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 61-year-old man with a history of type 1 diabetes mellitus and depression is brought to the emergency department because of increasing confusion and fever over the past 14 hours. Four days ago, he was prescribed metoclopramide by his physician for the treatment of diabetic gastroparesis. His other medications include... | Fluphenazine | {
"A": "Nortriptyline",
"B": "Fluphenazine",
"C": "Methamphetamine",
"D": "Tranylcypromine"
} | step1 | B | [
"61 year old man",
"history of type 1 diabetes mellitus",
"depression",
"brought",
"emergency department",
"increasing confusion",
"fever",
"past",
"hours",
"Four days",
"prescribed metoclopramide",
"physician",
"treatment",
"diabetic gastroparesis",
"medications include insulin",
"par... |
A 38-year-old woman presents to her primary care physician for complaints of insomnia. She states that for the last 8 months, she has had difficultly falling asleep. Additionally, she awakens in the middle of the night or early morning and cannot fall back to sleep. When further questioned, she reports decreased appeti... | Continue current medication | {
"A": "Add lithium",
"B": "Continue current medication",
"C": "Switch to bupropion",
"D": "Switch to paroxetine"
} | step2&3 | B | [
"year old woman presents",
"primary care physician",
"complaints",
"insomnia",
"states",
"last",
"months",
"falling asleep",
"middle",
"night",
"early morning",
"fall back to sleep",
"further questioned",
"reports decreased appetite",
"weight loss",
"last",
"months",
"recently demo... |
The lac operon allows E. coli to effectively utilize lactose when it is available, and not to produce unnecessary proteins. Which of the following genes is constitutively expressed and results in the repression of the lac operon? | LacI | {
"A": "LacI",
"B": "LacY",
"C": "LacA",
"D": "CAP"
} | step1 | A | [
"lac operon allows E",
"coli",
"lactose",
"available",
"not to",
"proteins",
"following genes",
"results",
"repression",
"lac operon"
] |
A 64-year-old female presents to her primary care physician for an annual checkup. She states that her health is adequate, but she has not been doing well since her husband died last year. She is able to get by but admits to having trouble caring for herself, cooking, cleaning, and paying her bills. The patient complai... | Osteomalacia | {
"A": "Osteopenia",
"B": "Osteoporosis",
"C": "Osteomalacia",
"D": "Hyperparathyroidism"
} | step2&3 | C | [
"64 year old female presents",
"primary care physician",
"annual checkup",
"states",
"health",
"adequate",
"not",
"well",
"husband died last year",
"able to get",
"admits",
"caring",
"cooking",
"cleaning",
"paying",
"bills",
"patient",
"diffuse muscle aches",
"pains",
"past med... |
A 14-year-old girl is referred to a gynecologist for amenorrhea. Her mother is also concerned that she hasn't grown any hair "in her private parts." The patient states that she is getting used to high school and wants to join the volleyball team but complains that her weakness and headaches limit her physical activity.... | 17-alpha-hydroxylase deficiency | {
"A": "3-beta-hydroxysteroid dehydrogenase deficiency",
"B": "5-alpha reductase deficiency",
"C": "11-beta-hydroxylase deficiency",
"D": "17-alpha-hydroxylase deficiency"
} | step2&3 | D | [
"year old girl",
"referred",
"gynecologist",
"amenorrhea",
"mother",
"concerned",
"air ",
"rivate arts.",
"atient tates ",
"etting sed ",
"igh school ",
"o ",
"olleyball eam ",
"eakness ",
"eadaches imit ",
"hysical activity.",
"ot hare ",
"other'",
"ncerns a",
"nses. ",
... |
A 60-year-old man who is a chronic smoker comes to the hospital with the chief complaint of shortness of breath which has worsened over the past 2 days. He also has a productive cough with yellowish sputum. There is no history of hemoptysis, chest pain, fever, palpitations, or leg swelling. He had a viral illness one w... | Increase Reid index | {
"A": "Curschmann spirals",
"B": "Increase Reid index",
"C": "Ferruginous bodies",
"D": "Non-caseating granuloma"
} | step1 | B | [
"60 year old man",
"chronic smoker",
"hospital",
"chief complaint of shortness",
"breath",
"worsened",
"past 2 days",
"productive cough",
"sputum",
"history",
"hemoptysis",
"chest pain",
"fever",
"palpitations",
"leg swelling",
"viral illness one week",
"using",
"inhaler",
"10 ye... |
A 65-year-old man comes to the physician because of a 6-month history of progressive fatigue and abdominal pain. Physical examination shows pale mucous membranes and splenomegaly. Hemoglobin concentration is 9.1 g/dL and leukocyte count is 3,400/mm3. Peripheral blood smear shows nucleated red blood cells and teardrop p... | Fibrosis in the bone marrow | {
"A": "Viral replication in lymphoid cells",
"B": "Fibrosis in the bone marrow",
"C": "Translocation between chromosome 9 and 22",
"D": "Elevated levels of circulating hepcidin"
} | step1 | B | [
"65 year old man",
"physician",
"month history",
"progressive fatigue",
"abdominal pain",
"Physical examination shows pale mucous membranes",
"splenomegaly",
"Hemoglobin concentration",
"g/dL",
"leukocyte count",
"3 400 mm3",
"Peripheral blood smear shows nucleated red blood cells",
"teardro... |
A 72-year-old man is admitted to the hospital with a productive cough and fever. A chest radiograph is obtained and shows a lobar consolidation. The patient is diagnosed with pneumonia. He has a history of a penicillin and cephalosporin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morn... | Discuss the error that occurred with the patient | {
"A": "Continue with ceftriaxone and use diphenhydramine as needed",
"B": "Desensitize the patient to ceftriaxone and continue treatment",
"C": "Discuss the error that occurred with the patient",
"D": "Inform the patient that nursing gave the wrong medication and it has been corrected"
} | step2&3 | C | [
"72 year old man",
"admitted",
"hospital",
"productive cough",
"fever",
"chest radiograph",
"obtained",
"shows",
"lobar consolidation",
"patient",
"diagnosed",
"pneumonia",
"history",
"penicillin",
"cephalosporin allergy",
"attending physician orders IV levofloxacin",
"empiric therap... |
A 3-year-old girl is brought to her pediatrician with 2 days of fever and abdominal pain. She has also been crying and complaining of pain while urinating. She was born at term without incident and was previously healthy at regular checkups. On presentation, her temperature is 102.2°F (39°C), blood pressure is 137/85 m... | Aniridia | {
"A": "11;22 chromosome translocation",
"B": "Aniridia",
"C": "Ash leaf spots",
"D": "Epstein-Barr virus"
} | step1 | B | [
"3 year old girl",
"brought",
"pediatrician",
"2 days",
"fever",
"abdominal pain",
"crying",
"pain",
"born",
"term",
"incident",
"healthy",
"regular checkups",
"presentation",
"temperature",
"blood pressure",
"85 mmHg",
"pulse",
"min",
"respirations",
"min",
"Physical exam ... |
A 47-year-old woman presents with abnormal vaginal bleeding. She reports that she has had heavy, irregular periods for the past 6 months. Her periods, which normally occur every 28 days, are sometimes now only 2-3 weeks apart, last 7-10 days, and has spotting in between menses. Additionally, her breasts feel enlarged a... | Estrogen | {
"A": "Cancer antigen-125",
"B": "Carcinoembryonic antigen",
"C": "Estrogen",
"D": "Testosterone"
} | step2&3 | C | [
"year old woman presents",
"abnormal vaginal bleeding",
"reports",
"heavy",
"irregular",
"past 6 months",
"periods",
"occur",
"days",
"sometimes now only",
"weeks",
"last",
"10 days",
"spotting",
"between menses",
"breasts feel enlarged",
"tender",
"denies abdominal pain",
"dysur... |
A 52-year-old man is admitted directly from the clinic for a serum glucose of 980 mg/dL. He has had type 2 diabetes for 16 years, for which he was prescribed metformin and glimepiride; however, he reports not having followed his prescription due to its high cost. For the past 12 days, he has had excess urination, and h... | Adding potassium to the intravenous fluids | {
"A": "Starting regular insulin infusion",
"B": "Adding potassium to the intravenous fluids",
"C": "Adding dopamine infusion",
"D": "Starting basal-bolus insulin"
} | step2&3 | B | [
"year old man",
"admitted directly",
"clinic",
"serum glucose",
"mg dL",
"type 2 diabetes",
"years",
"prescribed metformin",
"glimepiride",
"reports not",
"followed",
"prescription due to",
"high cost",
"past",
"days",
"excess urination",
"lost",
"kg",
"weight",
"noted",
"wor... |
A 45-year-old man is brought to the hospital by his daughter with complaints of wide-based gait. His daughter reveals that he was sitting silently in the examination chair with a blank face. In addition, he was frequently talking to the empty chairs and told that his friends are sitting there. He has been forgetting ma... | Cortical lewy bodies | {
"A": "Tau protein aggregates in cortex",
"B": "Lewy bodies in affected neurons",
"C": "Spongiform changes in cortex",
"D": "Cortical lewy bodies"
} | step1 | D | [
"year old man",
"brought",
"hospital",
"daughter",
"complaints",
"wide-based gait",
"daughter reveals",
"sitting",
"examination chair",
"blank face",
"addition",
"frequently talking",
"empty chairs",
"friends",
"sitting",
"forgetting",
"small things recently",
"physical examination... |
A 23-year-old Caucasian male presents to the emergency department with a persistent penile erection for the last 6 hours. He recently began outpatient treatment for depression with associated insomnia. He traveled to Mexico 5 months ago. His medical history is otherwise unremarkable.
Which of the following is the most... | Depression treatment with trazodone | {
"A": "Depression treatment with bupropion",
"B": "Depression treatment with trazodone",
"C": "Sickle cell disease",
"D": "Infection acquired in Mexico"
} | step1 | B | [
"23 year old Caucasian male presents",
"emergency department",
"persistent penile",
"hours",
"recently began outpatient treatment",
"depression",
"associated insomnia",
"traveled",
"Mexico",
"months",
"medical history",
"unremarkable",
"following",
"most likely precipitating factor",
"pr... |
A 6-year-old boy is brought to the physician because of right hip pain that started that afternoon. His mother reports that he has also been limping since the pain developed. He says that the pain worsens when he moves or walks. He participated in a dance recital yesterday, but his mother believes that he was not injur... | Transient synovitis | {
"A": "Slipped capital femoral epiphysis",
"B": "Transient synovitis",
"C": "Legg-Calve-Perthes disease",
"D": "Developmental dysplasia of the hip"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"right hip pain",
"started",
"afternoon",
"mother reports",
"limping",
"pain",
"pain worsens",
"moves",
"walks",
"dance",
"mother",
"not injured",
"time",
"born",
"term",
"healthy",
"episode of nasal congestion",
"mild cough 10 days",
... |
A 26-year-old gravida 1 at 36 weeks gestation is brought to the emergency department by her husband complaining of contractions lasting up to 2 minutes. The contractions are mostly in the front of her abdomen and do not radiate. The frequency and intensity of contractions have not changed since the onset. The patient w... | Reassurance, hydration, and ambulation | {
"A": "Admit to the Obstetrics Department in preparation for labor induction",
"B": "Reassurance, hydration, and ambulation",
"C": "Manage with terbutaline",
"D": "Admit to the Obstetrics Department for observation"
} | step2&3 | B | [
"year old gravida 1",
"36 weeks",
"brought",
"emergency department",
"husband",
"contractions lasting",
"minutes",
"contractions",
"mostly",
"front of",
"abdomen",
"not radiate",
"frequency",
"intensity",
"contractions",
"not changed",
"onset",
"patient worries",
"labor",
"bloo... |
A 12-year-old boy presents to the emergency department after falling from his bike. He is holding his right arm tenderly and complains of pain in his right wrist. When asked, he says that he fell after his front tire hit a rock and landed hard on his right hand. Upon physical examination he is found to have tenderness ... | Scaphoid | {
"A": "Scaphoid",
"B": "Lunate",
"C": "Pisiform",
"D": "Capitate"
} | step1 | A | [
"year old boy presents",
"emergency department",
"falling",
"bike",
"holding",
"right arm",
"pain",
"right wrist",
"fell",
"front tire hit",
"rock",
"landed hard",
"right hand",
"physical examination",
"found to",
"tenderness",
"dorsal aspect of",
"wrist",
"extensor pollicis long... |
A previously healthy 3-year-old boy is brought to the physician by his mother because of a headache, fever, and facial pain that started 10 days ago. The symptoms initially improved but have gotten significantly worse over the past 2 days. Immunizations are up-to-date. His temperature is 39.1°C (102.3°F). Physical exam... | Causal pathogen is unencapsulated | {
"A": "Causal pathogen produces phospholipase C",
"B": "Host has hyperviscous secretions",
"C": "Causal pathogen is unencapsulated",
"D": "Host has impaired splenic opsonization\n\""
} | step1 | C | [
"healthy",
"year old boy",
"brought",
"physician",
"mother",
"headache",
"fever",
"facial pain",
"started 10 days",
"symptoms initially improved",
"gotten",
"worse",
"past 2 days",
"Immunizations",
"date",
"temperature",
"Physical examination shows tenderness",
"palpation",
"chee... |
A 58-year-old man is diagnosed with right lower lobe pneumonia and has been admitted to a tertiary care hospital. His laboratory investigations suggest that he acquired an infection from the hospital where he underwent an elective abdominal surgery 3 weeks ago. His past medical records reveal a history of deep vein thr... | Contrast-enhanced computed tomography (CECT) of chest | {
"A": "Plasma D-dimer",
"B": "Serum brain natriuretic peptide",
"C": "Contrast-enhanced computed tomography (CECT) of chest",
"D": "Ventilation-perfusion scanning"
} | step2&3 | C | [
"58 year old man",
"diagnosed",
"right lower lobe pneumonia",
"admitted",
"tertiary",
"laboratory investigations suggest",
"acquired",
"infection",
"hospital",
"elective abdominal surgery 3 weeks",
"past medical records reveal",
"history of deep vein thrombosis",
"pulmonary embolism one year... |
A 43-year-old man with HIV infection comes to the physician because of a 2-week history of progressive diarrhea and a 3-kg (6.6-lb) weight loss. During this period, he has had 3–4 episodes of watery stools daily, with multiple instances of blood in the stool. He is currently receiving antiretroviral therapy with zidovu... | Pancytopenia | {
"A": "Hyperglycemia",
"B": "Abnormal dreams",
"C": "Hepatic steatosis",
"D": "Pancytopenia"
} | step1 | D | [
"year old man",
"HIV infection",
"physician",
"2-week history",
"progressive diarrhea",
"3 kg",
"6.6",
"weight loss",
"period",
"episodes of watery stools daily",
"multiple instances",
"blood",
"stool",
"currently receiving antiretroviral therapy",
"zidovudine",
"lamivudine",
"dolute... |
A 58-year-old patient comes to the physician because of progressive pain and swelling of his left calf for the past 2 days. He has no personal or family history of serious illness. He does not smoke or drink alcohol. His last digital rectal examination and colonoscopy at the age of 50 years were normal. His vital signs... | X-ray of the chest | {
"A": "Colonoscopy",
"B": "Inferior vena cava filter",
"C": "X-ray of the chest",
"D": "Streptokinase therapy"
} | step2&3 | C | [
"58 year old patient",
"physician",
"progressive pain",
"swelling of",
"left calf",
"past 2 days",
"personal",
"family history",
"serious illness",
"not smoke",
"drink alcohol",
"last digital rectal examination",
"colonoscopy",
"age",
"50 years",
"normal",
"vital signs",
"normal li... |
Three hours after delivery, a 1800-g (3-lb 15-oz) male newborn develops respiratory distress. He was born at 31 weeks' gestation to a 27-year-old primigravid woman. His temperature is 36.9°C (98.4F), pulse is 140/min, respirations are 69/min, and blood pressure is 60/30 mm Hg. Pulse oximetry on room air shows an oxygen... | Surfactant deficiency | {
"A": "Surfactant deficiency",
"B": "Hypertension in pulmonary vasculature",
"C": "Impaired ciliary function",
"D": "Delayed resorption of lung fluid"
} | step2&3 | A | [
"Three hours",
"delivery",
"g",
"oz",
"male newborn",
"respiratory distress",
"born",
"31 weeks",
"gestation",
"27 year old primigravid woman",
"temperature",
"36",
"98 4F",
"pulse",
"min",
"respirations",
"69 min",
"blood pressure",
"60 30 mm Hg",
"Pulse oximetry",
"room air... |
A 69-year-old diabetic woman comes to the emergency department due to right flank pain for 10 days. Her right flank pain is radiating towards her groin and is associated with fever and chills. The pain is exacerbated with hip extension. She feels fatigued and is lying on her left side with her right hip flexed. The CT ... | Diapedesis of neutrophils and chemotactic agents | {
"A": "Downregulation of regulation of cellular adhesion molecules in the endothelium",
"B": "Diapedesis of neutrophils and chemotactic agents",
"C": "Decreased expression of selectin in the endothelium",
"D": "Vasoconstriction"
} | step1 | B | [
"69 year old diabetic woman",
"emergency department due to right flank pain",
"10 days",
"right flank pain",
"radiating",
"groin",
"associated with fever",
"chills",
"pain",
"exacerbated",
"hip extension",
"feels fatigued",
"lying",
"left side",
"right hip flexed",
"CT guided percutane... |
A 57-year-old woman comes to the physician because of a 2-week history of worsening epigastric pain that improves with meals. She has had similar pain of lesser intensity for the past 4 years. Physical examination shows no abnormalities. Upper endoscopy shows a 0.5-cm mucosal breach in the anterior duodenal bulb that e... | Perforation | {
"A": "Perforation",
"B": "Hematemesis",
"C": "Gastric outlet obstruction",
"D": "Pernicious anemia"
} | step1 | A | [
"57 year old woman",
"physician",
"2-week history",
"worsening epigastric",
"improves",
"meals",
"similar pain",
"lesser intensity",
"past",
"years",
"Physical examination shows",
"abnormalities",
"Upper endoscopy shows",
"0.5",
"mucosal",
"anterior duodenal",
"extends",
"submucosa... |
A 3-month-old infant is brought to the E.R. by his parents. They state that the child has not had a bowel movement in several days and they are having trouble feeding the child. The physician examines the child and notices that the child appears less active and slightly hypotonic. Which of the following is most likely ... | Recent consumption of honey | {
"A": "Recent consumption of honey",
"B": "Recent episodes of diarrhea",
"C": "Recent episodes of tetany",
"D": "Recent episode of whooping cough"
} | step1 | A | [
"3 month old infant",
"brought",
"R",
"parents",
"state",
"child",
"not",
"bowel movement",
"days",
"feeding",
"child",
"physician",
"child",
"child appears less active",
"slightly hypotonic",
"following",
"most likely to",
"discovered",
"patient history"
] |
A 58-year-old man presents with lower back pain that started a couple of weeks ago and is gradually increasing in severity. At present, he rates the intensity of the pain as 6/10. There is no radiation or associated paresthesias. There is no history of trauma. Past medical history is significant for aggressive squamous... | Hematogenous spread | {
"A": "Collagenase produced by cancer cells dissolves the basement membrane and aids in cellular invasion",
"B": "Hematogenous spread",
"C": "Transcoelomic",
"D": "Lymphatic spread"
} | step1 | B | [
"58 year old man presents",
"lower back pain",
"started",
"couple",
"weeks",
"increasing",
"severity",
"present",
"rates",
"intensity",
"pain",
"10",
"radiation",
"associated paresthesias",
"history trauma",
"Past medical",
"significant",
"aggressive squamous cell carcinoma of the ... |
A group of researchers is trying to create a new drug that more effectively decreases systolic blood pressure levels, and it has entered the clinical trial period of their drug's development. If, during their trial, the scientists wanted to examine a mutual or linear relationship between 2 continuous variables, which o... | Correlation | {
"A": "Analysis of variance",
"B": "Correlation",
"C": "Chi-square exam",
"D": "Independent t-exam"
} | step2&3 | B | [
"A group",
"researchers",
"to create",
"new drug",
"more",
"decreases systolic blood pressure levels",
"entered",
"clinical",
"drug's development",
"trial",
"scientists wanted to",
"mutual",
"linear relationship",
"continuous variables",
"following statistical models",
"most appropriat... |
A 33-year-old immigrant from Bangladesh is evaluated by a primary care physician as a new patient. He immigrated from Bangladesh to the United States 1 month ago and lives with his extended family. He worked in a clothing factory in Bangladesh and has not been seen by a doctor in over 10 years. He reports that he has h... | Increased production of mycobacterial enzymes | {
"A": "Enzymatic drug inactivation",
"B": "Increased active drug efflux",
"C": "Increased production of mycobacterial enzymes",
"D": "Metabolic pathway alteration"
} | step1 | C | [
"year old immigrant",
"Bangladesh",
"evaluated",
"primary care physician",
"new patient",
"Bangladesh",
"United States",
"month",
"lives with",
"extended family",
"worked",
"clothing factory",
"Bangladesh",
"not",
"seen",
"doctor",
"over 10 years",
"reports",
"chronic cough",
"... |
An investigator is studying the electrophysical properties of gastrointestinal smooth muscle cells using microelectrodes. He measures the resting membrane potential of a cell to be -70 mV. The equilibrium potentials of different ions involved in generating the membrane potential are shown.
ENa+ +65 mV
EK -85 mV
ECa2+ +... | Influx of Na+ ions | {
"A": "Influx of Ca2+ ions",
"B": "Influx of Mg2+ ions",
"C": "Influx of Cl- ions",
"D": "Influx of Na+ ions"
} | step1 | D | [
"investigator",
"studying",
"properties",
"gastrointestinal smooth muscle cells using microelectrodes",
"measures",
"resting membrane potential",
"cell to",
"70 mV",
"equilibrium potentials",
"different ions involved",
"membrane potential",
"shown",
"ENa",
"65 mV EK",
"85",
"ECa2",
"... |
A 52-year-old woman presents with fatigue, difficulty swallowing solid foods, and frequent choking spells. She says her symptoms gradually onset 3 months ago and have progressively worsened. Past medical history is unremarkable. She reports drinking alcohol occasionally but denies smoking or illicit drug use. Her vital... | Plummer-Vinson syndrome | {
"A": "Esophageal carcinoma",
"B": "Zenker diverticulum",
"C": "Plummer-Vinson syndrome",
"D": "Diffuse esophageal spasm"
} | step2&3 | C | [
"year old woman presents",
"fatigue",
"difficulty swallowing solid foods",
"frequent choking spells",
"symptoms",
"onset",
"months",
"worsened",
"Past medical history",
"unremarkable",
"reports drinking alcohol occasionally",
"denies smoking",
"illicit drug use",
"vital signs include",
"... |
A 75-year-old man is referred for thyroidectomy for treatment of thyroid nodules. A portion of the thyroid gland is resected, and the neck is closed with sutures. After awakening from anesthesia, the patient complains of ‘hoarseness’. His vital signs are normal and his incisional pain is minimal. The surgeon realizes h... | "We made a mistake during the operation that may have harmed you." | {
"A": "\"A mistake occurred during the operation, but there was no harm to you.\"",
"B": "\"The case took longer than we thought it would, but everything went well.\"",
"C": "\"The operation was successful and no complications occurred.\"",
"D": "\"We made a mistake during the operation that may have harmed yo... | step2&3 | D | [
"75 year old man",
"referred",
"thyroidectomy",
"treatment of thyroid nodules",
"portion",
"thyroid gland",
"resected",
"neck",
"closed",
"sutures",
"awakening",
"anesthesia",
"patient",
"hoarseness",
"vital signs",
"normal",
"incisional pain",
"minimal",
"surgeon",
"most likel... |
A 70-year-old man presents with right-sided weakness. The patient says that symptoms acutely onset an hour ago while watching television at home. Past medical history is significant for poorly controlled hypertension and 2 myocardial infarctions in the last 2 years. His blood pressure is 140/100 mm Hg, the respiratory ... | Amyloid angiopathy | {
"A": "Cerebral atrophy",
"B": "Saccular aneurysm",
"C": "Amyloid angiopathy",
"D": "Pterion fracture"
} | step1 | C | [
"70 year old man presents",
"right-sided weakness",
"patient",
"symptoms",
"onset",
"hour",
"watching television",
"home",
"Past medical history",
"significant",
"poorly controlled hypertension",
"2 myocardial infarctions",
"years",
"blood pressure",
"100 mm Hg",
"respiratory rate",
... |
A 57-year-old woman comes to the physician for evaluation of a lump in the right breast that she first noticed a week ago. Biopsy of the mass confirms a diagnosis of a pleomorphic lobular carcinoma-in-situ that is estrogen receptor-positive. The patient undergoes lumpectomy, and treatment with tamoxifen is initiated. W... | Endometrial cancer | {
"A": "Endometrial cancer",
"B": "Osteoporosis",
"C": "Myelosuppression",
"D": "Ovarian cancer"
} | step1 | A | [
"57 year old woman",
"physician",
"evaluation",
"lump",
"right breast",
"first",
"week",
"Biopsy",
"mass confirms",
"diagnosis",
"pleomorphic lobular carcinoma-in-situ",
"estrogen receptor-positive",
"patient",
"lumpectomy",
"treatment",
"tamoxifen",
"initiated",
"following conditi... |
A healthy 20-year-old male college student attempts to climb Mount Everest and travels to the Tibetan plateau by plane. Upon landing, he feels increasingly dizzy and fatigued. He notices that he is breathing faster than usual. What is the initial stimulus for the most likely acid-base disorder? | Decreased partial pressure of alveolar oxygen | {
"A": "Decreased partial pressure of alveolar oxygen",
"B": "Increasing arterial partial pressure of carbon dioxide",
"C": "Worsened diffusion limitation of oxygen",
"D": "Undiagnosed atrial septal defect"
} | step1 | A | [
"healthy 20 year old male college student attempts",
"climb Mount",
"travels",
"plateau",
"plane",
"landing",
"feels",
"dizzy",
"fatigued",
"breathing faster",
"usual",
"initial stimulus",
"likely acid-base disorder"
] |
A 25-year-old man presents with pain and a limited range of motion in his right shoulder. He is a collegiate baseball player and says he has not been playing for approx. 1 week because his shoulder hurts when he throws. He also noticed trouble raising his arm over his head. He describes the pain as moderate, dull, and ... | NSAIDs and conservative measures | {
"A": "Conservative measures (rest and ice)",
"B": "NSAIDs and conservative measures",
"C": "Intra-articular corticosteroid injection",
"D": "Acromioplasty"
} | step2&3 | B | [
"year old man presents",
"pain",
"limited range of motion",
"right shoulder",
"collegiate baseball",
"not",
"playing",
"1 week",
"shoulder",
"throws",
"arm",
"head",
"pain",
"moderate",
"dull",
"aching",
"character",
"worse",
"moves",
"arm",
"shoulder",
"bed",
"side",
"... |
A 23-year-old man presents to the emergency department with testicular pain. His symptoms started 15 minutes ago and have not improved on the ride to the hospital. The patient’s past medical history is non-contributory, and he is not currently taking any medications. His temperature is 98.5°F (36.9°C), blood pressure i... | Bilateral surgical procedure | {
"A": "Bilateral surgical procedure",
"B": "Ceftriaxone",
"C": "Ciprofloxacin",
"D": "Surgical debridement"
} | step2&3 | A | [
"23 year old man presents",
"emergency department",
"testicular pain",
"symptoms started 15 minutes",
"not improved",
"hospital",
"patients past medical history",
"non contributory",
"not currently taking",
"medications",
"temperature",
"98",
"36",
"blood pressure",
"62 mmHg",
"pulse",... |
A 61-year-old woman visits the clinic with a complaint of new-onset episodic abnormal body movements. She says her husband noticed it twice in the past week. There were jerky movements for roughly 15 seconds during her last episode. She denies any recent trauma or fever. Her vital signs include: blood pressure 114/74 m... | Astrocytes | {
"A": "Meningothelial cells",
"B": "Ependymal cells",
"C": "Astrocytes",
"D": "Oligodendroglia"
} | step1 | C | [
"61 year old woman visits",
"clinic",
"complaint of new-onset episodic abnormal body movements",
"husband",
"twice",
"past week",
"jerky movements",
"seconds",
"last episode",
"denies",
"recent trauma",
"fever",
"vital signs include",
"blood pressure",
"74 mm Hg",
"pulse 81 min",
"te... |
A researcher is investigating the blood supply of the adrenal gland. While performing an autopsy on a patient who died from unrelated causes, he identifies a vessel that supplies oxygenated blood to the inferior aspect of the right adrenal gland. Which of the following vessels most likely gave rise to the vessel in que... | Renal artery | {
"A": "Renal artery",
"B": "Inferior phrenic artery",
"C": "Superior mesenteric artery",
"D": "Common iliac artery"
} | step1 | A | [
"researcher",
"investigating",
"blood supply",
"adrenal gland",
"performing",
"autopsy",
"patient",
"died",
"unrelated causes",
"vessel",
"supplies",
"blood",
"inferior aspect",
"right adrenal gland",
"following vessels",
"likely gave rise",
"vessel",
"question"
] |
A 74-year-old female with a history of lung adenocarcinoma status post lobectomy, chronic obstructive pulmonary disease, congestive heart failure, and diabetic nephropathy presents to clinic complaining of hearing loss. Over the last week, she has noticed that she has had difficulty hearing the telephone or the televis... | Furosemide | {
"A": "Cisplatin",
"B": "Aspirin",
"C": "Docetaxel",
"D": "Furosemide"
} | step2&3 | D | [
"74 year old female",
"history of lung adenocarcinoma",
"lobectomy",
"chronic obstructive pulmonary disease",
"congestive heart failure",
"diabetic nephropathy presents",
"clinic",
"of hearing loss",
"last week",
"difficulty hearing",
"telephone",
"television",
"sitting",
"quiet room",
"... |
A 60-year-old man is brought to your medical office by his daughter, who noticed that he has had a progressive increase in breast size over the past 6 months. The patient does not complain of anything else except easy fatigability and weakness. His daughter adds that he does not have a good appetite as in the past. He ... | Cirrhosis | {
"A": "Cirrhosis",
"B": "Chronic kidney disease",
"C": "Hyperthyroidism",
"D": "Physiologic"
} | step1 | A | [
"60 year old man",
"brought",
"medical office",
"daughter",
"progressive increase in breast size",
"past 6 months",
"patient",
"not",
"else",
"easy fatigability",
"weakness",
"daughter adds",
"not",
"good appetite",
"past",
"occasional discomfort",
"nipple sensitivity",
"puts",
"... |
A 40-year-old G1P0010 presents to the clinic with nausea and vomiting 8 weeks after a spontaneous abortion at 10 weeks gestation. She admits to heavy drinking (7–8 glasses of wine per day) for the last 20 years; however, after the pregnancy loss, she increased her drinking to 8–9 glasses per day. Hepatomegaly, right up... | ↑ NADH/NAD+; AST:ALT ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↑; lactic acid ↑ | {
"A": "↑ NADH/NAD+; AST:ALT ≥ 2:1; ß-oxidation ↓; ß-hydroxybutyrate ↑; lactic acid ↑",
"B": "↑ NAD+/NADH; ALT:AST ≥ 2:1; ß-oxidation ↑; ß-hydroxybutyrate, no change; lactic acid ↓",
"C": "↑ NAD+/NADH; AST:ALT ≥ 2:1; ß-oxidation ↑; ß-hydroxybutyrate ↓; lactic acid ↓",
"D": "↑ NADH/NAD+; ALT:AST ≥ 2:1; ß-oxidati... | step1 | A | [
"40 year old",
"presents",
"clinic",
"nausea",
"vomiting",
"weeks",
"spontaneous abortion",
"10 weeks gestation",
"admits",
"heavy drinking",
"glasses",
"wine",
"day",
"last 20 years",
"pregnancy loss",
"increased",
"drinking",
"glasses",
"day",
"Hepatomegaly",
"right upper q... |
A 63-year-old woman presents to the primary care physician’s clinic complaining of fatigue, diarrhea, headaches, and a loss of appetite. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. Her past medical history... | Lifelong Vitamin B12 supplementation | {
"A": "Lifelong Vitamin B12 supplementation",
"B": "Iron supplementation for 4–6 months",
"C": "Obtain a Coomb’s test",
"D": "Give corticosteroids and iron supplementation"
} | step2&3 | A | [
"63 year old woman presents",
"primary care clinic",
"fatigue",
"diarrhea",
"headaches",
"loss of appetite",
"denies",
"personal history",
"blood clots",
"past",
"mother",
"to",
"treated",
"pulmonary embolism",
"recent past",
"past medical history",
"significant",
"preeclampsia",
... |
A 33-year-old man presents with his recent laboratory results. He has no symptoms currently, but he underwent a medical evaluation as a requirement for taking up a new job. His medical history is not significant. His laboratory reports are as follows:
Blood hemoglobin 13.7 g/dL
Leukocyte count 8,000/mm3
Platelet count ... | Palmar xanthomas in flexor creases | {
"A": "Achilles tendon xanthoma",
"B": "Palmar xanthomas in flexor creases",
"C": "Metacarpophalangeal extensor tendon xanthoma",
"D": "Xanthelasma"
} | step1 | B | [
"year old man presents",
"recent laboratory results",
"symptoms currently",
"medical evaluation",
"requirement",
"new job",
"medical history",
"not significant",
"laboratory reports",
"follows",
"Blood",
"Leukocyte count",
"mm3 Platelet count 350",
"Serum",
"alanine aminotransferase",
... |
A 30-year-old man with history of intravenous drug use and methamphetamine-associated chronic thromboembolic pulmonary hypertension (CTEPH) is brought to the emergency department by his girlfriend for worsening abdominal pain and fevers. The patient said the pain was initially around his umbilicus, but he is now experi... | Fresh frozen plasma | {
"A": "Do nothing",
"B": "Fresh frozen plasma",
"C": "Phytonadione",
"D": "Protamine"
} | step2&3 | B | [
"30 year old man",
"history",
"intravenous drug use",
"methamphetamine associated chronic thromboembolic pulmonary hypertension",
"brought",
"emergency department",
"girlfriend",
"worsening abdominal",
"fevers",
"patient",
"pain",
"initially",
"umbilicus",
"now experiencing intense tendern... |
A 62-year-old man, who is known to have recurrent thromboembolic strokes, presents to his physician for a routine follow-up visit. While assessing drug compliance, the physician realizes that the patient inadvertently doubled his dose of warfarin 1 month ago. When he is asked about any new complaints, the patient denie... | Phytonadione | {
"A": "Fresh frozen plasma",
"B": "Phytonadione",
"C": "Recombinant factor VIIa",
"D": "Protamine sulfate"
} | step1 | B | [
"62 year old man",
"known to",
"recurrent thromboembolic strokes",
"presents",
"physician",
"routine follow-up visit",
"assessing drug compliance",
"physician",
"patient",
"doubled",
"dose",
"warfarin",
"month",
"new complaints",
"patient denies",
"symptoms",
"including bleeding",
... |
A 15-year-old girl is brought to the physician for her annual physical examination. Breast and pubic hair development began at the age of 12 years, but menses have not yet occurred. She is 160 cm (5 ft 3 in) tall and weighs 54 kg (120 lb); BMI is 21 kg/m2. Physical examination shows normal external genitalia. Breast an... | Paramesonephric duct | {
"A": "Mesonephric duct",
"B": "Gubernaculum",
"C": "Urogenital sinus",
"D": "Paramesonephric duct"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"annual physical examination",
"Breast",
"pubic hair development began",
"age",
"years",
"menses",
"not",
"occurred",
"5 ft",
"tall",
"54 kg",
"BMI",
"kg/m2",
"Physical examination shows normal external genitalia",
"Breast",
"pubic hair de... |
A 59-year-old man comes to the physician because of worsening fatigue and a 1-week history of gingival bleeding. He has also had decreased appetite and a 5-kg (11-lb) weight loss over the past month. He has tried over-the-counter vitamin supplements with no relief of his symptoms. He appears pale. His temperature 37.8°... | Peroxidase-positive granules | {
"A": "Translocation t(9;22)",
"B": "Positive heterophile antibody test",
"C": "Peroxidase-positive granules",
"D": "Follicular hyperkeratosis\n\""
} | step2&3 | C | [
"59 year old man",
"physician",
"worsening fatigue",
"1-week history",
"gingival bleeding",
"decreased appetite",
"5 kg",
"weight loss",
"past month",
"over-the-counter vitamin supplements",
"relief",
"symptoms",
"appears pale",
"temperature",
"100",
"pulse",
"72 min",
"blood press... |
A 74-year-old retired female teacher is referred to the endocrinology clinic. She is very concerned about a large mass in her neck that has progressively enlarged over the past 2 weeks. She also reports a 15 pound weight loss over the last 3 months. She now has hoarseness and difficulty swallowing her food, giving her ... | Inactivating mutation of the p53 tumor suppressor gene | {
"A": "MEN2 gene mutation",
"B": "RET gene mutation",
"C": "Calcitonin receptor mutation",
"D": "Inactivating mutation of the p53 tumor suppressor gene"
} | step2&3 | D | [
"74 year old retired female teacher",
"referred",
"endocrinology clinic",
"very concerned",
"large mass",
"neck",
"enlarged",
"past 2 weeks",
"reports",
"pound weight loss",
"months",
"now",
"hoarseness",
"difficulty swallowing",
"food",
"giving",
"sensation",
"food gets stuck",
... |
An institutionalized 65-year-old man is brought to the emergency department because of abdominal pain and distension for 12 hours. The pain was acute in onset and is a cramping-type pain associated with nausea, vomiting, and constipation. He has a history of chronic constipation and has used laxatives for years. There ... | Sigmoid volvulus | {
"A": "Acute diverticulitis",
"B": "Sigmoid volvulus",
"C": "Intussusception",
"D": "Colon cancer"
} | step1 | B | [
"institutionalized 65 year old man",
"brought",
"emergency department",
"abdominal pain",
"distension",
"12 hours",
"pain",
"acute",
"onset",
"cramping type pain associated with nausea",
"vomiting",
"constipation",
"history",
"chronic constipation",
"used laxatives",
"years",
"histor... |
A 59-year-old male with a history of aortic stenosis secondary to a bicuspid aortic valve treated with aortic valve replacement (AVR) presents with fever and shortness of breath. Patient states a gradual onset of symptoms approximately five days ago that have been getting steadily worse. He reports that he has trouble ... | Administer vancomycin 1 g IV every 12 hours, gentamicin 70 mg IV every 8 hours, and rifampin 300 mg IV every 8 hours | {
"A": "Stop warfarin immediately",
"B": "Administer vancomycin 1 g IV every 12 hours, gentamicin 70 mg IV every 8 hours, and rifampin 300 mg IV every 8 hours",
"C": "Emergency replacement of the mechanical aortic valve",
"D": "Administer dobutamine"
} | step2&3 | B | [
"59 year old male",
"history of aortic stenosis secondary to",
"bicuspid aortic valve treated with aortic valve replacement",
"presents",
"fever",
"shortness of breath",
"Patient states",
"gradual onset",
"symptoms approximately five days",
"getting",
"worse",
"reports",
"getting",
"walkin... |
A 36-year-old woman is admitted to the hospital for the evaluation of progressive breathlessness. She has no history of major medical illness. Her temperature is 37°C (98.6°F), pulse is 110/min, and respirations are 22/min. Pulse oximetry on room air shows an oxygen saturation of 99%. Cardiac examination shows a loud S... | Decreased hemoglobin concentration | {
"A": "Increased carbon dioxide retention",
"B": "Increased peripheral shunting",
"C": "Increased pulmonary vascular resistance",
"D": "Decreased hemoglobin concentration"
} | step1 | D | [
"36 year old woman",
"admitted",
"hospital",
"evaluation",
"progressive breathlessness",
"history of major medical illness",
"temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"Pulse oximetry",
"room air shows",
"oxygen",
"99",
"Cardiac examination shows",
"loud S1",
"S2... |
A 64-year-old female with a history of end-stage renal disease presents to her primary care physician complaining of weakness. She reports a six-month history of progressive weakness accompanied by occasional dull aching pain in her arms, legs, and lower back. She has also started to increase her fiber intake because o... | Calcimimetic agent | {
"A": "Sodium chloride cotransporter antagonist",
"B": "Calcimimetic agent",
"C": "Osteoprotegerin analog",
"D": "Carbonic anhydrase inhibitor"
} | step1 | B | [
"year",
"female",
"history of end-stage renal disease presents",
"primary care physician",
"weakness",
"reports",
"six-month history",
"progressive weakness",
"occasional dull aching",
"arms",
"legs",
"lower back",
"started to increase",
"fiber intake",
"occasional strained bowel movemen... |
A 70 year-old-man comes to the clinic for generalized fatigue. He says that he is more tired than before and has difficulty catching his breath while walking upstairs. He feels tired quickly doing his usual activity such as gardening and shopping. He does not have any symptoms of fever, change in bowel habits, abdomina... | Angiodysplasia | {
"A": "Diverticulitis",
"B": "Hereditary hemorrhagic telangiectasia",
"C": "Angiodysplasia",
"D": "Intestinal obstruction"
} | step1 | C | [
"70 year old man",
"clinic",
"generalized fatigue",
"more tired",
"difficulty catching",
"breath",
"walking upstairs",
"feels tired",
"usual activity",
"gardening",
"shopping",
"not",
"symptoms",
"fever",
"change in bowel habits",
"abdominal pain",
"rectal bleeding",
"weight loss",... |
A 27-year-old man presents to the emergency department with unrelenting muscle spasms for the past several hours. The patient’s girlfriend states that he started having jaw spasms and soreness last night but now his neck, back, and arms are spasming. She also states that he stepped on a nail about 1 week ago. Past medi... | An exotoxin that cleaves SNARE proteins | {
"A": "A heat-labile toxin that inhibits ACh release at the NMJ",
"B": "A toxin that disables the G-protein coupled receptor",
"C": "An exotoxin that cleaves SNARE proteins",
"D": "An exotoxin that causes ADP-ribosylation of EF-2"
} | step1 | C | [
"27 year old man presents",
"emergency department",
"muscle spasms",
"past",
"hours",
"patients girlfriend states",
"started",
"jaw spasms",
"soreness",
"night",
"now",
"neck",
"back",
"arms",
"spasming",
"states",
"stepped",
"nail",
"1 week",
"Past medical history",
"patient... |
A 72-year-old woman presents to the emergency department complaining of left gluteal pain for the last 3 months. The onset of the pain was gradual and she does not recall any trauma to the region. She describes the pain as sharp and progressive, with radiation down the posterior left thigh to the level of the knee. She... | Walking | {
"A": "Rise from a sitting position",
"B": "Walking",
"C": "Standing",
"D": "Running"
} | step1 | B | [
"72 year old woman presents",
"emergency department",
"left",
"last",
"months",
"onset",
"pain",
"gradual",
"not recall",
"trauma",
"region",
"pain",
"sharp",
"progressive",
"radiation",
"posterior",
"level",
"knee",
"non-smoker",
"history of anticoagulant therapy",
"past med... |
A 27-year-old woman presents to her primary care physician because of headaches that she has had over the last three weeks. She has not had any significant past medical history though she does recall that various types of cancer run in her family. She has also noticed that she has been gaining some weight, and her feet... | String-of-beads appearance on angiography | {
"A": "Mass present in adrenal cortex",
"B": "Mass present in adrenal medulla",
"C": "No lesions present",
"D": "String-of-beads appearance on angiography"
} | step1 | D | [
"27 year old woman presents",
"primary care physician",
"headaches",
"last three weeks",
"not",
"significant past medical history",
"recall",
"various types",
"cancer run in",
"family",
"gaining",
"weight",
"feet",
"longer fit",
"shoes",
"presentation",
"temperature",
"98",
"bloo... |
A 76-year-old woman seeks evaluation at a medical office for chest pain and shortness of breath on exertion of 3 months' duration. Physical examination shows bilateral pitting edema on the legs. On auscultation, diffuse crackles are heard over the lower lung fields. Cardiac examination shows jugular venous distention a... | Lisinopril | {
"A": "Digoxin",
"B": "Furosemide",
"C": "Lisinopril",
"D": "Propranolol"
} | step1 | C | [
"76 year old woman",
"evaluation",
"medical office",
"chest pain",
"shortness of breath",
"exertion",
"months",
"duration",
"Physical examination shows bilateral pitting",
"legs",
"auscultation",
"diffuse crackles",
"heard",
"lower lung fields",
"Cardiac examination shows jugular venous ... |
A 45-year-old man presents to the emergency room with cough, dyspnea, and fever over the past 2 days. He also has substernal chest pain that worsens with inspiration. He recently recovered from a mild upper respiratory infection. His past medical history is notable for gout, hypertension, major depressive disorder, obe... | Picornavirus | {
"A": "Coronavirus",
"B": "Flavivirus",
"C": "Paramyxovirus",
"D": "Picornavirus"
} | step1 | D | [
"year old man presents",
"emergency room",
"cough",
"dyspnea",
"fever",
"past 2 days",
"substernal chest pain",
"worsens",
"inspiration",
"recently recovered",
"mild upper respiratory infection",
"past medical history",
"notable",
"gout",
"hypertension",
"major depressive disorder",
... |
A 38-year-old woman is referred to a cardiologist for evaluation of syncope. Over the past year she has experienced 2 syncopal events. The first event occurred while she was standing, and the second when she laid down on her side. She denies bowel or bladder incontinence during the episodes or palpitations. However, sh... | Left atrial pedunculated mass | {
"A": "Decreased left ventricular ejection fraction",
"B": "Flail mitral valve leaflet",
"C": "Left atrial pedunculated mass",
"D": "Patent foramen ovale"
} | step1 | C | [
"year old woman",
"referred",
"cardiologist",
"evaluation",
"syncope",
"past year",
"experienced 2 syncopal events",
"first event occurred",
"standing",
"second",
"side",
"denies bowel",
"bladder incontinence",
"episodes",
"palpitations",
"reports",
"presence",
"low-grade fever",
... |
A 55-year-old man presents to his primary care physician for a wellness checkup. He states that he generally feels well and has no complaints at this time. The patient consumes alcohol frequently, eats a high sodium diet, and is sedentary. His temperature is 97.5°F (36.4°C), blood pressure is 167/108 mmHg, pulse is 90/... | Weight loss | {
"A": "DASH diet",
"B": "Reduce alcohol consumption",
"C": "Sodium restriction",
"D": "Weight loss"
} | step2&3 | D | [
"55 year old man presents",
"primary care physician",
"wellness checkup",
"states",
"feels well",
"complaints",
"time",
"patient",
"alcohol frequently",
"eats",
"high sodium diet",
"sedentary",
"temperature",
"97",
"36 4C",
"blood pressure",
"mmHg",
"pulse",
"90 min",
"respirat... |
A 72-year-old man comes to the emergency department because of severe, acute, right leg pain for 2 hours. The patient's symptoms started suddenly while he was doing household chores. He has no history of leg pain at rest or with exertion. Yesterday, he returned home after a 6-hour bus ride from his grandson's home. He ... | Echocardiography | {
"A": "Echocardiography",
"B": "Doppler ultrasonography of the legs",
"C": "Biopsy of a superficial vein",
"D": "Digital subtraction angiography"
} | step2&3 | A | [
"72 year old man",
"emergency department",
"of severe",
"acute",
"right leg pain",
"hours",
"patient's symptoms started",
"household chores",
"history",
"leg pain",
"rest",
"exertion",
"returned home",
"hour bus",
"grandson's home",
"hypertension treated with ramipril",
"appears",
... |
A 42-year-old man presents to his dermatologist with a rash on the extensor surfaces of his elbows and knees which has occurred episodically ever since he was a teenager. The patient was recently diagnosed with essential hypertension and was prescribed lisinopril by his primary care physician. The vital signs include: ... | Topical clobetasol and/or topical calcipotriol | {
"A": "Topical clobetasol and/or topical calcipotriol",
"B": "Methotrexate",
"C": "Cyclosporine",
"D": "Oral prednisolone"
} | step2&3 | A | [
"year old man presents",
"dermatologist",
"rash",
"extensor surfaces of",
"elbows",
"knees",
"occurred",
"ever",
"teenager",
"patient",
"recently diagnosed",
"essential hypertension",
"prescribed lisinopril",
"primary care physician",
"vital signs include",
"temperature 36",
"98",
... |
A 32-year-old woman presents to her family physician with a long history of depression, irritability, and, more recently, personality changes. As her partner comments, she has stopped engaging in activities she used to enjoy like dancing, drumming lessons, and yoga. The patient denies changes in skin pigmentation and a... | Wilson disease | {
"A": "Wilson disease",
"B": "Hemochromatosis",
"C": "Nonalcoholic fatty liver disease",
"D": "Primary sclerosing cholangitis"
} | step1 | A | [
"year old woman presents",
"family physician",
"long history of depression",
"irritability",
"more recently",
"personality changes",
"partner comments",
"stopped engaging",
"activities",
"used",
"dancing",
"drumming",
"yoga",
"patient denies changes in skin pigmentation",
"keeps",
"bal... |
A 55-year-old man presents to the internal medicine clinic with complaints of numbness and tingling in his fingers that he first noticed 6 months ago. It has been progressively worsening and has reached the point where it is affecting his normal daily activities, such as brushing his teeth. His past medical history is ... | Eosinophilic granulomatosis with polyangiitis | {
"A": "Eosinophilic granulomatosis with polyangiitis",
"B": "Granulomatosis with polyangiitis",
"C": "CREST syndrome",
"D": "Polyarteritis nodosa"
} | step2&3 | A | [
"55 year old man presents",
"internal medicine clinic",
"complaints",
"numbness",
"tingling in",
"fingers",
"first",
"months",
"worsening",
"reached",
"point",
"affecting",
"normal daily activities",
"brushing",
"teeth",
"past medical history",
"significant",
"sinusitis",
"allerg... |
A 20-year-old man comes to the clinic complaining of shoulder pain for the past week. He is a pitcher for the baseball team at his university and reports that the pain started shortly after a game. The pain is described as achy and dull, intermittent, 7/10, and is concentrated around the right shoulder area. He denies ... | Suprascapular nerve | {
"A": "Accessory nerve",
"B": "Axillary nerve",
"C": "Subscapular nerve",
"D": "Suprascapular nerve"
} | step1 | D | [
"20 year old man",
"clinic",
"shoulder",
"past week",
"baseball team",
"university",
"reports",
"pain started",
"game",
"pain",
"described",
"achy",
"dull",
"intermittent",
"10",
"concentrated",
"right shoulder area",
"denies",
"significant medical history",
"trauma",
"fever"... |
A 6-year-old boy and his parents present to the emergency department with high-grade fever, headache, and projectile vomiting. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. H... | Streptococcus pneumoniae | {
"A": "Streptococcus pneumoniae",
"B": "Streptococcus agalactiae",
"C": "Staphylococcus aureus",
"D": "Neisseria meningitidis"
} | step1 | A | [
"year old boy",
"parents present",
"emergency department",
"high-grade fever",
"headache",
"projectile vomiting",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"Past medical history",
"sick contacts",
"sch... |
A forty-five-year-old farmer with past medical history of diabetes, hypertension, and glaucoma comes into your emergency room confused, diaphoretic, salivating, vomiting and shedding tears. He has pinpoint pupils. You conclude that he is showing effects of acute organophosphate poisoning. While administering the antido... | Acute closed-angle glaucoma | {
"A": "Tinnitus",
"B": "Bronchospasm",
"C": "Acute closed-angle glaucoma",
"D": "Hyperkalemia"
} | step1 | C | [
"forty-five year old farmer",
"past medical history of diabetes",
"hypertension",
"glaucoma",
"emergency room confused",
"diaphoretic",
"salivating",
"vomiting",
"tears",
"pinpoint pupils",
"conclude",
"showing effects",
"acute organophosphate poisoning",
"administering",
"antidote",
"... |
A 54-year-old man is brought to the emergency department after having been hit by a car while riding his bicycle. He was not wearing a helmet. Despite appropriate life-saving measures, he dies 2 hours later because of a severe intracranial hemorrhage. Autopsy of the heart shows general thickening of the left ventricula... | Chronic hypertension | {
"A": "Aortic regurgitation",
"B": "Chronic hypertension",
"C": "Hemochromatosis",
"D": "Sarcoidosis"
} | step1 | B | [
"54 year old man",
"brought",
"emergency department",
"hit by",
"car",
"bicycle",
"not",
"helmet",
"appropriate life saving measures",
"hours later",
"severe intracranial",
"Autopsy",
"heart shows general thickening of",
"left ventricular wall",
"narrowing",
"ventricular chamber",
"f... |
A 25-year-old woman presents her physician with a complaint of feeling tired and low on energy for the past 6 months. She also has noticed she has been having trouble performing daily tasks and at times experiencing near-fainting spells. She has no recollection of similar instances in the past. Her past medical history... | Methylmalonic acid | {
"A": "Succinyl CoA",
"B": "Homocysteine",
"C": "Ferritin",
"D": "Methylmalonic acid"
} | step2&3 | D | [
"year old woman presents",
"physician",
"complaint",
"feeling tired",
"low",
"energy",
"past 6 months",
"performing daily tasks",
"times experiencing near fainting spells",
"recollection",
"similar instances",
"past",
"past medical history",
"fact",
"vegan",
"years",
"vital signs",
... |
A 30-year old G2P1 woman, currently at 38 weeks estimated gestational age, presents with contractions. She says that she did not have any prenatal care, because she does not have health insurance. Upon delivery, the infant appears jaundiced and has marked hepatosplenomegaly. Serum hemoglobin is 11.6 g/dL and serum bili... | The mother generated IgG antibodies against fetal red blood cells | {
"A": "The neonate developed IgM autoantibodies to its own red blood cells",
"B": "The mother generated IgG antibodies against fetal red blood cells",
"C": "The mother generated IgM antibodies against fetal red blood cells",
"D": "Vitamin K deficiency has led to hemolytic anemia"
} | step1 | B | [
"30 year old",
"woman",
"currently",
"weeks estimated gestational age",
"presents",
"contractions",
"not",
"prenatal care",
"not",
"health insurance",
"delivery",
"infant appears jaundiced",
"marked hepatosplenomegaly",
"Serum hemoglobin",
"g/dL",
"serum bilirubin",
"mg/dL",
"direc... |
A 39-year-old female with poorly controlled systemic lupus erythematosus (SLE) presents to the emergency room with a cough and pleuritic chest pain. She states that she developed these symptoms 2 days prior. The pain appears to improve when the patient leans forward. She currently takes hydroxychloroquine for her syste... | PR depressions and diffuse ST elevations | {
"A": "Prolonged PR interval with normal QRS complexes",
"B": "Peaked T waves with flattened P waves",
"C": "Irregularly irregular QRS complexes with no P waves",
"D": "PR depressions and diffuse ST elevations"
} | step1 | D | [
"year old female",
"poorly controlled systemic lupus erythematosus",
"presents",
"emergency room",
"cough",
"pleuritic chest pain",
"states",
"symptoms",
"days prior",
"pain appears to",
"patient",
"forward",
"currently takes hydroxychloroquine",
"systemic lupus erythematosus",
"missed",... |
A 32-year-old male patient presents to the emergency department after being found down on a sidewalk. He is able to be aroused but seems confused and confabulates extensively during history taking. Physical exam of the eye reveals nystagmus and the patient is unable to complete finger-to-nose or heel-to-shin testing. C... | Vitamin B1 | {
"A": "Vitamin B1",
"B": "Vitamin B12",
"C": "Folate",
"D": "Fomepizole"
} | step1 | A | [
"year old male patient presents",
"emergency department",
"found",
"sidewalk",
"able to",
"aroused",
"confused",
"history taking",
"Physical exam",
"eye reveals nystagmus",
"patient",
"unable to complete finger",
"nose",
"heel",
"shin testing",
"Chart review shows",
"patient",
"wel... |
A 6-month-old boy is referred to a geneticist after he is found to have persistent hypotonia and failure to thrive. He has also had episodes of what appears to be respiratory distress and has an enlarged heart on physical exam. There is a family history of childhood onset hypertrophic cardiomyopathy, so a biopsy is per... | Lysosomal alpha 1,4-glucosidase | {
"A": "Glucose-6-phosphatase",
"B": "Lysosomal alpha 1,4-glucosidase",
"C": "Debranching enzyme",
"D": "Branching enzyme"
} | step1 | B | [
"month old boy",
"referred",
"geneticist",
"found to",
"persistent hypotonia",
"failure to thrive",
"episodes of",
"appears to",
"respiratory distress",
"enlarged heart",
"physical exam",
"family history of childhood onset hypertrophic cardiomyopathy",
"biopsy",
"performed showing electron... |
A 68-year-old man is brought to the physician by his wife because she is concerned about his speech being irregular. Specifically, she says that over the last 8 months, her husband has been saying increasingly nonsensical statements at home. In addition, he is no longer able to perform basic verbal tasks such as orderi... | Hyperphosphorylated tau inclusion bodies | {
"A": "Alpha-synuclein",
"B": "Hyperphosphorylated tau inclusion bodies",
"C": "Large intracellular vacuoles",
"D": "Perivascular inflammation"
} | step1 | B | [
"68 year old man",
"brought",
"physician",
"wife",
"concerned",
"speech",
"irregular",
"last",
"months",
"husband",
"nonsensical statements",
"home",
"addition",
"longer able to perform basic verbal tasks",
"giving directions",
"English teacher prior to retirement",
"reports",
"rec... |
A 3-year-old boy is brought to your pediatrics office by his parents for a well-child checkup. The parents are Amish and this is the first time their child has seen a doctor. His medical history is unknown, and he was born at 39 weeks gestation. His temperature is 98.3°F (36.8°C), blood pressure is 97/58 mmHg, pulse is... | Hearing exam | {
"A": "Educating the parents about autism spectrum disorder",
"B": "Hearing exam",
"C": "Restructuring of the home environment",
"D": "Risperidone"
} | step2&3 | B | [
"3 year old boy",
"brought",
"pediatrics office",
"parents",
"well checkup",
"parents",
"Amish",
"first time",
"child",
"seen",
"doctor",
"medical history",
"unknown",
"born",
"weeks gestation",
"temperature",
"98",
"36",
"blood pressure",
"97 58 mmHg",
"pulse",
"90 min",
... |
A 26-year-old primigravid woman at 39 weeks' gestation is admitted to the hospital in active labor. Pregnancy was complicated by mild oligohydramnios detected a week ago, which was managed with hydration. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Pelvic examination shows 100% cer... | Maternal repositioning and oxygen administration | {
"A": "Emergent cesarean section",
"B": "Reassurance",
"C": "Maternal repositioning and oxygen administration",
"D": "Elevation of the fetal head"
} | step2&3 | C | [
"year old primigravid woman",
"weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"Pregnancy",
"complicated",
"mild oligohydramnios detected",
"week",
"managed",
"hydration",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"76 mm Hg",
"Pelvic examination shows ... |
A 22-year-old sexually active female presents to the emergency department in severe pain. She states that she has significant abdominal pain that seems to worsen whenever she urinates. This seems to have progressed over the past day and is accompanied by increased urge and frequency. The emergency room physician obtain... | Staphylococcus saprophyticus | {
"A": "Klebsiella pneumoniae",
"B": "Staphylococcus saprophyticus",
"C": "Escherichia coli",
"D": "Serratia marcescens"
} | step1 | B | [
"year old sexually active female presents",
"emergency department",
"severe pain",
"states",
"significant abdominal pain",
"to worsen",
"to",
"progressed",
"past day",
"increased",
"frequency",
"emergency physician obtains",
"urinalysis",
"demonstrates",
"following",
"SG",
"1",
"Le... |
A 10-year-old boy is brought to the emergency department due to vomiting and weakness. He is attending a summer camp and was on a hike with the other kids and a camp counselor. His friends say that the boy skipped breakfast, and the counselor says he forgot to pack snacks for the kids during the hike. The child’s paren... | Acyl-CoA dehydrogenase | {
"A": "α-glucosidase",
"B": "Acyl-CoA dehydrogenase",
"C": "Glucose-6-phosphatase",
"D": "Nicotinic acid"
} | step1 | B | [
"A 10 year old boy",
"brought",
"emergency department",
"vomiting",
"weakness",
"attending",
"summer camp",
"kids",
"camp counselor",
"friends",
"boy skipped breakfast",
"counselor",
"forgot to pack snacks",
"kids",
"childs parents",
"contacted",
"report",
"child",
"completely he... |
A middle aged man is brought in by emergency medical services after being found unconscious, lying on the street next to an empty bottle of vodka. His past medical history is unknown. Upon evaluation, he opens his eyes spontaneously and is able to obey commands. After peripheral access is obtained, IV normal saline and... | Vitamin B1 | {
"A": "Vitamin A",
"B": "Vitamin B9",
"C": "Vitamin B6",
"D": "Vitamin B1"
} | step1 | D | [
"middle aged man",
"brought",
"emergency medical services",
"found unconscious",
"lying",
"street next to",
"empty bottle",
"vodka",
"past medical history",
"unknown",
"evaluation",
"opens",
"eyes",
"able",
"commands",
"peripheral access",
"obtained",
"IV normal",
"glucose",
"a... |
A 22-year-old woman is brought to the physician by her husband because of a gradual 20-kg (45-lb) weight loss and recurrent episodes of vomiting without diarrhea over the past 2 years. Her last menstrual period was 6 months ago. On physical examination, she appears fatigued and emaciated, and there is bilateral swellin... | Decreased triiodothyronine | {
"A": "Decreased growth hormone",
"B": "Increased testosterone",
"C": "Decreased triiodothyronine",
"D": "Increased beta-hCG"
} | step1 | C | [
"year old woman",
"brought",
"physician",
"husband",
"gradual 20 kg",
"weight loss",
"recurrent episodes of vomiting",
"diarrhea",
"past",
"years",
"last menstrual period",
"months",
"physical examination",
"appears fatigued",
"emaciated",
"bilateral swelling",
"fossa",
"Laboratory... |
A 32-year-old man presents to the physician with a history of fever, malaise, and arthralgia in the large joints for the last 2 months. He also mentions that his appetite has been significantly decreased during this period, and he has lost considerable weight. He also informs the physician that he often experiences tin... | Hepatitis B virus | {
"A": "Hepatitis B virus",
"B": "Epstein-Barr virus infection",
"C": "Mycoplasma pneumoniae",
"D": "Chlamydophila pneumoniae"
} | step1 | A | [
"year old man presents",
"physician",
"history",
"fever",
"malaise",
"arthralgia",
"large joints",
"last",
"months",
"appetite",
"decreased",
"period",
"lost",
"weight",
"informs",
"physician",
"often experiences tingling",
"numbness",
"right",
"urine",
"dark",
"color",
"... |
A 20-year-old man presents to his physician with diarrhea, vomiting, and fever for the past 2 days. After laboratory evaluation, he is diagnosed with bacterial gastroenteritis. The man is a microbiology major and knows that the human gastrointestinal tract, respiratory tract, and skin are lined by epithelia which act a... | γδ T cells | {
"A": "Naïve T cells",
"B": "Natural killer T cells",
"C": "Αβ T cells",
"D": "γδ T cells"
} | step1 | D | [
"20 year old man presents",
"physician",
"diarrhea",
"vomiting",
"fever",
"past 2 days",
"laboratory evaluation",
"diagnosed",
"bacterial gastroenteritis",
"man",
"microbiology major",
"human gastrointestinal tract",
"respiratory tract",
"skin",
"lined",
"epithelia",
"act",
"barrie... |
A 28-year-old man presents with a yellow coloration of his skin. He says he feels well and denies any recent history of nausea, fatigue or fever, or discoloration of his urine or stool. The patient reports episodes with similar symptoms in the past. Family history is significant for similar symptoms in his father. The ... | No therapy indicated | {
"A": "Inhibitors of heme oxygenase",
"B": "Phenobarbital",
"C": "No therapy indicated",
"D": "Plasma exchange transfusion"
} | step1 | C | [
"year old man presents",
"yellow coloration of",
"skin",
"feels well",
"denies",
"recent history",
"nausea",
"fatigue",
"fever",
"discoloration",
"urine",
"stool",
"patient reports episodes",
"similar symptoms",
"past",
"Family",
"significant",
"similar symptoms",
"father",
"pa... |
A 5-month-old boy is brought to the physician by his mother because of poor weight gain and chronic diarrhea. He has had 3 episodes of otitis media since birth. Pregnancy and delivery were uncomplicated but his mother received no prenatal care. His immunizations are up-to-date. He is at the 10th percentile for height a... | Zidovudine | {
"A": "Fluconazole",
"B": "Pencillin G",
"C": "Zidovudine",
"D": "Rifampin"
} | step1 | C | [
"5 month old boy",
"brought",
"physician",
"mother",
"poor weight gain",
"chronic diarrhea",
"3 episodes of otitis media",
"birth",
"Pregnancy",
"delivery",
"uncomplicated",
"mother received",
"prenatal care",
"immunizations",
"date",
"percentile",
"height",
"5th percentile",
"we... |
In the coronary steal phenomenon, vessel dilation is paradoxically harmful because blood is diverted from ischemic areas of the myocardium. Which of the following is responsible for the coronary steal phenomenon? | Microvessel dilation | {
"A": "Venodilation",
"B": "Microvessel dilation",
"C": "Arterial dilation",
"D": "Volume loss of fluid in the periphery"
} | step1 | B | [
"coronary steal phenomenon",
"vessel dilation",
"blood",
"diverted",
"ischemic areas",
"myocardium",
"following",
"responsible",
"coronary steal phenomenon"
] |
A 15-year-old boy is brought to the emergency department one hour after sustaining an injury during football practice. He collided head-on into another player while wearing a mouthguard and helmet. Immediately after the collision he was confused but able to use appropriate words. He opened his eyes spontaneously and fo... | Observe for 6 hours in the ED and refrain from contact sports for one week | {
"A": "Discharge without activity restrictions",
"B": "Administer prophylactic phenytoin and observe for 24 hours",
"C": "Discharge and refrain from all physical activity for one week",
"D": "Observe for 6 hours in the ED and refrain from contact sports for one week"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department one hour",
"sustaining",
"injury",
"football practice",
"head",
"mouthguard",
"helmet",
"Immediately",
"collision",
"confused",
"able to use appropriate words",
"opened",
"eyes",
"followed commands",
"loss of consciousness",
"headach... |
A 26-year-old woman comes to the emergency department 30 minutes after she was bitten by her neighbor's cat. She has no history of serious illness and takes no medications. She received all recommended immunizations during childhood but has not received any since then. Vital signs are within normal limits. Physical exa... | Administer oral amoxicillin-clavulanate | {
"A": "Obtain a wound culture",
"B": "Administer oral amoxicillin-clavulanate",
"C": "Close the wound surgically",
"D": "Close the wound with cyanoacrylate tissue adhesive"
} | step2&3 | B | [
"year old woman",
"emergency department 30 minutes",
"bitten by",
"neighbor's cat",
"history",
"serious illness",
"takes",
"medications",
"received",
"recommended immunizations",
"childhood",
"not received",
"since then",
"Vital signs",
"normal",
"Physical examination shows four punctu... |
An 11-month-old boy is brought to the pediatrician by his mother due to fever and tugging at his right ear. The mother says that he is currently irritable with a mild fever. About 1 week ago, he had a mild cough, mild fever, body aches, and a runny nose. He was treated with children’s Tylenol and the symptoms resolved... | Second hand smoke | {
"A": "Day care exposure",
"B": "Cystic Fibrosis",
"C": "Immunodeficiency",
"D": "Second hand smoke"
} | step2&3 | D | [
"month old boy",
"brought",
"pediatrician",
"mother due to fever",
"tugging",
"right ear",
"mother",
"currently irritable",
"mild fever",
"1 week",
"mild cough",
"mild fever",
"body aches",
"runny nose",
"treated with",
"Tylenol",
"symptoms resolved",
"days",
"child lives in",
... |
A 43-year-old male is transferred from an outside hospital to the neurologic intensive care unit for management of a traumatic brain injury after suffering a 30-foot fall from a roof-top. He now lacks decision-making capacity but does not fulfill the criteria for brain-death. The patient does not have a living will and... | The patient's 22-year-old daughter | {
"A": "The patient's 67-year-old mother",
"B": "The patient's girlfriend of 12 years",
"C": "The patient's 22-year-old daughter",
"D": "The patient's older brother"
} | step1 | C | [
"year old male",
"transferred",
"outside hospital",
"intensive care unit",
"traumatic brain injury",
"suffering",
"30 foot fall from",
"roof top",
"now lacks decision-making capacity",
"not fulfill",
"criteria",
"brain-death",
"patient",
"not",
"living will",
"not name",
"specific su... |
A previously healthy 33-year-old woman comes to the emergency department because she could feel her heart racing intermittently for the last 2 hours. Each episode lasts about 10 minutes. She does not have any chest pain. Her mother died of a heart attack and her father had an angioplasty 3 years ago. She has smoked a h... | Vagal maneuvers | {
"A": "Intravenous procainamide",
"B": "Vagal maneuvers",
"C": "Coronary angioplasty",
"D": "Aspirin"
} | step2&3 | B | [
"healthy",
"year old woman",
"emergency department",
"feel",
"heart racing",
"hours",
"episode",
"10 minutes",
"not",
"chest pain",
"mother died",
"heart attack",
"father",
"angioplasty",
"years",
"smoked",
"half pack",
"cigarettes daily",
"years",
"drinks one",
"two beers da... |
A 19-year-old female presents with a malodorous vaginal discharge. She notes that the odor is more prominent after sexual intercourse. She is sexually active with one partner and uses barrier contraception. Her past medical history is significant only for community-acquired pneumonia treated with antibiotics 2 months a... | Bacteria-coated epithelial cells on wet mount microscopy | {
"A": "Gram-positive diplococci on Gram stain",
"B": "Negative whiff test",
"C": "Bacteria-coated epithelial cells on wet mount microscopy",
"D": "Numerous gram-positive rod-shaped bacteria on Gram stain"
} | step2&3 | C | [
"year old female presents",
"vaginal discharge",
"notes",
"odor",
"more prominent",
"sexual intercourse",
"sexually active",
"one partner",
"uses barrier contraception",
"past medical history",
"significant only",
"community-acquired pneumonia treated with antibiotics",
"months",
"vital si... |
A 42-year-old man presents to the clinic for a several-month history of fatigue, and it is starting to affect his work. He often needs to sneak away in the middle of the day to take naps or else he cannot focus and is at risk of falling asleep at his desk. He has been feeling like this for approximately 1 year. Otherwi... | Levothyroxine | {
"A": "Erythropoietin",
"B": "Levothyroxine",
"C": "Packed red blood cell (RBC) transfusion",
"D": "Prednisone"
} | step2&3 | B | [
"year old man presents",
"clinic",
"several month history",
"fatigue",
"starting to affect",
"work",
"often needs to",
"middle",
"day to take naps",
"else",
"focus",
"at",
"falling asleep",
"feeling",
"approximately",
"year",
"feels healthy",
"takes",
"medications",
"further qu... |
A 22-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been uncomplicated. She has asthma treated with theophylline and inhaled corticosteroids. She has had 2 surgeries in the past to repair multiple lower limb and pelvis fractures that were the result of a car... | Cephalopelvic disproportion | {
"A": "Inefficient maternal pushing",
"B": "Epidural anesthesia",
"C": "Cephalopelvic disproportion",
"D": "Deep transverse arrest"
} | step2&3 | C | [
"year old primigravid woman",
"weeks",
"gestation",
"admitted",
"hospital",
"active labor",
"Pregnancy",
"uncomplicated",
"asthma treated with theophylline",
"inhaled corticosteroids",
"2",
"past to repair multiple lower limb",
"pelvis fractures",
"result",
"car accident",
"healthy",
... |
A senior medicine resident receives negative feedback on a grand rounds presentation from his attending. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his medical student for not showing enough initiative, though he had voiced only satisfaction with the student... | Displacement | {
"A": "Countertransference",
"B": "Externalization",
"C": "Displacement",
"D": "Projection\n\""
} | step1 | C | [
"senior medicine resident receives negative feedback",
"grand rounds presentation",
"attending",
"performance",
"next project",
"Later",
"day",
"medical student",
"not showing",
"initiative",
"voiced only satisfaction",
"student's performance",
"point",
"following psychological defense mec... |
A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. ... | Non-selectively inhibits monoamine oxidase A and B | {
"A": "Inhibit the uptake of serotonin and norepinephrine at the presynaptic cleft",
"B": "Non-selectively inhibits monoamine oxidase A and B",
"C": "Stimulates the release of norepinephrine and dopamine in the presynaptic cleft",
"D": "Works as an antagonist at the dopamine and serotonin receptors"
} | step2&3 | B | [
"year old man visits",
"psychiatrist",
"feelings of sadness",
"days of the week",
"past 4 weeks",
"unable to",
"daily activities",
"finds",
"hard to get out",
"bed",
"days",
"scheduled",
"day",
"sometimes sleeps",
"hours",
"stretch",
"certain days",
"legs feel heavy",
"finds",
... |
A 27-year-old man presents to the emergency department for altered mental status. The patient was found napping in a local market and brought to the hospital. The patient has a past medical history of polysubstance abuse and is homeless. His temperature is 104°F (40.0°C), blood pressure is 100/52 mmHg, pulse is 133/min... | Remove the central line and send for cultures | {
"A": "Add micafungin to the patient’s antibiotics",
"B": "Remove all peripheral IV’s and send for cultures",
"C": "Remove the central line and send for cultures",
"D": "Perform a lumbar puncture"
} | step2&3 | C | [
"27 year old man presents",
"emergency department",
"altered mental status",
"patient",
"found napping",
"local market",
"brought",
"hospital",
"patient",
"past medical polysubstance abuse",
"homeless",
"temperature",
"40",
"blood pressure",
"100",
"mmHg",
"pulse",
"min",
"respir... |
A 25-year-old man is brought to the emergency department by his girlfriend for a nosebleed. Pinching the nose for the past hour has not stopped the bleeding. For the past several months, he has had recurring nosebleeds that resolved with pressure. He has no history of hypertension or trauma. He has asthma that is well ... | Cocaine use | {
"A": "Hereditary hemorrhagic telangiectasia",
"B": "Adverse effect of medication",
"C": "Cocaine use",
"D": "Nasopharyngeal angiofibroma\n\""
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"girlfriend",
"nosebleed",
"Pinching",
"nose",
"past hour",
"not stopped",
"bleeding",
"past",
"months",
"recurring nosebleeds",
"resolved",
"pressure",
"history of hypertension",
"trauma",
"asthma",
"well controlled",
"albuter... |
A 36-year-old man presents with increasing shortness of breath for a month, which is aggravated while walking and climbing up the stairs. He also complains of pain and stiffness in both wrists, and the distal interphalangeal and metacarpophalangeal joints of both hands. He was diagnosed with rheumatoid arthritis 6 mont... | Drug-induced pulmonary disease | {
"A": "Granulomatous lung disease",
"B": "Drug-induced pulmonary disease",
"C": "Cardiogenic pulmonary edema",
"D": "Radiation-induced pulmonary disease"
} | step1 | B | [
"36 year old man presents",
"increasing shortness of breath",
"month",
"aggravated",
"walking",
"climbing",
"stairs",
"pain",
"stiffness",
"wrists",
"distal",
"joints of",
"hands",
"diagnosed",
"rheumatoid arthritis",
"months",
"started",
"methotrexate",
"improvement",
"lifetim... |
A 27-year-old man presents to the emergency department after being stabbed. The patient was robbed at a local pizza parlor and was stabbed over 10 times with a large kitchen knife with an estimated 7 inch blade in the ventral abdomen. His temperature is 97.6°F (36.4°C), blood pressure is 74/54 mmHg, pulse is 180/min, r... | Exploratory laparotomy | {
"A": "CT scan of the abdomen and pelvis",
"B": "Diagnostic peritoneal lavage",
"C": "Exploratory laparoscopy",
"D": "Exploratory laparotomy"
} | step2&3 | D | [
"27 year old man presents",
"emergency department",
"stabbed",
"patient",
"local pizza",
"stabbed",
"10 times",
"large kitchen knife",
"estimated",
"inch blade",
"ventral abdomen",
"temperature",
"97",
"36 4C",
"blood pressure",
"74 54 mmHg",
"pulse",
"min",
"respirations",
"mi... |
A 37-year-old woman comes to the physician because of irregular menses and generalized fatigue for the past 4 months. Menses previously occurred at regular 25- to 29-day intervals and lasted for 5 days but now occur at 45- to 60-day intervals. She has no history of serious illness and takes no medications. She is 155 c... | Cushing syndrome | {
"A": "Cushing syndrome",
"B": "Primary hyperaldosteronism",
"C": "Polycystic ovarian syndrome",
"D": "Hypothyroidism"
} | step2&3 | A | [
"year old woman",
"physician",
"irregular menses",
"generalized fatigue",
"past",
"months",
"Menses",
"occurred",
"regular",
"29 day intervals",
"lasted",
"5 days",
"now occur",
"60 day intervals",
"history",
"serious illness",
"takes",
"medications",
"5 ft",
"tall",
"kg",
... |
A 18-year-old male presents to his primary care provider with his parents for a sports physical. He was last seen in clinic several months ago, when he was diagnosed with attention deficit hyperactivity disorder (ADHD). He was started on methylphenidate at that time, and the patient now reports improvement in his abili... | Meiotic nondisjunction | {
"A": "Anabolic steroid use",
"B": "CGG trinucleotide repeat disorder",
"C": "Failure of neuronal migration",
"D": "Meiotic nondisjunction"
} | step2&3 | D | [
"year old male presents",
"primary care provider",
"parents",
"sports physical",
"last seen in clinic",
"months",
"diagnosed with attention deficit hyperactivity disorder",
"started",
"methylphenidate",
"time",
"patient now reports improvement",
"ability to concentrate in school",
"at home",... |
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