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 28-year-old woman, gravida 2, para 1, at 14 weeks' gestation, comes to the physician with a 3-day history of abnormal vaginal discharge. She has not had fever, chills, or abdominal pain. One week ago, her 2-year-old daughter had a urinary tract infection that quickly resolved after antibiotic therapy. The patient rep... | Nucleic acid amplification test | {
"A": "Wet mount preparation",
"B": "Amine test",
"C": "Urine analysis and culture",
"D": "Nucleic acid amplification test"
} | step2&3 | D | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"physician",
"3-day history",
"abnormal vaginal discharge",
"not",
"fever",
"chills",
"abdominal pain",
"One week",
"her 2 year old daughter",
"urinary tract infection",
"resolved",
"antibiotic therapy",
"patient report... |
A 4-year-old boy is brought to the clinic by his mother with a history of multiple falls for the last 8 months. He was born at term without any perinatal complications. At birth, his weight and height were 57th and 62nd percentile for his age, respectively. For the first year, he had normal developmental milestones. He... | Pseudohypertrophy of the calf muscles | {
"A": "Early contractures at multiple joints",
"B": "Inability to release grasp after handshake",
"C": "Pseudohypertrophy of the calf muscles",
"D": "Rash over shoulders and anterior chest"
} | step2&3 | C | [
"4 year old boy",
"brought",
"clinic",
"mother",
"history of multiple falls",
"last",
"months",
"born",
"term",
"perinatal complications",
"birth",
"weight",
"height",
"percentile",
"age",
"first year",
"normal developmental milestones",
"started walking",
"age",
"months",
"s... |
A 35-year-old woman with irritable bowel syndrome comes to the physician because of increased diarrhea. She has not had any fever, bloody stools, nausea, or vomiting. The increase in stool frequency began when she started a new job. She is started on loperamide, and her symptoms improve. Which of the following is the p... | μ-opioid receptor agonism | {
"A": "μ-opioid receptor agonism",
"B": "5-HT3 receptor antagonism",
"C": "Acetylcholine receptor antagonism",
"D": "Physical protection of stomach mucosa"
} | step1 | A | [
"35 year old woman",
"irritable bowel syndrome",
"physician",
"increased diarrhea",
"not",
"fever",
"bloody stools",
"nausea",
"vomiting",
"increase",
"stool frequency began",
"started",
"new job",
"started",
"loperamide",
"symptoms",
"following",
"primary mechanism of action",
"... |
A 2-year-old boy presents to the doctor with multiple skin abscesses caused by Staphylococcus aureus. He has a past history of recurrent infections with the same organism. The nitroblue tetrazolium test is performed, and the solution remains clear. Which of the following key pathophysiologic events relates to the condi... | Inability to generate the microbicidal respiratory burst | {
"A": "Tyrosine kinase deficiency blocking B cell maturation",
"B": "Inability to fuse lysosomes with phagosomes",
"C": "MHC class-II deficiency",
"D": "Inability to generate the microbicidal respiratory burst"
} | step1 | D | [
"2 year old boy presents",
"doctor",
"multiple skin caused",
"Staphylococcus aureus",
"past history of recurrent infections",
"same organism",
"nitroblue tetrazolium test",
"performed",
"solution",
"clear",
"following",
"pathophysiologic events relates",
"condition",
"most likely responsib... |
A 2-year-old boy is brought to the physician by his mother for evaluation of recurrent infections and easy bruising. The patient has been hospitalized 3 times for severe skin and respiratory infections, which responded to antibiotic treatment. Examination shows sparse silvery hair. His skin is hypopigmented, and exhibi... | Defective lysosomal trafficking regulator gene | {
"A": "Defective CD40 ligand",
"B": "Defective lysosomal trafficking regulator gene",
"C": "Defective NADPH oxidase",
"D": "WAS gene mutation"
} | step2&3 | B | [
"2 year old boy",
"brought",
"physician",
"mother",
"evaluation",
"recurrent infections",
"easy bruising",
"patient",
"hospitalized 3",
"severe skin",
"respiratory infections",
"antibiotic treatment",
"Examination shows sparse silvery hair",
"skin",
"hypopigmented",
"exhibits diffuse p... |
A 35-year-old woman comes to the clinic with complaints of joint pain and stiffness for the past few months. Her hands, lower back, and left knee are involved and associated with morning stiffness that improves throughout the day with activities. She also complains that her fingers change color upon exposure to cold. S... | Diffuse cutaneous systemic scleroderma | {
"A": "Limited cutaneous systemic scleroderma",
"B": "Diffuse cutaneous systemic scleroderma",
"C": "Polymyositis",
"D": "SLE"
} | step2&3 | B | [
"35 year old woman",
"clinic",
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"joint pain",
"stiffness",
"past",
"months",
"hands",
"lower back",
"left knee",
"involved",
"associated with morning stiffness",
"improves",
"day",
"activities",
"fingers change color",
"exposure",
"cold",
"skin",
"face",
"thinnin... |
An 8-year-old girl presents to the psychiatrist to discuss the recent divorce of her parents. The girl explains that her mother is the most caring and loving mother anyone could ever have and that she will be spending the majority of her time with her mother. On the other hand, she exclaims that her father is an evil p... | Splitting | {
"A": "Denial",
"B": "Projection",
"C": "Regression",
"D": "Splitting"
} | step1 | D | [
"year old girl presents",
"psychiatrist to discuss",
"recent divorce",
"parents",
"girl",
"mother",
"most caring",
"loving mother",
"spending",
"majority",
"time",
"mother",
"hand",
"father",
"person",
"hates",
"following ego defenses",
"best",
"girl"
] |
A 27-year-old man comes to the physician for a follow-up evaluation. Two days ago, he was involved in a physical altercation and sustained a bruise on his left arm and an injury to his left shoulder. Initially, there was a reddish-purple discoloration on his left upper arm. A photograph of the left upper arm today is s... | Heme oxygenase | {
"A": "Aminolevulinate dehydratase",
"B": "Bilirubin UDP-glucuronosyltransferase",
"C": "Heme oxygenase",
"D": "Uroporphyrinogen decarboxylase"
} | step1 | C | [
"27 year old man",
"physician",
"follow-up evaluation",
"Two days",
"involved",
"physical altercation",
"sustained",
"bruise",
"left",
"injury",
"left",
"Initially",
"purple discoloration",
"left upper arm",
"photograph",
"left upper arm today",
"shown",
"following enzymes",
"mos... |
A 30-year-old man presents with fatigue and low energy. He says that he has been "feeling down" and tired on most days for the last 3 years. He also says that he has had difficulty concentrating and has been sleeping excessively. The patient denies any manic or hypomanic symptoms. He also denies any suicidal ideation o... | Venlafaxine | {
"A": "Clonidine",
"B": "Venlafaxine",
"C": "Lithium",
"D": "Phenylephrine"
} | step1 | B | [
"30 year old man presents",
"fatigue",
"low energy",
"feeling",
"tired",
"days",
"last",
"years",
"difficulty concentrating",
"sleeping excessively",
"patient denies",
"manic",
"hypomanic symptoms",
"denies",
"suicidal ideation",
"preoccupation with death",
"physical examination",
... |
A 23-year-old woman presents to her primary care physician with 3 days of fatigue and back pain after she started a drug for malaria prophylaxis. She says that her urine has also been darker over the same time period. Her past medical history is significant for allergies as well as a broken elbow that was treated in a ... | Red pulp of the spleen | {
"A": "Bone marrow",
"B": "Blood vessels",
"C": "Lymph nodes",
"D": "Red pulp of the spleen"
} | step1 | D | [
"23 year old woman presents",
"primary care physician",
"3 days",
"fatigue",
"back pain",
"started",
"drug",
"malaria",
"urine",
"darker",
"same time period",
"past medical history",
"significant",
"allergies",
"broken elbow",
"treated",
"cast 10 years",
"not take",
"medications"... |
A 48-year-old man with a history of nephrolithiasis presents with acute-onset left flank pain. He says that the pain started suddenly 4 hours ago and has progressively worsened. He describes the pain as severe, sharp, and localized to the left flank. The patient denies any fever, chills, nausea, vomiting, or dysuria. H... | Non-contrast CT of the abdomen and pelvis | {
"A": "Admit to hospital floor for IV dilaudid patient-controlled analgesia",
"B": "Administer ibuprofen and acetaminophen for pain control",
"C": "Discharge patient with prescription of dilaudid with follow-up in 3 months",
"D": "Non-contrast CT of the abdomen and pelvis"
} | step2&3 | D | [
"48 year old man",
"history of nephrolithiasis presents",
"acute-onset left flank pain",
"pain started",
"hours",
"worsened",
"pain",
"severe",
"sharp",
"localized",
"left flank",
"patient denies",
"fever",
"chills",
"nausea",
"vomiting",
"dysuria",
"past medical history",
"signi... |
A 43-year-old woman presents to a hematology clinic to discuss the results of a bone marrow biopsy that was performed about 4 weeks ago. She was referred to this clinic to evaluate her chronic anemia after all other noninvasive diagnostic testing was inconclusive. Today her blood pressure is 114/76 mm Hg, pulse is 94/m... | Pyridoxine | {
"A": "Niacin",
"B": "Folic acid",
"C": "Riboflavin",
"D": "Pyridoxine"
} | step1 | D | [
"year old woman presents",
"hematology clinic to discuss",
"results of",
"bone marrow biopsy",
"performed",
"weeks",
"referred",
"clinic to evaluate",
"chronic anemia",
"noninvasive diagnostic testing",
"inconclusive",
"Today",
"blood pressure",
"76 mm Hg",
"pulse",
"min",
"respirato... |
A 47-year-old woman comes to the physician because of repetitive tongue twisting and abnormal movements of the hands and legs that started several days ago. She has a 2-year history of schizophrenia that has been controlled with fluphenazine. Two weeks ago, she was switched to risperidone. Examination shows protrusion ... | Tardive dyskinesia | {
"A": "Cerebellar stroke",
"B": "Neuroleptic malignant syndrome",
"C": "Akathisia",
"D": "Tardive dyskinesia"
} | step1 | D | [
"year old woman",
"physician",
"tongue twisting",
"abnormal movements",
"hands",
"legs",
"started several days",
"2 year history of schizophrenia",
"controlled",
"fluphenazine",
"Two weeks",
"switched",
"risperidone",
"Examination shows protrusion of",
"tongue",
"smacking",
"lips",
... |
A 74-year-old man comes to the attention of the inpatient hospital team because he started experiencing shortness of breath and left-sided back pain 3 days after suffering a right hip fracture that was treated with hip arthroplasty. He says that the pain is sharp and occurs with deep breathing. His past medical history... | Increased dead space | {
"A": "Creation of a shunt",
"B": "Hypoventilation",
"C": "Increased dead space",
"D": "Obstructive lung disease"
} | step1 | C | [
"74 year old man",
"attention",
"inpatient hospital team",
"started experiencing shortness of breath",
"left-sided back pain 3 days",
"suffering",
"right",
"treated with hip arthroplasty",
"pain",
"sharp",
"occurs",
"deep breathing",
"past medical history",
"significant",
"diabetes",
"... |
A 42-year-old woman comes to the physician because of pain in her left ankle for 2 days. The pain is worse at night and with exercise. Five days ago, the patient was diagnosed with Salmonella gastroenteritis and started on ciprofloxacin. She has ulcerative colitis, hypertension, and hypercholesterolemia. She has smoked... | Adverse medication effect | {
"A": "Adverse medication effect",
"B": "Recent bacterial gastroenteritis",
"C": "Crystal formation within the joint",
"D": "Bacterial seeding of the joint\n\""
} | step2&3 | A | [
"year old woman",
"physician",
"of pain in",
"left ankle",
"2 days",
"pain",
"worse",
"night",
"exercise",
"Five days",
"patient",
"diagnosed",
"Salmonella gastroenteritis",
"started",
"ciprofloxacin",
"ulcerative colitis",
"hypertension",
"hypercholesterolemia",
"smoked two pack... |
A 33-year-old man comes to the physician for evaluation of progressive hair loss from his scalp. He first noticed receding of the hairline over the bitemporal regions of his scalp 5 years ago. Since then, his hair has gradually become thinner over the crown of his head. He is otherwise healthy and takes no medications.... | Finasteride | {
"A": "Clomipramine",
"B": "Triamcinolone",
"C": "Levothyroxine",
"D": "Finasteride"
} | step1 | D | [
"year old man",
"physician",
"evaluation of progressive hair loss",
"scalp",
"first",
"receding",
"hairline",
"bitemporal regions",
"scalp",
"years",
"then",
"hair",
"crown of",
"head",
"healthy",
"takes",
"medications",
"Examination shows diffuse",
"hair loss",
"scalp",
"bit... |
A 61-year-old man with a past medical history significant for asthma and psoriasis presents to the clinic for a wellness visit. He has no specific complaints. The patient’s blood pressure is 121/73 mm Hg, the pulse is 81/min, the respiratory rate is 16/min, and the temperature is 37.2°C (99.1°F). Physical examination r... | Plaque | {
"A": "Lichenification",
"B": "Excoriation",
"C": "Plaque",
"D": "Papule"
} | step2&3 | C | [
"61 year old man",
"past medical history significant",
"asthma",
"psoriasis presents",
"clinic",
"wellness visit",
"specific complaints",
"patients blood pressure",
"mm Hg",
"pulse",
"81 min",
"respiratory rate",
"min",
"temperature",
"99",
"Physical examination reveals",
"3.3",
"1... |
A 32-year-old G0P0 female complains of unsuccessful pregnancy since discontinuing an oral contraceptive 12 months ago. She reports menarche at age 15 and has had irregular periods since. She had occasional spotting while taking an oral contraceptive, but she has not had a “normal period” since discontinuing the pill. S... | Primary ovarian insufficiency | {
"A": "Polycystic ovary syndrome",
"B": "Hyperprolactinemia",
"C": "Primary ovarian insufficiency",
"D": "Secondary ovarian insufficiency"
} | step2&3 | C | [
"year old",
"female",
"unsuccessful pregnancy",
"discontinuing",
"oral contraceptive 12 months",
"reports menarche at age",
"irregular periods",
"occasional spotting",
"taking",
"oral contraceptive",
"not",
"normal period",
"discontinuing",
"pill",
"currently denies",
"hot flashes",
... |
A 54-year-old woman appears in your office for a new patient visit. She reports a past medical history of hypertension, which she was told was related to "adrenal gland disease." You recall that Conn syndrome and pheochromocytomas are both conditions affecting the adrenal gland that result in hypertension by different ... | Zona glomerulosa; medulla | {
"A": "Zona glomerulosa; zona fasciculata",
"B": "Zona glomerulosa; medulla",
"C": "Medulla; zona reticularis",
"D": "Zona fasciculata; zona reticularis"
} | step1 | B | [
"54 year old woman appears",
"office",
"new patient visit",
"reports",
"past medical",
"related",
"adrenal gland disease",
"recall",
"Conn syndrome",
"pheochromocytomas",
"conditions affecting",
"adrenal gland",
"result",
"hypertension",
"different mechanisms",
"areas",
"adrenal glan... |
A 63-year-old woman is brought to the emergency department 1 hour after the onset of right-sided weakness. She was eating breakfast when suddenly she could not lift her spoon. She cried out to her husband but her speech was slurred. For the past 4 months, she has been more anxious than usual and felt fatigued. She used... | Irregularly irregular rhythm without P waves on ECG | {
"A": "Irregularly irregular rhythm without P waves on ECG",
"B": "Left-sided carotid stenosis on duplex ultrasound",
"C": "Intraparenchymal hyperdensity on head CT",
"D": "Spikes and sharp waves in temporal region on EEG\n\""
} | step2&3 | A | [
"63 year old woman",
"brought",
"emergency department",
"hour",
"onset",
"right-sided weakness",
"eating breakfast",
"not lift",
"spoon",
"cried out",
"husband",
"speech",
"slurred",
"past",
"months",
"more anxious",
"usual",
"felt fatigued",
"used to exercise",
"to give",
"e... |
A 42-year-old woman comes to the physician because of an 8 month history of intermittent pain and stiffness in her hands and feet. She reports that these episodes occur about three times a month after she wakes up and last for approximately one hour. She often also experiences fever and myalgia on the days that these e... | Methotrexate | {
"A": "Methotrexate",
"B": "Adalimumab",
"C": "Prednisolone",
"D": "Diclofenac\n\""
} | step2&3 | A | [
"year old woman",
"physician",
"month history",
"intermittent pain",
"stiffness",
"hands",
"feet",
"reports",
"episodes occur",
"three times",
"month",
"wakes up",
"last",
"approximately one hour",
"often",
"experiences fever",
"myalgia",
"days",
"episodes occur",
"attacks",
... |
A 75-year-old man presents to his primary care physician because he has been coughing up bloody sputum over the last week. He also notes that he feels increasingly short of breath and that his coughing has progressively worsened over the last 6 months. His past medical history is significant for hypertension for which ... | Autophagic vacuoles | {
"A": "Autophagic vacuoles",
"B": "Chromosomes",
"C": "Mitochondria",
"D": "Mitotic spindles"
} | step1 | A | [
"75 year old man presents",
"primary care physician",
"coughing up bloody sputum",
"last week",
"notes",
"feels",
"short of breath",
"coughing",
"worsened",
"months",
"past medical history",
"significant",
"hypertension",
"takes lisinopril",
"last visit",
"months",
"lost",
"pounds"... |
A 60-year-old man comes to the office because of an 8-month history of cough, night sweats, shortness of breath, and fatigue. He has also had a 9-kg (19.8-lb) weight loss during this time. He appears pale. Abdominal examination shows hepatosplenomegaly. His leukocyte count is 80,000/mm3 and his leukocyte alkaline phosp... | Leukemoid reaction | {
"A": "Leukemoid reaction",
"B": "Tuberculosis",
"C": "Chronic myeloid leukemia",
"D": "Acute lymphoblastic leukemia"
} | step1 | A | [
"60 year old man",
"office",
"month history",
"cough",
"night sweats",
"shortness of breath",
"fatigue",
"kg",
"weight loss",
"time",
"appears pale",
"Abdominal examination shows hepatosplenomegaly",
"leukocyte count",
"80",
"mm3",
"leukocyte",
"increased",
"peripheral blood smear ... |
A scientist is studying the replication sequences of a number of different viruses. He observes that one particular virus he is studying creates a single stranded DNA from an RNA template during its replication sequence. Which of the following viruses is he most likely observing? | Hepatitis B virus | {
"A": "Hepatitis B virus",
"B": "Hepatitis C virus",
"C": "HSV-1",
"D": "Norovirus"
} | step1 | A | [
"scientist",
"studying",
"replication sequences",
"number",
"different viruses",
"observes",
"one",
"virus",
"studying creates",
"single stranded",
"RNA template",
"replication sequence",
"following viruses",
"most likely observing"
] |
A 53-year-old woman seeks medical care for superficial erosions and blisters over the skin of her head and trunk. She also has significant involvement of her buccal mucosa, which has made eating difficult. A year earlier, she developed tender sores on the oral mucosa and soft palate of her mouth, which was initially tr... | Pemphigus vulgaris | {
"A": "Toxic epidermal necrolysis",
"B": "Pemphigus vulgaris",
"C": "Dermatitis herpetiformis",
"D": "Behcet’s disease"
} | step2&3 | B | [
"year old woman",
"medical care",
"superficial erosions",
"blisters",
"the skin of",
"head",
"trunk",
"significant involvement",
"buccal mucosa",
"made eating difficult",
"year earlier",
"tender sores",
"oral mucosa",
"soft palate",
"mouth",
"initially treated",
"herpes stomatitis",
... |
A 61-year-old man with HIV comes to the physician because of a 3-week history of fatigue, nonproductive cough, and worsening shortness of breath. He appears ill. Pulse oximetry on room air shows an oxygen saturation of 89%. Laboratory studies show a CD4+ T-lymphocyte count of 67/mm3 (N ≥ 500/mm3) and an elevated HIV vi... | Toxoplasmosis | {
"A": "Candidiasis",
"B": "Toxoplasmosis",
"C": "Cryptosporidiosis",
"D": "Cytomegalovirus end-organ disease"
} | step1 | B | [
"61 year old man",
"HIV",
"physician",
"3 week history",
"fatigue",
"nonproductive cough",
"worsening shortness of breath",
"appears ill",
"Pulse oximetry",
"room air shows",
"oxygen saturation",
"Laboratory studies show",
"CD4",
"T-lymphocyte",
"67 mm3",
"N",
"500 mm3",
"elevated ... |
A 40-year-old woman brings her 2-day-old infant to the pediatrician’s office for a routine checkup. She tells the pediatrician that her baby vomits a greenish-yellow fluid after every feeding session. She has not been very successful in feeding him due to this problem. She also says that her baby has not passed stool s... | Trisomy | {
"A": "Trisomy",
"B": "Genomic imprinting",
"C": "Anticipation",
"D": "Monosomy"
} | step2&3 | A | [
"40 year old woman",
"her 2 day old infant",
"pediatricians office",
"routine checkup",
"pediatrician",
"baby vomits",
"yellow fluid",
"feeding session",
"not",
"very successful",
"feeding",
"due to",
"problem",
"baby",
"not passed stool",
"left",
"hospital",
"examination",
"pedi... |
A 6-year-old girl is brought to the clinic by her mother with fever, sore throat, and a rash. The patient’s mother says that her symptoms started 3 days ago with a high-grade fever, sore throat, vomiting, and malaise. Twenty-four hours later, she says a rash appeared on the patient’s neck and, over the next 24 hours, s... | Rapid antigen test | {
"A": "Rapid antigen test",
"B": "PCR",
"C": "Serum CRP and ESR",
"D": "Serology for IgM and IgG antibodies"
} | step2&3 | A | [
"year old girl",
"brought",
"clinic",
"mother",
"fever",
"sore throat",
"rash",
"patients mother",
"symptoms started 3 days",
"high-grade fever",
"sore throat",
"vomiting",
"malaise",
"Twenty-four hours later",
"rash appeared",
"patients neck",
"next 24 hours",
"spread",
"trunk",... |
A 70-year-old man comes to the physician for evaluation of worsening nocturia, fatigue, and shortness of breath on exertion. While he used to be able to walk for 15 minutes at a time, he now has to pause every 5 minutes. Recently, he has started using two pillows to avoid waking up short of breath at night. He has a hi... | Constriction of efferent renal arterioles | {
"A": "Constriction of efferent renal arterioles",
"B": "Decrease in total peripheral vascular resistance",
"C": "Reduction of alveolar surface tension",
"D": "Retention of potassium"
} | step1 | A | [
"70 year old man",
"physician",
"evaluation",
"worsening nocturia",
"fatigue",
"shortness of breath",
"exertion",
"used to",
"able to walk",
"15 minutes",
"time",
"now",
"to pause",
"5 minutes",
"Recently",
"started using two pillows to",
"waking",
"short of breath at night",
"hi... |
A 31-year-old woman is brought to the emergency department because of a severe right-sided temporal headache with conjunctival swelling and anterior bulging of the left eye for 1 hour. The patient has had right-sided purulent nasal discharge and nasal congestion for the past 2 days. There is no personal or family histo... | Intravenous vancomycin, ceftriaxone, and metronidazole | {
"A": "Intranasal sumatriptan",
"B": "Surgical debridement",
"C": "Intravenous vancomycin, ceftriaxone, and metronidazole",
"D": "Intravenous dihydroergotamine\n\""
} | step2&3 | C | [
"31 year old woman",
"brought",
"emergency department",
"of",
"severe right-sided temporal headache",
"conjunctival swelling",
"anterior bulging",
"left eye",
"1 hour",
"patient",
"right-sided purulent nasal discharge",
"nasal congestion",
"past 2 days",
"personal",
"family history",
"... |
A 25-year-old woman presents to her primary care physician with complaints of chronic congestion. She notes that she has always had trouble breathing through her nose, and her new husband has told her that she breathes loudly when she sleeps. She denies frequent infections or allergies. She has no chronic medical probl... | Deep sedation | {
"A": "Minimal sedation",
"B": "Epidural anesthesia",
"C": "Deep sedation",
"D": "Dissociation"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"complaints",
"chronic congestion",
"notes",
"always",
"breathing",
"nose",
"new husband",
"sleeps",
"denies frequent infections",
"allergies",
"chronic medical problems",
"takes",
"medications",
"Family history",
"blood pressure",... |
A 45-year-old woman comes to the physician’s office with complaints of clumsiness. She feels like she is tripping over her feet more often, and she recently fell and sprained her wrist. Her medical history is significant for well-controlled diabetes. She has been a strict vegan for over 20 years. She lives at home with... | Fasciculus gracilis | {
"A": "Fasciculus gracilis",
"B": "Fasciculus cuneatus",
"C": "Vestibulospinal",
"D": "Anterior spinothalamic tract"
} | step1 | A | [
"year old woman",
"physicians office",
"complaints",
"clumsiness",
"feels",
"tripping",
"feet",
"often",
"recently fell",
"sprained",
"wrist",
"medical history",
"significant",
"well-controlled diabetes",
"vegan",
"20 years",
"lives at home",
"husband",
"two children",
"exam",
... |
A 28-year-old man is brought to the emergency department by ambulance after being hit in the head with a baseball bat. Physical examination shows swelling and bruising around the left temple and eye. A CT scan of the head shows a transverse fracture through the sphenoid bone and blood in the sphenoid sinus. Neurologica... | Inward deviation of the left eye | {
"A": "Inward deviation of the left eye",
"B": "Left facial paralysis",
"C": "Decreased hearing in the left ear",
"D": "Deviation of uvula to the right"
} | step1 | A | [
"year old man",
"brought",
"emergency department",
"ambulance",
"hit",
"head",
"baseball bat",
"Physical examination shows swelling",
"bruising",
"left temple",
"eye",
"CT scan of",
"head shows",
"transverse fracture",
"sphenoid bone",
"blood",
"sphenoid sinus",
"Neurological",
"... |
A mother brings her son to the pediatrician because she is concerned about his health. She states that throughout her child's life he has demonstrated aggressive behavior. However, he has recently begun biting himself causing injury and bleeding. The patient has a past medical history of mental retardation and episodes... | X-linked recessive | {
"A": "Autosomal recessive",
"B": "Maternal",
"C": "X-linked dominant",
"D": "X-linked recessive"
} | step1 | D | [
"mother",
"son",
"pediatrician",
"concerned",
"health",
"states",
"child's life",
"aggressive behavior",
"recently begun biting",
"causing injury",
"bleeding",
"patient",
"past medical mental retardation",
"episodes of severe joint pain",
"temperature",
"99",
"blood pressure",
"87 ... |
A 44-year-old woman is brought to the emergency department for confusion and lethargy for the past 2 hours. Per the husband, the patient was behaving weirdly and forgot how to get to the bathroom at her house. She was also difficult to wake up from her nap. The husband denies any fever, weight loss, headaches, dizzines... | Increase the serum sodium slowly with hypertonic saline solution | {
"A": "Increase the serum potassium with potassium solution",
"B": "Increase the serum sodium slowly with hypertonic saline solution",
"C": "Increase the serum sodium slowly with normal saline solution",
"D": "Start patient on maintenance anti-epileptic medications"
} | step1 | B | [
"year old woman",
"brought",
"emergency department",
"confusion",
"lethargy",
"past",
"hours",
"husband",
"patient",
"forgot",
"to get",
"bathroom",
"house",
"difficult",
"wake up",
"nap",
"husband denies",
"fever",
"weight loss",
"headaches",
"dizziness",
"chest pain",
"... |
A 65-year-old woman is brought to the emergency department because of left wrist pain and swelling that began after she fell from a seated position. Menopause occurred 15 years ago. Her serum parathyroid hormone level is within normal limits. An x-ray of the left wrist shows a nondisplaced fracture of the distal radial... | Pyrophosphate
" | {
"A": "Inositol",
"B": "Keratan sulfate",
"C": "Hydroxyapatite",
"D": "Pyrophosphate\n\""
} | step1 | D | [
"65 year old woman",
"brought",
"emergency department",
"left",
"swelling",
"began",
"fell",
"seated position",
"Menopause occurred",
"years",
"serum parathyroid hormone level",
"normal limits",
"x-ray of",
"left wrist shows",
"nondisplaced fracture",
"distal radial metaphysis",
"dec... |
A 64-year-old man presents to his primary care physician for 4 weeks of recurrent fever, night sweats, malaise, and fatigue. Associated with shortness of breath and orthopnea. Family and personal history are unremarkable. Upon physical examination, he is found with a blood pressure of 100/68 mm Hg, a heart rate of 98/m... | Mitral valve prolapse | {
"A": "Rheumatic heart disease",
"B": "Systemic lupus erythematosus",
"C": "Mitral valve prolapse",
"D": "Pulmonary stenosis"
} | step1 | C | [
"64 year old man presents",
"primary care physician",
"4 weeks",
"recurrent fever",
"night sweats",
"malaise",
"fatigue",
"Associated with shortness of breath",
"orthopnea",
"Family",
"personal history",
"unremarkable",
"physical examination",
"found",
"blood pressure",
"100 68 mm Hg",... |
A 69-year-old woman presents to the clinic with one week of suicidal ideation. She has a history of depression that began after her husband passed away from a motor vehicle accident seven years ago. At the time, she attempted to overdose on over-the-counter pills, but was able to recover completely. Her depression had ... | Previous attempt | {
"A": "Female sex",
"B": "No spouse",
"C": "Firearm possession",
"D": "Previous attempt"
} | step1 | D | [
"69 year old woman presents",
"clinic",
"one week",
"suicidal ideation",
"history of depression",
"began",
"husband passed",
"motor vehicle accident seven years",
"time",
"attempted",
"overdose",
"over-the-counter pills",
"able to recover completely",
"depression",
"controlled",
"sertr... |
A 68-year-old woman presents to the emergency department for leg weakness. About 4 hours ago, she was out walking her dog when she had a sudden onset of left-leg weakness. She had no prior symptoms and noticed nothing else except that she was unable to move her left leg like she normally could. This weakness lasted for... | Transient ischemic attack | {
"A": "Acute limb ischemia",
"B": "Ischemic stroke",
"C": "Subarachnoid hemorrhage",
"D": "Transient ischemic attack"
} | step2&3 | D | [
"68 year old woman presents",
"emergency department",
"leg weakness",
"4 hours",
"out walking",
"dog",
"sudden onset of left-leg weakness",
"prior symptoms",
"else except",
"unable to move",
"left leg",
"weakness lasted",
"hours",
"resolved completely",
"car",
"emergency department",
... |
A 3-year-old boy is brought to the physician for the evaluation of recurrent skin lesions. The episodes of lesions started at the age of 3 months. He has also had several episodes of respiratory tract infections, enlarged lymph nodes, and recurrent fevers since birth. The boy attends daycare. The patient's immunization... | NADPH oxidase deficiency | {
"A": "Defective neutrophil chemotaxis",
"B": "NADPH oxidase deficiency",
"C": "Impaired repair of double-strand DNA breaks",
"D": "Impaired signaling to actin cytoskeleton reorganization"
} | step1 | B | [
"3 year old boy",
"brought",
"physician",
"evaluation",
"recurrent skin lesions",
"episodes of lesions started",
"age",
"months",
"several episodes of respiratory tract infections",
"enlarged lymph nodes",
"recurrent fevers",
"birth",
"boy attends daycare",
"patient's immunizations",
"da... |
A 16-year-old boy comes to the physician because of muscle weakness and cramps for 5 months. He becomes easily fatigued and has severe muscle pain and swelling after 15 minutes of playing basketball with his friends. The symptoms improve after a brief period of rest. After playing, he sometimes also has episodes of red... | Myophosphorylase deficiency | {
"A": "CTG repeat in the DMPK gene",
"B": "Acid maltase deficiency",
"C": "Medium-chain acyl-CoA dehydrogenase deficiency",
"D": "Myophosphorylase deficiency"
} | step1 | D | [
"year old boy",
"physician",
"muscle weakness",
"cramps",
"months",
"easily fatigued",
"severe muscle",
"swelling",
"15 minutes",
"playing basketball",
"friends",
"symptoms",
"brief period",
"rest",
"playing",
"sometimes",
"episodes of",
"brown urine",
"family history",
"seriou... |
A 43-year-old man hospitalized for acute pancreatitis develops a high-grade fever and productive cough with gelatinous sputum. A sample of his expectorated sputum is obtained and fixed to a microscope slide using heat. A crystal violet dye is applied to the slide, followed by an iodine solution, acetone solution, and l... | Peptidoglycan | {
"A": "Peptidoglycan",
"B": "Protein",
"C": "Mycolic acid",
"D": "Capsular polysaccharide"
} | step1 | A | [
"year old man hospitalized",
"acute pancreatitis",
"high-grade fever",
"productive cough",
"gelatinous sputum",
"sample",
"expectorated sputum",
"obtained",
"fixed",
"microscope using heat",
"crystal violet dye",
"applied",
"slide",
"followed by",
"iodine solution",
"acetone solution",... |
A previously healthy 32-year-old male comes to the emergency department because of a high-grade fever and malaise for 3 days. He has severe generalized joint and body pains refractory to acetaminophen. He also has a severe stabbing pain behind his eyes. He returned from a trip to Taiwan 1 week ago. He is sexually activ... | Mosquito repellent | {
"A": "Safe sexual practices",
"B": "Mosquito repellent",
"C": "Vaccination",
"D": "Frequent hand washing"
} | step2&3 | B | [
"healthy",
"year old male",
"emergency department",
"high-grade fever",
"malaise",
"3 days",
"severe generalized joint",
"body pains refractory",
"acetaminophen",
"severe stabbing pain",
"eyes",
"returned",
"trip",
"Taiwan",
"week",
"sexually active",
"uses condoms",
"temperature",... |
A 30-year-old woman presents to an urgent care center with progressively worsening cough and difficulty breathing. She has had similar prior episodes since childhood, one of which required intubation with mechanical ventilation. On physical exam, she appears anxious and diaphoretic, with diffuse wheezes and diminished ... | Beta-2 agonist | {
"A": "Beta-1 agonist",
"B": "Beta-1 antagonist",
"C": "Beta-2 agonist",
"D": "Beta-2 antagonist"
} | step1 | C | [
"30 year old woman presents",
"urgent care center",
"worsening cough",
"difficulty breathing",
"similar prior episodes",
"childhood",
"one",
"required intubation",
"mechanical ventilation",
"physical exam",
"appears anxious",
"diaphoretic",
"diffuse wheezes",
"diminished breath sounds",
... |
A 2-month-old boy is brought to the pediatrician by his parents after they notice that he had a “floppy” appearance, poor suckling, vomiting, and spontaneous generalized movements a few weeks after birth. The boy was born at home, and routine newborn screening was normal. On physical examination, the infant is hypotoni... | Dihydropteridine reductase | {
"A": "Dopamine hydroxylase",
"B": "Phenylethanolamine N-methyltransferase",
"C": "Phenylalanine hydroxylase",
"D": "Dihydropteridine reductase"
} | step1 | D | [
"2 month old boy",
"brought",
"pediatrician",
"parents",
"floppy appearance",
"poor",
"vomiting",
"spontaneous generalized",
"few weeks after birth",
"boy",
"born at home",
"routine newborn screening",
"normal",
"physical examination",
"infant",
"hypotonic",
"poor",
"hold",
"head... |
A 34-year-old G3P2 is admitted to the hospital at 32 weeks gestation with vaginal bleeding, which started 4 hours ago when she was taking a nap. She reports no pain or uterine contractions. The course of the current pregnancy has been uncomplicated. The two previous pregnancies resulted in cesarean sections. She did no... | Transvaginal ultrasound | {
"A": "Transvaginal ultrasound",
"B": "Digital cervical examination",
"C": "Coagulation studies",
"D": "Transabdominal ultrasound"
} | step2&3 | A | [
"year old",
"admitted",
"hospital",
"weeks gestation",
"vaginal bleeding",
"started 4 hours",
"taking",
"nap",
"reports",
"pain",
"uterine contractions",
"course",
"current pregnancy",
"uncomplicated",
"two previous pregnancies resulted",
"cesarean sections",
"not",
"scheduled ultr... |
A 44-year-old man comes to the physician for a routine health maintenance examination. He had not seen his primary care physician for 7 years. He has no complaints other than feeling easily fatigued. He has no significant medical history. He reports drinking half a pint of liquor a day. His temperature is 98.7°F (37.1°... | Hypersplenism | {
"A": "Bone marrow infiltration",
"B": "Uremia",
"C": "Hypersplenism",
"D": "Autoimmune antibodies"
} | step2&3 | C | [
"year old man",
"physician",
"routine health maintenance examination",
"not seen",
"primary care physician",
"years",
"complaints",
"feeling easily fatigued",
"significant medical history",
"reports drinking half",
"pint",
"liquor",
"day",
"temperature",
"98",
"pulse",
"65 min",
"r... |
A 70-year-old man comes to the emergency room for worsening leg pain and a rash consistent with wet gangrene. He has no history of skin infections but has type 2 diabetes mellitus and has smoked 2 packs of cigarettes daily for 20 years. Three days after admission, he becomes increasingly hypoxic and tachypneic. He is e... | Increase the positive end-expiratory pressure | {
"A": "Prone positioning of patient",
"B": "Increase the tidal volume",
"C": "Increase the positive end-expiratory pressure",
"D": "Transfusion of red blood cells"
} | step2&3 | C | [
"70 year old man",
"emergency room",
"worsening leg pain",
"rash consistent with wet gangrene",
"history of skin infections",
"type 2 diabetes mellitus",
"smoked 2 packs",
"cigarettes daily",
"20 years",
"Three days",
"admission",
"hypoxic",
"tachypneic",
"intubated",
"support",
"initi... |
Ultrasonography of the scrotum shows a 2-cm hypoechoic, homogeneous testicular mass with sharp margins. A CT scan of the abdomen shows a single enlarged para-aortic lymph node. Which of the following is the most appropriate next step in management? | Radical inguinal orchiectomy | {
"A": "Systemic polychemotherapy",
"B": "Scrotal orchiectomy",
"C": "Radical inguinal orchiectomy",
"D": "Open testicular biopsy"
} | step2&3 | C | [
"Ultrasonography of",
"scrotum shows",
"2",
"homogeneous testicular mass",
"sharp margins",
"CT scan",
"abdomen shows",
"single enlarged para-aortic lymph node",
"following",
"most appropriate next step",
"management"
] |
A 27-year-old woman is brought to the emergency department after sustaining a fall from her bicycle 1 hour ago. The patient was on her way to work as she lost her balance, hitting her head on the sidewalk. She had an initial loss of consciousness for a couple of minutes following the accident. She currently has nausea ... | Epidural hematoma | {
"A": "Ischemic stroke",
"B": "Intracerebral hemorrhage",
"C": "Idiopathic intracranial hypertension",
"D": "Epidural hematoma"
} | step2&3 | D | [
"27 year old woman",
"brought",
"emergency department",
"sustaining",
"fall",
"bicycle",
"hour",
"patient",
"to work",
"lost",
"balance",
"hitting",
"head",
"sidewalk",
"initial loss of consciousness",
"couple",
"minutes following",
"accident",
"currently",
"nausea",
"headach... |
A 32-year-old female with a history of depression presents to the emergency department after a suspected ingestion. She is confused, reporting blurry vision, and responding to visual hallucinations. Vital signs are as follows:
Temperature: 98.9 degrees Farenheit (37.2 Celsius)
Heart Rate: 105 bpm
Blood Pressure: 90/65... | Amitriptyline | {
"A": "Lithium",
"B": "Amitriptyline",
"C": "Paroxetine",
"D": "Quetiapine"
} | step1 | B | [
"year old female",
"history of depression presents",
"emergency department",
"suspected ingestion",
"confused",
"reporting blurry vision",
"visual hallucinations",
"Vital signs",
"follows",
"Temperature",
"98",
"degrees",
"Celsius",
"Heart Rate",
"Blood Pressure",
"90 65 mmHg Respirato... |
A 57-year-old man comes to the physician for a follow-up examination. During the last 6 months, he has had recurring pneumonia after undergoing a surgical operation. He reports that, when food has gone down his windpipe, he has not automatically coughed. Examination shows normal voluntary coughing, but an impaired coug... | Piriform recess | {
"A": "Infratemporal fossa",
"B": "Foramen magnum",
"C": "Piriform recess",
"D": "Parotid gland"
} | step1 | C | [
"57 year old man",
"physician",
"follow-up examination",
"last",
"months",
"recurring pneumonia",
"surgical operation",
"reports",
"food",
"windpipe",
"not automatically coughed",
"Examination shows normal voluntary coughing",
"impaired cough reflex",
"nerve responsible",
"patient's symp... |
A 26-year-old G6P1050 presents for evaluation of infertility. She and her husband have been trying to have a child for the past three years. Over that time period, the patient suffered five miscarriages. Her past medical history is significant for anemia, bipolar disorder, and a blood clot in her right lower extremity ... | Positive VDRL | {
"A": "Elevated TSH levels",
"B": "Autosomal dominant mutation in factor V",
"C": "Positive VDRL",
"D": "Positive antihistone antibodies"
} | step2&3 | C | [
"year old",
"presents",
"evaluation",
"infertility",
"husband",
"to",
"child",
"past three years",
"time period",
"patient suffered five miscarriages",
"past medical history",
"significant",
"anemia",
"bipolar disorder",
"blood clot",
"right lower extremity",
"occurred",
"first pre... |
A 22-year-old man with a history of schizophrenia presents to the emergency room escorted by police. The officers state that the patient was found at a local mall, threatening to harm people in the parking lot, screaming at them, and chasing them. The patient states that those people were agents of the government sent ... | Begin treatment due to patient's lack of decision making capacity. | {
"A": "Let the patient leave against medical advice.",
"B": "Wait for a psychiatrist to determine patient capacity.",
"C": "Begin treatment due to patient's lack of decision making capacity.",
"D": "Ask the police to escort the patient to jail."
} | step1 | C | [
"year old man",
"history of schizophrenia presents",
"emergency room escorted",
"police",
"officers state",
"patient",
"found",
"local mall",
"to",
"people",
"parking lot",
"screaming",
"patient states",
"people",
"agents",
"government sent to kill",
"patient",
"agitated",
"to",
... |
A 49-year-old man presents to his primary care physician complaining of heartburn and mild epigastric pain after eating for the past 6 months. He reports that his symptoms occur within an hour of eating a meal and persist for approximately an hour. He admits his symptoms have been progressively worsening. He recently b... | Omeprazole | {
"A": "24-hour pH monitoring",
"B": "Endoscopy",
"C": "Omeprazole",
"D": "Metoclopramide"
} | step2&3 | C | [
"year old man presents",
"primary care physician",
"heartburn",
"mild epigastric",
"eating",
"past 6 months",
"reports",
"symptoms occur",
"hour",
"eating",
"meal",
"approximately",
"hour",
"admits",
"symptoms",
"worsening",
"recently began",
"symptoms",
"supine position",
"eat... |
A 6-year-old boy is brought to the physician by his mother because of a 3-month history of episodic chest pain and shortness of breath on exertion. He is at the 99th percentile for height and 40th percentile for weight. Examination shows a high-arched palate, long and slender upper extremities, and elbows and knees tha... | Area F | {
"A": "Area A",
"B": "Area E",
"C": "Area F",
"D": "Area G"
} | step1 | C | [
"year old boy",
"brought",
"physician",
"mother",
"of",
"month history",
"episodic chest pain",
"shortness of breath",
"exertion",
"99th percentile",
"height",
"percentile",
"weight",
"Examination shows",
"high-arched palate",
"long",
"slender upper",
"elbows",
"knees",
"Cardia... |
A 12-year-old boy is brought to the emergency department by his parents after he was bitten by a friend's cat while playing at their house. The patient reports moderate pain of the right hand and wrist but has full range of motion and strength. He is up to date on his vaccinations and is generally healthy. His vitals a... | Amoxicillin-clavulanate | {
"A": "Ampicillin-sulbactam, surgical debridgment, and laceration closure",
"B": "Amoxicillin-clavulanate",
"C": "Amoxicillin-clavulanate and laceration closure",
"D": "Laceration closure"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"parents",
"bitten by",
"friend's cat",
"playing",
"house",
"patient reports moderate pain",
"right hand",
"wrist",
"full range of motion",
"strength",
"date",
"vaccinations",
"healthy",
"unremarkable",
"Physical exam reveals",
"... |
A 48-year-old man comes to the physician for the evaluation of dyspnea and cough. He was diagnosed with esophageal cancer 10 months ago, for which he received radiochemotherapy. He has a history of atopic dermatitis and has smoked one pack of cigarettes daily for 30 years. Auscultation of the lungs shows decreased brea... | Pulmonary fibrosis | {
"A": "Chronic bronchitis",
"B": "Allergic asthma",
"C": "Pulmonary fibrosis",
"D": "Pulmonary embolism"
} | step1 | C | [
"48 year old man",
"physician",
"evaluation",
"dyspnea",
"cough",
"diagnosed",
"esophageal cancer 10 months",
"received radiochemotherapy",
"history",
"atopic dermatitis",
"smoked one pack",
"cigarettes daily",
"30 years",
"Auscultation",
"lungs shows decreased breath sounds",
"Spirome... |
A 72-year-old woman presents to her primary care provider complaining of fatigue for the last 6 months. She can barely complete her morning chores before having to take a long break in her chair. She rarely climbs the stairs to the second floor of her house anymore because it is too tiring. Past medical history is sign... | Pernicious anemia | {
"A": "Lead poisoning",
"B": "Pernicious anemia",
"C": "Anemia due to chronic alcoholism",
"D": "Helicobacter pylori gastritis"
} | step1 | B | [
"72 year old woman presents",
"primary care provider",
"fatigue",
"last",
"months",
"complete",
"morning chores",
"to take",
"long break",
"chair",
"rarely climbs",
"stairs",
"second floor",
"house",
"tiring",
"Past medical history",
"significant",
"Hashimoto's thyroiditis",
"hyp... |
A 9-year-old boy is admitted to the hospital for placement of halo gravitational traction in order to treat his previously observed kyphoscoliosis. Specifically, he has a previously diagnosed curve that has gotten worse over time and now threatens to compromise his thoracic cavity. His past medical history is significa... | FGFR3 receptor | {
"A": "alpha-L iduronidase",
"B": "COL1A1 strand",
"C": "FGFR3 receptor",
"D": "SLC26A2 transporter"
} | step1 | C | [
"year old boy",
"admitted",
"hospital",
"placement",
"halo gravitational traction",
"order to treat",
"observed kyphoscoliosis",
"diagnosed curve",
"gotten worse",
"time",
"now",
"to compromise",
"thoracic cavity",
"past medical history",
"significant",
"short stature",
"5th percenti... |
While studying vesicular trafficking in mammalian epithelial cells, a scientist identified a specific protein that was responsible for contorting the plasma membrane to capture extracellular materials and forming endosomes. This protein also helps transport those endosomes from the trans-Golgi network to lysosomes. Whi... | Clathrin | {
"A": "Kinesin",
"B": "COPII",
"C": "Sar1",
"D": "Clathrin"
} | step1 | D | [
"studying vesicular trafficking",
"mammalian epithelial cells",
"scientist identified",
"specific protein",
"responsible",
"plasma membrane to",
"extracellular materials",
"forming endosomes",
"protein",
"helps transport",
"endosomes",
"trans-Golgi network",
"lysosomes",
"following",
"pr... |
An 11-year-old boy is brought to the physician for the evaluation of frequent falling. His mother reports that the patient has had increased difficulty walking over the last few months and has refused to eat solid foods for the past 2 weeks. He has met all developmental milestones. The patient has had multiple ear infe... | Expansion of GAA trinucleotide repeats | {
"A": "Expansion of GAA trinucleotide repeats",
"B": "Absence of dystrophin protein",
"C": "Duplication of PMP22 gene",
"D": "Defect of ATM protein\n\""
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"evaluation",
"frequent falling",
"mother reports",
"patient",
"increased difficulty walking",
"months",
"refused to eat solid foods",
"past 2 weeks",
"met",
"developmental milestones",
"patient",
"multiple ear infections",
"birth",
"temperatur... |
A 54-year-old man presents with 3 days of non-bloody and non-bilious emesis every time he eats or drinks. He has become progressively weaker and the emesis has not improved. He denies diarrhea, fever, or chills and thinks his symptoms may be related to a recent event that involved sampling many different foods. His tem... | Metabolic alkalosis and hypokalemia | {
"A": "Anion gap metabolic acidosis and hypokalemia",
"B": "Metabolic alkalosis and hypokalemia",
"C": "Non-anion gap metabolic acidosis and hypokalemia",
"D": "Respiratory acidosis and hyperkalemia"
} | step2&3 | B | [
"54 year old man presents",
"3 days",
"non bloody",
"non bilious emesis",
"time",
"eats",
"drinks",
"weaker",
"emesis",
"not improved",
"denies diarrhea",
"fever",
"chills",
"thinks",
"symptoms",
"related",
"recent event",
"involved sampling",
"different foods",
"temperature",
... |
A 27-year-old man comes to the physician because of a 2-month history of palpitations and shortness of breath on exertion. He has no history of serious illness. He does not smoke or use illicit drugs. His pulse is 90/min, respirations are 18/min, and blood pressure is 140/40 mm Hg. Cardiac examination shows a murmur al... | Increased left ventricular end-diastolic volume | {
"A": "Increased left ventricular end-diastolic volume",
"B": "Decreased left ventricular wall compliance",
"C": "Decreased left ventricular wall stress",
"D": "Increased right ventricular oxygen saturation"
} | step1 | A | [
"27 year old man",
"physician",
"of",
"2 month history",
"palpitations",
"shortness of breath",
"exertion",
"history",
"serious illness",
"not smoke",
"use illicit",
"pulse",
"90 min",
"respirations",
"min",
"blood pressure",
"40 mm Hg",
"Cardiac examination shows",
"murmur",
"... |
A 26-year-old woman is found wandering in the street at 3 AM in the morning shouting about a new cure for cancer. When interviewed in the psychiatric triage unit, she speaks rapidly without pauses and continues to boast of her upcoming contribution to science. When the physician attempts to interrupt her, she becomes a... | Atrialization of the right ventricle in the patient’s fetus | {
"A": "Tardive dyskinesia",
"B": "Atrialization of the right ventricle in the patient’s fetus",
"C": "Weight loss",
"D": "Stevens-Johnson syndrome"
} | step2&3 | B | [
"year old woman",
"found wandering",
"street",
"3",
"morning shouting",
"new cure",
"cancer",
"interviewed",
"psychiatric triage unit",
"speaks rapidly",
"pauses",
"continues",
"contribution",
"science",
"physician attempts to interrupt",
"angry",
"begins to shout",
"accomplishment... |
A 54-year-old man comes to the physician because of persistent right knee pain and swelling for 2 weeks. Six months ago, he had a total knee replacement because of osteoarthritis. His temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 139/84 mm Hg. Examination shows warmth and erythema of the righ... | Exopolysaccharides | {
"A": "Protein A",
"B": "Vi capsule",
"C": "Exopolysaccharides",
"D": "Cord factor"
} | step1 | C | [
"54 year old man",
"physician",
"persistent right",
"swelling",
"2 weeks",
"Six months",
"total knee replacement",
"of osteoarthritis",
"temperature",
"pulse",
"100 min",
"blood pressure",
"84 mm Hg",
"Examination shows warmth",
"erythema",
"right knee",
"range of motion",
"limited... |
Two days after coronary artery stent placement for a posterior myocardial infarction, a 70-year-old woman complains of difficulty breathing and retrosternal chest pain. She has a history of atrial fibrillation, for which she takes verapamil. Following stent placement, the patient was started on aspirin and clopidogrel.... | Chest compressions | {
"A": "Intravenous epinephrine therapy",
"B": "Chest compressions",
"C": "Coronary angiography",
"D": "Synchronized cardioversion"
} | step2&3 | B | [
"Two days",
"coronary artery stent placement",
"posterior myocardial infarction",
"70 year old woman",
"difficulty breathing",
"retrosternal chest pain",
"history of atrial fibrillation",
"takes verapamil",
"Following stent placement",
"patient",
"started",
"aspirin",
"clopidogrel",
"appea... |
Four weeks after starting hydrochlorothiazide, a 49-year-old man with hypertension comes to the physician because of muscle cramps and weakness. His home medications also include amlodipine. His blood pressure today is 176/87 mm Hg. Physical examination shows no abnormalities. The precordial leads of a 12-lead ECG are ... | Eplerenone | {
"A": "Torsemide",
"B": "Nifedipine",
"C": "Eplerenone",
"D": "Hydralazine"
} | step1 | C | [
"Four weeks",
"starting hydrochlorothiazide",
"year old man",
"hypertension",
"physician",
"muscle cramps",
"weakness",
"home medications",
"include amlodipine",
"blood pressure today",
"87 mm Hg",
"Physical examination shows",
"abnormalities",
"precordial leads",
"12-lead ECG",
"shown... |
A 47–year-old man presents to the emergency department with worsening weakness in the setting of persistent abdominal pain. The man arrived to the United States 6 months ago and has been working in a restaurant as a cook. His abdominal pain started 4 months ago, but he could not find time away from work to see a doctor... | Amoxicillin, clarithromycin, and pantoprazole | {
"A": "Amoxicillin, clarithromycin, and pantoprazole",
"B": "Full thickness biopsy",
"C": "Hospice care",
"D": "Partial gastrectomy"
} | step2&3 | A | [
"old man presents",
"emergency department",
"worsening weakness",
"setting",
"persistent abdominal pain",
"man arrived",
"United States",
"months",
"working",
"restaurant",
"cook",
"abdominal pain started 4 months",
"not find time",
"work to see",
"doctor",
"reports nausea",
"denies"... |
A hospital committee is established in order to respond to a national report on the dangers of wrong site surgery. The committee decides to conduct an investigation using a method that will hopefully prevent wrong site surgery from occurring prior to having any incidents. Therefore, the committee begins by analyzing sy... | Failure modes | {
"A": "Failure modes",
"B": "Plan do study act cycles",
"C": "Root causes",
"D": "Simplification"
} | step1 | A | [
"hospital committee",
"established",
"order to",
"national report",
"wrong site surgery",
"committee",
"to conduct",
"investigation using",
"method",
"prevent wrong site surgery",
"occurring prior to",
"incidents",
"committee begins",
"systemic",
"design",
"process",
"service issues"... |
A 45-year-old man visits a psychiatrist with his wife asking for help with their ongoing family problem. The couple has been married for 20 years and the last 2 months the patient is fully convinced that his wife is cheating on him. He has hired numerous private investigators, who deny any such evidence for an extramar... | Delusions must be non-bizarre | {
"A": "Daily functioning must be impaired",
"B": "Delusions must be non-bizarre",
"C": "Must have active symptoms for 1 month followed by 6 months total duration",
"D": "Must have 1 symptom from the core domain"
} | step1 | B | [
"year old man visits",
"psychiatrist",
"wife",
"help",
"ongoing family problem",
"couple",
"married",
"20 years",
"last",
"months",
"patient",
"wife",
"cheating",
"hired numerous private investigators",
"deny",
"evidence",
"extramarital affair",
"persistent belief",
"begun",
"s... |
A 3-year-old boy is brought to the emergency department because of pain and swelling of his right knee joint for 1 day. He has not had any trauma to the knee. He was born at term and has been healthy since. His maternal uncle has a history of a bleeding disorder. His temperature is 37.1°C (98.8°F) and pulse is 97/min. ... | Prolonged partial thromboplastin time | {
"A": "Decreased platelet count",
"B": "Prolonged partial thromboplastin time",
"C": "Elevated erythrocyte sedimentation rate",
"D": "Elevated antinuclear antibody levels"
} | step2&3 | B | [
"3 year old boy",
"brought",
"emergency department",
"pain",
"swelling of",
"right knee joint",
"1 day",
"not",
"trauma",
"knee",
"born",
"term",
"healthy",
"maternal uncle",
"history of",
"bleeding disorder",
"temperature",
"98",
"pulse",
"97 min",
"right knee",
"erythemat... |
A 32-year-old man recently visiting from Thailand presents with diarrhea and fatigue for the past 6 days, which began before leaving Thailand. The patient denies any recent history of laxatives, nausea, or vomiting. His vital signs include: blood pressure 80/50 mm Hg, heart rate 105/min, and temperature 37.7°C (99.8°F)... | Secretory diarrhea | {
"A": "Secretory diarrhea",
"B": "Invasive diarrhea",
"C": "Osmotic diarrhea",
"D": "Steatorrhea"
} | step1 | A | [
"year old man recently visiting",
"Thailand presents",
"diarrhea",
"fatigue",
"past 6 days",
"began before leaving Thailand",
"patient denies",
"recent history",
"laxatives",
"nausea",
"vomiting",
"vital signs include",
"blood pressure 80 50 mm Hg",
"heart rate",
"min",
"temperature",
... |
A 28-year-old woman with HIV comes to the physician because of an 8-day history of severe pain while swallowing. She has been hospitalized several times with opportunistic infections and has poor adherence to her antiretroviral drug regimen. Endoscopy shows extensive, white, plaque-like lesions in the proximal esophagu... | Decreased glucan synthesis | {
"A": "Decreased DNA synthesis",
"B": "Binding to tubulin",
"C": "Decreased glucan synthesis",
"D": "Inhibition of squalene epoxidase"
} | step1 | C | [
"year old woman",
"HIV",
"physician",
"day history",
"severe pain",
"swallowing",
"hospitalized",
"times",
"opportunistic infections",
"poor adherence",
"antiretroviral drug regimen",
"Endoscopy shows extensive",
"white",
"plaque-like lesions",
"proximal esophagus",
"Culture of",
"bi... |
A study looking to examine the utility of colorectal cancer screening in patients younger than 50 is currently seeking subjects to enroll. A 49-year-old man with a family history of colorectal cancer is very interested in enrolling in the study, due to his own personal concerns about developing cancer. If enrolled in t... | Selection bias | {
"A": "Recall bias",
"B": "Lead-time bias",
"C": "Selection bias",
"D": "Length bias"
} | step2&3 | C | [
"study looking to",
"utility of colorectal cancer screening",
"patients younger",
"50",
"currently",
"subjects to",
"year",
"man",
"family history of colorectal cancer",
"very interested",
"study",
"due to",
"personal concerns",
"cancer",
"enrolled",
"study",
"following types",
"bi... |
A 43-year-old Hispanic woman was admitted to the emergency room with intermittent sharp and dull pain in the right lower quadrant for the past 2 days. The patient denies nausea, vomiting, diarrhea, or fever. She states that she was ‘completely normal’ prior to this sudden episode of pain. The patient states that she is... | The surgeon should obtain consent to biopsy the mass from the patient when she wakes up from cholecystectomy | {
"A": "The surgeon should resect the gastric mass",
"B": "The surgeon should obtain consent to biopsy the mass from the patient when she wakes up from cholecystectomy",
"C": "The surgeon should contact an ethics committee to obtain consent to biopsy the mass",
"D": "The surgeon should contact an attorney to ob... | step2&3 | B | [
"year old Hispanic woman",
"admitted",
"emergency room",
"intermittent sharp",
"dull pain",
"right lower quadrant",
"past 2 days",
"patient denies nausea",
"vomiting",
"diarrhea",
"fever",
"states",
"completely normal prior to",
"sudden episode of pain",
"patient states",
"sure",
"no... |
A previously healthy 35-year-old woman comes to the physician for a 3-week history of alternating constipation and diarrhea with blood in her stool. She has not had any fevers or weight loss. Her father died of gastric cancer at 50 years of age. Physical examination shows blue-gray macules on the lips and palms of both... | Hamartomatous | {
"A": "Adenomatous",
"B": "Mucosal",
"C": "Serrated",
"D": "Hamartomatous"
} | step1 | D | [
"healthy 35 year old woman",
"physician",
"3 week history",
"alternating constipation",
"diarrhea",
"blood",
"stool",
"not",
"fevers",
"weight loss",
"father died",
"gastric cancer",
"50 years",
"age",
"Physical examination shows blue gray macules",
"lips",
"palms of",
"hands",
"... |
A 55-year-old woman is brought to the emergency department due to sudden onset retrosternal chest pain. An ECG shows ST-segment elevation. A diagnosis of myocardial infarction is made and later confirmed by elevated levels of troponin I. The patient is sent to the cardiac catheter laboratory where she undergoes percuta... | Complication from femoral artery access | {
"A": "Complication from femoral artery access",
"B": "Fat embolism",
"C": "Patent ductus arteriosus",
"D": "Ventricular septal defect"
} | step1 | A | [
"55 year old woman",
"brought",
"emergency department",
"sudden onset retrosternal chest pain",
"ECG shows ST-segment elevation",
"diagnosis",
"myocardial infarction",
"made",
"later confirmed by elevated levels",
"troponin",
"patient",
"sent",
"cardiac catheter laboratory",
"percutaneous ... |
A 21-year-old man comes to the physician because of a 6-month history of severe abdominal pain, bloating, and episodic diarrhea. He has also had a 5-kg (11-lb) weight loss during this time. Physical examination shows a mildly distended abdomen, hyperactive bowel sounds, and diffuse abdominal tenderness. A biopsy specim... | Increased activity of type 1 T helper cells | {
"A": "Increased activity of type 1 T helper cells",
"B": "Ectopic secretion of serotonin",
"C": "Intestinal overgrowth of toxigenic bacteria",
"D": "Accumulation of intracellular bacteria in macrophages"
} | step1 | A | [
"21-year-old man",
"physician",
"month history",
"severe abdominal",
"bloating",
"episodic diarrhea",
"5 kg",
"weight loss",
"time",
"Physical examination shows",
"mildly distended abdomen",
"hyperactive bowel sounds",
"diffuse abdominal tenderness",
"biopsy specimen",
"colonic mucosa sh... |
A researcher needs to measure the volume of a specific body fluid compartment in subjects enrolled in his experiment. For such measurements, he injects an intravenous tracer into the subjects and then measures the concentration of the tracer in their blood samples. The volume of the specific body compartment will be ca... | Inulin | {
"A": "Albumin",
"B": "Heavy water (D2O)",
"C": "Inulin",
"D": "Urea"
} | step1 | C | [
"researcher needs to measure",
"volume of",
"specific body fluid compartment",
"subjects enrolled",
"experiment",
"measurements",
"injects",
"intravenous tracer",
"subjects",
"then measures",
"concentration",
"tracer",
"blood samples",
"volume",
"specific body",
"calculated using",
"... |
A 35-year-old woman comes to the physician because of swelling of her right breast for the past 4 days. She also reports malaise and some pain with breastfeeding. Three weeks ago, she delivered a healthy 3500-g (7.7-lb) girl. She has no history of serious illness. Her mother died of breast cancer at the age of 55 years... | Dicloxacillin and continued breastfeeding | {
"A": "Dicloxacillin and continued breastfeeding",
"B": "Continued breastfeeding, cold compresses, and ibuprofen",
"C": "Stop breastfeeding and perform mammography",
"D": "Stop breastfeeding and perform breast biopsy"
} | step2&3 | A | [
"35 year old woman",
"physician",
"of swelling",
"right breast",
"past",
"days",
"reports malaise",
"pain",
"breastfeeding",
"Three weeks",
"delivered",
"healthy 3500 g",
"girl",
"history",
"serious illness",
"mother died of breast cancer",
"age",
"55 years",
"only medication",
... |
A 19-year-old man presents to the office for a routine physical exam and a meningitis vaccination prior to attending college on a basketball scholarship. Also present at the appointment is his father who appears to be in his mid-sixties and is much shorter. The patient’s pulse is 70/min, respirations are 18/min, temper... | FBN1 | {
"A": "COL3A1",
"B": "ELN",
"C": "FBN1",
"D": "IT15"
} | step1 | C | [
"year old man presents",
"office",
"routine physical exam",
"meningitis vaccination prior to attending college",
"basketball scholarship",
"present",
"appointment",
"father",
"appears to",
"mid sixties",
"much shorter",
"patients pulse",
"70 min",
"respirations",
"min",
"temperature",
... |
A 68-year-old man comes to the physician 3 months after noticing skin changes on his scalp. When he scrapes off the crust of the lesion, it reappears after a few days. Occasionally, his scalp itches or he notices a burning sensation. He had a mole removed on his right forearm 5 years ago. He is a retired winemaker. His... | Actinic keratosis | {
"A": "Keratoacanthoma",
"B": "Actinic keratosis",
"C": "Bowen disease",
"D": "Amelanotic melanoma"
} | step2&3 | B | [
"68 year old man",
"physician",
"months",
"skin changes",
"scalp",
"scrapes",
"crust",
"lesion",
"days",
"Occasionally",
"scalp itches",
"burning sensation",
"mole removed",
"right forearm",
"years",
"retired",
"vital signs",
"normal limits",
"Examination shows multiple",
"patc... |
A 20-year-old G1P0 woman at 12 weeks estimated gestational age presents to the obstetric clinic for the first prenatal visit She admits to being unsure of whether to keep or abort the pregnancy but now has finally decided to keep it. She says she is experiencing constant fatigue. Physical examination reveals conjunctiv... | Pica | {
"A": "Pica",
"B": "Exercise tolerance",
"C": "Onychorrhexis",
"D": "Increased Transferrin Saturation"
} | step2&3 | A | [
"20 year old",
"woman",
"weeks estimated gestational age presents",
"obstetric clinic",
"first prenatal visit",
"admits to",
"unsure",
"to keep",
"abort",
"pregnancy",
"now",
"to keep",
"experiencing constant fatigue",
"Physical examination reveals conjunctival pallor",
"hemoglobin level... |
A 13-year-old male presents to his primary care provider with joint pain in his right knee. He has had multiple episodes of pain and effusion in both knees throughout his life as well as easy bruising. Most of these episodes followed minor trauma, including accidentally hitting his knee on a coffee table, but they occa... | Factor concentrate | {
"A": "Desmopressin",
"B": "Cryoprecipitate",
"C": "Factor concentrate",
"D": "Additional rest between symptomatic episodes"
} | step2&3 | C | [
"year old male presents",
"primary care provider",
"joint pain in",
"right knee",
"multiple episodes of pain",
"effusion",
"knees",
"life",
"easy bruising",
"of",
"episodes followed minor trauma",
"including",
"hitting",
"knee",
"coffee table",
"occasionally occurred",
"uncle",
"gr... |
A 13-year-old boy presents to the pediatrician with yellow discoloration of the sclerae since yesterday, and dark-colored urine for 2 days. A detailed history is taken and reveals that he had a cough, cold, and fever the week before the onset of the current symptoms, and was treated with over-the-counter medications. H... | Serum anti-HAV IgM antibody | {
"A": "Serum anti-HAV IgM antibody",
"B": "Plasma tyrosine and methionine",
"C": "Urine for reducing substances",
"D": "Percutaneous liver biopsy"
} | step2&3 | A | [
"year old boy presents",
"pediatrician",
"yellow",
"sclerae",
"dark-colored urine",
"2 days",
"detailed history",
"taken",
"reveals",
"cough",
"cold",
"fever",
"week",
"onset",
"current symptoms",
"treated with over-the-counter medications",
"reports",
"improvement",
"upper respi... |
A 4-year-old boy is brought to the emergency department because of fever, nausea, and headache for 1 day. His temperature is 39.7°C (103.5°F). Examination shows involuntary flexion of the knees and hips when the neck is flexed. A lumbar puncture is performed and cerebrospinal fluid (CSF) analysis shows numerous segment... | Adrenal insufficiency | {
"A": "Temporal lobe inflammation",
"B": "Acute pancreatitis",
"C": "Adrenal insufficiency",
"D": "Deep neck abscess"
} | step1 | C | [
"4 year old boy",
"brought",
"emergency department",
"fever",
"nausea",
"headache",
"1 day",
"temperature",
"Examination shows involuntary flexion of",
"knees",
"hips",
"neck",
"flexed",
"lumbar puncture",
"performed",
"cerebrospinal fluid",
"analysis shows numerous segmented neutrop... |
A 24-year-old woman presents with 3 days of diarrhea. She was recently on vacation in Peru and admits that on her last day of the trip she enjoyed a dinner of the local food and drink. Upon return to the United States the next day, she developed abdominal cramps and watery diarrhea, occurring about 3-5 times per day. S... | Unwashed fruits and vegetables | {
"A": "Raw oysters",
"B": "Fried rice",
"C": "Ground meat",
"D": "Unwashed fruits and vegetables"
} | step2&3 | D | [
"year old woman presents",
"3 days",
"diarrhea",
"recently",
"vacation",
"Peru",
"admits",
"last day",
"trip",
"enjoyed",
"dinner",
"local food",
"drink",
"return",
"United States",
"next day",
"abdominal cramps",
"watery diarrhea",
"occurring",
"times",
"day",
"not",
"bl... |
A 30-year-old woman, gravida 3, para 1, at 25 weeks' gestation comes to the physician because of mild itching of the vulva and anal region for 2 weeks. She has a history of 2 episodes of vulvovaginal candidiasis last year that both subsided following 1 week of treatment with butoconazole. Vital signs are within normal ... | Supportive therapy | {
"A": "Praziquantel",
"B": "Ivermectin",
"C": "Pyrantel pamoate",
"D": "Supportive therapy"
} | step2&3 | D | [
"30 year old woman",
"gravida 3",
"para 1",
"weeks",
"gestation",
"physician",
"of mild itching",
"vulva",
"anal region",
"2 weeks",
"history of",
"episodes",
"vulvovaginal candidiasis",
"year",
"following 1 week",
"treatment",
"butoconazole",
"Vital signs",
"normal limits",
"P... |
A 62-year-old healthy man is rushed into the emergency department after experiencing sharp chest pain that radiates down his left arm. Pre-hospital electrocardiography (ECG) shows ST-segment depression and the patient is administered supplemental oxygen, aspirin, and sublingual nitroglycerin. On arrival at the ER, the ... | Procainamide | {
"A": "Flecainide",
"B": "Mexiletine",
"C": "Procainamide",
"D": "Timolol"
} | step1 | C | [
"62 year old healthy man",
"rushed",
"emergency department",
"experiencing sharp chest pain",
"radiates",
"left arm",
"Pre hospital electrocardiography",
"shows ST-segment depression",
"patient",
"administered supplemental oxygen",
"aspirin",
"sublingual nitroglycerin",
"arrival",
"ER",
... |
A 44-year-old female is brought to the emergency room after losing consciousness at a shopping mall. Her husband states that they were shopping when the patient appeared sweaty and tremulous, became confused, then collapsed. She was unconscious for 5 minutes until a paramedic arrived. Fingerstick glucose at that time w... | Insulinoma | {
"A": "Insulinoma",
"B": "Sulfonylurea use",
"C": "Noninsulinoma pancreatogenous hypoglycemia syndrome (NIPHS)",
"D": "Primary adrenal insufficiency"
} | step2&3 | A | [
"year old female",
"brought",
"emergency room",
"consciousness",
"shopping mall",
"husband states",
"shopping",
"patient appeared sweaty",
"tremulous",
"confused",
"then collapsed",
"unconscious",
"5 minutes",
"paramedic arrived",
"Fingerstick glucose",
"time",
"31 mg/dL",
"intramu... |
A 55-year-old man with HIV on antiretroviral therapy comes to the physician for a follow-up examination. His HIV viral load is 559 copies/mL (N<49). His physician is concerned about the development of drug resistance. The result of HIV genotype testing shows reduced viral susceptibility to darunavir and ritonavir. Whic... | Modification of translated proteins | {
"A": "Integration of DNA into the host genome",
"B": "Binding of aminoacyl-tRNA to ribosomes",
"C": "Modification of translated proteins",
"D": "Binding of glycoproteins to T-cell receptors"
} | step1 | C | [
"55 year old man",
"HIV",
"antiretroviral therapy",
"physician",
"follow-up examination",
"HIV viral load",
"copies/mL",
"N",
"physician",
"concerned",
"development",
"drug resistance",
"result",
"HIV testing shows reduced viral susceptibility",
"darunavir",
"ritonavir",
"following m... |
A 38-year-old man comes to the physician because of fever, malaise, productive cough, and left-sided chest pain for 2 weeks. During this time, he has woken up to a wet pillow in the morning on multiple occasions and has not been as hungry as usual. He was diagnosed with HIV infection 1 year ago. He currently stays at a... | Pulmonary tuberculosis
" | {
"A": "Rheumatoid arthritis",
"B": "Pneumocystis jirovecii pneumonia",
"C": "Lung cancer",
"D": "Pulmonary tuberculosis\n\""
} | step2&3 | D | [
"year old man",
"physician",
"fever",
"malaise",
"productive cough",
"left-sided chest pain",
"weeks",
"time",
"woken up",
"wet pillow",
"morning",
"multiple occasions",
"not",
"hungry",
"usual",
"diagnosed",
"HIV infection 1 year",
"currently",
"homeless shelter",
"smoked one ... |
A 24-year-old female presents to her primary care physician with right knee pain for the last week. She states that she first noticed it after a long flight on her way back to the United States from Russia, where she had run a marathon along a mountain trail. The patient describes the pain as dull, aching, and localize... | Patellar compression with extended knee | {
"A": "MRI of the knee",
"B": "Ballotable patella test",
"C": "Patellar compression with extended knee",
"D": "Anterior drawer test"
} | step2&3 | C | [
"year old female presents",
"primary care physician",
"right",
"week",
"states",
"first",
"long flight",
"back",
"United States",
"Russia",
"run",
"marathon",
"mountain trail",
"patient",
"pain",
"dull",
"aching",
"localized",
"front",
"kneecap",
"worsens",
"sitting",
"im... |
A 27-year-old woman presents to your office complaining of right arm numbness and weakness. Her past medical history is unremarkable. Her family history, however, is significant for the unexpected death of both her parents at age 59 in a motor vehicle accident last week. On physical exam, her bicep, brachioradialis, an... | Conversion disorder | {
"A": "Conversion disorder",
"B": "Amyotrophic lateral sclerosis",
"C": "Arnold-Chiari malformation",
"D": "Multiple sclerosis"
} | step1 | A | [
"27 year old woman presents",
"office",
"right arm numbness",
"weakness",
"past medical history",
"unremarkable",
"family history",
"significant",
"unexpected death",
"parents",
"age 59",
"motor vehicle accident",
"week",
"physical exam",
"bicep",
"brachioradialis",
"patellar reflexe... |
A 22-year-old woman presents to the physician due to lightheadedness. Earlier in the day, she had her first job interview since graduating from college 3 months ago. While waiting outside the interviewer’s office, she began to feel nervous and started breathing really fast. She then felt as if she was going to faint. S... | Decreased arterial pCO2 | {
"A": "Decreased arterial pCO2",
"B": "Increased arterial pO2",
"C": "Decreased arterial pH",
"D": "Vagus nerve stimulation"
} | step1 | A | [
"year old woman presents",
"physician due to lightheadedness",
"Earlier",
"day",
"first job interview",
"graduating",
"college",
"months",
"waiting outside",
"interviewers office",
"began to feel nervous",
"started breathing",
"fast",
"then felt",
"faint",
"interview",
"requested",
... |
Twelve hours after undergoing a right hip revision surgery for infected prosthesis, a 74-year-old man has numbness in his fingertips and around the lips. His surgery was complicated by severe blood loss. He underwent a total right hip replacement 2 years ago. He has hypertension and type 2 diabetes mellitus. His father... | Multiple blood transfusions | {
"A": "Multiple blood transfusions",
"B": "Hypoparathyroidism",
"C": "Vitamin B12 deficiency",
"D": "Peripheral nerve injury"
} | step2&3 | A | [
"Twelve hours",
"right hip revision surgery for infected prosthesis",
"74 year old man",
"numbness",
"fingertips",
"lips",
"surgery",
"complicated",
"severe blood loss",
"total right hip replacement",
"years",
"hypertension",
"type 2 diabetes mellitus",
"father",
"hypoparathyroidism",
... |
Two days after undergoing emergent laparotomy with splenectomy for a grade IV splenic laceration sustained in a motor vehicle collision, a 54-year-old man develops decreased urinary output. His urine output is < 350 mL/day despite aggressive fluid resuscitation. During the emergent laparotomy, he required three units o... | Acute tubular necrosis | {
"A": "Acute tubular necrosis",
"B": "Focal segmental glomerulosclerosis",
"C": "Myorenal syndrome",
"D": "Acute renal infarction"
} | step2&3 | A | [
"Two days",
"emergent laparotomy",
"splenectomy",
"grade IV splenic laceration sustained",
"motor vehicle collision",
"54 year old man",
"decreased urinary output",
"urine output",
"350 mL/day",
"aggressive fluid resuscitation",
"emergent laparotomy",
"required three units",
"packed RBCs",
... |
A 34-year-old woman comes to the emergency department with midsternal chest pain, shortness of breath, and cough with bloody sputum for the past 3 hours. The pain started after moving furniture at home and worsens when taking deep breaths. The patient has a history of hypertension. She has smoked one pack of cigarettes... | Wedge-shaped filling defect on chest CT | {
"A": "Thrombus in the left atrium on TEE",
"B": "Wedge-shaped filling defect on chest CT",
"C": "Tracheal deviation on CXR",
"D": "Elevated serum CK-MB"
} | step2&3 | B | [
"year old woman",
"emergency department",
"chest pain",
"shortness of breath",
"cough",
"bloody",
"past",
"hours",
"pain started",
"moving furniture at home",
"worsens",
"taking deep breaths",
"patient",
"history of hypertension",
"smoked one pack",
"cigarettes daily",
"past 20 years... |
A 15-year-old girl presents to her primary care physician with her parents. She is complaining of fever and a sore throat for the past 4 days. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and is meeting all developmental milestones. Her boyfriend at school has th... | Epstein-Barr virus | {
"A": "Epstein-Barr virus",
"B": "Variola virus",
"C": "Cytomegalovirus",
"D": "Varicella virus"
} | step1 | A | [
"year old girl presents",
"primary care physician",
"parents",
"fever",
"sore throat",
"past 4 days",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"boyfriend",
"school",
"same symptoms including fever",
"sore th... |
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