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 medical student is spending his research year studying the physiology of cholesterol transport within the body. Specifically, he wants to examine how high density lipoprotein (HDL) particles are able to give other lipoproteins the ability to hydrolyse triglycerides into free fatty acids. He labels all the proteins on... | ApoC-II | {
"A": "Apo-A1",
"B": "ApoB-100",
"C": "ApoC-II",
"D": "Lipoprotein lipase"
} | step1 | C | [
"medical student",
"spending",
"research year studying",
"physiology",
"cholesterol transport",
"body",
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"high density lipoprotein",
"particles",
"able to give",
"lipoproteins",
"ability",
"triglycerides",
"free fatty acids",
"labels",
"proteins",
"HDL particles",
"tracer dye"... |
A patient is hospitalized for pneumonia. Gram-positive cocci in clusters are seen on sputum gram stain. Which of the following clinical scenarios is most commonly associated with this form of pneumonia? | Hospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness | {
"A": "HIV positive adult with a CD4 count less than 150 and an impaired diffusion capacity",
"B": "An otherwise healthy young adult with a week of mild fatigue, chills, and cough",
"C": "Hospitalized adult with development of pneumonia symptoms 2 weeks following a viral illness",
"D": "An alcoholic with evide... | step2&3 | C | [
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"Gram-positive",
"clusters",
"seen",
"sputum gram stain",
"following clinical scenarios",
"most",
"associated with",
"form",
"pneumonia"
] |
A 25-year-old man is brought to the emergency department 30 minutes after he was involved in a motorcycle collision. He was not wearing a helmet. Physical examination shows left periorbital ecchymosis. A CT scan of the head shows a fracture of the greater wing of the left sphenoid bone with compression of the left supe... | Absent left corneal reflex | {
"A": "Decreased sense of smell",
"B": "Numbness of the left cheek",
"C": "Preserved left lateral gaze",
"D": "Absent left corneal reflex"
} | step1 | D | [
"year old man",
"brought",
"emergency department 30 minutes",
"involved",
"motorcycle collision",
"not",
"helmet",
"Physical examination shows left periorbital ecchymosis",
"CT scan of",
"head shows",
"fracture of",
"greater wing",
"left sphenoid bone",
"compression",
"left superior orbi... |
A 47-year-old woman presents with difficulty in speaking and swallowing for the past 2 weeks. She has difficulty in swallowing solid food but not liquids. She also complains of blurry vision. No significant past medical history. The patient is afebrile and vital signs are within normal limits. Physical examination is s... | Double-positive for CD4 and CD8 | {
"A": "Positive for c-kit",
"B": "Positive for CD5, CD7 and TdT and negative for keratin",
"C": "Double-positive for CD4 and CD8",
"D": "Positive for CD15 and CD30 and negative for CD45, CD3, CD43 and keratin"
} | step1 | C | [
"year old woman presents",
"difficulty",
"speaking",
"swallowing",
"past 2 weeks",
"difficulty in swallowing solid food",
"not liquids",
"blurry vision",
"significant past medical history",
"patient",
"afebrile",
"vital signs",
"normal",
"Physical examination",
"significant",
"fullness... |
A researcher wants to study how smoking electronic cigarettes affects the risk of developing lung cancer. She decides to perform a cohort study and consults a medical statistician in order to discuss how the study should be designed. After looking at the data she has available, she concludes that she will perform a ret... | Subjects who smoke electronic cigarettes and subjects who do not smoke | {
"A": "Subjects who smoke electronic cigarettes and subjects who do not smoke",
"B": "Subjects who smoke electronic cigarettes and subjects who smoke normal cigarettes",
"C": "Subjects with lung cancer and subjects without lung cancer",
"D": "Subjects with lung cancer who smoke and subjects without lung cancer... | step1 | A | [
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"order to discuss",
"study",
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"available",
"concludes",
"perform",
"retrospective study",
"p... |
A 39-year-old woman comes to the physician because of a 6-month history of vaginal bleeding for 2 to 5 days every 2 to 3 weeks. The flow is heavy with passage of clots. Menarche occurred at the age of 10 years, and menses previously occurred at regular 28- to 32- day intervals and lasted for 5 days with normal flow. He... | Endometrial biopsy | {
"A": "Endometrial ablation",
"B": "Endometrial biopsy",
"C": "Abdominal ultrasonography",
"D": "Diagnostic laparoscopy"
} | step2&3 | B | [
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"5 days",
"normal flow",
"only medication",
... |
A 24-year-old man is brought by ambulance to the emergency department after a motor vehicle accident. He was the front seat driver in a head on collision. He is currently unconscious. The patient’s past medical history is only notable for an allergy to amoxicillin as he developed a rash when it was given for a recent u... | Laceration of the spleen | {
"A": "Duodenal hematoma",
"B": "Laceration of the spleen",
"C": "No signs of internal trauma",
"D": "Rupture of the inferior vena cava"
} | step2&3 | B | [
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"rash",
"given",
"recent upper respiratory infection 1 week",
... |
A 52-year-old male presents to the office for diabetes follow-up. He is currently controlling his diabetes through lifestyle modification only. He monitors his blood glucose at home with a glucometer. He gives the doctor a list of his most recent early morning fasting glucose readings from the past 8 days, which are 12... | 129 mg/dL | {
"A": "127 mg/dL",
"B": "128 mg/dL",
"C": "129 mg/dL",
"D": "130 mg/dL"
} | step1 | C | [
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"mg/dL... |
A 33-year-old woman presents to her local clinic in rural eastern India complaining of neck pain and fever. She reports a 4 day history of severe neck pain, neck stiffness, mild diarrhea, and fever. She has not taken her temperature. She works as a laborer and frequently carries heavy weights on her back. She is prescr... | 50S ribosomal subunit inhibitor | {
"A": "DNA-dependent RNA polymerase inhibitor",
"B": "DNA gyrase inhibitor",
"C": "30S ribosomal subunit inhibitor",
"D": "50S ribosomal subunit inhibitor"
} | step1 | D | [
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"local clinic in rural eastern India",
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"neck stiffness",
"mild diarrhea",
"fever",
"not taken",
"temperature",
"works",
"laborer",
"frequently carries heavy weights",
"back",
"prescribed",
... |
A 4-year-old girl is brought by her mother to the pediatrician for neck drainage. The mother reports that the child has always had a small pinpoint opening on the front of her neck, though the opening has never been symptomatic. The child developed a minor cold approximately 10 days ago which resolved after a week. How... | Epithelial tonsillar lining | {
"A": "Epithelial lining of the Eustachian tube",
"B": "Inferior parathyroid glands",
"C": "Superior parathyroid glands",
"D": "Epithelial tonsillar lining"
} | step1 | D | [
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"neck drainage",
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"opening",
"never",
"symptomatic",
"child",
"minor cold approximately 10 days",
"resolved",
"week",
"past 2 days",
"mother... |
On physical examination and imaging, a 3-year-old male shows evidence of multiple healed fractures and bruising. On eye exam, the child's irises appear blue, and results of a fundoscopic exam are shown in Image A. What is the most appropriate next step in the care of this patient? | Call child protective services | {
"A": "Genetic testing for collagen synthesis disorder",
"B": "Call child protective services",
"C": "Hearing test",
"D": "Bone marrow transplant"
} | step1 | B | [
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"child's irises appear blue",
"results",
"fundoscopic exam",
"shown",
"Image",
"most appropriate next step",
"care",
"patient"
] |
A 32-year-old woman presents with odorless vaginal discharge, irritation, and itching. She developed these symptoms about a week ago, which was 5 days after she had finished treatment with ceftriaxone for otitis media. She has a single sexual partner and uses oral contraceptives. She is allergic to macrolides, azoles, ... | 2 | {
"A": "1",
"B": "2",
"C": "4",
"D": "5"
} | step1 | B | [
"year old woman presents",
"vaginal discharge",
"irritation",
"itching",
"symptoms",
"week",
"5 days",
"finished treatment",
"ceftriaxone",
"otitis media",
"single sexual",
"uses oral contraceptives",
"allergic",
"macrolides",
"azoles",
"nystatin",
"vital signs",
"follows",
"bloo... |
A 34-year-old woman comes to the physician for a routine health maintenance examination. She has gastroesophageal reflux disease. She recently moved to a new city. Her father was diagnosed with colon cancer at age 46. Her father's brother died because of small bowel cancer. Her paternal grandfather died because of stom... | Hysterectomy and bilateral salpingo-oophorectomy | {
"A": "Hysterectomy and bilateral salpingo-oophorectomy",
"B": "Celecoxib or sulindac therapy",
"C": "Bilateral prophylactic mastectomy",
"D": "Prophylactic proctocolectomy with ileoanal anastomosis"
} | step2&3 | A | [
"year old woman",
"physician",
"routine health maintenance examination",
"gastroesophageal reflux disease",
"recently moved to",
"new city",
"father",
"diagnosed",
"colon cancer",
"age",
"father's brother died",
"of small bowel cancer",
"paternal grandfather died",
"of stomach cancer",
"... |
A 35-year-old woman comes to the physician because of progressive left flank pain over the past 2 weeks. She has a history of type 1 diabetes mellitus. Her temperature is 38°C (100.4°F). There is tenderness to percussion along the left flank. Passive extension of the left hip is painful. Her leukocyte count is 16,000/m... | Psoas major muscle | {
"A": "Quadratus lumborum muscle",
"B": "Iliacus muscle",
"C": "Psoas major muscle",
"D": "Left kidney"
} | step1 | C | [
"35 year old woman",
"physician",
"of progressive left flank pain",
"past 2 weeks",
"history of type 1 diabetes mellitus",
"temperature",
"100 4F",
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"percussion",
"left",
"Passive extension",
"hip",
"painful",
"leukocyte count",
"mm3",
"axial CT scan",
"shown",
"underl... |
A 45-year-old woman comes to the physician because of a 3-month history of worsening fatigue, loss of appetite, itching of the skin, and progressive leg swelling. Although she has been drinking 2–3 L of water daily, she has been passing only small amounts of urine. She has type 1 diabetes mellitus, chronic kidney disea... | Living donor kidney transplant | {
"A": "Cadaveric kidney transplant",
"B": "Fluid restriction",
"C": "Living donor kidney transplant",
"D": "Peritoneal dialysis"
} | step2&3 | C | [
"year old woman",
"physician",
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"worsening fatigue",
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"progressive leg swelling",
"drinking 23",
"water daily",
"passing only small amounts",
"urine",
"type 1 diabetes mellitus",
"chronic kidney disease",
"hypertension",
"diabe... |
A research team is studying certain congenital anomalies of the respiratory tract. The method consists of marking a certain germinal layer with an isotope, following its development stages in chicken embryos, and finally analyzing the specimen. A given specimen of tissue is presented in the exhibit. Which of the follow... | Endoderm | {
"A": "Endoderm",
"B": "Mesoderm",
"C": "Ectoderm",
"D": "Surface ectoderm"
} | step1 | A | [
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"chicken embryos",
"specimen",
"given specimen",
"tissue",
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"exhibit",
"following",
"struct... |
A 59-year-old man presents to his primary care provider with the complaint of daytime fatigue. He often has a headache that is worse in the morning and feels tired when he awakes. He perpetually feels fatigued even when he sleeps in. The patient lives alone, drinks 2-3 beers daily, drinks coffee regularly, and has a 10... | Weight loss | {
"A": "Alcohol avoidance in the evening",
"B": "Caffeine avoidance",
"C": "Screening for depression",
"D": "Weight loss"
} | step2&3 | D | [
"59 year old man presents",
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"morning",
"feels tired",
"awakes",
"feels fatigued",
"sleeps",
"patient lives alone",
"drinks 2-3 beers daily",
"drinks coffee",
"a 10 pack-year smoking history",
"temp... |
A 21-year-old man comes to the physician because of painful, firm, dark bumps on his neck and jawline. He has no history of serious illness and takes no medications. His brother had a similar rash that improved with topical erythromycin therapy. A photograph of the rash is shown. Which of the following is the most like... | Interfollicular penetration of the skin by distal end of hair | {
"A": "Trichophyton infection of the superficial hair follicle",
"B": "Cutibacterium acnes colonization of the pilosebaceous unit",
"C": "Follicular obstruction with subsequent duct rupture",
"D": "Interfollicular penetration of the skin by distal end of hair"
} | step1 | D | [
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"improved",
"topical erythromycin therapy",
"photograph",
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"shown",
"following",
"most likely underlying mechanism",
"patie... |
A 25-year-old woman comes to the physician because of pain and weakness in her right forearm and hand for several months. Two years ago, she sustained a fracture of her ulnar shaft with dislocation of the radial head that was treated surgically. Physical examination shows mild tenderness a few centimeters distal to the... | Posterior interosseous nerve | {
"A": "Ulnar nerve",
"B": "Anterior interosseous nerve",
"C": "Superficial radial nerve",
"D": "Posterior interosseous nerve"
} | step1 | D | [
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"ulnar",
"dislocation of the radial head",
"treated surgically",
"Physical examination shows mild tenderness",
"few centimeters distal",
"lateral epicondyle",
"... |
A 74-year-old man is admitted to the medical ward after he developed a fungal infection. He has aplastic anemia. The most recent absolute neutrophil count was 450/µL. An anti-fungal agent is administered that inhibits the fungal enzyme, (1→3)-β-D-glucan synthase, and thereby disrupts the integrity of the fungal cell wa... | Candidemia | {
"A": "Paracoccidioidomycosis",
"B": "Candidemia",
"C": "Invasive aspergillosis",
"D": "Mucormycosis"
} | step1 | B | [
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"glucan synthase",
"disrupts",
"integrity",
"fungal cell wall",
"well",
"treatment",
"am... |
A 31-year-old Asian woman presents with painless vaginal bleeding late in the first trimester of her pregnancy. She has had no prenatal care up to this point. Serum HCG levels are elevated much more than expected. You obtain an abdominal ultrasound, and observed the findings in figure A.
Which of the following is the ... | 46XX | {
"A": "45XO",
"B": "47XYY",
"C": "46XX",
"D": "69XXX"
} | step1 | C | [
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"first trimester",
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"Serum HCG levels",
"elevated much",
"expected",
"obtain",
"abdominal ultrasound",
"observed",
"findings",
"following",
"most likely karyotype associated with",... |
A 20-year-old man comes to the clinic complaining of fever and a sore throat for 5 days. He receives oral penicillin from his primary doctor. After a day of antibiotic treatment, he developed gross hematuria. As a child, he recalls having multiple episodes of hematuria. The vital signs are within normal limits. On phys... | Berger’s disease | {
"A": "Berger’s disease",
"B": "Post-streptococcal glomerulonephritis",
"C": "Hemolytic uremic syndrome",
"D": "Celiac disease"
} | step1 | A | [
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"5 days",
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"child",
"recalls",
"multiple episodes of hematuria",
"vital signs",
"normal limits",
"physical examination",
"pharyngeal ede... |
A 46-year-old woman presents with palpitations, tremors, and anxiety. She says these symptoms have been present ever since a recent change in her diabetic medication. The most recent time she felt these symptoms, her blood glucose level was 65 mg/dL, and she felt better after eating a cookie. Which of the following is ... | Blocking of the ATP-sensitive K+ channels | {
"A": "Block reabsorption of glucose in proximal convoluted tubule (PCT)",
"B": "Inhibition of α-glucosidase",
"C": "Blocking of the ATP-sensitive K+ channels",
"D": "Decreased hepatic gluconeogenesis"
} | step1 | C | [
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"65 mg/dL",
"felt better",
"eating",
"cookie",
"following",
"mechanism of action",
"drug ... |
A 21-year-old male presents to the ED with a stab wound to the right neck. The patient is alert and responsive, and vital signs are stable. Which of the following neurologic findings would most likely support the diagnosis of right-sided spinal cord hemisection? | Right-sided tactile, vibration, and proprioception loss; left-sided pain and temperature sensation loss; right-sided paresis | {
"A": "Right-sided tactile, vibration, and proprioception loss; left-sided pain and temperature sensation loss; right-sided paresis",
"B": "Left-sided tactile, vibration, and proprioception loss; right-sided pain and temperature sensation loss; left-sided paresis",
"C": "Right-sided tactile, vibration, and propr... | step1 | A | [
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"right neck",
"patient",
"alert",
"responsive",
"vital signs",
"stable",
"following neurologic findings",
"most likely support",
"diagnosis",
"right-sided spinal cord"
] |
A 9-year-old girl presents with a 3-week history of cough. Her mother reports that initially, she had a runny nose and was tired, with a slight cough, but as the runny nose resolved, the cough seemed to get worse. She further states that the cough is dry sounding and occurs during the day and night. She describes havin... | Her 3-month-old brother should be treated with azithromycin as prophylaxis. | {
"A": "Her 3-month-old brother should be treated with azithromycin as prophylaxis.",
"B": "Her classmates should be treated with clarithromycin as prophylaxis.",
"C": "She will have lifelong natural immunity against Bordetella pertussis.",
"D": "Her classmates should receive a TdaP booster regardless of their ... | step2&3 | A | [
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"cough",
"mother reports",
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"runny nose",
"tired",
"slight cough",
"runny nose resolved",
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"worse",
"further states",
"cough",
"dry sounding",
"occurs",
"day",
"night",
"coughing spasms",
"occasionally end",
... |
A 29-year-old woman comes to the emergency room with a 4-day history of fever and worsening cough. She describes bringing up a purulent, yellow sputum when she coughs. The patient has a history of cystic fibrosis and works as an elementary school teacher. The patient’s temperature is 102.3°F (39.1°C), blood pressure is... | Pseudomonas aeruginosa | {
"A": "Haemophilus influenzae",
"B": "Pseudomonas aeruginosa",
"C": "Staphylococcus aureus",
"D": "Streptococcus pneumoniae"
} | step2&3 | B | [
"29 year old woman",
"emergency room",
"4-day history",
"fever",
"worsening cough",
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"cystic fibrosis",
"works",
"elementary school teacher",
"patients temperature",
"blood pressure",
"mmHg",
"pulse",
"98 min",
"respirations",
... |
A 45-year-old man comes to the physician for evaluation of a recurrent rash. He has multiple skin lesions on his legs, buttocks, and around his mouth. The rash first appeared a year ago and tends to resolve spontaneously in one location before reappearing in another location a few days later. It begins with painless, r... | Increased fasting serum glucagon level | {
"A": "Antibodies against hemidesmosomes",
"B": "Antibodies against glutamic acid decarboxylase",
"C": "Increased fasting serum glucagon level",
"D": "Increased serum vasoactive intestinal polypeptide level"
} | step2&3 | C | [
"year old man",
"physician",
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"multiple skin lesions",
"legs",
"buttocks",
"mouth",
"rash first appeared",
"year",
"to resolve",
"one location",
"location",
"few days later",
"begins",
"painless",
"spots",
"increase in size",
"then",
"painful",
... |
A 14-year-old male is brought to the Emergency Department by his mother. She is worried because his face has become puffy and his urine has turned a tea-color. Patient history reveals the child recently suffered from a sore throat. The physician suspects a bacterial infection. Which of the following describes the likel... | Beta-hemolytic | {
"A": "Catalase positive",
"B": "Beta-hemolytic",
"C": "Bacitracin insensitive",
"D": "Gram negative"
} | step1 | B | [
"year old male",
"brought",
"Emergency Department",
"mother",
"worried",
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"urine",
"turned",
"tea color",
"Patient history reveals",
"child recently suffered",
"sore throat",
"physician suspects",
"bacterial infection",
"following",
"likely bacteria responsible"
] |
A 45-year-old woman presents with gradual abdominal distension that has progressively increased over the past 3 months. The physical examination showed shifting dullness. A paracentesis showed malignant cells. An ultrasound shows an adnexal mass. Which is the most likely cause of this condition? | Mucinous cystadenocarcinoma | {
"A": "Endometrioma",
"B": "Mucinous cystadenocarcinoma",
"C": "Choriocarcinoma",
"D": "Benign cystic teratoma"
} | step1 | B | [
"year old woman presents",
"gradual abdominal distension",
"increased",
"past 3 months",
"physical examination showed shifting dullness",
"paracentesis showed malignant cells",
"ultrasound shows",
"adnexal mass",
"most likely cause",
"condition"
] |
A 27-year-old man is brought to the emergency department after a motor vehicle accident. He was the unrestrained driver in a head on collision. The patient is responding incoherently and is complaining of being in pain. He has several large lacerations and has been impaled with a piece of metal. IV access is unable to ... | Obtain intraosseus access | {
"A": "Administer oral fluids",
"B": "Exploratory laparatomy",
"C": "Obtain intraosseus access",
"D": "Reattempt intravenous access"
} | step2&3 | C | [
"27 year old man",
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"driver",
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"several large lacerations",
"piece",
"metal",
"IV access",
"unable to",
"obtained",
"FAST exam",
"performed",
"temperature",
"98",
"36",
"blood p... |
An 18-month-old girl is brought to the emergency department because of the stiffening of her body and unresponsiveness that occurred 1 hour ago. Her symptoms lasted < 10 minutes. She has had coryza for 24 hours without any fever. She had an episode of a febrile generalized tonic-clonic seizure 6 months ago. Her past me... | Focal seizure | {
"A": "Family history of epilepsy",
"B": "Focal seizure",
"C": "History of prior febrile seizure",
"D": "Seizure within 1 hour of fever onset"
} | step2&3 | B | [
"month old girl",
"brought",
"emergency department",
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"occurred 1 hour",
"symptoms lasted",
"10 minutes",
"coryza",
"24 hours",
"fever",
"episode of",
"febrile generalized tonic-clonic seizure",
"months",
"past medical history",
"unremarkable",
"vaccination... |
An 8-year-old girl is brought to the physician by her mother because of a 6-month history of an episodic dry cough, shortness of breath, and chest tightness. She has seasonal allergic rhinitis. Physical examination shows high-pitched expiratory wheezes throughout both lung fields. Pulmonary function testing shows an FE... | Budesonide | {
"A": "Salmeterol",
"B": "Adenosine",
"C": "Tiotropium",
"D": "Budesonide"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"mother",
"of",
"month history",
"episodic dry cough",
"shortness of breath",
"chest tightness",
"seasonal allergic rhinitis",
"Physical examination shows high-pitched expiratory wheezes",
"lung fields",
"Pulmonary function testing shows",
"FEV1",
... |
A 31-year-old woman comes to the physician because of a 2-day history of low-grade intermittent fever, dyspnea, and chest pain that worsens on deep inspiration. Over the past 4 weeks, she has had pain in her wrists and the fingers of both hands. During this period, she has also had difficulties working on her computer ... | Increased titer of anti-citrullinated peptide antibodies | {
"A": "Blood urea nitrogen level > 60 mg/dL",
"B": "Decreased C3 complement levels",
"C": "Increased titer of anti-citrullinated peptide antibodies",
"D": "Coxsackie virus RNA"
} | step1 | C | [
"31 year old woman",
"physician",
"2-day history",
"low-grade intermittent fever",
"dyspnea",
"chest pain",
"worsens",
"deep inspiration",
"past 4 weeks",
"pain in",
"wrists",
"fingers of",
"hands",
"period",
"difficulties working",
"computer due to limited range of motion",
"fingers... |
A 49-year-old man presents to the clinic for evaluation of puncture wounds on the dorsal aspect of his right second and third metacarpals. He states that he was in a fight 3 nights ago and he struck another individual in the mouth. The patient’s medical history is significant for peripheral vascular disease and hyperte... | Clindamycin plus doxycycline with irrigation and debridement | {
"A": "Azithromycin with irrigation and debridement",
"B": "Clindamycin plus doxycycline with irrigation and debridement",
"C": "Doxycycline with irrigation and debridement",
"D": "Irrigation and debridement"
} | step2&3 | B | [
"year old man presents",
"clinic",
"evaluation",
"puncture wounds",
"dorsal aspect",
"right second",
"third metacarpals",
"states",
"fight",
"nights",
"struck",
"individual",
"mouth",
"patients medical history",
"significant",
"peripheral vascular disease",
"hypertension",
"takes a... |
A 55-year-old man comes to the physician because of a 4-month history of episodic, pressure-like chest pain. The chest pain occurs when he is walking up stairs and improves with rest. He has hypertension and type 2 diabetes mellitus. His father died from a myocardial infarction at the age of 50 years. Current medicatio... | Metoprolol | {
"A": "Isosorbide mononitrate",
"B": "Aspirin",
"C": "Metoprolol",
"D": "Clopidogrel"
} | step2&3 | C | [
"55 year old man",
"physician",
"of",
"4 month history",
"episodic",
"pressure",
"chest pain",
"chest pain occurs",
"walking",
"stairs",
"improves",
"rest",
"hypertension",
"type 2 diabetes mellitus",
"father died",
"myocardial infarction",
"age",
"50 years",
"Current medications... |
A 19-year-old man is brought to the emergency department by his mother because of increasing agitation and aggression at home. He has a history of bipolar disorder. During the last week, he has refused to take his lithium medication because it makes him “feel empty inside.” The mother thinks he has experimented with il... | Benztropine | {
"A": "Diazepam",
"B": "Botulinum toxin",
"C": "Benztropine",
"D": "Bromocriptine"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"mother",
"increasing agitation",
"aggression at home",
"history of bipolar disorder",
"last week",
"refused to take",
"lithium medication",
"makes",
"feel empty",
"mother thinks",
"experimented",
"illicit drugs",
"past",
"appears",
... |
A research group is investigating an allosteric modulator to improve exercise resistance and tolerance at low-oxygen conditions. The group has created cultures of myocytes derived from high-performance college athletes. The application of this compound to these cultures in a low-oxygen environment and during vigorous c... | Lactate dehydrogenase | {
"A": "Pyruvate dehydrogenase",
"B": "Bisphosphoglycerate mutase",
"C": "Malate dehydrogenase",
"D": "Lactate dehydrogenase"
} | step1 | D | [
"research group",
"investigating",
"modulator to",
"exercise resistance",
"tolerance",
"low oxygen conditions",
"group",
"created cultures",
"myocytes derived",
"high performance college athletes",
"application",
"compound",
"cultures",
"low oxygen environment",
"vigorous contraction lea... |
A 67-year-old man with a history of diabetes mellitus, COPD, and a ST-elevation myocardial infarction currently on dialysis presents with shortness of breath for the past 2 hours. The patient missed his recent dialysis appointment and has been noncompliant with his other medications. The patient found out his best frie... | Cardiac tamponade | {
"A": "Cardiac tamponade",
"B": "Myocardial infarction",
"C": "Takotsubo cardiomyopathy",
"D": "Tension pneumothorax"
} | step2&3 | A | [
"67 year old man",
"history of diabetes mellitus",
"COPD",
"ST-elevation myocardial infarction currently",
"dialysis presents",
"shortness of breath",
"past",
"hours",
"patient missed",
"recent dialysis appointment",
"noncompliant",
"medications",
"patient found out",
"best friend died",
... |
A 36-year-old woman complains of recurrent headaches. The pain is located on the right side of the head, is accompanied by nausea, worsens when lifting heavy objects, and typically lasts 2 days. She describes the pain as pulsatile and says that they are usually triggered by eating chocolates. Her headache is not associ... | 5-HT1B/D agonist | {
"A": "D2 receptor blocker",
"B": "Beta-blocker",
"C": "GABA transaminase inhibitor",
"D": "5-HT1B/D agonist"
} | step2&3 | D | [
"36 year old woman",
"recurrent headaches",
"pain",
"right side of",
"head",
"nausea",
"worsens",
"lifting heavy objects",
"lasts 2 days",
"pain",
"pulsatile",
"usually triggered by eating chocolates",
"headache",
"not associated with",
"aura",
"sits",
"dark room",
"increased disco... |
A 55-year-old man presents to the emergency department for severe pain in his knee. The patient states that the pain began yesterday and has steadily worsened. The patient has a history of osteoarthritis of the knee, which was previously responsive to ibuprofen. He reports taking 3 doses of hydrochlorothiazide today af... | Arthrocentesis | {
"A": "Arthrocentesis",
"B": "CT scan",
"C": "IV fluids",
"D": "Naproxen"
} | step2&3 | A | [
"55 year old man presents",
"emergency department",
"severe pain in",
"knee",
"patient states",
"pain began",
"worsened",
"patient",
"history",
"knee",
"responsive",
"ibuprofen",
"reports taking 3 doses",
"hydrochlorothiazide today",
"not taking",
"medication",
"3 days",
"recently ... |
A 27-year-old woman visits your office with a 3-day complaint of fever, malaise, myalgias, and headaches associated with vulvar itching, vulvar soreness, dysuria, and urethral discharge. The pain when urinating is so severe that she has attempted to avoid the use of the toilet. She just returned from a spring break in ... | Direct fluorescence antigen | {
"A": "Serology",
"B": "Direct fluorescence antigen",
"C": "Culture in Thayer-Martin agar",
"D": "Location of the lesions"
} | step1 | B | [
"27 year old woman visits",
"office",
"3-day complaint",
"fever",
"malaise",
"myalgias",
"headaches associated with vulvar itching",
"vulvar soreness",
"dysuria",
"urethral discharge",
"pain",
"so severe",
"attempted to",
"use of",
"toilet",
"returned",
"spring break",
"multiple",
... |
A 47-year-old man comes to the physician because of a 7-week history of cough, shortness of breath, and daily copious sputum production. He has had frequent respiratory tract infections over the past several years. Current medications include dextromethorphan and guaifenesin as needed. He does not smoke cigarettes. His... | Damage to bronchial vessels | {
"A": "Damage to bronchial vessels",
"B": "Infection with Rhizopus species",
"C": "Rupture of pulmonary blebs",
"D": "Neoplastic growth of pleural cells"
} | step2&3 | A | [
"year old man",
"physician",
"week history",
"cough",
"shortness of breath",
"daily copious",
"frequent respiratory tract infections",
"past",
"years",
"Current medications include dextromethorphan",
"guaifenesin as needed",
"not smoke cigarettes",
"temperature",
"98",
"pulse",
"88 min... |
An 11-year-old boy is brought to his pediatrician by his mother after he has complained of worsening left thumb pain for the last two weeks. The mother reports that the patient was previously healthy. Approximately 2 weeks ago, the family cat bit the patient’s thumb. The area around the bite wound then became red, hot,... | Pasteurella multocida | {
"A": "Bartonella henselae",
"B": "Pasteurella multocida",
"C": "Pseudomonas aeruginosa",
"D": "Salmonella spp."
} | step1 | B | [
"year old boy",
"brought",
"pediatrician",
"mother",
"worsening left thumb pain",
"last two weeks",
"mother reports",
"patient",
"healthy",
"Approximately",
"weeks",
"family cat bit",
"patients thumb",
"area",
"bite wound then",
"red",
"hot",
"slightly swollen",
"never healed",
... |
A 32-year-old woman comes to the emergency department because of a 3-hour history of severe nausea, vomiting, tremor, and anxiety. She recently started a new medication but does not remember its name. She has a history of major depressive disorder treated with fluoxetine. Her temperature is 38.9 C (102.1 F), pulse is 1... | Sumatriptan | {
"A": "Amiodarone",
"B": "Sumatriptan",
"C": "Scopolamine",
"D": "Succinylcholine"
} | step1 | B | [
"year old woman",
"emergency department",
"3 hour history",
"severe nausea",
"vomiting",
"tremor",
"anxiety",
"recently started",
"new medication",
"not remember",
"name",
"history of major depressive disorder treated with fluoxetine",
"temperature",
"F",
"pulse",
"min",
"respiration... |
A 25-year old woman is brought to the emergency department because of a 1-day history of lower abdominal pain and vaginal bleeding. Her last menstrual period was 6 weeks ago. She is sexually active and uses condoms inconsistently with her boyfriend. She had pelvic inflammatory disease at the age of 22 years. Her temper... | Administration of anti-D immunoglobulin and intramuscular methotrexate | {
"A": "Administration of anti-D immunoglobulin and intramuscular methotrexate",
"B": "Administration of intramuscular methotrexate",
"C": "Repeat serum β-hCG and pelvic ultrasound in 2 days",
"D": "Administration of anti-D immunoglobulin and oral misoprostol"
} | step2&3 | A | [
"year old woman",
"brought",
"emergency department",
"1-day history",
"lower abdominal pain",
"vaginal bleeding",
"last menstrual period",
"weeks",
"sexually active",
"uses condoms",
"boyfriend",
"pelvic inflammatory disease",
"age",
"years",
"temperature",
"pulse",
"90 min",
"resp... |
A 26-year-old woman presents to the women’s health clinic with a 9-week delay in menses. The patient has a history of grand mal seizures, and was recently diagnosed with acute sinusitis. She is prescribed lamotrigine and amoxicillin. The patient smokes one-half pack of cigarettes every day for 10 years, and drinks soci... | Folic acid supplementation | {
"A": "Decrease alcohol consumption",
"B": "Folic acid supplementation",
"C": "Switching to another antiepileptic medication",
"D": "Switching to cephalexin"
} | step2&3 | B | [
"year old woman presents",
"womens health clinic",
"week delay",
"menses",
"patient",
"history",
"grand mal seizures",
"recently diagnosed",
"acute sinusitis",
"prescribed lamotrigine",
"amoxicillin",
"patient smokes one half pack",
"cigarettes",
"day",
"10 years",
"drinks",
"weekend... |
A 24-year-old woman presents to her primary care physician for bilateral nipple discharge. She states that this started recently and seems to be worsening. She denies any other current symptoms. The patient states that she is not currently sexually active, and her last menstrual period was over a month ago. Her medical... | Alteration of the tuberoinfundibular pathway | {
"A": "Alteration of the tuberoinfundibular pathway",
"B": "Alteration of the nigrostriatal pathway",
"C": "Alteration of the mesolimbic pathway",
"D": "Normal pregnancy"
} | step2&3 | A | [
"year old woman presents",
"primary care physician",
"bilateral nipple discharge",
"states",
"started recently",
"to",
"worsening",
"denies",
"current symptoms",
"patient states",
"not currently sexually active",
"last menstrual period",
"over",
"month",
"medical history",
"notable",
... |
A 60-year-old man comes to the clinic with the complaint of knee pain for the past few weeks. The pain is located in the left knee, associated with morning stiffness for about an hour, and improves with activities throughout the day. He also has a history of diabetes mellitus, hypertension, peptic ulcer disease, and is... | Synovial fluid analysis | {
"A": "X-ray left knee",
"B": "Synovial fluid analysis",
"C": "Ibuprofen",
"D": "Flucloxacillin"
} | step2&3 | B | [
"60 year old man",
"clinic",
"complaint",
"knee pain",
"past",
"weeks",
"pain",
"left knee",
"associated with morning stiffness",
"about",
"hour",
"improves",
"activities",
"day",
"history of diabetes mellitus",
"hypertension",
"peptic ulcer disease",
"ischemic heart disease",
"a... |
A 61-year-old man comes to the physician because of a 9-month history of progressive shortness of breath on exertion. Pulmonary examinations shows fine bibasilar end-inspiratory crackles. There is digital clubbing. Pulmonary functions tests show an FEV1:FVC ratio of 97% and a total lung capacity of 70%. An x-ray of the... | Shipbuilding | {
"A": "Shipbuilding",
"B": "Aerospace manufacturing",
"C": "Sandblasting",
"D": "Coal mining"
} | step1 | A | [
"61 year old man",
"physician",
"of",
"month history",
"progressive shortness",
"breath",
"exertion",
"Pulmonary examinations shows fine",
"end inspiratory crackles",
"digital clubbing",
"Pulmonary functions tests show",
"FEV1:FVC ratio",
"97",
"total lung capacity",
"70",
"x-ray of",
... |
A 28-year-old man presents for a pre-placement health check-up. Auscultation reveals a mid-systolic click. An echocardiogram reveals a floppy mitral valve and a dilated aortic root. An ocular examination finds a subluxated lens superior and laterally. What is the most likely genetic defect? | Fibrillin | {
"A": "NF1 protein",
"B": "Cystathionine synthase deficiency",
"C": "Fibrillin",
"D": "Dystrophin"
} | step1 | C | [
"year old man presents",
"pre placement health check-up",
"Auscultation reveals",
"mid-systolic click",
"echocardiogram reveals",
"floppy mitral valve",
"dilated aortic root",
"ocular examination finds",
"lens superior",
"most likely genetic defect"
] |
A 61-year-old man with longstanding diabetes and coronary artery disease presents to the ER with chest pain and dyspnea. The echocardiogram reveals moderate-to-severe mitral regurgitation and an ejection fraction of 27%. A chest X-ray shows bibasilar infiltrates. A new drug is added to his medication regimen, and the p... | Inhibits mineralocorticoid receptor on the cortical collecting duct | {
"A": "Inhibits beta-adrenergic receptors to decrease SA node conduction velocity",
"B": "Inhibits epithelial Na-channels on the cortical collecting duct",
"C": "Inhibits mineralocorticoid receptor on the cortical collecting duct",
"D": "Inhibits Na-Cl symporter on the distal convoluted tubule"
} | step1 | C | [
"61 year old man",
"diabetes",
"coronary artery disease presents",
"ER",
"chest pain",
"dyspnea",
"echocardiogram reveals moderate-to-severe mitral regurgitation",
"ejection fraction of 27",
"chest X-ray shows",
"infiltrates",
"new drug",
"added",
"medication regimen",
"physician",
"urin... |
A 28-year-old woman presents to the emergency department with a sudden onset of nausea, vomiting, and pain in the upper abdomen for the past 3 hours. She reports that the pain has increased in severity over these 3 hours and frequently radiates to the back. She was diagnosed as HIV positive 2 years ago. She was placed ... | Discontinue didanosine | {
"A": "Discontinue abacavir",
"B": "Discontinue didanosine",
"C": "Discontinue dolutegravir",
"D": "Discontinue enfuvirtide"
} | step2&3 | B | [
"year old woman presents",
"emergency department",
"sudden onset",
"nausea",
"vomiting",
"pain",
"upper abdomen",
"past",
"hours",
"reports",
"pain",
"increased",
"severity",
"3 hours",
"frequently radiates",
"back",
"diagnosed",
"HIV positive 2 years",
"placed",
"raltegravir t... |
A previously healthy 4-year-old girl is brought to the physician for evaluation of a 3-week history of recurrent vomiting and difficulty walking. Examination shows a broad-based gait and bilateral optic disc swelling. An MRI shows an intracranial tumor. A ventriculoperitoneal shunt is placed, and surgical excision of t... | Medulloblastoma | {
"A": "Glioblastoma multiforme",
"B": "Medulloblastoma",
"C": "Oligodendroglioma",
"D": "Pinealoma"
} | step1 | B | [
"healthy",
"year old girl",
"brought",
"physician",
"evaluation",
"week history",
"recurrent vomiting",
"difficulty walking",
"Examination shows",
"broad-based gait",
"bilateral optic disc swelling",
"MRI shows",
"intracranial tumor",
"ventriculoperitoneal shunt",
"placed",
"surgical",... |
A 77-year-old man is brought to the emergency department by his wife because of headache, nausea, and vomiting for 24 hours. His wife says that over the past 2 weeks, he has been more irritable and has had trouble remembering to do routine errands. Two weeks ago, he fell during a skiing accident but did not lose consci... | Surgical evacuation | {
"A": "Recombinant tissue plasminogen activator administration",
"B": "Observation",
"C": "Surgical evacuation",
"D": "Obtain an Electroencephalography"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"wife",
"headache",
"nausea",
"vomiting",
"24 hours",
"wife",
"past 2 weeks",
"more irritable",
"remembering",
"routine",
"Two weeks",
"fell",
"skiing accident",
"not",
"consciousness",
"coronary artery disease",
"hypertension"... |
A 17-year-old girl makes an appointment with her pediatrician because she is concerned that she may have gotten a sexually transmitted infection. Specifically, she had unprotected sex two weeks ago and has since been experiencing painful urination and abdominal pain. Laboratory tests confirm a diagnosis of Chlamydial i... | Do not contact her parents but do report to public health agencies | {
"A": "Choose based on the physician's interpretation of the patient's best interests",
"B": "Contact her parents as well as report to public health agencies",
"C": "Do not contact her parents and do not report to public health agencies",
"D": "Do not contact her parents but do report to public health agencies... | step1 | D | [
"year old girl makes",
"appointment",
"pediatrician",
"concerned",
"gotten",
"sexually transmitted infection",
"unprotected sex two weeks",
"since",
"experiencing painful urination",
"abdominal pain",
"Laboratory tests confirm",
"diagnosis",
"Chlamydial infection",
"point",
"girl",
"to... |
A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 y... | Persistent depressive disorder | {
"A": "Cyclothymia",
"B": "Disruptive mood dysregulation disorder",
"C": "Persistent depressive disorder",
"D": "Seasonal affective disorder"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"wellness exam",
"currently",
"acute concerns",
"feeling hopeless",
"poor appetite",
"difficulty",
"concentration",
"sleep",
"poor self-esteem",
"symptoms",
"occurring",
"past",
"years",
"felt better",
"lasted",
"few weeks out of... |
A 17-year-old boy is brought to the pediatrician by his mother for an initial visit. He recently immigrated from Cambodia. Through an interpreter, the patient reports 6 months of mild exertional dyspnea. He denies chest pain or palpitations. His medical history is unremarkable and he has never had any surgeries. His fa... | Atrial septal defect | {
"A": "Atrial septal defect",
"B": "Bicuspid aortic valve",
"C": "Hypertrophic cardiomyopathy",
"D": "Ventricular septal defect"
} | step2&3 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"initial visit",
"recently",
"Cambodia",
"interpreter",
"patient reports",
"months",
"mild exertional dyspnea",
"denies chest pain",
"palpitations",
"medical history",
"unremarkable",
"never",
"surgeries",
"family history",
"si... |
A 35-year-old man comes to the physician because of dull abdominal pain on his right side for 4 months. He also reports episodic nausea and vomiting during this period. He does not have fever, altered bowel habits, or weight loss. He has had a pet dog for 8 years. He appears healthy. Vital signs are within normal limit... | Epinephrine | {
"A": "Exploratory laparotomy",
"B": "Epinephrine",
"C": "Cricothyrotomy",
"D": "Norepinephrine\n\""
} | step2&3 | B | [
"35 year old man",
"physician",
"of dull abdominal pain",
"right side",
"4 months",
"reports episodic nausea",
"vomiting during this period",
"not",
"fever",
"altered bowel habits",
"weight loss",
"pet dog",
"years",
"appears healthy",
"Vital signs",
"normal limits",
"Abdominal exami... |
An 85-year-old woman otherwise healthy presents with left-sided weakness. Her symptoms started 4 hours ago while she was on the phone with her niece. The patient recalls dropping the phone and not being able to pick it up with her left hand. No significant past medical history. No current medications. Physical examinat... | Homonymous hemianopsia | {
"A": "Amaurosis fugax",
"B": "Profound lower limb weakness",
"C": "Homonymous hemianopsia",
"D": "Prosopagnosia"
} | step1 | C | [
"85 year old woman",
"healthy presents",
"left-sided weakness",
"symptoms started 4 hours",
"phone",
"niece",
"patient recalls dropping",
"phone",
"not",
"able to pick",
"left hand",
"significant past medical history",
"current medications",
"Physical examination reveals decreased sensatio... |
A 27-year-old-man is brought to the emergency department 30 minutes after being involved in a motorcycle accident. He lost control at high speed and was thrown forward onto the handlebars. On arrival, he is alert and responsive. He has abdominal pain and superficial lacerations on his left arm. Vital signs are within n... | Pancreatic ductal injury | {
"A": "Pancreatic ductal injury",
"B": "Aortic dissection",
"C": "Abdominal compartment syndrome",
"D": "Splenic rupture"
} | step2&3 | A | [
"27 year old man",
"brought",
"emergency department 30 minutes",
"involved",
"motorcycle accident",
"lost control",
"high speed",
"thrown forward",
"arrival",
"alert",
"responsive",
"abdominal pain",
"superficial lacerations",
"left arm",
"Vital signs",
"normal limits",
"Examination ... |
A 55-year-old man with a history of IV drug abuse presents to the emergency department with an altered mental status. He was found unconscious in the park by police. His temperature is 100.0°F (37.8°C), blood pressure is 87/48 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. Ph... | Ringer lactate | {
"A": "Dextrose 5% normal saline",
"B": "Hypertonic saline",
"C": "Normal saline",
"D": "Ringer lactate"
} | step2&3 | D | [
"55 year old man",
"history of IV drug abuse presents",
"emergency department",
"altered mental status",
"found unconscious",
"park",
"police",
"temperature",
"100",
"blood pressure",
"87 48 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Phy... |
A 32-year-old G1P0 woman at 27 weeks estimated gestational age presents for her first prenatal care appointment. She recently immigrated to the United States and didn’t receive any prenatal care in her country. Her blood pressure is 130/70 mm Hg, pulse is 85/min, and respirations are 16/min. Her BMI is 38.3 kg/m2. Phys... | Oral glucose tolerance test | {
"A": "C-peptide",
"B": "Oral glucose tolerance test",
"C": "Glycated hemoglobin",
"D": "Leptin"
} | step1 | B | [
"year old",
"woman",
"27 weeks estimated gestational age presents",
"first prenatal care appointment",
"recently",
"United States",
"receive",
"prenatal care",
"country",
"blood pressure",
"70 mm Hg",
"pulse",
"85 min",
"respirations",
"min",
"BMI",
"kg/m2",
"Physical examination",... |
A 66-year-old man presents to the emergency department for shortness of breath for the last 2 hours. Despite his diagnosis of heart failure 2 years ago, he has refused to make any diet changes. He takes aspirin and carvedilol but is poorly compliant. His vitals signs are pulse of 135/min, respirations 30/min, and a blo... | Blocking the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle | {
"A": "Acting on the β-adrenergic receptors to increase cardiac contractility",
"B": "Blocking the Na+-K+-2Cl- cotransporter in the thick ascending limb of the loop of Henle",
"C": "Blocking the angiotensin II receptors, leading to vasodilation",
"D": "Blocking the NaCl channels in the distal tubule of the nep... | step1 | B | [
"66 year old man presents",
"emergency department",
"shortness of breath",
"last",
"hours",
"diagnosis",
"heart failure",
"years",
"refused to make",
"diet changes",
"takes aspirin",
"carvedilol",
"poorly compliant",
"signs",
"pulse",
"min",
"respirations 30/min",
"blood pressure",... |
A 60-year-old woman is brought into the office by his son. His son states that the patient has been acting inappropriately over the last few years. She has been taking off her clothes in front of visitors and putting objects in her mouth. She has had no emotional response to the death of one of her close friends and wa... | Pick's disease | {
"A": "Alzheimer's dementia",
"B": "Lewy body dementia",
"C": "Pick's disease",
"D": "Vascular dementia"
} | step2&3 | C | [
"60 year old woman",
"brought",
"office",
"son",
"son states",
"patient",
"acting",
"years",
"taking off",
"clothes",
"putting objects",
"mouth",
"emotional response",
"death of one",
"close friends",
"laughing",
"funeral",
"almost",
"memory issues",
"sometimes forgets",
"to ... |
A previously well 25-year-old woman was brought to the emergency department by her boyfriend because of progressive blurred vision. Examination of the eyes reveals loss of horizontal gaze, intact convergence, and nystagmus. A clinical diagnosis of multiple sclerosis is made and the patient is started on a course of cor... | Loss of bilateral medial longitudinal fasciculus | {
"A": "Loss of reticular formations",
"B": "Loss of frontal eye fields",
"C": "Loss of bilateral medial longitudinal fasciculus",
"D": "Loss of cranial nerve VI"
} | step1 | C | [
"well",
"year old woman",
"brought",
"emergency department",
"boyfriend",
"of progressive blurred vision",
"Examination",
"eyes reveals loss",
"horizontal gaze",
"intact convergence",
"nystagmus",
"clinical diagnosis",
"multiple sclerosis",
"made",
"patient",
"started",
"course",
"... |
A 58-year-old man comes to the physician because of a 6-month history of headaches and back pain. Examination shows mild sensorineural hearing loss. Serum concentration of alkaline phosphatase is increased. An x-ray of the skull is shown. The most appropriate pharmacotherapy for this patient is a drug that has which of... | Apoptosis of osteoclasts | {
"A": "Inhibition of tubulin polymerization",
"B": "Inhibition of nuclear factor-κB",
"C": "Formation of DNA strand breaks",
"D": "Apoptosis of osteoclasts"
} | step1 | D | [
"58 year old man",
"physician",
"of",
"month history",
"headaches",
"back pain",
"Examination shows mild sensorineural hearing loss",
"Serum concentration",
"alkaline phosphatase",
"increased",
"x-ray of",
"skull",
"shown",
"most appropriate pharmacotherapy",
"patient",
"drug",
"of",... |
A 9-month-old female infant is brought in by her mother to the pediatrician because she is concerned that her daughter is not growing normally. On physical exam, the head circumference is 95th percentile and the height is 5th percentile. The child has disproportionate growth such that both the upper and lower extremiti... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "X-linked recessive",
"C": "X-linked dominant",
"D": "Mitochondrial pattern of inheritance"
} | step1 | A | [
"month old female infant",
"brought",
"mother",
"pediatrician",
"concerned",
"daughter",
"not",
"physical exam",
"head circumference",
"95th percentile",
"height",
"5th percentile",
"child",
"disproportionate growth",
"upper",
"lower extremities show",
"rhizomelic pattern",
"shorte... |
A 52-year-old woman presents to a local hospital complaining about a rash on her face and torso, as well as night sweats, low-grade fever, diarrhea, and unintentional weight loss. Her personal history is relevant for homelessness; she also has a history of risky behaviors such as the use and abuse of intravenous drugs,... | HHV-8 infection | {
"A": "Human alphaherpesvirus 3 (HHV-3) infection",
"B": "HHV-8 infection",
"C": "HHV-5 infection",
"D": "HHV-6 infection"
} | step2&3 | B | [
"year old woman presents",
"local hospital",
"rash on",
"face",
"torso",
"night sweats",
"low-grade fever",
"diarrhea",
"unintentional weight loss",
"personal history",
"relevant",
"homelessness",
"history",
"risky behaviors",
"use",
"abuse of intravenous drugs",
"unprotected interco... |
A 21-year-old woman was brought to the emergency department after her roommate found her unconscious at their apartment. On arrival, her GCS was 3/15, with bilateral mydriasis, fever of 39.4℃ (103.0℉), and ventricular tachycardia which was converted to sinus rhythm. She had one episode of a generalized tonic-clonic sei... | Cocaine | {
"A": "Cocaine",
"B": "MPTP",
"C": "PCP",
"D": "Opioid"
} | step1 | A | [
"21-year-old woman",
"brought",
"emergency department",
"roommate found",
"unconscious",
"apartment",
"arrival",
"GCS",
"3/15",
"bilateral mydriasis",
"fever",
"0",
"ventricular tachycardia",
"sinus rhythm",
"one episode of",
"generalized tonic-clonic seizure",
"hospital",
"managed... |
A 4-year-old boy is brought to the emergency department with intense crying and pain in both hands after playing with ice cubes. His mother denies any preceding trauma. The temperature is 37.0°C (98.6°F), the blood pressure is 90/55 mm Hg, and the pulse is 100/min. The physical examination shows swollen dorsa of the ha... | Hydroxyurea | {
"A": "Avoidance of sulfa drugs",
"B": "Vaccinations",
"C": "Hydroxyurea",
"D": "Allopurinol"
} | step2&3 | C | [
"4 year old boy",
"brought",
"emergency department",
"intense crying",
"pain",
"hands",
"playing",
"ice cubes",
"mother denies",
"preceding trauma",
"temperature",
"98",
"blood pressure",
"90 55 mm Hg",
"pulse",
"100 min",
"physical examination shows swollen dorsa of",
"hands",
"... |
A 25-year-old woman is brought to the emergency department by her roommate with severe right lower quadrant pain for the last 8 hours. The pain is progressively getting worse and is associated with vomiting. When you ask the patient about her last menstrual period, she tells you that although she stopped keeping track ... | Urinary human chorionic gonadotropin (hCG) | {
"A": "Urinary human chorionic gonadotropin (hCG)",
"B": "Urinalysis",
"C": "Complete blood count",
"D": "Appendectomy"
} | step1 | A | [
"year old woman",
"brought",
"emergency department",
"roommate",
"severe right lower quadrant pain",
"last 8 hours",
"pain",
"getting worse",
"associated with vomiting",
"patient",
"last menstrual period",
"stopped keeping track",
"cycle",
"surgical sterilization",
"year",
"recalls ble... |
A 65-year-old man presents to the emergency department for sudden weakness. He was doing mechanical work on his car where he acutely developed right-leg weakness and fell to the ground. He is accompanied by his wife, who said that this has never happened before. He was last seen neurologically normal approximately 2 ho... | Noncontrast head CT | {
"A": "Aspirin",
"B": "CT angiogram",
"C": "Noncontrast head CT",
"D": "Thrombolytics"
} | step2&3 | C | [
"65 year old man presents",
"emergency department",
"sudden weakness",
"mechanical work",
"car",
"right",
"fell",
"wife",
"never happened before",
"last seen",
"normal approximately",
"hours prior to presentation",
"past medical history",
"significant",
"hypertension",
"type II diabete... |
A 70-year-old man comes to the physician for the evaluation of pain, cramps, and tingling in his lower extremities over the past 6 months. The patient reports that the symptoms worsen with walking more than two blocks and are completely relieved by rest. Over the past 3 months, his symptoms have not improved despite hi... | Administration of cilostazol | {
"A": "Administration of cilostazol",
"B": "Compression stockings",
"C": "Endarterectomy",
"D": "Bypass surgery"
} | step2&3 | A | [
"70 year old man",
"physician",
"evaluation",
"pain",
"cramps",
"tingling",
"lower extremities",
"past 6 months",
"patient reports",
"symptoms worsen",
"walking",
"two blocks",
"completely relieved by rest",
"past 3 months",
"symptoms",
"not improved",
"participating",
"exercise th... |
A 44-year-old man comes to the physician because of a 5-month history of persistent cough productive of thick, yellow sputum and worsening shortness of breath. One year ago, he had similar symptoms that lasted 4 months. He has smoked two packs of cigarettes daily for the past 20 years. Physical examination shows scatte... | Increased goblet cells | {
"A": "Increased ciliated epithelial cells",
"B": "Decreased alveolar macrophages",
"C": "Decreased smooth muscle cells",
"D": "Increased goblet cells"
} | step1 | D | [
"year old man",
"physician",
"5 month history",
"persistent cough productive",
"thick",
"yellow",
"worsening shortness of breath",
"One year ago",
"similar symptoms",
"lasted 4 months",
"smoked two packs",
"cigarettes daily",
"past 20 years",
"Physical examination shows scattered expirator... |
One day after undergoing surgery for a traumatic right pelvic fracture, a 73-year-old man has pain over his buttocks and scrotum and urinary incontinence. Physical examination shows right-sided perineal hypesthesia and absence of anal sphincter contraction when the skin around the anus is touched. This patient is most ... | Absent reflex erection | {
"A": "Paralysis of hip adductors",
"B": "Absent reflex erection",
"C": "Impaired hip flexion",
"D": "Impaired psychogenic erection"
} | step1 | B | [
"One",
"One day",
"surgery",
"traumatic right pelvic",
"year old man",
"pain",
"buttocks",
"scrotum",
"urinary incontinence",
"Physical examination shows right-sided perineal hypesthesia",
"absence",
"anal sphincter contraction",
"skin",
"anus",
"touched",
"patient",
"most likely to"... |
A 27-year-old man presents to his primary care physician for exposure to toxic materials. The patient states that when he left for work this morning he was certain that he had closed the door to his pantry. However, upon returning home, he saw that the door to his pantry was wide open. The patient is certain that his n... | Paranoid | {
"A": "Schizoid",
"B": "Paranoid",
"C": "Intermittent explosive disorder",
"D": "Borderline"
} | step2&3 | B | [
"27 year old man presents",
"primary care physician",
"exposure to toxic materials",
"patient states",
"left",
"work",
"morning",
"certain",
"closed",
"door",
"returning home",
"saw",
"door",
"wide open",
"patient",
"certain",
"neighbors",
"food",
"poisoned",
"further states",
... |
A 43-year-old man presents with acute-onset left flank pain for the past 6 hours. He describes the pain as severe, intermittent, colicky, and “coming in waves”, and he points to the area of the left costovertebral angle (CVA). He says he recently has been restricting oral liquid intake to only 2 glasses of water per da... | Non-contrast CT of the abdomen and pelvis | {
"A": "Contrast CT of the abdomen and pelvis",
"B": "Renal ultrasound",
"C": "Non-contrast CT of the abdomen and pelvis",
"D": "Supine abdominal radiograph"
} | step2&3 | C | [
"year old man presents",
"acute-onset left flank pain",
"past",
"hours",
"pain",
"severe",
"intermittent",
"colicky",
"waves",
"points",
"area",
"left",
"angle",
"recently",
"restricting oral liquid intake",
"only",
"glasses",
"water",
"day based",
"advice",
"reports nausea",... |
A 2-year-old boy presents to the pediatrician for evaluation of an elevated temperature, sore throat, runny nose, and lacrimation for the past week, and a rash which he developed yesterday. The rash began on the patient’s face and spread down to the trunk, hands, and feet. The patient’s mother gave him ibuprofen to con... | Morbillivirus | {
"A": "Rubulavirus",
"B": "Morbillivirus",
"C": "Influenzavirus",
"D": "Group A Streptococcus"
} | step1 | B | [
"2 year old boy presents",
"pediatrician",
"evaluation",
"elevated temperature",
"sore throat",
"runny nose",
"lacrimation",
"past week",
"rash",
"rash began",
"patients face",
"spread",
"trunk",
"hands",
"feet",
"patients mother gave",
"ibuprofen to control",
"fever",
"child",
... |
A 6-year-old boy is brought to the physician by his mother for coughing, nasal congestion, and intermittent wheezing for the past 2 months. The child has a history of eczema. Since birth, he has had three upper respiratory tract infections that resolved without treatment, and one episode of acute otitis media treated w... | Spirometry | {
"A": "Spirometry",
"B": "Skin prick testing",
"C": "Throat culture",
"D": "Dihydrorhodamine 123 test"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"mother",
"coughing",
"nasal congestion",
"intermittent wheezing",
"past",
"months",
"child",
"history of eczema",
"birth",
"three upper respiratory tract infections",
"resolved",
"treatment",
"one episode of acute otitis media treated with antib... |
A 15-year-old boy is brought to the emergency department by ambulance after his mother found him having muscle spasms and stiffness in his room. His mother stated he scraped his foot on a rusty razor on the bathroom floor 2 days prior. On presentation, his temperature is 102.0°F (38.9°C), blood pressure is 108/73 mmHg,... | Wound debridement and antitoxin | {
"A": "Antitoxin",
"B": "Wound debridement and antitoxin",
"C": "Wound debridement and booster vaccine",
"D": "Wound debridement, antitoxin, and booster vaccine"
} | step1 | B | [
"year old boy",
"brought",
"emergency department",
"ambulance",
"mother found",
"muscle spasms",
"stiffness",
"room",
"mother stated",
"scraped",
"foot",
"rusty razor",
"bathroom floor",
"days prior",
"presentation",
"temperature",
"blood pressure",
"mmHg",
"pulse",
"min",
"r... |
A 6-month-old boy is brought to the emergency department by his mother because of recurrent vomiting and yellowing of his eyes. The mother says that he has been eating poorly since she started weaning him off of breast milk 5 days ago. At this time, mashed vegetables and fruits were added to his diet. Examination shows... | Aldolase B | {
"A": "Galactokinase",
"B": "Galactose-1 phosphate uridyltransferase",
"C": "Aldolase B",
"D": "Glucose-6-phosphatase"
} | step1 | C | [
"month old boy",
"brought",
"emergency department",
"mother",
"recurrent vomiting",
"yellowing",
"eyes",
"mother",
"eating poorly",
"started weaning",
"off",
"breast milk 5 days",
"time",
"vegetables",
"fruits",
"added",
"diet",
"Examination shows scleral jaundice",
"dry mucous m... |
A 23-year-old pregnant woman (gravida 1, para 0) presents during her 16th week of pregnancy for a check-up. The course of her current pregnancy is unremarkable. She had normal results on the previous ultrasound examination. Her human chorionic gonadotropin (hCG) level measured at week 12 of pregnancy was 0.9 multiples ... | Trisomy 21 | {
"A": "Trisomy 21",
"B": "Neural tube defect",
"C": "Congenital toxoplasmosis",
"D": "Trophoblastic disease"
} | step2&3 | A | [
"23 year old pregnant woman",
"gravida 1",
"para 0",
"presents",
"week",
"pregnancy",
"check-up",
"course",
"current pregnancy",
"unremarkable",
"normal results",
"previous ultrasound examination",
"human chorionic gonadotropin",
"level measured",
"week",
"of pregnancy",
"0.9 multipl... |
A 78-year old woman presents to the emergency department with severe abdominal pain. Past medical history is significant for congestive heart failure, hypertension, hyperlipidemia, and gout. Her medications include lisinopril, metoprolol, atorvastatin, and allopurinol. Her blood pressure is 125/90 mm Hg, heart rate 95/... | Left colic artery | {
"A": "Sigmoid arteries",
"B": "Internal pudendal artery",
"C": "Left colic artery",
"D": "Superior rectal artery"
} | step1 | C | [
"year old woman presents",
"emergency department",
"severe abdominal",
"Past medical history",
"significant",
"congestive heart failure",
"hypertension",
"hyperlipidemia",
"gout",
"medications include lisinopril",
"metoprolol",
"atorvastatin",
"allopurinol",
"blood pressure",
"90 mm Hg",... |
A 59-year-old woman is scheduled to undergo a right hip total arthroplasty for severe hip osteoarthritis that has failed conservative management. She has never had surgery before. She has a history of major depressive disorder and takes sertraline daily and ibuprofen occasionally for pain. Her mother died of breast can... | Ryanodine receptor antagonist | {
"A": "Antihistamine",
"B": "Cholinesterase inhibitor",
"C": "Dopamine receptor agonist",
"D": "Ryanodine receptor antagonist"
} | step1 | D | [
"59 year old woman",
"scheduled to",
"right hip total arthroplasty",
"severe",
"osteoarthritis",
"failed conservative management",
"never",
"surgery",
"history of major depressive disorder",
"takes sertraline daily",
"ibuprofen occasionally",
"pain",
"mother died of breast cancer",
"father... |
A 24-year-old woman comes to the emergency department because she has had dyspnea and palpitations occurring with mild exertion for the past 8 days. At first, the symptoms subsided immediately after cessation of activity, but they have become worse and now last up to 45 minutes. The patient returned from a summer campi... | Intravenous ceftriaxone therapy | {
"A": "Intravenous ceftriaxone therapy",
"B": "Oral amoxicillin therapy",
"C": "Oral doxycycline therapy",
"D": "Permanent pacemaker implantation"
} | step2&3 | A | [
"year old woman",
"emergency department",
"dyspnea",
"palpitations occurring",
"mild exertion",
"past",
"days",
"first",
"symptoms",
"immediately",
"cessation",
"activity",
"worse",
"now last",
"45 minutes",
"patient returned",
"summer camping trip",
"Vermont",
"weeks",
"Except... |
A 19-year-old female college student is brought into the emergency department by her boyfriend. The boyfriend reports that the patient got caught stealing from the company she works for and subsequently got fired. The boyfriend received a text that evening saying “I’ll miss you.” When he arrived at her dorm room, the p... | Involuntarily admit the patient | {
"A": "Discontinue lithium and start valproate",
"B": "Have the patient sign a suicide contract before discharge",
"C": "Involuntarily admit the patient",
"D": "Set up a next-day appointment with the patient’s psychiatrist"
} | step2&3 | C | [
"year old female college student",
"brought",
"emergency department",
"boyfriend",
"boyfriend reports",
"patient",
"caught stealing",
"company",
"works",
"got fired",
"boyfriend received",
"text",
"evening",
"Ill miss",
"arrived",
"room",
"patient",
"shower covered",
"blood",
"... |
An 8-year-old boy is brought to the physician because of a 1-day history of severe left hand pain. He has had similar painful episodes in the past that required hospitalization. Physical examination shows pale conjunctivae. There is tenderness on palpation of the wrist and the small joints of the left hand. Peripheral ... | S phase | {
"A": "M phase",
"B": "S phase",
"C": "G2 phase",
"D": "G1 phase"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"of",
"1-day history",
"severe left hand pain",
"similar painful episodes",
"past",
"required hospitalization",
"Physical examination shows pale conjunctivae",
"tenderness",
"palpation",
"wrist",
"small joints of",
"left hand",
"Peripheral blood ... |
A 28-year-old man is brought to the emergency department after being struck by a car an hour ago as he was crossing the street. He did not lose consciousness. He is complaining of pain in his right arm, forehead, and pelvis. He also has the urge to urinate, but has been unable to do so since the accident. He takes no m... | Retrograde urethrogram | {
"A": "Retrograde urethrogram",
"B": "IV pyelogram",
"C": "Contrast-enhanced CT scan of the abdomen",
"D": "Retroperitoneal ultrasound"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department",
"struck by",
"car",
"hour",
"crossing",
"street",
"not",
"consciousness",
"pain",
"right arm",
"forehead",
"pelvis",
"to",
"unable to do",
"accident",
"takes",
"medications",
"temperature",
"98 9F",
"pulse",
"72 min",
"... |
A homeless 45-year-old man presents to the emergency room in December complaining of malaise, body aches, chills, and fever. He reports that his symptoms started 4 days ago. His myalgias and chills have begun to resolve, but now he is starting to develop a dry cough, dyspnea, and a sore throat. He does not have a prima... | Reassortment | {
"A": "Complementation",
"B": "Reassortment",
"C": "Recombination",
"D": "Transduction"
} | step1 | B | [
"homeless",
"year old man presents",
"emergency room",
"December",
"malaise",
"body aches",
"chills",
"fever",
"reports",
"symptoms started 4 days",
"myalgias",
"chills",
"begun to resolve",
"now",
"starting to",
"dry cough",
"dyspnea",
"sore throat",
"not",
"primary care provi... |
Three days after admission to the hospital with a clinical diagnosis of ischemic colitis, a 65-year-old man has recovered from his initial symptoms of bloody diarrhea and abdominal pain with tenderness. He feels well at this point and wishes to go home. He has a 15-year history of diabetes mellitus. Currently, he recei... | Colonoscopy | {
"A": "Colonoscopy",
"B": "Discharge home with follow-up in one month",
"C": "Laparoscopy",
"D": "Laparotomy"
} | step2&3 | A | [
"Three days",
"admission",
"hospital",
"clinical diagnosis",
"ischemic colitis",
"65 year old man",
"recovered",
"initial symptoms",
"bloody",
"abdominal",
"tenderness",
"feels well",
"point",
"wishes to go home",
"year history of diabetes mellitus",
"Currently",
"receives",
"mouth... |
The surgical equipment used during a craniectomy is sterilized using pressurized steam at 121°C for 15 minutes. Reuse of these instruments can cause transmission of which of the following pathogens? | Prions | {
"A": "Non-enveloped viruses",
"B": "Enveloped viruses",
"C": "Yeasts",
"D": "Prions"
} | step1 | D | [
"surgical equipment used",
"craniectomy",
"sterilized using",
"steam",
"15 minutes",
"Reuse",
"instruments",
"cause transmission",
"following pathogens"
] |
A 68-year-old community-dwelling woman is transported to the emergency department with decreased consciousness, headache, and nausea. The symptoms began after the patient had a syncopal episode and fell at her home. She has a history of arterial hypertension and atrial fibrillation. Her current medications include hydr... | Rupture of the cerebral bridging veins | {
"A": "Rupture of the middle meningeal artery",
"B": "Rupture of a saccular aneurysm in the carotid circulation region",
"C": "Laceration of the leptomeningeal blood vessels",
"D": "Rupture of the cerebral bridging veins"
} | step2&3 | D | [
"68 year old community-dwelling woman",
"transported",
"emergency department",
"decreased consciousness",
"headache",
"nausea",
"symptoms began",
"patient",
"syncopal episode",
"fell",
"home",
"history of arterial hypertension",
"atrial fibrillation",
"current medications include hydrochlo... |
A 34-year-old G3P2 presents at 33 weeks gestation with several episodes of bloody spotting and mild vaginal bleeding over the past 2 weeks. The bleeding has no specific triggers and resolves spontaneously. She does not report abdominal pain or uterine contractions. She has had two cesarean deliveries. At 20 weeks gesta... | Normally lying placenta → marginal previa | {
"A": "Normally lying placenta → marginal previa",
"B": "Normally placed placenta → low-lying placenta",
"C": "Marginal previa → partial previa",
"D": "Low-lying placenta → marginal previa"
} | step2&3 | A | [
"year old",
"presents",
"weeks gestation",
"several episodes of bloody spotting",
"mild vaginal",
"past 2 weeks",
"bleeding",
"specific triggers",
"resolves",
"not report abdominal pain",
"uterine contractions",
"two cesarean deliveries",
"20 weeks gestation",
"ultrasound examination showe... |
A 40-year-old man with a past medical history of major depression presents to the clinic. He is interested in joining a research study on depression-related sleep disturbances. He had 2 episodes of major depression within the last 2 years, occurring once during the summer and then during the winter of the other year. H... | Increased total REM sleep | {
"A": "Increased total REM sleep",
"B": "Increased slow wave sleep",
"C": "Late morning awakenings",
"D": "Increased REM sleep latency"
} | step1 | A | [
"man",
"past medical history of major depression presents",
"clinic",
"interested",
"research study",
"depression related sleep disturbances",
"2 episodes of major depression",
"last",
"years",
"occurring",
"summer",
"then",
"winter",
"year",
"non-compliant",
"medication",
"strong de... |
A 54-year-old woman with breast cancer comes to the physician because of redness and pain in the right breast. She has been undergoing ionizing radiation therapy daily for the past 2 weeks as adjuvant treatment for her breast cancer. Physical examination shows erythema, edema, and superficial desquamation of the skin a... | Nonhomologous end joining repair | {
"A": "Base excision repair",
"B": "DNA mismatch repair",
"C": "Nucleotide excision repair",
"D": "Nonhomologous end joining repair"
} | step1 | D | [
"54 year old woman",
"breast cancer",
"physician",
"redness",
"pain in the right breast",
"ionizing radiation therapy daily",
"past 2 weeks",
"adjuvant treatment",
"breast cancer",
"Physical examination shows erythema",
"edema",
"superficial desquamation of",
"skin",
"right breast",
"sit... |
An 11-month-old male is brought to the emergency room by his mother. The mother reports that the child is in severe pain and has not moved his right leg since earlier this morning when he was crawling on the floor. The child did not fall or sustain any obvious injury. The child’s past medical history is notable for ane... | Acidification deficiency | {
"A": "Acidification deficiency",
"B": "Vitamin deficiency",
"C": "Surreptitious child abuse",
"D": "Collagen production deficiency"
} | step1 | A | [
"month old male",
"brought",
"emergency room",
"mother",
"mother reports",
"child",
"severe pain",
"not moved",
"right leg since earlier",
"morning",
"crawling",
"floor",
"child",
"not fall",
"sustain",
"injury",
"childs past medical history",
"notable",
"anemia",
"recurrent in... |
A 27-year-old African-American woman, gravida 1, para 0, at 11 weeks' gestation comes to her physician for a prenatal visit. She feels more fatigued than usual but has no other symptoms. She has no history of serious illness. She takes no medications. Her mother has systemic lupus erythematosus. Her temperature is 37.2... | Hemoglobin electrophoresis | {
"A": "Measure anticardiolipin antibody titers",
"B": "Amniocentesis",
"C": "Perform direct Coombs test",
"D": "Hemoglobin electrophoresis"
} | step2&3 | D | [
"27 year old African-American woman",
"gravida 1",
"para 0",
"weeks",
"estation ",
"hysician ",
"renatal visit.",
"eels ore atigued ",
"sual ",
"ymptoms.",
"istory ",
"erious llness.",
"akes ",
"edications.",
"other ",
"ystemic lupus erythematosus.",
"emperature ",
"8. F)",
"u... |
A 4-year-old boy is brought to the physician by his father because of a 3-day history of generalized rash. The rash is not pruritic. He has no cough. He has had a fever and a sore throat for 4 days. He was born at term and has been healthy except for an episode of tonsillitis 6 months ago treated with erythromycin. His... | Rapid streptococcal antigen test | {
"A": "Elevated C-reactive protein",
"B": "Detection of antistreptolysin titer",
"C": "Echocardiography",
"D": "Rapid streptococcal antigen test"
} | step2&3 | D | [
"4 year old boy",
"brought",
"physician",
"father",
"3-day history",
"generalized rash",
"rash",
"not",
"cough",
"fever",
"sore throat",
"4 days",
"born",
"term",
"healthy",
"episode of tonsillitis",
"months",
"treated with erythromycin",
"immunizations",
"date",
"temperature... |
A 55-year-old man comes to the physician because of a 3-day history of decreased urine output, progressively worsening bilateral pedal edema, and fatigue. He has a 4-month history of persistent lower back pain. He has hypercholesterolemia and stable angina pectoris. Current medications include atorvastatin, aspirin, an... | Bone marrow biopsy | {
"A": "Peripheral blood smear",
"B": "Parathyroid hormone levels",
"C": "Bone marrow biopsy",
"D": "Skeletal survey"
} | step2&3 | C | [
"55 year old man",
"physician",
"3-day history",
"decreased urine output",
"worsening bilateral pedal edema",
"fatigue",
"month history of persistent lower back pain",
"hypercholesterolemia",
"stable angina pectoris",
"Current medications include atorvastatin",
"aspirin",
"ibuprofen",
"pulse... |
A 7-year-old girl is brought to the physician by her mother because of a 4-week history of irritability, diarrhea, and a 2.2-kg (5-lb) weight loss that was preceded by a dry cough. The family returned from a vacation to Indonesia 2 months ago. Her vital signs are within normal limits. Abdominal examination shows mild t... | Albendazole | {
"A": "Diethylcarbamazine",
"B": "Metronidazole",
"C": "Albendazole",
"D": "Praziquantel"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"mother",
"week history",
"irritability",
"diarrhea",
"2.2 kg",
"5",
"weight loss",
"preceded",
"dry cough",
"family returned",
"vacation",
"Indonesia",
"months",
"vital signs",
"normal limits",
"Abdominal examination shows mild tenderness... |
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