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A 9-year-old girl comes to the clinic with a chief complaint of a swollen eye and sinus infection for 4 days. She complained of left nasal pain prior to these symptoms. The patient noticed that the swelling and redness of her left eye has progressively worsened. It has been difficult to open her eyelids, and she complains of diplopia and pain during ocular movement. The visual acuity is 20/20 in both eyes. Intraocular pressure measurement shows values of 23 and 14 mm Hg in the right and left eyes, respectively. The test results for the complete blood count, ESR, and CRP are as follows (on admission):
CBC results
Leukocytes 18,000 cells/mm3
Neutrophils 80%
Lymphocytes 14%
Eosinophils 1%
Basophils 0%
Monocytes 5%
Hemoglobin 12 g/dL
ESR 65
CRP 4.6
The organism causing the above condition is destroyed by which one of the following immunological processes? | Phagolysosome formation by neutrophils | {
"A": "Release of cytotoxic granules by cytotoxic T cells",
"B": "Activation of cytosolic caspases",
"C": "Perforins and granzymes by natural killer cells",
"D": "Phagolysosome formation by neutrophils"
} | step1 | D | [
"year old girl",
"clinic",
"chief complaint",
"swollen eye",
"sinus infection",
"4 days",
"left nasal pain",
"symptoms",
"patient",
"swelling",
"redness",
"left eye",
"worsened",
"difficult to open",
"eyelids",
"diplopia",
"pain",
"ocular",
"visual acuity",
"20/20",
"eyes",
"Intraocular pressure measurement shows values",
"23",
"mm Hg",
"right",
"left eyes",
"test results",
"complete blood count",
"ESR",
"CRP",
"follows",
"on admission",
"CBC results",
"Leukocytes",
"cells/mm3 Neutrophils 80",
"Eosinophils 1",
"Basophils 0",
"5",
"Hemoglobin 12 g/dL ESR",
"CRP",
"6",
"organism causing",
"above condition",
"destroyed",
"one",
"following immunological processes"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 9-year-old girl comes to the clinic with a chief complaint of a swollen eye and sinus infection for 4 days. She complained of left nasal pain prior to these symptoms. The patient noticed that the swelling and redness of her left eye has progressively worsened. It has been difficult to open her eyelids, and she complains of diplopia and pain during ocular movement. The visual acuity is 20/20 in both eyes. Intraocular pressure measurement shows values of 23 and 14 mm Hg in the right and left eyes, respectively. The test results for the complete blood count, ESR, and CRP are as follows (on admission):
CBC results
Leukocytes 18,000 cells/mm3
Neutrophils 80%
Lymphocytes 14%
Eosinophils 1%
Basophils 0%
Monocytes 5%
Hemoglobin 12 g/dL
ESR 65
CRP 4.6
The organism causing the above condition is destroyed by which one of the following immunological processes?
Choose one of the following::
A. Release of cytotoxic granules by cytotoxic T cells
B. Activation of cytosolic caspases
C. Perforins and granzymes by natural killer cells
D. Phagolysosome formation by neutrophils | [
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A 16-year-old Caucasian boy presents to your family practice office complaining of itchiness. He denies other symptoms. He also denies tobacco, alcohol, or other illicit drug use and is not sexually active. He has no other significant past medical or surgical history aside from a meniscal repair from a wrestling injury sustained two years ago from which he has recovered fully. Vitals are T 98.3, HR 67, BP 110/70. On exam you note several pruritic, erythematous, slightly raised annular patches with central clearing on his back.
Which of the following additional tests or features are sufficient to make the diagnosis of this boy's skin lesion? | Presence of hyphae when KOH added to skin scrapings | {
"A": "History of recent herald patch and lesions along skin cleavage lines",
"B": "Presence of hyphae when KOH added to skin scrapings",
"C": "Symmetrical distribution on bilaterial extremities progressing proximally",
"D": "History of time spent in a Lyme-endemic region"
} | step2&3 | B | [
"year old Caucasian boy presents",
"family practice office",
"itchiness",
"denies",
"symptoms",
"denies tobacco",
"alcohol",
"illicit drug use",
"not sexually active",
"significant past medical",
"surgical history",
"meniscal repair",
"wrestling injury sustained two years",
"recovered",
"T 3",
"67",
"BP",
"70",
"exam",
"note several",
"erythematous",
"slightly raised annular patches",
"central clearing",
"back",
"following additional tests",
"features",
"sufficient to make",
"diagnosis",
"boy's skin lesion"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 16-year-old Caucasian boy presents to your family practice office complaining of itchiness. He denies other symptoms. He also denies tobacco, alcohol, or other illicit drug use and is not sexually active. He has no other significant past medical or surgical history aside from a meniscal repair from a wrestling injury sustained two years ago from which he has recovered fully. Vitals are T 98.3, HR 67, BP 110/70. On exam you note several pruritic, erythematous, slightly raised annular patches with central clearing on his back.
Which of the following additional tests or features are sufficient to make the diagnosis of this boy's skin lesion?
Choose one of the following::
A. History of recent herald patch and lesions along skin cleavage lines
B. Presence of hyphae when KOH added to skin scrapings
C. Symmetrical distribution on bilaterial extremities progressing proximally
D. History of time spent in a Lyme-endemic region | [
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A 55-year-old female with a history of poorly controlled hyperlipidemia and obesity presents to her primary care physician for a follow-up visit. She reports that she feels well and has no complaints. She currently takes atorvastatin. Her temperature is 99°F (37.2°C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 16/min. Her BMI is 31 kg/m2. Her total cholesterol is 290 mg/dl, triglycerides are 120 mg/dl, and LDL cholesterol is 215 mg/dl. Her physician considers starting her on a medication that forces the liver to consume cholesterol to make more bile salts. Which of the following adverse effects is this patient at highest risk of developing following initiation of the medication? | Fat malabsorption | {
"A": "Gallstones",
"B": "Acanthosis nigricans",
"C": "Facial flushing",
"D": "Fat malabsorption"
} | step1 | D | [
"55 year old female",
"history of poorly controlled hyperlipidemia",
"obesity presents",
"primary care physician",
"follow-up visit",
"reports",
"feels well",
"complaints",
"currently takes atorvastatin",
"temperature",
"blood pressure",
"80 mmHg",
"pulse",
"80 min",
"respirations",
"min",
"BMI",
"31 kg/m2",
"total cholesterol",
"mg/dl",
"triglycerides",
"mg/dl",
"LDL cholesterol",
"mg/dl",
"physician considers starting",
"medication",
"forces",
"liver",
"cholesterol to make more bile salts",
"following adverse effects",
"patient",
"highest risk of",
"following initiation",
"medication"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 55-year-old female with a history of poorly controlled hyperlipidemia and obesity presents to her primary care physician for a follow-up visit. She reports that she feels well and has no complaints. She currently takes atorvastatin. Her temperature is 99°F (37.2°C), blood pressure is 135/80 mmHg, pulse is 80/min, and respirations are 16/min. Her BMI is 31 kg/m2. Her total cholesterol is 290 mg/dl, triglycerides are 120 mg/dl, and LDL cholesterol is 215 mg/dl. Her physician considers starting her on a medication that forces the liver to consume cholesterol to make more bile salts. Which of the following adverse effects is this patient at highest risk of developing following initiation of the medication?
Choose one of the following::
A. Gallstones
B. Acanthosis nigricans
C. Facial flushing
D. Fat malabsorption | [
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A 6-year-old boy is brought to the emergency department with a mild fever for the past week. He has also had generalized weakness and fatigue for the past month. He has been complaining of diffuse pain in his legs and arms. He has a history of Down syndrome with surgical repair of a congenital atrial septal defect as an infant. His temperature is 38.0° C (100.4° F), pulse is 85/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. He has enlarged cervical lymph nodes bilaterally that are nontender to palpation. He is uncooperative for the rest of the examination. Laboratory studies show:
Hemoglobin 10.2 g/dL
Hematocrit 30.0%
Leukocyte count 50,000/mm3
Platelet count 20,000/mm3
Serum
Sodium 136 mEq/L
Potassium 4.7 mEq/L
Chloride 102 mEq/L
Bicarbonate 25 mEq/L
Urea nitrogen 18 mg/dL
Creatinine 1.1 mg/dL
Total bilirubin 0.9 mg/dL
AST 30 U/L
ALT 46 U/L
Which of the following is most likely to confirm the diagnosis?" | Bone marrow biopsy | {
"A": "Monospot test",
"B": "Blood culture",
"C": "Bone marrow biopsy",
"D": "Serum protein electrophoresis\n\""
} | step2&3 | C | [
"year old boy",
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"mild fever",
"past week",
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"fatigue",
"past month",
"diffuse pain",
"legs",
"arms",
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"Down syndrome",
"surgical repair of",
"congenital atrial septal defect",
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"85 min",
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"10.2",
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"Serum",
"mg",
"mg",
"ALT",
"following",
"most likely to confirm",
"diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 6-year-old boy is brought to the emergency department with a mild fever for the past week. He has also had generalized weakness and fatigue for the past month. He has been complaining of diffuse pain in his legs and arms. He has a history of Down syndrome with surgical repair of a congenital atrial septal defect as an infant. His temperature is 38.0° C (100.4° F), pulse is 85/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. He has enlarged cervical lymph nodes bilaterally that are nontender to palpation. He is uncooperative for the rest of the examination. Laboratory studies show:
Hemoglobin 10.2 g/dL
Hematocrit 30.0%
Leukocyte count 50,000/mm3
Platelet count 20,000/mm3
Serum
Sodium 136 mEq/L
Potassium 4.7 mEq/L
Chloride 102 mEq/L
Bicarbonate 25 mEq/L
Urea nitrogen 18 mg/dL
Creatinine 1.1 mg/dL
Total bilirubin 0.9 mg/dL
AST 30 U/L
ALT 46 U/L
Which of the following is most likely to confirm the diagnosis?"
Choose one of the following::
A. Monospot test
B. Blood culture
C. Bone marrow biopsy
D. Serum protein electrophoresis
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An 83-year-old woman with a history of atrial fibrillation, multiple ischemic strokes, and early dementia is found unresponsive in her apartment at her retirement community. She is believed to have not refilled any of her medications for a month, and it is determined that she passed away from a stroke nearly 2 weeks ago. The family is adamant that she receive an autopsy. Which of the following findings are most likely on brain histology? | Cystic cavitation | {
"A": "Cellular debris and lymphocytes",
"B": "Cystic cavitation",
"C": "Fat saponification",
"D": "Increased binding of acidophilic dyes"
} | step1 | B | [
"83 year old woman",
"history of atrial fibrillation",
"multiple ischemic strokes",
"early dementia",
"found unresponsive",
"apartment",
"retirement community",
"to",
"not refilled",
"medications",
"month",
"passed",
"stroke nearly 2 weeks",
"family",
"receive",
"autopsy",
"following findings",
"most likely",
"brain histology"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An 83-year-old woman with a history of atrial fibrillation, multiple ischemic strokes, and early dementia is found unresponsive in her apartment at her retirement community. She is believed to have not refilled any of her medications for a month, and it is determined that she passed away from a stroke nearly 2 weeks ago. The family is adamant that she receive an autopsy. Which of the following findings are most likely on brain histology?
Choose one of the following::
A. Cellular debris and lymphocytes
B. Cystic cavitation
C. Fat saponification
D. Increased binding of acidophilic dyes | [
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A 6-year-old girl is brought to the pediatrician for the first time by her mother. Her mother states that her family just emigrated from China and her daughter has seemed to have difficulty adjusting to the American diet. Specifically, she seems to have abdominal discomfort and increased flatulence whenever she eats milk or cheese. The pediatrician orders a test to diagnose the patient. Which of the following results is most likely to be observed in this patient? | Positive hydrogen breath test | {
"A": "Negative hydrogen breath test",
"B": "Positive hydrogen breath test",
"C": "Positive technetium 99 scan",
"D": "Abnormal abdominal ultrasound"
} | step2&3 | B | [
"year old girl",
"brought",
"pediatrician",
"first time",
"mother",
"mother states",
"family",
"China",
"daughter",
"to",
"difficulty",
"American diet",
"to",
"abdominal discomfort",
"increased flatulence",
"eats milk",
"cheese",
"pediatrician orders",
"test to diagnose",
"patient",
"following results",
"most likely to",
"observed",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 6-year-old girl is brought to the pediatrician for the first time by her mother. Her mother states that her family just emigrated from China and her daughter has seemed to have difficulty adjusting to the American diet. Specifically, she seems to have abdominal discomfort and increased flatulence whenever she eats milk or cheese. The pediatrician orders a test to diagnose the patient. Which of the following results is most likely to be observed in this patient?
Choose one of the following::
A. Negative hydrogen breath test
B. Positive hydrogen breath test
C. Positive technetium 99 scan
D. Abnormal abdominal ultrasound | [
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"ds_index": 10105,
"similar_dg_indices": [
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} |
A 5-day-old, 2200 g (4 lb 14 oz) male newborn is brought to the physician because of poor feeding and irritability. He was born at 36 weeks' gestation after the pregnancy was complicated by premature rupture of membranes. His APGAR scores at delivery were 5 and 8 at 1 and 5 minutes, respectively. He appears lethargic. His temperature is 38.5°C (101.3°F), pulse is 170/min, and respirations are 63/min. Examination shows scleral icterus. Subcostal retractions and nasal flaring are present. Capillary refill time is 4 seconds. Laboratory studies are ordered and an x-ray of the chest is scheduled. Which of the following is the most appropriate next step in management? | Ampicillin and gentamicin therapy | {
"A": "Methimazole therapy",
"B": "Surfactant therapy",
"C": "Ampicillin and gentamicin therapy",
"D": "Endotracheal intubation"
} | step2&3 | C | [
"5 day old",
"g",
"oz",
"male newborn",
"brought",
"physician",
"poor feeding",
"irritability",
"born",
"36 weeks",
"gestation",
"pregnancy",
"complicated",
"premature rupture of membranes",
"APGAR scores",
"delivery",
"5",
"8",
"1",
"5 minutes",
"appears lethargic",
"temperature",
"pulse",
"min",
"respirations",
"63 min",
"Examination shows scleral icterus",
"Subcostal retractions",
"nasal flaring",
"present",
"Capillary refill time",
"4 seconds",
"Laboratory studies",
"ordered",
"x-ray of",
"chest",
"scheduled",
"following",
"most appropriate next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-day-old, 2200 g (4 lb 14 oz) male newborn is brought to the physician because of poor feeding and irritability. He was born at 36 weeks' gestation after the pregnancy was complicated by premature rupture of membranes. His APGAR scores at delivery were 5 and 8 at 1 and 5 minutes, respectively. He appears lethargic. His temperature is 38.5°C (101.3°F), pulse is 170/min, and respirations are 63/min. Examination shows scleral icterus. Subcostal retractions and nasal flaring are present. Capillary refill time is 4 seconds. Laboratory studies are ordered and an x-ray of the chest is scheduled. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Methimazole therapy
B. Surfactant therapy
C. Ampicillin and gentamicin therapy
D. Endotracheal intubation | [
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You are tasked with analyzing the negative predictive value of an experimental serum marker for ovarian cancer. You choose to enroll 2,000 patients across multiple clinical sites, including both 1,000 patients with ovarian cancer and 1,000 age-matched controls. From the disease and control subgroups, 700 and 100 are found positive for this novel serum marker, respectively. Which of the following represents the NPV for this test? | 900 / (900 + 300) | {
"A": "900 / (900 + 100)",
"B": "900 / (900 + 300)",
"C": "700 / (700 + 100)",
"D": "700 / (700 + 300)"
} | step2&3 | B | [
"tasked",
"negative predictive value",
"experimental serum marker",
"ovarian cancer",
"choose to",
"2",
"patients",
"multiple clinical sites",
"including",
"1",
"patients",
"ovarian cancer",
"1",
"age matched controls",
"disease",
"control subgroups",
"700",
"100",
"found positive",
"novel serum marker",
"following represents",
"NPV",
"test"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: You are tasked with analyzing the negative predictive value of an experimental serum marker for ovarian cancer. You choose to enroll 2,000 patients across multiple clinical sites, including both 1,000 patients with ovarian cancer and 1,000 age-matched controls. From the disease and control subgroups, 700 and 100 are found positive for this novel serum marker, respectively. Which of the following represents the NPV for this test?
Choose one of the following::
A. 900 / (900 + 100)
B. 900 / (900 + 300)
C. 700 / (700 + 100)
D. 700 / (700 + 300) | [
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A 24-year-old woman recently noticed a mass in her left breast. The examination shows a 4-cm mass in the left upper quadrant. The mass is firm, mobile, and has well-defined margins. She complains of occasional tenderness. There is no lymphatic involvement. Mammography showed a dense lesion. What is the most likely cause? | Fibroadenoma | {
"A": "Ductal carcinoma in situ (DCIS)",
"B": "Fibroadenoma",
"C": "Phyllodes tumor",
"D": "Inflammatory carcinoma"
} | step1 | B | [
"year old woman recently",
"mass in",
"left breast",
"examination shows",
"4",
"mass",
"left upper quadrant",
"mass",
"firm",
"mobile",
"well-defined margins",
"occasional tenderness",
"lymphatic involvement",
"Mammography showed",
"dense lesion",
"most likely cause"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 24-year-old woman recently noticed a mass in her left breast. The examination shows a 4-cm mass in the left upper quadrant. The mass is firm, mobile, and has well-defined margins. She complains of occasional tenderness. There is no lymphatic involvement. Mammography showed a dense lesion. What is the most likely cause?
Choose one of the following::
A. Ductal carcinoma in situ (DCIS)
B. Fibroadenoma
C. Phyllodes tumor
D. Inflammatory carcinoma | [
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} |
A 36-year-old woman with no significant medical history presents with a four-week history of epigastric pain. The pain tends to occur two hours after meals. She has lost 4 pounds over the last four weeks. She is allergic to azithromycin and clarithromycin. A urea breath test detects radiolabeled carbon dioxide in exhaled breath. Two days after starting definitive treatment, she returns to the hospital with flushing, headaches, nausea and vomiting after having a few beers that night. What is the mechanism of the drug involved in the adverse reaction? | Formation of free radicals | {
"A": "Formation of free radicals",
"B": "Binding to the 50S subunit of the ribosome",
"C": "Binding to the 30S subunit of the ribosome",
"D": "Coating of the gastric lining"
} | step1 | A | [
"36 year old woman",
"significant medical history presents",
"four week history",
"epigastric pain",
"pain",
"to occur two hours after meals",
"lost 4 pounds",
"four weeks",
"allergic",
"azithromycin",
"clarithromycin",
"urea breath detects radiolabeled carbon dioxide",
"exhaled breath",
"Two days",
"starting definitive treatment",
"returns",
"hospital",
"flushing",
"headaches",
"nausea",
"vomiting",
"beers",
"night",
"mechanism",
"drug involved",
"adverse reaction"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 36-year-old woman with no significant medical history presents with a four-week history of epigastric pain. The pain tends to occur two hours after meals. She has lost 4 pounds over the last four weeks. She is allergic to azithromycin and clarithromycin. A urea breath test detects radiolabeled carbon dioxide in exhaled breath. Two days after starting definitive treatment, she returns to the hospital with flushing, headaches, nausea and vomiting after having a few beers that night. What is the mechanism of the drug involved in the adverse reaction?
Choose one of the following::
A. Formation of free radicals
B. Binding to the 50S subunit of the ribosome
C. Binding to the 30S subunit of the ribosome
D. Coating of the gastric lining | [
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A 1-day-old male infant is evaluated in the neonatal intensive care unit (NICU) for dyspnea. He was born at 34 weeks gestation. Apgar scores were 6 and 8 at 1 and 5 minutes, respectively. The pregnancy was complicated by polyhydramnios. His mother is a healthy 33-year-old G1P1 woman who received adequate prenatal care. The nurse in the NICU noted increased oral secretions and intermittent desaturations. His temperature is 100.8°F (38.2°C), blood pressure is 100/55 mmHg, pulse is 130/min, and respirations are 28/min. On exam, the child appears to be in respiratory distress. Intercostal retractions are noted. Auscultation of the lungs reveals rales bilaterally. The patient’s abdomen is moderately distended. A chest radiograph is performed and demonstrates coiling of the nasogastric (NG) tube in the esophagus. This patient should be evaluated for which of the following conditions? | Ventricular septal defect | {
"A": "Cryptorchidism",
"B": "Hirschsprung disease",
"C": "Pyloric stenosis",
"D": "Ventricular septal defect"
} | step1 | D | [
"day old male infant",
"evaluated",
"neonatal intensive care unit",
"dyspnea",
"born",
"weeks gestation",
"Apgar scores",
"8",
"1",
"5 minutes",
"pregnancy",
"complicated",
"polyhydramnios",
"mother",
"healthy",
"year old G1P1 woman",
"received adequate prenatal care",
"nurse",
"NICU noted increased oral secretions",
"intermittent desaturations",
"temperature",
"100",
"blood pressure",
"100 55 mmHg",
"pulse",
"min",
"respirations",
"min",
"exam",
"child appears to",
"respiratory distress",
"Intercostal retractions",
"noted",
"Auscultation",
"lungs reveals rales",
"patients abdomen",
"moderately distended",
"chest radiograph",
"performed",
"demonstrates coiling",
"nasogastric",
"tube",
"esophagus",
"patient",
"evaluated",
"following conditions"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 1-day-old male infant is evaluated in the neonatal intensive care unit (NICU) for dyspnea. He was born at 34 weeks gestation. Apgar scores were 6 and 8 at 1 and 5 minutes, respectively. The pregnancy was complicated by polyhydramnios. His mother is a healthy 33-year-old G1P1 woman who received adequate prenatal care. The nurse in the NICU noted increased oral secretions and intermittent desaturations. His temperature is 100.8°F (38.2°C), blood pressure is 100/55 mmHg, pulse is 130/min, and respirations are 28/min. On exam, the child appears to be in respiratory distress. Intercostal retractions are noted. Auscultation of the lungs reveals rales bilaterally. The patient’s abdomen is moderately distended. A chest radiograph is performed and demonstrates coiling of the nasogastric (NG) tube in the esophagus. This patient should be evaluated for which of the following conditions?
Choose one of the following::
A. Cryptorchidism
B. Hirschsprung disease
C. Pyloric stenosis
D. Ventricular septal defect | [
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A 24-year-old man presents with a history of intermittent fever for the last 2 days. He says his episodes of fever are accompanied by shaking and chills. He mentions that his father has been recently recovered from chloroquine-resistant P. falciparum malaria, which was treated successfully with quinine. On physical examination, his temperature is 38.9°C (102°F), pulse rate is 110/min, blood pressure is 116/80 mm Hg, and respiratory rate is 18/min. Examination of his abdomen reveals splenomegaly. His blood sample is sent for the examination of the peripheral smear, which confirms the diagnosis of Plasmodium falciparum malaria. The patient is placed on treatment with oral quinine. After 5 days, the patient returns with improved symptoms of malaria but with complaints of a headache, tinnitus, nausea, and dizziness. The patient mentions that he has been taking a drug for the last 3 months to control his dyspepsia symptoms. Which of the following drugs is most likely to have caused the above-mentioned symptoms in this patient? | Cimetidine | {
"A": "Sucralfate",
"B": "Cimetidine",
"C": "Ranitidine",
"D": "Pantoprazole"
} | step1 | B | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 24-year-old man presents with a history of intermittent fever for the last 2 days. He says his episodes of fever are accompanied by shaking and chills. He mentions that his father has been recently recovered from chloroquine-resistant P. falciparum malaria, which was treated successfully with quinine. On physical examination, his temperature is 38.9°C (102°F), pulse rate is 110/min, blood pressure is 116/80 mm Hg, and respiratory rate is 18/min. Examination of his abdomen reveals splenomegaly. His blood sample is sent for the examination of the peripheral smear, which confirms the diagnosis of Plasmodium falciparum malaria. The patient is placed on treatment with oral quinine. After 5 days, the patient returns with improved symptoms of malaria but with complaints of a headache, tinnitus, nausea, and dizziness. The patient mentions that he has been taking a drug for the last 3 months to control his dyspepsia symptoms. Which of the following drugs is most likely to have caused the above-mentioned symptoms in this patient?
Choose one of the following::
A. Sucralfate
B. Cimetidine
C. Ranitidine
D. Pantoprazole | [
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A 30-year-old man presents to his physician for a follow-up appointment for a blood pressure of 140/90 mm Hg during his last visit. He was advised to record his blood pressure at home with an automated device twice every day. He recorded a wide range of blood pressure values in the past week, ranging from 110/70 mm Hg to 135/84 mm Hg. The medical history is unremarkable and he takes no medications. He occasionally drinks alcohol after work, but denies smoking and illicit drug use. Which of the following factors is responsible for maintaining a near-normal renal blood flow over a wide range of systemic blood pressures? | Afferent arteriole | {
"A": "Afferent arteriole",
"B": "Aldosterone",
"C": "Efferent arteriole",
"D": "Sympathetic nervous system"
} | step1 | A | [
"30 year old man presents",
"physician",
"follow-up appointment",
"blood pressure",
"90 mm Hg",
"last visit",
"to record",
"blood pressure at home",
"automated device twice",
"day",
"recorded",
"wide range",
"blood pressure values",
"past week",
"ranging",
"70 mm Hg",
"84 mm Hg",
"medical history",
"unremarkable",
"takes",
"medications",
"occasionally drinks alcohol",
"work",
"denies smoking",
"illicit drug use",
"following factors",
"responsible",
"maintaining",
"near normal renal blood flow",
"wide range",
"systemic",
"pressures"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 30-year-old man presents to his physician for a follow-up appointment for a blood pressure of 140/90 mm Hg during his last visit. He was advised to record his blood pressure at home with an automated device twice every day. He recorded a wide range of blood pressure values in the past week, ranging from 110/70 mm Hg to 135/84 mm Hg. The medical history is unremarkable and he takes no medications. He occasionally drinks alcohol after work, but denies smoking and illicit drug use. Which of the following factors is responsible for maintaining a near-normal renal blood flow over a wide range of systemic blood pressures?
Choose one of the following::
A. Afferent arteriole
B. Aldosterone
C. Efferent arteriole
D. Sympathetic nervous system | [
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A 40-year-old man visits the office with complaints of fever and abdominal pain for the past 6 days. He is also concerned about his weight loss as he weighs 3.6 kg (8 lb) less, today, than he did 2 months ago. He has a previous history of being admitted to the hospital for recurrent cholangitis. The vital signs include: heart rate 97/min, respiratory rate 17/min, temperature 39.0°C (102.2°F), and blood pressure 114/70 mm Hg. On physical examination, there is tenderness on palpation of the right upper quadrant. The laboratory results are as follows:
Hemoglobin 16 g/dL
Hematocrit 44%
Leukocyte count 18,000/mm3
Neutrophils 60%
Bands 4%
Eosinophils 2%
Basophils 1%
Lymphocytes 27%
Monocytes 6%
Platelet count 345,000/mm3
Aspartate aminotransferase (AST) 57 IU/L
Alanine aminotransferase (ALT) 70 IU/L
Alkaline phosphatase 140 U/L
Total bilirubin 8 mg/dL
Direct bilirubin 5 mg/dL
An ultrasound is also done to the patient which is shown in the picture. What is the most likely diagnosis? | Liver abscess | {
"A": "Liver abscess",
"B": "Hepatitis B",
"C": "Acute cholecystitis",
"D": "Cholangitis"
} | step1 | A | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 40-year-old man visits the office with complaints of fever and abdominal pain for the past 6 days. He is also concerned about his weight loss as he weighs 3.6 kg (8 lb) less, today, than he did 2 months ago. He has a previous history of being admitted to the hospital for recurrent cholangitis. The vital signs include: heart rate 97/min, respiratory rate 17/min, temperature 39.0°C (102.2°F), and blood pressure 114/70 mm Hg. On physical examination, there is tenderness on palpation of the right upper quadrant. The laboratory results are as follows:
Hemoglobin 16 g/dL
Hematocrit 44%
Leukocyte count 18,000/mm3
Neutrophils 60%
Bands 4%
Eosinophils 2%
Basophils 1%
Lymphocytes 27%
Monocytes 6%
Platelet count 345,000/mm3
Aspartate aminotransferase (AST) 57 IU/L
Alanine aminotransferase (ALT) 70 IU/L
Alkaline phosphatase 140 U/L
Total bilirubin 8 mg/dL
Direct bilirubin 5 mg/dL
An ultrasound is also done to the patient which is shown in the picture. What is the most likely diagnosis?
Choose one of the following::
A. Liver abscess
B. Hepatitis B
C. Acute cholecystitis
D. Cholangitis | [
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A 1-year-old Caucasian male is on pancreatic enzyme replacement therapy (PERT) to maintain a healthy body mass index. Sweat chloride test is 68 mmol/L (< 29 mmol/L = normal). The patient has a relative who was also on PERT but passed away in his mid-20s due to respiratory failure, and was unable to have children. Which of the following would be most improved by PERT? | Bone mineral density | {
"A": "Bone mineral density",
"B": "Nasal polyps",
"C": "Hypoglycemia",
"D": "A lack of respiratory infections"
} | step1 | A | [
"year old Caucasian male",
"pancreatic enzyme replacement therapy",
"to maintain",
"body mass index",
"Sweat chloride test",
"68 mmol/L",
"29 mmol/L",
"normal",
"patient",
"relative",
"PERT",
"passed",
"20s",
"respiratory failure",
"unable to",
"children",
"following",
"most improved",
"PERT"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 1-year-old Caucasian male is on pancreatic enzyme replacement therapy (PERT) to maintain a healthy body mass index. Sweat chloride test is 68 mmol/L (< 29 mmol/L = normal). The patient has a relative who was also on PERT but passed away in his mid-20s due to respiratory failure, and was unable to have children. Which of the following would be most improved by PERT?
Choose one of the following::
A. Bone mineral density
B. Nasal polyps
C. Hypoglycemia
D. A lack of respiratory infections | [
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A 24-hour-old newborn presents to the emergency department after a home birth because of fever, irritability alternating with lethargy, and poor feeding. The patient’s mother says symptoms acutely onset 12 hours ago and have not improved. No significant past medical history. His mother did not receive any prenatal care, and she had rupture of membranes 20 hours prior to delivery. His vital signs include: heart rate 150/min, respiratory rate 65/min, temperature 39.0°C (102.2°F), and blood pressure 60/40 mm Hg. On physical examination, the patient has delayed capillary refill. Laboratory studies show a pleocytosis and a low glucose level in the patient’s cerebrospinal fluid. Which of the following is the most likely causative organism for this patient’s condition? | Group B Streptococcus | {
"A": "Cryptococcus neoformans",
"B": "Enterovirus",
"C": "Group B Streptococcus",
"D": "Streptococcus pneumoniae"
} | step1 | C | [
"hour old newborn presents",
"emergency department",
"home birth",
"fever",
"irritability alternating",
"lethargy",
"poor feeding",
"patients mother",
"symptoms",
"onset 12 hours",
"not improved",
"significant past medical history",
"mother",
"not receive",
"prenatal care",
"rupture of membranes 20 hours",
"delivery",
"vital signs include",
"heart rate",
"min",
"respiratory rate 65 min",
"temperature",
"blood pressure 60 40 mm Hg",
"physical examination",
"patient",
"delayed capillary refill",
"Laboratory studies show",
"pleocytosis",
"low glucose level",
"patients cerebrospinal fluid",
"following",
"most likely",
"organism",
"patients condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 24-hour-old newborn presents to the emergency department after a home birth because of fever, irritability alternating with lethargy, and poor feeding. The patient’s mother says symptoms acutely onset 12 hours ago and have not improved. No significant past medical history. His mother did not receive any prenatal care, and she had rupture of membranes 20 hours prior to delivery. His vital signs include: heart rate 150/min, respiratory rate 65/min, temperature 39.0°C (102.2°F), and blood pressure 60/40 mm Hg. On physical examination, the patient has delayed capillary refill. Laboratory studies show a pleocytosis and a low glucose level in the patient’s cerebrospinal fluid. Which of the following is the most likely causative organism for this patient’s condition?
Choose one of the following::
A. Cryptococcus neoformans
B. Enterovirus
C. Group B Streptococcus
D. Streptococcus pneumoniae | [
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A 28-year-old man presents to the emergency department after being rescued from his home. He was working at home alone on some renovations when 1 of his house's walls collapsed on him. His legs were trapped under the debris for about 30 hours before a neighbor came by, found him, and called an ambulance. He is very mildly confused and reports pain throughout both legs. The physical examination is notable for dry mucous membranes and tenderness to palpation throughout both legs with many superficial abrasions, but no active hemorrhage. The full-body computed tomography (CT) scan shows small fractures in both tibias, but no hematomas. He is admitted to the trauma service for observation. On hospital day 1, his urine appears very dark. Urine output over the preceding 24 hours is 200 mL. The laboratory studies show a creatinine of 2.7 mg/dL and serum creatine kinase (CK) of 29,700 IU/L. Which of the following is the next best step in the management of this patient? | Start IV fluids | {
"A": "Order anti-nuclear antibody (ANA) titers",
"B": "Order anti-glomerular basement membrane (GBM) titers",
"C": "Order anti-streptolysin O titers",
"D": "Start IV fluids"
} | step2&3 | D | [
"year old man presents",
"emergency department",
"home",
"working",
"home",
"1",
"house's walls collapsed",
"legs",
"trapped",
"debris",
"about 30 hours",
"neighbor",
"found",
"called",
"ambulance",
"very mildly confused",
"reports pain",
"legs",
"physical examination",
"notable",
"dry mucous membranes",
"tenderness",
"palpation",
"legs",
"superficial abrasions",
"active hemorrhage",
"full body computed tomography",
"scan shows small fractures",
"tibias",
"hematomas",
"admitted",
"trauma service",
"observation",
"hospital",
"urine appears very dark",
"Urine output",
"preceding 24 hours",
"200 mL",
"laboratory studies show",
"creatinine",
"mg/dL",
"serum creatine kinase",
"29 700 IU/L",
"following",
"next best step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 28-year-old man presents to the emergency department after being rescued from his home. He was working at home alone on some renovations when 1 of his house's walls collapsed on him. His legs were trapped under the debris for about 30 hours before a neighbor came by, found him, and called an ambulance. He is very mildly confused and reports pain throughout both legs. The physical examination is notable for dry mucous membranes and tenderness to palpation throughout both legs with many superficial abrasions, but no active hemorrhage. The full-body computed tomography (CT) scan shows small fractures in both tibias, but no hematomas. He is admitted to the trauma service for observation. On hospital day 1, his urine appears very dark. Urine output over the preceding 24 hours is 200 mL. The laboratory studies show a creatinine of 2.7 mg/dL and serum creatine kinase (CK) of 29,700 IU/L. Which of the following is the next best step in the management of this patient?
Choose one of the following::
A. Order anti-nuclear antibody (ANA) titers
B. Order anti-glomerular basement membrane (GBM) titers
C. Order anti-streptolysin O titers
D. Start IV fluids | [
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A researcher wants to study the carcinogenic effects of a food additive. From the literature, he finds that 7 different types of cancers have been linked to the consumption of this food additive. He wants to study all 7 possible outcomes. He conducts interviews with people who consume food containing these additives and people who do not. He then follows both groups for several years to see if they develop any of these 7 cancers or any other health outcomes. Which of the following study models best represents this study? | Cohort study | {
"A": "Case-control study ",
"B": "Cohort study ",
"C": "Crossover study",
"D": "Cross-sectional study"
} | step1 | B | [
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"cancers",
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"cancers",
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A researcher wants to study the carcinogenic effects of a food additive. From the literature, he finds that 7 different types of cancers have been linked to the consumption of this food additive. He wants to study all 7 possible outcomes. He conducts interviews with people who consume food containing these additives and people who do not. He then follows both groups for several years to see if they develop any of these 7 cancers or any other health outcomes. Which of the following study models best represents this study?
Choose one of the following::
A. Case-control study
B. Cohort study
C. Crossover study
D. Cross-sectional study | [
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A 42-year-old woman presents for a follow-up visit. She was diagnosed with iron deficiency anemia 3 months ago, for which she was prescribed ferrous sulfate twice daily. She says the medication has not helped, and she still is suffering from fatigue and shortness of breath when she exerts herself. Past medical history is remarkable for chronic dyspepsia. The patient denies smoking, drinking alcohol, or use of illicit drugs. She immigrated from Egypt 4 years ago. No significant family history. Physical examination is unremarkable. Laboratory findings are significant for the following:
3 month ago Current
Hemoglobin 10.1 g/dL 10.3 g/dL
Erythrocyte count 3.2 million/mm3 3.3 million/mm3
Mean corpuscular volume (MCV) 72 μm3 74 μm3
Mean corpuscular hemoglobin (MCH) 20.1 pg/cell 20.3 pg/cell
Red cell distribution width (RDW) 17.2% 17.1%
Serum ferritin 10.1 ng/mL 10.3 ng/mL
Total iron binding capacity (TIBC) 475 µg/dL 470 µg/dL
Transferrin saturation 11% 12%
Which of the following is the next best step in the management of this patient’s most likely condition? | Helicobacter pylori fecal antigen | {
"A": "Hemoglobin electrophoresis",
"B": "Gastrointestinal endoscopy",
"C": "Bone marrow biopsy",
"D": "Helicobacter pylori fecal antigen"
} | step2&3 | D | [
"year old woman presents",
"follow-up visit",
"diagnosed",
"iron deficiency anemia 3 months",
"prescribed ferrous sulfate twice daily",
"medication",
"not helped",
"suffering",
"fatigue",
"shortness of breath",
"exerts",
"Past medical history",
"chronic dyspepsia",
"patient denies smoking",
"drinking alcohol",
"use of illicit drugs",
"Egypt",
"years",
"significant family history",
"Physical examination",
"unremarkable",
"Laboratory findings",
"significant",
"following",
"3",
"Hemoglobin",
"g dL",
"2",
"hemoglobin",
"pg",
"mL",
"Total",
"12",
"following",
"next best step",
"management",
"patients",
"likely condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 42-year-old woman presents for a follow-up visit. She was diagnosed with iron deficiency anemia 3 months ago, for which she was prescribed ferrous sulfate twice daily. She says the medication has not helped, and she still is suffering from fatigue and shortness of breath when she exerts herself. Past medical history is remarkable for chronic dyspepsia. The patient denies smoking, drinking alcohol, or use of illicit drugs. She immigrated from Egypt 4 years ago. No significant family history. Physical examination is unremarkable. Laboratory findings are significant for the following:
3 month ago Current
Hemoglobin 10.1 g/dL 10.3 g/dL
Erythrocyte count 3.2 million/mm3 3.3 million/mm3
Mean corpuscular volume (MCV) 72 μm3 74 μm3
Mean corpuscular hemoglobin (MCH) 20.1 pg/cell 20.3 pg/cell
Red cell distribution width (RDW) 17.2% 17.1%
Serum ferritin 10.1 ng/mL 10.3 ng/mL
Total iron binding capacity (TIBC) 475 µg/dL 470 µg/dL
Transferrin saturation 11% 12%
Which of the following is the next best step in the management of this patient’s most likely condition?
Choose one of the following::
A. Hemoglobin electrophoresis
B. Gastrointestinal endoscopy
C. Bone marrow biopsy
D. Helicobacter pylori fecal antigen | [
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The human body obtains vitamin D either from diet or from sun exposure. Darker-skinned individuals require more sunlight to create adequate vitamin D stores as the increased melanin in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamin D synthesis. Therefore, if these individuals spend inadequate time in the light, dietary sources of vitamin D are necessary. Which of the following requires sunlight for its formation? | Cholecalciferol (D3) | {
"A": "7-dehydrocholestrol",
"B": "Cholecalciferol (D3)",
"C": "1,25-dihydroxyvitamin D",
"D": "Ergocalciferol (D2)"
} | step1 | B | [
"human body obtains vitamin D",
"diet",
"sun exposure",
"Darker-skinned individuals",
"more sunlight to create adequate vitamin D stores",
"increased melanin",
"skin acts",
"sunscreen",
"blocks",
"UV required",
"vitamin D synthesis",
"individuals spend inadequate time",
"light",
"dietary sources",
"vitamin D",
"following",
"sunlight",
"formation"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: The human body obtains vitamin D either from diet or from sun exposure. Darker-skinned individuals require more sunlight to create adequate vitamin D stores as the increased melanin in their skin acts like sunscreen; thus, it blocks the necessary UV required for vitamin D synthesis. Therefore, if these individuals spend inadequate time in the light, dietary sources of vitamin D are necessary. Which of the following requires sunlight for its formation?
Choose one of the following::
A. 7-dehydrocholestrol
B. Cholecalciferol (D3)
C. 1,25-dihydroxyvitamin D
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A 21-year-old woman is brought to the emergency room 1 hour after she ingested 12 pills of acetaminophen. She had a fight with her boyfriend immediately prior to the ingestion, during which she threatened to kill herself if he broke up with her. She has been hospitalized 4 times for overdoses in the past 3 years following breakups with her partners. On the way to the hospital, she screamed and then assaulted the paramedic who attempted to take her temperature. Physical examination shows multiple rows of well-healed scars bilaterally on the wrists. This patient is most likely to display which of the following defense mechanisms? | Splitting | {
"A": "Fantasy",
"B": "Sublimation",
"C": "Displacement",
"D": "Splitting"
} | step1 | D | [
"21-year-old woman",
"brought",
"emergency room",
"hour",
"ingested",
"pills",
"acetaminophen",
"fight",
"boyfriend immediately",
"ingestion",
"to kill",
"broke",
"hospitalized 4 times",
"overdoses",
"past",
"years following",
"partners",
"hospital",
"screamed",
"then assaulted",
"paramedic",
"attempted to take",
"temperature",
"Physical examination shows multiple rows",
"well healed scars",
"wrists",
"patient",
"most likely to display",
"following defense mechanisms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 21-year-old woman is brought to the emergency room 1 hour after she ingested 12 pills of acetaminophen. She had a fight with her boyfriend immediately prior to the ingestion, during which she threatened to kill herself if he broke up with her. She has been hospitalized 4 times for overdoses in the past 3 years following breakups with her partners. On the way to the hospital, she screamed and then assaulted the paramedic who attempted to take her temperature. Physical examination shows multiple rows of well-healed scars bilaterally on the wrists. This patient is most likely to display which of the following defense mechanisms?
Choose one of the following::
A. Fantasy
B. Sublimation
C. Displacement
D. Splitting | [
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A 16-year-old girl is brought to the physician for evaluation of severe acne on her face, chest, and back for the past 2 years. She has no itching or scaling associated with the lesions. She has been treated in the past with a combination of oral cephalexin and topical benzoyl peroxide without clinical improvement. She is sexually active with 1 male partner, and they use condoms inconsistently. She does not smoke, drink alcohol, or use illicit drugs. There is no personal or family history of serious illness. Her vital signs are within normal limits. Examination shows mild facial scarring and numerous open comedones and sebaceous skin lesions on her face, chest, and back. Which of the following is indicated prior to initiating the next most appropriate step in treatment? | Measure serum beta-hCG levels | {
"A": "Administer oral contraceptives",
"B": "Measure creatinine kinase levels",
"C": "Measure serum beta-hCG levels",
"D": "Screen for depression with a questionnaire"
} | step2&3 | C | [
"year old girl",
"brought",
"physician",
"evaluation",
"severe acne",
"face",
"chest",
"back",
"past",
"years",
"itching",
"scaling associated with",
"lesions",
"treated",
"past",
"combination",
"oral cephalexin",
"topical benzoyl peroxide",
"clinical improvement",
"sexually active",
"male partner",
"use condoms",
"not smoke",
"drink alcohol",
"use illicit",
"personal",
"family history",
"serious illness",
"vital signs",
"normal limits",
"Examination shows mild facial scarring",
"numerous open comedones",
"skin lesions",
"face",
"chest",
"back",
"following",
"indicated prior to initiating",
"next",
"appropriate step",
"treatment"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 16-year-old girl is brought to the physician for evaluation of severe acne on her face, chest, and back for the past 2 years. She has no itching or scaling associated with the lesions. She has been treated in the past with a combination of oral cephalexin and topical benzoyl peroxide without clinical improvement. She is sexually active with 1 male partner, and they use condoms inconsistently. She does not smoke, drink alcohol, or use illicit drugs. There is no personal or family history of serious illness. Her vital signs are within normal limits. Examination shows mild facial scarring and numerous open comedones and sebaceous skin lesions on her face, chest, and back. Which of the following is indicated prior to initiating the next most appropriate step in treatment?
Choose one of the following::
A. Administer oral contraceptives
B. Measure creatinine kinase levels
C. Measure serum beta-hCG levels
D. Screen for depression with a questionnaire | [
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A 12-year-old boy is brought to the emergency department by his mother for a rash. The patient had a sore throat a few days ago with symptoms initially well-controlled with lozenges. However, today he had a rash covering his body, which prompted his presentation. The mother states that she did smear an herbal remedy on the rash with no alleviation in symptoms and also gave him a single dose of amoxicillin left over from a previous infection. The patient is up to date on his vaccinations and has no past medical conditions. His temperature is 101°F (38.3°C), blood pressure is 102/68 mmHg, pulse is 97/min, respirations are 19/min, and oxygen saturation is 99% on room air. Physical exam is notable for the findings in Figures A and B. The rash seen in Figure B is very coarse. Which of the following is the most likely diagnosis? | Scarlet fever | {
"A": "Infectious mononucleosis",
"B": "Rheumatic fever",
"C": "Scarlet fever",
"D": "Urticaria"
} | step2&3 | C | [
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"97 min",
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"99",
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"Physical exam",
"notable",
"findings",
"rash seen",
"very coarse",
"following",
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 12-year-old boy is brought to the emergency department by his mother for a rash. The patient had a sore throat a few days ago with symptoms initially well-controlled with lozenges. However, today he had a rash covering his body, which prompted his presentation. The mother states that she did smear an herbal remedy on the rash with no alleviation in symptoms and also gave him a single dose of amoxicillin left over from a previous infection. The patient is up to date on his vaccinations and has no past medical conditions. His temperature is 101°F (38.3°C), blood pressure is 102/68 mmHg, pulse is 97/min, respirations are 19/min, and oxygen saturation is 99% on room air. Physical exam is notable for the findings in Figures A and B. The rash seen in Figure B is very coarse. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Infectious mononucleosis
B. Rheumatic fever
C. Scarlet fever
D. Urticaria | [
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A 2-year-old male is brought to your office by his mother for evaluation. The patient develops a skin presentation similar to Image A on his cheeks and chin when exposed to certain food products. This patient is most likely predisposed to develop which of the following? | Wheezing | {
"A": "Fingernail pitting",
"B": "Arthralgias",
"C": "Wheezing",
"D": "Cyanosis"
} | step1 | C | [
"2 year old male",
"brought",
"office",
"mother",
"evaluation",
"patient",
"skin presentation similar",
"Image",
"cheeks",
"chin",
"exposed",
"certain food products",
"patient",
"most likely predisposed to",
"following"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 2-year-old male is brought to your office by his mother for evaluation. The patient develops a skin presentation similar to Image A on his cheeks and chin when exposed to certain food products. This patient is most likely predisposed to develop which of the following?
Choose one of the following::
A. Fingernail pitting
B. Arthralgias
C. Wheezing
D. Cyanosis | [
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A 27-year-old man with a history of intravenous drug use comes to the physician because of anorexia, nausea, dark urine, and abdominal pain for 2 weeks. Physical examination shows scleral icterus and right upper quadrant tenderness. Serum studies show:
Alanine aminotransferase 1248 U/L
Aspartate aminotransferase 980 U/L
Hepatitis B surface antigen negative
Anti-hepatitis B surface antibody positive
Anti-hepatitis C antibody negative
Further evaluation shows hepatitis C virus RNA detected by PCR. Without appropriate treatment, which of the following is the most likely outcome of this patient's current condition?" | Slowly progressive hepatitis | {
"A": "Slowly progressive hepatitis",
"B": "Liver cirrhosis",
"C": "Transient infection",
"D": "Fulminant hepatitis"
} | step1 | A | [
"27 year old man",
"history",
"intravenous drug use",
"physician",
"anorexia",
"nausea",
"dark urine",
"abdominal pain",
"2 weeks",
"Physical examination shows scleral icterus",
"right upper quadrant tenderness",
"Serum studies show",
"U",
"Hepatitis B surface antigen negative",
"antibody",
"Further evaluation shows hepatitis C virus RNA detected",
"PCR",
"appropriate treatment",
"following",
"most",
"patient",
"urrent ondition?"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old man with a history of intravenous drug use comes to the physician because of anorexia, nausea, dark urine, and abdominal pain for 2 weeks. Physical examination shows scleral icterus and right upper quadrant tenderness. Serum studies show:
Alanine aminotransferase 1248 U/L
Aspartate aminotransferase 980 U/L
Hepatitis B surface antigen negative
Anti-hepatitis B surface antibody positive
Anti-hepatitis C antibody negative
Further evaluation shows hepatitis C virus RNA detected by PCR. Without appropriate treatment, which of the following is the most likely outcome of this patient's current condition?"
Choose one of the following::
A. Slowly progressive hepatitis
B. Liver cirrhosis
C. Transient infection
D. Fulminant hepatitis | [
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An investigator has conducted a prospective study to evaluate the relationship between asthma and the risk of myocardial infarction (MI). She stratifies her analyses by biological sex and observed that among female patients, asthma was a significant predictor of MI risk (hazard ratio = 1.32, p < 0.001). However, among male patients, no relationship was found between asthma and MI risk (p = 0.23). Which of the following best explains the difference observed between male and female patients? | Effect modification
" | {
"A": "Confounding",
"B": "Measurement bias",
"C": "Stratified sampling",
"D": "Effect modification\n\""
} | step1 | D | [
"investigator",
"conducted",
"prospective study to evaluate",
"relationship",
"asthma",
"risk",
"myocardial infarction",
"analyses",
"biological sex",
"observed",
"female patients",
"asthma",
"significant predictor",
"MI risk",
"hazard ratio",
"1",
"p",
"0.001",
"male patients",
"relationship",
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"asthma",
"MI risk",
"p",
"0 23",
"following best",
"difference observed",
"male",
"female patients"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An investigator has conducted a prospective study to evaluate the relationship between asthma and the risk of myocardial infarction (MI). She stratifies her analyses by biological sex and observed that among female patients, asthma was a significant predictor of MI risk (hazard ratio = 1.32, p < 0.001). However, among male patients, no relationship was found between asthma and MI risk (p = 0.23). Which of the following best explains the difference observed between male and female patients?
Choose one of the following::
A. Confounding
B. Measurement bias
C. Stratified sampling
D. Effect modification
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An 11-year-old girl is brought to her primary care physician by her mother with complaints of constant lower abdominal pain and foul-smelling urine for the past 2 days. The patient has had several previous episodes of simple urinary tract infections in the past. Her vitals signs show mild tachycardia without fever. Physical examination reveals suprapubic tenderness without costovertebral angle tenderness on percussion. Urinalysis reveals positive leukocyte esterase and nitrite. Further questioning reveals that the patient does not use the school toilets and holds her urine all day until she gets home. When pressed further, she gets teary-eyed and starts to cry and complains that other girls will make fun of her if she uses the bathroom and will spread rumors to the teachers and her friends. She reports that though this has never happened in the past it concerns her a great deal. Which of the following is the most likely diagnosis for this patient? | Social anxiety disorder | {
"A": "Social anxiety disorder",
"B": "Panic disorder",
"C": "Specific phobia",
"D": "Agoraphobia"
} | step2&3 | A | [
"year old girl",
"brought",
"primary care physician",
"mother",
"complaints",
"constant lower abdominal pain",
"foul-smelling urine",
"past 2 days",
"patient",
"several previous episodes of simple urinary tract infections",
"past",
"signs show mild tachycardia",
"fever",
"Physical examination reveals suprapubic tenderness",
"costovertebral angle",
"percussion",
"Urinalysis reveals positive leukocyte esterase",
"nitrite",
"Further questioning reveals",
"patient",
"not use",
"school toilets",
"holds",
"urine all day",
"gets home",
"further",
"gets teary eyed",
"starts",
"cry",
"girls",
"make",
"uses",
"bathroom",
"spread rumors",
"teachers",
"friends",
"reports",
"never happened",
"past",
"concerns",
"great",
"following",
"most likely diagnosis",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An 11-year-old girl is brought to her primary care physician by her mother with complaints of constant lower abdominal pain and foul-smelling urine for the past 2 days. The patient has had several previous episodes of simple urinary tract infections in the past. Her vitals signs show mild tachycardia without fever. Physical examination reveals suprapubic tenderness without costovertebral angle tenderness on percussion. Urinalysis reveals positive leukocyte esterase and nitrite. Further questioning reveals that the patient does not use the school toilets and holds her urine all day until she gets home. When pressed further, she gets teary-eyed and starts to cry and complains that other girls will make fun of her if she uses the bathroom and will spread rumors to the teachers and her friends. She reports that though this has never happened in the past it concerns her a great deal. Which of the following is the most likely diagnosis for this patient?
Choose one of the following::
A. Social anxiety disorder
B. Panic disorder
C. Specific phobia
D. Agoraphobia | [
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A 27-year-old man presents to the emergency department with back pain. The patient states that he has back pain that has been steadily worsening over the past month. He states that his pain is worse in the morning but feels better after he finishes at work for the day. He rates his current pain as a 7/10 and says that he feels short of breath. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 99% on room air. On physical exam, you note a young man who does not appear to be in any distress. Cardiac exam is within normal limits. Pulmonary exam is notable only for a minor decrease in air movement bilaterally at the lung bases. Musculoskeletal exam reveals a decrease in mobility of the back in all four directions. Which of the following is the best initial step in management of this patient? | Radiography of the lumbosacral spine | {
"A": "Radiography of the lumbosacral spine",
"B": "MRI of the sacroiliac joint",
"C": "CT scan of the chest",
"D": "Ultrasound"
} | step2&3 | A | [
"27 year old man presents",
"emergency department",
"back pain",
"patient states",
"back pain",
"worsening",
"past month",
"states",
"pain",
"worse",
"morning",
"feels better",
"finishes",
"work",
"day",
"rates",
"current pain",
"10",
"feels short of breath",
"temperature",
"99",
"blood pressure",
"85 mmHg",
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"80 min",
"respirations",
"min",
"oxygen saturation",
"99",
"room air",
"physical exam",
"note",
"young man",
"not appear to",
"distress",
"Cardiac exam",
"normal limits",
"Pulmonary exam",
"notable only",
"minor decrease",
"air movement",
"lung bases",
"Musculoskeletal exam reveals",
"decrease",
"mobility of",
"back",
"four directions",
"following",
"best initial step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old man presents to the emergency department with back pain. The patient states that he has back pain that has been steadily worsening over the past month. He states that his pain is worse in the morning but feels better after he finishes at work for the day. He rates his current pain as a 7/10 and says that he feels short of breath. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 99% on room air. On physical exam, you note a young man who does not appear to be in any distress. Cardiac exam is within normal limits. Pulmonary exam is notable only for a minor decrease in air movement bilaterally at the lung bases. Musculoskeletal exam reveals a decrease in mobility of the back in all four directions. Which of the following is the best initial step in management of this patient?
Choose one of the following::
A. Radiography of the lumbosacral spine
B. MRI of the sacroiliac joint
C. CT scan of the chest
D. Ultrasound | [
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A 68-year-old man comes to the physician for a routine health maintenance examination. Over the past six months, he has had an increase in the frequency of his bowel movements and occasional bloody stools. He has hypertension, coronary artery disease, and chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His current medications include aspirin, lisinopril, and salmeterol. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 128/75 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The abdomen is soft with no organomegaly. Digital rectal examination shows a large internal hemorrhoid. Test of the stool for occult blood is positive. Which of the following is the most appropriate next step in the management of this patient? | Colonoscopy | {
"A": "Rubber band ligation",
"B": "Colonoscopy",
"C": "Capsule endoscopy",
"D": "Hemorrhoidectomy"
} | step2&3 | B | [
"68 year old man",
"physician",
"routine health maintenance examination",
"past six months",
"increase",
"frequency of",
"bowel movements",
"occasional bloody stools",
"hypertension",
"coronary artery disease",
"chronic obstructive pulmonary disease",
"smoked one pack",
"cigarettes daily",
"40 years",
"current medications include aspirin",
"lisinopril",
"salmeterol",
"temperature",
"98",
"pulse",
"75 min",
"blood pressure",
"75 mm Hg",
"lungs",
"clear",
"auscultation",
"Cardiac shows",
"murmurs",
"rubs",
"abdomen",
"soft",
"organomegaly",
"Digital rectal examination shows",
"large internal hemorrhoid",
"Test",
"stool",
"occult blood",
"positive",
"following",
"most appropriate next step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 68-year-old man comes to the physician for a routine health maintenance examination. Over the past six months, he has had an increase in the frequency of his bowel movements and occasional bloody stools. He has hypertension, coronary artery disease, and chronic obstructive pulmonary disease. He has smoked one pack of cigarettes daily for 40 years. His current medications include aspirin, lisinopril, and salmeterol. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 128/75 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. The abdomen is soft with no organomegaly. Digital rectal examination shows a large internal hemorrhoid. Test of the stool for occult blood is positive. Which of the following is the most appropriate next step in the management of this patient?
Choose one of the following::
A. Rubber band ligation
B. Colonoscopy
C. Capsule endoscopy
D. Hemorrhoidectomy | [
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A 52-year-old man, with a history of alcoholism, presents with loss of appetite, abdominal pain, and fever for the past 24 hours. He says he consumed 12 beers and a bottle of vodka 2 days ago. He reports a 19-year history of alcoholism. His blood pressure is 100/70 mm Hg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Laboratory findings are significant for the following:
Sodium 137 mEq/L
Potassium 3.4 mEq/L
Alanine aminotransferase (ALT) 230 U/L
Aspartate aminotransferase (AST) 470 U/L
Which of the following histopathologic findings would most likely be found on a liver biopsy of this patient? | Cytoplasmic inclusion bodies with keratin | {
"A": "T-lymphocyte infiltration",
"B": "Macronodular cirrhosis",
"C": "Periportal necrosis",
"D": "Cytoplasmic inclusion bodies with keratin"
} | step1 | D | [
"year old man",
"history of alcoholism",
"presents",
"loss of appetite",
"abdominal pain",
"fever",
"past 24 hours",
"beers",
"bottle",
"vodka 2 days",
"reports",
"year history of alcoholism",
"blood pressure",
"100 70 mm Hg",
"pulse",
"100 min",
"respirations",
"20 min",
"oxygen saturation",
"99",
"room air",
"Laboratory findings",
"significant",
"following",
"Sodium",
"mEq/L Potassium",
"Alanine aminotransferase",
"ALT",
"U/L Aspartate aminotransferase",
"AST",
"U/L",
"following histopathologic findings",
"most likely",
"found",
"liver biopsy of",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 52-year-old man, with a history of alcoholism, presents with loss of appetite, abdominal pain, and fever for the past 24 hours. He says he consumed 12 beers and a bottle of vodka 2 days ago. He reports a 19-year history of alcoholism. His blood pressure is 100/70 mm Hg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Laboratory findings are significant for the following:
Sodium 137 mEq/L
Potassium 3.4 mEq/L
Alanine aminotransferase (ALT) 230 U/L
Aspartate aminotransferase (AST) 470 U/L
Which of the following histopathologic findings would most likely be found on a liver biopsy of this patient?
Choose one of the following::
A. T-lymphocyte infiltration
B. Macronodular cirrhosis
C. Periportal necrosis
D. Cytoplasmic inclusion bodies with keratin | [
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A 55-year-old woman comes to the emergency department because of epigastric pain, sweating, and breathlessness for 45 minutes. She has hypertension treated with hydrochlorothiazide. She has smoked 1 pack of cigarettes daily for the past 30 years and drinks 1 glass of wine daily. Her pulse is 105/min and blood pressure is 100/70 mm Hg. Arterial blood gas analysis on room air shows:
pH 7.49
pCO2 32 mm Hg
pO2 57 mm Hg
Which of the following is the most likely cause of hypoxemia in this patient?" | Increased pulmonary capillary pressure | {
"A": "Decreased transpulmonary pressure",
"B": "Increased pulmonary capillary pressure",
"C": "Decreased total body hemoglobin",
"D": "Increased pulmonary capillary permeability\n\""
} | step1 | B | [
"55 year old woman",
"emergency department",
"epigastric pain",
"sweating",
"breathlessness",
"45 minutes",
"hypertension treated with hydrochlorothiazide",
"smoked 1 pack",
"cigarettes daily",
"past 30 years",
"drinks 1 glass",
"wine daily",
"pulse",
"min",
"blood pressure",
"100 70 mm Hg",
"Arterial blood gas analysis",
"room air shows",
"pH 7",
"pCO2",
"mm Hg pO2 57",
"following",
"most likely cause",
"hypoxemia",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 55-year-old woman comes to the emergency department because of epigastric pain, sweating, and breathlessness for 45 minutes. She has hypertension treated with hydrochlorothiazide. She has smoked 1 pack of cigarettes daily for the past 30 years and drinks 1 glass of wine daily. Her pulse is 105/min and blood pressure is 100/70 mm Hg. Arterial blood gas analysis on room air shows:
pH 7.49
pCO2 32 mm Hg
pO2 57 mm Hg
Which of the following is the most likely cause of hypoxemia in this patient?"
Choose one of the following::
A. Decreased transpulmonary pressure
B. Increased pulmonary capillary pressure
C. Decreased total body hemoglobin
D. Increased pulmonary capillary permeability
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A 43-year-old man comes to the physician because of a 2-week history of nonbloody diarrhea, abdominal discomfort, and bloating. When the symptoms began, several of his coworkers had similar symptoms but only for about 3 days. Abdominal examination shows diffuse tenderness with no guarding or rebound. Stool sampling reveals a decreased stool pH. Which of the following is the most likely underlying cause of this patient's prolonged symptoms? | Lactase deficiency | {
"A": "Intestinal type 1 helper T cells",
"B": "Anti-endomysial antibodies",
"C": "Heat-labile toxin",
"D": "Lactase deficiency"
} | step1 | D | [
"year old man",
"physician",
"2-week history",
"diarrhea",
"abdominal discomfort",
"bloating",
"symptoms began",
"several",
"coworkers",
"similar symptoms",
"only",
"3 days",
"Abdominal examination shows diffuse tenderness",
"guarding",
"Stool sampling reveals",
"decreased stool",
"following",
"most likely underlying cause",
"patient's prolonged symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 43-year-old man comes to the physician because of a 2-week history of nonbloody diarrhea, abdominal discomfort, and bloating. When the symptoms began, several of his coworkers had similar symptoms but only for about 3 days. Abdominal examination shows diffuse tenderness with no guarding or rebound. Stool sampling reveals a decreased stool pH. Which of the following is the most likely underlying cause of this patient's prolonged symptoms?
Choose one of the following::
A. Intestinal type 1 helper T cells
B. Anti-endomysial antibodies
C. Heat-labile toxin
D. Lactase deficiency | [
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A 4-year-old boy is brought to the physician by his parents because of fever and mild abdominal pain for 7 days. His parents report that he developed a rash 2 days ago. He has had no diarrhea or vomiting. Four weeks ago, he returned from a camping trip to Colorado with his family. His immunization records are unavailable. His temperature is 39.4°C (102.9°F), pulse is 111/min, respirations are 27/min, and blood pressure is 96/65 mm Hg. Examination shows bilateral conjunctival injections and fissures on his lower lips. The pharynx is erythematous. There is tender cervical lymphadenopathy. The hands and feet appear edematous. A macular morbilliform rash is present over the trunk. Bilateral knee joints are swollen and tender; range of motion is limited by pain. Which of the following is the most appropriate treatment for this patient's condition? | Intravenous immunoglobulin | {
"A": "Oral doxycycline",
"B": "Supportive treatment only",
"C": "Oral penicillin",
"D": "Intravenous immunoglobulin"
} | step2&3 | D | [
"4 year old boy",
"brought",
"physician",
"parents",
"fever",
"mild abdominal pain",
"7 days",
"parents report",
"rash",
"days",
"diarrhea",
"vomiting",
"Four weeks",
"returned",
"camping trip",
"Colorado",
"family",
"immunization records",
"unavailable",
"temperature",
"4C",
"9F",
"pulse",
"min",
"respirations",
"27 min",
"blood pressure",
"96 65 mm Hg",
"Examination shows bilateral conjunctival injections",
"fissures",
"lower lips",
"pharynx",
"erythematous",
"tender cervical lymphadenopathy",
"hands",
"feet appear edematous",
"macular morbilliform",
"present",
"trunk",
"Bilateral knee joints",
"swollen",
"tender",
"range of motion",
"limited",
"pain",
"following",
"most appropriate treatment",
"patient's condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 4-year-old boy is brought to the physician by his parents because of fever and mild abdominal pain for 7 days. His parents report that he developed a rash 2 days ago. He has had no diarrhea or vomiting. Four weeks ago, he returned from a camping trip to Colorado with his family. His immunization records are unavailable. His temperature is 39.4°C (102.9°F), pulse is 111/min, respirations are 27/min, and blood pressure is 96/65 mm Hg. Examination shows bilateral conjunctival injections and fissures on his lower lips. The pharynx is erythematous. There is tender cervical lymphadenopathy. The hands and feet appear edematous. A macular morbilliform rash is present over the trunk. Bilateral knee joints are swollen and tender; range of motion is limited by pain. Which of the following is the most appropriate treatment for this patient's condition?
Choose one of the following::
A. Oral doxycycline
B. Supportive treatment only
C. Oral penicillin
D. Intravenous immunoglobulin | [
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Expression of an mRNA encoding for a soluble form of the Fas protein prevents a cell from undergoing programmed cell death. However, after inclusion of a certain exon, this same Fas pre-mRNA eventually leads to the translation of a protein that is membrane bound, subsequently promoting the cell to undergo apoptosis. Which of the following best explains this finding? | Alternative splicing | {
"A": "Base excision repair",
"B": "Histone deacetylation",
"C": "Post-translational modifications",
"D": "Alternative splicing"
} | step1 | D | [
"Expression",
"mRNA encoding",
"a soluble form",
"protein prevents",
"cell",
"programmed",
"death",
"inclusion",
"certain exon",
"same",
"pre-mRNA",
"leads",
"translation",
"protein",
"membrane bound",
"promoting",
"cell to",
"apoptosis",
"following best",
"finding"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Expression of an mRNA encoding for a soluble form of the Fas protein prevents a cell from undergoing programmed cell death. However, after inclusion of a certain exon, this same Fas pre-mRNA eventually leads to the translation of a protein that is membrane bound, subsequently promoting the cell to undergo apoptosis. Which of the following best explains this finding?
Choose one of the following::
A. Base excision repair
B. Histone deacetylation
C. Post-translational modifications
D. Alternative splicing | [
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A 36-year-old woman complains of difficulty falling asleep over the past 4 months. On detailed history taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the time on her cell phone on and off for an hour before falling asleep. In the morning, she is tired and makes mistakes at work. Her husband has not noticed excessive snoring or abnormal breathing during sleep. Medical history is unremarkable. She has smoked 5–7 cigarettes daily for 7 years and denies excess alcohol consumption. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition? | Proper sleep hygiene | {
"A": "Proper sleep hygiene",
"B": "Modafinil",
"C": "Continuous positive airway pressure",
"D": "Ropinirole"
} | step2&3 | A | [
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"best initial step",
"management",
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 36-year-old woman complains of difficulty falling asleep over the past 4 months. On detailed history taking, she says that she drinks her last cup of tea at 8:30 p.m. before retiring at 10:30 p.m. She then watches the time on her cell phone on and off for an hour before falling asleep. In the morning, she is tired and makes mistakes at work. Her husband has not noticed excessive snoring or abnormal breathing during sleep. Medical history is unremarkable. She has smoked 5–7 cigarettes daily for 7 years and denies excess alcohol consumption. Her physical examination is normal. Which of the following is the best initial step in the management of this patient’s condition?
Choose one of the following::
A. Proper sleep hygiene
B. Modafinil
C. Continuous positive airway pressure
D. Ropinirole | [
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A 45-year-old man presents to the emergency department with upper abdominal pain. He reports vomiting blood 2 times at home. He has smoked 30–40 cigarettes daily for 15 years. He is otherwise well, takes no medications, and abstains from the use of alcohol. While in the emergency department, he vomits bright red blood into a bedside basin and becomes light-headed. Blood pressure is 86/40 mm Hg, pulse 120/min, and respiratory rate 24/min. His skin is cool to touch, pale, and mottled. Which of the following is a feature of this patient’s condition? | ↑ peripheral vascular resistance | {
"A": "↑ pulmonary capillary wedge pressure",
"B": "↑ peripheral vascular resistance",
"C": "↓ peripheral vascular resistance ",
"D": "Initial ↓ of hemoglobin and hematocrit concentration"
} | step2&3 | B | [
"year old man presents",
"emergency department",
"upper abdominal pain",
"reports vomiting blood",
"times at home",
"smoked",
"cigarettes daily",
"years",
"well",
"takes",
"medications",
"use",
"alcohol",
"emergency department",
"vomits bright red blood",
"basin",
"light-headed",
"Blood pressure",
"40 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"skin",
"cool",
"touch",
"pale",
"mottled",
"following",
"feature",
"patients"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 45-year-old man presents to the emergency department with upper abdominal pain. He reports vomiting blood 2 times at home. He has smoked 30–40 cigarettes daily for 15 years. He is otherwise well, takes no medications, and abstains from the use of alcohol. While in the emergency department, he vomits bright red blood into a bedside basin and becomes light-headed. Blood pressure is 86/40 mm Hg, pulse 120/min, and respiratory rate 24/min. His skin is cool to touch, pale, and mottled. Which of the following is a feature of this patient’s condition?
Choose one of the following::
A. ↑ pulmonary capillary wedge pressure
B. ↑ peripheral vascular resistance
C. ↓ peripheral vascular resistance
D. Initial ↓ of hemoglobin and hematocrit concentration | [
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An 11-year-old boy presents with a sore throat, fever, chills, and difficulty swallowing for the past 3 days. The patient’s mother says that last night he was short of breath and had a headache. Past medical history is unremarkable. The patient has not been vaccinated as his mother thinks it is "unnecessary". His temperature is 38.3°C (101.0°F), blood pressure is 120/70 mm Hg, pulse is 110/min, and respiratory rate is 18/min. On physical examination, the patient is ill-appearing and dehydrated. A grayish-white membrane and pharyngeal erythema are present in the oropharynx. Significant cervical lymphadenopathy is also present. A throat swab is taken and gram staining shows gram-positive club-shaped bacilli along with few neutrophils. Which of the following would most likely be the result of the bacterial culture of the throat swab in this patient? | Small black colonies on tellurite agar | {
"A": "Small black colonies on tellurite agar",
"B": "Hemolytic black colonies on blood agar",
"C": "Bluish green colonies on Loeffler’s serum",
"D": "Greyish-white colonies on Thayer-Martin agar"
} | step1 | A | [
"year old boy presents",
"sore throat",
"fever",
"chills",
"difficulty swallowing",
"past 3 days",
"patients mother",
"last night",
"short of breath",
"headache",
"Past medical history",
"unremarkable",
"patient",
"not",
"vaccinated",
"mother thinks",
"temperature",
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"70 mm Hg",
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"min",
"respiratory rate",
"min",
"physical examination",
"patient",
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"dehydrated",
"grayish white membrane",
"pharyngeal erythema",
"present",
"oropharynx",
"Significant cervical lymphadenopathy",
"present",
"throat swab",
"taken",
"gram staining shows gram-positive club-shaped bacilli",
"neutrophils",
"following",
"most likely",
"result",
"bacterial culture",
"throat swab",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: An 11-year-old boy presents with a sore throat, fever, chills, and difficulty swallowing for the past 3 days. The patient’s mother says that last night he was short of breath and had a headache. Past medical history is unremarkable. The patient has not been vaccinated as his mother thinks it is "unnecessary". His temperature is 38.3°C (101.0°F), blood pressure is 120/70 mm Hg, pulse is 110/min, and respiratory rate is 18/min. On physical examination, the patient is ill-appearing and dehydrated. A grayish-white membrane and pharyngeal erythema are present in the oropharynx. Significant cervical lymphadenopathy is also present. A throat swab is taken and gram staining shows gram-positive club-shaped bacilli along with few neutrophils. Which of the following would most likely be the result of the bacterial culture of the throat swab in this patient?
Choose one of the following::
A. Small black colonies on tellurite agar
B. Hemolytic black colonies on blood agar
C. Bluish green colonies on Loeffler’s serum
D. Greyish-white colonies on Thayer-Martin agar | [
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A 25-year-old man presents to his physician for new-onset palpitations and tremors in his right hand. He also feels more active than usual, but with that, he is increasingly feeling fatigued. He lost about 3 kg (6.6 lb) in the last 2 months and feels very anxious about his symptoms. He survived neuroblastoma 15 years ago and is aware of the potential complications. On examination, a nodule around the size of 2 cm is palpated in the right thyroid lobule; the gland is firm and nontender. There is no lymphadenopathy. His blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 87/min, and temperature is 37.5°C (99.5°F). Which of the following is the best next step in the management of this patient? | Fine needle aspiration with cytology | {
"A": "Ultrasound examination",
"B": "Fine needle aspiration with cytology",
"C": "Life-long monitoring",
"D": "Thyroid hormone replacement therapy"
} | step2&3 | B | [
"year old man presents",
"physician",
"new-onset palpitations",
"tremors in",
"right hand",
"feels more active",
"usual",
"feeling fatigued",
"lost",
"kg",
"6.6",
"last",
"months",
"feels very anxious",
"symptoms",
"survived neuroblastoma",
"years",
"aware",
"potential complications",
"examination",
"nodule",
"size of",
"palpated",
"right thyroid lobule",
"gland",
"firm",
"nontender",
"lymphadenopathy",
"blood pressure",
"75 mm Hg",
"respirations",
"min",
"pulse",
"87 min",
"temperature",
"99",
"following",
"best next step",
"management",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 25-year-old man presents to his physician for new-onset palpitations and tremors in his right hand. He also feels more active than usual, but with that, he is increasingly feeling fatigued. He lost about 3 kg (6.6 lb) in the last 2 months and feels very anxious about his symptoms. He survived neuroblastoma 15 years ago and is aware of the potential complications. On examination, a nodule around the size of 2 cm is palpated in the right thyroid lobule; the gland is firm and nontender. There is no lymphadenopathy. His blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 87/min, and temperature is 37.5°C (99.5°F). Which of the following is the best next step in the management of this patient?
Choose one of the following::
A. Ultrasound examination
B. Fine needle aspiration with cytology
C. Life-long monitoring
D. Thyroid hormone replacement therapy | [
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A 27-year old male who works on an organic farm is diagnosed with infection by N. americanus, a helminthic parasite. Eosinophils require which antibody isotype to destroy these parasites via antibody-dependent cellular cytotoxicity? | IgE | {
"A": "IgA",
"B": "IgE",
"C": "IgM",
"D": "IgG"
} | step1 | B | [
"27 year old male",
"works",
"organic farm",
"diagnosed",
"infection",
"N",
"helminthic parasite",
"Eosinophils",
"antibody isotype to destroy",
"parasites",
"antibody-dependent cellular cytotoxicity"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year old male who works on an organic farm is diagnosed with infection by N. americanus, a helminthic parasite. Eosinophils require which antibody isotype to destroy these parasites via antibody-dependent cellular cytotoxicity?
Choose one of the following::
A. IgA
B. IgE
C. IgM
D. IgG | [
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A 45-year-old man is brought to the emergency department after being found down outside of a bar. He does not have any identifying information and is difficult to arouse. On presentation, his temperature is 101.2°F (38.4°C), blood pressure is 109/72 mmHg, pulse is 102/min, and respirations are 18/min. Physical exam reveals an ill-appearing and disheveled man with labored breathing and coughing productive of viscous red sputum. Lung auscultation demonstrates consolidation of the left upper lobe of the patient. Given these findings, cultures are obtained and broad spectrum antibiotics are administered. Which of the following agar types should be used to culture the most likely organism in this case? | MacConkey agar | {
"A": "Blood agar",
"B": "Eaton agar",
"C": "Löwenstein-Jensen agar",
"D": "MacConkey agar"
} | step1 | D | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 45-year-old man is brought to the emergency department after being found down outside of a bar. He does not have any identifying information and is difficult to arouse. On presentation, his temperature is 101.2°F (38.4°C), blood pressure is 109/72 mmHg, pulse is 102/min, and respirations are 18/min. Physical exam reveals an ill-appearing and disheveled man with labored breathing and coughing productive of viscous red sputum. Lung auscultation demonstrates consolidation of the left upper lobe of the patient. Given these findings, cultures are obtained and broad spectrum antibiotics are administered. Which of the following agar types should be used to culture the most likely organism in this case?
Choose one of the following::
A. Blood agar
B. Eaton agar
C. Löwenstein-Jensen agar
D. MacConkey agar | [
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A 6-year-old girl comes with her parents to the physician’s office to initiate care with a new physician. The patient was recently adopted and her parents do not know her birth history; however, she has had some issues with fatigue. They were told by the adoption agency that the patient has required blood transfusions for “low blood count” in the past but they are not aware of the reason for these transfusions. Her temperature is 37.8°C (99.8°F), blood pressure is 110/84 mmHg, and pulse is 95/min. Physical examination is notable for conjunctival pallor, pale skin, and mild splenomegaly. A complete blood count is taken in the office with the following results:
Hemoglobin: 6.8 g/dL
Leukocyte count: 5,000/mm^3
Platelet count: 190,000/mm^3
Peripheral smear shows echinocytes and further analysis reveals rigid red blood cells. The most likely cause of this patient's symptoms has which of the following modes of inheritance? | Autosomal recessive | {
"A": "Autosomal recessive",
"B": "X-linked dominant",
"C": "X-linked recessive",
"D": "Mitochondrial inheritance"
} | step1 | A | [
"year old girl",
"parents",
"physicians office to initiate care",
"new physician",
"patient",
"recently adopted",
"parents",
"not",
"birth history",
"issues",
"fatigue",
"adoption agency",
"patient",
"required blood transfusions",
"low",
"count",
"past",
"not aware",
"reason",
"transfusions",
"temperature",
"99",
"blood pressure",
"84 mmHg",
"pulse",
"95 min",
"Physical examination",
"notable",
"conjunctival pallor",
"pale skin",
"mild splenomegaly",
"complete blood count",
"taken",
"office",
"following results",
"Hemoglobin",
"g/dL Leukocyte count",
"5",
"mm",
"Platelet count",
"mm",
"Peripheral smear shows echinocytes",
"further analysis reveals rigid red blood cells",
"most likely cause",
"patient's symptoms",
"of",
"following modes",
"inheritance"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 6-year-old girl comes with her parents to the physician’s office to initiate care with a new physician. The patient was recently adopted and her parents do not know her birth history; however, she has had some issues with fatigue. They were told by the adoption agency that the patient has required blood transfusions for “low blood count” in the past but they are not aware of the reason for these transfusions. Her temperature is 37.8°C (99.8°F), blood pressure is 110/84 mmHg, and pulse is 95/min. Physical examination is notable for conjunctival pallor, pale skin, and mild splenomegaly. A complete blood count is taken in the office with the following results:
Hemoglobin: 6.8 g/dL
Leukocyte count: 5,000/mm^3
Platelet count: 190,000/mm^3
Peripheral smear shows echinocytes and further analysis reveals rigid red blood cells. The most likely cause of this patient's symptoms has which of the following modes of inheritance?
Choose one of the following::
A. Autosomal recessive
B. X-linked dominant
C. X-linked recessive
D. Mitochondrial inheritance | [
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A 63-year-old woman is brought to the emergency department because of severe abdominal pain and vomiting for the past 3 hours. She reports previous episodes of abdominal pain that lasted for 10–15 minutes and resolved with antacids. She lives with her daughter and grandchildren. She divorced her husband last year. She is alert and oriented. Her temperature is 37.3°C (99.1°F), the pulse is 134/min, and the blood pressure is 90/70 mm Hg. The abdomen is rigid and diffusely tender. Guarding and rebound tenderness is present. The rectal examination shows a collapsed rectum. Infusion of 0.9% saline is begun, and a CT of the abdomen shows intestinal perforation. The surgeon discusses with the patient the need for emergent exploratory laparotomy and she agrees to the surgery. Written informed consent is obtained. While in the holding area awaiting emergent transport to the operating room, she calls for the surgeon and informs him that she no longer wants the surgery. He explains to her the risks of not performing the surgery and she indicates that she understands, but is adamant about not proceeding with surgery. Which of the following is the most appropriate next step in management? | Cancel the surgery | {
"A": "Cancel the surgery",
"B": "Consult the hospital’s ethics committee",
"C": "Continue with the emergency life-saving surgery",
"D": "Wait until the patient is unconscious, then proceed with surgery"
} | step2&3 | A | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 63-year-old woman is brought to the emergency department because of severe abdominal pain and vomiting for the past 3 hours. She reports previous episodes of abdominal pain that lasted for 10–15 minutes and resolved with antacids. She lives with her daughter and grandchildren. She divorced her husband last year. She is alert and oriented. Her temperature is 37.3°C (99.1°F), the pulse is 134/min, and the blood pressure is 90/70 mm Hg. The abdomen is rigid and diffusely tender. Guarding and rebound tenderness is present. The rectal examination shows a collapsed rectum. Infusion of 0.9% saline is begun, and a CT of the abdomen shows intestinal perforation. The surgeon discusses with the patient the need for emergent exploratory laparotomy and she agrees to the surgery. Written informed consent is obtained. While in the holding area awaiting emergent transport to the operating room, she calls for the surgeon and informs him that she no longer wants the surgery. He explains to her the risks of not performing the surgery and she indicates that she understands, but is adamant about not proceeding with surgery. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Cancel the surgery
B. Consult the hospital’s ethics committee
C. Continue with the emergency life-saving surgery
D. Wait until the patient is unconscious, then proceed with surgery | [
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A 5-year-old boy with developmental delays presents to his pediatrician’s office with an ‘itchy rash’ on the flexor surfaces of his knees, elbows, and around his eyelids. The patient’s mother notes that the rashes have had a relapsing-remitting course since the child was an infant. Vital signs are within normal limits. Physical examination shows hypopigmentation of the patient’s skin and hair, as well as a musty odor in his sweat and urine. Based on the patient’s symptoms and history, which of the following is the most appropriate dietary recommendation? | Avoid meat | {
"A": "Avoid fresh fruits",
"B": "Avoid meat",
"C": "Increase intake of bread",
"D": "Increase intake of dairy products"
} | step1 | B | [
"5 year old boy",
"developmental delays presents",
"pediatricians office",
"itchy rash",
"flexor surfaces of",
"knees",
"elbows",
"eyelids",
"patients mother notes",
"rashes",
"relapsing-remitting course",
"child",
"infant",
"Vital signs",
"normal",
"Physical examination shows hypopigmentation of the patients skin",
"hair",
"musty odor",
"sweat",
"urine",
"Based",
"patients symptoms",
"history",
"following",
"most appropriate dietary recommendation"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 5-year-old boy with developmental delays presents to his pediatrician’s office with an ‘itchy rash’ on the flexor surfaces of his knees, elbows, and around his eyelids. The patient’s mother notes that the rashes have had a relapsing-remitting course since the child was an infant. Vital signs are within normal limits. Physical examination shows hypopigmentation of the patient’s skin and hair, as well as a musty odor in his sweat and urine. Based on the patient’s symptoms and history, which of the following is the most appropriate dietary recommendation?
Choose one of the following::
A. Avoid fresh fruits
B. Avoid meat
C. Increase intake of bread
D. Increase intake of dairy products | [
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A 45-year-old man comes to the physician because of a 1-day history of progressive pain and blurry vision of his right eye. He has difficulties opening the eye because of pain. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthma treated with inhaled salbutamol. He works as a kindergarten teacher. His temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 135/75 mm Hg. Examination shows a visual acuity in the left eye of 20/25 and the ability to count fingers at 3 feet in the right eye. A photograph of the right eye is shown. Which of the following is the most likely diagnosis? | Pseudomonas keratitis | {
"A": "Staphylococcus aureus keratitis",
"B": "Pseudomonas keratitis",
"C": "Angle-closure glaucoma",
"D": "Herpes zoster keratitis"
} | step2&3 | B | [
"year old man",
"physician",
"1-day history",
"progressive pain",
"blurry vision",
"right eye",
"difficulties opening",
"eye",
"pain",
"left eye",
"asymptomatic",
"contact lenses",
"bronchial asthma treated with inhaled salbutamol",
"works",
"kindergarten teacher",
"temperature",
"98",
"pulse",
"85 min",
"blood pressure",
"75 mm Hg",
"Examination shows",
"visual acuity",
"left eye",
"20",
"ability to count fingers",
"3 feet",
"right eye",
"photograph",
"right eye",
"shown",
"following",
"most likely diagnosis"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 45-year-old man comes to the physician because of a 1-day history of progressive pain and blurry vision of his right eye. He has difficulties opening the eye because of pain. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthma treated with inhaled salbutamol. He works as a kindergarten teacher. His temperature is 37°C (98.6°F), pulse is 85/min, and blood pressure is 135/75 mm Hg. Examination shows a visual acuity in the left eye of 20/25 and the ability to count fingers at 3 feet in the right eye. A photograph of the right eye is shown. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Staphylococcus aureus keratitis
B. Pseudomonas keratitis
C. Angle-closure glaucoma
D. Herpes zoster keratitis | [
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} |
A 44-year-old caucasian male complains of carpopedal spasms, peri-oral numbness, and paresthesias of the hands and feet. His wife also mentions that he had a seizure not too long ago. His past surgical history is significant for total thyroidectomy due to papillary thyroid carcinoma. They then realized all of the symptoms occurred after the surgery. Which of the following would be present in this patient? | Chvostek sign, QT prolongation, decreased PTH, decreased serum calcium, increased serum phosphate | {
"A": "Chvostek sign, QT prolongation, increased PTH, decreased serum calcium, decreased serum phosphate",
"B": "Chvostek sign, QT prolongation, decreased PTH, increased serum calcium, decreased serum phosphate",
"C": "Chvostek sign, QT shortening, increased PTH, increased serum calcium, increased serum phosphate",
"D": "Chvostek sign, QT prolongation, decreased PTH, decreased serum calcium, increased serum phosphate"
} | step1 | D | [
"year old caucasian male",
"carpopedal spasms",
"peri oral numbness",
"paresthesias of",
"hands",
"feet",
"wife",
"seizure not too long",
"past surgical history",
"significant",
"total thyroidectomy",
"papillary thyroid carcinoma",
"then",
"symptoms occurred",
"surgery",
"following",
"present",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 44-year-old caucasian male complains of carpopedal spasms, peri-oral numbness, and paresthesias of the hands and feet. His wife also mentions that he had a seizure not too long ago. His past surgical history is significant for total thyroidectomy due to papillary thyroid carcinoma. They then realized all of the symptoms occurred after the surgery. Which of the following would be present in this patient?
Choose one of the following::
A. Chvostek sign, QT prolongation, increased PTH, decreased serum calcium, decreased serum phosphate
B. Chvostek sign, QT prolongation, decreased PTH, increased serum calcium, decreased serum phosphate
C. Chvostek sign, QT shortening, increased PTH, increased serum calcium, increased serum phosphate
D. Chvostek sign, QT prolongation, decreased PTH, decreased serum calcium, increased serum phosphate | [
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A previously healthy 11-year-old boy is brought to the emergency department because of a 3-day history of fever, cough, and a runny nose. During this period, he has also had pink, itchy eyes. The patient emigrated from Syria 2 weeks ago. His parents died 6 months ago. He has not yet received any routine childhood vaccinations. He lives at a foster home with ten other refugees; two have similar symptoms. He appears anxious and is sweating. His temperature is 39.2°C (102.5°F), pulse is 100/min, respirations are 20/min, and blood pressure is 125/75 mm Hg. Examination shows conjunctivitis of both eyes. There are multiple bluish-gray lesions on an erythematous background on the buccal mucosa and the soft palate. This patient is at increased risk for which of the following complications? | Subacute sclerosing panencephalitis | {
"A": "Aplastic crisis",
"B": "Coronary artery aneurysm",
"C": "Subacute sclerosing panencephalitis",
"D": "Immune thrombocytopenic purpura"
} | step2&3 | C | [
"healthy",
"year old boy",
"brought",
"emergency department",
"3-day history",
"fever",
"cough",
"runny nose",
"period",
"pink",
"itchy eyes",
"patient",
"Syria 2 weeks",
"parents died",
"months",
"not",
"received",
"routine childhood vaccinations",
"lives",
"foster home",
"ten",
"refugees",
"two",
"similar symptoms",
"appears anxious",
"sweating",
"temperature",
"pulse",
"100 min",
"respirations",
"20 min",
"blood pressure",
"75 mm Hg",
"Examination shows conjunctivitis of both eyes",
"multiple",
"gray lesions",
"erythematous background",
"buccal mucosa",
"soft palate",
"patient",
"increased risk",
"following complications"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A previously healthy 11-year-old boy is brought to the emergency department because of a 3-day history of fever, cough, and a runny nose. During this period, he has also had pink, itchy eyes. The patient emigrated from Syria 2 weeks ago. His parents died 6 months ago. He has not yet received any routine childhood vaccinations. He lives at a foster home with ten other refugees; two have similar symptoms. He appears anxious and is sweating. His temperature is 39.2°C (102.5°F), pulse is 100/min, respirations are 20/min, and blood pressure is 125/75 mm Hg. Examination shows conjunctivitis of both eyes. There are multiple bluish-gray lesions on an erythematous background on the buccal mucosa and the soft palate. This patient is at increased risk for which of the following complications?
Choose one of the following::
A. Aplastic crisis
B. Coronary artery aneurysm
C. Subacute sclerosing panencephalitis
D. Immune thrombocytopenic purpura | [
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A 31-year-old woman comes to the emergency department because of a 4-week history of worsening headache, nausea, and vomiting. The headache is worse at night. Fundoscopic examination shows swelling of the optic discs. A CT scan of the brain shows a heterogeneous, hyperintense, intraventricular mass. The patient undergoes surgical excision of the mass. Pathologic examination of the surgical specimen confirms that the tumor is of neuronal origin. The cells in this specimen are most likely to stain positive for which of the following immunohistochemical markers? | Synaptophysin | {
"A": "Desmin",
"B": "Synaptophysin",
"C": "Glial fibrillary acidic protein",
"D": "Cytokeratin"
} | step1 | B | [
"31 year old woman",
"emergency department",
"of",
"4 week history",
"worsening headache",
"nausea",
"vomiting",
"headache",
"worse",
"night",
"Fundoscopic examination shows swelling",
"optic discs",
"CT scan",
"brain shows",
"heterogeneous",
"intraventricular mass",
"patient",
"surgical excision",
"mass",
"Pathologic examination",
"specimen confirms",
"tumor",
"neuronal origin",
"cells",
"specimen",
"most likely to stain positive",
"following",
"markers"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 31-year-old woman comes to the emergency department because of a 4-week history of worsening headache, nausea, and vomiting. The headache is worse at night. Fundoscopic examination shows swelling of the optic discs. A CT scan of the brain shows a heterogeneous, hyperintense, intraventricular mass. The patient undergoes surgical excision of the mass. Pathologic examination of the surgical specimen confirms that the tumor is of neuronal origin. The cells in this specimen are most likely to stain positive for which of the following immunohistochemical markers?
Choose one of the following::
A. Desmin
B. Synaptophysin
C. Glial fibrillary acidic protein
D. Cytokeratin | [
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} |
A 27-year-old dental radiographer presented to a clinic with red lesions on his palate, right lower and mid-upper lip, as well as one of his fingers. These lesions were accompanied by slight pain, and the patient had a low-grade fever 1 week before the appearance of the lesions. The patient touched the affected area repeatedly, which resulted in bleeding. Two days prior to his visit, he observed a small vesicular eruption on his right index finger, which merged with other eruptions and became cloudy on the day of the visit. He has not had similar symptoms previously. He did not report drug usage. A Tzanck smear was prepared from scrapings of the aforementioned lesions by the attending physician, and multinucleated epithelial giant cells were observed microscopically. According to the clinical presentation and histologic finding, which viral infection should be suspected in this case? | Herpes simplex infection | {
"A": "Herpangina",
"B": "Herpes simplex infection",
"C": "Hand-foot-and-mouth disease",
"D": "Measles"
} | step1 | B | [
"27 year old dental radiographer presented",
"clinic",
"red lesions",
"palate",
"right lower",
"mid upper lip",
"one",
"fingers",
"lesions",
"slight pain",
"patient",
"low-grade fever 1 week",
"appearance",
"lesions",
"patient touched",
"affected area repeatedly",
"resulted",
"bleeding",
"Two days",
"visit",
"observed",
"small vesicular eruption",
"right finger",
"merged",
"eruptions",
"cloudy",
"day",
"visit",
"not",
"similar symptoms",
"not report drug usage",
"Tzanck smear",
"prepared",
"scrapings",
"lesions",
"attending physician",
"multinucleated epithelial giant cells",
"observed",
"clinical presentation",
"histologic finding",
"viral infection",
"suspected",
"case"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old dental radiographer presented to a clinic with red lesions on his palate, right lower and mid-upper lip, as well as one of his fingers. These lesions were accompanied by slight pain, and the patient had a low-grade fever 1 week before the appearance of the lesions. The patient touched the affected area repeatedly, which resulted in bleeding. Two days prior to his visit, he observed a small vesicular eruption on his right index finger, which merged with other eruptions and became cloudy on the day of the visit. He has not had similar symptoms previously. He did not report drug usage. A Tzanck smear was prepared from scrapings of the aforementioned lesions by the attending physician, and multinucleated epithelial giant cells were observed microscopically. According to the clinical presentation and histologic finding, which viral infection should be suspected in this case?
Choose one of the following::
A. Herpangina
B. Herpes simplex infection
C. Hand-foot-and-mouth disease
D. Measles | [
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A 7-year-old boy presents to the urgent care from a friends birthday party with trouble breathing. He is immediately placed on supplemental oxygen therapy. His father explains that peanut butter treats were served at the event but he didn’t see his son actually eat one. During the party, his son approached him with facial flushing and some difficulty breathing while itching his face and neck. He was born at 40 weeks via spontaneous vaginal delivery. He has met all developmental milestones and is fully vaccinated. Past medical history is significant for peanut allergy and asthma. He carries an emergency inhaler. Family history is noncontributory. His blood pressure is 110/85 mm Hg, the heart rate is 110/min, the respiratory rate is 25/min, and the temperature is 37.2°C (99.0°F). On physical examination, he has severe edema over his face and severe audible stridor in both lungs. Of the following, which type of hypersensitivity reaction is this patient experiencing?
| Type 1 - anaphylactic hypersensitivity reaction | {
"A": "Type 1 - anaphylactic hypersensitivity reaction",
"B": "Type 2 - cytotoxic hypersensitivity reaction",
"C": "Type 3 - immune complex mediated hypersensitivity reaction ",
"D": "Both A & B"
} | step2&3 | A | [
"year old boy presents",
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"friends",
"party",
"trouble breathing",
"immediately placed",
"supplemental oxygen therapy",
"father",
"peanut butter treats",
"event",
"see",
"son",
"eat one",
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"face",
"neck",
"born",
"40 weeks",
"spontaneous vaginal delivery",
"met",
"developmental milestones",
"vaccinated",
"Past medical history",
"significant",
"peanut allergy",
"asthma",
"carries",
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"Family history",
"blood pressure",
"85 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature",
"99",
"physical examination",
"severe",
"face",
"severe",
"stridor",
"lungs",
"following",
"type",
"hypersensitivity",
"patient experiencing"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 7-year-old boy presents to the urgent care from a friends birthday party with trouble breathing. He is immediately placed on supplemental oxygen therapy. His father explains that peanut butter treats were served at the event but he didn’t see his son actually eat one. During the party, his son approached him with facial flushing and some difficulty breathing while itching his face and neck. He was born at 40 weeks via spontaneous vaginal delivery. He has met all developmental milestones and is fully vaccinated. Past medical history is significant for peanut allergy and asthma. He carries an emergency inhaler. Family history is noncontributory. His blood pressure is 110/85 mm Hg, the heart rate is 110/min, the respiratory rate is 25/min, and the temperature is 37.2°C (99.0°F). On physical examination, he has severe edema over his face and severe audible stridor in both lungs. Of the following, which type of hypersensitivity reaction is this patient experiencing?
Choose one of the following::
A. Type 1 - anaphylactic hypersensitivity reaction
B. Type 2 - cytotoxic hypersensitivity reaction
C. Type 3 - immune complex mediated hypersensitivity reaction
D. Both A & B | [
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A 23-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department by her husband because of increasing confusion and high-grade fever over the past 16 hours. Three days ago, she was prescribed metoclopramide by her physician for the treatment of nausea and vomiting. She has a history of depression. Current medications include fluoxetine. She is confused and not oriented to time, place, or person. Her temperature is 39.8°C (103.6°F), pulse is 112/min, and blood pressure is 168/96 mm Hg. Examination shows profuse diaphoresis and flushed skin. Muscle rigidity is present. Her deep tendon reflexes are decreased bilaterally. Mental status examination shows psychomotor agitation. Laboratory studies show:
Hemoglobin 12.2 g/dL
Leukocyte count 17,500/mm3
Serum
Creatinine 1.4 mg/dL
Total bilirubin 0.7 mg/dL
Alkaline phosphatase 45 U/L
AST 122 U/L
ALT 138 U/L
Creatine kinase 1070 U/L
Which of the following drugs is most likely to also cause the condition that is responsible for this patient’s current symptoms?" | Haloperidol | {
"A": "Succinylcholine",
"B": "Haloperidol",
"C": "Dextroamphetamine",
"D": "Amitriptyline\n\""
} | step2&3 | B | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 23-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department by her husband because of increasing confusion and high-grade fever over the past 16 hours. Three days ago, she was prescribed metoclopramide by her physician for the treatment of nausea and vomiting. She has a history of depression. Current medications include fluoxetine. She is confused and not oriented to time, place, or person. Her temperature is 39.8°C (103.6°F), pulse is 112/min, and blood pressure is 168/96 mm Hg. Examination shows profuse diaphoresis and flushed skin. Muscle rigidity is present. Her deep tendon reflexes are decreased bilaterally. Mental status examination shows psychomotor agitation. Laboratory studies show:
Hemoglobin 12.2 g/dL
Leukocyte count 17,500/mm3
Serum
Creatinine 1.4 mg/dL
Total bilirubin 0.7 mg/dL
Alkaline phosphatase 45 U/L
AST 122 U/L
ALT 138 U/L
Creatine kinase 1070 U/L
Which of the following drugs is most likely to also cause the condition that is responsible for this patient’s current symptoms?"
Choose one of the following::
A. Succinylcholine
B. Haloperidol
C. Dextroamphetamine
D. Amitriptyline
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Which of the following compounds is most responsible for the maintenance of appropriate coronary blood flow? | Nitric oxide | {
"A": "Norepinephrine",
"B": "Histamine",
"C": "Nitric oxide",
"D": "VEGF"
} | step1 | C | [
"following compounds",
"most responsible",
"maintenance",
"appropriate coronary blood"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Which of the following compounds is most responsible for the maintenance of appropriate coronary blood flow?
Choose one of the following::
A. Norepinephrine
B. Histamine
C. Nitric oxide
D. VEGF | [
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A 44-year-old woman comes to the physician because of a 1-month history of progressively worsening headaches and fatigue. She has also had a 5-kg (11-lb) weight loss in the same time period. MRI of the head shows a hyperintense mass with extension into the right foramen rotundum. Further evaluation of this patient is most likely to show which of the following findings? | Decreased sensation over the cheekbone, nasolabial fold, and the upper lip | {
"A": "Decreased sensation over the cheekbone, nasolabial fold, and the upper lip",
"B": "Abnormal taste of the distal tongue and decreased sensation behind the ear",
"C": "Absent corneal reflex and decreased sensation of the forehead",
"D": "Masseter and temporalis muscle wasting with jaw deviation to the right"
} | step1 | A | [
"year old woman",
"physician",
"of",
"month history",
"worsening headaches",
"fatigue",
"5 kg",
"weight loss",
"same time period",
"MRI of",
"head shows",
"mass",
"extension",
"right foramen rotundum",
"Further evaluation",
"patient",
"most likely to show",
"following findings"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 44-year-old woman comes to the physician because of a 1-month history of progressively worsening headaches and fatigue. She has also had a 5-kg (11-lb) weight loss in the same time period. MRI of the head shows a hyperintense mass with extension into the right foramen rotundum. Further evaluation of this patient is most likely to show which of the following findings?
Choose one of the following::
A. Decreased sensation over the cheekbone, nasolabial fold, and the upper lip
B. Abnormal taste of the distal tongue and decreased sensation behind the ear
C. Absent corneal reflex and decreased sensation of the forehead
D. Masseter and temporalis muscle wasting with jaw deviation to the right | [
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A 38-year-old male presents to his primary care doctor with 8 months of uncontrollable anxiety. He states that he experiences overwhelming anxiety and worry in peforming just ordinary tasks of daily living. He is started on venlafaxine for treatment of generalized anxiety disorder. Which of the following is a potential side effect of this medication? | Hypertension | {
"A": "Seizures",
"B": "Weight gain",
"C": "Hypertension",
"D": "Increased urination"
} | step1 | C | [
"year old male presents",
"primary care doctor",
"months",
"anxiety",
"states",
"experiences",
"anxiety",
"worry",
"tasks",
"daily living",
"started",
"venlafaxine",
"treatment",
"generalized",
"following",
"potential side effect",
"medication"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 38-year-old male presents to his primary care doctor with 8 months of uncontrollable anxiety. He states that he experiences overwhelming anxiety and worry in peforming just ordinary tasks of daily living. He is started on venlafaxine for treatment of generalized anxiety disorder. Which of the following is a potential side effect of this medication?
Choose one of the following::
A. Seizures
B. Weight gain
C. Hypertension
D. Increased urination | [
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A 27-year-old woman seeks an evaluation from her gynecologist complaining of vaginal discharge. She has been sexually active with 3 partners for the past year. Recently, she has been having pain during intercourse. Her temperature is 37.2°C (99.1°F), the blood pressure is 110/80 mm Hg, and the pulse is 78/min. The genital examination is positive for cervical motion tenderness. Even with treatment, which of the following complications is most likely to occur later in this patient's life? | Ectopic pregnancy | {
"A": "Spontaneous abortion",
"B": "Leiomyoma",
"C": "Ectopic pregnancy",
"D": "Condyloma acuminatum"
} | step2&3 | C | [
"27 year old woman",
"evaluation",
"gynecologist",
"vaginal discharge",
"sexually active",
"partners",
"past year",
"Recently",
"pain",
"intercourse",
"temperature",
"99",
"blood pressure",
"80 mm Hg",
"pulse",
"min",
"genital examination",
"positive",
"cervical motion tenderness",
"treatment",
"following complications",
"most likely to occur later",
"patient's life"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 27-year-old woman seeks an evaluation from her gynecologist complaining of vaginal discharge. She has been sexually active with 3 partners for the past year. Recently, she has been having pain during intercourse. Her temperature is 37.2°C (99.1°F), the blood pressure is 110/80 mm Hg, and the pulse is 78/min. The genital examination is positive for cervical motion tenderness. Even with treatment, which of the following complications is most likely to occur later in this patient's life?
Choose one of the following::
A. Spontaneous abortion
B. Leiomyoma
C. Ectopic pregnancy
D. Condyloma acuminatum | [
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A 15-year-old boy is brought to the physician because of progressive left leg pain for the past 2 months. The pain is worse while running and at night. Examination of the left leg shows swelling and tenderness proximal to the knee. Laboratory studies show an alkaline phosphatase level of 200 U/L. An x-ray of the left leg shows sclerosis, cortical destruction, and new bone formation in the soft tissues around the distal femur. There are multiple spiculae radiating perpendicular to the bone. This patient's malignancy is most likely derived from cells in which of the following structures? | Periosteum | {
"A": "Periosteum",
"B": "Bone marrow",
"C": "Epiphyseal plate",
"D": "Neural crest\n\""
} | step1 | A | [
"year old boy",
"brought",
"physician",
"of progressive left leg pain",
"past",
"months",
"pain",
"worse",
"running",
"night",
"Examination of",
"left leg shows swelling",
"tenderness proximal",
"knee",
"Laboratory studies show",
"alkaline phosphatase level",
"200 U/L",
"x-ray",
"left leg shows sclerosis",
"cortical destruction",
"new bone formation",
"soft tissues",
"distal femur",
"multiple spiculae radiating perpendicular",
"bone",
"patient's malignancy",
"most likely derived",
"cells",
"following structures"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 15-year-old boy is brought to the physician because of progressive left leg pain for the past 2 months. The pain is worse while running and at night. Examination of the left leg shows swelling and tenderness proximal to the knee. Laboratory studies show an alkaline phosphatase level of 200 U/L. An x-ray of the left leg shows sclerosis, cortical destruction, and new bone formation in the soft tissues around the distal femur. There are multiple spiculae radiating perpendicular to the bone. This patient's malignancy is most likely derived from cells in which of the following structures?
Choose one of the following::
A. Periosteum
B. Bone marrow
C. Epiphyseal plate
D. Neural crest
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A 12-year-old boy is brought to the emergency department by his mother because of progressive shortness of breath, difficulty speaking, and diffuse, colicky abdominal pain for the past 3 hours. Yesterday he underwent a tooth extraction. His father and a paternal uncle have a history of repeated hospitalizations for upper airway and orofacial swelling. The patient takes no medications. His blood pressure is 112/62 mm Hg. Examination shows edematous swelling of the lips, tongue, arms, and legs; there is no rash. Administration of a drug targeting which of the following mechanisms of action is most appropriate for this patient? | Antagonist at bradykinin receptor | {
"A": "Antagonist at histamine receptor",
"B": "Agonist at androgen receptor",
"C": "Antagonist at bradykinin receptor",
"D": "Agonist at glucocorticoid receptor"
} | step1 | C | [
"year old boy",
"brought",
"emergency department",
"mother",
"of progressive shortness",
"breath",
"difficulty speaking",
"diffuse",
"colicky abdominal pain",
"past",
"hours",
"tooth extraction",
"father",
"paternal uncle",
"history of repeated hospitalizations",
"upper airway",
"orofacial swelling",
"patient takes",
"medications",
"blood pressure",
"62 mm Hg",
"Examination shows edematous swelling of the lips",
"tongue",
"arms",
"legs",
"rash",
"Administration",
"drug",
"of",
"following mechanisms",
"action",
"most appropriate",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 12-year-old boy is brought to the emergency department by his mother because of progressive shortness of breath, difficulty speaking, and diffuse, colicky abdominal pain for the past 3 hours. Yesterday he underwent a tooth extraction. His father and a paternal uncle have a history of repeated hospitalizations for upper airway and orofacial swelling. The patient takes no medications. His blood pressure is 112/62 mm Hg. Examination shows edematous swelling of the lips, tongue, arms, and legs; there is no rash. Administration of a drug targeting which of the following mechanisms of action is most appropriate for this patient?
Choose one of the following::
A. Antagonist at histamine receptor
B. Agonist at androgen receptor
C. Antagonist at bradykinin receptor
D. Agonist at glucocorticoid receptor | [
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A 25-year-old female with a history of childhood asthma presents to clinic complaining of a three month history of frequent, loose stools. She currently has three to four bowel movements per day, and she believes that these episodes have been getting worse and are associated with mild abdominal pain. She also endorses seeing red blood on the toilet tissue. On further questioning, she also endorses occasional palpitations over the past few months. She denies fevers, chills, headache, blurry vision, cough, shortness of breath, wheezing, nausea, or vomiting. She describes her mood as slightly irritable and she has been sleeping poorly. A review of her medical chart reveals a six pound weight loss since her visit six months ago, but she says her appetite has been normal. The patient denies any recent illness or travel. She is a non-smoker. Her only current medication is an oral contraceptive pill.
Her temperature is 37°C (98.6°F), pulse is 104/min, blood pressure is 95/65 mmHg, respirations are 16/min, and oxygen saturation is 99% on room air. On physical exam, the physician notes that her thyroid gland appears symmetrically enlarged but is non-tender to palpation. Upon auscultation there is an audible thyroid bruit. Her cranial nerve is normal and ocular exam reveals exophthalmos. Her abdomen is soft and non-tender to palpation. Deep tendon reflexes are 3+ throughout. Lab results are as follows:
Serum:
Na+: 140 mEq/L
K+: 4.1 mEq/L
Cl-: 104 mEq/L
HCO3-: 26 mEql/L
BUN: 18 mg/dL
Creatinine 0.9 mg/dL
Hemoglobin: 14.0 g/dL
Leukocyte count: 7,400/mm^3
Platelet count 450,000/mm^3
TSH & Free T4: pending
A pregnancy test is negative. The patient is started on propranolol for symptomatic relief. What is the most likely best next step in management for this patient? | Propylthiouracil | {
"A": "IV hydrocortisone",
"B": "Propylthiouracil",
"C": "Thyroid scintigraphy with I-123",
"D": "Surgical thyroidectomy"
} | step2&3 | B | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 25-year-old female with a history of childhood asthma presents to clinic complaining of a three month history of frequent, loose stools. She currently has three to four bowel movements per day, and she believes that these episodes have been getting worse and are associated with mild abdominal pain. She also endorses seeing red blood on the toilet tissue. On further questioning, she also endorses occasional palpitations over the past few months. She denies fevers, chills, headache, blurry vision, cough, shortness of breath, wheezing, nausea, or vomiting. She describes her mood as slightly irritable and she has been sleeping poorly. A review of her medical chart reveals a six pound weight loss since her visit six months ago, but she says her appetite has been normal. The patient denies any recent illness or travel. She is a non-smoker. Her only current medication is an oral contraceptive pill.
Her temperature is 37°C (98.6°F), pulse is 104/min, blood pressure is 95/65 mmHg, respirations are 16/min, and oxygen saturation is 99% on room air. On physical exam, the physician notes that her thyroid gland appears symmetrically enlarged but is non-tender to palpation. Upon auscultation there is an audible thyroid bruit. Her cranial nerve is normal and ocular exam reveals exophthalmos. Her abdomen is soft and non-tender to palpation. Deep tendon reflexes are 3+ throughout. Lab results are as follows:
Serum:
Na+: 140 mEq/L
K+: 4.1 mEq/L
Cl-: 104 mEq/L
HCO3-: 26 mEql/L
BUN: 18 mg/dL
Creatinine 0.9 mg/dL
Hemoglobin: 14.0 g/dL
Leukocyte count: 7,400/mm^3
Platelet count 450,000/mm^3
TSH & Free T4: pending
A pregnancy test is negative. The patient is started on propranolol for symptomatic relief. What is the most likely best next step in management for this patient?
Choose one of the following::
A. IV hydrocortisone
B. Propylthiouracil
C. Thyroid scintigraphy with I-123
D. Surgical thyroidectomy | [
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} |
A previously healthy 8-year-old boy is brought to the physician because of increasing visual loss and deterioration of his hearing and speech over the past 2 months. During this period, he has had difficulty walking, using the stairs, and feeding himself. His teachers have noticed that he has had difficulty concentrating. His grades have worsened and his handwriting has become illegible. His maternal male cousin had similar complaints and died at the age of 6 years. Vital signs are within normal limits. Examination shows hyperpigmented skin and nails and an ataxic gait. His speech is dysarthric. Neurologic examination shows spasticity and decreased muscle strength in all extremities. Deep tendon reflexes are 4+ bilaterally. Plantar reflex shows an extensor response bilaterally. Sensation is decreased in the lower extremities. Fundoscopy shows optic atrophy. There is sensorineural hearing loss bilaterally. Which of the following is the most likely cause of this patient's symptoms? | ATP-binding cassette transporter dysfunction | {
"A": "β-Glucocerebrosidase deficiency",
"B": "ATP-binding cassette transporter dysfunction",
"C": "Arylsulfatase A deficiency",
"D": "α-Galactosidase A deficiency"
} | step2&3 | B | [
"healthy",
"year old boy",
"brought",
"physician",
"increasing visual loss",
"deterioration",
"hearing",
"speech",
"past",
"months",
"period",
"difficulty walking",
"using",
"stairs",
"feeding",
"teachers",
"difficulty concentrating",
"grades",
"worsened",
"handwriting",
"maternal male",
"similar complaints",
"died",
"age",
"years",
"Vital signs",
"normal limits",
"Examination shows hyperpigmented skin",
"nails",
"ataxic gait",
"speech",
"Neurologic examination shows spasticity",
"decreased muscle strength",
"extremities",
"Deep tendon reflexes",
"4",
"Plantar reflex shows",
"extensor response",
"Sensation",
"decreased",
"lower extremities",
"Fundoscopy shows optic atrophy",
"sensorineural hearing loss",
"following",
"most likely cause",
"patient's symptoms"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A previously healthy 8-year-old boy is brought to the physician because of increasing visual loss and deterioration of his hearing and speech over the past 2 months. During this period, he has had difficulty walking, using the stairs, and feeding himself. His teachers have noticed that he has had difficulty concentrating. His grades have worsened and his handwriting has become illegible. His maternal male cousin had similar complaints and died at the age of 6 years. Vital signs are within normal limits. Examination shows hyperpigmented skin and nails and an ataxic gait. His speech is dysarthric. Neurologic examination shows spasticity and decreased muscle strength in all extremities. Deep tendon reflexes are 4+ bilaterally. Plantar reflex shows an extensor response bilaterally. Sensation is decreased in the lower extremities. Fundoscopy shows optic atrophy. There is sensorineural hearing loss bilaterally. Which of the following is the most likely cause of this patient's symptoms?
Choose one of the following::
A. β-Glucocerebrosidase deficiency
B. ATP-binding cassette transporter dysfunction
C. Arylsulfatase A deficiency
D. α-Galactosidase A deficiency | [
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A 30-year-old male gang member is brought to the emergency room with a gunshot wound to the abdomen. The patient was intubated and taken for an exploratory laparotomy, which found peritoneal hemorrhage and injury to the small bowel. He required 5 units of blood during this procedure. Following the operation, the patient was sedated and remained on a ventilator in the surgical intensive care unit (SICU). The next day, a central line is placed and the patient is started on total parenteral nutrition. Which of the following complications is most likely in this patient? | Sepsis | {
"A": "Cholelithiasis",
"B": "Hypocalcemia",
"C": "Refeeding syndrome",
"D": "Sepsis"
} | step2&3 | D | [
"30 year old male gang member",
"brought",
"emergency room",
"gunshot",
"abdomen",
"patient",
"intubated",
"taken",
"exploratory laparotomy",
"found peritoneal hemorrhage",
"injury",
"small",
"required 5 units of blood",
"procedure",
"Following",
"operation",
"patient",
"sedated",
"ventilator",
"surgical intensive care unit",
"next day",
"central line",
"placed",
"patient",
"started",
"total parenteral nutrition",
"following complications",
"most likely",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 30-year-old male gang member is brought to the emergency room with a gunshot wound to the abdomen. The patient was intubated and taken for an exploratory laparotomy, which found peritoneal hemorrhage and injury to the small bowel. He required 5 units of blood during this procedure. Following the operation, the patient was sedated and remained on a ventilator in the surgical intensive care unit (SICU). The next day, a central line is placed and the patient is started on total parenteral nutrition. Which of the following complications is most likely in this patient?
Choose one of the following::
A. Cholelithiasis
B. Hypocalcemia
C. Refeeding syndrome
D. Sepsis | [
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A 34-year-old woman presents to the office with weight gain despite her dietary modifications. She also says she has associated constipation and feels she has no energy. She says she often feels the ambient temperature is too cold these days. Her past medical history is insignificant. Her blood pressure is 140/85 mm Hg, the pulse is 60/min, the temperature is 36.7°C (98.0°F), and the respirations are 22/min. On physical examination, deep tendon reflexes are 1+ at the right ankle, which has a delayed relaxation phase. A hormone deficiency disorder is suspected and blood samples are sent to the lab for investigation. The laboratory report confirms the suspicion, and the patient is prescribed a synthetic hormone. How does this hormone most likely act to produce its cellular effects? | Binds to a nuclear receptor | {
"A": "Increases cyclic adenosine monophosphate (cAMP)",
"B": "Increases intake of iodine by thyroid cells",
"C": "Binds to a nuclear receptor",
"D": "Increases activity of phospholipase C"
} | step1 | C | [
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"feels",
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"often feels",
"ambient temperature",
"cold",
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"60 min",
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"hormone",
"likely act to",
"cellular effects"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 34-year-old woman presents to the office with weight gain despite her dietary modifications. She also says she has associated constipation and feels she has no energy. She says she often feels the ambient temperature is too cold these days. Her past medical history is insignificant. Her blood pressure is 140/85 mm Hg, the pulse is 60/min, the temperature is 36.7°C (98.0°F), and the respirations are 22/min. On physical examination, deep tendon reflexes are 1+ at the right ankle, which has a delayed relaxation phase. A hormone deficiency disorder is suspected and blood samples are sent to the lab for investigation. The laboratory report confirms the suspicion, and the patient is prescribed a synthetic hormone. How does this hormone most likely act to produce its cellular effects?
Choose one of the following::
A. Increases cyclic adenosine monophosphate (cAMP)
B. Increases intake of iodine by thyroid cells
C. Binds to a nuclear receptor
D. Increases activity of phospholipase C | [
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A 4-month-old African-American infant is brought to the pediatrician for a well-baby check up. He was born at term through a normal vaginal delivery and has been well since. His 4-year old brother has sickle-cell disease. He is exclusively breastfed and receives vitamin D supplements. His immunizations are up-to-date. He appears healthy. His length is at the 70th percentile and weight is at the 75th percentile. Cardiopulmonary examination is normal. His mother has heard reports of sudden infant death syndrome (SIDS) being common in his age group and would like to hear more information about it. Which of the following is the most important recommendation to prevent this condition? | Have the baby sleep in supine position | {
"A": "Have the baby sleep with the parent",
"B": "Have the baby sleep in supine position",
"C": "Make sure that no one smokes around the baby",
"D": "Cardiorespiratory monitoring of the baby at home\n\""
} | step2&3 | B | [
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"well",
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"to hear more information",
"following",
"most important recommendation to prevent",
"condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 4-month-old African-American infant is brought to the pediatrician for a well-baby check up. He was born at term through a normal vaginal delivery and has been well since. His 4-year old brother has sickle-cell disease. He is exclusively breastfed and receives vitamin D supplements. His immunizations are up-to-date. He appears healthy. His length is at the 70th percentile and weight is at the 75th percentile. Cardiopulmonary examination is normal. His mother has heard reports of sudden infant death syndrome (SIDS) being common in his age group and would like to hear more information about it. Which of the following is the most important recommendation to prevent this condition?
Choose one of the following::
A. Have the baby sleep with the parent
B. Have the baby sleep in supine position
C. Make sure that no one smokes around the baby
D. Cardiorespiratory monitoring of the baby at home
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} |
Renal clearance of substance Y is experimentally studied. At a constant glomerular filtration rate, it is found that the amount of substance Y excreted is greater than the amount filtered. This holds true across all physiologic values on the titration curve. Substance Y is most similar to which of the following? | Para-amino hippuric acid | {
"A": "Magnesium",
"B": "Bicarbonate",
"C": "Para-amino hippuric acid",
"D": "Glucose"
} | step1 | C | [
"Renal clearance of substance",
"studied",
"constant glomerular filtration rate",
"found",
"amount",
"substance",
"excreted",
"greater than",
"amount filtered",
"holds true",
"physiologic values",
"titration curve",
"Substance",
"most similar"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: Renal clearance of substance Y is experimentally studied. At a constant glomerular filtration rate, it is found that the amount of substance Y excreted is greater than the amount filtered. This holds true across all physiologic values on the titration curve. Substance Y is most similar to which of the following?
Choose one of the following::
A. Magnesium
B. Bicarbonate
C. Para-amino hippuric acid
D. Glucose | [
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A 14-year-old Caucasian female commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots? | Macrophages | {
"A": "Macrophages",
"B": "Endothelium",
"C": "T-cells",
"D": "Neutrophils"
} | step1 | A | [
"year old Caucasian female commits suicide",
"drug overdose",
"family",
"to",
"organs",
"heart",
"removed",
"donation",
"removing",
"heart",
"cardiothoracic surgeon",
"flat yellow spots",
"aorta",
"of",
"following cell types predominate",
"yellow spots"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 14-year-old Caucasian female commits suicide by drug overdose. Her family decides to donate her organs, and her heart is removed for donation. After removing the heart, the cardiothoracic surgeon notices flat yellow spots on the inside of her aorta. Which of the following cell types predominate in these yellow spots?
Choose one of the following::
A. Macrophages
B. Endothelium
C. T-cells
D. Neutrophils | [
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] | {
"ds_index": 10162,
"similar_dg_indices": [
901360,
701536,
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312859,
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177402
]
} |
A 7-year-old girl is brought to her pediatrician by her mother because of puffiness under both eyes in the morning. The mother reports that the child has just recovered from a seasonal influenza infection a few days ago. Vital signs include: temperature 37°C (98.6°F), blood pressure 100/67 mm Hg, and pulse 95/min. On examination, there is facial edema and bilateral 2+ pitting edema over the legs. Laboratory results are shown:
Serum albumin 2.1 g/dL
Serum triglycerides 200 mg/dL
Serum cholesterol 250 mg/dL
Urine dipstick 4+ protein
Which of the following casts are more likely to be present in this patient’s urine? | Fatty casts | {
"A": "Fatty casts",
"B": "Red cell casts",
"C": "Granular casts",
"D": "Waxy casts"
} | step2&3 | A | [
"year old girl",
"brought",
"pediatrician",
"mother",
"puffiness",
"eyes",
"morning",
"mother reports",
"child",
"recovered",
"a seasonal influenza infection",
"few days",
"Vital signs include",
"temperature",
"98",
"blood pressure 100 67 mm Hg",
"pulse 95 min",
"examination",
"facial edema",
"bilateral 2",
"pitting edema",
"legs",
"Laboratory results",
"shown",
"Serum albumin",
"g",
"triglycerides",
"mg",
"cholesterol",
"Urine dipstick",
"protein",
"following casts",
"more likely to",
"present",
"patients urine"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 7-year-old girl is brought to her pediatrician by her mother because of puffiness under both eyes in the morning. The mother reports that the child has just recovered from a seasonal influenza infection a few days ago. Vital signs include: temperature 37°C (98.6°F), blood pressure 100/67 mm Hg, and pulse 95/min. On examination, there is facial edema and bilateral 2+ pitting edema over the legs. Laboratory results are shown:
Serum albumin 2.1 g/dL
Serum triglycerides 200 mg/dL
Serum cholesterol 250 mg/dL
Urine dipstick 4+ protein
Which of the following casts are more likely to be present in this patient’s urine?
Choose one of the following::
A. Fatty casts
B. Red cell casts
C. Granular casts
D. Waxy casts | [
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A 68-year-old woman is brought to the emergency department by her son for altered mental status. She recently had a right knee arthroplasty and was discharged 2 days ago. Her medical history is significant for type 2 diabetes mellitus and hypertension, for which she takes metformin and hydrochlorothiazide, respectively. She also had left cataract surgery 1 year ago. Her temperature is 97°F (36.1°C), blood pressure is 99/70 mmHg, pulse is 60/min, respirations are 8/min. Her exam is notable for anisocoria with an irregularly shaped left pupil and a 1 mm in diameter right pupil. She opens her eyes and withdraws all of her limbs to loud voice and painful stimulation. Her fingerstick glucose level is 79. The patient does not have any intravenous access at this time. What is the best next step in management? | Intranasal naloxone | {
"A": "Computed tomography of head without contrast",
"B": "Forced air warmer",
"C": "Intranasal naloxone",
"D": "Intubate"
} | step2&3 | C | [
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"son",
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"recently",
"right",
"discharged 2 days",
"medical history",
"significant",
"type 2 diabetes mellitus",
"hypertension",
"takes metformin",
"hydrochlorothiazide",
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"year",
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"36",
"blood pressure",
"99 70 mmHg",
"pulse",
"60 min",
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"min",
"exam",
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"shaped left pupil",
"1 mm",
"diameter right",
"opens",
"eyes",
"withdraws",
"limbs",
"loud voice",
"painful stimulation",
"fingerstick glucose level",
"patient",
"not",
"intravenous access",
"time",
"best next step",
"management"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 68-year-old woman is brought to the emergency department by her son for altered mental status. She recently had a right knee arthroplasty and was discharged 2 days ago. Her medical history is significant for type 2 diabetes mellitus and hypertension, for which she takes metformin and hydrochlorothiazide, respectively. She also had left cataract surgery 1 year ago. Her temperature is 97°F (36.1°C), blood pressure is 99/70 mmHg, pulse is 60/min, respirations are 8/min. Her exam is notable for anisocoria with an irregularly shaped left pupil and a 1 mm in diameter right pupil. She opens her eyes and withdraws all of her limbs to loud voice and painful stimulation. Her fingerstick glucose level is 79. The patient does not have any intravenous access at this time. What is the best next step in management?
Choose one of the following::
A. Computed tomography of head without contrast
B. Forced air warmer
C. Intranasal naloxone
D. Intubate | [
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A 71-year-old man presents to the emergency department because of blood in his stool. The patient states that he is not experiencing any pain during defecation and is without pain currently. The patient recently returned from a camping trip where he consumed meats cooked over a fire pit and drank water from local streams. The patient has a past medical history of obesity, diabetes, constipation, irritable bowel syndrome, ulcerative colitis that is in remission, and a 70 pack-year smoking history. The patient has a family history of breast cancer in his mother and prostate cancer in his father. His temperature is 98.9°F (37.2°C), blood pressure is 160/87 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Abdominal exam reveals a non-tender and non-distended abdomen with normal bowel sounds. An abdominal radiograph and barium swallow are within normal limits. Which of the following is an appropriate treatment for this patient’s condition? | Cautery of an arteriovenous malformation | {
"A": "Cautery of an arteriovenous malformation",
"B": "Ciprofloxacin",
"C": "Surgical removal of malignant tissue",
"D": "Surgical resection of a portion of the colon"
} | step2&3 | A | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 71-year-old man presents to the emergency department because of blood in his stool. The patient states that he is not experiencing any pain during defecation and is without pain currently. The patient recently returned from a camping trip where he consumed meats cooked over a fire pit and drank water from local streams. The patient has a past medical history of obesity, diabetes, constipation, irritable bowel syndrome, ulcerative colitis that is in remission, and a 70 pack-year smoking history. The patient has a family history of breast cancer in his mother and prostate cancer in his father. His temperature is 98.9°F (37.2°C), blood pressure is 160/87 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for an obese man in no current distress. Abdominal exam reveals a non-tender and non-distended abdomen with normal bowel sounds. An abdominal radiograph and barium swallow are within normal limits. Which of the following is an appropriate treatment for this patient’s condition?
Choose one of the following::
A. Cautery of an arteriovenous malformation
B. Ciprofloxacin
C. Surgical removal of malignant tissue
D. Surgical resection of a portion of the colon | [
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A 61-year-old man presents to his primary care provider with fatigue, weight loss, and muscle aches. He has experienced these symptoms for the past year but initially attributed them to stress at his work as an attorney. However, over the past month, he has developed intermittent fevers associated with a skin rash that prompted him to seek medical evaluation. He denies any recent history of asthma, rhinitis, hematuria, or difficulty breathing. He is otherwise healthy and takes no medications. He has a distant history of cocaine abuse but has not used any drugs in 30 years. His family history is notable for pancreatic cancer in his father and inflammatory bowel disease in his sister. His temperature is 99.3°F (37.4°C), blood pressure is 130/75 mmHg, pulse is 90/min, and respirations are 18/min. On examination, rales are heard at the bilateral lung bases. S1 and S2 are normal. Strength is 5/5 in the bilateral upper and lower extremities and his gait is normal. Palpable purpura are noted on his trunk and bilateral upper and lower extremities. Erythrocyte sedimentation rate and C-reactive protein are both elevated. This patient’s condition is associated with antibodies directed against which of the following enzymes? | Myeloperoxidase | {
"A": "Complement component 1q",
"B": "Myeloperoxidase",
"C": "Topoisomerase-1",
"D": "Type IV collagen"
} | step1 | B | [
"61 year old man presents",
"primary care provider",
"fatigue",
"weight loss",
"muscle aches",
"experienced",
"symptoms",
"past year",
"initially attributed",
"stress",
"work",
"attorney",
"past month",
"intermittent fevers associated with",
"skin rash",
"prompted",
"to",
"medical evaluation",
"denies",
"recent history of asthma",
"rhinitis",
"hematuria",
"difficulty breathing",
"healthy",
"takes",
"medications",
"distant history of cocaine abuse",
"not used",
"drugs",
"30 years",
"family history",
"notable",
"pancreatic cancer",
"father",
"inflammatory bowel disease",
"sister",
"temperature",
"99",
"4C",
"blood pressure",
"75 mmHg",
"pulse",
"90 min",
"respirations",
"min",
"examination",
"rales",
"heard",
"bilateral lung",
"S1",
"S2",
"normal",
"Strength",
"5/5",
"bilateral upper",
"lower extremities",
"gait",
"normal",
"Palpable purpura",
"noted",
"trunk",
"bilateral upper",
"lower extremities",
"Erythrocyte sedimentation rate",
"C-reactive protein",
"elevated",
"patients condition",
"associated with antibodies directed",
"following enzymes"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 61-year-old man presents to his primary care provider with fatigue, weight loss, and muscle aches. He has experienced these symptoms for the past year but initially attributed them to stress at his work as an attorney. However, over the past month, he has developed intermittent fevers associated with a skin rash that prompted him to seek medical evaluation. He denies any recent history of asthma, rhinitis, hematuria, or difficulty breathing. He is otherwise healthy and takes no medications. He has a distant history of cocaine abuse but has not used any drugs in 30 years. His family history is notable for pancreatic cancer in his father and inflammatory bowel disease in his sister. His temperature is 99.3°F (37.4°C), blood pressure is 130/75 mmHg, pulse is 90/min, and respirations are 18/min. On examination, rales are heard at the bilateral lung bases. S1 and S2 are normal. Strength is 5/5 in the bilateral upper and lower extremities and his gait is normal. Palpable purpura are noted on his trunk and bilateral upper and lower extremities. Erythrocyte sedimentation rate and C-reactive protein are both elevated. This patient’s condition is associated with antibodies directed against which of the following enzymes?
Choose one of the following::
A. Complement component 1q
B. Myeloperoxidase
C. Topoisomerase-1
D. Type IV collagen | [
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A 62-year-old woman is brought to the physician by her daughter for the evaluation of weight loss and a bloody cough that began 3 weeks ago. Twenty years ago, she had a major depressive episode and a suicide attempt. Since then, her mental status has been stable. She lives alone and takes care of all her activities of daily living. The patient has smoked 1 pack of cigarettes daily for the past 40 years. She does not take any medications. An x-ray of the chest shows a central solitary nodule in the right lung; bronchoscopy with transbronchial biopsy shows a small cell lung cancer. A CT scan of the abdomen shows multiple metastatic lesions within the liver. The patient previously designated her daughter as her healthcare decision-maker. As the physician goes to reveal the diagnosis to the patient, the patient's daughter is waiting outside her room. The daughter asks the physician not to tell her mother the diagnosis. Which of the following is the most appropriate action by the physician? | Clarify the daughter's reasons for the request | {
"A": "Ask the patient if she wants to know the truth",
"B": "Disclose the diagnosis to the patient",
"C": "Encourage the daughter to disclose the diagnosis to her mother",
"D": "Clarify the daughter's reasons for the request"
} | step2&3 | D | [
"62 year old woman",
"brought",
"physician",
"daughter",
"evaluation of weight loss",
"bloody cough",
"began 3 weeks",
"Twenty years",
"major depressive episode",
"suicide attempt",
"then",
"mental status",
"stable",
"lives alone",
"takes care",
"activities of daily living",
"patient",
"smoked 1 pack",
"cigarettes daily",
"past 40 years",
"not take",
"medications",
"x-ray of",
"chest shows",
"central solitary nodule",
"right lung",
"bronchoscopy with transbronchial biopsy shows",
"small cell lung cancer",
"CT scan",
"abdomen shows multiple metastatic lesions",
"liver",
"patient",
"designated",
"daughter",
"healthcare decision maker",
"physician goes to reveal",
"diagnosis",
"patient",
"patient's daughter",
"waiting outside",
"room",
"daughter",
"physician not to",
"mother",
"diagnosis",
"following",
"most appropriate action",
"physician"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 62-year-old woman is brought to the physician by her daughter for the evaluation of weight loss and a bloody cough that began 3 weeks ago. Twenty years ago, she had a major depressive episode and a suicide attempt. Since then, her mental status has been stable. She lives alone and takes care of all her activities of daily living. The patient has smoked 1 pack of cigarettes daily for the past 40 years. She does not take any medications. An x-ray of the chest shows a central solitary nodule in the right lung; bronchoscopy with transbronchial biopsy shows a small cell lung cancer. A CT scan of the abdomen shows multiple metastatic lesions within the liver. The patient previously designated her daughter as her healthcare decision-maker. As the physician goes to reveal the diagnosis to the patient, the patient's daughter is waiting outside her room. The daughter asks the physician not to tell her mother the diagnosis. Which of the following is the most appropriate action by the physician?
Choose one of the following::
A. Ask the patient if she wants to know the truth
B. Disclose the diagnosis to the patient
C. Encourage the daughter to disclose the diagnosis to her mother
D. Clarify the daughter's reasons for the request | [
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A 61-year-old Caucasian male presents to your office complaining of morning headaches of 6 weeks duration. A head MRI reveals a likely metastasis of unknown origin in the supratentorial region of the brain. On biopsy, the neoplastic mass is shown to have a mutation in BRAF, a protein kinase, in which a glutamic acid is substituted for valine at position 600 of the protein. Where did this metastasis most likely originate? | Skin | {
"A": "Stomach",
"B": "Breast",
"C": "Skin",
"D": "Brain"
} | step1 | C | [
"61 year old Caucasian male presents",
"office",
"morning headaches",
"weeks duration",
"head MRI reveals",
"likely metastasis",
"unknown origin",
"supratentorial region of",
"brain",
"biopsy",
"neoplastic mass",
"shown to",
"mutation",
"BRAF",
"a protein",
"glutamic acid",
"valine",
"position 600",
"protein",
"metastasis",
"likely"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 61-year-old Caucasian male presents to your office complaining of morning headaches of 6 weeks duration. A head MRI reveals a likely metastasis of unknown origin in the supratentorial region of the brain. On biopsy, the neoplastic mass is shown to have a mutation in BRAF, a protein kinase, in which a glutamic acid is substituted for valine at position 600 of the protein. Where did this metastasis most likely originate?
Choose one of the following::
A. Stomach
B. Breast
C. Skin
D. Brain | [
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A 53-year-old man presents with a 2-year-history of dull, nonspecific flank pain that subsides with rest. His past medical history is significant for hypertension, hypercholesterolemia, and type 2 diabetes mellitus. He has no allergies and takes no medications. His father died of kidney disease at the age of 51, and his mother has been treated for ovarian cancer. On presentation, his blood pressure is 168/98 mm Hg, and his heart rate is 102/min. Abdominal examination is significant for palpable bilateral renal masses. His laboratory tests are significant for creatinine of 2.0 mg/dL and a BUN of 22 mg/dL. Which of the following tests is most recommended in this patient? | CT angiography of the head | {
"A": "Stress echocardiography",
"B": "Coronary angiography",
"C": "CT angiography of the head",
"D": "Serum measurement of alpha-fetoprotein"
} | step2&3 | C | [
"year old man presents",
"year history of dull",
"nonspecific flank pain",
"rest",
"past medical history",
"significant",
"hypertension",
"hypercholesterolemia",
"type 2 diabetes mellitus",
"allergies",
"takes",
"medications",
"father died of kidney disease",
"age",
"mother",
"treated",
"ovarian cancer",
"presentation",
"blood pressure",
"98 mm Hg",
"heart rate",
"min",
"Abdominal examination",
"significant",
"palpable bilateral renal masses",
"laboratory tests",
"significant",
"creatinine",
"2.0 mg/dL",
"BUN",
"mg dL",
"following tests",
"most recommended",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 53-year-old man presents with a 2-year-history of dull, nonspecific flank pain that subsides with rest. His past medical history is significant for hypertension, hypercholesterolemia, and type 2 diabetes mellitus. He has no allergies and takes no medications. His father died of kidney disease at the age of 51, and his mother has been treated for ovarian cancer. On presentation, his blood pressure is 168/98 mm Hg, and his heart rate is 102/min. Abdominal examination is significant for palpable bilateral renal masses. His laboratory tests are significant for creatinine of 2.0 mg/dL and a BUN of 22 mg/dL. Which of the following tests is most recommended in this patient?
Choose one of the following::
A. Stress echocardiography
B. Coronary angiography
C. CT angiography of the head
D. Serum measurement of alpha-fetoprotein | [
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A 33-year-old woman presents to her physician's office for a postpartum check-up. She gave birth to a 38-week-old boy via an uncomplicated vaginal delivery 3 weeks ago and has been exclusively breastfeeding her son. The hormone most responsible for promoting milk let-down during lactation in this new mother would lead to the greatest change in the level of which of the following factors? | IP3 | {
"A": "cGMP",
"B": "IP3",
"C": "Ras",
"D": "Phospholipase A"
} | step1 | B | [
"year old woman presents",
"physician's office",
"postpartum check-up",
"gave birth",
"week old boy",
"uncomplicated vaginal",
"weeks",
"breastfeeding",
"son",
"hormone most responsible",
"promoting milk let-down",
"lactation",
"new mother",
"lead",
"greatest change",
"level",
"following factors"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 33-year-old woman presents to her physician's office for a postpartum check-up. She gave birth to a 38-week-old boy via an uncomplicated vaginal delivery 3 weeks ago and has been exclusively breastfeeding her son. The hormone most responsible for promoting milk let-down during lactation in this new mother would lead to the greatest change in the level of which of the following factors?
Choose one of the following::
A. cGMP
B. IP3
C. Ras
D. Phospholipase A | [
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A 51-year-old man presents to the office with complaints of a gradual swelling of his face and frothy urine, which was first noticed by his wife 4 days ago. He also noticed that his limbs appear swollen. His past medical history include diabetes mellitus for the past 10 years. He is currently on metformin and has well-controlled blood sugar and HbA1c levels. He does not smoke and drinks alcohol occasionally. His laboratory results during his last visit 6 months ago were normal. On physical examination, there is pitting edema in the lower extremities and on his face. His vital signs include: blood pressure 121/78 mm Hg, pulse 77/min, temperature 36.7°C (98.1°F), and respiratory rate 10/min.
The urinalysis shows:
pH 6.2
Color light yellow
RBC none
WBC 3–4/HPF
Protein 4+
Cast fat globules
Glucose absent
Crystal none
Ketone absent
Nitrite absent
24-hour urine protein excretion 5.1 g
Which of the following is the most likely cause of the generalized edema in this patient? | Hypoalbuminemia | {
"A": "Hypoalbuminemia",
"B": "Hyperlipidemia",
"C": "Loss of antithrombin III in the urine",
"D": "Loss of globulin in the urine"
} | step1 | A | [
"year old man presents",
"office",
"complaints of",
"gradual swelling",
"face",
"frothy urine",
"first",
"wife 4 days",
"limbs appear swollen",
"past medical history include diabetes mellitus",
"past 10 years",
"currently",
"metformin",
"well-controlled blood sugar",
"levels",
"not smoke",
"drinks alcohol occasionally",
"laboratory results",
"visit",
"months",
"normal",
"physical examination",
"pitting edema",
"lower extremities",
"face",
"vital signs include",
"blood pressure",
"mm Hg",
"pulse",
"min",
"temperature 36",
"98",
"respiratory rate 10/min",
"urinalysis shows",
"pH",
"Color light yellow RBC",
"WBC",
"HPF Protein",
"Cast fat globules Glucose absent Crystal",
"Ketone absent Nitrite",
"24-hour urine protein excretion",
"g",
"following",
"most likely cause",
"generalized edema",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 51-year-old man presents to the office with complaints of a gradual swelling of his face and frothy urine, which was first noticed by his wife 4 days ago. He also noticed that his limbs appear swollen. His past medical history include diabetes mellitus for the past 10 years. He is currently on metformin and has well-controlled blood sugar and HbA1c levels. He does not smoke and drinks alcohol occasionally. His laboratory results during his last visit 6 months ago were normal. On physical examination, there is pitting edema in the lower extremities and on his face. His vital signs include: blood pressure 121/78 mm Hg, pulse 77/min, temperature 36.7°C (98.1°F), and respiratory rate 10/min.
The urinalysis shows:
pH 6.2
Color light yellow
RBC none
WBC 3–4/HPF
Protein 4+
Cast fat globules
Glucose absent
Crystal none
Ketone absent
Nitrite absent
24-hour urine protein excretion 5.1 g
Which of the following is the most likely cause of the generalized edema in this patient?
Choose one of the following::
A. Hypoalbuminemia
B. Hyperlipidemia
C. Loss of antithrombin III in the urine
D. Loss of globulin in the urine | [
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A 47-year-old man presents to a physician with a chronic cough and recurrent episodes of dyspnea for the last 3 years. He has visited multiple physicians but gained only temporary and partial relief. He has been hospitalized 3 times for severe exacerbations of his symptoms over the last 3 years. He has been a smoker for the last 17 years. He has a family history of allergic disorders in his father and brother. He is a farmer by profession. His past medical records do not suggest any specific diagnosis and his recent chest radiographs also show nonspecific findings. After a detailed physical examination, the physician orders a spirometric evaluation. The flow-volume loop obtained during the test is given. Which of the following findings is most likely to be present in the report of his pulmonary function test? | Increased total lung capacity (TLC) | {
"A": "Normal FEV1",
"B": "Increased FEF25-75",
"C": "Increased total lung capacity (TLC)",
"D": "Decreased functional residual capacity (FRC)"
} | step2&3 | C | [
"year old man presents",
"physician",
"chronic cough",
"recurrent episodes of dyspnea",
"last",
"years",
"visited multiple physicians",
"gained only temporary",
"partial relief",
"hospitalized 3 times",
"severe exacerbations",
"symptoms",
"last",
"years",
"smoker",
"years",
"family history of allergic disorders",
"father",
"brother",
"farmer",
"profession",
"past medical records",
"not suggest",
"specific diagnosis",
"recent chest radiographs",
"show nonspecific findings",
"detailed physical examination",
"physician orders",
"spirometric evaluation",
"flow-volume loop obtained",
"test",
"given",
"following findings",
"most likely to",
"present",
"report",
"pulmonary function"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 47-year-old man presents to a physician with a chronic cough and recurrent episodes of dyspnea for the last 3 years. He has visited multiple physicians but gained only temporary and partial relief. He has been hospitalized 3 times for severe exacerbations of his symptoms over the last 3 years. He has been a smoker for the last 17 years. He has a family history of allergic disorders in his father and brother. He is a farmer by profession. His past medical records do not suggest any specific diagnosis and his recent chest radiographs also show nonspecific findings. After a detailed physical examination, the physician orders a spirometric evaluation. The flow-volume loop obtained during the test is given. Which of the following findings is most likely to be present in the report of his pulmonary function test?
Choose one of the following::
A. Normal FEV1
B. Increased FEF25-75
C. Increased total lung capacity (TLC)
D. Decreased functional residual capacity (FRC) | [
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A 60-year-old man presents to the emergency department for fatigue and feeling off for the past week. He has not had any sick contacts and states that he can’t think of any potential preceding symptoms or occurrence to explain his presentation. The patient has a past medical history of diabetes, hypertension, and congestive heart failure with preserved ejection fraction. His temperature is 98°F (36.7°C), blood pressure is 125/65 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 100% on room air. Laboratory values are obtained and shown below.
Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 6,500/mm^3 with normal differential
Platelet count: 197,000/mm^3
Serum:
Na+: 147 mEq/L
Cl-: 105 mEq/L
K+: 4.1 mEq/L
HCO3-: 26 mEq/L
BUN: 21 mg/dL
Glucose: 100 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.1 mg/dL
AST: 12 U/L
ALT: 10 U/L
Urine:
Appearance: clear
Specific gravity: 1.003
The patient is admitted to the floor, a water deprivation test is performed, and his urine studies are repeated yet unchanged. Which of the following is the best next step in management? | Administer desmopressin | {
"A": "Administer demeclocycline",
"B": "Administer desmopressin",
"C": "Administer hypotonic fluids",
"D": "Perform a head CT"
} | step2&3 | B | [
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] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 60-year-old man presents to the emergency department for fatigue and feeling off for the past week. He has not had any sick contacts and states that he can’t think of any potential preceding symptoms or occurrence to explain his presentation. The patient has a past medical history of diabetes, hypertension, and congestive heart failure with preserved ejection fraction. His temperature is 98°F (36.7°C), blood pressure is 125/65 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 100% on room air. Laboratory values are obtained and shown below.
Hemoglobin: 12 g/dL
Hematocrit: 36%
Leukocyte count: 6,500/mm^3 with normal differential
Platelet count: 197,000/mm^3
Serum:
Na+: 147 mEq/L
Cl-: 105 mEq/L
K+: 4.1 mEq/L
HCO3-: 26 mEq/L
BUN: 21 mg/dL
Glucose: 100 mg/dL
Creatinine: 1.1 mg/dL
Ca2+: 10.1 mg/dL
AST: 12 U/L
ALT: 10 U/L
Urine:
Appearance: clear
Specific gravity: 1.003
The patient is admitted to the floor, a water deprivation test is performed, and his urine studies are repeated yet unchanged. Which of the following is the best next step in management?
Choose one of the following::
A. Administer demeclocycline
B. Administer desmopressin
C. Administer hypotonic fluids
D. Perform a head CT | [
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A 45-year-old male with a 15-year history of diabetes mellitus presents to his primary care provider for a routine checkup. His doctor is concerned about his renal function and would like to order a test to detect renal impairment. Which of the following is the most sensitive test for detecting renal impairment in diabetic patients? | Urine microalbumin to creatinine ratio | {
"A": "Cystatin C levels",
"B": "Urine microalbumin to creatinine ratio",
"C": "Hemoglobin A1C",
"D": "Urine protein dipstick"
} | step2&3 | B | [
"year old male",
"history of diabetes mellitus presents",
"primary care provider",
"routine checkup",
"doctor",
"concerned",
"renal function",
"to order",
"test to detect renal impairment",
"following",
"most sensitive test",
"detecting renal impairment",
"diabetic patients"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 45-year-old male with a 15-year history of diabetes mellitus presents to his primary care provider for a routine checkup. His doctor is concerned about his renal function and would like to order a test to detect renal impairment. Which of the following is the most sensitive test for detecting renal impairment in diabetic patients?
Choose one of the following::
A. Cystatin C levels
B. Urine microalbumin to creatinine ratio
C. Hemoglobin A1C
D. Urine protein dipstick | [
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After receiving a positive newborn screening result, a 2-week-old male infant is brought to the pediatrician for a diagnostic sweat test. The results demonstrated chloride levels of 65 mmol/L (nl < 29 mmol/L). Subsequent DNA sequencing revealed a 3 base pair deletion in a transmembrane cAMP-activated ion channel known to result in protein instability and early degradation. The physician discusses with the parents that the infant will develop respiratory infections due to improper mucus clearance and reviews various mucolytic agents, such as one that cleaves disulfide bonds between mucus glycoproteins thereby loosening the mucus plug. This mucolytic can also be used as a treatment for which of the following overdoses? | Acetaminophen | {
"A": "Opioids",
"B": "Acetaminophen",
"C": "Cyanide",
"D": "Benzodiazepines"
} | step1 | B | [
"receiving",
"positive newborn",
"2 week old male infant",
"brought",
"pediatrician",
"diagnostic sweat",
"results",
"chloride levels",
"65 mmol/L",
"nl",
"29 mmol/L",
"Subsequent DNA sequencing revealed",
"3 base pair deletion",
"transmembrane cAMP activated ion channel known to result",
"protein instability",
"early degradation",
"physician discusses",
"parents",
"infant",
"respiratory due to",
"mucus clearance",
"reviews various mucolytic agents",
"one",
"disulfide bonds",
"mucus glycoproteins",
"loosening",
"mucus plug",
"mucolytic",
"used",
"treatment",
"following overdoses"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: After receiving a positive newborn screening result, a 2-week-old male infant is brought to the pediatrician for a diagnostic sweat test. The results demonstrated chloride levels of 65 mmol/L (nl < 29 mmol/L). Subsequent DNA sequencing revealed a 3 base pair deletion in a transmembrane cAMP-activated ion channel known to result in protein instability and early degradation. The physician discusses with the parents that the infant will develop respiratory infections due to improper mucus clearance and reviews various mucolytic agents, such as one that cleaves disulfide bonds between mucus glycoproteins thereby loosening the mucus plug. This mucolytic can also be used as a treatment for which of the following overdoses?
Choose one of the following::
A. Opioids
B. Acetaminophen
C. Cyanide
D. Benzodiazepines | [
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A 25-year-old man comes to the office because of pain in his left shoulder. He says that this pain started 3 years ago and has progressively worsened. He denies joint trauma, fever, dysuria, or morning stiffness. He says that his urine turns black after it is exposed to air and has done so since childhood. He has one sexual partner and they regularly use condoms. His pulse is 72/min, respiratory rate is 18/min, temperature is 37.2°C (99.0°F), and blood pressure is 135/80 mm Hg. Physical examination shows bilateral scleral darkening and point tenderness upon palpation of his right elbow, left knee, and shoulder. Leukocyte count is 6,000/mm3. Which of the following enzymes is most likely deficient in this patient? | Homogentisic acid oxidase | {
"A": "Branched-chain alpha-ketoacid dehydrogenase",
"B": "Cystathionine synthase deficiency",
"C": "Homogentisic acid oxidase",
"D": "Propionyl-CoA carboxylase"
} | step1 | C | [
"year old man",
"office",
"of pain in",
"left shoulder",
"pain started 3 years",
"worsened",
"denies joint trauma",
"fever",
"dysuria",
"morning stiffness",
"urine turns black",
"exposed",
"air",
"so",
"childhood",
"one sexual partner",
"use condoms",
"pulse",
"72 min",
"respiratory rate",
"min",
"temperature",
"99",
"blood pressure",
"80 mm Hg",
"Physical examination shows bilateral scleral",
"point tenderness",
"palpation",
"right elbow",
"left knee",
"shoulder",
"Leukocyte count",
"mm3",
"following enzymes",
"most likely deficient",
"patient"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 25-year-old man comes to the office because of pain in his left shoulder. He says that this pain started 3 years ago and has progressively worsened. He denies joint trauma, fever, dysuria, or morning stiffness. He says that his urine turns black after it is exposed to air and has done so since childhood. He has one sexual partner and they regularly use condoms. His pulse is 72/min, respiratory rate is 18/min, temperature is 37.2°C (99.0°F), and blood pressure is 135/80 mm Hg. Physical examination shows bilateral scleral darkening and point tenderness upon palpation of his right elbow, left knee, and shoulder. Leukocyte count is 6,000/mm3. Which of the following enzymes is most likely deficient in this patient?
Choose one of the following::
A. Branched-chain alpha-ketoacid dehydrogenase
B. Cystathionine synthase deficiency
C. Homogentisic acid oxidase
D. Propionyl-CoA carboxylase | [
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A 26-year-old primigravid woman comes to the emergency department because of a 10-hour history of vaginal bleeding and lower abdominal pain. She also had nausea and fatigue for the past 4 weeks. Her last menstrual period was 9 weeks ago. There is no history of medical illness. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 9-week gestation. A urine pregnancy test is positive. β-HCG level is 108,000 mIU/mL (N < 5 mIU/mL). Transvaginal ultrasonography shows unclear, amorphous fetal parts and a large placenta with multiple cystic spaces. Which of the following is the most likely cause of this patient's condition? | Partial molar pregnancy | {
"A": "Complete molar pregnancy",
"B": "Choriocarcinoma",
"C": "Partial molar pregnancy",
"D": "Placental abruption"
} | step1 | C | [
"year old primigravid woman",
"emergency department",
"a 10 hour history",
"vaginal bleeding",
"lower abdominal pain",
"nausea",
"fatigue",
"past 4 weeks",
"last menstrual period",
"weeks",
"history of medical illness",
"Vital signs",
"normal limits",
"Pelvic examination shows",
"uterus consistent",
"size",
"week gestation",
"urine pregnancy test",
"positive",
"HCG level",
"mIU/mL",
"N",
"5 mIU/mL",
"Transvaginal ultrasonography shows",
"amorphous fetal parts",
"large placenta",
"multiple cystic spaces",
"following",
"most likely cause",
"patient's condition"
] | You are a clinical decision-making assistant specialized in obstetric care. Your task is to read the provided clinical scenario carefully and choose the best treatment option from the provided choices.
Question: A 26-year-old primigravid woman comes to the emergency department because of a 10-hour history of vaginal bleeding and lower abdominal pain. She also had nausea and fatigue for the past 4 weeks. Her last menstrual period was 9 weeks ago. There is no history of medical illness. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 9-week gestation. A urine pregnancy test is positive. β-HCG level is 108,000 mIU/mL (N < 5 mIU/mL). Transvaginal ultrasonography shows unclear, amorphous fetal parts and a large placenta with multiple cystic spaces. Which of the following is the most likely cause of this patient's condition?
Choose one of the following::
A. Complete molar pregnancy
B. Choriocarcinoma
C. Partial molar pregnancy
D. Placental abruption | [
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Subsets and Splits