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 64-year-old man presents to the emergency department with sudden onset of pleuritic chest pain and dyspnea on exertion. He has a history of lung cancer and is currently being treated with outpatient chemotherapy. His temperature is 98.9°F (37.2°C), blood pressure is 111/64 mmHg, pulse is 130/min, respirations are 25/... | Stop heparin | {
"A": "Blood transfusion",
"B": "No treatment changes needed",
"C": "Platelet transfusion",
"D": "Stop heparin"
} | step2&3 | D | [
"64 year old man presents",
"emergency department",
"sudden onset of pleuritic chest pain",
"dyspnea on exertion",
"history cancer",
"currently",
"treated with outpatient chemotherapy",
"temperature",
"98 9F",
"blood pressure",
"64 mmHg",
"pulse",
"min",
"respirations",
"min",
"oxygen ... |
A 36-year-old woman comes to the physician because of prolonged stiffness in the morning and progressive pain and swelling of her wrists and hands over the past 4 months. Examination shows bilateral swelling and mild tenderness of the wrists and the second, third, and fourth metacarpophalangeal joints. Her range of mot... | Pyridoxine | {
"A": "Niacin",
"B": "Folic acid",
"C": "Riboflavin",
"D": "Pyridoxine"
} | step1 | D | [
"36 year old woman",
"physician",
"of prolonged stiffness",
"morning",
"progressive pain",
"swelling",
"wrists",
"hands",
"past",
"months",
"Examination shows bilateral swelling",
"mild tenderness",
"wrists",
"second",
"third",
"fourth metacarpophalangeal joints",
"range of motion",
... |
An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg (7-lb) weight loss. Since the death of her husband one year... | Assess for suicidal ideation
" | {
"A": "Notify adult protective services",
"B": "Recommend relocation to a nursing home",
"C": "Begin cognitive-behavioral therapy",
"D": "Assess for suicidal ideation\n\""
} | step2&3 | D | [
"year old woman",
"physician",
"difficulty sleeping",
"increasing fatigue",
"past 3 months",
"waking up early",
"trouble falling asleep",
"night",
"period",
"decreased appetite",
"3.2 kg",
"weight loss",
"death",
"husband one year ago",
"living",
"son",
"wife",
"worried",
"feels ... |
A 14-year-old boy is brought to the physician by his parents for a well-child visit. The patient was born at 38 weeks' gestation via vaginal delivery and has been healthy. He attends a junior high school and is having difficulties keeping up with his classmates in many classes. He is at the 97th percentile for height a... | Karyotyping | {
"A": "Serum IGF-1 measurement",
"B": "Urinalysis",
"C": "Slit-lamp examination",
"D": "Karyotyping"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"parents",
"well-child visit",
"patient",
"born",
"weeks",
"gestation",
"vaginal delivery",
"healthy",
"attends",
"junior high",
"difficulties keeping",
"classmates",
"classes",
"percentile",
"height",
"50th percentile",
"weight",
"Vita... |
A 37-year-old man is brought to the emergency department following a motor vehicle collision. His temperature is 38.1°C (100.6°F), pulse is 39/min, respirations are 29/min, and blood pressure is 58/42 mm Hg. There is no improvement in his blood pressure despite adequate fluid resuscitation. A drug is administered that ... | No change ↑ ↑ | {
"A": "No change ↑ ↑",
"B": "↑ ↑ ↓",
"C": "↓ ↓ ↑",
"D": "↑ ↓ ↓"
} | step1 | A | [
"year old man",
"brought",
"emergency department following",
"motor vehicle collision",
"temperature",
"100",
"pulse",
"min",
"respirations",
"29 min",
"blood pressure",
"58",
"mm Hg",
"improvement",
"blood pressure",
"adequate fluid resuscitation",
"drug",
"administered",
"cause... |
A 57-year-old man is brought to the emergency department by his family because of several episodes of vomiting of blood in the past 24 hours. He has a history of alcoholic cirrhosis and is being treated for ascites with diuretics and for encephalopathy with lactulose. His vital signs include a temperature of 36.9°C (98... | Combined vasoactive and endoscopic therapy | {
"A": "Non-selective beta-blockers",
"B": "Combined vasoactive and endoscopic therapy",
"C": "Balloon tamponade",
"D": "Transjugular intrahepatic portosystemic shunt (TIPS)"
} | step2&3 | B | [
"57 year old man",
"brought",
"emergency department",
"family",
"of",
"episodes",
"vomiting",
"blood",
"past 24 hours",
"history",
"alcoholic cirrhosis",
"treated",
"ascites",
"diuretics",
"encephalopathy",
"lactulose",
"vital signs include",
"temperature",
"36",
"98 4F",
"pu... |
A 3-year-old boy is brought to his pediatrician by his mother when he developed redness, burning, itching, and exquisite pain all over his arms, lower legs, neck, and face. The mother states that she just recently began taking him to the local playground in the afternoons. She reports that she applied liberal amounts o... | Initiate oral beta carotene | {
"A": "Begin dexamethasone taper",
"B": "Start therapeutic phlebotomy",
"C": "Initiate oral beta carotene",
"D": "Prescribe chloroquine"
} | step2&3 | C | [
"3 year old boy",
"brought",
"pediatrician",
"mother",
"redness",
"burning",
"itching",
"pain",
"arms",
"lower legs",
"neck",
"face",
"mother states",
"recently began",
"local playground",
"afternoons",
"reports",
"applied liberal amounts",
"sunscreen",
"time outside",
"state... |
An 8-month-old boy presents with poor feeding. The patient’s mother says that he has refused to eat since yesterday morning. She also noticed that he has had trouble keeping his head up and appears floppy. She had breastfed him exclusively and just recently introduced him to pureed foods. His last bowel movement was 3 ... | Ingestion of a preformed toxin | {
"A": "Autoantibodies against acetylcholine receptors",
"B": "Bacterial infection of the meninges",
"C": "Ingestion of a preformed toxin",
"D": "Haemophilus influenzae infection"
} | step2&3 | C | [
"month old boy presents",
"poor feeding",
"patients mother",
"refused to eat",
"morning",
"keeping",
"head up",
"appears floppy",
"breastfed",
"recently introduced",
"to",
"foods",
"last bowel movement",
"3 days",
"normal",
"Past medical history",
"significant",
"recent otitis medi... |
A 72-year-old man is brought into clinic by his daughter for increasing confusion. The daughter states that over the past 2 weeks, she has noticed that the patient “seems to stare off into space.” She reports he has multiple episodes a day during which he will walk into a room and forget why. She is also worried about ... | Subdural hematoma | {
"A": "Alzheimer disease",
"B": "Ischemic stroke",
"C": "Subdural hematoma",
"D": "Vitamin B12 deficiency"
} | step2&3 | C | [
"72 year old man",
"brought",
"clinic",
"daughter",
"increasing confusion",
"daughter states",
"past 2 weeks",
"patient",
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"reports",
"multiple episodes",
"day",
"walk",
"room",
"forget",
"worried",
"balance",
"several falls",
"worst",
"3 weeks",
"trippe... |
A 3-year-old girl is brought to the physician by her parents because of a barking cough, a raspy voice, and noisy breathing for the last 3 days. Five days ago, she had a low-grade fever and runny nose. She attends daycare. Her immunizations are up-to-date. Her temperature is 37.8°C (100°F) and respirations are 33/min. ... | Subglottic larynx | {
"A": "Distal trachea",
"B": "Pharynx",
"C": "Subglottic larynx",
"D": "Bronchioles"
} | step1 | C | [
"3 year old girl",
"brought",
"physician",
"parents",
"barking cough",
"raspy voice",
"noisy breathing",
"days",
"Five",
"low-grade fever",
"runny nose",
"attends daycare",
"immunizations",
"date",
"temperature",
"respirations",
"min",
"Physical examination shows supraclavicular re... |
A student health coordinator plans on leading a campus-wide HIV screening program that will be free for the entire undergraduate student body. The goal is to capture as many correct HIV diagnoses as possible with the fewest false positives. The coordinator consults with the hospital to see which tests are available to ... | Test C on the entire student body followed by Test A on those who are positive | {
"A": "Test A on the entire student body followed by Test C on those who are positive",
"B": "Test B on the entire student body followed by Test A on those who are positive",
"C": "Test C on the entire student body followed by Test A on those who are positive",
"D": "Test C on the entire student body followed ... | step1 | C | [
"student health coordinator plans",
"leading",
"wide HIV screening program",
"free",
"entire undergraduate student body",
"goal",
"to",
"correct HIV diagnoses",
"possible",
"false positives",
"coordinator consults",
"hospital to see",
"tests",
"available to use",
"program",
"Test",
"... |
A 40-year-old man is brought into the emergency department because he was involved in a bar fight and sustained an injury to the head. The next day, as requested by the patient, the psychiatry team is called to address some of the concerns he has regarding his drinking habits. He admits that he got irate last night at ... | Preparation | {
"A": "Precontemplation",
"B": "Contemplation",
"C": "Preparation",
"D": "Action"
} | step2&3 | C | [
"40 year old man",
"brought",
"emergency department",
"involved",
"fight",
"sustained",
"injury",
"head",
"next day",
"requested by",
"patient",
"psychiatry team",
"called to address",
"concerns",
"drinking habits",
"admits",
"got",
"night",
"drivers license",
"recently taken",... |
A 30-year-old woman presents with generalized fatigue, joint pain, and decreased appetite. She says that symptoms onset a year ago and have not improved. The patient’s husband says he has recently noticed that her eyes and skin are yellowish. The patient denies any history of smoking or alcohol use, but she admits to u... | Ribavirin | {
"A": "Simeprevir",
"B": "Ribavirin",
"C": "Interferon-alpha",
"D": "Cidofovir"
} | step1 | B | [
"30 year old woman presents",
"generalized fatigue",
"joint pain",
"decreased appetite",
"symptoms onset",
"year",
"not improved",
"patients husband",
"recently",
"eyes",
"skin",
"patient denies",
"history of smoking",
"alcohol use",
"admits to using different kinds",
"intravenous illi... |
A 10-year-old girl is brought to the physician because of a severe, throbbing headache for 1 hour. The headache is located in the right frontotemporal region. It is her fifth such headache in the past 2 months. Her mother says that all the previous episodes started after soccer practice, following which the child would... | Acetaminophen therapy | {
"A": "Neuro-optometric assessment",
"B": "Acetaminophen therapy",
"C": "MRI of the brain",
"D": "Acyclovir therapy"
} | step2&3 | B | [
"A 10 year old girl",
"brought",
"physician",
"severe",
"throbbing headache",
"hour",
"headache",
"right frontotemporal region",
"fifth",
"headache",
"past",
"months",
"mother",
"previous episodes started",
"soccer practice",
"following",
"child",
"lock",
"room",
"close",
"cu... |
A 60-year-old woman comes to the physician because of lower back pain, generalized weakness, and weight loss that has occurred over the past 6 weeks. She also says that her urine has appeared foamy recently. Physical examination shows focal midline tenderness of the lumbar spine and conjunctival pallor. Her temperature... | Grouped erythrocytes with stacked-coin appearance | {
"A": "B-lymphocytes with radial cytoplasmic projections",
"B": "Neutrophils with hypersegmented nuclear lobes",
"C": "Grouped erythrocytes with stacked-coin appearance",
"D": "Myeloblasts with needle-shaped cytoplasmic inclusions"
} | step1 | C | [
"60 year old woman",
"physician",
"lower back pain",
"generalized weakness",
"weight loss",
"occurred",
"past",
"weeks",
"urine",
"appeared foamy recently",
"Physical examination shows focal midline tenderness",
"lumbar spine",
"conjunctival pallor",
"temperature",
"100",
"photomicrogr... |
A 52-year-old woman presents with mild epigastric pain and persistent heartburn for the past 2 months. An endoscopy is performed and reveals inflammation of the stomach mucosa without evidence of ulceration. A biopsy is performed and reveals intestinal metaplasia with destruction of a large number of parietal cells. Sh... | Destruction of the mucosa of the stomach is mediated by T cells. | {
"A": "It is the most common cause of folate deficiency in the US.",
"B": "Caused by a gram-negative rod that is urease positive",
"C": "MALT lymphoma is a common complication.",
"D": "Destruction of the mucosa of the stomach is mediated by T cells."
} | step1 | D | [
"year old woman presents",
"mild epigastric pain",
"persistent heartburn",
"past",
"months",
"endoscopy",
"performed",
"reveals inflammation of",
"stomach mucosa",
"evidence",
"ulceration",
"biopsy",
"performed",
"reveals intestinal",
"destruction",
"large number",
"parietal cells",
... |
A 62-year-old man presents to the emergency department with sudden onset of severe left leg pain accompanied by numbness and weakness. His medical history is remarkable for hypertension and hyperlipidemia. His vital signs include a blood pressure of 155/92 mm Hg, a temperature of 37.1°C (98.7°F), and an irregular pulse... | Thromboembolectomy | {
"A": "Thromboembolectomy",
"B": "Fasciotomy",
"C": "Warfarin",
"D": "Antibiotics"
} | step2&3 | A | [
"62 year old man presents",
"emergency department",
"sudden onset",
"severe left leg",
"numbness",
"weakness",
"medical history",
"hypertension",
"hyperlipidemia",
"vital signs include",
"blood pressure",
"mm Hg",
"temperature",
"98",
"irregular pulse of",
"min",
"Physical examinatio... |
A 25-year-old male presents to his primary doctor with difficulty sleeping. On exam, he is noted to have impaired upgaze bilaterally, although the rest of his ocular movements are intact. On pupillary exam, both pupils accommodate, but do not react to light. What is the most likely cause of his symptoms? | Pinealoma | {
"A": "Frontal lobe cavernoma",
"B": "Craniopharyngioma",
"C": "Pinealoma",
"D": "Spinal cord ependymoma"
} | step1 | C | [
"year old male presents",
"primary doctor",
"difficulty sleeping",
"exam",
"noted to",
"impaired",
"rest",
"ocular movements",
"intact",
"pupillary exam",
"pupils",
"not react",
"light",
"most likely cause",
"symptoms"
] |
A 49-year-old man being treated for Helicobacter pylori infection presents to his primary care physician complaining of lower back pain. His physician determines that a non-steroidal anti-inflammatory drug (NSAID) would be the most appropriate initial treatment. Which of the following is the most appropriate NSAID for ... | Celecoxib | {
"A": "Ibuprofen",
"B": "Codeine",
"C": "Bismuth",
"D": "Celecoxib"
} | step1 | D | [
"year old man",
"treated",
"Helicobacter pylori infection presents",
"primary care physician complaining of lower back pain",
"physician",
"non-steroidal anti-inflammatory drug",
"most appropriate initial treatment",
"following",
"most appropriate NSAID",
"patient"
] |
Five sets of PCR primers were designed and sythesized, one for each of the viruses listed below. The viral genomic material from each virus was extracted and added to a PCR reaction containing a DNA-dependent Taq polymerase with the corresponding primers. However, of the five PCR reactions, only one yielded an amplifie... | Adenovirus | {
"A": "Poliovirus",
"B": "Rhinovirus",
"C": "Adenovirus",
"D": "Yellow Fever virus"
} | step1 | C | [
"Five sets",
"PCR primers",
"designed",
"one",
"viruses listed",
"viral genomic material",
"extracted",
"added",
"PCR reaction containing a DNA dependent Taq polymerase",
"primers",
"five PCR reactions",
"only one",
"product",
"detected",
"gel agarose",
"following viruses",
"PCR prod... |
A 72-year-old man with type 2 diabetes mellitus, hypertension, and systolic heart failure comes to the physician because of a 5-day history of progressively worsening shortness of breath at rest. Physical examination shows jugular venous distention, diffuse crackles over the lower lung fields, and bilateral lower extre... | Brain natriuretic peptide | {
"A": "Angiotensin II",
"B": "Brain natriuretic peptide",
"C": "Prostacyclin",
"D": "Somatostatin"
} | step1 | B | [
"72 year old man",
"type 2 diabetes mellitus",
"hypertension",
"systolic heart failure",
"physician",
"5-day history",
"worsening shortness of breath",
"rest",
"Physical examination shows jugular venous distention",
"diffuse crackles",
"lower lung fields",
"bilateral lower extremity edema",
... |
A 14-year-old boy is brought to the physician because of blurry vision. He is at the 97th percentile for height and 25th percentile for weight. He has long, slender fingers and toes that are hyperflexible. Examination of the oropharynx shows a high-arched palate. Slit lamp examination shows bilateral lens subluxation i... | Variable expressivity | {
"A": "Variable expressivity",
"B": "Compound heterozygosity",
"C": "Frameshift mutation",
"D": "Chromosomal instability"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"blurry vision",
"percentile",
"height",
"percentile",
"weight",
"long",
"slender fingers",
"toes",
"Examination",
"oropharynx shows",
"high-arched palate",
"Slit lamp examination shows bilateral lens subluxation",
"direction",
"patient's older... |
A 45-year-old male alcoholic presents with fever, productive cough, and foul-smelling sputum for the past two weeks. Vital signs are T 38.3 C, HR 106, BP 118/64 and RR 16. Oxygen saturation on room air is 90%. Given a diagnosis of aspiration pneumonia, initial chest radiograph findings would most likely include: | Right lung abscess due to the right main bronchus being wider and more vertically oriented | {
"A": "Left lung abscess due to increased ventilation-perfusion ratio of the left lung",
"B": "Left lung abscess due to the left main bronchus being located superior to the right main bronchus",
"C": "Right lung abscess due to increased anterior-posterior diameter of the right lung",
"D": "Right lung abscess d... | step1 | D | [
"year old male alcoholic presents",
"fever",
"productive cough",
"foul-smelling sputum",
"past two weeks",
"Vital signs",
"T",
"3",
"BP",
"64",
"RR",
"Oxygen saturation",
"room air",
"90",
"Given",
"diagnosis",
"aspiration pneumonia",
"initial chest findings",
"most likely includ... |
A 66-year-old man comes to the emergency department because of a 1-day history of chest pain, palpitations, and dyspnea on exertion. He had a similar episode 3 days ago and was diagnosed with an inferior wall myocardial infarction. He was admitted and a percutaneous transluminal coronary angioplasty was successfully do... | Creatine kinase MB | {
"A": "Lactate dehydrogenase",
"B": "Creatine kinase MB",
"C": "Cardiac troponin T",
"D": "Copeptin"
} | step2&3 | B | [
"66 year old man",
"emergency department",
"of",
"day history",
"chest pain",
"palpitations",
"dyspnea on exertion",
"similar episode",
"days",
"diagnosed",
"inferior wall myocardial infarction",
"admitted",
"percutaneous transluminal coronary angioplasty",
"day",
"fractional flow reserv... |
A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial? | Phase I | {
"A": "Phase III",
"B": "Phase 0",
"C": "Phase V",
"D": "Phase I"
} | step1 | D | [
"research group",
"to assess",
"safety",
"toxicity profile",
"new drug",
"clinical trial",
"conducted",
"20 volunteers to estimate",
"maximum tolerated dose",
"monitor",
"apparent toxicity",
"drug",
"study design",
"best described",
"following phases",
"clinical trial"
] |
A 32-year-old African American woman presents to the office with complaints of frothy urine and swelling of her body that started 4 days ago. She noticed the swelling 1st in the face then gradually involved in other parts of her body. The frequency of urination is the same with no noticeable change in its appearance. S... | Focal segmental glomerulosclerosis | {
"A": "Minimal change disease",
"B": "Focal segmental glomerulosclerosis",
"C": "Diffuse proliferative glomerulonephritis",
"D": "Post-streptococcal glomerulonephritis"
} | step1 | B | [
"year old African American woman presents",
"office",
"complaints",
"frothy urine",
"swelling",
"body",
"started 4 days",
"swelling 1st",
"face then",
"involved",
"parts",
"body",
"frequency of urination",
"same",
"change",
"appearance",
"human immunodeficiency virus",
"positive",
... |
A 5-year-old patient is brought to the emergency department by his parents for concerning behavior. His parents relate that over the past 3 weeks, he has had multiple episodes of staring into space, lip smacking, and clasping his hands together. The patient has his eyes open during these episode but does not respond to... | Complex partial seizure | {
"A": "Complex partial seizure",
"B": "Generalized tonic-clonic seizure",
"C": "Absence seizure",
"D": "Syncopal episodes"
} | step1 | A | [
"5 year old patient",
"brought",
"emergency department",
"parents",
"concerning behavior",
"parents relate",
"past",
"weeks",
"multiple episodes of staring",
"space",
"lip smacking",
"clasping",
"hands together",
"patient",
"eyes open",
"episode",
"not",
"parents voice",
"name",
... |
A 23-year-old man presents into his physician's office with increasing breathlessness over the past one month. He was diagnosed with asthma when he was a child and has been able to keep his symptoms under control with a Ventolin inhaler. However, over the past year or so he has found that he gets out of breath on sever... | Methacholine bronchoprovocation test | {
"A": "Arterial blood gas",
"B": "Patch test",
"C": "Methacholine bronchoprovocation test",
"D": "Follow up spirometry in 2 months"
} | step2&3 | C | [
"23 year old man presents",
"physician's office",
"increasing breathlessness",
"past one",
"diagnosed",
"asthma",
"child",
"able to keep",
"symptoms",
"control",
"Ventolin inhaler",
"past year",
"so",
"found",
"gets out of breath",
"several occasions",
"week",
"wakes up",
"week",... |
A 12-year-old boy is brought to his orthopedic surgeon for evaluation of leg pain and positioning. Specifically, over the past several months he has been complaining of thigh pain and has more difficulty sitting in his wheelchair. His medical history is significant for spastic quadriplegic cerebral palsy since birth an... | Obturator | {
"A": "Femoral nerve",
"B": "Nerve to the iliopsoas",
"C": "Obturator",
"D": "Superior gluteal nerve"
} | step1 | C | [
"year old boy",
"brought",
"orthopedic surgeon",
"evaluation",
"leg",
"positioning",
"past",
"months",
"thigh pain",
"more difficulty sitting",
"wheelchair",
"medical history",
"significant",
"spastic quadriplegic cerebral palsy",
"birth",
"number",
"surgeries",
"contractures",
"... |
A 59-year-old man is brought to the emergency department with signs of spontaneous bruising of the lower legs. The patient has a history of alcohol use disorder and has been unemployed for the last 2 years. He reports a 1-year history of fatigue and joint pain. Physical examination of the patient’s legs reveals the fin... | Hydroxylation of lysine residues | {
"A": "Conversion of pyruvate to acetyl-CoA",
"B": "Gamma-carboxylation of glutamic acid residues",
"C": "Hydroxylation of lysine residues",
"D": "Intestinal absorption of Ca2+ and PO43-"
} | step2&3 | C | [
"59 year old man",
"brought",
"emergency department",
"signs",
"spontaneous bruising",
"lower legs",
"patient",
"history of alcohol use disorder",
"unemployed",
"years",
"reports",
"year history",
"fatigue",
"joint pain",
"Physical examination of",
"patients legs reveals",
"findings"... |
A 22-year-old woman comes to the physician because of abdominal pain and diarrhea for 2 months. The pain is intermittent, colicky and localized to her right lower quadrant. She has anorexia and fears eating due to the pain. She has lost 4 kg (8.8 lb) during this time. She has no history of a serious illness and takes n... | Budesonide | {
"A": "Budesonide",
"B": "Ciprofloxacin",
"C": "Metronidazole",
"D": "Rectal mesalamine"
} | step2&3 | A | [
"year old woman",
"physician",
"abdominal pain",
"diarrhea",
"months",
"pain",
"intermittent",
"colicky",
"localized",
"right lower quadrant",
"anorexia",
"fears eating due to",
"pain",
"lost 4 kg",
"8.8",
"time",
"history",
"serious illness",
"takes",
"medications",
"tempera... |
An 8-month-old boy is brought to the physician by his parents for gradually increasing loss of neck control and inability to roll over for the past 2 months. During this time, he has had multiple episodes of unresponsiveness with a blank stare and fluttering of the eyelids. His parents state that he sometimes does not ... | β-hexosaminidase A deficiency
" | {
"A": "Sphingomyelinase deficiency",
"B": "ATP-binding cassette transporter mutation",
"C": "α-galactosidase A deficiency",
"D": "β-hexosaminidase A deficiency\n\""
} | step2&3 | D | [
"month old boy",
"brought",
"physician",
"parents",
"increasing loss",
"neck control",
"roll over",
"past",
"months",
"time",
"multiple episodes of unresponsiveness",
"blank stare",
"fluttering",
"eyelids",
"parents state",
"sometimes",
"not turn",
"called",
"gets",
"loud noise... |
A 70-year-old woman presents with numbness and tingling that is worse in the soles of her feet. She says that symptoms started a few weeks ago and have progressively worsened. She also complains of mild nausea and white lines on her fingernails. Past medical history is significant for diabetes mellitus type 2, managed ... | Dimercaprol | {
"A": "Tight control of her diabetes mellitus by adding insulin",
"B": "Calcium disodium edetate (EDTA)",
"C": "Dimercaprol",
"D": "Trientine"
} | step1 | C | [
"70 year old woman presents",
"numbness",
"tingling",
"worse",
"soles of",
"feet",
"symptoms started",
"few weeks",
"worsened",
"mild nausea",
"white lines",
"fingernails",
"Past medical history",
"significant",
"diabetes mellitus type 2",
"managed",
"metformin",
"last",
"5.8",
... |
A 56-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. He reports that he has been compliant with his current antidiabetic medication regimen. His hemoglobin A1c concentration is 8.5%. The physician prescribes a drug that reversibly inhibits a membrane-bound enzyme that hydr... | Miglitol | {
"A": "Linagliptin",
"B": "Canagliflozin",
"C": "Miglitol",
"D": "Rosiglitazone"
} | step1 | C | [
"year old man",
"type 2 diabetes mellitus",
"physician",
"follow-up examination",
"reports",
"compliant",
"current antidiabetic regimen",
"hemoglobin concentration",
"8.5",
"physician",
"drug",
"inhibits",
"membrane bound enzyme",
"carbohydrate",
"following drugs",
"most likely added",... |
A 60-year-old woman is brought to the emergency department by paramedics after being found unresponsive. It is not possible to obtain a history. Her blood pressure is 75/30 mmHg and pulse is 108/min. Her extremities are cool and mottled. She admitted to the intensive care unit (ICU) for further supportive care, where s... | Blood pressure increases; pulse decreases | {
"A": "Blood pressure increases; pulse increases",
"B": "Blood pressure decreases; pulse decreases",
"C": "Blood pressure increases; pulse decreases",
"D": "Blood pressure decreases; pulse increases"
} | step1 | C | [
"60 year old woman",
"brought",
"emergency department",
"paramedics",
"found unresponsive",
"not possible to obtain",
"history",
"blood pressure",
"75 30 mmHg",
"pulse",
"min",
"extremities",
"cool",
"mottled",
"admitted to",
"intensive care unit",
"further supportive care",
"start... |
A 62-year-old man with a history of coronary artery disease comes to the emergency department with substernal chest pain for several hours. An ECG shows no abnormalities. Troponin T test results are negative. The patient is admitted to the hospital and treated with intravenous nitroglycerin, with an initial resolution ... | Phenylephrine | {
"A": "Levodopa",
"B": "Alprazolam",
"C": "Phenylephrine",
"D": "Hydrocodone"
} | step1 | C | [
"year old man",
"history of coronary artery disease",
"emergency department",
"substernal chest pain",
"hours",
"ECG shows",
"abnormalities",
"Troponin T test results",
"negative",
"patient",
"admitted",
"hospital",
"treated with intravenous nitroglycerin",
"initial resolution",
"symptom... |
A 21-year-old man presents to the clinic complaining of feeling tired during the day. He is concerned as his grades in school have worsened and he does not want to lose his scholarship. Upon further questioning, the patient describes frequently experiencing a dreamlike state before falling asleep and after waking up. H... | Narcolepsy | {
"A": "Obstructive sleep apnea (OSA)",
"B": "Delayed sleep phase syndrome (DSPS)",
"C": "Narcolepsy",
"D": "Alcohol withdrawal"
} | step2&3 | C | [
"21-year-old man presents",
"clinic",
"feeling tired",
"day",
"concerned",
"grades in school",
"worsened",
"not",
"to",
"scholarship",
"further questioning",
"patient",
"frequently experiencing",
"dreamlike state",
"falling asleep",
"waking",
"frequent nighttime awakenings",
"finds... |
A 43-year-old man presents to a primary care clinic complaining of several months of fatigue and difficulty concentrating at work. He is tired throughout the day and often falls asleep briefly at work. He sleeps for 9 hours per night, falling asleep easily, waking up several times in the middle of the night, and then h... | Obstructive sleep apnea | {
"A": "Chronic fatigue syndrome",
"B": "Circadian rhythm sleep wake disorder",
"C": "Hypothyroidism",
"D": "Obstructive sleep apnea"
} | step2&3 | D | [
"year old man presents",
"primary care clinic",
"months",
"fatigue",
"difficulty concentrating",
"work",
"tired",
"day",
"often falls asleep",
"work",
"sleeps",
"hours",
"night",
"falling asleep easily",
"waking up",
"times",
"middle",
"night",
"then",
"waking",
"morning",
... |
A 78-year-old man comes to the physician because of a change in his voice. His wife says his voice has progressively become higher pitched, and he has had a 5.4-kg (11.9-lb) weight loss over the past 4 months. He has smoked half a pack of cigarettes daily for the past 40 years. Direct laryngoscopy shows an irregular, n... | 4th arch | {
"A": "6th arch",
"B": "2nd arch",
"C": "3rd arch",
"D": "4th arch"
} | step1 | D | [
"year old man",
"physician",
"of",
"change in",
"voice",
"wife",
"voice",
"higher pitched",
"5.4 kg",
"weight loss",
"past",
"months",
"smoked half",
"pack",
"cigarettes daily",
"past 40 years",
"Direct laryngoscopy shows",
"irregular",
"nodular",
"biopsy",
"mass shows poorly... |
A 63-year-old woman visits her family physician because she has been experiencing difficulty to get her urine stream started in the past 8 months with many occasions needing extra effort to pass the urine. She describes the stream as intermittent and slow, and comments that she needs to go to the restroom again immedia... | Overflow incontinence | {
"A": "Stress incontinence",
"B": "Mixed incontinence",
"C": "Overflow incontinence",
"D": "Functional incontinence"
} | step1 | C | [
"63 year old woman visits",
"family physician",
"experiencing difficulty to",
"urine stream started",
"past",
"months",
"occasions needing extra effort to pass",
"urine",
"stream",
"intermittent",
"slow",
"comments",
"needs to go",
"restroom",
"immediately",
"personal medical history",... |
A 50-year-old man is brought to the hospital after being found unresponsive in his bed in the morning. He is declared dead on arrival in the emergency room. His wife states that he always had uncontrolled hypertension despite being on multiple medications. An autopsy is performed, and the cause of his death is found to... | Raised renin level in the blood | {
"A": "Elevated C-reactive protein in the blood",
"B": "Raised cholesterol level in the blood",
"C": "Raised calcium level in the blood",
"D": "Raised renin level in the blood"
} | step1 | D | [
"50 year old man",
"brought",
"hospital",
"found unresponsive",
"bed",
"morning",
"dead on arrival",
"emergency room",
"wife states",
"always",
"uncontrolled hypertension",
"multiple medications",
"autopsy",
"performed",
"cause of",
"death",
"found to",
"hemorrhage",
"right",
"... |
A 68-year-old woman comes to the physician with dysphagia and halitosis for several months. She feels food sticking to her throat immediately after swallowing. Occasionally, she regurgitates undigested food hours after eating. She has no history of any serious illness and takes no medications. Her vital signs are withi... | Barium swallow with video fluoroscopy | {
"A": "Barium swallow with video fluoroscopy",
"B": "Cervical magnetic resonance imaging",
"C": "Chest X-ray",
"D": "Upper gastrointestinal series"
} | step2&3 | A | [
"68 year old woman",
"physician",
"dysphagia",
"halitosis",
"months",
"feels food sticking",
"throat immediately",
"swallowing",
"Occasionally",
"regurgitates undigested food hours",
"eating",
"history",
"serious illness",
"takes",
"medications",
"vital signs",
"normal",
"Physical ... |
A 37-year-old woman is brought to the emergency department 15 minutes after falling down a flight of stairs. On arrival, she has shortness of breath, right-sided chest pain, right upper quadrant abdominal pain, and right shoulder pain. She is otherwise healthy. She takes no medications. She appears pale. Her temperatur... | Liver hematoma | {
"A": "Splenic laceration",
"B": "Pneumothorax",
"C": "Liver hematoma",
"D": "Duodenal hematoma"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department 15 minutes",
"falling down",
"flight",
"stairs",
"arrival",
"shortness of breath",
"right-sided chest pain",
"right upper quadrant abdominal pain",
"right shoulder pain",
"healthy",
"takes",
"medications",
"appears pale",
"temperature"... |
An investigator is studying the interaction between epithelial cells and calcium ion concentration. When the calcium ion concentration available to a sample of epithelial tissue is decreased, an increased gap between adjacent epithelial cells is seen on electron microscopy. This observed decrease in cell adhesion is mo... | Cadherin | {
"A": "Claudin",
"B": "Cadherin",
"C": "Actin",
"D": "Integrin"
} | step1 | B | [
"investigator",
"studying",
"interaction",
"epithelial cells",
"calcium ion concentration",
"calcium ion concentration available",
"sample of epithelial tissue",
"decreased",
"increased gap",
"adjacent epithelial cells",
"seen",
"electron microscopy",
"observed decrease",
"cell adhesion",
... |
A 26-year-old man with no past medical history is brought in to the trauma bay by ambulance after sustaining a motorcycle crash against a parked car. The patient is alert and oriented with no focal neurologic defects. The patient has a few lower extremity abrasions but is otherwise healthy and is discharged. One week l... | Alpha toxin | {
"A": "Alpha toxin",
"B": "Botulinum toxin",
"C": "Cytotoxin",
"D": "Tetanospasmin"
} | step1 | A | [
"year old man",
"past medical history",
"brought",
"trauma bay",
"ambulance",
"sustaining",
"motorcycle crash",
"parked car",
"patient",
"alert",
"oriented",
"focal neurologic defects",
"patient",
"few lower extremity abrasions",
"healthy",
"discharged",
"One week later",
"patient ... |
A 5-year-old boy is brought to the office by his mother with complaints of facial puffiness and “frothy” urine for 4 days. The puffiness first started in his eyes and then spread to the face. His mother does not provide any history of similar symptoms in the past. Past medical history is non-significant. His birth hist... | Lipoid nephrosis | {
"A": "Membranoproliferative glomerulonephritis",
"B": "Focal segmental glomerulosclerosis",
"C": "Lipoid nephrosis",
"D": "Membranous nephropathy"
} | step1 | C | [
"5 year old boy",
"brought",
"office",
"mother",
"complaints",
"facial puffiness",
"frothy urine",
"4 days",
"puffiness first started",
"eyes",
"then spread",
"face",
"mother",
"not provide",
"history",
"similar symptoms",
"past",
"Past medical history",
"non significant",
"bir... |
An 18-year-old woman presents to the medical clinic 6 days after her boyfriend’s condom broke during sexual intercourse. The patient states “I do not wish to get pregnant at this point in my life.” She has no other medical conditions and takes no prescription medications. Her family history is negative. She is a social... | Copper-IUD | {
"A": "Ulipristal acetate",
"B": "Copper-IUD",
"C": "Levonorgestrel",
"D": "Ethinyl estradiol"
} | step2&3 | B | [
"year old woman presents",
"medical clinic 6 days",
"boyfriends condom",
"sexual intercourse",
"patient states I",
"not wish to",
"pregnant",
"point",
"life",
"medical conditions",
"takes",
"prescription medications",
"family history",
"negative",
"social drinker",
"drinking",
"days"... |
A 68-year-old woman is being evaluated for fatigue during a follow-up visit after implantation of a prosthetic aortic valve a month ago. She reports she has been feeling more tired than usual but associates it with her recent surgery. A complete blood count (CBC) reveals a hemoglobin of 9.5 g/L and a reticulocyte perce... | Schistocytes | {
"A": "Dacrocytes",
"B": "Schistocytes",
"C": "Basophilic stippling",
"D": "Degmacytes"
} | step1 | B | [
"68 year old woman",
"evaluated",
"fatigue",
"follow-up visit",
"implantation",
"aortic valve",
"month",
"reports",
"feeling more tired",
"usual",
"associates",
"recent surgery",
"complete blood count",
"CBC",
"reveals a hemoglobin",
"9.5 g/L",
"reticulocyte percentage",
"2",
"se... |
A 64-year-old female with type 2 diabetes mellitus comes to the physician because of a 1-week history of painful red swelling on her left thigh. Examination shows a 3- x 4-cm, tender, fluctuant mass. Incision and drainage of the abscess are performed. Culture of the abscess fluid grows gram-positive, coagulase-positive... | Altered target of the antibiotic | {
"A": "Degradation of the antibiotic",
"B": "Decreased uptake of the antibiotic",
"C": "Altered target of the antibiotic",
"D": "Decreased activation of the antibiotic"
} | step1 | C | [
"64 year old female",
"type 2 diabetes mellitus",
"physician",
"1-week history",
"painful red swelling",
"left thigh",
"Examination shows",
"3",
"4",
"tender",
"fluctuant mass",
"Incision",
"drainage of",
"abscess",
"performed",
"Culture",
"abscess fluid",
"gram-positive",
"coagu... |
A 30-year-old female with a history of epilepsy becomes pregnant. Her epilepsy has been well controlled by taking a medication that increases sodium channel inactivation. Her obstetrician informs her that her epilepsy medication has been shown to have teratogenic effects. Of the following, which teratogenic effect is t... | Neural tube defect | {
"A": "Discolored teeth",
"B": "Limb defects",
"C": "Ebstein's anomaly",
"D": "Neural tube defect"
} | step1 | D | [
"30 year old female",
"history of epilepsy",
"pregnant",
"epilepsy",
"well controlled",
"medication",
"increases sodium channel inactivation",
"obstetrician informs",
"epilepsy medication",
"shown to",
"teratogenic effects",
"following",
"teratogenic effect",
"woman's medication most likel... |
A 45-year-old man comes to the physician because of a 6-month history of a slowly enlarging nodule on the left upper eyelid that has persisted despite treatment with warm compresses. He also reports heaviness of the eyelid and mild blurring of vision in the left eye. Vital signs are within normal limits. Visual acuity ... | Biopsy | {
"A": "Eyelid hygiene",
"B": "Cryotherapy",
"C": "Biopsy",
"D": "Mohs micrographic surgery"
} | step2&3 | C | [
"year old man",
"physician",
"month history",
"slowly enlarging nodule",
"left upper eyelid",
"treatment",
"warm compresses",
"reports heaviness",
"eyelid",
"mild blurring of vision",
"left eye",
"Vital signs",
"normal limits",
"Visual acuity",
"decreased",
"left",
"examination shows... |
A 65-year-old male presents to the emergency room complaining of a severe headache. He developed a sudden-onset severe throbbing headache while watching a football game on television. His past medical history is significant for migraines and hypertension; however, he states that this headache is different from his norm... | Anterior cerebral artery | {
"A": "Anterior cerebral artery",
"B": "Maxillary artery",
"C": "Internal carotid artery",
"D": "Posterior cerebral artery"
} | step1 | A | [
"65 year old male presents",
"emergency room complaining of a severe headache",
"sudden-onset severe throbbing",
"watching",
"football game",
"television",
"past medical history",
"significant",
"migraines",
"hypertension",
"states",
"headache",
"different",
"normal migraine headaches",
... |
A 31-year-old woman presents to the clinic with shortness of breath, palpitations, and fatigue. She has had these symptoms over the last several weeks. She had been tolerating these symptoms until last night when she could not fall asleep due to palpitations. She has a past medical history of infective endocarditis 6 m... | 5th intercostal space at the midclavicular line on the left side | {
"A": "Right lower end of the body of the sternum",
"B": "4th intercostal space at the midclavicular line on the left side",
"C": "Medial end of the 2nd intercostal space on the right side",
"D": "5th intercostal space at the midclavicular line on the left side"
} | step1 | D | [
"31 year old woman presents",
"clinic",
"shortness of breath",
"palpitations",
"fatigue",
"symptoms",
"weeks",
"symptoms",
"night",
"not fall asleep due to palpitations",
"past medical history of infective endocarditis 6 months",
"treated with antibiotics",
"not smoke",
"drink alcohol",
... |
A 42-year-old man comes to the emergency department because of tingling in his hands and legs and palpitations for 1 week. He has also had severe cramping in his hands, feet, and abdomen during this period. Three months ago, he was hospitalized for acute pancreatitis. He discharged himself against medical advice at tha... | Magnesium sulfate | {
"A": "Sodium bicarbonate",
"B": "Lorazepam",
"C": "Magnesium sulfate",
"D": "Vitamin B1 (thiamine)\n\""
} | step2&3 | C | [
"year old man",
"emergency department",
"of tingling",
"hands",
"legs",
"palpitations",
"1 week",
"severe cramping",
"hands",
"feet",
"abdomen",
"period",
"Three months",
"hospitalized",
"acute pancreatitis",
"discharged",
"medical advice",
"time",
"family history",
"illness",
... |
A 72-year-old woman is brought to the emergency department with dyspnea for 2 days. She is on regular hemodialysis at 3 sessions a week but missed her last session due to an unexpected trip. She has a history of congestive heart failure. After urgent hemodialysis, the patient’s dyspnea does not improve as expected. The... | Two patient identifiers at every patient encounter by any healthcare provider | {
"A": "A patient’s medical identification number at every encounter by any healthcare provider",
"B": "A patient’s medical identification number at every physician-patient encounter",
"C": "Two patient identifiers at every nurse-patient encounter",
"D": "Two patient identifiers at every patient encounter by an... | step2&3 | D | [
"72 year old woman",
"brought",
"emergency department",
"dyspnea",
"2 days",
"regular hemodialysis",
"3 sessions",
"week",
"missed",
"last session due to",
"unexpected trip",
"history of congestive heart failure",
"urgent hemodialysis",
"patients dyspnea",
"not",
"expected",
"cardiol... |
A 30-year-old woman presents to the emergency department in a state of confusion and disorientation that started this morning. She is accompanied by her husband who says that she has been unwell for about one week. She has been complaining of fatigue. Her husband says that this morning, she also complained that her uri... | Decreased ADAMTS13 causing platelet adhesion and formation of microthrombi | {
"A": "GPIIb/IIIa deficiency and failure of platelet aggregation",
"B": "E. coli-mediated endothelial damage and formation of microthrombi",
"C": "Decreased ADAMTS13 causing platelet adhesion and formation of microthrombi",
"D": "Antiplatelet antibodies"
} | step1 | C | [
"30 year old woman presents",
"emergency department",
"state",
"confusion",
"disorientation",
"started",
"morning",
"husband",
"unwell",
"one week",
"fatigue",
"husband",
"morning",
"urine",
"dark red",
"color",
"red spots",
"legs",
"changes",
"level of consciousness",
"worse... |
A 19-year-old man presents to the clinic with a complaint of increasing shortness of breath for the past 2 years. His shortness of breath is associated with mild chest pain and occasional syncopal attacks during strenuous activity. There is no history of significant illness in the past, however, one of his uncles had s... | ↑ Mean Arterial Pressure, ↓ Heart rate, ↑ Baroreceptor activity, ↑ Parasympathetic Outflow | {
"A": "↓ Mean Arterial Pressure, ↑ Heart rate, ↑ Baroreceptor activity, ↓ Parasympathetic Outflow",
"B": "↑ Mean Arterial Pressure, ↑ Heart rate, ↓ Baroreceptor activity, ↓ Parasympathetic Outflow",
"C": "↓ Mean Arterial Pressure, ↑ Heart rate, ↓ Baroreceptor activity, ↓ Parasympathetic Outflow",
"D": "↑ Mean ... | step1 | D | [
"year old man presents",
"clinic",
"complaint of increasing shortness",
"breath",
"past",
"years",
"shortness of breath",
"associated with mild chest",
"occasional syncopal attacks",
"strenuous activity",
"history",
"significant illness",
"past",
"one",
"uncles",
"similar symptoms",
... |
A 34-year-old woman comes to the physician a week after noticing a lump in her left breast. Three months ago, she was discharged from the hospital after treatment of multiple injuries sustained in a motor vehicle collision. Her only medication is an oral contraceptive. Her mother died of ovarian cancer. Examination sho... | Release of cytoplasmic triglycerides | {
"A": "Thrombophlebitis of subcutaneous veins",
"B": "Stimulation of estrogen receptors",
"C": "Defect in DNA repair",
"D": "Release of cytoplasmic triglycerides"
} | step1 | D | [
"year old woman",
"physician",
"week",
"lump in",
"left breast",
"Three months",
"discharged from",
"hospital after treatment",
"multiple injuries sustained",
"motor vehicle collision",
"only medication",
"oral contraceptive",
"mother died of ovarian cancer",
"Examination shows",
"2.5",
... |
A 24-year-old man comes to the physician because his vision has worsened rapidly over the last 2 months. His maternal uncle lost his vision suddenly over a period of 3 months at 26 years of age. The patient's wife and 1-year-old son have normal vision. Funduscopic examination of the patient shows bilateral circumpapill... | 0% | {
"A": "0%",
"B": "25%",
"C": "33%",
"D": "50%"
} | step1 | A | [
"year old man",
"physician",
"vision",
"worsened rapidly",
"months",
"maternal uncle lost",
"vision",
"period",
"months",
"years",
"age",
"patient's wife",
"1-year-old son",
"normal vision",
"Funduscopic examination of",
"patient shows bilateral",
"telangiectasia",
"Genetic testing... |
A 6-month-old infant boy (neonate) is brought to the clinic for a check-up by a couple who recently adopted him from foster care. The biological mother was from a rehabilitation facility and was found incompetent to care for the child, hence he was handed over to foster care. No other information is available regarding... | Alcohol | {
"A": "Alcohol",
"B": "Lithium",
"C": "Tobacco",
"D": "Cocaine"
} | step2&3 | A | [
"month old infant boy",
"neonate",
"brought",
"clinic",
"check-up",
"couple",
"recently adopted",
"foster care",
"biological mother",
"rehabilitation facility",
"found incompetent to care",
"child",
"handed over",
"foster care",
"information",
"available",
"prenatal",
"birth histor... |
A 16-year-old girl is brought to the emergency department unresponsive. A witness reports that she became anxious, lightheaded, and began sweating and trembling a few minutes before she lost consciousness. Her vitals are as follows: blood pressure 95/60 mm Hg, heart rate 110/min, respiratory rate 21/min, and temperatur... | Hypoglycemia in this patient is being compensated with an increased glycogenolysis rate. | {
"A": "The patient’s symptoms are most likely the consequence of increased insulin secretion from the pancreatic islets.",
"B": "Hypoglycemia in this patient is being compensated with an increased glycogenolysis rate.",
"C": "Epinephrine-induced gluconeogenesis is the main process that allows for the compensatio... | step1 | B | [
"year old girl",
"brought",
"emergency department unresponsive",
"witness reports",
"anxious",
"lightheaded",
"began sweating",
"trembling",
"few minutes",
"lost consciousness",
"follows",
"blood pressure 95 60 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature 35",... |
A 47-year-old man was brought in by his wife for progressively worsening memory and bizarre behavior over the past 2 months. The wife reports that he has been sleeping 15 hours a day, but is still complaining of fatigue. He frequently forgets important events such as his son’s graduation and left the stove running 2 da... | Specific autoclave sterilization | {
"A": "Antidepressant therapy",
"B": "Good social and familial support system",
"C": "Specific autoclave sterilization",
"D": "Statin therapy"
} | step1 | C | [
"year old man",
"brought",
"wife",
"worsening memory",
"bizarre behavior",
"past",
"months",
"wife reports",
"sleeping",
"hours",
"day",
"fatigue",
"frequently forgets important events",
"sons graduation",
"left",
"stove running 2 days",
"encounter",
"patient reports",
"longer",
... |
A 9-year-old boy is brought to the pediatrician by his parents with a fever, cough, and cold symptoms that began 7 days ago. He has been complaining of right ear pain for the last 2 days. He is otherwise a completely healthy child with no known medical conditions. On physical examination, the temperature is 39.0°C (102... | Trimethoprim-sulfamethoxazole | {
"A": "Cefadroxil",
"B": "Doxycycline",
"C": "Linezolid",
"D": "Trimethoprim-sulfamethoxazole"
} | step1 | D | [
"year old boy",
"brought",
"pediatrician",
"parents",
"fever",
"cough",
"cold symptoms",
"began 7 days",
"right",
"last 2 days",
"completely healthy child",
"known medical conditions",
"physical examination",
"temperature",
"pulse",
"min",
"blood pressure",
"74 mm Hg",
"respirato... |
A 21-year-old nurse starts to feel ill during his evening shift. Earlier this evening, he started his shift in his normal state of health. Past medical history is significant for multiple admissions to the hospital under strange circumstances. One time he presented to the emergency department complaining of severe abdo... | Normal c-peptide levels | {
"A": "Increased anion gap",
"B": "Normal c-peptide levels",
"C": "Increased c-peptide levels",
"D": "Presence of norepinephrine and vanillylmandelic acid in the urine"
} | step1 | B | [
"21-year-old nurse starts to feel ill",
"evening shift",
"Earlier",
"evening",
"started",
"shift",
"normal state of health",
"Past medical history",
"significant",
"multiple admissions",
"hospital",
"One time",
"presented",
"emergency department",
"severe abdominal",
"gallstones",
"s... |
A 53-year-old man comes to the emergency department because of a 1-month history of cough productive of small amounts of blood-tinged sputum. During this time, he has also developed fatigue, myalgia, and shortness of breath on exertion. He has had a 4-lb (2-kg) weight loss over the past 2 months. He has no personal his... | Myeloperoxidase antineutrophil cytoplasmic antibody | {
"A": "Anti-glomerular basement membrane antibodies",
"B": "Increased serum cryoglobulins",
"C": "Myeloperoxidase antineutrophil cytoplasmic antibody",
"D": "Hepatitis B surface antigen"
} | step2&3 | C | [
"year old man",
"emergency department",
"month history",
"cough productive of small amounts",
"blood tinged sputum",
"time",
"fatigue",
"myalgia",
"shortness of breath",
"exertion",
"4",
"2 kg",
"weight loss",
"past",
"months",
"personal history",
"serious illness",
"mother",
"sy... |
A 61-year-old male is given acetazolamide to treat open-angle glaucoma. Upon diuresis, his urine is found to be highly alkaline. Which of the following accounts for the alkaline nature of this patient’s urine? | Inhibition of bicarbonate reabsorption in the proximal tubule | {
"A": "Inhibition of chlorine reabsorption in the thick ascending loop of Henle",
"B": "Inhibition of acid secretion in alpha-intercalated cells",
"C": "Inhibition of bicarbonate reabsorption in the proximal tubule",
"D": "Inhibition of bicarbonate reabsorption in beta-intercalated cells"
} | step1 | C | [
"61 year old male",
"given acetazolamide to treat open-angle glaucoma",
"diuresis",
"urine",
"found to",
"highly alkaline",
"following accounts",
"alkaline nature",
"patients urine"
] |
A 45-year-old man is brought to the emergency department by ambulance after a motor vehicle collision. He is not responsive to verbal commands and is unable to provide any history. His pulse is 108/min and regular. Physical examination shows ecchymoses over the neck and back. Neurological examination indicates damage t... | T6 | {
"A": "L4",
"B": "C2",
"C": "S2",
"D": "T6"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"ambulance",
"motor vehicle collision",
"not responsive",
"verbal commands",
"unable to provide",
"history",
"pulse",
"min",
"regular",
"Physical examination shows ecchymoses",
"neck",
"back",
"Neurological examination",
"damage",
... |
A 3-day-old girl is brought to the physician by her mother because of difficulty feeding and lethargy for 1 day. She had jaundice after birth and was scheduled for a follow-up visit the next day. Her hemoglobin is 18.5 g/dL, total bilirubin is 38.1 mg/dL, and direct bilirubin is 0.1 mg/dL. Despite appropriate measures,... | Impaired glucuronidation of bilirubin | {
"A": "Defective intracellular bilirubin transport",
"B": "Extrahepatic obliteration of the biliary tree",
"C": "Impaired glucuronidation of bilirubin",
"D": "Decreased bilirubin uptake in hepatocytes"
} | step1 | C | [
"3 day old girl",
"brought",
"physician",
"mother",
"difficulty feeding",
"lethargy",
"1 day",
"jaundice after birth",
"scheduled",
"follow-up visit",
"next day",
"hemoglobin",
"g/dL",
"total bilirubin",
"mg/dL",
"direct bilirubin",
"0.1 mg/dL",
"appropriate measures",
"infant",
... |
A 57-year-old man with a known angina pectoris starts to experience a severe burning retrosternal pain that radiates to his left hand. After 2 consecutive doses of sublingual nitroglycerin taken 5 minutes apart, there is no improvement in his symptoms, and the patient calls an ambulance. Emergency medical service arriv... | Administer aspirin 325 mg and transport to percutaneous coronary intervention center | {
"A": "Administer aspirin 81 mg and transport to a percutaneous coronary intervention center",
"B": "Perform pre-hospital thrombolysis and transport to emergency department irrespective of percutaneous coronary intervention center presence",
"C": "Administer aspirin 325 mg and transport to percutaneous coronary ... | step2&3 | C | [
"57 year old man",
"known angina pectoris starts to experience",
"severe burning retrosternal",
"radiates",
"left hand",
"2 consecutive doses",
"sublingual nitroglycerin taken 5 minutes",
"improvement",
"symptoms",
"patient calls",
"ambulance",
"Emergency medical service",
"10 minutes",
"b... |
A 30-year-old woman who is 24-weeks pregnant presents to the emergency department with fever, painful urination, and headache. The patient's blood pressure is 111/67 mm Hg, the pulse is 95/min, the respiratory rate is 16/min, and the temperature is 38.3°C (101.1°F). Physical examination reveals bilateral tender inguina... | Vesicle | {
"A": "Ulcer",
"B": "Vesicle",
"C": "Papule",
"D": "Bulla"
} | step2&3 | B | [
"30 year old woman",
"weeks pregnant presents",
"emergency department",
"fever",
"painful urination",
"headache",
"patient's blood pressure",
"67 mm Hg",
"pulse",
"95 min",
"respiratory rate",
"min",
"temperature",
"3C",
"Physical examination reveals bilateral tender inguinal lymphadenop... |
An 8-year-old boy is brought to the emergency department because of shortness of breath and dry cough for 2 days. His symptoms began after he helped his father clean the basement. He is allergic to shellfish. Respirations are 26/min. Physical examination shows diffuse end-expiratory wheezing and decreased inspiratory-t... | Terminal bronchioles | {
"A": "Pleural cavity",
"B": "Alveoli",
"C": "Distal trachea",
"D": "Terminal bronchioles"
} | step1 | D | [
"year old boy",
"brought",
"emergency department",
"of shortness",
"breath",
"dry cough",
"2 days",
"symptoms began",
"helped",
"father clean",
"basement",
"allergic",
"shellfish",
"Respirations",
"min",
"Physical examination shows diffuse end",
"decreased inspiratory",
"expiratory... |
A 20-year-old man presents to the doctor's office for advice on improving his health. He admits to eating mostly junk food, and he knows that he should lose some weight. His daily physical activity is limited to walking around the college campus between classes. Except for an occasional headache for which he takes acet... | Weight reduction | {
"A": "Weight reduction",
"B": "Increasing dietary fiber",
"C": "Increasing daily water intake",
"D": "Starting a multivitamin"
} | step1 | A | [
"20 year old man presents",
"doctor's office",
"advice",
"improving",
"health",
"admits",
"eating mostly junk food",
"weight",
"daily physical",
"limited",
"walking",
"college",
"classes",
"Except for",
"occasional headache",
"takes acetaminophen",
"health concerns",
"takes",
"me... |
A 64-year-old man presents to the emergency department with sudden onset of chest pain and an episode of vomiting. He also complains of ongoing nausea and heavy sweating (diaphoresis). He denies having experienced such symptoms before and is quite upset. Medical history is significant for hypertension and types 2 diabe... | Right coronary artery | {
"A": "Right coronary artery",
"B": "Left anterior descending artery",
"C": "Left main coronary artery",
"D": "There is no obstruction"
} | step2&3 | A | [
"64 year old man presents",
"emergency department",
"sudden onset of chest pain",
"episode of vomiting",
"ongoing nausea",
"heavy sweating",
"diaphoresis",
"denies",
"experienced",
"symptoms",
"upset",
"Medical history",
"significant",
"hypertension",
"types 2 diabetes mellitus",
"curr... |
A 3400-g (7 lb 8 oz) female newborn is delivered at 40 weeks' gestation. Physical examination shows pale skin, blonde hair, and blue irides. Her parents are from Haiti and express concern regarding the newborn's appearance. The most likely cause of this newborn's condition is a defect in which of the following processe... | Oxidation of dihydroxyphenylalanine | {
"A": "Intracellular transport of melanosomes",
"B": "Oxidation of dihydroxyphenylalanine",
"C": "Transfer of melanosomes to keratinocytes",
"D": "Migration of neural crest cell derivates"
} | step1 | B | [
"3400 g",
"8 oz",
"female newborn",
"delivered",
"40 weeks",
"gestation",
"Physical examination shows pale skin",
"blonde hair",
"blue irides",
"parents",
"Haiti",
"concern",
"newborn's appearance",
"most likely cause",
"newborn's condition",
"defect",
"following processes"
] |
A 48-year-old woman with a known past medical history significant for hypertension presents for a second opinion of a left breast lesion. The lesions were characterized as eczema by the patient’s primary care physician and improved briefly after a trial of topical steroids. However, the patient is concerned that the le... | Punch biopsy of the nipple, followed by bilateral mammography | {
"A": "Bilateral breast ultrasound",
"B": "Punch biopsy of the nipple, followed by bilateral mammography",
"C": "Oral corticosteroids",
"D": "Left breast MRI"
} | step2&3 | B | [
"48 year old woman",
"known past medical history significant",
"hypertension presents",
"second opinion of",
"left breast lesion",
"lesions",
"characterized",
"eczema",
"patients primary care physician",
"improved",
"trial",
"topical steroids",
"patient",
"concerned",
"lesions",
"start... |
A 27-year-old man comes to the physician with his wife because they have been unable to conceive. They have had regular unprotected sex for the past 18 months without using contraception. His wife has been tested and is fertile. The patient began puberty at the age of 13 years. He has been healthy except for an infecti... | Anabolic steroid use | {
"A": "Anabolic steroid use",
"B": "Heat from friction",
"C": "Anorexia nervosa",
"D": "Kallmann syndrome\n\""
} | step2&3 | A | [
"27 year old man",
"physician",
"wife",
"unable to",
"regular unprotected sex",
"past",
"months",
"using contraception",
"wife",
"tested",
"fertile",
"patient began puberty",
"age",
"years",
"healthy",
"infection",
"Chlamydia trachomatis 10 years",
"treated with azithromycin",
"p... |
A 38-year-old woman presents with fever and acute onset chest pain for the past 12 hours. She describes the pain as severe, sharp and stabbing in character, and localized to the retrosternal area. She also says the pain is worse when she breathes deeply or coughs. Past medical history is significant for recently diagno... | Serous pericarditis | {
"A": "Serous pericarditis",
"B": "Pericardial tamponade",
"C": "Septic shock",
"D": "Acute myocardial infarction"
} | step1 | A | [
"year old woman presents",
"fever",
"acute chest",
"past 12 hours",
"pain",
"severe",
"sharp",
"stabbing",
"character",
"localized",
"retrosternal area",
"pain",
"worse",
"deeply",
"coughs",
"Past medical history",
"significant",
"recently diagnosed systemic lupus erythematosus",
... |
A previously healthy 64-year-old man comes to the physician 3 days after noticing a lump in his right groin while he was bathing. He has no history of trauma to the region. He has hypercholesterolemia and hypertension treated with atorvastatin and labetalol. He has smoked 2 packs of cigarettes daily for 35 years. His v... | Femoral artery aneurysm | {
"A": "Femoral lymphadenopathy",
"B": "Arteriovenous fistula of the femoral vessels",
"C": "Femoral abscess",
"D": "Femoral artery aneurysm"
} | step2&3 | D | [
"healthy 64 year old man",
"physician 3 days",
"lump",
"right",
"bathing",
"history",
"trauma",
"region",
"hypercholesterolemia",
"hypertension treated with atorvastatin",
"labetalol",
"smoked 2 packs",
"cigarettes daily",
"35 years",
"vital signs",
"normal limits",
"Examination show... |
A 3-month-old boy is brought to the physician by his parents because of a 2-day history of poor feeding and lethargy. He was born at term and has had three episodes of bilateral otitis media since birth. Umbilical cord separation occurred at the age of 8 weeks. He is at the 30th percentile for height and 20th percentil... | Defective beta-2 integrin | {
"A": "Defective beta-2 integrin",
"B": "Defective tyrosine kinase",
"C": "Defective microtubules",
"D": "Defective actin cytoskeleton"
} | step1 | A | [
"3 month old boy",
"brought",
"physician",
"parents",
"2-day history",
"poor feeding",
"lethargy",
"born",
"term",
"three episodes of bilateral otitis media",
"birth",
"Umbilical cord separation occurred",
"age",
"weeks",
"percentile",
"height",
"percentile",
"weight",
"temperatu... |
A 37‐year‐old woman presents with a severe, deep, sharp pain in her right hand and forearm. A week before she presented her pain symptoms, she fell on her right forearm and developed mild bruising. She has type-1 diabetes mellitus and is on an insulin treatment. The physical examination reveals that her right hand and ... | Complex regional pain syndrome | {
"A": "Cellulitis",
"B": "Compartment syndrome",
"C": "Complex regional pain syndrome",
"D": "Limb ischemia"
} | step2&3 | C | [
"woman presents",
"severe",
"deep",
"sharp",
"right hand",
"forearm",
"week",
"presented",
"pain symptoms",
"fell",
"right forearm",
"mild bruising",
"type-1 diabetes mellitus",
"insulin treatment",
"physical examination reveals",
"right hand",
"forearm",
"warmer",
"swollen",
"... |
A 55-year-old man with a history of repeated hospitalization for chronic pancreatitis comes to the physician because of difficulty walking and standing steadily. Neurological examination shows an unsteady, broad-based gait, distal muscle weakness, decreased deep tendon reflexes, and an abnormal Romberg test. His hemogl... | Tocopherol | {
"A": "Tocopherol",
"B": "Folate",
"C": "Pyridoxine",
"D": "Phytomenadione"
} | step1 | A | [
"55 year old man",
"history of repeated hospitalization",
"chronic pancreatitis",
"physician",
"difficulty walking",
"standing",
"Neurological examination shows",
"unsteady",
"broad-based gait",
"distal muscle weakness",
"decreased deep tendon reflexes",
"abnormal Romberg test",
"hemoglobin ... |
An 18-year-old man is brought to the emergency department 30 minutes after being stabbed in the chest during a fight. He has no other injuries. His pulse is 120/min, blood pressure is 90/60 mm Hg, and respirations are 22/min. Examination shows a 4-cm deep, straight stab wound in the 4th intercostal space 2 cm medial to... | Pectoral fascia, transversus thoracis muscle, right lung | {
"A": "Pectoral fascia, transversus thoracis muscle, right lung",
"B": "Intercostal muscles, internal thoracic artery, right heart",
"C": "External oblique muscle, superior epigastric artery, azygos vein",
"D": "Pectoralis minor muscle, dome of the diaphragm, right lobe of the liver"
} | step1 | A | [
"year old man",
"brought",
"emergency department 30 minutes",
"stabbed",
"chest",
"fight",
"injuries",
"pulse",
"min",
"blood pressure",
"90 60 mm Hg",
"respirations",
"min",
"Examination shows",
"4",
"deep",
"straight stab wound",
"4th intercostal space 2",
"medial",
"right mi... |
A 42-year-old man comes to the physician because of a 6-month history of progressively worsening shortness of breath with exertion. He was diagnosed with systemic sclerosis 5 years ago. Vital signs are within normal limits. Physical examination shows puffy, taut skin over the fingers. Pulmonary examination is unremarka... | Enhanced activity of nitric oxide | {
"A": "Blockade of endothelin-1 binding at the endothelin receptor",
"B": "Increased activation of protein kinase A",
"C": "Reduced transmembrane calcium current",
"D": "Enhanced activity of nitric oxide"
} | step1 | D | [
"year old man",
"physician",
"month history",
"worsening shortness of breath",
"exertion",
"diagnosed",
"systemic sclerosis",
"years",
"Vital signs",
"normal",
"Physical examination shows puffy",
"taut skin",
"fingers",
"Pulmonary examination",
"unremarkable",
"jugular venous distentio... |
A 20-year-old male presents to the emergency department because of several days of back pain and fatigue. He is a college student who just returned from a study abroad program in Morocco. During his final week abroad he engaged in a number of recreational activities including swimming at the beach, eating local foods s... | Absent urine bilirubin | {
"A": "Absent urine bilirubin",
"B": "Decreased urine urobilinogen",
"C": "Conjugated hyperbilirubinemia",
"D": "Elevated aspartate aminotransferase"
} | step1 | A | [
"20 year old male presents",
"emergency department",
"several days",
"back pain",
"fatigue",
"college student",
"returned",
"study",
"program",
"Morocco",
"final week",
"engaged",
"number",
"recreational activities including swimming",
"beach",
"eating local foods",
"couscous",
"be... |
A 40-year-old man presents with acute abdominal pain. Past medical history is significant for hepatitis C, complicated by multiple recent visits with associated ascites. His temperature is 38.3°C (100.9°F), heart rate is 115/min, blood pressure is 88/48 mm Hg, and respiratory rate is 16/min. On physical examination, th... | Intravenous cefotaxime | {
"A": "Surgical consultation",
"B": "Intravenous cefotaxime",
"C": "Serum lipase level",
"D": "Abdominal radiography and contrast CT of the abdomen"
} | step1 | B | [
"40 year old man presents",
"acute abdominal pain",
"Past medical history",
"significant",
"hepatitis C",
"complicated",
"multiple recent visits",
"associated ascites",
"temperature",
"3C",
"100 9F",
"heart rate",
"min",
"blood pressure",
"88 48 mm Hg",
"respiratory rate",
"min",
"... |
A 78-year-old woman is accompanied by her family for a routine visit to her primary care provider. The family states that 5 months prior, the patient had a stroke and is currently undergoing physical therapy. Today, her temperature is 98.2°F (36.8°C), blood pressure is 112/72 mmHg, pulse is 64/min, and respirations are... | Intention tremor | {
"A": "Contralateral eye deviation",
"B": "Hemiballismus",
"C": "Intention tremor",
"D": "Truncal ataxia"
} | step1 | C | [
"year old woman",
"family",
"routine visit",
"primary care provider",
"family states",
"5 months prior",
"patient",
"stroke",
"currently",
"physical therapy",
"Today",
"temperature",
"98",
"36",
"blood pressure",
"72 mmHg",
"pulse",
"64 min",
"respirations",
"min",
"exam",
... |
A 72-year-old man presents to the primary care clinic for evaluation of progressive fatigue and weight loss. His past medical history is significant for hypercholesterolemia, type 2 diabetes mellitus, aortic stenosis, and chronic renal insufficiency. He endorses being well-rested after waking from sleep but fatiguing r... | Cladribine | {
"A": "Hydroxyurea",
"B": "Cladribine",
"C": "Filgrastim",
"D": "Doxorubicin"
} | step2&3 | B | [
"72 year old man presents",
"primary care clinic",
"evaluation",
"progressive fatigue",
"weight loss",
"past medical history",
"significant",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"aortic stenosis",
"chronic renal insufficiency",
"well rested",
"waking",
"sleep",
"fatiguing... |
A 21-year-old female presents to her first gynecology visit. She states that six months ago, she tried to have sexual intercourse but experienced severe pain in her genital region when penetration was attempted. This has continued until now, and she has been unable to have intercourse with her partner. The pain is not ... | Generalized anxiety disorder | {
"A": "Low estrogen state",
"B": "Generalized anxiety disorder",
"C": "Squamous cell carcinoma of the vulva",
"D": "Body dysmorphic disorder"
} | step2&3 | B | [
"21-year-old female presents",
"first gynecology visit",
"states",
"six months",
"to",
"sexual intercourse",
"severe pain",
"genital region",
"penetration",
"attempted",
"continued",
"now",
"unable to",
"intercourse",
"partner",
"pain",
"not present",
"times",
"attempts",
"pene... |
A 52-year-old man presents to the emergency department because of fatigue, abdominal distension, and swelling of both legs for the last 3 weeks. His wife says that he lost some weight recently. He has had type 2 diabetes mellitus for 12 years, for which he takes metformin and sitagliptin. He has a history of Hodgkin’s ... | Pericardiectomy | {
"A": "Pericardiocentesis",
"B": "Pericardiectomy",
"C": "Pleurodesis",
"D": "Percutaneous aspiration with high-flow oxygen"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"fatigue",
"abdominal distension",
"swelling of",
"legs",
"last",
"weeks",
"wife",
"lost",
"weight recently",
"type 2 diabetes mellitus",
"years",
"takes metformin",
"sitagliptin",
"history of Hodgkins lymphoma",
"treated with mediasti... |
A 20-year-old man is brought to the emergency department for evaluation of an animal bite. He was hiking earlier that day when he was bitten by a raccoon. He says the attack was unprovoked and the animal ran away after the encounter. He was bitten by a stray dog when he was 11 years old and received postexposure prophy... | Rabies vaccination | {
"A": "No action needed",
"B": "Rabies immunoglobulin and vaccine",
"C": "Tetanus booster",
"D": "Rabies vaccination"
} | step2&3 | D | [
"20 year old man",
"brought",
"emergency department",
"evaluation of",
"animal bite",
"hiking earlier",
"day",
"bitten by",
"raccoon",
"attack",
"animal ran away",
"encounter",
"bitten by",
"dog",
"years old",
"received postexposure prophylaxis",
"rabies",
"time",
"immunizations"... |
A 35-year-old woman with no significant past medical history is brought in by ambulance after a major motor vehicle collision. Temperature is 97.8 deg F (36.5 deg C), blood pressure is 76/40, pulse is 110/min, and respirations are 12/min. She arouses to painful stimuli and makes incomprehensible sounds, but is unable t... | Administer blood products | {
"A": "Consult the hospital ethics committee",
"B": "Observe and reassess mental status in an hour to see if patient can consent for herself",
"C": "Administer blood products",
"D": "In accordance with the husband's wishes, do not transfuse any blood products"
} | step1 | C | [
"35 year old woman",
"significant past medical history",
"brought",
"ambulance",
"major motor vehicle collision",
"Temperature",
"97 8 deg F",
"36 5",
"blood pressure",
"76 40",
"pulse",
"min",
"respirations",
"min",
"arouses to painful stimuli",
"makes incomprehensible sounds",
"una... |
A 22-year-old man comes to the physician for a routine physical examination. He feels well. He has no history of major medical illness and takes no medications. His vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies, including a complete blood count and a standard electrolyte p... | No changes needed | {
"A": "Decrease purine intake",
"B": "No changes needed",
"C": "Eliminate galactose and lactose",
"D": "Increase intake of ketogenic amino acids"
} | step1 | B | [
"year old man",
"physician",
"routine physical examination",
"feels well",
"history of major medical illness",
"takes",
"medications",
"vital signs",
"normal limits",
"Examination shows",
"abnormalities",
"Laboratory studies",
"including",
"complete blood count",
"standard electrolyte pa... |
A 24-year-old woman, G1P0, presents to her OB/GYN for her annual examination with complaints of painful cramps, abdominal pressure, and bloating with her cycle. She reports that she has not menstruated since her missed abortion requiring dilatation and curettage (D&C) seven months ago. She is sexually active with her h... | Asherman syndrome | {
"A": "Ectopic pregnancy",
"B": "Pelvic inflammatory disease",
"C": "Asherman syndrome",
"D": "Hypothalamic hypoestrogenism"
} | step2&3 | C | [
"year old woman",
"presents",
"OB/GYN",
"annual examination",
"complaints",
"painful cramps",
"abdominal pressure",
"bloating",
"cycle",
"reports",
"not",
"missed abortion",
"dilatation and curettage",
"seven months",
"sexually active",
"husband",
"not using",
"form",
"contracept... |
A 62-year-old woman presents to the clinic for postmenopausal bleeding for the past month. She reports that the bleeding often occurs after intercourse with her husband. The patient denies fever, weight loss, chills, chest pain, abdominal pain, or shortness of breath but endorses mild dyspareunia and vaginal discharge.... | Metastasis of cervical cancer via direct extension | {
"A": "Atrophy of vaginal tissues secondary to old age",
"B": "Metastasis of cervical cancer via direct extension",
"C": "Metastasis of cervical cancer via hematogenous spread",
"D": "Primary malignancy of vaginal squamous cells"
} | step2&3 | B | [
"62 year old woman presents",
"clinic",
"postmenopausal bleeding",
"past month",
"reports",
"bleeding often occurs",
"intercourse",
"husband",
"patient denies fever",
"weight loss",
"chills",
"chest pain",
"abdominal pain",
"shortness of breath",
"mild dyspareunia",
"vaginal discharge"... |
A 69-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up examination. His only medication is metformin. He has tried to lose weight for several years without success. He is 168 cm (5 ft 6 in) tall and weighs 110 kg (243 lb); BMI is 39 kg/m2. His hemoglobin A1c is 8.5%. Which of the followi... | Liraglutide | {
"A": "Miglitol",
"B": "Liraglutide",
"C": "Nateglinide",
"D": "Rosiglitazone"
} | step1 | B | [
"69 year old man",
"type 2 diabetes mellitus",
"physician",
"follow-up examination",
"only medication",
"metformin",
"to",
"weight",
"years",
"success",
"5 ft 6",
"tall",
"kg",
"BMI",
"kg/m2",
"hemoglobin A1c",
"8.5",
"following",
"most appropriate antidiabetic drug to address",
... |
A 52-year-old man presents to the emergency department (ED) complaining of palpitations and lightheadedness for the last 30 minutes. He denies feeling pain or discomfort in his chest and is not short of breath. He does not have any known medical problems and does not take any medications regularly. He drinks 4–6 caffei... | Verapamil slows atrioventricular conduction more effectively than nifedipine. | {
"A": "Verapamil slows atrioventricular conduction more effectively than nifedipine.",
"B": "Verapamil has fewer negative inotropic effects than nifedipine.",
"C": "Verapamil is more effective in decreasing blood pressure than nifedipine.",
"D": "Verapamil binds to the α2 subunit of the L-type calcium channel,... | step1 | A | [
"year old man presents",
"emergency department",
"palpitations",
"lightheadedness",
"30 minutes",
"denies feeling pain",
"discomfort in",
"chest",
"not short of breath",
"not",
"known medical problems",
"not take",
"medications",
"drinks",
"drinks",
"day",
"temperature",
"36",
"9... |
A 65-year-old woman is brought to the emergency room by her family with complaints of confusion and change in behavior. Her family states that over the last 2 weeks, the patient has become increasingly irritable and confusion as well as aggressive toward strangers. In addition to her altered mental status, her family a... | Serum 5-hydroxyindoleacetic acid levels | {
"A": "Stool culture",
"B": "Anti-nuclear antibody titer",
"C": "CT scan of the abdomen",
"D": "Serum 5-hydroxyindoleacetic acid levels"
} | step2&3 | D | [
"65 year old woman",
"brought",
"emergency room",
"family",
"complaints",
"confusion",
"change in behavior",
"family states",
"last 2 weeks",
"patient",
"irritable",
"confusion",
"aggressive",
"strangers",
"altered mental status",
"family",
"recent episodes of abdominal pain",
"wat... |
A 2-day-old boy is evaluated in the nursery for minimal movement in his left upper limb. He was born at 41 weeks gestation by an assisted forceps-vaginal delivery to a 42-year-old obese woman. Birth weight was 4.4 kg (9.7 lb). The mother had 4 previous vaginal deliveries, all requiring forceps. Examinations of the left... | Triceps | {
"A": "Deltoid",
"B": "Triceps",
"C": "Supraspinatus",
"D": "Infraspinatus"
} | step1 | B | [
"2-day old boy",
"evaluated",
"nursery",
"minimal movement",
"left upper limb",
"born",
"weeks gestation",
"assisted forceps vaginal delivery",
"year",
"obese woman",
"Birth weight",
"4.4 kg",
"mother",
"4 previous vaginal deliveries",
"forceps",
"Examinations of",
"left upper limb s... |
In an experimental model, a compound is centrally administered to mice. Following administration, the mice display increased desire for food and increased appetite. The administered compound is most likely similar to which of the following? | Neuropeptide-Y | {
"A": "Neuropeptide-Y",
"B": "Peptide YY",
"C": "Glucagon-like peptide 1",
"D": "Cholecystokinin"
} | step1 | A | [
"experimental model",
"compound",
"administered",
"mice",
"Following administration",
"mice display increased desire for food",
"increased appetite",
"administered compound",
"most likely similar"
] |
A 30-year-old man presents to your clinic complaining of excessive thirst and frequent urination for the past few months. Urine testing reveals a low urine osmolarity, which fails to increase after subjecting the patient to a water deprivation test and injection of desmopressin. Further into the encounter, the patient ... | Nephrogenic diabetes insipidus | {
"A": "Central diabetes insipidus",
"B": "Nephrogenic diabetes insipidus",
"C": "Primary polydipsia",
"D": "Urinary tract infection"
} | step1 | B | [
"30 year old man presents",
"clinic",
"excessive thirst",
"frequent urination",
"past",
"months",
"Urine testing reveals",
"low urine osmolarity",
"fails to increase",
"subjecting",
"patient",
"water deprivation test",
"injection",
"desmopressin",
"Further",
"encounter",
"patient rev... |
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