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 52-year-old woman presents with decreased exercise tolerance and difficulty breathing on exertion and while sleeping at night. She says that she requires 2 pillows to sleep at night to alleviate her shortness of breath. These symptoms started 6 months ago and are gradually increasing in severity. She does not have an... | Cardiac arrhythmia | {
"A": "Infective endocarditis",
"B": "Myocarditis",
"C": "Cardiac arrhythmia",
"D": "High-output heart failure"
} | step2&3 | C | [
"year old woman presents",
"decreased exercise tolerance",
"difficulty breathing",
"exertion",
"sleeping",
"night",
"2 pillows to sleep",
"night to",
"shortness of breath",
"symptoms started",
"months",
"increasing",
"severity",
"not",
"chronic health problems",
"smoked",
"cigarettes... |
A 64-year-old man comes to the physician because of a 2-week history of intractable hiccups and shortness of breath on exertion. He also has a 1-month history of left shoulder pain. He has smoked one pack of cigarettes daily for 35 years. Physical examination shows decreased breath sounds at the left lung base. An x-ra... | Fibrous pericardium | {
"A": "Fibrous pericardium",
"B": "Serratus anterior muscle",
"C": "Vocal cords",
"D": "Ciliary muscle"
} | step1 | A | [
"64 year old man",
"physician",
"2-week history",
"intractable hiccups",
"shortness of breath",
"exertion",
"month history",
"left shoulder pain",
"smoked one pack",
"cigarettes daily",
"35 years",
"Physical examination shows decreased breath sounds",
"left lung base",
"x-ray of",
"chest... |
A 30-year-old woman, gravida 4, para 3, at 39 weeks' gestation comes to the hospital 20 minutes after the onset of vaginal bleeding. She has not received prenatal care. Her third child was delivered by lower segment transverse cesarean section because of a footling breech presentation. Her other two children were deliv... | Ruptured vasa previa | {
"A": "Placenta previa",
"B": "Placenta accreta",
"C": "Bloody show",
"D": "Ruptured vasa previa"
} | step2&3 | D | [
"30 year old woman",
"gravida 4",
"para 3",
"weeks",
"gestation",
"hospital 20 minutes",
"onset",
"vaginal bleeding",
"not received prenatal care",
"third child",
"delivered",
"lower segment transverse cesarean",
"footling breech presentation",
"two children",
"delivered",
"temperature... |
A male infant is born at 27 weeks following premature rupture of membranes and a precipitous labor to a G4P3 female. Given the speed of delivery steroids are not given. Shortly after delivery he develops respiratory distress and the decision is made to administer surfactant replacement therapy. While the components of ... | Phospholipids | {
"A": "Protein S",
"B": "Zinc finger protein",
"C": "Surfactant-associated proteins",
"D": "Phospholipids"
} | step1 | D | [
"male infant",
"born",
"27 weeks following premature rupture of membranes",
"precipitous labor",
"female",
"Given",
"speed of delivery steroids",
"not given",
"delivery",
"respiratory distress",
"decision",
"made",
"administer surfactant replacement therapy",
"components",
"surfactant us... |
A 66-year-old woman comes to the physician for a routine health maintenance examination. She has no history of serious medical illness and takes no medications. A screening DEXA scan shows a T-score of -1.5 at the femur. Which of the following is the strongest predisposing factor for osteopenia? | Smoking | {
"A": "Hypoparathyroidism",
"B": "NSAID use",
"C": "Obesity",
"D": "Smoking"
} | step1 | D | [
"66 year old woman",
"physician",
"routine health maintenance examination",
"history of serious medical illness",
"takes",
"medications",
"screening DEXA scan shows a T score",
"1",
"femur",
"following",
"strongest predisposing factor",
"osteopenia"
] |
A 68-year-old man presents to the emergency department with shortness of breath for the past 2 hours. He mentions that he had a cough, cold, and fever for the last 3 days and has taken an over-the-counter cold preparation. He is hypertensive and has had coronary artery disease for the last 7 years. His regular medicati... | Furosemide | {
"A": "Dobutamine",
"B": "Digoxin",
"C": "Furosemide",
"D": "Nitroglycerin"
} | step2&3 | C | [
"68 year old man presents",
"emergency department",
"shortness of breath",
"past",
"hours",
"cough",
"cold",
"fever",
"3 days",
"taken",
"over-the-counter cold preparation",
"hypertensive",
"coronary artery disease",
"years",
"regular medications include aspirin",
"ramipril",
"physic... |
A 34-year-old gravida 2, para 1 woman at 37+6 weeks of gestation presents for elective cesarean delivery. She says she has been having increased fatigue over the past few weeks. Past medical history includes gestational hypertension for which she has been taking an antihypertensive drug twice daily since week 24. Her v... | Drug-induced immune hemolytic reaction | {
"A": "Preeclampsia",
"B": "Hereditary spherocytosis",
"C": "HELLP syndrome",
"D": "Drug-induced immune hemolytic reaction"
} | step2&3 | D | [
"year old gravida 2",
"para woman",
"6 weeks of gestation presents",
"elective cesarean delivery",
"increased fatigue",
"past",
"weeks",
"Past medical history includes gestational hypertension",
"taking",
"antihypertensive drug twice daily",
"week",
"vital signs include",
"temperature 36",
... |
A 14-year-old boy is brought to the physician for evaluation of his tall stature. His father is 174 cm (5 ft 7 in) tall; his mother is 162 cm (5 ft 3 in) tall. He is at the 99th percentile for height and 88th percentile for BMI. Examination shows pronounced sweat stains below the armpits and broad hands and feet. There... | Increased serum insulin-like growth factor 1 | {
"A": "Circulating TSH receptor autoantibodies",
"B": "Increased serum insulin-like growth factor 1",
"C": "Tumor of the posterior pituitary gland",
"D": "Mutated growth hormone receptor"
} | step1 | B | [
"year old boy",
"brought",
"physician",
"evaluation",
"tall stature",
"father",
"5 ft",
"tall",
"mother",
"5 ft",
"tall",
"99th percentile",
"height",
"percentile",
"BMI",
"Examination shows",
"sweat stains",
"armpits",
"broad hands",
"feet",
"frontal bossing",
"protrusion"... |
Fifteen years ago, a physician was exposed to Mycobacterium tuberculosis during a medical mission trip to Haiti. A current CT scan of his chest reveals respiratory apical granulomas. The formation of this granuloma helped prevent the spread of the infection to other sites. Which pair of cells contributed to the walling... | TH1 cells and macrophages | {
"A": "TH1 cells and macrophages",
"B": "TH2 cells and macrophages",
"C": "TH1 cells and neutrophils",
"D": "CD8 T cells and NK cells"
} | step1 | A | [
"Fifteen years",
"physician",
"exposed",
"Mycobacterium tuberculosis",
"medical mission trip",
"Haiti",
"current CT scan of",
"chest reveals respiratory apical granulomas",
"formation",
"granuloma helped prevent",
"spread",
"infection",
"sites",
"pair",
"cells contributed",
"walling",
... |
A 63-year-old man comes to the physician because of a 3-week history of fatigue and shortness of breath. Physical examination shows diminished breath sounds at the right lung base. An x-ray of the chest shows blunting of the right costophrenic angle. Thoracentesis shows clear, yellow-colored fluid with a protein concen... | Congestive heart failure | {
"A": "Pulmonary tuberculosis",
"B": "Pulmonary sarcoidosis",
"C": "Congestive heart failure",
"D": "Bacterial pneumonia"
} | step1 | C | [
"63 year old man",
"physician",
"3 week history",
"fatigue",
"shortness of breath",
"Physical examination shows diminished breath sounds",
"right lung base",
"x-ray of",
"chest shows blunting",
"right costophrenic angle",
"Thoracentesis shows clear",
"yellow colored fluid",
"a protein concen... |
A 4-year-old boy is brought to the physician because of a 1-day history of passing small quantities of dark urine. Two weeks ago, he had fever, abdominal pain, and bloody diarrhea for several days that were treated with oral antibiotics. Physical examination shows pale conjunctivae and scleral icterus. His hemoglobin c... | Undercooked beef | {
"A": "Mushrooms",
"B": "Shellfish",
"C": "Raw pork",
"D": "Undercooked beef"
} | step1 | D | [
"4 year old boy",
"brought",
"physician",
"a 1-day history",
"small quantities",
"dark",
"Two weeks",
"fever",
"abdominal pain",
"bloody diarrhea",
"days",
"treated with oral antibiotics",
"Physical shows pale conjunctivae",
"scleral icterus",
"hemoglobin concentration",
"7.5 g/dL",
... |
A 45-year-old gentleman comes to his primary care physician complaining of redness and foul-smelling discharge from his penis. The patient is not married and denies sexual activity. Upon further questioning, he denies trauma or any associated fevers or chills. After the initial work-up was found to be negative for sexu... | Circumcision | {
"A": "Having frequent intercourse",
"B": "Smoking",
"C": "Circumcision",
"D": "UV light treatments for psoriasis"
} | step1 | C | [
"year old",
"primary care physician",
"redness",
"smelling discharge from",
"penis",
"patient",
"not married",
"denies sexual activity",
"further questioning",
"denies trauma",
"associated fevers",
"chills",
"initial work-up",
"found to",
"negative",
"sexually-transmitted diseases",
... |
A 21-year-old man seeks evaluation at an urgent care clinic because of nausea, vomiting, and abdominal pain that began 2 hours ago. He attended a picnic this afternoon, where he ate a cheese sandwich and potato salad. He says that a number of his friends who were at the picnic have similar symptoms, so he thinks the sy... | A toxin produced by a gram-positive, catalase-positive bacteria | {
"A": "A toxin produced by a gram-positive, catalase-positive bacteria",
"B": "Antigliadin antibody",
"C": "Gram-negative bacillus",
"D": "Gram-positive, catalase-negative bacteria"
} | step1 | A | [
"21-year-old man",
"evaluation",
"urgent care clinic",
"nausea",
"vomiting",
"abdominal pain",
"began 2 hours",
"attended",
"afternoon",
"ate",
"cheese sandwich",
"potato salad",
"number",
"friends",
"similar symptoms",
"thinks",
"symptoms",
"associated with",
"food",
"medical ... |
A 34-year-old woman is brought into the emergency department by emergency medical services after an electrical fire in her apartment. She is coughing with an O2 saturation of 98%, on 2L of nasal cannula. The patient's physical exam is significant for a burn on her right forearm that appears to be dry, white, and leathe... | Excision and grafting | {
"A": "Bacitracin",
"B": "Mafenide acetate",
"C": "Excision and grafting",
"D": "Amputation"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"emergency medical services",
"electrical fire",
"apartment",
"coughing",
"O2 saturation",
"98",
"nasal cannula",
"patient's",
"significant",
"burn",
"right forearm",
"appears to",
"dry",
"white",
"leathery",
"texture",
"puls... |
A 44-year-old female presents to her primary care physician complaining of fatigue. She reports a four-month history of increasing fatigue accompanied by occasional constipation. She also reports a 15-pound weight gain over the same time period. She is otherwise healthy and takes no medications. She has never been preg... | Lymphocytic infiltrate with germinal center formation | {
"A": "Large pleomorphic cells with vascular invasion and necrosis",
"B": "Randomly oriented papillae with pleomorphic cells and dense fibrosis",
"C": "Lymphocytic infiltrate with germinal center formation",
"D": "Hyperplasia and hypertrophy of follicular cells"
} | step1 | C | [
"year old female presents",
"primary care physician",
"fatigue",
"reports",
"four month history",
"increasing",
"occasional constipation",
"reports",
"pound weight gain",
"same time period",
"healthy",
"takes",
"medications",
"never",
"pregnant",
"physical examination",
"skin",
"dr... |
A 18-year-old woman presents to her primary care physician reporting that she has not experienced her first menses. She is accompanied by her mother who states that she personally experienced menstruation at age 12 and that the patient's sister started menstruating at the age of 11 years. The patient is not sexually-ac... | Anorexia nervosa | {
"A": "Anorexia nervosa",
"B": "Binge-eating disorder",
"C": "Illicit substance use",
"D": "Major depressive disorder"
} | step1 | A | [
"year old woman presents",
"primary care physician reporting",
"not experienced",
"first menses",
"mother",
"states",
"menstruation",
"age",
"patient's sister started",
"age",
"years",
"patient",
"not sexually-active",
"denies taking",
"medications",
"physical examination",
"patient ... |
A 3-day-old infant presents because the patient’s parents noticed that his skin was becoming yellow. The mother said that the patient eats well, has normal stool and urine color. It’s her first child from first healthy pregnancy. The patient was born on time and delivered via spontaneous vaginal delivery with no compli... | Crigler–Najjar syndrome type I | {
"A": "Crigler–Najjar syndrome type II",
"B": "Crigler–Najjar syndrome type I",
"C": "Hemolytic anemia",
"D": "Gilbert syndrome"
} | step1 | B | [
"3 day old infant presents",
"patients parents",
"skin",
"yellow",
"mother",
"patient eats well",
"normal stool",
"urine color",
"first child",
"healthy pregnancy",
"patient",
"born on time",
"delivered",
"spontaneous vaginal delivery",
"complications",
"Family history",
"significant... |
A 29-year-old woman, gravida 1, para 0 at 11 weeks' gestation comes to the physician because of a 2-day history of left lower extremity pain and swelling. Her temperature is 37.9°C (100.2°F). Physical examination shows a tender, palpable cord on the lateral aspect of the left lower leg. The overlying skin is erythemato... | Superficial thrombophlebitis | {
"A": "Deep vein thrombosis",
"B": "Erythema nodosum",
"C": "Varicose vein",
"D": "Superficial thrombophlebitis"
} | step1 | D | [
"29 year old woman",
"gravida 1",
"para 0",
"11 weeks",
"gestation",
"physician",
"2-day history",
"left",
"swelling",
"temperature",
"100",
"Physical examination shows",
"tender",
"palpable cord",
"lateral aspect of",
"left lower leg",
"skin",
"erythematous",
"indurated",
"Dup... |
A 2-year-old, previously healthy female presents to the emergency department complaining of 7 hours of 10/10 intermittent abdominal pain, vomiting, and dark red stools. On exam, there is tenderness to palpation in the right lower quadrant and high-pitched bowel sounds. Technetium-99m pertechnetate scan was performed (I... | It contains all the layers of the GI tract | {
"A": "It contains all the layers of the GI tract",
"B": "It typically affects females more than males",
"C": "It is a remnant of the allantois",
"D": "It is typically symptomatic"
} | step1 | A | [
"2 year old",
"healthy female presents",
"emergency department",
"hours",
"10",
"intermittent abdominal pain",
"vomiting",
"dark red stools",
"exam",
"tenderness",
"palpation",
"right lower quadrant",
"high-pitched bowel sounds",
"Technetium-99m pertechnetate scan",
"performed",
"Image... |
A 33-year-old woman comes to the physician because of constipation, abdominal pain, and decreased appetite for the past 2 months. She started a new diet and has been exercising 2 hours daily for several months in order to lose weight. She has a history of hypertension and hypothyroidism. She does not smoke or drink alc... | Vitamin D toxicity | {
"A": "Primary hypothyroidism",
"B": "Primary hyperparathyroidism",
"C": "Excess calcium carbonate intake",
"D": "Vitamin D toxicity"
} | step2&3 | D | [
"year old woman",
"physician",
"constipation",
"abdominal pain",
"decreased appetite",
"past",
"months",
"started",
"new diet",
"exercising 2 hours daily",
"months",
"order to",
"weight",
"history of hypertension",
"hypothyroidism",
"not smoke",
"drink alcohol",
"Current medication... |
A 22-year-old man presents with a painful right arm. He says the pain started several hours ago after he fell on his right shoulder while playing college football. He says that he felt a stinging sensation running down his right arm when he fell. On physical examination, there is a reduced range of motion of the right ... | Diplopia | {
"A": "Fever",
"B": "Increased appetite",
"C": "Diplopia",
"D": "Renal failure"
} | step1 | C | [
"year old man presents",
"painful right arm",
"pain started several hours",
"fell",
"right shoulder",
"playing college football",
"felt",
"stinging sensation running",
"right arm",
"fell",
"physical examination",
"reduced range of motion of",
"right arm",
"radiographs",
"shoulder confirm... |
An 8-year-old child is brought to the emergency department because of profuse diarrhea and vomiting that have lasted for 2 days. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory.... | String test | {
"A": "Mononuclear spot test",
"B": "String test",
"C": "Tzanck smear",
"D": "Catalase test"
} | step1 | B | [
"year old child",
"brought",
"emergency department",
"diarrhea",
"vomiting",
"lasted",
"2 days",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"Past medical history",
"family recently made",
"trip",
"I... |
A 9-year-old boy is brought to the hospital by his mother with complaints of fever and right flank pain for the past 3 days. His mom mentions that he has had these symptoms recurrently for the past 4 years. He was treated with antibiotics in the past and got better, but eventually, these symptoms recurred. On physical ... | Tubules containing eosinophilic casts | {
"A": "Normal glomeruli with accumulated lipid in proximal convoluted tubular cells",
"B": "Sloughed tubular cells within tubular lumen",
"C": "Tubules containing eosinophilic casts",
"D": "Polygonal clear cells with accumulated lipids and carbohydrates"
} | step1 | C | [
"year old boy",
"brought",
"hospital",
"mother",
"complaints",
"fever",
"right flank pain",
"past 3 days",
"mom",
"symptoms",
"past",
"years",
"treated with antibiotics",
"past",
"got better",
"symptoms recurred",
"physical examination",
"warm",
"touch",
"tenderness",
"right ... |
A 41-year-old woman presents for evaluation of a mild bloody vaginal discharge for the past 4 months. Bleeding increases after sexual intercourse. For the past few weeks, the patient also began to note an unpleasant odor. The patient has a regular 28-day menstrual cycle. Her husband has been her only sexual partner for... | Human papillomavirus infection | {
"A": "Hyperestrogenemia",
"B": "IUD complication",
"C": "Human papillomavirus infection",
"D": "Exposure to radioactive iodine"
} | step2&3 | C | [
"year old woman presents",
"evaluation",
"mild bloody vaginal discharge",
"past",
"months",
"Bleeding increases after sexual intercourse",
"past",
"weeks",
"patient",
"began to note",
"odor",
"patient",
"regular",
"day menstrual cycle",
"husband",
"only sexual partner",
"past",
"ye... |
A 6-year-old female from a rural village in Afghanistan presents with her mother to a local health center complaining of leg weakness. Her mother also reports that the patient had a fever, fatigue, and headache a week prior that resolved. The patient has not received any immunizations since being born. Her temperature ... | Non-enveloped (+) ssRNA virus | {
"A": "Non-enveloped (+) ssRNA virus",
"B": "Enveloped (+) ssRNA virus",
"C": "Non-enveloped (-) ssRNA virus",
"D": "dsRNA virus"
} | step1 | A | [
"year old female",
"rural village",
"Afghanistan presents",
"mother",
"local health",
"of leg weakness",
"mother",
"reports",
"patient",
"fever",
"fatigue",
"headache",
"week prior",
"resolved",
"patient",
"not received",
"immunizations",
"born",
"temperature",
"98",
"blood p... |
A 42-year-old man presents for evaluation of vitamin D deficiency with possible osteomalacia. The patient had a pathologic fracture 3 weeks ago and was found to have dangerously low levels of vitamin D with normal serum calcium levels. Bone density has been drastically affected, leading to the fracture this patient exp... | Calcitriol | {
"A": "Calcifediol",
"B": "Calcitriol",
"C": "Vitamin D binding protein",
"D": "PTH"
} | step1 | B | [
"year old man presents",
"evaluation",
"vitamin D deficiency",
"possible osteomalacia",
"patient",
"pathologic fracture",
"weeks",
"found to",
"low levels",
"vitamin D",
"normal serum calcium levels",
"Bone density",
"affected",
"leading",
"fracture",
"patient experienced",
"lack",
... |
A 49-year-old woman comes to the physician because of a 4-month history of a dry cough and shortness of breath on exertion. She also reports recurrent episodes of pain, stiffness, and swelling in her wrist and her left knee over the past 6 months. She had two miscarriages at age 24 and 28. Physical examination shows pa... | Decreased diffusing capacity | {
"A": "Decreased right atrial pressure",
"B": "Increased airway resistance",
"C": "Decreased diffusing capacity",
"D": "Increased lung compliance"
} | step1 | C | [
"year old woman",
"physician",
"4 month history",
"dry cough",
"shortness of breath",
"exertion",
"reports recurrent episodes of pain",
"stiffness",
"swelling",
"wrist",
"left knee",
"past 6 months",
"two miscarriages",
"age",
"Physical examination shows pallor",
"ulcerations",
"pala... |
A 35-year-old man is found in the wilderness behind a ski resort where he was lost for 2 days, and deprived of food and water. He is rushed to the emergency department for medical care. Which of the following parameters best describes his physiologic state when found? | Urine volume: decreased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): increased | {
"A": "Urine volume: decreased; urine osmolarity: increased; free water clearance: increased; antidiuretic hormone (ADH): increased",
"B": "Urine volume: decreased; urine osmolarity: increased; free water clearance: decreased; antidiuretic hormone (ADH): decreased",
"C": "Urine volume: decreased; urine osmolarit... | step1 | D | [
"35 year old man",
"found",
"wilderness",
"ski resort",
"lost",
"2 days",
"food",
"water",
"rushed",
"emergency department",
"medical care",
"following parameters best",
"physiologic state",
"found"
] |
A 72-year-old man presents to the emergency department for a change in his behavior. The patient's wife called 911 and he was brought in by emergency medical services. She noticed that he seemed somnolent and not very responsive. The patient has a past medical history of type II diabetes, obesity, osteoarthritis, and m... | Discontinue the patient's home medications | {
"A": "Potassium",
"B": "Bicarbonate",
"C": "Insulin and potassium",
"D": "Discontinue the patient's home medications"
} | step2&3 | D | [
"72 year old man presents",
"emergency department",
"change in",
"behavior",
"patient's wife called",
"brought",
"emergency medical services",
"somnolent",
"not very responsive",
"patient",
"a past medical type II diabetes",
"obesity",
"osteoarthritis",
"migraine headaches",
"current med... |
A 28-year-old man seeks evaluation at a medical office for facial swelling and blood in his urine during the last 3 days. He claims that he has had weakness, malaise, and low-grade fevers for the past 3 months. On physical examination, the blood pressure is 160/96 mm Hg and he has periorbital edema bilaterally. The lab... | Collagen type IV | {
"A": "Collagen type I",
"B": "Collagen type V",
"C": "Collagen type II",
"D": "Collagen type IV"
} | step1 | D | [
"year old man",
"evaluation",
"medical office",
"facial swelling",
"blood in",
"urine",
"last",
"days",
"weakness",
"malaise",
"low-grade fevers",
"past 3 months",
"physical examination",
"blood pressure",
"96 mm Hg",
"periorbital edema",
"lab testing",
"significant",
"leukocytos... |
A 64-year-old man is admitted with a history of altered mental status. He was in his usual state of health until a few days ago when he has started to become confused, lethargic, forgetful, and repeating the same questions. Over the last few days, he sometimes appears perfectly normal, and, at other times, he has diffi... | Delirium | {
"A": "Delirium",
"B": "Dementia",
"C": "Transient global amnesia",
"D": "Wernicke’s aphasia"
} | step2&3 | A | [
"64 year old man",
"admitted",
"history",
"altered mental status",
"usual state of health",
"few days",
"started to",
"confused",
"lethargic",
"forgetful",
"repeating",
"same questions",
"last",
"days",
"sometimes appears",
"normal",
"times",
"difficulty",
"family members",
"sc... |
A 43-year-old man presents with a severe, throbbing, left-sided headache for the last 2 hours. He says that the pain has been progressively worsening and is aggravated by movement. The patient says he has had similar episodes in the past and would take acetaminophen and ‘sleep it off’. He also complains that the light ... | 5-hydroxytryptamine type 1 (5-HT1) receptors | {
"A": "5-hydroxytryptamine type 1 (5-HT1) receptors",
"B": "Angiotensin II receptors",
"C": "5-hydroxytryptamine type 2 (5-HT2) receptors",
"D": "Muscarinic receptors"
} | step1 | A | [
"year old man presents",
"severe",
"throbbing",
"left-sided headache",
"hours",
"pain",
"worsening",
"aggravated",
"movement",
"patient",
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"past",
"take acetaminophen",
"sleep",
"light",
"room",
"bright",
"starting to feel nauseous",
"significant past medical h... |
A 27-year-old male with a history of injection drug use has been feeling short of breath and fatigued for the past several weeks. He is having trouble climbing the stairs to his apartment and occasionally feels like his heart is racing out of control. His past medical history is most notable for a previous bout of infe... | Widened pulse pressure | {
"A": "Mid-systolic click",
"B": "Venous hum",
"C": "Widened pulse pressure",
"D": "Systolic murmur that increases with valsalva"
} | step1 | C | [
"year old male",
"history of injection drug use",
"feeling short of breath",
"fatigued",
"past",
"weeks",
"climbing",
"stairs",
"apartment",
"occasionally feels",
"heart",
"racing out",
"control",
"past medical history",
"most notable",
"previous bout",
"infective endocarditis",
"l... |
Six hours after giving birth to a healthy 3100 g (6 lb 13oz) girl, a 40-year-old woman, gravida 1, para 1 suddenly has a tonic-clonic seizure for 2-minutes while on the ward. She had been complaining of headache, blurry vision, and abdominal pain for an hour before the incident. Her pregnancy was complicated by gestati... | Magnesium sulfate | {
"A": "Magnesium sulfate",
"B": "Valproic acid",
"C": "Hydralazine",
"D": "Phenytoin"
} | step2&3 | A | [
"Six hours",
"giving birth",
"healthy 3100 g",
"girl",
"40 year old woman",
"gravida 1",
"para 1",
"tonic-clonic seizure",
"minutes",
"ward",
"headache",
"blurry vision",
"abdominal pain",
"hour",
"incident",
"pregnancy",
"complicated",
"gestational",
"iron deficiency anemia",
... |
A 47-year-old woman comes to the emergency department 4 hours after the onset of abdominal and right shoulder pain. She has nausea and has had 2 episodes of vomiting. The pain began after her last meal, is constant, and she describes it as 7 out of 10 in intensity. She has had multiple similar episodes over the past 4 ... | Abdominal paracentesis | {
"A": "Intravenous vitamin K",
"B": "Abdominal paracentesis",
"C": "Laparoscopic cholecystectomy",
"D": "Open cholecystectomy"
} | step2&3 | B | [
"year old woman",
"emergency department",
"hours",
"onset",
"abdominal",
"right shoulder pain",
"nausea",
"2 episodes of vomiting",
"pain began",
"meal",
"constant",
"out",
"10",
"intensity",
"multiple similar episodes",
"past",
"months",
"resolved",
"drinks 2 pints",
"vodka da... |
A 22-year-old female presents to your clinic for evaluation of "skin problems." She complains of severe acne and "spots" all over her face that have persisted for the last 8 years, despite innumerable creams and lotions. She reports spending several hours every morning using make-up just to go outside. She wishes to le... | Major depressive disorder | {
"A": "Malingering",
"B": "Munchausen's syndrome",
"C": "Anorexia",
"D": "Major depressive disorder"
} | step1 | D | [
"year old female presents",
"clinic",
"evaluation",
"skin problems",
"severe acne",
"spots",
"face",
"years",
"creams",
"lotions",
"reports spending several hours",
"morning using make",
"to go outside",
"wishes to learn",
"cosmetic procedures",
"surgeries",
"problem",
"concern",
... |
Thirty minutes after surgical nasal polyp removal for refractory rhinitis, a 40-year-old man has retrosternal chest tightness and shortness of breath in the post-anesthesia care unit. The surgical course was uncomplicated and the patient was successfully extubated before arrival to the unit. He received 0.5 L of lactat... | Pseudoallergic reaction | {
"A": "Excessive beta-adrenergic blockade",
"B": "Alveolar rupture",
"C": "Pseudoallergic reaction",
"D": "Bradykinin-induced bronchial irritation"
} | step2&3 | C | [
"Thirty minutes",
"surgical nasal polyp removal",
"refractory rhinitis",
"40 year old man",
"retrosternal chest tightness",
"shortness of breath",
"post-anesthesia care unit",
"surgical course",
"uncomplicated",
"patient",
"extubated",
"arrival",
"unit",
"received 0.5 L",
"lactated Ringe... |
A healthy 28-year-old woman at 30-weeks gestational age, has gained 35lbs since becoming pregnant. She complains of several weeks of bilateral numbness and tingling of her palms, thumbs, index and middle fingers that is worse at night. She also notes weakness gripping objects at the office. Which nerve is most likely a... | Median nerve | {
"A": "Median nerve",
"B": "Ulnar nerve",
"C": "Radial nerve",
"D": "Anterior interosseous nerve"
} | step2&3 | A | [
"healthy",
"year old woman",
"30 weeks",
"gained",
"pregnant",
"weeks",
"bilateral numbness",
"tingling",
"palms",
"thumbs",
"index",
"middle fingers",
"worse",
"night",
"notes weakness gripping objects",
"office",
"nerve",
"most likely affected"
] |
A 67-year-old man comes to the emergency department complaining of severe abdominal pain for the last several hours. The pain is cramp-like in nature, constant, 8/10, and has worsened over time. It is associated with bilious vomiting. He gives a history of episodic right upper abdominal pain for the past few months, mo... | Cholelithiasis | {
"A": "Cholelithiasis",
"B": "Pancreatitis",
"C": "Peptic ulcer disease",
"D": "Intestinal adhesion"
} | step2&3 | A | [
"67 year old man",
"emergency department",
"severe abdominal",
"last",
"hours",
"pain",
"cramp",
"nature",
"constant",
"10",
"worsened",
"time",
"associated with bilious vomiting",
"gives",
"history of episodic right upper",
"past",
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"mostly",
"fatty foods",
"radiating... |
A 30-year-old woman comes to the physician because of severe headaches and lightheadedness for 2 months. She has also been hearing a 'swoosh' sound in her left ear for the past month. She has allergic rhinitis and acne. Her sister is being treated for thyroid cancer. Current medications include levocetirizine, topical ... | Elevated renin level | {
"A": "Increased 24-hour urine cortisol",
"B": "Abnormal breathing pattern at night",
"C": "Parathyroid adenoma",
"D": "Elevated renin level"
} | step2&3 | D | [
"30 year old woman",
"physician",
"severe headaches",
"lightheadedness",
"months",
"hearing",
"sound",
"left ear",
"past month",
"allergic rhinitis",
"acne",
"sister",
"treated",
"thyroid cancer",
"Current medications include levocetirizine",
"topical clindamycin",
"azelastine-flutic... |
A 76-year-old man presents with progressive fatigue, shortness of breath, and brownish discoloration of the urine for the past 5 weeks. Past medical history is significant for aortic valve replacement surgery 2 years ago. His vital signs include: temperature 36.7°C (98.0°F), blood pressure 130/85 mm Hg, pulse 87/min. P... | Schistocytes | {
"A": "Schistocytes",
"B": "Ringed sideroblasts",
"C": "Elliptocytes",
"D": "Target cells"
} | step2&3 | A | [
"76 year old man presents",
"progressive fatigue",
"shortness of breath",
"discoloration",
"urine",
"past",
"weeks",
"Past medical history",
"significant",
"aortic valve replacement surgery 2 years",
"vital signs include",
"temperature 36",
"98",
"blood pressure",
"85 mm Hg",
"pulse 87... |
A 28-year-old woman comes to a fertility clinic because she has been trying to conceive for over a year without success. She has never been pregnant, but her husband has 2 children from a previous marriage. She broke a collarbone during a skiing accident but has otherwise been healthy with no chronic conditions. On phy... | X-linked recessive | {
"A": "Autosomal recessive",
"B": "Extra chromosome",
"C": "Multiple genetic loci",
"D": "X-linked recessive"
} | step1 | D | [
"year old woman",
"fertility clinic",
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"success",
"never",
"pregnant",
"husband",
"2 children",
"previous marriage",
"broke",
"collarbone",
"skiing accident",
"healthy",
"chronic conditions",
"physical exam",
"found to",
"minimal pubic hair",
"suprapubic masses",
"... |
A 16-year-old girl is brought to the physician for recurrent episodes of shortness of breath, nonproductive cough, and chest tightness for 3 months. These episodes occur especially while playing sports and resolve spontaneously with rest. She appears healthy. Her pulse is 63/min, respirations are 15/min, and blood pres... | Albuterol before exercise | {
"A": "Albuterol before exercise",
"B": "Prednisone therapy",
"C": "Genetic testing",
"D": "Echocardiography"
} | step2&3 | A | [
"year old girl",
"brought",
"physician",
"recurrent episodes of shortness",
"breath",
"nonproductive cough",
"chest tightness",
"months",
"episodes occur",
"playing sports",
"resolve",
"rest",
"appears healthy",
"pulse",
"63 min",
"respirations",
"min",
"blood pressure",
"70 mm H... |
A 34-year-old woman with HIV comes to the emergency department because of a 2-week history of diarrhea and abdominal cramping. She has had up to 10 watery stools per day. She also has anorexia and nausea. She returned from a trip to Mexico 4 weeks ago where she went on two hiking trips and often drank from spring water... | Cryptosporidium parvum | {
"A": "Cytomegalovirus",
"B": "Entamoeba histolytica",
"C": "Giardia lamblia",
"D": "Cryptosporidium parvum"
} | step2&3 | D | [
"year old woman",
"HIV",
"emergency department",
"2-week history",
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"up to 10 watery stools",
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"Mexico",
"weeks",
"two hiking trips",
"often drank",
"spring water",
"diagnosed",
"HIV",
"years",
"... |
A 7-year-old girl is brought to the physician by her mother because of a 2-week history of generalized fatigue, intermittent fever, and progressively worsening shortness of breath. Physical examination shows pallor, jugular venous distention, and nontender cervical and axillary lymphadenopathy. Inspiratory stridor is h... | Positive CD3/CD7 staining | {
"A": "t(8;14) translocation",
"B": "Positive myeloperoxidase staining",
"C": "t(9;22) translocation",
"D": "Positive CD3/CD7 staining"
} | step1 | D | [
"year old girl",
"brought",
"physician",
"mother",
"2-week history",
"generalized fatigue",
"intermittent fever",
"worsening shortness of breath",
"Physical examination shows pallor",
"jugular venous distention",
"nontender cervical",
"axillary lymphadenopathy",
"Inspiratory stridor",
"hea... |
A 67-year-old man is brought to the emergency room after being involved in a traffic accident. He currently complains of bilateral hip pain. His vital signs are within the normal range, and he is hemodynamically stable. The pelvic compression test is positive. External genitalia appears normal, except there is blood at... | Obtain a retrograde urethrogram (RUG), including a pre-injection kidney, ureter, and bladder (KUB) film | {
"A": "Obtain a retrograde urethrogram (RUG), including a pre-injection kidney, ureter, and bladder (KUB) film",
"B": "Insert a Foley catheter",
"C": "Perform a suprapubic cystostomy",
"D": "Take the patient emergently to the operating room and check for a urethral injury with IV indigo carmine"
} | step2&3 | A | [
"67 year old man",
"brought",
"emergency room",
"involved",
"traffic accident",
"currently",
"bilateral hip pain",
"vital signs",
"normal range",
"hemodynamically stable",
"pelvic compression test",
"positive",
"External genitalia appears normal",
"blood",
"urethral meatus",
"contusion... |
A 73-year-old woman visits an urgent care clinic with a complaint of fever for the past 48 hours. She has been having frequent chills and increasing abdominal pain since her fever spiked to 39.4°C (103.0°F) at home. She states that abdominal pain is constant, non-radiating, and rates the pain as a 4/10. She also compla... | Ascending cholangitis | {
"A": "Ascending cholangitis",
"B": "Liver abscess",
"C": "Cholecystitis",
"D": "Appendicitis"
} | step1 | A | [
"year old woman visits",
"urgent care clinic",
"complaint",
"fever",
"past 48 hours",
"frequent chills",
"increasing abdominal pain",
"fever",
"4C",
"at home",
"states",
"abdominal pain",
"constant",
"non radiating",
"rates",
"pain",
"4/10",
"malaise",
"fatigue",
"past medical ... |
A 52-year-old man visits his primary care provider for a routine check-up. He reports he has always had trouble sleeping, but falling asleep and staying asleep have become more difficult over the past few months. He experiences daytime fatigue and sleepiness but does not have time to nap. He drinks one cup of coffee in... | Inhibits REM | {
"A": "Increases stage N1",
"B": "REM (rapid eye movement) rebound",
"C": "Inhibits REM",
"D": "Increases total REM sleep"
} | step2&3 | C | [
"year old man visits",
"primary care provider",
"routine check-up",
"reports",
"always",
"trouble sleeping",
"falling asleep",
"asleep",
"more difficult",
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"months",
"experiences daytime fatigue",
"sleepiness",
"not",
"time",
"nap",
"drinks one cup",
"coffee",
"morning",
... |
A 15-year-old African-American male with a BMI of 22 is brought to his physician by his mother to address concerns about a change in his dietary habits. The patient's mother notes that he is constantly hungry and thirsty, despite his eating and drinking water in excess. She also reports an increase in his use of the ba... | Insulitis | {
"A": "Insulitis",
"B": "Pancreatic islet hyperplasia and hypertrophy",
"C": "The patient's weight",
"D": "Insensitivity to insulin"
} | step1 | A | [
"year old African-American male",
"BMI",
"brought",
"physician",
"mother to address concerns",
"change",
"dietary habits",
"patient's mother notes",
"constantly hungry",
"thirsty",
"eating",
"drinking water",
"excess",
"reports",
"increase",
"use of",
"bathroom",
"physician begins"... |
A 10-month-old boy is brought to his pediatrician because of a 3-day history of fever and lethargy. He has previously had more infections than expected since birth but otherwise appears to be developing normally. On exam, the boy is found to have a purulent, erythematous bump on his left upper extremity. This lesion is... | HMP shunt | {
"A": "Beta oxidation",
"B": "Citric acid cycle",
"C": "Gluconeogenesis",
"D": "HMP shunt"
} | step1 | D | [
"A 10 month old boy",
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"pediatrician",
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"fever",
"lethargy",
"more infections",
"expected",
"birth",
"appears to",
"exam",
"boy",
"found to",
"purulent",
"erythematous",
"left upper extremity",
"lesion",
"cultured",
"found to",
"catalase positive",
"... |
A 55-year-old woman comes to the emergency department because of a 24-hour history of severe lower abdominal pain. She has had two episodes of nonbloody vomiting today and has been unable to keep down food or fluids. She has not had a bowel movement since the day before. She has hypertension, hyperlipidemia, and osteoa... | CT scan of the abdomen with contrast | {
"A": "Abdominal ultrasound",
"B": "Flexible sigmoidoscopy",
"C": "CT scan of the abdomen with contrast",
"D": "Abdominal x-ray"
} | step2&3 | C | [
"55 year old woman",
"emergency department",
"hour history",
"severe lower abdominal pain",
"two episodes of",
"vomiting today",
"unable to keep",
"food",
"fluids",
"not",
"bowel movement",
"day",
"hypertension",
"hyperlipidemia",
"osteoarthritis",
"cholecystectomy",
"years",
"smok... |
A 70-year-old man without recent travel history presents a 2-week history of gradually worsening abdominal pruritus. He is unsure if his skin has yellowed, and carries an identification card without a photograph for comparison. On physical examination, the liver morphology is normal. A basic chemistry panel reveal sodi... | Portal vein thrombosis | {
"A": "Portal vein thrombosis",
"B": "Postherpetic neuralgia",
"C": "Polycythemia vera",
"D": "Lichen planus"
} | step2&3 | A | [
"70 year old man",
"recent travel history presents",
"2-week history",
"worsening abdominal pruritus",
"unsure",
"skin",
"yellowed",
"carries",
"identification card",
"photograph",
"comparison",
"physical examination",
"liver morphology",
"normal",
"basic chemistry panel reveal sodium",
... |
A 5-year-old girl presents for a routine checkup. The patient’s parents say she has been looking pale and tired lately. Her family history is unremarkable. Upon physical examination, several bruises are seen, as well as petechial bleeding on her limbs. A complete blood count shows leukocytosis with severe anemia and th... | Acute lymphoblastic leukemia | {
"A": "Acute lymphoblastic leukemia",
"B": "Chronic lymphocytic leukemia",
"C": "Aplastic anemia",
"D": "Chronic myeloid leukemia"
} | step1 | A | [
"5 year old girl presents",
"routine checkup",
"patients parents",
"looking pale",
"tired",
"family history",
"unremarkable",
"physical examination",
"several bruises",
"seen",
"petechial bleeding",
"limbs",
"complete blood count shows leukocytosis",
"severe anemia",
"thrombocytopenia",
... |
A 44-year-old woman is brought to the emergency department by her husband because of increasing confusion for 3 days. Her husband states that he noticed a yellowish discoloration of her eyes for the past 6 days. She has osteoarthritis. Current medications include acetaminophen and a vitamin supplement. She does not dri... | N-acetylcysteine therapy | {
"A": "Oral rifaximin therapy",
"B": "Liver transplant",
"C": "N-acetylcysteine therapy",
"D": "Intravenous glucocorticoids therapy"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department",
"husband",
"increasing confusion",
"3 days",
"husband states",
"discoloration",
"eyes",
"past",
"days",
"osteoarthritis",
"Current medications include acetaminophen",
"vitamin supplement",
"not drink alcohol",
"uses intravenous cocai... |
A 35-year-old obese man presents to the office complaining of chronic heartburn and nausea for the past 6 months. These symptoms are relieved when he takes 20 mg of omeprazole twice a day. The patient was prompted to come to the doctor when he recently experienced difficulty breathing and shortness of breath, symptoms ... | Protrusion of fundus of the stomach through the diaphragm into the thoracic cavity | {
"A": "Protrusion of fundus of the stomach through the diaphragm into the thoracic cavity",
"B": "Lung hypoplasia due to a defect in the diaphragm",
"C": "\"Hourglass stomach\" due to upward displacement of the gastroesophageal junction",
"D": "Cardiomegaly with pulmonary effusion"
} | step1 | A | [
"35 year old obese man presents",
"office",
"chronic heartburn",
"nausea",
"past 6 months",
"symptoms",
"relieved",
"takes 20 mg",
"omeprazole twice a day",
"patient",
"prompted to",
"doctor",
"recently",
"difficulty breathing",
"shortness of breath",
"symptoms",
"serious health cond... |
A 39-year-old woman comes to the physician because of a 5-day history of pain and stiffness in her hands and wrists and a nonpruritic generalized rash. The stiffness is worst in the morning and improves after 15–20 minutes of activity. She had fever and a runny nose 10 days ago that resolved without treatment. She is s... | Parvovirus arthritis | {
"A": "Psoriatic arthritis",
"B": "Parvovirus arthritis",
"C": "Disseminated gonococcal disease",
"D": "Rheumatoid arthritis"
} | step1 | B | [
"year old woman",
"physician",
"5-day history",
"pain",
"stiffness",
"hands",
"wrists",
"nonpruritic generalized rash",
"stiffness",
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"morning",
"improves",
"minutes",
"activity",
"fever",
"runny nose 10 days",
"resolved",
"treatment",
"sexually active",
"male partner",... |
An investigator is studying physiological changes in the autonomic nervous system in response to different stimuli. 40 μg of epinephrine is infused in a healthy volunteer over a period of 5 minutes, and phenoxybenzamine is subsequently administered. Which of the following effects is most likely to be observed in this v... | Increased secretion of insulin | {
"A": "Decreased breakdown of muscle glycogen",
"B": "Decreased secretion of aqueous humor",
"C": "Increased secretion of insulin",
"D": "Increased pressure inside the bladder"
} | step1 | C | [
"investigator",
"studying physiological changes",
"autonomic nervous system",
"response to different stimuli",
"40 g",
"epinephrine",
"infused",
"healthy volunteer",
"period",
"5 minutes",
"phenoxybenzamine",
"administered",
"following effects",
"most likely to",
"observed",
"volunteer... |
A 43-year-old female presents to her endocrinologist for a new patient appointment. She initially presented three months ago as a referral for a new diagnosis of type II diabetes mellitus. At that time, her HbA1c was found to be 8.8%, and she was started on metformin. Her metformin was quickly uptitrated to the maximum... | Exenatide | {
"A": "Exenatide",
"B": "Glipizide",
"C": "Repaglinide",
"D": "Sitagliptin"
} | step2&3 | A | [
"year old female presents",
"endocrinologist",
"new patient appointment",
"initially presented three months",
"referral",
"new diagnosis",
"type II diabetes mellitus",
"time",
"found to",
"8.8",
"started",
"metformin",
"metformin",
"maximum recommended dose",
"same visit",
"body mass i... |
A mother brings her 8-month-old child to your pediatric clinic with concerns of a rash. Physical exam reveals an erythematous, weeping rash involving bilateral cheeks and scalp. You prescribe a topical agent that is considered the first-line pharmacological treatment for this condition. What is a common concern that th... | Skin atrophy | {
"A": "Hyperpigmentation",
"B": "Skin atrophy",
"C": "Paresthesia",
"D": "Increased risk of melanoma"
} | step1 | B | [
"mother",
"month old child",
"pediatric clinic",
"concerns",
"rash",
"Physical exam reveals",
"erythematous",
"weeping rash involving bilateral cheeks",
"scalp",
"topical agent",
"considered",
"first-line pharmacological treatment",
"condition",
"common concern",
"mother",
"alerted",
... |
A 28-year-old woman comes to the emergency department because of increasing weakness and numbness of her legs for 3 days. She noticed that the weakness was more severe after she had a hot shower that morning. A year ago, she had an episode of partial vision loss in her left eye that resolved within 3 weeks. She is sexu... | Oligoclonal bands in cerebral spinal fluid | {
"A": "Positive rapid plasma reagin test",
"B": "Slow nerve conduction velocity",
"C": "Elevated intrinsic factor antibody level",
"D": "Oligoclonal bands in cerebral spinal fluid"
} | step2&3 | D | [
"year old woman",
"emergency department",
"increasing weakness",
"numbness",
"legs",
"3 days",
"weakness",
"more severe",
"hot shower",
"morning",
"year",
"episode of partial vision loss",
"left eye",
"resolved",
"weeks",
"sexually active",
"male partners",
"uses condoms",
"appea... |
A 33-year-old man comes to the physician 1 hour after he slipped in the shower and fell on his back. Since the event, he has had severe neck pain. He rates the pain as an 8–9 out of 10. On questioning, he has had lower back pain for the past 2 years that radiates to the buttocks bilaterally. He reports that the pain so... | Recurring eye redness and pain | {
"A": "Foot drop and difficulty heel walking",
"B": "Urinary and fecal incontinence",
"C": "Recent episode of urethritis",
"D": "Recurring eye redness and pain"
} | step2&3 | D | [
"year old man",
"physician",
"hour",
"slipped",
"shower",
"fell",
"back",
"event",
"severe neck",
"rates",
"pain",
"10",
"questioning",
"lower back pain",
"past",
"years",
"radiates",
"buttocks",
"reports",
"pain sometimes",
"night",
"worse",
"morning",
"resting",
"ba... |
A 66-year-old man is brought to the clinic with a history of recurrent falls. He has been slow in his movements and walks clumsily. He denies fever, vision problems, limb weakness, numbness, abnormal sensation in his limbs, trauma, or inability to pass urine. The past medical history is unremarkable, and he only takes ... | Loss of dopaminergic neurons in the substantia nigra | {
"A": "Cerebellar atrophy",
"B": "Dilated ventricles with increased CSF volume",
"C": "Generalized brain atrophy",
"D": "Loss of dopaminergic neurons in the substantia nigra"
} | step2&3 | D | [
"66 year old man",
"brought",
"clinic",
"history of recurrent falls",
"slow",
"movements",
"walks",
"denies fever",
"vision problems",
"limb weakness",
"numbness",
"abnormal",
"limbs",
"trauma",
"to pass urine",
"past medical history",
"unremarkable",
"only takes calcium",
"vitam... |
A 46-year-old man is admitted to the hospital with a 3-day history of productive cough with purulent sputum and fever with chills. On the second day of admission, he develops bloody vomiting, altered mental status, and multiple red spots all over the body. He is oriented only to self. His temperature is 39.3°C (102.7°F... | Disseminated intravascular coagulation | {
"A": "Disseminated intravascular coagulation",
"B": "Immune thrombocytopenic purpura",
"C": "Severe hepatic dysfunction",
"D": "Thrombotic thrombocytopenic purpura"
} | step1 | A | [
"year old man",
"admitted",
"hospital",
"3-day history",
"productive cough",
"purulent sputum",
"fever with chills",
"second day",
"admission",
"bloody vomiting",
"altered mental status",
"multiple red spots",
"body",
"oriented only",
"self",
"temperature",
"3C",
"pulse",
"min",
... |
A 45-year-old woman undergoes endoscopic retrograde cholangiopancreatography (ERCP) for evaluation of suspected biliary strictures. The ERCP identifies 2 ducts in the pancreas (a small ventral duct and a larger dorsal duct). A diagnosis of a congenital pancreatic anomaly is made. Which of the following statements best ... | Magnetic resonance cholangiopancreatography (MRCP) scanning of the abdomen is the most sensitive non-invasive diagnostic technique for this condition | {
"A": "It is a rare congenital anomaly of the pancreas",
"B": "Patients with recurrent episodes of pancreatitis due to this condition do not require any intervention",
"C": "Magnetic resonance cholangiopancreatography (MRCP) scanning of the abdomen is the most sensitive non-invasive diagnostic technique for this... | step1 | C | [
"year old woman",
"endoscopic retrograde cholangiopancreatography",
"evaluation",
"suspected biliary strictures",
"ERCP",
"2 ducts",
"pancreas",
"small ventral duct",
"larger dorsal duct",
"diagnosis of",
"congenital pancreatic anomaly",
"made",
"following statements best",
"anomaly"
] |
A 70-year-old man is admitted with fever, chills, and rigor which have lasted for 4 days. He also complains of associated recent-onset fatigue. Past medical history is insignificant. He drinks a can of beer every night. His temperature is 39.0°C (102.2°F), pulse is 120/min, blood pressure is 122/80 mm Hg, and respirati... | Refer for an outpatient colonoscopy | {
"A": "Prepare and schedule valve replacement surgery",
"B": "Repeat the transesophageal echocardiography",
"C": "Perform a transthoracic echocardiogram",
"D": "Refer for an outpatient colonoscopy"
} | step1 | D | [
"70 year old man",
"admitted",
"fever",
"chills",
"rigor",
"lasted",
"4 days",
"of associated recent onset fatigue",
"Past medical",
"drinks",
"beer",
"night",
"temperature",
"pulse",
"min",
"blood pressure",
"80 mm Hg",
"respirations",
"min",
"Physical examination reveals spli... |
A 36-year-old primigravid woman at 15 weeks' gestation comes to the physician for a routine prenatal visit. She has not been taking prenatal vitamins and admits to consuming alcohol regularly. Pelvic examination shows a uterus consistent in size with a 15-week gestation. A quadruple screening test shows markedly elevat... | Spina bifida cystica | {
"A": "Trisomy 21",
"B": "Holoprosencephaly",
"C": "Spina bifida cystica",
"D": "Trisomy 18"
} | step1 | C | [
"36 year old primigravid woman",
"weeks",
"gestation",
"physician",
"routine prenatal visit",
"not",
"taking prenatal vitamins",
"admits",
"alcohol",
"Pelvic examination shows",
"uterus consistent",
"size",
"week gestation",
"quadruple screening test shows markedly elevated maternal serum"... |
A 71-year-old male with worsening memory, behavior changes, and disorientation over the span of several years was admitted to the hospital for signs of severe pneumonia. He passes away after failed antibiotic therapy. Which of the following findings would most likely be identified on autopsy? | Extracellular amyloid forming parenchymal plaques | {
"A": "Lewy bodies",
"B": "Pick bodies",
"C": "Extracellular amyloid forming parenchymal plaques",
"D": "A spongiform cortex with large intracellular vacuoles"
} | step1 | C | [
"71 year old male",
"worsening memory",
"behavior changes",
"disorientation",
"span",
"years",
"admitted",
"hospital",
"signs",
"severe pneumonia",
"passes",
"failed antibiotic therapy",
"following findings",
"most likely",
"identified",
"autopsy"
] |
A 56-year-old woman presents to her physician for a routine health maintenance examination. Recently, she has felt weak, and she has dyspnea when she performs her daily exercise routine. She has no significant past medical history. She has not had any menstrual bleeding for more than 6 years. She has smoked half a pack... | Gastrointestinal endoscopy | {
"A": "Gastrointestinal endoscopy",
"B": "Hemoglobin electrophoresis",
"C": "JAK2 mutation",
"D": "No further testing is indicated"
} | step2&3 | A | [
"year old woman presents",
"physician",
"routine health maintenance examination",
"Recently",
"felt weak",
"dyspnea",
"performs",
"daily exercise routine",
"significant past medical history",
"not",
"menstrual bleeding",
"years",
"smoked half",
"pack",
"cigarettes",
"more",
"20 years... |
A 69-year-old man comes to the physician because of a 2-month history of severe right hip pain. The pain is worse at night. He has chronic headaches and back pain for which he takes vitamin D, calcium supplements, and ibuprofen. Examination shows hip tenderness and mild sensorineural hearing loss. X-ray of the hip show... | Osteosarcoma | {
"A": "Multiple myeloma",
"B": "Chondrosarcoma",
"C": "Osteosarcoma",
"D": "Ewing sarcoma"
} | step1 | C | [
"69 year old man",
"physician",
"history",
"severe right hip pain",
"pain",
"worse",
"night",
"chronic headaches",
"back pain",
"takes vitamin D",
"calcium supplements",
"ibuprofen",
"Examination shows hip tenderness",
"mild sensorineural hearing loss",
"X-ray",
"hip shows",
"radiolu... |
A 44-year-old with a past medical history significant for human immunodeficiency virus infection presents to the emergency department after he was found to be experiencing worsening confusion. The patient was noted to be disoriented by residents and staff at the homeless shelter where he resides. On presentation he rep... | Herpes simplex virus | {
"A": "Cryptococcus",
"B": "Group B streptococcus",
"C": "Herpes simplex virus",
"D": "Neisseria meningitidis"
} | step1 | C | [
"year old",
"past medical history significant",
"human immunodeficiency virus infection presents",
"emergency department",
"found to",
"experiencing worsening confusion",
"patient",
"noted to",
"disoriented",
"residents",
"staff",
"homeless shelter",
"resides",
"presentation",
"reports h... |
A 35-year-old man comes to the physician because of a 3-month history of intermittent right lateral hip pain that radiates to the thigh. Climbing stairs and lying on his right side aggravates the pain. Examination shows tenderness to palpation over the upper lateral part of the right thigh. There is no swelling. When t... | Greater trochanter
" | {
"A": "Acetabulum",
"B": "Lateral femoral cutaneous nerve",
"C": "Femoral head",
"D": "Greater trochanter\n\""
} | step1 | D | [
"35 year old man",
"physician",
"history",
"intermittent right lateral hip pain",
"radiates",
"thigh",
"Climbing stairs",
"lying",
"right side aggravates",
"pain",
"Examination shows tenderness",
"palpation",
"upper lateral part of",
"right thigh",
"swelling",
"patient",
"to",
"pas... |
A 23-year-old primigravid woman comes to the physician for an initial prenatal visit at 13 weeks' gestation. She has had episodic headaches over the past month. She has no history of serious illness. Her immunizations are up-to-date. Her temperature is 37°C (98.6°F) and pulse is 90/min. Repeated measurements show a blo... | Chronic hypertension | {
"A": "Eclampsia",
"B": "High normal blood pressure",
"C": "Preeclampsia",
"D": "Chronic hypertension"
} | step2&3 | D | [
"23 year old primigravid woman",
"physician",
"initial prenatal visit",
"weeks",
"gestation",
"episodic headaches",
"past month",
"history",
"serious illness",
"immunizations",
"date",
"temperature",
"98",
"pulse",
"90 min",
"Repeated measurements show",
"blood pressure",
"95 mm Hg... |
A 56-year-old man presents to his family physician for a routine check-up but also states he has been feeling less energetic than usual. He mentions that he has recently been promoted to a nurse manager position at a regional medical center. His medical history is significant for hypertension and hyperlipidemia, for wh... | Isoniazid, rifampin, ethambutol, and pyrazinamide | {
"A": "Isoniazid, rifampin, ethambutol, and pyrazinamide",
"B": "Isoniazid and ethambutol",
"C": "Levofloxacin and ethambutol",
"D": "Repeat sputum culture and smear"
} | step2&3 | A | [
"year old man presents",
"family physician",
"routine check-up",
"states",
"feeling less energetic than usual",
"recently",
"promoted",
"nurse manager position",
"regional medical",
"medical history",
"significant",
"hypertension",
"hyperlipidemia",
"takes enalapril",
"atorvastatin",
"... |
A 40-year-old man comes to the physician because of lower back pain that has become progressively worse over the past 2 months. The pain is also present at night and does not improve if he changes his position. He has stiffness for at least 1 hour each morning that improves throughout the day. Over the past 3 months, h... | PPD skin test | {
"A": "Pulmonary function test",
"B": "Discontinue allopurinol",
"C": "PPD skin test",
"D": "Liver function test"
} | step2&3 | C | [
"40 year old man",
"physician",
"lower back pain",
"worse",
"past",
"months",
"pain",
"present",
"night",
"not",
"changes",
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"stiffness",
"hour",
"morning",
"improves",
"day",
"past 3 months",
"3 episodes of acute gout",
"started",
"allopurinol",
"vital signs",
... |
A 4-year-old boy is brought into your office by his parents who state that the boy has been noncompliant with his toilet training and passes stools every 4 days. They describe his stool as hard pellets. They deny any problems during pregnancy and state that he was born at a weight of 7 lbs and 10 oz. They state that he... | Laxatives and stool softeners | {
"A": "Proctoscopy",
"B": "Fiber supplementation",
"C": "Laxatives and stool softeners",
"D": "Sigmoidoscopy and biopsy"
} | step2&3 | C | [
"4 year old boy",
"brought",
"office",
"parents",
"state",
"boy",
"noncompliant",
"toilet training",
"passes stools",
"4 days",
"stool",
"hard pellets",
"deny",
"problems",
"pregnancy",
"state",
"born",
"weight",
"lbs",
"10 oz",
"state",
"hospital",
"one day",
"delivery... |
A 44-year-old man comes to the physician for a follow-up examination. Ten months ago, he was diagnosed with HIV infection and appropriate antiretroviral therapy was initiated. Physical examination shows no abnormalities. Laboratory studies show increased viral load despite ongoing treatment. His pharmacotherapy is swit... | Viral fusion and entry into host cells | {
"A": "Viral particle assembly",
"B": "Viral docking and attachment to host cells",
"C": "Viral genome transcription",
"D": "Viral fusion and entry into host cells"
} | step1 | D | [
"year old man",
"physician",
"follow-up examination",
"Ten months",
"diagnosed",
"HIV infection",
"appropriate antiretroviral therapy",
"initiated",
"Physical examination shows",
"abnormalities",
"Laboratory studies show increased viral load",
"ongoing treatment",
"pharmacotherapy",
"switc... |
A 38-year-old man presents with pruritus and jaundice. Past medical history is significant for ulcerative colitis diagnosed 2 years ago, well managed medically. He is vaccinated against hepatitis A and B and denies any recent travel abroad. On physical examination, prominent hepatosplenomegaly is noted. Which of the fo... | Endoscopic retrograde cholangiopancreatography (ERCP) | {
"A": "Endoscopic retrograde cholangiopancreatography (ERCP)",
"B": "Contrast CT of the abdomen",
"C": "Ultrasound of the abdomen",
"D": "Magnetic resonance cholangiopancreatography (MRCP)"
} | step1 | A | [
"year old man presents",
"pruritus",
"jaundice",
"Past medical history",
"significant",
"ulcerative colitis diagnosed 2 years",
"well managed",
"vaccinated",
"hepatitis A",
"denies",
"recent travel abroad",
"physical examination",
"prominent hepatosplenomegaly",
"noted",
"following",
"... |
A 5-year-old boy presents to the emergency department with a sore throat and trouble breathing. His mother states that his symptoms started last night and have rapidly been worsening. The patient is typically healthy, has received all his childhood immunizations, and currently takes a daily multivitamin. His temperatur... | Streptococcus pneumoniae | {
"A": "Candidia albicans",
"B": "Haemophilus influenzae",
"C": "Streptococcus pneumoniae",
"D": "Streptococcus viridans"
} | step2&3 | C | [
"5 year old boy presents",
"emergency department",
"sore throat",
"trouble breathing",
"mother states",
"symptoms started last night",
"rapidly",
"worsening",
"patient",
"healthy",
"received",
"childhood immunizations",
"currently takes",
"daily multivitamin",
"temperature",
"4C",
"b... |
A 35-year-old man comes to the physician because of progressive swelling of his legs over the past 2 months. During this period, the patient has had an unintentional 5-kg (11-lb) weight gain. He also reports frequent numbness of the tips of his fingers and cramping in his back and leg muscles. He has a history of HIV i... | Segmental sclerosis | {
"A": "Thickened glomerular capillary loops",
"B": "Segmental sclerosis",
"C": "Crescent formation, monocytes, and macrophages",
"D": "No changes"
} | step2&3 | B | [
"35 year old man",
"physician",
"of progressive swelling",
"legs",
"past",
"months",
"period",
"patient",
"unintentional",
"kg",
"weight gain",
"reports frequent numbness of",
"tips",
"fingers",
"cramping",
"back",
"leg muscles",
"history",
"HIV infection treated with combined an... |
A 43-year-old woman is brought to the emergency department 10 minutes after the sudden onset of shortness of breath, dry cough, nausea, and an itchy rash. The symptoms started 15 minutes after she had dinner with her husband and her two sons at a local seafood restaurant. The patient has a 2-year history of hypertensio... | Intramuscular epinephrine administration | {
"A": "Intramuscular epinephrine administration",
"B": "Intravenous methylprednisolone administration",
"C": "Nebulized albuterol administration",
"D": "Endotracheal intubation"
} | step2&3 | A | [
"year old woman",
"brought",
"emergency department 10 minutes",
"sudden onset of shortness",
"breath",
"dry cough",
"nausea",
"itchy rash",
"symptoms started 15 minutes",
"dinner",
"husband",
"two sons",
"local seafood restaurant",
"patient",
"2 year history of hypertension treated with ... |
A 60-year-old man, who was a coal miner for more than 15 years presents with complaints of a cough and shortness of breath. His cough started 6 years ago and is dry and persistent. The shortness of breath started 4 months ago and is exacerbated by physical activity. When interviewed, his physician discovers that he doe... | Coal worker' s pneumoconiosis | {
"A": "Coal worker' s pneumoconiosis",
"B": "Caplan syndrome",
"C": "Asbestosis",
"D": "Bronchogenic carcinoma"
} | step1 | A | [
"60 year old man",
"coal miner",
"years presents",
"complaints",
"cough",
"shortness of breath",
"cough started",
"years",
"dry",
"persistent",
"shortness of breath started 4 months",
"exacerbated",
"physical activity",
"interviewed",
"physician discovers",
"take",
"safety measures",... |
An investigator studying new drug delivery systems administers an aerosol containing 6.7-μm sized particles to a healthy subject via a nonrebreather mask. Which of the following is the most likely route of clearance of the particulate matter in this subject? | Expulsion by the mucociliary escalator | {
"A": "Trapping by nasal vibrissae",
"B": "Expulsion by the mucociliary escalator",
"C": "Phagocytosis by alveolar macrophages",
"D": "Diffusion into pulmonary capillaries"
} | step1 | B | [
"investigator studying new drug delivery systems administers",
"aerosol containing",
"7-m sized particles",
"healthy subject",
"nonrebreather mask",
"following",
"most likely route",
"clearance",
"particulate matter",
"subject"
] |
A 56-year-old man suffered seizure-like activity followed by a loss of consciousness within minutes after surfacing from a recreational 55-foot dive with some friends. His friends laid him on his side and called emergency services. Past medical history is significant for paroxysmal atrial fibrillation status post faile... | Secure the patient’s airway and administer 100% oxygen and rapid transport for recompression in a hyperbaric chamber. | {
"A": "Give a loading dose of phenytoin followed by 12-hour infusion.",
"B": "Insert 2 large bore IVs and start high volume fluid resuscitation.",
"C": "Secure the patient’s airway and administer 100% oxygen and rapid transport for recompression in a hyperbaric chamber.",
"D": "Obtain a noncontrast head CT and... | step1 | C | [
"year old man suffered seizure",
"activity followed by",
"loss of consciousness",
"minutes",
"surfacing",
"recreational 55 foot dive",
"friends",
"friends",
"side",
"called emergency services",
"Past medical history",
"significant",
"paroxysmal atrial fibrillation",
"failed catheter ablati... |
Twelve hours after delivery a 2700-g (5-lb 15-oz) male newborn has 3 episodes of bilious vomiting. He was born at 36 weeks' gestation to a 27-year-old woman. Pregnancy was complicated by polyhydramnios. The mother has smoked one half-pack of cigarettes daily and has a history of intravenous cocaine use. Vital signs are... | Jejunal atresia | {
"A": "Malrotation with volvulus",
"B": "Jejunal atresia",
"C": "Hirschsprung disease",
"D": "Hypertrophic pyloric stenosis"
} | step2&3 | B | [
"Twelve hours",
"delivery",
"2700 g",
"oz",
"male newborn",
"3 episodes of bilious vomiting",
"born",
"36 weeks",
"gestation",
"27 year old woman",
"Pregnancy",
"complicated",
"polyhydramnios",
"mother",
"smoked one half pack",
"cigarettes daily",
"history of intravenous cocaine use"... |
A 26-year-old woman with a history of asthma presents to the emergency room with persistent gnawing left lower quadrant abdominal pain. She first noticed the pain several hours ago and gets mild relief with ibuprofen. She has not traveled recently, tried any new foods or medications, or been exposed to sick contacts. S... | Exploratory laporoscopy | {
"A": "CT scan of the abdomen and pelvis",
"B": "Transvaginal ultrasound",
"C": "Administer levonorgestrel",
"D": "Exploratory laporoscopy"
} | step1 | D | [
"year old woman",
"history of asthma presents",
"emergency room",
"persistent gnawing left lower quadrant abdominal pain",
"first",
"pain",
"hours",
"gets mild relief",
"ibuprofen",
"not traveled recently",
"new foods",
"medications",
"exposed",
"sick contacts",
"sexually active",
"boy... |
You are a sleep physician comparing the results of several hypnograms taken in the sleep lab the prior night. You examine one chart which shows decreased REM sleep, less total time sleeping, and more frequent nocturnal awakenings. Which of these patients most likely exhibits this pattern? | A healthy 75-year-old male | {
"A": "A healthy 3-year-old male",
"B": "A healthy 40 year-old male",
"C": "A healthy 20-year-old female",
"D": "A healthy 75-year-old male"
} | step1 | D | [
"sleep physician comparing",
"results",
"taken",
"sleep lab",
"prior night",
"one chart",
"shows decreased REM sleep",
"less total time sleeping",
"more frequent nocturnal awakenings",
"patients",
"likely exhibits",
"pattern"
] |
A 27-year-old woman seeks evaluation by her general physician with complaints of an odorous yellow vaginal discharge and vaginal irritation for the past 3 days. She also complains of itching and soreness. The medical history is unremarkable. She is not diabetic. She has been sexually active with a single partner for th... | Metronidazole | {
"A": "Metronidazole",
"B": "Nystatin",
"C": "Ampicillin",
"D": "Acyclovir"
} | step1 | A | [
"27 year old woman",
"evaluation",
"general",
"complaints of",
"odorous yellow vaginal discharge",
"vaginal irritation",
"past 3 days",
"itching",
"soreness",
"medical history",
"unremarkable",
"not diabetic",
"sexually active",
"single partner",
"last",
"years",
"vaginal swab",
"s... |
A 1-year-old child who was born outside of the United States is brought to a pediatrician for the first time because she is not gaining weight. Upon questioning, the pediatrician learns that the child has had frequent pulmonary infections since birth, and on exam the pediatrician appreciates several nasal polyps. Genet... | Phenylalanine | {
"A": "Leucine",
"B": "Lysine",
"C": "Valine",
"D": "Phenylalanine"
} | step1 | D | [
"year old child",
"born outside",
"United States",
"brought",
"pediatrician",
"first time",
"not gaining weight",
"questioning",
"pediatrician learns",
"child",
"frequent pulmonary",
"birth",
"exam",
"pediatrician",
"several nasal",
"Genetic testing",
"ordered to confirm",
"suspect... |
A 61-year-old man presents to the office with a past medical history of hypertension, diabetes mellitus type II, hypercholesterolemia, and asthma. Recently, he describes increasing difficulty with breathing, particularly when performing manual labor. He also endorses a new cough, which occurs both indoors and out. He d... | Asbestosis | {
"A": "Asbestosis",
"B": "Coal miner’s disease",
"C": "Silicosis",
"D": "Hypersensitivity pneumonitis"
} | step2&3 | A | [
"61 year old man presents",
"office",
"past medical",
"diabetes mellitus type II",
"hypercholesterolemia",
"asthma",
"Recently",
"increasing difficulty",
"breathing",
"performing manual labor",
"new cough",
"occurs",
"out",
"denies",
"recent tobacco use",
"40 pack-year history",
"sym... |
A 40-year-old man presents with substernal chest pain for the past hour. He describes the chest pain as severe, squeezing in nature, diffusely localized to the substernal area and radiating down his left arm. He also has associated nausea, dizziness, and diaphoresis. He denies any recent history of fever, chest trauma,... | Acute coronary syndrome | {
"A": "Acute coronary syndrome",
"B": "GERD",
"C": "Diffuse esophageal spasm",
"D": "Pulmonary embolism"
} | step1 | A | [
"40 year old man presents",
"substernal chest pain",
"past hour",
"chest",
"severe",
"squeezing",
"nature",
"localized",
"area",
"radiating",
"left arm",
"associated nausea",
"dizziness",
"diaphoresis",
"denies",
"recent history",
"fever",
"chest trauma",
"palpitations",
"synco... |
А 55-уеаr-old mаn рrеѕеntѕ to thе offісе wіth a сomрlаіnt of generalized pain particularly in the back. This pain is also present in his knees, elbows, and shoulders bilaterally. Не has stage 4 chronіс kіdnеу dіѕеаѕе and is on weekly hemodialysis; he is wаіtіng for a renal trаnѕрlаnt. Оn physical ехаmіnаtіon, thеrе іѕ ... | PTH ↑, Ca ↓, phosphate ↑, calcitriol ↓ | {
"A": "PTH ↑, Ca ↑, phosphate ↓, calcitriol ↓",
"B": "PTH ↑, Ca ↓, phosphate ↑, calcitriol ↓",
"C": "PTH ↓, Ca ↑, phosphate ↑, calcitriol ↑",
"D": "PTH ↓, Ca ↓, phosphate ↑, calcitriol ↓"
} | step1 | B | [
" 55 r old mn",
"th",
"generalized pain",
"back",
"pain",
"present",
"knees",
"elbows",
"shoulders",
"stage 4 chron",
"weekly hemodialysis",
"renal",
"physical",
"thr",
"dm",
"mrk",
"th",
"trunk",
"gn include",
"blood",
"88 mm g",
"ul 84 mn",
"36",
"97 9F",
"rt",
"m... |
A 60-year-old woman presents to the emergency department with her husband. He is concerned that she has had abnormal behavior and involuntary movements of her body for the last 3 weeks. She now has difficulty remembering names, dates, and events. She even fails to recognize pictures of her children. She was in her norm... | Creutzfeldt-Jakob disease | {
"A": "Acute disseminated encephalomyelitis",
"B": "Creutzfeldt-Jakob disease",
"C": "Hashimoto thyroiditis",
"D": "Herpes viral encephalitis"
} | step2&3 | B | [
"60 year old woman presents",
"emergency department",
"husband",
"concerned",
"abnormal behavior",
"involuntary movements",
"body",
"last",
"weeks",
"now",
"difficulty remembering names",
"dates",
"events",
"fails to",
"pictures",
"children",
"normal state of health",
"weeks",
"h... |
A 10-year-old boy is brought in to the emergency room by his parents after he complained of being very weak during a soccer match the same day. The parents noticed that yesterday, the patient seemed somewhat clumsy during soccer practice and was tripping over himself. Today, the patient fell early in his game and compl... | Gram-negative, oxidase-positive, comma-shaped bacteria | {
"A": "Gram-positive bacillus",
"B": "Gram-negative, oxidase-positive bacillus",
"C": "Gram-negative, oxidase-positive, comma-shaped bacteria",
"D": "Gram-negative, oxidase-negative, bacillus with hydrogen sulfide gas production"
} | step1 | C | [
"A 10 year old boy",
"brought",
"emergency room",
"parents",
"very weak",
"soccer match",
"same day",
"parents",
"patient",
"somewhat clumsy",
"soccer practice",
"tripping over",
"Today",
"patient fell early",
"game",
"not",
"back",
"patient",
"date",
"vaccinations",
"previou... |
A 16-year-old woman with no known past medical history and non-significant social and family histories presents to the outpatient clinic for an annual wellness checkup. She has no complaints, and her review of systems is negative. She is up to date on her childhood and adolescent vaccinations. The patient's blood press... | Begin 3-year interval cervical cancer screening via Pap smear at age 21 | {
"A": "Begin 2-year interval cervical cancer screening via Pap smear today",
"B": "Begin 3-year interval cervical cancer screening via Pap smear at age 21",
"C": "Begin 5-year interval cervical cancer screening via Pap smear at age 21",
"D": "Offer to administer the HPV vaccine so that Pap smears can be avoide... | step2&3 | B | [
"year old woman",
"known past medical history",
"non significant social",
"family histories presents",
"outpatient clinic",
"annual wellness checkup",
"complaints",
"review of systems",
"negative",
"date",
"childhood",
"adolescent vaccinations",
"patient's blood pressure",
"mm Hg",
"puls... |
A 28-year-old woman, gravida 2, para 1, at 40 weeks of gestation is admitted to the hospital in active labor. The patient has attended many prenatal appointments and followed her physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her pregnancy has been uncomplicated. She has no his... | Repositioning | {
"A": "Administration of beta-agonists",
"B": "Operative vaginal delivery",
"C": "Repositioning",
"D": "Urgent Cesarean delivery"
} | step2&3 | C | [
"year old woman",
"gravida 2",
"para 1",
"40 weeks of gestation",
"admitted",
"hospital",
"active labor",
"patient",
"attended",
"prenatal appointments",
"followed",
"physician's advice",
"screening",
"diseases",
"laboratory testing",
"diet",
"exercise",
"pregnancy",
"uncomplicat... |
A father calls the pediatrician because his 7-year-old son began wetting the bed days after the birth of his new born sister. He punished his son for bedwetting but it only made the situation worse. The pediatrician advised him to talk with his son about how he feels, refrain from drinking water near bedtime, and prais... | Regression | {
"A": "Regression",
"B": "Isolation of affect",
"C": "Identification",
"D": "Rationalization"
} | step1 | A | [
"father calls",
"pediatrician",
"year old son began wetting",
"bed days",
"birth",
"new born sister",
"punished",
"son",
"bedwetting",
"only made",
"worse",
"pediatrician",
"to talk",
"son",
"feels",
"drinking water",
"bedtime",
"praise",
"son",
"keeps",
"bed dry",
"followi... |
A 30-year-old woman was brought in by ambulance after being struck by a truck while crossing the street. She has lost a large volume of blood, and a transfusion of packed RBCs is indicated. The patient’s blood type is confirmed to be AB+. She is to be given two units of packed red blood cells (RBCs). Which of the follo... | A+, A-, B+, B-, AB+, AB-, O+, O- | {
"A": "A-, B-, O-",
"B": "A+, B+, AB+, O+",
"C": "A+, B+",
"D": "A+, A-, B+, B-, AB+, AB-, O+, O-"
} | step1 | D | [
"30 year old woman",
"brought",
"ambulance",
"struck by",
"truck",
"crossing",
"street",
"lost",
"large volume of blood",
"transfusion of packed RBCs",
"indicated",
"patients blood type",
"confirmed to",
"to",
"given two units",
"packed red blood cells",
"following type s",
"packed... |
A 61-year-old woman presents to the emergency department with bloody vomiting for the last hour. She had been vomiting for several hours. Additionally, she states she felt a sudden onset of chest and epigastric pain when she noted blood in her vomit. In the emergency room, she endorses feeling lightheaded and denies di... | Perform endoscopy | {
"A": "Administer fresh frozen plasma (FFP)",
"B": "Perform transjugular intrahepatic portosystemic shunt (TIPS)",
"C": "Administer a non-selective ß-blocker",
"D": "Perform endoscopy"
} | step2&3 | D | [
"61 year old woman presents",
"emergency department",
"bloody vomiting",
"hour",
"vomiting",
"hours",
"states",
"felt",
"sudden onset",
"chest",
"epigastric pain",
"noted blood",
"vomit",
"emergency room",
"feeling lightheaded",
"denies difficulty breathing",
"coughing",
"pain",
... |
A 31-year-old G2P2002 delivers a male child at 40 weeks gestation after an uncomplicated spontaneous vaginal delivery. The newborn is vigorous at birth with Apgar scores of 7 and 9 at 1 and 5 minutes, respectively. The mother has a first-degree laceration that is hemostatically repaired, and the two are transferred to ... | Breastfeeding | {
"A": "Goat’s milk",
"B": "Breastfeeding",
"C": "Cow’s milk",
"D": "Soy formula"
} | step2&3 | B | [
"31 year old",
"delivers",
"male child",
"40 weeks gestation",
"uncomplicated spontaneous vaginal delivery",
"newborn",
"vigorous",
"birth",
"Apgar scores",
"7",
"5 minutes",
"mother",
"first-degree laceration",
"repaired",
"two",
"transferred",
"postpartum unit",
"routine care",
... |
A 28-year-old man presented with gradually progressive gait disturbances since 10 years of age. His gait was clumsy and slow, and it was very difficult for him to perform brisk walking and running. After a few years, he developed tremors involving both upper limbs along with progressively increasing fatigability. Over ... | The gene locus which is mutated in this condition is on chromosome 9 | {
"A": "Vertical nystagmus is characteristically seen in patients with this condition",
"B": "Gait ataxia in this condition is a pure sensory ataxia",
"C": "The gene locus which is mutated in this condition is on chromosome 9",
"D": "The condition is inherited as autosomal dominant condition"
} | step1 | C | [
"year old man presented",
"progressive gait disturbances",
"10",
"age",
"gait",
"clumsy",
"slow",
"very difficult",
"to perform brisk walking",
"running",
"few years",
"tremors involving",
"upper limbs",
"increasing fatigability",
"last",
"months",
"friends",
"speech",
"slow",
... |
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