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 59-year-old male presents to his primary care physician complaining of a tremor. He developed a tremor in his left hand approximately three months ago. It appears to be worse at rest and diminishes if he points to something or uses the hand to hold an object. His past medical history is notable for emphysema and myas... | Major depressive disorder | {
"A": "Major depressive disorder",
"B": "Influenza",
"C": "Seasonal allergies",
"D": "Restless leg syndrome"
} | step1 | A | [
"59 year old male presents",
"primary care physician",
"tremor",
"tremor",
"left approximately three months",
"appears to",
"worse",
"rest",
"diminishes",
"points",
"uses",
"hand to hold",
"object",
"past medical history",
"notable",
"emphysema",
"myasthenia gravis",
"40 pack-year ... |
A 61-year-old man is brought to the emergency room with slurred speech. According to the patient's wife, they were watching a movie together when he developed a minor headache. He soon developed difficulty speaking in complete sentences, at which point she decided to take him to the emergency room. His past medical his... | Anterior cerebral artery and middle cerebral artery watershed area | {
"A": "Anterior cerebral artery and middle cerebral artery watershed area",
"B": "Inferior division of the middle cerebral artery",
"C": "Middle cerebral artery and posterior cerebral artery watershed area",
"D": "Proximal middle cerebral artery"
} | step1 | A | [
"61 year old man",
"brought",
"emergency room",
"slurred speech",
"patient's wife",
"watching",
"movie together",
"minor headache",
"difficulty speaking",
"complete sentences",
"point",
"to take",
"emergency room",
"past medical history",
"notable",
"hypertension",
"hyperlipidemia",
... |
A 45-year-old man comes to the emergency department because of hematuria and bilateral flank pain. He has passed urinary stones twice before and has a history of recurrent urinary tract infections. He reports no recent trauma. His father had a history of kidney failure and underwent a kidney transplant. His temperature... | Cerebral saccular aneurysm | {
"A": "Vesicoureteral reflux",
"B": "Portal hypertension",
"C": "Osteolytic bone lesions",
"D": "Cerebral saccular aneurysm"
} | step1 | D | [
"year old man",
"emergency department",
"hematuria",
"bilateral flank pain",
"passed urinary twice",
"history of recurrent urinary tract infections",
"reports",
"recent trauma",
"father",
"history of kidney failure",
"kidney transplant",
"temperature",
"100 4F",
"pulse",
"min",
"blood ... |
A 12-year-old boy develops muscle weakness and pain, vomiting, seizures, and severe headache. Additionally, he presents with hemiparesis on one side of the body. A muscle biopsy shows 'ragged red fibers'. What is true about the mode of inheritance of the disease described? | It is transmitted only through the mother. | {
"A": "Commonly more severe in males",
"B": "Skips generations",
"C": "Mothers transmit to 50% of daughters and son",
"D": "It is transmitted only through the mother."
} | step1 | D | [
"year old boy",
"muscle weakness",
"pain",
"vomiting",
"seizures",
"severe headache",
"presents",
"hemiparesis",
"one side",
"body",
"muscle biopsy shows",
"ragged red fibers",
"true",
"mode of inheritance",
"disease described"
] |
A 35-year-old woman comes to the physician because of a 2-month history of progressive fatigue and intermittent abdominal pain. During this time, she has noticed that her urine is darker when she wakes up in the morning. Her stool is of normal color. Five months ago, she was diagnosed with type 2 diabetes mellitus, for... | Venous thrombosis | {
"A": "Acrocyanosis",
"B": "Hepatocellular carcinoma",
"C": "Venous thrombosis",
"D": "Chronic lymphocytic leukemia"
} | step2&3 | C | [
"35 year old woman",
"physician",
"2 month history",
"progressive fatigue",
"intermittent abdominal pain",
"time",
"urine",
"darker",
"wakes up",
"morning",
"stool",
"normal color",
"Five months",
"diagnosed",
"type 2 diabetes mellitus",
"takes metformin",
"Physical examination shows... |
A 52-year-old woman is brought to the emergency department by her husband because of weakness, abdominal pain, and a productive cough for 4 days. She also reports increased urination for the past 2 days. This morning, she had nausea and five episodes of vomiting. She has type 1 diabetes mellitus and hypertension. Curre... | Extracellular potassium shift | {
"A": "Increased renal potassium absorption",
"B": "Muscle cell breakdown",
"C": "Extracellular potassium shift",
"D": "Repeated vomiting"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"husband",
"weakness",
"abdominal pain",
"productive cough",
"4 days",
"reports increased urination",
"past 2 days",
"morning",
"nausea",
"five episodes of vomiting",
"type 1 diabetes mellitus",
"hypertension",
"Current medications i... |
A 3-year-old girl with cystic fibrosis is brought to the physician for a follow-up examination. Her mother has noticed that the child has had multiple falls over the past 4 months while walking, especially in the evening. Her current medications include pancreatic enzyme supplements, an albuterol inhaler, and acetylcys... | Administer vitamin A | {
"A": "Administer zinc",
"B": "Administer vitamin A",
"C": "Administer riboflavin",
"D": "Administer lutein"
} | step2&3 | B | [
"3 year old girl",
"cystic fibrosis",
"brought",
"physician",
"follow-up examination",
"mother",
"child",
"multiple falls",
"past",
"months",
"walking",
"evening",
"current medications include pancreatic enzyme supplements",
"albuterol inhaler",
"acetylcysteine",
"percentile",
"heigh... |
An otherwise healthy 55-year-old woman comes to the physician because of a 7-month history of insomnia. She has difficulty initiating sleep, and her sleep onset latency is normally about 1 hour. She takes melatonin most nights. The physician gives the following recommendations: leave the bedroom when unable to fall asl... | Stimulus control therapy | {
"A": "Relaxation",
"B": "Stimulus control therapy",
"C": "Improved sleep hygiene",
"D": "Cognitive behavioral therapy"
} | step1 | B | [
"healthy 55 year old woman",
"physician",
"month history",
"insomnia",
"difficulty initiating sleep",
"sleep onset latency",
"hour",
"takes melatonin",
"nights",
"physician gives",
"following recommendations",
"leave",
"bedroom",
"unable to fall asleep",
"20 minutes to read",
"listen",... |
A 59-year-old man comes to the physician because of bilateral blurry vision and difficulty driving at night that has been worsening progressively over the past 5 months. He has hypertension, type 2 diabetes mellitus, and hyperlipidemia. His hemoglobin A1c concentration is 8.9 mg/dL. A slit-lamp shows cloudy opacities o... | Aldose reductase | {
"A": "Aldolase B",
"B": "Glucokinase",
"C": "Aldose reductase",
"D": "Sorbitol dehydrogenase"
} | step1 | C | [
"59 year old man",
"physician",
"bilateral blurry vision",
"difficulty driving",
"night",
"worsening",
"past",
"months",
"hypertension",
"type 2 diabetes mellitus",
"hyperlipidemia",
"hemoglobin concentration",
"mg/dL",
"slit-lamp shows cloudy opacities of the lenses",
"patient's eye",
... |
A 15-month-old infant is brought to the pediatrician with diarrhea. The infant’s history is positive for repeated episodes of diarrhea over the last 9 months. The mother reports that he was completely healthy until about 6 months of age. There is no history of lethargy, pedal edema, constipation, or vomiting. She menti... | Failure to thrive | {
"A": "Constitutional growth delay",
"B": "Mild wasting",
"C": "Mild stunting",
"D": "Failure to thrive"
} | step2&3 | D | [
"month old infant",
"brought",
"pediatrician",
"diarrhea",
"infants history",
"positive",
"repeated episodes of diarrhea",
"last",
"months",
"mother reports",
"completely healthy",
"about",
"months",
"age",
"history",
"lethargy",
"pedal edema",
"constipation",
"vomiting",
"symp... |
A 31-year-old G1P0 woman with a history of hypertension presents to the emergency department because she believes that she is in labor. She is in her 38th week of pregnancy and her course has thus far been uncomplicated. This morning, she began feeling painful contractions and noted vaginal bleeding after she fell off ... | Abruptio placentae | {
"A": "Abruptio placentae",
"B": "Normal labor",
"C": "Placenta previa",
"D": "Uterine rupture"
} | step2&3 | A | [
"31 year old",
"woman",
"history of hypertension presents",
"emergency department",
"labor",
"week",
"pregnancy",
"course",
"far",
"uncomplicated",
"morning",
"began feeling painful contractions",
"noted vaginal bleeding",
"fell",
"bike",
"to work",
"experiencing lower abdominal",
... |
A 79-year-old homeless man is brought to the emergency department by ambulance 30 minutes after being found unresponsive by the police. On arrival, he is apneic and there are no palpable pulses. Despite appropriate life-saving measures, he dies. Examination of the heart during autopsy shows normal ventricles with a sig... | Oxidation of phospholipid molecules | {
"A": "Accumulation of iron granules",
"B": "Clumping of defective mitochondria",
"C": "Oxidation of phospholipid molecules",
"D": "Aggregation of alpha-synuclein"
} | step1 | C | [
"year old homeless man",
"brought",
"emergency department",
"ambulance 30 minutes",
"found unresponsive",
"police",
"arrival",
"apneic",
"palpable pulses",
"appropriate life saving measures",
"Examination of",
"heart",
"autopsy shows normal ventricles",
"sigmoid shaped interventricular sep... |
A 19-year-old college student presents to student health with 1 day of fever and chills. He says that he has also been coughing for 2 days. His roommate was sick 3 days ago with similar symptoms and was diagnosed with Mycoplasma infection. He has otherwise been healthy and has had all the required vaccines as scheduled... | Pentamers | {
"A": "Dimers",
"B": "Pentamers",
"C": "Tetramers",
"D": "Trimers"
} | step1 | B | [
"year old college student presents",
"student health",
"1 day",
"fever",
"chills",
"coughing",
"2 days",
"roommate",
"sick 3 days",
"similar symptoms",
"diagnosed",
"Mycoplasma infection",
"healthy",
"required vaccines",
"scheduled",
"currently taking",
"biology",
"part of",
"stu... |
A 42-year-old woman is seen by her primary care physician for her annual checkup. She has no current concerns and says that she has been healthy over the last year except for a bout of the flu in December. She has no significant past medical history and is not currently taking any medications. She has smoked 1 pack per... | Homologous recombination | {
"A": "Base excision repair",
"B": "Homologous recombination",
"C": "Mismatch repair",
"D": "Non-homologous end joining"
} | step1 | B | [
"year old woman",
"seen by",
"primary care physician",
"annual checkup",
"current concerns",
"healthy",
"year except for",
"bout",
"flu",
"December",
"significant past medical history",
"not currently taking",
"medications",
"smoked 1 pack",
"day",
"drinks",
"friends",
"family hist... |
A 56-year-old man presents to the emergency department with severe epigastric pain that began an hour prior to presentation. He describes the pain as sharp, 10/10 in severity, and radiating to the back. Swallowing worsens the pain and causes him to cough. Before the pain started, he had been vomiting multiple times per... | Transmural esophageal rupture | {
"A": "Coronary artery occlusion",
"B": "Dissection of the aorta",
"C": "Ulcerative changes in the gastric mucosa",
"D": "Transmural esophageal rupture"
} | step1 | D | [
"year old man presents",
"emergency department",
"severe epigastric",
"began",
"hour prior to presentation",
"pain",
"sharp",
"10",
"severity",
"radiating to",
"back",
"Swallowing worsens",
"pain",
"causes",
"to cough",
"pain started",
"vomiting multiple times per day",
"past week"... |
A researcher is studying the interactions between foreign antigens and human immune cells. She has isolated a line of lymphocytes that is known to bind antigen-presenting cells. From this cell line, she has isolated a cell surface protein that binds the constant portion of the class I major histocompatibility complex m... | Interleukin 2 | {
"A": "Interleukin 2",
"B": "Interleukin 4",
"C": "Interleukin 6",
"D": "Interleukin 8"
} | step1 | A | [
"researcher",
"studying",
"interactions",
"foreign antigens",
"human immune cells",
"isolated",
"line",
"lymphocytes",
"known to bind antigen-presenting cells",
"cell line",
"isolated",
"cell surface protein",
"binds",
"constant portion",
"class I major histocompatibility complex molecul... |
A 76-year-old woman with a history of hypertension and type 2 diabetes mellitus is brought to the emergency department 60 minutes after the acute onset of left-sided abdominal pain and nausea with vomiting. Three weeks ago, she underwent emergency surgical revascularization for acute left lower extremity ischemia. Phys... | Absent P waves on electrocardiogram | {
"A": "Absent P waves on electrocardiogram",
"B": "Non-compressible femoral vein on ultrasonography",
"C": "Infrarenal aortic aneurysm on abdominal CT scan",
"D": "Schistocytes on peripheral blood smear"
} | step1 | A | [
"76 year old woman",
"history of hypertension",
"type 2 diabetes mellitus",
"brought",
"emergency department 60 minutes",
"acute onset",
"left-sided",
"nausea with vomiting",
"Three weeks",
"emergency surgical revascularization",
"acute left",
"Physical examination shows left upper quadrant te... |
A 50-year-old woman comes to the physician for a follow-up examination. Two weeks ago she was seen for adjustment of her antihypertensive regimen and prescribed lisinopril because of persistently high blood pressure readings. A complete blood count and renal function checked at her last visit were within the normal lim... | Renal artery stenosis
" | {
"A": "Hyperthyroidism",
"B": "Diabetic kidney disease",
"C": "Polycystic kidney disease",
"D": "Renal artery stenosis\n\""
} | step2&3 | D | [
"50 year old woman",
"physician",
"follow-up examination",
"Two weeks",
"seen",
"adjustment",
"antihypertensive regimen",
"prescribed lisinopril",
"persistently high blood pressure readings",
"complete blood count",
"renal function checked",
"visit",
"normal limits",
"questioning",
"fati... |
A 77-year-old man presents to the emergency department complaining of feeling like “his heart was racing” for the last 8 days. He denies any chest pain, dizziness, or fainting but complains of fatigue, difficulty breathing with exertion, and swelling of his legs bilaterally for the last 2 weeks. He has had hypertension... | Rivaroxaban for 3–4 weeks followed by cardioversion and continuation of rivaroxaban | {
"A": "Immediate direct current (DC) cardioversion",
"B": "Rivaroxaban for 3–4 weeks followed by cardioversion and continuation of rivaroxaban",
"C": "Warfarin and diltiazem indefinitely",
"D": "Catheter ablation for pulmonary vein isolation"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"feeling",
"heart",
"racing",
"days",
"denies",
"chest pain",
"dizziness",
"fainting",
"fatigue",
"difficulty breathing",
"exertion",
"swelling of",
"legs",
"last",
"weeks",
"hypertension",
"years",
"long history",
"heavy alcoh... |
A 64-year-old woman is brought to the emergency department because of a 1-week history of progressive shortness of breath, lower extremity edema, and a 4-kg (9-lb) weight gain. She has ischemic cardiomyopathy and rheumatoid arthritis. Her respirations are 27/min. Examination shows pitting edema of the lower extremities... | Diclofenac | {
"A": "Sulfasalazine",
"B": "Diclofenac",
"C": "Prednisone",
"D": "Infliximab"
} | step1 | B | [
"64 year old woman",
"brought",
"emergency department",
"of",
"1-week history",
"progressive shortness",
"breath",
"lower extremity edema",
"4 kg",
"weight gain",
"ischemic cardiomyopathy",
"rheumatoid arthritis",
"respirations",
"27 min",
"Examination shows pitting edema",
"lower extr... |
A 7-year-old girl is brought to the physician because of scant painless bleeding from the vagina 6 hours ago. She has no history of serious illness or trauma. Her older sister had her first period at age 11. The patient is at the 80th percentile for height and 95th percentile for weight and BMI. Examination shows greas... | Pulsatile GnRH release | {
"A": "Overproduction of adrenal cortisol",
"B": "Compensatory hyperinsulinemia",
"C": "Pulsatile GnRH release",
"D": "Deficiency of thyroid hormones\n\""
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"of scant painless bleeding from",
"vagina",
"hours",
"history",
"serious illness",
"trauma",
"older sister",
"first period",
"age",
"patient",
"80th percentile",
"height",
"95th percentile",
"weight",
"BMI",
"Examination shows greasy faci... |
A 9-year-old boy is brought to the physician by his mother because of a 3-day history of fever and bleeding after brushing his teeth. His mother also reports that her son has asked to be picked up early from soccer practice the past few days because of fatigue. He appears pale and ill. His temperature is 38.3°C (101.1°... | Hypocellular fat-filled marrow with RBCs of normal morphology | {
"A": "Sheets of abnormal plasma cells",
"B": "Hypocellular fat-filled marrow with RBCs of normal morphology",
"C": "Hypercellular, dysplastic bone marrow with ringed sideroblasts",
"D": "Infiltration of the marrow with collagen and fibrous tissue"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"mother",
"3-day history",
"fever",
"bleeding",
"brushing",
"teeth",
"mother",
"reports",
"son",
"to",
"picked",
"early",
"soccer practice",
"past",
"days",
"fatigue",
"appears pale",
"ill",
"temperature",
"3C",
"pulse",
"min",
... |
A 27-year-old woman comes to the physician because of a 1-year history of progressive shortness of breath. She is now unable to jog for more than 10 minutes without stopping to catch her breath. Cardiac examination shows a harsh systolic, crescendo-decrescendo murmur best heard at the lower left sternal border. The mur... | Myosin heavy chain defect | {
"A": "Dystrophin defect",
"B": "Fibrillin-1 defect",
"C": "Myosin heavy chain defect",
"D": "GAA trinucleotide repeats"
} | step1 | C | [
"27 year old woman",
"physician",
"of",
"year history",
"progressive shortness",
"breath",
"now unable",
"jog",
"10 minutes",
"stopping to catch",
"breath",
"Cardiac examination shows",
"harsh systolic",
"crescendo",
"murmur best heard",
"lower left sternal border",
"murmur increases... |
A 27-year-old woman presented to the clinic with recurrent abdominal swelling and stunted growth relative to her siblings. She has a history of multiple blood transfusions in her childhood. She has a family history of jaundice in her father who was operated on for multiple gallbladder stones. The physical examination r... | Hereditary spherocytosis | {
"A": "Hereditary spherocytosis",
"B": "Blood loss",
"C": "Aplastic anemia",
"D": "Vitamin B12 deficiency"
} | step2&3 | A | [
"27 year old woman presented",
"clinic",
"recurrent abdominal swelling",
"stunted growth relative to",
"siblings",
"history of multiple blood transfusions",
"childhood",
"family history of jaundice",
"father",
"operated",
"multiple gallbladder stones",
"physical examination reveals",
"pale",... |
A 43-year-old HIV positive male presents with signs and symptoms concerning for a fungal infection. He is currently not on antiretrovirals and his CD4 count is 98. Which of the following candidal infections could be seen in this patient but would be very rare in an immunocompetent host? | Esophagitis | {
"A": "Oral thrush",
"B": "Vaginitis",
"C": "Esophagitis",
"D": "Endocarditis"
} | step1 | C | [
"year old HIV positive male presents",
"signs",
"symptoms concerning",
"fungal infection",
"currently not",
"antiretrovirals",
"CD4 count",
"98",
"following candidal infections",
"seen",
"patient",
"very rare",
"immunocompetent host"
] |
A 55-year-old man is brought to the emergency department 3 hours after ingesting approximately 30 tablets of an unknown drug in an apparent suicide attempt. His temperature is 36.5°C (97.7°F), pulse is 40/min, respiratory rate is 19/min, and blood pressure is 85/50 mm Hg. Examination shows cold, clammy extremities. Sca... | Glucagon | {
"A": "Pralidoxime",
"B": "Glucagon",
"C": "Activated charcoal",
"D": "Naloxone"
} | step1 | B | [
"55 year old man",
"brought",
"emergency department",
"hours",
"ingesting approximately 30 tablets",
"unknown drug",
"apparent suicide attempt",
"temperature",
"36",
"97",
"pulse",
"40 min",
"respiratory rate",
"min",
"blood pressure",
"85 50 mm Hg",
"Examination shows cold",
"clam... |
A 33-year-old African-American female presents to her physician with complaints of a persistent, dry cough. She states that the cough has gone on for some time now. Three weeks ago, during her last general checkup, she was started on lisinopril and metformin for concerns regarding an elevated blood pressure and fasting... | Non-caseating granulomas are found on biopsy of mediastinal lymph nodes | {
"A": "Serum levels of bradykinin will be elevated",
"B": "Loratadine would best treat her chief complaint",
"C": "Beta agonists would relieve this patients symptoms",
"D": "Non-caseating granulomas are found on biopsy of mediastinal lymph nodes"
} | step1 | D | [
"year old African-American female presents",
"physician",
"complaints",
"persistent",
"dry cough",
"states",
"cough",
"time now",
"Three weeks",
"last general checkup",
"started",
"lisinopril",
"metformin",
"concerns",
"elevated blood pressure",
"fasting blood glucose",
"Past medical... |
Two hours after admission to the intensive care unit, a 56-year-old man with necrotizing pancreatitis develops profound hypotension. His blood pressure is 80/50 mm Hg and he is started on vasopressors. A central venous access line is placed. Which of the following is most likely to decrease the risk of complications fr... | Preparation of the skin with chlorhexidine and alcohol | {
"A": "Initiation of anticoagulation after placement",
"B": "Initiation of periprocedural systemic antibiotic prophylaxis",
"C": "Replacement of the central venous line every 7-10 days",
"D": "Preparation of the skin with chlorhexidine and alcohol"
} | step1 | D | [
"Two hours",
"admission",
"intensive care unit",
"year old man",
"necrotizing pancreatitis",
"profound hypotension",
"blood pressure",
"80 50 mm Hg",
"started",
"vasopressors",
"central venous access line",
"placed",
"following",
"most likely to decrease",
"risk",
"complications",
"p... |
A 51-year-old woman comes to the physician because of swelling of her legs for 4 months. She first noticed the changes on the left leg, followed by the right leg. Sometimes her legs are itchy. She has a 1-month history of hoarseness. She returned from a trip to Mexico 8 months ago. She has a history of hypertension, co... | Primary thyroid lymphoma | {
"A": "Renal vein thrombosis",
"B": "Esophageal variceal hemorrhage",
"C": "Elephantiasis",
"D": "Primary thyroid lymphoma"
} | step2&3 | D | [
"year old woman",
"physician",
"of swelling",
"legs",
"4 months",
"first",
"changes",
"left leg",
"followed by",
"right leg",
"Sometimes",
"legs",
"itchy",
"month history",
"hoarseness",
"returned",
"trip",
"Mexico",
"months",
"history of hypertension",
"constipation",
"cor... |
A 39-year-old male who recently presented with acetaminophen overdose was admitted to the MICU, where several attempts were made at obtaining intravenous access without success. The decision was made to place a right axillary arterial line, which became infected and was removed by the medical student while the patient ... | Compression of ulnar nerve secondary to coagulopathy | {
"A": "Needle injury to ulnar nerve secondary to blind line placement",
"B": "Needle injury to median nerve secondary to blind line placement",
"C": "Compression of ulnar nerve secondary to coagulopathy",
"D": "Compression of median nerve secondary to coagulopathy"
} | step1 | C | [
"year old male",
"recently presented",
"acetaminophen overdose",
"admitted",
"attempts",
"made",
"obtaining intravenous access",
"success",
"decision",
"made to place",
"right axillary arterial line",
"infected",
"removed",
"medical student",
"patient",
"intubated",
"later",
"swell... |
A mother brings her 6-year-old daughter in to the pediatrician’s clinic for a wellness visit. The mother has a history of von Willebrand’s disease (vWD) and is concerned that her daughter may be affected as well. The mother tells you that she has noticed that her daughter bruises very easily, and her bruises typically ... | Prolonged PTT | {
"A": "Prolonged PT",
"B": "Prolonged PTT",
"C": "Normal bleeding time",
"D": "Decreased factor IX"
} | step2&3 | B | [
"mother",
"year old daughter",
"pediatricians clinic",
"wellness visit",
"mother",
"history of von Willebrands disease",
"concerned",
"daughter",
"affected",
"well",
"mother",
"daughter bruises very easily",
"bruises",
"visible",
"longer period",
"time",
"brother",
"denies",
"per... |
A 35-year-old African American woman comes to the physician because of intermittent palpitations over the past 2 weeks. During this period she has also had constipation and has felt more tired than usual. She was diagnosed with hypertension 4 weeks ago and treatment with chlorthalidone was begun. Her temperature is 36.... | Perform saline infusion test | {
"A": "Perform adrenalectomy",
"B": "Perform CT scan of the abdomen",
"C": "Perform dexamethasone suppression test",
"D": "Perform saline infusion test"
} | step2&3 | D | [
"35 year old African American woman",
"physician",
"of intermittent palpitations",
"past 2 weeks",
"period",
"constipation",
"felt more tired",
"usual",
"diagnosed",
"hypertension",
"weeks",
"treatment",
"chlorthalidone",
"begun",
"temperature",
"36",
"97",
"pulse",
"75 min",
"... |
An 80-year-old man is brought to the emergency department because of a 2-day history of a decreasing level of consciousness. He had blurred vision for several days. Two weeks ago, he had transient numbness in the right arm for 3 days. He was diagnosed with monoclonal gammopathy of undetermined significance 2 years ago.... | Plasmapheresis | {
"A": "Dexamethasone",
"B": "Hemodialysis",
"C": "Intravenous hydration with normal saline",
"D": "Plasmapheresis"
} | step2&3 | D | [
"80 year old man",
"brought",
"emergency department",
"of",
"2-day history",
"decreasing level",
"consciousness",
"blurred vision",
"days",
"Two weeks",
"transient numbness",
"right arm",
"3 days",
"diagnosed",
"monoclonal gammopathy of undetermined significance",
"years",
"not",
"... |
A 24-year-old male is brought in by fire rescue after being the restrained driver in a motor vehicle accident. There was a prolonged extraction. At the scene, the patient was GCS 13. The patient was boarded and transported. In the trauma bay, vitals are T 97.2 F, HR 132 bpm, BP 145/90 mmHG, RR 22 rpm, and O2 Sat 100%. ... | Radiograph C | {
"A": "Radiograph B",
"B": "Radiograph C",
"C": "Radiograph D",
"D": "Radiograph E"
} | step2&3 | B | [
"year old male",
"brought",
"fire",
"restrained driver",
"motor vehicle accident",
"prolonged extraction",
"patient",
"GCS",
"patient",
"boarded",
"transported",
"trauma bay",
"T 97",
"F",
"BP",
"90 mmHG",
"RR",
"rpm",
"O2 Sat 100",
"ABCs",
"intact",
"GCS",
"secondary sur... |
A 46-year-old premenopausal woman undergoes lumpectomy after a diagnosis of invasive ductal carcinoma of the breast is made. Pathologic examination of the surgical specimen shows that the breast cancer cells stain positive for estrogen receptor and progesterone receptor, and negative for human epidermal growth factor r... | Selective agonist at estrogen receptors in bone tissue | {
"A": "Selective agonist at estrogen receptors in bone tissue",
"B": "Monoclonal antibody against tyrosine kinase receptor",
"C": "Monoclonal antibody against vascular endothelial growth factor",
"D": "Selective antagonist at estrogen receptors in endometrium\n\""
} | step1 | A | [
"year old premenopausal woman",
"lumpectomy",
"diagnosis of invasive ductal carcinoma",
"the breast",
"made",
"Pathologic examination",
"surgical specimen shows",
"breast cancer cells stain positive",
"estrogen receptor",
"progesterone receptor",
"negative",
"human epidermal growth factor rece... |
A 67-year-old woman comes to the physician with a 4-month history of chest pain that occurs on exertion. The pain is dull, and she experiences retrosternal pressure when she walks up the stairs to her apartment on the fifth floor. The pain disappears shortly after stopping for one minute. She has hypertension, for whic... | Elevated transaminases | {
"A": "Bloating",
"B": "Elevated transaminases",
"C": "Cholelithiasis",
"D": "Flushing\n\""
} | step2&3 | B | [
"67 year old woman",
"physician",
"4 month history of chest pain",
"occurs",
"exertion",
"pain",
"dull",
"experiences retrosternal pressure",
"walks up",
"stairs",
"apartment",
"fifth floor",
"pain",
"stopping",
"one minute",
"hypertension",
"takes lisinopril",
"metoprolol daily",
... |
Antigen presentation of extracellular pathogens by antigen presenting cells requires endocytosis of the antigen, followed by the degradation in the acidic environment of the formed phagolysosome. Should the phagolysosome become unable to lower its pH, what is the most likely consequence? | Deficient presentation of pathogens to CD4 T-cells | {
"A": "Deficient presentation of pathogens to CD4 T-cells",
"B": "Deficient presentation of pathogens to CD8 T-cells",
"C": "Deficient cell extravasation",
"D": "Deficient expression of B7"
} | step1 | A | [
"Antigen presentation",
"extracellular pathogens",
"antigen presenting cells",
"endocytosis",
"antigen",
"followed by",
"degradation",
"acidic environment",
"formed phagolysosome",
"phagolysosome",
"unable to lower",
"pH",
"most likely consequence"
] |
Five weeks after delivery, a 1350-g (3-lb 0-oz) male newborn has respiratory distress. He was born at 26 weeks' gestation. He required intubation and mechanical ventilation for a month following delivery and has been on noninvasive pressure ventilation for 5 days. His temperature is 36.8°C (98.2°F), pulse is 148/min, r... | Bronchopulmonary dysplasia | {
"A": "Tracheomalacia",
"B": "Bronchopulmonary dysplasia",
"C": "Interstitial emphysema",
"D": "Bronchiolitis obliterans\n\""
} | step2&3 | B | [
"Five weeks",
"delivery",
"1350 g",
"0 oz",
"male newborn",
"respiratory distress",
"born",
"weeks",
"gestation",
"required intubation",
"mechanical ventilation",
"month following delivery",
"noninvasive pressure ventilation",
"5 days",
"temperature",
"36",
"98",
"pulse",
"min",
... |
A healthy 34-year-old woman comes to the physician for advice on UV protection. She works as an archaeologist and is required to work outside for extended periods of time. She is concerned about premature skin aging. The physician recommends sun-protective clothing and sunscreen. In order to protect effectively against... | Zinc oxide | {
"A": "Trolamine salicylate",
"B": "Trimethoprim/sulfamethoxazole",
"C": "Vitamin E",
"D": "Zinc oxide"
} | step1 | D | [
"healthy",
"year old woman",
"physician",
"advice",
"UV protection",
"works",
"archaeologist",
"required to work outside",
"extended periods",
"time",
"concerned",
"premature skin aging",
"physician recommends sun protective clothing",
"sunscreen",
"order to",
"photoaging",
"sunscree... |
A 68-year-old man comes to the physician because of a 6-week history of episodic tremors, headaches, and sweating. During this time, he has gained 2.5-kg (5 lb 8 oz). Two months ago, he was diagnosed with type 2 diabetes mellitus and treatment with an oral antidiabetic drug was initiated. The beneficial effect of the d... | ATP-sensitive potassium channels | {
"A": "ATP-sensitive potassium channels",
"B": "Brush-border α-glucosidase",
"C": "Sodium-glucose cotransporter-2",
"D": "Dipeptidyl peptidase-4"
} | step1 | A | [
"68 year old man",
"physician",
"of",
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"episodic tremors",
"headaches",
"sweating",
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"gained 2.5 kg",
"5",
"8 oz",
"Two months",
"diagnosed",
"type 2 diabetes mellitus",
"treatment",
"oral antidiabetic drug",
"initiated",
"beneficial effect",
"drug",
"pres... |
A 27-year-old woman presents to her primary care physician with a chief complaint of pain in her hands, shoulders, and knees. She states that the pain has lasted for several months but seems to have worsened recently. Any activity such as opening jars, walking, or brushing her teeth is painful. The patient has a past m... | Anti-dsDNA antibodies | {
"A": "Anti-cyclic citrullinated peptide antibodies",
"B": "Anti-dsDNA antibodies",
"C": "Degenerated cartilage in weight bearing joints",
"D": "IgM against parvovirus B19"
} | step2&3 | B | [
"27 year old woman presents",
"primary care physician",
"chief complaint",
"pain",
"hands",
"shoulders",
"knees",
"states",
"pain",
"lasted",
"months",
"to",
"worsened recently",
"activity",
"opening jars",
"walking",
"brushing",
"teeth",
"painful",
"patient",
"past medical",... |
A previously healthy 46-year-old man comes to the physician for an 8-month history of headache that is more severe in the mornings. His blood pressure is 151/92 mm Hg. Examination shows enlargement of the nose, forehead, and jaw as well as the hands, fingers, and feet. Ophthalmologic examination shows impaired vision i... | Elevated serum insulin-like growth factor-1 level | {
"A": "Elevated urine cortisol level",
"B": "Low serum insulin level",
"C": "Elevated serum prolactin level",
"D": "Elevated serum insulin-like growth factor-1 level"
} | step1 | D | [
"healthy",
"year old man",
"physician",
"month history of headache",
"more severe",
"mornings",
"blood pressure",
"mm Hg",
"Examination shows enlargement",
"nose",
"forehead",
"jaw",
"hands",
"fingers",
"feet",
"Ophthalmologic shows impaired vision",
"outer peripheral fields of",
"... |
A 13-year-old boy is brought to the emergency department because of vomiting, diarrhea, abdominal pain, and dizziness for the past 3 hours with fever, chills, and muscle pain for the last day. He had presented 5 days ago for an episode of epistaxis caused by nasal picking and was treated with placement of anterior nasa... | Toxic shock syndrome | {
"A": "Disseminated gonococcal infection",
"B": "Toxic shock syndrome",
"C": "Stevens-Johnson syndrome",
"D": "Measles"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"vomiting",
"diarrhea",
"abdominal pain",
"dizziness",
"past",
"hours",
"fever",
"chills",
"muscle pain",
"day",
"presented 5 days",
"episode of epistaxis caused",
"nasal picking",
"treated with placement",
"anterior nasal packing"... |
A 56-year-old man presents with constipation and trouble urinating for the past day. He says that he tried drinking a lot of water but that did not help. He also says that he has been tired all the time recently. Past medical history is significant for schizophrenia, diagnosed 3 months ago, and being managed on antipsy... | Chlorpromazine | {
"A": "Haloperidol",
"B": "Ziprasidone",
"C": "Aripiprazole",
"D": "Chlorpromazine"
} | step1 | D | [
"year old man presents",
"constipation",
"past day",
"drinking",
"lot",
"water",
"not help",
"tired",
"time recently",
"Past medical history",
"significant",
"schizophrenia",
"diagnosed 3 months",
"managed",
"antipsychotic medication",
"Current medications",
"include sildenafil",
"... |
A 32-year-old woman comes to the physician because of a 3-month history of irregular menses, milky discharge from her nipples, fatigue, and weight gain. Menses occur at irregular 25–40-day intervals and last 1–2 days with minimal flow. 5 months ago, she was started on clozapine for treatment of schizophrenia. She has h... | Hypothyroidism | {
"A": "Hypothyroidism",
"B": "Prolactinoma",
"C": "Thyrotropic pituitary adenoma",
"D": "Ectopic prolactin production"
} | step1 | A | [
"year old woman",
"physician",
"3 month history",
"irregular menses",
"milky discharge from",
"nipples",
"fatigue",
"weight gain",
"Menses occur",
"irregular",
"day intervals",
"last 12 days",
"minimal flow",
"5 months",
"started",
"clozapine",
"treatment",
"schizophrenia",
"hypo... |
A 16-year-old Mexican female presents with symptoms of the common cold after the patient's respiratory epithelial cells were infected with Rhinovirus. Due to the presence of the virus, her respiratory epithelial cells begin producing interferon. Which is of the following is LEAST likely to be an outcome of the activati... | A rhinovirus-specific, cell-mediated immune response | {
"A": "Decreased viral replication within the cell",
"B": "A rhinovirus-specific, cell-mediated immune response",
"C": "Upregulation of NK cell ligands on the infected cell",
"D": "Activation of NK cells"
} | step1 | B | [
"year old Mexican female presents",
"symptoms",
"common",
"patient's respiratory epithelial cells",
"infected",
"Rhinovirus",
"Due to",
"presence of",
"virus",
"respiratory epithelial cells begin",
"interferon",
"following",
"LEAST likely to",
"outcome",
"activation",
"interferon respo... |
A 7-year-old boy is brought to the physician for evaluation of developmental delay and intellectual disability. He has been admitted to the hospital twice in the past 6 months because of a cerebral venous thrombosis and a pulmonary embolism, respectively. He is at 10th percentile for weight and 95th percentile for heig... | Decreased methionine concentration | {
"A": "Increased S-adenosylhomocysteine concentration",
"B": "Decreased methionine concentration",
"C": "Increased propionyl-CoA concentration",
"D": "Decreased cystathionine concentration\n\""
} | step1 | B | [
"year old boy",
"brought",
"physician",
"evaluation",
"developmental delay",
"intellectual disability",
"admitted",
"hospital twice",
"past 6 months",
"of",
"cerebral venous thrombosis",
"pulmonary embolism",
"percentile",
"weight",
"95th percentile",
"height",
"Physical examination ... |
A 38-year-old man is brought to the emergency room because of diarrhea for 2 days. He has abdominal cramps and has also noticed a dark red tint to his stool. He returned from a trip to Mexico 3 weeks ago, where he completed a marathon. He has a history of mild anemia. He does not smoke and drinks 3–4 beers on weekends.... | Metronidazole | {
"A": "Reassurance only",
"B": "Praziquantel",
"C": "Paromomycin",
"D": "Metronidazole"
} | step2&3 | D | [
"year old man",
"brought",
"emergency room",
"of diarrhea",
"2 days",
"abdominal cramps",
"dark red",
"stool",
"returned",
"trip",
"Mexico",
"weeks",
"completed",
"marathon",
"history of mild anemia",
"not smoke",
"drinks",
"beers",
"weekends",
"takes fish oil",
"multivitamin... |
A 46-year-old man presents to the clinic with a 2-week history of fever, fatigue, and coughing up blood. On questioning, he notes that he has also experienced some weight loss over the past 4 months and a change in the color of his urine, with intermittent passage of dark-colored urine during that time. The man does no... | Microscopic polyangiitis | {
"A": "Microscopic polyangiitis",
"B": "Disseminated tuberculosis",
"C": "Churg-Strauss syndrome",
"D": "Polyarteritis nodosa (PAN)"
} | step1 | A | [
"year old man presents",
"clinic",
"2-week history",
"fever",
"fatigue",
"coughing up blood",
"questioning",
"notes",
"experienced",
"weight loss",
"past",
"months",
"change",
"color",
"urine",
"intermittent passage of dark colored urine",
"time",
"man",
"not",
"prior history",... |
A 47-year-old woman is brought to the emergency department by her husband with the complaints of severe abdominal pain and discomfort. The pain began 2 days earlier, she describes it as radiating to her back and is associated with nausea. Her past medical history is significant for similar episodes of pain after fatty ... | Ultrasound of the gallbladder | {
"A": "Ultrasound of the appendix",
"B": "Ultrasound of the gallbladder",
"C": "Upper GI endoscopy",
"D": "Serum lipase levels"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"husband",
"complaints",
"severe abdominal",
"discomfort",
"pain began 2 days earlier",
"radiating to",
"back",
"associated with nausea",
"past medical history",
"significant",
"similar episodes of pain",
"meals",
"resolved",
"drin... |
A 62-year-old man is brought to the emergency department with a 2-day history of cough productive of yellowish sputum. He has had fever, chills, and worsening shortness of breath over this time. He has a 10-year history of hypertension and hyperlipidemia. He does not drink alcohol or smoke cigarettes. His current medic... | Increase in A-a gradient | {
"A": "Increased perfusion of right lung",
"B": "Improve the hypoxemia",
"C": "Decreased ventilation of the left lung",
"D": "Increase in A-a gradient"
} | step2&3 | D | [
"62 year old man",
"brought",
"emergency department",
"2-day history",
"cough productive",
"sputum",
"fever",
"chills",
"worsening shortness of breath",
"time",
"a 10 year history of hypertension",
"hyperlipidemia",
"not drink alcohol",
"smoke cigarettes",
"current medications include at... |
A 41-year-old woman comes to the primary care physician’s office with a 7-day history of headaches, sore throat, diarrhea, fatigue, and low-grade fevers. The patient denies any significant past medical history, recent travel, or recent sick contacts. On review of systems, the patient endorses performing sex acts in exc... | Retest with ELISA and Western blot in 2.5–8.5 weeks and again in 6 months | {
"A": "Repeat rapid HIV at this office check-up",
"B": "Retest with ELISA and Western blot in 2.5–8.5 weeks and again in 6 months",
"C": "Perform monospot test",
"D": "Perform VDRL"
} | step2&3 | B | [
"year old woman",
"primary care physicians office",
"7-day history of headaches",
"sore throat",
"diarrhea",
"fatigue",
"low-grade fevers",
"patient denies",
"significant past medical history",
"recent travel",
"recent sick contacts",
"review of systems",
"patient",
"performing sex acts",
... |
A 32-year-old woman comes to the physician because of flank pain, myalgia, and reddish discoloration of her urine for the past 2 days. One week ago, she had a fever and a sore throat and was prescribed antibiotics. She is otherwise healthy and has no history of serious illness. Her temperature is 37.9°C (100.2°F), puls... | Allergic interstitial nephritis | {
"A": "Allergic interstitial nephritis",
"B": "Pyelonephritis",
"C": "Crystal-induced acute kidney injury",
"D": "Thin basement membrane disease"
} | step2&3 | A | [
"year old woman",
"physician",
"flank pain",
"myalgia",
"discoloration",
"urine",
"past 2 days",
"One week",
"fever",
"sore throat",
"prescribed antibiotics",
"healthy",
"history",
"serious illness",
"temperature",
"100",
"pulse",
"70 min",
"blood pressure",
"75 mm Hg",
"Phys... |
An otherwise healthy 7-year-old boy is brought to the emergency department because of a 1-day history of involuntary muscle contractions and pain in his back and neck. Two weeks ago, he fell while playing in the sandbox and scraped both his knees. He has not received any vaccinations since birth. His temperature is 38.... | Denaturated bacterial product | {
"A": "Capsular polysaccharides",
"B": "Chemically-inactivated virus",
"C": "Denaturated bacterial product",
"D": "Viable but weakened microorganism"
} | step1 | C | [
"healthy",
"year old boy",
"brought",
"emergency department",
"1-day history",
"involuntary muscle contractions",
"pain in",
"back",
"neck",
"Two weeks",
"fell",
"playing",
"scraped",
"knees",
"not received",
"vaccinations",
"birth",
"temperature",
"diaphoretic",
"Examination s... |
A 25-year-old construction worker presents to the office due to a yellowish discoloration of his skin and eyes for the past 2 weeks. He also complains of nausea and loss of appetite for the same duration. The past medical history is insignificant. He is a smoker, but recently has grown a distaste for smoking. The vital... | Fecal-oral | {
"A": "Sexual contact",
"B": "Fecal-oral",
"C": "Blood transfusion",
"D": "Perinatal"
} | step1 | B | [
"year old construction worker presents",
"office due to",
"discoloration of",
"skin",
"eyes",
"past 2 weeks",
"nausea",
"loss of appetite",
"same duration",
"past medical history",
"smoker",
"recently",
"smoking",
"vital signs include",
"heart rate 83 min",
"respiratory rate",
"min",... |
A previously healthy 48-year-old man comes to the physician because of a 2-month history of weight loss and yellowing of the skin. He works as a farmer and cultivates soybean and corn. He does not smoke, drink alcohol, or use illicit drugs. His vital signs are within normal limits. Physical examination shows scleral ic... | Cytochrome P450 monooxygenases | {
"A": "Peroxisomal catalases",
"B": "Lysosomal serine proteases",
"C": "Cytosolic cysteine proteases",
"D": "Cytochrome P450 monooxygenases"
} | step1 | D | [
"healthy 48 year old man",
"physician",
"of",
"2 month history",
"weight loss",
"yellowing of the skin",
"works",
"farmer",
"soybean",
"corn",
"not smoke",
"drink alcohol",
"use illicit",
"vital signs",
"normal",
"Physical examination shows scleral icterus",
"tender hepatomegaly",
... |
A 66-year-old man presents to your office for a regular checkup. His only current complaint is periodic difficulty falling asleep at night. He takes captopril and hydrochlorothiazide for hypertension, atorvastatin for hyperlipidemia, and aspirin for cardiovascular disease prevention. His past medical history is signifi... | He had an allergic reaction to the Tdap vaccination. | {
"A": "It is contraindicated in patients over the age of 65 years.",
"B": "He has a history of intussusception.",
"C": "He had an allergic reaction to the Tdap vaccination.",
"D": "He has hyperlipidemia."
} | step1 | C | [
"66 year old man presents",
"office",
"regular checkup",
"only current complaint",
"periodic difficulty falling asleep",
"night",
"takes captopril",
"hydrochlorothiazide",
"hypertension",
"atorvastatin",
"hyperlipidemia",
"aspirin",
"cardiovascular disease prevention",
"past medical histor... |
A 29-year-old man comes to the physician because of a 3-day history of a swollen right knee. Over the past several weeks, he has had similar episodes affecting the right knee and sometimes also the left elbow, in which the swelling lasted an average of 5 days. He has a history of a rash that subsided 2 months ago. He l... | Borrelia burgdorferi | {
"A": "Borrelia burgdorferi",
"B": "Rheumatoid arthritis",
"C": "Neisseria gonorrhoeae",
"D": "Campylobacter jejuni\n\""
} | step2&3 | A | [
"29 year old man",
"physician",
"3-day history",
"swollen right",
"past",
"weeks",
"similar episodes affecting",
"right knee",
"sometimes",
"left elbow",
"swelling lasted",
"average",
"5 days",
"history",
"rash",
"2 months",
"lives",
"Connecticut",
"wife",
"works",
"temperatu... |
A 25-year-old man comes to the physician for the evaluation of recurrent episodes of nosebleeds over the past 6 months. The nosebleeds occur spontaneously and stop after 10 minutes after pinching the nose at the nostrils. He has no history of serious illness except for prolonged bleeding following wisdom teeth extracti... | Von Willebrand disease | {
"A": "Bernard-Soulier Syndrome",
"B": "Wiskott-Aldrich syndrome",
"C": "Factor X deficiency",
"D": "Von Willebrand disease"
} | step2&3 | D | [
"year old man",
"physician",
"evaluation of recurrent episodes",
"nosebleeds",
"past 6 months",
"nosebleeds occur",
"stop",
"10 minutes",
"pinching",
"nose",
"nostrils",
"history",
"serious illness",
"prolonged bleeding following wisdom teeth extraction",
"years",
"not smoke",
"drink... |
A 16-year-old girl is brought to the physician because of yellowish discoloration of her eyes and generalized fatigue since she returned from a 2-week class trip to Guatemala 2 days ago. During her time there, she had watery diarrhea, nausea, and lack of appetite for 3 days that resolved without treatment. She also too... | Gilbert's syndrome | {
"A": "Gilbert's syndrome",
"B": "Rotor syndrome",
"C": "Dubin-Johnson syndrome",
"D": "Hepatitis B infection"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"discoloration",
"eyes",
"generalized fatigue",
"returned",
"2 class trip",
"Guatemala",
"days",
"time",
"watery diarrhea",
"nausea",
"lack of appetite",
"3 days",
"resolved",
"treatment",
"took primaquine",
"malaria prophylaxis",
"Three... |
A 48-year-old male chef presents to the dermatologist complaining of skin problems on his hands. They are itchy, red, and tender, making his work difficult. He has been using the same dish soap, hand soap, and industrial cleaner at work and at home for the past 5 years. There are no significant changes in his life, in ... | Patients generally have insight into their condition. | {
"A": "Patients generally have insight into their condition.",
"B": "Disturbing thoughts are usually ego-syntonic.",
"C": "There is no role for deep brain stimulation.",
"D": "Compulsions are logically related to the obsessions."
} | step1 | A | [
"48 year old male chef presents",
"dermatologist",
"skin problems",
"hands",
"itchy",
"red",
"tender",
"making",
"work difficult",
"using",
"same dish soap",
"hand soap",
"industrial cleaner",
"work",
"at home",
"past",
"years",
"significant changes",
"life",
"kitchen",
"work... |
A 27-year-old woman presents to her primary care physician for minor aches and pains in her bones and muscles. She states that these symptoms have persisted throughout her entire life but have worsened recently when she moved to attend college. The patient is physically active, and states that she eats a balanced diet.... | Anaphylaxis when receiving a transfusion | {
"A": "Anaphylaxis when receiving a transfusion",
"B": "Premature ovarian failure",
"C": "Rash over the metacarpophalangeal joints",
"D": "Sleep deprivation"
} | step2&3 | A | [
"27 year old woman presents",
"primary care physician",
"minor aches",
"pains",
"bones",
"muscles",
"states",
"symptoms",
"entire life",
"worsened recently",
"moved to attend college",
"patient",
"physically active",
"states",
"eats",
"balanced diet",
"currently",
"full-time studen... |
A 65-year-old man presents to his primary care physician for a yearly checkup. He states he feels he has been in good health other than minor fatigue, which he attributes to aging. The patient has a past medical history of hypertension and is currently taking chlorthalidone. He drinks 1 glass of red wine every night. H... | Colonoscopy | {
"A": "Colonoscopy",
"B": "Counseling for alcohol cessation",
"C": "Exercise regimen and weight loss",
"D": "Iron supplementation"
} | step2&3 | A | [
"65 year old man presents",
"primary care physician",
"yearly checkup",
"states",
"feels",
"good health",
"minor fatigue",
"attributes",
"aging",
"patient",
"past medical",
"currently taking chlorthalidone",
"drinks 1 glass",
"red wine",
"night",
"lost 5 pounds",
"last appointment",
... |
A 19-year-old man comes to the physician because of a 2 day history of blood-speckled stools and a protruding rectal mass. He has no abdominal pain, altered bowel habits, or fever. His mother has inflammatory bowel disease. His vital signs are within normal limits. Examination shows multiple, small, hyperpigmented macu... | Pancreatic carcinoma | {
"A": "Medulloblastoma",
"B": "Enterovesicular fistula",
"C": "Pancreatic carcinoma",
"D": "Esophageal varices"
} | step2&3 | C | [
"year old man",
"physician",
"2 day history",
"blood speckled stools",
"protruding rectal mass",
"abdominal pain",
"altered bowel habits",
"fever",
"mother",
"inflammatory bowel disease",
"vital signs",
"normal limits",
"Examination shows multiple",
"small",
"hyperpigmented maculae",
"... |
A 26-year-old woman with poor prenatal care and minimal antenatal screening presents to the emergency department in labor. Shortly thereafter, she delivers a baby girl who subsequently demonstrates symptoms of chorioretinitis on examination. A series of postpartum screening questions is significant only for the presenc... | Toxoplasmosis | {
"A": "Toxoplasmosis",
"B": "Rubella",
"C": "HSV",
"D": "Syphilis"
} | step2&3 | A | [
"year old woman",
"poor prenatal care",
"minimal antenatal screening presents",
"emergency department",
"labor",
"delivers",
"baby girl",
"demonstrates symptoms",
"chorioretinitis",
"examination",
"series",
"postpartum screening questions",
"significant only",
"presence",
"multiple cats"... |
A 35-year-old woman with no significant past medical, past surgical, family or social history presents to clinic with a recently identified area of flat, intact, pigmented skin. The patient believes that this is a large freckle, and she states that it becomes darker during the summer when she is outdoors. On physical e... | Macule | {
"A": "Papule",
"B": "Macule",
"C": "Plaque",
"D": "Ulcer"
} | step2&3 | B | [
"35 year old woman",
"significant past medical",
"surgical",
"family",
"social history presents",
"clinic",
"recently identified area of flat",
"intact",
"pigmented skin",
"patient",
"large freckle",
"states",
"darker",
"summer",
"outdoors",
"physical examination",
"measure",
"lesi... |
A 31-year-old female presents to her primary care physician with mild anxiety and complaints of mood swings lasting several months. The patient reports that the mood swings affect her work and personal relationships. In addition, she complains of increased irritability, breast tenderness, bloating, fatigue, binge-eatin... | Oral contraceptive and nonsteroidal anti-inflammatory drugs (NSAIDs) | {
"A": "Anxiolytic therapy",
"B": "Selective serotonin reuptake inhibitors (SSRIs)",
"C": "Oral contraceptive and nonsteroidal anti-inflammatory drugs (NSAIDs)",
"D": "Nonserotonergic antidepressants"
} | step2&3 | C | [
"31 year old female presents",
"primary care physician",
"mild anxiety",
"complaints",
"mood swings lasting several months",
"patient reports",
"mood swings affect",
"work",
"personal relationships",
"addition",
"increased irritability",
"breast tenderness",
"bloating",
"fatigue",
"binge... |
A 43-year-old woman comes to the physician for an annual health maintenance examination. On questioning, she has had fatigue and headaches for the last month. A few weeks ago, she had to have her wedding ring resized because it had become too small for her finger. She has mild persistent asthma and anxiety disorder. Sh... | Insulin resistance | {
"A": "Decreased insulin production",
"B": "Stress",
"C": "Hypersecretion of ACTH",
"D": "Insulin resistance"
} | step2&3 | D | [
"year old woman",
"physician",
"annual health maintenance examination",
"questioning",
"fatigue",
"headaches",
"month",
"few weeks",
"to",
"wedding ring",
"small",
"finger",
"mild persistent asthma",
"anxiety disorder",
"drinks 23 glasses",
"red",
"night",
"smoked one pack",
"cig... |
A 24-year-old professional athlete is advised to train in the mountains to enhance his performance. After 5 months of training at an altitude of 1.5 km (5,000 feet), he is able to increase his running pace while competing at sea-level venues. Which of the following changes would produce the same effect on the oxygen-he... | Decreased pH | {
"A": "Decreased pH",
"B": "Decreased temperature",
"C": "Decreased 2,3-bisphosphoglycerate",
"D": "Increased partial pressure of oxygen"
} | step1 | A | [
"year old professional athlete",
"to train",
"mountains to enhance",
"performance",
"5 months",
"training",
"altitude",
"km",
"5",
"feet",
"able to increase",
"running pace",
"sea level",
"following changes",
"same effect",
"oxygen hemoglobin dissociation curve",
"athlete's training"... |
A scientist in Chicago is studying a new blood test to detect Ab to the EBV virus with increased sensitivity and specificity. So far, her best attempt at creating such an exam reached 82% sensitivity and 88% specificity. She is hoping to increase these numbers by at least 2 percent for each value. After several years o... | 98% | {
"A": "84%",
"B": "86%",
"C": "90%",
"D": "98%"
} | step2&3 | D | [
"scientist",
"Chicago",
"studying",
"new blood test to detect",
"EBV virus",
"increased sensitivity",
"specificity",
"far",
"best attempt",
"creating",
"exam reached",
"sensitivity",
"88",
"specificity",
"hoping to increase",
"numbers",
"percent",
"value",
"several years",
"wor... |
A 49-year-old man comes to the emergency department because of recurrent abdominal pain for 1 week. The pain is worse after eating and he has vomited twice during this period. He was hospitalized twice for acute pancreatitis during the past year; the latest being 2 months ago. There is no family history of serious illn... | CT-guided percutaneous drainage | {
"A": "Magnetic resonance cholangiopancreatography",
"B": "CT-guided percutaneous drainage",
"C": "Middle segment pancreatectomy",
"D": "Distal pancreatectomy"
} | step2&3 | B | [
"year old man",
"emergency department",
"of recurrent abdominal pain",
"1 week",
"pain",
"worse after eating",
"vomited twice",
"period",
"hospitalized twice",
"acute pancreatitis",
"past year",
"latest",
"2 months",
"family history",
"serious illness",
"only medication",
"vitamin su... |
A 65-year-old non-smoking woman with no symptoms comes to your clinic to establish care with a primary care provider. She hasn’t seen a doctor in 12 years and states that she feels very healthy. You realize that guidelines by the national cancer organization suggest that she is due for some cancer screening tests, incl... | Secondary prevention | {
"A": "Secondary prevention",
"B": "Tertiary prevention",
"C": "Quaternary prevention",
"D": "Cancer screening does not fit into these categories"
} | step1 | A | [
"65-year-old non smoking woman",
"symptoms",
"clinic to establish care",
"primary",
"provider",
"hasnt seen",
"doctor",
"years",
"states",
"feels very healthy",
"guidelines",
"national cancer organization suggest",
"due",
"cancer screening tests",
"including",
"mammogram",
"breast ca... |
A 14-year-old boy comes to the physician because of multiple patches on his trunk and thighs that are lighter than the rest of his skin. He also has similar depigmented lesions on his hands and feet and around the mouth. The patches have gradually increased in size over the past 2 years and are not associated with itch... | Autoimmune melanocyte destruction | {
"A": "Autoimmune melanocyte destruction",
"B": "Increased mTOR signalling",
"C": "Mycobacterum leprae infection",
"D": "Postinflammatory depigmentation\n\""
} | step2&3 | A | [
"year old boy",
"physician",
"of multiple patches",
"trunk",
"thighs",
"lighter",
"rest",
"skin",
"similar depigmented lesions",
"hands",
"feet",
"mouth",
"patches",
"increased in size",
"past",
"years",
"not associated with itchiness",
"redness",
"numbness",
"pain",
"family"... |
A physician at an internal medicine ward notices that several of his patients have hyponatremia without any associated symptoms. Severe hyponatremia, often defined as < 120 mEq/L, is associated with altered mental status, coma, and seizures, and warrants treatment with hypertonic saline. Because some patients are chron... | Increased specificity and decreased negative predictive value | {
"A": "Increased specificity and decreased negative predictive value",
"B": "Decreased specificity and increased negative predictive value",
"C": "Increased sensitivity and decreased positive predictive value",
"D": "Increased specificity and decreased positive predictive value"
} | step2&3 | A | [
"physician",
"internal medicine ward",
"several",
"patients",
"hyponatremia",
"associated",
"Severe",
"often defined",
"mEq/L",
"associated with altered mental status",
"coma",
"seizures",
"treatment",
"hypertonic saline",
"patients",
"hyponatremic",
"serum levels",
"mEq/L",
"asy... |
A husband and wife consult a geneticist after an IUFD (intrauterine fetal demise). They both have achondroplasia. This would have been their 3rd child and 1st loss. Their 1st son also has achondroplasia while their daughter is phenotypically normal and is expected to grow to a normal height. The displayed pedigree is d... | There is a 75% chance of having a viable offspring | {
"A": "All members of the 2nd generation are compound heterozygotes",
"B": "One half of the children are unaffected",
"C": "The disorder is likely completely dominant",
"D": "There is a 75% chance of having a viable offspring"
} | step1 | D | [
"husband",
"wife consult",
"geneticist",
"intrauterine fetal demise",
"achondroplasia",
"3rd child",
"1st loss",
"1st son",
"achondroplasia",
"daughter",
"normal",
"expected to",
"normal height",
"displayed pedigree",
"drawn",
"considers",
"severity",
"proposed skeletal disorder",
... |
For which of the following patients would you recommend prophylaxis against mycobacterium avium-intracellulare? | 30-year old HIV positive male with CD4 count of 20 cells/ microliter and a viral load of < 50 copies/mL | {
"A": "22-year old HIV positive female with CD4 count of 750 cells/ microliter and a viral load of 500,000 copies/mL",
"B": "30-year old HIV positive male with CD4 count of 20 cells/ microliter and a viral load of < 50 copies/mL",
"C": "50-year old HIV positive female with CD4 count of 150 cells/ microliter and ... | step1 | B | [
"following patients",
"recommend prophylaxis",
"mycobacterium avium-intracellulare"
] |
A 10-year-old girl is brought to the emergency department because of a 2-day history of bloody diarrhea and abdominal pain. Four days ago, she visited a petting zoo with her family. Her temperature is 39.4°C (102.9°F). Abdominal examination shows tenderness to palpation of the right lower quadrant. Stool cultures at 42... | Gram-negative, flagellated bacteria that do not ferment lactose | {
"A": "Gram-negative, non-flagellated bacteria that do not ferment lactose",
"B": "Gram-negative, flagellated bacteria that do not ferment lactose",
"C": "Gram-positive, aerobic, rod-shaped bacteria that produce catalase",
"D": "Gram-positive, aerobic, rod-shaped bacteria that form spores\n\""
} | step1 | B | [
"A 10 year old girl",
"brought",
"emergency department",
"2-day history",
"bloody diarrhea",
"abdominal pain",
"Four days",
"visited",
"petting",
"family",
"temperature",
"4C",
"9F",
"Abdominal examination shows tenderness",
"palpation",
"right lower quadrant",
"Stool cultures",
"4... |
A 6-week-old girl is brought to a pediatrician due to feeding difficulty for the last 4 days. Her mother mentions that the infant breathes rapidly and sweats profusely while nursing. She has been drinking very little breast milk and stops feeding as if she is tired, only to start sucking again after a few minutes. Ther... | Patent ductus arteriosus | {
"A": "Congenital mitral insufficiency",
"B": "Patent ductus arteriosus",
"C": "Supracristal ventricular septal defect with aortic regurgitation",
"D": "Ruptured congenital sinus of Valsalva aneurysm"
} | step2&3 | B | [
"week old girl",
"brought",
"pediatrician due to feeding difficulty",
"4 days",
"mother",
"infant",
"rapidly",
"sweats",
"nursing",
"drinking very little breast milk",
"stops feeding",
"tired",
"only to start sucking",
"minutes",
"history",
"cough",
"sneezing",
"nasal congestion",
... |
A research group designed a study to investigate the epidemiology of syphilis in the United States. After a review of medical records, the investigators identified patients who were active cocaine users, but did not have a history of syphilis. They subsequently examined the patient's medical charts to determine whether... | Retrospective cohort study | {
"A": "Case-control study",
"B": "Meta-analysis",
"C": "Cross-sectional study",
"D": "Retrospective cohort study"
} | step1 | D | [
"research group designed",
"study to investigate",
"epidemiology",
"syphilis",
"United States",
"review",
"medical records",
"investigators identified patients",
"active cocaine users",
"not",
"history of syphilis",
"examined",
"patient's medical charts to",
"same group",
"patients",
"... |
A 16-year-old college student presents to the emergency department with a 3-day history of fever, muscle rigidity, and confusion. He was started on a new medication for schizophrenia 2 months ago. There is no history of sore throat, burning micturition, or loose motions. At the hospital, his temperature is 38.6°C (101.... | Chlorpromazine | {
"A": "Chlorpromazine",
"B": "Diazepam",
"C": "Levodopa",
"D": "Phenytoin"
} | step2&3 | A | [
"year old college student presents",
"emergency department",
"3-day history",
"fever",
"muscle rigidity",
"confusion",
"started",
"new medication",
"schizophrenia 2 months",
"history",
"sore throat",
"burning micturition",
"loose motions",
"hospital",
"temperature",
"blood pressure",
... |
A 3-month-old infant who lives in an old house is brought to the emergency department because of lethargy and skin discoloration that started after he was fed some locally prepared baby food being sold in a farmer's market. On presentation, he appears to be irritable and responds slowly to stimuli. Physical exam reveal... | Cyanide | {
"A": "Cyanide",
"B": "Lead",
"C": "Methanol",
"D": "Salicylates"
} | step1 | A | [
"3 month old infant",
"lives",
"old house",
"brought",
"emergency department",
"lethargy",
"skin discoloration",
"started",
"fed",
"locally prepared baby food",
"sold",
"farmer's market",
"presentation",
"appears to",
"irritable",
"slowly",
"stimuli",
"Physical exam reveals rapid",... |
A 27-year-old man comes to the physician because of pain and swelling in his right knee that began 3 days ago when he fell during football practice. He fell on his flexed right knee as he dove to complete a pass. He felt some mild knee pain but continued to practice. Over the next 2 days, the pain worsened and the knee... | Posterior cruciate ligament | {
"A": "Posterior cruciate ligament",
"B": "Anterior cruciate ligament",
"C": "Lateral collateral ligament",
"D": "Lateral meniscus"
} | step1 | A | [
"27 year old man",
"physician",
"pain",
"swelling",
"right",
"began 3 days",
"fell",
"football practice",
"fell",
"flexed right knee",
"dove to complete",
"pass",
"felt",
"mild knee",
"continued to practice",
"next",
"days",
"pain worsened",
"knee began to swell",
"Today",
"p... |
A 31-year-old G1P0000 presents to her obstetrician for her first prenatal visit after having a positive home pregnancy test one week ago. She states that her last menstrual period was 8 weeks ago. The patient has a past medical history of type I diabetes mellitus since childhood and is on insulin. Her hemoglobin A1c tw... | Neural tube defect | {
"A": "Aneuploidy",
"B": "Neural tube defect",
"C": "Neonatal hyperglycemia",
"D": "Oligohydramnios"
} | step2&3 | B | [
"31 year old",
"presents",
"obstetrician",
"first prenatal visit",
"positive home one week",
"states",
"last menstrual period",
"weeks",
"patient",
"past medical history of type I diabetes mellitus",
"childhood",
"insulin",
"hemoglobin A1c two weeks",
"time",
"found to",
"microalbuminu... |
A 59-year-old woman comes to the physician because of left leg swelling that started after a transcontinental flight. A duplex ultrasound of the left leg shows a noncompressible popliteal vein. A drug is prescribed that inhibits the coagulation cascade. Two weeks later, laboratory studies show:
Platelet count 210,000/m... | Apixaban | {
"A": "Alteplase",
"B": "Unfractionated heparin",
"C": "Apixaban",
"D": "Low molecular weight heparin"
} | step1 | C | [
"59 year old woman",
"physician",
"left leg swelling",
"started",
"flight",
"duplex ultrasound",
"left leg shows",
"popliteal vein",
"drug",
"prescribed",
"inhibits",
"coagulation cascade",
"Two weeks later",
"laboratory studies show",
"Platelet count",
"mm3 Partial thromboplastin time... |
A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon.... | Lack of concentration | {
"A": "Weight loss",
"B": "Lack of concentration",
"C": "Intense fear of losing control",
"D": "Anterograde amnesia"
} | step2&3 | B | [
"year old woman presents",
"depressed mood",
"days of the week",
"past month",
"lost",
"appetite",
"past",
"weeks",
"adds",
"job performance",
"deteriorated",
"symptoms",
"feels",
"to quit",
"job",
"hobbies",
"used",
"dancing",
"music",
"not",
"desire",
"patients husband",
... |
A randomized controlled trial is conducted investigating the effects of different diagnostic imaging modalities on breast cancer mortality. 8,000 women are randomized to receive either conventional mammography or conventional mammography with breast MRI. The primary outcome is survival from the time of breast cancer di... | Lead-time bias | {
"A": "Misclassification bias",
"B": "Lead-time bias",
"C": "Recall bias",
"D": "Because this study is a randomized controlled trial, it is free of bias"
} | step1 | B | [
"randomized controlled trial",
"conducted investigating",
"effects",
"different diagnostic imaging modalities",
"breast cancer mortality",
"women",
"randomized to receive either conventional mammography",
"conventional mammography",
"breast",
"primary outcome",
"survival",
"the time of breast ... |
A 40-year-old female visits the emergency department with right upper quadrant pain and fever of 2-hours duration. She denies alcohol, cigarette, and drug use and reports no other medical problems. Body mass index is 30 kg/m^2. Her temperature is 38.5 degrees Celsius (101.3 degrees Fahrenheit), blood pressure is 130/80... | Endoscopic retrograde cholangiopancreatography (ERCP) | {
"A": "Elective laparoscopic cholecystectomy",
"B": "Urgent open cholecystectomy",
"C": "Endoscopic retrograde cholangiopancreatography (ERCP)",
"D": "Administer bile acids"
} | step2&3 | C | [
"40 year old female visits",
"emergency department",
"right upper quadrant pain",
"fever",
"hours duration",
"denies alcohol",
"cigarette",
"drug use",
"reports",
"medical problems",
"Body mass index",
"30 kg/m",
"temperature",
"degrees Celsius",
"degrees Fahrenheit",
"blood pressure",... |
A 52-year-old woman is brought to the emergency department by fire and rescue after being involved in a motor vehicle accident. The paramedics report that the patient’s car slipped off the road during a rainstorm and rolled into a ditch. The patient was restrained and the airbags deployed during the crash. The patient ... | Diagnostic peritoneal lavage | {
"A": "Abdominal CT",
"B": "Diagnostic peritoneal lavage",
"C": "Diagnostic laparoscopy",
"D": "Emergency laparotomy"
} | step2&3 | B | [
"year old woman",
"brought",
"emergency department",
"fire",
"involved",
"motor vehicle accident",
"paramedics report",
"patients car slipped",
"road",
"rolled",
"patient",
"restrained",
"airbags deployed",
"patient",
"past medical",
"hyperlipidemia",
"hypothyroidism",
"gout",
"h... |
A 24-year-old healthy male presents to the emergency room complaining of severe abdominal pain. He reports that he was playing rugby for his college team when he was tackled on his left side by a member of the opposing team. He is currently experiencing severe left upper abdominal pain and left shoulder pain. A review ... | Basophilic nuclear remnants | {
"A": "Basophilic nuclear remnants",
"B": "Erythrocyte fragments",
"C": "Erythrocytes lacking central pallor",
"D": "Basophilic stippling"
} | step1 | A | [
"year old healthy male presents",
"emergency room",
"severe abdominal",
"reports",
"playing rugby",
"college team",
"left side",
"member",
"team",
"currently experiencing severe left upper abdominal pain",
"left shoulder pain",
"review",
"medical record reveals",
"seen by",
"primary care... |
A 28-year-old man is brought to the emergency department after he was found half dressed and incoherent in the middle of the road. In the emergency department he states that he has not slept for 36 hours and that he has incredible ideas that will make him a billionaire within a few months. He also states that secret ag... | Increased biogenic amine release | {
"A": "5-HT receptor agonist",
"B": "Gamma-aminobutyric acid receptor agonist",
"C": "Increased biogenic amine release",
"D": "Opioid receptor agonist"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"found half dressed",
"incoherent",
"middle",
"road",
"emergency department",
"states",
"not slept",
"36 hours",
"ideas",
"make",
"months",
"states",
"secret agents",
"Russia",
"heard one",
"speaking",
"hospital intercom",
"p... |
Thirty minutes after normal vaginal delivery of twins, a 35-year-old woman, gravida 5, para 4, has heavy vaginal bleeding with clots. Physical examination shows a soft, enlarged, and boggy uterus. Despite bimanual uterine massage, administration of uterotonic drugs, and placement of an intrauterine balloon for tamponad... | Cardinal ligament | {
"A": "Suspensory ligament",
"B": "Cardinal ligament",
"C": "Round ligament",
"D": "Ovarian ligament"
} | step1 | B | [
"Thirty minutes",
"normal vaginal",
"twins",
"35 year old woman",
"gravida 5",
"para 4",
"heavy vaginal bleeding",
"clots",
"Physical examination shows",
"soft",
"enlarged",
"boggy uterus",
"bimanual uterine massage",
"administration",
"drugs",
"placement",
"intrauterine balloon",
... |
A scientist is working on creating synthetic hemoglobin that can be used to replace blood loss in humans. She therefore starts to study the behavior of this artificial hemoglobin in terms of its ability to bind oxygen. She begins by measuring the affinity between this synthetic hemoglobin and oxygen in a purified syste... | Left-shifted curve and increased oxygen binding | {
"A": "Left-shifted curve and decreased oxygen binding",
"B": "Left-shifted curve and increased oxygen binding",
"C": "No shift in the curve and increased oxygen binding",
"D": "Right-shifted curve and decreased oxygen binding"
} | step1 | B | [
"scientist",
"working",
"creating synthetic hemoglobin",
"used to replace blood loss",
"humans",
"starts to study",
"behavior",
"artificial hemoglobin",
"ability to bind oxygen",
"begins",
"measuring",
"affinity",
"synthetic hemoglobin",
"oxygen",
"purified system",
"introducing modifi... |
A 32-year-old female comes to the physician because of recurrent episodes of abdominal pain, bloating, and loose stools lasting several days to a couple weeks. She has had these episodes since she was 24 years old but they have worsened over the last 6 weeks. The site of the abdominal pain and the intensity of pain var... | Relief of abdominal pain after defecation | {
"A": "Weight loss",
"B": "Bright red blood in the stool",
"C": "Relief of abdominal pain after defecation",
"D": "Abdominal pain at night"
} | step2&3 | C | [
"year old female",
"physician",
"recurrent episodes",
"abdominal pain",
"bloating",
"loose stools lasting several days",
"couple weeks",
"episodes",
"years old",
"worsened",
"weeks",
"site of",
"abdominal pain",
"intensity",
"pain",
"bowel movements",
"day",
"episodes",
"Menses",... |
A 59-year-old man comes to the physician because of a 1-year history of increased urinary frequency, weak urinary stream, and occasional straining to void urine. Rectal examination shows a large, nontender prostate without asymmetry or nodularity. His serum creatinine, prostate-specific antigen, and urinalysis are all ... | Decreased activity of phospholipase C | {
"A": "Decreased activity of protein kinase A",
"B": "Increased production of diacylglycerol",
"C": "Decreased activity of phospholipase C",
"D": "Increased activity of adenylyl cyclase\n\""
} | step1 | C | [
"59 year old man",
"physician",
"year history",
"increased urinary frequency",
"weak urinary stream",
"occasional straining to void urine",
"Rectal shows",
"large",
"nontender prostate",
"asymmetry",
"nodularity",
"serum creatinine",
"prostate-specific antigen",
"urinalysis",
"reference ... |
A 25-year-old woman presents to the emergency department with fatigue and weakness. She states over the past 24 hours she has not felt like herself and has felt like she has no strength. The patient has no significant past medical history other than a single episode of blood-tinged diarrhea 1 week ago which resolved on... | Spirometry | {
"A": "Dexamethasone",
"B": "Intubation",
"C": "Pyridostigmine",
"D": "Spirometry"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"fatigue",
"weakness",
"states",
"past 24 hours",
"not felt",
"felt",
"strength",
"patient",
"significant past medical history other",
"single episode of blood-tinged diarrhea 1 week",
"resolved",
"temperature",
"99 4F",
"4C",
"blood... |
A 47-year-old woman presents to the clinic complaining of bilateral eye pain for the past 2 days. The pain is described initially as “sand in the eye” but is now a sharp, stabbing pain. She denies any trauma, irritation, or new facial care products but endorses some joint pain in her fingers. Her past medical history i... | Anti-Ro antibodies | {
"A": "Antinuclear antibodies",
"B": "Anti-Ro antibodies",
"C": "Anti-Scl-70 antibodies",
"D": "Anti-SRP antibodies"
} | step1 | B | [
"year old woman presents",
"clinic",
"of bilateral eye pain",
"past 2 days",
"pain",
"described initially",
"sand",
"eye",
"now",
"sharp",
"stabbing pain",
"denies",
"trauma",
"irritation",
"new facial care products",
"joint",
"fingers",
"past medical history includes diabetes diag... |
A 72-year-old man comes to the emergency department because of blurry vision for the past 3 days. He has also had 4 episodes of right-sided headaches over the past month. He has no significant past medical history. His father died of coronary artery disease at the age of 62 years. His temperature is 37.2°C (99°F), puls... | Labetalol | {
"A": "Labetalol",
"B": "Hydralazine",
"C": "Fenoldopam",
"D": "Nitroprusside"
} | step1 | A | [
"72 year old man",
"emergency department",
"of blurry vision",
"past 3 days",
"4 episodes of right-sided headaches",
"past month",
"significant past medical history",
"father died of coronary artery disease",
"age",
"62 years",
"temperature",
"pulse",
"min",
"blood pressure",
"mm Hg",
... |
A 6-month-old girl presents to an outpatient office for a routine physical. She can sit momentarily propped on her hands, babbles with consonants, and transfers objects hand to hand. The pediatrician assures the parents that their daughter has reached appropriate developmental milestones. Which additional milestone wou... | Stranger anxiety | {
"A": "Engaging in pretend play",
"B": "Separation anxiety",
"C": "Showing an object to her parents to share her interest in that object",
"D": "Stranger anxiety"
} | step2&3 | D | [
"month old girl presents",
"outpatient office",
"routine physical",
"sit",
"hands",
"babbles",
"transfers objects hand",
"pediatrician",
"parents",
"daughter",
"reached appropriate developmental milestones",
"additional milestone",
"expected",
"stage",
"development"
] |
An 11-year-old boy who recently emigrated from Ukraine is brought to the physician for the evaluation of failure to thrive. Genetic analysis shows the deletion of the 508th codon in a gene on chromosome 7. The deletion results in defective post-translational folding of a protein and retention of the misfolded protein i... | Sodium channels of respiratory epithelial cells | {
"A": "Bicarbonate channels of pancreatic ductal cells",
"B": "Sodium channels of respiratory epithelial cells",
"C": "Chloride channels of epithelial cells in sweat glands",
"D": "ATP-sensitive potassium channels of pancreatic beta cells\n\""
} | step1 | B | [
"year old boy",
"recently",
"Ukraine",
"brought",
"physician",
"evaluation",
"failure to thrive",
"Genetic shows",
"deletion",
"codon",
"gene",
"chromosome 7",
"deletion results",
"defective post translational folding",
"a protein",
"retention",
"protein",
"rough endoplasmic reticu... |
A newborn is evaluated by the on-call pediatrician. She was born at 33 weeks gestation via spontaneous vaginal delivery to a 34-year-old G1P1. The pregnancy was complicated by poorly controlled diabetes mellitus type 2. Her birth weight was 3,700 g and the appearance, pulse, grimace, activity, and respiration (APGAR) s... | Infant respiratory distress syndrome | {
"A": "Transient tachypnea of the newborn",
"B": "Infant respiratory distress syndrome",
"C": "Meconium aspiration syndrome",
"D": "Fetal alcohol syndrome"
} | step2&3 | B | [
"newborn",
"evaluated",
"call pediatrician",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"year old G1P1",
"pregnancy",
"complicated",
"poorly controlled diabetes mellitus type 2",
"birth weight",
"3 700 g",
"appearance",
"pulse",
"grimace",
"activity",
"respiration",
... |
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