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 |
|---|---|---|---|---|---|
Following passage of a calcium oxalate stone, a 55-year-old male visits his physician to learn about nephrolithiasis prevention. Which of the following changes affecting urine composition within the bladder are most likely to protect against crystal precipitation? | Decreased calcium, increased citrate, decreased oxalate, increased free water clearance | {
"A": "Increased calcium, increased citrate, increased oxalate, increased free water clearance",
"B": "Decreased calcium, increased citrate, increased oxalate, increased free water clearance",
"C": "Decreased calcium, increased citrate, decreased oxalate, increased free water clearance",
"D": "Decreased calciu... | step1 | C | [
"Following passage",
"calcium oxalate stone",
"55 year old male visits",
"physician to learn",
"nephrolithiasis prevention",
"following changes affecting urine composition",
"bladder",
"most likely to",
"crystal precipitation"
] |
A 67-year-old woman is brought to the emergency department for the evaluation of fever, chest pain, and a cough productive of a moderate amount of greenish-yellow sputum for 2 days. During this period, she has had severe malaise, chills, and difficulty breathing. She has hypertension, hypercholesterolemia, and type 2 d... | Inpatient treatment with azithromycin and cefotaxime | {
"A": "Inpatient treatment with cefepime, azithromycin, and gentamicin",
"B": "Outpatient treatment with azithromycin and amoxicillin-clavulanate",
"C": "Inpatient treatment with azithromycin and cefotaxime",
"D": "Inpatient treatment with ceftriaxone"
} | step2&3 | C | [
"67 year old woman",
"brought",
"emergency department",
"evaluation",
"fever",
"chest pain",
"cough productive",
"moderate amount",
"yellow",
"2 days",
"period",
"severe malaise",
"chills",
"difficulty breathing",
"hypertension",
"hypercholesterolemia",
"type 2 diabetes mellitus",
... |
A study is conducted to investigate the relationship between the development of type 2 diabetes mellitus and the use of atypical antipsychotic medications in patients with schizophrenia. 300 patients who received the atypical antipsychotic clozapine and 300 patients who received the typical antipsychotic haloperidol in... | 0.03 | {
"A": "33.3",
"B": "0.3",
"C": "0.03",
"D": "1.48"
} | step1 | C | [
"study",
"conducted to investigate",
"relationship",
"development",
"type 2 diabetes mellitus",
"use of atypical",
"patients",
"schizophrenia",
"300 patients",
"received",
"atypical antipsychotic clozapine",
"300 patients",
"received",
"typical antipsychotic haloperidol",
"long acting in... |
A 44-year-old woman presents to her primary care physician for worsening dysuria, hematuria, and lower abdominal pain. Her symptoms began approximately 2 days ago and have progressively worsened. She denies headache, nausea, vomiting, or diarrhea. She endorses feeling "feverish" and notes to having foul smelling urine.... | Tobramycin | {
"A": "Aztreonam",
"B": "Clindamycin",
"C": "Levofloxacin",
"D": "Tobramycin"
} | step2&3 | D | [
"year old woman presents",
"primary care physician",
"worsening dysuria",
"hematuria",
"lower abdominal pain",
"symptoms began approximately",
"days",
"worsened",
"denies headache",
"nausea",
"vomiting",
"diarrhea",
"feeling",
"feverish",
"notes to",
"foul smelling urine",
"past medi... |
A 58-year-old man presents to the physician due to difficulty initiating and sustaining erections for the past year. According to the patient, he has a loving wife and he is still attracted to her sexually. While he still gets an occasional erection, he has not been able to maintain an erection throughout intercourse. ... | Check prolactin levels | {
"A": "Check prolactin levels",
"B": "Refer to a psychiatrist",
"C": "Start sildenafil",
"D": "Stop isosorbide dinitrate"
} | step1 | A | [
"58 year old man presents",
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"difficulty initiating",
"sustaining erections",
"past year",
"patient",
"loving wife",
"sexually",
"gets",
"occasional erection",
"not",
"able to maintain",
"erection",
"intercourse",
"longer gets morning erections",
"happy",
"work",
"feels... |
A 3-year-old girl is brought to the physician because of a cough for 2 days. The cough occurs as paroxysmal spells, with vomiting sometimes occurring afterwards. She takes a deep breath after these spells that makes a whooping sound. She has been unable to sleep well because of the cough. She had a runny nose and low-g... | Pneumothorax | {
"A": "Asthma",
"B": "Hemolytic anemia",
"C": "Pericarditis",
"D": "Pneumothorax"
} | step2&3 | D | [
"3 year old girl",
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"physician",
"of",
"cough",
"2 days",
"cough occurs",
"paroxysmal spells",
"vomiting sometimes occurring",
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"deep breath",
"spells",
"makes",
"whooping sound",
"unable to sleep well",
"cough",
"runny nose",
"low-grade fever",
"week",
"admit... |
A 34-year-old man is brought to the emergency room by emergency medical technicians after being found unconscious near a park bench. He appears disheveled with a strong odor of alcohol. There is no known past medical history other than treatment for alcohol withdrawal in the past at this institution.The patient is layi... | Glycogen depletion | {
"A": "Increase in insulin secretion",
"B": "A decrease in the ratio of reduced form of nicotinamide adenine dinucleotide to nicotinamide adenine dinucleotide (NADH/NAD+ ratio)",
"C": "Alcohol dehydrogenase-induced diuresis",
"D": "Glycogen depletion"
} | step1 | D | [
"year old man",
"brought",
"emergency room",
"emergency medical technicians",
"found unconscious",
"park",
"appears",
"strong odor",
"alcohol",
"known past medical history",
"treatment",
"alcohol withdrawal",
"past",
"institution",
"patient",
"laying",
"stretcher",
"altered mental ... |
A 68-year-old man is admitted to the emergency department after 2 days of difficulty breathing and fever. His past medical history is significant for hypertension and benign prostate hypertrophy. He takes hydrochlorothiazide and tamsulosin. He also admits to drinking alcohol on the weekends and a half pack a day smoki... | White blood cell casts | {
"A": "White blood cell casts",
"B": "Urate crystals",
"C": "Hyaline casts",
"D": "Calcium oxalate crystals"
} | step2&3 | A | [
"68 year old man",
"admitted",
"emergency department",
"2 days",
"difficulty breathing",
"fever",
"past medical history",
"significant",
"hypertension",
"benign prostate hypertrophy",
"takes hydrochlorothiazide",
"tamsulosin",
"admits",
"drinking alcohol",
"weekends",
"half pack",
"d... |
A 29-year-old man comes to the emergency department because of progressively worsening fatigue and shortness of breath for the past 2 weeks. His only medication is insulin. Examination shows elevated jugular venous distention and coarse crackles in both lungs. Despite appropriate life-saving measures, he dies. Gross ex... | GAA trinucleotide repeat expansion on chromosome 9 | {
"A": "SOD1 gene mutation on chromosome 21",
"B": "Dystrophin gene mutation on the X chromosome",
"C": "GAA trinucleotide repeat expansion on chromosome 9",
"D": "SMN1 gene mutation on chromosome 5"
} | step1 | C | [
"29 year old man",
"emergency department",
"worsening fatigue",
"shortness of breath",
"past 2 weeks",
"only medication",
"insulin",
"Examination shows elevated jugular venous distention",
"coarse crackles",
"lungs",
"appropriate life saving measures",
"Gross examination of",
"heart",
"aut... |
A 51-year-old woman comes to the physician because of a 3-month history of fatigue, increased urinary frequency, and low back pain. She reports frequent passing of hard stools, despite using stool softeners. During this time, she has not been as involved with her weekly book club. Her family is concerned that she is de... | Chief cells in the parathyroid gland | {
"A": "Chief cells in the parathyroid gland",
"B": "Parafollicular cells in the thyroid gland",
"C": "Spindle cells in the kidney",
"D": "Kulchitsky cells in the lung"
} | step1 | A | [
"year old woman",
"physician",
"3 month history",
"fatigue",
"increased urinary frequency",
"low back pain",
"reports frequent passing of hard stools",
"using stool softeners",
"time",
"not",
"involved",
"weekly book club",
"family",
"concerned",
"depressed",
"history",
"serious illn... |
A 43-year-old woman comes to the physician because of a 3-month history of increased flow and duration of her menses. Menses previously occurred at regular 28-day intervals and lasted 5 days with normal flow. They now last 8–9 days and the flow is heavy with the passage of clots. During this period, she has also had lo... | Endometrial tissue within the uterine wall | {
"A": "Benign tumor of the myometrium",
"B": "Endometrial tissue within the uterine wall",
"C": "Abnormal thickening of endometrial tissue",
"D": "Inflammation of the endometrium"
} | step2&3 | B | [
"year old woman",
"physician",
"3 month history",
"increased flow",
"duration",
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"occurred",
"regular",
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"normal flow",
"now last",
"days",
"flow",
"heavy",
"passage",
"clots",
"period",
"lower abdominal pain",
"begins 23 days prior to ... |
A 54-year-old man comes to the emergency department because of abdominal distension for the past 3 weeks. He also complains of generalized abdominal discomfort associated with nausea and decreased appetite. He was discharged from the hospital 3 months ago after an inguinal hernia repair with no reported complications. ... | Lymphoma | {
"A": "Recent surgery",
"B": "Lymphoma",
"C": "Infection with gram-positive bacteria",
"D": "Acute decompensated heart failure"
} | step2&3 | B | [
"54 year old man",
"emergency department",
"of abdominal distension",
"past",
"weeks",
"generalized abdominal associated with nausea",
"decreased appetite",
"discharged from",
"hospital",
"months",
"inguinal hernia repair",
"reported complications",
"history of type 2 diabetes mellitus",
"... |
A 29-year-old woman presents with a skin rash that has spread on her arm over the last few days. She also complains of fever, headache, joint pain, and stiffness of the neck associated with the onset of the rash. On physical examination, there is an annular, red rash with a clear area in the center similar to a bull’s-... | Bell’s palsy | {
"A": "Necrotizing fasciitis",
"B": "Bell’s palsy",
"C": "Pseudomembranous colitis",
"D": "Mitral valve prolapse"
} | step1 | B | [
"29 year old woman presents",
"skin rash",
"spread",
"arm",
"last",
"days",
"fever",
"headache",
"joint pain",
"stiffness",
"neck associated with",
"onset",
"rash",
"physical examination",
"annular",
"red rash",
"clear area",
"center similar",
"bulls-eye",
"see image",
"patie... |
A 45-year-old man presents to the office with complaints of facial puffiness and mild swelling in his lower back. He denies chest pain, blood in the urine, or fever. He was recently diagnosed with colon cancer. The vital signs include a blood pressure of 122/78 mm Hg, a pulse of 76/min, a temperature of 36.9°C (98.4°F)... | Spike and dome appearance | {
"A": "Effacement of foot process",
"B": "Subepithelial humps",
"C": "Spike and dome appearance",
"D": "Massive amyloid deposition and spicular aggregates"
} | step1 | C | [
"year old man presents",
"office",
"complaints",
"facial puffiness",
"mild swelling",
"lower back",
"denies chest pain",
"blood in",
"urine",
"fever",
"recently diagnosed",
"colon cancer",
"vital signs include",
"blood pressure",
"mm Hg",
"pulse",
"76 min",
"temperature",
"36",
... |
A 16-year-old female presents to her pediatrician’s office because she has not yet started menstruating. On review of systems, she states that she has been increasingly tired, constipated, and cold over the last 6 months. She also endorses a long history of migraines with aura that have increased in frequency over the ... | FSH and estrogen levels | {
"A": "Pelvic exam",
"B": "Prolactin level",
"C": "GnRH level",
"D": "FSH and estrogen levels"
} | step2&3 | D | [
"year old female presents",
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"not",
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"review of systems",
"states",
"tired",
"constipated",
"cold",
"months",
"long history of migraines",
"aura",
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"frequency",
"last year",
"symptoms",
"affected",
"performance",
"track team",
"state... |
An investigator is working with a mutant strain of mice that lack a consistent density of sarcolemmal transverse tubules in the skeletal muscle cells. Which of the following is the most likely associated finding as a result of this abnormality? | Impaired synchronization of cross-bridge formation | {
"A": "Decreased entry of calcium at the presynaptic membrane",
"B": "Decreased expression of sarcolemmal Na+/K+ ATPase",
"C": "Impaired synchronization of cross-bridge formation",
"D": "Impaired binding of acetylcholine to nicotinic acetylcholine receptors\n\""
} | step1 | C | [
"investigator",
"working",
"mutant strain of mice",
"lack",
"consistent density",
"transverse tubules",
"skeletal muscle cells",
"following",
"most likely associated finding",
"result",
"abnormality"
] |
A 4-year-old male is accompanied by his mother to the pediatrician. His mother reports that over the past two weeks, the child has had intermittent low grade fevers and has been more lethargic than usual. The child’s past medical history is notable for myelomeningocele complicated by lower extremity weakness as well as... | Tubular colloid casts with diffuse lymphoplasmacytic infiltrate | {
"A": "Mononuclear and eosinophilic infiltrate",
"B": "Replacement of renal parenchyma with foamy histiocytes",
"C": "Destruction of the proximal tubule and medullary thick ascending limb",
"D": "Tubular colloid casts with diffuse lymphoplasmacytic infiltrate"
} | step1 | D | [
"4 year old male",
"mother",
"pediatrician",
"mother reports",
"past two weeks",
"child",
"intermittent low grade fevers",
"more lethargic",
"usual",
"childs past medical history",
"notable",
"myelomeningocele complicated",
"lower extremity weakness",
"bowel",
"bladder dysfunction",
"h... |
A 5-month-old girl is brought to the physician with a red lesion on her scalp that was first noticed 2 months ago. The lesion has been increasing in size slowly. It is not associated with pain or pruritus. She was born at 37 weeks of gestation after an uncomplicated pregnancy and delivery. The patient’s older sister is... | Reassurance and follow-up | {
"A": "Intralesional bevacizumab",
"B": "Laser ablation",
"C": "Reassurance and follow-up",
"D": "Topical clobetasol"
} | step2&3 | C | [
"5 month old girl",
"brought",
"physician",
"red lesion",
"scalp",
"first",
"2 months",
"lesion",
"increasing in size slowly",
"not associated with pain",
"pruritus",
"born",
"weeks of gestation",
"uncomplicated pregnancy",
"delivery",
"patients older sister",
"currently",
"treatme... |
A 65-year-old man is admitted to the hospital because of a 1-month history of fatigue, intermittent fever, and weakness. Results from a peripheral blood smear taken during his evaluation are indicative of possible acute myeloid leukemia. Bone marrow aspiration and subsequent cytogenetic studies confirm the diagnosis. T... | """What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?""" | {
"A": "\"\"\"Your lab reports show that you have a acute myeloid leukemia\"\"\"",
"B": "\"\"\"What is your understanding of the reasons we did bone marrow aspiration and cytogenetic studies?\"\"\"",
"C": "\"\"\"Would you like to know all the details of your diagnosis, or would you prefer I just explain to you wh... | step2&3 | B | [
"65 year old man",
"admitted",
"hospital",
"month history",
"fatigue",
"intermittent fever",
"weakness",
"Results",
"peripheral blood smear taken",
"evaluation",
"possible acute myeloid leukemia",
"Bone marrow aspiration",
"subsequent cytogenetic studies confirm",
"diagnosis",
"physician... |
A 53-year-old homeless woman is brought to the emergency department by the police after she was found in the park lying unconscious on the ground. Both of her pupils are normal in size and reactive to light. There are no signs of head trauma. Finger prick test shows a blood glucose level of 20 mg/dL. She has been broug... | AST > ALT, increased gamma-glutamyl transferase | {
"A": "AST > ALT, increased gamma-glutamyl transferase",
"B": "Decreased ALP",
"C": "AST > ALT, normal gamma glutamyl transferase",
"D": "Decreased MCV"
} | step1 | A | [
"year old homeless woman",
"brought",
"emergency department",
"police",
"found",
"park lying unconscious",
"pupils",
"normal",
"size",
"reactive to light",
"signs",
"head trauma",
"Finger shows",
"blood glucose level",
"20 mg/dL",
"brought",
"emergency department",
"acute alcohol i... |
A 37-year-old woman comes to the physician because of difficulty swallowing for the past 1 year. She was diagnosed with gastroesophageal reflux 3 years ago and takes pantoprazole. She has smoked a pack of cigarettes daily for 14 years. Examination shows hardening of the skin of the fingers and several white papules on ... | Esophageal smooth muscle fibrosis | {
"A": "Esophageal smooth muscle fibrosis",
"B": "Degeneration of neurons within esophageal wall",
"C": "Outpouching of the lower pharyngeal mucosa",
"D": "Demyelination of brain and spinal cord axons"
} | step1 | A | [
"year old woman",
"physician",
"of difficulty swallowing",
"past",
"year",
"diagnosed",
"gastroesophageal reflux",
"years",
"takes pantoprazole",
"smoked",
"pack",
"cigarettes daily",
"years",
"Examination shows hardening of",
"skin",
"fingers",
"several white papules",
"fingertips... |
A 68-year-old man presents for his first hemodialysis treatment. He was diagnosed with progressive chronic kidney disease 6 years ago that has now resulted in end-stage renal disease (ESRD). He currently is on a waiting list for a kidney transplant. His past medical history is significant for hypertension and peptic ul... | Protein intake | {
"A": "Sodium intake",
"B": "Potassium intake",
"C": "Protein intake",
"D": "Fiber intake"
} | step2&3 | C | [
"68 year old man presents",
"first hemodialysis treatment",
"diagnosed",
"progressive chronic kidney disease 6 years",
"now resulted",
"end-stage renal disease",
"currently",
"waiting list",
"kidney transplant",
"past medical history",
"significant",
"hypertension",
"peptic ulcer disease",
... |
A 36-year-old woman presents to the outpatient department with a recent onset of generalized weakness and weight gain. On physical examination, there is diffuse nontender enlargement of the thyroid gland. Fine-needle aspiration and cytology show lymphocytic infiltration with germinal centers and epithelial Hürthle cell... | Antimicrosomal antibody | {
"A": "Anti-TSH receptor antibody",
"B": "Antimicrosomal antibody",
"C": "Antihistone antibody",
"D": "Anti-parietal cell antibody"
} | step1 | B | [
"36 year old woman presents",
"outpatient department",
"recent onset",
"generalized weakness",
"weight gain",
"physical examination",
"diffuse nontender enlargement of",
"thyroid gland",
"Fine-needle aspiration",
"cytology show lymphocytic infiltration",
"germinal centers",
"epithelial",
"ce... |
A 27-year-old woman is brought to the office at the insistence of her fiancé to be evaluated for auditory hallucinations for the past 8 months. The patient’s fiancé tells the physician that the patient often mentions that she can hear her own thoughts speaking aloud to her. The hallucinations have occurred intermittent... | Schizophrenia | {
"A": "Schizophrenia",
"B": "Schizophreniform disorder",
"C": "Schizoid personality disorder",
"D": "Schizoaffective disorder"
} | step2&3 | A | [
"27 year old woman",
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"office",
"to",
"evaluated",
"auditory hallucinations",
"past",
"months",
"patients",
"physician",
"patient often",
"hear",
"thoughts speaking",
"hallucinations",
"occurred",
"month periods",
"Past medical history",
"significant",
"hypertension",
... |
You are seeing an otherwise healthy 66-year-old male in clinic who is complaining of localized back pain and a new rash. On physical exam, his vital signs are within normal limits. You note a vesicular rash restricted to the upper left side of his back. In order to confirm your suspected diagnosis, you perform a diagno... | Multinucleated giant cells | {
"A": "Gram positive cocci",
"B": "Gram negative bacilli",
"C": "Branching pseudohyphae",
"D": "Multinucleated giant cells"
} | step1 | D | [
"seeing",
"healthy 66 year old male in clinic",
"localized back pain",
"new rash",
"physical exam",
"vital signs",
"normal limits",
"note",
"vesicular rash restricted",
"upper of",
"back",
"order to confirm",
"suspected diagnosis",
"perform",
"diagnostic test",
"to find",
"diagnostic... |
A 54-year-old man comes to the physician for a follow-up examination after presenting with elevated blood pressures on both arms at a routine visit 1 month ago. He feels well and takes no medications. He is 178 cm (5 ft 10 in) tall and weighs 99 kg (218 lb); BMI is 31 kg/m2. His pulse is 76/min, and blood pressure is 1... | Metanephric blastema | {
"A": "Ureteric bud",
"B": "Metanephric blastema",
"C": "Mesonephric duct",
"D": "Pronephros"
} | step1 | B | [
"54 year old man",
"physician",
"follow-up examination",
"presenting",
"elevated blood pressures",
"arms",
"routine visit",
"month",
"feels well",
"takes",
"medications",
"5 ft 10",
"tall",
"99 kg",
"BMI",
"31 kg/m2",
"pulse",
"76 min",
"blood pressure",
"85 mm Hg",
"right ar... |
An 18-year-old boy is brought to the emergency department by his parents because he suddenly collapsed while playing football. His parents mention that he had complained of dizziness while playing before, but never fainted in the middle of a game. On physical examination, the blood pressure is 130/90 mm Hg, the respira... | Nitrates | {
"A": "Βeta-blockers",
"B": "Dobutamine",
"C": "Potassium channel blockers",
"D": "Nitrates"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"parents",
"collapsed",
"playing football",
"parents",
"dizziness",
"playing before",
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"physical examination",
"blood pressure",
"90 mm Hg",
"respirations",
"min",
"pulse",
"min",
"chest",
"c... |
An investigator is studying the crossbridge cycle of muscle contraction. Tissue from the biceps brachii muscle is obtained at the autopsy of an 87-year-old man. Investigation of the muscle tissue shows myosin heads attached to actin filaments. Binding of myosin heads to which of the following elements would most likely... | ATP | {
"A": "Troponin C",
"B": "ATP",
"C": "Tropomyosin",
"D": "ADP"
} | step1 | B | [
"investigator",
"studying",
"crossbridge cycle",
"muscle",
"Tissue",
"biceps brachii muscle",
"obtained",
"autopsy",
"87 year old man",
"Investigation",
"muscle shows myosin heads attached",
"actin filaments",
"Binding",
"myosin heads",
"following elements",
"most likely cause detachme... |
A 52-year-old man awakens in the middle of the night with excruciating pain in his right great toe. He reports that even the touch of the bed sheet was unbearably painful. His right foot is shown in figure A. He is treated with colchicine. Which of the following describes the mechanism of colchicine? | Decreases microtubule polymerization | {
"A": "Inhibition of xanthine oxidase",
"B": "Inhibition of reabsorption of uric acid in proximal convoluted tubule",
"C": "Binds to glucocorticoid receptor",
"D": "Decreases microtubule polymerization"
} | step1 | D | [
"year old man",
"middle",
"night",
"excruciating pain",
"right great toe",
"reports",
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"painful",
"right foot",
"shown",
"treated with colchicine",
"following",
"mechanism",
"colchicine"
] |
A 15-year-old boy and his mother were referred to a pulmonology clinic. She is concerned that her son is having some breathing difficulty for the past few months, which is aggravated with exercise. The family is especially concerned because the patient’s older brother has cystic fibrosis. The past medical history is no... | Vital capacity | {
"A": "Expiratory reserve volume",
"B": "Tidal volume",
"C": "Total lung capacity",
"D": "Vital capacity"
} | step1 | D | [
"year old boy",
"mother",
"referred",
"pulmonology clinic",
"concerned",
"son",
"breathing difficulty",
"past",
"months",
"aggravated",
"exercise",
"family",
"concerned",
"patients older brother",
"cystic fibrosis",
"past medical history",
"Today",
"vital signs include",
"blood p... |
A 39-year-old woman is brought to the emergency department 30 minutes after her husband found her unconscious on the living room floor. She does not report having experienced light-headedness, nausea, sweating, or visual disturbance before losing consciousness. Three weeks ago, she was diagnosed with open-angle glaucom... | Timolol | {
"A": "Latanoprost",
"B": "Timolol",
"C": "Dorzolamide",
"D": "Tropicamide"
} | step1 | B | [
"year old woman",
"brought",
"emergency department 30 minutes",
"husband found",
"unconscious",
"living room floor",
"not report",
"light-headedness",
"nausea",
"sweating",
"visual",
"consciousness",
"Three weeks",
"diagnosed",
"open-angle glaucoma",
"began treatment",
"drug",
"for... |
A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain... | Intravenous fluids and electrolytes | {
"A": "Esophagogastroduodenoscopy",
"B": "Intravenous fluids and electrolytes",
"C": "Parenteral artesunate plus sulfadoxine/pyrimethamine",
"D": "Use of N95 masks"
} | step2&3 | B | [
"30 year old forest landscape specialist",
"brought",
"emergency department",
"hematemesis",
"confusion",
"One week",
"diagnosed",
"influenza",
"fevers",
"severe headaches",
"myalgias",
"hip",
"shoulder pain",
"maculopapular rash",
"day",
"relative remission",
"abdominal pain",
"vo... |
You have isolated cells from a patient with an unknown disorder and would like to locate the defect in this patient. When radiolabeled propionate is added to the mitochondria, no radiolabeled carbon dioxide is detected. However, when radiolabeled methylmalonic acid is added, radiolabeled carbon dioxide is detected from... | Phenylalanine | {
"A": "Methionine",
"B": "Threonine",
"C": "Isoleucine",
"D": "Phenylalanine"
} | step1 | D | [
"isolated",
"patient",
"unknown disorder",
"to",
"defect",
"patient",
"radiolabeled propionate",
"added",
"mitochondria",
"radiolabeled carbon dioxide",
"detected",
"radiolabeled methylmalonic acid",
"added",
"radiolabeled carbon dioxide",
"detected",
"cells",
"following amino acids"... |
A 21-year-old woman is brought to the clinic for evaluation by her brother. The patient’s brother says that, 3 days ago, the patient had put on her best pantsuit and makeup and insisted that she was returning to work and driving to Seattle to take over for the CEO of the Amazon Corporation. He says this was especially ... | Brief psychotic disorder | {
"A": "Schizoid personality disorder",
"B": "Borderline personality disorder",
"C": "Schizotypal personality disorder",
"D": "Brief psychotic disorder"
} | step2&3 | D | [
"21-year-old woman",
"brought",
"clinic",
"evaluation",
"brother",
"patients brother",
"3 days",
"patient",
"put",
"best",
"makeup",
"returning to work",
"driving",
"take",
"CEO",
"Amazon Corporation",
"odd",
"husband",
"killed",
"automobile accident",
"different city 2 days"... |
A 55-year-old man comes to the physician for a follow-up examination. During the past month, he has had mild itching. He has alcoholic cirrhosis, hypertension, and gastroesophageal reflux disease. He used to drink a pint of vodka and multiple beers daily but quit 4 months ago. Current medications include ramipril, esom... | Repeat abdominal ultrasound in 6 months | {
"A": "Measure serum α-fetoprotein levels in 3 months",
"B": "Obtain CT scan of the abdomen now",
"C": "Repeat abdominal ultrasound in 6 months",
"D": "Perform liver biopsy now"
} | step2&3 | C | [
"55 year old man",
"physician",
"follow-up examination",
"past month",
"mild itching",
"alcoholic cirrhosis",
"hypertension",
"gastroesophageal reflux disease",
"used to drink",
"pint",
"vodka",
"multiple beers daily",
"quit",
"months",
"Current medications include ramipril",
"esomepra... |
A newborn infant is born at 40 weeks gestation to a G1P1 mother. The pregnancy was uncomplicated and was followed by the patient's primary care physician. The mother has no past medical history and is currently taking a multi-vitamin, folate, B12, and iron. The infant is moving its limbs spontaneously and is crying. Hi... | Intramuscular (IM) vitamin K and topical erythromycin | {
"A": "Fluid resuscitation",
"B": "Intramuscular (IM) vitamin K and topical erythromycin",
"C": "No further management needed",
"D": "Silver nitrate eye drops and basic lab work"
} | step2&3 | B | [
"newborn infant",
"born",
"40 weeks gestation",
"G1P1 mother",
"pregnancy",
"uncomplicated",
"followed by",
"patient's primary care physician",
"mother",
"past medical history",
"currently taking",
"multi vitamin",
"folate",
"B12",
"iron",
"infant",
"moving",
"limbs",
"crying",
... |
Researchers are investigating a new strain of a virus that has been infecting children over the past season and causing dermatitis. They have isolated the virus and have run a number of tests to determine its structure and characteristics. They have found that this new virus has an outer coating that is high in phospho... | Herpesvirus | {
"A": "Papillomavirus",
"B": "Adenovirus",
"C": "Hepadnavirus",
"D": "Herpesvirus"
} | step1 | D | [
"Researchers",
"investigating",
"new strain",
"virus",
"infecting children",
"past season",
"causing dermatitis",
"isolated",
"virus",
"run",
"number",
"tests to",
"structure",
"characteristics",
"found",
"new virus",
"outer coating",
"high",
"phospholipids",
"Protein targeting... |
A 48-year-old woman is brought to the emergency department by her family at her psychiatrist's recommendation. According to her family, she has been more restless than her baseline over the past week. The patient herself complains that she feels her mind is racing. Her past medical history is significant for bipolar di... | Thyroid stimulating hormone and free thyroxine levels | {
"A": "Thyroglobulin level",
"B": "Thyroid stimulating hormone and free thyroxine levels",
"C": "Thyroid stimulating hormone and total thyroxine levels",
"D": "Triiodothyronine and thyroxine levels"
} | step2&3 | B | [
"48 year old woman",
"brought",
"emergency department",
"family",
"psychiatrist's recommendation",
"family",
"more restless",
"baseline",
"past week",
"patient",
"feels",
"mind",
"racing",
"past medical history",
"significant",
"bipolar disorder",
"lithium",
"type 1 diabetes mellit... |
A 42-year-old man with systolic heart failure secondary to amyloidosis undergoes heart transplantation. The donor heart is obtained from a 17-year-old boy who died in a motor vehicle collision. Examination of the donor heart during the procedure shows a flat, yellow-white discoloration with an irregular border on the l... | Lipoprotein-laden macrophages | {
"A": "Lipoprotein-laden macrophages",
"B": "Proteoglycan accumulation",
"C": "Apoptotic smooth muscle cells",
"D": "Necrotic cell debris"
} | step1 | A | [
"year old man",
"systolic heart failure secondary to amyloidosis",
"heart transplantation",
"donor heart",
"obtained",
"year old boy",
"died",
"motor vehicle collision",
"Examination of",
"donor heart",
"procedure shows",
"flat",
"yellow white discoloration",
"irregular border",
"luminal... |
A 14-year-old boy is brought to the emergency department because of a 4-hour history of vomiting, lethargy, and confusion. Three days ago, he was treated with an over-the-counter medication for fever and runny nose. He is oriented only to person. His blood pressure is 100/70 mm Hg. Examination shows bilateral optic dis... | Decreased uric acid elimination | {
"A": "Decreased uric acid elimination",
"B": "Reversible inhibition of cyclooxygenase-1",
"C": "Decreased expression of glycoprotein IIb/IIIa",
"D": "Irreversible inhibition of ATP synthase"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"4-hour history",
"vomiting",
"lethargy",
"confusion",
"Three days",
"treated with",
"over-the-counter medication",
"fever",
"runny nose",
"oriented only",
"person",
"blood pressure",
"100 70 mm Hg",
"Examination shows bilateral opti... |
A 53-year-old woman comes to the physician because of pain in her ankle. She twisted her right ankle inward when walking on uneven ground the previous day. She describes the pain as 6 out of 10 in intensity. She is able to bear weight on the ankle and ambulate. Three weeks ago, she had an episode of gastroenteritis tha... | Microvascular damage | {
"A": "Acute inflammatory demyelinating polyradiculopathy",
"B": "Medication side effect",
"C": "Vitamin B12 deficiency",
"D": "Microvascular damage"
} | step2&3 | D | [
"year old woman",
"physician",
"of pain in",
"ankle",
"twisted",
"right ankle inward",
"walking",
"ground",
"previous day",
"pain",
"out",
"10",
"intensity",
"able to bear weight",
"ankle",
"ambulate",
"Three weeks",
"episode of gastroenteritis",
"lasted",
"two days",
"resolv... |
A 62-year-old man with a 5-year history of chronic obstructive pulmonary disease comes to the physician for a follow-up examination. He has had episodic palpitations over the past week. His only medication is a tiotropium-formoterol inhaler. His pulse is 140/min and irregular, respirations are 17/min, and blood pressur... | Verapamil therapy | {
"A": "Radiofrequency ablation",
"B": "Procainamide therapy",
"C": "Verapamil therapy",
"D": "Propranolol therapy\n\""
} | step2&3 | C | [
"62 year",
"man",
"5",
"history",
"chronic obstructive pulmonary disease",
"physician",
"follow-up examination",
"episodic palpitations",
"past week",
"only medication",
"tiotropium formoterol inhaler",
"pulse",
"min",
"irregular",
"respirations",
"min",
"blood pressure",
"70 mm Hg... |
A 63-year-old woman comes to the physician with a 3-month history of progressively worsening right calf pain. She reports that the pain occurs after walking for about 10 minutes and resolves when she rests. She has hypertension and hyperlipidemia. She takes lisinopril and simvastatin daily. She has smoked two packs of ... | Acute myocardial infarction
" | {
"A": "Lower extremity lymphedema",
"B": "Limb amputation",
"C": "Acute mesenteric ischemia",
"D": "Acute myocardial infarction\n\""
} | step2&3 | D | [
"63 year old woman",
"physician",
"3 month history",
"worsening right",
"reports",
"pain occurs",
"walking",
"about 10 minutes",
"resolves",
"rests",
"hypertension",
"hyperlipidemia",
"takes lisinopril",
"simvastatin daily",
"smoked two packs",
"cigarettes daily",
"years",
"pulse",... |
An 11-month-old boy is brought to the physician for the evaluation of recurrent otitis media since birth. The patient’s immunizations are up-to-date. He is at the 5th percentile for height and weight. Physical examination shows multiple petechiae and several eczematous lesions over the scalp and extremities. The remain... | Wiskott-Aldrich syndrome | {
"A": "Chédiak-Higashi syndrome",
"B": "Chronic granulomatous disease",
"C": "Severe combined immunodeficiency",
"D": "Wiskott-Aldrich syndrome"
} | step2&3 | D | [
"month old boy",
"brought",
"physician",
"evaluation",
"recurrent otitis media",
"birth",
"patients immunizations",
"date",
"5th percentile",
"height",
"weight",
"Physical examination shows multiple petechiae",
"several eczematous lesions",
"scalp",
"extremities",
"examination reveals"... |
A 65-year-old man with chronic myelogenous leukemia comes to the physician because of severe pain and swelling in both knees for the past day. He finished a cycle of chemotherapy 1 week ago. His temperature is 37.4°C (99.4°F). Physical examination shows swelling and erythema of both knees and the base of his left big t... | Monosodium urate crystals | {
"A": "Monosodium urate crystals",
"B": "Calcium pyrophosphate crystals",
"C": "Calcium phosphate crystals",
"D": "Gram-positive cocci in clusters"
} | step1 | A | [
"65-year-old man",
"chronic myelogenous leukemia",
"physician",
"severe pain",
"swelling",
"knees",
"past day",
"finished",
"cycle",
"chemotherapy 1 week",
"temperature",
"4C",
"99 4F",
"Physical examination shows swelling",
"erythema",
"knees",
"base",
"left big toe",
"Laborator... |
In translation, the wobble phenomenon is best illustrated by the fact that: | A tRNA with the UUU anticodon can bind to either AAA or AAG codons | {
"A": "A tRNA with the UUU anticodon can bind to either AAA or AAG codons",
"B": "There are more amino acids than possible codons",
"C": "The last nucleotide provides specificity for the given amino acid",
"D": "The genetic code is preserved without mutations"
} | step1 | A | [
"translation",
"phenomenon",
"best",
"fact"
] |
A 34-year-old primigravid woman at 8 weeks' gestation comes to the emergency department 4 hours after the onset of vaginal bleeding and crampy lower abdominal pain. She has passed multiple large and small blood clots. The vaginal bleeding and pain have decreased since their onset. Her temperature is 37°C (98.6°F), puls... | Complete abortion | {
"A": "Missed abortion",
"B": "Complete abortion",
"C": "Threatened abortion",
"D": "Incomplete abortion"
} | step2&3 | B | [
"year old primigravid woman",
"weeks",
"gestation",
"emergency department",
"hours",
"onset",
"vaginal bleeding",
"crampy lower abdominal pain",
"passed multiple large",
"small blood clots",
"vaginal bleeding",
"pain",
"decreased",
"onset",
"temperature",
"98",
"pulse",
"98 min",
... |
A 6-year-old boy presents to his pediatrician accompanied by his mother for evaluation of a rash. The rash appeared a little over a week ago, and since that time the boy has felt tired. He is less interested in playing outside, preferring to remain indoors because his knees and stomach hurt. His past medical history is... | Leukocytoclastic vasculitis | {
"A": "Coronary artery aneurysms",
"B": "Leukocytoclastic vasculitis",
"C": "Mitral regurgitation",
"D": "Thrombocytopenia"
} | step2&3 | B | [
"year old boy presents",
"pediatrician",
"mother",
"evaluation",
"rash",
"rash appeared",
"little",
"week",
"since",
"time",
"boy",
"felt tired",
"less interested",
"playing outside",
"to",
"knees",
"stomach",
"past medical history",
"significant",
"upper respiratory infection"... |
An investigator is studying a drug that acts on a G protein-coupled receptor in the pituitary gland. Binding of the drug to this receptor leads to increased production of inositol triphosphate (IP3) in the basophilic cells of the anterior pituitary. Administration of this drug every 90 minutes is most likely to be bene... | Anovulatory infertility | {
"A": "Prostate cancer",
"B": "Anovulatory infertility",
"C": "Central diabetes insipidus",
"D": "Hyperkalemia"
} | step1 | B | [
"investigator",
"studying",
"drug",
"acts",
"G protein-coupled receptor",
"pituitary gland",
"Binding",
"drug",
"receptor leads",
"increased production",
"inositol triphosphate",
"IP3",
"basophilic cells",
"anterior pituitary",
"Administration",
"drug",
"90 minutes",
"most likely t... |
A 69-year-old male presents to his primary care provider for a general checkup. The patient currently has no complaints. He has a past medical history of diabetes mellitus type II, hypertension, depression, obesity, and a myocardial infarction seven years ago. The patient's prescribed medications are metoprolol, aspiri... | Heart sound prior to S1 | {
"A": "Normal S1 and S2",
"B": "Heart sound prior to S1",
"C": "Heart sound after S2",
"D": "Holosystolic murmur at the apex"
} | step2&3 | B | [
"69 year old male presents",
"primary care provider",
"general checkup",
"patient currently",
"complaints",
"past medical history of diabetes mellitus type II",
"hypertension",
"depression",
"obesity",
"myocardial infarction seven years",
"patient's prescribed medications",
"metoprolol",
"as... |
A 17-year-old teenager is brought to the emergency department with severe bleeding from his right hand. He was involved in a gang fight about 30 minutes ago where he received a penetrating stab wound by a sharp knife in the region of the ‘anatomical snuffbox’. A vascular surgeon is called in for consultation. Damage to... | Radial artery | {
"A": "Radial artery",
"B": "Ulnar artery",
"C": "Princeps pollicis artery",
"D": "Brachial artery"
} | step1 | A | [
"year old teenager",
"brought",
"emergency department",
"severe bleeding",
"right hand",
"involved",
"gang fight",
"30 minutes",
"received",
"penetrating stab",
"sharp knife",
"region",
"anatomical",
"vascular surgeon",
"called",
"consultation",
"Damage",
"artery",
"most likely r... |
A 36-year-old woman comes to the gynecologist because of a 4-month history of irregular menstrual cycles. Menses occur at irregular 15 to 45-day intervals and last 1–2 days with minimal flow. She also reports a milk-like discharge from her nipples for 3 months, as well as a history of fatigue and muscle and joint pain.... | Hypothyroidism | {
"A": "Thyrotropic pituitary adenoma",
"B": "Ectopic prolactin production",
"C": "Cushing disease",
"D": "Hypothyroidism"
} | step2&3 | D | [
"36 year old woman",
"gynecologist",
"4 month history",
"irregular menstrual cycles",
"Menses occur",
"irregular",
"day intervals",
"last",
"days",
"minimal flow",
"reports",
"milk",
"discharge",
"nipples",
"3 months",
"history",
"fatigue",
"muscle",
"joint pain",
"not",
"abd... |
A 14-year-old girl presents to the emergency room complaining of abdominal pain. She was watching a movie 3 hours prior to presentation when she developed severe non-radiating right lower quadrant pain. The pain has worsened since it started. She also had non-bloody non-bilious emesis 1 hour ago and continues to feel n... | Standardization | {
"A": "Forcing function",
"B": "Resilience engineering",
"C": "Safety culture",
"D": "Standardization"
} | step1 | D | [
"year old girl presents",
"emergency room",
"abdominal pain",
"watching",
"movie",
"hours prior to presentation",
"severe non radiating right lower quadrant pain",
"pain",
"worsened",
"started",
"non bloody",
"bilious emesis",
"hour",
"continues to feel nauseated",
"temperature",
"3C",... |
A 6-year-old boy is brought to the emergency department for acute intermittent umbilical abdominal pain and several episodes of nonbilious vomiting for 4 hours. The pain radiates to his right lower abdomen and occurs every 15–30 minutes. During these episodes of pain, the boy draws up his knees to the chest. He had two... | Meckel diverticulum | {
"A": "Meckel diverticulum",
"B": "Malrotation with volvulus",
"C": "Intestinal polyps",
"D": "Intestinal adhesions"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"acute intermittent umbilical abdominal pain",
"several episodes of",
"vomiting",
"4 hours",
"pain radiates",
"right lower abdomen",
"occurs",
"minutes",
"episodes",
"pain",
"boy draws",
"knees",
"chest",
"two similar episodes",
"p... |
A 16-year-old female presents to the physician for delayed onset of menstruation. She reports that all of her friends have experienced their first menses, and she wonders whether “something is wrong with me.” The patient is a sophomore in high school and doing well in school. Her past medical history is significant for... | Karyotype analysis | {
"A": "Karyotype analysis",
"B": "Serum FSH and LH levels",
"C": "Serum testosterone level",
"D": "Serum 17-hydroxyprogesterone level"
} | step2&3 | A | [
"year old female presents",
"physician",
"delayed onset of menstruation",
"reports",
"friends",
"experienced",
"first menses",
"wrong",
"patient",
"sophomore",
"high school",
"well",
"school",
"past medical history",
"significant",
"episode of streptococcal pharyngitis six months",
"... |
A 23-year-old male comes to the physician because of a 2-week history of fatigue, muscle aches, and a dry cough. He has also had episodes of painful, bluish discoloration of the tips of his fingers, nose, and earlobes during this period. Three months ago, he joined the military and attended basic training in southern C... | Mycoplasma pneumoniae | {
"A": "Adenovirus",
"B": "Mycoplasma pneumoniae",
"C": "Chlamydophila pneumoniae",
"D": "Influenza virus"
} | step1 | B | [
"23 year old male",
"physician",
"2-week history",
"fatigue",
"muscle aches",
"dry cough",
"episodes of painful",
"discoloration",
"tips",
"fingers",
"nose",
"earlobes",
"period",
"Three months",
"military",
"attended basic training",
"southern California",
"not smoke",
"use illi... |
A 7-year-old boy is brought to the clinic by his parents due to right ear pain. For the past few days, the patient’s parents say he has had a low-grade fever, a runny nose, and has been frequently pulling on his left ear. Past medical history is significant for a similar episode one month ago for which he has prescribe... | Inhibitor effect | {
"A": "Tachyphylactic effect",
"B": "Inhibitor effect",
"C": "Additive effect",
"D": "Synergistic effect"
} | step1 | B | [
"year old boy",
"brought",
"clinic",
"parents due to right",
"past",
"days",
"patients parents",
"low-grade fever",
"runny nose",
"frequently pulling",
"left",
"Past medical history",
"significant",
"similar episode one month",
"prescribed a 10 day course",
"amoxicillin",
"date",
"... |
A 4-year-old male presents to the pediatrician with a one week history of fever, several days of bloody diarrhea, and right-sided abdominal pain. The mother explains that several other children at his son's pre-K have been having similar symptoms. She heard the daycare owner had similar symptoms and may have her append... | Yersinia enterocolitica | {
"A": "Yersinia enterocolitica",
"B": "Enterotoxigenic E. coli",
"C": "Vibrio cholerae",
"D": "Rotavirus"
} | step1 | A | [
"4 year old male presents",
"pediatrician",
"one week history",
"fever",
"several days",
"bloody diarrhea",
"right-sided abdominal pain",
"mother",
"several",
"children",
"son's pre K",
"similar symptoms",
"heard",
"daycare owner",
"similar symptoms",
"appendix removed",
"mother",
... |
A 45-year-old man comes to the physician for the evaluation of limited mobility of his right hand for 1 year. The patient states he has had difficulty actively extending his right 4th and 5th fingers, and despite stretching exercises, his symptoms have progressed. He has type 2 diabetes mellitus. He has been working as... | Palmar fibromatosis | {
"A": "Palmar fibromatosis",
"B": "Ganglion cyst",
"C": "Ulnar nerve lesion",
"D": "Tenosynovitis"
} | step2&3 | A | [
"year old man",
"physician",
"evaluation",
"limited mobility",
"right hand",
"1 year",
"patient states",
"difficulty",
"extending",
"right 4th",
"5th fingers",
"stretching exercises",
"symptoms",
"progressed",
"type 2 diabetes mellitus",
"working",
"mason",
"over 20 years",
"fath... |
A 2-year-old boy is being evaluated for an autosomal-recessive condition that produces valine instead of glutamine in the β-globin gene. On further examination, the patient’s X-ray showed a crew cut appearance of the skull. Which of the following statements about his condition is false? | An individual needs 2 defective β-globin genes to have the sickle cell trait | {
"A": "Complications are due to vaso-occlusion",
"B": "Target cells are seen in blood smear",
"C": "An individual needs 2 defective β-globin genes to have the sickle cell trait",
"D": "Salmonella paratyphi can cause osteomyelitis in these patients"
} | step1 | C | [
"2 year old boy",
"evaluated",
"autosomal-recessive condition",
"valine",
"glutamine",
"globin gene",
"further examination",
"patients X-ray showed",
"cut appearance",
"skull",
"following statements",
"condition",
"false"
] |
A 7-year-old boy is brought to his pediatrician by his parents because of a new rash. The family immigrated from Laos one year ago and recently obtained health insurance. A week ago, the boy stated that he was “not feeling well” and asked to stay home from school. At the time, he starting having cough, nasal congestion... | CNS degeneration | {
"A": "CNS degeneration",
"B": "Valvular heart disease",
"C": "Nonreactive pupils",
"D": "Monoarticular arthritis"
} | step1 | A | [
"year old boy",
"brought",
"pediatrician",
"parents",
"new rash",
"family",
"Laos one year ago",
"recently obtained health insurance",
"week",
"boy stated",
"not feeling well",
"to",
"home",
"school",
"time",
"starting",
"cough",
"nasal congestion",
"eyes",
"symptoms",
"paren... |
A 41-year-old nulliparous woman, at 15 weeks' gestation comes to the emergency department because of an 8-hour history of light vaginal bleeding. She had a spontaneous abortion at 11 weeks' gestation 9 months ago. Vital signs are within normal limits. Abdominal examination is unremarkable. On pelvic examination, there ... | Theca lutein cysts | {
"A": "Theca lutein cysts",
"B": "Corpus luteum cysts",
"C": "Dermoid cyst",
"D": "Follicular cyst"
} | step1 | A | [
"year old nulliparous woman",
"weeks",
"gestation",
"emergency department",
"8 history",
"light vaginal bleeding",
"spontaneous abortion",
"weeks",
"gestation 9 months",
"Vital signs",
"normal limits",
"Abdominal examination",
"unremarkable",
"pelvic examination",
"old blood",
"vaginal... |
A 39-year-old pregnant woman at 16 weeks gestation recently underwent a quad-screen which revealed elevated beta-hCG, elevated inhibin A, decreased alpha-fetoprotein, and decreased estradiol. An ultrasound was performed which found increased nuchal translucency. Which of the following is recommended for diagnosis? | Confirmatory amniocentesis and chromosomal analysis of the fetal cells | {
"A": "Fetus is normal, continue with pregnancy as expected",
"B": "Confirmatory amniocentesis and chromosomal analysis of the fetal cells",
"C": "Biopsy and pathologic examination of fetus",
"D": "Maternal karyotype"
} | step1 | B | [
"year old pregnant woman",
"weeks recently",
"quad-screen",
"revealed elevated beta",
"elevated inhibin A",
"decreased alpha-fetoprotein",
"decreased estradiol",
"ultrasound",
"performed",
"found increased nuchal translucency",
"following",
"recommended",
"diagnosis"
] |
Four months after giving birth, a young woman presents to the hospital complaining of lack of breast milk secretion. The patient complains of constantly feeling tired. Physical exam reveals that she is slightly hypotensive and has lost a significant amount of weight since giving birth. The patient states that she has n... | Obstetric hemorrage | {
"A": "Obstetric hemorrage",
"B": "Prolactinoma",
"C": "Primary empty sella syndrome",
"D": "Increased anterior pituitary perfusion"
} | step1 | A | [
"Four months",
"giving birth",
"young woman presents",
"hospital",
"lack",
"breast milk secretion",
"patient",
"constantly feeling tired",
"Physical exam reveals",
"slightly hypotensive",
"lost",
"significant amount",
"weight",
"giving birth",
"patient states",
"not",
"menstruation",... |
A 64-year-old African American female comes to the physician’s office for a routine check-up. The patient’s past medical history is significant for hypertension, diabetes, and osteoarthritis in her right knee. Her medications include metformin, glimepiride, lisinopril, metoprolol, hydrochlorothiazide, and ibuprofen as ... | Efferent arteriole | {
"A": "Distal convoluted tubule",
"B": "Afferent arteriole",
"C": "Efferent arteriole",
"D": "Collecting duct"
} | step1 | C | [
"64 year old African American female",
"physicians office",
"routine check-up",
"patients past medical history",
"significant",
"hypertension",
"diabetes",
"osteoarthritis",
"right",
"medications include metformin",
"glimepiride",
"lisinopril",
"metoprolol",
"hydrochlorothiazide",
"ibupr... |
A 26-year-old primigravida woman presents to her obstetrician for her first prenatal visit. Her last menstrual cycle was 12 weeks ago. She denies tobacco, alcohol, illicit drug use, or history of sexually transmitted infections. She denies recent travel outside the country but is planning on visiting her family in Cana... | Influenza vaccination | {
"A": "Influenza vaccination",
"B": "Measles-mumps-rubella vaccination",
"C": "PCV23 vaccination",
"D": "Rh-D immunoglobulin"
} | step2&3 | A | [
"year old primigravida woman presents",
"obstetrician",
"first prenatal visit",
"last menstrual cycle",
"weeks",
"denies tobacco",
"alcohol",
"illicit drug use",
"history",
"sexually transmitted infections",
"denies recent travel outside",
"country",
"planning",
"visiting",
"family",
"... |
A 38-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the physician for a prenatal visit. Pregnancy and delivery of her first child were uncomplicated. She has type 1 diabetes mellitus treated with insulin. Her temperature is 37.2°C (99°F), pulse is 92/min, respirations are 16/min, and blood pressure ... | Pulmonary hypoplasia | {
"A": "Fetal malposition",
"B": "Renal dysplasia",
"C": "Anencephaly",
"D": "Pulmonary hypoplasia"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
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"gestation",
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"delivery",
"first child",
"uncomplicated",
"type 1 diabetes mellitus treated with insulin",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",... |
A researcher is investigating the relationship between interleukin-1 (IL-1) levels and mortality in patients with end-stage renal disease (ESRD) on hemodialysis. In 2017, 10 patients (patients 1–10) with ESRD on hemodialysis were recruited for a pilot study in which IL-1 levels were measured (mean = 88.1 pg/mL). In 201... | The median of IL-1 measurements is now larger than the mean. | {
"A": "Systematic error was introduced by the five new patients who joined the study in 2018.",
"B": "The standard deviation was decreased by the five new patients who joined the study in 2018.",
"C": "The median of IL-1 measurements is now larger than the mean.",
"D": "The range of the data set is unaffected ... | step1 | C | [
"researcher",
"investigating",
"relationship",
"interleukin-1",
"levels",
"mortality",
"patients",
"end-stage renal disease",
"hemodialysis",
"10 patients",
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"hemodialysis",
"pilot study",
"IL-1 levels",
"measured",
"mean",
"88",
"pg/mL",
"5 additional patien... |
A 68-year-old man presents to his primary care physician with pain that started after he visited his daughter as she moved into her new apartment. The patient states that the pain is likely related to all the traveling he has done and helping his daughter move and setup up furniture. The patient has a past medical hist... | NSAIDS and activity as tolerated | {
"A": "NSAIDS and activity as tolerated",
"B": "NSAIDS and bed rest",
"C": "Oxycodone and bed rest",
"D": "MRI of the spine"
} | step2&3 | A | [
"68 year old man presents",
"primary care physician",
"pain",
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"visited",
"daughter",
"moved",
"new apartment",
"patient states",
"pain",
"likely related",
"traveling",
"daughter move",
"setup",
"furniture",
"patient",
"past medical",
"type II diabetes",
"multiple concu... |
A laboratory technician processes basic metabolic panels for two patients. Patient A is 18 years old and patient B is 83 years old. Neither patient takes any medications regularly. Serum laboratory studies show:
Patient A Patient B
Na+ (mEq/L) 145 141
K+ (mEq/L) 3.9 4.4
Cl- (mEq/L) 103 109
HCO3- (mEq/L) 22 21
BUN (mg/d... | Normal aging | {
"A": "Insulin resistance",
"B": "Normal aging",
"C": "High serum aldosterone levels",
"D": "Low body mass index"
} | step1 | B | [
"laboratory technician processes basic metabolic panels",
"two patients",
"Patient",
"years old",
"patient",
"83 years old",
"patient takes",
"medications",
"Serum laboratory studies show",
"Patient",
"Patient",
"Na",
"mEq/L",
"K",
"mEq/L",
"3.9",
"Cl",
"mEq/L",
"HCO3",
"mEq/L"... |
A 55-year-old woman is being managed on the surgical floor after having a total abdominal hysterectomy as a definitive treatment for endometriosis. On day 1 after the operation, the patient complains of fevers. She has no other complaints other than aches and pains from lying in bed as she has not moved since the proce... | Inflammatory stimulus of surgery | {
"A": "Abscess formation",
"B": "Inflammatory stimulus of surgery",
"C": "Urinary tract infection",
"D": "Wound infection"
} | step2&3 | B | [
"55 year old woman",
"managed",
"surgical floor",
"total abdominal hysterectomy",
"definitive treatment",
"endometriosis",
"day",
"operation",
"patient",
"fevers",
"complaints",
"aches",
"pains",
"lying in bed",
"not moved",
"procedure",
"currently receiving ondansetron",
"acetamin... |
A 63-year-old man presents to the clinic concerned about numbness in his bilateral shoulders and arms for the past 8 weeks. The symptoms started when he fell from scaffolding at work and landed on his back. Initial workup was benign and he returned to normal duty. However, his symptoms have progressively worsened since... | Central cord syndrome | {
"A": "Anterior cord syndrome",
"B": "Central cord syndrome",
"C": "Guillain-Barre syndrome",
"D": "Pontine infarction"
} | step2&3 | B | [
"63 year old man presents",
"clinic concerned about numbness in",
"bilateral shoulders",
"arms",
"past",
"weeks",
"symptoms started",
"fell from scaffolding",
"work",
"landed",
"back",
"Initial workup",
"benign",
"returned",
"normal",
"symptoms",
"worsened",
"fall",
"denies fever... |
A 47-year-old woman comes to the physician because of body aches for the past 9 months. She also has stiffness of the shoulders and knees that is worse in the morning and tingling in the upper extremities. Examination shows marked tenderness over the posterior neck, bilateral mid trapezius, and medial aspect of the lef... | Fibromyalgia | {
"A": "Polymyositis",
"B": "Major depressive disorder",
"C": "Fibromyalgia",
"D": "Rheumatoid arthritis"
} | step1 | C | [
"year old woman",
"physician",
"of body aches",
"past",
"months",
"stiffness",
"shoulders",
"knees",
"worse",
"morning",
"tingling",
"upper extremities",
"Examination shows marked tenderness",
"posterior",
"bilateral",
"trapezius",
"medial aspect of",
"left knee",
"complete blood... |
A 51-year-old man presents to the clinic with a history of hematuria and hemoptysis following pneumonia several weeks ago. He works as a hotel bellhop. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type II, and mild intellectual disability. He currently smokes 2 pack... | Type II–cytotoxic hypersensitivity reaction | {
"A": "Type I–anaphylactic hypersensitivity reaction",
"B": "Type II–cytotoxic hypersensitivity reaction",
"C": "Type III–immune complex-mediated hypersensitivity reaction",
"D": "Type I and IV–mixed anaphylactic and cell-mediated hypersensitivity reaction"
} | step2&3 | B | [
"year old man presents",
"clinic",
"history of hematuria",
"hemoptysis following pneumonia",
"weeks",
"works",
"hotel",
"medical history",
"significant",
"gout",
"hypertension",
"hypercholesterolemia",
"diabetes mellitus type II",
"mild intellectual disability",
"currently smokes 2 packs... |
A 57-year-old man presents to his oncologist to discuss management of small cell lung cancer. The patient is a lifelong smoker and was diagnosed with cancer 1 week ago. The patient states that the cancer was his fault for smoking and that there is "no hope now." He seems disinterested in discussing the treatment option... | "It must be very challenging having received this diagnosis. I want to work with you to create a plan." | {
"A": "\"I respect your decision and we will not administer any treatment. Let me know if I can help in any way.\"",
"B": "\"It must be very challenging having received this diagnosis. I want to work with you to create a plan.\"",
"C": "\"We are going to need to treat your lung cancer. I am here to help you thro... | step2&3 | B | [
"57 year old man presents",
"oncologist to discuss management of small cell lung cancer",
"patient",
"lifelong smoker",
"diagnosed",
"cancer 1 week",
"patient states",
"cancer",
"fault",
"smoking",
"hope now",
"discussing",
"treatment options",
"making",
"plan",
"treatment",
"followu... |
A 63-year-old woman comes to the emergency department because of a 1-day history of progressive blurring and darkening of her vision in the right eye. Upon waking up in the morning, she suddenly started seeing multiple dark streaks. She has migraines and type 2 diabetes mellitus diagnosed at her last health maintenance... | Vitreous hemorrhage | {
"A": "Central retinal vein occlusion",
"B": "Central retinal artery occlusion",
"C": "Cataract",
"D": "Vitreous hemorrhage"
} | step2&3 | D | [
"63 year old woman",
"emergency department",
"1-day history",
"progressive blurring",
"vision",
"right eye",
"waking",
"morning",
"started seeing multiple dark streaks",
"migraines",
"type 2 diabetes mellitus diagnosed",
"health maintenance examination 20 years",
"smoked one pack",
"cigare... |
A 33-year-old man presents to the emergency department because of an episode of bloody emesis. He has had increasing dyspnea over the past 2 days. He was diagnosed with peptic ulcer disease last year. He has been on regular hemodialysis for the past 2 years because of end-stage renal disease. He skipped his last dialys... | Hemodialysis | {
"A": "Double-balloon tamponade",
"B": "Hemodialysis",
"C": "Observation in the intensive care unit",
"D": "Transfusion of packed red blood cells"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"of",
"episode",
"bloody emesis",
"increasing dyspnea",
"past 2 days",
"diagnosed",
"peptic ulcer disease",
"year",
"regular hemodialysis",
"past",
"years",
"end-stage renal disease",
"skipped",
"last dialysis session",
"unexpected bus... |
A 6-year-old boy is brought to the emergency department 12 hours after ingesting multiple pills. The patient complains of noise in both his ears for the past 10 hours. The patient’s vital signs are as follows: pulse rate, 136/min; respirations, 39/min; and blood pressure, 108/72 mm Hg. The physical examination reveals ... | Supportive care | {
"A": "Gastrointestinal decontamination",
"B": "Hemodialysis",
"C": "Multiple-dose activated charcoal",
"D": "Supportive care"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department 12 hours",
"ingesting multiple pills",
"patient",
"noise",
"ears",
"past 10 hours",
"patients vital signs",
"follows",
"pulse rate",
"min",
"respirations",
"min",
"blood pressure",
"72 mm Hg",
"physical examination reveals diaphoresis"... |
A 25-year-old man is scheduled for an orthopedic surgery. His routine preoperative laboratory tests are within normal limits. An urticarial reaction occurs when a non-depolarizing neuromuscular blocking agent is injected for muscle relaxation and mechanical ventilation. The patient’s lungs are manually ventilated with ... | D-tubocurarine | {
"A": "Succinylcholine",
"B": "Neostigmine",
"C": "D-tubocurarine",
"D": "Ketamine"
} | step1 | C | [
"year old man",
"scheduled",
"orthopedic",
"routine preoperative laboratory tests",
"normal limits",
"urticarial reaction occurs",
"non depolarizing neuromuscular blocking agent",
"injected",
"muscle relaxation",
"mechanical ventilation",
"patients lungs",
"manually ventilated",
"100",
"O2... |
A 65-year-old woman arrives for her annual physical. She has no specific complaints. She has seasonal allergies and takes loratadine. She had a cholecystectomy 15 years ago. Her last menstrual period was 9 years ago. Both her mother and her maternal aunt had breast cancer. A physical examination is unremarkable. The pa... | Raloxifene | {
"A": "Alendronate",
"B": "Denosumab",
"C": "Raloxifene",
"D": "Zoledronic acid"
} | step2&3 | C | [
"65 year old woman",
"annual physical",
"specific complaints",
"seasonal allergies",
"takes loratadine",
"cholecystectomy",
"years",
"last menstrual period",
"years",
"mother",
"maternal aunt",
"breast cancer",
"physical examination",
"unremarkable",
"patient",
"given",
"pneumococcal... |
A 62-year-old retired professor comes to the clinic with the complaints of back pain and increasing fatigue over the last 4 months. For the past week, his back pain seems to have worsened. It radiates to his legs and is burning in nature, 6/10 in intensity. There is no associated tingling sensation. He has lost 4.0 kg ... | Chemotherapy and autologous stem cell transplant | {
"A": "Bisphosphonates",
"B": "Chemotherapy alone",
"C": "Renal dialysis",
"D": "Chemotherapy and autologous stem cell transplant"
} | step1 | D | [
"62 year old retired professor",
"clinic",
"complaints of back pain",
"increasing fatigue",
"months",
"past week",
"back pain",
"to",
"worsened",
"radiates",
"legs",
"burning",
"nature",
"6/10",
"intensity",
"associated tingling sensation",
"lost 4 0 kg",
"8.8",
"past",
"months... |
A 19-year-old man comes to the emergency department with sharp, left-sided chest pain and shortness of breath. He has no history of recent trauma. He does not smoke or use illicit drugs. He is 196 cm (6 feet 5 in) tall and weighs 70 kg (154 lb); BMI is 18 kg/m2. Examination shows reduced breath sounds over the left lun... | Increased right-to-left shunting | {
"A": "Increased transpulmonary pressure",
"B": "Increased physiological dead space",
"C": "Increased right-to-left shunting",
"D": "Increased lung compliance"
} | step1 | C | [
"year old man",
"emergency department",
"sharp",
"left-sided chest pain",
"shortness of breath",
"history",
"recent trauma",
"not smoke",
"use illicit",
"6 feet 5",
"tall",
"70 kg",
"BMI",
"kg/m2",
"Examination shows reduced breath sounds",
"left lung field",
"x-ray of",
"chest",
... |
Thirty minutes after delivery, a 1780-g (3-lb 15-oz) male newborn develops respiratory distress. He was born at 30 weeks' gestation via vaginal delivery. His temperature is 36.8C (98.2F), pulse is 140/min, respirations are 64/min, and blood pressure is 61/32 mm Hg. Pulse oximetry on room air shows an oxygen saturation ... | Respiratory distress syndrome | {
"A": "Respiratory distress syndrome",
"B": "Tracheomalacia",
"C": "Neonatal pneumonia",
"D": "Tracheoesophageal fistula"
} | step2&3 | A | [
"Thirty minutes",
"delivery",
"g",
"oz",
"male newborn",
"respiratory distress",
"born",
"30 weeks",
"gestation",
"vaginal delivery",
"temperature",
"36",
"98",
"pulse",
"min",
"respirations",
"64 min",
"blood pressure",
"61",
"mm Hg",
"Pulse oximetry",
"room air shows",
... |
A 5-year-old boy presents for a regularly scheduled check-up. The child is wheelchair bound due to lower extremity paralysis and suffers from urinary incontinence. At birth, it was noted that the child had lower limbs of disproportionately small size in relation to the rest of his body. Radiograph imaging at birth also... | Uncontrolled maternal diabetes mellitus | {
"A": "Uncontrolled maternal diabetes mellitus",
"B": "Maternal use of tetracyclines",
"C": "Maternal use of lithium",
"D": "Maternal use of nicotine"
} | step1 | A | [
"5 year old boy presents",
"scheduled check-up",
"child",
"wheelchair bound due to lower extremity paralysis",
"suffers",
"urinary incontinence",
"birth",
"noted",
"child",
"lower limbs",
"small size in relation to",
"rest",
"body",
"Radiograph imaging",
"birth",
"revealed several",
... |
A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hope... | The patient is at risk for double depression. | {
"A": "The patient is at risk for double depression.",
"B": "The patient may have symptoms of mania or psychosis.",
"C": "The patient is likely to show anhedonia.",
"D": "The patient likely has paranoid personality disorder."
} | step1 | A | [
"mental health volunteer",
"interviewing locals",
"part of",
"community outreach program",
"year old man",
"felt sad",
"long",
"remember",
"feels",
"life",
"terrible",
"happen",
"usually",
"difficulty making decisions",
"feels hopeless",
"feels",
"worsening suicidal ideations",
"gu... |
Five minutes after initiating a change of position and oxygen inhalation, the oxytocin infusion is discontinued. A repeat CTG that is done 10 minutes later shows recurrent variable decelerations and a total of 3 uterine contractions in 10 minutes. Which of the following is the most appropriate next step in management? | Amnioinfusion | {
"A": "Administer terbutaline",
"B": "Monitor without intervention",
"C": "Amnioinfusion",
"D": "Emergent Cesarean section"
} | step2&3 | C | [
"Five minutes",
"initiating",
"change",
"position",
"oxygen inhalation",
"oxytocin infusion",
"discontinued",
"repeat",
"10 minutes later shows recurrent variable decelerations",
"total",
"uterine contractions",
"10 minutes",
"following",
"most appropriate next step",
"management"
] |
A 3-month-old boy is brought to the pediatrician by his mother after she notices orange sand–like crystalline material in her child’s diaper. He is not currently taking any medication and is exclusively breastfed. His immunizations are up to date. The doctor tells the mother that her son may have an X-linked recessive ... | Xanthine oxidase | {
"A": "Hypoxanthine-guanine phosphoribosyltransferase",
"B": "Xanthine oxidase",
"C": "Adenosine deaminase",
"D": "Aminolevulinic acid synthetase"
} | step1 | B | [
"3 month old boy",
"brought",
"pediatrician",
"mother",
"orange",
"crystalline material",
"childs diaper",
"not currently taking",
"medication",
"breastfed",
"immunizations",
"date",
"doctor",
"mother",
"son",
"X-linked recessive disorder",
"boy",
"prescribed",
"medication",
"i... |
A 22-year-old man presents to clinic with a chief concern about a painless ulcer on his penis that he noticed 4 weeks ago and resolved one week ago. He denies any pain on urination or changes in urinary patterns. He admits to having multiple sexual partners in the past 3 months and inconsistent use of barrier protectio... | D-Ala-D-Ala | {
"A": "D-Ala-D-Ala",
"B": "Adenine",
"C": "Folate intermediates",
"D": "Retinoic acid"
} | step1 | A | [
"year old man presents",
"clinic",
"concern",
"painless ulcer",
"penis",
"4 weeks",
"resolved one week",
"denies",
"pain",
"urination",
"changes",
"urinary patterns",
"admits to",
"multiple sexual partners",
"past 3 months",
"inconsistent use of barrier protection",
"normal limits",
... |
A biology student is studying apoptosis pathways. One of the experiments conducted involves the binding of a ligand to a CD95 receptor. A defect of this pathway will most likely cause which of the conditions listed below? | Autoimmune lymphoproliferative syndrome | {
"A": "Follicular lymphoma",
"B": "Leukocyte adhesion deficiency",
"C": "Chédiak-Higashi syndrome",
"D": "Autoimmune lymphoproliferative syndrome"
} | step1 | D | [
"biology student",
"studying apoptosis pathways",
"One",
"experiments conducted",
"binding",
"ligand",
"receptor",
"defect",
"pathway",
"most likely cause",
"conditions listed"
] |
A 7-month-old boy is brought by his parents to the pediatrician’s office. His mother says the child has been weakening progressively and is not as active as he used to be when he was born. His condition seems to be getting worse, especially over the last month. He was born at 41 weeks through normal vaginal delivery. T... | Hexosaminidase | {
"A": "Glucosidase",
"B": "Sphingomyelinase",
"C": "Hexosaminidase",
"D": "Arylsulfatase"
} | step2&3 | C | [
"month old boy",
"brought",
"parents",
"pediatricians office",
"mother",
"child",
"not",
"active",
"used to",
"born",
"condition",
"to",
"getting worse",
"month",
"born",
"weeks",
"normal vaginal",
"complications observed",
"prenatal period",
"progressing well",
"1st",
"mon... |
A 34-year-old woman is brought to the emergency department because of a 3-hour history of weakness, agitation, and slurred speech. She speaks slowly with frequent breaks and has difficulty keeping her eyes open. Over the past three days, she has had a sore throat, a runny nose, and a low-grade fever. She says her eyes ... | Endotracheal intubation | {
"A": "Intravenous immunoglobulin therapy",
"B": "Plasmapheresis",
"C": "Endotracheal intubation",
"D": "Administration of edrophonium\n\""
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"3 hour history",
"weakness",
"agitation",
"slurred speech",
"speaks slowly",
"frequent breaks",
"difficulty keeping",
"eyes open",
"past three days",
"sore throat",
"runny nose",
"low-grade fever",
"eyes",
"tongue",
"heavy",
"... |
A 63-year-old man is brought by his wife to the emergency department after he was found with nausea, headache, and agitation 1 hour ago. When the wife left their lakeside cabin earlier in the day to get more firewood, the patient did not have any symptoms. Vital signs are within normal limits. Pulse oximetry on room ai... | Hyperbaric oxygen therapy | {
"A": "Intravenous hydroxycobalamin",
"B": "Heliox therapy",
"C": "Hyperbaric oxygen therapy",
"D": "Intranasal sumatriptan"
} | step1 | C | [
"63 year old man",
"brought",
"wife",
"emergency department",
"found",
"nausea",
"headache",
"agitation",
"hour",
"wife left",
"earlier",
"day to",
"more",
"patient",
"not",
"symptoms",
"Vital signs",
"normal limits",
"Pulse oximetry",
"room air shows",
"oxygen saturation of ... |
A deficiency in which of the following lysosomal enzymes is inherited in a pattern similar to a deficiency of iduronate sulfatase (Hunter syndrome)? | Alpha-galactosidase A | {
"A": "Sphingomyelinase",
"B": "Alpha-galactosidase A",
"C": "Galactocerebrosidase",
"D": "Alpha-L-iduronidase"
} | step1 | B | [
"deficiency",
"following lysosomal",
"inherited",
"pattern similar",
"deficiency of iduronate sulfatase",
"Hunter syndrome"
] |
A 46-year-old Caucasian female presents with cold intolerance, weight gain, and constipation. She has also noticed that her nails have become thinner recently but denies any fever or neck pain. Which of the following is NOT an expected histological finding in the thyroid? | Multinucleate giant cells | {
"A": "Multinucleate giant cells",
"B": "Lymphocytic infiltration",
"C": "Fibrosis",
"D": "Hurthle cells"
} | step1 | A | [
"year old Caucasian female presents",
"cold intolerance",
"weight gain",
"constipation",
"nails",
"thinner recently",
"denies",
"fever",
"neck pain",
"following",
"NOT",
"expected histological finding",
"thyroid"
] |
A 24-year-old man with a history of schizophrenia presents for follow-up. The patient says that he is still having paranoia and visual hallucinations on his latest atypical antipsychotic medication. Past medical history is significant for schizophrenia diagnosed 1 year ago that failed to be adequately controlled on 2 s... | Dopaminergic receptor antagonist | {
"A": "Cholinergic receptor agonist",
"B": "Dopaminergic partial agonist",
"C": "Dopaminergic receptor antagonist",
"D": "Serotonergic receptor antagonist"
} | step1 | C | [
"year old man",
"history of schizophrenia presents",
"follow-up",
"patient",
"paranoia",
"visual hallucinations",
"atypical",
"Past medical history",
"significant",
"schizophrenia diagnosed 1 year",
"failed to",
"controlled",
"2 separate atypical antipsychotic medications",
"patient",
"s... |
A 21-year-old man comes to the emergency department because of a 2-week history of progressive shortness of breath and intermittent cough with blood-tinged sputum. During this time, he has also noticed blood in his urine. He has no history of serious illness and does not take any medications. His temperature is 37°C (9... | Autoimmune hemolytic anemia | {
"A": "Henoch-Schönlein purpura",
"B": "Polyarteritis nodosa",
"C": "Poststreptococcal glomerulonephritis",
"D": "Autoimmune hemolytic anemia"
} | step1 | D | [
"21-year-old man",
"emergency department",
"of",
"2-week history",
"progressive shortness",
"breath",
"intermittent cough",
"blood-tinged sputum",
"time",
"blood in",
"urine",
"history",
"serious illness",
"not take",
"medications",
"temperature",
"98",
"pulse",
"min",
"respira... |
A 7-year-old girl presents with fatigue, jaundice, pruritus, and frequent pale stools. She developed these symptoms gradually over the past 3 months. Her past medical history is significant for multiple episodes of bronchitis and pneumonia. When asked about current respiratory symptoms, she says that she sometimes feel... | Periodic acid-Schiff (PAS)-positive, diastase-resistant cytoplasmic granules in the hepatocytes | {
"A": "Periodic acid-Schiff (PAS)-positive, diastase-resistant cytoplasmic granules in the hepatocytes",
"B": "Feathery degeneration of the hepatocytes",
"C": "Widespread positive staining with Prussian blue",
"D": "Extensive Congo-red positive cytoplasmic drops in the hepatocytes"
} | step1 | A | [
"year old girl presents",
"fatigue",
"jaundice",
"pruritus",
"frequent pale",
"symptoms",
"past 3 months",
"past medical history",
"significant",
"multiple episodes of bronchitis",
"pneumonia",
"current respiratory symptoms",
"sometimes feels short of breath",
"dry",
"non-productive coug... |
A 68-year-old man presents to his physician for symptoms of chronic weight loss, abdominal bloating, and loose stools. He notes that he has also been bothered by a chronic cough. The patient’s laboratory work-up includes a WBC differential, which is remarkable for an eosinophil count of 9%. Stool samples are obtained, ... | Strongyloides stercoralis | {
"A": "Ascaris lumbricoides",
"B": "Strongyloides stercoralis",
"C": "Taenia saginata",
"D": "Taenia solium"
} | step1 | B | [
"68 year old man presents",
"physician",
"symptoms of chronic weight loss",
"abdominal bloating",
"loose stools",
"notes",
"chronic cough",
"patients laboratory work-up includes",
"WBC differential",
"eosinophil count",
"Stool samples",
"obtained",
"ova",
"parasite examination revealing ro... |
A 56-year-old man presents with feelings of anxiety and fatigue for the past 4 months. He says that he has also had some weight loss, as well as occasional double vision and a gritty sensation in his eyes for the last 2 months, which is worse at the end of the day. He has also noticed some painless swelling in his fing... | Autoantibody stimulation of a receptor | {
"A": "Autoantibodies resulting in tissue destruction",
"B": "Autoantibody stimulation of a receptor",
"C": "Excessive exogenous hormone use",
"D": "Infiltration of tissue by neoplastic cells"
} | step1 | B | [
"year old man presents",
"feelings",
"anxiety",
"fatigue",
"past",
"months",
"weight loss",
"occasional double vision",
"gritty sensation",
"eyes",
"last",
"months",
"worse",
"end",
"day",
"painless swelling",
"fingers",
"lower legs",
"same time period",
"patient denies",
"re... |
An endocervical swab is performed and nucleic acid amplification testing via polymerase chain reaction is conducted. It is positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae. Which of the following is the most appropriate pharmacotherapy? | Oral azithromycin | {
"A": "Intravenous cefoxitin plus oral doxycycline",
"B": "Intramuscular ceftriaxone plus oral azithromycin",
"C": "Oral azithromycin",
"D": "Oral doxycycline"
} | step2&3 | C | [
"endocervical swab",
"performed",
"nucleic acid amplification testing",
"polymerase chain reaction",
"conducted",
"positive",
"Chlamydia trachomatis",
"negative",
"Neisseria gonorrhoeae",
"following",
"most appropriate pharmacotherapy"
] |
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