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 47-year-old man is admitted to the emergency room after a fight in which he was hit in the head with a hammer. The witnesses say that the patient initially lost consciousness, but regained consciousness by the time emergency services arrived. On admission, the patient complained of a diffuse headache. He opened his e... | Administration of levetiracetam | {
"A": "Administration of levetiracetam",
"B": "Surgical evacuation of the clots",
"C": "Lumbar puncture",
"D": "Administration of methylprednisolone"
} | step2&3 | A | [
"year old man",
"admitted",
"emergency room",
"fight",
"hit",
"head",
"hammer",
"witnesses",
"patient initially lost consciousness",
"regained consciousness",
"time emergency services arrived",
"On admission",
"patient",
"diffuse headache",
"opened",
"eyes",
"responsive",
"confused... |
A 31-year-old G3P0020 presents to her physician for a prenatal visit at 12 weeks gestation. She does not smoke cigarettes and stopped drinking alcohol once she was diagnosed with pregnancy at 10 weeks gestation. An ultrasound examination showed the following:
Ultrasound finding Measured Normal value (age-specified)
Hea... | To increase the diagnostic accuracy of this result, the levels of free beta-hCG and pregnancy-associated plasma protein A (PAPP-A) should be determined. | {
"A": "Pathology other than Down syndrome should be suspected because of the presence of a nasal bone.",
"B": "To increase the diagnostic accuracy of this result, the levels of free beta-hCG and pregnancy-associated plasma protein A (PAPP-A) should be determined.",
"C": "At this gestational age, nuchal transluce... | step2&3 | B | [
"31 year old",
"presents",
"physician",
"prenatal visit",
"weeks gestation",
"not smoke cigarettes",
"stopped drinking alcohol",
"diagnosed",
"pregnancy",
"10 weeks gestation",
"ultrasound examination showed",
"following",
"Ultrasound finding Measured Normal value",
"age specified",
"Hea... |
A 45-year-old woman presents to the emergency department with fever, cough, tonsillar enlargement, and bleeding lips. She has a diffuse blistering rash that encompasses the palms and soles of her feet, in total covering 55% of her total body surface area (TBSA). The upper epidermal layer easily slips away with slight r... | Exposure to carbamazepine | {
"A": "Herpes simplex virus",
"B": "Molluscum contagiosum",
"C": "Exposure to carbamazepine",
"D": "Cytomegalovirus"
} | step2&3 | C | [
"year old woman presents",
"emergency department",
"fever",
"cough",
"tonsillar enlargement",
"bleeding lips",
"diffuse blistering",
"palms",
"soles of",
"feet",
"total covering 55",
"of",
"body surface area",
"upper epidermal layer easily slips",
"slight",
"24 hours",
"rash progress... |
A previously healthy 35-year-old woman comes to the physician because of palpitations and anxiety for the past 2 months. She has had a 3.1-kg (7-lb) weight loss in this period. Her pulse is 112/min. Cardiac examination shows normal heart sounds with a regular rhythm. Neurologic examination shows a fine resting tremor o... | ↓ ↑ ↑ normal | {
"A": "↓ ↑ ↑ normal",
"B": "↓ ↑ normal ↑",
"C": "↑ ↓ ↓ ↓",
"D": "↑ normal normal normal"
} | step1 | A | [
"healthy 35 year old woman",
"physician",
"palpitations",
"anxiety",
"past",
"months",
"3.1 kg",
"weight loss",
"period",
"pulse",
"min",
"Cardiac examination shows normal heart",
"regular rhythm",
"Neurologic examination shows",
"fine resting tremor of",
"hands",
"patellar reflexes"... |
A 37-year-old woman comes to the office complaining of fatigue and itchiness for the past 2 months. She tried applying body lotion with limited improvement. Her symptoms have worsened over the past month, and she is unable to sleep at night due to intense itching. She feels very tired throughout the day and complains o... | Anti-mitochondrial antibody | {
"A": "Elevated alkaline phosphatase and gamma glutamyltransferase",
"B": "P-ANCA staining",
"C": "Anti-mitochondrial antibody",
"D": "‘Onion skin fibrosis’ on liver biopsy"
} | step2&3 | C | [
"year old woman",
"office",
"fatigue",
"itchiness",
"past",
"months",
"applying body lotion",
"limited improvement",
"symptoms",
"worsened",
"past month",
"unable to sleep",
"night",
"intense itching",
"feels very tired",
"day",
"decreased appetite",
"not smoke cigarettes",
"drin... |
A 14-year-old boy is brought to the physician for the evaluation of back pain for the past six months. The pain is worse with exercise and when reclining. He attends high school and is on the swim team. He also states that he lifts weights on a regular basis. He has not had any trauma to the back or any previous proble... | Spondylolisthesis | {
"A": "Spondylolisthesis",
"B": "Facet joint syndrome",
"C": "Disc herniation",
"D": "Overuse injury"
} | step2&3 | A | [
"year old boy",
"brought",
"physician",
"evaluation of back pain",
"past six months",
"pain",
"worse",
"exercise",
"attends high school",
"swim team",
"states",
"lifts weights",
"regular basis",
"not",
"trauma",
"back",
"previous problems",
"joints",
"history",
"serious illness... |
A 45-year-old male presents to the emergency room following a seizure. The patient suffered from an upper respiratory infection complicated by sinusitis two weeks ago. The patient's past medical history is remarkable for hypertension for which he takes hydrochlorathiazide. Temperature is 39.5C, blood pressure is 120/60... | Ceftriaxone and vancomycin | {
"A": "Ceftriaxone",
"B": "Ceftriaxone and vancomycin",
"C": "Ceftriaxone, vancomycin and ampicillin",
"D": "MRI of the head"
} | step2&3 | B | [
"year old male presents",
"emergency room following",
"seizure",
"patient suffered",
"upper respiratory infection complicated",
"sinusitis two weeks",
"patient's past",
"hypertension",
"takes",
"Temperature",
"blood pressure",
"60 mmHg",
"pulse",
"85 min",
"respiratory rate",
"20 min",... |
A 38-year-old woman presents to the emergency department with painless vaginal bleeding of sudden onset approx. 1 hour ago. The woman informs the doctor that, currently, she is in the 13th week of pregnancy. She also mentions that she was diagnosed with hyperemesis gravidarum during the 6th week of pregnancy. On physic... | 46, XX | {
"A": "46, XX",
"B": "46, XY",
"C": "46, YY",
"D": "69, XXY"
} | step1 | A | [
"year old woman presents",
"emergency department",
"painless vaginal bleeding",
"sudden onset",
"hour",
"woman informs",
"doctor",
"currently",
"week",
"pregnancy",
"diagnosed",
"hyperemesis gravidarum",
"week",
"pregnancy",
"physical examination",
"temperature",
"99",
"pulse rate"... |
A 51-year-old man comes to the physician for the evaluation of a 3-week history of fatigue and shortness of breath. One year ago, a screening colonoscopy showed colonic polyps. His brother has a bicuspid aortic valve. On examination, a late systolic crescendo-decrescendo murmur is heard at the right upper sternal borde... | Fragmentation of erythrocytes | {
"A": "Gastrointestinal bleeding",
"B": "Autoimmune destruction of erythrocytes",
"C": "Fragmentation of erythrocytes",
"D": "Erythrocyte enzyme defect\n\""
} | step1 | C | [
"year old man",
"physician",
"evaluation",
"week history",
"fatigue",
"shortness of breath",
"One year ago",
"screening colonoscopy showed colonic polyps",
"brother",
"bicuspid aortic valve",
"examination",
"late systolic crescendo-decrescendo murmur",
"heard",
"right upper sternal border"... |
A 5-day-old boy is brought to the emergency department because of altered mental status. His mother called an ambulance after finding him grey and unarousable in his crib. The patient was born via cesarean section due to preterm premature rupture of membranes (PPROM). Since birth, the infant has gained little weight an... | Three sign | {
"A": "Target sign",
"B": "Three sign",
"C": "Tram tracking",
"D": "Tree-in-bud pattern"
} | step2&3 | B | [
"5 day old boy",
"brought",
"emergency department",
"altered mental status",
"mother called",
"ambulance",
"finding",
"grey",
"crib",
"patient",
"born",
"cesarean section due to preterm premature rupture of membranes",
"birth",
"infant",
"gained little weight",
"fussy",
"temperature"... |
A 63-year-old retired teacher presents to his family physician for an annual visit. He has been healthy for most of his life and currently takes no medications, although he has had elevated blood pressure on several visits in the past few years but declined taking any medication. He has no complaints about his health a... | Repeat the urinalysis | {
"A": "Perform a CT scan of the abdomen with contrast",
"B": "Perform intravenous pyelography",
"C": "Perform a cystoscopy",
"D": "Repeat the urinalysis"
} | step2&3 | D | [
"63 year old retired teacher presents",
"family physician",
"annual visit",
"healthy",
"life",
"currently takes",
"medications",
"elevated blood pressure",
"visits",
"past",
"years",
"taking",
"medication",
"complaints",
"health",
"time",
"grandchildren",
"smoker",
"40",
"half"... |
A 57-year-old woman comes to the physician because of a 1-month history of lesions on her eyelids. A photograph of the lesions is shown. This patient's eye condition is most likely associated with which of the following processes? | Autoimmune destruction of lobular bile ducts | {
"A": "Autoimmune destruction of lobular bile ducts",
"B": "Deposition of immunoglobulin light chains",
"C": "Infection with humanherpes virus 8",
"D": "Dietary protein-induced inflammation of duodenum"
} | step1 | A | [
"57 year old woman",
"physician",
"month history",
"lesions",
"eyelids",
"photograph",
"lesions",
"shown",
"patient's eye",
"most likely associated with",
"following processes"
] |
A 65-year-old male presents to the emergency department with a 2-day onset of right-lower quadrant and right flank pain. He also states that over this period of time he has felt dizzy, light-headed, and short of breath. He denies any recent trauma or potential inciting event. His vital signs are as follows: T 37.1 C, H... | CT abdomen/pelvis | {
"A": "Ultrasound of the right flank",
"B": "Radiographs of the abdomen and pelvis",
"C": "MRI abdomen/pelvis",
"D": "CT abdomen/pelvis"
} | step2&3 | D | [
"65 year old male presents",
"emergency department",
"2-day onset",
"right-lower quadrant",
"right flank pain",
"states",
"period",
"time",
"felt dizzy",
"light-headed",
"short of breath",
"denies",
"recent trauma",
"potential",
"event",
"vital signs",
"follows",
"T",
"BP 74",
... |
A 22-year-old man comes to the physician for the evaluation of a skin rash over both of his shoulders and elbows for the past 5 days. The patient reports severe itching and burning sensation. He has no history of serious illness except for recurrent episodes of diarrhea and abdominal cramps, which have occurred every o... | Oral dapsone | {
"A": "Oral dapsone",
"B": "Systemic prednisone",
"C": "Oral acyclovir",
"D": "Topical permethrin"
} | step2&3 | A | [
"year old man",
"physician",
"evaluation",
"skin",
"shoulders",
"elbows",
"past 5 days",
"patient reports severe itching",
"burning sensation",
"history",
"serious illness except for recurrent episodes of diarrhea",
"abdominal cramps",
"occurred",
"over",
"past three months",
"stools",... |
A 30-year-old woman presents with a history of progressive forgetfulness, fatigue, unsteady gait, and tremor. Family members also report that not only has her speech become slurred, but her behavior has significantly changed over the past few years. On physical examination, there is significant hepatomegaly with a posi... | II, IV, VI, VII | {
"A": "I, II, IV, VII",
"B": "I, II, IV, VI",
"C": "II, IV, V, VI",
"D": "II, IV, VI, VII"
} | step1 | D | [
"30 year old woman presents",
"history",
"progressive forgetfulness",
"fatigue",
"unsteady gait",
"tremor",
"Family members",
"report",
"not only",
"speech",
"slurred",
"behavior",
"changed",
"past",
"years",
"physical examination",
"significant hepatomegaly",
"positive fluid wave"... |
A 15-month-old girl is brought to the physician because of a 2-day history of low-grade fever and a painful lesion on her right index finger. She was born at term and has been healthy except for a rash on her upper lip 2 weeks ago, which resolved without treatment. She lives at home with her parents, her 5-year-old bro... | Herpes simplex virus type 1 | {
"A": "Sporothrix schenckii",
"B": "Human papillomavirus type 1",
"C": "Herpes simplex virus type 1",
"D": "Trichophyton rubrum"
} | step2&3 | C | [
"month old girl",
"brought",
"physician",
"2-day history",
"low-grade fever",
"painful lesion",
"right index finger",
"born",
"term",
"healthy",
"rash",
"upper lip",
"weeks",
"resolved",
"treatment",
"lives at home",
"parents",
"5 year old brother",
"two cats",
"temperature",
... |
A 35-year-old G0P1 female presents to her OB/GYN after 17 weeks gestation. A quad screen is performed revealing the following results: elevated inhibin and beta HCG, decreased aFP and estriol. An ultrasound was performed demonstrating increased nuchal translucency. When the fetus is born, what may be some common charac... | Epicanthal folds, macroglossia, flat profile, depressed nasal bridge, and simian palmar crease | {
"A": "Epicanthal folds, high-pitched crying/mewing, and microcephaly",
"B": "Microphthalmia, microcephaly, cleft lip/palate, holoprosencephaly, and polydactyly",
"C": "Epicanthal folds, macroglossia, flat profile, depressed nasal bridge, and simian palmar crease",
"D": "Elfin facies, low nasal bridge, and ext... | step1 | C | [
"35 year old",
"female presents",
"OB/GYN",
"weeks gestation",
"quad screen",
"performed revealing",
"following results",
"elevated inhibin",
"beta HCG",
"decreased",
"estriol",
"ultrasound",
"performed",
"increased nuchal translucency",
"fetus",
"born",
"common characteristics",
"... |
A 3-month-old boy is brought to his pediatrician’s office to be evaluated for seizures and failure to thrive. The patient’s mother says that he is unable to hold his own head up and does not seem to follow the movement of her fingers. On physical exam the patient is hypotonic. Initial serum studies show elevated lactat... | Leucine | {
"A": "Alanine",
"B": "Asparagine",
"C": "Leucine",
"D": "Methionine"
} | step1 | C | [
"3 month old boy",
"brought",
"pediatricians office to",
"evaluated",
"seizures",
"failure to thrive",
"patients mother",
"unable to hold",
"head up",
"not",
"to follow",
"movement",
"fingers",
"physical exam",
"patient",
"hypotonic",
"Initial serum studies show elevated lactate leve... |
A 56-year-old man comes to the emergency department because of pain and swelling in his left leg. He has a history of pancreatic cancer and is currently receiving chemotherapy. Three weeks ago, he had a similar episode in his right arm that resolved without treatment. His temperature is 38.2°C (100.8°F). Palpation of t... | Great saphenous vein | {
"A": "Anterior tibial artery",
"B": "Superficial femoral artery",
"C": "Great saphenous vein",
"D": "External iliac vein"
} | step1 | C | [
"year old man",
"emergency department",
"pain",
"swelling",
"left",
"history of pancreatic cancer",
"currently receiving chemotherapy",
"Three weeks",
"similar episode",
"right arm",
"resolved",
"treatment",
"temperature",
"100",
"Palpation",
"left leg shows",
"tender",
"cord shape... |
A 38-year-old man is admitted to the hospital because of fever, yellowing of the skin, and nausea for 1 day. He recently returned from a backpacking trip to Brazil and Paraguay, during which he had a 3-day episode of high fever that resolved spontaneously. Physical examination shows jaundice, epigastric tenderness, and... | Apoptosis | {
"A": "Necrosis",
"B": "Regeneration",
"C": "Apoptosis",
"D": "Proliferation"
} | step1 | C | [
"year old man",
"admitted",
"hospital",
"fever",
"yellowing of the skin",
"nausea",
"1 day",
"recently returned",
"trip",
"Brazil",
"Paraguay",
"3-day episode of high fever",
"resolved",
"Physical examination shows jaundice",
"epigastric tenderness",
"petechiae",
"trunk",
"Five hou... |
A 54-year-old woman presents to the emergency department with sudden shortness of breath. A CT scan shows multiple nodules in her left lung. She reports that for the past 6 months, she has been feeling tired and depressed. She also has frequently felt flushed, which she presumed is a symptom of getting closer to menopa... | Vandetanib | {
"A": "Radioactive iodine (radioiodine)",
"B": "Thyroid-stimulating hormone (TSH) suppression",
"C": "Tamoxifen",
"D": "Vandetanib"
} | step2&3 | D | [
"54 year old woman presents",
"emergency department",
"sudden shortness of breath",
"CT scan shows multiple nodules",
"left lung",
"reports",
"past 6 months",
"feeling tired",
"depressed",
"frequently felt flushed",
"symptom",
"getting",
"menopause",
"physical examination",
"nodule",
"... |
A 53-year-old man presents to your office with a 2 month history of abdominal bloating. He states that he feels full after eating only a small amount and has experienced bloating, diarrhea, and occasionally vomiting when he tries to eat large amounts. He states his diarrhea has now become more profuse and is altering t... | Rifaximin | {
"A": "Elimination of dairy from the diet",
"B": "Metoclopramide",
"C": "Rifaximin",
"D": "Vancomycin"
} | step2&3 | C | [
"year old man presents",
"office",
"2 month history",
"abdominal bloating",
"states",
"feels full",
"eating only",
"small amount",
"bloating",
"diarrhea",
"occasionally vomiting",
"to eat large amounts",
"states",
"diarrhea",
"now",
"more",
"altering",
"quality of",
"life",
"On... |
A 50-year-old woman presents with severe abdominal pain. Past medical history is significant for a peptic ulcer. Physical examination is limited because the patient will not allow abdominal palpation due to the pain. The attending makes a presumptive diagnosis of peritonitis. Which of the following non-invasive maneuve... | Forced cough elicits abdominal pain | {
"A": "Forced cough elicits abdominal pain",
"B": "Pain is aroused with gentle intensity/pressure at the costovertebral angle",
"C": "Rectal examination shows guaiac positive stool",
"D": "Bowel sounds are absent on auscultation"
} | step1 | A | [
"50 year old woman presents",
"severe abdominal",
"Past medical history",
"significant",
"a peptic ulcer",
"Physical examination",
"limited",
"patient",
"not allow abdominal palpation due to",
"pain",
"attending makes",
"presumptive diagnosis",
"peritonitis",
"following non-invasive",
"m... |
A 45-year-old man comes to the physician because of numbness and tingling in his fingers and toes for the past month. He also describes difficulty with balance while walking. Laboratory studies show a hemoglobin concentration of 9.5 g/dL. Serum homocysteine and methylmalonic acid levels are elevated. Peripheral blood s... | Cyanocobalamin supplementation | {
"A": "Avoidance of canned foods",
"B": "Cyanocobalamin supplementation",
"C": "Pyridoxine supplementation",
"D": "Folic acid supplementation"
} | step1 | B | [
"year old man",
"physician",
"numbness",
"tingling in",
"fingers",
"toes",
"past month",
"difficulty",
"balance",
"walking",
"Laboratory studies show a hemoglobin concentration",
"9.5 g/dL",
"Serum homocysteine",
"methylmalonic acid levels",
"elevated",
"Peripheral blood smear shows hy... |
A 63-year-old female with known breast cancer presents with progressive motor weakness in bilateral lower extremities and difficulty ambulating. Physical exam shows 4 of 5 motor strength in her legs and hyper-reflexia in her patellar tendons. Neurologic examination 2 weeks prior was normal. Imaging studies, including a... | Surgical decompression and postoperative radiotherapy | {
"A": "Palliative pain management consultation",
"B": "Radiation therapy alone",
"C": "Chemotherapy alone",
"D": "Surgical decompression and postoperative radiotherapy"
} | step2&3 | D | [
"63 year old female",
"known breast cancer presents",
"progressive motor weakness",
"bilateral lower extremities",
"difficulty ambulating",
"Physical exam shows 4 of 5 motor strength",
"legs",
"hyper-reflexia",
"patellar tendons",
"Neurologic examination 2 weeks prior",
"normal",
"Imaging stud... |
A 23-year-old woman presents to her primary care physician because she has been having difficulty seeing despite previously having perfect vision all her life. Specifically, she notes that reading, driving, and recognizing faces has become difficult, and she feels that her vision has become fuzzy. She is worried becaus... | Daughter: 100% and son 100% | {
"A": "Daughter: ~0% and son: 50%",
"B": "Daughter: 25% and son: 25%",
"C": "Daughter: 50% and son: 50%",
"D": "Daughter: 100% and son 100%"
} | step1 | D | [
"23 year old woman presents",
"primary care physician",
"difficulty seeing",
"vision",
"life",
"notes",
"reading",
"driving",
"faces",
"difficult",
"feels",
"vision",
"fuzzy",
"worried",
"older brothers",
"visual loss",
"similar presentation",
"exam reveals bilateral loss of centra... |
A 22-year-old woman comes to the physician for gradual worsening of her vision. Her father died at 40 years of age. She is 181 cm (5 ft 11 in) tall and weighs 69 kg (152 lb); BMI is 21 kg/m2. A standard vision test shows severe myopia. Genetic analysis shows an FBN1 gene mutation on chromosome 15. This patient is at gr... | Intimal tear of the aortic root | {
"A": "Obstruction of the superior vena cava lumen",
"B": "Increased pressure in the pulmonary arteries",
"C": "Eccentric ventricular hypertrophy",
"D": "Intimal tear of the aortic root"
} | step1 | D | [
"year old woman",
"physician",
"gradual worsening",
"vision",
"father died",
"40",
"age",
"5 ft",
"tall",
"69 kg",
"BMI",
"kg/m2",
"standard vision test shows severe myopia",
"Genetic analysis shows",
"FBN1 gene mutation",
"chromosome",
"patient",
"greatest risk",
"mortality due ... |
A 4-year-old boy is brought to a pediatrician by his parents with a history of fever for the last 5 days and irritability, decreased appetite, vomiting, and swelling of the hands and feet for the last 3 days. The patient’s mother mentions that he has been taking antibiotics and antipyretics prescribed by another physic... | Coronary artery ectasia | {
"A": "Acute renal failure",
"B": "Coronary artery ectasia",
"C": "Lower gastrointestinal hemorrhage",
"D": "Pulmonary embolism"
} | step1 | B | [
"4 year old boy",
"brought",
"pediatrician",
"parents",
"history",
"fever",
"last",
"days",
"irritability",
"decreased appetite",
"vomiting",
"swelling of",
"hands",
"feet",
"3 days",
"patients mother",
"taking antibiotics",
"antipyretics prescribed",
"physician",
"last",
"da... |
A 67-year-old woman presents to her primary care physician because she has been feeling increasingly fatigued over the last month. She has noticed that she gets winded halfway through her favorite walk in the park even though she was able to complete the entire walk without difficulty for years. She recently moved to a... | Glucocorticoid administration | {
"A": "Avoidance of fava beans",
"B": "Chronic blood transfusions",
"C": "Glucocorticoid administration",
"D": "Vitamin supplementation"
} | step1 | C | [
"67 year old woman presents",
"primary care physician",
"feeling",
"fatigued",
"month",
"gets winded",
"walk in",
"park",
"able to complete",
"entire walk",
"difficulty",
"years",
"recently moved to",
"old house",
"started",
"new Mediterranean diet",
"past medical history",
"signif... |
A 23-year-old patient who has recently found out she was pregnant presents to her physician for her initial prenatal visit. The estimated gestational age is 10 weeks. Currently, the patient complains of recurrent palpitations. She is gravida 1 para 0 with no history of any major diseases. On examination, the blood pres... | Beta-blockers are the preferable drug class for rate control in this case. | {
"A": "The patient requires balloon commissurotomy.",
"B": "Warfarin should be used for thromboembolism prophylaxis.",
"C": "It is reasonable to start antidiuretic therapy right at this moment.",
"D": "Beta-blockers are the preferable drug class for rate control in this case."
} | step2&3 | D | [
"23 year old patient",
"recently found out",
"pregnant presents",
"physician",
"initial prenatal visit",
"estimated gestational age",
"10 weeks",
"Currently",
"patient",
"recurrent palpitations",
"gravida 1 para 0",
"history of",
"major diseases",
"examination",
"blood pressure",
"60 m... |
A 53-year-old man is brought to the emergency department by his wife for the evaluation of a progressively generalized headache that started suddenly 2 hours ago. He describes the pain as 10 out of 10 in intensity. The pain radiates to the neck and is aggravated by lying down. The patient has vomited once on his way to... | CT scan of the head without contrast | {
"A": "Lumbar puncture",
"B": "MRI scan of the brain",
"C": "CT angiography of the head",
"D": "CT scan of the head without contrast"
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"wife",
"evaluation",
"generalized headache",
"started",
"hours",
"pain",
"10 out",
"10",
"intensity",
"pain radiates",
"neck",
"aggravated",
"lying",
"patient",
"vomited",
"hospital",
"similar headache",
"week",
"resolved"... |
The physician recommends that the patient receive an influenza vaccine. The patient becomes nervous and reports that he has never received an influenza vaccination because of an allergy to eggs. The allergy was diagnosed many years ago, after he developed hives upon eating scrambled eggs. Which of the following is the ... | Administer inactivated influenza vaccine | {
"A": "Administer inactivated influenza vaccine",
"B": "Administer influenza immunoglobulins",
"C": "End the examination without additional measures",
"D": "Prescribe oseltamivir for standby emergency treatment"
} | step2&3 | A | [
"physician recommends",
"patient receive",
"influenza vaccine",
"patient",
"nervous",
"reports",
"never received",
"influenza",
"allergy",
"eggs",
"allergy",
"diagnosed",
"years",
"hives",
"eating scrambled eggs",
"following",
"most appropriate next step",
"management"
] |
A 25-year-old male graduate student is brought to the emergency department for respiratory distress after he was found by his roommate coughing and severely short of breath. He was diagnosed with HIV infection 3 months ago but is not compliant with his antiretroviral therapy. He is from Chile and moved here 5 years ago... | Prednisone | {
"A": "Prednisone",
"B": "Isoniazid",
"C": "Azithromycin",
"D": "Filgrastim"
} | step2&3 | A | [
"year old male graduate student",
"brought",
"emergency department",
"respiratory distress",
"found",
"roommate coughing",
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"diagnosed",
"HIV infection 3 months",
"not compliant",
"antiretroviral therapy",
"Chile",
"moved",
"years",
"appears unwell",
"unable"... |
A 7-year-old boy is brought to the pediatrician by his parents due to pubic hair growth and changes in his voice. He has been developing in the 98th percentile for his age. His vaccination is up-to-date. The patient’s blood pressure is within the 60th percentile for his age. Physical examination reveals pubic and armpi... | 21-hydroxylase | {
"A": "17-α-hydroxylase",
"B": "5-α-reductase",
"C": "21-hydroxylase",
"D": "Aromatase"
} | step1 | C | [
"year old boy",
"brought",
"pediatrician",
"parents due to pubic",
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"age",
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"date",
"patients blood pressure",
"percentile",
"age",
"Physical examination reveals pubic",
"armpit hair",
"Tanner characterized",
"enlarged scrotum",
"te... |
A 34-year-old woman with beta-thalassemia major is brought to the physician because of a 2-month history of fatigue, darkening of her skin, and pain in her ankle joints. She has also had increased thirst and frequent urination for 2 weeks. She receives approximately 5 blood transfusions every year; her last transfusion... | Elevated ferritin | {
"A": "Elevated hepcidin",
"B": "Elevated ferritin",
"C": "Decreased transferrin saturation",
"D": "Decreased haptoglobin"
} | step1 | B | [
"year old woman",
"beta-thalassemia major",
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"physician",
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"increased thirst",
"frequent urination",
"2 weeks",
"receives approximately",
"blood transfusions",
"year",
"last transfusion",
"3 months"... |
A 68-year-old man presents to his primary care physician for a routine checkup. He currently has no complaints. During routine blood work, he is found to have a slightly elevated calcium (10.4 mg/dL) and some findings of plasma cells in his peripheral blood smear (less than 10%). His physician orders a serum protein el... | Kidney damage | {
"A": "Peripheral neuropathy",
"B": "Kidney damage",
"C": "Raynaud's phenomenon",
"D": "Splenomegaly"
} | step1 | B | [
"68 year old man presents",
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"routine checkup",
"currently",
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"slightly elevated calcium",
"10.4 mg/dL",
"findings",
"plasma cells",
"peripheral blood smear",
"less than 10",
"physician orders",
"serum protein electr... |
A 30-year-old woman presents to the emergency department with breathlessness for the last hour. She is unable to provide any history due to her dyspnea. Her vitals include: respiratory rate 20/min, pulse 100/min, and blood pressure 144/84 mm Hg. On physical examination, she is visibly obese, and her breathing is labore... | Alveolar hypoventilation | {
"A": "Impaired gas diffusion",
"B": "Alveolar hypoventilation",
"C": "Right to left shunt",
"D": "Ventricular septal defect"
} | step1 | B | [
"30 year old woman presents",
"emergency department",
"breathlessness",
"hour",
"unable to provide",
"history due to",
"dyspnea",
"include",
"respiratory rate 20 min",
"pulse 100 min",
"blood pressure",
"84 mm Hg",
"physical examination",
"obese",
"breathing",
"labored",
"decreased b... |
A 75-year-old woman presents with episodic abdominal pain following meals for the past few years. She says these episodes have worsened over the past month. Past medical history is significant for type 2 diabetes mellitus diagnosed 30 years ago, managed with metformin. Her most recent HbA1C last month was 10%. Vital si... | Mesenteric artery occlusion | {
"A": "Acute pancreatitis",
"B": "Hepatic infarction",
"C": "Chronic renal failure",
"D": "Mesenteric artery occlusion"
} | step1 | D | [
"75 year old woman presents",
"episodic abdominal pain following meals",
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"years",
"episodes",
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"past month",
"Past medical history",
"significant",
"type 2 diabetes mellitus diagnosed 30 years",
"managed",
"metformin",
"most recent",
"month",
"10",
"Vital signs inclu... |
A 64-year-old woman with osteoarthritis presents to the emergency room with a 2-day history of nausea and vomiting. Over the past few weeks, the patient has been taking painkillers to control worsening knee pain. Physical examination reveals scleral icterus and tender hepatomegaly. The patient appears confused. Laborat... | N-acetylcysteine | {
"A": "N-acetylaspartic acid",
"B": "N-acetylcysteine",
"C": "N-acetylglucosamine",
"D": "N-acetyl-p-benzoquinoneimine"
} | step2&3 | B | [
"64 year old woman",
"osteoarthritis presents",
"emergency room",
"2-day history",
"nausea",
"vomiting",
"past",
"weeks",
"patient",
"taking painkillers to control worsening knee pain",
"Physical examination reveals scleral icterus",
"tender hepatomegaly",
"patient appears confused",
"Labo... |
A 4-year-old girl presents to a pediatrician for a scheduled follow-up visit. She was diagnosed with her first episode of acute otitis media 10 days ago and had been prescribed oral amoxicillin. Her clinical features at the time of the initial presentation included pain in the ear, fever, and nasal congestion. The tymp... | Observation and regular follow-up | {
"A": "Continue oral amoxicillin for a total of 21 days",
"B": "Prescribe amoxicillin-clavulanate for 14 days",
"C": "Prescribe oral prednisolone for 7 days",
"D": "Observation and regular follow-up"
} | step2&3 | D | [
"4 year old girl presents",
"pediatrician",
"scheduled follow-up visit",
"diagnosed",
"first episode of acute otitis media 10 days",
"prescribed oral amoxicillin",
"clinical features",
"time",
"initial presentation included pain in",
"ear",
"fever",
"nasal congestion",
"tympanic membrane",
... |
A 71-year-old female presents to the clinic with frequent and voluminous urination for 2 weeks. She is a new patient and does not have any medical records as she recently moved to the US from Europe to live with her grandson. When asked about any prior health issues, she looks confused and shows some medications that s... | Lithium | {
"A": "Primary polydipsia",
"B": "Aspirin",
"C": "Omeprazole",
"D": "Lithium"
} | step2&3 | D | [
"71 year old female presents",
"clinic",
"frequent",
"urination",
"2 weeks",
"new patient",
"not",
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"Europe to live",
"grandson",
"prior health issues",
"looks confused",
"shows",
"medications",
"takes",
"day",
"includes aspirin",
"omeprazol... |
An 18-year-old man presents to the emergency department with complaints of sudden severe groin pain and swelling of his left testicle. It started roughly 5 hours ago and has been progressively worsening. History reveals that he has had multiple sexual partners but uses condoms regularly. Vital signs include: blood pres... | Surgery | {
"A": "Urinalysis",
"B": "Antibiotics",
"C": "Surgery",
"D": "Ultrasound of the scrotum"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"complaints",
"sudden severe groin",
"swelling of",
"left testicle",
"started",
"hours",
"worsening",
"History reveals",
"multiple sexual partners",
"uses condoms",
"Vital signs include",
"blood pressure",
"80 mm Hg",
"heart rate 84 min"... |
A 31 year-old-man presents to an urgent care clinic with symptoms of lower abdominal pain, bloating, bloody diarrhea, and fullness, all of which have become more frequent over the last 3 months. Rectal examination reveals a small amount of bright red blood. His vital signs include: temperature 36.7°C (98.0°F), blood pr... | Total proctocolectomy | {
"A": "Sulfasalazine",
"B": "Systemic corticosteroids",
"C": "Azathioprine",
"D": "Total proctocolectomy"
} | step2&3 | D | [
"31 year old man presents",
"urgent care clinic",
"symptoms",
"lower",
"bloating",
"bloody diarrhea",
"fullness",
"more frequent",
"months",
"Rectal examination reveals",
"small amount",
"bright red blood",
"vital signs include",
"temperature 36",
"98",
"blood pressure",
"74 mm Hg",
... |
A 5 month-old boy with no significant past medical, surgical, or family history is brought the pediatrician by his parents for a new rash. The parents state that the rash started several weeks earlier and has not changed. The boy has breastfed since birth and started experimenting with soft foods at the age of 4 months... | Infantile seborrheic dermatitis | {
"A": "Infantile seborrheic dermatitis",
"B": "Langerhans cell histiocytosis",
"C": "Pityriasis amiantacea",
"D": "Atopic dermatitis"
} | step2&3 | A | [
"5 month old boy",
"significant past medical",
"surgical",
"family history",
"brought",
"pediatrician",
"parents",
"new rash",
"parents state",
"rash started several weeks earlier",
"not changed",
"boy",
"breastfed",
"birth",
"started experimenting",
"soft foods",
"age",
"months",
... |
A 25-year-old woman presents to you for a routine health checkup. She has no complaints. Family history is significant for 2 of her siblings who have died from Tay-Sachs disease, but she and her parents are phenotypically normal. Which of the following are the chances of this person being a heterozygous carrier of the ... | 66% | {
"A": "25%",
"B": "33%",
"C": "66%",
"D": "50%"
} | step1 | C | [
"year old woman presents",
"routine health checkup",
"complaints",
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"significant",
"2",
"siblings",
"died",
"Tay-Sachs disease",
"parents",
"normal",
"following",
"chances",
"person",
"heterozygous carrier",
"mutation",
"causes Tay-Sachs disease"
] |
A nine-year-old female presents to the pediatrician for short stature. The patient is in third grade and is the shortest child in her class. She is otherwise doing well in school, and her teacher reports that she is at or above grade level in all subjects. The patient has many friends and plays well with her two younge... | Continuous, flow murmur best heard in the interscapular region | {
"A": "Continuous, machine-like murmur best heard in the left subclavicular region",
"B": "Continuous, flow murmur best heard in the interscapular region",
"C": "Holosystolic, harsh-sounding murmur best heard at the left lower sternal border",
"D": "Late systolic, crescendo murmur at the apex with mid-systolic... | step2&3 | B | [
"nine year old female presents",
"pediatrician",
"short stature",
"patient",
"third grade",
"shortest child",
"class",
"well",
"school",
"teacher reports",
"above grade level",
"subjects",
"patient",
"friends",
"plays well",
"two younger siblings at home",
"past mild",
"right ear",... |
A 57-year-old man is brought to the emergency department by his son for odd behavior. The patient and his son had planned to go on a hike today. On the drive up to the mountain, the patient began acting strangely which prompted the patient's son to bring him in. The patient has a past medical history of constipation, s... | Physostigmine | {
"A": "Atropine",
"B": "IV fluids, thiamine, and dextrose",
"C": "Naloxone",
"D": "Physostigmine"
} | step2&3 | D | [
"57 year old man",
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"emergency department",
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"odd behavior",
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"son",
"planned to go",
"today",
"drive",
"mountain",
"patient began acting",
"prompted",
"patient's son to",
"patient",
"past medical constipation",
"seasonal allergies",
"alcohol abuse",
"IV... |
A 15-year-old boy presents with sudden onset right sided weakness of his arm and face and difficulty speaking. He denies any problems with hearing or comprehension. The patient has no history of chest pain, hypertension, or diabetes mellitus. No significant past medical history. The patient is afebrile, and vital signs... | Cystathionine synthase | {
"A": "Phenylalanine hydroxylase",
"B": "Homogentisate oxidase",
"C": "Cystathionine synthase",
"D": "Branched-chain ketoacid dehydrogenase"
} | step1 | C | [
"year old boy presents",
"sudden onset right sided weakness of",
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"face",
"difficulty speaking",
"denies",
"problems with hearing",
"comprehension",
"patient",
"history of chest pain",
"hypertension",
"diabetes mellitus",
"significant past medical history",
"patient",
"afebrile",
... |
A 57-year-old woman presents to her physician for a checkup. The past medical history is significant for diabetes mellitus type 2, and a history of myocardial infarction. The current medications are aspirin, lisinopril, metoprolol, atorvastatin, and metformin. The patient’s HbA1c is 7.9%, and her fasting blood glucose ... | It does not decrease cardiovascular outcomes. | {
"A": "It cannot be combined with metformin.",
"B": "It does not decrease cardiovascular outcomes.",
"C": "There is a high risk of hypoglycemia in patients who use this medication.",
"D": "This medication should not be combined with insulin."
} | step2&3 | B | [
"57 year old woman presents",
"physician",
"checkup",
"past medical history",
"significant",
"diabetes mellitus type 2",
"history of myocardial infarction",
"current medications",
"aspirin",
"lisinopril",
"metoprolol",
"atorvastatin",
"metformin",
"patients",
"fasting blood glucose",
"... |
A medical student volunteers for an experiment in the physiology laboratory. Before starting the experiment, her oral temperature is recorded as 36.9°C (98.4°F). She is then made to dip both her hands in a bowl containing ice cold water. She withdraws her hands out of the water, and finds that they look pale and feel v... | Cutaneous vasoconstriction | {
"A": "Cutaneous vasoconstriction",
"B": "Diving reflex",
"C": "Muscular contraction",
"D": "Shivering"
} | step1 | A | [
"medical student volunteers",
"experiment",
"physiology laboratory",
"Before starting",
"experiment",
"oral temperature",
"recorded",
"36",
"98 4F",
"then made",
"dip",
"hands",
"bowl containing ice",
"withdraws",
"hands out",
"water",
"finds",
"look pale",
"feel very cold",
"o... |
A 58-year-old man presents to the emergency department with progressive shortness of breath, productive cough, and fever of 38.3°C (100.9°F) for the past 2 days. The patient is known to be a severe smoker with an estimated 40 pack-year history and has been hospitalized 2 times due to similar symptoms over the past year... | Increase in P wave amplitude | {
"A": "Tented, tall T waves",
"B": "Low voltage",
"C": "Increase in P wave amplitude",
"D": "Bifid P waves"
} | step2&3 | C | [
"58 year old man presents",
"emergency department",
"progressive shortness of breath",
"productive cough",
"fever",
"3C",
"100 9F",
"past 2 days",
"patient",
"known to",
"severe smoker",
"estimated 40 pack-year history",
"hospitalized 2 times due to similar symptoms",
"past year",
"exami... |
A 2-day-old boy born to a primigravida with no complications has an ear infection. He is treated with antibiotics and sent home. His parents bring him back 1 month later with an erythematous and swollen umbilical cord still attached to the umbilicus. A complete blood cell count shows the following:
Hemoglobin 18.1 g/d... | CD18 | {
"A": "CD18",
"B": "Histamine",
"C": "Prostaglandin E2",
"D": "IL-1"
} | step1 | A | [
"2-day old boy born",
"primigravida",
"complications",
"ear infection",
"treated with antibiotics",
"sent home",
"parents",
"back",
"month later",
"erythematous",
"swollen umbilical cord",
"attached",
"umbilicus",
"complete blood cell count shows",
"following",
"Hemoglobin",
"g/dL He... |
A 52-year-old man comes to the physician for a routine medical check-up. The patient feels well. He has hypertension, type 2 diabetes mellitus, and recurrent panic attacks. He had a myocardial infarction 3 years ago. He underwent a left inguinal hernia repair at the age of 25 years. A colonoscopy 2 years ago was normal... | Mitral valve prolapse | {
"A": "Pulmonary valve regurgitation",
"B": "Tricuspid valve stenosis",
"C": "Pulmonary valve stenosis",
"D": "Mitral valve prolapse"
} | step2&3 | D | [
"year old man",
"physician",
"routine medical check-up",
"patient feels well",
"hypertension",
"type 2 diabetes mellitus",
"recurrent panic attacks",
"myocardial infarction",
"years",
"left inguinal hernia repair",
"age of",
"years",
"colonoscopy",
"years",
"normal",
"works",
"nurse"... |
A 13-month-old girl is brought to the physician because of a pruritic rash for 2 days. The girl's mother says she noticed a few isolated skin lesions on her trunk two days ago that appear to be itching. The girl received her routine immunizations 18 days ago. Her mother has been giving her ibuprofen for her symptoms. T... | Replication of the attenuated vaccine strain | {
"A": "Antigen contact with presensitized T-lymphocytes",
"B": "Reactivation of virus dormant in dorsal root ganglion",
"C": "Crosslinking of preformed IgE antibodies",
"D": "Replication of the attenuated vaccine strain"
} | step2&3 | D | [
"month old girl",
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"2 days",
"girl's mother",
"few isolated skin lesions",
"trunk two days",
"appear to",
"itching",
"girl received",
"routine immunizations",
"days",
"mother",
"giving",
"ibuprofen",
"symptoms",
"patient",
"known si... |
A parent-teacher conference is called to discuss the behavior of a 9-year-old boy. According to the boy's teacher, he has become progressively more disruptive during class. He is performing poorly in school and has trouble focusing. He is destructive to classroom property, tore a classmate's art project, and takes othe... | Conduct disorder | {
"A": "Conduct disorder",
"B": "Oppositional defiant disorder",
"C": "Antisocial personality disorder",
"D": "Attention deficit disorder"
} | step1 | A | [
"parent teacher conference",
"called to discuss",
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"boy",
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"lass.",
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"estructive ",
"lassroom roperty,",
"ore ",
"lassmate'",
"t p oject, ",
"kes o",
"ildren's",
"ches re",
"ss... |
An anesthesiologist is preparing a patient for a short surgical procedure. The physician would like to choose a sedating agent that can be given intravenously and will have a quick onset of action and short half-life. Which of the following agents would be ideal for this purpose? | Sodium thiopental | {
"A": "Succinylcholine",
"B": "Hydromorphone",
"C": "Sodium thiopental",
"D": "Lidocaine"
} | step1 | C | [
"anesthesiologist",
"preparing",
"patient",
"short surgical",
"physician",
"to choose",
"sedating agent",
"given",
"quick onset of action",
"short half-life",
"following agents",
"ideal",
"purpose"
] |
A previously healthy 44-year-old man is brought by his coworkers to the emergency department 45 minutes after he became light-headed and collapsed while working in the boiler room of a factory. He did not lose consciousness. His coworkers report that 30 minutes prior to collapsing, he told them he was nauseous and had ... | Ice water immersion | {
"A": "Ice water immersion",
"B": "Platelet transfusion",
"C": "CT scan of the head",
"D": "Evaporative cooling\n\""
} | step2&3 | A | [
"healthy",
"year old man",
"brought",
"coworkers",
"emergency department 45 minutes",
"light-headed",
"collapsed",
"working",
"boiler room",
"factory",
"not",
"consciousness",
"coworkers report",
"30 minutes prior to collapsing",
"nauseous",
"headache",
"appears sweaty",
"lethargic... |
A 32-year-old man comes to the physician because of episodic tingling and numbness in his right hand for the past 3 months. His symptoms are worse in the evening. There is no history of trauma. He is employed as a carpenter. He has smoked 1 pack of cigarettes daily for the past 10 years. He drinks a pint of vodka daily... | Cubital tunnel | {
"A": "Cubital tunnel",
"B": "Radial groove",
"C": "Guyon canal",
"D": "Carpal tunnel"
} | step2&3 | A | [
"year old man",
"physician",
"episodic tingling",
"numbness",
"right",
"past 3 months",
"symptoms",
"worse",
"evening",
"history",
"trauma",
"employed",
"carpenter",
"smoked 1 pack",
"cigarettes daily",
"past 10 years",
"drinks",
"pint",
"vodka daily",
"not use illicit drugs",
... |
A 24-year-old man and his mother arrive for a psychiatric evaluation. She is concerned about his health and behavior ever since he dropped out of graduate school and moved back home 8 months ago. He is always very anxious and preoccupied with thoughts of school and getting a job. He also seems to behave very oddly at t... | Schizophrenia disorder | {
"A": "Schizophreniform disorder",
"B": "Schizophrenia disorder",
"C": "Substance-induced psychosis",
"D": "Brief psychotic disorder"
} | step1 | B | [
"year old man",
"mother",
"psychiatric evaluation",
"concerned",
"health",
"behavior ever",
"dropped out",
"graduate school",
"moved back home",
"months",
"always very anxious",
"thoughts",
"school",
"getting",
"job",
"to",
"very",
"times",
"winter jacket",
"summer",
"hears v... |
An 11-year-old boy is brought to the emergency department 30 minutes after he was found screaming and clutching his head. He has had nausea and occasional episodes of vomiting for 1 week, fever and left-sided headaches for 2 weeks, and increasing tooth pain over the past 3 weeks. He has no history of ear or sinus infec... | Pyogenic brain abscess | {
"A": "Medulloblastoma",
"B": "HSV encephalitis",
"C": "Pyogenic brain abscess",
"D": "Cavernous sinus thrombosis"
} | step2&3 | C | [
"year old boy",
"brought",
"emergency department 30 minutes",
"found screaming",
"head",
"nausea",
"occasional episodes of vomiting",
"1 week",
"fever",
"left-sided headaches",
"2 weeks",
"increasing tooth pain",
"past 3 weeks",
"history",
"ear",
"sinus infections",
"moderate distres... |
A 5-year-old child whose family recently immigrated from Africa is brought in for a wellness visit. The boy appears indifferent, doesn’t seem to make eye contact, and keeps to himself. Upon examination, it is noted that his height and weight are below the 5th percentile. Furthermore, his abdomen is protuberant, and the... | Severe protein malnutrition | {
"A": "Total caloric deprivation",
"B": "Hypothyroidism",
"C": "Vitamin A deficiency",
"D": "Severe protein malnutrition"
} | step1 | D | [
"5 year old child",
"family recently",
"Africa",
"brought",
"wellness visit",
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"keeps",
"examination",
"noted",
"height",
"weight",
"5th percentile",
"abdomen",
"protuberant",
"multiple zones",
"hyper",
"hypopigmentation",
"desquam... |
A 32-year-old man presents with excessive urination. He reports that he urinates 10 times a day and wakes up multiple times a night to pee. He complains that this is affecting both his social life and his ability to concentrate at work. He states that he always has an “active bladder,” but his symptoms worsened when he... | Lithium cessation | {
"A": "Calcitonin and zoledronic acid",
"B": "Furosemide",
"C": "Hydrochlorothiazide",
"D": "Lithium cessation"
} | step2&3 | D | [
"year old man presents",
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"reports",
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"day",
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"night",
"pee",
"affecting",
"social life",
"ability to concentrate",
"work",
"states",
"always",
"active bladder",
"symptoms worsened",
"started meeting",
"physical trainer",
... |
A 36-year-old female presents to the emergency department with right upper quadrant (RUQ) pain. She describes the pain as dull and getting progressively worse over the last several weeks. She denies any relationship to eating. Her past medical history is significant for endometriosis, which she manages with oral contra... | Oral contraceptive pill use | {
"A": "Chronic alcohol abuse",
"B": "Recent contact with dogs",
"C": "Recent travel to Mexico",
"D": "Oral contraceptive pill use"
} | step2&3 | D | [
"36 year old female presents",
"emergency department",
"right upper quadrant",
"pain",
"pain",
"dull",
"getting",
"worse",
"weeks",
"denies",
"relationship",
"eating",
"past medical history",
"significant",
"endometriosis",
"oral contraceptive pills",
"follicular thyroid cancer",
"... |
A 60-year-old African American gentleman presents to the emergency department with sudden onset "vice-like" chest pain, diaphoresis, and pain radiating to his left shoulder. He has ST elevations on his EKG and elevated cardiac enzymes. Concerning his current pathophysiology, which of the following changes would you exp... | Decreased cardiac output; increased systemic vascular resistance | {
"A": "No change in cardiac output; increased systemic vascular resistance",
"B": "No change in cardiac output; decreased venous return",
"C": "Decreased cardiac output; increased systemic vascular resistance",
"D": "Increased cardiac output; increased systemic vascular resistance"
} | step1 | C | [
"60 year old African American",
"presents",
"emergency department",
"sudden onset",
"vice",
"chest pain",
"diaphoresis",
"pain radiating to",
"left shoulder",
"ST elevations",
"EKG",
"elevated cardiac enzymes",
"Concerning",
"current pathophysiology",
"following changes",
"to see",
"... |
A 17-year-old woman with no significant past medical history presents to the outpatient OB/GYN clinic with her parents for concerns of primary amenorrhea. She denies any symptoms and appears relatively unconcerned about her presentation. The review of systems is negative. Physical examination demonstrates an age-approp... | Serum beta hCG | {
"A": "Pelvic ultrasound",
"B": "Left hand radiograph",
"C": "Serum beta hCG",
"D": "Serum FSH"
} | step2&3 | C | [
"year old woman",
"significant past medical history presents",
"outpatient OB/GYN clinic",
"parents",
"concerns",
"primary amenorrhea",
"denies",
"symptoms",
"appears",
"presentation",
"review of systems",
"negative",
"Physical examination demonstrates",
"age appropriate degree of developm... |
A 61-year-old woman presents to her primary care provider with complaints of fatigue, weight gain of 5.5 kg (12.1 lb) and intermittent nausea over the past 4 months. She denies any changes to her diet. She has had type 2 diabetes mellitus for the past 27 years complicated by diabetic neuropathy. Vital signs include: te... | Perindopril | {
"A": "Hydrochlorothiazide",
"B": "Perindopril",
"C": "Metoprolol",
"D": "Diltiazem"
} | step2&3 | B | [
"61 year old woman presents",
"primary care provider",
"complaints",
"fatigue",
"weight gain",
"kg",
"intermittent nausea",
"past",
"months",
"denies",
"changes",
"diet",
"type 2 diabetes mellitus",
"past 27 years complicated",
"diabetic neuropathy",
"Vital signs include",
"temperatu... |
A study is performed to assess the intelligence quotient and the crime rate in a neighborhood. Students at a local high school are given an assessment and their criminal and disciplinary records are reviewed. One of the subjects scores 2 standard deviations over the mean. What percent of students did he score higher th... | 97.5% | {
"A": "68%",
"B": "95%",
"C": "96.5%",
"D": "97.5%"
} | step1 | D | [
"study",
"performed to assess",
"intelligence quotient",
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"Students",
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"given",
"assessment",
"criminal",
"records",
"reviewed",
"One",
"subjects scores 2 standard",
"mean",
"percent",
"students",
"score higher"
] |
A 14-year-old male presents to his primary care physician with complaints of shortness of breath and easy fatigability when exercising for extended periods of time. He also reports that, when he exercises, his lower legs and feet turn a bluish-gray color. He cannot remember visiting a doctor since he was in elementary ... | Continuous, machine-like murmur at the left infraclavicular area | {
"A": "Mid-systolic murmur loudest at the right second intercostal space, with radiation to the right neck",
"B": "Holodiastolic murmur loudest at the apex, with an opening snap following the S2 heart sound",
"C": "Left infraclavicular systolic ejection murmur with decreased blood pressure in the lower extremiti... | step1 | D | [
"year old male presents",
"primary care physician",
"complaints of shortness",
"breath",
"easy fatigability",
"exercising",
"extended periods",
"time",
"reports",
"exercises",
"lower legs",
"feet turn",
"gray color",
"remember visiting",
"doctor",
"elementary school",
"vital signs",
... |
A 41-year-old man presents to urgent care with a 1-week history of severe diarrhea. He says that he has been having watery stools every 2-3 hours. The stools do not contain blood and do not float. On presentation, he is observed to have significant facial flushing, and laboratory tests reveal the following:
Serum:
Na+... | Vasoactive intestinal peptide | {
"A": "Gastrin",
"B": "Glucagon",
"C": "Somatostatin",
"D": "Vasoactive intestinal peptide"
} | step1 | D | [
"year old man presents",
"urgent care",
"1-week history",
"severe diarrhea",
"watery stools",
"2",
"hours",
"stools",
"not contain blood",
"not float",
"presentation",
"observed to",
"significant facial flushing",
"laboratory tests reveal",
"following",
"Serum",
"Na",
"137 mEq L K"... |
A 65-year-old man comes to the physician because of shortness of breath, chest pain, and a cough for 2 days. The pain is exacerbated by deep inspiration. He has a history of congestive heart failure, hypertension, type 2 diabetes mellitus, and hyperlipidemia. Current medications include metoprolol, lisinopril, spironol... | Parenchymal consolidation | {
"A": "Parenchymal consolidation",
"B": "Pleural fluid accumulation",
"C": "Ruptured pulmonary blebs",
"D": "Pulmonary infarction"
} | step2&3 | A | [
"65 year old man",
"physician",
"of shortness",
"breath",
"chest pain",
"cough",
"2 days",
"pain",
"exacerbated",
"deep inspiration",
"history of congestive heart failure",
"hypertension",
"type 2 diabetes mellitus",
"hyperlipidemia",
"Current medications include metoprolol",
"lisinopr... |
A 46-year-old male presents in consultation for weight loss surgery. He is 6’0” and weighs 300 pounds. He has tried multiple dietary and exercise regimens but has been unsuccessful in losing weight. The surgeon suggests a sleeve gastrectomy, a procedure that reduces the size of the stomach removing a large portion of t... | Splenic artery | {
"A": "Right gastric artery",
"B": "Splenic artery",
"C": "Right gastroepiploic artery",
"D": "Gastroduodenal artery"
} | step1 | B | [
"year old male presents",
"consultation",
"weight loss surgery",
"60",
"300 pounds",
"multiple dietary",
"exercise regimens",
"unsuccessful",
"weight",
"surgeon suggests",
"sleeve gastrectomy",
"procedure",
"size",
"stomach removing",
"large portion",
"stomach",
"middle part of",
"... |
A 16-year-old teenager is brought to the emergency department after having slipped on ice while walking to school. She hit her head on the side of the pavement and retained consciousness. She was brought to the closest ER within an hour of the incident. The ER physician sends her immediately to get a CT scan and also o... | Phosphofructokinase | {
"A": "Pyruvate carboxylase",
"B": "Phosphofructokinase",
"C": "Glucose-6-phosphatase",
"D": "Glycogen phosphorylase"
} | step1 | B | [
"year old teenager",
"brought",
"emergency department",
"slipped",
"ice",
"walking",
"school",
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"side",
"pavement",
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"brought",
"closest ER",
"hour",
"incident",
"ER physician sends",
"immediately to",
"CT scan",
"orders routine blood work... |
A 4-year-old boy who otherwise has no significant past medical history presents to the pediatric clinic accompanied by his father for a 2-day history of high fever, sore throat, nausea, vomiting, and bloody diarrhea. The patient’s father endorses that these symptoms began approximately 3 weeks after the family got a ne... | Exposure to bacteria at school | {
"A": "The new dog",
"B": "A recent antibiotic prescription",
"C": "Exposure to bacteria at school",
"D": "Failure to appropriately immunize the patient"
} | step2&3 | C | [
"4 year old boy",
"significant past medical history presents",
"pediatric clinic",
"father",
"2-day history",
"high fever",
"sore throat",
"nausea",
"vomiting",
"bloody diarrhea",
"patients father",
"symptoms began approximately",
"weeks",
"family got",
"new dog",
"father",
"states",... |
A 28-year-old man presents with a complaint of penile discharge. He says that he noticed a yellowish watery discharge from his penis since last week. He adds that he has painful urination only in the mornings, but he sometimes feels a lingering pain in his genital region throughout the day. He denies any fever, body ac... | Doxycycline | {
"A": "Ampicillin",
"B": "Doxycycline",
"C": "Gentamicin",
"D": "Streptomycin"
} | step1 | B | [
"year old man presents",
"complaint",
"penile discharge",
"watery discharge from",
"penis",
"week",
"adds",
"painful urination only",
"mornings",
"sometimes feels",
"pain",
"genital",
"day",
"denies",
"fever",
"body aches",
"joint pains",
"significant past medical history",
"curr... |
A 16-year-old male presents to his pediatrician with a sore throat. He reports a severely painful throat preceded by several days of malaise and fatigue. He has a history of seasonal allergies and asthma. The patient is a high school student and is on the school wrestling team. He takes cetirizine and albuterol. His te... | CD21 | {
"A": "CD3",
"B": "CD4",
"C": "CD19",
"D": "CD21"
} | step1 | D | [
"year old male presents",
"pediatrician",
"sore throat",
"reports",
"severely painful throat preceded",
"days",
"malaise",
"fatigue",
"history of seasonal allergies",
"asthma",
"patient",
"high school student",
"school wrestling team",
"takes cetirizine",
"albuterol",
"temperature",
... |
A 55-year-old woman is brought to the emergency department by her husband because of chest pain and a cough productive of blood-tinged sputum that started 1 hour ago. Two days ago, she returned from a trip to China. She has smoked 1 pack of cigarettes daily for 35 years. Her only home medication is oral hormone replace... | Iliac vein | {
"A": "Posterior tibial vein",
"B": "Iliac vein",
"C": "Subclavian vein",
"D": "Renal vein"
} | step2&3 | B | [
"55 year old woman",
"brought",
"emergency department",
"husband",
"of chest pain",
"cough productive of blood tinged sputum",
"started 1 hour",
"Two days",
"returned",
"trip",
"China",
"smoked 1 pack",
"cigarettes daily",
"35 years",
"only home medication",
"oral hormone replacement t... |
A 58-year-old female comes to the physician because of generalized fatigue and malaise for 3 months. Four months ago, she was treated for a urinary tract infection with trimethoprim-sulfamethoxazole. She has hypertension, asthma, chronic lower back pain, and chronic headaches. Current medications include hydrochlorothi... | Inhibition of prostaglandin I2 production | {
"A": "Overproduction of light chains",
"B": "Hypersensitivity reaction",
"C": "Inhibition of prostaglandin I2 production",
"D": "Precipitation of drugs within the renal tubules"
} | step1 | C | [
"58 year old female",
"physician",
"generalized fatigue",
"malaise",
"months",
"Four months",
"treated",
"urinary tract infection",
"trimethoprim-sulfamethoxazole",
"hypertension",
"asthma",
"chronic lower back pain",
"chronic headaches",
"Current medications include hydrochlorothiazide",
... |
A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no signific... | Continue sertraline | {
"A": "Add buspirone",
"B": "Add aripiprazole",
"C": "Switch to a different SSRI",
"D": "Continue sertraline"
} | step2&3 | D | [
"year old man presents",
"month history",
"depressed mood",
"feeling low",
"days of the week",
"difficulty sleeping",
"feelings",
"worthless",
"difficulty performing",
"work",
"decreased interest",
"reading books",
"hobby",
"significant past medical history",
"patient denies",
"history... |
A 57-year-old woman presents complaining of feeling sleepy all the time. She reports having an uncontrollable urge to take multiple naps during the day and sometimes sees strange shadows in front of her before falling asleep. Although she awakens feeling refreshed and energized, she often finds herself ‘stuck’ and cann... | Methylphenidate | {
"A": "Melatonin",
"B": "Methylphenidate",
"C": "Alprazolam",
"D": "Orlistat"
} | step1 | B | [
"57 year old woman presents",
"feeling sleepy",
"time",
"reports",
"to take multiple naps",
"day",
"sometimes sees",
"shadows",
"front",
"falling asleep",
"feeling refreshed",
"often finds",
"stuck",
"move",
"waking",
"overweight",
"failed to",
"weight",
"multiple attempts",
"d... |
A 21-year-old woman presents to the women’s clinic with chronic pelvic pain, especially during sexual intercourse. She also reports new onset yellowish vaginal discharge. She has no significant past medical history. She does not take contraceptive pills as she has had a copper intrauterine device placed. She smokes 2–3... | Pelvic inflammatory disease | {
"A": "Ectopic pregnancy",
"B": "Bacterial vaginosis",
"C": "Urinary tract infection",
"D": "Pelvic inflammatory disease"
} | step2&3 | D | [
"21-year-old woman presents",
"clinic",
"chronic pelvic pain",
"sexual intercourse",
"reports new onset",
"vaginal discharge",
"significant past medical history",
"not take contraceptive pills",
"copper intrauterine device placed",
"smokes 23 cigarettes",
"day",
"drinks beer",
"weekends",
... |
A 45-year-old man with type 1 diabetes mellitus comes to the physician for a health maintenance examination. He has a 10-month history of tingling of his feet at night and has had two recent falls. Three years ago, he underwent retinal laser photocoagulation in both eyes. Current medications include insulin and lisinop... | Incomplete bladder emptying | {
"A": "Increased lower esophageal sphincter pressure",
"B": "Dilated pupils",
"C": "Incomplete bladder emptying",
"D": "Hyperreflexia"
} | step2&3 | C | [
"year old man",
"type 1 diabetes mellitus",
"physician",
"health maintenance examination",
"a 10 month history",
"tingling",
"feet",
"night",
"two recent falls",
"Three years",
"retinal laser photocoagulation",
"eyes",
"Current include insulin",
"lisinopril",
"admits not adhering",
"in... |
A previously healthy 24-year-old woman comes to the physician because of a 1-day history of nausea and weakness. She is sexually active with 2 male partners and uses an oral contraceptive; she uses condoms inconsistently. Her last menstrual period was 4 days ago. Her temperature is 38.4°C (101°F). Physical examination ... | Ascending bacteria from the bladder | {
"A": "Ascending bacteria from the endocervix",
"B": "Noninfectious inflammation of the bladder",
"C": "Ascending bacteria from the bladder",
"D": "Decreased urinary pH"
} | step1 | C | [
"healthy",
"year old woman",
"physician",
"1-day history",
"nausea",
"weakness",
"sexually active",
"male partners",
"uses",
"oral contraceptive",
"uses condoms",
"last menstrual period",
"4 days",
"temperature",
"4C",
"Physical examination shows right costovertebral angle tenderness",... |
An 11-year-old girl is brought in to her pediatrician by her parents due to developmental concerns. The patient developed normally throughout childhood, but she has not yet menstruated and has noticed that her voice is getting deeper. The patient has no other health issues. On exam, her temperature is 98.6°F (37.0°C), ... | Scrotum and the labia majora | {
"A": "Bulbourethral glands and the urethral/paraurethral glands",
"B": "Corpus spongiosum and the clitoral crura",
"C": "Corpus spongiosum and the greater vestibular glands",
"D": "Scrotum and the labia majora"
} | step1 | D | [
"year old girl",
"brought",
"pediatrician",
"parents due to developmental concerns",
"patient",
"childhood",
"not",
"voice",
"getting deeper",
"patient",
"health issues",
"exam",
"temperature",
"98",
"blood pressure",
"68 mmHg",
"pulse",
"74 min",
"respirations",
"min",
"pati... |
A 64-year-old woman is brought to the emergency department 30 minutes after the onset of right-sided weakness and impaired speech. On admission, she is diagnosed with thrombotic stroke and treatment with alteplase is begun. Neurologic examination four weeks later shows residual right hemiparesis. A CT scan of the head ... | Liquefactive necrosis | {
"A": "Gangrenous necrosis",
"B": "Liquefactive necrosis",
"C": "Caseous necrosis",
"D": "Fat necrosis"
} | step1 | B | [
"64 year old woman",
"brought",
"emergency department 30 minutes",
"onset",
"right-sided weakness",
"impaired speech",
"admission",
"diagnosed",
"thrombotic stroke",
"treatment",
"alteplase",
"begun",
"Neurologic examination four weeks later shows residual right hemiparesis",
"CT scan of",... |
A 3-year-old boy is brought to the office by his mother because of a large head contusion and altered mental status. At first, the mother says her son got injured when a “pot fell from a shelf onto his head.” Later, she changes the story and says that he hit his head after “tripping over a football.” Physical examinati... | Child abuse | {
"A": "Child abuse",
"B": "Cranioschisis",
"C": "Osteogenesis imperfecta",
"D": "Rickets"
} | step1 | A | [
"3 year old boy",
"brought",
"office",
"mother",
"of",
"large head contusion",
"altered mental status",
"first",
"mother",
"son",
"injured",
"pot fell",
"head",
"Later",
"changes",
"story",
"hit",
"head",
"tripping",
"football",
"Physical examination shows cracks",
"suture ... |
A 32-year-old man presents to the emergency department with a severe headache. He says that the pain has been getting progressively worse over the last 24 hours and is located primarily in his left forehead and eye. The headaches have woken him up from sleep and it is not relieved by over-the-counter medications. He ha... | Ophthalmoplegia | {
"A": "Anosmia",
"B": "Mandibular pain",
"C": "Ophthalmoplegia",
"D": "Vertigo"
} | step1 | C | [
"year old man presents",
"emergency department",
"severe headache",
"pain",
"getting",
"worse",
"24 hours",
"left forehead",
"eye",
"headaches",
"woken",
"sleep",
"not relieved by over-the-counter medications",
"recovering from",
"sinus infection",
"started 1 week",
"past medical his... |
A doctor is interested in developing a new over-the-counter medication that can decrease the symptomatic interval of upper respiratory infections from viral etiologies. The doctor wants one group of affected patients to receive the new treatment, but he wants another group of affected patients to not be given the treat... | Clinical treatment trial | {
"A": "Clinical treatment trial",
"B": "Case-control study",
"C": "Historical cohort study",
"D": "Cohort study"
} | step2&3 | A | [
"doctor",
"interested",
"new over-the-counter medication",
"decrease",
"symptomatic interval",
"upper respiratory infections",
"viral etiologies",
"doctor",
"one group",
"affected patients to receive",
"new treatment",
"group",
"affected patients",
"not",
"given",
"treatment",
"follo... |
A previously healthy 22-year-old woman comes to the emergency department because of several episodes of palpitations that began a couple of days ago. The palpitations are intermittent in nature, with each episode lasting 5–10 seconds. She states that during each episode she feels as if her heart is going to “spin out o... | Observation and rest | {
"A": "Echocardiography",
"B": "Observation and rest",
"C": "Electrical cardioversion",
"D": "Pharmacologic cardioversion"
} | step2&3 | B | [
"healthy",
"year old woman",
"emergency department",
"of several episodes",
"palpitations",
"began",
"couple",
"days",
"palpitations",
"intermittent",
"nature",
"episode lasting 510 seconds",
"states",
"episode",
"feels",
"heart",
"to spin out",
"control",
"recently",
"late to ... |
A 32-year-old woman presents to the emergency department with abdominal pain. She states it started last night and has been getting worse during this time frame. She states she is otherwise healthy, does not use drugs, and has never had sexual intercourse. Her temperature is 99.0°F (37.2°C), blood pressure is 120/83 mm... | Ultrasound and serum hCG in 48 hours | {
"A": "Laparoscopy",
"B": "Methotrexate",
"C": "Salpingostomy",
"D": "Ultrasound and serum hCG in 48 hours"
} | step2&3 | D | [
"year old woman presents",
"emergency department",
"abdominal pain",
"states",
"started last night",
"getting worse",
"time frame",
"states",
"healthy",
"not use drugs",
"never",
"sexual intercourse",
"temperature",
"99",
"blood pressure",
"83 mmHg",
"pulse",
"85 min",
"respirati... |
A 46-year-old man comes to the physician because of a 2-month history of hoarseness and drooling. Initially, he had difficulty swallowing solid food, but now he has difficulty swallowing foods like oatmeal as well. During this period, he also developed weakness in both arms and has had an 8.2 kg (18 lb) weight loss. He... | Destruction of upper and lower motor neurons | {
"A": "Multiple cerebral infarctions",
"B": "Autoimmune destruction of acetylcholine receptors",
"C": "Demyelination of peripheral nerves",
"D": "Destruction of upper and lower motor neurons"
} | step1 | D | [
"year old man",
"physician",
"2 month history",
"hoarseness",
"drooling",
"Initially",
"difficulty swallowing solid food",
"now",
"difficulty swallowing foods",
"oatmeal",
"well",
"period",
"weakness",
"arms",
"kg",
"weight loss",
"appears ill",
"vital signs",
"normal limits",
... |
At 10 a.m. this morning, a semi-truck carrying radioactive waste toppled over due to a blown tire. One container was damaged, and a small amount of its contents leaked into the nearby river. You are a physician on the government's hazardous waste committee and must work to alleviate the town's worries and minimize the ... | Potassium iodide | {
"A": "Methylene blue",
"B": "Potassium iodide",
"C": "EDTA",
"D": "Succimer"
} | step1 | B | [
"10",
"m",
"morning",
"truck carrying radioactive waste",
"over due to",
"blown tire",
"One container",
"damaged",
"small amount",
"contents leaked",
"river",
"physician",
"government's hazardous waste committee",
"work to",
"town's worries",
"health hazards due to",
"radioactive lea... |
A 41-year-old African American woman presents to her primary care physician with a 3-week history of lower extremity edema and shortness of breath. She says that she has also noticed that she gets fatigued more easily and has been gaining weight. Her past medical history is significant for sickle cell disease and HIV i... | Segmental scarring | {
"A": "Birefringence under polarized light",
"B": "Normal glomeruli",
"C": "Expansion of the mesangium",
"D": "Segmental scarring"
} | step1 | D | [
"year old African American woman presents",
"primary care physician",
"3 week history of lower extremity edema",
"shortness of breath",
"gets fatigued more easily",
"gaining weight",
"past medical history",
"significant",
"sickle cell disease",
"HIV infection",
"currently taking combination ther... |
A 45-year-old man is brought to the trauma bay by emergency services after a motorbike accident in which the patient, who was not wearing a helmet, hit a pole of a streetlight with his head. When initially evaluated by the paramedics, the patient was responsive, albeit confused, opened his eyes spontaneously, and was a... | Surgical evacuation | {
"A": "Ventricular drainage",
"B": "Middle meningeal artery embolization",
"C": "Surgical evacuation",
"D": "Decompressive craniectomy"
} | step2&3 | C | [
"year old man",
"brought",
"trauma bay",
"emergency services",
"motorbike accident",
"patient",
"not",
"helmet",
"hit",
"pole",
"head",
"initially evaluated",
"paramedics",
"patient",
"responsive",
"confused",
"opened",
"eyes",
"able to follow commands",
"hour later",
"admiss... |
Two days after being admitted for pneumonia, a 70-year-old man has repeated episodes of palpitations and nausea. He does not feel lightheaded and does not have chest pain. The patient appears mildly distressed. His pulse is 59/min and blood pressure is 110/60 mm Hg. Examination shows no abnormalities. Sputum cultures t... | Administration of magnesium sulfate | {
"A": "Administration of metoprolol",
"B": "Administration of magnesium sulfate",
"C": "Intermittent transvenous overdrive pacing",
"D": "Adminstration of potassium chloride"
} | step2&3 | B | [
"Two days",
"admitted",
"pneumonia",
"70 year old man",
"repeated episodes of palpitations",
"nausea",
"not feel lightheaded",
"not",
"chest pain",
"patient appears mildly distressed",
"pulse",
"59 min",
"blood pressure",
"60 mm Hg",
"Examination shows",
"abnormalities",
"Sputum cult... |
A 19-year-old male college student is admitted to an inpatient psychiatric unit with a chief complaint of “thoughts about killing my girlfriend.” The patient explains that throughout the day he becomes suddenly overwhelmed by thoughts about strangling his girlfriend and hears a voice saying “kill her.” He recognizes th... | Clomipramine | {
"A": "Alprazolam",
"B": "Amitriptyline",
"C": "Buspirone",
"D": "Clomipramine"
} | step2&3 | D | [
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"admitted",
"inpatient",
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"guilty",
"feels",
... |
Two hours after undergoing allogeneic kidney transplantation for polycystic kidney disease, a 14-year-old girl has lower abdominal pain. Examination shows tenderness to palpation in the area the donor kidney was placed. Ultrasound of the donor kidney shows diffuse tissue edema. Serum creatinine begins to increase and d... | Preformed antibodies against class I HLA molecules | {
"A": "Proliferation of donor T lymphocytes",
"B": "Preformed antibodies against class I HLA molecules",
"C": "Irreversible intimal fibrosis and obstruction of vessels",
"D": "Immune complex deposition in donor tissue"
} | step1 | B | [
"Two hours",
"allogeneic kidney",
"polycystic kidney disease",
"year old girl",
"lower abdominal pain",
"Examination shows tenderness",
"palpation",
"area",
"donor kidney",
"placed",
"Ultrasound of",
"donor kidney shows diffuse tissue edema",
"Serum creatinine begins to increase",
"dialysi... |
A 25-year-old woman presents to her primary care physician complaining of several months of diarrhea. She has also had crampy abdominal pain. She has tried modifying her diet without improvement. She has many watery, non-bloody bowel movements per day. She also reports feeling fatigued. The patient has not recently tra... | Focal ulcerations with granuloma | {
"A": "Diffuse, non-focal ulcerations with granuloma",
"B": "Diffuse, non-focal ulcerations without granuloma",
"C": "Focal ulcerations with granuloma",
"D": "Friable mucosa with pinpoint hemorrhages"
} | step2&3 | C | [
"year old woman presents",
"primary care physician",
"months",
"diarrhea",
"crampy abdominal pain",
"modifying",
"diet",
"improvement",
"watery",
"non bloody bowel movements",
"day",
"reports feeling fatigued",
"patient",
"not recently traveled outside",
"country",
"lost 10 pounds",
... |
A 73-year-old woman presents to clinic with a week of fatigue, headache, and swelling of her ankles bilaterally. She reports that she can no longer go on her daily walk around her neighborhood without stopping frequently to catch her breath. At night she gets short of breath and has found that she can only sleep well i... | (160 - 100) * 115 | {
"A": "160 - 100",
"B": "(160 - 100) * 115",
"C": "(160 - 100) / 160",
"D": "108/3 + (2 * 78)/3"
} | step1 | B | [
"year old woman presents",
"clinic",
"week",
"fatigue",
"headache",
"swelling",
"ankles",
"reports",
"longer go",
"daily walk",
"neighborhood",
"stopping frequently to catch",
"breath",
"night",
"gets short of breath",
"found",
"only sleep well",
"past medical history",
"signific... |
A 45-year-old man comes to the physician for a routine health maintenance examination. He is asymptomatic. He reports that he recently found out that his wife had an affair with her personal trainer and that she now left him for her new partner. The patient is alone with their two children now. To be able to care for t... | Intellectualization | {
"A": "Intellectualization",
"B": "Humor",
"C": "Sublimation",
"D": "Externalization"
} | step2&3 | A | [
"year old man",
"physician",
"routine health maintenance examination",
"asymptomatic",
"reports",
"recently found out",
"wife",
"personal trainer",
"now left",
"new partner",
"patient",
"alone",
"two children now",
"To",
"able to care",
"to",
"working hours",
"to give",
"playing ... |
A 2-week-old boy presents to the pediatrics clinic. The medical records notes a full-term delivery, however, the boy was born with chorioretinitis and swelling and calcifications in his brain secondary to an in utero infection. A drug exists that can be used to prevent infection by the pathogen responsible for this neo... | Pneumocystitis jiroveci | {
"A": "Mycobacterium tuberculosis",
"B": "Mycobacterium avium complex",
"C": "Pneumocystitis jiroveci",
"D": "Cytomegalovirus"
} | step1 | C | [
"2 week old boy presents",
"pediatrics clinic",
"medical records notes",
"full",
"boy",
"born",
"chorioretinitis",
"swelling",
"calcifications",
"brain secondary to",
"in utero infection",
"drug exists",
"used to prevent infection",
"pathogen responsible",
"neonate's findings",
"drug",... |
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