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 28-year-old woman, gravida 1, para 0, at 32 weeks' gestation is evaluated for vaginal bleeding. Five days ago, she was admitted to the hospital and started on treatment for a deep vein thrombosis in the right leg. Her pulse is 125/min and blood pressure is 95/67 mm Hg. Physical examination shows large hematomas on th... | Protamine sulfate | {
"A": "Protamine sulfate",
"B": "Prothrombin complex concentrate",
"C": "Alteplase",
"D": "Fresh frozen plasma"
} | step1 | A | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"evaluated",
"vaginal bleeding",
"Five days",
"admitted",
"hospital",
"started on treatment",
"deep vein thrombosis",
"right leg",
"pulse",
"min",
"blood pressure",
"95 67 mm Hg",
"Physical examination shows large hemat... |
A 2-week old newborn is brought to the physician for a follow-up examination after the initial newborn examination showed asymmetry of the legs. She was born at term to a 26-year-old woman, gravida 3, para 2. Pregnancy was complicated by a breech presentation and treated with an emergency lower segment transverse cesar... | Treat using a harness | {
"A": "Reassure the mother and schedule follow-up appointment in 4 weeks",
"B": "Perform closed reduction of the right hip",
"C": "Obtain an MRI of the right hip",
"D": "Treat using a harness"
} | step2&3 | D | [
"2 week old newborn",
"brought",
"physician",
"follow-up examination",
"initial newborn",
"showed asymmetry",
"legs",
"born",
"term",
"year old woman",
"gravida 3",
"para 2",
"Pregnancy",
"complicated",
"breech presentation",
"treated with",
"emergency lower segment transverse cesare... |
A 29-year-old man presents to his primary care provider complaining of not being able to get enough rest at night. He goes to bed early enough and has otherwise good sleep hygiene but feels drained the next day. He feels he is unable to perform optimally at work, but he is still a valued employee and able to complete h... | Symptoms will wax and wane but may persist for 6-12 months | {
"A": "Symptoms will wax and wane but may persist for 6-12 months",
"B": "Symptoms are persistent and must resolve within 6 months of the stressor terminating",
"C": "Symptoms develop within 3 months of the stressor",
"D": "Symptoms are usually self-limited and may persist for 2 years"
} | step1 | A | [
"29 year old man presents",
"primary care provider",
"not",
"able to",
"rest",
"night",
"goes",
"bed early",
"good sleep hygiene",
"feels drained",
"next day",
"feels",
"unable to perform",
"work",
"valued employee",
"able to complete",
"share",
"work",
"month",
"wife",
"year... |
A 27-year-old man visits the office with complaints of pain in his lower limb muscles and joints. He cannot remember exactly when it started, but it intensified after his recent hiking trip. He is a hiking enthusiast and mentions having gone on a recent trekking expedition in Connecticut. He does not recall any particu... | Start doxycycline therapy | {
"A": "Serological testing",
"B": "Blood culture",
"C": "Start doxycycline therapy",
"D": "Ask him to come back after one week"
} | step2&3 | C | [
"27 year old man visits",
"office",
"complaints",
"pain",
"lower limb muscles",
"joints",
"remember",
"started",
"recent hiking trip",
"hiking enthusiast",
"recent trekking expedition",
"Connecticut",
"not recall",
"symptoms",
"except for",
"rash",
"left calf",
"borders",
"image ... |
A 30-year-old man is brought to the emergency department by his brother for the evaluation of progressive confusion over the past 6 hours. The patient is lethargic and unable to answer questions. His brother states that there is no personal or family history of serious illness. His temperature is 37°C (98.6°F), pulse i... | Antihistamine
" | {
"A": "Cannabis",
"B": "Amphetamine",
"C": "Carbon monoxide",
"D": "Antihistamine\n\""
} | step2&3 | D | [
"30 year old man",
"brought",
"emergency department",
"brother",
"evaluation",
"progressive confusion",
"past",
"hours",
"patient",
"lethargic",
"unable to answer questions",
"brother states",
"personal",
"family history",
"serious illness",
"temperature",
"98",
"pulse",
"min",
... |
A 12-year-old boy, otherwise healthy, presents with frequent nosebleeds and lower extremity bruising. His mother reports that his symptoms started about 2 weeks ago and have not improved. The patient received the Tdap vaccine 2 weeks ago. He has no current medications. The review of systems is significant for the patie... | IgG autoantibodies against platelet glycoproteins | {
"A": "Deficiency of ADAMTS13",
"B": "IgG autoantibodies against platelet glycoproteins",
"C": "Systemic activation of clotting cascade resulting in platelet and coagulation factor consumption",
"D": "Deposition of IgA immune complexes"
} | step2&3 | B | [
"year old boy",
"healthy",
"presents",
"frequent nosebleeds",
"lower extremity bruising",
"mother reports",
"symptoms started",
"2 weeks",
"not improved",
"patient received",
"Tdap vaccine",
"weeks",
"current medications",
"review of systems",
"significant",
"patient",
"stomach ache"... |
A 67-year-old male with a past medical history of diabetes type II, obesity, and hyperlipidemia presents to the general medical clinic with bilateral hearing loss. He also reports new onset vertigo and ataxia. The symptoms started a day after undergoing an uncomplicated cholecystectomy. If a drug given prophylactically... | Inhibition of the formation of the translation initiation complex | {
"A": "Inhibition of the formation of the translation initiation complex",
"B": "Inhibition of DNA-dependent RNA polymerase",
"C": "Inhibition of DNA gyrase",
"D": "Formation of free radical toxic metabolites that damage DNA"
} | step1 | A | [
"year old male",
"past medical history of diabetes type II",
"obesity",
"hyperlipidemia presents",
"general medical clinic",
"bilateral hearing loss",
"reports new onset vertigo",
"ataxia",
"symptoms started",
"day",
"uncomplicated cholecystectomy",
"drug given",
"prior",
"surgery",
"cau... |
A 72-year-old female is brought to the emergency department by ambulance because she was unable to walk. She says that she cut her leg while falling about a week ago. Since then, the wound has started draining fluid and become progressively more painful. She is found to have necrotizing fasciitis and is taken emergentl... | Condensation of DNA into a basophilic mass | {
"A": "Chromatin dissolution and disappearance",
"B": "Condensation of DNA into a basophilic mass",
"C": "Fragmentation of the nucleus",
"D": "Membrane blebbing from organelles"
} | step1 | B | [
"72 year old female",
"brought",
"emergency department",
"ambulance",
"unable to walk",
"cut",
"leg",
"falling",
"week",
"then",
"wound",
"started draining fluid",
"painful",
"found to",
"necrotizing fasciitis",
"taken",
"operating room",
"Histological examination of cells",
"fas... |
A 12-year-old boy is brought to the physician because of fever, malaise, and a painful, itchy rash on the right shoulder for 2 weeks. The patient's mother says the boy's condition has worsened over the past 4 days. He has a history of atopic dermatitis. He has lived with his mother at several public shelters since she ... | Eczema herpeticum | {
"A": "Bed bug bites",
"B": "Nonbullous impetigo",
"C": "Stevens-Johnson syndrome",
"D": "Eczema herpeticum"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"fever",
"malaise",
"painful",
"itchy rash",
"right shoulder",
"2 weeks",
"patient's mother",
"boy's condition",
"worsened",
"past 4 days",
"history",
"atopic dermatitis",
"lived",
"mother",
"several",
"shelters",
"separated",
"father",... |
A 60-year-old man presents to the emergency department with progressive dyspnea for the last 3 weeks. He complains of shortness of breath while lying flat and reports nighttime awakenings due to shortness of breath for the same duration. The patient has been a smoker for the last 30 years. Past medical history is signi... | Intravenous diuretics | {
"A": "Intravenous beta blockers",
"B": "Echocardiography",
"C": "Cardiac stress testing",
"D": "Intravenous diuretics"
} | step2&3 | D | [
"60 year old man presents",
"emergency department",
"progressive dyspnea",
"weeks",
"of shortness",
"breath",
"lying flat",
"reports nighttime awakenings due to shortness of breath",
"same duration",
"patient",
"smoker",
"30 years",
"Past medical history",
"significant",
"myocardial infa... |
A 25-year-old man is brought to the emergency department by police. The patient was found intoxicated at a local bar. The patient is combative and smells of alcohol. The patient has a past medical history of alcoholism, IV drug use, and schizophrenia. His current medications include IM haloperidol and ibuprofen. The pa... | Mucosal tear at the gastroesophageal junction | {
"A": "Gastric mucosal erosion",
"B": "Mucosal tear at the gastroesophageal junction",
"C": "Transmural distal esophagus tear",
"D": "Transmural erosion of the gastric wall"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"police",
"patient",
"found",
"local",
"patient",
"combative",
"smells",
"alcohol",
"patient",
"past medical",
"IV drug use",
"schizophrenia",
"current medications include",
"haloperidol",
"ibuprofen",
"patient",
"currently hom... |
A 22-year-old man volunteers for a research study on lung function. He has no history of lung disease or allergies and does not smoke. His pulmonary blood flow is measured in the various labeled segments of the lungs while standing. Then the volunteer, still standing, is given very low continuous positive airway pressu... | Reduced blood flow in zone 1 | {
"A": "Reduced blood flow in zone 1",
"B": "Increased blood flow in zone 1",
"C": "Reduced blood flow in zone 3",
"D": "Increased blood flow in zone 3"
} | step1 | A | [
"year old man volunteers",
"research",
"lung function",
"history disease",
"allergies",
"not smoke",
"pulmonary blood flow",
"measured",
"various labeled segments of",
"lungs",
"standing",
"Then",
"volunteer",
"standing",
"given very low continuous positive airway pressure",
"blood flo... |
An 8-year-old girl is brought to the pediatrician because she is significantly shorter than her classmates. Her mother notes that she has had thick, oral secretions for the past several months, along with a chronic cough. Her exam is notable for clubbed fingernails. Her pediatrician sends a genetic test for a transmemb... | In-frame mutation | {
"A": "In-frame mutation",
"B": "Nonsense mutation",
"C": "Triplet expansion",
"D": "Silent mutation"
} | step1 | A | [
"year old girl",
"brought",
"pediatrician",
"shorter",
"classmates",
"mother notes",
"thick",
"oral secretions",
"past",
"months",
"chronic cough",
"exam",
"notable",
"clubbed fingernails",
"pediatrician sends",
"genetic",
"transmembrane channel mutation",
"shows",
"normal DNA se... |
A 4-year-old boy is brought by his parents to his pediatrician’s office. His mother mentions that the child has been producing an increased number of foul stools recently. His mother says that over the past year, he has had 1 or 2 foul-smelling stools per month. Lately, however, the stools are looser, more frequent, an... | Chromosome 7 | {
"A": "Chromosome 15",
"B": "Chromosome 4",
"C": "Chromosome 22",
"D": "Chromosome 7"
} | step2&3 | D | [
"4 year old boy",
"brought",
"parents",
"pediatricians office",
"mother",
"child",
"increased number of",
"stools recently",
"mother",
"past year",
"1",
"2 foul-smelling stools",
"month",
"stools",
"looser",
"frequent",
"odor",
"past",
"years",
"admitted 4 times",
"episodes o... |
A 37-year-old female presents to the emergency room complaining of headaches and palpitations. She reports that she initially started experiencing these symptoms several months prior but attributed them to stress at work. The symptoms occur episodically. Her family history is notable for medullary thyroid cancer and hy... | Phenoxybenzamine | {
"A": "Phenoxybenzamine",
"B": "Propranolol",
"C": "Phentolamine",
"D": "Atenolol"
} | step1 | A | [
"year old female presents",
"emergency room",
"headaches",
"palpitations",
"reports",
"initially started experiencing",
"symptoms",
"months prior",
"attributed",
"stress",
"work",
"symptoms occur",
"family history",
"notable",
"medullary thyroid cancer",
"hyperparathyroidism",
"tempe... |
A patient is receiving daily administrations of Compound X. Compound X is freely filtered in the glomeruli and undergoes net secretion in the renal tubules. The majority of this tubular secretion occurs in the distal convoluted tubule. Additional information regarding this patient’s renal function and the renal process... | 2 mg/mL | {
"A": "0.5 mg/mL",
"B": "1 mg/mL",
"C": "2 mg/mL",
"D": "3 mg/mL"
} | step1 | C | [
"patient",
"receiving daily administrations",
"Compound",
"Compound",
"freely filtered",
"glomeruli",
"net secretion",
"renal tubules",
"majority",
"tubular secretion occurs",
"distal convoluted tubule",
"Additional information",
"patients renal function",
"renal processing",
"Compound",... |
A 22-year-old woman with a history of type I diabetes mellitus presents to the emergency department with nausea, vomiting, and drowsiness for the past day. Her temperature is 98.3°F (36.8°C), blood pressure is 114/74 mmHg, pulse is 120/min, respirations are 27/min, and oxygen saturation is 100% on room air. Physical ex... | Normal saline and potassium | {
"A": "Insulin and potassium",
"B": "Normal saline and insulin",
"C": "Normal saline and potassium",
"D": "Normal saline, insulin, and potassium"
} | step2&3 | C | [
"year old woman",
"history of type I diabetes mellitus presents",
"emergency department",
"nausea",
"vomiting",
"drowsiness",
"past day",
"temperature",
"98",
"36",
"blood pressure",
"74 mmHg",
"pulse",
"min",
"respirations",
"27 min",
"oxygen saturation",
"100",
"room air",
"P... |
A 57-year-old man comes to the physician for a follow-up visit. Serum studies show:
AST 134 U/L
ALT 152 U/L
Hepatitis B surface antigen Positive
A photomicrograph of the microscopic findings of a liver biopsy is shown. These biopsy findings are most characteristic of which of the following types of inflammatory reactio... | Chronic inflammation | {
"A": "Ischemic necrosis",
"B": "Malignant transformation",
"C": "Granulomatous inflammation",
"D": "Chronic inflammation"
} | step1 | D | [
"57 year old man",
"physician",
"follow-up visit",
"Serum studies show",
"AST",
"U/L ALT",
"Hepatitis B surface antigen Positive",
"photomicrograph of",
"microscopic findings",
"liver biopsy",
"shown",
"biopsy findings",
"most characteristic",
"following types",
"inflammatory reactions"
... |
A 7-day-old male infant presents to the pediatrician for weight loss. There is no history of excessive crying, irritability, lethargy, or feeding difficulty. The parents deny any history of fast breathing, bluish discoloration of lips/nails, fever, vomiting, diarrhea, or seizures. He was born at full term by vaginal de... | Reassurance of parents | {
"A": "Reassurance of parents",
"B": "Emphasize the need to clothe the infant warmly to prevent hypothermia",
"C": "Supplementation of breastfeeding with a appropriate infant formula",
"D": "Admission of the infant in the NICU to treat with empiric intravenous antibiotics"
} | step2&3 | A | [
"day old male infant presents",
"pediatrician",
"weight loss",
"history",
"excessive crying",
"irritability",
"lethargy",
"feeding difficulty",
"parents deny",
"history",
"fast breathing",
"discoloration",
"lips nails",
"fever",
"vomiting",
"diarrhea",
"seizures",
"born",
"full t... |
A 16-year-old teenager presents to his pediatrician complaining of burning with urination and purulent urethral discharge. He states that he has had unprotected sex with his girlfriend several times and recently she told him that she has gonorrhea. His blood pressure is 119/78 mm Hg, pulse is 85/min, respiratory rate i... | Maintain confidentiality and treat the patient. | {
"A": "Break confidentiality and inform the patient that his parents must consent to this treatment.",
"B": "Inform the patient that his parents will not be informed, but he cannot receive medical care without their consent.",
"C": "Maintain confidentiality and treat the patient.",
"D": "Treat the patient and ... | step1 | C | [
"year old teenager presents",
"pediatrician",
"burning",
"urination",
"purulent urethral",
"states",
"unprotected sex",
"girlfriend",
"times",
"recently",
"gonorrhea",
"blood pressure",
"mm Hg",
"pulse",
"85 min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"urethra... |
A previously healthy 4-year-old boy is brought to the physician by his parents because he has had a fever, diffuse joint pain, and a rash on his abdomen for the past week. Acetaminophen did not improve his symptoms. He emigrated from China with his family 2 years ago. He attends daycare. His immunization records are no... | Echocardiography | {
"A": "Echocardiography",
"B": "ANA measurement",
"C": "Antistreptolysin O titer measurement",
"D": "HHV-6 immunoglobulin M (IgM) detection"
} | step2&3 | A | [
"healthy",
"year old boy",
"brought",
"physician",
"parents",
"fever",
"diffuse joint",
"rash",
"abdomen",
"past week",
"Acetaminophen",
"not",
"symptoms",
"China",
"family",
"years",
"attends daycare",
"immunization records",
"not available",
"temperature",
"pulse",
"min",... |
A 30-year-old woman is brought to the emergency department because of a 30-minute history of palpitations, dizziness, and chest discomfort. She has also not urinated since she woke up. She has a history of fibromyalgia treated with clomipramine. There is no family history of serious illness. She does not smoke or drink... | Sodium bicarbonate | {
"A": "Glucagon",
"B": "Cyproheptadine",
"C": "Sodium bicarbonate",
"D": "Lorazepam"
} | step2&3 | C | [
"30 year old woman",
"brought",
"emergency department",
"of",
"30-minute history",
"palpitations",
"dizziness",
"chest discomfort",
"not",
"woke up",
"history",
"fibromyalgia treated with clomipramine",
"family history",
"serious illness",
"not smoke",
"drink alcohol",
"temperature",... |
A newborn female is found to have ambiguous genitalia and hypotension. Laboratory workup reveals hyperkalemia, hyperreninemia, and elevated levels of 17-hydroxyprogesterone in the patient's urine. Which of the following enzymes would you expect to be deficient in this patient? | 21-hydroxylase | {
"A": "Angiotensin II",
"B": "DHT",
"C": "21-hydroxylase",
"D": "11-hydroxylase"
} | step1 | C | [
"newborn female",
"found to",
"ambiguous genitalia",
"hypotension",
"Laboratory workup reveals hyperkalemia",
"hyperreninemia",
"elevated levels",
"17-hydroxyprogesterone",
"patient's urine",
"following enzymes",
"to",
"deficient",
"patient"
] |
A 58-year-old woman comes to the physician because of a 3-month history of itching of both legs. She also has swelling and dull pain that are worse at the end of the day and are more severe in her right leg. She has hyperthyroidism, asthma, and type 2 diabetes mellitus. Four years ago, she had basal cell carcinoma of t... | Venous valve incompetence | {
"A": "Type IV hypersensitivity reaction",
"B": "Venous valve incompetence",
"C": "Malignant proliferation of epidermal keratinocytes",
"D": "Dermal accumulation of glycosaminoglycans"
} | step2&3 | B | [
"58 year old woman",
"physician",
"3 month history",
"itching",
"legs",
"swelling",
"dull pain",
"worse",
"end",
"day",
"more severe",
"right leg",
"hyperthyroidism",
"asthma",
"type 2 diabetes mellitus",
"Four years",
"basal cell carcinoma of",
"face",
"treated with Mohs surgery... |
One hour after undergoing an uncomplicated laparoscopic appendectomy, a 22-year-old man develops agitation and restlessness. He also has tremors, diffuse sweating, headache, and nausea with dry heaves. One liter of lactated ringer's was administered during the surgery and he had a blood loss of approximately 100 mL. Hi... | Administer intravenous lorazepam | {
"A": "Administer intravenous lorazepam",
"B": "Administer intravenous naloxone",
"C": "Adminster intravenous dexamethasone",
"D": "Administer 5% dextrose in 1/2 normal saline"
} | step2&3 | A | [
"One hour",
"uncomplicated laparoscopic appendectomy",
"year old man",
"agitation",
"restlessness",
"tremors",
"diffuse sweating",
"headache",
"nausea",
"dry heaves",
"One liter",
"lactated ringer's",
"administered",
"surgery",
"blood loss of approximately 100 mL",
"urine output",
"1... |
A 37-year-old woman comes to the physician because of a 2-week history of palpitations and loose stools. She has had a 2.3-kg (5-lb) weight loss over the past month. She has had no change in appetite. She has no history of serious illness. She works in accounting and has been under more stress than usual lately. She ta... | Toxic adenoma | {
"A": "Thyroid storm",
"B": "Graves' disease",
"C": "Toxic adenoma",
"D": "Goiter\n\""
} | step2&3 | C | [
"year old woman",
"physician",
"of",
"2-week history",
"palpitations",
"loose stools",
"2.3 kg",
"5",
"weight loss",
"past month",
"change in appetite",
"history",
"serious illness",
"works",
"accounting",
"more stress",
"usual",
"takes",
"medications",
"appears pale",
"tempe... |
A 34-year-old woman, gravida 2, para 0, at 28 weeks' gestation comes to the physician for a prenatal visit. She has not had regular prenatal care. Her most recent ultrasound at 20 weeks of gestation confirmed accurate fetal dates and appropriate fetal development. She takes levothyroxine for hypothyroidism. She used to... | Hepatitis A vaccination | {
"A": "Undergo liver biopsy",
"B": "Hepatitis A vaccination",
"C": "Schedule a cesarean delivery",
"D": "Plan to give hepatitis B vaccine and hepatitis B Ig to the newborn"
} | step2&3 | B | [
"year old woman",
"gravida 2",
"para 0",
"weeks",
"gestation",
"physician",
"prenatal visit",
"not",
"regular prenatal care",
"most recent ultrasound",
"20 weeks of gestation confirmed accurate fetal dates",
"appropriate fetal development",
"takes levothyroxine",
"hypothyroidism",
"used ... |
A 47-year-old woman comes to the physician because of involuntary leakage of urine for the past 4 months, which she has experienced when bicycling to work and when laughing. She has not had any dysuria or urinary urgency. She has 4 children that were all delivered vaginally. She is otherwise healthy and takes no medica... | S3–S4 nerve roots | {
"A": "S1-S2 nerve roots",
"B": "Superior hypogastric plexus",
"C": "Obturator nerve",
"D": "S3–S4 nerve roots"
} | step1 | D | [
"year old woman",
"physician",
"of involuntary leakage",
"urine",
"past",
"months",
"experienced",
"bicycling to work",
"laughing",
"not",
"dysuria",
"urinary urgency",
"4 children",
"delivered",
"healthy",
"takes",
"medications",
"muscles",
"likely affected",
"patient's receiv... |
A 51-year-old man presents to the urgent care center with a blood pressure of 201/111 mm Hg. He is complaining of a severe headache and chest pain. Physical examination reveals regular heart sounds and clear bilateral lung sounds. Ischemic changes are noted on his electrocardiogram (ECG). What is the most appropriate t... | IV labetalol - lower mean arterial pressure no more than 25% over the 1st hour | {
"A": "Oral beta-blocker - lower mean arterial pressure no more than 25% over the 1st hour",
"B": "IV labetalol - redose until blood pressure within normal limits",
"C": "IV labetalol - lower mean arterial pressure no more than 50% over the 1st hour",
"D": "IV labetalol - lower mean arterial pressure no more t... | step2&3 | D | [
"year old man presents",
"urgent care center",
"blood pressure",
"mm Hg",
"complaining of a severe headache",
"chest",
"Physical examination reveals regular heart sounds",
"clear bilateral lung sounds",
"Ischemic changes",
"noted",
"electrocardiogram",
"most appropriate treatment",
"patients... |
A large pharmaceutical company is seeking healthy volunteers to participate in a drug trial. The drug is excreted in the urine, and the volunteers must agree to laboratory testing before enrolling in the trial.
The laboratory results of one volunteer are shown below:
Serum glucose (random) 148 mg/dL
Sodium 140 mEq/L
Po... | Glucose: 0 mg/dL, Sodium: 0.25 mL/min, Creatinine: 100 mg/dL | {
"A": "Glucose: 0 mg/dL, Sodium: 0.25 mL/min, Creatinine: 100 mg/dL",
"B": "Glucose: 0 mg/dL, Sodium: 48 mL/min, Creatinine: 100 mg/dL",
"C": "Glucose: 148 mg/dL, Sodium: 105 mL/min, Creatinine: 99 mg/dL",
"D": "Glucose: 0 mg/dL, Sodium: 4 mL/min, Creatinine: 0.01 mg/dL"
} | step1 | A | [
"large pharmaceutical company",
"healthy volunteers to",
"drug trial",
"drug",
"excreted",
"urine",
"volunteers",
"agree",
"laboratory testing",
"trial",
"laboratory results",
"one volunteer",
"shown",
"Serum glucose",
"random",
"mg",
"L",
"Chloride",
"creatinine",
"mg",
"Uri... |
A 52-year-old woman complains of intermittent diffuse abdominal pain that becomes worse after eating meals and several episodes of diarrhea, the last of which was bloody. These symptoms have been present for the previous 6 months but have worsened recently. She has had significant weight loss since the onset of symptom... | Ischemic bowel disease | {
"A": "Ischemic bowel disease",
"B": "Ulcerative colitis",
"C": "Small bowel obstruction",
"D": "Acute pancreatitis"
} | step2&3 | A | [
"year old woman",
"intermittent diffuse abdominal pain",
"worse after eating meals",
"several episodes of diarrhea",
"last",
"bloody",
"symptoms",
"present",
"previous",
"months",
"worsened recently",
"significant weight loss",
"onset",
"symptoms",
"past medical history includes systemic... |
A healthy 29-year-old woman comes to the doctor because of recurrent episodes of bleeding from the nose and gums during the past week. These episodes occur spontaneously and resolve with compression. She also had 1 episode of blood in the urine 2 days ago. Examination shows punctate, nonblanching, reddish macules over ... | Megakaryocyte hyperplasia | {
"A": "Erythroid hyperplasia",
"B": "Absence of hematopoietic cells",
"C": "Megakaryocyte hyperplasia",
"D": "Plasma cell hyperplasia"
} | step1 | C | [
"healthy 29 year old woman",
"doctor",
"of recurrent episodes",
"bleeding",
"nose",
"gums",
"past week",
"episodes occur",
"resolve",
"compression",
"1 episode of blood",
"urine",
"days",
"Examination shows punctate",
"macules",
"neck",
"chest",
"lower extremities",
"leukocyte co... |
A 26-year-old man comes to the emergency department because of a 1-week history of worsening fatigue, nausea, and vomiting. Six weeks ago, he was diagnosed with latent tuberculosis and appropriate low-dose pharmacotherapy was initiated. Physical examination shows right upper quadrant tenderness and scleral icterus. Lab... | Acetylation | {
"A": "Sulfation",
"B": "Hydrolysis",
"C": "Glucuronidation",
"D": "Acetylation"
} | step1 | D | [
"year old man",
"emergency department",
"1-week history",
"worsening fatigue",
"nausea",
"vomiting",
"Six weeks",
"diagnosed",
"latent tuberculosis",
"appropriate low-dose pharmacotherapy",
"initiated",
"Physical examination shows right upper quadrant tenderness",
"scleral icterus",
"Labor... |
A 22-year-old man comes to the physician for the evaluation of a 2-day history of right testicular pain. At the age of 6 months, he was treated for hypospadias and cryptorchidism. Physical examination shows a rubbery, large right testicle. Orchidectomy is performed. A photomicrograph of a section of the mass is shown. ... | Increased glandular breast tissue | {
"A": "Increased radio-femoral delay",
"B": "Increased placental alkaline phosphatase",
"C": "Decreased smell perception",
"D": "Increased glandular breast tissue"
} | step1 | D | [
"year old man",
"physician",
"evaluation",
"2-day history",
"right testicular pain",
"age",
"months",
"treated",
"hypospadias",
"cryptorchidism",
"Physical examination shows",
"rubbery",
"large right",
"Orchidectomy",
"performed",
"photomicrograph",
"section",
"mass",
"shown",
... |
A 19-year-old man with a past medical history significant only for moderate facial acne and mild asthma presents to his primary care physician with a new rash. He notes it has developed primarily over the backs of his elbows and is itchy. He also reports a 6-month history of foul-smelling diarrhea. He has no significan... | Celiac disease | {
"A": "Food allergy",
"B": "Type 2 diabetes mellitus",
"C": "Celiac disease",
"D": "IgA nephropathy"
} | step2&3 | C | [
"year old man",
"past medical history significant only",
"moderate facial acne",
"mild asthma presents",
"primary care physician",
"new rash",
"notes",
"backs of",
"elbows",
"itchy",
"reports",
"6 month history",
"smelling diarrhea",
"significant social",
"family history",
"patient's b... |
A researcher is studying the effect of hypothalamic lesions on rat behavior and development. She has developed a novel genetic engineering technology that allows her to induce specific mutations in rat embryos that interfere with rat CNS development. She creates several lines of mice with mutations in only one region o... | Lateral hypothalamus | {
"A": "Lateral hypothalamus",
"B": "Paraventricular nucleus",
"C": "Posterior hypothalamus",
"D": "Suprachiasmatic nucleus"
} | step1 | A | [
"researcher",
"studying",
"effect",
"hypothalamic lesions",
"rat behavior",
"development",
"novel genetic technology",
"allows",
"to induce specific mutations",
"rat embryos",
"interfere",
"rat CNS development",
"creates several lines",
"mice",
"mutations",
"only one region",
"pituit... |
A 6-year-old girl is brought to the physician for intermittent fevers and painful swelling of the left ankle for 2 weeks. She has no history of trauma to the ankle. She has a history of sickle cell disease. Current medications include hydroxyurea and acetaminophen for pain. Her temperature is 38.4°C (101.2°F) and pulse... | Salmonella enterica | {
"A": "Pseudomonas aeruginosa",
"B": "Coccidioides immitis",
"C": "Salmonella enterica",
"D": "Escherichia coli"
} | step1 | C | [
"year old girl",
"brought",
"physician",
"intermittent fevers",
"painful swelling",
"left",
"2 weeks",
"history",
"trauma",
"ankle",
"history of sickle cell disease",
"Current medications include hydroxyurea",
"acetaminophen",
"pain",
"temperature",
"4C",
"pulse",
"min",
"Examina... |
A 48-year-old woman comes to the physician for a follow-up examination. Six months ago, she was diagnosed with overactive bladder syndrome and began treatment with oxybutynin. She continues to have involuntary loss of urine with sudden episodes of significant bladder discomfort that is only relieved by voiding. A subst... | Gram-positive, spore-forming rod | {
"A": "Gram-negative, encapsulated diplococcus",
"B": "Gram-negative, aerobic coccobacillus",
"C": "Gram-positive, club-shaped rod",
"D": "Gram-positive, spore-forming rod"
} | step1 | D | [
"48 year old woman",
"physician",
"follow-up examination",
"Six months",
"diagnosed",
"overactive bladder syndrome",
"began treatment",
"oxybutynin",
"continues to",
"involuntary loss",
"urine",
"sudden episodes of significant bladder discomfort",
"only relieved by voiding",
"substance",
... |
A 32-year-old Caucasian man presents to the physician because of the swelling and discomfort of the right testis for 3 weeks. There is no history of trauma, fever, or night sweats. He had surgery for an undescended right testis when he was 6 months old. There is no history of liver disease or hypogonadism. He has fathe... | Embryonal carcinoma | {
"A": "Embryonal carcinoma",
"B": "Leydig cell tumor",
"C": "Metastasis to testis",
"D": "Seminomatous germ cell tumor"
} | step2&3 | A | [
"year old Caucasian man presents",
"physician",
"swelling",
"discomfort",
"right testis",
"3 weeks",
"history",
"trauma",
"fever",
"night sweats",
"surgery",
"undescended right testis",
"months old",
"history of liver disease",
"hypogonadism",
"fathered 2 children",
"takes",
"medic... |
A 56-year-old man undergoes a cystoscopy for the evaluation of macroscopic hematuria. During the procedure, an opening covered with a mucosal flap is visualized at the base of the trigone. Which of the following best describes this structure? | Ureteric orifice | {
"A": "Internal urethral orifice",
"B": "Ureteric orifice",
"C": "Diverticular opening",
"D": "Prostatic utricle"
} | step1 | B | [
"year old man",
"cystoscopy",
"evaluation",
"macroscopic hematuria",
"procedure",
"opening covered",
"mucosal flap",
"visualized",
"base",
"trigone",
"following best",
"structure"
] |
A 37-year-old woman presents to her physician with a newly detected pregnancy for the initial prenatal care visit. She is gravida 3 para 2 with a history of preeclampsia in her 1st pregnancy. Her history is also significant for arterial hypertension diagnosed 1 year ago for which she did not take any medications. The p... | No medications needed | {
"A": "Fosinopril",
"B": "Magnesium sulfate",
"C": "Labetalol",
"D": "No medications needed"
} | step2&3 | D | [
"year old woman presents",
"physician",
"newly detected pregnancy",
"initial prenatal care visit",
"gravida",
"history of preeclampsia",
"1st pregnancy",
"history",
"significant",
"arterial hypertension diagnosed 1 year",
"not take",
"medications",
"patient reports",
"8-pack year smoking h... |
A 28-year-old woman with a history of migraines presents to your office due to sudden loss of vision in her left eye and difficulty speaking. Two weeks ago she experienced muscle aches, fever, and cough. Her muscle aches are improving but she continues to have a cough. She also feels as though she has been more tired t... | Natalizumab | {
"A": "Dexamethasone",
"B": "Methotrexate",
"C": "Natalizumab",
"D": "Adalimumab"
} | step1 | C | [
"year old woman",
"history of migraines presents",
"office due to sudden loss of vision",
"left eye",
"difficulty speaking",
"Two weeks",
"experienced muscle aches",
"fever",
"cough",
"muscle aches",
"improving",
"continues to",
"cough",
"feels",
"more tired",
"usual",
"similar episo... |
A 72-year-old woman presents to the clinic complaining of diarrhea for the past week. She mentions intense fatigue and intermittent, cramping abdominal pain. She has not noticed any blood in her stool. She recalls an episode of pneumonia last month for which she was hospitalized and treated with antibiotics. She has tr... | Peptic ulcer disease treated with esomeprazole | {
"A": "Recent travel to Florida",
"B": "Peptic ulcer disease treated with esomeprazole",
"C": "Hypercholesterolemia treated with atorvastatin",
"D": "Osteoporosis treated with calcium and vitamin D"
} | step2&3 | B | [
"72 year old woman presents",
"clinic",
"diarrhea",
"past week",
"intense fatigue",
"intermittent",
"cramping abdominal pain",
"not",
"blood in",
"stool",
"recalls",
"episode of pneumonia",
"month",
"hospitalized",
"treated with antibiotics",
"traveled recently",
"Florida to visit",
... |
A 30-year-old male presents to a local clinic with a complaint of a stiff neck. The patient is known to be sporadic with follow-up appointments but was last seen recently for a regular depot injection. He initially presented with complaints of paranoid delusions and auditory hallucinations that lasted for 7 months and ... | Haloperidol | {
"A": "Olanzapine",
"B": "Benztropine",
"C": "Haloperidol",
"D": "Thioridazine"
} | step1 | C | [
"30 year old male presents",
"local clinic",
"complaint",
"stiff neck",
"patient",
"known to",
"sporadic",
"follow-up appointments",
"last seen recently",
"regular depot injection",
"initially presented",
"complaints",
"paranoid delusions",
"auditory hallucinations",
"lasted",
"months"... |
A 30-year-old man is admitted to the hospital with a presumed pneumonia and started on antibiotics. Two days later, the patient shows no improvement. Blood cultures reveal yeast with pseudophyphae. Which of the following cell types is most likely deficient or dysfunctional in this patient? | Neutrophils | {
"A": "B-cells",
"B": "Neutrophils",
"C": "Eosinophils",
"D": "Phagocytes"
} | step1 | B | [
"30 year old man",
"admitted",
"hospital",
"presumed pneumonia",
"started",
"antibiotics",
"Two days later",
"patient shows",
"improvement",
"Blood cultures reveal yeast",
"of",
"following cell types",
"most likely deficient",
"dysfunctional",
"patient"
] |
A 28-year-old man presents to his primary care physician after experiencing intense nausea and vomiting yesterday. He states that he ran a 15-kilometer race in the morning and felt well while resting in a hammock afterward. However, when he rose from the hammock, he experienced two episodes of emesis accompanied by a s... | Particle repositioning maneuver | {
"A": "Particle repositioning maneuver",
"B": "Triptan therapy",
"C": "Meclizine",
"D": "Increased fluid intake"
} | step2&3 | A | [
"year old man presents",
"primary care physician",
"experiencing intense nausea",
"vomiting",
"states",
"ran",
"kilometer race",
"morning",
"felt well",
"resting",
"rose",
"experienced two episodes of emesis",
"sensation",
"world",
"spinning",
"lasted",
"one minute",
"self resolved... |
A 28-year-old woman comes to the physician because she is unable to conceive for 3 years. She and her partner are sexually active and do not use contraception. They were partially assessed for this complaint 6 months ago. Analysis of her husband's semen has shown normal sperm counts and hormonal assays for both partner... | Hysterosalpingogram | {
"A": "Postcoital testing",
"B": "Hysteroscopy",
"C": "Hysterosalpingogram",
"D": "Chromosomal karyotyping"
} | step2&3 | C | [
"year old woman",
"physician",
"unable to",
"years",
"partner",
"sexually active",
"not use contraception",
"assessed",
"complaint",
"months",
"Analysis",
"husband's semen",
"shown normal sperm counts",
"hormonal assays",
"partners",
"normal",
"menses occur",
"regular",
"day inte... |
A 63-year-old man presents to the emergency room because of worsening breathlessness that began overnight. He was diagnosed with asthma 3 years ago and has been using albuterol and steroid inhalers. He does not have a prior history of cardiac disease or other respiratory diseases. The man is a retired insurance agent a... | Eosinophilic granulomatosis with polyangiitis (EGPA) | {
"A": "Eosinophilic granulomatosis with polyangiitis (EGPA)",
"B": "Chagas disease",
"C": "Primary dilated cardiomyopathy",
"D": "Extrinsic asthma"
} | step1 | A | [
"63 year old man presents",
"emergency room",
"worsening breathlessness",
"began overnight",
"diagnosed",
"asthma",
"years",
"using albuterol",
"steroid inhalers",
"not",
"prior history of cardiac disease",
"respiratory diseases",
"man",
"retired insurance agent",
"lived",
"entire life... |
A 36-year-old woman comes to the physician because of a 4-day history of fever, malaise, chills, and a cough productive of moderate amounts of yellow-colored sputum. Over the past 2 days, she has also had right-sided chest pain that is exacerbated by deep inspiration. Four months ago, she was diagnosed with a urinary t... | Outpatient treatment with oral doxycycline | {
"A": "Outpatient treatment with oral doxycycline",
"B": "Inpatient treatment with intravenous ceftriaxone and oral azithromycin",
"C": "Outpatient treatment with oral levofloxacin",
"D": "Inpatient treatment with intravenous cefepime and oral levofloxacin"
} | step2&3 | A | [
"36 year old woman",
"physician",
"4-day history",
"fever",
"malaise",
"chills",
"cough productive of moderate amounts",
"yellow colored sputum",
"past 2 days",
"right-sided chest pain",
"exacerbated",
"deep inspiration",
"Four months",
"diagnosed",
"urinary tract infection",
"treated ... |
A 3-year-old boy is brought to the physician for a well-child examination. He has had multiple falls while walking and running for the past 4 months. He used to be able to climb stairs independently but now requires assistance. He started speaking in 2-word sentences at 2 years of age. He is at the 50th percentile for ... | Frameshift mutation | {
"A": "Same sense mutation",
"B": "Missense mutation",
"C": "Splice site mutation",
"D": "Frameshift mutation"
} | step2&3 | D | [
"3 year old boy",
"brought",
"physician",
"well",
"multiple falls",
"walking",
"running",
"past",
"months",
"used to",
"able to climb stairs",
"now",
"assistance",
"started speaking in",
"word sentences",
"years",
"age",
"50th percentile",
"height",
"percentile",
"weight",
... |
A 60-year-old female presents to her primary care physician complaining of bloating and fatigue over the past year. On examination, she has abdominal distension and ascites. Abdominal imaging reveals a mass-like lesion affecting the left ovary. A biopsy of the lesion demonstrates serous cystadenocarcinoma. She is subse... | Peripheral neuropathy | {
"A": "Cardiotoxicity",
"B": "Pulmonary fibrosis",
"C": "Hemorrhagic cystitis",
"D": "Peripheral neuropathy"
} | step1 | D | [
"60 year old female presents",
"primary care physician",
"bloating",
"fatigue",
"past year",
"examination",
"abdominal distension",
"ascites",
"Abdominal imaging reveals",
"mass",
"lesion affecting",
"left ovary",
"biopsy",
"lesion demonstrates serous cystadenocarcinoma",
"started",
"c... |
A 29-year-old man presents to an STD clinic complaining of a painful lesion at the end of his penis. The patient says it started as a tiny red bump and grew over several days. He has no history of a serious illness and takes no medications. He has had several sexual partners in the past few months. At the clinic, his t... | Chancroid | {
"A": "Chancre",
"B": "Chancroid",
"C": "Condyloma acuminatum",
"D": "Lymphogranuloma venereum"
} | step2&3 | B | [
"29 year old man presents",
"clinic complaining of a painful lesion",
"end",
"penis",
"patient",
"started",
"red",
"days",
"history",
"serious illness",
"takes",
"medications",
"several sexual partners",
"past",
"months",
"clinic",
"temperature",
"100",
"blood pressure",
"70 mm... |
A 74-year-old woman with no significant past medical history presents with 1 week of fever, unremitting headache and hip and shoulder stiffness. She denies any vision changes. Physical examination is remarkable for right scalp tenderness and range of motion is limited due to pain and stiffness. Neurological testing is ... | Start oral prednisone | {
"A": "Obtain CT head without contrast",
"B": "Perform a temporal artery biopsy",
"C": "Start oral prednisone",
"D": "Start IV methylprednisolone"
} | step2&3 | C | [
"74 year old woman",
"significant past medical history presents",
"1 week",
"fever",
"headache",
"hip",
"shoulder stiffness",
"denies",
"vision changes",
"Physical examination",
"right scalp",
"range of motion",
"limited due to pain",
"stiffness",
"Neurological testing",
"normal",
"L... |
A 29-year-old man comes to the physician because of a 3-month history of fatigue, weight loss, and multiple painless swellings on his neck and axilla. He reports that his swellings become painful after he drinks alcohol. Physical examination shows nontender cervical and axillary lymphadenopathy. A lymph node biopsy spe... | Hodgkin lymphoma | {
"A": "Hodgkin lymphoma",
"B": "Diffuse large B-cell lymphoma",
"C": "Adult T-cell lymphoma",
"D": "Acute lymphocytic leukemia"
} | step1 | A | [
"29 year old man",
"physician",
"3 month history",
"fatigue",
"weight loss",
"multiple painless swellings",
"neck",
"axilla",
"reports",
"swellings",
"painful",
"drinks alcohol",
"Physical examination shows nontender cervical",
"axillary lymphadenopathy",
"lymph node biopsy specimen show... |
A 48-year-old male presents to his primary care provider with a two-week history of low back pain and left leg pain. He reports that his symptoms started while he was working at his job as a construction worker. He has since experienced intermittent achy pain over his lumbar spine. He has also noticed pain radiating in... | Anterior compartment | {
"A": "Superficial posterior compartment",
"B": "Anterior compartment",
"C": "Lateral compartment",
"D": "Medial compartment"
} | step1 | B | [
"48 year old male presents",
"primary care provider",
"history of low back pain",
"left leg pain",
"reports",
"symptoms started",
"working",
"job",
"construction worker",
"since experienced intermittent achy pain",
"lumbar spine",
"pain radiating",
"left leg",
"weakness",
"left ankle dor... |
A 44-year-old man presents for a routine check-up. He has a past medical history of rheumatic fever. The patient is afebrile, and the vital signs are within normal limits. Cardiac examination reveals a late systolic crescendo murmur with a mid-systolic click, best heard over the apex and loudest just before S2. Which o... | Standing | {
"A": "Handgrip",
"B": "Left lateral decubitus position",
"C": "Rapid squatting",
"D": "Standing"
} | step1 | D | [
"year old man presents",
"routine check-up",
"past medical history of rheumatic fever",
"patient",
"afebrile",
"vital signs",
"normal limits",
"Cardiac examination reveals",
"late systolic crescendo murmur",
"best heard",
"apex",
"loudest",
"S2",
"following physical examination maneuvers",... |
A 35-year-old woman comes to the physician because of blurred vision for the past 2 months. During this period, she has also had difficulty chewing and swallowing. She reports that her symptoms worsen throughout the day and improve with rest. There is no personal or family history of serious illness. The patient works ... | CT scan of the chest | {
"A": "Physostigmine therapy",
"B": "Plasmapheresis",
"C": "CT scan of the chest",
"D": "Anti-VGCC antibody level"
} | step2&3 | C | [
"35 year old woman",
"physician",
"of blurred vision",
"past",
"months",
"period",
"difficulty chewing",
"swallowing",
"reports",
"symptoms worsen",
"day",
"rest",
"personal",
"family history",
"serious illness",
"patient works",
"teacher",
"great",
"stress",
"not smoke",
"dr... |
Three days after undergoing outpatient percutaneous coronary intervention with stent placement in the right coronary artery, a 60-year-old woman has left-sided painful facial swelling. The pain is worse while chewing. The patient has hypertension and coronary artery disease. Her current medications include enalapril, m... | Administer nafcillin and metronidazole | {
"A": "Perform salivary duct dilation",
"B": "Parotidectomy",
"C": "Obtain a parotid biopsy",
"D": "Administer nafcillin and metronidazole"
} | step2&3 | D | [
"Three days",
"outpatient percutaneous coronary intervention",
"stent placement",
"right coronary artery",
"60 year old woman",
"left-sided painful facial swelling",
"pain",
"worse",
"chewing",
"patient",
"hypertension",
"coronary artery disease",
"current medications include enalapril",
"... |
A 61-year-old male presents to an urgent care clinic with the complaints of pain in his joints and recurrent headaches for a month. He is also currently concerned about sweating excessively even at room temperature. His wife, who is accompanying him, adds that his facial appearance has changed over the past few years a... | Elevated insulin-like growth factor (IGF1) and growth hormone (GH) | {
"A": "Elevated cortisol level",
"B": "Elevated prolactin levels",
"C": "Elevated insulin-like growth factor (IGF1) and growth hormone (GH)",
"D": "Low insulin levels"
} | step2&3 | C | [
"61 year old male presents",
"urgent care clinic",
"complaints",
"pain",
"joints",
"recurrent headaches",
"month",
"currently concerned",
"sweating excessively",
"room temperature",
"wife",
"adds",
"facial appearance",
"changed",
"past",
"years",
"now",
"protruding jaw",
"promine... |
A 50-year-old man with a history of atrial fibrillation presents to his cardiologist’s office for a follow-up visit. He recently started treatment with an anti-arrhythmic drug to prevent future recurrences and reports that he has been feeling well and has no complaints. The physical examination shows that the arrhythmi... | Sotalol | {
"A": "Carvedilol",
"B": "Propranolol",
"C": "Sotalol",
"D": "Verapamil"
} | step1 | C | [
"50 year old man",
"history of atrial fibrillation presents",
"cardiologists office",
"follow-up visit",
"recently started treatment",
"anti-arrhythmic drug to prevent future recurrences",
"reports",
"feeling well",
"complaints",
"physical examination shows",
"arrhythmia appears to",
"resolved... |
A 60-year-old man presents to the emergency room with a chief complaint of constipation. His history is also significant for weakness, a dry cough, weight loss, recurrent kidney stones, and changes in his mood. He has a 30 pack-year history of smoking. A chest x-ray reveals a lung mass. Labs reveal a calcium of 14. Wha... | Administer intravenous fluids | {
"A": "Begin alendronate",
"B": "Administer calcitonin",
"C": "Begin furosemide",
"D": "Administer intravenous fluids"
} | step1 | D | [
"60 year old man presents",
"emergency room",
"chief complaint",
"constipation",
"history",
"significant",
"weakness",
"dry cough",
"weight loss",
"recurrent kidney stones",
"changes in",
"mood",
"30 pack-year history of smoking",
"chest x-ray reveals",
"lung mass",
"Labs reveal",
"c... |
A 7-year-old boy is brought to the emergency department by his parents with a 2-day history of severe fatigue. His parents say that he has no past medical history, but caught an illness that was going around his school 1 week ago. While ill, he had several days of abdominal pain and bloody diarrhea. His family history ... | Schistocytes | {
"A": "Codocytes",
"B": "Echinocytes",
"C": "Schistocytes",
"D": "Spherocytes"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"parents",
"2-day history",
"severe fatigue",
"parents",
"past medical history",
"caught",
"illness",
"school 1 week",
"ill",
"several days",
"abdominal pain",
"bloody diarrhea",
"family history",
"significant",
"family members",
... |
A 20-year-old primigravid woman comes to the physician in October for her first prenatal visit. She has delayed the visit because she wanted a “natural birth” but was recently convinced to get a checkup after feeling more tired than usual. She feels well. Menarche was at the age of 12 years and menses used to occur at ... | Tdap and influenza | {
"A": "Tdap and influenza",
"B": "Varicella and Tdap",
"C": "Varicella and influenza",
"D": "Hepatitis B and MMR"
} | step2&3 | A | [
"20 year old primigravid woman",
"physician",
"October",
"first prenatal visit",
"delayed",
"visit",
"wanted",
"natural birth",
"recently",
"to",
"checkup",
"feeling more tired",
"usual",
"feels well",
"Menarche",
"age",
"years",
"menses used to occur",
"regular",
"day interval... |
A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies of any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosi... | Selective serotonin reuptake inhibitor; anorgasmia, insomnia | {
"A": "Selective serotonin reuptake inhibitor; hypomania, suicidal thoughts",
"B": "Selective serotonin reuptake inhibitor; anorgasmia, insomnia",
"C": "Monoamine oxidase inhibitors; hypomania, suicidal thoughts",
"D": "Tricyclic antidepressants; hypomania, suicidal thoughts"
} | step1 | B | [
"year old male",
"psychiatric clinic",
"consistent sadness",
"feelings of worthlessness",
"anxiety",
"anhedonia",
"past couple months",
"denies feeling suicidal",
"further denies of",
"past episodes",
"feeling",
"energetic",
"racing thoughts",
"Confident",
"diagnosis",
"recommend",
"... |
A 16-year-old boy is brought in to a psychiatrist's office by his mother for increasingly concerning erratic behavior. Her son has recently entered a new relationship, and he constantly voices beliefs that his girlfriend is cheating on him. He ended his last relationship after voicing the same beliefs about his last pa... | Schizophrenia | {
"A": "Major depressive disorder",
"B": "Narcolepsy",
"C": "Schizophrenia",
"D": "Substance use disorder"
} | step1 | C | [
"year old boy",
"brought",
"psychiatrist's office",
"mother",
"concerning",
"behavior",
"son",
"recently entered",
"new relationship",
"constantly voices beliefs",
"girlfriend",
"cheating",
"ended",
"last relationship",
"voicing",
"same beliefs",
"partner",
"visit",
"patient repo... |
A 35-year-old man is brought to the emergency department 20 minutes after being involved in a motor vehicle collision in which he was a restrained passenger. The patient is confused. His pulse is 140/min and blood pressure is 85/60 mm Hg. Examination shows a hand-sized hematoma on the anterior chest wall. An ECG shows ... | Aortic isthmus | {
"A": "Aortic isthmus",
"B": "Aortic valve",
"C": "Inferior vena cava",
"D": "Left main coronary artery"
} | step1 | A | [
"35 year old man",
"brought",
"emergency department 20 minutes",
"involved",
"motor vehicle collision",
"restrained passenger",
"patient",
"confused",
"pulse",
"min",
"blood pressure",
"85 60 mm Hg",
"Examination shows",
"hand-sized hematoma",
"anterior chest wall",
"ECG shows sinus ta... |
A 66-year-old woman presents to her primary care physician with complaints of constipation and left lower abdominal discomfort. She says the pain usually gets worse after meals, which is felt as a dull pain. Her past medical history is positive for gastroesophageal reflux disease, for which she takes omeprazole. There ... | Abdominal CT | {
"A": "Abdominal ultrasound",
"B": "Abdominal CT",
"C": "Colonoscopy",
"D": "Barium study"
} | step1 | B | [
"66 year old woman presents",
"primary care physician",
"complaints",
"constipation",
"left lower abdominal discomfort",
"pain usually gets worse",
"meals",
"felt",
"dull",
"past medical history",
"positive",
"gastroesophageal reflux disease",
"takes omeprazole",
"positive history",
"chr... |
A 48-year-old man with a lengthy history of angina is brought to the emergency department after the acute onset of severe chest pain that started 40 minutes ago. Unlike previous episodes of chest pain, this one is unresponsive to nitroglycerin. His medical history is significant for hypertension, type 2 diabetes mellit... | White scar tissue | {
"A": "Coagulation necrosis",
"B": "Red granulation tissue",
"C": "White scar tissue",
"D": "Yellow necrotic area"
} | step1 | C | [
"48 year old man",
"lengthy history",
"angina",
"brought",
"emergency department",
"acute onset of severe chest pain",
"started 40 minutes",
"previous episodes of chest pain",
"one",
"unresponsive",
"nitroglycerin",
"medical history",
"significant",
"hypertension",
"type 2 diabetes melli... |
The principal investigators of both studies recently met at a rheumatology conference. They both expressed an interest in combining data from their individual studies to be analyzed in a single study. A third researcher at the conference, who conducted her own project on the same topic recently, has also indicated she ... | The results are more precise in comparison to individual studies | {
"A": "The results are more precise in comparison to individual studies",
"B": "It is unable to resolve differences in outcomes between individual studies",
"C": "It overcomes limitations in the quality of individual studies",
"D": "There is a decreased likelihood of type I error"
} | step2&3 | A | [
"principal investigators",
"studies recently met",
"rheumatology conference",
"interest",
"combining data",
"individual studies to",
"analyzed",
"single study",
"third researcher",
"conference",
"conducted",
"project",
"same topic recently",
"indicated",
"to contribute data",
"pooled a... |
A 36-year-old G4P0A3 woman presents at the prenatal diagnostic center at 18 weeks of gestation for the scheduled fetal anomaly scan. The patient's past medical history reveals spontaneous abortions. She reports that her 1st, 2nd, and 3rd pregnancy losses occurred at 8, 10, and 12 weeks of gestation, respectively. Ultra... | 45 X0 | {
"A": "Trisomy 21",
"B": "Monosomy 18",
"C": "Trisomy 13",
"D": "45 X0"
} | step2&3 | D | [
"36 year old",
"woman presents",
"prenatal diagnostic center",
"weeks of gestation",
"scheduled fetal anomaly scan",
"patient's past reveals spontaneous abortions",
"reports",
"1st",
"2nd",
"3rd pregnancy losses occurred",
"10",
"weeks of gestation",
"Ultrasonography",
"female fetus",
"c... |
A scientist is studying patients with neuromuscular weakness and discovers a mutation in a plasma membrane ion channel. She thinks that this mutation may have an effect on the dynamics of action potentials so she investigates its effect in an isolated neuronal membrane. She finds that the ion channel has no effect when... | Decreased action potential amplitude | {
"A": "Decreased action potential amplitude",
"B": "Decreased hyperpolarization potential",
"C": "Decreased resting membrane potential",
"D": "Increased action potential refractory period"
} | step1 | A | [
"scientist",
"studying patients",
"neuromuscular weakness",
"discovers",
"mutation",
"plasma membrane ion channel",
"thinks",
"mutation",
"effect",
"dynamics",
"action potentials",
"investigates",
"effect",
"isolated neuronal membrane",
"finds",
"ion channel",
"no effect",
"potassi... |
A 21-year-old lacrosse player comes to the doctor for an annual health assessment. She does not smoke or drink alcohol. She is 160 cm (5 ft 3 in) tall and weighs 57 kg (125 lb); BMI is 22 kg/m2. Pulmonary function tests show an FEV1 of 90% and an FVC of 3600 mL. Whole body plethysmography is performed to measure airway... | Segmental bronchi | {
"A": "Respiratory bronchioles",
"B": "Mainstem bronchi",
"C": "Segmental bronchi",
"D": "Terminal bronchioles"
} | step1 | C | [
"21-year-old lacrosse",
"doctor",
"annual health",
"not smoke",
"drink alcohol",
"5 ft",
"tall",
"57 kg",
"BMI",
"kg/m2",
"Pulmonary function tests show",
"FEV1",
"90",
"FVC",
"mL",
"Whole body plethysmography",
"performed to measure airway resistance",
"following structures",
"r... |
A 68-year-old man undergoes successful mechanical prosthetic aortic valve replacement for severe aortic valve stenosis. After the procedure, he is started on an oral medication and instructed that he should take for the rest of his life and that he should avoid consuming large amounts of dark-green, leafy vegetables. W... | Prothrombin time
" | {
"A": "Anti-factor Xa activity",
"B": "Thrombin time",
"C": "Activated partial thromboplastin time",
"D": "Prothrombin time\n\""
} | step1 | D | [
"68 year old man",
"successful mechanical prosthetic aortic valve replacement",
"severe",
"stenosis",
"procedure",
"started",
"oral medication",
"take",
"rest",
"life",
"large amounts",
"dark green",
"leafy vegetables",
"following laboratory parameters",
"monitored to guide dosing",
"d... |
A 55-year-old female presents with pain in both hands and wrists for the past several years. It is associated with morning stiffness that lasts for almost an hour. Physical examination reveals tenderness and swelling in both hands and wrists, most severe over the proximal interphalangeal joints. Laboratory investigatio... | Type III hypersensitivity | {
"A": "Self-tolerance",
"B": "Both type II and III hypersensitivities",
"C": "IgE-mediated immune responses only",
"D": "Type III hypersensitivity"
} | step1 | D | [
"55 year old female presents",
"pain",
"hands",
"wrists",
"past",
"years",
"associated with morning stiffness",
"lasts",
"almost",
"hour",
"Physical examination reveals tenderness",
"swelling",
"hands",
"wrists",
"severe",
"proximal interphalangeal joints",
"Laboratory investigation ... |
A 12-year-old African American boy is brought to the emergency room due to a severely painful penile erection for the past 5 hours. He was attending a class at his school when his penis became spontaneously tumescent. A complete blood count and a cavernous blood gas analysis showed the following:
Hemoglobin (Hb) 11.5 g... | Sickle cell disease (SCD) | {
"A": "Sickle cell disease (SCD)",
"B": "Glucose-6 phosphate dehydrogenase (G6PD) deficiency",
"C": "Thrombotic thrombocytopenic purpura (TTP)",
"D": "Hereditary spherocytosis"
} | step1 | A | [
"year old African American boy",
"brought",
"emergency room due to",
"severely painful penile erection",
"past",
"hours",
"attending",
"class",
"school",
"penis",
"tumescent",
"complete blood count",
"cavernous blood gas analysis showed",
"following",
"Hemoglobin",
"g",
"g dL",
"0"... |
A 72-year-old female is brought to the emergency department after being found unresponsive in her garage with an open bottle of unmarked fluid. She is confused and is unable to answer questions on arrival. Her medical history is significant for Alzheimer disease, but her family says she has no medical comorbidities. Se... | Curve D | {
"A": "Curve A",
"B": "Curve C",
"C": "Curve D",
"D": "Curve E"
} | step1 | C | [
"72 year old female",
"brought",
"emergency department",
"found unresponsive",
"garage",
"open bottle",
"fluid",
"confused",
"unable to answer questions",
"arrival",
"medical history",
"significant",
"Alzheimer disease",
"family",
"medical comorbidities",
"Serum analysis",
"patient's... |
A 2-year-old boy is brought the his primary care physician for persistent failure to thrive. He has not been meeting normal motor developmental milestones. Further questioning reveals a family history of congenital kidney disorders, although the parents do not know details. Based on clinical suspicion a panel of lab te... | Furosemide | {
"A": "Acetazolamide",
"B": "Furosemide",
"C": "Hydrochlorothiazide",
"D": "Amiloride"
} | step1 | B | [
"2 year old boy",
"brought",
"primary care physician",
"persistent failure to thrive",
"not",
"meeting normal motor developmental milestones",
"Further questioning reveals",
"family history of congenital kidney disorders",
"parents",
"not",
"details",
"Based",
"clinical suspicion",
"panel"... |
A 48-year-old Caucasian man presents to your office for initial evaluation as he has recently moved to your community and has become your patient. He has no significant past medical history and has not seen a physician in over 10 years. He takes no medications and denies having any allergies. He has been a smoker for t... | Prescribe lisinopril | {
"A": "Prescribe lisinopril",
"B": "Prescribe hydrochlorothiazide",
"C": "Prescribe bisoprolol",
"D": "Prescribe lisinopril and bisoprolol"
} | step2&3 | A | [
"48 year old Caucasian man presents",
"office",
"initial evaluation",
"recently moved to",
"community",
"patient",
"significant past medical history",
"not seen",
"physician",
"10 years",
"takes",
"medications",
"denies",
"allergies",
"smoker",
"past 20 years",
"smokes approximately ... |
Multiple patients present to your office with hematuria following an outbreak of Group A Streptococcus. Biopsy reveals that all of the patients have the same disease, characterized by large, hypercellular glomeruli with neutrophil infiltration. Which patient has the best prognosis? | 8-year-old boy who undergoes no treatment | {
"A": "65-year-old nulliparous woman",
"B": "50-year-old man with a history of strep infection",
"C": "8-year-old boy who undergoes no treatment",
"D": "38-year-old man with sickle cell trait"
} | step1 | C | [
"Multiple patients present",
"office",
"hematuria following",
"outbreak",
"Group A Streptococcus",
"Biopsy reveals",
"patients",
"same disease",
"characterized",
"large",
"hypercellular glomeruli",
"neutrophil infiltration",
"patient",
"best prognosis"
] |
A 56-year-old woman with a longstanding history of gastroesophageal reflux presents for follow-up evaluation of endoscopically confirmed gastric and duodenal ulcers. Her symptoms have been unresponsive to proton pump inhibitors and histamine receptor antagonists in the past. Results for H. pylori infection are still pe... | Hyperplasia of submucosal bicarbonate-secreting glands | {
"A": "Increased secretions from crypts of Lieberkühn",
"B": "Increased glucose-dependent insulinotropic peptide (GIP) release from K cells",
"C": "Hyperplasia of submucosal bicarbonate-secreting glands",
"D": "Proliferation of secretin-releasing S cells"
} | step1 | C | [
"year old woman",
"history",
"gastroesophageal reflux presents",
"follow-up evaluation",
"confirmed gastric",
"duodenal ulcers",
"symptoms",
"unresponsive",
"proton pump inhibitors",
"histamine receptor antagonists",
"past",
"Results",
"H",
"pylori infection",
"following changes",
"exp... |
A 53-year-old man with hyperlipidemia comes to the physician for a follow-up examination. His home medications include acetaminophen and atorvastatin. Serum studies show elevated total cholesterol and triglyceride concentrations. A drug that activates the peroxisome proliferator-activated receptor alpha is added to his... | Reddish-brown discoloration of urine | {
"A": "Waxing and waning confusion",
"B": "Reddish-brown discoloration of urine",
"C": "Pruritus and flushing of the skin",
"D": "Bleeding from minor trauma"
} | step1 | B | [
"year old man",
"hyperlipidemia",
"physician",
"follow-up examination",
"home medications include acetaminophen",
"atorvastatin",
"Serum studies show elevated total cholesterol",
"triglyceride concentrations",
"drug",
"activates",
"peroxisome proliferator-activated receptor alpha",
"added",
... |
A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past hour. He was unable to get out of bed that morning. His pants are soaked with urine. He has hypertension and coronary artery disease. Current medications include enalapril, carvedilol, aspirin, and simvastatin. His... | Right anterior cerebral artery occlusion | {
"A": "Right anterior cerebral artery occlusion",
"B": "Right posterior cerebral artery occlusion",
"C": "Left anterior cerebral artery occlusion",
"D": "Hypertensive encephalopathy"
} | step2&3 | A | [
"66 year old man",
"brought",
"emergency department",
"of weakness",
"left leg",
"past hour",
"unable to get out",
"bed",
"morning",
"pants",
"soaked",
"urine",
"hypertension",
"coronary artery disease",
"Current medications include enalapril",
"carvedilol",
"aspirin",
"simvastatin... |
A 2-day-old premature newborn presents with petechiae and persistent subcutaneous bruising. No additional complications during delivery. His vitals include: heart rate 180/min, respiratory rate 54/min, temperature 35.9°C (96.6°F), and blood pressure 60/30 mm Hg. On physical examination, there are dullness to percussion... | Disseminated intravascular coagulation | {
"A": "Disseminated intravascular coagulation",
"B": "Alloimmune neonatal thrombocytopenia",
"C": "Vitamin K deficiency",
"D": "Platelet dysfunction"
} | step1 | A | [
"2-day old premature newborn presents",
"petechiae",
"persistent subcutaneous bruising",
"additional complications",
"delivery",
"include",
"heart rate",
"min",
"respiratory rate 54 min",
"temperature 35",
"96",
"blood pressure 60 30 mm Hg",
"physical examination",
"dullness",
"percussio... |
A 52-year-old man presents to the office for evaluation of a ‘weird rash’ that appeared over his torso last week. The patient states that the rash just seemed to appear, but denies itching, pain, or exposure. On physical examination, the patient has multiple light brown-colored flat plaques on the torso. They appear to... | Gastric adenocarcinoma | {
"A": "Basal cell carcinoma (BCC)",
"B": "Infection with a Poxvirus",
"C": "Gastric adenocarcinoma",
"D": "Slow-growing squamous cell carcinoma"
} | step1 | C | [
"year old man presents",
"office",
"evaluation",
"rash",
"appeared",
"torso",
"week",
"patient states",
"rash",
"to appear",
"denies itching",
"pain",
"exposure",
"physical examination",
"patient",
"multiple light brown-colored flat plaques",
"torso",
"appear to",
"stuck",
"not... |
A 60-year-old man comes to the physician because of recurrent nose bleeds that occur with light trauma or at random times during the day. Over the past 6 months, the patient has felt weak and fatigued and has had a 10-kg (22-lb) weight loss. He has poor appetite and describes abdominal discomfort. He does not have nigh... | Cladribine | {
"A": "Transfusion of packed red blood cells",
"B": "Transfusion of platelets",
"C": "Melphalan",
"D": "Cladribine"
} | step2&3 | D | [
"60 year old man",
"physician",
"recurrent nose",
"occur",
"light trauma",
"random times",
"day",
"past 6 months",
"patient",
"felt weak",
"fatigued",
"a 10 kg",
"weight loss",
"poor appetite",
"abdominal discomfort",
"not",
"night sweats",
"pulse",
"72 min",
"blood pressure",
... |
A 57-year-old man comes to the physician with a 9-month history of cough and progressive dyspnea. The cough is usually worse in the mornings. He has smoked two packs of cigarettes daily for 30 years. Pulmonary examination shows diffuse wheezing during expiration. Spirometry shows a FEV1:FVC ratio of 45%. An x-ray of th... | Neutrophil cells | {
"A": "Th2 cells",
"B": "Type II alveolar cells",
"C": "Mast cells",
"D": "Neutrophil cells"
} | step1 | D | [
"57 year old man",
"physician",
"month history",
"cough",
"progressive dyspnea",
"cough",
"usually worse",
"mornings",
"smoked two packs",
"cigarettes daily",
"30 years",
"Pulmonary examination shows diffuse wheezing",
"expiration",
"Spirometry shows",
"FEV1:FVC ratio",
"x-ray of",
"... |
A sexually active 37-year-old man comes to the physician because of a 7-day history of itching in the area of his genitals. He also reports burning on micturition. He has type 2 diabetes mellitus, which is well controlled with oral metformin. Pelvic examination shows tender, atrophic white papules on the glans and prep... | Biopsy of the lesion | {
"A": "Local application of clobetasol",
"B": "Local application of fluconazole",
"C": "Biopsy of the lesion",
"D": "Local application of tacrolimus"
} | step2&3 | C | [
"sexually active",
"year old man",
"physician",
"7-day history",
"itching",
"area",
"genitals",
"reports burning",
"micturition",
"type 2 diabetes mellitus",
"well controlled",
"oral metformin",
"Pelvic shows tender",
"atrophic white papules",
"glans",
"prepuce",
"erythema of",
"su... |
A 48-year-old man is brought to the emergency department after he was found in a stuporous state with a small cut on his forehead on a cold night in front of his apartment. Non-contrast head CT is normal, and he is monitored in the emergency department. Twelve hours later, he yells for help because he hears the wallpap... | Alcoholic hallucinosis | {
"A": "Alcoholic hallucinosis",
"B": "Cocaine intoxication",
"C": "Delirium tremens",
"D": "Brief psychotic disorder"
} | step2&3 | A | [
"48 year old man",
"brought",
"emergency department",
"found",
"stuporous state",
"small cut",
"forehead",
"cold night",
"front of",
"apartment",
"Non contrast head CT",
"normal",
"monitored",
"emergency department",
"Twelve hours later",
"help",
"hears",
"family",
"headache",
... |
A 32-year-old female presents to the gynecologist with a primary concern of infertility. She has been unable to become pregnant over the last 16 months despite consistently trying with her husband. She has not used any form of contraception during this time and her husband has had a normal semen analysis. She has never... | Chlamydia serovars D-K | {
"A": "Chlamydia serovars A, B, or C",
"B": "Chlamydia serovars D-K",
"C": "Syphilis",
"D": "Herpes simplex virus"
} | step1 | B | [
"year old female presents",
"gynecologist",
"primary concern",
"infertility",
"unable to",
"pregnant",
"months",
"husband",
"not used",
"form",
"contraception",
"time",
"husband",
"normal semen analysis",
"never",
"diagnosed",
"chronic conditions",
"infertility",
"remembers testi... |
A 78-year-old man with a history of myocardial infarction status post coronary artery bypass grafting and a 60-pack-year history of smoking is found deceased in his apartment after not returning calls to his family for the last 2 days. The man was last known to be alive 3 days ago, when his neighbor saw him getting his... | Uniform binding of acidophilic dyes | {
"A": "Cellular debris and macrophages",
"B": "Cystic cavitation",
"C": "Fat saponification",
"D": "Uniform binding of acidophilic dyes"
} | step1 | D | [
"year old man",
"history of myocardial infarction",
"coronary artery bypass grafting",
"60 pack-year history of smoking",
"found deceased",
"apartment",
"not returning calls",
"family",
"last 2 days",
"man",
"last known to",
"alive",
"days",
"neighbor saw",
"getting",
"mail",
"family... |
A 48-year-old female suffers a traumatic brain injury while skiing in a remote area. Upon her arrival to the ER, she is severely hypoxemic and not responsive to O2 therapy. She is started on a mechanical ventilator and 2 days later upon auscultation, you note late inspiratory crackles. Which of the following is most li... | Left atrial pressure | {
"A": "Type II pneumocytes",
"B": "Chest X-ray",
"C": "Alveolar-arterial gradient",
"D": "Left atrial pressure"
} | step1 | D | [
"48 year old female suffers",
"traumatic brain injury",
"skiing",
"remote area",
"arrival",
"ER",
"severely",
"not responsive",
"O2 therapy",
"started",
"mechanical ventilator",
"2 days later",
"auscultation",
"note late inspiratory crackles",
"following",
"most likely normal",
"pati... |
A 46-year-old female with a history of hypertension and asthma presents to her primary care physician for a health maintenance visit. She states that she has no current complaints and generally feels very healthy. The physician obtains routine blood work, which demonstrates elevated transaminases. The physician should ... | Smoking history | {
"A": "IV drug use",
"B": "International travel",
"C": "Sex practices",
"D": "Smoking history"
} | step2&3 | D | [
"year old female",
"history of hypertension",
"asthma presents",
"primary care physician",
"health maintenance visit",
"states",
"current complaints",
"feels very healthy",
"physician obtains routine blood work",
"demonstrates elevated transaminases",
"physician",
"obtain further history",
"... |
A 13-year-old boy is being evaluated for failure to thrive and bad performance at school. He has a history of microcytic anemia and takes a multivitamin every morning with breakfast. An electrophoresis analysis shows no adult hemoglobin (HbA), elevated hemoglobin adult type 2 (HbA2), and normal fetal hemoglobin (HbF). ... | β-thal major | {
"A": "α-thal trait",
"B": "Hb Bart disease",
"C": "β-thal major",
"D": "β-thal minor"
} | step1 | C | [
"year old boy",
"evaluated",
"failure to thrive",
"bad performance",
"school",
"history of microcytic anemia",
"takes",
"multivitamin",
"morning",
"breakfast",
"electrophoresis analysis shows",
"adult hemoglobin",
"HbA",
"elevated hemoglobin adult type 2",
"normal fetal",
"HbF",
"sku... |
A 68-year-old male is diagnosed with squamous cell carcinoma in the upper lobe of his right lung. A chest radiograph can be seen in image A. Which of the following would you most expect to find in this patient? | Anisocoria | {
"A": "Polydipsia",
"B": "Digital clubbing",
"C": "Anisocoria",
"D": "Lateral gaze palsy"
} | step1 | C | [
"68 year old male",
"diagnosed",
"squamous cell carcinoma",
"the upper lobe of",
"right lung",
"chest radiograph",
"seen",
"image",
"following",
"most",
"to find",
"patient"
] |
A 7-year-old boy is brought to the physician for a follow-up examination after the removal of a tooth. During the procedure, he had prolonged bleeding that did not resolve with pressure and gauze packing and eventually required suture placement. His older brother had a similar episode a year ago, but his parents and tw... | Factor VIII | {
"A": "Factor VIII",
"B": "Von Willebrand factor",
"C": "Factor XI",
"D": "Protein C"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"follow-up examination",
"removal of",
"tooth",
"procedure",
"prolonged bleeding",
"not resolve",
"pressure",
"gauze packing",
"required suture placement",
"older brother",
"similar episode",
"year",
"parents",
"two sisters",
"never",
"prob... |
A 19-year-old woman with a known history of malabsorption presents with a painful red tongue, red eyes, and cracked lips. She says her symptoms gradually onset 4 months ago after moving away from home for college. She also complains of photophobia, spontaneous lacrimation, and itchy dermatitis. Past medical history is ... | Measurement of erythrocyte glutathione reductase activity | {
"A": "Measurement of erythrocyte glutamic oxaloacetic transaminase activity",
"B": "Measurement of serum methylmalonic acid levels",
"C": "Measurement of erythrocyte folate levels",
"D": "Measurement of erythrocyte glutathione reductase activity"
} | step1 | D | [
"year old woman",
"known history",
"malabsorption presents",
"painful red",
"red eyes",
"cracked lips",
"symptoms",
"onset",
"months",
"moving",
"home",
"college",
"photophobia",
"spontaneous lacrimation",
"itchy dermatitis",
"Past medical history",
"significant",
"long standing ma... |
A 45-year-old man comes to the physician because of a 3-day history of pain in his mouth and throat and difficulty swallowing. He has a history of COPD, for which he takes theophylline and inhaled budesonide-formoterol. Physical examination shows white patches on the tongue and buccal mucosa that can be scraped off eas... | Fluconazole | {
"A": "Fluconazole",
"B": "Amphotericin B",
"C": "Terbinafine",
"D": "Griseofulvin"
} | step1 | A | [
"year old man",
"physician",
"3-day history",
"pain",
"mouth",
"throat",
"difficulty swallowing",
"history",
"COPD",
"takes theophylline",
"inhaled budesonide-formoterol",
"Physical examination shows white patches",
"tongue",
"buccal mucosa",
"scraped",
"easily",
"Appropriate pharmac... |
A 56-year-old woman comes to the physician for follow-up after a measurement of elevated blood pressure at her last visit three months ago. She works as a high school teacher at a local school. She says that she mostly eats cafeteria food and take-out. She denies any regular physical activity. She does not smoke or use... | Losing 15 kg (33 lb) of body weight | {
"A": "Losing 15 kg (33 lb) of body weight",
"B": "Decreasing alcohol consumption to maximum of one drink per day",
"C": "Adopting a DASH diet",
"D": "Walking for 30 minutes, 5 days per week"
} | step2&3 | A | [
"year old woman",
"physician",
"follow-up",
"measurement",
"elevated blood pressure",
"last visit three months",
"works",
"high school teacher",
"local school",
"mostly eats cafeteria food",
"take out",
"denies",
"regular physical activity",
"not smoke",
"use",
"recreational drugs",
... |
A 43-year-old woman comes to the physician because of a 3-month history of tremor, diarrhea, and a 5-kg (11-lb) weight loss. Her pulse is 110/min. Examination shows protrusion of the eyeball when looking forward. A bruit is heard over the anterior neck on auscultation. Serum studies show autoantibodies to the thyroid-s... | Transmembrane carrier | {
"A": "Transmembrane carrier",
"B": "Lysosomal protease",
"C": "Hormone-activating enzyme",
"D": "Anion-oxidizing enzyme"
} | step1 | A | [
"year old woman",
"physician",
"3 month history",
"tremor",
"diarrhea",
"5 kg",
"weight loss",
"pulse",
"min",
"Examination shows protrusion",
"eyeball",
"looking forward",
"bruit",
"heard",
"anterior neck",
"auscultation",
"Serum studies show autoantibodies",
"thyroid-stimulating ... |
A 62-year-old man presents with “yellowing” of the skin. He says he has been having intermittent upper abdominal pain, which is relieved by Tylenol. He also recalls that he has lost some weight over the past several months but can not quantify the amount. His past medical history is significant for type 2 diabetes mell... | CA 19-9 is a marker for this condition. | {
"A": "Caffeine consumption is an established risk factor for this condition.",
"B": "The majority of cases occur in the body of the pancreas.",
"C": "Patients with this condition often rapidly develop glucose intolerance and severe diabetes.",
"D": "CA 19-9 is a marker for this condition."
} | step1 | D | [
"62 year old man presents",
"yellowing of the skin",
"intermittent upper",
"relieved by Tylenol",
"recalls",
"lost",
"weight",
"past",
"months",
"not quantify",
"amount",
"past medical history",
"significant",
"type 2 diabetes mellitus",
"reports",
"40 pack-year smoking history",
"pa... |
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