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 32-year-old woman comes to the physician because of a 3-month history of recurrent headaches and nausea. The headaches occur a few times a month and alternately affect the right or left side. The headaches are exacerbated by loud sounds or bright light. She is in graduate school and has been under a lot of stress rec... | Migraine headache | {
"A": "Migraine headache",
"B": "Tension headache",
"C": "Trigeminal neuralgia",
"D": "Cluster headache"
} | step1 | A | [
"year old woman",
"physician",
"of",
"3 month history",
"recurrent headaches",
"nausea",
"headaches occur",
"few times",
"month",
"affect",
"right",
"left side",
"headaches",
"exacerbated",
"loud sounds",
"bright light",
"graduate school",
"lot",
"stress recently",
"not smoke",... |
A 12-year-old girl is brought to the emergency department 3 hours after the sudden onset of colicky abdominal pain and vomiting. She also has redness and swelling of the face and lips without pruritus. Her symptoms began following a tooth extraction earlier this morning. She had a similar episode of facial swelling aft... | Complement inhibitor deficiency | {
"A": "Drug-induced bradykinin excess",
"B": "Complement inhibitor deficiency",
"C": "Immune-complex deposition",
"D": "T-cell mediated immune reaction"
} | step2&3 | B | [
"year old girl",
"brought",
"emergency department",
"hours",
"sudden onset",
"colicky abdominal pain",
"vomiting",
"redness",
"swelling of",
"face",
"lips",
"pruritus",
"symptoms began following",
"tooth extraction earlier",
"morning",
"similar episode of facial swelling",
"bicycle a... |
A 23-year-old man comes to the physician because of a 1-year history of episodic shortness of breath. Physical examination shows no abnormalities. Laboratory studies show elevated serum IgE levels. Microscopic examination of the sputum shows eosinophilic, hexagonal, double-pointed crystals. A methacholine challenge tes... | Dust mites | {
"A": "Aspirin",
"B": "Cold air",
"C": "Dust mites",
"D": "Tobacco smoke"
} | step1 | C | [
"23 year old man",
"physician",
"of",
"year history",
"episodic shortness",
"breath",
"Physical examination shows",
"abnormalities",
"Laboratory studies show elevated serum IgE levels",
"Microscopic examination of",
"sputum shows eosinophilic",
"hexagonal",
"double",
"crystals",
"methach... |
A 58-year-old man comes to the emergency department for complaints of crushing chest pain for 4 hours. He was shoveling snow outside when the pain started. It is rated 7/10 and radiates to his left arm. An electrocardiogram (ECG) demonstrates ST-segment elevation in leads V2-4. He subsequently undergoes percutaneous co... | Harsh, loud, holosystolic murmur at the lower left sternal border | {
"A": "Harsh, loud, holosystolic murmur at the lower left sternal border",
"B": "Normal findings",
"C": "Pulseless electrical activity",
"D": "Widespread ST-segment elevations"
} | step1 | A | [
"58 year old man",
"emergency department",
"complaints of crushing chest pain",
"4 hours",
"snow outside",
"pain started",
"rated",
"10",
"radiates",
"left arm",
"electrocardiogram",
"demonstrates ST-segment elevation",
"leads V2",
"percutaneous coronary intervention",
"discharged",
"a... |
A 73-year-old man presents to your clinic for a routine checkup. His medical history is notable for a previous myocardial infarction. He states that he has not seen a doctor in "many years". He has no complaints. When you auscultate over the cardiac apex with the bell of your stethoscope, you notice an additional sound... | Decreased left ventricular compliance | {
"A": "Increased left ventricular compliance",
"B": "Decreased left ventricular compliance",
"C": "Increased left ventricular filling volume",
"D": "Increased pulmonary compliance"
} | step1 | B | [
"year old man presents",
"clinic",
"routine checkup",
"medical history",
"notable",
"previous myocardial infarction",
"states",
"not seen",
"doctor",
"years",
"complaints",
"cardiac apex",
"bell",
"stethoscope",
"additional sound immediately preceding S1",
"extra heart sound",
"most ... |
A 4-year-old boy is brought to the physician because of a 3-day history of fever and left ear pain. Examination of the left ear shows a bulging tympanic membrane with green discharge. Gram stain of the discharge shows a gram-negative coccobacillus. The isolated organism grows on chocolate agar. The causal pathogen most... | Cleavage of secretory immunoglobulins | {
"A": "Binding of the Fc region of immunoglobulins",
"B": "Overactivation of adenylate cyclase",
"C": "Cleavage of secretory immunoglobulins",
"D": "Inactivation of elongation factor"
} | step1 | C | [
"4 year old boy",
"brought",
"physician",
"3-day history",
"fever",
"left ear pain",
"Examination of",
"shows",
"bulging tympanic membrane",
"green discharge",
"Gram stain",
"shows",
"gram-negative coccobacillus",
"isolated organism",
"chocolate agar",
"causal pathogen",
"likely",
... |
You have been asked to deliver a lecture to medical students about the effects of various body hormones and neurotransmitters on the metabolism of glucose. Which of the following statements best describes the effects of sympathetic stimulation on glucose metabolism? | Epinephrine increases liver glycogenolysis. | {
"A": "Norepinephrine causes increased glucose absorption within the intestines.",
"B": "Without epinephrine, insulin cannot act on the liver.",
"C": "Sympathetic stimulation to alpha receptors of the pancreas increases insulin release.",
"D": "Epinephrine increases liver glycogenolysis."
} | step1 | D | [
"to deliver",
"lecture",
"medical students",
"effects",
"various body hormones",
"neurotransmitters",
"metabolism",
"glucose",
"following statements best",
"effects",
"stimulation",
"glucose metabolism"
] |
A 43-year-old man with a history of chronic alcoholism presents with a chronic cough and dyspnea. He says he traveled to Asia about 4 months ago and his symptoms started shortly after he returned. His temperature is 40.2°C (104.4°F) and pulse is 92/min. Physical examination reveals poor personal hygiene and a cough pro... | Inoculation of a sputum sample into selective agar media needs to be incubated at 35–37°C (95.0–98.6°F) for up to 8 weeks. | {
"A": "Stains of gastric washing and urine have a high diagnostic yield on microscopy.",
"B": "Inoculation of a sputum sample into selective agar media needs to be incubated at 35–37°C (95.0–98.6°F) for up to 8 weeks.",
"C": "Ziehl-Neelsen staining is more sensitive than fluorescence microscopy with auramine-rho... | step1 | B | [
"year old man",
"history of chronic alcoholism presents",
"chronic cough",
"dyspnea",
"traveled",
"Asia",
"months",
"symptoms started",
"returned",
"temperature",
"40",
"4F",
"pulse",
"min",
"Physical examination reveals poor personal hygiene",
"cough productive of",
"blood streaked ... |
A 47-year-old female with a history of mild asthma, type II diabetes, hypertension, and hyperlipidemia presents to clinic complaining of swelling in her lips (Image A). She has had no changes to her medications within the past two years. Vital signs are stable. Physical exam is notable for significant erythema around a... | Inhibition of angiotensin-converting enzyme | {
"A": "Inhibition of angiotensin-converting enzyme",
"B": "Inhibition of HMG-CoA reductase",
"C": "Stimulation of the Beta 2 receptor",
"D": "Inhibition of the Na/K/Cl triple transporter of the thick ascending limb"
} | step1 | A | [
"year old female",
"history of mild asthma",
"type II diabetes",
"hypertension",
"hyperlipidemia presents",
"clinic",
"swelling",
"lips",
"Image",
"changes",
"medications",
"past two years",
"Vital signs",
"stable",
"Physical exam",
"notable",
"significant erythema",
"swelling of t... |
A 24-year-old man presents to the physician because of headache, malaise, fatigue, aching pain in the bones, and a non-itchy skin rash for the past week. He reports that he had developed a single, raised, red-colored eruption over the glans penis 2 months ago, which had healed spontaneously 1 month ago. Physical examin... | Prescribe an antipyretic and an analgesic for symptom relief | {
"A": "Prescribe an antipyretic and an analgesic for symptom relief",
"B": "Prescribe oral prednisone for 5 days",
"C": "Administer intramuscular epinephrine",
"D": "Prescribe doxycycline for 28 days"
} | step2&3 | A | [
"year old man presents",
"physician",
"headache",
"malaise",
"fatigue",
"aching pain",
"bones",
"non itchy skin rash",
"past week",
"reports",
"single",
"raised",
"red colored eruption",
"glans penis",
"months",
"healed",
"month",
"Physical examination shows",
"symmetric",
"dis... |
A 2-year-old boy is brought to the office by his mother due to the recent onset of fever and ear pain. He began tugging on his ear and complaining of pain 3 days ago. The mother reports a temperature of 37.8°C (100.0°F) this morning, with decreased appetite. The current temperature is 38.6ºC (101.4ºF). Ear, nose, and t... | Amoxicillin | {
"A": "Amoxicillin",
"B": "Azithromycin",
"C": "Ceftriaxone",
"D": "Ciprofloxacin"
} | step2&3 | A | [
"2 year old boy",
"brought",
"office",
"mother due to",
"recent onset",
"fever",
"ear pain",
"began tugging",
"ear",
"pain 3 days",
"mother reports",
"temperature",
"100",
"morning",
"decreased appetite",
"current temperature",
"4F",
"Ear",
"nose",
"throat",
"examination show... |
A 27-year-old man comes to the physician because of worsening abdominal pain over the last several months. He has also had recent feelings of sadness and a lack of motivation at work, where he is employed as a computer programmer. He denies suicidal thoughts. He has a history of multiple kidney stones. He has a family ... | Urine metanephrines | {
"A": "Urine metanephrines",
"B": "Urine 5-HIAA",
"C": "Midnight salivary cortisol",
"D": "Serum gastrin"
} | step2&3 | A | [
"27 year old man",
"physician",
"of worsening abdominal",
"months",
"recent feelings of sadness",
"lack of motivation",
"work",
"employed",
"computer programmer",
"denies suicidal thoughts",
"history of multiple kidney stones",
"family history of thyroid cancer",
"father",
"uncle",
"thyr... |
An 82-year-old woman presents with 2 months of foul-smelling, greasy diarrhea. She says that she also has felt very tired recently and has had some associated bloating and flatus. She denies any recent abdominal pain, nausea, melena, hematochezia, or vomiting. She also denies any history of recent travel and states tha... | Fecal fat test | {
"A": "Fecal fat test",
"B": "CT of the abdomen with oral contrast",
"C": "Stool guaiac test",
"D": "Tissue transglutaminase antibody test"
} | step1 | A | [
"year old woman presents",
"months",
"smelling",
"greasy diarrhea",
"felt very tired recently",
"associated bloating",
"flatus",
"denies",
"recent abdominal pain",
"nausea",
"melena",
"hematochezia",
"vomiting",
"denies",
"history of recent travel",
"states",
"home",
"city water",
... |
A 12-year-old boy is brought to the office by his mother with complaints of clear nasal discharge and cough for the past 2 weeks. The mother says that her son has pain during swallowing. Also, the boy often complains of headaches with a mild fever. Although his mother gave him some over-the-counter medication, there wa... | Acute sinusitis | {
"A": "Acute sinusitis",
"B": "Non-allergic vasomotor rhinitis",
"C": "Streptococcal pharyngitis",
"D": "Common cold"
} | step1 | A | [
"year old boy",
"brought",
"office",
"mother",
"complaints",
"clear nasal discharge",
"cough",
"past 2 weeks",
"mother",
"son",
"pain",
"swallowing",
"boy often",
"headaches",
"mild fever",
"mother gave",
"over-the-counter medication",
"only",
"slight improvement",
"Five days",... |
A 65-year-old male presents to the physician after noticing gross blood with urination. He reports that this is not associated with pain. The patient smokes 1.5 packs per day for 45 years. Dipstick analysis is positive for blood, with 5 RBC per high-power field (HPF) on urinalysis. A cystoscopy is performed, which is s... | Gentamicin enhances toxicity risk | {
"A": "Gentamicin enhances toxicity risk",
"B": "Cardiotoxicity",
"C": "Myelosuppression",
"D": "Addition of mesna decreases drug toxicity"
} | step1 | A | [
"65 year old male presents",
"physician",
"gross blood",
"urination",
"reports",
"not associated with pain",
"patient smokes",
"packs per day",
"years",
"Dipstick analysis",
"positive",
"blood",
"5 RBC",
"high-power field",
"urinalysis",
"cystoscopy",
"performed",
"significant",
... |
Three hours after undergoing open proctocolectomy for ulcerative colitis, a 42-year-old male complains of abdominal pain. The pain is localized to the periumbilical and hypogastric regions. A total of 20 mL of urine has drained from his urinary catheter since the end of the procedure. Temperature is 37.2°C (98.9°F), pu... | Administer intravenous fluids | {
"A": "Administer intravenous furosemide",
"B": "Administer intravenous fluids",
"C": "Obtain an abdominal CT",
"D": "Administer tamsulosin"
} | step2&3 | B | [
"Three hours",
"open proctocolectomy",
"ulcerative colitis",
"year old male",
"abdominal pain",
"pain",
"localized",
"periumbilical",
"hypogastric regions",
"total",
"20 mL",
"urine",
"drained",
"urinary catheter",
"end",
"procedure",
"Temperature",
"98 9F",
"pulse",
"min",
"... |
Three days after undergoing coronary artery bypass surgery, a 72-year-old man has severe right upper quadrant pain, fever, nausea, and vomiting. He has type 2 diabetes mellitus, benign prostatic hyperplasia, peripheral vascular disease, and chronic mesenteric ischemia. He had smoked one pack of cigarettes daily for 30 ... | Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy | {
"A": "Intravenous heparin therapy followed by embolectomy",
"B": "Careful observation with serial abdominal examinations",
"C": "Immediate cholecystectomy",
"D": "Intravenous piperacillin-tazobactam therapy and percutaneous cholecystostomy"
} | step2&3 | D | [
"Three days",
"coronary artery bypass surgery",
"72 year old man",
"severe right upper quadrant pain",
"fever",
"nausea",
"vomiting",
"type 2 diabetes mellitus",
"benign prostatic hyperplasia",
"peripheral vascular disease",
"chronic mesenteric ischemia",
"smoked one pack",
"cigarettes daily... |
A 57-year-old man presents to the emergency department for weight loss and abdominal pain. The patient states that he has felt steadily more fatigued over the past month and has lost 22 pounds without effort. Today, he fainted prompting his presentation. The patient has no significant past medical history. He does have... | Intellectualization | {
"A": "Optimism",
"B": "Pessimism",
"C": "Intellectualization",
"D": "Dissociation"
} | step2&3 | C | [
"57 year old man presents",
"emergency department",
"weight loss",
"abdominal pain",
"patient states",
"felt",
"more fatigued",
"past month",
"lost",
"pounds",
"effort",
"Today",
"fainted prompting",
"presentation",
"patient",
"significant past medical history",
"pack-year smoking hi... |
A home drug screening test kit is currently being developed. The cut-off level is initially set at 4 mg/uL, which is associated with a sensitivity of 92% and a specificity of 97%. How might the sensitivity and specificity of the test change if the cut-off level is changed to 2 mg/uL? | Sensitivity = 97%, specificity = 96% | {
"A": "Sensitivity = 92%, specificity = 97%",
"B": "Sensitivity = 95%, specificity = 98%",
"C": "Sensitivity = 97%, specificity = 96%",
"D": "Sensitivity = 100%, specificity = 97%"
} | step2&3 | C | [
"home drug screening test kit",
"currently",
"cut-off level",
"initially set",
"mg/uL",
"associated with",
"sensitivity",
"specificity",
"97",
"sensitivity and specificity",
"test change",
"cut-off level",
"changed",
"2 mg uL"
] |
A 49-year-old woman presents to the office for a follow-up visit. She was diagnosed with cirrhosis of the liver 1 year ago and is currently receiving symptomatic treatment along with complete abstinence from alcohol. She does not have any complaints. She has a 4-year history of gout, which has been asymptomatic during ... | Liver disease | {
"A": "Use of probenecid",
"B": "Liver disease",
"C": "Spironolactone",
"D": "Increase in dietary protein"
} | step1 | B | [
"year old woman presents",
"office",
"follow-up visit",
"diagnosed",
"cirrhosis of",
"liver",
"year",
"currently receiving symptomatic treatment",
"complete abstinence",
"alcohol",
"not",
"complaints",
"4 year history of gout",
"asymptomatic",
"treatment",
"medication",
"currently pr... |
A 65-year-old man comes to the physician because of abdominal pain and bloody, mucoid diarrhea for 3 days. He has been taking over-the-counter supplements for constipation over the past 6 months. He was diagnosed with type 2 diabetes mellitus 15 years ago. He has smoked one pack of cigarettes daily for 35 years. His cu... | Focal weakness of the colonic muscularis layer | {
"A": "Focal weakness of the colonic muscularis layer",
"B": "Infiltrative growth in the descending colon",
"C": "Twisting of the sigmoid colon around its mesentery",
"D": "Decreased perfusion to mesenteric blood vessel"
} | step1 | A | [
"65 year old man",
"physician",
"abdominal pain",
"bloody",
"mucoid diarrhea",
"3 days",
"taking over-the-counter supplements",
"constipation",
"past 6 months",
"diagnosed",
"type 2 diabetes mellitus",
"years",
"smoked one pack",
"cigarettes daily",
"35 years",
"current medications inc... |
A 55-year-old woman comes to the physician with concerns about swelling and pain in her right breast. Physical examination shows erythema and prominent pitting of the hair follicles overlying the upper and lower outer quadrants of the right breast. There are no nipple changes or discharge. A core needle biopsy shows in... | Obstruction of the lymphatic channels | {
"A": "Bacterial invasion of the subcutaneous tissue",
"B": "Obstruction of the lymphatic channels",
"C": "Involution of the breast parenchyma and ductal system",
"D": "Infiltration of the lactiferous ducts"
} | step1 | B | [
"55 year old woman",
"physician",
"concerns",
"swelling",
"pain in",
"right breast",
"Physical examination shows erythema",
"prominent pitting",
"hair follicles",
"upper",
"lower outer quadrants of",
"right breast",
"nipple changes",
"discharge",
"core needle biopsy shows invasive carcin... |
A 59-year-old woman comes to the emergency department 25 minutes after the onset of severe left periorbital pain and blurred vision in the same eye. The pain began soon after she entered a theater to watch a movie. She has a headache and vomited twice on the way to the hospital. Two weeks ago, she had acute sinusitis t... | Angle-closure glaucoma | {
"A": "Open-angle glaucoma",
"B": "Retrobulbar neuritis",
"C": "Acute iridocyclitis",
"D": "Angle-closure glaucoma"
} | step2&3 | D | [
"59 year old woman",
"emergency department",
"minutes",
"onset",
"severe left periorbital pain",
"blurred vision",
"same eye",
"pain began",
"entered",
"theater to",
"movie",
"headache",
"vomited twice",
"hospital",
"Two weeks",
"acute sinusitis",
"resolved",
"atrial fibrillation",... |
A 70-year-old female with chronic kidney failure secondary to diabetes asks her nephrologist to educate her about the techniques used to evaluate the degree of kidney failure progression. She learns about the concept of glomerular filtration rate (GFR) and learns that it can be estimated by measuring the levels of some... | Inulin | {
"A": "Glucose",
"B": "Inulin",
"C": "Paraaminohippurate (PAH)",
"D": "Sodium"
} | step1 | B | [
"70 year old female",
"chronic kidney failure secondary to diabetes",
"nephrologist to educate",
"techniques used to evaluate",
"degree",
"kidney failure progression",
"learns",
"concept",
"glomerular filtration rate",
"learns",
"estimated",
"measuring",
"levels",
"substances",
"clearanc... |
A 32-year-old man is brought to the emergency department because he was found stumbling in the street heedless of oncoming traffic. On arrival, he is found to be sluggish and has slow and sometimes incoherent speech. He is also drowsy and falls asleep several times during questioning. Chart review shows that he has pre... | Cardiovascular collapse | {
"A": "Cardiovascular collapse",
"B": "Flashbacks",
"C": "Insomnia",
"D": "Piloerection"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"found stumbling",
"street",
"traffic",
"arrival",
"found to",
"sluggish",
"slow",
"sometimes incoherent speech",
"drowsy",
"falls asleep",
"times",
"questioning",
"Chart review shows",
"admitted",
"getting",
"severe cut",
"fig... |
A 4-month-old boy is brought to the physician for a well-child examination. He was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. He weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, he appears well. His pulse is 146/min, the respirations are 39/min, and the blo... | Intentionally rolls over | {
"A": "Grasps small objects between thumb and finger",
"B": "Intentionally rolls over",
"C": "Sits with support of pelvis",
"D": "Transfers objects from hand to hand"
} | step2&3 | B | [
"4 month old boy",
"brought",
"physician",
"well",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"breastfed",
"3 400 g",
"8 oz",
"birth",
"physician's office",
"appears well",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"7.5 kg",
"oz",
"me... |
A 62-year-old man comes to the physician for a 1-month history of fever, malaise, and skin rash. He has had a 5-kg (11-lb) weight loss during this period. He does not smoke, drink alcohol, or use illicit drugs. He appears pale. His temperature is 39.1°C (102.3°F), pulse is 110/min, and blood pressure is 140/85 mm Hg. P... | Microemboli | {
"A": "IgE immune complexes",
"B": "Aschoff granulomas",
"C": "Microemboli",
"D": "Non-caseating granulomas"
} | step1 | C | [
"62 year old man",
"physician",
"month history",
"fever",
"malaise",
"skin rash",
"5 kg",
"weight loss",
"period",
"not smoke",
"drink alcohol",
"use illicit",
"appears pale",
"temperature",
"pulse",
"min",
"blood pressure",
"85 mm Hg",
"Physical examination shows nontender",
"... |
A 23-year-old man is brought to the emergency department by the police for impaired cognition and agitation after being struck in the head at a local nightclub. The patient refuses to respond to questions and continues to be markedly agitated. An alcoholic smell is noted. His temperature is 36.9°C (98.4°F), pulse is 10... | Phencyclidine | {
"A": "Heroin",
"B": "Lysergic acid diethylamide",
"C": "Methamphetamine",
"D": "Phencyclidine"
} | step2&3 | D | [
"23 year old man",
"brought",
"emergency department",
"police",
"impaired cognition",
"agitation",
"struck",
"head",
"local nightclub",
"patient refuses to",
"questions",
"continues to",
"markedly agitated",
"alcoholic smell",
"noted",
"temperature",
"36",
"98 4F",
"pulse",
"mi... |
A 34-year-old woman, gravida 1, para 0, at 18 weeks' gestation, comes to the physician for a prenatal visit. She recently read about a genetic disorder that manifests with gait ataxia, kyphoscoliosis, and arrhythmia and is concerned about the possibility of her child inheriting the disease. There is no personal or fami... | 1/40,000 | {
"A": "1/10,000",
"B": "1/20,000",
"C": "1/40,000",
"D": "1/200"
} | step1 | C | [
"year old woman",
"gravida 1",
"para 0",
"weeks",
"gestation",
"physician",
"prenatal visit",
"recently read",
"genetic disorder",
"manifests",
"gait ataxia",
"kyphoscoliosis",
"arrhythmia",
"concerned",
"possibility",
"child inheriting",
"disease",
"personal",
"family history of... |
A previously healthy 5-year-old girl is brought to the emergency department because of difficulty breathing and vomiting that began 1 hour after she took an amoxicillin tablet. She appears anxious. Her pulse is 140/min, respirations are 40/min, and blood pressure is 72/39 mmHg. She has several well-circumscribed, raise... | Epinephrine | {
"A": "Methylprednisolone",
"B": "Norepinephrine",
"C": "Dobutamine",
"D": "Epinephrine"
} | step1 | D | [
"healthy",
"year old girl",
"brought",
"emergency department",
"difficulty breathing",
"vomiting",
"began 1 hour",
"took",
"amoxicillin tablet",
"appears anxious",
"pulse",
"min",
"respirations",
"40 min",
"blood pressure",
"72",
"mmHg",
"several well circumscribed",
"raised",
... |
An 8-year-old boy is brought in for initial evaluation by a pediatrician after he was adopted from an international orphanage. On presentation, he is found to have difficulty with walking as well as bone and joint pain. The adoption papers for the child state that he was the product of a normal birth with no medical is... | It is a fat soluble vitamin | {
"A": "It is a fat soluble vitamin",
"B": "It is a water soluble vitamin",
"C": "It is produced by chief cells of the parathyroid gland",
"D": "It is produced by oxyphil cells of the parathyroid gland"
} | step1 | A | [
"year old boy",
"brought",
"initial evaluation",
"pediatrician",
"adopted",
"international orphanage",
"presentation",
"found to",
"difficulty",
"walking",
"bone",
"joint pain",
"adoption papers for",
"child state",
"product",
"normal birth",
"medical issues noted",
"time",
"then... |
A 4-year-old boy presents to the emergency department after his parents found him drinking blue liquid out of an unlabeled bottle in the garage. They have no idea what was in the bottle and are concerned for his health. They have brought the bottle with them to the emergency department. The child's past medical history... | Gastrografin swallow and endoscopy | {
"A": "Administration of a diluent",
"B": "Administration of a weak acid",
"C": "Charcoal",
"D": "Gastrografin swallow and endoscopy"
} | step2&3 | D | [
"4 year old boy presents",
"emergency department",
"parents found",
"drinking blue liquid out",
"bottle",
"garage",
"idea",
"bottle",
"concerned",
"health",
"brought",
"bottle",
"emergency department",
"child's past medical history",
"not",
"currently not taking",
"medications",
"p... |
A newborn is brought to the pediatric clinic by his mother because she has noticed a swelling in the belly while dressing her baby. On physical examination, the newborn is found to have a non-tender upper abdominal mass. The clinician also noticed absent irises and undescended testes in this baby. A magnetic resonance ... | Deletion 11-p-13 | {
"A": "WT-1 missense mutation",
"B": "Deletion 11-p-13",
"C": "Deletion 11-p-15",
"D": "Duplication of 11-p-15"
} | step2&3 | B | [
"newborn",
"brought",
"pediatric clinic",
"mother",
"swelling",
"belly",
"dressing",
"baby",
"physical examination",
"newborn",
"found to",
"non-tender upper abdominal mass",
"clinician",
"absent irises",
"undescended testes",
"baby",
"magnetic resonance image",
"scan",
"abdomen ... |
A 3-year-old is brought in to the pediatrician's office for a routine checkup. Her parents report that they noticed some regression in their daughter’s behavior. She seemed to be progressing well during the first 18 months of her life. She had started saying words such as ‘I’, ‘you’ and ‘mama’ and she was linking words... | X-linked dominant | {
"A": "X-linked dominant",
"B": "X-linked recessive",
"C": "Autosomal dominant",
"D": "Chromosomal trisomy"
} | step2&3 | A | [
"3 year old",
"brought",
"pediatrician's office",
"routine checkup",
"parents report",
"regression",
"daughters behavior",
"to",
"progressing well",
"first",
"months",
"life",
"started",
"words",
"I",
"mama",
"linking words together",
"learned to follow simple instructions",
"pas... |
A 6-year-old boy presents with bleeding gums. His past medical history reveals a recent supracondylar fracture of the right humerus as the result of a fall while playing. On physical examination, petechiae are seen all over the patient’s body. The patient’s tongue is shown in the image. Which of the following is the mo... | Vitamin C deficiency | {
"A": "Child abuse",
"B": "Menkes disease",
"C": "Vitamin C deficiency",
"D": "Ehlers-Danlos syndrome"
} | step1 | C | [
"year old boy presents",
"bleeding gums",
"past medical history reveals",
"recent supracondylar fracture of",
"right humerus",
"result",
"fall",
"playing",
"physical examination",
"petechiae",
"seen",
"patients body",
"patients tongue",
"shown",
"image",
"following",
"most likely cau... |
A 26-year-old man from India visits the clinic with complaints of feeling tired all the time and experiencing lack of energy for the past couple of weeks. He also complains of weakness and numbness of his lower limbs. He has been strictly vegan since the age of 18, including not consuming eggs and milk. He does not tak... | Ataxia | {
"A": "Ataxia",
"B": "Psychiatric symptoms",
"C": "Decreased visual acuity",
"D": "Microcytic anemia"
} | step1 | A | [
"year old man",
"India visits",
"clinic",
"complaints",
"feeling tired",
"time",
"experiencing lack of energy",
"past couple",
"weeks",
"weakness",
"numbness of",
"lower limbs",
"vegan",
"age",
"including not",
"eggs",
"milk",
"not take",
"vitamin",
"dietary supplements",
"Ph... |
A 66-year-old man is brought to the emergency department with complaints of progressively worsening hemoptysis. The patient states that he has had a chronic cough on account of his COPD, but he noticed that he had been coughing more consistently and frequently for the past 3 weeks. Initially, the blood in his sputum wa... | Secure airway and maintain adequate oxygen saturation | {
"A": "Consult a radiologist to perform a bronchial artery embolization",
"B": "Consult a pulmonologist to perform a fiberoptic bronchoscopy",
"C": "Secure airway and maintain adequate oxygen saturation",
"D": "Obtain a chest CT to determine site of bleeding"
} | step2&3 | C | [
"66 year old man",
"brought",
"emergency department",
"complaints",
"worsening hemoptysis",
"patient states",
"chronic cough",
"account",
"COPD",
"coughing more",
"frequently",
"past",
"weeks",
"Initially",
"blood",
"sputum",
"minimal",
"now",
"seeing",
"amount",
"blood",
"... |
A 24-year-old man is brought to the emergency department after he is found sluggish, drowsy, feverish, and complaining about a headache. His past medical history is unremarkable. His vital signs include: blood pressure 120/60 mm Hg, heart rate 70/min, respiratory rate 17/min, and body temperature 39.0°C (102.2°F). On p... | Opening pressure: 15 cm H2O, color: clear, protein: 50 mg/dL, cell count: 40 cells/µL, mostly lymphocytes, ratio CSF:blood glucose: 0.65 | {
"A": "Opening pressure: 28 cm H2O, color: cloudy, protein: 68 mg/dL, cell count: 150 cells/µL, mostly PMNs, ratio CSF:blood glucose: 0.3",
"B": "Opening pressure: 40 cm H2O, color: cloudy, protein: 80 mg/dL, cell count: 135 cells/µL, mostly lymphocytes with some PMNs, ratio CSF:blood glucose: 0.2",
"C": "Openin... | step1 | C | [
"year old man",
"brought",
"emergency department",
"found sluggish",
"drowsy",
"feverish",
"headache",
"past medical history",
"unremarkable",
"vital signs include",
"blood pressure",
"60 mm Hg",
"heart rate 70 min",
"respiratory rate",
"min",
"body temperature",
"physical examinatio... |
A 40-year-old male presents to the clinic. The patient has begun taking large doses of vitamin E in order to slow down the aging process and increase his sexual output. He has placed himself on this regimen following reading a website that encouraged this, without consulting a healthcare professional. He is interested ... | Hemorrhage | {
"A": "Night blindness",
"B": "Deep venous thrombosis",
"C": "Peripheral neuropathy",
"D": "Hemorrhage"
} | step1 | D | [
"40 year old male presents",
"clinic",
"patient",
"begun taking large doses",
"vitamin E",
"order",
"slow down",
"aging process",
"increase",
"sexual output",
"placed",
"regimen following reading",
"website",
"consulting",
"healthcare professional",
"interested",
"to continue",
"su... |
A 60-year-old man with a history of hypertension, diabetes, and hyperlipidemia was successfully managed for acute myocardial infarction involving the left anterior descending artery. Eight months after his discharge home, an echocardiogram reveals the presence of a ventricular aneurysm. The patient subsequently dies af... | Stroke occurring as result of a mural thrombus | {
"A": "Stroke occurring as result of a mural thrombus",
"B": "Stroke occurring because of a paradoxical embolus",
"C": "Stroke occurring because of a deep venous thrombosis",
"D": "Rupture of an aneurysm leading to hemorrhagic stroke"
} | step1 | A | [
"60 year old man",
"history of hypertension",
"diabetes",
"hyperlipidemia",
"managed",
"acute myocardial infarction involving",
"left anterior descending artery",
"Eight months",
"discharge home",
"echocardiogram reveals",
"presence",
"ventricular aneurysm",
"patient",
"dies",
"stroke",
... |
A 55-year-old man presents to his physician with weakness and fatigue for 1 week. There is no significant past medical history. He mentions that he is very health conscious and has heard about the health benefits of juices. He is following a juice-only diet for the last 2 weeks. His physical examination is completely n... | Decreased resting membrane potential of skeletal muscle cells | {
"A": "Decreased resting membrane potential of skeletal muscle cells",
"B": "Dysfunction of dystrophin-glycoprotein complex",
"C": "Hyperpolarization of skeletal muscle cells",
"D": "Prolonged release of Ca2+ ions after stimulation of Ryanodine receptors"
} | step1 | A | [
"55 year old man presents",
"physician",
"weakness",
"fatigue",
"1 week",
"significant past medical history",
"very health conscious",
"heard",
"health benefits",
"juices",
"following",
"juice only diet",
"2 weeks",
"physical examination",
"completely normal",
"depressed deep",
"only... |
A 4-year-old boy is brought to the physician for a well-child examination. He started walking at 20 months of age. He can use a cup to drink but cannot use silverware. He speaks in 2-word sentences and can build a tower of 4 blocks. He can scribble but cannot draw a circle. He is above the 99th percentile for height an... | Cystathionine synthase deficiency | {
"A": "Hypoxanthine-guanine-phosphoribosyl transferase deficiency",
"B": "Fibrillin 1 deficiency",
"C": "Cystathionine synthase deficiency",
"D": "Galactokinase deficiency"
} | step2&3 | C | [
"4 year old boy",
"brought",
"physician",
"well",
"started walking",
"20 months",
"age",
"use",
"cup to drink",
"use",
"speaks",
"word sentences",
"build",
"tower",
"blocks",
"scribble",
"draw",
"circle",
"99th percentile",
"height",
"percentile",
"weight",
"Vital signs",... |
A 78-year-old man suffers a fall in a nursing home and is brought to the emergency room. A right hip fracture is diagnosed, and he is treated with a closed reduction with internal fixation under spinal anesthesia. On the second postoperative day, the patient complains of pain in the lower abdomen and states that he has... | Parasympathetic agonist | {
"A": "Parasympathetic agonist",
"B": "Sympathetic agonist",
"C": "Alpha-blocker",
"D": "Beta-blocker"
} | step1 | A | [
"year old man suffers",
"fall in",
"nursing home",
"brought",
"emergency room",
"right",
"diagnosed",
"treated with",
"closed reduction",
"internal fixation",
"spinal anesthesia",
"second postoperative day",
"patient",
"pain",
"lower abdomen",
"states",
"not",
"surgery",
"ultraso... |
A 33-year-old woman with a history of multiple sclerosis is brought to the physician because of dizziness, urinary incontinence, loss of vision in her right eye, and numbness and weakness of the left leg. She has had recurrent episodes of neurological symptoms despite several changes in her medication regimen. An MRI o... | Alemtuzumab | {
"A": "Eculizumab",
"B": "Bevacizumab",
"C": "Alemtuzumab",
"D": "Rituximab"
} | step1 | C | [
"year old woman",
"history",
"multiple sclerosis",
"brought",
"physician",
"dizziness",
"urinary incontinence",
"loss of vision",
"right eye",
"numbness",
"weakness of",
"left leg",
"recurrent episodes of neurological symptoms",
"several changes",
"medication regimen",
"MRI of",
"bra... |
An 85-year-old man with terminal stage colon cancer formally designates his best friend as his medical durable power of attorney. After several courses of chemotherapy and surgical intervention, the patient’s condition does not improve, and he soon develops respiratory failure. He is then placed on a ventilator in a co... | Act according to the patient’s living will | {
"A": "The durable medical power of attorney’s decision should be followed.",
"B": "Follow the daughter’s decision for the patient",
"C": "Contact other family members to get their input for the patient",
"D": "Act according to the patient’s living will"
} | step1 | D | [
"85 year old man",
"terminal cancer",
"best friend",
"medical durable power of attorney",
"several courses",
"chemotherapy",
"surgical intervention",
"patients condition",
"not",
"respiratory failure",
"then placed",
"ventilator",
"comatose condition",
"friend",
"medical power of attorne... |
A 8-month-old boy is brought to the physician for the evaluation of shortening of his arms and legs. The parents report that they have also noticed that their son's head is progressively enlarging. The patient was born at term via vaginal delivery. There is no personal or family history of serious illness. His immuniza... | CT scan of the head | {
"A": "Growth hormone therapy",
"B": "Levothyroxine therapy",
"C": "CT scan of the head",
"D": "Bisphosphonate therapy\n\""
} | step2&3 | C | [
"month old boy",
"brought",
"physician",
"the evaluation of shortening",
"arms",
"legs",
"parents report",
"son's head",
"enlarging",
"patient",
"born",
"term",
"vaginal delivery",
"personal",
"family history",
"serious illness",
"immunizations",
"date",
"3rd percentile",
"heig... |
A 21-year-old primigravida presents to her physician for a prenatal visit. She has a positive pregnancy test 1 week ago. The estimated gestational age is 16 weeks. She has no complaints. She has a history of type 1 diabetes mellitus and takes insulin for glucose control. The urine dipstick test shows 3+ glucose and neg... | Triple test | {
"A": "Oral glucose tolerance test",
"B": "Triple test",
"C": "Serum creatinine",
"D": "Chorionic villus sampling"
} | step2&3 | B | [
"21-year-old primigravida presents",
"physician",
"prenatal visit",
"positive pregnancy test",
"week",
"estimated gestational age",
"weeks",
"complaints",
"history of type 1 diabetes mellitus",
"takes insulin",
"glucose",
"urine dipstick test shows 3",
"glucose",
"negative",
"protein",
... |
A 16-year-old boy comes to the physician for a routine health maintenance examination. He feels well. He has no history of serious illness. He is at the 60th percentile for height and weight. Vital signs are within normal limits. The lungs are clear to auscultation. A grade 3/6 ejection systolic murmur is heard along t... | Sudden cardiac death | {
"A": "Angiodysplasia",
"B": "Infective endocarditis",
"C": "Sudden cardiac death",
"D": "Pulmonary apoplexy"
} | step2&3 | C | [
"year old boy",
"physician",
"routine health maintenance examination",
"feels well",
"history",
"serious illness",
"percentile",
"height",
"weight",
"Vital signs",
"normal limits",
"lungs",
"clear",
"auscultation",
"grade",
"ejection systolic murmur",
"heard",
"lower left sternal b... |
A 27-year-old man comes to the physician with throbbing right scrotal pain for 1 day. He has also had a burning sensation on urination during the last 4 days. He is sexually active with multiple female partners and does not use condoms. Physical examination shows a tender, palpable swelling on the upper pole of the rig... | Chlamydia trachomatis | {
"A": "Pseudomonas aeruginosa",
"B": "Mycobacterium tuberculosis",
"C": "Chlamydia trachomatis",
"D": "Staphylococcus aureus"
} | step1 | C | [
"27 year old man",
"physician",
"throbbing right scrotal",
"1 day",
"burning sensation",
"urination",
"last",
"days",
"sexually active",
"multiple female partners",
"not use condoms",
"Physical examination shows",
"tender",
"palpable swelling",
"upper pole of",
"right testicle",
"lif... |
A 76-year-old male presents to his primary care physician because he is concerned about changes in urination. Over the last few months, he has noticed increased urinary frequency as well as difficulty with initiating and stopping urination. He denies having pain with urination. Physical exam reveals a uniformly enlarge... | Male pattern baldness | {
"A": "Erectile dysfunction",
"B": "Male pattern baldness",
"C": "Polycystic ovarian syndrome (PCOS)",
"D": "Prostate adenocarcinoma"
} | step1 | B | [
"76 year old male presents",
"primary care physician",
"concerned",
"changes",
"urination",
"last",
"months",
"increased urinary frequency",
"difficulty",
"initiating",
"stopping urination",
"denies",
"pain",
"urination",
"Physical exam reveals",
"enlarged",
"non-tender prostate",
... |
A 19-year-old woman presents with an irregular menstrual cycle. She says that her menstrual cycles have been light with irregular breakthrough bleeding for the past three months. She also complains of hair loss and increased the growth of facial and body hair. She had menarche at 11. Vital signs are within normal limit... | Ovarian theca cells | {
"A": "Ovarian follicular cells",
"B": "Pituitary gonadotropic cells",
"C": "Ovarian theca cells",
"D": "Pituitary lactotrophs"
} | step1 | C | [
"year old woman presents",
"irregular menstrual cycle",
"menstrual cycles",
"light",
"irregular breakthrough bleeding",
"past three months",
"of hair loss",
"increased",
"growth",
"facial",
"body hair",
"menarche",
"Vital signs",
"normal limits",
"weight",
"97 0 kg",
"height",
"5 f... |
A 23-year-old man presents to the emergency department with a severe headache. The patient states he gets sudden, severe pain over his face whenever anything touches it, including shaving or putting lotion on his skin. He describes the pain as electric and states it is only exacerbated by touch. He is currently pain fr... | Trigeminal neuralgia | {
"A": "Cluster headache",
"B": "Migraine headache",
"C": "Tension headache",
"D": "Trigeminal neuralgia"
} | step2&3 | D | [
"23 year old man presents",
"emergency department",
"severe headache",
"patient states",
"gets sudden",
"severe",
"face",
"touches",
"including shaving",
"putting lotion",
"skin",
"pain",
"electric",
"states",
"only exacerbated",
"touch",
"currently pain free",
"temperature",
"98... |
A 6-year-old girl is brought to the emergency department because of right elbow swelling and pain 30 minutes after falling onto her outstretched right arm. She has been unable to move her right elbow since the fall. Physical examination shows bruising, swelling, and tenderness of the right elbow; range of motion is lim... | Absent distal radial pulse | {
"A": "Absent distal radial pulse",
"B": "Radial deviation of the wrist",
"C": "Inability to abduct shoulder",
"D": "Inability to flex the elbow"
} | step1 | A | [
"year old girl",
"brought",
"emergency department",
"right",
"pain 30 minutes",
"falling",
"right arm",
"unable to move",
"right elbow",
"fall",
"Physical examination shows bruising",
"swelling",
"tenderness",
"right",
"range of motion",
"limited",
"pain",
"x-ray",
"right arm sho... |
A 57-year-old man presents to the emergency department for feeling weak for the past week. He states that he has felt much more tired than usual and has had a subjective fever during this time. The patient has a past medical history of IV drug use, hepatitis C, atrial fibrillation, cirrhosis, alcohol dependence, obesit... | Bacterial destruction | {
"A": "Bacterial destruction",
"B": "Decreased metabolism of an anticoagulant",
"C": "Decreased renal excretion of an anticoagulant",
"D": "Worsening infection"
} | step2&3 | A | [
"57 year old man presents",
"emergency department",
"feeling weak",
"past week",
"states",
"felt much more tired",
"usual",
"subjective fever",
"time",
"patient",
"past medical IV drug use",
"hepatitis C",
"atrial fibrillation",
"cirrhosis",
"alcohol dependence",
"obesity",
"depressi... |
A 71-year-old woman comes to the physician with a 2-month history of fatigue, anorexia, abdominal swelling, shortness of breath, and a 5-kg (11-lb) weight loss. She appears chronically ill. Examination shows jaundice, bilateral temporalis muscle wasting, hepatosplenomegaly, and tense ascites. Ultrasonography of the abd... | Metastatic spread of malignant cells from the colon | {
"A": "Metastatic spread of malignant cells from the colon",
"B": "Proliferation of hepatic capillaries",
"C": "Hyperplasia of atypical bile duct tissue",
"D": "Lymphoproliferative disorder of hepatic sinusoids"
} | step1 | A | [
"71 year old woman",
"physician",
"2 month history",
"fatigue",
"anorexia",
"abdominal swelling",
"shortness of breath",
"5 kg",
"weight loss",
"appears chronically ill",
"Examination shows jaundice",
"bilateral temporalis",
"hepatosplenomegaly",
"tense ascites",
"Ultrasonography of",
... |
A 68-year-old man comes to the physician in July for a routine health maintenance examination. He is a retired teacher and lives in a retirement community. He has hypercholesterolemia, hypertension, and osteoarthritis of the left knee. Last year, he was diagnosed with chronic lymphocytic leukemia. A colonoscopy 8 years... | Pneumococcal conjugate vaccine 13 | {
"A": "Pneumococcal conjugate vaccine 13",
"B": "Meningococcal conjugate vaccine",
"C": "Varicella vaccine",
"D": "Influenza vaccine"
} | step2&3 | A | [
"68 year old man",
"physician",
"July",
"routine health maintenance examination",
"retired teacher",
"lives in a retirement community",
"hypercholesterolemia",
"hypertension",
"osteoarthritis of",
"left knee",
"year",
"diagnosed",
"chronic lymphocytic leukemia",
"colonoscopy",
"years",
... |
A 38-year-old man is brought to the emergency department after suffering a motor vehicle accident as the passenger. He had no obvious injuries, but he complains of excruciating right hip pain. His right leg is externally rotated, abducted, and extended at the hip and the femoral head can be palpated anterior to the pel... | Paresis and numbness of the medial thigh and medial side of the calf, weak hip flexion and knee extension | {
"A": "Paresis and numbness of the medial thigh and medial side of the calf, weak hip flexion and knee extension",
"B": "Numbness of the medial side of the thigh and inability to adduct the thigh",
"C": "Numbness of the ipsilateral scrotum and upper medial thigh",
"D": "Sensory loss to the dorsal surface of th... | step1 | A | [
"year old man",
"brought",
"emergency department",
"suffering",
"motor vehicle accident",
"passenger",
"injuries",
"excruciating right hip pain",
"right leg",
"externally rotated",
"extended",
"hip",
"femoral head",
"palpated anterior",
"pelvis",
"Plain radiographs of",
"reveal",
"... |
A 49-year-old man comes to the physician because of increasing difficulty achieving an erection for 6 months. During this period, he has had to reduce his hours as a construction worker because of pain in his lower back and thighs and a progressive lower limb weakness when walking for longer distances. His pain resolve... | Decreased bilateral femoral pulses | {
"A": "Decreased bilateral femoral pulses",
"B": "Internuclear ophthalmoplegia",
"C": "Papular rash over the palms and soles",
"D": "Jugular venous distention"
} | step2&3 | A | [
"year old man",
"physician",
"increasing difficulty",
"erection",
"months",
"period",
"to",
"hours",
"construction worker",
"of pain",
"lower back",
"thighs",
"progressive lower limb weakness",
"walking",
"longer distances",
"pain resolves",
"resting",
"minutes",
"recurs",
"ret... |
A 38-year-old woman presents to the primary care physician with a complaint of painless hematuria over the last 5 days. History reveals that she has a 20 pack-year smoking history, and her last menses was 10 days ago. Her blood pressure is 130/80 mm Hg, heart rate is 86/min, respiratory rate is 19/min, and temperature ... | Cystoscopy | {
"A": "Digital rectal examination",
"B": "Check urine for NMP22 and BTA",
"C": "Cystoscopy",
"D": "Reassurance"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"complaint",
"painless hematuria",
"last",
"days",
"History reveals",
"20 smoking history",
"last menses",
"10 days",
"blood pressure",
"80 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"36",
"98",
"P... |
In an experiment, a certain gene product is known to stimulate the production of a particular hormone synthesized in the liver. This hormone, when present in increased amounts, downregulates the expression of a divalent cation transmembrane transporter located on the basolateral membranes of enterocytes. Mutations in t... | Preload: decreased, cardiac contractility: unchanged, afterload: increased | {
"A": "Preload: increased, cardiac contractility: decreased, afterload: increased",
"B": "Preload: decreased, cardiac contractility: decreased, afterload: decreased",
"C": "Preload: increased, cardiac contractility: increased, afterload: increased",
"D": "Preload: decreased, cardiac contractility: unchanged, a... | step1 | D | [
"experiment",
"certain gene product",
"known to",
"production",
"hormone synthesized",
"liver",
"hormone",
"present",
"increased amounts",
"expression",
"divalent cation transmembrane transporter",
"basolateral membranes",
"enterocytes",
"Mutations",
"gene product",
"linked",
"certai... |
A 48-year-old homeless man presents to a free clinic complaining of several weeks of bleeding gums. He states that he has not seen dental or medical care for several years and that the bleeding has been painless. He normally sleeps on the street or occasionally stays at a shelter and typically eats 1-2 fast food meals ... | Hydroxylation | {
"A": "Cross-linking",
"B": "Glycosylation",
"C": "Hydroxylation",
"D": "Translation"
} | step1 | C | [
"48 year old homeless man presents",
"free clinic",
"weeks",
"bleeding gums",
"states",
"not seen dental",
"medical care",
"years",
"bleeding",
"painless",
"sleeps",
"street",
"occasionally",
"shelter",
"eats 1 fast food meals",
"day",
"exam",
"temperature",
"98 4F",
"36",
"b... |
A 4-year-old boy presents to his pediatrician for severe developmental delay. On exam he is noted to have macroorchidism, hypertelorism, large protruding ears, a large jaw, and a long thin face. Suspicious of what the diagnosis may be, the pediatrician orders a PCR and DNA sequencing. The results reveal an expansion of... | Fragile X syndrome | {
"A": "Huntington's disease",
"B": "Fragile X syndrome",
"C": "Myotonic dystrophy type 1",
"D": "Spinal and bulbar muscular atrophy"
} | step2&3 | B | [
"4 year old boy presents",
"pediatrician",
"severe developmental delay",
"exam",
"noted to",
"macroorchidism",
"hypertelorism",
"large protruding ears",
"large jaw",
"long thin",
"Suspicious",
"diagnosis",
"pediatrician orders",
"PCR",
"DNA sequencing",
"results reveal",
"repeats",
... |
A 13-year-old African-American boy is brought to the physician because of a 4-week history of left groin and buttock pain. The pain is worse with activity but also present at rest. He has had many episodes of abdominal, back, and chest pain that required hospitalization in the past. He is at the 20th percentile for hei... | Avascular necrosis | {
"A": "Septic arthritis",
"B": "Proximal femoral osteosarcoma",
"C": "Avascular necrosis",
"D": "Transient synovitis"
} | step1 | C | [
"year old African-American boy",
"brought",
"physician",
"4 week history",
"left groin",
"buttock pain",
"pain",
"worse",
"activity",
"present",
"rest",
"episodes of abdominal",
"back",
"chest pain",
"required hospitalization",
"past",
"percentile",
"height",
"percentile",
"wei... |
A 54-year-old woman comes to the physician because of a 6-month history of dull, persistent pain and swelling of her right leg. The pain is worse at the end of the day and is relieved by walking or elevating her feet. Two years ago, she developed acute deep vein thrombosis in her right calf after a long flight, which w... | Duplex ultrasonography | {
"A": "Computerized tomography scan with contrast",
"B": "Nerve conduction studies",
"C": "D-dimer assay",
"D": "Duplex ultrasonography"
} | step1 | D | [
"54 year old woman",
"physician",
"month history",
"dull",
"persistent pain",
"swelling of",
"right leg",
"pain",
"worse",
"end",
"day",
"relieved by walking",
"elevating",
"feet",
"Two years",
"acute deep vein thrombosis",
"right calf",
"long flight",
"treated with anticoagulant... |
A 36-year-old woman comes to the physician because of an 8-month history of occasional tremor. The tremor is accompanied by sudden restlessness and nausea, which disrupts her daily work as a professional violinist. The symptoms worsen shortly before upcoming concerts but also appear when she goes for a walk in the city... | Generalized anxiety disorder | {
"A": "Generalized anxiety disorder",
"B": "Adjustment disorder",
"C": "Panic disorder",
"D": "Atypical depressive disorder"
} | step2&3 | A | [
"36 year old woman",
"physician",
"month history",
"occasional tremor",
"tremor",
"sudden restlessness",
"nausea",
"disrupts",
"daily work",
"professional",
"symptoms worsen",
"appear",
"goes",
"walk in",
"city",
"concerned",
"neurological illness",
"to give",
"career",
"patien... |
A 67-year-old man with a past medical history of sleep apnea presents to the emergency room in severe respiratory distress. On exam, his blood pressure is 135/75 mmHg, heart rate is 110/min, respiratory rate is 34/min, and SpO2 is 73% on room air. He is intubated, admitted to the intensive care unit, and eventually req... | Central sleep apnea | {
"A": "Incorrect ventilator settings",
"B": "Central sleep apnea",
"C": "Obstructive sleep apnea",
"D": "Heart failure"
} | step1 | B | [
"year old man",
"past medical history of sleep apnea presents",
"emergency room",
"severe respiratory distress",
"exam",
"blood pressure",
"75 mmHg",
"heart rate",
"min",
"respiratory rate",
"min",
"room air",
"intubated",
"admitted to",
"intensive care unit",
"tracheostomy tube",
"s... |
A 40-year-old man is brought to the emergency department 20 minutes after his wife found him unconscious on the bathroom floor. On arrival, he is conscious and alert. He remembers having palpitations and feeling lightheaded and short of breath before losing consciousness. He takes captopril for hypertension and glyburi... | Accessory atrioventricular pathway | {
"A": "A dysfunctional AV node",
"B": "Ectopic foci within the ventricles",
"C": "Low serum glucose levels",
"D": "Accessory atrioventricular pathway"
} | step2&3 | D | [
"40 year old man",
"brought",
"emergency department 20 minutes",
"wife found",
"unconscious",
"bathroom floor",
"arrival",
"conscious",
"alert",
"remembers",
"palpitations",
"feeling lightheaded",
"short of breath",
"consciousness",
"takes captopril",
"hypertension",
"glyburide",
"... |
A 33-year-old woman, gravida 2, para 1, at 24 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. She returned from a trip to South Asia 2 weeks ago. Her immunizations are up-to-date and she has never received blood products. Her temperature is 38.9°C (1... | Anti-HEV IgM | {
"A": "HBsAg",
"B": "Anti-HEV IgM",
"C": "Anti-HCV IgG",
"D": "Anti-HAV IgM"
} | step1 | B | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"brought",
"emergency department",
"husband",
"lethargy",
"nausea",
"vomiting",
"4 days",
"returned",
"trip",
"South Asia",
"weeks",
"immunizations",
"date",
"never received blood products",
"temperature",
"not or... |
A 9-year-old boy, otherwise healthy, presents with persistent bleeding following tooth extraction. The patient’s mother states that yesterday, the patient had a tooth extracted that was complicated intraoperatively by persistent bleeding that continued postoperatively. She also says he has had no bleeding issues in the... | Epistaxis | {
"A": "Epistaxis",
"B": "Hemarthrosis",
"C": "Purpura fulminans",
"D": "Intracranial hemorrhage"
} | step2&3 | A | [
"year old boy",
"healthy",
"presents",
"persistent bleeding following tooth extraction",
"patients mother states",
"patient",
"tooth extracted",
"complicated",
"persistent bleeding",
"continued",
"bleeding issues",
"past",
"past medical history",
"unremarkable",
"patient",
"meeting",
... |
A 63-year-old man comes to the physician with a 4-week history of fatigue, crampy abdominal pain, watery diarrhea, and pain in his mouth and gums. He returned from a 2-week trip to the Dominican Republic 2 months ago. He has smoked one pack of cigarettes daily for 45 years. Examination shows three 1.5-cm, painful ulcer... | Crohn disease | {
"A": "Behcet disease",
"B": "Crohn disease",
"C": "Whipple disease",
"D": "Ulcerative colitis"
} | step1 | B | [
"63 year old man",
"physician",
"4 week history",
"fatigue",
"crampy abdominal pain",
"watery diarrhea",
"pain",
"mouth",
"gums",
"returned",
"2-week trip",
"Dominican Republic",
"months",
"smoked one pack",
"cigarettes daily",
"years",
"Examination shows three",
"painful ulcers",
... |
A 13-year-old girl is admitted to the hospital due to muscle weakness, pain, and arthralgia in her wrist joints. The patient says, "I am having trouble walking home after school, especially climbing steep hills." She also complains of malaise. On physical examination, a heliotrope rash is observed around her eyes, and ... | Anti-Jo-1 | {
"A": "Anti-Sm",
"B": "Anti-Jo-1",
"C": "Anti-Scl-70",
"D": "Anti-histone"
} | step1 | B | [
"year old girl",
"admitted",
"hospital",
"muscle weakness",
"pain",
"arthralgia",
"wrist",
"patient",
"I",
"walking home",
"school",
"climbing",
"hills",
"malaise",
"physical examination",
"heliotrope rash",
"observed",
"eyes",
"multiple hyperkeratotic",
"flat",
"red",
"cen... |
You are a resident in the surgical ICU. One of the patients you are covering is a 35-year-old pregnant G1P0 in her first trimester admitted for complicated appendicitis and awaiting appendectomy. Your attending surgeon would like you to start the patient on moxifloxacin IV preoperatively. You remember from your obstetr... | Wait to administer any antibiotics until you discuss your safety concerns with your attending. | {
"A": "Administer piperacillin/tazobactam instead of moxifloxacin without discussing with the attending since your obligation is to \"first, do no harm\" and both are acceptable antibiotics for complicated appendicitis.",
"B": "Administer moxifloxacin since the attending is the executive decision maker and had to ... | step1 | D | [
"resident",
"surgical ICU",
"One",
"patients",
"covering",
"35 year old pregnant",
"first trimester admitted",
"complicated appendicitis",
"appendectomy",
"attending surgeon",
"to start",
"patient",
"moxifloxacin IV",
"remember",
"obstetrics",
"moxifloxacin",
"Pregnancy Category",
... |
Six hours after delivery, a 3100-g (6-lb 13-oz) male newborn has an episode of bilious projectile vomiting. He was born at term to a 21-year-old woman. The pregnancy was complicated by polyhydramnios. The mother smoked a pack of cigarettes daily during the pregnancy. Physical examination shows a distended upper abdomen... | Jejunal atresia | {
"A": "Duodenal atresia",
"B": "Meconium ileus",
"C": "Jejunal atresia",
"D": "Hirschsprung disease"
} | step1 | C | [
"Six hours",
"delivery",
"3100 g",
"oz",
"male newborn",
"episode of bilious projectile vomiting",
"born",
"term",
"21-year-old woman",
"pregnancy",
"complicated",
"polyhydramnios",
"mother smoked",
"pack",
"cigarettes daily",
"pregnancy",
"Physical shows",
"distended upper",
"x-... |
A 47-year-old woman presents to the physician with complaints of fatigue accompanied by symmetric pain, swelling, and stiffness in her wrists, fingers, knees, and other joints. She describes the stiffness as being particularly severe upon awakening, but gradually improves as she moves throughout her day. Her physician ... | Nephrotoxicity | {
"A": "Hyperglycemia",
"B": "Nephrotoxicity",
"C": "Osteoporosis",
"D": "Pancytopenia"
} | step1 | B | [
"year old woman presents",
"physician",
"complaints",
"fatigue",
"symmetric pain",
"swelling",
"stiffness",
"wrists",
"fingers",
"knees",
"joints",
"stiffness",
"severe",
"awakening",
"improves",
"moves",
"day",
"physician initially suggests",
"take NSAIDs",
"few months",
"mi... |
A P2G1 diabetic woman is at risk of delivering at 29 weeks gestation. Her obstetrician counsels her that there is a risk the baby could have significant pulmonary distress after it is born. However, she states she will give the mother corticosteroids, which will help prevent this from occurring. Additionally, the obste... | lecithin:sphingomyelin < 1.5 | {
"A": "lecithin:sphingomyelin > 1.5",
"B": "lecithin:phosphatidylserine > 3.0",
"C": "lecithin:sphingomyelin < 1.5",
"D": "lecithin:phosphatidylserine < 1.5"
} | step1 | C | [
"diabetic woman",
"at risk",
"delivering",
"29 weeks gestation",
"obstetrician counsels",
"risk",
"baby",
"significant pulmonary distress",
"born",
"states",
"give",
"mother corticosteroids",
"help prevent",
"occurring",
"obstetrician states",
"perform",
"test",
"amniotic fluid",
... |
A 30-year-old man presents with progressive muscle weakness for the past 6 hours. He says he had significant bilateral ankle pain which onset shortly after completing a triathlon earlier in the day. Then, he says he awoke this morning with bilateral upper and lower extremity weakness, which has progressively worsened. ... | ECG | {
"A": "Hemodialysis",
"B": "ECG",
"C": "Kayexalate",
"D": "IV calcium chloride"
} | step2&3 | B | [
"30 year old man presents",
"progressive muscle weakness",
"past",
"hours",
"significant bilateral ankle pain",
"onset",
"completing",
"earlier",
"day",
"Then",
"awoke",
"morning",
"bilateral upper",
"lower extremity weakness",
"worsened",
"significant past medical history",
"takes",... |
A 70-year-old man with a history of Alzheimer dementia presents to the emergency department with a change in his behavior. The patient has been more confused recently and had a fever. Upon presentation, he is too confused to answer questions. His temperature is 103°F (39.4°C), blood pressure is 102/68 mmHg, pulse is 15... | Diphenhydramine | {
"A": "Acute infection",
"B": "Diphenhydramine",
"C": "Haloperidol",
"D": "Olanzapine"
} | step2&3 | B | [
"70 year old man",
"history of",
"dementia presents",
"emergency department",
"change in",
"behavior",
"patient",
"more confused recently",
"fever",
"presentation",
"confused to answer questions",
"temperature",
"4C",
"blood pressure",
"68 mmHg",
"pulse",
"min",
"respirations",
"... |
A 67-year-old woman comes to the physician because of a 3-week history of fatigue and worsening back and abdominal pain. During this period, she has also had excessive night sweats and a 4.6-kg (10-lb) weight loss. She has had swelling of the neck for 3 days. She does not smoke or drink alcohol. Vital signs are within ... | Diffuse large B-cell lymphoma | {
"A": "Marginal zone lymphoma",
"B": "Diffuse large B-cell lymphoma",
"C": "Hairy cell leukemia",
"D": "Follicular lymphoma"
} | step2&3 | B | [
"67 year old woman",
"physician",
"3 week history",
"fatigue",
"worsening back",
"abdominal pain",
"period",
"excessive night sweats",
"4.6 kg",
"10",
"weight loss",
"swelling of the neck",
"3 days",
"not smoke",
"drink alcohol",
"Vital signs",
"normal limits",
"Physical examinatio... |
A 55-year-old woman presents with pain in both hands and wrists for several years. It is associated with morning stiffness that lasts for almost an hour. She has a blood pressure of 124/76 mm Hg, heart rate of 71/min, and respiratory rate of 14/min. Physical examination reveals tenderness and swelling in both hands and... | Type III hypersensitivity | {
"A": "Type III hypersensitivity",
"B": "IgE-mediated immune responses only",
"C": "Self-tolerance",
"D": "Both type II and III hypersensitivities"
} | step1 | A | [
"55 year old woman presents",
"pain",
"hands",
"wrists",
"years",
"associated with morning stiffness",
"lasts",
"almost",
"hour",
"blood pressure",
"76 mm Hg",
"heart rate",
"71 min",
"respiratory rate",
"min",
"Physical examination reveals tenderness",
"swelling",
"hands",
"wris... |
A 41-year-old man is brought to the emergency room after a blunt-force injury to the abdomen. His pulse is 130/min and blood pressure is 70/40 mm Hg. Ultrasound of the abdomen shows a large amount of blood in the hepatorenal recess and the pelvis. Which of the following responses by the kidney is most likely? | Increased sodium reabsorption | {
"A": "Decreased proton excretion",
"B": "Increased sodium reabsorption",
"C": "Increased sodium filtration",
"D": "Increased creatinine absorption"
} | step1 | B | [
"year old man",
"brought",
"emergency room",
"blunt force injury to",
"abdomen",
"pulse",
"min",
"blood pressure",
"70 40 mm Hg",
"Ultrasound of",
"abdomen shows",
"large amount",
"blood",
"hepatorenal recess",
"pelvis",
"following responses",
"kidney",
"most likely"
] |
A 45-year-old woman comes to the emergency department with severe menorrhagia for 3 days. She also reports dizziness. She has hypertension, for which she takes lisinopril. She appears pale. Her temperature is 37.5˚C (99.5˚F), pulse is 110/min, and blood pressure is 100/60 mmHg. Pulse oximetry shows an oxygen saturation... | Transfusion-associated circulatory overload | {
"A": "Type 1 hypersensitivity reaction",
"B": "Acute pulmonary embolism",
"C": "Acute kidney injury",
"D": "Transfusion-associated circulatory overload"
} | step2&3 | D | [
"year old woman",
"emergency department",
"severe menorrhagia",
"3 days",
"reports dizziness",
"hypertension",
"takes lisinopril",
"appears pale",
"temperature",
"99",
"pulse",
"min",
"blood pressure",
"100 60 mmHg",
"Pulse oximetry shows",
"oxygen saturation",
"98",
"room air",
... |
A 4670-g (10-lb 5-oz) male newborn is delivered at term to a 26-year-old woman after prolonged labor. Apgar scores are 9 and 9 at 1 and 5 minutes. Examination in the delivery room shows swelling, tenderness, and crepitus over the left clavicle. There is decreased movement of the left upper extremity. Movement of the ha... | Pin sleeve to the shirt | {
"A": "Physical therapy",
"B": "Pin sleeve to the shirt",
"C": "Splinting of the arm",
"D": "MRI of the clavicle"
} | step2&3 | B | [
"g",
"10",
"5 oz",
"male newborn",
"delivered",
"term",
"year old woman",
"prolonged labor",
"Apgar scores",
"5 minutes",
"Examination",
"delivery shows swelling",
"tenderness",
"crepitus",
"left clavicle",
"decreased movement",
"left upper extremity",
"hands",
"wrists",
"norma... |
A 33-year-old woman who was recently involved in a motor vehicle accident presents to a medical clinic for a follow-up visit. She was in the front passenger seat when the vehicle swerved off the road and struck 2 pedestrians. She was restrained by her seatbelt and did not suffer any significant physical injury. Since t... | Memory loss is usually self-limiting. | {
"A": "The condition is the least common form of dissociative disorder.",
"B": "Patients are unable to recall obscure details in this condition.",
"C": "Patients are more likely to also have bipolar disorder.",
"D": "Memory loss is usually self-limiting."
} | step1 | D | [
"year old woman",
"recently involved",
"motor vehicle accident presents",
"medical clinic",
"follow-up visit",
"front passenger seat",
"vehicle",
"road",
"struck",
"pedestrians",
"restrained",
"seatbelt",
"not suffer",
"significant physical injury",
"then",
"1 outpatient visit",
"rec... |
A 9-year-old boy is brought to the physician because of short stature. He has always had short stature around the 35th percentile on the growth curve. Over the past year, he has dropped further on the curve, despite maintaining the same diet. He has a history of low birth weight. The vital signs include: respiration ra... | Fanconi anemia | {
"A": "Diamond-Blackfan anemia",
"B": "Fanconi anemia",
"C": "Neurofibromatosis type 1",
"D": "Rickets"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"short stature",
"always",
"short stature",
"percentile",
"growth curve",
"past year",
"dropped further",
"curve",
"maintaining",
"same diet",
"history of low birth weight",
"vital signs include",
"respiration rate",
"min",
"pulse 85 min",
... |
A 21-year-old man presents for a pre-employment medical check-up. He has a history of persistent asthma and regularly uses inhaled fluticasone for prophylaxis. For the last week, he has been experiencing increasing symptoms, such as night time cough and wheezing on exertion. Because his albuterol metered-dose inhaler r... | Pulse rate is 116/min | {
"A": "Pulse rate is 116/min",
"B": "Myoclonus",
"C": "Serum potassium is 5.5 mEq/L (5.5 mmol/L)",
"D": "Serum magnesium is 2.4 mEq/L (1.2 mmol/L)"
} | step1 | A | [
"21-year-old man presents",
"pre employment medical check-up",
"history of persistent asthma",
"uses inhaled fluticasone",
"prophylaxis",
"last week",
"experiencing increasing symptoms",
"night time cough",
"wheezing",
"exertion",
"albuterol metered-dose inhaler ran out",
"taking oral albutero... |
A 28-year-old male comes to the physician for worsening back pain. The pain began 10 months ago, is worse in the morning, and improves with activity. He has also had bilateral hip pain and difficulty bending forward during exercise for the past 3 months. He has celiac disease and eats a gluten-free diet. Examination sh... | HLA-B27 positive genotype | {
"A": "Presence of anti-dsDNA antibodies",
"B": "High levels of rheumatoid factor",
"C": "HLA-B27 positive genotype",
"D": "HLA-DR3-positive genotype"
} | step1 | C | [
"year old male",
"physician",
"worsening back pain",
"pain began 10 months",
"worse",
"morning",
"improves",
"activity",
"bilateral hip pain",
"difficulty bending forward",
"exercise",
"past 3 months",
"celiac disease",
"eats",
"gluten-free diet",
"Examination shows",
"limited range"... |
A previously healthy 30-year-old woman comes to the physician because of nervousness and difficulty sleeping over the past 4 weeks. She has difficulty falling asleep at night because she cannot stop worrying about her relationship and her future. Three months ago, her new boyfriend moved in with her. Before this relati... | Obsessive-compulsive personality disorder | {
"A": "Major depressive disorder",
"B": "Generalized anxiety disorder",
"C": "Obsessive-compulsive disorder",
"D": "Obsessive-compulsive personality disorder"
} | step2&3 | D | [
"healthy 30 year old woman",
"physician",
"nervousness",
"difficulty sleeping",
"past 4 weeks",
"difficulty falling asleep",
"night",
"stop worrying",
"relationship",
"future",
"Three months",
"new boyfriend moved",
"relationship",
"single",
"years",
"reports",
"boyfriend",
"not ke... |
A population is studied for risk factors associated with testicular cancer. Alcohol exposure, smoking, dietary factors, social support, and environmental exposure are all assessed. The researchers are interested in the incidence and prevalence of the disease in addition to other outcomes. Which pair of studies would be... | 1. Prospective cohort study 2. Cross sectional study | {
"A": "1. Case-control study 2. Prospective cohort study",
"B": "1. Clinical trial 2. Cross sectional study",
"C": "1. Cross sectional study 2. Retrospective cohort study",
"D": "1. Prospective cohort study 2. Cross sectional study"
} | step2&3 | D | [
"population",
"studied",
"risk factors associated with testicular cancer",
"Alcohol exposure",
"smoking",
"dietary factors",
"social support",
"environmental exposure",
"assessed",
"researchers",
"interested",
"incidence",
"prevalence",
"disease",
"outcomes",
"pair",
"studies",
"be... |
A 57-year-old man with a history of long-standing hypertension is brought to the emergency department because of headache, dyspnea, and blurry vision for 2 hours. He says that he forgot to fill his prescription for his antihypertensive medications last week. His blood pressure is 230/130 mm Hg. Intravenous infusion of ... | Hydroxycobalamin | {
"A": "Dimercaprol",
"B": "Amyl nitrite",
"C": "Hydroxycobalamin",
"D": "Sodium thiosulfate"
} | step1 | C | [
"57 year old man",
"history of long standing hypertension",
"brought",
"emergency department",
"headache",
"dyspnea",
"blurry vision",
"hours",
"forgot to fill",
"prescription for",
"antihypertensive medications last week",
"blood pressure",
"mm Hg",
"Intravenous infusion",
"sodium nitro... |
A 26-year-old male is brought into the emergency room because he collapsed after working out. The patient is a jockey, and he states that he feels dehydrated and has an upcoming meet for which he needs to lose some weight. On exam, the patient has dry mucosa with cracked lips. His temperature is 98.9 deg F (37.2 deg C)... | Furosemide | {
"A": "Furosemide",
"B": "Metoprolol",
"C": "Polyethylene glycol",
"D": "Amiloride"
} | step2&3 | A | [
"year old male",
"brought",
"emergency room",
"collapsed",
"working out",
"patient",
"jockey",
"states",
"feels dehydrated",
"meet",
"needs to",
"weight",
"exam",
"patient",
"dry mucosa",
"cracked lips",
"temperature",
"98",
"deg F",
"blood pressure",
"70 mmHg",
"pulse",
... |
A 61-year-old man decides to undergo surgery for a hip replacement after seeing no improvement in his pain with non-operative treatment. At some point during the surgery, he is administered an agent that results in fasciculations in the patient's extremities. This was the expected response to the administered agent so ... | No reversal, neostigmine | {
"A": "Neostigmine, no reversal",
"B": "Neostigmine, neostigmine",
"C": "No reversal, atracurium",
"D": "No reversal, neostigmine"
} | step1 | D | [
"61 year old man",
"to",
"surgery",
"hip",
"seeing",
"improvement",
"pain",
"non operative treatment",
"point",
"surgery",
"administered",
"agent",
"results",
"fasciculations",
"patient's extremities",
"expected response",
"administered agent",
"intervention",
"needed",
"fascic... |
A 60-year-old man is brought to the emergency department by his wife with a sudden onset of right-sided weakness 2 hours ago. He can speak clearly without difficulty and denies any similar symptoms in the past. Past medical history is significant for hypertension and diabetes, both poorly managed due to medication non-... | Hyaline arteriosclerosis | {
"A": "Carotid artery atherosclerosis",
"B": "Charcot-Bouchard aneurysm",
"C": "Hyaline arteriosclerosis",
"D": "Hypertensive encephalopathy"
} | step1 | C | [
"60 year old man",
"brought",
"emergency department",
"wife",
"sudden onset",
"right-sided weakness",
"hours",
"speak",
"difficulty",
"denies",
"similar symptoms",
"past",
"Past medical history",
"significant",
"hypertension",
"diabetes",
"poorly managed due to medication non-complia... |
An inpatient psychiatrist recently had two patients who developed serious gastrointestinal infections while taking clozapine. He was concerned that his patients had developed agranulocytosis, a relatively rare but dangerous adverse event associated with clozapine. When the psychiatrist checked the absolute neutrophil c... | Increased false positives | {
"A": "Increased positive predictive value",
"B": "Decreased true positives",
"C": "Increased false positives",
"D": "Decreased sensitivity\n\""
} | step2&3 | C | [
"inpatient psychiatrist recently",
"two patients",
"serious gastrointestinal infections",
"taking clozapine",
"concerned",
"patients",
"agranulocytosis",
"rare",
"dangerous adverse event associated with clozapine",
"psychiatrist checked",
"absolute neutrophil count",
"patients",
"one",
"45... |
A 63-year-old man with inoperable esophageal carcinoma undergoes palliative chemoradiotherapy. Four hours after his first infusion of carboplatin and paclitaxel, he develops nausea and 3 episodes of vomiting and dry heaving. This adverse reaction is caused by stimulation of a brain region on the floor of the fourth ven... | Claudins and occludins | {
"A": "Integrins",
"B": "Claudins and occludins",
"C": "Cadherins and catenins",
"D": "Desmogleins and desmocollins"
} | step1 | B | [
"63 year old man",
"inoperable esophageal carcinoma",
"palliative chemoradiotherapy",
"Four hours",
"first infusion",
"carboplatin",
"paclitaxel",
"nausea",
"3 episodes of vomiting",
"dry heaving",
"adverse reaction",
"caused",
"stimulation",
"brain region",
"the floor of",
"fourth ven... |
A 25-year-old woman comes to the physician because of a 4-month history of anxiety and weight loss. She also reports an inability to tolerate heat and intermittent heart racing for 2 months. She appears anxious. Her pulse is 108/min and blood pressure is 145/87 mm Hg. Examination shows a fine tremor of her outstretched... | Decreased production of proinflammatory cytokines | {
"A": "Inhibition of iodide oxidation",
"B": "Elimination of excess fluid",
"C": "Replacement of thyroid hormones",
"D": "Decreased production of proinflammatory cytokines"
} | step1 | D | [
"year old woman",
"physician",
"4 month history",
"anxiety",
"weight loss",
"reports",
"to",
"heat",
"intermittent heart racing",
"months",
"appears anxious",
"pulse",
"min",
"blood pressure",
"87 mm Hg",
"Examination shows",
"fine tremor of",
"hands",
"confirmation of",
"diagn... |
A 60-year-old obese man comes to the emergency department with tightness in his chest and lower extremity edema. He has a history of heart failure that has gotten worse over the last several years. He takes finasteride, lisinopril, and albuterol. He does not use oxygen at home. He has mildly elevated blood pressure, an... | Cardiac output went down, and right atrial pressure went up | {
"A": "Cardiac output went up, and right atrial pressure went down",
"B": "Cardiac output went down, and right atrial pressure went up",
"C": "Cardiac output went down, and right atrial pressure went down",
"D": "Both cardiac output and right atrial pressures are unchanged"
} | step1 | B | [
"60 year old obese man",
"emergency department",
"tightness in",
"chest",
"lower extremity edema",
"history of heart failure",
"gotten worse",
"years",
"takes finasteride",
"lisinopril",
"albuterol",
"not use oxygen at home",
"mildly elevated blood pressure",
"tachycardic",
"tachypneic",... |
A 3-year-old girl is brought to the emergency department because of an inability to walk for a few days. The patient’s mother says that the child was lying on the bed and must have fallen onto the carpeted floor. She lives at home with her mother and her 3-month-old brother. When the patient is directly asked what happ... | Obtain a complete skeletal survey to detect other bony injuries and report child abuse case. | {
"A": "Check copper levels.",
"B": "Collagen biochemical testing",
"C": "Obtain a complete skeletal survey to detect other bony injuries and report child abuse case.",
"D": "Run a serum venereal disease research laboratory (VDRL) test."
} | step1 | C | [
"3 year old girl",
"brought",
"emergency department",
"to walk",
"days",
"patients mother",
"child",
"lying",
"bed",
"fallen",
"carpeted floor",
"lives at home",
"mother",
"month old brother",
"patient",
"directly",
"happened",
"looks",
"floor",
"not answer",
"Past medical hi... |
A 52-year-old male presents with recent weight loss, fever, and joint pain. He reports frequent bouts of diarrhea. An intestinal biopsy demonstrates PAS-positive, non-acid fast macrophage inclusions in the lamina propria. Which of the following organisms is likely responsible for this patient’s illness: | Tropheryma whippelii | {
"A": "Ascaris lumbricoides",
"B": "Mycobacterium avium-intracellulare complex",
"C": "Campylobacter jejuni",
"D": "Tropheryma whippelii"
} | step1 | D | [
"year old male presents",
"recent weight loss",
"fever",
"joint pain",
"reports frequent bouts of diarrhea",
"intestinal biopsy demonstrates PAS positive",
"non acid fast macrophage inclusions",
"lamina propria",
"following organisms",
"likely responsible",
"patients illness"
] |
A 5-year-old boy is brought to the physician by his parents for evaluation of easy bruising. He has met all developmental milestones. Vital signs are within normal limits. He is at the 50th percentile for height and weight. Physical examination shows velvety, fragile skin that can be stretched further than normal and m... | Lysine-hydroxylysine cross-linking | {
"A": "α-collagen triple helix formation",
"B": "Fibrillin-1 glycoprotein production",
"C": "Proline and lysine hydroxylation",
"D": "Lysine-hydroxylysine cross-linking"
} | step1 | D | [
"5 year old boy",
"brought",
"physician",
"parents",
"evaluation",
"easy bruising",
"met",
"developmental milestones",
"Vital signs",
"normal limits",
"50th percentile",
"height",
"weight",
"Physical examination shows",
"fragile skin",
"stretched further",
"normal",
"multiple ecchy... |
A 3-year-old boy is seen in clinic. He was born at home without perinatal care. He was apparently normal at birth, but later developed failure to thrive and developmental delay. He also has a history of cataracts. His older brother had a myocardial infarction at the age of 18 and is rather lanky and tall in appearance.... | Cystathionine synthase deficiency | {
"A": "Cystathionine synthase deficiency",
"B": "Decreased in phenylalanine hydroxylase",
"C": "Deficiency of homogentisic acid oxidase",
"D": "Inability to degrade branched chain amino acids"
} | step1 | A | [
"3 year old boy",
"seen in clinic",
"born at home",
"perinatal care",
"apparently normal at birth",
"later",
"failure to thrive",
"developmental delay",
"history of cataracts",
"older brother",
"myocardial infarction",
"age",
"rather",
"tall",
"appearance",
"Laboratory testing of",
"... |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.