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 65-year-old woman comes to the emergency department because of blurry vision for 10 hours. She has also had urinary urgency and discomfort while urinating for the past 4 days. She has been feeling increasingly weak and nauseous since yesterday. She has a history of type 2 diabetes mellitus and arterial hypertension. ... | Hyperosmolar hyperglycemic state | {
"A": "Ischemic optic neuropathy",
"B": "Hypoglycemia",
"C": "Posterior uveitis",
"D": "Hyperosmolar hyperglycemic state"
} | step2&3 | D | [
"65 year old woman",
"emergency department",
"of blurry vision",
"10 hours",
"urinary urgency",
"discomfort",
"past 4 days",
"feeling",
"weak",
"nauseous",
"history of type 2 diabetes mellitus",
"arterial hypertension",
"One year ago",
"treated",
"infection",
"eyes",
"drinks 23 glass... |
A 13-year-old Caucasian male presents with his father to the pediatrician’s office complaining of left lower thigh pain. He reports slowly progressive pain over the distal aspect of his left thigh over the past three months. He denies any recent trauma to the area. His temperature is 100.9°F (38.3°C). On exam, there is... | Bone marrow suppression | {
"A": "Pulmonary fibrosis",
"B": "Peripheral neuropathy",
"C": "Hemorrhagic cystitis",
"D": "Bone marrow suppression"
} | step1 | D | [
"year old Caucasian male presents",
"father",
"pediatricians office",
"of left lower thigh pain",
"reports slowly progressive pain",
"distal aspect of",
"left thigh",
"past three months",
"denies",
"recent trauma",
"area",
"temperature",
"100 9F",
"3C",
"exam",
"swelling",
"tendernes... |
A 7-year-old boy presents to the pediatric emergency department for knee pain. The child fell while riding his skateboard yesterday. He claims that ever since then he has had swelling and knee pain that is severe. His parents state that he has trouble walking due to the pain. The child has a past medical history of sea... | Arthrocentesis | {
"A": "Antibiotics",
"B": "Arthrocentesis",
"C": "CT scan",
"D": "Supportive therapy and further physical exam"
} | step2&3 | B | [
"year old boy presents",
"pediatric emergency department",
"knee pain",
"child fell",
"skateboard",
"ever",
"then",
"swelling",
"knee pain",
"severe",
"parents state",
"trouble walking due to",
"pain",
"child",
"past medical seasonal allergies",
"asthma",
"current medications include... |
A 67-year-old woman presents to her primary care physician for memory difficulty. She states that for the past couple months she has had trouble with her memory including forgetting simple things like bills she needs to pay or locking doors. She was previously fully functional and did not make these types of mistakes. ... | Depression | {
"A": "Alzheimer dementia",
"B": "Depression",
"C": "Hypothyroidism",
"D": "Vascular dementia"
} | step2&3 | B | [
"67 year old woman presents",
"primary care physician",
"memory difficulty",
"states",
"past couple months",
"memory including forgetting simple things",
"bills",
"needs to pay",
"locking doors",
"functional",
"not make",
"types",
"mistakes",
"patient",
"not",
"ill",
"daughter",
"c... |
A 17-year-old girl is brought to the physician by her mother for evaluation of mild acne. Six months ago, the girl developed papules over her back and shoulders. Her mother reports that her daughter has only been wearing clothes that cover her complete back and shoulders recently and that she spends a lot of time check... | Cognitive-behavioral therapy | {
"A": "Dialectical behavioral therapy",
"B": "Suggest hospitalization",
"C": "Nutritional rehabilitation",
"D": "Cognitive-behavioral therapy"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"mother",
"evaluation",
"mild acne",
"Six months",
"girl",
"papules",
"back",
"shoulders",
"mother reports",
"daughter",
"only",
"clothes",
"cover",
"complete back",
"shoulders recently",
"spends",
"lot",
"time checking",
"skin",
"... |
A 6-month-old baby boy presents to his pediatrician for the evaluation of recurrent bacterial infections. He is currently well but has already been hospitalized multiple times due to his bacterial infections. His blood pressure is 103/67 mm Hg and heart rate is 74/min. Physical examination reveals light-colored skin an... | Chediak-Higashi syndrome | {
"A": "Chediak-Higashi syndrome",
"B": "Leukocyte adhesion deficiency-1",
"C": "Congenital thymic aplasia",
"D": "Acquired immunodeficiency syndrome"
} | step1 | A | [
"month old baby boy presents",
"pediatrician",
"evaluation",
"recurrent bacterial infections",
"currently well",
"hospitalized multiple times due to",
"bacterial infections",
"blood pressure",
"67 mm Hg",
"heart rate",
"74 min",
"Physical examination reveals light colored skin",
"silver hair... |
A 2-year-old boy presents to the emergency department with new onset seizures. After controlling the seizures with fosphenytoin loading, a history is obtained that reveals mild hypotonia and developmental delay since birth. There is also a history of a genetic biochemical disorder on the maternal side but the family do... | Pyruvate dehydrogenase | {
"A": "Alanine transaminase",
"B": "Glucose-6-phosphate dehydrogenase",
"C": "Pyruvate dehydrogenase",
"D": "Pyruvate kinase"
} | step1 | C | [
"2 year old boy presents",
"emergency department",
"new onset seizures",
"controlling",
"seizures",
"fosphenytoin loading",
"history",
"obtained",
"reveals mild hypotonia",
"developmental delay",
"birth",
"history of",
"genetic biochemical disorder",
"maternal side",
"family",
"not",
... |
A 71-year-old man presents to his oncologist with nausea. He recently underwent chemotherapy for pancreatic cancer and has developed severe intractable nausea over the past week. He vomits several times a day. His past medical history is notable for gout, osteoarthritis, and major depressive disorder. He takes allopuri... | 5-HT3 receptor antagonist | {
"A": "5-HT3 receptor antagonist",
"B": "D2 receptor antagonist",
"C": "H1 receptor antagonist",
"D": "M1 receptor antagonist"
} | step1 | A | [
"71 year old man presents",
"oncologist",
"nausea",
"recently",
"chemotherapy",
"pancreatic",
"severe intractable nausea",
"past week",
"vomits several times",
"day",
"past medical history",
"notable",
"gout",
"osteoarthritis",
"major depressive disorder",
"takes allopurinol",
"sertr... |
A 55-year-old man comes to the physician because of episodic retrosternal chest pain and shortness of breath for the past 6 months. His symptoms occur when he takes long walks or climbs stairs but resolve promptly with rest. He has a history of chronic obstructive pulmonary disease, for which he takes ipratropium bromi... | Labetalol | {
"A": "Atenolol",
"B": "Labetalol",
"C": "Betaxolol",
"D": "Bisoprolol"
} | step1 | B | [
"55 year old man",
"physician",
"episodic retrosternal chest pain",
"shortness of breath",
"past 6 months",
"symptoms occur",
"takes long walks",
"climbs stairs",
"resolve",
"rest",
"history",
"chronic obstructive pulmonary disease",
"takes ipratropium bromide",
"pulse",
"81 min",
"blo... |
A 17-year-old boy comes to the physician for a follow-up visit. Two days ago, he had a routine health maintenance examination that showed 3+ proteinuria on urine dipstick testing. During the initial routine examination, the patient reported feeling well, apart from being exhausted from his day at work. He had an upper ... | Standing for long periods of time | {
"A": "Standing for long periods of time",
"B": "Subepithelial immune complex depositions",
"C": "Loss of negative charge on the glomerular basement membrane",
"D": "Splitting of the glomerular basement membrane"
} | step2&3 | A | [
"year old boy",
"physician",
"follow-up visit",
"Two days",
"routine health maintenance examination",
"showed 3",
"proteinuria",
"urine dipstick testing",
"initial routine examination",
"patient reported feeling well",
"exhausted",
"day",
"work",
"upper respiratory infection",
"month",
... |
A 40-year-old farmer from Ohio seeks evaluation at a clinic with complaints of a chronic cough, fevers, and anorexia of several months duration. On examination, he has generalized lymphadenopathy with hepatosplenomegaly. A chest radiograph reveals local infiltrates and patchy opacities involving all lung fields. Fine n... | Histoplasmosis | {
"A": "Blastomycosis",
"B": "Histoplasmosis",
"C": "Cryptococcosis",
"D": "Coccidioidomycosis"
} | step1 | B | [
"40 year old farmer",
"Ohio",
"evaluation",
"clinic",
"complaints",
"chronic cough",
"fevers",
"anorexia",
"months duration",
"examination",
"generalized lymphadenopathy",
"hepatosplenomegaly",
"chest radiograph reveals local infiltrates",
"patchy opacities involving",
"lung fields",
"... |
A 71-year-old woman presents with a transient episode of right arm and hand weakness that resolved in approximately one hour. Her symptoms started while she was gardening. Her past medical history is notable for hypertension, diabetes, anxiety, and dyslipidemia. Her current medications include insulin, metformin, and f... | Aspirin | {
"A": "Aspirin",
"B": "Left carotid endarterectomy only",
"C": "Observation",
"D": "Warfarin"
} | step2&3 | A | [
"71 year old woman presents",
"transient episode of right arm",
"hand weakness",
"resolved",
"approximately one hour",
"symptoms started",
"gardening",
"past medical history",
"notable",
"hypertension",
"diabetes",
"anxiety",
"dyslipidemia",
"current medications include insulin",
"metfor... |
A 14-year-old boy is rushed to the emergency room after he became disoriented at home. His parents say that the boy was doing well until 2 days ago when he got sick and vomited several times. They thought he was recovering but today he appeared to be disoriented since the morning. His vitals are normal except shallow r... | Insulin lispro | {
"A": "NPH insulin",
"B": "Insulin lispro",
"C": "Insulin glargine",
"D": "NPH and regular insulin"
} | step2&3 | B | [
"year old boy",
"rushed",
"emergency room",
"disoriented at home",
"parents",
"boy",
"well",
"2 days",
"got sick",
"vomited several times",
"thought",
"recovering",
"today",
"appeared to",
"disoriented",
"morning",
"normal",
"shallow rapid breathing",
"rate",
"min",
"blood su... |
A 62-year-old woman presents to her primary care physician for a routine physical exam. The patient has no specific complaints but does comment on some mild weight gain. She reports that she recently retired from her job as a math teacher and has taken up hiking. Despite the increase in activity, she believes her pants... | Pelvic ultrasound | {
"A": "Abdominal MRI",
"B": "CA-125 level",
"C": "Exploratory laparotomy and debulking",
"D": "Pelvic ultrasound"
} | step2&3 | D | [
"62 year old woman presents",
"primary care physician",
"routine physical exam",
"patient",
"specific complaints",
"comment",
"mild weight gain",
"reports",
"recently retired",
"job",
"math teacher",
"taken",
"hiking",
"increase",
"activity",
"pants",
"tighter",
"denies headaches",... |
A 28-year-old man comes to the physician because of increasing shortness of breath, abdominal fullness, and pedal edema for 3 months. Four months ago, he was diagnosed with pulmonary tuberculosis and is currently receiving therapy with isoniazid, rifampin, pyrazinamide, and ethambutol. His temperature is 37°C (98.6°F),... | Pericardiectomy | {
"A": "Colchicine therapy",
"B": "Pericardiectomy",
"C": "Metoprolol therapy",
"D": "Heart transplantation"
} | step2&3 | B | [
"year old man",
"physician",
"of increasing shortness",
"breath",
"abdominal fullness",
"pedal edema",
"months",
"Four",
"diagnosed",
"pulmonary tuberculosis",
"currently receiving therapy",
"isoniazid",
"rifampin",
"pyrazinamide",
"ethambutol",
"temperature",
"98",
"pulse",
"100... |
A 78-year-old left-handed woman with hypertension and hyperlipidemia is brought to the emergency room because of sudden-onset right leg weakness and urinary incontinence. Neurologic examination shows decreased sensation over the right thigh. Muscle strength is 2/5 in the right lower extremity and 4/5 in the right upper... | Left anterior cerebral artery | {
"A": "Right anterior cerebral artery",
"B": "Right vertebrobasilar artery",
"C": "Left posterior cerebral artery",
"D": "Left anterior cerebral artery"
} | step1 | D | [
"year old left-handed woman",
"hypertension",
"hyperlipidemia",
"brought",
"emergency room",
"sudden-onset right",
"urinary incontinence",
"Neurologic examination shows decreased sensation",
"right thigh",
"Muscle strength",
"2/5",
"right lower extremity",
"4/5",
"right upper extremity",
... |
A 15-year-old boy is brought to the emergency department by his father 10 minutes after falling into a frozen lake during ice fishing. He was in the water for less than 1 minute before his father managed to pull him out. On arrival, his clothes are still wet and he appears scared. His body temperature is 36.2°C (97.1°F... | Involuntary muscular contractions | {
"A": "Involuntary muscular contractions",
"B": "Contraction of arrector pili muscles",
"C": "Inhibition of the thyroid axis",
"D": "Activation of thermogenin"
} | step1 | A | [
"year old boy",
"brought",
"emergency department",
"father 10 minutes",
"falling",
"frozen lake",
"ice fishing",
"water",
"less than",
"minute",
"father managed to pull",
"out",
"arrival",
"clothes",
"wet",
"appears scared",
"body temperature",
"36",
"97",
"pulse",
"min",
"... |
A 57-year-old construction worker presents with gradually worsening shortness of breath for the past several months and left pleuritic chest pain for 2 weeks. He denies fever, cough, night sweats, wheezing, or smoking. He is recently diagnosed with hypertension and started amlodipine 10 days ago. He has been working in... | Asbestosis | {
"A": "Asbestosis",
"B": "Drug-induced interstitial lung disease",
"C": "Sarcoidosis",
"D": "Allergic bronchopulmonary aspergillosis"
} | step1 | A | [
"57 year old construction worker presents",
"worsening shortness of breath",
"past",
"months",
"left pleuritic chest pain",
"2 weeks",
"denies fever",
"cough",
"night sweats",
"wheezing",
"smoking",
"recently diagnosed",
"hypertension",
"started amlodipine 10 days",
"working",
"constru... |
A 26-year-old man presents to his primary doctor with one week of increasing weakness. He reports that he first noticed difficulty walking while attending his sister's graduation last week, and yesterday he had difficulty taking his coffee cup out of the microwave. He remembers having nausea and vomiting a few weeks pr... | Normal cell count, high protein, normal glucose, normal opening pressure | {
"A": "High neutrophils, high protein, low glucose, high opening pressure",
"B": "High lymphocytes, normal protein, normal glucose, normal opening pressure",
"C": "Normal cell count, high protein, normal glucose, normal opening pressure",
"D": "Normal cell count, normal protein, normal glucose, normal opening ... | step1 | C | [
"year old man presents",
"primary doctor",
"one week",
"increasing weakness",
"reports",
"first",
"difficulty walking",
"attending",
"sister's graduation",
"week",
"difficulty",
"coffee cup out",
"microwave",
"remembers",
"nausea",
"vomiting",
"few weeks prior",
"other",
"signifi... |
A newborn is found to have cystic fibrosis during routine newborn screening. The parents, both biochemists, are curious about the biochemical basis of their newborn's condition. The pediatrician explains that the mutation causing cystic fibrosis affects the CFTR gene which codes for the CFTR channel. Which of the follo... | Defective post-translational glycosylation of the CFTR channel | {
"A": "Insufficient CFTR channel production",
"B": "Defective post-translational glycosylation of the CFTR channel",
"C": "Defective post-translational hydroxylation of the CFTR channel",
"D": "Defective post-translational phosphorylation of the CFTR channel"
} | step1 | B | [
"newborn",
"found to",
"cystic fibrosis",
"routine newborn screening",
"parents",
"biochemists",
"curious",
"biochemical basis",
"newborn's condition",
"pediatrician",
"mutation causing cystic fibrosis affects",
"CFTR gene",
"codes",
"CFTR channel",
"following",
"pathogenesis",
"comm... |
A 27-year-old G2P1 female gives birth to a baby girl at 33 weeks gestation. The child is somnolent with notable difficulty breathing. Pulse pressure is widened. She is profusely cyanotic. Auscultation is notable for a loud single S2. An echocardiogram demonstrates an enlarged heart and further studies show blood from t... | Formation of the aorticopulmonary septum | {
"A": "Closure of an aorticopulmonary shunt",
"B": "Formation of the interatrial septum",
"C": "Spiraling of the truncal and bulbar ridges",
"D": "Formation of the aorticopulmonary septum"
} | step1 | D | [
"27 year old",
"female gives birth",
"baby girl",
"weeks gestation",
"child",
"somnolent",
"notable difficulty breathing",
"Pulse pressure",
"widened",
"cyanotic",
"Auscultation",
"notable",
"loud single S2",
"echocardiogram demonstrates",
"enlarged heart",
"further studies show blood"... |
A 4-year-old boy is brought to the physician by his parents for a well-child examination. He has been healthy and has met all development milestones. His immunizations are up-to-date. He is at the 97th percentile for height and 50th percentile for weight. His vital signs are within normal limits. The lungs are clear to... | Echocardiography | {
"A": "Karyotyping",
"B": "Echocardiography",
"C": "IGF-1 measurement",
"D": "Measure plasma homocysteine concentration"
} | step2&3 | B | [
"4 year old boy",
"brought",
"physician",
"parents",
"well",
"healthy",
"met",
"development milestones",
"immunizations",
"date",
"percentile",
"height",
"50th percentile",
"weight",
"vital signs",
"normal limits",
"lungs",
"clear",
"auscultation",
"of",
"heart shows",
"hig... |
A 15-year-old girl is brought to the physician because of a 8-month history of fatigue, intermittent postprandial abdominal bloating and discomfort, foul-smelling, watery diarrhea, and a 7-kg (15-lb) weight loss. She developed a pruritic rash on her knees 3 days ago. Physical examination shows several tense, excoriated... | IgA tissue transglutaminase antibodies | {
"A": "IgA tissue transglutaminase antibodies",
"B": "Periodic acid-Schiff-positive macrophages",
"C": "Elevated serum amylase concentration",
"D": "Positive hydrogen breath test"
} | step1 | A | [
"year old girl",
"brought",
"physician",
"month history",
"fatigue",
"intermittent postprandial abdominal bloating",
"discomfort",
"smelling",
"watery diarrhea",
"kg",
"weight loss",
"pruritic rash",
"knees 3 days",
"Physical examination shows several tense",
"excoriated vesicles",
"kn... |
A 32-year-old woman presented for her annual physical examination. She mentioned that her family history had changed since her last visit: her mother was recently diagnosed with breast cancer and her sister tested positive for the BRCA2 mutation. The patient, therefore, requested testing as well. If the patient tests p... | Twice-yearly clinical breast exams, annual mammography, annual breast MRI, and breast self-exams | {
"A": "Annual clinical breast exams, annual mammography, and monthly self-breast exams",
"B": "Twice-yearly clinical breast exams, annual mammography, annual breast MRI, and breast self-exams",
"C": "Annual ultrasound, annual mammography, and monthly self-breast exams",
"D": "Order magnetic resonance imaging o... | step2&3 | B | [
"year old woman presented",
"annual physical examination",
"family history",
"changed",
"last visit",
"mother",
"recently diagnosed",
"breast cancer",
"sister tested positive",
"BRCA2 mutation",
"patient",
"requested testing",
"well",
"patient tests positive",
"BRCA1",
"BRCA2 mutation"... |
Which of the following patient presentations would be expected in an infant with defective LFA-1 integrin (CD18) protein on phagocytes, in addition to recurrent bacterial infections? | Skin infections with absent pus formation, delayed umbilicus separation | {
"A": "Eczema and thrombocytopenia",
"B": "Skin infections with absent pus formation, delayed umbilicus separation",
"C": "Cardiac defects, hypoparathyroidism, palatal defects, and learning disabilities",
"D": "Chronic diarrhea, oral candidiasis, severe infections since birth, absent thymic shadow"
} | step1 | B | [
"following patient presentations",
"expected",
"infant",
"defective LFA-1 integrin",
"CD18",
"protein",
"phagocytes",
"recurrent bacterial infections"
] |
A 7-year-old male is admitted to the hospital with his fourth episode of wheezing and dyspnea. His symptoms are exacerbated by mold and pollen. Which of the following is most likely to be observed in this patient? | Sputum eosinophils | {
"A": "Abnormal chest radiograph",
"B": "Normal FEV1",
"C": "Sputum eosinophils",
"D": "Ground glass opacities on chest CT"
} | step1 | C | [
"year old male",
"admitted",
"hospital",
"fourth episode of wheezing",
"dyspnea",
"symptoms",
"exacerbated",
"mold",
"pollen",
"following",
"most likely to",
"observed",
"patient"
] |
A 42-year-old man is referred for an endocrinology consult because of decreased triiodothyronine (T3) hormone levels. He presented to the emergency department 1 week prior to this consultation with pneumonia and was admitted to a medicine service for management of his infection. He has since recovered from his infectio... | Increased reverse T3 concentration | {
"A": "Decreased free T3 concentration",
"B": "Increased free T3 concentration",
"C": "Increased reverse T3 concentration",
"D": "Normal free and reverse T3 concentration"
} | step1 | C | [
"year old man",
"referred",
"endocrinology consult",
"decreased triiodothyronine",
"hormone levels",
"presented",
"emergency department 1 week prior to",
"consultation",
"pneumonia",
"admitted",
"medicine service",
"management",
"infection",
"since recovered",
"infection",
"intravenous... |
A 29-year-old woman presents to a physician for evaluation of palpitations, increased sweating, and unintentional weight loss despite a good appetite. She also reports difficulty swallowing and voice changes. All of the symptoms have developed over the past 6 months. The patient has no concurrent illnesses and takes no... | This condition results from a failure of caudal migration of thyroid tissue. | {
"A": "Most often in such a condition, there is an additional thyroid tissue elsewhere in the neck.",
"B": "There is a male predilection for this condition.",
"C": "This is the rarest location for ectopic thyroid tissue.",
"D": "This condition results from a failure of caudal migration of thyroid tissue."
} | step1 | D | [
"29 year old woman presents",
"physician",
"evaluation",
"palpitations",
"increased sweating",
"unintentional weight loss",
"good appetite",
"reports difficulty swallowing",
"voice changes",
"symptoms",
"past 6 months",
"patient",
"concurrent illnesses",
"takes",
"medications",
"vital ... |
A 2-month-old girl is admitted to the hospital because of a 1-day history of fever and difficulty breathing. She has also had nasal congestion for 2 days. She was born at 28 weeks' gestation and weighed 1105 g (2 lb 7 oz); she currently weighs 2118 g (4 lb 11 oz). Her neonatal course was complicated by respiratory dist... | Palivizumab | {
"A": "Postnatal glucocorticoid",
"B": "Ceftriaxone",
"C": "Respiratory syncytial virus immune globulin",
"D": "Palivizumab"
} | step2&3 | D | [
"2 month old girl",
"admitted",
"hospital",
"1-day history",
"fever",
"difficulty breathing",
"nasal congestion",
"2 days",
"born",
"weeks",
"gestation",
"g",
"oz",
"currently",
"g",
"oz",
"neonatal course",
"complicated",
"respiratory distress syndrome",
"required supplemental... |
A 45-year-old man comes to the emergency department with the complaint of pain and swelling of the proximal joint in the third finger of his right hand. The pain is so severe that it woke him up from sleep this morning. He has never had an episode like this before. The patient has smoked a pack of cigarettes daily for ... | Acute gout | {
"A": "Chronic gout",
"B": "Septic arthritis",
"C": "Acute gout",
"D": "Reactive arthritis"
} | step2&3 | C | [
"year old man",
"emergency department",
"complaint",
"pain",
"swelling of",
"proximal joint",
"third finger",
"right hand",
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"so severe",
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"morning",
"never",
"episode",
"patient",
"smoked",
"pack",
"cigarettes daily",
"last",
"years",
"drinks alcohol... |
A 9-year-old boy is brought to the physician because his parents are concerned that he has been unable to keep up with his classmates at school. He is at the 4th percentile for height and at the 15th percentile for weight. Physical examination shows dysmorphic facial features. Psychologic testing shows impaired intelle... | Supravalvular aortic stenosis | {
"A": "Hand flapping movements",
"B": "Brushfield spots on the iris",
"C": "Testicular enlargement",
"D": "Supravalvular aortic stenosis"
} | step1 | D | [
"year old boy",
"brought",
"physician",
"parents",
"concerned",
"unable to keep",
"classmates",
"school",
"4th percentile",
"height",
"percentile",
"weight",
"Physical examination shows dysmorphic facial features",
"Psychologic testing shows impaired",
"adaptive functions",
"Genetic an... |
A 7-year-old boy is brought to the emergency department because of a 3-day history of generalized fatigue, myalgia, and fever. He has sickle cell disease. His current medications include hydroxyurea and folic acid. He appears ill. His temperature is 39.2°C (102.6°F), pulse is 103/min, and respirations are 28/min. Exami... | Ceftriaxone | {
"A": "Prednisone",
"B": "Vancomycin",
"C": "Clindamycin",
"D": "Ceftriaxone"
} | step2&3 | D | [
"year old boy",
"brought",
"emergency department",
"3-day history",
"generalized fatigue",
"myalgia",
"fever",
"sickle cell disease",
"current medications include hydroxyurea",
"folic acid",
"appears ill",
"temperature",
"pulse",
"min",
"respirations",
"min",
"Examination shows pale ... |
An 8-month-old female infant from a first-degree consanguinous couple was brought to the physican because the mother noticed abnormalities in the growth of her child as well as the different lengths of her child's legs. The infant had gingival hyperplasia, restricted movement in both shoulders, a prominent, pointed for... | N-acetyl-glucosamine-1-phosphotransferase | {
"A": "Glucose-6-phosphate dehydrogenase",
"B": "Lysosomal alpha-1,4-glucosidase",
"C": "N-acetyl-glucosamine-1-phosphotransferase",
"D": "Alpha-galactosidase A"
} | step1 | C | [
"month old female infant",
"first-degree consanguinous couple",
"brought",
"mother",
"abnormalities",
"growth",
"child",
"different lengths",
"child's legs",
"infant",
"gingival hyperplasia",
"restricted movement",
"shoulders",
"prominent",
"forehead",
"enophthalmos",
"slight opacity... |
A 45-year-old male presents to his primary care physician complaining of joint pain and stiffness. He reports progressively worsening pain and stiffness in his wrists and fingers bilaterally over the past six months that appears to improve in the afternoon and evening. His past medical history is notable for obesity an... | Citrullinated peptides | {
"A": "Fc region of IgG molecule",
"B": "Citrullinated peptides",
"C": "Topoisomerase I",
"D": "Centromeres"
} | step1 | B | [
"year old male presents",
"primary care physician",
"joint",
"stiffness",
"reports",
"worsening pain",
"stiffness",
"wrists",
"fingers",
"past six months",
"appears to",
"afternoon",
"evening",
"past medical history",
"notable",
"obesity",
"diabetes mellitus",
"takes metformin",
... |
A 38-year-old man comes to the clinic complaining of recurrent abdominal pain for the past 2 months. He reports a gnawing, dull pain at the epigastric region that improves with oral ingestion. He has been taking calcium carbonate for the past few weeks; he claims that “it used to help a lot but it’s losing its effects ... | Lack of submucosal Brunner glands | {
"A": "Lack of goblet cells",
"B": "Lack of submucosal Brunner glands",
"C": "Peyer patches",
"D": "Pilcae circulares"
} | step1 | B | [
"year old man",
"clinic",
"recurrent abdominal pain",
"past",
"months",
"reports",
"gnawing",
"dull pain",
"epigastric region",
"improves",
"oral ingestion",
"taking calcium carbonate",
"past",
"weeks",
"used to help",
"lot",
"effects now",
"Laboratory testing",
"increased gastri... |
An investigator is studying the activity of N-terminal peptidase in eukaryotes. Sulfur-containing amino acids are radiolabeled and isolated using 35S. During translation of a non-mitochondrial human genome, some of the radiolabeled amino acids bind to the aminoacyl, peptidyl, and exit sites of a eukaryotic ribosome but... | 5'-CAU-3' | {
"A": "5'-UCA-3'",
"B": "5'-CAU-3'",
"C": "5'-ACA-3'",
"D": "5'-ACU-3'"
} | step1 | B | [
"investigator",
"studying",
"activity",
"N terminal peptidase",
"eukaryotes",
"Sulfur containing amino acids",
"radiolabeled",
"isolated using",
"translation",
"non mitochondrial human genome",
"radiolabeled amino acids bind",
"exit sites of",
"eukaryotic ribosome",
"others bind only",
"... |
A 3-day-old female newborn delivered vaginally at 36 weeks to a 27-year-old woman has generalized convulsions lasting 3 minutes. Prior to the event, she was lethargic and had difficulty feeding. The infant has two healthy older siblings and the mother's immunizations are up-to-date. The infant appears icteric. The infa... | Congenital Toxoplasma gondii infection | {
"A": "Congenital Treponema pallidum infection",
"B": "Congenital rubella infection",
"C": "Congenital parvovirus infection",
"D": "Congenital Toxoplasma gondii infection"
} | step1 | D | [
"3 day old female newborn delivered",
"36 weeks",
"27 year old woman",
"generalized convulsions lasting 3 minutes",
"event",
"lethargic",
"difficulty feeding",
"infant",
"two healthy older siblings",
"mother's immunizations",
"date",
"infant appears icteric",
"infant's weight",
"length",
... |
A 53-year-old man with a history of alcoholic liver cirrhosis was admitted to the hospital with ascites and general wasting. He has a history of 3-5 ounces of alcohol consumption per day for 20 years and 20-pack-year smoking history. Past medical history is significant for alcoholic cirrhosis of the liver, diagnosed 5 ... | Esophageal branch of left gastric vein – esophageal branches of azygos vein | {
"A": "Left branch of portal vein – inferior vena cava",
"B": "Esophageal branch of left gastric vein – esophageal branches of azygos vein",
"C": "Umbilical vein – superficial epigastric veins",
"D": "Superior and middle rectal vein – inferior rectal veins"
} | step1 | B | [
"year old man",
"history of alcoholic liver cirrhosis",
"admitted",
"hospital",
"ascites",
"general wasting",
"history",
"ounces",
"alcohol consumption",
"day",
"20 years",
"20 smoking history",
"Past medical history",
"significant",
"alcoholic cirrhosis of",
"liver",
"diagnosed 5 ye... |
A 21-year-old man presents to the emergency room complaining of pain upon urination and a watery discharge from his penis. It started a few days ago and has been getting progressively worse. His temperature is 98.0°F (36.7°C), blood pressure is 122/74 mmHg, pulse is 83/min, respirations are 14/min, and oxygen saturatio... | Chlamydia trachomatis | {
"A": "Chlamydia trachomatis",
"B": "Escherichia coli",
"C": "Staphylococcus saprophyticus",
"D": "Trichomonas vaginalis"
} | step2&3 | A | [
"21-year-old man presents",
"emergency room",
"pain",
"urination",
"watery discharge from",
"penis",
"started",
"few days",
"getting",
"worse",
"temperature",
"98",
"36",
"blood pressure",
"74 mmHg",
"pulse",
"83 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room... |
A 9-year-old girl is brought to the pediatrician by her mother who reports that the girl has been complaining of genital itching over the past few days. She states she has noticed her daughter scratching her buttocks and anus for the past week; however, now she is scratching her groin quite profusely as well. The mothe... | Enterobius vermicularis | {
"A": "Enterobius vermicularis",
"B": "Gardnerella vaginalis",
"C": "Giardia lamblia",
"D": "Herpes simplex virus"
} | step2&3 | A | [
"year old girl",
"brought",
"pediatrician",
"mother",
"reports",
"girl",
"complaining of genital itching",
"past",
"days",
"states",
"daughter scratching",
"buttocks",
"anus",
"past week",
"now",
"scratching",
"groin",
"well",
"mother",
"symptoms",
"to",
"worse",
"night",... |
Replication in eukaryotic cells is a highly organized and accurate process. The process involves a number enzymes such as primase, DNA polymerase, topoisomerase II, and DNA ligase. In which of the following directions is DNA newly synthesized? | 5' --> 3' | {
"A": "3' --> 5'",
"B": "5' --> 3'",
"C": "N terminus --> C terminus",
"D": "C terminus --> N terminus"
} | step1 | B | [
"Replication",
"eukaryotic cells",
"highly organized",
"accurate process",
"process",
"number enzymes",
"primase",
"DNA polymerase",
"topoisomerase II",
"DNA ligase",
"following directions",
"DNA newly synthesized"
] |
A researcher is designing an experiment to examine the toxicity of a new chemotherapeutic agent in mice. She splits the mice into 2 groups, one of which she exposes to daily injections of the drug for 1 week. The other group is not exposed to any intervention. Both groups are otherwise raised in the same conditions wit... | 12.5 | {
"A": "12.5",
"B": "13.7",
"C": "16.3",
"D": "23.0"
} | step1 | A | [
"researcher",
"designing",
"experiment to",
"toxicity",
"new chemotherapeutic agent",
"mice",
"splits",
"mice",
"2 groups",
"one",
"daily injections of",
"drug",
"1 week",
"group",
"not exposed",
"intervention",
"groups",
"raised",
"same conditions",
"same diet",
"One month l... |
A 24-year-old woman presents to the emergency department for evaluation of lower abdominal pain. She endorses 6 hours of progressively worsening pain. She denies any significant past medical history and her physical examination is positive for non-specific, diffuse pelvic discomfort. She denies the possibility of pregn... | Serum hCG | {
"A": "Surgical consultation",
"B": "Abdominal CT scan",
"C": "Serum hCG",
"D": "Admission and observation"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"evaluation",
"lower abdominal pain",
"6 hours",
"worsening pain",
"denies",
"significant past medical history",
"physical examination",
"positive",
"non-specific",
"diffuse pelvic discomfort",
"denies",
"possibility",
"pregnancy given",... |
A 32-year-old man presents to his primary care physician because he has been experiencing intermittent episodes of squeezing chest pain and tightness. He says that the pain is 8/10 in severity, radiates to his left arm, and does not appear to be associated with activity. The episodes started 3 months ago and have been ... | Adenosine | {
"A": "Adenosine",
"B": "Angiotensin",
"C": "Epinephrine",
"D": "Histamine"
} | step1 | A | [
"year old man presents",
"primary care physician",
"experiencing intermittent episodes of squeezing chest pain",
"tightness",
"pain",
"8/10",
"severity",
"radiates",
"left arm",
"not appear to",
"associated with activity",
"episodes started 3 months",
"occuring about twice per month",
"pas... |
A 63-year-old man who recently immigrated to the United States from Indonesia comes to the physician because of worsening shortness of breath and swollen extremities for the past 3 months. He has had a 4-kg (8.8-lb) weight loss and intermittent fevers over the last 6 months. Examination shows pitting pedal edema and ab... | Pericardial knock | {
"A": "Absent jugular venous pulse y descent",
"B": "Pericardial knock",
"C": "Pulsus parvus et tardus",
"D": "Fixed split second heart sound"
} | step1 | B | [
"63 year old man",
"recently",
"United States",
"Indonesia",
"physician",
"of worsening shortness",
"breath",
"swollen extremities",
"past 3 months",
"4 kg",
"8.8",
"weight loss",
"intermittent fevers",
"months",
"Examination shows pitting pedal",
"abdominal distension",
"pressure",
... |
A 30-year-old computer scientist receives negative feedback on a recent project from his senior associate. He is told sternly that he must improve his performance on the next project. Later that day, he yells at his intern, a college student, for not showing enough initiative, though he had voiced only satisfaction wit... | Displacement | {
"A": "Projection",
"B": "Displacement",
"C": "Countertransference",
"D": "Transference"
} | step2&3 | B | [
"30 year old computer scientist receives negative feedback",
"recent project",
"senior associate",
"performance",
"next project",
"Later",
"day",
"intern",
"college student",
"not showing",
"initiative",
"voiced only satisfaction",
"performance",
"point",
"following psychological defense... |
A 27-year-old diabetic male rushes to the emergency department after finding his blood glucose level to be 492 mg/dL which is reconfirmed in the ED. He currently does not have any complaints except for a mild colicky abdominal pain. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min, and blood p... | Papilledema | {
"A": "Hypoglycemia",
"B": "Pancreatitis",
"C": "Papilledema",
"D": "Peripheral edema"
} | step2&3 | C | [
"27 year old diabetic male rushes",
"emergency department",
"finding",
"blood glucose level to",
"mg/dL",
"ED",
"currently",
"not",
"complaints",
"mild colicky abdominal pain",
"temperature",
"98",
"respirations",
"min",
"pulse",
"67 min",
"blood pressure",
"88 mm Hg",
"Blood",
... |
A 70-year-old male presents to his primary care provider complaining of decreased sexual function. He reports that over the past several years, he has noted a gradual decline in his ability to sustain an erection. He used to wake up with erections but no longer does. His past medical history is notable for diabetes, hy... | Decrease cGMP degradation | {
"A": "Increase cAMP production",
"B": "Increase cGMP production",
"C": "Increase cGMP degradation",
"D": "Decrease cGMP degradation"
} | step1 | D | [
"70 year old male presents",
"primary care provider",
"decreased sexual function",
"reports",
"past",
"years",
"noted",
"gradual",
"ability to sustain",
"erection",
"used to wake up",
"erections",
"longer",
"past medical history",
"notable",
"diabetes",
"hyperlipidemia",
"prior myo... |
A 37-year-old man with Crohn disease is admitted to the hospital because of acute small bowel obstruction. Endoscopy shows a stricture in the terminal ileum. The ileum is surgically resected after endoscopic balloon dilatation fails to relieve the obstruction. Three years later, he returns for a follow-up examination. ... | Weakness and ataxia | {
"A": "Weakness and ataxia",
"B": "Hyperreflexia with tetany",
"C": "Pallor with koilonychia",
"D": "Dry skin and keratomalacia"
} | step1 | A | [
"year old man",
"Crohn disease",
"admitted",
"hospital",
"acute small",
"Endoscopy shows",
"stricture",
"terminal ileum",
"ileum",
"surgically resected",
"endoscopic balloon fails to relieve",
"obstruction",
"Three years later",
"returns",
"follow-up examination",
"takes",
"medicatio... |
A 52-year-old woman presents to the emergency department with breathlessness for the past 6 hours. She denies cough, nasal congestion or discharge, sneezing, blood in sputum, or palpitation. There is no past history of chronic respiratory or cardiovascular medical conditions, but she mentions that she has been experien... | Alveolar hyperventilation | {
"A": "Decreased alveolar-arterial oxygen tension gradient",
"B": "Secretion of vasodilating neurohumoral substances in pulmonary vascular bed",
"C": "Alveolar hyperventilation",
"D": "Increased right ventricular preload"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"breathlessness",
"past",
"hours",
"denies cough",
"nasal congestion",
"discharge",
"sneezing",
"blood",
"sputum",
"palpitation",
"past history of chronic respiratory",
"cardiovascular medical conditions",
"experiencing frequent cramps i... |
A 24-year-old woman comes to the physician because of progressively worsening episodes of severe, crampy abdominal pain and nonbloody diarrhea for the past 3 years. Examination of the abdomen shows mild distension and generalized tenderness. There is a fistula draining stool in the perianal region. Immunohistochemistry... | NF-κB | {
"A": "β-catenin",
"B": "NF-κB",
"C": "IL-10",
"D": "IL-1β"
} | step1 | B | [
"year old woman",
"physician",
"of",
"worsening episodes",
"severe",
"crampy abdominal pain",
"diarrhea",
"past",
"years",
"Examination of",
"abdomen shows mild distension",
"generalized tenderness",
"fistula draining stool",
"perianal region",
"Immunohistochemistry shows dysfunction",
... |
A 35-year-old man presents with yellow discoloration of his eyes and skin for the past week. He also says he has pain in the right upper quadrant for the past few days. He is fatigued constantly and has recently developed acute onset itching all over his body. The patient denies any allergies. Past medical history is s... | Primary sclerosing cholangitis | {
"A": "Hepatitis E",
"B": "Primary sclerosing cholangitis",
"C": "Hepatitis A",
"D": "Primary biliary cirrhosis"
} | step1 | B | [
"35 year old man presents",
"yellow",
"eyes",
"skin",
"past week",
"pain",
"right upper quadrant",
"past",
"days",
"fatigued constantly",
"recently",
"acute onset itching",
"body",
"patient denies",
"allergies",
"Past medical history",
"significant",
"ulcerative colitis diagnosed 2... |
A 42-year-old man presents to the physician with a painful ulcer in the mouth for 1 week. He has had similar episodes of ulcers over the past year. Every episode lasts about a week and heals without leaving a scar. He has also had similar ulcers on the scrotum, but the ulcers have left scars. He takes no medications. H... | Uveitis | {
"A": "Uveitis",
"B": "Deforming arthritis",
"C": "Gastrointestinal ulceration",
"D": "Pulmonary embolism"
} | step2&3 | A | [
"year old man presents",
"physician",
"painful ulcer",
"mouth",
"1 week",
"similar episodes of ulcers",
"past year",
"episode",
"week",
"heals",
"leaving",
"scar",
"similar ulcers",
"scrotum",
"ulcers",
"left scars",
"takes",
"medications",
"temperature",
"36",
"98",
"rest"... |
A 48-year-old man presents to the ER with a sudden-onset, severe headache. He is vomiting and appears confused. His wife, who accompanied him, says that he has not had any trauma, and that the patient has no relevant family history. He undergoes a non-contrast head CT that shows blood between the arachnoid and pia mate... | Arterial Vasospasm | {
"A": "Blindness",
"B": "Arterial Vasospasm",
"C": "Hemorrhagic shock",
"D": "Bacterial Meningitis"
} | step1 | B | [
"48 year old man presents",
"ER",
"sudden-onset",
"severe headache",
"vomiting",
"appears confused",
"wife",
"not",
"trauma",
"patient",
"relevant family history",
"non contrast head CT",
"shows blood",
"arachnoid",
"pia mater",
"most likely complication",
"condition"
] |
A 25-year-old man presents to his primary care physician for recurrent headaches. The patient states that the headaches have been going on for the past week, and he is concerned that he may have cancer. Based on his symptoms, he strongly believes that he needs further diagnostic workup. The patient works as a nurse at ... | Fluoxetine | {
"A": "Buspirone",
"B": "Clonazepam",
"C": "Fluoxetine",
"D": "Sumatriptan"
} | step2&3 | C | [
"year old man presents",
"primary care physician",
"recurrent headaches",
"patient states",
"headaches",
"past week",
"concerned",
"cancer",
"Based",
"symptoms",
"needs further diagnostic workup",
"patient works",
"nurse",
"local hospital",
"concerned",
"to",
"job",
"patient",
"c... |
A 54-year-old woman is brought to the emergency department by a nurse 30 minutes after receiving scheduled radiation therapy for papillary thyroid cancer. After the radioisotope was ingested, the physician realized that a much larger fixed dose was given instead of the appropriate dose based on radiation dosimetry. Whi... | Potassium iodide | {
"A": "Propylthiouracil",
"B": "Mercaptoethanesulfonate",
"C": "Potassium iodide",
"D": "Methimazole"
} | step1 | C | [
"54 year old woman",
"brought",
"emergency department",
"nurse 30 minutes",
"receiving scheduled radiation therapy",
"papillary thyroid cancer",
"radioisotope",
"ingested",
"physician",
"much larger fixed dose",
"given",
"appropriate dose based",
"radiation dosimetry",
"following pharmacot... |
A 37-year-old man is brought into the emergency department as he was wandering the streets naked with a sword. The patient had to be forcibly restrained by police and is currently combative. Upon calming the patient and obtaining further history, the patient states that he is being pursued and that he needs to kill the... | Fluphenazine | {
"A": "Lithium",
"B": "Fluoxetine",
"C": "Fluphenazine",
"D": "Valproic acid"
} | step2&3 | C | [
"year old man",
"brought",
"emergency department",
"wandering",
"streets naked",
"sword",
"patient",
"to",
"restrained by police",
"currently combative",
"calming",
"patient",
"obtaining further history",
"patient states",
"needs to kill",
"patient",
"given intramuscular",
"haloper... |
A 15-year-old boy is referred to a child psychologist because of worsening behavior and constant disruption in class. He has received multiple reprimands in the past 6 months for not doing the homework his teacher assigned, and he refuses to listen to the classroom instructions. Additionally, his teachers say he is ver... | Oppositional defiant disorder | {
"A": "Attention deficit hyperactivity disorder",
"B": "Conduct disorder",
"C": "Major depressive disorder",
"D": "Oppositional defiant disorder"
} | step2&3 | D | [
"year old boy",
"referred",
"child psychologist",
"worsening behavior",
"constant disruption",
"class",
"received multiple",
"past 6 months",
"not",
"homework",
"teacher assigned",
"refuses to listen",
"classroom instructions",
"teachers",
"very",
"blames",
"children",
"not letting... |
A 33-year-old HIV-positive male is seen in clinic for follow-up care. When asked if he has been adhering to his HIV medications, the patient exclaims that he has been depressed, thus causing him to not take his medication for six months. His CD4+ count is now 33 cells/mm3. What medication(s) should he take in addition ... | Azithromycin and trimethoprim-sulfamethoxazole | {
"A": "Fluconazole",
"B": "Azithromycin and trimethoprim-sulfamethoxazole",
"C": "Azithromycin and fluconazole",
"D": "Azithromycin, dapsone, and fluconazole"
} | step2&3 | B | [
"year old HIV-positive male",
"seen in clinic",
"follow-up care",
"adhering",
"HIV medications",
"patient",
"depressed",
"causing",
"to not take",
"medication",
"six months",
"CD4",
"count",
"now",
"cells/mm3",
"medication",
"take in addition to",
"anti-retroviral therapy"
] |
A 25-year-old G1P0 at 20 weeks of gestation woman arrives at a prenatal appointment complaining of pelvic pressure. She has had an uncomplicated pregnancy thus far. She takes prenatal vitamins and eats a well-balanced diet. Her medical history is significant for major depressive disorder that has been well-controlled o... | Vaginal progesterone | {
"A": "Metformin",
"B": "Metronidazole",
"C": "Prednisone",
"D": "Vaginal progesterone"
} | step2&3 | D | [
"25 year old",
"20 weeks of gestation woman",
"prenatal appointment",
"pelvic pressure",
"uncomplicated pregnancy",
"far",
"takes prenatal vitamins",
"eats",
"well balanced diet",
"medical history",
"significant",
"major depressive disorder",
"well-controlled",
"citalopram",
"mother",
... |
A 31-year-old woman comes to the emergency department requesting an abortion. She hears voices telling her that she needs ""to undergo a cleanse."" She experiences daytime sleepiness because she repeatedly wakes up at night. She says that she is no longer interested in activities that she used to enjoy. About 2 months ... | Clozapine therapy | {
"A": "Clozapine therapy",
"B": "Electroconvulsive therapy",
"C": "Clomipramine therapy",
"D": "Lithium therapy"
} | step2&3 | A | [
"31 year old woman",
"emergency department requesting",
"abortion",
"hears voices",
"needs",
"to",
"cleanse",
"experiences daytime sleepiness",
"repeatedly wakes up",
"night",
"longer interested",
"activities",
"used",
"2 months",
"psychiatrist switched",
"medication",
"aripiprazole"... |
A 34-year-old man comes to the physician because of foul-smelling diarrhea, fatigue, and bloating for 6 months. During this time, he has had a 5-kg (11-lb) weight loss without a change in diet. He has type 1 diabetes mellitus that is well-controlled with insulin. Examination shows conjunctival pallor and inflammation o... | Avoidance of certain types of cereal grains | {
"A": "Treatment with ceftriaxone",
"B": "Avoidance of certain types of cereal grains",
"C": "Reduced intake of milk proteins",
"D": "Supplemention of pancreatic enzymes\n\""
} | step1 | B | [
"year old man",
"physician",
"smelling diarrhea",
"fatigue",
"bloating",
"months",
"time",
"5 kg",
"weight loss",
"change",
"diet",
"type 1 diabetes mellitus",
"well-controlled",
"insulin",
"Examination shows conjunctival pallor",
"inflammation of the corners of",
"mouth",
"abdomen... |
A 55-year-old man presents to his primary care physician for trouble swallowing. The patient claims that he used to struggle when eating food if he did not chew it thoroughly, but now he occasionally struggles with liquids as well. He also complains of a retrosternal burning sensation whenever he eats. He also claims t... | Endoscopy | {
"A": "Barium swallow",
"B": "Endoscopy",
"C": "Manometry",
"D": "Omeprazole trial"
} | step2&3 | B | [
"55 year old man presents",
"primary care physician",
"swallowing",
"patient",
"used",
"eating food",
"not chew",
"thoroughly",
"now",
"occasionally",
"liquids",
"well",
"retrosternal burning sensation",
"eats",
"feels",
"throat burns",
"goes",
"bed",
"patient",
"complaints",
... |
A 63-year-old man comes to the physician because of a 2-day history of fever and blood-tinged sputum. He has also had a productive cough for 1 year and has had 3 episodes of sinusitis during this time. Physical examination shows palpable erythematous skin lesions over his hands and feet that do not blanch on pressure. ... | Elevated c-ANCA titers | {
"A": "Elevated anti-Smith titers",
"B": "Elevated serum IgA titers",
"C": "Positive tuberculin test",
"D": "Elevated c-ANCA titers"
} | step1 | D | [
"63 year old man",
"physician",
"2-day history",
"fever",
"blood-tinged sputum",
"productive cough",
"year",
"3 episodes of sinusitis",
"time",
"Physical examination shows palpable erythematous skin lesions",
"hands",
"feet",
"not blanch",
"pressure",
"ulcerations",
"nasopharyngeal muc... |
A 35-year-old man is brought into the emergency department by emergency medical services with his right hand wrapped in bloody bandages. The patient states that he is a carpenter and was cutting some wood for a home renovation project when he looked away and injured one of his digits with a circular table saw. He state... | In a sterile plastic bag wrapped in saline moistened gauze on ice | {
"A": "Wrapped in a towel",
"B": "In a sterile bag of tap water",
"C": "In a sterile plastic bag wrapped in saline moistened gauze",
"D": "In a sterile plastic bag wrapped in saline moistened gauze on ice"
} | step2&3 | D | [
"35 year old man",
"brought",
"emergency department",
"emergency medical services",
"right hand wrapped",
"bloody bandages",
"patient states",
"carpenter",
"cutting",
"wood",
"home",
"project",
"looked",
"injured one",
"digits",
"circular table saw",
"states",
"index finger",
"sl... |
A 22-year-old female presents to your office with gas, abdominal distention, and explosive diarrhea. She normally enjoys eating cheese but has been experiencing these symptoms after eating it for the past few months. She has otherwise been entirely well except for a few days of nausea, diarrhea, and vomiting earlier in... | Decreased stool pH | {
"A": "Decreased stool pH",
"B": "Positive fecal smear for leukocytes",
"C": "Positive stool culture for Rotavirus",
"D": "Positive stool culture for T. whippelii"
} | step1 | A | [
"year old female presents",
"office",
"gas",
"abdominal distention",
"explosive diarrhea",
"eating cheese",
"experiencing",
"symptoms",
"eating",
"past",
"months",
"well",
"days",
"nausea",
"diarrhea",
"vomiting earlier",
"year",
"recovered",
"treatment",
"following laboratory ... |
A 12-year-old boy is brought to the emergency department with a hot, swollen, and painful knee. He was playing with his friends and accidentally bumped into one of them with his knee prior to presentation. His medical history is significant for an immunodeficiency syndrome, and he has been treated with long courses of ... | Protein C | {
"A": "Factor VIII",
"B": "Platelet factor 4",
"C": "Protein C",
"D": "von Willebrand factor"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"hot",
"swollen",
"painful knee",
"playing",
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"one",
"knee prior to presentation",
"medical history",
"significant",
"immunodeficiency syndrome",
"treated with long courses",
"antibiotics",
"multiple infections",
"mother",
... |
A 36-year-old woman comes to the physician for an annual pelvic examination and Pap smear. Her last Pap smear was 3 years ago. She has been sexually active with multiple male partners and takes an oral contraceptive. She has smoked one pack of cigarettes daily for 10 years. Pelvic examination shows no abnormalities. A ... | Condylomata acuminata | {
"A": "Trichomoniasis",
"B": "Condylomata acuminata",
"C": "Syphilitic chancre",
"D": "Bacterial vaginosis"
} | step1 | B | [
"36 year old woman",
"physician",
"annual pelvic examination",
"Pap smear",
"last Pap smear",
"3 years",
"sexually active",
"multiple male partners",
"takes",
"oral contraceptive",
"smoked one pack",
"cigarettes daily",
"10 years",
"Pelvic examination shows",
"abnormalities",
"photomic... |
A 4-year-old boy is brought to the physician by his parents because of concerns about his behavior during the past year. His parents report that he often fails to answer when they call him and has regular unprovoked episodes of crying and screaming. At kindergarten, he can follow and participate in group activities, bu... | Hearing impairment | {
"A": "Selective mutism",
"B": "Hearing impairment",
"C": "Specific-learning disorder",
"D": "Conduct disorder"
} | step2&3 | B | [
"4 year old boy",
"brought",
"physician",
"parents",
"concerns",
"behavior",
"past year",
"parents report",
"often fails to answer",
"call",
"regular",
"episodes of crying",
"screaming",
"kindergarten",
"follow",
"group activities",
"not follow",
"teacher's instructions",
"given"... |
A 30-year-old woman presents to her primary care physician for evaluation of irregular and heavy periods. She also complains of recent fatigue, joint pain, and constipation. Physical exam is notable for thinning eyebrows and recent weight gain. Her temperature is 98.0°F (36.7°C), blood pressure is 140/90 mmHg, 51/min, ... | Thyroid lymphoma | {
"A": "Papillary carcinoma",
"B": "Parathyroid adenoma",
"C": "Subacute thyroiditis",
"D": "Thyroid lymphoma"
} | step2&3 | D | [
"30 year old woman presents",
"primary care physician",
"evaluation",
"irregular",
"heavy periods",
"recent fatigue",
"joint pain",
"constipation",
"Physical exam",
"notable",
"thinning eyebrows",
"recent weight gain",
"temperature",
"98",
"36",
"blood pressure",
"90 mmHg",
"min",
... |
A 9-year-old African-American boy is brought to the physician by his mother because of an itchy rash on the right side of his scalp and progressive loss of hair for 1 month. He has no history of serious illness. His younger sibling was treated for pediculosis capitis 3 months ago. The boy attends elementary school, but... | Oral griseofulvin | {
"A": "Shampoo containing zinc-pyrithone",
"B": "Topical mupirocin",
"C": "Oral griseofulvin",
"D": "Topical permethrin"
} | step2&3 | C | [
"year old African-American boy",
"brought",
"physician",
"mother",
"itchy rash",
"right side",
"scalp",
"progressive loss of hair",
"1 month",
"history",
"serious illness",
"younger sibling",
"treated",
"pediculosis capitis",
"months",
"boy attends elementary school",
"not",
"week"... |
A 13-year-old boy is brought to the physician by his mother because she is concerned about her son's behavior. She reports that he has been wearing her dresses at home and asks to be called Lilly. He also stopped going to swim class because he “doesn't feel comfortable in swim trunks.” Since starting puberty about a ye... | Gender dysphoria | {
"A": "Gender nonconformity",
"B": "Body dysmorphic disorder",
"C": "Gender dysphoria",
"D": "Fetishistic disorder"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"mother",
"concerned",
"son's behavior",
"reports",
"dresses at home",
"to",
"called",
"stopped",
"to swim class",
"feel",
"swim trunks",
"starting puberty",
"year",
"not",
"friends",
"teachers report",
"bullied at school",
"academic pe... |
A 42-year-old woman comes to her primary care physician with 2 days of fever and malaise. She also says that she has a painful red lesion on her left hand that she noticed after shucking oysters at a recent family reunion. Physical exam reveals a well-demarcated swollen, tender, warm, red lesion on her left hand. Press... | Gram-negative facultative anaerobe | {
"A": "Gram-negative aerobe",
"B": "Gram-negative anaerobe",
"C": "Gram-negative facultative anaerobe",
"D": "Gram-positive clusters"
} | step1 | C | [
"year old woman",
"primary care physician",
"2 days",
"fever",
"malaise",
"painful red lesion",
"left",
"oysters",
"recent family reunion",
"Physical exam reveals",
"well",
"swollen",
"tender",
"warm",
"red lesion",
"left",
"lesion causes",
"small",
"purulent drainage",
"materi... |
A 10-year-old boy is brought to the emergency room after a fall from a horse. He has severe pain in his right forearm. He has a history of asthma and atopic dermatitis. His current medications include an albuterol inhaler and hydrocortisone cream. Examination shows an open fracture of the right forearm and no other inj... | Administer intramuscular epinephrine | {
"A": "Administer intravenous diphenhydramine",
"B": "Administer vancomycin and piperacillin-tazobactam",
"C": "Administer intramuscular epinephrine",
"D": "Endotracheal intubation"
} | step2&3 | C | [
"A 10 year old boy",
"brought",
"emergency room",
"fall",
"horse",
"severe pain in",
"right forearm",
"history of asthma",
"atopic dermatitis",
"current medications include",
"albuterol inhaler",
"hydrocortisone cream",
"Examination shows",
"open fracture of",
"right forearm",
"injurie... |
A 25-year-old man presents to the emergency department after numerous episodes of vomiting. The patient states that he thinks he ‘ate something weird’ and has been vomiting for the past 48 hours. He says that he came to the hospital because the last few times he "threw up blood". He is hypotensive with a blood pressure... | Mallory-Weiss tear | {
"A": "Boerhaave syndrome",
"B": "Gastric ulcer",
"C": "Hiatal hernia",
"D": "Mallory-Weiss tear"
} | step1 | D | [
"year old man presents",
"emergency department",
"numerous episodes of vomiting",
"patient states",
"thinks",
"ate",
"vomiting",
"past 48 hours",
"hospital",
"last",
"times",
"threw",
"blood",
"hypotensive",
"blood pressure",
"90 55 mm Hg",
"pulse",
"min",
"opening",
"intraveno... |
A child is born by routine delivery and quickly develops respiratory distress. He is noted to have epicanthal folds, low-set ears that are pressed against his head, widely set eyes, a broad, flat nose, clubbed fleet, and a receding chin. The mother had one prenatal visit, at which time the routine ultrasound revealed a... | Bilateral renal agenesis | {
"A": "An extra 18th chromosome",
"B": "Bilateral renal agenesis",
"C": "Unilateral renal agenesis",
"D": "A microdeletion in chromosome 22"
} | step1 | B | [
"child",
"born",
"routine delivery",
"respiratory distress",
"noted to",
"epicanthal folds",
"low-set ears",
"head",
"set eyes",
"broad",
"flat nose",
"clubbed fleet",
"receding chin",
"mother",
"one prenatal visit",
"time",
"routine ultrasound revealed",
"amniotic fluid index",
... |
A 27-year-old primigravid woman at 32 weeks' gestation comes to the physician for a prenatal visit. She has had swollen legs, mild shortness of breath, and generalized fatigue for the past 2 weeks. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F), pulse is 93/min, respirations a... | Reassurance and monitoring
" | {
"A": "Urinalysis",
"B": "Lower extremity doppler",
"C": "Ventilation-perfusion scan",
"D": "Reassurance and monitoring\n\""
} | step2&3 | D | [
"27 year old primigravid woman",
"weeks",
"gestation",
"physician",
"prenatal visit",
"swollen legs",
"mild shortness of breath",
"generalized fatigue",
"past 2 weeks",
"Medications include iron supplements",
"multivitamin",
"temperature",
"pulse",
"min",
"respirations",
"20 min",
"b... |
A 34-year-old primigravida was brought to an obstetric clinic with a chief complaint of painless vaginal bleeding. She was diagnosed with placenta praevia and transfused with 2 units of whole blood. Five hours after the transfusion, she developed a fever and chills. How could the current situation be prevented? | Transfusing leukocyte reduced blood products | {
"A": "Performing Coombs test before transfusion",
"B": "Administering prophylactic immunoglobulins",
"C": "Transfusing leukocyte reduced blood products",
"D": "ABO grouping and Rh typing before transfusion"
} | step1 | C | [
"year old primigravida",
"brought",
"obstetric clinic",
"chief complaint",
"painless vaginal bleeding",
"diagnosed",
"placenta praevia",
"transfused",
"units of whole blood",
"Five hours",
"transfusion",
"fever",
"chills",
"current",
"prevented"
] |
A previously healthy 6-year-old boy is brought to the physician because of a 3-day history of progressive rash. The rash started on his face and now involves the entire body. For the past week, he has had a cough and a runny nose. He is visiting from the Philippines with his family. He is in first grade and spends his ... | Measles-specific IgM antibodies | {
"A": "Rapid plasma reagin",
"B": "Tzanck smear",
"C": "Measles-specific IgM antibodies",
"D": "Rapid antigen detection testing"
} | step2&3 | C | [
"healthy",
"year old boy",
"brought",
"physician",
"3-day history",
"progressive rash",
"rash started",
"face",
"now",
"entire body",
"past week",
"cough",
"runny nose",
"visiting",
"Philippines",
"family",
"first grade",
"spends",
"afternoons",
"school program",
"Immunizatio... |
An investigator is studying bacterial toxins in a nonpathogenic bacterial monoculture that has been inoculated with specific bacteriophages. These phages were previously cultured in a toxin-producing bacterial culture. After inoculation, a new toxin is isolated from the culture. Genetic sequencing shows that the bacter... | Corynebacterium diphtheriae | {
"A": "Staphylococcus aureus",
"B": "Corynebacterium diphtheriae",
"C": "Haemophilus influenzae",
"D": "Neisseria meningitidis"
} | step1 | B | [
"investigator",
"studying bacterial toxins",
"inoculated",
"specific bacteriophages",
"phages",
"cultured",
"toxin",
"bacterial culture",
"inoculation",
"new toxin",
"isolated",
"culture",
"Genetic sequencing shows",
"bacteria",
"viral genetic information",
"including",
"gene",
"to... |
A 35-year-old patient is brought into the emergency department post motor vehicle crash. Stabilization of the patient in the trauma bay requires endotracheal intubation. The patient has a laceration on the femoral artery from shrapnel and seems to have lost large quantities of blood. The patient is transfused with 13 u... | Fresh frozen plasma and platelets | {
"A": "Fresh frozen plasma and platelets",
"B": "Dextrose",
"C": "Normal saline",
"D": "Cryoprecipitate"
} | step2&3 | A | [
"35 year old patient",
"brought",
"emergency department post motor vehicle crash",
"Stabilization",
"patient",
"trauma bay",
"endotracheal intubation",
"patient",
"laceration",
"femoral artery",
"shrapnel",
"to",
"lost large quantities",
"blood",
"patient",
"transfused",
"units",
"... |
A 42-year-old woman comes to the physician because of urinary leakage over the last year. She reports involuntarily losing small amounts of urine after experiencing a sudden need to void. She has difficulty making it to the bathroom in time, and only feels comfortable going out into public if she has documented the loc... | Antagonism of muscarinic M3 receptors | {
"A": "Antagonism of muscarinic M3 receptors",
"B": "Antagonism of beta-3 adrenergic receptors",
"C": "Agonism of beta-2 adrenergic receptors",
"D": "Agonism of muscarinic M2 receptors"
} | step1 | A | [
"year old woman",
"physician",
"of urinary leakage",
"year",
"reports",
"small amounts",
"urine",
"experiencing",
"sudden need",
"void",
"difficulty making",
"bathroom",
"time",
"only feels",
"out",
"documented",
"location",
"restrooms",
"begun to wake up",
"night to",
"sympt... |
Prior to undergoing a total knee arthroplasty, a 62-year-old man with coronary artery disease undergoes diagnostic cardiac catheterization. The catheter is inserted via the femoral artery and then advanced to the ascending aorta. Pressure tracing of the catheter is shown. The peak marked by the arrow is most likely cau... | Closure of the aortic valve | {
"A": "Right atrial relaxation",
"B": "Closure of the aortic valve",
"C": "Right ventricular contraction",
"D": "Left atrial contraction"
} | step1 | B | [
"total knee arthroplasty",
"62 year old man",
"coronary artery disease",
"diagnostic cardiac",
"catheter",
"inserted",
"femoral artery",
"then advanced",
"ascending aorta",
"Pressure",
"catheter",
"shown",
"peak marked",
"arrow",
"most likely caused"
] |
A 43-year-old woman comes to the physician because of a fever, nausea, and a nonproductive cough for 7 days. During this period, she has had headaches, generalized fatigue, and muscle and joint pain. She has also had increasing shortness of breath for 2 days. She has type 2 diabetes mellitus and osteoarthritis of her l... | Mycoplasma pneumoniae | {
"A": "Klebsiella pneumoniae",
"B": "Haemophilus influenzae",
"C": "Staphylococcus aureus",
"D": "Mycoplasma pneumoniae"
} | step2&3 | D | [
"year old woman",
"physician",
"fever",
"nausea",
"nonproductive cough",
"7 days",
"period",
"headaches",
"generalized fatigue",
"muscle",
"joint pain",
"increasing shortness of breath",
"2 days",
"type 2 diabetes mellitus",
"osteoarthritis of",
"left knee",
"Current medications incl... |
A 4-year-old boy is brought by his mother to the emergency room after the child was bitten by a rattlesnake one hour prior to presentation. The child was reportedly playing in the backyard alone when his mother heard the child scream. She rushed out to her child and found a snake with a rattle on its tail slithering aw... | Antibody-antigen complex deposition | {
"A": "Antibodies directed against cell membrane antigens",
"B": "Antibodies directed against cell surface receptors",
"C": "Antibody-antigen complex deposition",
"D": "IgE-mediated mast cell degranulation"
} | step1 | C | [
"4 year old boy",
"brought",
"mother",
"emergency room",
"child",
"bitten",
"rattlesnake one hour",
"presentation",
"child",
"playing",
"backyard alone",
"mother heard",
"child scream",
"rushed out",
"child",
"found",
"snake",
"rattle",
"tail",
"child",
"examination",
"chil... |
A 78-year-old woman is brought by her grandson to the urgent care clinic following a fall. He states that he was in the kitchen making lunch when he heard a thud in the living room. When he ran into the room, he found the patient conscious but lying on the floor. The patient says she remembers getting up to go to the b... | Decreased fractional excretion of sodium | {
"A": "Decreased fractional excretion of sodium",
"B": "Decreased hemoglobin",
"C": "Increased fractional excretion of urea",
"D": "New ST-elevation on electrocardiogram"
} | step2&3 | A | [
"year old woman",
"brought",
"grandson",
"urgent care clinic following",
"fall",
"states",
"kitchen making lunch",
"heard",
"living room",
"ran",
"room",
"found",
"patient conscious",
"lying",
"floor",
"patient",
"remembers getting",
"go",
"bathroom",
"feeling lightheaded",
"... |
A previously healthy 66-year-old woman comes to the physician because of a 3-day history of fever, cough, and right-sided chest pain. Her temperature is 38.8°C (101.8°F) and respirations are 24/min. Physical examination shows dullness to percussion, increased tactile fremitus, and egophony in the right lower lung field... | Consolidation of a lung segment | {
"A": "Fluid in the pleural space",
"B": "Fluid in the interstitial space",
"C": "Consolidation of a lung segment",
"D": "Air in the pleural space\n\""
} | step1 | C | [
"healthy 66 year old woman",
"physician",
"3-day history",
"fever",
"cough",
"right-sided chest pain",
"temperature",
"respirations",
"min",
"Physical examination shows dullness",
"percussion",
"increased tactile fremitus",
"egophony",
"right lower lung field",
"examination shows",
"ab... |
A 12-year-old boy is found on a routine auditory screening to have mild high frequency hearing impairment. On exam, he has no ear pain, no focal neurological deficits, and no cardiac murmurs. He has not had any recent illness. Laboratory studies show:
Serum:
Creatinine: 0.7 mg/dl
Protein: 3.8 g/dl
Antistreptolysin O t... | “Basket-weave” pattern of basement membrane on electron microscopy | {
"A": "“Basket-weave” pattern of basement membrane on electron microscopy",
"B": "Crescent-moon shapes on light microscopy",
"C": "Large eosinophilic nodular lesions on light microscopy",
"D": "Thickened “tram-track” appearance of basement membrane on electron microscopy"
} | step1 | A | [
"year old boy",
"found",
"routine auditory screening to",
"mild high frequency hearing impairment",
"exam",
"ear pain",
"focal neurological deficits",
"cardiac murmurs",
"not",
"recent illness",
"Laboratory studies show",
"Serum",
"Creatinine",
"0.7 mg/dl Protein",
"3",
"g/dl Antistrep... |
A 61-year-old woman comes to the physician because of a 1-week history of dizziness, nausea, vomiting, and repeated falls. Neurologic examination shows past-pointing on a finger-nose test. She has a broad-based gait. Ophthalmologic exam shows rhythmic leftward movement of the globes. A serum antibody assay is positive ... | Breast cancer | {
"A": "Ovarian teratoma",
"B": "Breast cancer",
"C": "Thymoma",
"D": "Small cell lung cancer"
} | step1 | B | [
"61 year old woman",
"physician",
"1-week history",
"dizziness",
"nausea",
"vomiting",
"repeated falls",
"Neurologic examination shows past pointing",
"a finger-nose test",
"broad-based gait",
"Ophthalmologic exam shows rhythmic",
"movement",
"globes",
"serum antibody assay",
"positive",... |
A 42-year-old man is brought to the emergency department by the police after he was involved in a physical altercation at a friend’s home. Upon physical examination, the patient is disheveled. He is very agitated and actively strikes out at nurses and other hospital staff. A decision is made to place him in restraints.... | Sudden cardiac arrest | {
"A": "Malignant hyperthermia",
"B": "Respiratory depression",
"C": "Seizure",
"D": "Sudden cardiac arrest"
} | step1 | D | [
"year old man",
"brought",
"emergency department",
"police",
"involved",
"physical altercation",
"friends home",
"physical examination",
"patient",
"very agitated",
"strikes out",
"nurses",
"hospital staff",
"decision",
"made to place",
"restraints",
"Head",
"eyes",
"ears",
"no... |
A 32-year-old man is brought to the emergency department 15 minutes after falling 7 feet onto a flat-top wooden post. On arrival, he is in severe pain and breathing rapidly. His pulse is 135/min, respirations are 30/min, and blood pressure is 80/40 mm Hg. There is an impact wound in the left fourth intercostal space at... | Hemothorax | {
"A": "Cardiac tamponade",
"B": "Tension pneumothorax",
"C": "Flail chest",
"D": "Hemothorax"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department 15 minutes",
"falling",
"feet",
"flat top wooden post",
"arrival",
"severe pain",
"breathing rapidly",
"pulse",
"min",
"respirations",
"30/min",
"blood pressure",
"80 40 mm Hg",
"impact wound",
"left fourth intercostal space",
"midax... |
A 66-year-old man is transferred to from another hospital after 3 days of progressively severe headache, vomiting, low-grade fever, and confusion. According to his partner, the patient has been dealing with some memory loss and complaining about headaches for the past 2 weeks. He has a history of interstitial pulmonary... | Aspect: cloudy, opening pressure: ↑, cell count: ↑ lymphocytes, protein: ↑, glucose: ↓ | {
"A": "Aspect: xanthochromic, opening pressure: normal, cell count: ↑ red blood cells, protein: normal, glucose: normal",
"B": "Aspect: cloudy, opening pressure: ↑, cell count: ↑ neutrophils, protein: ↑, glucose: ↓",
"C": "Aspect: clear, opening pressure: normal, cell count: ↑ lymphocytes, protein: normal, gluco... | step2&3 | D | [
"66 year old man",
"transferred to",
"hospital",
"3 days",
"severe headache",
"vomiting",
"low-grade fever",
"confusion",
"partner",
"patient",
"memory loss",
"headaches",
"past 2 weeks",
"history of interstitial pulmonary disease",
"required lung transplantation",
"years",
"admissio... |
A 56-year-old woman comes to the emergency department because of worsening pain and swelling in her right knee for 3 days. She underwent a total knee arthroplasty of her right knee joint 5 months ago. The procedure and immediate aftermath were uneventful. She has hypertension and osteoarthritis. Current medications inc... | Staphylococcus epidermidis | {
"A": "Pseudomonas aeruginosa",
"B": "Staphylococcus epidermidis",
"C": "Staphylococcus aureus",
"D": "Streptococcus agalactiae"
} | step2&3 | B | [
"year old woman",
"emergency department",
"worsening pain",
"swelling",
"right",
"3 days",
"total knee arthroplasty",
"right",
"joint",
"months",
"procedure",
"immediate",
"hypertension",
"osteoarthritis",
"Current medications include glucosamine",
"amlodipine",
"meloxicam",
"tempe... |
A 52-year-old woman presents to the urgent care center with several hours of worsening abdominal discomfort that radiates to the back. The patient also complains of malaise, chills, nausea, and vomiting. Social history is notable for alcoholism. On physical exam, she is febrile to 39.5°C (103.1℉), and she is diffusely ... | Gallstone pancreatitis | {
"A": "Cholelithiasis",
"B": "Gallstone pancreatitis",
"C": "Choledocholithiasis",
"D": "Ascending cholangitis"
} | step2&3 | B | [
"year old woman presents",
"urgent care center",
"several hours",
"worsening abdominal discomfort",
"radiates",
"back",
"patient",
"malaise",
"chills",
"nausea",
"vomiting",
"Social history",
"notable",
"alcoholism",
"physical exam",
"febrile",
"tender",
"abdominal palpation",
"v... |
A 32-year-old man and his wife are sent to a fertility specialist after trying to conceive for several years without success. They have had unprotected sex several times a week. He has no history of a serious illness and does not take any medications. There are no concerns about his libido or erections. His female part... | Microsurgical varicocelectomy | {
"A": "Intracytoplasmic sperm injection",
"B": "Ligation of processus vaginalis",
"C": "Microsurgical varicocelectomy",
"D": "No therapy at this time"
} | step2&3 | C | [
"year old man",
"wife",
"sent",
"fertility specialist",
"to",
"years",
"success",
"unprotected sex",
"times",
"week",
"history",
"serious illness",
"not take",
"medications",
"concerns",
"libido",
"erections",
"female partner",
"not",
"contraceptive medication",
"child",
"p... |
An 80-year-old man presents to the emergency department because of gnawing substernal chest pain that started an hour ago and radiates to his neck and left jaw. A 12-lead ECG is obtained and shows ST-segment elevation with newly developing Q waves. He is admitted for treatment. 4 days after hospitalization he suddenly ... | Compression of heart chambers by blood in the pericardial space | {
"A": "Acute pulmonary edema causing right heart failure",
"B": "Arrhythmia caused by ventricular fibrillation",
"C": "Compression of heart chambers by blood in the pericardial space",
"D": "Pericardial inflammation"
} | step1 | C | [
"80 year old man presents",
"emergency department",
"gnawing substernal chest pain",
"started",
"hour",
"radiates",
"neck",
"left jaw",
"12-lead ECG",
"obtained",
"shows ST-segment elevation",
"newly",
"Q waves",
"admitted",
"treatment",
"4 days",
"hospitalization",
"altered mental... |
A 72-year-old man is admitted to the hospital with productive cough and fever. A chest radiograph is obtained and shows lobar consolidation. The patient is diagnosed with pneumonia. He has a history of penicillin allergy. The attending physician orders IV levofloxacin as empiric therapy. On morning rounds the next day,... | Switch the patient back to levofloxacin and discuss the error with the patient | {
"A": "Continue with ceftriaxone and add azithromycin as inpatient empiric pneumonia therapy",
"B": "Switch the patient to oral azithromycin in preparation for discharge and home therapy",
"C": "Administer diphenhydramine as prophylaxis against allergic reaction",
"D": "Switch the patient back to levofloxacin ... | step1 | D | [
"72 year old man",
"admitted",
"hospital",
"productive cough",
"fever",
"chest radiograph",
"obtained",
"shows lobar consolidation",
"patient",
"diagnosed",
"pneumonia",
"history",
"penicillin allergy",
"attending physician orders IV levofloxacin",
"empiric therapy",
"morning rounds",
... |
A 49-year-old man is diagnosed with hypertension. He has asthma. The creatinine and potassium levels are both slightly elevated. Which of the following anti-hypertensive drugs would be appropriate in his case? | Amlodipine | {
"A": "Amlodipine",
"B": "Propranolol",
"C": "Hydrochlorothiazide (HCT)",
"D": "Spironolactone"
} | step1 | A | [
"year old man",
"diagnosed",
"hypertension",
"asthma",
"creatinine",
"potassium levels",
"slightly elevated",
"following anti-hypertensive drugs",
"appropriate",
"case"
] |
A 5-year-old girl is brought to the physician because of watery discharge from her right eye for 2 weeks. She and her parents, who are refugees from Sudan, arrived in Texas a month ago. Her immunization status is not known. She is at the 25th percentile for weight and the 50th percentile for height. Her temperature is ... | Trachoma conjunctivitis | {
"A": "Angular conjunctivitis",
"B": "Acute hemorrhagic conjuctivitis",
"C": "Neisserial conjunctivitis",
"D": "Trachoma conjunctivitis"
} | step2&3 | D | [
"5 year old girl",
"brought",
"physician",
"of watery discharge from",
"right eye",
"2 weeks",
"parents",
"refugees",
"Sudan",
"arrived",
"Texas",
"month",
"immunization status",
"not known",
"percentile",
"weight",
"50th percentile",
"height",
"temperature",
"pulse",
"90 min... |
A 52-year-old Caucasian man with hypertension comes to the physician because of frequent urination and increased thirst. He drinks 4 oz of alcohol daily and has smoked 1 pack of cigarettes daily for the past 30 years. He is 180 cm (5 ft 10 in) tall and weighs 106 kg (233 lb); BMI is 33 kg/m2. His blood pressure is 130/... | High calorie diet | {
"A": "Alcohol consumption",
"B": "High calorie diet",
"C": "Smoking history",
"D": "HLA-DR4 status"
} | step1 | B | [
"year old Caucasian man",
"hypertension",
"physician",
"frequent urination",
"increased thirst",
"drinks 4 oz",
"alcohol daily",
"smoked 1 pack",
"cigarettes daily",
"past 30 years",
"5 ft 10",
"tall",
"kg",
"BMI",
"kg/m2",
"blood pressure",
"80 mm Hg",
"Laboratory studies show a h... |
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