"temperature",
"100... |
A 7-year-old child is brought to the emergency room by his parents in severe pain. They state that he fell on his outstretched right arm while playing with his friends. He is unable to move his right arm which is being supported by his left. On exam, his vitals are normal. His right extremity reveals normal pulses with... | Supracondular humerus fracture | {
"A": "Midhumerus fracture",
"B": "Scaphoid fracture",
"C": "Distal radius fracture",
"D": "Supracondular humerus fracture"
} | step2&3 | D | [
"year old child",
"brought",
"emergency room",
"parents",
"severe pain",
"state",
"fell",
"right arm",
"playing",
"friends",
"unable to move",
"right arm",
"supported",
"left",
"exam",
"normal",
"right extremity reveals normal pulses",
"swelling",
"compartments",
"crepitus",
... |
A 14-month-old Caucasian boy is admitted to the pediatric clinic with an 8-month history of diarrhea, abdominal tenderness and concomitant failure to thrive. One of the possibilities that may cause these symptoms is Crohn’s disease, and on the basis of the attending pediatrician’s experience, the pre-test probability o... | 2.5% | {
"A": "2.5%",
"B": "25%",
"C": "75%",
"D": "97.5%"
} | step1 | A | [
"month old Caucasian boy",
"admitted",
"pediatric clinic",
"month history",
"diarrhea",
"abdominal tenderness",
"concomitant failure to thrive",
"One",
"possibilities",
"cause",
"symptoms",
"Crohns disease",
"on",
"basis",
"attending pediatricians experience",
"pre test probability",
... |
A 5-week-old male infant is brought to the physician by his mother because of a 4-day history of recurrent nonbilious vomiting after feeding. He was born at 36 weeks' gestation via spontaneous vaginal delivery. Vital signs are within normal limits. Physical examination shows a 2-cm epigastric mass. Further diagnostic e... | Elongated and thickened pylorus on abdominal ultrasound | {
"A": "High serum 17-hydroxyprogesterone concentration",
"B": "Dilated colon segment on abdominal x-ray",
"C": "Elongated and thickened pylorus on abdominal ultrasound",
"D": "Corkscrew sign on upper gastrointestinal contrast series\n\""
} | step1 | C | [
"5 week old male infant",
"brought",
"physician",
"mother",
"4-day history",
"recurrent",
"vomiting",
"feeding",
"born",
"36 weeks",
"gestation",
"spontaneous vaginal delivery",
"Vital signs",
"normal limits",
"Physical examination shows",
"2",
"epigastric mass",
"Further diagnosti... |
A 42-year-old woman presents to the emergency department with pain in her abdomen. She was eating dinner when her symptoms began. Upon presentation, her symptoms have resolved. She has a past medical history of type II diabetes mellitus, hypertension, heavy menses, morbid obesity, and constipation. Her current medicati... | Ursodeoxycholic acid | {
"A": "Antibiotics, IV fluids, and NPO",
"B": "Ibuprofen",
"C": "Strict diet and rapid weight loss in the next month",
"D": "Ursodeoxycholic acid"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"pain",
"abdomen",
"eating dinner",
"symptoms began",
"presentation",
"symptoms",
"resolved",
"past medical history of type II diabetes mellitus",
"hypertension",
"heavy menses",
"morbid obesity",
"constipation",
"current medications inc... |
A 21-year-old man is admitted to the intensive care unit for respiratory failure requiring mechanical ventilation. His minute ventilation is calculated to be 7.0 L/min, and his alveolar ventilation is calculated to be 5.1 L/min. Which of the following is most likely to decrease the difference between minute ventilation... | Decreasing the physiologic dead space | {
"A": "Increasing the respiratory rate",
"B": "Increasing the partial pressure of inhaled oxygen",
"C": "Decreasing the physiologic dead space",
"D": "Increasing the respiratory depth"
} | step1 | C | [
"21-year-old man",
"admitted to",
"intensive care unit",
"respiratory failure",
"mechanical ventilation",
"minute ventilation",
"calculated to",
"0",
"min",
"alveolar ventilation",
"calculated to",
"5",
"min",
"following",
"most likely to decrease",
"difference",
"minute ventilation"... |
A 70-year-old man presents to a physician with a cough and difficulty breathing during the last 7 years. He has smoked since his teenage years and regularly inhales tiotropium, formoterol, and budesonide and takes oral theophylline. The number of exacerbations has been increasing over the last 6 months. His temperature... | Supplemental oxygen | {
"A": "Prophylactic azithromycin",
"B": "Roflumilast",
"C": "Pulmonary rehabilitation",
"D": "Supplemental oxygen"
} | step2&3 | D | [
"70 year old man presents",
"physician",
"cough",
"difficulty breathing",
"years",
"smoked",
"teenage years",
"inhales tiotropium",
"formoterol",
"budesonide",
"takes oral theophylline",
"number",
"exacerbations",
"increasing",
"months",
"temperature",
"heart rate",
"min",
"blood... |
A 12-year-old boy presents to the emergency department with a recent history of easy bleeding. He experienced multiple episodes of epistaxis and bleeding gums over the past two days. He also had flu-like symptoms a week ago which resolved over the past few days. His past medical history is notable for well-controlled a... | von Willebrand factor | {
"A": "von Willebrand factor",
"B": "Myeloperoxidase",
"C": "Heparin",
"D": "Tryptase"
} | step1 | A | [
"year old boy presents",
"emergency department",
"recent history",
"easy bleeding",
"experienced multiple episodes of epistaxis",
"bleeding gums",
"past two days",
"flu-like symptoms",
"week",
"resolved",
"past",
"days",
"past medical history",
"notable",
"well-controlled asthma",
"tem... |
An 8-year-old boy is brought to the emergency department because of a 4-day history of severe, left-sided ear pain and purulent discharge from his left ear. One week ago, he returned with his family from their annual summer vacation at a lakeside cabin, where he spent most of the time outdoors hiking and swimming. Exam... | Infection with Pseudomonas aeruginosa
" | {
"A": "Abnormal epithelial growth on tympanic membrane",
"B": "Infection with Aspergillus species",
"C": "Pleomorphic replacement of normal bone",
"D": "Infection with Pseudomonas aeruginosa\n\""
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"4 history",
"severe",
"left-sided ear",
"purulent discharge from",
"left ear",
"One week",
"returned",
"family",
"annual summer vacation",
"spent most of the time outdoors hiking",
"swimming",
"Examination shows tragal tenderness",
"m... |
A 49-year-old man with a past medical history of hypertension on amlodipine presents to your office to discuss ways to lessen his risk of complications from heart disease. After a long discussion, he decides to significantly decrease his intake of trans fats in an attempt to lower his risk of coronary artery disease. W... | Primary prevention | {
"A": "Primary prevention",
"B": "Secondary prevention",
"C": "Tertiary prevention",
"D": "Delayed prevention"
} | step2&3 | A | [
"year old man",
"past medical",
"amlodipine presents",
"office to discuss",
"to",
"risk",
"complications",
"heart disease",
"long discussion",
"to",
"decrease",
"intake",
"trans fats",
"attempt to lower",
"risk",
"coronary artery disease",
"type",
"prevention",
"patient initiatin... |
A 45-year-old man presents to the surgery clinic with an ulcer on his left heel, which he first noticed a week ago. He was surprised by the large size of the ulcer since because he had never noticed it before, and it was asymptomatic. The man also noticed fluid oozing out of the ulcer, which he has been wiping off with... | A greater volume of granulation tissue is formed during healing by secondary intention, which results in a larger scar followed by wound contraction. | {
"A": "A greater volume of granulation tissue is formed during healing by secondary intention, which results in a larger scar followed by wound contraction.",
"B": "During the process of healing, large tissue defects have a greater volume of necrotic debris, exudate, and fibrin that aids with healing.",
"C": "In... | step1 | A | [
"year old man presents",
"surgery clinic",
"ulcer",
"left",
"first",
"week",
"large size",
"ulcer",
"never",
"before",
"asymptomatic",
"man",
"fluid",
"out",
"ulcer",
"wiping",
"clean cloth",
"diabetes mellitus",
"past 10 years",
"hypertension",
"past",
"years",
"medicati... |
An otherwise healthy 57-year-old man presents to the emergency department because of progressive shortness of breath and exercise intolerance for the past 5 days. He denies recent travel or illicit habits. His temperature is 36.7°C (98.1°F), the blood pressure is 88/57 mm Hg, and the pulse is 102/min. The radial pulse ... | Pericardial drainage | {
"A": "Cardiac catheterization",
"B": "Pericardiectomy",
"C": "Pericardial drainage",
"D": "Cardiac MRI"
} | step2&3 | C | [
"healthy 57 year old man presents",
"emergency department",
"of progressive shortness",
"breath",
"exercise intolerance",
"past 5 days",
"denies recent travel",
"illicit habits",
"temperature",
"36",
"98",
"blood pressure",
"88 57 mm Hg",
"pulse",
"min",
"radial pulse",
"so weak",
... |
A 29-year-old woman presents with a 2-hour history of sudden onset of severe mid-epigastric pain. The pain radiates to the back, and is not relieved by over-the-counter antacids. The patient also complains of profuse vomiting. The patient’s medical history is negative for similar symptoms. She consumes 3–4 alcoholic dr... | Fat necrosis | {
"A": "Coagulative necrosis",
"B": "Fat necrosis",
"C": "Dry gangrene",
"D": "Colliquative necrosis"
} | step1 | B | [
"29 year old woman presents",
"hour history",
"sudden onset",
"severe",
"epigastric pain",
"pain radiates",
"back",
"not relieved by over-the-counter antacids",
"patient",
"vomiting",
"patients medical history",
"negative",
"similar symptoms",
"alcoholic drinks daily",
"blood pressure",
... |
A 75-year-old woman comes to the physician because of a 6-month history of fatigue. During this period, she has had fever, pain in both shoulders and her hips, and a 5-kg (11-lb) weight loss. She also reports feeling stiff for about an hour after waking up. She has a history of hypertension and hypercholesterolemia. Th... | Low-dose of oral prednisone | {
"A": "Muscle biopsy",
"B": "Low-dose of oral prednisone",
"C": "Electromyography",
"D": "Antibody screening"
} | step2&3 | B | [
"75 year old woman",
"physician",
"month history",
"fatigue",
"period",
"fever",
"pain in",
"shoulders",
"hips",
"5 kg",
"weight loss",
"reports feeling stiff",
"hour",
"waking",
"history of hypertension",
"hypercholesterolemia",
"family history",
"serious illness",
"smoked",
"... |
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