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 45-year-old man presents for his annual checkup. The patient has a past medical history of diabetes mellitus (DM) type 2 that is well-controlled with diet. In addition, he was admitted to this hospital 1-year ago for a myocardial infarction (MI). The patient reports a 40-pack-year smoking history. However, after his ... | Maintenance | {
"A": "Maintenance",
"B": "Precontemplation",
"C": "Preparation",
"D": "Action"
} | step2&3 | A | [
"year old man presents",
"annual checkup",
"patient",
"past medical history of diabetes mellitus",
"type 2",
"well",
"diet",
"addition",
"admitted to this hospital",
"year",
"myocardial infarction",
"patient reports",
"40 pack-year smoking history",
"MI",
"doctors informed",
"about",
... |
One week after discharge from the neonatal intensive care unit to a regular pediatric ward, a 1450-g (3-lb 1-oz) male infant has respiratory distress and wheezing. After birth, the patient was intubated and mechanically ventilated for 3 weeks because of hypoxia. He required a 60% fraction of inspired oxygen to achieve ... | Bronchopulmonary dysplasia | {
"A": "Bronchiolitis obliterans",
"B": "Bronchopulmonary dysplasia",
"C": "Meconium aspiration syndrome",
"D": "Pulmonary hypoplasia"
} | step1 | B | [
"One week",
"discharge from",
"neonatal intensive care unit",
"regular pediatric ward",
"g",
"1 oz",
"male infant",
"respiratory distress",
"wheezing",
"birth",
"patient",
"intubated",
"ventilated",
"weeks",
"hypoxia",
"required",
"60",
"fraction of inspired oxygen to",
"adequate... |
A 19-year-old woman comes to the physician because of a 1-year history of severe abdominal pain, bloating, and episodic diarrhea. She has also has a 10-kg (22-lb) weight loss over the past 10 months. Physical examination shows a mildly distended abdomen, diffuse abdominal tenderness, and multiple erythematous, tender n... | Transmural inflammation | {
"A": "Villous atrophy",
"B": "No structural abnormalities",
"C": "Melanosis coli",
"D": "Transmural inflammation"
} | step1 | D | [
"year old woman",
"physician",
"year history",
"severe abdominal",
"bloating",
"episodic diarrhea",
"a 10 kg",
"weight loss",
"past 10 months",
"Physical examination shows",
"mildly distended abdomen",
"diffuse abdominal tenderness",
"multiple erythematous",
"tender nodules",
"anterior a... |
A 21-year-old woman presents with palpitations and anxiety. She had a recent outpatient ECG that was suggestive of supraventricular tachycardia, but her previous physician failed to find any underlying disease. No other significant past medical history. Her vital signs include blood pressure 102/65 mm Hg, pulse 120/min... | Length of PR interval | {
"A": "QRS complex amplitude",
"B": "Length of QT interval",
"C": "Length of PR interval",
"D": "Length of QRS complex"
} | step1 | C | [
"21-year-old woman presents",
"palpitations",
"anxiety",
"recent outpatient ECG",
"suggestive of supraventricular tachycardia",
"previous physician failed to find",
"underlying disease",
"significant past medical history",
"vital signs include blood pressure",
"65 mm Hg",
"pulse",
"min",
"re... |
A 27-year-old is going through a pre-employment evaluation. The patient has no history of any medical conditions, but there is a strong family history of ischemic heart disease on his father’s side. The patient drinks alcohol occasionally but does not use any illicit drugs or smoke. On examination, the physician notice... | Fibrillin defect | {
"A": "Fibrillin defect",
"B": "Group A streptococcal pharyngitis",
"C": "Root dilatation",
"D": "Collagen defect"
} | step1 | A | [
"27 year old",
"pre employment evaluation",
"patient",
"history of",
"medical conditions",
"strong family history of ischemic heart disease",
"fathers side",
"patient drinks alcohol occasionally",
"not use",
"illicit drugs",
"smoke",
"examination",
"physician",
"patient",
"very flexible ... |
Three hours after undergoing left hip arthroplasty for chronic hip pain, a 62-year-old man complains of a prickling sensation in his left anteromedial thigh and lower leg. He has never had these symptoms before. He has hyperlipidemia and coronary artery disease. He has had recent right-sided gluteal and thigh pain with... | Femoral nerve injury | {
"A": "Femoral nerve injury",
"B": "Surgical site infection",
"C": "Sural nerve injury",
"D": "Femoral artery occlusion\n\""
} | step2&3 | A | [
"Three hours",
"left",
"chronic hip pain",
"62 year old man",
"prickling sensation",
"left anteromedial thigh",
"lower leg",
"never",
"symptoms",
"hyperlipidemia",
"coronary artery disease",
"recent right-sided gluteal",
"thigh pain",
"ambulation",
"Vital signs",
"normal limits",
"Se... |
A 46-year-old woman presents to your office with oral lesions as shown in Image A. On examination, you find that her back has flaccid bullae that spread when you apply lateral pressure with your fingertips. This patient most likely has autoantibodies directed against which of the following? | Desmosomes | {
"A": "Desmosomes",
"B": "Hemidesmosomes",
"C": "Lamina lucida",
"D": "Type VII collagen"
} | step1 | A | [
"year old woman presents",
"office",
"oral lesions",
"shown",
"Image",
"examination",
"find",
"back",
"flaccid bullae",
"spread",
"apply lateral pressure",
"fingertips",
"patient",
"likely",
"autoantibodies directed"
] |
A 23-year-old G1P0 female presents to her OB/GYN for her routine 36-week visit. Her current complaints include increased fatigue at the end of the day, and edema in her ankles. The patient’s physical examination is unremarkable except for inguinal adenopathy. Upon pelvic examination for cervical changes, the OB/GYN not... | Primary syphilis | {
"A": "Primary syphilis",
"B": "Gummatous syphilis",
"C": "Neurosyphilis",
"D": "Cardiovascular syphilis"
} | step2&3 | A | [
"23 year old",
"female presents",
"OB/GYN",
"routine 36 week visit",
"current complaints include increased fatigue",
"end",
"day",
"edema",
"ankles",
"patients physical examination",
"unremarkable",
"inguinal adenopathy",
"pelvic examination",
"cervical changes",
"OB/GYN",
"vaginal cha... |
A 73-year-old man is brought to the emergency department because of fever, headaches, and confusion for the past 24 hours. Three years ago, he underwent heart transplantation because of congestive heart failure. His temperature is 38.1°C (100.5°F). He is oriented only to person. Physical examination shows nuchal rigidi... | Ampicillin | {
"A": "Chloramphenicol",
"B": "Doxycycline",
"C": "Ampicillin",
"D": "Vancomycin"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"fever",
"headaches",
"confusion",
"past 24 hours",
"Three years",
"heart",
"of congestive",
"failure",
"temperature",
"100",
"oriented only",
"person",
"Physical examination shows nuchal rigidity",
"cerebrospinal fluid culture",
"... |
A 23-year-old primigravid woman comes to the physician at 28 weeks' gestation for a prenatal visit. Over the past 2 months, she has developed a hoarse voice and facial hair. Her medications include iron and a multivitamin. The last fetal ultrasonography, performed at 21 weeks' gestation, was unremarkable. Vital signs a... | Monitoring | {
"A": "Diagnostic laparoscopy",
"B": "Oophorectomy",
"C": "Monitoring",
"D": "Measurement of serum CEA"
} | step2&3 | C | [
"23 year old primigravid woman",
"physician",
"weeks",
"gestation",
"prenatal visit",
"past",
"months",
"hoarse voice",
"facial hair",
"medications include iron",
"multivitamin",
"last fetal ultrasonography",
"performed",
"weeks",
"gestation",
"unremarkable",
"Vital signs",
"normal... |
A 4-year-old girl is brought to the physician for a painless lump on her neck. She has no history of serious illness and her vital signs are within normal limits. On examination, there is a firm, 2-cm swelling at the midline just below the level of the hyoid bone. The mass moves cranially when she is asked to protrude ... | Thyroglossal cyst | {
"A": "Thyroglossal cyst",
"B": "Laryngocele",
"C": "Cystic hygroma",
"D": "Dermoid cyst"
} | step1 | A | [
"4 year old girl",
"brought",
"physician",
"painless lump on",
"neck",
"history",
"serious illness",
"vital signs",
"normal limits",
"examination",
"firm",
"2",
"swelling",
"midline",
"level",
"hyoid bone",
"mass moves",
"to",
"tongue",
"following",
"most likely diagnosis"
] |
A researcher is studying the effects of hormones on different cells within the ovarian follicle. She adds follicle stimulating hormone (FSH) to a culture of ovarian follicle cells. She then measures the activity levels of different enzymes within the cells. Which enzyme and ovarian cell type would be expected to be sti... | Aromatase; granulosa cell | {
"A": "Desmolase; theca interna cell",
"B": "Aromatase; theca externa cell",
"C": "Aromatase; granulosa cell",
"D": "Aromatase; theca interna cell"
} | step1 | C | [
"researcher",
"studying",
"effects",
"hormones",
"different cells",
"ovarian follicle",
"adds follicle",
"culture",
"ovarian",
"cells",
"then measures",
"activity",
"different enzymes",
"cells",
"enzyme",
"ovarian cell type",
"expected to",
"stimulated",
"addition",
"FSH"
] |
To prepare for an endoscopy, a 27-year-old male was asked by the gastroenterologist to fast overnight for his 12 p.m. appointment the next day. Therefore, his last meal was dinner at 5 p.m. the day before the appointment. By 12 p.m. the day of the appointment, his primary source of glucose was being generated from gluc... | Pyruvate to oxaloacetate | {
"A": "Glucose-6-phosphate to glucose",
"B": "Fructose-1,6-biphosphate to fructose-6-phosphate",
"C": "Pyruvate to oxaloacetate",
"D": "Phosphoenolypyruvate to pyruvate"
} | step1 | C | [
"To prepare",
"endoscopy",
"27 year old male",
"gastroenterologist",
"fast overnight",
"m",
"appointment",
"next day",
"last meal",
"dinner",
"5",
"m",
"day",
"appointment",
"m",
"day",
"appointment",
"primary source",
"glucose",
"generated",
"gluconeogenesis",
"occurs",
... |
A 29-year-old female visits her gynecologist because of an inability to conceive with her husband. Past medical history reveals that she has been amenorrheic for several months, and she complains of frequent white nipple discharge. Urine tests for beta-HCG are negative. A receptor agonist for which of the following neu... | Dopamine | {
"A": "Somatostatin",
"B": "Dopamine",
"C": "Vasopressin",
"D": "Insulin"
} | step1 | B | [
"29 year old female visits",
"gynecologist",
"to",
"husband",
"Past medical history reveals",
"months",
"frequent white nipple discharge",
"Urine tests",
"beta HCG",
"negative",
"receptor agonist",
"following neurotransmitters",
"most likely to treat",
"condition"
] |
A 21-year-old woman is brought by her mother to a psychiatrist due to concerns about her behavior. The patient’s mother tells the psychiatrist that she believes that a famous Hollywood celebrity actor loves her and will marry her. When the patient is asked about this, she says that she attended a function at which this... | Delusional disorder | {
"A": "Delusional disorder",
"B": "Schizoid personality disorder",
"C": "Schizotypal personality disorder",
"D": "Schizophreniform disorder"
} | step2&3 | A | [
"21-year-old woman",
"brought",
"mother to",
"psychiatrist due",
"concerns",
"behavior",
"patients mother",
"psychiatrist",
"famous",
"celebrity actor loves",
"marry",
"patient",
"attended",
"function",
"actor",
"six months back",
"waved",
"hand",
"understood",
"loves",
"to c... |
A 53-year-old woman visits her physician with complaints of shortness of breath and fatigue over the last few weeks. Her past medical history includes hypertension diagnosed 20 years ago. She takes hydrochlorothiazide and losartan daily. Her mother died at the age of 54 from a stroke, and both of her grandparents suffe... | Ejection fraction: 40% with increased left ventricular wall thickness | {
"A": "Ejection fraction: 40% with increased left ventricular wall thickness",
"B": "Ejection fraction: 60% with normal left ventricular wall thickness",
"C": "Ejection fraction: 55% with dilated chambers and thin walls",
"D": "Ejection fraction: 65% with rapid early diastolic filling and slow late diastolic f... | step1 | A | [
"year old woman visits",
"physician",
"complaints of shortness",
"breath",
"fatigue",
"weeks",
"past medical history includes hypertension diagnosed 20 years",
"takes hydrochlorothiazide",
"losartan daily",
"mother died",
"age",
"54",
"stroke",
"grandparents suffered",
"cardiovascular di... |
A 28-year-old female comes to the emergency department complaining of heart palpitations. She has had multiple episodes of these in the past few months. She has found that if she wears tight clothing then sometimes these episodes will stop spontaneously. On presentation to the ED, she feels like her heart is pounding a... | Glossopharyngeal | {
"A": "Vagus",
"B": "Trigeminal",
"C": "Glossopharyngeal",
"D": "Facial"
} | step1 | C | [
"year old female",
"emergency department",
"heart palpitations",
"multiple episodes",
"past",
"months",
"found",
"tight clothing then sometimes",
"episodes",
"stop",
"presentation",
"ED",
"feels",
"heart",
"pounding",
"reports feeling nauseous",
"appears mildly diaphoretic",
"blood... |
A 45-year-old woman presents to the clinic with a variety of complaints on different areas of her body, including telangiectasias on both the upper and lower extremities, bluish discoloration of the fingertips when exposed to cold, and burning midsternal chest pain. She is a tobacco smoker and works as a school teacher... | Erythematous periorbital rash | {
"A": "Dysphagia",
"B": "Erythematous periorbital rash",
"C": "Spasm of blood vessels in response to cold or stress",
"D": "Thickening and tightening of the skin on the fingers"
} | step1 | B | [
"year old woman presents",
"clinic",
"variety",
"complaints",
"different areas",
"body",
"including telangiectasias",
"upper",
"lower extremities",
"bluish discoloration of",
"fingertips",
"exposed",
"cold",
"burning",
"chest pain",
"tobacco smoker",
"works",
"school teacher",
"e... |
A 23-year-old active college student has a sudden loss of consciousness 40 minutes after he was playing basketball with his team. Cardiopulmonary resuscitation is administered by bystanders. On arrival of emergency medical professionals, he regains his consciousness. He has no past medical history. He does not smoke or... | Metoprolol | {
"A": "High-dose diuretics",
"B": "Nitroglycerin",
"C": "Metoprolol",
"D": "Forceful attempted exhalation against a closed airway"
} | step2&3 | C | [
"23 year old active college student",
"sudden loss of consciousness 40 minutes",
"playing basketball",
"team",
"Cardiopulmonary resuscitation",
"administered",
"bystanders",
"arrival",
"emergency medical professionals",
"regains",
"consciousness",
"past medical history",
"not smoke",
"drin... |
A 33-year-old woman comes to the clinic for a follow-up visit after recently starting high dose corticosteroids for a newly diagnosed autoimmune condition. She was first evaluated a month ago due to fatigue, muscle weakness, and a scaly rash on both hands. On examination, muscle strength was rated 2 out of 5 in the upp... | Breast cancer | {
"A": "Breast cancer",
"B": "Acute myeloid leukemia",
"C": "Uveitis",
"D": "Hodgkin lymphoma"
} | step2&3 | A | [
"year old woman",
"clinic",
"follow-up visit",
"recently starting high dose corticosteroids",
"newly diagnosed autoimmune condition",
"first evaluated",
"month",
"due to fatigue",
"muscle weakness",
"scaly rash",
"hands",
"examination",
"muscle strength",
"rated 2 out of 5",
"upper extre... |
A 2-year-old boy is brought to a pediatrician because his parents have noticed that he seems to be getting tired very easily at home. Specifically, they have noticed that he is often panting for breath after walking around the house for a few minutes and that he needs to take naps fairly often throughout the day. He ha... | LV: normal, RV: increased, SC: normal | {
"A": "LV: decreased, RV: normal, SC: decreased",
"B": "LV: normal, RV: increased, SC: normal",
"C": "LV: normal, RV: normal, SC: decreased",
"D": "LV: normal, RV: normal, SC: normal"
} | step1 | B | [
"2 year old boy",
"brought",
"pediatrician",
"parents",
"to",
"getting tired very easily",
"home",
"often panting",
"breath",
"walking",
"house",
"few minutes",
"needs to take naps fairly often",
"day",
"well",
"parents",
"not recall",
"recent infections",
"born at home",
"mom"... |
A 21-year-old woman comes to the physician for an annual health maintenance examination. She has no particular health concerns. Laboratory studies show:
Hemoglobin 11.2 g/dL
Mean corpuscular volume 74 μm3
Mean corpuscular hemoglobin concentration 30% Hb/cell
Red cell distribution width 14% (N=13–15)
Genetic analysis sh... | Small nuclear ribonucleoprotein | {
"A": "Transfer RNA",
"B": "MicroRNA",
"C": "TATA-rich nucleotide sequence",
"D": "Small nuclear ribonucleoprotein"
} | step1 | D | [
"21-year-old woman",
"physician",
"annual health maintenance examination",
"health concerns",
"Laboratory studies show",
"Hemoglobin",
"g",
"Mean corpuscular volume",
"m3",
"concentration",
"Hb cell Red cell",
"N",
"Genetic analysis shows a point mutation",
"intron",
"gene",
"short arm... |
A 68-year-old male is brought to his primary care physician by his wife who is concerned that the patient seems more confused and irritable than usual. Three months ago, she started noticing that he appeared confused while doing simple tasks and seemed to be off balance. He has fallen several times over that time perio... | Accumulations of beta-pleated sheets | {
"A": "Accumulations of beta-pleated sheets",
"B": "Intracellular aggregates of alpha-synuclein",
"C": "Intracellular rounded hyperphosphorylated tau",
"D": "Extracellular accumulation of amyloid beta"
} | step1 | A | [
"68 year old male",
"brought",
"primary care physician",
"wife",
"concerned",
"patient",
"more confused",
"irritable",
"usual",
"Three months",
"started",
"appeared confused",
"simple tasks",
"to",
"balance",
"fallen",
"times",
"time period",
"one",
"grandchildren",
"arm star... |
A 14-year-old girl presents with pain in the right lower quadrant of her abdomen. She describes the pain as sudden, severe, colicky, and associated with nausea and vomiting. Physical exam reveals tachycardia and severe tenderness to palpation with rebound in the right iliac region. Emergency laparotomy is performed whi... | Phagocytosis | {
"A": "Antigen presentation",
"B": "Transplant rejection",
"C": "Allergic reaction",
"D": "Phagocytosis"
} | step1 | D | [
"year old girl presents",
"pain",
"right lower quadrant of",
"abdomen",
"pain",
"sudden",
"severe",
"colicky",
"associated with nausea",
"vomiting",
"Physical exam reveals tachycardia",
"severe tenderness",
"palpation",
"right iliac region",
"Emergency laparotomy",
"performed",
"reve... |
A 44-year-old female is admitted to the neurological service. You examine her chart and note that after admission she was started on nimodipine. Which of the following pathologies would benefit from this pharmacologic therapy? | Subarachnoid hemorrhage | {
"A": "Thromboembolic stroke",
"B": "Epidural hematoma",
"C": "Subdural hematoma",
"D": "Subarachnoid hemorrhage"
} | step1 | D | [
"year old female",
"admitted",
"neurological service",
"chart",
"note",
"admission",
"started",
"nimodipine",
"following pathologies",
"benefit",
"pharmacologic therapy"
] |
A 47-year-old man presents to the emergency department with jaundice and extreme fatigue for the past 4 days. He also noticed that his stool is very pale and urine is dark. Past medical history is unremarkable. The review of systems is significant for a 23 kg (50 lb) weight loss over the last 3 months which he says is ... | Candida parapsilosis | {
"A": "Hepatitis B virus",
"B": "E. coli",
"C": "Candida parapsilosis",
"D": "Pseudomonas aeruginosa"
} | step1 | C | [
"year old man presents",
"emergency department",
"jaundice",
"extreme fatigue",
"past 4 days",
"stool",
"very pale",
"urine",
"dark",
"Past medical history",
"unremarkable",
"review of systems",
"significant",
"23 kg",
"50",
"weight loss",
"months",
"due to decreased appetite",
"... |
A 6-year-old boy is brought to the physician because of headache, cough, runny nose, and a low-grade fever since waking up that morning. He has been healthy except for a urinary tract infection one week ago that has resolved with trimethoprim-sulfamethoxazole therapy. Both parents have a history of allergic rhinitis. H... | Medication side effect | {
"A": "Medication side effect",
"B": "CMV infection",
"C": "EBV infection",
"D": "Acute myelogenous leukemia"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"headache",
"cough",
"runny nose",
"low-grade fever",
"waking up",
"morning",
"healthy",
"urinary tract infection one week",
"resolved",
"trimethoprim-sulfamethoxazole therapy",
"parents",
"history",
"allergic rhinitis",
"temperature",
"Physi... |
A 16-year-old male is brought to the clinic by his mother for the complaints of fever, nonproductive cough, fatigue, lack of appetite, and sore throat for the past 2 months. Several other students at his high school have had similar symptoms. Physical exam shows a whitish membrane in his oropharynx, bilateral enlarged... | Monospot test | {
"A": "Throat culture",
"B": "Urine culture",
"C": "Enzyme-linked immunosorbent assay",
"D": "Monospot test"
} | step2&3 | D | [
"year old male",
"brought",
"clinic",
"mother",
"complaints",
"fever",
"nonproductive cough",
"fatigue",
"lack of appetite",
"sore throat",
"past",
"months",
"students",
"high school",
"similar symptoms",
"Physical exam shows",
"membrane",
"oropharynx",
"bilateral enlarged cervic... |
Pancreatic islets were isolated from a healthy, non-diabetic donor to perform an experiment to look at insulin secretion inhibition. Compounds would be added to separate wells containing the islets bathed in a high glucose solution for one hour. After one hour, the supernatant would be collected, and the insulin conten... | Clonidine | {
"A": "Dobutamine",
"B": "Isoproterenol",
"C": "Tolbutamide",
"D": "Clonidine"
} | step1 | D | [
"Pancreatic islets",
"isolated",
"healthy",
"non diabetic donor to perform",
"experiment to look",
"insulin secretion inhibition",
"Compounds",
"added to separate wells containing",
"bathed",
"high",
"one hour",
"one hour",
"supernatant",
"collected",
"insulin content",
"measured",
"... |
Five days after being admitted to the hospital for an open cholecystectomy, a 56-year-old woman develops difficulty breathing. She also has fevers, chills, and malaise. She has a cough productive of minimal amounts of yellowish-white sputum that started two days prior. She has type 2 diabetes mellitus, hypertension, an... | Intravenous vancomycin and cefepime | {
"A": "CT of the chest with contrast",
"B": "External cooling and intravenous acetaminophen",
"C": "Intravenous vancomycin and cefepime",
"D": "Intravenous dobutamine"
} | step2&3 | C | [
"Five days",
"admitted",
"hospital",
"open cholecystectomy",
"year old woman",
"difficulty breathing",
"fevers",
"chills",
"malaise",
"cough productive",
"minimal amounts",
"white",
"started two days prior",
"type 2 diabetes mellitus",
"hypertension",
"history of gallstones",
"curren... |
A 23-year-old man comes to the physician because of lightening of his skin on both hands, under his eyes, and on his neck for 2 years. During this period the lesions slowly grew in size. There is no itchiness or pain. He regularly visits his family in India. Vital signs are within normal limits. Examination shows sharp... | Elevated anti-TPO antibody levels | {
"A": "“Spaghetti and meatballs” appearance on KOH scraping",
"B": "Decreased pigment with normal melanocyte count",
"C": "Elevated anti-TPO antibody levels",
"D": "Renal angiomyolipoma on abdominal MRI"
} | step2&3 | C | [
"23 year old man",
"physician",
"lightening",
"skin",
"hands",
"eyes",
"neck",
"2 years",
"period",
"lesions slowly",
"size",
"itchiness",
"pain",
"visits",
"family",
"India",
"Vital signs",
"normal limits",
"Examination shows",
"depigmented skin patches",
"dorsum of",
"han... |
A 50-year-old man comes to the physician because of diffuse weakness for the past several months. There is an anterior mediastinal mass on a lateral x-ray of the chest that was performed as part of a pre-employment medical evaluation. He has gastroesophageal reflux disease. His only medication is rabeprazole. He is 178... | Acetylcholine receptor antibodies | {
"A": "Elevated serum alpha-fetoprotein level",
"B": "Acetylcholine receptor antibodies",
"C": "Elevated TSH and a nodular anterior cervical mass",
"D": "Increased urinary catecholamines"
} | step2&3 | B | [
"50 year old man",
"physician",
"of diffuse weakness",
"past",
"months",
"anterior mediastinal mass",
"ray of",
"performed",
"part of",
"pre employment medical evaluation",
"gastroesophageal reflux disease",
"only medication",
"rabeprazole",
"5 ft 10",
"tall",
"kg",
"BMI",
"kg/m2",... |
A 67-year-old woman presents with progressive shortness of breath, lower extremity swelling, and early satiety. These symptoms started 4 months ago and have been progressively worsening. She has had type 2 diabetes mellitus for 25 years and hypertension for 15 years; for these, she takes metformin and captopril. She ha... | Right-ventricular dilatation with subsequent functional tricuspid valve dysfunction | {
"A": "Right-ventricular dilatation with subsequent functional tricuspid valve dysfunction",
"B": "Streptococcal infection followed by mitral valve dysfunction",
"C": "Release of serotonin and other vasoactive peptides into the systemic circulation",
"D": "Thickening of the parietal pericardium with impaired f... | step2&3 | A | [
"67 year old woman presents",
"progressive shortness of breath",
"lower extremity swelling",
"early satiety",
"symptoms started 4 months",
"worsening",
"type 2 diabetes mellitus",
"years",
"hypertension",
"years",
"takes metformin",
"captopril",
"anterolateral ST-segment elevation myocardial... |
A 26-year-old primigravid woman at 25 weeks' gestation comes to the physician for a prenatal visit. She has no history of serious illness and her only medication is a daily prenatal vitamin. A 1-hour 50-g glucose challenge shows a glucose concentration of 167 mg/dL (N < 135). A 100-g oral glucose tolerance test shows g... | Islet cell hyperplasia | {
"A": "Islet cell hyperplasia",
"B": "Decreased amniotic fluid production",
"C": "Omphalocele",
"D": "Decreased hematocrit"
} | step1 | A | [
"year old primigravid woman",
"weeks",
"gestation",
"physician",
"prenatal visit",
"history",
"serious illness",
"only medication",
"daily prenatal vitamin",
"hour 50 g glucose challenge shows",
"glucose concentration",
"mg/dL",
"N",
"100 g oral glucose tolerance test shows glucose concent... |
A 45-year-old woman with type 1 diabetes mellitus is brought to the emergency department by her husband because of polyuria, nausea, vomiting, and altered mental status for 4 hours. On arrival, she is unconscious. Treatment with a drug is begun that increases glucose transport to skeletal muscle and adipose tissue. Whi... | Dephosphorylation of fructose-1,6-bisphosphatase | {
"A": "Dephosphorylation of fructose-1,6-bisphosphatase",
"B": "Upregulation of glucose transporter type 3 expression",
"C": "Cleavage of UDP from UDP-glucose",
"D": "Phosphorylation of glycogen phosphorylase kinase"
} | step1 | A | [
"year old woman",
"type 1 diabetes mellitus",
"brought",
"emergency department",
"husband",
"polyuria",
"nausea",
"vomiting",
"altered mental status",
"hours",
"arrival",
"unconscious",
"Treatment",
"drug",
"begun",
"increases glucose transport",
"skeletal muscle",
"adipose tissue"... |
A 71-year-old male is brought to the emergency room by his caretaker and presents with difficulty breathing, muscle rigidity in the face, neck, back and upper extremities, and profuse sweating. The intern notes a large wound on his head near the back of his right ear which his caretaker had bandaged up. The caretaker e... | Glycine | {
"A": "Glycine",
"B": "Acetylcholine",
"C": "Dopamine",
"D": "Serotonin"
} | step1 | A | [
"71 year old male",
"brought",
"emergency room",
"caretaker",
"presents",
"difficulty breathing",
"muscle rigidity",
"face",
"neck",
"back",
"upper extremities",
"profuse sweating",
"intern notes",
"large wound",
"head",
"back of",
"right ear",
"caretaker",
"bandaged",
"caretak... |
A 38-year-old man comes to the physician because of a 6-month history of chest discomfort and progressive dyspnea. He cannot do daily chores without feeling out of breath. He has a history of an X-linked recessive disorder that causes progressive proximal muscle weakness and gait abnormalities. Physical examination sho... | Impaired connection of cytoskeletal actin filaments to membrane-bound dystroglycan | {
"A": "Impaired connection of cytoskeletal actin filaments to membrane-bound dystroglycan",
"B": "Defective lysine-hydroxylysine crosslinking of tropocollagen",
"C": "Interruption of microtubule depolymerization through stabilization of GDP-tubulin",
"D": "Increased number of CTG repeats in the DMPK gene"
} | step1 | A | [
"year old man",
"physician",
"month history",
"chest discomfort",
"progressive dyspnea",
"daily chores",
"feeling",
"breath",
"history of",
"X-linked recessive disorder",
"causes progressive proximal muscle weakness",
"gait abnormalities",
"Physical examination shows",
"waddling gait",
"... |
A 24-year-old gravida 2 para 0 presents to her physician at 15 weeks gestation to discuss the results of recent screening tests. She has no complaints and the current pregnancy has been uncomplicated. Her previous pregnancy terminated with spontaneous abortion in the first trimester. Her immunizations are up to date. H... | T. pallidum hemagglutination assay | {
"A": "PCR for HBV DNA",
"B": "T. pallidum hemagglutination assay",
"C": "HBV vaccination",
"D": "Full serum panel for HBV"
} | step2&3 | B | [
"year old gravida 2 para 0 presents",
"physician",
"weeks gestation to discuss",
"results",
"recent screening tests",
"complaints",
"current pregnancy",
"uncomplicated",
"previous pregnancy terminated",
"spontaneous abortion",
"first trimester",
"immunizations",
"date",
"vital signs",
"f... |
A 52-year-old man comes to the physician because of a 4-day history of a productive cough, shortness of breath, and low-grade fever. He works as a farmer in southern Arizona. Physical examination shows multiple skin lesions with a dark blue center, pale intermediate zone, and red peripheral rim on the upper and lower e... | Coccidioides immitis | {
"A": "Coccidioides immitis",
"B": "Aspergillus fumigatus",
"C": "Paracoccidioides brasiliensis",
"D": "Candida albicans"
} | step1 | A | [
"year old man",
"physician",
"4-day history",
"productive cough",
"shortness of breath",
"low-grade fever",
"works",
"farmer",
"southern Arizona",
"Physical examination shows multiple skin lesions",
"dark blue center",
"pale intermediate zone",
"red peripheral rim",
"upper",
"lower extre... |
A 19-year-old woman presents to the family medicine clinic after noticing swelling of her right index finger a few hours ago. She has no past medical history and takes no prescription medications. She takes ibuprofen occasionally, as needed. She says that she has smoked a few cigarettes a day for the last year. On furt... | Amoxicillin–clavulanate | {
"A": "Amoxicillin",
"B": "Amoxicillin–clavulanate",
"C": "Clindamycin",
"D": "Azithromycin"
} | step2&3 | B | [
"year old woman presents",
"family medicine clinic",
"swelling",
"right index finger",
"few hours",
"past medical history",
"takes",
"prescription medications",
"takes ibuprofen occasionally",
"as needed",
"smoked",
"few cigarettes",
"day",
"year",
"further questioning",
"patient",
"... |
A 55-year-old woman has a total thyroidectomy for papillary thyroid carcinoma. She complains of tingling around the mouth 11 hours after the operation. Her condition rapidly deteriorates with difficulty breathing and chest tightness. Which of the following best represent the signaling pathway of the deficient hormone r... | Cyclic adenosine monophosphate (cAMP) | {
"A": "Cyclic guanosine monophosphate (cGMP)",
"B": "Cyclic adenosine monophosphate (cAMP)",
"C": "Inositol trisphosphate (IP3)",
"D": "Intracellular receptors"
} | step2&3 | B | [
"55 year old woman",
"total thyroidectomy",
"papillary thyroid carcinoma",
"tingling",
"mouth",
"hours",
"operation",
"condition rapidly deteriorates",
"difficulty breathing",
"chest tightness",
"following best represent",
"signaling pathway",
"deficient hormone responsible",
"patients sym... |
A 35-year-old woman comes to the physician for the evaluation of fatigue over the past 6 months. During this period, she has also had fever, joint pain, and a recurrent skin rash on her face. She has smoked one pack of cigarettes daily for the past 15 years. Her temperature is 38.5°C (101.3°F), pulse is 90/min, and blo... | Adverse effect of medication | {
"A": "Autoantibodies against postsynaptic acetylcholine receptors",
"B": "Autoantibodies against myelin",
"C": "Upper and lower motor neuron degeneration",
"D": "Adverse effect of medication"
} | step2&3 | D | [
"35 year old woman",
"physician",
"evaluation",
"fatigue",
"past 6 months",
"period",
"fever",
"joint pain",
"recurrent skin rash",
"face",
"smoked one pack",
"cigarettes daily",
"past",
"years",
"temperature",
"pulse",
"90 min",
"blood pressure",
"80 mm Hg",
"Physical examinat... |
A 7-year-old boy is brought to the emergency room because of severe, acute diarrhea. He is drowsy with a dull, lethargic appearance. He has sunken eyes, poor skin turgor, and dry oral mucous membranes and tongue. He has a rapid, thready pulse with a systolic blood pressure of 60 mm Hg and his respirations are 33/min. H... | Start IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output | {
"A": "Give initial IV bolus of 2 L of Ringer’s lactate, followed by packed red cells, fresh frozen plasma, and platelets in a ratio of 1:1:1",
"B": "Start IV fluid resuscitation with normal saline or Ringer’s lactate, along with monitoring of vitals and urine output",
"C": "Start IV fluid resuscitation by admin... | step2&3 | B | [
"year old boy",
"brought",
"emergency room",
"severe",
"acute",
"drowsy",
"dull",
"lethargic appearance",
"sunken eyes",
"poor skin turgor",
"dry oral mucous membranes",
"tongue",
"rapid",
"thready pulse",
"systolic blood pressure",
"mm Hg",
"respirations",
"min",
"capillary refi... |
A 16-year-old boy is brought to the physician by his mother because of a 4-day history of painful lesions in his mouth. During the past year, he has twice had similar lesions that resolved without treatment after approximately 10 days. He has never had any genital or anal lesions. His mother reports that he has been ve... | Aphthous stomatitis | {
"A": "Pemphigus vulgaris",
"B": "Oral thrush",
"C": "Herpangina",
"D": "Aphthous stomatitis"
} | step1 | D | [
"year old boy",
"brought",
"physician",
"mother",
"4-day history",
"painful lesions",
"mouth",
"past year",
"twice",
"similar lesions",
"resolved",
"treatment",
"approximately 10 days",
"never",
"genital",
"anal lesions",
"mother reports",
"very stressed",
"past month",
"approa... |
A 65-year-old man with hypertension and paroxysmal atrial fibrillation presents to his cardiologist for follow-up after recently starting metoprolol for rate control. His EKG shows an atrial rate of 260/min with ventricular rate of 50/min on an irregular baseline. An echocardiogram from his previous visit revealed no e... | Flecainide | {
"A": "Verapamil",
"B": "Flecainide",
"C": "Procainamide",
"D": "Amiodarone"
} | step2&3 | B | [
"65-year-old man",
"hypertension",
"paroxysmal atrial fibrillation presents",
"cardiologist",
"follow-up",
"recently starting metoprolol",
"rate control",
"EKG shows",
"atrial rate",
"min",
"ventricular rate",
"50 min",
"irregular baseline",
"echocardiogram",
"previous visit revealed",
... |
A 36-year-old male is brought to the emergency department for severe chest pain and vomiting. He reports sudden onset 10/10 pain concentrated along his lower chest/epigastric region that radiates to his back for the past 3 hours. He denies any precipitating event, alcohol use, exertion, biliary colic, or family history... | Gemfibrozil | {
"A": "Aspirin",
"B": "Atorvastatin",
"C": "Gemfibrozil",
"D": "Niacin"
} | step1 | C | [
"36 year old male",
"brought",
"emergency department",
"severe chest",
"vomiting",
"reports sudden onset 10",
"pain concentrated",
"lower chest epigastric region",
"radiates",
"back",
"past",
"hours",
"denies",
"precipitating event",
"alcohol use",
"exertion",
"biliary colic",
"fam... |
A 70-year-old caucasian woman presents to her primary care provider complaining of a heavy cough with blood-tinged sputum. Her cough has bothered her for the last 2 weeks. Over the counter medications are no longer alleviating her symptoms. She also reports that she has unintentionally lost 6.8 kg (15 lb) in the last 5... | Gender | {
"A": "Medication",
"B": "Occupational history",
"C": "Race",
"D": "Gender"
} | step1 | D | [
"70 year old caucasian woman presents",
"primary care provider complaining of",
"heavy cough",
"blood-tinged sputum",
"cough",
"the last 2 weeks",
"Over",
"counter medications",
"longer",
"symptoms",
"reports",
"lost",
"kg",
"last",
"months",
"past medical history",
"significant",
... |
A 64-year-old man presents to the emergency department because he has been experiencing increased shortness of breath for the last 2 weeks. Specifically, he says that he can barely walk up the stairs to his apartment before he feels winded. In addition, he has been waking up at night gasping for breath and has only bee... | Extra heart sound in early diastole | {
"A": "Extra heart sound in early diastole",
"B": "Extra heart sound in late diastole",
"C": "Fixed splitting",
"D": "Opening snap"
} | step1 | A | [
"64 year old man presents",
"emergency department",
"experiencing increased shortness of breath",
"last",
"weeks",
"walk",
"stairs",
"apartment",
"feels winded",
"addition",
"waking up",
"night gasping for breath",
"only",
"able to sleep",
"2 more pillows",
"usual",
"Physical exam re... |
A 65-year-old obese man presents to his primary care clinic feeling weak. He was in the military and stationed in Vietnam in his youth. His current weakness gradually worsened to the point that he had to call his son to help him stand to get on the ambulance. He smokes a pack of cigarettes every day and drinks a bottle... | MRI of the pituitary gland | {
"A": "MRI of the adrenal glands",
"B": "MRI of the pituitary gland",
"C": "Low-dose dexamethasone therapy for 3 months",
"D": "High-dose dexamethasone therapy for 3 months"
} | step2&3 | B | [
"65 year old obese man presents",
"primary care clinic feeling weak",
"military",
"stationed",
"Vietnam",
"youth",
"current weakness",
"worsened",
"point",
"to call",
"son to help",
"stand to get",
"ambulance",
"smokes",
"pack",
"cigarettes",
"day",
"drinks",
"bottle",
"vodka",... |
A 52-year-old woman visits your office complaining about discharge from her left nipple for the past 3 months. The discharge looks like gray greenish and its amount is progressively increasing. She appears to be anxious and extremely uncomfortable with this situation as it is embarrassing for her when it occurs outdoor... | Duct ectasia | {
"A": "Periareolar fistula",
"B": "Duct ectasia",
"C": "Periductal mastitis",
"D": "Intraductal papilloma"
} | step1 | B | [
"year old woman visits",
"office",
"discharge",
"left nipple",
"past 3 months",
"discharge looks",
"gray",
"amount",
"increasing",
"appears to",
"anxious",
"extremely",
"embarrassing",
"occurs outdoors",
"Past medical history",
"family history",
"negative",
"breast",
"ovarian dis... |
Two days after delivery, a 3470-g (7-lb 10-oz) newborn has an episode of bilious vomiting. He has not yet passed meconium. He was born at term to a 26-year-old woman; pregnancy and delivery were uncomplicated. His vital signs are within normal limits. Examination shows a distended abdomen. There is tympany to percussio... | Impaired migration of neural crest cells | {
"A": "Ischemic necrosis of the intestinal mucosa",
"B": "Incomplete coiling of the intestine",
"C": "Impaired migration of neural crest cells",
"D": "Mutation in the CFTR gene"
} | step1 | C | [
"Two days",
"delivery",
"g",
"10 oz",
"newborn",
"episode of bilious vomiting",
"not",
"passed meconium",
"born",
"term",
"year old woman",
"pregnancy",
"delivery",
"uncomplicated",
"vital signs",
"normal limits",
"Examination shows",
"distended abdomen",
"tympany",
"percussion... |
Health officials are considering a change be made to the interpretation of the tuberculin skin test that will change the cut-off for a positive purified protein derivative (PPD) from 10 mm to 5 mm for healthcare workers. Which of the following is a true statement regarding this potential change? | This change will decrease the positive predictive value of the test | {
"A": "This change will decrease the positive predictive value of the test",
"B": "This change will decrease the negative predictive value of the test",
"C": "This change will not change the negative predictive value of the test",
"D": "This change will increase the specificity of the test"
} | step1 | A | [
"Health officials",
"considering",
"change",
"made",
"interpretation",
"tuberculin skin test",
"change",
"cut-off",
"positive purified protein derivative",
"10 mm",
"5",
"healthcare workers",
"following",
"true statement",
"potential change"
] |
A 39-year-old female presents with confusion. Her husband reports that she doesn't know where she is and cannot remember the date. She was recently diagnosed with small cell lung cancer. Vital signs are T 37C, HR 80, BP 120/80 mmHg, RR 14, and O2 sat 99% on room air. She is not orthostatic. Physical examination reveals... | Urinary osmolarity will be > 100, and this illness will not correct with saline infusion | {
"A": "Urinary osmolarity will be > 100, and this illness will not correct with saline infusion",
"B": "Urinary sodium will be > 20 and fractional excretion of sodium will be >1%",
"C": "Urinary sodium will be < 10, and fractional excretion of sodium will be <1%",
"D": "Urinary sodium will be > 20 and another ... | step2&3 | A | [
"year old female presents",
"confusion",
"husband reports",
"remember",
"date",
"recently diagnosed",
"small cell lung cancer",
"Vital signs",
"T",
"80",
"BP",
"80 mmHg",
"RR",
"O2 sat 99",
"room air",
"not orthostatic",
"Physical examination reveals moist mucous membranes",
"norma... |
A 25-year-old woman presents to the physician with a complaint of several episodes of headaches in the past 4 weeks that are affecting her school performance. These episodes are getting progressively worse, and over-the-counter medications do not seem to help. She also mentions having to raise her head each time to loo... | Aqueduct of Sylvius | {
"A": "Tegmentum",
"B": "Corpora quadrigemina",
"C": "Aqueduct of Sylvius",
"D": "3rd ventricle"
} | step1 | C | [
"year old woman presents",
"physician",
"complaint of",
"episodes",
"headaches",
"past 4 weeks",
"affecting",
"school performance",
"episodes",
"getting",
"worse",
"over-the-counter medications",
"not",
"to help",
"to",
"head",
"time to look",
"board",
"taking notes",
"eyes",
... |
A 67-year-old man presents to the emergency department for squeezing and substernal chest pain. He states that he was at home eating dinner when his symptoms began. The patient has a past medical history of diabetes, hypertension, and dyslipidemia. He is currently taking atorvastatin, lisinopril, insulin, metformin, me... | Creatine kinase-muscle/brain | {
"A": "Angiography",
"B": "Creatine kinase-muscle/brain",
"C": "Myoglobin",
"D": "Stress testing"
} | step1 | B | [
"67 year old man presents",
"emergency department",
"squeezing",
"substernal chest pain",
"states",
"at home eating dinner",
"symptoms began",
"patient",
"past medical diabetes",
"hypertension",
"dyslipidemia",
"currently taking atorvastatin",
"lisinopril",
"insulin",
"metformin",
"met... |
A 42-year-old man comes to the physician because of severe epigastric pain for a week. The pain is constant and he describes it as 6 out of 10 in intensity. The pain radiates to his back and is worse after meals. He has had several episodes of nausea and vomiting during this period. He has taken ibuprofen for multiple ... | Pancreatic enzyme therapy | {
"A": "Gluten-free diet",
"B": "Whipple procedure",
"C": "Endoscopic stent placement",
"D": "Pancreatic enzyme therapy"
} | step2&3 | D | [
"year old man",
"physician",
"of severe epigastric",
"week",
"pain",
"constant",
"out",
"10",
"intensity",
"pain radiates",
"back",
"worse",
"meals",
"several episodes of nausea",
"vomiting during this period",
"taken ibuprofen",
"multiple similar episodes of pain",
"past 6 months"... |
A 40-year-old woman who works as a secretary presents to your office complaining of new pain and numbness in both of her hands. For the past few weeks, the sensation has occurred after long days of typing, but it now occasionally wakes her up from sleep. You do not note any deformities of her wrists or hands, but you a... | Splinting | {
"A": "A trial of gabapentin",
"B": "Local steroid injections",
"C": "Carpal tunnel release surgery",
"D": "Splinting"
} | step2&3 | D | [
"40 year old woman",
"works",
"secretary presents",
"office",
"new pain",
"numbness",
"of",
"hands",
"past",
"weeks",
"sensation",
"occurred",
"long days",
"typing",
"now occasionally wakes",
"sleep",
"not note",
"deformities",
"wrists",
"hands",
"able to",
"pain",
"numbn... |
A 71-year-old woman comes to the physician because of sudden loss of vision in her right eye for 15 minutes that morning, which subsided spontaneously. Over the past 4 months, she has had fatigue, a 4-kg (8.8-lb) weight loss, and has woken up on several occasions at night covered in sweat. She has had frequent headache... | Thoracic aortic aneurysm | {
"A": "Myocardial infarction",
"B": "Thoracic aortic aneurysm",
"C": "Rapidly progressive glomerulonephritis",
"D": "Pulmonary artery hypertension"
} | step2&3 | B | [
"71 year old woman",
"physician",
"of sudden loss",
"vision",
"right eye",
"15 minutes",
"morning",
"past",
"months",
"fatigue",
"4 kg",
"8.8",
"weight loss",
"woken up",
"several occasions",
"night covered",
"sweat",
"frequent headaches",
"pain in",
"jaw",
"chewing",
"past... |
A 24-year-old woman visits her psychiatrist a week after she delivered a baby. She is holding her baby and crying as she waits for her appointment. She tells her physician that a day or so after her delivery, she has been finding it difficult to contain her feelings. She is often sad and unable to contain her tears. Sh... | Come back for a follow-up in 2 weeks | {
"A": "Start on a small dose of fluoxetine daily",
"B": "Get admitted immediately",
"C": "Come back for a follow-up in 2 weeks",
"D": "Schedule an appointment for electroconvulsive therapy"
} | step2&3 | C | [
"year old woman visits",
"psychiatrist",
"week",
"delivered",
"baby",
"holding",
"baby",
"crying",
"waits",
"appointment",
"physician",
"day",
"so",
"delivery",
"finding",
"difficult to contain",
"feelings",
"often sad",
"unable to contain",
"tears",
"embarrassed",
"often s... |
A 53-year-old patient presents to his primary care provider with a 1-week history of abdominal pain at night and between meals. He has attempted taking antacids, which help briefly, but then the pain returns. The patient has not noticed any changes to the color of his stool but states that he has been having some loose... | Parathyroid hormone | {
"A": "Calcitonin",
"B": "Parathyroid hormone",
"C": "Plasma metanephrines",
"D": "Thyroid stimulating hormone"
} | step1 | B | [
"year old patient presents",
"primary care provider",
"1-week history",
"abdominal pain",
"night",
"meals",
"attempted taking antacids",
"help",
"then",
"pain returns",
"patient",
"not",
"changes",
"color of",
"stool",
"states",
"loose bowel movements",
"patient reports",
"duoden... |
A 13-month-old boy is brought to the emergency department by his parents 30 minutes after having a 1-minute seizure. He has had a 1-day history of severe diarrhea and fever and 1 episode of vomiting. He has no history of serious illness. His immunization records are not available. He appears restless and cries when pic... | Sunken anterior fontanelle | {
"A": "Increased serum bicarbonate levels",
"B": "Retinal hemorrhages",
"C": "Sunken anterior fontanelle",
"D": "Kussmaul breathing"
} | step2&3 | C | [
"month old boy",
"brought",
"emergency department",
"parents 30 minutes",
"minute seizure",
"1-day history",
"severe diarrhea",
"fever",
"1 episode of vomiting",
"history",
"serious illness",
"immunization records",
"not available",
"appears restless",
"cries",
"picked",
"mother's la... |
A 57-year-old woman comes to the physician for a routine examination. She takes no medications. She swims 3 times weekly and jogs several miles with her dog on most mornings. Her diet consists primarily of vegetables, fish, and whole grains; she avoids processed foods and carbohydrates. She drinks one glass of red wine... | High density lipoprotein | {
"A": "Very low density lipoprotein",
"B": "High density lipoprotein",
"C": "Apolipoprotein B-100",
"D": "Low density lipoprotein"
} | step1 | B | [
"57 year old woman",
"physician",
"routine examination",
"takes",
"medications",
"swims 3 times weekly",
"jogs several miles",
"dog",
"mornings",
"diet consists",
"vegetables",
"fish",
"whole grains",
"processed foods",
"carbohydrates",
"drinks one glass",
"red wine",
"dinner",
"... |
A 52-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He was an unrestrained passenger who was ejected from the vehicle. On presentation, he is found to be actively bleeding from numerous wounds. His blood pressure is 76/42 mmHg and pulse is 152/min. Attempts at resuscita... | Decreased function of the Na+/K+-ATPase | {
"A": "Decreased activity of caspase 7",
"B": "Decreased function of the Na+/K+-ATPase",
"C": "Increased activity of caspase 9",
"D": "Increased function of the Na+/K+-ATPase"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"ambulance",
"motor vehicle accident",
"passenger",
"vehicle",
"presentation",
"found to",
"bleeding",
"numerous",
"blood pressure",
"76",
"mmHg",
"pulse",
"min",
"Attempts",
"resuscitation fail",
"minutes later",
"Autopsy show... |
A 59-year-old male presents to the emergency room with shortness of breath. Ten days ago, he was in the cardiac critical care unit after receiving a balloon angioplasty and a bare metal stent for an ST-elevation myocardial infarction (STEMI). On physical examination, a holosystolic murmur is heard at the cardiac apex r... | Rupture of the posteromedial papillary muscle of the left ventricle | {
"A": "Rupture of the anterior papillary muscle on the right ventricle",
"B": "Rupture of the posterior papillary muscle on the right ventricle",
"C": "Rupture of the anterolateral papillary muscle of the left ventricle",
"D": "Rupture of the posteromedial papillary muscle of the left ventricle"
} | step1 | D | [
"59 year old male presents",
"emergency room",
"shortness of breath",
"Ten days",
"cardiac critical care unit",
"receiving",
"balloon angioplasty",
"bare metal stent",
"ST-elevation myocardial infarction",
"physical examination",
"holosystolic murmur",
"heard",
"cardiac apex radiating",
"a... |
A 52-year-old man with a history of type I diabetes mellitus presents to the emergency room with increasing fatigue. Two days ago, he ran out of insulin and has not had time to obtain a new prescription. He denies fevers or chills. His temperature is 37.2 degrees Celsius, blood pressure 84/56 mmHg, heart rate 100/min, ... | Metabolic acidosis with appropriate respiratory compensation | {
"A": "Metabolic acidosis with appropriate respiratory compensation",
"B": "Respiratory acidosis with appropriate metabolic compensation",
"C": "Mixed metabolic and respiratory acidosis",
"D": "Metabolic alkalosis with appropriate respiratory compensation"
} | step1 | A | [
"year",
"man",
"history of type I diabetes mellitus presents",
"emergency room",
"increasing fatigue",
"Two days",
"ran out",
"insulin",
"not",
"time to obtain",
"new prescription",
"denies fevers",
"chills",
"temperature",
"degrees Celsius",
"blood pressure 84",
"mmHg",
"heart rat... |
A 32-year-old woman presents to her primary care provider complaining of a psoriatic flare that has worsened over the past 2 days. The patient states that her psoriasis is normally well-controlled. She also complains of some fatigue and states that she has recently developed pain and tenderness in the joints of her han... | Release of TNF and activation of RANKL pathway | {
"A": "Local invasive infection of the joint space",
"B": "Repetitive injury",
"C": "Deposition of crystals in the joint space",
"D": "Release of TNF and activation of RANKL pathway"
} | step1 | D | [
"year old woman presents",
"primary care provider",
"flare",
"worsened",
"past 2 days",
"patient states",
"psoriasis",
"well-controlled",
"fatigue",
"states",
"recently",
"pain",
"tenderness",
"joints of",
"hands",
"right hand",
"more tender",
"left",
"hands",
"stiff",
"morni... |
A 65-year-old female with a past medical history of hypertension presents to her primary care doctor with a 3 month history of spasmodic facial pain. The pain is located in her right cheek and seems to be triggered when she smiles, chews, or brushes her teeth. The pain is sharp and excruciating, lasts for a few seconds... | CN V | {
"A": "CN III",
"B": "CN V",
"C": "CN VI",
"D": "CN VII"
} | step1 | B | [
"65-year-old female",
"past medical presents",
"primary care doctor",
"3 month history",
"spasmodic facial pain",
"pain",
"right cheek",
"to",
"triggered",
"smiles",
"chews",
"brushes",
"teeth",
"pain",
"sharp",
"excruciating",
"seconds",
"occurs",
"twenty times",
"day",
"den... |
A 22-year-old man presents to his primary care provider because of fever, diarrhea, and abdominal cramps. He has returned from Dhaka, Bangladesh recently where he was visiting his relatives. He is diagnosed with Shigella infection, and ciprofloxacin is started. He develops severe nausea and weakness 2 days later and co... | Glucose-6-phosphate spectrophotometry | {
"A": "Hemoglobin electrophoresis",
"B": "Eosin-5-maleimide (EMA) binding test",
"C": "ADAMTS-13 activity assay",
"D": "Glucose-6-phosphate spectrophotometry"
} | step2&3 | D | [
"year old man presents",
"primary care provider",
"fever",
"diarrhea",
"abdominal cramps",
"returned",
"Bangladesh recently",
"visiting",
"relatives",
"diagnosed",
"Shigella infection",
"ciprofloxacin",
"started",
"severe nausea",
"weakness",
"days later",
"dark urine",
"lab test r... |
A 67-year-old woman with chronic kidney disease, hypertension, and diabetes mellitus presented with congestive heart failure and underwent uneventful 3-vessel coronary artery bypass surgery. Within 20 hours, she was extubated and all infusions except nitroprusside were stopped. On the 4th postoperative day, she deterio... | Cyanide toxicity | {
"A": "Cyanide toxicity",
"B": "Carbon monoxide poisoning",
"C": "Sulfmethemoglobinemia",
"D": "Anemia"
} | step1 | A | [
"67 year old woman",
"chronic kidney disease",
"hypertension",
"diabetes mellitus presented",
"congestive heart failure",
"vessel coronary artery bypass surgery",
"20 hours",
"extubated",
"infusions",
"nitroprusside",
"stopped",
"4th postoperative day",
"deteriorated",
"exhibiting restless... |
The height of American adults is expected to follow a normal distribution, with a typical male adult having an average height of 69 inches with a standard deviation of 0.1 inches. An investigator has been informed about a community in the American Midwest with a history of heavy air and water pollution in which a lower... | 0.85 | {
"A": "0.85",
"B": "0.10",
"C": "0.90",
"D": "0.05\n\""
} | step1 | A | [
"height",
"American adults",
"expected to follow",
"normal distribution",
"typical male adult",
"average height",
"69 inches",
"standard deviation",
"0.1 inches",
"investigator",
"informed",
"community",
"American",
"history",
"heavy air",
"water pollution",
"lower mean height",
"r... |
A 52-year-old G0P0 presents to her gynecologist for an annual exam. The patient notes that she recently felt a lump in her right breast, and it has persisted for several months. She has not noticed any abnormal breast discharge or skin changes, and the lump is not particularly tender. The patient also reports feeling e... | Nulliparity | {
"A": "Late age at menarche",
"B": "Nulliparity",
"C": "Low body weight",
"D": "Use of levonorgestrel intrauterine device"
} | step2&3 | B | [
"year old",
"presents",
"gynecologist",
"annual exam",
"patient notes",
"recently felt",
"lump in",
"right breast",
"months",
"not",
"abnormal breast",
"skin changes",
"lump",
"not",
"tender",
"patient",
"reports feeling",
"sweaty",
"three months",
"occasionally",
"sudden hea... |
A 17-year-old boy presents to the emergency department for the evaluation of severe chest pain that started one hour ago. The pain suddenly began after he lifted a heavy object and the pain is constant. He has no history of a serious illness and takes no medications. His blood pressure is 125/85 mm Hg, the pulse is 89/... | Supplemental oxygen | {
"A": "Chest tube",
"B": "Needle aspiration",
"C": "Supplemental oxygen",
"D": "Surgical exploration"
} | step2&3 | C | [
"year old boy presents",
"emergency department",
"evaluation of severe chest pain",
"started one hour",
"pain",
"began",
"lifted",
"heavy object",
"pain",
"constant",
"history",
"serious illness",
"takes",
"medications",
"blood pressure",
"85 mm Hg",
"pulse",
"min",
"respiratory ... |
A 27-year-old new patient presents to the physician’s office with complaints of burning, upper abdominal pain for the past 6 months. The pain does not radiate and is only partially relieved by eating small meals, over the counter antacids, and PPI. He previously underwent upper endoscopy that revealed small ulcers in t... | Pituitary adenoma | {
"A": "Pheochromocytoma",
"B": "Medullary thyroid cancer",
"C": "Papillary thyroid cancer",
"D": "Pituitary adenoma"
} | step2&3 | D | [
"27 year old new patient presents",
"physicians office",
"complaints",
"burning",
"upper abdominal pain",
"past 6 months",
"pain",
"not radiate",
"only",
"relieved by eating small meals",
"over the counter antacids",
"PPI",
"upper endoscopy",
"revealed small ulcers",
"stomach",
"duoden... |
A 15-year-old boy presents to the clinic complaining of an uncomfortable skin condition that started 2 years ago. The patient states that his skin feels ‘oily’ and that he is embarrassed by his appearance. On examination, he is a healthy-looking teenager who has reached the expected Tanner stage for his age. The skin o... | Cutibacterium acnes | {
"A": "Streptococcus pyogenes",
"B": "Cutibacterium acnes",
"C": "Human papillomavirus (HPV) strains 2 and 4",
"D": "Bartonella henselae"
} | step1 | B | [
"year old boy presents",
"clinic",
"skin condition",
"started 2 years",
"patient states",
"skin feels oily",
"embarrassed",
"appearance",
"examination",
"healthy looking teenager",
"reached",
"expected Tanner stage",
"age",
"skin",
"face",
"back",
"erythematous",
"shows signs",
"... |
A 64-year-old woman presents to an endocrinologist after her second time having a kidney stone in the last year. The patient reports no other symptoms except overall fatigue. On evaluation, the patient’s temperature is 98.4°F (36.9°C), blood pressure is 120/76 mmHg, pulse is 72/min, and respirations are 12/min. The pat... | Fourth branchial pouch | {
"A": "Dorsal wings of the third branchial pouch",
"B": "Fourth branchial arch",
"C": "Fourth branchial pouch",
"D": "Ventral wings of the third branchial pouch"
} | step1 | C | [
"64 year old woman presents",
"endocrinologist",
"second time",
"kidney stone in",
"year",
"patient reports",
"symptoms",
"overall fatigue",
"evaluation",
"patients temperature",
"98 4F",
"36",
"blood pressure",
"76 mmHg",
"pulse",
"72 min",
"respirations",
"min",
"patient",
"n... |
A 42-year-old man is brought to the emergency department 20 minutes after the sudden onset of severe chest pain, diaphoresis, shortness of breath, and palpitations. His symptoms occurred while he was at a party with friends. He has smoked one pack of cigarettes daily for 24 years. He uses cocaine occasionally. The last... | Unsynchronized cardioversion | {
"A": "Administer lidocaine",
"B": "Unsynchronized cardioversion",
"C": "Administer epinephrine",
"D": "Synchronized cardioversion"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department 20 minutes",
"sudden onset of severe chest pain",
"diaphoresis",
"shortness of breath",
"palpitations",
"symptoms occurred",
"party",
"friends",
"smoked one pack",
"cigarettes daily",
"years",
"uses cocaine occasionally",
"last use",
"th... |
A 73-year-old man is brought to the emergency department by ambulance after being found to be non-communicative by his family during dinner. On presentation he appears to be alert, though he is confused and cannot follow instructions. When he tries to speak, he vocalizes a string of fluent but unintelligible syllables.... | Tertiary prevention | {
"A": "Primary prevention",
"B": "Seconday prevention",
"C": "Tertiary prevention",
"D": "Quartenary prevention"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"ambulance",
"found to",
"non communicative",
"family",
"dinner",
"presentation",
"appears to",
"alert",
"confused",
"follow instructions",
"speak",
"vocalizes",
"string",
"fluent",
"unintelligible syllables",
"Given",
"present... |
A 19-year-old primigravid woman at 32 weeks' gestation comes to the physician because of a 2-day history of headache and blurred vision. She has had no prenatal care. She is diagnosed with pre-eclampsia. Amniocentesis shows a lecithin-sphingomyelin ratio of 0.7. If delivery is induced at this time, the newborn is most ... | Decreased functional residual capacity | {
"A": "Decreased right ventricular afterload",
"B": "Increased diffusion capacity for carbon monoxide",
"C": "Decreased functional residual capacity",
"D": "Increased lung compliance"
} | step1 | C | [
"year old primigravid woman",
"weeks",
"gestation",
"physician",
"of",
"2-day history",
"headache",
"blurred vision",
"prenatal care",
"diagnosed",
"pre-eclampsia",
"Amniocentesis shows",
"lecithin-sphingomyelin ratio",
"0.7",
"delivery",
"induced",
"time",
"newborn",
"most likel... |
A 52-year-old male presents to clinic with complaints of anxiety and fatigue for 4 months. He has also been experiencing palpitations, muscle weakness, increased sweating, and an increase in the frequency of defecation. Past medical history is insignificant. He neither consumes alcohol nor smokes cigarettes. His pulse ... | Low TSH; High T4; High T3 | {
"A": "Low TSH; High T4; High T3",
"B": "Normal TSH; Low T4; Low T3",
"C": "Normal TSH; Low total T4; Normal Free T4 and T3",
"D": "High TSH; High T4; High T3"
} | step2&3 | A | [
"year old male presents",
"clinic",
"complaints",
"anxiety",
"fatigue",
"months",
"experiencing palpitations",
"muscle weakness",
"increased sweating",
"increase",
"frequency of defecation",
"Past medical history",
"alcohol",
"smokes cigarettes",
"pulse",
"min",
"irregular",
"blood... |
A 75-year-old man presents with a tremor in his legs and arms. He says he has had the tremor for ‘many years’, but it has worsened in the last year. The tremor is more prominent at rest and nearly disappears on movement. He also says his family has mentioned that his movements have been slower, and he does feel like he... | Levodopa/carbidopa | {
"A": "Levodopa/carbidopa",
"B": "Bromocriptine",
"C": "Benztropine",
"D": "Entacapone"
} | step1 | A | [
"75 year old man presents",
"tremor",
"legs",
"arms",
"tremor",
"years",
"worsened",
"year",
"tremor",
"more prominent",
"rest",
"nearly",
"movement",
"family",
"movements",
"slower",
"feel",
"problem initiating movements",
"significant past medical history",
"often drinks wine... |
A 34-year-old G5P5 woman gave birth to a healthy infant 30 minutes ago by vacuum-assisted vaginal delivery and is now experiencing vaginal bleeding. The placenta was delivered spontaneously and was intact upon examination. The infant weighed 5.2 kg and had Apgar scores of 8 and 9. No perineal tear or intentional episio... | Perform uterine massage and administer oxytocin | {
"A": "Administer misoprostol",
"B": "Manually remove retained placental fragments",
"C": "Perform uterine artery embolization",
"D": "Perform uterine massage and administer oxytocin"
} | step2&3 | D | [
"year old",
"woman gave birth",
"healthy infant 30 minutes",
"vacuum assisted vaginal delivery",
"now experiencing vaginal bleeding",
"placenta",
"delivered",
"intact",
"examination",
"infant",
"5.2 kg",
"Apgar scores",
"8",
"perineal tear",
"intentional episiotomy occurred",
"patient"... |
A 31-year-old woman comes to the physician because of headaches and nausea for 2 weeks. The headaches are worse on awakening and she describes them as 7 out of 10 in intensity. During this period, she has noticed brief episodes of visual loss in both eyes lasting several seconds, especially when she suddenly stands up ... | Acetazolamide therapy | {
"A": "Acetazolamide therapy",
"B": "Optic nerve sheath fenestration",
"C": "Ventricular shunting",
"D": "Furosemide therapy"
} | step2&3 | A | [
"31 year old woman",
"physician",
"headaches",
"nausea",
"2 weeks",
"headaches",
"worse",
"awakening",
"out",
"10",
"intensity",
"period",
"brief episodes of visual loss",
"eyes lasting several seconds",
"stands up",
"bends over",
"5 ft 5",
"tall",
"98 kg",
"BMI",
"36 kg/m2",... |
A 22-year-old female college student presents to the clinic with complaints of intense vaginal itching and a painful sensation when urinating. She also notes that she has felt more lethargic and has additionally been experiencing recent fevers and headaches. She says that she is sexually active and occasionally uses co... | Herpes simplex virus type 2 | {
"A": "Chlamydia trachomatis",
"B": "Herpes simplex virus type 2",
"C": "Klebsiella granulomatis",
"D": "Treponema pallidum"
} | step1 | B | [
"year old female college student presents",
"clinic",
"complaints",
"intense vaginal itching",
"painful sensation",
"notes",
"felt more lethargic",
"experiencing recent fevers",
"headaches",
"sexually active",
"occasionally uses condoms",
"physical exam",
"found to",
"red",
"vesicular ul... |
A 36-year-old G1P0 Caucasian woman in her 12th week of pregnancy presents to her obstetrician with vaginal bleeding. She also reports 3 episodes of non-bloody, non-bilious emesis. She failed to show up for her last 2 pre-natal visits due to work. Her past medical history is notable for obesity and type I diabetes melli... | Intrauterine cystic mass | {
"A": "Fetal parts",
"B": "Intrauterine cystic mass",
"C": "Large intramural masses",
"D": "Non-viable fetus"
} | step1 | B | [
"36 year old",
"Caucasian woman",
"week",
"pregnancy presents",
"obstetrician",
"vaginal bleeding",
"reports 3 episodes of non bloody",
"bilious emesis",
"failed to show",
"last",
"pre natal visits due to work",
"past medical history",
"notable",
"obesity",
"type I diabetes mellitus",
... |
A 68-year-old woman is brought to the emergency department with intense abdominal pain for the past 2 hours. She has had 1 episode of bloody diarrhea recently. She has an 18-year history of diabetes mellitus. She was diagnosed with hypertension and ischemic heart disease 6 years ago. She is fully alert and oriented. He... | Inpatient observation | {
"A": "Angiography",
"B": "Gastrografin-enhanced X-ray",
"C": "Inpatient observation",
"D": "Sigmoidoscopy"
} | step2&3 | C | [
"68 year old woman",
"brought",
"emergency department",
"intense abdominal pain",
"past",
"hours",
"1 episode of bloody diarrhea recently",
"year history of diabetes mellitus",
"diagnosed",
"hypertension",
"ischemic heart disease",
"years",
"alert",
"oriented",
"temperature",
"99",
"... |
A 47-year-old woman presents to her primary care provider because of numbness and tingling on the palmar aspects of both hands. She denies any symptoms at the base of her thumbs. The symptoms are worse on the right (dominant hand) and are increased with activities such as driving or brushing her hair. She frequently wa... | Focal slowing of conduction velocity in the median nerve in the carpal tunnel | {
"A": "Denervation in C7 innervated paraspinal, arms, and shoulder muscles",
"B": "Widespread symmetrical neuropathic changes without focal abnormalities",
"C": "Focal slowing of conduction velocity in the median nerve in the carpal tunnel",
"D": "Neuropathic changes in the palmar branch of the median nerve"
} | step2&3 | C | [
"year old woman presents",
"primary care provider",
"numbness",
"tingling",
"palmar aspects of",
"hands",
"denies",
"symptoms",
"base",
"thumbs",
"symptoms",
"worse",
"right",
"dominant hand",
"increased",
"activities",
"driving",
"brushing",
"hair",
"frequently wakes up",
"p... |
A 15-year-old girl is brought to the physician because of a 2-week history of vaginal discharge. She has type 1 diabetes mellitus and her only medication is insulin. Menses occur at 28- to 29-day intervals, and her last menstrual period was 3 weeks ago. She does not want to share information regarding sexual activity. ... | Physiologic leukorrhea | {
"A": "Vaginal foreign body",
"B": "Trichomoniasis",
"C": "Physiologic leukorrhea",
"D": "Vaginal candidiasis"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"2-week history",
"vaginal discharge",
"type 1 diabetes mellitus",
"only medication",
"insulin",
"Menses occur",
"29 day intervals",
"last menstrual period",
"3 weeks",
"not",
"to share information",
"sexual activity",
"percentile",
"height",
... |
A 24-year-old woman presents to her primary care physician for unilateral breast pain. The patient states that she has been breastfeeding her son but has been experiencing worsening pain recently. Her pain is severe enough that she is now struggling to breastfeed her son with her left breast. The patient's past medical... | Incision and drainage | {
"A": "Ice packs and breast pumping",
"B": "Incision and drainage",
"C": "No intervention necessary",
"D": "Ultrasound and fine needle aspiration"
} | step2&3 | B | [
"year old woman presents",
"primary care physician",
"unilateral breast",
"patient states",
"breastfeeding",
"son",
"experiencing worsening pain recently",
"pain",
"severe",
"now",
"to breastfeed",
"son",
"left breast",
"patient's past",
"notable",
"gestational diabetes",
"controlled... |
A 68-year-old man presents to his primary care provider after noticing that his urine has been pink for the last week. He does not have any pain with urination, nor has he had any associated fevers or infections. On his review of systems, the patient notes that he thinks he has lost some weight since his belt is looser... | Cushing syndrome | {
"A": "Carcinoid syndrome",
"B": "Cushing syndrome",
"C": "Lambert-Eaton myasthenic syndrome",
"D": "Myelitis"
} | step1 | B | [
"68 year old man presents",
"primary care provider",
"urine",
"pink",
"week",
"not",
"pain",
"urination",
"associated fevers",
"infections",
"review of systems",
"patient notes",
"thinks",
"lost",
"weight",
"belt",
"looser",
"occasional dull pressure",
"back",
"past two months"... |
A 40-year-old woman comes to the physician for right lower abdominal pain for 6 months. She has multiple non-bloody, watery bowel movements daily and experiences abdominal cramping. Sometimes, she feels sudden palpitations, is short of breath, and her face becomes red. She has lost 7 kg over the past 3 months. She went... | Carcinoid tumor | {
"A": "Ascaris lumbricoides infection",
"B": "Pheochromocytoma",
"C": "Inflammatory bowel disease",
"D": "Carcinoid tumor"
} | step2&3 | D | [
"40 year old woman",
"physician",
"right lower abdominal pain",
"months",
"multiple non bloody",
"watery bowel movements daily",
"experiences abdominal cramping",
"Sometimes",
"feels sudden palpitations",
"short of breath",
"face",
"red",
"lost",
"kg",
"past 3 months",
"week hiking tri... |
Two days after vaginal delivery of a healthy newborn at term, a 32-year-old woman, gravida 2, para 2, is unable to breastfeed. Her labor was complicated by antepartum hemorrhage and she received two units of packed red blood cells. Her pulse is 99/min and blood pressure is 90/55 mm Hg. Further evaluation of this patien... | ↓ ↑ ↓ | {
"A": "↓ normal ↑",
"B": "↑ normal ↑",
"C": "↓ ↑ ↓",
"D": "↓ normal ↓"
} | step1 | C | [
"Two days",
"vaginal delivery",
"healthy newborn",
"term",
"year old woman",
"gravida 2",
"para 2",
"unable to breastfeed",
"labor",
"complicated",
"antepartum hemorrhage",
"received two units",
"packed red blood cells",
"pulse",
"99 min",
"blood pressure",
"90 55 mm Hg",
"Further ... |
A 23-year-old woman presents to her primary care provider complaining of diarrhea. She reports a 2 month history of 3-4 bloody stools per day as well as 10 pounds of unexpected weight loss. She has also developed intermittent mild gnawing lower abdominal pain. Her past medical history is unremarkable. She takes no medi... | COX inhibitor | {
"A": "Calcineurin inhibitor",
"B": "COX inhibitor",
"C": "DNA gyrase inhibitor",
"D": "NF-kB inhibitor"
} | step1 | B | [
"23 year old woman presents",
"primary care provider",
"diarrhea",
"reports",
"2 month history of 3",
"bloody stools",
"day",
"10 pounds of unexpected weight loss",
"intermittent mild gnawing lower abdominal pain",
"past medical history",
"unremarkable",
"takes",
"medications",
"denies",
... |
A 32-year-old man comes to the office complaining of right-sided upper abdominal pain for about 2 weeks. He is also complaining of subjective fever and malaise for the same duration. He has never been out of the United States. Additionally, he describes several episodes of bloody diarrhea and crampy abdominal pain that... | Amoebic liver abscess | {
"A": "Amoebic liver abscess",
"B": "Gonorrhea",
"C": "Secondary syphilis",
"D": "Alcoholic steatohepatitis"
} | step2&3 | A | [
"year old man",
"office",
"right-sided upper abdominal pain",
"about",
"weeks",
"subjective fever",
"malaise",
"same duration",
"never",
"out",
"United States",
"several episodes of bloody diarrhea",
"crampy abdominal pain",
"resolved",
"few months",
"Travel history",
"sexually activ... |
A 4-day-old girl presents with jaundice for the last 2 days. Although the patient’s parents were initially told that it was neonatal jaundice and would resolve quickly, they think that the yellow color of the patient’s skin appears to be more obvious today. The patient’s mother reports that the girl eats well, has norm... | Plasma exchange transfusion | {
"A": "Continuation of phototherapy",
"B": "Plasma exchange transfusion",
"C": "No further treatment needed",
"D": "Furosemide"
} | step1 | B | [
"4 day old girl presents",
"jaundice",
"last 2 days",
"patients parents",
"initially",
"neonatal jaundice",
"resolve",
"think",
"yellow color of",
"patients skin appears to",
"more",
"today",
"patients mother reports",
"girl eats well",
"normal stool",
"urine color",
"first child",
... |
A 55-year-old man is brought to the emergency room by his roommate due to an abdominal pain that started 2 hours ago. His pain is dull, aching, and radiates to the back. He admits to binge drinking alcohol for the past 2 days. Past medical history is significant for multiple admissions to the hospital for similar abdom... | Fat necrosis | {
"A": "Coagulative necrosis",
"B": "Caseous necrosis",
"C": "Liquefactive necrosis",
"D": "Fat necrosis"
} | step1 | D | [
"55 year old man",
"brought",
"emergency room",
"roommate due to",
"abdominal pain",
"started 2 hours",
"pain",
"dull",
"aching",
"radiates",
"back",
"admits to binge drinking alcohol",
"past 2 days",
"medical history",
"significant",
"multiple admissions",
"hospital",
"similar abd... |
A 62-year-old man presents to his physician complaining of difficulty maintaining an erection over the past month. Otherwise he feels well. He has a history of hypertension and congestive heart failure. His current medications include metoprolol, amlodipine, furosemide, losartan, and aspirin. Three months ago, lisinopr... | Reducing the metoprolol dose | {
"A": "Adding indapamide",
"B": "Increasing the amlodipine dose",
"C": "Reducing the metoprolol dose",
"D": "Switching losartan to lisinopril"
} | step2&3 | C | [
"62 year old man presents",
"physician",
"difficulty maintaining",
"erection",
"past month",
"feels well",
"history of hypertension",
"congestive heart failure",
"current medications include metoprolol",
"amlodipine",
"furosemide",
"losartan",
"aspirin",
"Three months",
"lisinopril",
"... |
A 59-year-old man with alcohol use disorder is brought to the emergency department by a friend because of progressively worsening forgetfulness and frequent falls. He appears disheveled. On mental status examination, he is confused and oriented only to person. Neurologic examination shows horizontal nystagmus on latera... | Vitamin B1 | {
"A": "Vitamin B12",
"B": "Vitamin B1",
"C": "Vitamin B6",
"D": "Vitamin B9"
} | step1 | B | [
"59 year old man",
"alcohol use disorder",
"brought",
"emergency department",
"friend",
"worsening forgetfulness",
"frequent falls",
"appears",
"mental",
"confused",
"oriented only",
"person",
"Neurologic examination shows horizontal nystagmus on lateral gaze",
"walks",
"wide-based",
"... |
A newborn boy develops projectile vomiting 48 hours after delivery. He is found to be lethargic, with poor muscle tone, and is hyperventilating. Within hours, he suffers important neurological deterioration, leading to seizures, coma, and, ultimately, death. An autopsy is performed and the pathology team makes a diagno... | Carbamoyl phosphate synthetase I | {
"A": "Carbamoyl phosphate synthetase I",
"B": "Arginase",
"C": "Argininosuccinate lyase",
"D": "Argininosuccinate synthetase"
} | step1 | A | [
"newborn boy",
"projectile vomiting 48 hours",
"delivery",
"found to",
"lethargic",
"poor muscle tone",
"hyperventilating",
"hours",
"suffers important neurological deterioration",
"leading",
"seizures",
"coma",
"death",
"autopsy",
"performed",
"pathology team makes",
"diagnosis",
... |
A 50-year-old female presents with a holosystolic murmur heard best over the apex, radiating to the axilla. She has no signs of pulmonary hypertension or edema. What best explains her lack of symptoms? | The left atrium is compensating with increased compliance | {
"A": "The right ventricle is compensating with decreased compliance",
"B": "The left atrium is compensating with increased compliance",
"C": "The aorta is compensating with increased compliance",
"D": "There is only a ballooning of the valve which would not result in any hemodynamic changes in the heart"
} | step1 | B | [
"50 year old female presents",
"holosystolic murmur heard best",
"apex",
"radiating to",
"axilla",
"signs",
"pulmonary hypertension",
"edema",
"best",
"lack",
"symptoms"
] |
A 9-year-old girl is brought to her primary care physician because of a 4-month history of early morning headaches and worsening fatigue. The headaches are often accompanied by nausea and sometimes relieved by vomiting. She stopped going to her ballet lessons 2 weeks ago because she was embarrassed about falling freque... | Pilocytic astrocytoma | {
"A": "Acoustic schwannoma",
"B": "Pilocytic astrocytoma",
"C": "Oligodendroglioma",
"D": "Ependymoma"
} | step2&3 | B | [
"year old girl",
"brought",
"primary care physician",
"of",
"4 month history",
"early morning headaches",
"worsening fatigue",
"headaches",
"often",
"nausea",
"sometimes relieved by vomiting",
"stopped",
"ballet",
"2 weeks",
"embarrassed",
"falling frequently",
"increasing difficulty... |
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