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 26-year-old G1P0 female who is 39 weeks pregnant presents to the emergency department in labor. She reports following her primary care physician’s recommendations throughout her pregnancy and has not had any complications. During delivery, the baby’s head turtled back into the vaginal canal and did not advance any fu... | 5 | {
"A": "3",
"B": "4",
"C": "5",
"D": "6"
} | step1 | C | [
"year old",
"female",
"weeks pregnant presents",
"emergency department",
"labor",
"reports following",
"primary care physicians recommendations",
"pregnancy",
"not",
"complications",
"delivery",
"head",
"back",
"vaginal canal",
"not advance",
"further",
"neonatal",
"called",
"sho... |
A 71-year-old man is brought to the emergency department by his wife because of increasing confusion, weakness, and vomiting for 1 day. He has had 5 episodes of vomiting and blurry vision; he told his wife that “everything appears in different colors.” He has been unable to recall his wife's name or their address. His ... | Increased PR interval | {
"A": "Peaked T waves",
"B": "Mobitz type 2 atrioventricular block",
"C": "Low QRS voltage",
"D": "Increased PR interval"
} | step2&3 | D | [
"71 year old man",
"brought",
"emergency department",
"wife",
"increasing confusion",
"weakness",
"vomiting",
"1 day",
"5 episodes of vomiting",
"blurry vision",
"wife",
"appears",
"different colors",
"unable to recall",
"wife's name",
"address",
"wife reports",
"drug regimen",
"... |
A 48-year-old woman with a history of type 2 diabetes mellitus presents to her primary care physician with complaints of headaches, fatigue, dry cough, and frequent episodes of bronchospasm. She was diagnosed with moderate nonproliferative diabetic retinopathy by an ophthalmologist last month. Her blood pressure measur... | Lisinopril | {
"A": "Amlodipine",
"B": "Hydrochlorothiazide",
"C": "Lisinopril",
"D": "Losartan"
} | step2&3 | C | [
"48 year old woman",
"history of type 2 diabetes mellitus presents",
"primary care physician",
"complaints",
"headaches",
"fatigue",
"dry cough",
"frequent episodes of bronchospasm",
"diagnosed",
"moderate nonproliferative diabetic retinopathy",
"ophthalmologist",
"month",
"blood pressure me... |
A 48-year-old man is brought to the emergency department 20 minutes after being rescued from a house fire. He reports headache, metallic taste, abdominal pain, and nausea. He appears confused and agitated. His pulse is 125/min, respirations are 33/min, and blood pressure is 100/65 mm Hg. Pulse oximetry on room air show... | Formation of methemoglobin | {
"A": "Synthesis of 2,3-bisphosphoglycerate",
"B": "Formation of methemoglobin",
"C": "Dissociation of carboxyhemoglobin",
"D": "Inhibition of cytochrome c oxidase"
} | step1 | B | [
"48 year old man",
"brought",
"emergency department 20 minutes",
"house fire",
"reports headache",
"metallic taste",
"abdominal pain",
"nausea",
"appears confused",
"agitated",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"100 65 mm Hg",
"Pulse oximetry",
"room air show... |
Six days after undergoing open reduction and internal fixation of a left-sided femur fracture that he sustained in a motor vehicle collision, a 67-year-old man has sudden-onset severe pain and paresthesia in his right arm. The operation and the immediate postoperative course were uneventful. Prior to hospitalization, h... | Adverse effect of medication | {
"A": "Peripheral arterial disease",
"B": "Adverse effect of medication",
"C": "Atrial fibrillation",
"D": "Disseminated intravascular coagulation\n\""
} | step2&3 | B | [
"Six days",
"open reduction",
"internal fixation of",
"left-sided femur fracture",
"sustained",
"motor vehicle collision",
"67 year old man",
"sudden-onset severe pain",
"paresthesia",
"right arm",
"operation",
"immediate postoperative course",
"hospitalization",
"not take",
"medications... |
Background: Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on morbidity and mortality among patients with acute myocardial infarction complicated by... | Eplerenone, when added to optimal medical therapy, decreases all cause mortality in patients with left ventricular dysfunction following myocardial infarction. | {
"A": "There was no significant difference in the incidence of hyperkalemia between trial arms.",
"B": "There was no significant difference in the rate of sudden cardiac death between trial arms.",
"C": "Eplerenone, when added to optimal medical therapy, decreases all cause mortality in patients with left ventri... | step2&3 | C | [
"Background",
"Aldosterone blockade",
"mortality",
"morbidity",
"patients",
"severe heart failure",
"conducted",
"double-blind",
"placebo-controlled evaluating",
"effect",
"eplerenone",
"selective aldosterone",
"morbidity",
"mortality",
"patients",
"acute myocardial infarction complica... |
A neuro-oncology investigator has recently conducted a randomized controlled trial in which the addition of a novel alkylating agent to radiotherapy was found to prolong survival in comparison to survival radiotherapy alone (HR = 0.7, p < 0.01). A number of surviving participants who took the alkylating agent reported ... | Chi-square test | {
"A": "Unpaired t-test",
"B": "Paired t-test",
"C": "Pearson correlation coefficient",
"D": "Chi-square test"
} | step2&3 | D | [
"neuro-oncology investigator",
"recently conducted",
"randomized controlled trial",
"addition",
"novel alkylating agent",
"radiotherapy",
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"comparison",
"radiotherapy alone",
"0.7",
"p",
"0.01",
"number",
"surviving participants",
"took",
"alkylating agent repo... |
A 36-year-old primigravida woman visits her gynecologist during the 28th week of her pregnancy. Physical examination reveals pitting edema around her ankles and elevated systolic blood pressure. 24-hour urine collection yields 4 grams of protein. If left untreated, the patient is most at increased risk for which of the... | Hemolysis | {
"A": "Urethral infection",
"B": "Hemolysis",
"C": "Gestational diabetes",
"D": "Placenta accreta"
} | step1 | B | [
"36 year old primigravida woman visits",
"gynecologist",
"week",
"pregnancy",
"Physical examination reveals pitting",
"ankles",
"elevated systolic blood pressure",
"24-hour urine collection",
"4 grams",
"protein",
"left untreated",
"patient",
"most",
"increased risk",
"following"
] |
A previously healthy 42-year-old man is brought to the emergency department 1 hour after he was involved in a motor vehicle collision. He is conscious. He smoked one pack of cigarettes daily for 16 years but quit 8 years ago. Physical examination shows several ecchymoses over the trunk and abdomen. The abdomen is soft,... | Positron emission tomography | {
"A": "Antituberculous therapy",
"B": "Positron emission tomography",
"C": "Follow-up CT scan in 12 months",
"D": "Reassurance"
} | step2&3 | B | [
"healthy",
"year old man",
"brought",
"emergency department",
"hour",
"involved",
"motor vehicle collision",
"conscious",
"smoked one pack",
"cigarettes daily",
"years",
"quit",
"years",
"Physical examination shows several ecchymoses",
"trunk",
"abdomen",
"abdomen",
"soft",
"tend... |
A 44-year-old man is brought to the emergency department by his daughter for a 1-week history of right leg weakness, unsteady gait, and multiple falls. During the past 6 months, he has become more forgetful and has sometimes lost his way along familiar routes. He has been having difficulties operating simple kitchen ap... | Progressive multifocal leukoencephalopathy | {
"A": "Cryptococcal meningoencephalitis",
"B": "HIV encephalopathy",
"C": "Primary CNS lymphoma",
"D": "Progressive multifocal leukoencephalopathy"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"daughter",
"1-week history of right leg weakness",
"unsteady gait",
"multiple falls",
"past 6 months",
"more forgetful",
"sometimes lost",
"familiar routes",
"difficulties operating simple kitchen appliances",
"coffee maker",
"recently",
... |
A 3-month-old boy presents to his pediatrician with persistent diarrhea, oral candidiasis, and signs and symptoms of respiratory syncytial virus (RSV) pneumonia. He is very lean with weight in the 10th percentile. His blood pressure is 105/64 mm Hg and heart rate is 84/min. He is being evaluated for an immunodeficiency... | Defective T cell function | {
"A": "An X-linked inheritance of HLA genes",
"B": "Defective T cell function",
"C": "Selective IgA deficiency",
"D": "Grossly reduced levels of B cells"
} | step1 | B | [
"3 month old boy presents",
"pediatrician",
"persistent diarrhea",
"oral candidiasis",
"signs",
"symptoms",
"respiratory syncytial virus",
"pneumonia",
"very lean",
"weight",
"percentile",
"blood pressure",
"64 mm Hg",
"heart rate",
"84 min",
"evaluated",
"immunodeficiency",
"Labor... |
A 36-year-old man comes to the physician for a follow-up examination. Two weeks ago, he was diagnosed with an ischemic stroke of the right middle cerebral artery. He was treated with thrombolytics and does not have any residual symptoms. His pulse is 82/min and regular. Cardiovascular examination shows no abnormalities... | Hypospadias | {
"A": "Midgut volvulus",
"B": "Transposition of the great vessels",
"C": "Thyroglossal duct cyst",
"D": "Hypospadias"
} | step1 | D | [
"36 year old man",
"physician",
"follow-up examination",
"Two weeks",
"diagnosed",
"ischemic stroke",
"right middle cerebral artery",
"treated with thrombolytics",
"not",
"residual symptoms",
"pulse",
"min",
"regular",
"Cardiovascular examination shows",
"abnormalities",
"Echocardiogra... |
A 72-year-old woman comes to the emergency department 4 hours after the sudden onset of a diffuse, dull, throbbing headache. During this time, she also reports blurred vision, nausea, and one episode of vomiting. She has a history of hypertension and type 2 diabetes mellitus. Her medications include hydrochlorothiazide... | Hypertensive emergency | {
"A": "Ischemic stroke",
"B": "Subarachnoid hemorrhage",
"C": "Idiopathic intracranial hypertension",
"D": "Hypertensive emergency"
} | step2&3 | D | [
"72 year old woman",
"emergency department",
"hours",
"sudden onset",
"diffuse",
"dull",
"throbbing headache",
"time",
"reports blurred vision",
"nausea",
"one episode of vomiting",
"history of hypertension",
"type 2 diabetes mellitus",
"medications include hydrochlorothiazide",
"lisinop... |
A 50-year-old man comes to the physician for the evaluation of recurrent palpitations and a feeling of pressure in the chest for the past 6 months. He also reports shortness of breath when walking several blocks or while going upstairs. There is no personal or family history of serious illness. He does not smoke. He ha... | Abstinence from alcohol | {
"A": "Abstinence from alcohol",
"B": "Dietary iron restriction",
"C": "Salt and fluid restriction",
"D": "Levothyroxine substitution\n\""
} | step2&3 | A | [
"50 year old man",
"physician",
"evaluation",
"recurrent palpitations",
"feeling",
"pressure",
"chest",
"past 6 months",
"reports shortness of breath",
"walking several blocks",
"upstairs",
"personal",
"family history",
"serious illness",
"not smoke",
"30 year history",
"drinking",
... |
A 32-year-old woman comes to the clinic with concerns related to her medication. She recently learned that she is pregnant and wants to know if she needs to change anything. She is taking levothyroxine for hypothyroidism. She does not take any other medication. A urine pregnancy test is positive. What should this patie... | Her medication dose should be increased by 30% | {
"A": "She should stop taking her medication immediately",
"B": "Her medication dose should be increased by 30%",
"C": "She should be switched to an alternative medication",
"D": "The decision should be based on an evaluation of fetal risks and maternal benefits"
} | step2&3 | B | [
"year old woman",
"clinic",
"concerns related",
"medication",
"recently learned",
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"needs to change",
"taking levothyroxine",
"hypothyroidism",
"not take",
"medication",
"urine pregnancy test",
"positive",
"patient",
"medication",
"pregnancy"
] |
A 56-year-old man comes to the physician for a follow-up examination. Physical examination shows hyperpigmented plaques on the posterior neck and in the axillae. His hemoglobin A1c concentration is 7.4% and fasting serum glucose concentration is 174 mg/dL. Which of the following is the strongest predisposing factor for... | High waist circumference
" | {
"A": "Increased BMI during childhood",
"B": "Increased serum testosterone level",
"C": "History of smoking",
"D": "High waist circumference\n\""
} | step1 | D | [
"year old man",
"physician",
"follow-up examination",
"Physical examination shows hyperpigmented plaques",
"posterior neck",
"axillae",
"hemoglobin concentration",
"7.4",
"fasting serum",
"mg/dL",
"following",
"strongest predisposing factor",
"patient's laboratory findings"
] |
A 45-year-old woman visits your office with concerns about recent changes in her menstrual cycle. She noticed that her menses last longer and are heavier, to the point of needing almost twice the number of sanitary pads than 6 months ago. She denies any abdominal or pelvic discomfort. She started menstruating at 9 year... | Endometrial hyperplasia | {
"A": "Endometrial carcinoma",
"B": "Uterine adenomyosis",
"C": "Endometrial polyp",
"D": "Endometrial hyperplasia"
} | step1 | D | [
"year old woman visits",
"office",
"concerns",
"recent changes",
"menstrual cycle",
"menses last longer",
"heavier",
"point",
"needing almost twice",
"number of sanitary pads",
"months",
"denies",
"abdominal",
"pelvic discomfort",
"started",
"years",
"age",
"negative Pap smear",
... |
A 45-year-old man undergoes elective vasectomy for permanent contraception. The procedure is performed under local anesthesia. There are no intra-operative complications and he is discharged home with ibuprofen for post-operative pain. This patient is at increased risk for which of the following complications? | Sperm granuloma | {
"A": "Sperm granuloma",
"B": "Seminoma",
"C": "Inguinal hernia",
"D": "Prostatitis\n\""
} | step1 | A | [
"year old man",
"elective vasectomy for permanent contraception",
"procedure",
"performed",
"local anesthesia",
"intra-operative complications",
"discharged home",
"ibuprofen",
"post-operative pain",
"patient",
"increased risk",
"following complications"
] |
A 39-year-old man presents to his primary care physician with a high fever, cough, and malaise. One week ago, he returned from a vacation to Hawaii where he went waterskiing with his family. Three days before presentation, he started experiencing intermittent abdominal pain, which was followed by flu-like symptoms, itc... | Doxycycline | {
"A": "Azithromycin",
"B": "Doxycycline",
"C": "Ganciclovir",
"D": "Metronidazole"
} | step1 | B | [
"year old man presents",
"primary care physician",
"high fever",
"cough",
"malaise",
"One week",
"returned",
"vacation",
"Hawaii",
"waterskiing",
"family",
"Three days",
"presentation",
"started experiencing intermittent abdominal pain",
"followed by flu-like symptoms",
"itchiness",
... |
A 24-year-old woman at 36 weeks pregnant presents to the emergency department with a headache and abdominal pain. The woman has no known past medical history and has inconsistently followed up with an obstetrician for prenatal care. Her temperature is 98.5°F (36.9°C), blood pressure is 163/101 mmHg, pulse is 90/min, re... | Magnesium and cesarean section | {
"A": "Diazepam, magnesium, and continuous monitoring",
"B": "Magnesium and continuous monitoring",
"C": "Magnesium and cesarean section",
"D": "Nifedipine and cesarean section"
} | step2&3 | C | [
"year old woman",
"36 weeks pregnant presents",
"emergency department",
"headache",
"abdominal pain",
"woman",
"known past medical history",
"followed up",
"obstetrician",
"prenatal care",
"temperature",
"98",
"36",
"blood pressure",
"mmHg",
"pulse",
"90 min",
"respirations",
"mi... |
A 9-year-old boy is brought to the physician by his mother because of poor performance in school for the last year. He has difficulty sitting still at his desk, does not follow the teacher's instructions, and frequently blurts out answers in class. He often gets sent outside the classroom for failing to work quietly. A... | Atomoxetine | {
"A": "Atomoxetine",
"B": "Suvorexant",
"C": "Fluoxetine",
"D": "Varenicline"
} | step1 | A | [
"year old boy",
"brought",
"physician",
"mother",
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"year",
"difficulty sitting",
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"frequently",
"out answers",
"class",
"often gets sent outside",
"classroom",
"to work",
"hockey practice",
"not wait",
"turn",
"d... |
A 62-year-old woman presents to the emergency department after an episode of light-headedness. She was using the bathroom when she felt light-headed and fell to the floor. Her daughter found her and brought her into the emergency department right away. The patient has a past medical history of obesity and diabetes mell... | CA-125 | {
"A": "CA-125",
"B": "Cardiac arrhythmia",
"C": "Dehydration",
"D": "Vagal response"
} | step2&3 | A | [
"62 year old woman presents",
"emergency department",
"episode of light-headedness",
"using",
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"felt light-headed",
"fell",
"floor",
"daughter found",
"brought",
"emergency department right",
"patient",
"past medical",
"diabetes mellitus",
"emergency department 1 week",
"sim... |
A 2-year-old male is referred to a geneticist for developmental delay and intellectual disability. He was hypotonic at birth and his parents are concerned that he tries to eat everything, including erasers and chalk. Physical exam is remarkable for severe obesity and hypogonadism. Genetic analysis reveals that he has o... | Imprinting | {
"A": "Autosomal dominant inheritance pattern",
"B": "Imprinting",
"C": "Locus heterogeneity",
"D": "Uniparental disomy"
} | step1 | B | [
"2 year old male",
"referred",
"geneticist",
"developmental delay",
"intellectual disability",
"hypotonic",
"birth",
"parents",
"concerned",
"to eat",
"including",
"chalk",
"Physical exam",
"severe obesity",
"hypogonadism",
"Genetic analysis reveals",
"one mutated allele",
"one nor... |
A researcher is tracing the fate of C-peptide, a product of preproinsulin cleavage. Which of the following is a true statement regarding the fate of C-peptide? | C-peptide is packaged with insulin in secretory vesicles | {
"A": "C-peptide is immediately degraded by the proteasome",
"B": "C-peptide is packaged with insulin in secretory vesicles",
"C": "C-peptide exits the cells via a protein channel",
"D": "C-peptide activates an intracellular signaling cascade"
} | step1 | B | [
"researcher",
"tracing",
"fate",
"C-peptide",
"product",
"preproinsulin cleavage",
"following",
"true statement",
"fate",
"C-peptide"
] |
A 79-year-old man, hospitalized for overnight monitoring after elective surgery, is found on morning rounds to be confused and disoriented. He was recovering well in the post-anesthesia care unit before being moved up to the inpatient floor unit; however, he was found to be delirious and agitated overnight. Therefore, ... | Flumazenil | {
"A": "Ammonium chloride",
"B": "Flumazenil",
"C": "Naloxone",
"D": "Sodium bicarbonate"
} | step1 | B | [
"year old man",
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"overnight monitoring",
"elective surgery",
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"post-anesthesia care unit",
"moved",
"to",
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"found to",
"delirious",
"agitated overnight",
"given",
"dose"... |
A 25-year-old woman comes into her family doctor’s clinic confused as to how she failed her work-required urine drug test. The patient has no significant past medical history and takes no medications. She states that she does not smoke and denies ever using any alcohol or recreational drugs. The patient’s social histor... | Miosis | {
"A": "Miosis",
"B": "Anhidrosis",
"C": "Tachypnea",
"D": "Myalgia"
} | step2&3 | A | [
"year old woman",
"family doctors clinic confused",
"failed",
"work required urine drug test",
"patient",
"significant past medical history",
"takes",
"medications",
"states",
"not smoke",
"denies",
"using",
"alcohol",
"recreational drugs",
"patients social history reveals",
"recent ch... |
A 5-year-old child presents with lower-extremity edema for the past 4 days. Three weeks ago, he experienced several days of cough and fever that was treated with acetaminophen. His medical history is unremarkable; he was born after an uneventful term pregnancy. His vaccinations are up to date. At presentation, his bloo... | Oral prednisone | {
"A": "Oral prednisone",
"B": "Oral azathioprine",
"C": "Intravenous cyclophosphamide",
"D": "No treatment is required"
} | step2&3 | A | [
"5 year old child presents",
"lower-extremity edema",
"past",
"days",
"Three weeks",
"experienced several days",
"cough",
"fever",
"treated with acetaminophen",
"medical history",
"unremarkable",
"born",
"term pregnancy",
"vaccinations",
"date",
"presentation",
"blood pressure",
"8... |
A 4-day-old male newborn is brought to the physician for a well-child examination. His mother is concerned that he is losing weight. He was born at 40 weeks' gestation and weighed 2980g (6-lb 9-oz); he currently weighs 2830g (6-lb 4-oz). Pregnancy was uncomplicated. He passed stool and urine 8 and 10 hours after delive... | Continue breastfeeding
" | {
"A": "Serum creatinine and urea nitrogen",
"B": "Add rice based cereal",
"C": "Add cow milk based formula",
"D": "Continue breastfeeding\n\""
} | step2&3 | D | [
"4 day old male newborn",
"brought",
"physician",
"well",
"mother",
"concerned",
"weight",
"born",
"40 weeks",
"gestation",
"6",
"9 oz",
"currently",
"6",
"4 oz",
"Pregnancy",
"uncomplicated",
"passed stool",
"urine",
"10 hours",
"delivery",
"breast fed",
"birth",
"feed... |
A 52-year-old female presents with a primary complaint of amenorrhea for the past 6 months. She also reports dyspareunia, recurrent headache, and infrequent episodes of night sweats. Diagnostic work-up reveals increased serum FSH levels. Which additional laboratory findings would most likely be seen in this patient? | Decreased serum estradiol and increased serum LH | {
"A": "Increased serum estradiol and decreased serum LH",
"B": "Increased serum progesterone and increased serum LH",
"C": "Decreased serum estradiol and increased serum LH",
"D": "Decreased serum progesterone and increased serum testosterone"
} | step1 | C | [
"year old female presents",
"primary complaint",
"amenorrhea",
"past 6 months",
"reports dyspareunia",
"recurrent headache",
"infrequent episodes of night sweats",
"Diagnostic work-up reveals increased serum FSH levels",
"additional laboratory findings",
"most likely",
"seen",
"patient"
] |
A 10-year-old boy presents to his pediatrician for a well child appointment. The patient has been doing well in school. He plays on a club basketball team and is also a member of the chess club. He has many friends and is very happy. His parents currently have no concerns for him. His temperature is 99.5°F (37.5°C), bl... | Leydig cell tumor | {
"A": "Leydig cell tumor",
"B": "Normal development in the setting of obesity",
"C": "Pituitary adenoma",
"D": "Precocious puberty"
} | step2&3 | A | [
"A 10 year old boy presents",
"pediatrician",
"well child appointment",
"patient",
"well",
"school",
"plays",
"club basketball team",
"member",
"chess club",
"friends",
"very happy",
"parents currently",
"concerns",
"temperature",
"99",
"blood pressure",
"68 mmHg",
"pulse",
"85... |
A 27-year-old woman presents to the psychiatrist due to feelings of sadness for the past 3 weeks. She was let go from her job 1 month ago, and she feels as though her whole life is coming to an end. She is unable to sleep well at night and also finds herself crying at times during the day. She has not been able to eat ... | Venlafaxine | {
"A": "Venlafaxine",
"B": "Sertraline",
"C": "Lithium",
"D": "Bupropion"
} | step2&3 | A | [
"27 year old woman presents",
"psychiatrist due to feelings of sadness",
"past",
"weeks",
"let go",
"job 1 month",
"feels",
"whole life",
"end",
"unable to sleep well",
"night",
"finds",
"crying",
"times",
"day",
"not",
"able to eat well",
"weight",
"result",
"to go out",
"me... |
A 72-year-old man presents to his primary care physician because he has had difficulty swallowing. Specifically, he occasionally feels like he is choking while eating solids and then later regurgitates the undigested food. In addition, he says that his family has been complaining that he now has really bad breath. Base... | Cricopharyngeus and thyropharyngeus | {
"A": "Circular and longitudinal muscle of the esophagus",
"B": "Cricopharyngeus and circular muscle of the esophagus",
"C": "Cricopharyngeus and thyropharyngeus",
"D": "Superior and inferior pharyngeal constrictors"
} | step1 | C | [
"72 year old man presents",
"primary care physician",
"difficulty swallowing",
"occasionally feels",
"choking",
"eating solids",
"then later regurgitates",
"food",
"addition",
"family",
"now",
"bad breath",
"Based",
"clinical suspicion",
"sent",
"barium swallow study",
"reveals",
"... |
A 49-year-old male complains of heartburn, epigastric pain, and diarrhea. He has a past medical history significant for heartburn that is nonresponsive to omeprazole. He denies any alcohol intake, and has not been taking any nonsteroidal anti-inflammatory drugs. An endoscopy is performed, which shows two ulcers in the ... | Parietal cell hypertrophy is likely present | {
"A": "Increasing omeprazole dose will likely decrease the suspected hormone level",
"B": "Chronic atrophic gastritis would decrease the suspected hormone level",
"C": "Parietal cell hypertrophy is likely present",
"D": "The suspected hormone acts via a receptor tyrosine kinase signaling pathway"
} | step1 | C | [
"year old male",
"heartburn",
"epigastric pain",
"diarrhea",
"past medical history significant",
"heartburn",
"omeprazole",
"denies",
"alcohol intake",
"not",
"taking",
"nonsteroidal anti-inflammatory drugs",
"endoscopy",
"performed",
"shows two ulcers",
"proximal duodenum",
"one",
... |
A 19-year-old man comes to the emergency department for right wrist pain and swelling 2 hours after falling on an outstretched hand while playing softball. The pain worsened when he attempted to pitch after the fall. He has eczema and type 1 diabetes mellitus. Current medications include insulin and topical clobetasol.... | Scaphoid fracture | {
"A": "Colles' fracture",
"B": "Transscaphoid perilunate dislocation",
"C": "Scaphoid fracture",
"D": "De Quervain's tenosynovitis"
} | step2&3 | C | [
"year old man",
"emergency department",
"right wrist pain",
"swelling 2 hours",
"falling",
"hand",
"playing softball",
"pain worsened",
"attempted to pitch",
"fall",
"eczema",
"type 1 diabetes mellitus",
"Current medications include insulin",
"topical clobetasol",
"appears",
"Examinati... |
A 81-year-old man presents to his cardiologist for ongoing management of mild heart failure. He has not had any changes in his cardiac function status and says that he is tolerating lisinopril without any major side effects. During the course of the visit, the patient says that he is unhappy with his urologist because ... | Encourage the patient to speak with his urologist directly | {
"A": "Call the urologist and warn him of an impending lawsuit",
"B": "Call the urologist to convey the patient's dissatisfaction",
"C": "Contact his insurance agent to discuss possible risks",
"D": "Encourage the patient to speak with his urologist directly"
} | step1 | D | [
"81 year old man presents",
"cardiologist",
"ongoing management",
"mild heart failure",
"not",
"changes in",
"cardiac function status",
"lisinopril",
"major side effects",
"course",
"visit",
"patient",
"unhappy",
"urologist",
"experiencing episodes of dizziness",
"starting prazosin",
... |
A 33-year-old man presents to the emergency department complaining of weakness and fatigue. He states that his symptoms have worsened over the past day. He has a past medical history of IV drug abuse and alcoholism and he currently smells of alcohol. His temperature is 102°F (38.9°C), blood pressure is 111/68 mmHg, pul... | Vancomycin | {
"A": "Ceftriaxone",
"B": "Ibuprofen and warm compresses",
"C": "Piperacillin-tazobactam",
"D": "Vancomycin"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"weakness",
"fatigue",
"states",
"symptoms",
"worsened",
"past day",
"past medical history of IV drug abuse",
"alcoholism",
"currently smells",
"alcohol",
"temperature",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"respirations",
... |
Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as de... | Can affect two or more closely related individuals. | {
"A": "A trial separation is likely to worsen symptoms.",
"B": "Can affect two or more closely related individuals.",
"C": "Treatment can be augmented with antipsychotics.",
"D": "Cognitive behavioral therapy is a good first-line."
} | step1 | B | [
"Two dizygotic twins present",
"university clinic",
"poisoned",
"school's cafeteria food",
"brought",
"concerns",
"past",
"students",
"cafeteria staff support",
"belief",
"average students",
"strong",
"weak subject areas",
"course grade books",
"known medical conditions",
"not known to... |
A 4-year-old boy presents to the emergency department with diarrhea. Several days ago, he experienced a fever which has progressed to vomiting and diarrhea. He has had multiple episodes of non-bloody diarrhea and states that he feels fatigued. He is not up to date on his vaccinations and takes many different herbal sup... | Rotavirus | {
"A": "Campylobacter jejuni",
"B": "Coronavirus",
"C": "Rotavirus",
"D": "Vibrio cholerae"
} | step2&3 | C | [
"4 year old boy presents",
"emergency department",
"diarrhea",
"days",
"experienced",
"fever",
"progressed",
"vomiting",
"diarrhea",
"multiple episodes of non bloody diarrhea",
"states",
"feels fatigued",
"not",
"date",
"vaccinations",
"takes",
"different herbal supplements",
"pare... |
A 14-year-old boy is admitted to the emergency department with acute onset of confusion, malaise, diffuse abdominal pain, nausea, and a single episode of vomiting. He denies ingestion of any suspicious foods, fevers, respiratory symptoms, or any other symptoms preceding his current condition. However, he notes an incre... | Regular insulin | {
"A": "Insulin detemir",
"B": "Cefazolin",
"C": "Regular insulin",
"D": "Potassium chloride"
} | step2&3 | C | [
"year old boy",
"admitted",
"emergency department",
"acute onset of confusion",
"malaise",
"diffuse abdominal",
"nausea",
"single episode of vomiting",
"denies ingestion",
"suspicious foods",
"fevers",
"respiratory symptoms",
"symptoms preceding",
"current condition",
"notes",
"increas... |
A 29-year-old primigravid woman at 18 weeks’ gestation comes to the physician for her first prenatal visit. She works as a paralegal and lives with her husband. Her current pregnancy was unexpected, and she did not take any prenatal medications or supplements. Physical examination shows a uterus 2 inches above the umbi... | Anencephaly | {
"A": "Holoprosencephaly",
"B": "Lissencephaly",
"C": "Myelomeningocele",
"D": "Anencephaly"
} | step1 | D | [
"29 year old primigravid woman",
"weeks",
"physician",
"first prenatal visit",
"works",
"lives with",
"husband",
"current pregnancy",
"unexpected",
"not take",
"prenatal medications",
"supplements",
"Physical examination shows",
"uterus",
"inches",
"umbilicus",
"concentration",
"fe... |
An otherwise healthy 58-year-old man comes to the physician because of a 1-year history of episodic coughing whenever he cleans his left ear. There is no history of hearing loss, tinnitus, or vertigo. Stimulating his left ear canal with a cotton swab triggers a bout of coughing. The physician informs him that these sym... | Ipsilateral vocal cord palsy | {
"A": "Inability to raise ipsilateral eyebrow",
"B": "Decreased secretion from ipsilateral sublingual gland",
"C": "Ipsilateral vocal cord palsy",
"D": "Ipsilateral sensorineural hearing loss"
} | step1 | C | [
"healthy 58 year old man",
"physician",
"of",
"year history",
"episodic coughing",
"cleans",
"left ear",
"history of hearing loss",
"tinnitus",
"vertigo",
"Stimulating",
"left ear canal",
"cotton swab triggers",
"bout of coughing",
"physician informs",
"symptoms",
"caused",
"hypers... |
A 7-year-old girl is brought to the physician because of generalized fatigue and dark urine for 1 week. Four weeks ago, she was treated with topical mupirocin for a skin infection. Her 5-year-old brother has steroid-resistant nephrotic syndrome. Her temperature is 37°C (98.6°F), pulse is 90/min, respirations are 14/min... | Subepithelial immune complex deposition | {
"A": "Subepithelial immune complex deposition",
"B": "Antibodies against type IV collagen",
"C": "Defective circulating IgA antibodies",
"D": "Inflammation of small-sized blood vessels"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"generalized fatigue",
"dark urine",
"1 week",
"Four weeks",
"treated with topical mupirocin",
"skin infection",
"5 year old brother",
"steroid-resistant nephrotic syndrome",
"temperature",
"98",
"pulse",
"90 min",
"respirations",
"min",
"bl... |
A 9-year-old boy is getting fitted for leg braces because he has become too weak to walk without them. He developed normally until age 3 but then he began to get tired more easily and fell a lot. Over time he started having trouble walking and would stand up by using the Gower maneuver. Despite this weakness, his neuro... | Frameshift | {
"A": "Frameshift",
"B": "Missense",
"C": "Nonsense",
"D": "Splice site"
} | step1 | A | [
"year old boy",
"getting fitted",
"leg braces",
"weak to walk",
"age",
"then",
"began to",
"tired more easily",
"fell",
"lot",
"time",
"started",
"walking",
"stand up",
"using",
"Gower maneuver",
"weakness",
"neurologic development",
"normal for",
"age",
"exam",
"calves app... |
A 64-year-old woman comes to the physician because of gradually worsening blurry vision in both eyes for 5 months. She has also had intermittent headaches for the past 2 months. She has type 2 diabetes mellitus, osteoarthritis, second-degree heart block, and presbyopia. Her current medications include metformin, lisino... | Topical latanoprost therapy | {
"A": "Topical pilocarpine therapy",
"B": "Topical latanoprost therapy",
"C": "Topical timolol",
"D": "Laser iridotomy\n\""
} | step2&3 | B | [
"64 year old woman",
"physician",
"worsening blurry vision",
"eyes",
"5 months",
"intermittent headaches",
"past",
"months",
"type 2 diabetes mellitus",
"osteoarthritis",
"second-degree heart block",
"presbyopia",
"current medications include metformin",
"lisinopril",
"ibuprofen",
"Exa... |
A 25-year-old woman comes to the physician because she has noted darkening of the skin around her neck since wearing a chain she recently bought at a thrift shop. The darkening occurred gradually over the past 2 months and is accompanied by thickening of the affected skin. She has peptic ulcer disease. Menses occur at ... | Polycystic ovaries on ultrasonography of the pelvis | {
"A": "Diffusely enlarged thyroid gland on ultrasonography of the neck",
"B": "Elevated serum 17-hydroxyprogesterone levels",
"C": "Malignant glandular cells on gastric biopsy",
"D": "Polycystic ovaries on ultrasonography of the pelvis"
} | step2&3 | D | [
"year old woman",
"physician",
"noted darkening",
"skin",
"neck",
"chain",
"recently bought",
"shop",
"occurred",
"past",
"months",
"thickening of",
"affected skin",
"peptic ulcer disease",
"Menses occur",
"irregular 35",
"60 day intervals",
"last",
"days",
"heavy flow",
"Men... |
A 51-year-old woman comes to the physician because of a 1-year history of occasional discoloration and tingling in her fingers. She has no history of major medical illness and takes no medications. Examination of the hands and fingers shows thickened, waxy skin and several firm white nodules on the fingertips. Further ... | Telangiectasia | {
"A": "Upper eyelid rash",
"B": "Telangiectasia",
"C": "Endocardial immune complex deposition",
"D": "Interstitial lung disease"
} | step1 | B | [
"year old woman",
"physician",
"year history",
"occasional discoloration",
"tingling in",
"fingers",
"history of major medical illness",
"takes",
"medications",
"Examination of",
"hands",
"fingers shows thickened",
"waxy skin",
"several firm white nodules",
"fingertips",
"Further evalu... |
A 26-year-old African-American woman presents to the clinic for a routine check-up. Review of systems reveals that she often feels nervous and has recently developed a slight tremor. Of note, she has lost 15 pounds in the past 3 months, despite an increased appetite. The patient’s temperature is 99°F (37.2°C), blood pr... | Lymphocytic infiltration | {
"A": "Anti-thyroid peroxidase antibodies",
"B": "Anti-thyroglobulin antibodies",
"C": "Lymphocytic infiltration",
"D": "Anti-myelin antibodies"
} | step1 | C | [
"year old African-American woman presents",
"clinic",
"routine check-up",
"Review of systems reveals",
"often feels nervous",
"recently",
"slight tremor",
"note",
"lost",
"pounds",
"past 3 months",
"increased appetite",
"patients temperature",
"blood pressure",
"mmHg",
"pulse",
"85 m... |
A 33-year-old man has a history of intermittent bloody diarrhea, tenesmus, fever, fatigue, and lower abdominal cramps for the past 2 weeks. On physical examination, he is lethargic and appears lean and pale. He has aphthous stomatitis, red congested conjunctiva, and tender swollen joints. At the doctor’s office, his pu... | Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance | {
"A": "Colonoscopy: Continuous ulcerated lesions involving the mucosa and submucosa granular mucosa, crypt abscess, and pseudopolyps, Barium study: Lead pipe colon appearance",
"B": "Colonoscopy: Patches of mucosal erosions with pseudomembrane formation, Barium study: Lead pipe colon appearance",
"C": "Colonosco... | step2&3 | A | [
"year old man",
"history",
"intermittent bloody",
"tenesmus",
"fever",
"fatigue",
"lower abdominal cramps",
"past 2 weeks",
"physical examination",
"lethargic",
"appears",
"pale",
"aphthous stomatitis",
"red congested conjunctiva",
"tender swollen joints",
"doctors office",
"pulse",
... |
A 72-year-old woman with metastatic ovarian cancer is brought to the physician by her son because she is in immense pain and cries all the time. On a 10-point scale, she rates the pain as an 8 to 9. One week ago, a decision to shift to palliative care was made after she failed to respond to 2 years of multiple chemothe... | Increase dosage of morphine | {
"A": "Increase dosage of morphine",
"B": "Initiate palliative radiotherapy",
"C": "Change morphine to a non-opioid analgesic",
"D": "Counsel patient and continue same opioid dose"
} | step2&3 | A | [
"72 year old woman",
"metastatic ovarian cancer",
"brought",
"physician",
"son",
"pain",
"cries",
"time",
"a point scale",
"rates",
"pain",
"One week",
"decision to shift",
"palliative care",
"made",
"failed to",
"years",
"multiple chemotherapy regimens",
"now",
"chemotherapy d... |
A 20-year-old man is brought to the emergency department because of fever and lethargy for the past 2 days. He reports that during this time he has had occasional palpitations and shortness of breath. He has asthma and sickle cell disease. Current medications include inhaled albuterol, hydroxyurea, and folic acid. He a... | Viral infection | {
"A": "Dysfunctional erythrocyte membrane proteins",
"B": "Splenic sequestration crisis",
"C": "Viral infection",
"D": "Adverse effect of medication"
} | step2&3 | C | [
"20 year old man",
"brought",
"emergency department",
"fever",
"lethargy",
"past 2 days",
"reports",
"time",
"occasional palpitations",
"shortness of breath",
"asthma",
"sickle cell disease",
"Current medications include inhaled albuterol",
"hydroxyurea",
"folic acid",
"appears fatigue... |
A well-dressed couple presents to the emergency department with sudden onset of headache, a sensation of floating, and weakness of arms and legs after eating a plate of shellfish 2 hours ago. They mention that they had experienced tingling of the lips and mouth within 15 minutes of ingesting the shellfish. They also co... | Blockade of voltage-gated fast sodium channels | {
"A": "Inactivation of syntaxin",
"B": "Blockade of voltage-gated fast sodium channels",
"C": "Increased opening of presynaptic calcium channels",
"D": "Inhibition of acetylcholinesterase"
} | step1 | B | [
"well-dressed couple presents",
"emergency department",
"sudden onset",
"headache",
"sensation of floating",
"weakness of arms",
"legs",
"eating",
"plate",
"shellfish",
"hours",
"tingling",
"lips",
"mouth",
"15 minutes",
"ingesting",
"shellfish",
"mild nausea",
"abdominal discomf... |
A 53-year-old woman presents to her primary care doctor due to discolored, itchy skin, joint pain, and a feeling of abdominal fullness for the past week. Her medical history includes anxiety and depression. She also experiences occasional headaches and dizziness. Of note, the patient recently returned from an expeditio... | Plasma retinol levels | {
"A": "Antimitochondrial antibodies",
"B": "BRCA2 gene mutation",
"C": "Elevated hepatic venous pressure gradient",
"D": "Plasma retinol levels"
} | step1 | D | [
"year old woman presents",
"primary care doctor",
"discolored",
"itchy skin",
"joint pain",
"feeling",
"abdominal fullness",
"past week",
"medical history includes anxiety",
"depression",
"experiences occasional headaches",
"dizziness",
"note",
"patient recently returned",
"expedition",
... |
A 26-year-old African-American woman comes to the physician because of a 4-day history of a nonproductive cough and chest pain. The pain is sharp and worse when she breathes deeply. During this time, she has also had two episodes of hematuria. Over the past 6 months, she has had intermittent pain, stiffness, and swelli... | Low serum levels of C3 and C4 | {
"A": "Anti-histone antibodies",
"B": "Low serum levels of C3 and C4",
"C": "Erosions of the metacarpophalangeal joints",
"D": "Cytotoxic glomerular antibodies"
} | step2&3 | B | [
"year old African-American woman",
"physician",
"4-day history",
"nonproductive cough",
"chest pain",
"pain",
"sharp",
"worse",
"deeply",
"time",
"two episodes of hematuria",
"past 6 months",
"intermittent pain",
"stiffness",
"swelling",
"fingers",
"left knee",
"two miscarriages",
... |
One and a half hours after undergoing an elective cardiac catheterization, a 53-year-old woman has right flank and back pain. She has hypertension, hypercholesterolemia, and type 2 diabetes mellitus. She had an 80% stenosis in the left anterior descending artery and 2 stents were placed. Intravenous unfractionated hepa... | CT scan of the abdomen and pelvis | {
"A": "Administer protamine sulfate",
"B": "CT scan of the abdomen and pelvis",
"C": "Administer intravenous atropine",
"D": "Obtain an ECG"
} | step2&3 | B | [
"One",
"half hours",
"elective cardiac catheterization",
"year old woman",
"right flank",
"back pain",
"hypertension",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"80",
"stenosis",
"left anterior descending artery",
"2 stents",
"placed",
"Intravenous unfractionated heparin",
"u... |
A 4-month-old girl is brought to the physician by her father because he is concerned that she appears sickly and lethargic. She has always had a pale complexion, but it has been getting worse over the past month. She was delivered at home at 36 weeks to a 26-year-old woman following an uncomplicated pregnancy. She has ... | Triphalangeal thumb | {
"A": "Mild neutropenia",
"B": "Spherocytes",
"C": "Triphalangeal thumb",
"D": "Target cells"
} | step2&3 | C | [
"4 month old girl",
"brought",
"physician",
"father",
"concerned",
"appears",
"lethargic",
"always",
"pale complexion",
"getting worse",
"past month",
"delivered",
"home",
"36 weeks",
"year old woman following",
"uncomplicated pregnancy",
"not",
"examined",
"physician",
"2nd pe... |
A 55-year-old man presents to his physician complaining of pain. He states that in the morning he feels rather stiff and has general discomfort and pain in his muscles. The patient has a past medical history of diabetes and is not currently taking any medications. His temperature is 99.2°F (37.3°C), blood pressure is 1... | Glucocorticoids | {
"A": "Aldolase levels",
"B": "Glucocorticoids",
"C": "Temporal artery biopsy",
"D": "Thyroxine"
} | step2&3 | B | [
"55 year old man presents",
"physician",
"pain",
"states",
"morning",
"feels",
"stiff",
"general discomfort",
"pain",
"muscles",
"patient",
"past medical diabetes",
"not currently taking",
"medications",
"temperature",
"99",
"3C",
"blood pressure",
"98 mmHg",
"pulse",
"80 min... |
A 28-year-old man is brought in by ambulance to the ER, barely conscious, after feeling drowsy and falling to the floor during a presentation several hours ago. His colleague who accompanied him says he has had similar episodes 5 times in the past 3 months. No significant past medical history. His blood pressure is 110... | Glucose: ↓, Insulin: ↑, C-Peptide: ↑, Ketoacidosis: Absent | {
"A": "Glucose: Normal, Insulin: Normal, C-Peptide: Normal, Ketoacidosis: Absent",
"B": "Glucose: ↓, Insulin: ↑, C-Peptide: ↑, Ketoacidosis: Absent",
"C": "Glucose: ↑, Insulin: ↓, C-Peptide: ↓, Ketoacidosis: Present",
"D": "Glucose: ↑, Insulin: ↑/Normal, C-Peptide: ↑/Normal, Ketoacidosis: Absent"
} | step1 | B | [
"year old man",
"brought",
"ambulance",
"ER",
"conscious",
"feeling drowsy",
"falling",
"floor",
"presentation",
"hours",
"similar episodes",
"times",
"past 3 months",
"significant past medical history",
"blood pressure",
"80 mm Hg",
"pulse",
"min",
"capillary blood glucose",
"... |
A 73-year-old man comes to the physician because of a 4-kg (9-lb) weight loss over the last month. During this time he has not been able to eat more than one bite without coughing immediately and sometimes he regurgitates food through his nose. His symptoms are worse with liquids. One month ago he had a stroke in the r... | Videofluoroscopy | {
"A": "Videofluoroscopy",
"B": "Barium swallow",
"C": "Esophageal manometry",
"D": "Transnasal laryngoscopy"
} | step2&3 | A | [
"year old man",
"physician",
"4 kg",
"weight loss",
"month",
"time",
"not",
"able to eat more",
"one bite",
"coughing immediately",
"sometimes",
"regurgitates food",
"nose",
"symptoms",
"worse",
"liquids",
"One month",
"stroke",
"right middle cerebral artery",
"history of hyper... |
A 21-year-old man presents to the emergency room with abdominal pain and nausea for the past 5 hours. The pain is diffusely spread and of moderate intensity. The patient also says he has not felt like eating since yesterday. He has no past medical history and is not on any medications. He regularly drinks 2–4 beers per... | Burn out of pancreatic beta cells | {
"A": "Blunt trauma to the abdomen",
"B": "Burn out of pancreatic beta cells",
"C": "Fecalith in the caecum",
"D": "Presence of gut contents in the abdominal cavity"
} | step1 | B | [
"21-year-old man presents",
"emergency room",
"abdominal pain",
"nausea",
"past",
"hours",
"pain",
"spread",
"moderate intensity",
"patient",
"not felt",
"eating",
"past medical history",
"not",
"medications",
"drinks",
"beers",
"day",
"not smoke",
"use illicit substances",
"... |
A 51-year-old woman comes to the physician because of fatigue and progressive pain and stiffness in her hands for 3 months. She used to play tennis but stopped 1 month ago because of difficulties holding the racket and her skin becoming “very sensitive to sunlight.” Her last menstrual period was 1 year ago. She has dia... | Iron studies | {
"A": "Synovial fluid analysis",
"B": "Testing for parvovirus B19 antibodies",
"C": "Iron studies",
"D": "Testing for rheumatoid factors"
} | step2&3 | C | [
"year old woman",
"physician",
"fatigue",
"progressive pain",
"stiffness",
"hands",
"3 months",
"used to play tennis",
"stopped 1 month",
"difficulties holding",
"skin",
"very sensitive to sunlight",
"last menstrual period",
"1 year",
"diabetes mellitus controlled",
"insulin",
"not s... |
A 7-year-old boy is brought to the physician because of repetitive, involuntary blinking, shrugging, and grunting for the past year. His mother states that his symptoms improve when he is physically active, while tiredness, boredom, and stress aggravate them. He has felt increasingly embarrassed by his symptoms in scho... | Excessive impulsivity and inattention | {
"A": "Excessive impulsivity and inattention",
"B": "Feelings of persistent sadness and loss of interest",
"C": "Chorea and hyperreflexia",
"D": "Recurrent episodes of intense fear"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"involuntary blinking",
"grunting",
"past year",
"mother states",
"symptoms",
"physically active",
"tiredness",
"boredom",
"stress aggravate",
"felt",
"embarrassed",
"symptoms in school",
"grades",
"dropping",
"average levels",
"met",
"de... |
An 18-month-old boy is brought to the physician by his parents for the evaluation of passing large amounts of dark red blood from his rectum for 2 days. His parents noticed that he has also had several episodes of dark stools over the past 3 weeks. The parents report that their child has been sleeping more and has been... | Technetium-99m pertechnetate scan | {
"A": "Technetium-99m pertechnetate scan",
"B": "Water-soluble contrast enema",
"C": "Esophagogastroduodenoscopy",
"D": "Colonoscopy"
} | step2&3 | A | [
"month old boy",
"brought",
"physician",
"parents",
"evaluation",
"large amounts",
"dark red blood",
"rectum",
"2 days",
"parents",
"several episodes of dark stools",
"past",
"weeks",
"parents report",
"child",
"sleeping more",
"more pale",
"usual",
"past 24 hours",
"boy",
"p... |
A 22-year-old man comes to the physician because of an ulcer on his penis for 12 days. The ulcer is painful and draining yellow purulent material. He returned from a study abroad trip to India 3 months ago. His immunizations are up-to-date. He is sexually active with one female partner and uses condoms inconsistently. ... | Haemophilus ducreyi | {
"A": "Chlamydia trachomatis",
"B": "Klebsiella granulomatis",
"C": "Herpes simplex virus 2",
"D": "Haemophilus ducreyi"
} | step2&3 | D | [
"year old man",
"physician",
"of",
"ulcer",
"penis",
"days",
"ulcer",
"painful",
"draining yellow purulent material",
"returned",
"study",
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"India",
"months",
"immunizations",
"date",
"sexually active",
"one female partner",
"uses condoms",
"appears",
"temperature",
... |
A 49-year-old man comes to the physician because of tender, red nodules that appeared on his chest 3 days ago. Three weeks ago, he had similar symptoms in his right lower limb and another episode in his left foot; both episodes resolved spontaneously. He also has diarrhea and has had a poor appetite for 1 month. He has... | CT scan of the abdomen | {
"A": "Serum angiotensin-converting enzyme level",
"B": "CT scan of the abdomen",
"C": "Coagulation studies",
"D": "Ankle brachial index"
} | step2&3 | B | [
"year old man",
"physician",
"tender",
"red nodules",
"appeared",
"chest 3 days",
"Three weeks",
"similar symptoms",
"right lower limb",
"episode",
"left foot",
"episodes resolved",
"diarrhea",
"poor appetite",
"month",
"history",
"dry cough",
"joint pain",
"takes albuterol",
"... |
A 31-year-old woman presents to the emergency room with high-grade fever and abdominal pain for the past 2 days. She also complains of malaise and has vomited several times since last night. The past medical history is benign. The vital signs include: temperature 40.0°C (104.0°F), pulse 120/min, respiratory rate 28/min... | It is composed of tubules and parenchyma. | {
"A": "It produces hydrochloric acid.",
"B": "It is composed of tubules and parenchyma.",
"C": "It is the most common site of Meckel's diverticulum.",
"D": "It is composed of white pulp and red pulp."
} | step1 | B | [
"31 year old woman presents",
"emergency room",
"high-grade fever",
"abdominal pain",
"past 2 days",
"malaise",
"vomited",
"times",
"night",
"past medical history",
"benign",
"vital signs include",
"temperature 40",
"pulse",
"min",
"respiratory rate",
"min",
"blood pressure",
"mm... |
A 43-year-old woman visits her primary care provider complaining of fatigue. Although she has had it for several months, her fatigue has been worsening over the past few weeks. She has no other symptoms. Past medical history is significant for hypertension. She takes chlorthalidone, an oral contraceptive pill, and a mu... | Homocysteine | {
"A": "Homocysteine",
"B": "Methionine",
"C": "Cysteine",
"D": "Phenylalanine"
} | step1 | A | [
"year old woman visits",
"primary care provider",
"fatigue",
"several months",
"fatigue",
"worsening",
"past",
"weeks",
"symptoms",
"Past medical history",
"significant",
"hypertension",
"takes chlorthalidone",
"oral contraceptive pill",
"multivitamin",
"day",
"Family history",
"dr... |
A 22-year-old woman comes to the emergency department because of frontal throbbing headaches for 3 weeks. Yesterday, the patient had blurry vision in both eyes and a brief episode of double vision. She has been taking ibuprofen with only mild improvement of her symptoms. She has polycystic ovarian syndrome, type 2 diab... | Lumbar puncture | {
"A": "Emergent craniotomy",
"B": "Acetazolamide therapy",
"C": "Cerebral shunt",
"D": "Lumbar puncture"
} | step2&3 | D | [
"year old woman",
"emergency department",
"of frontal throbbing",
"weeks",
"patient",
"blurry vision",
"eyes",
"brief episode of double vision",
"taking ibuprofen",
"only mild improvement",
"symptoms",
"polycystic ovarian syndrome",
"type 2 diabetes mellitus",
"facial acne",
"not",
"tr... |
A 14-year-old boy is brought to the emergency department because of abdominal swelling and vomiting over the past 24 hours. He has generalized abdominal pain. He has no history of any serious illnesses and takes no medications. His temperature is 36.7°C (98.1°F), blood pressure is 115/70 mm/Hg, pulse is 88/min, and res... | Endoscopy | {
"A": "Colectomy",
"B": "Endoscopy",
"C": "IV antibiotics",
"D": "Rectal tube"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"abdominal swelling",
"vomiting",
"past 24 hours",
"generalized abdominal pain",
"history",
"serious illnesses",
"takes",
"medications",
"temperature",
"36",
"98",
"blood pressure",
"70 mm/Hg",
"pulse",
"88 min",
"respirations",
... |
A 71-year-old man is admitted to the ICU with a history of severe pancreatitis and new onset difficulty breathing. His vital signs are a blood pressure of 100/60 mm Hg, heart rate of 100/min, respirations of 27/min, temperature of 36.7°C (98.1°F), and oxygen saturation of 85% on room air. Physical examination shows a c... | Alveolar sacs | {
"A": "Respiratory bronchioles",
"B": "Bronchioles",
"C": "Alveolar sacs",
"D": "Bronchi"
} | step1 | C | [
"71 year old man",
"admitted",
"ICU",
"history of severe pancreatitis",
"new onset difficulty breathing",
"vital signs",
"blood pressure",
"100 60 mm Hg",
"heart rate",
"100 min",
"respirations",
"27 min",
"temperature",
"36",
"98",
"oxygen",
"85",
"room air",
"Physical examinati... |
A 40-year-old homeless man is brought to the emergency department after police found him in the park lying on the ground with a minor cut at the back of his head. He is confused with slurred speech and fails a breathalyzer test. Pupils are normal in size and reactive to light. A bolus of intravenous dextrose, thiamine,... | Ataxic gait | {
"A": "Ataxic gait",
"B": "Pin point pupil",
"C": "Vertical nystagmus",
"D": "High blood pressure"
} | step1 | A | [
"40 year old homeless man",
"brought",
"emergency department",
"police found",
"park lying",
"minor cut",
"back of",
"head",
"confused",
"slurred speech",
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"breathalyzer test",
"Pupils",
"normal",
"size",
"reactive to light",
"bolus",
"intravenous",
"thiamine",
"naloxon... |
A 59-year-old man is brought to the emergency department one hour after developing shortness of breath and “squeezing” chest pain that began while he was mowing the lawn. He has asthma, hypertension, and erectile dysfunction. Current medications include salmeterol, amlodipine, lisinopril, and vardenafil. His pulse is 1... | Cyclic GMP elevation | {
"A": "Bradykinin accumulation",
"B": "Alpha-1 receptor antagonism",
"C": "Cyclic GMP elevation",
"D": "Decreased nitric oxide production"
} | step1 | C | [
"59 year old man",
"brought",
"emergency department one hour",
"shortness of breath",
"squeezing chest pain",
"began",
"asthma",
"hypertension",
"erectile dysfunction",
"Current medications include salmeterol",
"amlodipine",
"lisinopril",
"vardenafil",
"pulse",
"min",
"blood pressure",... |
A 49-year-old man presents to his primary care physician complaining of multiple symptoms. He states that over the past 8 months he has noticed voice changes and difficulty swallowing. The dysphagia started with just dry foods like crackers but has progressed to include smoothies and ice cream. He works as a newspaper ... | Riluzole | {
"A": "Amantadine",
"B": "Beta interferon",
"C": "Reserpine",
"D": "Riluzole"
} | step2&3 | D | [
"year old man presents",
"primary care physician",
"multiple symptoms",
"states",
"past",
"months",
"voice changes",
"difficulty swallowing",
"dysphagia started",
"dry foods",
"crackers",
"progressed to include",
"ice cream",
"works",
"newspaper editor",
"writing",
"dominant hand",
... |
A 72-year-old woman comes to the physician because of a 1-month history of progressive fatigue and shortness of breath. Physical examination shows generalized pallor. Laboratory studies show:
Hemoglobin 5.8 g/dL
Hematocrit 17%
Mean corpuscular volume 86 μm3
Leukocyte count 6,200/mm3 with a normal differential
Platelet ... | Thymic tumor | {
"A": "Polyomavirus infection",
"B": "HbF persistence",
"C": "Thymic tumor",
"D": "Lead poisoning"
} | step1 | C | [
"72 year old woman",
"physician",
"month history",
"progressive fatigue",
"shortness of breath",
"Physical examination shows generalized pallor",
"Laboratory studies show",
"Hemoglobin",
"8 g",
"Hematocrit 17",
"Mean corpuscular volume",
"m3 Leukocyte 6 200 mm3",
"normal differential Platele... |
A 38-year-old man is brought to the emergency department 35 minutes after he sustained a gunshot wound to the right thigh. He has type 1 diabetes mellitus. On arrival, his pulse is 112/min, respirations are 20/min, and blood pressure is 115/69 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. There i... | Duplex ultrasonography | {
"A": "Wound cleaning and tetanus toxoid",
"B": "Fasciotomy",
"C": "Digital subtraction angiography",
"D": "Duplex ultrasonography"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department 35 minutes",
"sustained",
"gunshot wound",
"right thigh",
"type 1 diabetes mellitus",
"arrival",
"pulse",
"min",
"respirations",
"20 min",
"blood pressure",
"69 mm Hg",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"98",
... |
A 73-year-old male is brought in by ambulance after he was found to be lethargic and confused. He has not been routinely seeing a physician and is unable to recall how he came to be in the hospital. His temperature is 99°F (37°C), blood pressure is 150/95 mmHg, pulse is 75/min, and respirations are 18/min. His past med... | Increased Bowman's space oncotic pressure | {
"A": "Decreased filtration coefficient",
"B": "Decreased glomerular capillary hydrostatic pressure",
"C": "Increased glomerular capillary oncotic pressure",
"D": "Increased Bowman's space oncotic pressure"
} | step1 | D | [
"year old male",
"brought",
"ambulance",
"found to",
"lethargic",
"confused",
"not",
"seeing",
"physician",
"unable to recall",
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"hospital",
"temperature",
"blood pressure",
"95 mmHg",
"pulse",
"75 min",
"respirations",
"min",
"past medical history",
"significant",
"po... |
A previously healthy 25-year-old woman is brought to the emergency department because of a 1-hour history of sudden severe lower abdominal pain. The pain started shortly after having sexual intercourse. The pain is worse with movement and urination. The patient had several urinary tract infections as a child. She is se... | Emergency exploratory laparotomy | {
"A": "Oral doxycycline and metronidazole administration",
"B": "Uterine artery embolization",
"C": "Intravenous methotrexate administration",
"D": "Emergency exploratory laparotomy"
} | step2&3 | D | [
"healthy",
"year old woman",
"brought",
"emergency department",
"hour history",
"sudden severe lower abdominal pain",
"pain started",
"sexual intercourse",
"pain",
"worse",
"movement",
"urination",
"patient",
"several urinary tract infections",
"child",
"sexually active",
"boyfriend"... |
A 58-year-old man presents to the Emergency Department after 3 hours of intense suprapubic pain associated with inability to urinate for the past day or two. His medical history is relevant for benign prostatic hyperplasia (BPH) that has been under treatment with prazosin and tadalafil. Upon admission, he is found to h... | Urine output | {
"A": "Serum creatinine (SCr)",
"B": "Serum blood urea nitrogen (BUN)",
"C": "Urine output",
"D": "Estimated glomerular filtration rate (eGFR)"
} | step2&3 | C | [
"58 year old man presents",
"Emergency Department",
"3 hours",
"intense suprapubic pain associated with",
"to",
"past day",
"two",
"medical history",
"relevant",
"benign prostatic hyperplasia",
"under treatment",
"prazosin",
"tadalafil",
"admission",
"found to",
"blood pressure",
"10... |
Study X examined the relationship between coffee consumption and lung cancer. The authors of Study X retrospectively reviewed patients' reported coffee consumption and found that drinking greater than 6 cups of coffee per day was associated with an increased risk of developing lung cancer. However, Study X was criticiz... | Confounding; randomization or crossover study | {
"A": "Lead time bias; placebo",
"B": "Selection bias; randomization",
"C": "Measurement bias; blinding",
"D": "Confounding; randomization or crossover study"
} | step1 | D | [
"Study",
"examined",
"relationship",
"coffee consumption",
"lung cancer",
"authors",
"Study",
"reviewed patients",
"reported coffee consumption",
"found",
"drinking greater than",
"cups",
"coffee",
"day",
"associated with",
"increased risk of",
"lung cancer",
"Study",
"authors",
... |
An 87-year-old woman is brought to the emergency department from her nursing home because of increasing confusion and lethargy for 12 hours. The nursing home aide says she did not want to get out of bed this morning and seemed less responsive than usual. She has Alzheimer's disease, hypertension, and a history of nephr... | Proteus mirabilis | {
"A": "Proteus mirabilis",
"B": "Enteroccocus faecalis",
"C": "Staphylococcus saprophyticus",
"D": "Klebsiella pneumoniae"
} | step2&3 | A | [
"87 year old woman",
"brought",
"emergency department",
"nursing home",
"increasing confusion",
"lethargy",
"12 hours",
"nursing home aide",
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"to get out",
"bed",
"morning",
"less responsive than usual",
"Alzheimer",
"isease,",
"ypertension,",
"istory of nephrolithiasis.",
"h... |
A 17-year-old girl is brought into the physician's office with complaints of nausea, vomiting, headache, and blurry vision. In preparation for final exams the patient's mother started her on an array of supplements and herbal preparations given the "viral illness" that is prevalent at her school. Despite these remedies... | Supplement use | {
"A": "Head trauma",
"B": "Supplement use",
"C": "Idiopathic intracranial hypertension",
"D": "Migraine headache with aura"
} | step2&3 | B | [
"year old girl",
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"omplaints ",
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"ther s arted h",
"ray o",
"pplements a",
"rbal preparations g ven t",
"ral illness\" ",
"evalent a",
"hool. ",
"rl h",
... |
A 6-year-old boy is brought to the pediatrician by his mother complaining of abdominal pain and constipation. She reports that his appetite has been reduced and that he has not had a bowel movement in 2 days. Prior to this, he had a regular bowel movement once a day. She also reports that he has appeared to be more tir... | Inhibition of ferrochelatase | {
"A": "Inhibition of ferrochelatase",
"B": "Activation of glutathione",
"C": "Inhibition of ALA synthase",
"D": "Inactivation of uroporphyrinogen III cosynthase"
} | step1 | A | [
"year old boy",
"brought",
"pediatrician",
"mother",
"abdominal pain",
"constipation",
"reports",
"appetite",
"reduced",
"not",
"bowel movement",
"2 days",
"regular bowel movement",
"day",
"reports",
"appeared to",
"more tired",
"usual",
"family recently moved",
"house built",
... |
A 72-year-old man is taken to the emergency room after losing consciousness. According to his wife, he suddenly complained of fluttering in his chest, lightheadedness, and profuse sweating while walking to the grocery store. He then turned gray, lost consciousness, and collapsed onto the ground. His medical history is ... | Implantable cardioverter-defibrillator | {
"A": "Intravenous magnesium sulphate",
"B": "Implantable cardioverter-defibrillator",
"C": "Intravenous adenosine",
"D": "Temporary or permanent cardiac pacing"
} | step2&3 | B | [
"72 year old man",
"taken",
"emergency room",
"consciousness",
"wife",
"fluttering",
"chest",
"lightheadedness",
"profuse sweating",
"walking",
"grocery store",
"then turned gray",
"lost consciousness",
"collapsed",
"medical history",
"significant",
"prior anterior wall myocardial in... |
A 58-year-old woman presents with vision loss in her right eye. She noticed the visual changes the morning of presentation and has never experienced this visual disturbance before. Her medical history is significant for hypertension, hypercholesterolemia, and type II diabetes mellitus. She is currently on lisinopril, l... | Lateral geniculate nucleus | {
"A": "Lateral geniculate nucleus",
"B": "Edinger-Westphal nucleus",
"C": "Oculomotor nucleus",
"D": "Ventral posteromedial nucleus"
} | step1 | A | [
"58 year old woman presents",
"vision loss",
"right eye",
"visual changes",
"morning",
"presentation",
"never experienced",
"visual disturbance",
"medical history",
"significant",
"hypertension",
"hypercholesterolemia",
"type II diabetes mellitus",
"currently",
"lisinopril",
"lovastati... |
A 10-year-old boy is brought to the physician by his parents for a follow-up examination. He has had a short stature since birth and underwent diagnostic testing. Genetic analyses showed a gain of function mutation in the fibroblast growth factor receptor 3 (FGFR3) gene. He has met all developmental milestones. He is a... | Frontal bossing | {
"A": "Absent collar bones",
"B": "Blue sclerae",
"C": "Long extremities",
"D": "Frontal bossing"
} | step1 | D | [
"A 10 year old boy",
"brought",
"physician",
"parents",
"follow-up examination",
"short stature",
"birth",
"diagnostic testing",
"Genetic analyses showed",
"gain of function mutation",
"fibroblast growth factor receptor 3",
"FGFR3",
"gene",
"met",
"developmental milestones",
"percentil... |
A 19-year-old woman presents to her university health clinic for a regularly scheduled visit. She has a past medical history of depression, acne, attention-deficit/hyperactivity disorder, and dysmenorrhea. She is currently on paroxetine, dextroamphetamine, and naproxen during her menses. She is using nicotine replaceme... | Check hCG | {
"A": "Check hCG",
"B": "Check prolactin",
"C": "Check TSH",
"D": "Recheck blood pressure in 1 week"
} | step2&3 | A | [
"year old woman presents",
"university health clinic",
"scheduled visit",
"past medical history of depression",
"acne",
"attention-deficit/hyperactivity disorder",
"dysmenorrhea",
"currently",
"paroxetine",
"dextroamphetamine",
"naproxen",
"menses",
"using nicotine replacement products to qu... |
A 2-year-old boy is brought to his pediatrician for evaluation of a tender red big toe. His mother also notes that she has seen him recently starting to bite his own fingers and also exhibits spasms of muscle tightness. She reports that his diapers often contain the substance shown in the photograph. On exam he is note... | Allopurinol | {
"A": "6-mercaptopurine",
"B": "Allopurinol",
"C": "Hydroxyurea",
"D": "Probenecid"
} | step1 | B | [
"2 year old boy",
"brought",
"pediatrician",
"evaluation",
"tender red big toe",
"mother",
"notes",
"seen",
"recently starting to bite",
"fingers",
"exhibits spasms of muscle tightness",
"reports",
"diapers often contain",
"substance shown",
"photograph",
"exam",
"noted to",
"delay... |
A 32-year-old man is brought to the Emergency Department after 3 consecutive days of diarrhea, fatigue and weakness. His stool has been soft and mucoid, with no blood stains. The patient just came back from a volunteer mission in Guatemala, where he remained asymptomatic. His personal medical history is unremarkable. T... | High urine osmolality, low FeNa+, low urine Na+ | {
"A": "High urine osmolality, high fractional excretion of sodium (FeNa+), high urine Na+",
"B": "High urine osmolality, low FeNa+, low urine Na+",
"C": "Low urine osmolality, high FeNa+, high urine Na+",
"D": "Low urine osmolality, high FeNa+, low urine Na+"
} | step2&3 | B | [
"year old man",
"brought",
"Emergency Department",
"3 consecutive days",
"diarrhea",
"fatigue",
"weakness",
"stool",
"soft",
"mucoid",
"blood stains",
"patient",
"back",
"volunteer mission",
"Guatemala",
"asymptomatic",
"personal medical history",
"unremarkable",
"Today",
"bloo... |
A 32-year-old woman comes to the physician with fever and malaise. For the past 2 days, she has felt fatigued and weak and has had chills. Last night, had a temperature of 40.8°C (104.2°F). She has had a sore throat since this morning. The patient was recently diagnosed with Graves disease and started on methimazole. L... | Discontinue methimazole | {
"A": "Switch to propylthiouracil",
"B": "Bone marrow biopsy",
"C": "Begin oral aminopenicillin",
"D": "Discontinue methimazole"
} | step1 | D | [
"year old woman",
"physician",
"fever",
"malaise",
"past 2 days",
"felt fatigued",
"weak",
"chills",
"Last night",
"temperature",
"40",
"sore throat",
"morning",
"patient",
"recently diagnosed",
"Graves disease",
"started",
"methimazole",
"Laboratory studies show",
"Hemoglobin"... |
A 62-year-old woman comes to the physician because of a 2-month history of exertional shortness of breath and fatigue. She sometimes wakes up at night coughing and gasping for air. Cardiac examination shows a grade 3/6 holosystolic murmur best heard at the apex. Which of the following physical exam findings would be co... | Early diastolic extra heart sound | {
"A": "Early diastolic extra heart sound",
"B": "Prominent V wave",
"C": "Head bobbing",
"D": "Absence of A2 heart sound"
} | step1 | A | [
"62 year old woman",
"physician",
"of",
"2 month history",
"exertional shortness",
"breath",
"fatigue",
"sometimes wakes up",
"night coughing",
"gasping for air",
"Cardiac examination shows",
"grade",
"6 holosystolic murmur best heard",
"apex",
"following physical exam findings",
"cons... |
A group of investigators who are studying individuals infected with Trypanosoma cruzi is evaluating the ELISA absorbance cutoff value of serum samples for diagnosis of infection. The previous cutoff point is found to be too high, and the researchers decide to lower the threshold by 15%. Which of the following outcomes ... | Increased negative predictive value | {
"A": "Increased negative predictive value",
"B": "Unchanged true positive results",
"C": "Increased positive predictive value",
"D": "Increased specificity"
} | step1 | A | [
"A group",
"investigators",
"studying individuals infected",
"Trypanosoma cruzi",
"evaluating",
"ELISA absorbance cutoff value",
"serum samples",
"diagnosis",
"infection",
"previous cutoff point",
"found to",
"too high",
"researchers",
"to lower",
"threshold",
"following outcomes",
"... |
A 33-year-old man comes to the physician because of a 2-month history of burning epigastric pain, dry cough, and occasional regurgitation. The pain is aggravated by eating and lying down. Physical examination shows a soft, non-tender abdomen. Upper endoscopy shows hyperemia in the distal third of the esophagus. Which o... | Lansoprazole | {
"A": "Pirenzepine",
"B": "Ranitidine",
"C": "Aluminum hydroxide",
"D": "Lansoprazole"
} | step1 | D | [
"year old man",
"physician",
"2 month history",
"burning epigastric pain",
"dry cough",
"occasional regurgitation",
"pain",
"aggravated",
"eating",
"lying",
"Physical examination shows",
"soft",
"non",
"Upper shows hyperemia",
"distal third of",
"esophagus",
"following drugs",
"mos... |
A 24-year-old woman comes to the physician for a routine health maintenance examination. She feels well. Menses occur at regular 28-day intervals and last for 3–5 days, with normal flow. They are occasionally accompanied by pain. Three years ago, she was diagnosed with chlamydial cervicitis and treated with doxycycline... | Repeat Pap smear in 12 months | {
"A": "Colposcopy with endocervical sampling",
"B": "Colposcopy with endocervical and endometrial sampling",
"C": "Repeat Pap smear in 12 months",
"D": "Repeat Pap smear in 3 years"
} | step2&3 | C | [
"year old woman",
"physician",
"routine health maintenance examination",
"feels well",
"Menses occur",
"regular",
"day intervals",
"last",
"35 days",
"normal flow",
"occasionally",
"pain",
"Three years",
"diagnosed",
"chlamydial cervicitis",
"treated with doxycycline",
"sexually acti... |
A 43-year-old man presents to the office with complaints of mild abdominal pain, yellowish discoloration of eyes, and itching all over his body for a year. He recently lost 2.4 kg (5.3 lb) over a period of 1 month. He says that his urine is dark and stool appears clay-colored. He denies any history of hematemesis, mele... | Idiopathic inflammatory scarring of the bile duct | {
"A": "Long term carcinogenic effect of the contrast agent",
"B": "Idiopathic inflammatory scarring of the bile duct",
"C": "Liver fluke induced inflammation leading to metaplastic change",
"D": "Abnormal cystic dilation of the biliary tree"
} | step1 | B | [
"year old man presents",
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"discoloration",
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"recently lost 2.4 kg",
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"denies",
"history of hematemesis",
"melena",
"fever",
"travel... |
A 1-month-old girl is brought to the physician for evaluation of a rash on her face that first appeared 3 days ago. She was delivered at term after an uncomplicated pregnancy. She is at the 25th percentile for length and 40th percentile for weight. Examination shows small perioral vesicles surrounded by erythema and ho... | Severe congenital neutropenia | {
"A": "Severe congenital neutropenia",
"B": "Parvovirus B19 infection",
"C": "Acute lymphoblastic leukemia",
"D": "Selective IgA deficiency"
} | step1 | A | [
"month old girl",
"brought",
"physician",
"evaluation",
"rash",
"face",
"first appeared 3 days",
"delivered",
"term",
"uncomplicated pregnancy",
"percentile",
"length",
"percentile",
"weight",
"Examination shows small perioral vesicles surrounded",
"erythema",
"honey colored crusts",... |
A 56-year-old man is brought to the emergency department 25 minutes after he was involved in a high-speed motor vehicle collision where he was the unrestrained passenger. He has severe lower abdominal and pelvic pain. On arrival, he is alert and oriented. His pulse is 95/min, respirations are 22/min, and blood pressure... | Retrograde cystography | {
"A": "Intravenous pyelography",
"B": "External fixation of the pelvis",
"C": "Retrograde urethrography",
"D": "Retrograde cystography"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"minutes",
"involved",
"high speed motor vehicle collision",
"passenger",
"severe lower abdominal",
"pelvic pain",
"arrival",
"alert",
"oriented",
"pulse",
"95 min",
"respirations",
"min",
"blood pressure",
"62 mm Hg",
"Examinati... |
A 43-year-old woman comes to the physician because of worsening heartburn and abdominal pain for the past 4 months. During this period she has also had multiple episodes of greasy diarrhea. Six months ago, she had similar symptoms and was diagnosed with a duodenal ulcer. Her mother died of complications from uncontroll... | Parietal cell hyperplasia in the stomach | {
"A": "Anti-tissue transglutaminase antibodies in the serum",
"B": "Parietal cell hyperplasia in the stomach",
"C": "Noncaseating granulomas in the jejunum",
"D": "Dystrophic calcifications in the pancreas"
} | step1 | B | [
"year old woman",
"physician",
"worsening heartburn",
"abdominal pain",
"past",
"months",
"period",
"multiple episodes of greasy diarrhea",
"Six months",
"similar symptoms",
"diagnosed",
"duodenal ulcer",
"mother died",
"complications",
"uncontrolled hypoglycemia",
"primary hyperparath... |
A 25-year-old man presents with a mass on his neck. He says that he first noticed the mass a few weeks ago while taking a shower. Since then, the mass has not increased in size. He denies any pain or difficulty in swallowing. Past medical history is unremarkable. Family history is significant for his father who had his... | Medullary carcinoma | {
"A": "Anaplastic carcinoma",
"B": "Papillary carcinoma",
"C": "Follicular adenoma",
"D": "Medullary carcinoma"
} | step1 | D | [
"year old man presents",
"mass",
"neck",
"first",
"mass",
"few weeks",
"taking",
"shower",
"Since then",
"mass",
"not increased in size",
"denies",
"pain",
"difficulty in swallowing",
"Past medical history",
"unremarkable",
"Family history",
"significant",
"father",
"thyroid re... |
A 46-year-old man presents to the office complaining of dry, irritated eyes that have gotten worse over the last week. The patient states that he has also developed a red bumpy rash on his arms. On exam, his bilateral cornea and conjunctiva are dry and thickened. There are small ulcerations on the cornea. The skin of t... | Vitamin A | {
"A": "Folic acid",
"B": "Vitamin B12",
"C": "Thiamine",
"D": "Vitamin A"
} | step1 | D | [
"year old man presents",
"office",
"of dry",
"eyes",
"gotten worse",
"week",
"patient states",
"red",
"rash",
"arms",
"exam",
"bilateral cornea",
"conjunctiva",
"dry",
"thickened",
"small ulcerations",
"cornea",
"skin of",
"bilateral arms",
"erythematous rash characterized",
... |
A 3-year-old boy presents with fever, generalized fatigue, nausea, and progressive anemia. The patient’s mother says his condition was normal until one week ago when he started having flu-like symptoms such as fever, general fatigue, and abdominal discomfort. Past medical experience is significant for sickle cell disea... | Parvovirus infection | {
"A": "Parvovirus infection",
"B": "IgG-mediated hemolytic anemia",
"C": "Sickle cell disease",
"D": "Myelofibrosis"
} | step2&3 | A | [
"3 year old boy presents",
"fever",
"generalized fatigue",
"nausea",
"progressive anemia",
"patients mother",
"condition",
"normal",
"one week",
"started",
"flu-like symptoms",
"fever",
"general fatigue",
"abdominal discomfort",
"Past medical experience",
"significant",
"sickle cell ... |
A 35-year-old man presents to his primary care provider complaining of dull pain in his scrotum and lower back pain over the last 3 months. He is a computer engineer working in a private IT company. He had an uncomplicated appendectomy at the age of 22 years, but is otherwise without a significant past medical history.... | Chemotherapy | {
"A": "Observation",
"B": "Chemotherapy",
"C": "Radiotherapy",
"D": "Immunotherapy"
} | step2&3 | B | [
"35 year old man presents",
"primary care provider",
"dull pain",
"scrotum",
"lower back pain over the",
"months",
"computer engineer working",
"private",
"company",
"uncomplicated appendectomy",
"age",
"years",
"significant past medical history",
"smokes 23 cigarettes",
"weekends",
"d... |
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