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 33-year-old man presents to the emergency department with dizziness. He states he has experienced a sustained sense of disequilibrium for the past 2 days. He feels that the floor is unstable/moving. The patient is otherwise healthy and does not have any other medical diagnoses. The patient is currently taking vitamin... | Vestibular neuritis | {
"A": "Benign paroxysmal positional vertigo",
"B": "Meniere disease",
"C": "Vertebrobasilar stroke",
"D": "Vestibular neuritis"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"dizziness",
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"sustained sense",
"disequilibrium",
"past 2 days",
"feels",
"floor",
"unstable moving",
"patient",
"healthy",
"not",
"medical diagnoses",
"patient",
"currently taking vitamin C",
"multiple famil... |
After 1 week of intubation and sedation in the ICU for severe pneumonia, a 62-year-old man develops severe pain in his penis. He has a history of chronic obstructive pulmonary disease. He is an ex-smoker. He is currently on broad-spectrum IV antibiotics. In the ICU, his temperature is 36.7°C (98.1°F), blood pressure is... | Manual reduction | {
"A": "Emergency circumcision",
"B": "Manual reduction",
"C": "Referral to a urologist after discharge",
"D": "Topical betamethasone"
} | step2&3 | B | [
"1 week",
"intubation",
"sedation",
"ICU",
"severe pneumonia",
"62 year old man",
"severe pain in",
"penis",
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"chronic obstructive pulmonary disease",
"ex-smoker",
"currently",
"broad spectrum IV antibiotics",
"ICU",
"temperature",
"36",
"98",
"blood pressure",
"70 mm/H... |
A 35-year-old woman comes to the physician because of fatigue and a 9-kg (20-lb) weight gain over the past 12 months. She also has irregular menstrual cycles and difficulty sleeping. Menses occur at irregular 35- to 50-day intervals and last 3–7 days. Menarche was at age of 13 years and her last menstrual period was 4 ... | Decreased bone mineral density | {
"A": "Increased serum erythropoietin",
"B": "Decreased bone mineral density",
"C": "Discoloration of the corneal margin",
"D": "Enlarged ovaries with multiple follicles\n\""
} | step2&3 | B | [
"35 year old woman",
"physician",
"fatigue",
"kg",
"20",
"weight gain",
"past 12 months",
"irregular menstrual cycles",
"difficulty sleeping",
"Menses occur",
"irregular 35",
"50 day intervals",
"last",
"days",
"Menarche",
"age",
"years",
"last menstrual period",
"4 weeks",
"ha... |
A 50-year-old woman comes to the office complaining of fatigue over the last several months. She feels ‘drained out’ most of the time and she drinks coffee and takes other stimulants to make it through the day. She also complains of severe itching all over her body for about 3 months which worsens at night. Her past me... | Anti mitochondrial antibody (AMA) | {
"A": "ERCP",
"B": "Anti mitochondrial antibody (AMA)",
"C": "Anti smooth muscle antibody",
"D": "MRCP"
} | step2&3 | B | [
"50 year old woman",
"office",
"fatigue",
"last",
"months",
"feels drained out",
"time",
"drinks coffee",
"takes",
"stimulants to make",
"day",
"severe itching all",
"body",
"months",
"worsens",
"night",
"past medical history",
"significant",
"celiac disease",
"uses eye drops",... |
A 32-year-old Caucasian female required a kidney transplant 3 years ago. She presents with elevated creatinine levels (2.6 mg/dl) and an elevated blood pressure (160/90 mmHg). A biopsy is taken of the transplanted kidney. Following histological findings, a diagnosis of chronic graft rejection is made. Which of the foll... | Glomerular crescents | {
"A": "Interstitial fibrosis",
"B": "Tubular atrophy",
"C": "Graft arteriosclerosis",
"D": "Glomerular crescents"
} | step1 | D | [
"year old Caucasian female required",
"kidney transplant",
"years",
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"elevated creatinine levels",
"2.6 mg/dl",
"elevated blood pressure",
"90 mmHg",
"biopsy",
"taken of",
"transplanted kidney",
"Following histological findings",
"diagnosis",
"chronic graft rejection",
"made",... |
A 6-month-old infant girl is brought by her parents to the emergency room due to abnormal jerky movements of the upper and lower limbs for the past month. When questioned about her birth history, the parents mention that a prenatal scan of the fetal heart revealed that the patient had a mass in the left ventricle, whic... | Ash-leaf spots | {
"A": "Ash-leaf spots",
"B": "Cafe-au-lait spots",
"C": "Cavernous hemangioma of the skin",
"D": "Port-wine stain"
} | step1 | A | [
"month old infant girl",
"brought",
"parents to",
"emergency room due",
"abnormal jerky",
"upper",
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"questioned",
"birth history",
"parents",
"prenatal scan",
"fetal revealed",
"patient",
"mass",
"left ventricle",
"led",
"diagnosis",
"neurocutaneous di... |
A medical student is conducting an experiment related to body fluids. Part of his research requires a relatively precise estimation of extracellular body fluid in each volunteer. He knows that extracellular body fluid accounts for approximately 33% of the volume of total body water. Which of the following substances is... | Mannitol | {
"A": "Evans blue",
"B": "Heavy water",
"C": "Mannitol",
"D": "Radio-iodine labeled serum albumin"
} | step1 | C | [
"medical student",
"conducting",
"experiment related",
"body fluids",
"Part of",
"research",
"precise estimation",
"extracellular body fluid",
"volunteer",
"extracellular body fluid accounts",
"approximately",
"volume",
"total body water",
"following substances",
"most likely to",
"hel... |
A 35-year-old woman presents to the ER with shortness of breath, cough, and severe lower limb enlargement. The dyspnea was of sudden onset, started a week ago, and increased with exercise but did not disappear with rest. Her cough was dry, persistent, and non-productive. She has a family history of maternal hypertensio... | Cor pulmonale | {
"A": "Left-sided heart failure",
"B": "Coronary artery disease",
"C": "Budd-chiari syndrome",
"D": "Cor pulmonale"
} | step1 | D | [
"35 year old woman presents",
"ER",
"shortness of breath",
"cough",
"severe lower limb enlargement",
"dyspnea",
"sudden onset",
"started",
"week",
"increased",
"exercise",
"not",
"rest",
"cough",
"dry",
"persistent",
"non productive",
"family history of maternal hypertension",
"v... |
A 68-year-old woman with osteoarthritis comes to the physician because of a swollen and painful right knee for the past 2 days. Temperature is 37°C (98.6°F). Examination shows erythema and swelling of the right knee with a normal range of motion. An x-ray of the right knee shows punctate radiodensities in both menisci ... | Calcium pyrophosphate dihydrate crystal deposition | {
"A": "Calcium pyrophosphate dihydrate crystal deposition",
"B": "Immune complex deposition",
"C": "Gram-negative diplococci infection",
"D": "Monosodium urate crystal precipitation"
} | step1 | A | [
"68 year old woman",
"osteoarthritis",
"physician",
"swollen",
"painful right",
"past 2 days",
"Temperature",
"98",
"Examination shows erythema",
"swelling of",
"right knee",
"normal range of motion",
"x-ray of",
"right knee shows punctate radiodensities",
"menisci",
"joint capsule",
... |
A 33-year-old comes to her dermatologist complaining of a rash that recently started appearing on her face. She states that over the past three months, she has noticed that her cheeks have been getting darker, which has been causing her psychological distress. She has attempted using skin lighteners on her cheeks, but ... | Medication | {
"A": "Autoantibodies",
"B": "Enzyme inhibition",
"C": "Hypersensitivity reaction",
"D": "Medication"
} | step1 | D | [
"year old",
"dermatologist complaining of a rash",
"recently started appearing",
"face",
"states",
"past three months",
"cheeks",
"getting darker",
"causing",
"psychological distress",
"attempted using skin",
"cheeks",
"recently",
"more dark spots",
"forehead",
"first-trimester miscarr... |
A 6-year-old boy is brought to the physician because of worsening headaches and a rash for 2 weeks. His mother reports that the rash started on his abdomen and diffusely spread to other areas. Over the past 2 months, he has had recurrent episodes of otitis media. Examination shows a diffuse, erythematous, papular rash ... | Langerhans cells | {
"A": "Natural killer cells",
"B": "Langerhans cells",
"C": "Eosinophils",
"D": "Plasma cells"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"worsening headaches",
"rash",
"2 weeks",
"mother reports",
"rash started",
"abdomen",
"spread",
"areas",
"past",
"months",
"recurrent episodes of otitis media",
"Examination shows",
"diffuse",
"erythematous",
"papular rash involving",
"gro... |
Please refer to the summary above to answer this question
In the study, all participants who were enrolled and randomly assigned to treatment with pulmharkimab were analyzed in the pulmharkimab group regardless of medication nonadherence or refusal of allocated treatment. A medical student reading the abstract is confu... | To reduce selection bias | {
"A": "To increase internal validity of study",
"B": "To increase sample size",
"C": "To assess treatment efficacy more accurately",
"D": "To reduce selection bias"
} | step2&3 | D | [
"refer",
"summary above to answer",
"question",
"study",
"participants",
"enrolled",
"assigned",
"treatment",
"analyzed",
"group",
"medication nonadherence",
"refusal of",
"treatment",
"medical student reading",
"abstract",
"confused about",
"participants assigned",
"not adhere",
... |
A 24-year-old G1P1 presents to her physician to discuss the results of her Pap smear. Her previous 2 Pap smears were normal. Her family history is significant for breast cancer in her grandmother and cervical carcinoma in situ in her older sister. The results of her current Pap smear are as follows:
Specimen adequacy: ... | Test for HPV | {
"A": "Repeat Pap smear in 3 years",
"B": "Perform colposcopy",
"C": "Obtain a vaginal smear",
"D": "Test for HPV"
} | step2&3 | D | [
"year old G1P1 presents",
"physician to discuss",
"results",
"Pap smear",
"previous",
"Pap smears",
"normal",
"family history",
"significant",
"breast cancer",
"grandmother",
"cervical carcinoma in situ",
"older sister",
"results",
"current Pap smear",
"follows",
"Specimen adequacy",... |
A 23-year-old woman comes to the physician because of a 2-month history of diarrhea, flatulence, and fatigue. She reports having 3–5 episodes of loose stools daily that have an oily appearance. The symptoms are worse after eating. She also complains of an itchy rash on her elbows and knees. A photograph of the rash is ... | HLA-DQ2 serotype | {
"A": "Macrocytic, hypochromic red blood cells",
"B": "PAS-positive intestinal macrophages",
"C": "HLA-DQ2 serotype",
"D": "Elevated urine tryptophan levels"
} | step1 | C | [
"23 year old woman",
"physician",
"2 month history",
"diarrhea",
"flatulence",
"fatigue",
"reports",
"35 episodes of loose stools daily",
"oily appearance",
"symptoms",
"worse after eating",
"itchy rash",
"elbows",
"knees",
"photograph",
"rash",
"shown",
"Further evaluation",
"pa... |
A 2-year-old boy is brought to the physician by his father for a well-child examination. He recently emigrated from Mexico with his family and has not seen a physician since birth. Vital signs are within normal limits. Cardiac examination shows a harsh, grade 3/6 holosystolic murmur heard best at the left lower sternal... | Pulmonary artery | {
"A": "Ascending aorta",
"B": "Superior vena cava",
"C": "Pulmonary artery",
"D": "Mitral valve"
} | step1 | C | [
"2 year old boy",
"brought",
"physician",
"father",
"well",
"recently",
"Mexico",
"family",
"not seen",
"physician",
"birth",
"Vital signs",
"normal limits",
"Cardiac examination shows",
"harsh",
"grade",
"6 holosystolic murmur heard best",
"left lower sternal border",
"deep insp... |
A 48-year-old man who emigrated from Sri Lanka 2 years ago comes to the physician because of a 1-month history of fever, cough, and a 6-kg (13-lb) weight loss. He appears ill. An x-ray of the chest shows patchy infiltrates in the upper lung fields with a cavernous lesion at the right apex. A CT-guided biopsy of the les... | CD14 | {
"A": "CD8",
"B": "CD56",
"C": "CD14",
"D": "CD34"
} | step1 | C | [
"48 year old man",
"Sri Lanka",
"years",
"physician",
"month history",
"fever",
"cough",
"kg",
"weight loss",
"appears ill",
"x-ray of",
"chest shows patchy infiltrates",
"upper lung fields",
"cavernous lesion",
"right apex",
"CT-guided biopsy",
"lesion",
"obtained",
"photomicrog... |
A 30-year-old man with Down syndrome is brought to the physician by his mother for the evaluation of fatigue. Physical examination shows bluish-colored lips and digital clubbing that were not present at his most recent examination. Right heart catheterization shows a right atrial pressure of 32 mmHg. Which of the follo... | Right ventricular hypertrophy | {
"A": "Aortic valve regurgitation",
"B": "Reversible pulmonary hypertension",
"C": "Right ventricular hypertrophy",
"D": "Asymmetric septal hypertrophy"
} | step1 | C | [
"30 year old man",
"Down syndrome",
"brought",
"physician",
"mother",
"evaluation",
"fatigue",
"Physical shows",
"colored lips",
"digital clubbing",
"not present",
"recent examination",
"Right heart catheterization shows",
"right atrial pressure",
"mmHg",
"following",
"most likely in... |
A data analyst is putting systolic blood pressure values into a spreadsheet for a research study on hypertension during pregnancy. The majority of systolic blood pressure values fall between 130 and 145. For one of the study participants, she accidentally types “1400” instead of “140”. Which of the following statements... | The median is now smaller than the mean | {
"A": "This is a systematic error",
"B": "The standard deviation of the data set is decreased",
"C": "The range of the data set is unaffected",
"D": "The median is now smaller than the mean"
} | step2&3 | D | [
"data analyst",
"putting systolic blood pressure values",
"spreadsheet",
"research study",
"hypertension",
"pregnancy",
"majority",
"systolic blood pressure values fall",
"one",
"study participants",
"types",
"following statements",
"most likely to",
"correct"
] |
A 4-year-old girl is brought to her pediatrician for a routine check-up. She was diagnosed with sickle cell disease last year after an episode of dactylitis. She was started on hydroxyurea, with no painful crises or acute chest episodes since starting the medication. Which of the following is an appropriate preventive ... | Pneumococcal vaccine | {
"A": "Splenectomy",
"B": "Pneumococcal vaccine",
"C": "Intranasal influenza vaccine",
"D": "Human papillomavirus vaccine"
} | step2&3 | B | [
"4 year old girl",
"brought",
"pediatrician",
"routine check-up",
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"sickle cell disease",
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"episode of dactylitis",
"started",
"hydroxyurea",
"painful crises",
"acute chest episodes",
"starting",
"medication",
"following",
"appropriate preventive measure",
"patient... |
A 37-year-old man presents to a clinic with complaints of breathlessness and fever for the past few days. He says that the breathlessness is the same throughout the day and is not related to exertion. He recorded his body temperature at home as 38.1°C (100.5°F). Past medical history is insignificant. He denies visiting... | Staphylococcus aureus | {
"A": "Viridans group streptococci",
"B": "Kingella kingae",
"C": "Streptococcus gallolyticus",
"D": "Staphylococcus aureus"
} | step1 | D | [
"year old man presents",
"clinic",
"complaints",
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"fever",
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"not related",
"exertion",
"recorded",
"body temperature at home",
"100",
"Past medical history",
"denies visiting",
"sick person recently",
"admits",
"u... |
A 31 year-old African-American female presents with a painful shin nodules, uveitis, and calcified hilar lymph nodes. A transbronchial biopsy of the lung would most likely show which of the following histologies? | Non-caseating granulomas | {
"A": "Silica particles (birefringent) surrounded by collagen",
"B": "Golden-brown fusiform rods",
"C": "Patchy interstitial lymphoid infiltrate into walls of alveolar units",
"D": "Non-caseating granulomas"
} | step1 | D | [
"31 year old African-American female presents",
"painful shin nodules",
"uveitis",
"calcified hilar",
"transbronchial biopsy",
"lung",
"most likely show",
"following histologies"
] |
A 57-year-old man is admitted to the ER due to an abrupt onset of abdominal pain that radiates to the back, nausea, and multiple vomiting episodes for the past 10 hours. He does not have any significant past medical history. He admits to drinking alcohol every night. During admission, he is found to have a body tempera... | Age, LDH, AST | {
"A": "Glucose, LDH, AST",
"B": "Age, LDH, AST",
"C": "WBC, platelet count, AST",
"D": "AST, amylase, lipase"
} | step2&3 | B | [
"57 year old man",
"admitted",
"ER due to",
"abrupt onset",
"abdominal pain",
"radiates",
"back",
"nausea",
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"past 10 hours",
"not",
"significant past medical history",
"admits",
"drinking alcohol",
"night",
"admission",
"found to",
"body temperature",
... |
A 57-year-old man presents to his primary care provider because of chest pain for the past 3 weeks. The chest pain occurs after climbing more than 2 flights of stairs or walking for more than 10 minutes. His symptoms remain for an average of 30 minutes despite rest, but they eventually remit. He is obese, has a history... | Symptoms present for 30 minutes despite rest | {
"A": "ST segment depression on ECG",
"B": "Symptoms present for 30 minutes despite rest",
"C": "Rales on auscultation",
"D": "S3 on auscultation"
} | step2&3 | B | [
"57 year old man presents",
"primary care provider",
"of chest pain",
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"2 flights",
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"10 minutes",
"symptoms",
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"30 minutes",
"rest",
"remit",
"obese",
"history of type 2 diabetes mellitus",
"smoked",
... |
A 56-year-old man is brought to the emergency department for the evaluation of a 3-day history of left lower abdominal pain. During this period, the patient has also had a low-grade fever and has not had a bowel movement. He has a history of constipation. He underwent a cholecystectomy at the age of 53 years. He has sm... | CT-guided percutaneous abscess drainage | {
"A": "Observation and serial CT scans",
"B": "Left laparoscopic hemicolectomy",
"C": "CT-guided percutaneous abscess drainage",
"D": "Segmental colonic resection\n\""
} | step2&3 | C | [
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"not",
"bowel movement",
"history",
"constipation",
"cholecystectomy",
"age",
"years",
"smoked one pack",
"cigarettes daily",
"la... |
A 36-year-old man comes to the emergency department 4 hours after a bike accident for severe pain and swelling in his right leg. He has not had a headache, nausea, vomiting, abdominal pain, or blood in his urine. He has a history of gastroesophageal reflux disease and allergic rhinitis. He has smoked one pack of cigare... | Fasciotomy | {
"A": "Low molecular weight heparin",
"B": "Open reduction and internal fixation",
"C": "Fasciotomy",
"D": "IVC filter placement"
} | step2&3 | C | [
"36 year old man",
"emergency department",
"hours",
"bike accident",
"severe pain",
"swelling",
"right",
"not",
"headache",
"nausea",
"vomiting",
"abdominal pain",
"blood in",
"urine",
"history of gastroesophageal reflux disease",
"allergic rhinitis",
"smoked one pack",
"cigarettes... |
A previously healthy 27-year-old man comes to the physician because of a 3-week history of anxiety, diarrhea, and a 4.1-kg (9-lb) weight loss. On questioning, he also reports that he noticed a painless mass on his left testicle 2 weeks ago. His pulse is 110/min and irregular and blood pressure is 150/70 mm Hg. Examinat... | Positive urine hCG | {
"A": "Proptosis on exophthalmometry",
"B": "Elevated serum AFP",
"C": "Positive urine metanephrines",
"D": "Positive urine hCG"
} | step1 | D | [
"healthy 27 year old man",
"physician",
"3 week history",
"anxiety",
"diarrhea",
"4.1 kg",
"weight loss",
"questioning",
"reports",
"painless mass",
"left testicle 2 weeks",
"pulse",
"min",
"irregular",
"blood pressure",
"70 mm Hg",
"Examination shows diaphoresis",
"fine tremor of"... |
An 85-year-old man who recently immigrated to the US from Spain presents to your office complaining of hoarseness and dysphagia for the past 2 months. He says his symptoms have been getting progressively worse, and he expresses concerns about the difficulty swallowing as he cannot eat well and has even lost 9 kg (20 lb... | Malignant proliferation of squamous cells | {
"A": "Malignant proliferation of squamous cells",
"B": "Malignant proliferation of glandular tissue in the esophagus",
"C": "Reduced lower esophageal pressure",
"D": "Chronic autoimmune gastritis"
} | step1 | A | [
"85 year old man",
"recently",
"Spain presents",
"office",
"hoarseness",
"dysphagia",
"past",
"months",
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"difficulty swallowing",
"eat well",
"lost",
"kg",
"20",
"last visit",
"months",
"denies",
"shortness of breath",
"coughing",
... |
A 32-year-old man presents with difficulty sleeping and ‘feeling low’ for the past 6 months. Although he denies any suicidal thoughts, he admits to having an occasional feeling of hopelessness and loss of concentration at work. For the last 2 months, he has made excuses to avoid meeting his friends. He got married 1 ye... | Bupropion | {
"A": "Nortriptyline",
"B": "Bupropion",
"C": "Buspirone",
"D": "Fluoxetine"
} | step1 | B | [
"year old man presents",
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"feeling low",
"past 6 months",
"denies",
"suicidal thoughts",
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"loss",
"concentration",
"work",
"last",
"months",
"made",
"to",
"meeting",
"friends",
"got married 1 year",
"couple p... |
A 55-year-old patient is brought to the emergency department because he has had sharp chest pain for the past 3 hours. He reports that he can only take shallow breaths because deep inspiration worsens the pain. He also reports that the pain increases with coughing. Two weeks ago, he underwent cardiac catheterization fo... | Increase aspirin dose | {
"A": "Start heparin infusion",
"B": "Administer nitroglycerin",
"C": "Increase aspirin dose",
"D": "Perform CT angiography"
} | step2&3 | C | [
"55 year old patient",
"brought",
"emergency department",
"sharp chest pain",
"past",
"hours",
"reports",
"only take shallow breaths",
"deep inspiration worsens",
"pain",
"reports",
"pain increases",
"coughing",
"Two weeks",
"cardiac catheterization",
"acute myocardial infarction",
"... |
A 25-year-old G2P1 woman at 28 weeks estimated gestational age presents with questions on getting epidural anesthesia for her upcoming delivery. She has not received any prenatal care until now. Her previous pregnancy was delivered safely at home by an unlicensed midwife, but she would like to receive an epidural for t... | Anti-RhO(D) immunoglobulin | {
"A": "Folic acid",
"B": "Vitamin K",
"C": "Anti-RhO(D) immunoglobulin",
"D": "Vitamin D"
} | step1 | C | [
"year old",
"woman",
"weeks estimated gestational age presents",
"questions",
"getting epidural anesthesia",
"delivery",
"not received",
"prenatal care",
"now",
"previous pregnancy",
"delivered",
"home",
"midwife",
"to receive",
"epidural",
"delivery",
"inquiry",
"admits",
"desir... |
A 55-year-old man comes to the physician because of worsening fatigue and recurrent bleeding from his gums for 2 weeks. Physical examination shows marked pallor. There are scattered red, nonblanching pinpoints spots on his trunk and extremities. Laboratory studies show a hemoglobin of 8.0 g/dL, a leukocyte count of 80,... | Myeloperoxidase | {
"A": "Myeloperoxidase",
"B": "Tartrate resistant acid phosphatase",
"C": "Periodic acid-Schiff",
"D": "Terminal deoxynucleotidyl transferase"
} | step1 | A | [
"55 year old man",
"physician",
"worsening fatigue",
"recurrent",
"gums",
"2 weeks",
"Physical examination shows marked pallor",
"scattered red",
"pinpoints spots",
"trunk",
"extremities",
"Laboratory studies show a hemoglobin",
"0 g/dL",
"leukocyte count",
"80",
"mm3",
"platelet cou... |
A 69-year-old woman presents to her physician’s office with cough, increasing fatigue, and reports an alarming loss of 15 kg (33 lb) weight over the last 4 months. She says that she has observed this fatigue and cough to be present over the past year, but pushed it aside citing her age as a reason. The cough has been p... | Adenocarcinoma | {
"A": "Mesothelioma",
"B": "Large cell carcinoma",
"C": "Squamous cell carcinoma",
"D": "Adenocarcinoma"
} | step2&3 | D | [
"69 year old woman presents",
"physicians office",
"cough",
"increasing fatigue",
"reports",
"alarming loss",
"kg",
"weight",
"months",
"observed",
"fatigue",
"cough to",
"present",
"past year",
"pushed",
"age",
"reason",
"cough",
"progressing",
"weight loss",
"worrying",
"... |
A 5-month-old male presents to the pediatrician with his mother for a well visit. The patient was born at 35 weeks gestation to a 30-year-old gravida 2 via vaginal delivery. The pregnancy and labor were uncomplicated. The patient required no resuscitation after delivery and was discharged from the hospital on day two o... | Supplement his diet with iron and vitamin D | {
"A": "Add cow's milk to his diet",
"B": "Add pureed foods to his diet",
"C": "Supplement his diet with formula",
"D": "Supplement his diet with iron and vitamin D"
} | step2&3 | D | [
"5 month old male presents",
"pediatrician",
"mother",
"well visit",
"patient",
"born",
"35 weeks gestation",
"30 year old gravida 2",
"vaginal delivery",
"pregnancy",
"labor",
"uncomplicated",
"patient required",
"resuscitation",
"delivery",
"discharged from",
"hospital",
"day two... |
A 67-year-old male presents to his primary care physician complaining of increased fatigue over the last year. He also says that his friends say he appears to be more pale. His past medical history is significant for 10 years of arthritis. Physical exam reveals spoon shaped nails as well as conjunctival pallor. Based o... | Anemia of chronic disease | {
"A": "Anemia of chronic disease",
"B": "Beta-thalassemia",
"C": "Iron deficiency anemia",
"D": "Lead poisoning anemia"
} | step1 | A | [
"67 year old male presents",
"primary care physician",
"increased fatigue",
"last year",
"friends",
"appears to",
"more pale",
"past medical history",
"significant",
"10 years",
"arthritis",
"Physical exam reveals spoon shaped nails",
"conjunctival pallor",
"Based",
"clinical suspicion R... |
A 25-year-old pregnant woman at 28 weeks gestation presents with a headache. Her pregnancy has been managed by a nurse practitioner. Her temperature is 99.0°F (37.2°C), blood pressure is 164/104 mmHg, pulse is 100/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for a com... | Severe preeclampsia | {
"A": "Acute fatty liver disease of pregnancy",
"B": "Eclampsia",
"C": "Preeclampsia",
"D": "Severe preeclampsia"
} | step2&3 | D | [
"year old pregnant woman",
"weeks presents",
"headache",
"pregnancy",
"managed",
"nurse practitioner",
"temperature",
"99",
"blood pressure",
"mmHg",
"pulse",
"100 min",
"respirations",
"min",
"oxygen saturation",
"98",
"room air",
"Physical exam",
"notable",
"appearing woman",... |
A 13-year-old boy is brought to the physician by his parents for the evaluation of multiple behavioral problems. The parents report that their son has been bullying several classmates at school over the past year. During this period, he has been accused twice of stealing items from a local store. He has also beaten up ... | Antisocial personality disorder | {
"A": "Major depressive disorder",
"B": "Obsessive-compulsive disorder",
"C": "Bipolar disorder",
"D": "Antisocial personality disorder"
} | step2&3 | D | [
"year old boy",
"brought",
"physician",
"parents",
"evaluation",
"multiple behavioral",
"parents report",
"son",
"bullying several classmates",
"school",
"past year",
"period",
"twice",
"stealing items",
"local store",
"neighbor's son",
"reason",
"parents state",
"to give",
"do... |
A 39-year-old woman with a history of migraine headaches is brought to the emergency room because of a severe, sudden-onset, throbbing headache and double vision for 1 hour. She says that she has been having frequent headaches and has not had her period in several months. Her blood pressure is 93/61 mm Hg. Visual field... | Pituitary apoplexy | {
"A": "Transient ischemic attack",
"B": "Pituitary apoplexy",
"C": "Sheehan syndrome",
"D": "Migraine with aura"
} | step1 | B | [
"year old woman",
"history of migraine headaches",
"brought",
"emergency room",
"severe",
"sudden-onset",
"throbbing headache",
"double vision",
"hour",
"frequent headaches",
"not",
"period",
"months",
"blood pressure",
"61 mm Hg",
"Visual field testing shows decreased visual acuity",
... |
A 40-year-old man comes to the physician because of a 1-week history of palpitations and dizziness. His pulse is 65/min and regular. An ECG is shown. A drug is administered that inhibits non-dihydropyridine calcium channels in the heart and his symptoms improve. The drug administered to the patient most likely has whic... | Prolongation of AV node repolarization | {
"A": "Prolongation of Purkinje fiber refractory period",
"B": "Decrease in bundle of His refractory period",
"C": "Decrease in ventricular myocardial action potential duration",
"D": "Prolongation of AV node repolarization"
} | step1 | D | [
"40 year old man",
"physician",
"of",
"1-week history",
"palpitations",
"dizziness",
"pulse",
"65 min",
"regular",
"ECG",
"shown",
"drug",
"administered",
"inhibits non dihydropyridine calcium channels",
"heart",
"symptoms",
"drug administered",
"patient",
"likely",
"following ... |
A 5-year-old girl is brought to the physician because of a 2-day history of redness and foreign body sensation in both eyes. She has not had vision loss. Her mother reports that she has also had violent coughing spells followed by a high-pitched inspiratory sound during this time. For the past week, she has had low-gra... | Oral azithromycin | {
"A": "Topical azithromycin",
"B": "Oral azithromycin",
"C": "Artificial tears",
"D": "Topical tobramycin"
} | step2&3 | B | [
"5 year old girl",
"brought",
"physician",
"2-day history",
"redness",
"foreign body sensation in",
"eyes",
"not",
"vision loss",
"mother reports",
"violent coughing spells followed by",
"high-pitched inspiratory sound",
"time",
"past week",
"low-grade fevers",
"runny nose",
"only va... |
A 57-year-old man presents to the emergency department with fatigue. He states that his symptoms started yesterday and have been worsening steadily. The patient endorses a recent weight loss of 7 pounds this past week and states that he feels diffusely itchy. The patient has a past medical history of alcohol abuse, obe... | Severe migraine headaches treated with acetaminophen | {
"A": "Appropriate acute management of a deep vein thrombosis",
"B": "Prosthetic valve with appropriate post-operative care",
"C": "Recent antibiotic treatment with gentamicin",
"D": "Severe migraine headaches treated with acetaminophen"
} | step2&3 | D | [
"57 year old man presents",
"emergency department",
"fatigue",
"states",
"symptoms started",
"worsening",
"patient",
"recent weight loss",
"pounds",
"past week",
"states",
"feels",
"itchy",
"patient",
"past medical history of alcohol abuse",
"obesity",
"asthma",
"IV drug use",
"c... |
A 70-year-old man with hypertension and type 2 diabetes mellitus is admitted to the hospital 8 hours after the onset of impaired speech and right-sided weakness. Two days after admission, he becomes confused and is difficult to arouse. His pulse is 64/min and blood pressure is 166/96 mm Hg. Pulse oximetry on room air s... | Increase the respiratory rate | {
"A": "Increase the respiratory rate",
"B": "Increase the fraction of inhaled oxygen",
"C": "Increase the positive end-expiratory pressure",
"D": "Decrease the heart rate"
} | step1 | A | [
"70 year old man",
"hypertension",
"type 2 diabetes mellitus",
"admitted",
"hospital 8 hours",
"onset",
"impaired speech",
"right-sided weakness",
"Two days",
"admission",
"confused",
"difficult",
"pulse",
"64 min",
"blood pressure",
"96 mm Hg",
"Pulse oximetry",
"room air shows",
... |
A 59-year-old man presents to the emergency department with a 6 day history of persistent fevers. In addition, he has noticed that he feels weak and sometimes short of breath. His past medical history is significant for congenital heart disease though he doesn't remember the specific details. He has been unemployed for... | Left-sided colon cancer | {
"A": "Dental procedures due to poor hygiene",
"B": "Genitourinary procedures",
"C": "Left-sided colon cancer",
"D": "Prosthetic heart valves"
} | step1 | C | [
"59 year old man presents",
"emergency department",
"6 day history",
"persistent fevers",
"addition",
"feels weak",
"sometimes short of breath",
"past medical history",
"significant",
"congenital heart disease",
"remember",
"specific details",
"unemployed",
"years",
"occasionally homeles... |
A 63-year-old African American man presents to the emergency department with edema over his face and difficulty breathing. Past medical history is significant for hypertension and dyslipidemia. He recently began lisinopril and atorvastatin several weeks ago. His father died at 80 years from complications of a stroke an... | Drug-induced angioedema | {
"A": "Scleredema",
"B": "Erysipelas",
"C": "Drug-induced angioedema",
"D": "Contact dermatitis"
} | step2&3 | C | [
"63 year old African American man presents",
"emergency department",
"edema",
"face",
"difficulty breathing",
"Past medical history",
"significant",
"hypertension",
"dyslipidemia",
"recently began lisinopril",
"atorvastatin",
"weeks",
"father died",
"80 years",
"complications",
"stroke... |
A 45-year-old man presents to the office for evaluation of pruritic skin lesions, which he has had for 1 month on his elbows and knees. He has been using over-the-counter ointments, but they have not helped. He has not seen a healthcare provider for many years. He has no known allergies. His blood pressure is 140/80 mm... | Malabsorption | {
"A": "Malabsorption",
"B": "Transmural inflammation of the colon",
"C": "Erythema nodosum",
"D": "Acanthosis nigricans"
} | step1 | A | [
"year old man presents",
"office",
"evaluation",
"skin lesions",
"1 month",
"elbows",
"knees",
"using over-the-counter ointments",
"not helped",
"not seen",
"healthcare provider",
"years",
"known allergies",
"blood pressure",
"80 mm Hg",
"pulse",
"beats per minute",
"respirations",... |
A 50-year-old man is brought to the emergency department with progressive retrosternal chest pain and shortness of breath that started the day before. The pain is severe, worsens with inspiration, and radiates to his neck. He has also had a sore throat and neck pain the last 4 days. He remained bed-bound during this ti... | Intravenous ampicillin-sulbactam administration | {
"A": "Pericardiocentesis",
"B": "Intravenous ampicillin-sulbactam administration",
"C": "Blood pressure control",
"D": "Intravenous levofloxacin administration\n\""
} | step2&3 | B | [
"50 year old man",
"brought",
"emergency department",
"progressive retrosternal chest pain",
"shortness of breath",
"started",
"day",
"pain",
"severe",
"worsens",
"inspiration",
"radiates",
"neck",
"sore throat",
"neck pain",
"last",
"days",
"bed-bound",
"time",
"poor appetite"... |
Every time your neighbor in the adjacent apartment flushes the toilet, the water in your shower becomes very hot, causing you to jump out of the way of the water stream. After this has occurred for several months, you note that you reflexively jump back from the water directly after the sound of the flushing toilet but... | White coat syndrome (patient anxiety evoked at the sight of a white lab coat) | {
"A": "You consistently check the slots of pay telephones as you have previously found change left there",
"B": "A young child elects to not throw a temper tantrum to avoid being grounded by his parents",
"C": "A mouse repeatedly presses a red button to avoid receiving an electric shock",
"D": "White coat synd... | step1 | D | [
"time",
"neighbor",
"adjacent apartment flushes",
"toilet",
"water",
"shower",
"very hot",
"causing",
"to jump out",
"water stream",
"occurred",
"months",
"note",
"jump back",
"water directly",
"sound",
"flushing toilet",
"water temperature changes",
"following",
"most similar"... |
A 28-year-old woman, gravida 3, para 2, at 12 weeks' gestation comes to the physician for a prenatal visit. She reports feeling fatigued, but she is otherwise feeling well. Pregnancy and delivery of her first 2 children were complicated by iron deficiency anemia. The patient does not smoke or drink alcohol. She does no... | Small for gestational age | {
"A": "Small for gestational age",
"B": "Neonatal polycythemia",
"C": "Caudal regression syndrome",
"D": "Fetal hydantoin syndrome"
} | step2&3 | A | [
"year old woman",
"gravida 3",
"para 2",
"weeks",
"gestation",
"physician",
"prenatal visit",
"reports feeling fatigued",
"feeling well",
"Pregnancy",
"delivery",
"first 2 children",
"complicated",
"iron deficiency anemia",
"patient",
"not smoke",
"drink alcohol",
"not use illicit ... |
A 7-year-old girl is brought to the physician with complaints of recurrent episodes of dysuria for the past few months. Her parents reported 4 to 5 similar episodes in the last year. They also note that she has had several urinary tract infections throughout her childhood. She has no other medical problems and takes no... | Voiding cystourethrogram | {
"A": "Complete blood count",
"B": "Ultrasonography of the abdomen and pelvis",
"C": "Urine culture and sensitivity",
"D": "Voiding cystourethrogram"
} | step2&3 | D | [
"year old girl",
"brought",
"physician",
"complaints of recurrent episodes",
"dysuria",
"past",
"months",
"parents reported 4",
"5 similar episodes",
"last year",
"note",
"several urinary tract infections",
"childhood",
"medical problems",
"takes",
"medications",
"temperature",
"4F... |
Two days after undergoing hemicolectomy for colon cancer, a 78-year-old man is found agitated and confused in his room. He says that a burglar broke in. The patient points at one corner of the room and says “There he is, doctor!” Closer inspection reveals that the patient is pointing to his bathrobe, which is hanging o... | Illusion | {
"A": "Illusion",
"B": "Delusion",
"C": "Loose association",
"D": "Hallucination"
} | step2&3 | A | [
"Two days",
"hemicolectomy",
"colon cancer",
"year old man",
"found agitated",
"confused",
"room",
"burglar",
"patient points",
"one corner",
"room",
"doctor",
"inspection reveals",
"patient",
"pointing",
"hanging",
"wall",
"patient",
"type 2 diabetes mellitus",
"arterial hyper... |
Two days after an uncomplicated laparoscopic abdominal hernia repair, a 46-year-old man is evaluated for palpitations. He has a history of hypertension, type 2 diabetes mellitus, and a ventricular septal defect that closed spontaneously as a child. His father has coronary artery disease. Prior to admission, his only me... | Hypokalemia | {
"A": "Hypokalemia",
"B": "Accessory pathway in the heart",
"C": "Acute myocardial ischemia",
"D": "Atrial enlargement"
} | step2&3 | A | [
"Two days",
"uncomplicated laparoscopic abdominal",
"year old man",
"evaluated",
"palpitations",
"history of hypertension",
"type 2 diabetes mellitus",
"ventricular septal defect",
"closed",
"child",
"father",
"coronary artery disease",
"admission",
"only medications",
"hydrochlorothiazi... |
A 34-year-old man presents to the emergency department with a headache that has lasted for 2 hours. His headache is severe and he rates it as a 10/10 on the pain scale. It is generalized and associated with nausea and photophobia. He denies any history of head trauma or fever. He has a history of migraines, but he says... | CT head | {
"A": "Antibiotics",
"B": "Sumatriptan",
"C": "Lumbar puncture",
"D": "CT head "
} | step2&3 | D | [
"year old man presents",
"emergency department",
"headache",
"lasted",
"hours",
"headache",
"severe",
"rates",
"a 10",
"pain scale",
"generalized",
"associated with nausea",
"photophobia",
"denies",
"history",
"head trauma",
"fever",
"history of migraines",
"headache",
"worse",... |
An investigator is studying the structure and function of immunoglobulins that are transmitted across the placenta from mother to fetus. The structure indicated by the arrow is primarily responsible for which of the following immunological events? | Fixing of complement | {
"A": "Formation of dimer",
"B": "Fixing of complement",
"C": "Attachment to antigen",
"D": "Determination of idiotype\n\""
} | step1 | B | [
"investigator",
"studying",
"structure",
"function",
"immunoglobulins",
"transmitted",
"placenta",
"mother",
"fetus",
"structure indicated",
"arrow",
"responsible",
"following immunological events"
] |
A 45-year-old man is brought to the emergency department after being found down in the middle of the street. Bystanders reported to the police that they had seen the man as he exited a local bar, and he was subsequently assaulted. He sustained severe facial trauma, including multiple lacerations and facial bone fractur... | Voluntary motor and sensory components | {
"A": "Sensory component only",
"B": "Voluntary motor component only",
"C": "Voluntary motor and sensory components",
"D": "Parasympathetic component only"
} | step1 | C | [
"year old man",
"brought",
"emergency department",
"found",
"middle",
"street",
"Bystanders reported",
"police",
"seen",
"man",
"exited",
"local",
"assaulted",
"sustained severe facial trauma",
"including multiple lacerations",
"facial bone fractures",
"man",
"taken",
"operating ... |
A 75-year-old man with hypercholesterolemia, coronary artery disease, and history of a transient ischemic attack (TIA) comes to your office for evaluation of hypertension. Previously, his blood pressure was controlled with diet and an ACE inhibitor. Today, his blood pressure is 180/115 mm Hg, and his creatinine is incr... | Renal artery stenosis | {
"A": "Renal artery stenosis",
"B": "Coarctation of the aorta",
"C": "Pheochromocytoma",
"D": "Hypothyroidism"
} | step1 | A | [
"75 year old man",
"hypercholesterolemia",
"coronary artery disease",
"history of",
"transient ischemic attack",
"office",
"evaluation",
"hypertension",
"blood pressure",
"controlled",
"diet",
"ACE inhibitor",
"Today",
"blood pressure",
"mm Hg",
"creatinine",
"increased",
"0 54",
... |
A 69-year-old man presents to the urgent care clinic with a history of hypertension and a variety of systemic complaints including fatigue, occasional fever, abdominal pain, and diffuse palpable, pruritic eruptions over his lower extremities. He is currently unemployed. His medical history is significant for gout, hype... | Type III–immune complex-mediated hypersensitivity reaction | {
"A": "Type I–anaphylactic hypersensitivity reaction",
"B": "Type II–cytotoxic hypersensitivity reaction",
"C": "Type III–immune complex-mediated hypersensitivity reaction",
"D": "Type IV–cell-mediated (delayed) hypersensitivity reaction"
} | step2&3 | C | [
"69 year old man presents",
"urgent care clinic",
"history of hypertension",
"variety",
"systemic complaints including fatigue",
"occasional fever",
"abdominal pain",
"diffuse palpable",
"eruptions",
"lower extremities",
"currently unemployed",
"medical history",
"significant",
"gout",
"... |
A 12-year-old girl is brought to the physician for a follow-up examination. Two months ago, she was diagnosed with asthma and treatment was begun with an albuterol inhaler as needed. Since then, she has had episodic chest tightness and cough 2–3 times per week. The cough is intermittent and nonproductive; it is worse a... | Oropharyngeal candidiasis | {
"A": "Oropharyngeal candidiasis",
"B": "Bradycardia",
"C": "High-pitched voice",
"D": "Hypoglycemia"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"follow-up examination",
"Two months",
"diagnosed",
"asthma",
"treatment",
"begun",
"albuterol inhaler as needed",
"Since then",
"episodic chest tightness",
"cough 23 times",
"week",
"cough",
"intermittent",
"worse",
"night",
"healthy",
... |
A previously healthy 32-year-old woman comes to the emergency department with fatigue and bilateral leg swelling. Her pulse is 92/min, and respirations are 24/min. Physical examination shows jugular venous distention and pitting edema of the lower extremities. Her abdomen is distended with shifting dullness and tender ... | Intravenous drug use | {
"A": "45,XO genotype",
"B": "Intravenous drug use",
"C": "Fibrillin gene defect",
"D": "Streptococcal pharyngitis"
} | step1 | B | [
"healthy",
"year old woman",
"emergency department",
"fatigue",
"bilateral leg swelling",
"pulse",
"min",
"respirations",
"min",
"Physical examination shows jugular venous distention",
"pitting edema",
"lower extremities",
"abdomen",
"distended",
"shifting dullness",
"tender hepatomega... |
A 2-year-old boy is brought in by his parents to his pediatrician. The boy was born by spontaneous vaginal delivery at 39 weeks and 5 days after a normal pregnancy. The boy has received all age-appropriate vaccinations as of his last visit at 18 months of age. Of note, the boy has confirmed sickle cell disease and the ... | Pneumovax | {
"A": "Hib vaccine",
"B": "Live attenuated influenza vaccine",
"C": "Menactra",
"D": "Pneumovax"
} | step1 | D | [
"2 year old boy",
"brought",
"parents",
"pediatrician",
"boy",
"born",
"spontaneous vaginal delivery",
"weeks",
"5 days",
"normal pregnancy",
"boy",
"received",
"age appropriate vaccinations",
"visit",
"months",
"age",
"note",
"boy",
"confirmed sickle cell disease",
"only medic... |
Maturity Onset Diabetes of the Young (MODY) type 2 is a consequence of a defective pancreatic enzyme, which normally acts as a glucose sensor, resulting in a mild hyperglycemia. The hyperglycemia is especially exacerbated during pregnancy. Which of the following pathways is controlled by this enzyme? | Glucose --> glucose-6-phosphate | {
"A": "Glucose --> glucose-6-phosphate",
"B": "Glucose-6-phosphate --> fructose-6-phosphate",
"C": "Fructose-6-phosphate --> fructose-1,6-biphosphate",
"D": "Phosphoenolpyruvate --> pyruvate"
} | step1 | A | [
"Maturity Onset Diabetes of the Young",
"type 2",
"consequence of",
"defective pancreatic enzyme",
"acts",
"glucose sensor",
"resulting in",
"mild hyperglycemia",
"hyperglycemia",
"exacerbated",
"pregnancy",
"following pathways",
"controlled by",
"enzyme"
] |
A 75-year-old man presents to the clinic for chronic fatigue of 3 months duration. Past medical history is significant for type 2 diabetes and hypertension, both of which are controlled with medications, as well as constipation. He denies any fever, weight loss, pain, or focal neurologic deficits. A complete blood coun... | Inferior mesenteric artery | {
"A": "Inferior mesenteric artery",
"B": "Middle colic artery",
"C": "Right colic artery",
"D": "Superior mesenteric artery"
} | step1 | A | [
"75 year old man presents",
"clinic",
"chronic fatigue of 3 months duration",
"Past medical history",
"significant",
"type 2 diabetes",
"hypertension",
"controlled with medications",
"constipation",
"denies",
"fever",
"weight loss",
"pain",
"focal neurologic deficits",
"complete blood co... |
A 78-year-old man is brought to the emergency department by ambulance 30 minutes after the sudden onset of speech difficulties and right-sided arm and leg weakness. Examination shows paralysis and hypoesthesia on the right side, positive Babinski sign on the right, and slurred speech. A CT scan of the head shows a hype... | Alteplase | {
"A": "Rivaroxaban",
"B": "Alteplase",
"C": "Heparin",
"D": "Warfarin\n\""
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"ambulance 30 minutes",
"sudden onset",
"speech difficulties",
"right-sided arm",
"leg weakness",
"Examination shows paralysis",
"hypoesthesia",
"right side",
"positive Babinski sign",
"right",
"slurred speech",
"CT scan of",
"head sho... |
A 25-year-old woman presents to her physician with a missed mense and occasional morning nausea. Her menstrual cycles have previously been normal and on time. She has hypothyroidism resulting from Hashimoto thyroiditis diagnosed 2 years ago. She receives levothyroxine (50 mcg daily) and is euthyroid. She does not take ... | Increase levothyroxine dosage by 20%–30% | {
"A": "Decrease levothyroxine dosage by 30% ",
"B": "Discontinue levothyroxine",
"C": "Increase levothyroxine dosage by 20%–30%",
"D": "Increase levothyroxine dosage by 5% each week up, to 50%"
} | step2&3 | C | [
"year old woman presents",
"physician",
"missed",
"occasional morning nausea",
"menstrual cycles",
"normal",
"on time",
"hypothyroidism resulting",
"Hashimoto thyroiditis diagnosed 2 years",
"receives levothyroxine",
"50 mcg daily",
"euthyroid",
"not take",
"medications",
"including birt... |
To maintain blood glucose levels even after glycogen stores have been depleted, the body, mainly the liver, is able to synthesize glucose in a process called gluconeogenesis. Which of the following reactions of gluconeogenesis requires an enzyme different from glycolysis? | Fructose 1,6-bisphosphate --> Fructose-6-phosphate | {
"A": "Fructose 1,6-bisphosphate --> Fructose-6-phosphate",
"B": "Phosphoenolpyruvate --> 2-phosphoglycerate",
"C": "Dihydroxyacetone phosphate --> Glyceraldehyde 3-phosphate",
"D": "1,3-bisphosphoglycerate --> Glyceraldehyde 3-phosphate"
} | step1 | A | [
"To maintain blood glucose levels",
"glycogen stores",
"depleted",
"body",
"liver",
"able to",
"glucose",
"process called gluconeogenesis",
"following reactions",
"gluconeogenesis",
"enzyme different",
"glycolysis"
] |
A 46-year-old woman from Ecuador is admitted to the hospital because of tarry-black stools and epigastric pain for 2 weeks. The epigastric pain is relieved after meals, but worsens after 1–2 hours. She has no history of serious illness and takes no medications. Physical examination shows no abnormalities. Fecal occult ... | Curved, flagellated gram-negative rods | {
"A": "Curved, flagellated gram-negative rods",
"B": "Irregularly drumstick-shaped gram-positive rods",
"C": "Gram-positive lancet-shaped diplococci",
"D": "Dimorphic budding yeasts with pseudohyphae"
} | step1 | A | [
"year old woman",
"Ecuador",
"admitted",
"hospital",
"tarry black stools",
"epigastric pain",
"2 weeks",
"epigastric pain",
"relieved",
"meals",
"worsens",
"12 hours",
"history",
"serious illness",
"takes",
"medications",
"Physical examination shows",
"Fecal occult blood test",
"... |
A 1-year-old, pale-looking boy presents with high-grade fever and ecchymosis, which he has been experiencing for the past 2 weeks. The boy has achieved all developmental milestones on time and has no history of medical illness in the past. Lab investigations reveal the following:
Hemoglobin 5.5 g/dL
WBC 112,000/mm3
Pla... | CD19, terminal deoxynucleotidyl transferase (Tdt) | {
"A": "MHC II",
"B": "CD19, terminal deoxynucleotidyl transferase (Tdt)",
"C": "CD56",
"D": "CD16"
} | step1 | B | [
"year old",
"pale looking boy presents",
"high-grade fever",
"ecchymosis",
"experiencing",
"past 2 weeks",
"boy",
"developmental milestones on time",
"history of medical illness",
"past",
"Lab investigations reveal",
"following",
"Hemoglobin",
"g WBC",
"mm3 Platelets",
"ESR",
"1st ho... |
A 35-year-old man who is a professional baseball player presents with stiffness in his hands. He says he is unable to bat as he would like and feels like he lacks power in his swings. He also has noticed that he sometimes seems to be dragging his feet while walking, and his voice seems to have changed. On physical exam... | Amyotrophic lateral sclerosis | {
"A": "Lambert-Eaton Syndrome",
"B": "Multiple sclerosis",
"C": "Primary lateral sclerosis",
"D": "Amyotrophic lateral sclerosis"
} | step1 | D | [
"35 year old man",
"professional baseball",
"presents",
"stiffness",
"hands",
"unable to bat",
"feels",
"lacks power",
"sometimes",
"to",
"dragging",
"feet",
"walking",
"voice",
"to",
"changed",
"physical examination",
"strength",
"3 out of 5",
"extensor",
"flexor muscle grou... |
A 67-year-old man presents to the emergency room with malaise, nausea, and vomiting. Four hours prior to presentation, he was spraying insecticide at his farm when he started feeling nauseous. He has had multiple episodes of diarrhea and has vomited non-bloody, non-bilious fluid twice. He also complains of muscle cramp... | Pralidoxime | {
"A": "Activated charcoal",
"B": "Physostigmine",
"C": "Pralidoxime",
"D": "Sodium bicarbonate"
} | step1 | C | [
"67 year old man presents",
"emergency room",
"malaise",
"nausea",
"vomiting",
"Four hours prior to presentation",
"spraying insecticide",
"farm",
"started feeling nauseous",
"multiple episodes of diarrhea",
"vomited non bloody",
"fluid twice",
"muscle cramps",
"tremors",
"past medical h... |
A 48-year-old man presents to his primary care physician with a complaint of lower back pain that has developed over the past week. He works in construction but cannot recall a specific injury or incident that could have led to this pain. He denies any pain, weakness, or change/loss of sensation in his legs. The patien... | Naproxen and activity as tolerated | {
"A": "CRP level",
"B": "Ibuprofen and bed rest",
"C": "MRI spine",
"D": "Naproxen and activity as tolerated"
} | step2&3 | D | [
"48 year old man presents",
"primary care physician",
"complaint",
"lower back pain",
"past week",
"works",
"construction",
"recall",
"specific injury",
"incident",
"led",
"pain",
"denies",
"pain",
"weakness",
"change loss of sensation",
"legs",
"patient",
"reports",
"episodes ... |
A 4-year-old boy presents with vomiting and one day of lethargy after a one week history of flu-like symptoms and low-grade fevers. The vomiting is nonbilious and nonbloody. The patient has had no other symptoms aside from mild rhinorrhea and cough. He has no past medical history, and is on no medications except for ov... | Irreversible enzyme inhibition | {
"A": "Bacterial infection",
"B": "Chemical ingestion",
"C": "Reversible enzyme inhibition",
"D": "Irreversible enzyme inhibition"
} | step1 | D | [
"4 year old boy presents",
"vomiting",
"one day",
"lethargy",
"one week history",
"flu-like symptoms",
"low-grade fevers",
"vomiting",
"patient",
"symptoms",
"mild rhinorrhea",
"cough",
"past medical history",
"medications except for over-the-counter medications",
"fever",
"temperature... |
A 22-year-old woman comes to the office with complaints of dark urine and low-grade fever for 3 months. She also expresses her concerns about feeling fatigued most of the time. She says that she thought her dark urine was from dehydration and started to drink more water, but it showed minimal improvement. She reports a... | Autoimmune hepatitis | {
"A": "Primary biliary cholangitis",
"B": "Autoimmune hepatitis",
"C": "Primary sclerosing cholangitis",
"D": "Alpha-1 antitrypsin deficiency"
} | step1 | B | [
"year old woman",
"office",
"complaints",
"dark urine",
"low-grade fever",
"months",
"concerns",
"feeling fatigued most of the time",
"thought",
"dark urine",
"dehydration",
"started to drink more water",
"showed minimal improvement",
"reports",
"recent decrease in",
"appetite",
"sta... |
A 7-month-old boy presents with fever, chills, cough, runny nose, and watery eyes. His elder brother is having similar symptoms. Past medical history is unremarkable. The patient is diagnosed with an influenza virus infection. Assuming that this is the child’s first exposure to the influenza virus, which of the followi... | Natural killer cell-induced lysis of virus infected cells | {
"A": "Natural killer cell-induced lysis of virus infected cells",
"B": "Presentation of viral peptides on MHC- class I of CD4+ T cells",
"C": "Binding of virus-specific immunoglobulins to free virus",
"D": "Eosinophil-mediated lysis of virus infected cells"
} | step1 | A | [
"month old boy presents",
"fever",
"chills",
"cough",
"runny nose",
"watery eyes",
"elder brother",
"similar symptoms",
"Past medical history",
"unremarkable",
"patient",
"diagnosed",
"influenza virus infection",
"childs first exposure to",
"influenza virus",
"following immune mechanis... |
A 58-year-old man presents to the emergency department with worsening shortness of breath, cough, and fatigue. He reports that his shortness of breath was worst at night, requiring him to sit on a chair in order to get some sleep. Medical history is significant for hypertension, hypercholesterolemia, and coronary heart... | Ascending loop of Henle | {
"A": "Proximal tubule",
"B": "Ascending loop of Henle",
"C": "Distal tubule",
"D": "Collecting tubule"
} | step1 | B | [
"58 year old man presents",
"emergency department",
"worsening shortness of breath",
"cough",
"fatigue",
"reports",
"shortness of breath",
"worst",
"night",
"to sit",
"chair",
"order to",
"sleep",
"Medical history",
"significant",
"hypertension",
"hypercholesterolemia",
"coronary h... |
A 30-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a prenatal visit. She feels well. Pregnancy and delivery of her first child were uncomplicated. She has a history of bipolar disorder and hypothyroidism. She uses cocaine once a month and has a history of drinking alcohol excessiv... | Premature placental separation | {
"A": "Aplasia cutis congenita",
"B": "Neural tube defect",
"C": "Premature placental separation",
"D": "Shoulder dystocia"
} | step2&3 | C | [
"30 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"prenatal visit",
"feels well",
"Pregnancy",
"delivery",
"first child",
"uncomplicated",
"history of bipolar disorder",
"hypothyroidism",
"uses cocaine",
"month",
"history",
"drinking alcohol excessively... |
A 31-year-old woman presents to her gynecologist for cervical cancer screening. She has no complaints and is sexually active. There is no history of cervical cancer or other malignancy in her family. A complete physical examination, including an examination of the genitourinary system, is normal. A sampling of the cerv... | Colposcopy | {
"A": "Follow-up after 1 year and repeat cytology by Pap smear and HPV testing",
"B": "Colposcopy",
"C": "Endometrial biopsy",
"D": "Loop electrosurgical excision"
} | step2&3 | B | [
"31 year old woman presents",
"gynecologist",
"cervical cancer screening",
"complaints",
"sexually active",
"history of cervical cancer",
"malignancy",
"family",
"complete physical examination",
"including",
"examination of",
"genitourinary system",
"normal",
"sampling",
"cervix",
"per... |
A 23-year-old woman presents to her gynecologist for painful menses. Her menses are regular, occurring every 28 days and lasting approximately 4 days. Menarche was at age 12. Over the past 6 months, she has started to develop aching pelvic pain during the first 2 days of her menstrual period. Ibuprofen provides moderat... | Prostaglandin-induced myometrial contraction | {
"A": "Endometrial gland invasion into the uterine myometrium",
"B": "Extra-uterine endometrial gland formation",
"C": "Intrauterine adhesions",
"D": "Prostaglandin-induced myometrial contraction"
} | step1 | D | [
"23 year old woman presents",
"gynecologist",
"painful menses",
"menses",
"regular",
"occurring",
"days",
"approximately",
"days",
"Menarche",
"age",
"past 6 months",
"started to",
"aching pelvic pain",
"first 2 days",
"menstrual period",
"Ibuprofen provides moderate relief",
"symp... |
A 60-year-old woman comes to the physician because of intermittent abdominal pain for the past month. The patient reports that the pain is located in the right upper abdomen and that it does not change with food intake. She has had no nausea, vomiting, or change in weight. She has a history of hypertension and hyperlip... | Gallbladder adenocarcinoma | {
"A": "Gallbladder adenocarcinoma",
"B": "Pancreatic adenocarcinoma",
"C": "Hepatocellular carcinoma",
"D": "Acute pancreatitis"
} | step2&3 | A | [
"60 year old woman",
"physician",
"of intermittent abdominal pain",
"past month",
"patient reports",
"pain",
"right",
"not change",
"food intake",
"nausea",
"vomiting",
"change in weight",
"history of hypertension",
"hyperlipidemia",
"not smoke",
"drinks",
"glasses",
"wine",
"day... |
A 23-year-old woman goes to a walk-in clinic while on the fourth day of her honeymoon. She is very upset saying that her honeymoon is being ruined because she is in severe pain. She states that yesterday she began to experience severe pain with urination and seems to be urinating more frequently than normal. She does a... | P fimbriae | {
"A": "K capsule",
"B": "P fimbriae",
"C": "Flagella",
"D": "Exotoxin"
} | step1 | B | [
"23 year old woman goes",
"walk-in clinic",
"fourth day",
"very upset",
"severe pain",
"states",
"began to experience severe",
"urination",
"to",
"more frequently",
"normal",
"admit",
"increased sexual intercourse",
"new husband",
"physician diagnoses",
"patient",
"trimethoprim-sulfa... |
A 64-year-old man comes to the physician for a follow-up examination. Four months ago, he underwent a renal transplantation for end-stage renal disease. Current medications include sirolimus, tacrolimus, and prednisolone. Physical examination shows no abnormalities. Serum studies show a creatinine concentration of 2.7 ... | Tacrolimus toxicity | {
"A": "Tacrolimus toxicity",
"B": "Preformed antibody-mediated rejection",
"C": "Prednisolone toxicity",
"D": "Sirolimus toxicity"
} | step1 | A | [
"64 year old man",
"physician",
"follow-up examination",
"Four months",
"renal",
"end-stage",
"disease",
"Current medications include sirolimus",
"tacrolimus",
"prednisolone",
"Physical examination shows",
"abnormalities",
"Serum studies show",
"creatinine concentration",
"2",
"mg dL",... |
A 59-year-old man presents to the emergency department with a sudden onset of severe pain (10/10 in severity) between the shoulder blades. He describes the pain as tearing in nature. Medical history is positive for essential hypertension for 11 years. The patient has smoked 10–15 cigarettes daily for the past 30 years.... | Aortic atherosclerosis | {
"A": "Coronary atherosclerosis",
"B": "Aortic coarctation",
"C": "Aortic atherosclerosis",
"D": "Hypertensive urgency"
} | step2&3 | C | [
"59 year old man presents",
"emergency department",
"sudden onset",
"severe pain",
"10",
"severity",
"shoulder blades",
"pain",
"tearing",
"nature",
"Medical history",
"positive",
"essential hypertension",
"years",
"patient",
"smoked",
"cigarettes daily",
"past 30 years",
"temper... |
A 44-year-old male presents to the emergency department complaining of a headache. He reports that he developed a severe throbbing headache with blurred vision two hours ago. He has never experienced symptoms like these before. His past medical history is notable for hyperlipidemia and poorly controlled hypertension. H... | Administer IV labetalol | {
"A": "Administer oral hydralazine",
"B": "Administer IV labetalol",
"C": "Funduscopic exam",
"D": "Head CT"
} | step2&3 | B | [
"year old male presents",
"emergency department complaining of a headache",
"reports",
"severe throbbing",
"blurred vision two hours",
"never",
"symptoms",
"past medical history",
"notable",
"hyperlipidemia",
"poorly controlled hypertension",
"currently takes atorvastatin",
"lisinopril",
"... |
A 44-year-old woman comes to the emergency department because of a 10-hour history of severe nausea and abdominal pain that began 30 minutes after eating dinner. The pain primarily is in her right upper quadrant and occasionally radiates to her back. She has a history of type 2 diabetes mellitus and hypercholesterolemi... | Antibiotic therapy | {
"A": "Endoscopic retrograde cholangiopancreatography",
"B": "Antibiotic therapy",
"C": "Emergent open cholecystectomy",
"D": "Elective laparoscopic cholecystectomy in 6 weeks"
} | step2&3 | B | [
"year old woman",
"emergency department",
"a 10 hour history",
"severe nausea",
"abdominal pain",
"began 30 minutes",
"eating dinner",
"pain",
"right upper quadrant",
"occasionally radiates",
"back",
"history of type 2 diabetes mellitus",
"hypercholesterolemia",
"Current medications includ... |
A 21-year-old man presents to his physician with a cough that has persisted for 4 weeks. His cough is usually nocturnal and awakens him from sleep. He denies having a fever, but was diagnosed with asthma when he was 15 years old and uses inhaled albuterol for relief of his symptoms. He usually needs to use a rescue inh... | Add daily inhaled corticosteroids to the current regimen. | {
"A": "Use inhaled albuterol 4 times daily and follow up after 4 weeks.",
"B": "Add daily inhaled ipratropium bromide to the current regimen.",
"C": "Add daily inhaled corticosteroids to the current regimen.",
"D": "Add daily oral levocetirizine to the current regimen."
} | step1 | C | [
"21-year-old man presents",
"physician",
"cough",
"weeks",
"cough",
"usually nocturnal",
"sleep",
"denies",
"fever",
"diagnosed",
"asthma",
"years old",
"uses inhaled albuterol",
"relief",
"symptoms",
"usually needs to use",
"inhaler",
"twice",
"month",
"last",
"weeks",
"to... |
A 22-year-old man presents with multiple, target-like skin lesions on his right and left upper and lower limbs. He says that the lesions appeared 4 days ago and that, over the last 24 hours, they have extended to his torso. Past medical history is significant for pruritus and pain on the left border of his lower lip 1 ... | Interferon (IFN) gamma production by CD4+ T cells in the skin | {
"A": "Tumor necrosis factor (TNF) alpha production by CD4+ T cells in the skin",
"B": "Circulating anti-desmoglein antibodies",
"C": "IgA deposition in the papillary dermis",
"D": "Interferon (IFN) gamma production by CD4+ T cells in the skin"
} | step1 | D | [
"year old man presents",
"multiple",
"target",
"skin lesions",
"right",
"left upper",
"lower limbs",
"lesions appeared 4 days",
"last 24 hours",
"extended",
"torso",
"Past medical history",
"significant",
"pruritus",
"pain",
"left border",
"lower 1 week",
"followed by",
"developm... |
A 72-year-old man presents to his primary care physician with the symptom of generalized malaise over the last month. He also has abdominal pain that has been persistent and not relieved by ibuprofen. He has unintentionaly lost 22 pounds recently. During this time, the patient has experienced intermittent diarrhea when... | CT scan of the abdomen | {
"A": "CT scan of the abdomen",
"B": "Liver function tests including bilirubin levels",
"C": "Stool guaiac test and culture",
"D": "Sudan black stain of the stool"
} | step2&3 | A | [
"72 year old man presents",
"primary care physician",
"symptom",
"generalized",
"last month",
"abdominal pain",
"persistent",
"not relieved by ibuprofen",
"lost",
"pounds recently",
"time",
"patient",
"intermittent diarrhea",
"eats large meals",
"patient",
"past medical history of alco... |
A 49-year-old man comes to the physician because of a 6-hour history of fever, an itchy rash, and generalized body aches. Ten days ago, he received treatment in the emergency department for a snake bite. His temperature is 38.5°C (101.3°F), pulse is 80/min, and blood pressure is 120/84 mm Hg. Physical examination shows... | Decreased serum complement concentration | {
"A": "Keratinocyte necrosis on skin biopsy",
"B": "Increased antistreptolysin O titers",
"C": "Positive ELISA for anti-hemidesmosome antibodies",
"D": "Decreased serum complement concentration"
} | step1 | D | [
"year old man",
"physician",
"6-hour history",
"fever",
"itchy rash",
"generalized body aches",
"Ten days",
"received treatment",
"emergency",
"snake bite",
"temperature",
"pulse",
"80 min",
"blood pressure",
"84 mm Hg",
"Physical examination shows multiple well",
"raised",
"erythe... |
A 64-year-old man who is post-op day 4 following a radical nephrectomy is noted to have a temperature of 103.4F, pulse of 115, blood pressure of 86/44, and respiratory rate of 26. Arterial blood gas shows a pH of 7.29 and pCO2 of 28. Chemistry panel shows: Na+ 136, Cl- 100, HCO3- 14. CBC is significant for a significan... | Decreased activity of pyruvate dehydrogenase | {
"A": "Increased activity of alcohol dehydrogenase",
"B": "Decreased activity of pyruvate dehydrogenase",
"C": "Decreased activity of lactate dehydrogenase",
"D": "Increased flux through the electron transport chain"
} | step1 | B | [
"64 year old man",
"post",
"day 4 following",
"radical nephrectomy",
"noted to",
"temperature",
"4F",
"pulse",
"blood pressure",
"respiratory rate",
"Arterial blood gas shows",
"pH",
"7 29",
"pCO2",
"Chemistry panel shows",
"Na",
"Cl",
"100",
"HCO3",
"CBC",
"significant",
"... |
An 89-year-old woman is admitted to the neurology intensive care unit following a massive cerebral infarction. She has a history of hypertension, ovarian cancer, and lung cancer. Her medications include lisinopril and aspirin. She has smoked a few cigarettes each day for the last 60 years. She does not drink alcohol or... | Mechanical hyperventilation | {
"A": "Mannitol infusion",
"B": "Glucocorticoids",
"C": "Mechanical hyperventilation",
"D": "Elevating head position"
} | step1 | C | [
"year old woman",
"admitted to",
"neurology intensive care unit following",
"massive cerebral infarction",
"history of hypertension",
"ovarian cancer",
"lung cancer",
"medications include lisinopril",
"aspirin",
"smoked",
"few cigarettes",
"day",
"60 years",
"not drink alcohol",
"use dru... |
A 54-year-old male with a history of hypertension, coronary artery disease status post 3-vessel coronary artery bypass surgery 5 years prior, stage III chronic kidney disease and a long history of uncontrolled diabetes presents to your office. His diabetes is complicated by diabetic retinopathy, gastroparesis with asso... | Metoclopramide | {
"A": "Aspirin",
"B": "Gabapentin",
"C": "Glyburide",
"D": "Metoclopramide"
} | step2&3 | D | [
"54 year old male",
"history of hypertension",
"coronary artery disease",
"3",
"coronary artery bypass surgery 5 years prior",
"stage III chronic kidney disease",
"long history",
"uncontrolled diabetes presents",
"office",
"diabetes",
"complicated",
"diabetic retinopathy",
"gastroparesis wit... |
A 52-year-old man presents to his primary care physician for an annual check-up. He says that he has no significant developments over the last year and that he has been feeling well in general. On presentation, his temperature is 98.6°F (37°C), blood pressure is 140/95 mmHg, pulse is 85/min, and respirations are 12/min... | Pindolol | {
"A": "Carvedilol",
"B": "Esmolol",
"C": "Pindolol",
"D": "Propranolol"
} | step1 | C | [
"year old man presents",
"primary care physician",
"annual check-up",
"significant developments",
"year",
"feeling well",
"general",
"presentation",
"temperature",
"98",
"blood pressure",
"95 mmHg",
"pulse",
"85 min",
"respirations",
"min",
"third time",
"elevated blood pressure",
... |
A 32-year-old female presents to her primary care provider with pelvic pain. She reports that for the last several years, she has had chronic pain that is worst just before her menstrual period. Over the past two months, she has also had worsening pain during intercourse. She denies dysuria, vaginal discharge, or vagin... | Laparoscopy | {
"A": "Abdominal ultrasound",
"B": "Pelvic MRI",
"C": "Hysteroscopy",
"D": "Laparoscopy"
} | step2&3 | D | [
"year old female presents",
"primary care provider",
"pelvic pain",
"reports",
"last",
"years",
"chronic pain",
"worst",
"menstrual period",
"past two months",
"worsening",
"intercourse",
"denies dysuria",
"vaginal discharge",
"vaginal pruritus",
"patient",
"never",
"pregnant",
"... |
The study is performed to examine the association between type 2 diabetes mellitus (DM2) and Alzheimer's disease (AD). Group of 250 subjects diagnosed with DM2 and a matched group of 250 subjects without DM2 are enrolled. Each subject is monitored regularly over their lifetime for the development of symptoms of dementi... | It is a prospective observational study. | {
"A": "It is a retrospective observational study.",
"B": "It can provide proof of causation between DM2 and AD.",
"C": "It is a prospective observational study.",
"D": "It is a case-control study."
} | step2&3 | C | [
"study",
"performed to",
"association",
"type 2 diabetes mellitus",
"Alzheimer's disease",
"Group",
"subjects diagnosed",
"a matched group",
"subjects",
"enrolled",
"subject",
"monitored",
"lifetime",
"development",
"symptoms",
"dementia",
"mild cognitive impairment",
"symptoms",
... |
A 72-year-old man presents to the emergency department with chest pain and shortness of breath. An EKG demonstrates an ST elevation myocardial infarction, and he is managed appropriately. The patient suffers from multiple comorbidities and was recently hospitalized for a myocardial infarction. The patient has a documen... | Do not intubate the patient given his living will | {
"A": "Consult the hospital ethics committee",
"B": "Do not intubate the patient as his prognosis is poor even with intubation",
"C": "Do not intubate the patient given his living will",
"D": "Intubate the patient - a patient's next of kin take precedence over a living will"
} | step1 | C | [
"72 year old man presents",
"emergency department",
"chest pain",
"shortness of breath",
"EKG demonstrates",
"ST elevation myocardial infarction",
"managed",
"patient suffers",
"multiple comorbidities",
"recently hospitalized",
"myocardial infarction",
"patient",
"documented living will",
... |
A 52-year-old woman presents to the clinic complaining of dry mouth for the past 2 months. The patient states that she drinks a lot of water but that her mouth is always dry. She says that she recently went to the dentist and had 3 cavities, which is more than she has ever had in her adult life. She has a history of ty... | Autoimmune destruction of exocrine glands | {
"A": "Uncontrolled blood glucose levels",
"B": "Obstruction of salivary ducts",
"C": "Autoimmune destruction of exocrine glands",
"D": "Poor hygiene due to inability to care for self"
} | step1 | C | [
"year old woman presents",
"clinic",
"dry mouth",
"past",
"months",
"patient states",
"drinks",
"lot",
"water",
"mouth",
"always dry",
"recently",
"dentist",
"3 cavities",
"more",
"adult life",
"history",
"type 2 diabetes",
"rheumatoid arthritis",
"vital signs",
"normal limit... |
A 38-year-old woman is voted off the board of her garden club for tardiness and incomplete work on the spring fair. When she arrives home, her husband attempts to console her and she yells at him for constantly criticizing her. Which defense mechanism is the woman using? | Displacement | {
"A": "Projection",
"B": "Displacement",
"C": "Reaction formation",
"D": "Isolation of affect"
} | step2&3 | B | [
"year old woman",
"voted",
"board",
"garden club",
"tardiness",
"incomplete work",
"spring fair",
"home",
"husband attempts to console",
"constantly",
"defense mechanism",
"woman using"
] |
A 13-year-old girl presents to her primary care physician due to concerns of not having her first menstrual period. She reports a mild headache but otherwise has no concerns. She does not take any medications. She states that she is sexually active and uses condoms inconsistently. Medical history is unremarkable. Menar... | Obtain an MRI of the pituitary | {
"A": "Begin estrogen replacement therapy",
"B": "Obtain an HIV test",
"C": "Obtain an MRI of the pituitary",
"D": "Order a karyotype"
} | step2&3 | C | [
"year old girl presents",
"primary care physician due to concerns",
"not",
"first menstrual period",
"reports",
"mild headache",
"concerns",
"not take",
"medications",
"states",
"sexually active",
"uses condoms",
"Medical history",
"unremarkable",
"Menarche",
"mother",
"sister began"... |
A 66-year-old woman comes to the physician because of a 1-week history of pruritic blister formation. Physical examination shows multiple 1–3 cm bullae on the palms, soles, lower legs, and inguinal folds. Gentle rubbing of the skin does not result in sloughing of the epidermis. Immunofluorescence studies of a perilesio... | At the dermoepidermal junction | {
"A": "At the dermoepidermal junction",
"B": "Between epidermal keratinocytes",
"C": "In dermal papillae",
"D": "In dermal vessel walls"
} | step1 | A | [
"66 year old woman",
"physician",
"1-week history",
"blister formation",
"Physical examination shows multiple",
"bullae",
"palms",
"soles",
"lower legs",
"inguinal folds",
"Gentle",
"of",
"skin",
"not result",
"sloughing of",
"epidermis",
"Immunofluorescence studies",
"skin biopsy ... |
A 25-year-old woman presents to a medical clinic with complaints of right-sided chest pain, which is exacerbated during inspiration. She also reports intermittent fevers for the past 3 months associated with pain in both knee joints. She gives a history of an unintended 3 kg (6 lbs) weight loss in the past 2 months. Th... | Antibody to double-stranded deoxyribonucleic acid | {
"A": "Antibody to microsomal cellular organelles",
"B": "Antibody to double-stranded deoxyribonucleic acid",
"C": "Antibody to phospholipid of cell membranes",
"D": "Antibody to ribonucleoprotein"
} | step1 | B | [
"year old woman presents",
"medical clinic",
"complaints of right-sided chest pain",
"exacerbated",
"inspiration",
"reports intermittent fevers",
"past 3 months associated with pain",
"knee joints",
"gives",
"history",
"unintended",
"kg",
"lbs",
"weight loss",
"past",
"months",
"bloo... |
An investigator is studying the regulation of adrenal hormone synthesis in rats. The investigator takes serum concentrations of different hormones before and after intravenous administration of metyrapone, which inhibits adrenal 11β-hydroxylase. The serum concentration of which of the following hormones is most likely ... | Epinephrine | {
"A": "Adrenocorticotropic hormone",
"B": "Normetanephrine",
"C": "Epinephrine",
"D": "Dopamine"
} | step1 | C | [
"investigator",
"studying",
"regulation of",
"hormone synthesis",
"rats",
"investigator takes serum concentrations",
"different hormones",
"intravenous administration",
"metyrapone",
"inhibits",
"hydroxylase",
"serum concentration",
"following hormones",
"most likely to",
"decreased",
... |
Researchers are investigating a new mouse model of glycogen regulation. They add hepatocyte enzyme extracts to radiolabeled glucose to investigate glycogen synthesis, in particular two enzymes. They notice that the first enzyme adds a radiolabeled glucose to the end of a long strand of radiolabeled glucose. The second ... | Glycogen synthase and branching enzyme | {
"A": "Branching enzyme and debranching enzyme",
"B": "Glycogen synthase and branching enzyme",
"C": "Glycogen synthase and debranching enzyme",
"D": "Glycogen phosphorylase and glycogen synthase"
} | step1 | B | [
"Researchers",
"investigating",
"new mouse",
"glycogen regulation",
"add hepatocyte enzyme extracts",
"radiolabeled glucose to investigate glycogen synthesis",
"two enzymes",
"first enzyme adds",
"radiolabeled glucose",
"end",
"long strand",
"second enzyme then appears to",
"glycogen structu... |
A 56-year-old man comes to the physician because of intense anal pain that began 2 hours ago. He has a history of chronic constipation and rectal itching. His past medical history is otherwise unremarkable. He takes no medications. His vital signs are within normal limits. Because of extreme pain, a rectal examination ... | Elliptical excision | {
"A": "Elliptical excision",
"B": "Incision and drainage",
"C": "Rubber band ligation",
"D": "Sclerotherapy"
} | step2&3 | A | [
"year old man",
"physician",
"intense anal pain",
"began 2 hours",
"history",
"chronic constipation",
"rectal itching",
"past medical history",
"unremarkable",
"takes",
"medications",
"vital signs",
"normal limits",
"extreme pain",
"rectal examination",
"performed",
"office",
"loca... |
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