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 62-year-old man is referred to a gastroenterologist because of difficulty swallowing for the past 5 months. He has difficulty swallowing both solid and liquid foods, but there is no associated pain. He denies any shortness of breath or swelling in his legs. He immigrated from South America 10 years ago. He is a non-s... | Chagas disease | {
"A": "Chagas disease",
"B": "Squamous cell carcinoma of the esophagus",
"C": "Gastroesophageal reflux disease",
"D": "Pharyngoesophageal diverticulum"
} | step1 | A | [
"62 year old man",
"referred",
"gastroenterologist",
"of difficulty swallowing",
"past",
"months",
"difficulty swallowing",
"solid",
"liquid foods",
"associated pain",
"denies",
"shortness of breath",
"swelling",
"legs",
"South America 10 years",
"non-smoker",
"not drink alcohol",
... |
A 6-year-old boy is brought to the pediatrician by his mother after he reported having red urine. He has never experienced this before and did not eat anything unusual before the episode. His past medical history is notable for sensorineural deafness requiring hearing aids. He is otherwise healthy and enjoys being in t... | X-linked dominant | {
"A": "Autosomal recessive",
"B": "Mitochondrial inheritance",
"C": "X-linked dominant",
"D": "X-linked recessive"
} | step1 | C | [
"year old boy",
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"mother",
"reported",
"red urine",
"never experienced",
"before",
"not eat",
"unusual",
"episode",
"past medical history",
"notable",
"sensorineural deafness",
"hearing aids",
"healthy",
"1st grade",
"birth history",
"unremarkable",
"t... |
A 67-year-old woman presents to her physician for a regular checkup. She is a community-dwelling, retired teacher without any smoking history. She has arterial hypertension and takes hydrochlorothiazide 12.5 mg and valsartan 80 mg daily. She was recently discharged from the hospital after admission for an ulnar fractur... | Cholecalciferol | {
"A": "Estrogen plus progestin",
"B": "Cholecalciferol",
"C": "Tocopherol",
"D": "Denosumab"
} | step2&3 | B | [
"67 year old woman presents",
"physician",
"regular checkup",
"community-dwelling",
"retired teacher",
"smoking history",
"arterial hypertension",
"takes hydrochlorothiazide 12.5 mg",
"valsartan 80 mg daily",
"recently discharged from",
"hospital",
"admission",
"ulnar fracture",
"received"... |
A 44-year-old woman presents to the emergency department with a headache, vertigo, confusion, and dyspnea. A relevant history cannot be obtained from the patient because she seems confused and gives incoherent responses to questions. Her husband says that she was cleaning the kitchen this morning until the curtains cau... | Cyanide poisoning | {
"A": "Anemia",
"B": "Carbon monoxide poisoning",
"C": "Cyanide poisoning",
"D": "Polycythemia"
} | step1 | C | [
"year old woman presents",
"emergency department",
"headache",
"vertigo",
"confusion",
"dyspnea",
"relevant history",
"obtained",
"patient",
"confused",
"gives incoherent responses",
"questions",
"husband",
"cleaning",
"kitchen",
"morning",
"curtains caught",
"fire earlier",
"mor... |
A 46-year-old man is brought to the emergency department because of worsening confusion and weakness in his right arm and leg for 2 days. He has also had fever and headache that began 5 days ago. He has hypertension and type 2 diabetes mellitus. Current medications include metformin and lisinopril. His temperature is 3... | Acyclovir | {
"A": "Recombinant tissue plasminogen activator",
"B": "Acyclovir",
"C": "Ceftriaxone and vancomycin",
"D": "Amphotericin B"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"worsening confusion",
"weakness",
"right",
"leg",
"2 days",
"fever",
"headache",
"began 5 days",
"hypertension",
"type 2 diabetes mellitus",
"Current medications include metformin",
"lisinopril",
"temperature",
"3C",
"pulse",
"m... |
A 28-year-old Caucasian woman presents to a local walk-in clinic with the complaint of pruritus and a salmon-colored scaling patch on her back. The patient stated that she developed a cold a couple of weeks ago and that her skin lesion has enlarged in the last week. The past medical history is unremarkable. The physica... | Pruritus control and reassurance | {
"A": "Pruritus control and reassurance",
"B": "Systemic steroid therapy",
"C": "Topical steroid therapy",
"D": "Phototherapy"
} | step2&3 | A | [
"year old Caucasian woman presents",
"local walk-in clinic",
"complaint",
"pruritus",
"salmon colored scaling patch on",
"back",
"patient stated",
"cold",
"couple",
"weeks",
"skin lesion",
"enlarged",
"week",
"past medical history",
"unremarkable",
"physical examination reveals",
"ge... |
A 53-year-old man presents to the office for a routine examination. The medical history is significant for diabetes mellitus, for which he is taking metformin. The medical records show blood pressure readings from three separate visits to fall in the 130–160 mm Hg range for systolic and 90–100 mm Hg range for diastolic... | Vasodilation, bladder sphincter relaxation, miosis | {
"A": "Vasoconstriction, bladder sphincter constriction, mydriasis",
"B": "Vasodilation, bladder sphincter relaxation, miosis",
"C": "Vasodilation, decreased heart rate, bronchial constriction",
"D": "Vasodilation, increased peristalsis, bronchial dilation"
} | step1 | B | [
"year old man presents",
"office",
"routine examination",
"medical history",
"significant",
"diabetes mellitus",
"taking metformin",
"medical records show blood pressure readings",
"three separate visits to fall",
"mm Hg range",
"systolic",
"mm Hg range",
"diastolic",
"Prazosin",
"prescr... |
A 35-year-old man presents with pain in his feet during exercise and at rest. He says that his fingers and toes become pale upon exposure to cold temperatures. He has an extensive smoking history, but no history of diabetes mellitus nor hyperlipidemia. He used to exercise frequently but has stopped because of the sympt... | Buerger's disease | {
"A": "Peripheral arterial occlusive disease (PAOD)",
"B": "Atherosclerosis",
"C": "Frostbite",
"D": "Buerger's disease"
} | step1 | D | [
"35 year old man presents",
"pain",
"feet",
"exercise",
"rest",
"fingers",
"toes",
"pale",
"exposure",
"cold temperatures",
"extensive smoking history",
"history of diabetes mellitus",
"hyperlipidemia",
"used to exercise frequently",
"stopped",
"symptoms",
"inspection",
"ulcer",
... |
A 45-year-old man is brought to the emergency department following a motor vehicle collision. He reports right hip pain and numbness along the right thigh. Physical examination shows decreased sensation to light touch over a small area of the proximal medial thigh. X-rays of the pelvis show a displaced pelvic ring frac... | Impaired adduction of the hip | {
"A": "Sensory deficit of the dorsal foot",
"B": "Impaired hip extension",
"C": "Impaired extension of the knee",
"D": "Impaired adduction of the hip"
} | step1 | D | [
"year old man",
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"emergency department following",
"motor vehicle collision",
"reports right hip pain",
"numbness",
"right",
"Physical examination shows decreased",
"light",
"small area",
"proximal medial",
"X-rays",
"pelvis show",
"displaced pelvic ring fracture",
"Further eva... |
Group of 100 medical students took an end of the year exam. The mean score on the exam was 70%, with a standard deviation of 25%. The professor states that a student's score must be within the 95% confidence interval of the mean to pass the exam. Which of the following is the minimum score a student can have to pass th... | 65% | {
"A": "65%",
"B": "63.75%",
"C": "20%",
"D": "45%"
} | step2&3 | A | [
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"100 medical students took",
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"exam",
"70",
"standard deviation",
"professor states",
"student's score",
"95",
"confidence interval",
"mean to pass",
"exam",
"following",
"minimum score",
"student",
"to pass",
"exam"
] |
A 27-year-old woman presents to her obstetrician for a regular follow-up appointment. The patient is 32 weeks pregnant. She has been followed throughout her pregnancy and has been compliant with care. The patient has a past medical history of a seizure disorder which is managed with valproic acid as well as anaphylaxis... | Penicillin | {
"A": "Azithromycin and ceftriaxone",
"B": "Ceftriaxone",
"C": "Insulin, exercise, folic acid, and iron",
"D": "Penicillin"
} | step2&3 | D | [
"27 year old woman presents",
"obstetrician",
"regular follow-up appointment",
"patient",
"weeks pregnant",
"followed",
"pregnancy",
"compliant",
"care",
"patient",
"past medical",
"seizure disorder",
"managed",
"valproic acid",
"anaphylaxis",
"given IV contrast",
"penicillin",
"so... |
A 65-year-old man presents to his primary-care doctor for a 2-month history of dizziness. He describes feeling unsteady on his feet or like he's swaying from side-to-side; he's also occasionally had a room-spinning sensation. He first noticed it when he was in the front yard playing catch with his grandson, and he now ... | Doppler ultrasound | {
"A": "CT head (noncontrast)",
"B": "Doppler ultrasound",
"C": "Electrocardiogram",
"D": "Transthoracic echocardiogram"
} | step2&3 | B | [
"65 year old man presents",
"primary-care doctor",
"2 month history",
"dizziness",
"feeling unsteady on",
"feet",
"he",
"side-to-side",
"he",
"occasionally",
"room",
"first",
"front yard playing catch",
"grandson",
"now",
"gets",
"throwing",
"frisbee",
"dog",
"dizziness only ha... |
An investigator studying the molecular characteristics of various malignant cell lines collects tissue samples from several families with a known mutation in the TP53 tumor suppressor gene. Immunohistochemical testing performed on one of the cell samples stains positive for desmin. This sample was most likely obtained ... | Rhabdomyosarcoma | {
"A": "Prostate cancer",
"B": "Squamous cell carcinoma",
"C": "Melanoma",
"D": "Rhabdomyosarcoma"
} | step1 | D | [
"investigator studying",
"molecular characteristics",
"various malignant collects tissue samples",
"families",
"known mutation",
"TP53 tumor suppressor gene",
"testing performed",
"one",
"cell samples stains positive",
"desmin",
"sample",
"most likely obtained",
"following neoplasms"
] |
An academic medical center in the United States is approached by a pharmaceutical company to run a small clinical trial to test the effectiveness of its new drug, compound X. The company wants to know if the measured hemoglobin a1c (Hba1c) of patients with type 2 diabetes receiving metformin and compound X would be low... | Type II error | {
"A": "Type II error",
"B": "Hawthorne effect",
"C": "Confirmation bias",
"D": "Publication bias"
} | step1 | A | [
"academic medical center",
"United States",
"approached",
"pharmaceutical company to run",
"small clinical trial to test",
"effectiveness",
"new drug",
"compound",
"company",
"to",
"measured hemoglobin a1c",
"patients",
"type 2 diabetes receiving metformin",
"compound",
"lower",
"contr... |
An investigator performs a twin study to evaluate the effects of a novel drug that decreases serum glucose by inhibiting a transporter on the basolateral membrane of proximal convoluted tubule cells. The results of the study are shown.
Test Control
Serum glucose (mg/dL) 82.4 99
Dipstick urine glucose negative negative
... | Glutamine | {
"A": "Glutamine",
"B": "Sodium",
"C": "Alanine",
"D": "Leucine"
} | step1 | A | [
"investigator performs",
"twin study to evaluate",
"effects of",
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"decreases serum glucose",
"inhibiting",
"transporter",
"basolateral membrane",
"proximal convoluted tubule cells",
"results",
"study",
"shown",
"Test Control Serum glucose",
"mg/dL",
"99 Dipstick urine glucos... |
An 18-month-old boy is brought to the doctor’s office for evaluation of abdominal pain. The boy looks emaciated and he is now significantly below his growth chart predicted weight. The family history is non-contributory. The vital signs are unremarkable. On physical examination, a non-tender mass is felt in the upper p... | Elevation of vanillylmandelic acid in the urine | {
"A": "MRI showing the intrarenal origin of the mass",
"B": "Elevation of vanillylmandelic acid in the urine",
"C": "Increased lactic dehydrogenase",
"D": "Radiograph of the bone showing the presence of lytic bone lesion with periosteal reaction"
} | step2&3 | B | [
"month old boy",
"brought",
"doctors office",
"evaluation",
"abdominal",
"boy looks emaciated",
"now",
"growth chart predicted weight",
"family history",
"non contributory",
"vital signs",
"unremarkable",
"physical examination",
"non-tender mass",
"felt",
"upper part of",
"abdomen",
... |
A 32-year-old woman presents with a three-month history of difficulty swallowing. She says that it occurs with both solids and liquids with the sensation that food is getting stuck in her throat. Additionally, the patient reports that while shoveling snow this past winter, she had noticed that her hands would lose thei... | Anti-centromere antibodies | {
"A": "Anti-mitochondrial antibodies",
"B": "Anti-centromere antibodies",
"C": "Anti-U1-RNP antibodies",
"D": "Anti-CCP antibodies"
} | step1 | B | [
"year old woman presents",
"three month history",
"difficulty swallowing",
"occurs",
"solids",
"liquids",
"sensation",
"food",
"getting",
"throat",
"patient reports",
"snow",
"past winter",
"hands",
"color",
"numb",
"denies",
"cough",
"regurgitation",
"joint pains",
"shortnes... |
A 23-year-old man presents to the emergency department for altered mental status after a finishing a marathon. He has a past medical history of obesity and anxiety and is not currently taking any medications. His temperature is 104°F (40°C), blood pressure is 147/88 mmHg, pulse is 200/min, respirations are 33/min, and ... | Normal saline | {
"A": "50% normal saline 50% dextrose",
"B": "Hypotonic saline",
"C": "Lactated ringer",
"D": "Normal saline"
} | step2&3 | D | [
"23 year old man presents",
"emergency department",
"altered mental status",
"finishing",
"marathon",
"past medical",
"anxiety",
"not currently taking",
"medications",
"temperature",
"blood pressure",
"88 mmHg",
"pulse",
"200 min",
"respirations",
"min",
"oxygen saturation",
"99",
... |
A mother from rural Louisiana brings her 4-year-old son to a pediatrician. Her son is intellectually disabled, and she hopes that genetic testing will help determine the cause of her son's condition. She had previously been opposed to allowing physicians to treat her son, but his impulsive behavior and learning disabil... | CGG on the sex chromosome X | {
"A": "CAG on chromosome 4",
"B": "GAA on chromomsome 9",
"C": "CGG on the sex chromosome X",
"D": "CTG on chromosome 8"
} | step1 | C | [
"mother",
"rural Louisiana",
"4 year old son",
"pediatrician",
"son",
"disabled",
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"help",
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"allowing physicians to treat",
"son",
"impulsive behavior",
"learning disabilities",
"making",
"difficult to",
"care",
"exam",
"chi... |
A 31-year-old female undergoing treatment for leukemia is found to have a frontal lobe abscess accompanied by paranasal swelling. She additionally complains of headache, facial pain, and nasal discharge. Biopsy of the infected tissue would most likely reveal which of the following? | Irregular non-septate hyphae | {
"A": "Budding yeast with a narrow base",
"B": "Septate hyphae",
"C": "Irregular non-septate hyphae",
"D": "Spherules containing endospores"
} | step1 | C | [
"31 year old female",
"treatment",
"leukemia",
"found to",
"frontal lobe abscess",
"swelling",
"headache",
"facial pain",
"nasal",
"Biopsy",
"infected tissue",
"most likely reveal",
"following"
] |
A 39-year-old female presents to her gynecologist complaining of a breast lump. Two weeks ago, while performing a breast self-examination she noticed a small firm nodule in her left breast. She is otherwise healthy and takes no medications. Her family history is notable for a history of breast cancer in her mother and ... | Serous cystadenocarcinoma | {
"A": "Serous cystadenocarcinoma",
"B": "Granulosa-theca cell tumor",
"C": "Uterine leiomyosarcoma",
"D": "Transitional cell carcinoma"
} | step1 | A | [
"year old female presents",
"gynecologist",
"breast lump",
"Two weeks",
"performing",
"breast self-examination",
"small firm nodule",
"left breast",
"healthy",
"takes",
"medications",
"family history",
"notable",
"history of breast cancer",
"mother",
"maternal aunt",
"physical examin... |
Please refer to the summary above to answer this question
Further evaluation of this patient is most likely to show which of the following findings?"
"Patient Information
Age: 28 years
Gender: F, self-identified
Ethnicity: unspecified
Site of Care: office
History
Reason for Visit/Chief Concern: “I'm not making breast m... | Decreased serum oxytocin concentration | {
"A": "Increased serum sodium concentration",
"B": "Increased serum TSH concentration",
"C": "Decreased serum oxytocin concentration",
"D": "Decreased serum cortisol concentration"
} | step2&3 | C | [
"refer",
"summary above to answer",
"question Further evaluation",
"patient",
"most likely to show",
"following findings",
"Patient Age",
"years Gender",
"F",
"self identified Ethnicity",
"unspecified Site of Care",
"office History Reason for Visit",
"Concern",
"I",
" ot aking reast m... |
A 27-year-old school teacher visits her doctor because of disfiguring skin lesions that started to appear in the past few days. The lesions are mostly located on her chest, shoulders, and back. They are 2–5 mm in diameter, droplike, erythematous papules with fine silver scales. Besides a sore throat and laryngitis requ... | Guttate psoriasis | {
"A": "Guttate psoriasis",
"B": "Bullous pemphigoid",
"C": "Pemphigus vulgaris",
"D": "Plaque psoriasis"
} | step1 | A | [
"27 year old school teacher visits",
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"mostly",
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"shoulders",
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"mm",
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"erythematous papules",
"fine silver scales",
"sore throat",
"laryngitis",
"amoxicillin",
"weeks",
"significa... |
A 57-year-old woman with non-small cell lung cancer comes to the physician 4 weeks after her tumor was resected. She takes no medications. The physician starts her on a treatment regimen that includes vinblastine. This treatment puts the patient at highest risk for which of the following? | Invasive fungal infection | {
"A": "Pulmonary embolism",
"B": "Progressive multifocal leukoencephalopathy",
"C": "Pulmonary fibrosis",
"D": "Invasive fungal infection"
} | step1 | D | [
"57 year old woman",
"non-small cell lung cancer",
"physician",
"weeks",
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"medications",
"physician starts",
"treatment regimen",
"includes vinblastine",
"treatment puts",
"patient",
"highest risk",
"following"
] |
A 9-month-old baby boy is brought to his pediatrician due to poor feeding and fewer bowel movements. His father notes that he has been less active and is having difficulty with movements such as rolling over. Vital signs are normal, and physical exam is notable for weak sucking reflex, ptosis, and decreased eye movemen... | Inhibition of neurotransmitter release | {
"A": "Inhibition of neurotransmitter release",
"B": "Degradation of the cell membrane",
"C": "Increased chloride secretion within the gut",
"D": "Impairment of phagocytosis"
} | step1 | A | [
"month old baby boy",
"brought",
"pediatrician",
"poor feeding",
"fewer bowel movements",
"father notes",
"less active",
"difficulty",
"movements",
"rolling over",
"Vital signs",
"normal",
"physical exam",
"notable",
"weak sucking reflex",
"ptosis",
"decreased eye movements",
"addi... |
Four days after undergoing a total abdominal hysterectomy for atypical endometrial hyperplasia, a 59 year-old woman reports abdominal bloating and discomfort. She has also had nausea without vomiting. She has no appetite despite not having eaten since the surgery and drinking only sips of water. Her postoperative pain ... | Reduce use of opioid therapy | {
"A": "Esophagogastroduodenoscopy",
"B": "Reduce use of opioid therapy",
"C": "Colonoscopy",
"D": "Begin total parenteral nutrition"
} | step2&3 | B | [
"Four days",
"total abdominal hysterectomy",
"atypical endometrial hyperplasia",
"59 year old woman reports abdominal bloating",
"discomfort",
"nausea without vomiting",
"appetite",
"not",
"eaten",
"surgery",
"drinking only sips",
"water",
"postoperative pain",
"well controlled",
"hydrom... |
A 22-year-old woman is brought to the emergency department 20 minutes after being detained by campus police for attempting to steal from the bookstore. Her roommate says that the patient has been acting strangely over the last 2 weeks. She has not slept in 4 days and has painted her room twice in that time span. She ha... | Haloperidol | {
"A": "Haloperidol",
"B": "Lithium",
"C": "Valproate",
"D": "Sertraline"
} | step2&3 | A | [
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"emergency department 20 minutes",
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"2 weeks",
"not slept",
"4 days",
"painted",
"room twice",
"time span",
"spent",
"savings",
"shopping",
"history of psychiatric illness",
"substance... |
A 28-year-old woman presents to her physician for follow-up. She was found to be HIV-positive 9 months ago. Currently she is on ART with lamivudine, tenofovir, and efavirenz. She has no complaints and only reports a history of mild respiratory infection since the last follow-up. She is also allergic to egg whites. Her ... | The patient can get any approved recombinant or inactivated vaccine, including ones produced with egg-based technology. | {
"A": "As long as the patient is anemic, she should not be vaccinated.",
"B": "Nasal-spray influenza vaccine is the best option for vaccination in this patient.",
"C": "Inactivated or recombinant influenza vaccines fail to induce a sufficient immune response in patients with CD4+ cell counts under 500 cells/µL."... | step1 | D | [
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"physician",
"follow-up",
"found to",
"HIV-positive",
"months",
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"lamivudine",
"tenofovir",
"efavirenz",
"complaints",
"only reports",
"history",
"mild respiratory infection",
"last follow-up",
"allergic",
"egg whites",
"vital signs",... |
A 78-year-old man comes to the emergency department because of a 4-hour history of abdominal pain. Abdominal examination shows guarding with diffuse rebound tenderness. A CT scan of the abdomen shows an infrarenal abdominal aortic aneurysm that extends up to the level of the L4 vertebra and a partial filling defect in ... | Splenic flexure, descending colon, and sigmoid colon | {
"A": "Splenic flexure, descending colon, and sigmoid colon",
"B": "Hepatic flexure, transverse colon, and splenic flexure",
"C": "Cecum, ileum, and distal jejunum",
"D": "Ascending colon, cecum, and distal ileum"
} | step1 | A | [
"year old man",
"emergency department",
"4-hour history",
"abdominal pain",
"examination shows guarding",
"diffuse rebound",
"CT scan",
"abdomen shows",
"abdominal aortic aneurysm",
"extends",
"level",
"L4",
"partial filling defect in",
"anterior wall",
"aneurysm",
"following bowel reg... |
A previously healthy 65-year-old man comes to the physician for chronic left-sided abdominal discomfort. About 3 months ago, he started experiencing early satiety and eating less. He has lost 7 kg (15.4 lb) during this period. He also occasionally has left shoulder pain. He recently retired from his job on a production... | Thrombocytopenia | {
"A": "Peripheral lymphadenopathy",
"B": "Thrombocytopenia",
"C": "Lymphocytosis",
"D": "BCR-ABL gene"
} | step2&3 | B | [
"healthy 65 year old man",
"physician",
"chronic left-sided abdominal discomfort",
"3 months",
"started experiencing early satiety",
"eating",
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"kg",
"15.4",
"period",
"occasionally",
"left shoulder pain",
"recently retired",
"job",
"production line",
"shoe factory",
"pulse",
... |
A 37-year-old G1P000 presents to her obstetrician for her first prenatal visit. She states that her last menstrual period (LMP) was 11 weeks ago, though she is unsure of the exact date as her periods are sometimes irregular. She and her husband had 5 months of timed, unprotected intercourse before she had a positive ho... | Leiomyomata | {
"A": "Molar pregnancy",
"B": "Leiomyomata",
"C": "Multiple gestation pregnancy",
"D": "Anteverted uterus"
} | step2&3 | B | [
"year old",
"presents",
"obstetrician",
"first prenatal visit",
"states",
"last menstrual period",
"LMP",
"weeks",
"unsure",
"exact date",
"periods",
"sometimes irregular",
"husband",
"5 months",
"timed",
"unprotected intercourse",
"positive home",
"weeks",
"feeling",
"well",
... |
A 49-year-old woman presents to the primary care physician with complaints of recurrent episodes of right upper abdominal pain for the past 2 years. She is currently symptom-free. She mentions that the pain often occurs after a heavy fatty meal and radiates to her right shoulder. On examination, the patient has no tend... | Entrapped epithelial crypts seen as pockets of epithelium in the wall of the gallbladder | {
"A": "Neutrophilic infiltration with vascular congestion and fibrin deposition in the gallbladder",
"B": "Minimal lymphoid aggregates",
"C": "Entrapped epithelial crypts seen as pockets of epithelium in the wall of the gallbladder",
"D": "Hyalinized collagen and dystrophic calcification in the submucosal laye... | step1 | C | [
"year old woman presents",
"primary care physician",
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"currently symptom free",
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"heavy",
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"radiates",
"right shoulder",
"examination",
"patient",
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"abdomen",
"systemic examinat... |
A 55-year-old woman comes to the physician because of a 6-month history of worsening fatigue. During this time, she has noted a decrease in her exercise capacity and she becomes short of breath when walking briskly. She has had occasional streaks of blood in her stools during periods of constipation. She was diagnosed ... | Decreased erythropoietin production | {
"A": "Decreased erythropoietin production",
"B": "Chronic occult blood loss",
"C": "Deficient vitamin B12 intake",
"D": "Malignant plasma cell replication"
} | step2&3 | A | [
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A 14-year-old girl presents to the pediatrician for behavior issues. The girl has been having difficulty in school as a result. Every time the girl enters her classroom, she feels the urge to touch every wall before heading to her seat. When asked why she does this, she responds, "I'm not really sure. I just can't stop... | Cognitive behavioral therapy | {
"A": "Clomipramine",
"B": "Cognitive behavioral therapy",
"C": "Lorazepam",
"D": "Risperidone"
} | step2&3 | B | [
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An orthopaedic surgeon at a local community hospital has noticed that turnover times in the operating room have been unnecessarily long. She believes that the long wait times may be due to inefficient communication between the surgical nursing staff, the staff in the pre-operative area, and the staff in the post-operat... | Plan-Do-Study-Act cycle | {
"A": "Forcing function",
"B": "Plan-Do-Study-Act cycle",
"C": "Root cause analysis",
"D": "Standardization"
} | step1 | B | [
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"surgical",
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"staff",
"post-operative receiving area",
"secure communication mobile phone app",
"help",
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A 59-year-old man with a history of alcoholic cirrhosis is brought to the physician by his wife for a 1-week history of progressive abdominal distension and yellowing of the eyes. For the past month, he has been irritable, had difficulty falling asleep, become clumsy, and fallen frequently. Two months ago he underwent ... | Palmar erythema and gynecomastia | {
"A": "Jaundice and flapping tremor",
"B": "Palmar erythema and gynecomastia",
"C": "Caput medusae and spider angiomata",
"D": "Testicular atrophy and abdominal distension"
} | step2&3 | B | [
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"irritable",
"difficulty falling asleep",
"clumsy",
"fallen frequently",
"Two months",
"banding",
"esophagea... |
A 42-year-old woman presents with complaints of a sharp, stabbing pain in her chest upon coughing and inhalation. She says that the pain started acutely 2 days ago and has progressively worsened. Her past medical history is significant for a rash on her face, joint pains, and fatigue for the past few weeks. The patient... | Breakthrough pain that improves with leaning forward | {
"A": "Mid-systolic click",
"B": "Pain improvement with inspiration",
"C": "Displaced apical impulse",
"D": "Breakthrough pain that improves with leaning forward"
} | step1 | D | [
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"vital signs",... |
A 63-year-old man presents to his primary care provider complaining of changes in his vision. He says that he has been having transient episodes of "shimmering lights" and generalized blurring of his vision for the past 3 months. He is disturbed by this development as he worries it may interfere with his job as a bus d... | Decreased erythrocyte sedimentation rate | {
"A": "Decreased erythrocyte sedimentation rate",
"B": "Increased erythropoetin levels",
"C": "Schistocytes on peripheral smear",
"D": "Thrombocytopenia"
} | step1 | A | [
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"reports",
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"appeti... |
A 19-year-old woman is brought to the emergency department by ambulance 30 minutes after her neighbor found her unconscious on a running trail. Her neighbor reports that she has been training for a marathon since the beginning of the summer. She is alert and oriented but becomes irritable when realizing that she is at ... | Anorexia nervosa | {
"A": "Hypertrophic obstructive cardiomyopathy",
"B": "Hypothyroidism",
"C": "Heat exhaustion",
"D": "Anorexia nervosa"
} | step1 | D | [
"year old woman",
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"alert",
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"appears ti... |
An 18-year-old G1P0 woman who is 10 weeks pregnant presents for her first prenatal visit. She reports nausea with occasional vomiting but denies bleeding, urinary symptoms, or abdominal pain. She just graduated high school and works at the local grocery store. She does not take any medications and has no known drug all... | Nitrofurantoin for seven days | {
"A": "Observation and treatment if symptoms develop",
"B": "Nitrofurantoin for seven days",
"C": "Observation and repeat cultures in one week",
"D": "Nitrofurantoin for duration of pregnancy"
} | step2&3 | B | [
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"woman",
"10 weeks pregnant presents",
"first prenatal visit",
"reports nausea with occasional vomiting",
"denies bleeding",
"urinary symptoms",
"abdominal pain",
"graduated high school",
"works",
"local grocery store",
"not take",
"medications",
"known drug allergies",
"Phys... |
2 hours after being admitted to the hospital because of a fracture of the right ankle, a 75-year-old man continues to complain of pain despite treatment with acetaminophen and ibuprofen. He has a history of dementia and cannot recall his medical history. The presence of which of the following features would most likely... | Biliary tract dysfunction | {
"A": "Watery diarrhea",
"B": "Biliary tract dysfunction",
"C": "Persistent cough",
"D": "Tachypnea"
} | step1 | B | [
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An immunology expert is explaining the functions of macrophages to biology students. He describes a hypothetical case scenario as follows: a potentially harmful gram-negative bacillus encounters a macrophage in the tissues. The Toll-like receptor (TLR) on the macrophage recognizes the bacterial lipopolysaccharide (LPS)... | Interleukin-12 (IL-12) | {
"A": "Interleukin-1 receptor antagonist (IL-1RA)",
"B": "Interleukin-4 (IL-4)",
"C": "Interleukin-10 (IL-10)",
"D": "Interleukin-12 (IL-12)"
} | step1 | D | [
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"macrophage",
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... |
A 59-year-old woman with a past medical history of atrial fibrillation currently on warfarin presents to the emergency department for acute onset dizziness. She was watching TV in the living room when she suddenly felt the room spin around her as she was getting up to go to the bathroom. She denies any fever, weight lo... | Decreased gag reflex | {
"A": "Decreased gag reflex",
"B": "Left-sided tongue deviation",
"C": "Paralysis of the right lower limb",
"D": "Right-sided facial paralysis"
} | step1 | A | [
"year old woman",
"past medical history of atrial fibrillation currently",
"warfarin presents",
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"denies",
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... |
A 75-year-old man comes to the physician because of fatigue and decreased urine output for 1 week. He takes ibuprofen as needed for lower back pain and docusate for constipation. Physical examination shows tenderness to palpation over the lumbar spine. There is pedal edema. Laboratory studies show a hemoglobin concentr... | Immunoglobulin light chains | {
"A": "Immunoglobulin light chains",
"B": "Renal deposition of AL amyloid",
"C": "Anti double-stranded DNA antibodies",
"D": "Hypersensitivity reaction"
} | step1 | A | [
"75 year old man",
"physician",
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"1 week",
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"lower back pain",
"docusate",
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"Physical examination shows tenderness",
"palpation",
"lumbar spine",
"pedal edema",
"Laboratory studies show a hemoglobin concentratio... |
A 12-year-old Caucasian male presents with his mother to the pediatrician’s office complaining of right thigh pain. He reports that he has noticed slowly progressive pain and swelling over the distal aspect of his right thigh over the past two months. He denies any recent trauma to the area and his temperature is 100.9... | t(11;22) | {
"A": "t(8;14)",
"B": "t(11;22)",
"C": "TP53 inactivation",
"D": "RB1 inactivation"
} | step1 | B | [
"year old Caucasian male presents",
"mother",
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"100 9F",
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A 42-year-old, G3P2012 woman comes to the clinic complaining of painful menstruation for the past 4 months. She is also using more tampons compared to prior periods. She is concerned as her close friend was just diagnosed with endometrial cancer. Prior to these symptoms, her menstrual cycle was regular (every 28 days) ... | Invasion of endometrial glands into the myometrium | {
"A": "Abnormal endometrial gland proliferation at the endometrium",
"B": "Collection of endometrial tissue protruding into the uterine cavity",
"C": "Invasion of endometrial glands into the myometrium",
"D": "Non-neoplastic endometrial tissue outside of the endometrial cavity"
} | step1 | C | [
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"regular",
"days",
"pain",
"denies abnormal uterine bleeding",
"ab... |
A researcher is studying a new antituberculosis drug. In the laboratory, the drug has been shown to be effective against mycobacteria located within phagolysosomes of macrophages, but it is also significantly less effective against extracellular tuberculoid bacteria. The characteristics of this drug are most similar to... | Pyrazinamide | {
"A": "Rifampin",
"B": "Ethambutol",
"C": "Pyrazinamide",
"D": "Streptomycin"
} | step1 | C | [
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"studying",
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"laboratory",
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"effective",
"extracellular",
"bacteria",
"characteristics",
"drug",
"most similar",
"following agents"
] |
A cohort study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on asthma symptoms in a group of firefighters who worked at Ground Zero during the September 11, 2001 terrorist attacks in New York City and developed asthma in the attack's aftermath. The study compared patients who had PTS... | 0.50 | {
"A": "2.0",
"B": "0.25",
"C": "0.50",
"D": "4.0"
} | step2&3 | C | [
"cohort study",
"conducted to investigate",
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"ot ",
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... |
A previously healthy 25-year-old woman comes to the physician because of a 1-month history of palpitations that occur on minimal exertion and sometimes at rest. She has no chest discomfort or shortness of breath. She feels nervous and irritable most of the time and attributes these feelings to her boyfriend leaving her... | Exogenous hyperthyroidism | {
"A": "Coffee consumption",
"B": "Hashimoto thyroiditis",
"C": "Exogenous hyperthyroidism",
"D": "Generalized anxiety disorder\n\""
} | step2&3 | C | [
"healthy",
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"sometimes",
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"feels nervous",
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"time",
"attributes",
"feelings",
"boyfriend",
"her 2 months",
"then",
"... |
A 23-year-old woman comes to the physician for evaluation of two masses on her right auricle for several months. The masses appeared a few weeks after she had her ear pierced and have increased in size since then. A photograph of her right ear is shown. Which of the following is the most likely cause of these findings? | Increased production of hyalinized collagen | {
"A": "Implantation of epidermis into the dermis",
"B": "Increased production of hyalinized collagen",
"C": "Malignant transformation of keratinocytes",
"D": "Excess formation of organized extracellular matrix"
} | step1 | B | [
"23 year old woman",
"physician",
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"right auricle",
"months",
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"few weeks",
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"increased in size",
"then",
"photograph",
"right ear",
"shown",
"following",
"most likely cause",
"findings"
] |
A 37-year-old man presents to the clinic for evaluation of a chronic cough that has increased in frequency and severity for the past 2 days. His cough began 2 weeks ago but was not as bothersome as now. He states that he can hardly get to sleep because he is coughing all the time. Upon further questioning, he says that... | Azithromycin | {
"A": "Levofloxacin",
"B": "Azithromycin",
"C": "Azithromycin with amoxicillin-clavulanate",
"D": "Amoxicillin"
} | step2&3 | B | [
"year old man presents",
"clinic",
"evaluation",
"chronic cough",
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"cough began 2 weeks",
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"time",
"further questioning",
"low-grade fever",
"runny nose",
"fatigue",
"resolved",
... |
A previously healthy, 16-year-old boy is brought to the emergency department with persistent bleeding from his gums after an elective removal of an impacted tooth. Multiple gauze packs were applied with minimal effect. He has a history of easy bruising. His family history is unremarkable except for a maternal uncle who... | Hemophilia | {
"A": "Von Willebrand disease",
"B": "Glanzmann thrombasthenia",
"C": "Hemophilia",
"D": "Bernard-Soulier syndrome"
} | step1 | C | [
"healthy",
"year old boy",
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"minimal effect",
"history",
"easy bruising",
"family history",
"unremarkable",
"maternal uncle",
"history",
"eas... |
A 60-year-old woman presents with progressive difficulty swallowing solid foods for the past 2 months. She also says her voice has gradually changed, and she has had recent episodes of vertigo associated with nausea and vomiting and oscillating eye movements while reading. She denies any problems with the movement of h... | Posterior inferior cerebellar artery | {
"A": "Anterior spinal artery",
"B": "Middle cerebral artery",
"C": "Anterior inferior cerebellar artery",
"D": "Posterior inferior cerebellar artery"
} | step1 | D | [
"60 year old woman presents",
"progressive difficulty swallowing solid foods",
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"voice",
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"recent episodes of vertigo associated with nausea",
"vomiting",
"eye movements",
"reading",
"denies",
"problems",
"movement",
"face",
"extremities",
"Past medical histo... |
A 41-year-old woman presents to urgent care with complaints of a new rash. On review of systems, she endorses ankle pain bilaterally. Otherwise, she has no additional localized complaints. Physical examination reveals numerous red subcutaneous nodules overlying her shins, bilaterally. Complete blood count shows leukocy... | Sarcoidosis | {
"A": "Coccidioidomycosis",
"B": "Sarcoidosis",
"C": "Chlamydophila pneumoniae",
"D": "Histoplasmosis"
} | step2&3 | B | [
"year old woman presents",
"urgent care",
"complaints",
"new rash",
"review of systems",
"ankle pain",
"additional localized complaints",
"Physical examination reveals numerous red subcutaneous",
"shins",
"Complete blood count shows leukocytes 7 300",
"Hct",
"Hgb",
"g/dL",
"mean corpuscula... |
A 4-month-old boy is brought to the physician because of a seizure. He was delivered at term after an uncomplicated pregnancy. He is currently at the 10th percentile for height, 5th percentile for weight, and 15th percentile for head circumference. Examination shows muscle hypotonia. His serum lactic acid and alanine a... | Valine | {
"A": "Arachidonic acid",
"B": "Valine",
"C": "Lysine",
"D": "Thiamine"
} | step1 | B | [
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"uncomplicated pregnancy",
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"weight",
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"Examination shows muscle hypotonia",
"serum lactic acid",
"alanine",
"elevated",
"function... |
A 55-year-old woman presents with fatigue. She says her symptoms are present throughout the day and gradually started 4 months ago. Her past medical history is significant for rheumatoid arthritis–treated with methotrexate, and diabetes mellitus type 2–treated with metformin. The patient is afebrile, and her vital sign... | Serum ferritin and soluble transferrin receptor levels | {
"A": "Serum ferritin level",
"B": "Serum ferritin and serum iron levels",
"C": "Serum ferritin and soluble transferrin receptor levels",
"D": "Serum iron level"
} | step2&3 | C | [
"55 year old woman presents",
"fatigue",
"symptoms",
"present",
"day",
"started 4 months",
"past medical history",
"significant",
"methotrexate",
"diabetes mellitus type",
"metformin",
"patient",
"afebrile",
"vital signs",
"normal limits",
"physical examination reveals pallor",
"muco... |
A 31-year-old man presents to his primary care physician with shortness of breath. He states that he had a “cold” 2 weeks ago and since then has had a persistent cough and worsening shortness of breath. He denies fever, chills, chest pain, sore throat, or rhinorrhea. His medical history is significant for seasonal alle... | Liver biopsy | {
"A": "Bronchoalveolar lavage",
"B": "Enzyme-linked immunosorbent assay",
"C": "Liver biopsy",
"D": "Viral hepatitis serologies"
} | step2&3 | C | [
"31 year old man presents",
"primary care physician",
"shortness of breath",
"states",
"cold",
"weeks",
"since then",
"persistent cough",
"worsening shortness of breath",
"denies fever",
"chills",
"chest pain",
"sore throat",
"rhinorrhea",
"medical history",
"significant",
"seasonal ... |
A 70-year-old woman is brought to the emergency department due to worsening lethargy. She lives with her husband who says she has had severe diarrhea for the past few days. Examination shows a blood pressure of 85/60 mm Hg, pulse of 100/min, and temperature of 37.8°C (100.0°F). The patient is stuporous, while her skin ... | Non-anion gap metabolic acidosis with respiratory compensation | {
"A": "Anion gap metabolic acidosis",
"B": "Anion gap metabolic acidosis with respiratory compensation",
"C": "Non-anion gap metabolic acidosis with respiratory compensation",
"D": "Chronic respiratory acidosis"
} | step1 | C | [
"70 year old woman",
"brought",
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"days",
"Examination shows",
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"85 60 mm Hg",
"pulse",
"100 min",
"temperature",
"100",
"patient",
"stuporous",
"skin appears dry",
... |
A 25-year old man comes to the physician because of fatigue over the past 6 months. He has been to the emergency room several times over the past 3 years for recurrent shoulder and patella dislocations. Physical examination shows abnormal joint hypermobility and skin hyperextensibility. A high-frequency mid-systolic cl... | Abrupt standing | {
"A": "Hand grip",
"B": "Abrupt standing",
"C": "Valsalva release phase",
"D": "Leaning forward"
} | step1 | B | [
"year old man",
"physician",
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"past 6 months",
"emergency room",
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"past",
"years",
"recurrent shoulder",
"patella dislocations",
"Physical examination shows abnormal joint hypermobility",
"skin hyperextensibility",
"high-frequency",
"systolic click",
"heard",
"ausc... |
A 21-year-old female presents to her obstetrician because she has stopped getting her period, after being irregular for the last 3 months. Upon further questioning, the patient reveals that she has had a 17 lb. unintended weight loss, endorses chronic diarrhea, abdominal pain, and constipation that waxes and wanes. Fam... | Villous atrophy with crypt lengthening and intraepithelial lymphocytes | {
"A": "Cobblestoning with biopsy showing transmural inflammation and noncaseating granulomas",
"B": "Friable mucosal pseudopolyps with biopsy notable for crypt abscesses",
"C": "Normal appearing villi and biopsy",
"D": "Villous atrophy with crypt lengthening and intraepithelial lymphocytes"
} | step2&3 | D | [
"21-year-old female presents",
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"stopped getting",
"period",
"irregular",
"months",
"further questioning",
"patient reveals",
"unintended weight loss",
"chronic diarrhea",
"abdominal pain",
"constipation",
"waxes",
"Family history",
"notable only",
"older brother",
"Ty... |
A 56-year-old woman presents to the clinic complaining of fatigue and nausea. She was recently diagnosed with metastatic ovarian cancer and subsequently started treatment with an alkylating agent. The patient reports recent weight loss, malaise, and drowsiness, but denies fever, headaches, palpitations, shortness of br... | Granular casts | {
"A": "Elevated protein",
"B": "Granular casts",
"C": "Normal findings",
"D": "WBC casts"
} | step1 | B | [
"year old woman presents",
"clinic",
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"nausea",
"recently diagnosed",
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"started treatment",
"agent",
"patient reports recent weight loss",
"malaise",
"drowsiness",
"denies fever",
"headaches",
"palpitations",
"shortness of breath",
"genitourinary s... |
A 68-year-old man comes to the physician because of a 5-month history of undulating, dull pain in his right thigh. Physical examination shows a tender, round mass located above the right knee on the anterior aspect of the thigh. An x-ray of the right thigh shows sunburst pattern of osteolytic bone lesions in combinatio... | Paget disease of bone | {
"A": "Paget disease of bone",
"B": "Gardner syndrome",
"C": "t(11;22) translocation",
"D": "Hyperparathyroidism"
} | step1 | A | [
"68 year old man",
"physician",
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"anterior aspect of",
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"x-ray of",
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"combination",
"sclerotic bone f... |
An 11-month-old boy is brought to the emergency department because of intermittent episodes of inconsolable crying for 4 hours. The parents report that the patient does not appear to be in discomfort between episodes, and moves and plays normally. The episodes have occurred at roughly 15-minute intervals and have each ... | Air enema | {
"A": "Exploratory laparotomy",
"B": "X-ray of the abdomen",
"C": "MRI of the abdomen",
"D": "Air enema"
} | step2&3 | D | [
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"episodes",
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"lasted",
"few minutes",
"vomite... |
A 61-year-old woman presents to the emergency room with right hand pain and numbness. She was jogging around her neighborhood when she tripped and fell on her outstretched hand 3 hours prior to presentation. She reports severe wrist pain and numbness along the medial aspect of her hand. Her past medical history is nota... | Distal ulnar nerve | {
"A": "Distal median nerve",
"B": "Distal ulnar nerve",
"C": "Proximal ulnar nerve",
"D": "Recurrent branch of the median nerve"
} | step1 | B | [
"61 year old woman presents",
"emergency room",
"right",
"numbness",
"jogging",
"neighborhood",
"tripped",
"fell",
"hand",
"hours",
"presentation",
"reports severe wrist",
"numbness",
"medial aspect of",
"hand",
"past medical history",
"notable",
"osteoporosis",
"gastroesophageal... |
A 52-year-old African-American woman presents to the office complaining of difficulty swallowing for 1 week, and described it as "food getting stuck in her throat". Her discomfort is mainly for solid foods, and she does not have any problem with liquids. She further adds that she has frequent heartburn and lost 5 pound... | Scleroderma | {
"A": "Zenker's diverticulum",
"B": "Scleroderma",
"C": "Polyomyositis",
"D": "Diffuse esophageal spasm"
} | step1 | B | [
"year old African-American woman presents",
"office",
"difficulty swallowing",
"1 week",
"described",
"food getting",
"throat",
"discomfort",
"solid foods",
"not",
"problem",
"liquids",
"further adds",
"frequent heartburn",
"lost 5 pounds",
"month",
"discomfort",
"sometimes takes a... |
A 45-year-old woman comes to the physician because of a 1-week history of fatigue and bruises on her elbows. Examination shows a soft, nontender abdomen with no organomegaly. Laboratory studies show a hemoglobin concentration of 7 g/dL, a leukocyte count of 2,000/mm3, a platelet count of 40,000/mm3, and a reticulocyte ... | Hyperplasia of adipocytes | {
"A": "Sheets of abnormal plasma cells",
"B": "Wrinkled cells with a fibrillary cytoplasm",
"C": "Hyperplasia of adipocytes",
"D": "Increased myeloblast count"
} | step1 | C | [
"year old woman",
"physician",
"1-week history",
"fatigue",
"bruises",
"elbows",
"Examination shows",
"soft",
"nontender abdomen",
"organomegaly",
"Laboratory studies show a hemoglobin concentration",
"g/dL",
"leukocyte count",
"mm3",
"platelet count",
"40",
"mm3",
"reticulocyte co... |
A 45-year-old man has a history of smoking 1 pack per day and drinking a six-pack of beer daily over the last ten years. He is admitted to the medical floor after undergoing a cholecystectomy. One day after the surgery, the patient states that he feels anxious and that his hands are shaking. While being checked for a c... | Lorazepam | {
"A": "Urinalysis",
"B": "Lorazepam",
"C": "Morphine",
"D": "Antibiotics"
} | step2&3 | B | [
"year old man",
"history of smoking",
"pack",
"day",
"drinking",
"six-pack",
"beer daily",
"last ten years",
"admitted",
"medical floor",
"cholecystectomy",
"One",
"surgery",
"patient states",
"feels anxious",
"hands",
"shaking",
"checked",
"clean surgical site",
"patient start... |
A 63-year-old man comes to the physician for a routine health maintenance examination. He feels well. He has a history of hypertension, atrial fibrillation, bipolar disorder, and osteoarthritis of the knees. Current medications include lisinopril, amiodarone, lamotrigine, and acetaminophen. He started amiodarone 6 mont... | Discontinue amiodarone | {
"A": "Discontinue amiodarone",
"B": "Discontinue acetaminophen",
"C": "Follow-up laboratory results in 6 months",
"D": "Decrease alcohol consumption"
} | step2&3 | A | [
"63 year old man",
"physician",
"routine health maintenance examination",
"feels well",
"history of hypertension",
"atrial fibrillation",
"bipolar disorder",
"osteoarthritis of",
"knees",
"Current medications include lisinopril",
"amiodarone",
"lamotrigine",
"acetaminophen",
"started amiod... |
A 23-year-old woman comes to the emergency department because of a 5-day history of nausea and vomiting. There is no associated fever, abdominal pain, constipation, diarrhea, or dysuria. She is sexually active and uses condoms inconsistently. Her last menstrual period was 10 weeks ago. Her temperature is 37°C (98.6°F),... | Maintenance of the corpus luteum | {
"A": "Maintenance of the corpus luteum",
"B": "Hypertrophy of the uterine myometrium",
"C": "Stimulation of uterine contractions at term",
"D": "Fetal angiogenesis"
} | step2&3 | A | [
"23 year old woman",
"emergency department",
"5-day history",
"nausea",
"vomiting",
"associated fever",
"abdominal pain",
"constipation",
"diarrhea",
"dysuria",
"sexually active",
"uses condoms",
"last menstrual period",
"10 weeks",
"temperature",
"98",
"pulse",
"90 min",
"respir... |
A 25-year-old male medical student presents to student health with a chief complaint of picking at his skin. He states that at times he has urges to pick his skin that he struggles to suppress. Typically, he will participate in the act during finals or when he has "too many assignments to do." The patient states that h... | Fluoxetine | {
"A": "Clomipramine",
"B": "Fluoxetine",
"C": "Dialectical behavioral therapy",
"D": "Interpersonal psychotherapy"
} | step2&3 | B | [
"year old male medical student presents",
"student health",
"chief complaint",
"picking",
"skin",
"states",
"times",
"to pick",
"skin",
"to suppress",
"act",
"finals",
"assignments",
"patient states",
"behavior",
"not helping",
"causing",
"stopping",
"often",
"over",
"respons... |
A 31-year-old female presents to the clinic with excessive anxiety and palpitations for a month. She also mentions losing of 2.72 kg (6 lb) of her weight over the last month. Her past medical history is insignificant. She does not smoke nor does she drink alcohol. Her temperature is 37°C (98.6°F), pulse is 81/min, resp... | Thyroid stimulating antibodies | {
"A": "Inadequate iodine in her diet",
"B": "Thyroid stimulating antibodies",
"C": "Medullary carcinoma of the thyroid",
"D": "Use of propylthiouracil"
} | step2&3 | B | [
"31 year old female presents",
"clinic",
"excessive anxiety",
"palpitations",
"month",
"72 kg",
"weight",
"month",
"past medical history",
"not smoke",
"drink alcohol",
"temperature",
"98",
"pulse",
"81 min",
"respiratory rate",
"23 min",
"blood pressure",
"88 mm Hg",
"examinat... |
A 29-year-old woman presents to the emergency department with a history of a fever that "won't break." She has taken acetaminophen without relief. Upon obtaining a past medical history you learn that the patient is a prostitute who is homeless with a significant history of intravenous drug use and alcohol abuse. The pa... | Antibiotic therapy | {
"A": "Antibiotic therapy",
"B": "Coagulation cascade activation",
"C": "Bacterial infection of the bloodstream",
"D": "Factor VIII deficiency"
} | step2&3 | A | [
"29 year old woman presents",
"emergency department",
"history",
"fever",
"reak.",
"aken cetaminophen ",
"elief.",
"btaining ",
"ast medical history ",
"earn ",
"atient ",
"rostitute ",
"omeless ",
"ignificant istory ",
"ntravenous drug use ",
"lcohol abuse.",
"atient ses arrier ... |
A 2720-g (6-lb) female newborn is delivered at term to a 39-year-old woman, gravida 3, para 2. Apgar scores are 6 and 7 at 1 and 5 minutes, respectively. Examination in the delivery room shows micrognathia, prominent occiput with flattened nasal bridge, and pointy low-set ears. The eyes are upward slanting with small p... | Trisomy of chromosome 18 | {
"A": "Trisomy of chromosome 21",
"B": "Maternal alcohol intake",
"C": "FMR1 gene silencing",
"D": "Trisomy of chromosome 18"
} | step2&3 | D | [
"g",
"female newborn",
"delivered",
"term",
"year old woman",
"gravida 3",
"para 2",
"Apgar scores",
"5 minutes",
"Examination",
"delivery shows micrognathia",
"prominent",
"flattened",
"pointy low-set ears",
"eyes",
"upward slanting",
"small palpebral fissures",
"fists",
"clench... |
A 38-year-old woman, gravida 4, para 3, at 20 weeks' gestation comes to the physician for a prenatal care visit. She used fertility enhancing treatment for her current pregnancy. Her other children were born before 37 weeks' gestation. She is 170 cm (5 ft 7 in) tall and weighs 82 kg (180 lb); BMI is 28.4 kg/m2. Her vit... | Cervical insufficiency | {
"A": "Bicornuate uterus",
"B": "Placental insufficiency",
"C": "Diethylstilbestrol exposure",
"D": "Cervical insufficiency"
} | step2&3 | D | [
"year old woman",
"gravida 4",
"para 3",
"20 weeks",
"gestation",
"physician",
"prenatal visit",
"used fertility enhancing treatment",
"current pregnancy",
"children",
"born",
"weeks",
"gestation",
"5 ft",
"tall",
"kg",
"BMI",
"kg/m2",
"vital signs",
"normal limits",
"abdomen... |
An 11-year-old boy with a history of attention deficit disorder presents to a general medicine clinic with leg pain. He is accompanied by his mother. He reports dull, throbbing, diffuse pain in his bilateral lower extremities. He reports that the pain feels deep in his muscles. He has awakened several times at night wi... | Reassurance | {
"A": "Lower extremity venous ultrasound",
"B": "MRI of the knees",
"C": "Xray of the knees",
"D": "Reassurance"
} | step2&3 | D | [
"year old boy",
"history of attention deficit disorder presents",
"general medicine clinic",
"leg pain",
"mother",
"reports dull",
"throbbing",
"diffuse pain in",
"bilateral lower extremities",
"reports",
"pain feels deep",
"muscles",
"times",
"night",
"pain",
"symptoms",
"to",
"be... |
A 49-year-old woman presents to her primary care physician for a general check up. She has not seen a primary care physician for the past 20 years but states she has been healthy during this time frame. She had breast implants placed when she was 29 years old but otherwise has not had any surgeries. She is concerned ab... | No intervention indicated at this time | {
"A": "BRCA genetic testing",
"B": "Mammography",
"C": "No intervention indicated at this time",
"D": "Ultrasound"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"general check up",
"not seen",
"primary care physician",
"past 20 years",
"states",
"healthy",
"time frame",
"breast implants placed",
"29 years old",
"not",
"surgeries",
"concerned",
"risk",
"breast cancer given",
"friend",
"re... |
A 29-year-old man with post-traumatic stress disorder is admitted to the hospital following an intentional opioid overdose. He is a soldier who returned from a deployment in Afghanistan 3 months ago. He is divorced and lives alone. His mother died by suicide when he was 8 years of age. He states that he intended to end... | Attempted drug overdose | {
"A": "Family history of completed suicide",
"B": "Attempted drug overdose",
"C": "Use of medical marijuana",
"D": "Lack of social support"
} | step1 | B | [
"29 year old man",
"post-traumatic stress disorder",
"admitted",
"hospital following",
"intentional opioid overdose",
"soldier",
"returned",
"deployment",
"Afghanistan",
"months",
"divorced",
"lives alone",
"mother died",
"suicide",
"years",
"age",
"states",
"intended to end",
"l... |
A 37-year-old man presents to his primary care physician because he has had constipation for the last several weeks. He has also been feeling lethargic and complains that this winter has been particularly cold. He also complains that he has been gaining weight despite no change in his normal activities. He reveals that... | Granulomatous inflammation | {
"A": "Fibrous tissue",
"B": "Germinal follicles",
"C": "Granulomatous inflammation",
"D": "Scalloped clear areas"
} | step1 | C | [
"year old man presents",
"primary care physician",
"constipation",
"weeks",
"feeling lethargic",
"winter",
"cold",
"gaining weight",
"change",
"normal activities",
"reveals",
"two months prior to presentation",
"felt",
"flu",
"took tylenol",
"not",
"medical attention",
"days",
"a... |
A 28-year-old woman presents to her primary care physician with recurring muscle cramps that have lasted for the last 2 weeks. She mentions that she commonly has these in her legs and back. She also has a constant tingling sensation around her mouth. On physical examination, her vital signs are stable. The Trousseau si... | Reduction of afterhyperpolarization | {
"A": "Stimulation of GABA (γ-aminobutyric acid) receptors",
"B": "Reduction of afterhyperpolarization",
"C": "Inhibition of Na+ and Ca2+ currents through cyclic nucleotide-gated (CNG) channels",
"D": "Inhibition of sodium current through sodium leak channels (NALCN)"
} | step1 | B | [
"year old woman presents",
"primary care physician",
"recurring muscle cramps",
"lasted",
"2 weeks",
"legs",
"back",
"constant tingling",
"mouth",
"physical examination",
"vital signs",
"stable",
"Trousseau sign",
"Chvostek sign",
"present",
"exaggerated deep tendon reflexes",
"compr... |
A 56-year-old man is brought to the emergency department with increasing crampy abdominal pain and swelling over the past 2 days. He has not passed stool or flatus for over 12 hours. He has vomited twice. He has noted a lower stool caliber over the past month. His past medical history is unremarkable except for an appe... | Sigmoid tumor | {
"A": "Acute mesenteric ischemia",
"B": "Adhesions",
"C": "Diverticulitis",
"D": "Sigmoid tumor"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"increasing crampy abdominal pain",
"swelling",
"past 2 days",
"not passed stool",
"flatus",
"12 hours",
"vomited twice",
"noted",
"lower stool caliber",
"past month",
"past medical history",
"unremarkable",
"appendectomy",
"years",
... |
A 6-year-old boy is brought to the physician because he has a limp for 3 weeks. He was born at term and has been healthy since. His immunization are up-to-date; he received his 5th DTaP vaccine one month ago. He is at 50th percentile for height and weight. His temperature is 37°C (98.6°F), pulse is 80/min and respirati... | Damage to the right superior gluteal nerve | {
"A": "L5 radiculopathy",
"B": "Spinal abscess",
"C": "Damage to the right common peroneal nerve",
"D": "Damage to the right superior gluteal nerve"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"limp",
"weeks",
"born",
"term",
"healthy",
"immunization",
"date",
"received",
"5th DTaP vaccine one month",
"50th percentile",
"height",
"weight",
"temperature",
"98",
"pulse",
"80 min",
"respirations",
"min",
"to stand only",
"ri... |
A 47-year-old man with gastroesophageal reflux disease comes to the physician because of severe burning chest pain and belching after meals. He has limited his caffeine intake and has been avoiding food close to bedtime. Esophagogastroduodenoscopy shows erythema and erosions in the distal esophagus. Which of the follow... | Inhibition of ATPase | {
"A": "Enhancement of the mucosal barrier",
"B": "Inhibition of D2 receptors",
"C": "Inhibition of H2 receptors",
"D": "Inhibition of ATPase"
} | step1 | D | [
"year old man",
"gastroesophageal reflux disease",
"physician",
"severe burning chest pain",
"belching",
"meals",
"limited",
"caffeine intake",
"food close",
"bedtime",
"Esophagogastroduodenoscopy shows erythema",
"erosions",
"distal esophagus",
"following",
"mechanism of action",
"app... |
An 87-year-old male nursing home resident is currently undergoing antibiotic therapy for the treatment of a decubitus ulcer. One week into the treatment course, he experiences several episodes of watery diarrhea. Subsequent sigmoidoscopy demonstrates the presence of diffuse yellow plaques on the mucosa of the sigmoid c... | Oral metronidazole | {
"A": "Oral morphine",
"B": "Intravenous gentamicin",
"C": "Oral metronidazole",
"D": "Oral trimethoprim/sulfamethoxazole"
} | step1 | C | [
"87 year old male nursing home resident",
"currently",
"antibiotic",
"treatment",
"decubitus ulcer",
"One week",
"treatment course",
"experiences several episodes of watery diarrhea",
"Subsequent sigmoidoscopy demonstrates",
"presence",
"diffuse yellow plaques",
"mucosa of",
"sigmoid colon",... |
A 38-year-old woman comes to the physician because of a 3-month history of moderate abdominal pain that is unresponsive to medication. She has a history of two spontaneous abortions at 11 and 12 weeks' gestation. Ultrasound examination of the abdomen shows normal liver parenchyma, a dilated portal vein, and splenic enl... | Thrombocytopenia | {
"A": "Increased prothrombin time",
"B": "Hepatic venous congestion",
"C": "Councilman bodies",
"D": "Thrombocytopenia"
} | step1 | D | [
"year old woman",
"physician",
"3 month history",
"moderate abdominal",
"unresponsive",
"medication",
"history of two spontaneous abortions",
"weeks",
"gestation",
"Ultrasound examination",
"abdomen shows normal liver parenchyma",
"dilated portal",
"splenic enlargement",
"Upper endoscopy s... |
A 31-year-old man and his wife were referred to a genetic counselor. They are concerned about the chance that their children are likely to inherit certain conditions that run in their families. The wife’s father and grandfather are both healthy, but her grandfather can not see the color red. The husband is unaware if a... | Hemizygous; full penetrance | {
"A": "Heterozygotes; reduced or incomplete penetrance",
"B": "Hemizygous; reduced or incomplete penetrance",
"C": "Heterozygotes; full penetrance",
"D": "Hemizygous; full penetrance"
} | step1 | D | [
"31 year old man",
"wife",
"referred to",
"genetic counselor",
"concerned",
"chance",
"children",
"likely to inherit certain conditions",
"run in",
"families",
"father",
"grandfather",
"healthy",
"grandfather",
"not see",
"color red",
"husband",
"unaware",
"member",
"family",
... |
A 56-year-old woman presents to the emergency department after falling in the shower 2 days ago. At that time, she was complaining of severe back pain that she treated with over the counter acetaminophen. Since the fall, she has had increasing stomach pain and difficulty walking. She has not urinated or had a bowel mov... | Increased deep tendon reflexes | {
"A": "Decreased muscle strength in upper extremities",
"B": "Difficulty in swallowing",
"C": "Increased deep tendon reflexes",
"D": "Intentional tremors"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"falling in",
"shower 2 days",
"time",
"severe back pain",
"treated with over the counter acetaminophen",
"fall",
"increasing stomach pain",
"difficulty walking",
"not",
"bowel movement",
"incident",
"significant past medical history",
"... |
A 5-year-old girl is brought to the emergency department because of abdominal pain, vomiting, and diarrhea for 6 days. Her mother says that over the last 24 hours she has developed a rash and has been urinating less frequently than usual. One month ago, she had a 3-day episode of high fever and sore throat that subside... | Hemodialysis | {
"A": "Diazepam therapy",
"B": "Red blood cell transfusions",
"C": "Platelet transfusion",
"D": "Hemodialysis"
} | step2&3 | D | [
"5 year old girl",
"brought",
"emergency department",
"abdominal pain",
"vomiting",
"diarrhea",
"6 days",
"mother",
"last 24 hours",
"rash",
"less frequently than usual",
"One month",
"3-day episode of high fever",
"sore throat",
"medical treatment",
"appears weak",
"temperature",
... |
A 25-year-old man is brought to the emergency department by police for aggressive behavior. The patient is combative and shouts sexually aggressive remarks at the nursing staff. While obtaining the patient’s vitals, it is noted that he has markedly dilated pupils. His temperature is 98.2°F (36.8°C), pulse is 112/min, b... | Psychotherapy | {
"A": "Acamprosate",
"B": "Disulfiram",
"C": "Naltrexone",
"D": "Psychotherapy"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"police",
"aggressive behavior",
"patient",
"combative",
"shouts sexually aggressive remarks",
"nursing staff",
"obtaining",
"patients",
"noted",
"markedly dilated pupils",
"temperature",
"98",
"36",
"pulse",
"min",
"blood pressu... |
A 23-year-old woman is brought to the emergency department by her boyfriend 10 minutes after ingesting at least 15 acetaminophen tablets. She has been admitted to the hospital several times in the past few months after attempted self-harm. She claims that her boyfriend is “extremely selfish” and “does not care for her.... | Borderline personality disorder | {
"A": "Narcissistic personality disorder",
"B": "Cyclothymic disorder",
"C": "Bipolar II disorder",
"D": "Borderline personality disorder"
} | step1 | D | [
"23 year old woman",
"brought",
"emergency department",
"boyfriend 10 minutes",
"ingesting",
"15 acetaminophen tablets",
"admitted",
"hospital",
"times",
"past",
"months",
"attempted self-harm",
"boyfriend",
"extremely selfish",
"not care",
"feels lonely",
"boyfriend to pay attention... |
A 28-year-old primigravid woman at 36 weeks' gestation comes to the emergency department because of worsening pelvic pain for 2 hours. Three days ago, she had a burning sensation with urination that resolved spontaneously. She has nausea and has vomited fluid twice on her way to the hospital. She appears ill. Her tempe... | Administer intravenous ampicillin and gentamicin and induce labor | {
"A": "Administer intravenous ampicillin and gentamicin and perform C-section",
"B": "Expectant management",
"C": "Administer intravenous ampicillin and gentamicin and induce labor",
"D": "Perform C-section"
} | step2&3 | C | [
"year old primigravid woman",
"36 weeks",
"gestation",
"emergency department",
"of worsening pelvic",
"hours",
"Three days",
"burning sensation",
"urination",
"resolved",
"nausea",
"vomited fluid twice",
"hospital",
"appears ill",
"temperature",
"pulse",
"min",
"respirations",
"m... |
A 45-year-old woman with history of systemic sclerosis presents with new onset dyspnea, which is worsened with moderate exertion. She also complains of chest pain. An ECG was obtained, and showed right-axis deviation. Chest x-ray showed right ventricle hypertrophy. Given the patient's history and presentation, right he... | Endothelin receptor antagonist | {
"A": "Endothelin receptor antagonist",
"B": "Endothelin receptor agonist",
"C": "Phosphodiesterase type 5 inhibitor",
"D": "Calcium channel blocker"
} | step1 | A | [
"year old woman",
"history",
"systemic sclerosis presents",
"new onset dyspnea",
"worsened",
"moderate exertion",
"of chest pain",
"ECG",
"obtained",
"showed right-axis deviation",
"Chest x-ray showed right ventricle hypertrophy",
"Given",
"patient's history",
"presentation",
"right hear... |
A 34-year-old man presents to his primary care provider for evaluation of nocturnal cough and dyspnea. He has been a smoker for the past 15 years with a 7.5-pack-year smoking history. He has no significant medical history and takes no medications. His blood pressure is 118/76 mm Hg, the heart rate is 84/min, the respir... | Atopic asthma | {
"A": "Chronic obstructive pulmonary disease",
"B": "Atopic asthma",
"C": "Panacinar emphysema",
"D": "Pneumonia"
} | step1 | B | [
"year old man presents",
"primary care provider",
"evaluation",
"nocturnal cough",
"dyspnea",
"smoker",
"past",
"years",
"7.5 pack-year smoking history",
"significant medical history",
"takes",
"medications",
"blood pressure",
"76 mm Hg",
"heart rate",
"84 min",
"respiratory rate",
... |
A 35-year-old man, with a history of neurofibromatosis type 2 (NF2) diagnosed 2 years ago, presents with hearing loss in the right ear and tinnitus. Patient says that symptoms have been gradually progressive. He has difficulty hearing speech as well as loud sounds. He also gives a history of occasional headaches and ve... | Schwannoma | {
"A": "Hemangioblastoma",
"B": "Schwannoma",
"C": "Meningioma",
"D": "Craniopharyngioma"
} | step1 | B | [
"35 year old man",
"history",
"neurofibromatosis type 2",
"diagnosed 2 years",
"presents",
"hearing loss",
"right ear",
"tinnitus",
"Patient",
"symptoms",
"progressive",
"difficulty",
"loud sounds",
"gives",
"history of occasional headaches",
"vertigo",
"month",
"unresponsive",
"... |
A 24-year old G1P0 mother with no prenatal screening arrives to the hospital in labor and has an uneventful delivery. The infant is full term and has no significant findings on physical exam. Shortly after birth, an ophthalmic ointment is applied to the newborn in order to provide prophylaxis against infection. Which o... | Methylation of 23S rRNA-binding site | {
"A": "Penicillinase in bacteria cleaves the beta-lactam ring",
"B": "Alteration of amino acid cell wall",
"C": "Mutation in DNA polymerase",
"D": "Methylation of 23S rRNA-binding site"
} | step1 | D | [
"year old",
"mother",
"prenatal screening",
"hospital",
"labor",
"delivery",
"infant",
"full term",
"significant findings",
"physical exam",
"birth",
"ophthalmic ointment",
"applied",
"newborn",
"order to provide prophylaxis",
"infection",
"following",
"most common mechanism",
"r... |
A 2-year-old boy is brought to the emergency department by his mother 30 minutes after having a generalized tonic-clonic seizure. He was born at home and has not attended any well-child visits. He is not yet able to walk and does not use recognizable words. His paternal uncle has a severe intellectual disability and ha... | Tyrosine | {
"A": "Phenylalanine",
"B": "Glutamate",
"C": "Tyrosine",
"D": "Cysteine"
} | step1 | C | [
"2 year old boy",
"brought",
"emergency department",
"mother 30 minutes",
"generalized tonic-clonic seizure",
"born at home",
"not attended",
"well-child visits",
"not",
"able to walk",
"not use",
"words",
"paternal uncle",
"severe intellectual disability",
"living in",
"assisted-livin... |
A 30-year-old G3P0 woman who is 28 weeks pregnant presents for a prenatal care visit. She reports occasionally feeling her baby move but has not kept count over the past couple weeks. She denies any bleeding, loss of fluid, or contractions. Her previous pregnancies resulted in spontaneous abortions at 12 and 14 weeks. ... | Induction of labor now | {
"A": "Caesarean delivery",
"B": "Dilation and curettage",
"C": "Dilation and evacuation",
"D": "Induction of labor now"
} | step2&3 | D | [
"30 year old",
"woman",
"weeks pregnant presents",
"prenatal visit",
"reports occasionally feeling",
"baby move",
"not kept count",
"past couple weeks",
"denies",
"bleeding",
"loss of fluid",
"contractions",
"previous pregnancies resulted",
"spontaneous abortions",
"weeks",
"works",
... |
On the 3rd day post-anteroseptal myocardial infarction (MI), a 55-year-old man who was admitted to the intensive care unit is undergoing an examination by his physician. The patient complains of new-onset precordial pain which radiates to the trapezius ridge. The nurse informs the physician that his temperature was 37.... | Aspirin | {
"A": "Aspirin",
"B": "Colchicine",
"C": "Clarithromycin",
"D": "Furosemide"
} | step1 | A | [
"3rd day post anteroseptal myocardial infarction",
"55 year old man",
"admitted to",
"intensive care unit",
"examination",
"physician",
"patient",
"new-onset precordial pain",
"radiates",
"trapezius ridge",
"nurse informs",
"physician",
"temperature",
"99 9F",
"2 hours",
"physical exam... |
A 63-year-old man with alpha-1-antitrypsin deficiency is brought to the emergency department 1 hour after his daughter found him unresponsive. Despite appropriate care, the patient dies. At autopsy, examination of the lungs shows enlargement of the airspaces in the respiratory bronchioles and alveoli. Destruction of wh... | Type I pneumocytes | {
"A": "Non-ciliated cuboidal cells",
"B": "Type I pneumocytes",
"C": "Type II pneumocytes",
"D": "Ciliated columnar cells"
} | step1 | B | [
"63 year old man",
"alpha-1-antitrypsin deficiency",
"brought",
"emergency department",
"hour",
"daughter found",
"unresponsive",
"appropriate care",
"patient",
"autopsy",
"examination",
"lungs shows enlargement",
"respiratory bronchioles",
"alveoli",
"Destruction",
"following cells",
... |
A 32-year-old woman is supposed to undergo tooth extraction surgery. Physical examination is unremarkable, and she has a blood pressure of 126/84 mm Hg and regular pulse of 72/min. She takes no medications. Which of the following cardiac conditions would warrant antibiotic prophylaxis to prevent infective endocarditis ... | Past history of infective endocarditis | {
"A": "Hypertrophic obstructive cardiomyopathy (HOCM)",
"B": "Ventricular septal defect (VSD)",
"C": "Past history of infective endocarditis",
"D": "Mitral regurgitation"
} | step2&3 | C | [
"year old woman",
"to",
"tooth extraction surgery",
"Physical examination",
"unremarkable",
"blood pressure",
"84 mm Hg",
"regular pulse",
"72 min",
"takes",
"medications",
"following cardiac conditions",
"antibiotic prophylaxis to prevent infective endocarditis",
"patient"
] |
A 25-year-old man presents to the physician with 2 days of profuse, watery diarrhea. He denies seeing blood or mucus in the stools. On further questioning, he reveals that he eats a well-balanced diet and generally prepares his meals at home. He remembers having some shellfish from a street vendor 3 days ago. He takes ... | ADP-ribosylation of Gs protein | {
"A": "ADP-ribosylation of Gs protein",
"B": "Inflammation of the gastrointestinal wall",
"C": "Tyrosine kinase phosphorylation",
"D": "Tyrosine kinase dephosphorylation"
} | step1 | A | [
"year old man presents",
"physician",
"2 days",
"watery diarrhea",
"denies seeing blood",
"mucus in",
"stools",
"further questioning",
"reveals",
"eats",
"well balanced diet",
"prepares",
"meals at home",
"remembers",
"shellfish",
"street vendor 3 days",
"takes",
"medications",
"... |
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