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A 50-year-old woman presents with esophageal varices, alcoholic cirrhosis, hepatic encephalopathy, portal hypertension, and recent onset confusion. The patient’s husband does not recall her past medical history but knows her current medications and states that she is quite disciplined about taking them. Current medications are spironolactone, labetalol, lactulose, and furosemide. Her temperature is 38.3°C (100.9°F), heart rate is 115/min, blood pressure is 105/62 mm Hg, respiratory rate is 12/min, and oxygen saturation is 96% on room air. On physical examination, the patient is disoriented, lethargic, and poorly responsive to commands. A cardiac examination is unremarkable. Lungs are clear to auscultation. The abdomen is distended, tense, and mildly tender. Mild asterixis is present. Neurologic examination is normal. The digital rectal examination reveals guaiac negative stool. Laboratory findings are significant for the following:
Basic metabolic panel Unremarkable
Platelet count 95,500/µL
Leukocyte count 14,790/µL
Hematocrit 33% (baseline is 30%)
Which of the following would most likely be of diagnostic value in this patient? | Abdominal paracentesis | {
"A": "Noncontrast CT of the head",
"B": "Therapeutic trial of lactulose",
"C": "Abdominal paracentesis",
"D": "Serum ammonia level"
} | step1 | C | [
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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 50-year-old woman presents with esophageal varices, alcoholic cirrhosis, hepatic encephalopathy, portal hypertension, and recent onset confusion. The patient’s husband does not recall her past medical history but knows her current medications and states that she is quite disciplined about taking them. Current medications are spironolactone, labetalol, lactulose, and furosemide. Her temperature is 38.3°C (100.9°F), heart rate is 115/min, blood pressure is 105/62 mm Hg, respiratory rate is 12/min, and oxygen saturation is 96% on room air. On physical examination, the patient is disoriented, lethargic, and poorly responsive to commands. A cardiac examination is unremarkable. Lungs are clear to auscultation. The abdomen is distended, tense, and mildly tender. Mild asterixis is present. Neurologic examination is normal. The digital rectal examination reveals guaiac negative stool. Laboratory findings are significant for the following:
Basic metabolic panel Unremarkable
Platelet count 95,500/µL
Leukocyte count 14,790/µL
Hematocrit 33% (baseline is 30%)
Which of the following would most likely be of diagnostic value in this patient?
Choose one of the following::
A. Noncontrast CT of the head
B. Therapeutic trial of lactulose
C. Abdominal paracentesis
D. Serum ammonia level | [
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A 23-year-old woman is brought to the emergency department 8 hours after the sudden onset of shortness of breath and pleuritic chest pain. She has cystic fibrosis and, during the past year, has had 4 respiratory exacerbations that have required hospitalization. Current medications include an inhaled bronchodilator, an inhaled corticosteroid, inhaled N-acetylcysteine, and azithromycin. The patient appears chronically ill. Her temperature is 37.9°C (100.2°F), pulse is 96/min, respirations are 22/min and labored, and blood pressure is 106/64 mm Hg. Pulse oximetry on 2 L/min of oxygen via nasal cannula shows an oxygen saturation of 96%. Examination shows an increased anteroposterior chest diameter. There is digital clubbing. Chest excursions and tactile fremitus are decreased on the right side. On auscultation of the chest, breath sounds are significantly diminished over the right lung field and diffuse wheezing is heard over the left lung field. Which of the following is the most likely underlying cause of this patient's current symptoms? | Apical subpleural cyst | {
"A": "Bronchial hyperresponsiveness",
"B": "Infection with gram-negative coccobacilli",
"C": "Apical subpleural cyst",
"D": "Increased pulmonary capillary permeability"
} | step2&3 | C | [
"23 year old woman",
"brought",
"emergency department 8 hours",
"sudden onset of shortness",
"breath",
"pleuritic chest pain",
"cystic fibrosis",
"past year",
"4 respiratory exacerbations",
"required hospitalization",
"Current medications include",
"inhaled bronchodilator",
"inhaled corticosteroid",
"inhaled",
"acetylcysteine",
"azithromycin",
"patient appears chronically ill",
"temperature",
"100",
"pulse",
"96 min",
"respirations",
"min",
"labored",
"blood pressure",
"64 mm Hg",
"Pulse oximetry",
"L/min",
"oxygen",
"nasal cannula shows",
"oxygen saturation",
"96",
"Examination shows",
"increased",
"chest diameter",
"digital clubbing",
"Chest",
"tactile fremitus",
"decreased",
"right side",
"auscultation",
"chest",
"breath sounds",
"diminished",
"right lung field",
"diffuse wheezing",
"heard",
"left lung field",
"following",
"most likely underlying cause",
"patient's current 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 23-year-old woman is brought to the emergency department 8 hours after the sudden onset of shortness of breath and pleuritic chest pain. She has cystic fibrosis and, during the past year, has had 4 respiratory exacerbations that have required hospitalization. Current medications include an inhaled bronchodilator, an inhaled corticosteroid, inhaled N-acetylcysteine, and azithromycin. The patient appears chronically ill. Her temperature is 37.9°C (100.2°F), pulse is 96/min, respirations are 22/min and labored, and blood pressure is 106/64 mm Hg. Pulse oximetry on 2 L/min of oxygen via nasal cannula shows an oxygen saturation of 96%. Examination shows an increased anteroposterior chest diameter. There is digital clubbing. Chest excursions and tactile fremitus are decreased on the right side. On auscultation of the chest, breath sounds are significantly diminished over the right lung field and diffuse wheezing is heard over the left lung field. Which of the following is the most likely underlying cause of this patient's current symptoms?
Choose one of the following::
A. Bronchial hyperresponsiveness
B. Infection with gram-negative coccobacilli
C. Apical subpleural cyst
D. Increased pulmonary capillary permeability | [
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A 61-year-old diabetic woman is brought to the emergency department with the complaint of multiple bouts of abdominal pain in the last 24 hours. She says that the pain is dull aching in nature, radiates to the back, and worsens with meals. She also complains of nausea and occasional vomiting. She has been hospitalized repeatedly in the past with similar complaints. Her temperature is 37° C (98.6° F), respiratory rate is 16/min, pulse is 77/min, and blood pressure is 120/89 mm Hg. On physical exam, dark hyperpigmentation of the axillary skin is noted. Her blood test report from last month is given below:
Glycated hemoglobin (HbA1c): 9.1%
Triglyceride: 675 mg/dL
LDL-Cholesterol: 102 mg/dL
HDL-Cholesterol: 35 mg/dL
Total Cholesterol: 250 mg/dL
Serum Creatinine: 1.2 mg/dL
BUN: 12 mg/dL
Alkaline phosphatase: 100 U/L
Alanine aminotransferase: 36 U/L
Aspartate aminotransferase: 28 U/L
What is the most likely diagnosis in this case? | Pancreatitis | {
"A": "Cholecystitis",
"B": "Choledocholithiasis",
"C": "Pancreatitis",
"D": "Duodenal peptic ulcer"
} | step2&3 | C | [
"61 year old diabetic woman",
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"abdominal pain",
"last 24 hours",
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"mg/dL HDL-Cholesterol",
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"mg dL Serum Creatinine",
"1.2 mg dL BUN",
"mg/dL Alkaline phosphatase",
"100 U/L Alanine aminotransferase",
"36 U/L Aspartate aminotransferase",
"U/L",
"most diagnosis",
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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 61-year-old diabetic woman is brought to the emergency department with the complaint of multiple bouts of abdominal pain in the last 24 hours. She says that the pain is dull aching in nature, radiates to the back, and worsens with meals. She also complains of nausea and occasional vomiting. She has been hospitalized repeatedly in the past with similar complaints. Her temperature is 37° C (98.6° F), respiratory rate is 16/min, pulse is 77/min, and blood pressure is 120/89 mm Hg. On physical exam, dark hyperpigmentation of the axillary skin is noted. Her blood test report from last month is given below:
Glycated hemoglobin (HbA1c): 9.1%
Triglyceride: 675 mg/dL
LDL-Cholesterol: 102 mg/dL
HDL-Cholesterol: 35 mg/dL
Total Cholesterol: 250 mg/dL
Serum Creatinine: 1.2 mg/dL
BUN: 12 mg/dL
Alkaline phosphatase: 100 U/L
Alanine aminotransferase: 36 U/L
Aspartate aminotransferase: 28 U/L
What is the most likely diagnosis in this case?
Choose one of the following::
A. Cholecystitis
B. Choledocholithiasis
C. Pancreatitis
D. Duodenal peptic ulcer | [
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An 82-year-old woman is admitted to the hospital because of wet gangrene on her right leg. Two days after admission, she becomes increasingly confused and tachypneic. She is intubated and ventilatory support is initiated. Her temperature is 39.6°C (102.5°F), pulse is 127/min, and blood pressure is 83/47 mm Hg. The ventilator is set at a FiO2 of 100% and a respiratory rate of 20/min. An arterial blood gas checked 30 minutes after intubation shows a PCO2 of 41 mm Hg and a PO2 of 55 mm Hg. Despite appropriate care, the patient dies from respiratory failure. Further evaluation of this patient is most likely to show which of the following findings? | Fluid in the alveolar space | {
"A": "Hyperinflation of the lungs",
"B": "Emboli in the pulmonary vasculature",
"C": "Abscess in the lung parenchyma",
"D": "Fluid in the alveolar space"
} | step1 | D | [
"year old woman",
"admitted",
"hospital",
"of wet gangrene",
"right leg",
"Two days",
"admission",
"confused",
"tachypneic",
"intubated",
"support",
"initiated",
"temperature",
"pulse",
"min",
"blood pressure",
"83",
"mm Hg",
"ventilator",
"set",
"FiO2",
"100",
"respiratory rate",
"20 min",
"arterial blood gas checked 30 minutes",
"intubation shows",
"PCO2",
"mm Hg",
"PO2",
"55 mm Hg",
"appropriate care",
"patient dies",
"respiratory",
"Further evaluation",
"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: An 82-year-old woman is admitted to the hospital because of wet gangrene on her right leg. Two days after admission, she becomes increasingly confused and tachypneic. She is intubated and ventilatory support is initiated. Her temperature is 39.6°C (102.5°F), pulse is 127/min, and blood pressure is 83/47 mm Hg. The ventilator is set at a FiO2 of 100% and a respiratory rate of 20/min. An arterial blood gas checked 30 minutes after intubation shows a PCO2 of 41 mm Hg and a PO2 of 55 mm Hg. Despite appropriate care, the patient dies from respiratory failure. Further evaluation of this patient is most likely to show which of the following findings?
Choose one of the following::
A. Hyperinflation of the lungs
B. Emboli in the pulmonary vasculature
C. Abscess in the lung parenchyma
D. Fluid in the alveolar space | [
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A 57-year-old florist presents to his family physician with nodular lesions on his right hand and forearm. He explains that he got pricked by a rose thorn on his right "pointer finger" where the first lesions appeared, and the other lesions then began to appear in an ascending manner. The physician prescribed a medication and warned him of gynecomastia as a side effect if taken for long periods of time. Which of the following is the mechanism of action of the medication? | Inhibits ergosterol synthesis | {
"A": "Inhibits ergosterol synthesis",
"B": "Binds to ergosterol, forming destructive pores in cell membrane",
"C": "Inhibits formation of beta glucan",
"D": "Disrupts microtubule function"
} | step1 | A | [
"57 year old florist presents",
"family physician",
"nodular lesions",
"right hand",
"forearm",
"got pricked",
"rose thorn",
"right",
"pointer finger",
"first lesions appeared",
"lesions then began to appear",
"ascending",
"physician prescribed",
"medication",
"warned",
"gynecomastia",
"side effect",
"taken",
"long periods",
"time",
"following",
"mechanism of action",
"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 57-year-old florist presents to his family physician with nodular lesions on his right hand and forearm. He explains that he got pricked by a rose thorn on his right "pointer finger" where the first lesions appeared, and the other lesions then began to appear in an ascending manner. The physician prescribed a medication and warned him of gynecomastia as a side effect if taken for long periods of time. Which of the following is the mechanism of action of the medication?
Choose one of the following::
A. Inhibits ergosterol synthesis
B. Binds to ergosterol, forming destructive pores in cell membrane
C. Inhibits formation of beta glucan
D. Disrupts microtubule function | [
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A 58-year-old woman presents to the physician’s office with vaginal bleeding. The bleeding started as a spotting and has increased and has become persistent over the last month. The patient is G3P1 with a history of polycystic ovary syndrome and type 2 diabetes mellitus. She completed menopause 4 years ago. She took cyclic estrogen-progesterone replacement therapy for 1 year at the beginning of menopause. Her weight is 89 kg (196 lb), height 157 cm (5 ft 2 in). Her vital signs are as follows: blood pressure 135/70 mm Hg, heart rate 78/min, respiratory rate 12/min, and temperature 36.7℃ (98.1℉). Physical examination is unremarkable. Transvaginal ultrasound reveals an endometrium of 6 mm thickness. Speculum examination shows a cervix without focal lesions with bloody discharge from the non-dilated external os. On pelvic examination, the uterus is slightly enlarged, movable, and non-tender. Adnexa is non-palpable. What is the next appropriate step in the management of this patient? | Endometrial biopsy | {
"A": "Hysteroscopy with dilation and curettage",
"B": "Endometrial biopsy",
"C": "Saline infusion sonography",
"D": "Hysteroscopy with targeted biopsy"
} | step2&3 | B | [
"58 year old woman presents",
"physicians office",
"vaginal bleeding",
"bleeding started",
"spotting",
"increased",
"persistent",
"month",
"patient",
"history",
"polycystic ovary syndrome",
"type 2 diabetes mellitus",
"completed menopause",
"years",
"took cyclic estrogen progesterone replacement therapy",
"year",
"beginning",
"menopause",
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"height",
"5 ft 2",
"vital signs",
"follows",
"blood pressure",
"70 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"temperature 36",
"98",
"Physical examination",
"unremarkable",
"Transvaginal ultrasound reveals",
"endometrium of",
"mm thickness",
"Speculum examination shows",
"cervix",
"focal lesions",
"bloody discharge",
"non dilated external os",
"pelvic examination",
"uterus",
"slightly enlarged",
"movable",
"non-tender",
"Adnexa",
"non-palpable",
"next appropriate 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 58-year-old woman presents to the physician’s office with vaginal bleeding. The bleeding started as a spotting and has increased and has become persistent over the last month. The patient is G3P1 with a history of polycystic ovary syndrome and type 2 diabetes mellitus. She completed menopause 4 years ago. She took cyclic estrogen-progesterone replacement therapy for 1 year at the beginning of menopause. Her weight is 89 kg (196 lb), height 157 cm (5 ft 2 in). Her vital signs are as follows: blood pressure 135/70 mm Hg, heart rate 78/min, respiratory rate 12/min, and temperature 36.7℃ (98.1℉). Physical examination is unremarkable. Transvaginal ultrasound reveals an endometrium of 6 mm thickness. Speculum examination shows a cervix without focal lesions with bloody discharge from the non-dilated external os. On pelvic examination, the uterus is slightly enlarged, movable, and non-tender. Adnexa is non-palpable. What is the next appropriate step in the management of this patient?
Choose one of the following::
A. Hysteroscopy with dilation and curettage
B. Endometrial biopsy
C. Saline infusion sonography
D. Hysteroscopy with targeted biopsy | [
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A student is reviewing the various effects that can be plotted on a dose-response curve. He has observed that certain drugs can work as an agonist and an antagonist at a particular site. He has plotted a particular graph (as shown below) and is checking for other responses that can be measured on the same graph. He learned that drug B is less potent than drug A. Drug B also reduces the potency of drug A when combined in the same solution; however, if additional drug A is added to the solution, the maximal efficacy (Emax) of drug A increases. He wishes to plot another curve for drug C. He learns that drug C works on the same molecules as drugs A and B, but drug C reduces the maximal efficacy (Emax) of drug A significantly when combined with drug A. Which of the following best describes drug C? | Non-competitive antagonist | {
"A": "Competitive antagonist",
"B": "Non-competitive antagonist",
"C": "Inverse agonist",
"D": "Reversible antagonist"
} | 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 student is reviewing the various effects that can be plotted on a dose-response curve. He has observed that certain drugs can work as an agonist and an antagonist at a particular site. He has plotted a particular graph (as shown below) and is checking for other responses that can be measured on the same graph. He learned that drug B is less potent than drug A. Drug B also reduces the potency of drug A when combined in the same solution; however, if additional drug A is added to the solution, the maximal efficacy (Emax) of drug A increases. He wishes to plot another curve for drug C. He learns that drug C works on the same molecules as drugs A and B, but drug C reduces the maximal efficacy (Emax) of drug A significantly when combined with drug A. Which of the following best describes drug C?
Choose one of the following::
A. Competitive antagonist
B. Non-competitive antagonist
C. Inverse agonist
D. Reversible antagonist | [
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You are seeing a patient in clinic who recently started treatment for active tuberculosis. The patient is currently being treated with rifampin, isoniazid, pyrazinamide, and ethambutol. The patient is not used to taking medicines and is very concerned about side effects. Specifically regarding the carbohydrate polymerization inhibiting medication, which of the following is a known side effect? | Vision loss | {
"A": "Cutaneous flushing",
"B": "Paresthesias of the hands and feet",
"C": "Vision loss",
"D": "Arthralgias"
} | step1 | C | [
"seeing",
"patient in clinic",
"recently started treatment",
"active",
"patient",
"currently",
"treated with rifampin",
"isoniazid",
"pyrazinamide",
"ethambutol",
"patient",
"not used",
"taking medicines",
"very concerned",
"side effects",
"carbohydrate polymerization inhibiting medication",
"following",
"known side effect"
] | 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 seeing a patient in clinic who recently started treatment for active tuberculosis. The patient is currently being treated with rifampin, isoniazid, pyrazinamide, and ethambutol. The patient is not used to taking medicines and is very concerned about side effects. Specifically regarding the carbohydrate polymerization inhibiting medication, which of the following is a known side effect?
Choose one of the following::
A. Cutaneous flushing
B. Paresthesias of the hands and feet
C. Vision loss
D. Arthralgias | [
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A 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy? | Explain the procedure's benefits, alternatives, and potential complications | {
"A": "Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together",
"B": "Explain the procedure's benefits, alternatives, and potential complications",
"C": "Call the patient's wife to obtain her consent for the procedure",
"D": "Discourage the patient from undergoing the procedure because his wife wants children"
} | 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 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy?
Choose one of the following::
A. Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together
B. Explain the procedure's benefits, alternatives, and potential complications
C. Call the patient's wife to obtain her consent for the procedure
D. Discourage the patient from undergoing the procedure because his wife wants children | [
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A 48-year-old man is brought to the emergency department by his wife 20 minutes after she witnessed him vigorously shaking for about 1 minute. During this episode, he urinated on himself. He feels drowsy and has nausea. He has a history of chronic alcoholism; he has been drinking 15 beers daily for the past 3 days. Before this time, he drank 8 beers daily. His last drink was 2 hours ago. He appears lethargic. His vital signs are within normal limits. Physical and neurologic examinations show no other abnormalities. On mental status examination, he is confused and not oriented to time. Laboratory studies show:
Hematocrit 44.0%
Leukocyte count 12,000/mm3
Platelet count 320,000/mm3
Serum
Na+ 112 mEq/L
Cl- 75 mEq/L
K+ 3.8 mEq/L
HCO3- 13 mEq/L
Urea nitrogen 6 mEq/L
Creatinine 0.6 mg/dL
Albumin 2.1 g/dL
Glucose 80 mg/dL
Urgent treatment for this patient's current condition puts him at increased risk for which of the following adverse events?" | Osmotic myelinolysis | {
"A": "Cerebral edema",
"B": "Hyperglycemia",
"C": "Osmotic myelinolysis",
"D": "Wernicke encephalopathy"
} | step2&3 | C | [
"48 year old man",
"brought",
"emergency department",
"wife 20 minutes",
"witnessed",
"vigorously shaking",
"minute",
"episode",
"feels drowsy",
"nausea",
"history of chronic alcoholism",
"drinking",
"beers daily",
"past 3 days",
"time",
"drank",
"beers daily",
"last drink",
"2 hours",
"appears lethargic",
"vital signs",
"normal limits",
"Physical",
"neurologic examinations show",
"abnormalities",
"mental",
"confused",
"not oriented to time",
"Laboratory studies show",
"Leukocyte count",
"Platelet count",
"mEq",
"HCO3",
"mg dL Albumin",
"treatment",
"patient",
"urrent ondition uts ",
"ncreased risk ",
"ollowing dverse events?"
] | 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 48-year-old man is brought to the emergency department by his wife 20 minutes after she witnessed him vigorously shaking for about 1 minute. During this episode, he urinated on himself. He feels drowsy and has nausea. He has a history of chronic alcoholism; he has been drinking 15 beers daily for the past 3 days. Before this time, he drank 8 beers daily. His last drink was 2 hours ago. He appears lethargic. His vital signs are within normal limits. Physical and neurologic examinations show no other abnormalities. On mental status examination, he is confused and not oriented to time. Laboratory studies show:
Hematocrit 44.0%
Leukocyte count 12,000/mm3
Platelet count 320,000/mm3
Serum
Na+ 112 mEq/L
Cl- 75 mEq/L
K+ 3.8 mEq/L
HCO3- 13 mEq/L
Urea nitrogen 6 mEq/L
Creatinine 0.6 mg/dL
Albumin 2.1 g/dL
Glucose 80 mg/dL
Urgent treatment for this patient's current condition puts him at increased risk for which of the following adverse events?"
Choose one of the following::
A. Cerebral edema
B. Hyperglycemia
C. Osmotic myelinolysis
D. Wernicke encephalopathy | [
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A 48-year-old man presents early in the morning to the emergency department with a burning sensation in his chest. He describes a crushing feeling below the sternum and reports some neck pain on the left side. Furthermore, he complains of difficulty breathing. Late last night, he had come home and had eaten a family size lasagna by himself while watching TV. His past medical history is significant for type 2 diabetes and poorly controlled hypertension. The patient admits he often neglects to take his medications and has not been following his advised diet. His current medications are aspirin, metformin, and captopril. Examination reveals a distressed, overweight male sweating profusely. Which of the following is most likely to be found on auscultation? | Fourth heart sound | {
"A": "Ejection systolic murmur",
"B": "Expiratory wheezes",
"C": "Fixed splitting of the second heart sound",
"D": "Fourth heart sound"
} | step2&3 | D | [
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"sternum",
"reports",
"neck pain",
"left side",
"difficulty breathing",
"Late",
"night",
"home",
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"family size lasagna",
"watching TV",
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"poorly controlled hypertension",
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"current medications",
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"metformin",
"captopril",
"Examination reveals",
"distressed",
"overweight male sweating",
"following",
"most likely to",
"found",
"auscultation"
] | 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 48-year-old man presents early in the morning to the emergency department with a burning sensation in his chest. He describes a crushing feeling below the sternum and reports some neck pain on the left side. Furthermore, he complains of difficulty breathing. Late last night, he had come home and had eaten a family size lasagna by himself while watching TV. His past medical history is significant for type 2 diabetes and poorly controlled hypertension. The patient admits he often neglects to take his medications and has not been following his advised diet. His current medications are aspirin, metformin, and captopril. Examination reveals a distressed, overweight male sweating profusely. Which of the following is most likely to be found on auscultation?
Choose one of the following::
A. Ejection systolic murmur
B. Expiratory wheezes
C. Fixed splitting of the second heart sound
D. Fourth heart sound | [
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A 76-year-old man is brought to the emergency room because of one episode of hemoptysis. His pulse is 110/min. Physical examination shows pallor; there is blood in the oral cavity. Examination of the nasal cavity with a nasal speculum shows active bleeding from the posterior nasal cavity. Tamponade with a balloon catheter is attempted without success. The most appropriate next step in the management is ligation of a branch of a vessel of which of the following arteries? | Maxillary artery | {
"A": "Anterior cerebral artery",
"B": "Facial artery",
"C": "Occipital artery",
"D": "Maxillary artery"
} | step1 | D | [
"76 year old man",
"brought",
"emergency room",
"of one episode",
"hemoptysis",
"pulse",
"min",
"Physical examination shows pallor",
"blood in",
"oral cavity",
"Examination",
"nasal",
"nasal speculum shows active bleeding",
"posterior nasal cavity",
"Tamponade",
"balloon catheter",
"attempted",
"success",
"most appropriate next step",
"management",
"ligation",
"branch",
"vessel",
"following arteries"
] | 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 76-year-old man is brought to the emergency room because of one episode of hemoptysis. His pulse is 110/min. Physical examination shows pallor; there is blood in the oral cavity. Examination of the nasal cavity with a nasal speculum shows active bleeding from the posterior nasal cavity. Tamponade with a balloon catheter is attempted without success. The most appropriate next step in the management is ligation of a branch of a vessel of which of the following arteries?
Choose one of the following::
A. Anterior cerebral artery
B. Facial artery
C. Occipital artery
D. Maxillary artery | [
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A researcher is studying how arachidonic acid metabolites mediate the inflammatory response in rats. She has developed multiple enzyme inhibitors that specifically target individual proteins in the arachidonic acid pathway. She injects these inhibitors in rats who have been exposed to common bacterial pathogens and analyzes their downstream effects. In one of her experiments, she injects a leukotriene B4 inhibitor into a rat and observes an abnormal cell response. Which of the following interleukins would most closely restore the function of one of the missing products? | Interleukin 8 | {
"A": "Interleukin 1",
"B": "Interleukin 4",
"C": "Interleukin 5",
"D": "Interleukin 8"
} | 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 researcher is studying how arachidonic acid metabolites mediate the inflammatory response in rats. She has developed multiple enzyme inhibitors that specifically target individual proteins in the arachidonic acid pathway. She injects these inhibitors in rats who have been exposed to common bacterial pathogens and analyzes their downstream effects. In one of her experiments, she injects a leukotriene B4 inhibitor into a rat and observes an abnormal cell response. Which of the following interleukins would most closely restore the function of one of the missing products?
Choose one of the following::
A. Interleukin 1
B. Interleukin 4
C. Interleukin 5
D. Interleukin 8 | [
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A 23-year-old man comes to the physician because of recurrent episodes of chest pain, shortness of breath, palpitations, and a sensation of choking. The symptoms usually resolve with deep breathing exercises after about 5 minutes. He now avoids going to his graduate school classes because he is worried about having another episode. Physical examination is unremarkable. Treatment with lorazepam is initiated. The concurrent intake of which of the following drugs should be avoided in this patient? | Diphenhydramine | {
"A": "Diphenhydramine",
"B": "Naloxone",
"C": "Fluoxetine",
"D": "Ondansetron"
} | step1 | A | [
"23 year old man",
"physician",
"recurrent episodes",
"chest pain",
"shortness of breath",
"palpitations",
"sensation",
"choking",
"symptoms usually resolve",
"deep breathing exercises",
"about",
"minutes",
"now",
"graduate school classes",
"worried",
"episode",
"Physical examination",
"unremarkable",
"Treatment",
"lorazepam",
"initiated",
"concurrent intake",
"following drugs",
"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 23-year-old man comes to the physician because of recurrent episodes of chest pain, shortness of breath, palpitations, and a sensation of choking. The symptoms usually resolve with deep breathing exercises after about 5 minutes. He now avoids going to his graduate school classes because he is worried about having another episode. Physical examination is unremarkable. Treatment with lorazepam is initiated. The concurrent intake of which of the following drugs should be avoided in this patient?
Choose one of the following::
A. Diphenhydramine
B. Naloxone
C. Fluoxetine
D. Ondansetron | [
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A 17-year-old girl with a BMI of 14.5 kg/m2 is admitted to the hospital for the treatment of anorexia nervosa. The patient is administered intravenous fluids and is supplied with 1,600 calories daily with an increase of 200 calories each day. On day 5 of treatment, the patient manifests symptoms of weakness and confusion, and dark brown urine. Which of the following clinical conditions is the most likely cause of the patient's symptoms? | Hypophosphatemia | {
"A": "Hypercalcemia",
"B": "Hypermagnesemia",
"C": "Hypophosphatemia",
"D": "Thiamine deficiency"
} | step2&3 | C | [
"year old girl",
"BMI",
"kg/m2",
"admitted",
"hospital",
"treatment",
"anorexia nervosa",
"patient",
"administered intravenous fluids",
"supplied",
"600 calories daily",
"increase",
"200 calories",
"day",
"day 5",
"treatment",
"patient manifests symptoms",
"weakness",
"confusion",
"dark",
"following clinical conditions",
"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 17-year-old girl with a BMI of 14.5 kg/m2 is admitted to the hospital for the treatment of anorexia nervosa. The patient is administered intravenous fluids and is supplied with 1,600 calories daily with an increase of 200 calories each day. On day 5 of treatment, the patient manifests symptoms of weakness and confusion, and dark brown urine. Which of the following clinical conditions is the most likely cause of the patient's symptoms?
Choose one of the following::
A. Hypercalcemia
B. Hypermagnesemia
C. Hypophosphatemia
D. Thiamine deficiency | [
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A 25-year-old woman is brought to the emergency department after being involved in a rear-end collision, in which she was the restrained driver of the back car. On arrival, she is alert and active. She reports pain in both knees and severe pain over the right groin. Temperature is 37°C (98.6°F), pulse is 116/min, respirations are 19/min, and blood pressure is 132/79 mm Hg. Physical examination shows tenderness over both knee caps. The right groin is tender to palpation. The right leg is slightly shortened, flexed, adducted, and internally rotated. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis? | Posterior hip dislocation | {
"A": "Femoral neck fracture",
"B": "Anterior hip dislocation",
"C": "Femoral shaft fracture",
"D": "Posterior hip dislocation"
} | step2&3 | D | [
"year old woman",
"brought",
"emergency department",
"involved",
"rear-end collision",
"restrained driver of",
"back car",
"arrival",
"alert",
"active",
"reports pain in both knees",
"severe pain",
"right",
"Temperature",
"98",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Physical examination shows tenderness",
"knee",
"right groin",
"tender",
"palpation",
"right leg",
"slightly shortened",
"flexed",
"adducted",
"internally rotated",
"examination shows",
"abnormalities",
"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 25-year-old woman is brought to the emergency department after being involved in a rear-end collision, in which she was the restrained driver of the back car. On arrival, she is alert and active. She reports pain in both knees and severe pain over the right groin. Temperature is 37°C (98.6°F), pulse is 116/min, respirations are 19/min, and blood pressure is 132/79 mm Hg. Physical examination shows tenderness over both knee caps. The right groin is tender to palpation. The right leg is slightly shortened, flexed, adducted, and internally rotated. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Femoral neck fracture
B. Anterior hip dislocation
C. Femoral shaft fracture
D. Posterior hip dislocation | [
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An investigator is studying human genetics and cell division. A molecule is used to inhibit the exchange of genetic material between homologous chromosomes. Which of the following phases of the cell cycle does the molecule target? | Prophase I | {
"A": "Telophase I",
"B": "Metaphase II",
"C": "Prophase I",
"D": "Anaphase I"
} | step1 | C | [
"investigator",
"studying human genetics",
"cell division",
"molecule",
"used to inhibit",
"exchange",
"genetic",
"homologous chromosomes",
"following phases",
"cell cycle",
"molecule target"
] | 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 is studying human genetics and cell division. A molecule is used to inhibit the exchange of genetic material between homologous chromosomes. Which of the following phases of the cell cycle does the molecule target?
Choose one of the following::
A. Telophase I
B. Metaphase II
C. Prophase I
D. Anaphase I | [
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An investigator is studying neuronal regeneration. For microscopic visualization of the neuron, an aniline stain is applied. After staining, only the soma and dendrites of the neurons are visualized, not the axon. Presence of which of the following cellular elements best explains this staining pattern? | Rough endoplasmic reticulum | {
"A": "Microtubule",
"B": "Nucleus",
"C": "Lysosome",
"D": "Rough endoplasmic reticulum"
} | step1 | D | [
"investigator",
"studying neuronal regeneration",
"microscopic visualization",
"neuron",
"aniline stain",
"applied",
"staining",
"only",
"soma",
"dendrites",
"neurons",
"visualized",
"not",
"axon",
"Presence of",
"following cellular elements best",
"staining pattern"
] | 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 is studying neuronal regeneration. For microscopic visualization of the neuron, an aniline stain is applied. After staining, only the soma and dendrites of the neurons are visualized, not the axon. Presence of which of the following cellular elements best explains this staining pattern?
Choose one of the following::
A. Microtubule
B. Nucleus
C. Lysosome
D. Rough endoplasmic reticulum | [
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A 67-year-old woman presents to a surgeon with a painless, slowly growing ulcer in the periauricular region for the last 2 months. On physical examination, there is an irregular-shaped ulcer, 2 cm x 1 cm in its dimensions, with irregular margins and crusting over the surface. The woman is a fair-skinned individual who loves to go sunbathing. There is no family history of malignancy. After a complete physical examination, the surgeon performs a biopsy of the lesion under local anesthesia and sends the tissue for histopathological examination. The pathologist confirms the diagnosis of squamous cell carcinoma of the skin. When she asks about the cause, the surgeon explains that there are many possible causes, but it is likely that she has developed squamous cell carcinoma on her face due to repeated exposure to ultraviolet rays from the sun, especially ultraviolet B (UVB) rays. If the surgeon’s opinion is correct, which of the following mechanisms is most likely involved in the pathogenesis of the condition? | Intrastrand cross-linking of thymidine residues in DNA | {
"A": "Intrastrand cross-linking of thymidine residues in DNA",
"B": "Upregulation of expression of cyclin D2",
"C": "Activation of transcription factor NF-κB",
"D": "DNA damage caused by the formation of reactive oxygen species"
} | step1 | A | [
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"surgeon",
"painless",
"slowly",
"ulcer",
"region",
"last",
"months",
"physical examination",
"irregular shaped ulcer",
"2",
"dimensions",
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"crusting",
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"woman",
"fair-skinned individual",
"loves to go sunbathing",
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"malignancy",
"complete physical examination",
"surgeon performs",
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"pathologist confirms the diagnosis of squamous cell carcinoma",
"skin",
"cause",
"surgeon",
"possible causes",
"likely",
"squamous cell carcinoma",
"face due to repeated exposure",
"ultraviolet rays",
"sun",
"ultraviolet",
"rays",
"surgeons opinion",
"correct",
"following mechanisms",
"most likely involved",
"pathogenesis",
"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 67-year-old woman presents to a surgeon with a painless, slowly growing ulcer in the periauricular region for the last 2 months. On physical examination, there is an irregular-shaped ulcer, 2 cm x 1 cm in its dimensions, with irregular margins and crusting over the surface. The woman is a fair-skinned individual who loves to go sunbathing. There is no family history of malignancy. After a complete physical examination, the surgeon performs a biopsy of the lesion under local anesthesia and sends the tissue for histopathological examination. The pathologist confirms the diagnosis of squamous cell carcinoma of the skin. When she asks about the cause, the surgeon explains that there are many possible causes, but it is likely that she has developed squamous cell carcinoma on her face due to repeated exposure to ultraviolet rays from the sun, especially ultraviolet B (UVB) rays. If the surgeon’s opinion is correct, which of the following mechanisms is most likely involved in the pathogenesis of the condition?
Choose one of the following::
A. Intrastrand cross-linking of thymidine residues in DNA
B. Upregulation of expression of cyclin D2
C. Activation of transcription factor NF-κB
D. DNA damage caused by the formation of reactive oxygen species | [
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A 67-year-old man presents to the physician with profuse watery diarrhea along with fever and crampy abdominal pain. He has been taking an antibiotic course of cefixime for about a week to treat a respiratory tract infection. At the doctor’s office, his pulse is 112/min, the blood pressure is 100/66 mm Hg, the respirations are 22/min, and the temperature is 38.9°C (102.0°F). His oral mucosa appears dry and his abdomen is soft with vague diffuse tenderness. A digital rectal examination is normal. Laboratory studies show:
Hemoglobin 11.1 g/dL
Hematocrit 33%
Total leucocyte count 16,000/mm3
Serum lactate 0.9 mmol/L
Serum creatinine 1.1 mg/dL
What is most likely to confirm the diagnosis? | Identification of C. difficile toxin in stool | {
"A": "Identification of C. difficile toxin in stool",
"B": "Colonoscopy",
"C": "Abdominal X-ray",
"D": "CT scan of the abdomen"
} | step2&3 | A | [
"67 year old man presents",
"physician",
"watery diarrhea",
"fever",
"crampy abdominal pain",
"taking",
"antibiotic course",
"cefixime",
"about",
"week to treat",
"respiratory tract infection",
"doctors office",
"pulse",
"min",
"blood pressure",
"100 66 mm Hg",
"respirations",
"min",
"temperature",
"oral mucosa appears dry",
"abdomen",
"soft",
"vague diffuse tenderness",
"digital rectal examination",
"normal",
"Laboratory studies show",
"Hemoglobin",
"g dL Hematocrit 33",
"Total leucocyte count",
"Serum lactate",
"9 mmol/L",
"creatinine",
"mg dL",
"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 67-year-old man presents to the physician with profuse watery diarrhea along with fever and crampy abdominal pain. He has been taking an antibiotic course of cefixime for about a week to treat a respiratory tract infection. At the doctor’s office, his pulse is 112/min, the blood pressure is 100/66 mm Hg, the respirations are 22/min, and the temperature is 38.9°C (102.0°F). His oral mucosa appears dry and his abdomen is soft with vague diffuse tenderness. A digital rectal examination is normal. Laboratory studies show:
Hemoglobin 11.1 g/dL
Hematocrit 33%
Total leucocyte count 16,000/mm3
Serum lactate 0.9 mmol/L
Serum creatinine 1.1 mg/dL
What is most likely to confirm the diagnosis?
Choose one of the following::
A. Identification of C. difficile toxin in stool
B. Colonoscopy
C. Abdominal X-ray
D. CT scan of the abdomen | [
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A 45-year-old man presents to the emergency department with fever and easy bruising for 3 days. He has had fatigue for 2 weeks. He has no past medical history, and takes no medications. Excessive bleeding from intravenous lines was reported by the nurse. He does not smoke or drink alcohol. The temperature is 38.2°C (102.6°F), pulse is 105/min, respiration rate is 18/min, and blood pressure is 110/70 mm Hg. On physical examination, he has multiple purpura on the lower extremities and several ecchymoses on the lower back and buttocks. Petechiae are noticed on the soft palate. Cervical painless lymphadenopathy is detected on both sides. The examination of the lungs, heart, and abdomen shows no other abnormalities. The laboratory test results are as follows:
Hemoglobin 8 g/dL
Mean corpuscular volume 90 μm3
Leukocyte count 18,000/mm3
Platelet count 10,000/mm3
Partial thromboplastin time (activated) 60 seconds
Prothrombin time 25 seconds (INR: 2.2)
Fibrin split products Positive
Lactate dehydrogenase, serum 1,000 U/L
A Giemsa-stained peripheral blood smear is shown by the image. Intravenous fluids, blood products, and antibiotics are given to the patient. Based on the most likely diagnosis, which of the following is the best therapy for this patient at this time? | All-trans retinoic acid (ATRA) | {
"A": "All-trans retinoic acid (ATRA)",
"B": "Hematopoietic cell transplantation",
"C": "Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)",
"D": "Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD)"
} | step2&3 | A | [
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"soft palate",
"Cervical painless lymphadenopathy",
"detected",
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"mm3 Platelet",
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"INR",
"2.2",
"Fibrin split products Positive Lactate dehydrogenase",
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"Based",
"likely diagnosis",
"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 45-year-old man presents to the emergency department with fever and easy bruising for 3 days. He has had fatigue for 2 weeks. He has no past medical history, and takes no medications. Excessive bleeding from intravenous lines was reported by the nurse. He does not smoke or drink alcohol. The temperature is 38.2°C (102.6°F), pulse is 105/min, respiration rate is 18/min, and blood pressure is 110/70 mm Hg. On physical examination, he has multiple purpura on the lower extremities and several ecchymoses on the lower back and buttocks. Petechiae are noticed on the soft palate. Cervical painless lymphadenopathy is detected on both sides. The examination of the lungs, heart, and abdomen shows no other abnormalities. The laboratory test results are as follows:
Hemoglobin 8 g/dL
Mean corpuscular volume 90 μm3
Leukocyte count 18,000/mm3
Platelet count 10,000/mm3
Partial thromboplastin time (activated) 60 seconds
Prothrombin time 25 seconds (INR: 2.2)
Fibrin split products Positive
Lactate dehydrogenase, serum 1,000 U/L
A Giemsa-stained peripheral blood smear is shown by the image. Intravenous fluids, blood products, and antibiotics are given to the patient. Based on the most likely diagnosis, which of the following is the best therapy for this patient at this time?
Choose one of the following::
A. All-trans retinoic acid (ATRA)
B. Hematopoietic cell transplantation
C. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)
D. Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) | [
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A 2-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met? | Smiles in response to face | {
"A": "Absence of asymmetric tonic neck reflex",
"B": "Monosyllabic babble",
"C": "Smiles in response to face",
"D": "Stares at own hand"
} | step2&3 | C | [
"2 month old",
"brought",
"physician",
"well",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"breastfed",
"3 400 g",
"8 oz",
"birth",
"physician's office",
"appears well",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"5 200 g",
"8 oz",
"measures 57",
"length",
"physical examination",
"normal",
"following developmental milestones",
"patient",
"likely met"
] | 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-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?
Choose one of the following::
A. Absence of asymmetric tonic neck reflex
B. Monosyllabic babble
C. Smiles in response to face
D. Stares at own hand | [
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A 40-year-old female comes in with several months of unintentional weight loss, epigastric pain, and a sensation of abdominal pressure. She has diabetes well-controlled on metformin but no other prior medical history. She has not previously had any surgeries. On physical exam, her doctor notices brown velvety areas of pigmentation on her neck. Her doctor also notices an enlarged, left supraclavicular node. Endoscopic findings show a stomach wall that appears to be grossly thickened. Which of the following findings would most likely be seen on biopsy? | Cells with central mucin pool | {
"A": "Cells with central mucin pool",
"B": "Keratin pearls",
"C": "Psammoma bodies",
"D": "Peyer's patches"
} | step1 | A | [
"40 year old female",
"several months of unintentional weight loss",
"epigastric pain",
"sensation of abdominal pressure",
"diabetes well-controlled",
"metformin",
"prior medical history",
"not",
"surgeries",
"physical exam",
"doctor",
"brown",
"areas",
"pigmentation",
"neck",
"doctor",
"enlarged",
"left supraclavicular node",
"Endoscopic findings show",
"stomach wall",
"appears to",
"thickened",
"following findings",
"most likely",
"seen",
"biopsy"
] | 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 female comes in with several months of unintentional weight loss, epigastric pain, and a sensation of abdominal pressure. She has diabetes well-controlled on metformin but no other prior medical history. She has not previously had any surgeries. On physical exam, her doctor notices brown velvety areas of pigmentation on her neck. Her doctor also notices an enlarged, left supraclavicular node. Endoscopic findings show a stomach wall that appears to be grossly thickened. Which of the following findings would most likely be seen on biopsy?
Choose one of the following::
A. Cells with central mucin pool
B. Keratin pearls
C. Psammoma bodies
D. Peyer's patches | [
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A 6-year-old boy is brought to the emergency room by ambulance, accompanied by his kindergarten teacher. Emergency department staff attempt to call his parents, but they cannot be reached. The boy’s medical history is unknown. According to his teacher, the boy was eating in the cafeteria with friends when he suddenly complained of itching and developed a widespread rash. Physical exam is notable for diffuse hives and tongue edema. His pulse is 100/min and blood pressure is 90/60 mmHg. The boy appears frightened and tells you that he does not want any treatment until his parents arrive. Which of the following is the next best step in the management of this patient? | Immediately administer epinephrine and sedate and intubate the patient | {
"A": "Continue calling the patient’s parents and do not intubate until verbal consent is obtained over the phone",
"B": "Immediately administer epinephrine and sedate and intubate the patient",
"C": "Obtain written consent to intubate from the patient’s teacher",
"D": "Wait for the patient's parents to arrive, calm the patient, and provide written consent before intubating"
} | step1 | B | [
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"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 boy is brought to the emergency room by ambulance, accompanied by his kindergarten teacher. Emergency department staff attempt to call his parents, but they cannot be reached. The boy’s medical history is unknown. According to his teacher, the boy was eating in the cafeteria with friends when he suddenly complained of itching and developed a widespread rash. Physical exam is notable for diffuse hives and tongue edema. His pulse is 100/min and blood pressure is 90/60 mmHg. The boy appears frightened and tells you that he does not want any treatment until his parents arrive. Which of the following is the next best step in the management of this patient?
Choose one of the following::
A. Continue calling the patient’s parents and do not intubate until verbal consent is obtained over the phone
B. Immediately administer epinephrine and sedate and intubate the patient
C. Obtain written consent to intubate from the patient’s teacher
D. Wait for the patient's parents to arrive, calm the patient, and provide written consent before intubating | [
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A 12-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child? | Growth | {
"A": "Gross motor skills",
"B": "Growth",
"C": "Fine motor skills",
"D": "Social skills"
} | step2&3 | B | [
"month old boy",
"brought",
"physician",
"well",
"born",
"weeks",
"gestation",
"48",
"length",
"g",
"oz",
"currently 60",
"length",
"7",
"g",
"17",
"7 oz",
"walk",
"one hand held",
"throw",
"small ball",
"pick",
"object",
"thumb",
"index finger",
"wave",
"mama",
"oh",
"cries",
"left to play",
"alone",
"Physical examination shows",
"abnormalities",
"following",
"most likely delayed",
"child"
] | 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-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child?
Choose one of the following::
A. Gross motor skills
B. Growth
C. Fine motor skills
D. Social skills | [
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} |
A 27-year-old woman presents to the emergency department with right lower quadrant abdominal pain and vaginal spotting. She denies diarrhea, constipation, or blood in the stool. The medical history is unremarkable. She does not use tobacco or drink alcohol. She is sexually active with her husband and uses an IUD for contraception. The temperature is 37.2 °C (99.0°F), the blood pressure is 110/70 mm Hg, the pulse is 80/min, and the respiratory rate is 12/min. The physical examination reveals localized tenderness in the right adnexa, but no masses are palpated. The LMP was 8 weeks ago. Which of the following is most likely associated with this patient’s diagnosis? | Positive urinary beta-HCG and no intrauterine mass | {
"A": "Physical examination reveals rebound tenderness and tenderness at McBurney’s point",
"B": "Positive urinary beta-HCG and no intrauterine mass",
"C": "Barium enema shows true diverticuli in the colon",
"D": "Positive urinary beta-HCG and some products of conception in the uterus"
} | step2&3 | B | [
"27 year old woman presents",
"emergency department",
"right lower quadrant abdominal pain",
"vaginal spotting",
"denies diarrhea",
"constipation",
"blood in",
"stool",
"medical history",
"unremarkable",
"not use tobacco",
"drink alcohol",
"sexually active",
"husband",
"uses",
"IUD",
"contraception",
"temperature",
"99",
"blood pressure",
"70 mm Hg",
"pulse",
"80 min",
"respiratory rate",
"min",
"physical examination reveals localized tenderness",
"right",
"masses",
"palpated",
"LMP",
"weeks",
"following",
"most likely associated with",
"patients 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 27-year-old woman presents to the emergency department with right lower quadrant abdominal pain and vaginal spotting. She denies diarrhea, constipation, or blood in the stool. The medical history is unremarkable. She does not use tobacco or drink alcohol. She is sexually active with her husband and uses an IUD for contraception. The temperature is 37.2 °C (99.0°F), the blood pressure is 110/70 mm Hg, the pulse is 80/min, and the respiratory rate is 12/min. The physical examination reveals localized tenderness in the right adnexa, but no masses are palpated. The LMP was 8 weeks ago. Which of the following is most likely associated with this patient’s diagnosis?
Choose one of the following::
A. Physical examination reveals rebound tenderness and tenderness at McBurney’s point
B. Positive urinary beta-HCG and no intrauterine mass
C. Barium enema shows true diverticuli in the colon
D. Positive urinary beta-HCG and some products of conception in the uterus | [
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A 58-year-old man with a past medical history of diabetes, hypertension, and hyperlipidemia was brought into the emergency department by his wife after she observed him go without sleep for several days and recently open and max out several credit cards. She also reports that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The patient has no previous psychiatric history. Routine medical examination, investigations, and toxicology rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal function. What is the single best treatment for this patient? | Valproic acid | {
"A": "Valproic acid",
"B": "Lithium",
"C": "Pregabalin",
"D": "Lamotrigine"
} | step1 | A | [
"58 year old man",
"past medical history of diabetes",
"hypertension",
"hyperlipidemia",
"brought",
"emergency department",
"wife",
"observed",
"go",
"sleep",
"several days",
"recently open",
"out",
"credit cards",
"reports",
"quit",
"job",
"excessively talkative",
"easily",
"weeks",
"patient",
"previous psychiatric history",
"Routine medical examination",
"investigations",
"toxicology rule out",
"medical cause",
"substance abuse",
"Lab results",
"consistent with",
"impaired renal function",
"single best treatment",
"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 58-year-old man with a past medical history of diabetes, hypertension, and hyperlipidemia was brought into the emergency department by his wife after she observed him go without sleep for several days and recently open and max out several credit cards. She also reports that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The patient has no previous psychiatric history. Routine medical examination, investigations, and toxicology rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal function. What is the single best treatment for this patient?
Choose one of the following::
A. Valproic acid
B. Lithium
C. Pregabalin
D. Lamotrigine | [
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A 42-year-old woman comes to the physician for the evaluation of a 1-month history of dull lower abdominal pain, decreased appetite, and a 5-kg (11-lb) weight loss. Physical examination shows no abnormalities. Pelvic ultrasonography shows bilateral ovarian enlargement and free fluid in the rectouterine pouch. Biopsy specimens from the ovaries show multiple, round, mucin-filled cells with flat, peripheral nuclei. Further evaluation of this patient is most likely to show which of the following findings? | Gastric wall thickening | {
"A": "Decreased TSH levels",
"B": "Increased testosterone levels",
"C": "Dark blue peritoneal spots",
"D": "Gastric wall thickening"
} | step1 | D | [
"year old woman",
"physician",
"evaluation",
"month history",
"dull lower abdominal pain",
"decreased appetite",
"5 kg",
"weight loss",
"Physical examination shows",
"abnormalities",
"Pelvic ultrasonography shows bilateral ovarian enlargement",
"free fluid",
"rectouterine pouch",
"Biopsy specimens",
"ovaries show multiple",
"round",
"mucin filled cells",
"flat",
"peripheral nuclei",
"Further evaluation of",
"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 42-year-old woman comes to the physician for the evaluation of a 1-month history of dull lower abdominal pain, decreased appetite, and a 5-kg (11-lb) weight loss. Physical examination shows no abnormalities. Pelvic ultrasonography shows bilateral ovarian enlargement and free fluid in the rectouterine pouch. Biopsy specimens from the ovaries show multiple, round, mucin-filled cells with flat, peripheral nuclei. Further evaluation of this patient is most likely to show which of the following findings?
Choose one of the following::
A. Decreased TSH levels
B. Increased testosterone levels
C. Dark blue peritoneal spots
D. Gastric wall thickening | [
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A 71-year-old man presents to the clinic with complaints of right wrist pain for 2 days. On examination, redness and swelling were noted on the dorsal aspect of his right wrist. He had pain with extreme range of motion of the wrist. His history includes 2 hip replacements, 2 previous episodes of gout in both first metatarsophalangeal joints, and hypertension. Two days later, the swelling had increased in the dorsal aspect of his right wrist and hand. Wrist flexion was limited to 80% with severe pain. The pain was present on palpation of the scaphoid bone. Due to the suspicion of fracture, the patient was referred to his general practitioner for radiographs. These findings were consistent with gouty arthritis. What is the most likely cytokine involved in this process? | IL-1 | {
"A": "IL-1",
"B": "IL-10",
"C": "INFγ",
"D": "IL-5"
} | step1 | A | [
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"80",
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"pain",
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"scaphoid bone",
"Due to",
"suspicion",
"fracture",
"patient",
"referred",
"general practitioner",
"radiographs",
"findings",
"consistent with gouty arthritis",
"most likely cytokine involved",
"process"
] | 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 clinic with complaints of right wrist pain for 2 days. On examination, redness and swelling were noted on the dorsal aspect of his right wrist. He had pain with extreme range of motion of the wrist. His history includes 2 hip replacements, 2 previous episodes of gout in both first metatarsophalangeal joints, and hypertension. Two days later, the swelling had increased in the dorsal aspect of his right wrist and hand. Wrist flexion was limited to 80% with severe pain. The pain was present on palpation of the scaphoid bone. Due to the suspicion of fracture, the patient was referred to his general practitioner for radiographs. These findings were consistent with gouty arthritis. What is the most likely cytokine involved in this process?
Choose one of the following::
A. IL-1
B. IL-10
C. INFγ
D. IL-5 | [
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A group of investigators have conducted a randomized clinical trial to evaluate the efficacy of adding a novel adenosine A1 receptor agonist to the standard anti-epileptic treatment in reducing the frequency of focal seizures. It was found that patients taking the combination regimen (n = 200) had a lower seizure frequency compared to patients taking the standard treatment alone (n = 200; p < 0.01). However, several participants taking the novel drug reported severe drowsiness. The investigators administered a survey to both the combination treatment group and standard treatment group to evaluate whether the drowsiness interfered with daily functioning using a yes or no questionnaire. Results are shown:
Interference with daily functioning Yes (number of patients) No (number of patients)
Combination treatment group 115 85
Standard treatment group 78 122
Which of the following statistical methods would be most appropriate for assessing the statistical significance of these results?" | Chi-square test | {
"A": "Multiple linear regression",
"B": "Chi-square test",
"C": "Unpaired t-test",
"D": "Analysis of variance"
} | 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 group of investigators have conducted a randomized clinical trial to evaluate the efficacy of adding a novel adenosine A1 receptor agonist to the standard anti-epileptic treatment in reducing the frequency of focal seizures. It was found that patients taking the combination regimen (n = 200) had a lower seizure frequency compared to patients taking the standard treatment alone (n = 200; p < 0.01). However, several participants taking the novel drug reported severe drowsiness. The investigators administered a survey to both the combination treatment group and standard treatment group to evaluate whether the drowsiness interfered with daily functioning using a yes or no questionnaire. Results are shown:
Interference with daily functioning Yes (number of patients) No (number of patients)
Combination treatment group 115 85
Standard treatment group 78 122
Which of the following statistical methods would be most appropriate for assessing the statistical significance of these results?"
Choose one of the following::
A. Multiple linear regression
B. Chi-square test
C. Unpaired t-test
D. Analysis of variance | [
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A 39-year-old male presents to your office with nodular skin lesions that progress from his right hand to right shoulder. The patient reports that the initial lesion, currently necrotic and ulcerative, developed from an injury he received while weeding his shrubs a couple weeks earlier. The patient denies symptoms of respiratory or meningeal disease. Which of the following most likely characterizes the pattern of this patient’s skin lesions: | Ascending lymphangitis | {
"A": "Contact dermatitis",
"B": "Hematogenous dissemination",
"C": "Dermatophyte colonization",
"D": "Ascending lymphangitis"
} | step1 | D | [
"year old male presents",
"office",
"nodular skin lesions",
"progress",
"right hand",
"right shoulder",
"patient reports",
"initial lesion",
"currently necrotic",
"ulcerative",
"injury",
"received",
"weeding",
"couple weeks earlier",
"patient denies symptoms",
"respiratory",
"meningeal disease",
"following most likely characterizes",
"pattern",
"patients skin lesions"
] | 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 39-year-old male presents to your office with nodular skin lesions that progress from his right hand to right shoulder. The patient reports that the initial lesion, currently necrotic and ulcerative, developed from an injury he received while weeding his shrubs a couple weeks earlier. The patient denies symptoms of respiratory or meningeal disease. Which of the following most likely characterizes the pattern of this patient’s skin lesions:
Choose one of the following::
A. Contact dermatitis
B. Hematogenous dissemination
C. Dermatophyte colonization
D. Ascending lymphangitis | [
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A 17-year-old Latin American woman with no significant past medical history or family history presents to her pediatrician with concerns about several long-standing skin lesions. She notes that she has had a light-colored rash on her chest and abdomen that has been present for the last 2 years. The blood pressure is 111/81 mm Hg, pulse is 82/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals numerous hypopigmented macules over her chest and abdomen. No lesions are seen on her palms or soles. When questioned, she states that these lesions do not tan like the rest of her skin when exposed to the sun. The remainder of her review of systems is negative. What is the most likely cause of these lesions? | Malassezia yeast | {
"A": "Malassezia yeast",
"B": "Cutaneous T cell lymphoma",
"C": "TYR gene dysfunction in melanocytes",
"D": "Treponema pallidum infection"
} | step2&3 | A | [
"year old Latin American woman",
"significant past medical history",
"family history presents",
"pediatrician",
"concerns",
"long standing skin lesions",
"notes",
"light-colored rash",
"chest",
"abdomen",
"present",
"years",
"blood pressure",
"81 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"temperature",
"3C",
"99",
"Physical examination reveals numerous hypopigmented macules",
"chest",
"abdomen",
"lesions",
"seen",
"palms",
"soles",
"questioned",
"states",
"lesions",
"not tan",
"rest",
"skin",
"exposed",
"sun",
"of",
"review",
"systems",
"negative",
"most likely cause",
"lesions"
] | 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 17-year-old Latin American woman with no significant past medical history or family history presents to her pediatrician with concerns about several long-standing skin lesions. She notes that she has had a light-colored rash on her chest and abdomen that has been present for the last 2 years. The blood pressure is 111/81 mm Hg, pulse is 82/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals numerous hypopigmented macules over her chest and abdomen. No lesions are seen on her palms or soles. When questioned, she states that these lesions do not tan like the rest of her skin when exposed to the sun. The remainder of her review of systems is negative. What is the most likely cause of these lesions?
Choose one of the following::
A. Malassezia yeast
B. Cutaneous T cell lymphoma
C. TYR gene dysfunction in melanocytes
D. Treponema pallidum infection | [
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A 45-year-old male presents to the emergency room complaining of severe diarrhea. He recently returned from a business trip to Bangladesh. Since returning, he has experienced several loose bloody stools per day that are accompanied by abdominal cramping and occasional nausea and vomiting. His temperature is 101.7°F (38.7°C), blood pressure is 100/60 mmHg, pulse is 120/min, and respirations are 20/min. On examination, he demonstrates mild tenderness to palpation throughout his abdomen, delayed capillary refill, and dry mucus membranes. Results from a stool sample and subsequent stool culture are pending. What is the mechanism of action of the toxin elaborated by the pathogen responsible for this patient’s current condition? | Inhibition of 60S ribosomal subunit | {
"A": "ADP-ribosylation of elongation factor 2",
"B": "Stimulation of guanylyl cyclase",
"C": "ADP-ribosylation of a G protein",
"D": "Inhibition of 60S ribosomal subunit"
} | step1 | D | [
"year old male presents",
"emergency room",
"severe diarrhea",
"recently returned",
"business trip",
"Bangladesh",
"Since returning",
"loose bloody",
"day",
"abdominal cramping",
"occasional nausea",
"vomiting",
"temperature",
"blood pressure",
"100 60 mmHg",
"pulse",
"min",
"respirations",
"20 min",
"examination",
"demonstrates mild tenderness",
"palpation",
"abdomen",
"delayed capillary refill",
"dry mucus membranes",
"Results",
"stool sample",
"subsequent stool culture",
"mechanism of action",
"toxin",
"pathogen responsible",
"patients current 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 45-year-old male presents to the emergency room complaining of severe diarrhea. He recently returned from a business trip to Bangladesh. Since returning, he has experienced several loose bloody stools per day that are accompanied by abdominal cramping and occasional nausea and vomiting. His temperature is 101.7°F (38.7°C), blood pressure is 100/60 mmHg, pulse is 120/min, and respirations are 20/min. On examination, he demonstrates mild tenderness to palpation throughout his abdomen, delayed capillary refill, and dry mucus membranes. Results from a stool sample and subsequent stool culture are pending. What is the mechanism of action of the toxin elaborated by the pathogen responsible for this patient’s current condition?
Choose one of the following::
A. ADP-ribosylation of elongation factor 2
B. Stimulation of guanylyl cyclase
C. ADP-ribosylation of a G protein
D. Inhibition of 60S ribosomal subunit | [
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An 80-year-old woman seeks evaluation at an outpatient clinic for a firm nodular lump on the left side of her labia. The medical history is notable for hypertension, coronary artery disease status post CABG, and lichen sclerosus of the vagina that was treated with an over-the-counter steroid cream as needed. She first noticed the lump about 5 months ago. On physical examination, the temperature is 37°C (98.6°F), the blood pressure is 135/89 mm Hg, the pulse is 95/min, and the respiratory rate is 17/min. Examination of the genital area reveals a small nodular lump on the left labium majus with visible excoriations, but no white plaque-like lesions. What is the next best step in management? | Vulvar punch biopsy | {
"A": "HPV DNA testing",
"B": "Estrogen level measurement",
"C": "Pap smear",
"D": "Vulvar punch biopsy"
} | step2&3 | D | [
"80 year old woman",
"evaluation",
"outpatient clinic",
"firm nodular lump",
"left side",
"labia",
"medical history",
"notable",
"hypertension",
"coronary artery disease status post CABG",
"lichen sclerosus",
"vagina",
"treated with",
"over-the-counter steroid cream as needed",
"first",
"lump",
"months",
"physical examination",
"temperature",
"98",
"blood pressure",
"mm Hg",
"pulse",
"95 min",
"respiratory rate",
"min",
"Examination",
"genital area reveals",
"small nodular lump",
"left labium majus",
"visible excoriations",
"white plaque-like lesions",
"next best 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: An 80-year-old woman seeks evaluation at an outpatient clinic for a firm nodular lump on the left side of her labia. The medical history is notable for hypertension, coronary artery disease status post CABG, and lichen sclerosus of the vagina that was treated with an over-the-counter steroid cream as needed. She first noticed the lump about 5 months ago. On physical examination, the temperature is 37°C (98.6°F), the blood pressure is 135/89 mm Hg, the pulse is 95/min, and the respiratory rate is 17/min. Examination of the genital area reveals a small nodular lump on the left labium majus with visible excoriations, but no white plaque-like lesions. What is the next best step in management?
Choose one of the following::
A. HPV DNA testing
B. Estrogen level measurement
C. Pap smear
D. Vulvar punch biopsy | [
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A 75-year-old male is hospitalized for bloody diarrhea and abdominal pain after meals. Endoscopic work-up and CT scan lead the attending physician to diagnose ischemic colitis at the splenic flexure. Which of the following would most likely predispose this patient to ischemic colitis: | Obstruction of the abdominal aorta following surgery | {
"A": "Increased splanchnic blood flow following a large meal",
"B": "Essential hypertension",
"C": "Obstruction of the abdominal aorta following surgery",
"D": "Juxtaglomerular cell tumor"
} | step1 | C | [
"75 year old male",
"hospitalized",
"bloody diarrhea",
"abdominal pain",
"meals",
"Endoscopic work-up",
"CT scan lead",
"attending physician to diagnose ischemic colitis",
"splenic flexure",
"following",
"most likely",
"patient",
"ischemic colitis"
] | 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 75-year-old male is hospitalized for bloody diarrhea and abdominal pain after meals. Endoscopic work-up and CT scan lead the attending physician to diagnose ischemic colitis at the splenic flexure. Which of the following would most likely predispose this patient to ischemic colitis:
Choose one of the following::
A. Increased splanchnic blood flow following a large meal
B. Essential hypertension
C. Obstruction of the abdominal aorta following surgery
D. Juxtaglomerular cell tumor | [
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Two days following the home birth of her son, a mother brings the infant to the pediatric emergency room because of bilious vomiting. He is unable to pass meconium and his abdomen is distended. Endoscopic biopsy of the proximal colon demonstrates an absence of Meissner’s and Auerbach’s plexi in the bowel wall. Which of the following is the most likely diagnosis? | Hirschsprung’s disease | {
"A": "Hirschsprung’s disease",
"B": "Ileocecal intussusception",
"C": "Meckel’s diverticulum",
"D": "Juvenile polyposis syndrome"
} | step1 | A | [
"Two days following",
"home birth",
"son",
"mother",
"infant",
"pediatric emergency room",
"bilious vomiting",
"unable to pass meconium",
"abdomen",
"distended",
"Endoscopic biopsy of",
"proximal colon demonstrates",
"absence",
"Auerbachs plexi",
"bowel wall",
"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: Two days following the home birth of her son, a mother brings the infant to the pediatric emergency room because of bilious vomiting. He is unable to pass meconium and his abdomen is distended. Endoscopic biopsy of the proximal colon demonstrates an absence of Meissner’s and Auerbach’s plexi in the bowel wall. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Hirschsprung’s disease
B. Ileocecal intussusception
C. Meckel’s diverticulum
D. Juvenile polyposis syndrome | [
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A 49-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. His vital signs are within normal limits. Physical examination shows tanned skin and small testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a liver biopsy specimen shows intracellular material that stains with Prussian blue. This patient is at greatest risk for developing which of the following complications? | Restrictive cardiomyopathy | {
"A": "Colorectal carcinoma",
"B": "Restrictive cardiomyopathy",
"C": "Pancreatic adenocarcinoma",
"D": "Non-Hodgkin lymphoma"
} | step1 | B | [
"year old man",
"physician",
"month history",
"increasing fatigue",
"reduced libido",
"joint pain",
"hands",
"vital signs",
"normal",
"Physical examination shows tanned skin",
"small testes",
"second",
"third",
"joints of",
"hands",
"tender",
"palpation",
"range of motion",
"limited",
"liver",
"palpated 2",
"3 cm",
"right costal margin",
"Histopathologic examination of",
"liver biopsy specimen shows intracellular material",
"stains",
"Prussian blue",
"patient",
"greatest 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 49-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. His vital signs are within normal limits. Physical examination shows tanned skin and small testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a liver biopsy specimen shows intracellular material that stains with Prussian blue. This patient is at greatest risk for developing which of the following complications?
Choose one of the following::
A. Colorectal carcinoma
B. Restrictive cardiomyopathy
C. Pancreatic adenocarcinoma
D. Non-Hodgkin lymphoma | [
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A general surgery intern is paged to the bedside of a 59-year-old male who underwent a successful sigmoidectomy for treatment of recurrent diverticulitis. The patient's nurse just recorded a temperature of 38.7 C, and relates that the patient is complaining of chills. The surgery was completed 8 hours ago and was complicated by extensive bleeding, with an estimated blood loss of 1,700 mL. Post-operative anemia was diagnosed after a hemoglobin of 5.9 g/dL was found; 2 units of packed red blood cells were ordered, and the transfusion was initiated 90 minutes ago. The patient's vital signs are as follows: T 38.7 C, HR 88, BP 138/77, RR 18, SpO2 98%. Physical examination does not show any abnormalities. After immediately stopping the transfusion, which of the following is the best management of this patient's condition? | Monitor patient and administer acetaminophen | {
"A": "Monitor patient and administer acetaminophen",
"B": "Prescribe diphenhydramine",
"C": "Start supplemental oxygen by nasal cannula",
"D": "Initiate broad spectrum antibiotics"
} | 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 general surgery intern is paged to the bedside of a 59-year-old male who underwent a successful sigmoidectomy for treatment of recurrent diverticulitis. The patient's nurse just recorded a temperature of 38.7 C, and relates that the patient is complaining of chills. The surgery was completed 8 hours ago and was complicated by extensive bleeding, with an estimated blood loss of 1,700 mL. Post-operative anemia was diagnosed after a hemoglobin of 5.9 g/dL was found; 2 units of packed red blood cells were ordered, and the transfusion was initiated 90 minutes ago. The patient's vital signs are as follows: T 38.7 C, HR 88, BP 138/77, RR 18, SpO2 98%. Physical examination does not show any abnormalities. After immediately stopping the transfusion, which of the following is the best management of this patient's condition?
Choose one of the following::
A. Monitor patient and administer acetaminophen
B. Prescribe diphenhydramine
C. Start supplemental oxygen by nasal cannula
D. Initiate broad spectrum antibiotics | [
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A 22-year-old man presents to the emergency department with anxiety. The patient states that he is very anxious and has not been able to take his home anxiety medications. He is requesting to have his home medications administered. The patient has a past medical history of anxiety and depression. His current medications include clonazepam, amitriptyline, and lorazepam. Notably, the patient has multiple psychiatric providers who currently care for him. His temperature is 99.2°F (37.3°C), blood pressure is 130/85 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for an anxious, sweating, and tremulous young man who becomes more confused during his stay in the emergency department. Which of the following should be given to this patient? | Diazepam | {
"A": "Diazepam",
"B": "Midazolam",
"C": "Sodium bicarbonate",
"D": "Supportive therapy and monitoring"
} | step2&3 | A | [
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"home medications administered",
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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 22-year-old man presents to the emergency department with anxiety. The patient states that he is very anxious and has not been able to take his home anxiety medications. He is requesting to have his home medications administered. The patient has a past medical history of anxiety and depression. His current medications include clonazepam, amitriptyline, and lorazepam. Notably, the patient has multiple psychiatric providers who currently care for him. His temperature is 99.2°F (37.3°C), blood pressure is 130/85 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for an anxious, sweating, and tremulous young man who becomes more confused during his stay in the emergency department. Which of the following should be given to this patient?
Choose one of the following::
A. Diazepam
B. Midazolam
C. Sodium bicarbonate
D. Supportive therapy and monitoring | [
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An 18-year-old female returning from a trip to a developing country presents with diarrhea and pain in the abdominal region. Microscopic evaluation of the stool reveals the presence of RBC's and WBC's. The patient reports poor sewage sanitation in the region she visited. The physician suspects a bacterial infection and culture reveals Gram-negative rods that are non-lactose fermenting. The A subunit of the bacteria's toxin acts to: | Inhibit the 60S ribosome | {
"A": "Inhibit the 60S ribosome",
"B": "Lyse red blood cells",
"C": "Prevent phagocytosis",
"D": "Inhibit exocytosis of ACh from synaptic terminals"
} | step1 | A | [
"year old female returning",
"trip",
"developing country presents",
"diarrhea",
"pain",
"abdominal region",
"Microscopic evaluation",
"stool reveals",
"presence",
"RBC's",
"WBC's",
"patient reports poor sewage sanitation",
"region",
"visited",
"physician suspects",
"bacterial infection",
"culture reveals Gram-negative rods",
"non lactose",
"subunit",
"bacteria's toxin acts to"
] | 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 18-year-old female returning from a trip to a developing country presents with diarrhea and pain in the abdominal region. Microscopic evaluation of the stool reveals the presence of RBC's and WBC's. The patient reports poor sewage sanitation in the region she visited. The physician suspects a bacterial infection and culture reveals Gram-negative rods that are non-lactose fermenting. The A subunit of the bacteria's toxin acts to:
Choose one of the following::
A. Inhibit the 60S ribosome
B. Lyse red blood cells
C. Prevent phagocytosis
D. Inhibit exocytosis of ACh from synaptic terminals | [
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A 51-year-old man with a recent diagnosis of peptic ulcer disease currently treated with an oral proton pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. On physical exam, you find his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patient management? | Urgent CT abdomen and pelvis | {
"A": "Abdominal radiographs",
"B": "Urgent CT abdomen and pelvis",
"C": "H. pylori testing",
"D": "Serum gastrin level"
} | step2&3 | B | [
"year old man",
"recent diagnosis",
"peptic ulcer disease currently treated with",
"oral proton pump inhibitor twice daily presents",
"urgent care center",
"acute abdominal pain",
"began",
"hours",
"physical exam",
"find",
"abdomen to",
"mildly distended",
"tender",
"palpation",
"positive",
"rebound tenderness",
"Given",
"following options",
"next best step",
"patient 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 51-year-old man with a recent diagnosis of peptic ulcer disease currently treated with an oral proton pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. On physical exam, you find his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patient management?
Choose one of the following::
A. Abdominal radiographs
B. Urgent CT abdomen and pelvis
C. H. pylori testing
D. Serum gastrin level | [
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A 31-year-old male presents to the emergency room following an altercation with patrons at a local grocery store. He is acting aggressively toward hospital staff and appears to be speaking to non-existent individuals. On examination he is tachycardic and diaphoretic. Horizontal and vertical nystagmus is noted. The patient eventually admits to taking an illegal substance earlier in the evening. Which of the following mechanisms of action is most consistent with the substance this patient took? | NMDA receptor antagonist | {
"A": "Adenosine antagonist",
"B": "Mu receptor agonist",
"C": "GABA agonist",
"D": "NMDA receptor antagonist"
} | step1 | D | [
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"illegal substance earlier",
"evening",
"of",
"following mechanisms",
"action",
"most consistent with",
"substance",
"patient took"
] | 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 male presents to the emergency room following an altercation with patrons at a local grocery store. He is acting aggressively toward hospital staff and appears to be speaking to non-existent individuals. On examination he is tachycardic and diaphoretic. Horizontal and vertical nystagmus is noted. The patient eventually admits to taking an illegal substance earlier in the evening. Which of the following mechanisms of action is most consistent with the substance this patient took?
Choose one of the following::
A. Adenosine antagonist
B. Mu receptor agonist
C. GABA agonist
D. NMDA receptor antagonist | [
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A 29-year-old female presents to her primary care provider complaining of pain and stiffness in her hands and knees. She reports that the stiffness is worse in the morning and appears to get better throughout the day. She is otherwise healthy and denies any recent illness. She does not play sports. On examination, her metacarpal-phalangeal (MCP) and proximal interphalangeal (PIP) joints are swollen and erythematous. Her distal interphalangeal (DIP) joints appear normal. She exhibits pain with both passive and active range of motion in her knees bilaterally. Serological analysis reveals high titers of anti-cyclic citrullinated peptide antibodies. Which of the following processes underlies this patient’s condition? | Synovial hypertrophy and pannus formation | {
"A": "Precipitation of monosodium urate crystals in the intra-articular space",
"B": "Post-infectious inflammation of the articular surfaces",
"C": "Degenerative deterioration of articular cartilage",
"D": "Synovial hypertrophy and pannus formation"
} | step1 | D | [
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"knees",
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"morning",
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"passive",
"active range of motion",
"knees",
"Serological analysis reveals high titers",
"anti-cyclic citrullinated peptide antibodies",
"following processes",
"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 29-year-old female presents to her primary care provider complaining of pain and stiffness in her hands and knees. She reports that the stiffness is worse in the morning and appears to get better throughout the day. She is otherwise healthy and denies any recent illness. She does not play sports. On examination, her metacarpal-phalangeal (MCP) and proximal interphalangeal (PIP) joints are swollen and erythematous. Her distal interphalangeal (DIP) joints appear normal. She exhibits pain with both passive and active range of motion in her knees bilaterally. Serological analysis reveals high titers of anti-cyclic citrullinated peptide antibodies. Which of the following processes underlies this patient’s condition?
Choose one of the following::
A. Precipitation of monosodium urate crystals in the intra-articular space
B. Post-infectious inflammation of the articular surfaces
C. Degenerative deterioration of articular cartilage
D. Synovial hypertrophy and pannus formation | [
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A 28-year-old man presents for severe abdominal pain and is diagnosed with appendicitis. He is taken for emergent appendectomy. During the procedure, the patient has massive and persistent bleeding requiring a blood transfusion. The preoperative laboratory studies showed a normal bleeding time, normal prothrombin time (PT), an INR of 1.0, and a normal platelet count. Postoperatively, when the patient is told about the complications during the surgery, he recalls that he forgot to mention that he has a family history of an unknown bleeding disorder. The postoperative laboratory tests reveal a prolonged partial thromboplastin time (PTT). Which of the following is the most likely diagnosis in this patient? | Hemophilia A | {
"A": "Hemophilia A",
"B": "Bernard-Soulier syndrome",
"C": "Glanzman syndrome",
"D": "Thrombotic thrombocytopenic purpura"
} | step2&3 | A | [
"year old man presents",
"severe abdominal",
"diagnosed",
"appendicitis",
"taken",
"emergent appendectomy",
"procedure",
"patient",
"massive",
"persistent bleeding",
"blood transfusion",
"preoperative laboratory studies showed",
"normal bleeding time",
"normal prothrombin time",
"INR",
"1.0",
"normal platelet count",
"patient",
"complications",
"surgery",
"recalls",
"forgot to",
"family history of",
"unknown bleeding disorder",
"postoperative laboratory tests reveal",
"prolonged partial thromboplastin time",
"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: A 28-year-old man presents for severe abdominal pain and is diagnosed with appendicitis. He is taken for emergent appendectomy. During the procedure, the patient has massive and persistent bleeding requiring a blood transfusion. The preoperative laboratory studies showed a normal bleeding time, normal prothrombin time (PT), an INR of 1.0, and a normal platelet count. Postoperatively, when the patient is told about the complications during the surgery, he recalls that he forgot to mention that he has a family history of an unknown bleeding disorder. The postoperative laboratory tests reveal a prolonged partial thromboplastin time (PTT). Which of the following is the most likely diagnosis in this patient?
Choose one of the following::
A. Hemophilia A
B. Bernard-Soulier syndrome
C. Glanzman syndrome
D. Thrombotic thrombocytopenic purpura | [
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An 11-year-old girl is brought to the emergency department because of high-grade fever, headache, and nausea for 3 days. She avoids looking at any light source because this aggravates her headache. She has acute lymphoblastic leukemia and her last chemotherapy cycle was 2 weeks ago. She appears lethargic. Her temperature is 40.1°C (104.2°F), pulse is 131/min and blood pressure is 100/60 mm Hg. Examination shows a stiff neck. The pupils are equal and reactive to light. Neck flexion results in flexion of the knee and hip. Muscle strength is decreased in the right upper extremity. Deep tendon reflexes are 2+ bilaterally. Sensation is intact. Extraocular movements are normal. Two sets of blood cultures are obtained. Which of the following is the most appropriate next step in management? | Antibiotic therapy | {
"A": "CT scan of the head",
"B": "MRI of the brain",
"C": "Antibiotic therapy",
"D": "Lumbar puncture"
} | step2&3 | C | [
"year old girl",
"brought",
"emergency department",
"high-grade fever",
"headache",
"nausea",
"3 days",
"looking",
"light source",
"aggravates",
"headache",
"acute lymphoblastic leukemia",
"last chemotherapy cycle",
"2 weeks",
"appears lethargic",
"temperature",
"40",
"pulse",
"min",
"blood pressure",
"100 60 mm Hg",
"Examination shows",
"stiff neck",
"pupils",
"equal",
"reactive to light",
"Neck flexion results in flexion of",
"knee",
"hip",
"Muscle",
"decreased",
"right upper extremity",
"Deep tendon reflexes",
"2",
"Sensation",
"intact",
"Extraocular movements",
"normal",
"Two sets of blood cultures",
"obtained",
"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: An 11-year-old girl is brought to the emergency department because of high-grade fever, headache, and nausea for 3 days. She avoids looking at any light source because this aggravates her headache. She has acute lymphoblastic leukemia and her last chemotherapy cycle was 2 weeks ago. She appears lethargic. Her temperature is 40.1°C (104.2°F), pulse is 131/min and blood pressure is 100/60 mm Hg. Examination shows a stiff neck. The pupils are equal and reactive to light. Neck flexion results in flexion of the knee and hip. Muscle strength is decreased in the right upper extremity. Deep tendon reflexes are 2+ bilaterally. Sensation is intact. Extraocular movements are normal. Two sets of blood cultures are obtained. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. CT scan of the head
B. MRI of the brain
C. Antibiotic therapy
D. Lumbar puncture | [
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A 49-year-old man presents to a new primary care provider complaining of fatigue and occasional fever over the last month. These symptoms are starting to affect his job and he would like treatment. The physician runs a standard metabolic panel that shows elevated AST and ALT. The patient is then tested for hepatitis viruses. He is hepatitis C positive. The patient and his doctor discuss treatment options and agree upon pegylated interferon and oral ribavirin. Which side-effect is most likely while taking the ribavirin? | Hemolytic anemia | {
"A": "Hemolytic anemia",
"B": "Drug-associated lupus",
"C": "Hyperthyroidism",
"D": "Rash"
} | step1 | A | [
"year old man presents",
"new primary care provider",
"fatigue",
"occasional fever",
"month",
"symptoms",
"starting to affect",
"job",
"treatment",
"physician runs",
"standard metabolic panel",
"shows elevated AST",
"ALT",
"patient",
"then tested",
"hepatitis viruses",
"hepatitis",
"positive",
"patient",
"doctor discuss treatment options",
"agree",
"interferon",
"oral ribavirin",
"side-effect",
"most likely",
"taking",
"ribavirin"
] | 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 49-year-old man presents to a new primary care provider complaining of fatigue and occasional fever over the last month. These symptoms are starting to affect his job and he would like treatment. The physician runs a standard metabolic panel that shows elevated AST and ALT. The patient is then tested for hepatitis viruses. He is hepatitis C positive. The patient and his doctor discuss treatment options and agree upon pegylated interferon and oral ribavirin. Which side-effect is most likely while taking the ribavirin?
Choose one of the following::
A. Hemolytic anemia
B. Drug-associated lupus
C. Hyperthyroidism
D. Rash | [
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A 45-year-old immigrant presents with unintentional weight loss, sleep hyperhidrosis, and a persistent cough. He says these symptoms have been present for quite some time. Upon imaging, many granulomas in the upper lobes are present. It is noted that these apical granulomas have centers of necrosis that appear cheese-like in appearance. Encircling the area of necrosis are large cells with cytoplasms pale in color. Of the following surface markers, which one is specific for these cells? | CD14 | {
"A": "CD8",
"B": "CD4",
"C": "CD3",
"D": "CD14"
} | step1 | D | [
"year old immigrant presents",
"unintentional weight loss",
"sleep hyperhidrosis",
"persistent cough",
"symptoms",
"present",
"time",
"imaging",
"granulomas",
"upper lobes",
"present",
"noted",
"apical granulomas",
"centers",
"necrosis",
"appear cheese",
"appearance",
"Encircling",
"area",
"necrosis",
"large cells",
"cytoplasms pale",
"color",
"following surface markers",
"one",
"specific",
"cells"
] | 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 immigrant presents with unintentional weight loss, sleep hyperhidrosis, and a persistent cough. He says these symptoms have been present for quite some time. Upon imaging, many granulomas in the upper lobes are present. It is noted that these apical granulomas have centers of necrosis that appear cheese-like in appearance. Encircling the area of necrosis are large cells with cytoplasms pale in color. Of the following surface markers, which one is specific for these cells?
Choose one of the following::
A. CD8
B. CD4
C. CD3
D. CD14 | [
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A 27-year-old woman comes to the emergency room because of fever and severe left knee pain for the past week. She has not sustained any trauma or injury to the area, nor has she traveled or taken part in outdoor activities in the recent past. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill. Her temperature is 38°C (100.4°F), pulse is 98/min, respirations are 17/min, and blood pressure is 106/72 mm Hg. Physical examination shows multiple painless pustular lesions on her ankles and the dorsum and soles of her feet bilaterally, as well as a swollen, erythematous, exquisitely tender left knee. Her wrists are also mildly edematous and tender, with pain on extension. X-ray of the knees shows tissue swelling. Arthrocentesis of the knee shows yellow purulent fluid. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 58,000/mm3 with 93% neutrophils and no crystals. Which of the following is the most appropriate pharmacotherapy? | Intramuscular ceftriaxone and oral azithromycin | {
"A": "Oral penicillin V",
"B": "Intramuscular ceftriaxone and oral azithromycin",
"C": "Oral doxycycline",
"D": "Intramuscular ceftriaxone"
} | step2&3 | B | [
"27 year old woman",
"emergency room",
"fever",
"severe left knee pain",
"past week",
"not sustained",
"trauma",
"injury",
"area",
"traveled",
"taken part",
"outdoor activities",
"recent past",
"sexually active",
"one male partner",
"use condoms",
"appears ill",
"temperature",
"100 4F",
"pulse",
"98 min",
"respirations",
"min",
"blood pressure",
"72 mm Hg",
"Physical examination shows multiple painless pustular lesions",
"ankles",
"dorsum",
"soles of",
"feet",
"swollen",
"erythematous",
"tender left",
"wrists",
"mildly edematous",
"tender",
"pain",
"extension",
"X-ray",
"knees shows tissue swelling",
"Arthrocentesis of",
"knee shows yellow purulent fluid",
"Gram stain",
"negative",
"Analysis",
"synovial fluid shows",
"leukocyte count",
"58",
"mm3",
"neutrophils",
"crystals",
"following",
"most appropriate pharmacotherapy"
] | 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 comes to the emergency room because of fever and severe left knee pain for the past week. She has not sustained any trauma or injury to the area, nor has she traveled or taken part in outdoor activities in the recent past. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill. Her temperature is 38°C (100.4°F), pulse is 98/min, respirations are 17/min, and blood pressure is 106/72 mm Hg. Physical examination shows multiple painless pustular lesions on her ankles and the dorsum and soles of her feet bilaterally, as well as a swollen, erythematous, exquisitely tender left knee. Her wrists are also mildly edematous and tender, with pain on extension. X-ray of the knees shows tissue swelling. Arthrocentesis of the knee shows yellow purulent fluid. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 58,000/mm3 with 93% neutrophils and no crystals. Which of the following is the most appropriate pharmacotherapy?
Choose one of the following::
A. Oral penicillin V
B. Intramuscular ceftriaxone and oral azithromycin
C. Oral doxycycline
D. Intramuscular ceftriaxone | [
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A 30-year-old man presents with restlessness and an inability to sit or lie down for the past 2 days. Past medical history is significant for schizophrenia, diagnosed 3 weeks ago and managed medically. Vital signs are a blood pressure of 140/90 mm Hg and a pulse of 96/min. On physical examination, the patient is fidgety and anxious but well-oriented. Which of the following is the most likely diagnosis in this patient? | Akathisia | {
"A": "Psychotic agitation",
"B": "Essential tremor",
"C": "Drug-induced parkinsonism",
"D": "Akathisia"
} | step1 | D | [
"30 year old man presents",
"restlessness",
"sit",
"past",
"days",
"medical history",
"significant",
"schizophrenia",
"diagnosed 3 weeks",
"managed",
"Vital signs",
"blood pressure",
"90 mm Hg",
"pulse",
"96 min",
"physical examination",
"patient",
"fidgety",
"anxious",
"well oriented",
"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: A 30-year-old man presents with restlessness and an inability to sit or lie down for the past 2 days. Past medical history is significant for schizophrenia, diagnosed 3 weeks ago and managed medically. Vital signs are a blood pressure of 140/90 mm Hg and a pulse of 96/min. On physical examination, the patient is fidgety and anxious but well-oriented. Which of the following is the most likely diagnosis in this patient?
Choose one of the following::
A. Psychotic agitation
B. Essential tremor
C. Drug-induced parkinsonism
D. Akathisia | [
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"ds_index": 248,
"similar_dg_indices": [
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} |
In a previous experiment infecting hepatocytes, it was shown that viable HDV virions were only produced in the presence of a co-infection with HBV. To better understand which HBV particle was necessary for the production of viable HDV virions, the scientist encoded in separate plasmids the various antigens/proteins of HBV and co-infected the hepatocytes with HDV. In which of the experiments would viable HDV virions be produced in conjunction with the appropriate HBV antigen/protein? | HBsAg | {
"A": "HBsAg",
"B": "HBcAg",
"C": "HBV RNA polymerase",
"D": "HBeAg"
} | step1 | A | [
"previous experiment infecting hepatocytes",
"shown",
"viable HDV virions",
"only",
"presence of",
"co infection",
"better understand",
"particle",
"production",
"viable HDV virions",
"scientist encoded",
"separate plasmids",
"various antigens/proteins",
"co infected",
"hepatocytes",
"HDV",
"experiments",
"viable HDV virions",
"conjunction",
"appropriate",
"antigen/protein"
] | 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: In a previous experiment infecting hepatocytes, it was shown that viable HDV virions were only produced in the presence of a co-infection with HBV. To better understand which HBV particle was necessary for the production of viable HDV virions, the scientist encoded in separate plasmids the various antigens/proteins of HBV and co-infected the hepatocytes with HDV. In which of the experiments would viable HDV virions be produced in conjunction with the appropriate HBV antigen/protein?
Choose one of the following::
A. HBsAg
B. HBcAg
C. HBV RNA polymerase
D. HBeAg | [
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A 61-year-old woman presents to her primary care physician for a routine check-up. Physical examination demonstrates asymmetric peripheral neuropathy in her feet. The patient has no previous relevant history and denies any symptoms of diabetes. Routine blood work shows normal results, and she is referred to a hematologist. Subsequent serum protein electrophoresis demonstrates a slightly elevated gamma globulin level, and monoclonal gammopathy of undetermined significance is diagnosed. Which of the following diseases is most likely to develop over the course of this patient’s condition? | Multiple myeloma | {
"A": "Waldenström macroglobulinemia",
"B": "Multiple myeloma",
"C": "Acute myelocytic leukemia",
"D": "Chronic myelocytic leukemia"
} | step1 | B | [
"61 year old woman presents",
"primary care physician",
"routine check-up",
"Physical examination demonstrates asymmetric peripheral neuropathy",
"feet",
"patient",
"previous relevant history",
"denies",
"symptoms",
"diabetes",
"Routine blood work shows normal results",
"referred to",
"hematologist",
"Subsequent serum protein electrophoresis demonstrates",
"slightly elevated gamma globulin level",
"monoclonal gammopathy of undetermined significance",
"diagnosed",
"following diseases",
"most likely to",
"course",
"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 61-year-old woman presents to her primary care physician for a routine check-up. Physical examination demonstrates asymmetric peripheral neuropathy in her feet. The patient has no previous relevant history and denies any symptoms of diabetes. Routine blood work shows normal results, and she is referred to a hematologist. Subsequent serum protein electrophoresis demonstrates a slightly elevated gamma globulin level, and monoclonal gammopathy of undetermined significance is diagnosed. Which of the following diseases is most likely to develop over the course of this patient’s condition?
Choose one of the following::
A. Waldenström macroglobulinemia
B. Multiple myeloma
C. Acute myelocytic leukemia
D. Chronic myelocytic leukemia | [
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A 71-year-old man presents to his primary care physician because he is increasingly troubled by a tremor in his hands. He says that the tremor is worse when he is resting and gets better when he reaches for objects. His wife reports that he has been slowing in his movements and also has difficulty starting to walk. His steps have been short and unsteady even when he is able to initiate movement. Physical exam reveals rigidity in his muscles when tested for active range of motion. Histology in this patient would most likely reveal which of the following findings? | Alpha-synuclein | {
"A": "Alpha-synuclein",
"B": "Intracellular hyperphosphorylated tau",
"C": "Hyperphosphorylated tau inclusion bodies",
"D": "Perivascular inflammation"
} | step1 | A | [
"71 year old man presents",
"primary care physician",
"tremor",
"hands",
"tremor",
"worse",
"resting",
"gets better",
"reaches",
"objects",
"wife reports",
"slowing",
"movements",
"difficulty starting to walk",
"steps",
"short",
"unsteady",
"able to initiate movement",
"Physical exam reveals rigidity",
"muscles",
"tested",
"active range of motion",
"Histology",
"patient",
"most likely reveal",
"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 71-year-old man presents to his primary care physician because he is increasingly troubled by a tremor in his hands. He says that the tremor is worse when he is resting and gets better when he reaches for objects. His wife reports that he has been slowing in his movements and also has difficulty starting to walk. His steps have been short and unsteady even when he is able to initiate movement. Physical exam reveals rigidity in his muscles when tested for active range of motion. Histology in this patient would most likely reveal which of the following findings?
Choose one of the following::
A. Alpha-synuclein
B. Intracellular hyperphosphorylated tau
C. Hyperphosphorylated tau inclusion bodies
D. Perivascular inflammation | [
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A 52-year-old man is brought to the emergency department while on vacation with a history of sudden onset vertigo and difficulty walking. He was in normal health since starting his vacation a week ago, but today he is suffering from a loss of balance, mild headache, and has had 5–6 episodes of vomiting over the last few hours. He denies fever, neck pain, head trauma, weakness, and diplopia. Past medical history is significant for hypertension and dyslipidemia. His medications include valsartan and atorvastatin, but he missed several doses since leaving for this trip. Blood pressure is 198/112 mm Hg, the heart rate is 76/min, the respiratory rate is 16/min, and the temperature is 37.0°C (98.6°F). The patient is awake and oriented to time, place, and person. Extraocular movements are within normal limits. Muscle strength is normal in all 4 extremities. An urgent head CT is ordered and shown in the picture. What additional clinical features be expected in this patient? | Inability to perform repetitive alternating movements | {
"A": "Inability to comprehend commands",
"B": "Inability to perform repetitive alternating movements",
"C": "Right-sided neglect",
"D": "Right-sided visual field loss"
} | step2&3 | B | [
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"ordered",
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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 52-year-old man is brought to the emergency department while on vacation with a history of sudden onset vertigo and difficulty walking. He was in normal health since starting his vacation a week ago, but today he is suffering from a loss of balance, mild headache, and has had 5–6 episodes of vomiting over the last few hours. He denies fever, neck pain, head trauma, weakness, and diplopia. Past medical history is significant for hypertension and dyslipidemia. His medications include valsartan and atorvastatin, but he missed several doses since leaving for this trip. Blood pressure is 198/112 mm Hg, the heart rate is 76/min, the respiratory rate is 16/min, and the temperature is 37.0°C (98.6°F). The patient is awake and oriented to time, place, and person. Extraocular movements are within normal limits. Muscle strength is normal in all 4 extremities. An urgent head CT is ordered and shown in the picture. What additional clinical features be expected in this patient?
Choose one of the following::
A. Inability to comprehend commands
B. Inability to perform repetitive alternating movements
C. Right-sided neglect
D. Right-sided visual field loss | [
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A 65-year-old man presents with painless swelling of the neck over the past week. He also has noted severe night sweats, which require a change of clothes and bed linens the next day. His medical history is significant for long-standing hypertension. He received a kidney transplant 6 years ago. His current medications include amlodipine, metoprolol, furosemide, aspirin, tacrolimus, and mycophenolate. His family history is significant for his sister, who died last year from lymphoma. A review of systems is positive for a 6-kg (13.2-lb) unintentional weight loss over the past 2 months. His vital signs include: temperature 37.8℃ (100.0℉) and blood pressure 120/75 mm Hg. On physical examination, there are multiple painless lymph nodes, averaging 2 cm in diameter, palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is palpated on the right side. Abdominal examination is significant for a spleen of 16 cm below the cost margin on percussion. Laboratory studies are significant for the following:
Hemoglobin 9 g/dL
Mean corpuscular volume 88 μm3
Leukocyte count 12,000/mm3
Platelet count 130,000/mm3
Creatinine 1.1 mg/dL
Lactate dehydrogenase (LDH) 1 000 U/L
A peripheral blood smear is unremarkable. Which of the following is the most likely diagnosis in this patient? | Non-Hodgkin’s lymphoma (NHL) | {
"A": "Drug-induced lymphadenopathy",
"B": "Cytomegalovirus infection",
"C": "Multiple myeloma",
"D": "Non-Hodgkin’s lymphoma (NHL)"
} | step2&3 | 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 65-year-old man presents with painless swelling of the neck over the past week. He also has noted severe night sweats, which require a change of clothes and bed linens the next day. His medical history is significant for long-standing hypertension. He received a kidney transplant 6 years ago. His current medications include amlodipine, metoprolol, furosemide, aspirin, tacrolimus, and mycophenolate. His family history is significant for his sister, who died last year from lymphoma. A review of systems is positive for a 6-kg (13.2-lb) unintentional weight loss over the past 2 months. His vital signs include: temperature 37.8℃ (100.0℉) and blood pressure 120/75 mm Hg. On physical examination, there are multiple painless lymph nodes, averaging 2 cm in diameter, palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is palpated on the right side. Abdominal examination is significant for a spleen of 16 cm below the cost margin on percussion. Laboratory studies are significant for the following:
Hemoglobin 9 g/dL
Mean corpuscular volume 88 μm3
Leukocyte count 12,000/mm3
Platelet count 130,000/mm3
Creatinine 1.1 mg/dL
Lactate dehydrogenase (LDH) 1 000 U/L
A peripheral blood smear is unremarkable. Which of the following is the most likely diagnosis in this patient?
Choose one of the following::
A. Drug-induced lymphadenopathy
B. Cytomegalovirus infection
C. Multiple myeloma
D. Non-Hodgkin’s lymphoma (NHL) | [
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A 56-year-old man is brought to the emergency department by his neighbor 2 hours after ingesting an unknown substance in a suicide attempt. He is confused and unable to provide further history. His temperature is 39.1°C (102.3°F), pulse is 124/min, respiratory rate is 12/min, and blood pressure is 150/92 mm Hg. His skin is dry. Pupils are 12 mm and minimally reactive. An ECG shows no abnormalities. Which of the following is the most appropriate treatment for this patient's condition? | Physostigmine | {
"A": "Sodium bicarbonate",
"B": "Physostigmine",
"C": "Glucagon",
"D": "Flumazenil"
} | step1 | B | [
"year old man",
"brought",
"emergency department",
"neighbor",
"hours",
"ingesting",
"unknown substance",
"suicide attempt",
"confused",
"unable to provide further history",
"temperature",
"pulse",
"min",
"respiratory rate",
"min",
"blood pressure",
"mm Hg",
"skin",
"dry",
"Pupils",
"mm",
"reactive",
"ECG shows",
"abnormalities",
"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 56-year-old man is brought to the emergency department by his neighbor 2 hours after ingesting an unknown substance in a suicide attempt. He is confused and unable to provide further history. His temperature is 39.1°C (102.3°F), pulse is 124/min, respiratory rate is 12/min, and blood pressure is 150/92 mm Hg. His skin is dry. Pupils are 12 mm and minimally reactive. An ECG shows no abnormalities. Which of the following is the most appropriate treatment for this patient's condition?
Choose one of the following::
A. Sodium bicarbonate
B. Physostigmine
C. Glucagon
D. Flumazenil | [
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An 81-year-old man presents to his primary care physician for his yearly exam. His past medical history is significant for osteopenia, nephrolithiasis, and hypertension. His family history is significant for relatives who had early onset kidney failure. He takes occasional acetaminophen and supplemental calcium/vitamin D. He is physically active with a normal body mass index (BMI) and has no current concerns. Review of his laboratory results today were compared with those from 15 years ago with the following findings:
Results today:
Serum creatinine concentration: 1.1 mg/dL
Urine creatinine concentration: 100 mg/dL
Urine volume: 1000 mL/day
Results 15 years ago:
Serum creatinine concentration: 1.1 mg/dL
Urine creatinine concentration: 120 mg/dL
Urine volume: 1000 mL/day
Which is the most likely cause of these changes in his creatinine clearance? | Normal aging | {
"A": "Benign prostatic hyperplasia",
"B": "Nephrolithiasis",
"C": "Normal aging",
"D": "Renovascular disease"
} | step1 | C | [
"81 year old man presents",
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"past medical history",
"significant",
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"nephrolithiasis",
"hypertension",
"family history",
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"relatives",
"early onset kidney failure",
"takes occasional acetaminophen",
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"Review",
"laboratory results today",
"compared",
"years",
"following findings",
"Results today",
"Serum concentration",
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"100 mg/dL Urine volume",
"mL/day",
"Results",
"years",
"Serum concentration",
"1.1 mg/dL Urine creatinine concentration",
"mg/dL Urine volume",
"mL/day",
"most likely cause",
"changes",
"creatinine clearance"
] | 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 81-year-old man presents to his primary care physician for his yearly exam. His past medical history is significant for osteopenia, nephrolithiasis, and hypertension. His family history is significant for relatives who had early onset kidney failure. He takes occasional acetaminophen and supplemental calcium/vitamin D. He is physically active with a normal body mass index (BMI) and has no current concerns. Review of his laboratory results today were compared with those from 15 years ago with the following findings:
Results today:
Serum creatinine concentration: 1.1 mg/dL
Urine creatinine concentration: 100 mg/dL
Urine volume: 1000 mL/day
Results 15 years ago:
Serum creatinine concentration: 1.1 mg/dL
Urine creatinine concentration: 120 mg/dL
Urine volume: 1000 mL/day
Which is the most likely cause of these changes in his creatinine clearance?
Choose one of the following::
A. Benign prostatic hyperplasia
B. Nephrolithiasis
C. Normal aging
D. Renovascular disease | [
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A 72-year-old man presents to his primary care provider complaining of fatigue, mild headache, and discomfort with chewing for roughly 1 week. Before this, he felt well overall, but now is he is quite bothered by these symptoms. His medical history is notable for hypertension and hyperlipidemia, both controlled. On examination, he is uncomfortable but nontoxic-appearing. There is mild tenderness to palpation over his right temporal artery, but otherwise the exam is not revealing. Prompt recognition and treatment can prevent which of the following feared complications: | Blindness | {
"A": "Renal failure",
"B": "Blindness",
"C": "Pulmonary fibrosis",
"D": "Cognitive impairment"
} | step2&3 | B | [
"72 year old man presents",
"primary care provider",
"fatigue",
"mild headache",
"discomfort",
"chewing",
"week",
"felt well overall",
"now",
"symptoms",
"medical history",
"notable",
"hypertension",
"hyperlipidemia",
"controlled",
"examination",
"nontoxic appearing",
"mild tenderness",
"palpation",
"right temporal artery",
"exam",
"not revealing",
"Prompt recognition",
"treatment",
"prevent",
"following feared 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 72-year-old man presents to his primary care provider complaining of fatigue, mild headache, and discomfort with chewing for roughly 1 week. Before this, he felt well overall, but now is he is quite bothered by these symptoms. His medical history is notable for hypertension and hyperlipidemia, both controlled. On examination, he is uncomfortable but nontoxic-appearing. There is mild tenderness to palpation over his right temporal artery, but otherwise the exam is not revealing. Prompt recognition and treatment can prevent which of the following feared complications:
Choose one of the following::
A. Renal failure
B. Blindness
C. Pulmonary fibrosis
D. Cognitive impairment | [
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] | {
"ds_index": 256,
"similar_dg_indices": [
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]
} |
A 14-month-old boy is brought to the clinic for evaluation of a rash. The rash started on the face and spread to the trunk. He also had a fever and cough for the past 2 days. His mother says that they recently immigrated from Asia and cannot provide vaccination records. The physical examination reveals a maculopapular rash on the face, trunk, and proximal limbs with no lymphadenopathy. Blue-white spots are noted on the oral mucosa and there is bilateral mild conjunctival injection. The causative agent of this condition belongs to which of the following virus families? | ssRNA enveloped viruses | {
"A": "ssDNA enveloped viruses",
"B": "ssRNA naked viruses",
"C": "dsRNA naked viruses",
"D": "ssRNA enveloped viruses"
} | step1 | D | [
"month old boy",
"brought",
"clinic",
"evaluation",
"rash",
"rash started",
"face",
"spread",
"trunk",
"fever",
"cough",
"past 2 days",
"mother",
"recently",
"Asia",
"provide vaccination records",
"physical examination reveals",
"maculopapular rash on",
"face",
"trunk",
"proximal limbs",
"lymphadenopathy",
"Blue white spots",
"noted",
"oral mucosa",
"bilateral mild conjunctival injection",
"causative agent",
"condition",
"following virus families"
] | 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-month-old boy is brought to the clinic for evaluation of a rash. The rash started on the face and spread to the trunk. He also had a fever and cough for the past 2 days. His mother says that they recently immigrated from Asia and cannot provide vaccination records. The physical examination reveals a maculopapular rash on the face, trunk, and proximal limbs with no lymphadenopathy. Blue-white spots are noted on the oral mucosa and there is bilateral mild conjunctival injection. The causative agent of this condition belongs to which of the following virus families?
Choose one of the following::
A. ssDNA enveloped viruses
B. ssRNA naked viruses
C. dsRNA naked viruses
D. ssRNA enveloped viruses | [
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A 31-year-old G1P0 woman at 26 weeks gestation presents to the clinic for evaluation of an abnormal glucose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose 1 week earlier and demonstrated a subsequent venous plasma glucose level of 156 mg/dL 1 hour later. The vital signs are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management? | Administer an oral, 3-hour 100 g glucose dose | {
"A": "Repeat the 50 g oral glucose challenge",
"B": "Administer an oral, 3-hour 100 g glucose dose",
"C": "Advise the patient to follow an American Diabetic Association diet plan",
"D": "Begin insulin treatment"
} | step2&3 | B | [
"31 year old",
"woman",
"weeks presents",
"clinic",
"evaluation",
"abnormal glucose tolerance test",
"denies",
"symptoms",
"states",
"given 50 g",
"oral 1 earlier",
"subsequent venous level",
"mg/dL 1 hour later",
"vital signs",
"blood pressure",
"mm Hg",
"pulse",
"81 min",
"respiratory rate",
"min",
"Physical examination",
"normal limits",
"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 31-year-old G1P0 woman at 26 weeks gestation presents to the clinic for evaluation of an abnormal glucose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose 1 week earlier and demonstrated a subsequent venous plasma glucose level of 156 mg/dL 1 hour later. The vital signs are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Repeat the 50 g oral glucose challenge
B. Administer an oral, 3-hour 100 g glucose dose
C. Advise the patient to follow an American Diabetic Association diet plan
D. Begin insulin treatment | [
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A newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient? | Compression of periaqueductal grey matter | {
"A": "Normal lumbar puncture opening pressure",
"B": "Dilated cisterna magna",
"C": "Compression of periaqueductal grey matter",
"D": "Hypertrophic arachnoid granulations"
} | step1 | C | [
"newborn",
"mother",
"poor antenatal care",
"found to",
"larger",
"normal head circumference",
"bulging fontanelles",
"Physical examination reveals",
"predominant downward gaze",
"marked eyelid retraction",
"convergence-retraction nystagmus",
"Ultrasound examination showed dilated lateral ventricles",
"dilated third ventricle",
"Further imaging studies reveal",
"solid mass",
"pineal region",
"following",
"most likely finding",
"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 newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient?
Choose one of the following::
A. Normal lumbar puncture opening pressure
B. Dilated cisterna magna
C. Compression of periaqueductal grey matter
D. Hypertrophic arachnoid granulations | [
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} |
A 22-year-old man comes to the physician because of a progressive swelling and pain in his right ring finger for the past 2 days. The pain began while playing football, when his finger got caught in the jersey of another player who forcefully pulled away. Examination shows that the right ring finger is extended. There is pain and swelling at the distal interphalangeal joint. When the patient is asked to make a fist, his right ring finger does not flex at the distal interphalangeal joint. There is no joint laxity. Which of the following is the most likely diagnosis? | Rupture of the flexor digitorum profundus tendon at its point of insertion | {
"A": "Rupture of the flexor digitorum profundus tendon at its point of insertion",
"B": "Closed fracture of the distal phalanx",
"C": "Inflammation of the flexor digitorum profundus tendon sheath",
"D": "Slipping of the central band of the extensor digitorum tendon"
} | step1 | A | [
"year old man",
"physician",
"progressive swelling",
"pain",
"right ring finger",
"past 2 days",
"pain began",
"playing football",
"finger",
"caught",
"jersey",
"pulled",
"Examination shows",
"right ring finger",
"extended",
"pain",
"swelling",
"distal",
"patient",
"to make",
"fist",
"right ring finger",
"not",
"distal interphalangeal joint",
"joint laxity",
"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 22-year-old man comes to the physician because of a progressive swelling and pain in his right ring finger for the past 2 days. The pain began while playing football, when his finger got caught in the jersey of another player who forcefully pulled away. Examination shows that the right ring finger is extended. There is pain and swelling at the distal interphalangeal joint. When the patient is asked to make a fist, his right ring finger does not flex at the distal interphalangeal joint. There is no joint laxity. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Rupture of the flexor digitorum profundus tendon at its point of insertion
B. Closed fracture of the distal phalanx
C. Inflammation of the flexor digitorum profundus tendon sheath
D. Slipping of the central band of the extensor digitorum tendon | [
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A 50-year-old man comes to the physician for a routine checkup. He has had a progressively increasing swelling on the nape of his neck for 2 months. He does not have a fever or any discharge from the swelling. He underwent a colectomy for colon cancer at the age of 43 years. He has type 2 diabetes mellitus, hypertension, and osteoarthritis of the left knee. Current medications include insulin glargine, metformin, enalapril, and naproxen. He has worked as a traffic warden for the past 6 years and frequently plays golf. He appears healthy. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 130/86 mm Hg. Examination of the neck shows a 2.5-cm (1-in) firm, mobile, and painless nodule. The skin over the nodule cannot be pinched. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. A photograph of the lesion is shown. Which of the following is the most likely diagnosis? | Epidermoid cyst | {
"A": "Actinic keratosis",
"B": "Epidermoid cyst",
"C": "Dermatofibroma",
"D": "Squamous cell carcinoma\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 50-year-old man comes to the physician for a routine checkup. He has had a progressively increasing swelling on the nape of his neck for 2 months. He does not have a fever or any discharge from the swelling. He underwent a colectomy for colon cancer at the age of 43 years. He has type 2 diabetes mellitus, hypertension, and osteoarthritis of the left knee. Current medications include insulin glargine, metformin, enalapril, and naproxen. He has worked as a traffic warden for the past 6 years and frequently plays golf. He appears healthy. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 130/86 mm Hg. Examination of the neck shows a 2.5-cm (1-in) firm, mobile, and painless nodule. The skin over the nodule cannot be pinched. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. A photograph of the lesion is shown. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Actinic keratosis
B. Epidermoid cyst
C. Dermatofibroma
D. Squamous cell carcinoma
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} |
A 67-year-old man comes to the physician because of a 3-day history of fever, chills, headache, and fatigue. He appears ill. His temperature is 39°C (102.2°F). Analysis of nasal secretions shows infection with an enveloped, single-stranded segmented RNA virus. In response to infection with this pathogen, certain cells present antigens from the pathogen to CD8+ T-lymphocytes. Which of the following statements about the molecules used for the presentation of these antigens is most accurate? | The molecule consists of a heavy chain associated with β2 microglobulin | {
"A": "The antigens are loaded onto the molecule within lysosomes",
"B": "The molecule consists of a heavy chain associated with β2 microglobulin",
"C": "The molecule is made up of 2 chains of equal length",
"D": "The molecule is selectively expressed by antigen-presenting cells"
} | step1 | B | [
"67 year old man",
"physician",
"3-day history",
"fever",
"chills",
"headache",
"fatigue",
"appears ill",
"temperature",
"Analysis",
"nasal secretions shows infection",
"single-stranded segmented RNA virus",
"response",
"infection",
"pathogen",
"certain cells present antigens",
"pathogen",
"CD8",
"T-lymphocytes",
"following statements",
"molecules used",
"presentation",
"antigens",
"most accurate"
] | 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 67-year-old man comes to the physician because of a 3-day history of fever, chills, headache, and fatigue. He appears ill. His temperature is 39°C (102.2°F). Analysis of nasal secretions shows infection with an enveloped, single-stranded segmented RNA virus. In response to infection with this pathogen, certain cells present antigens from the pathogen to CD8+ T-lymphocytes. Which of the following statements about the molecules used for the presentation of these antigens is most accurate?
Choose one of the following::
A. The antigens are loaded onto the molecule within lysosomes
B. The molecule consists of a heavy chain associated with β2 microglobulin
C. The molecule is made up of 2 chains of equal length
D. The molecule is selectively expressed by antigen-presenting cells | [
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} |
A 58-year-old female, being treated on the medical floor for community-acquired pneumonia with levofloxacin, develops watery diarrhea. She reports at least 9 episodes of diarrhea within the last two days, with lower abdominal discomfort and cramping. Her temperature is 98.6° F (37° C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her physical examination is unremarkable. Laboratory testing shows:
Hb% 13 gm/dL
Total count (WBC): 13,400/mm3
Differential count:
Neutrophils: 80%
Lymphocytes: 15%
Monocytes: 5%
ESR: 33 mm/hr
What is the most likely diagnosis? | C. difficile colitis | {
"A": "Ulcerative colitis",
"B": "C. difficile colitis",
"C": "Irritable bowel syndrome",
"D": "Giardiasis"
} | step2&3 | B | [
"58 year old female",
"treated",
"medical floor",
"community-acquired pneumonia",
"levofloxacin",
"watery diarrhea",
"reports",
"episodes",
"diarrhea",
"last two days",
"lower abdominal discomfort",
"cramping",
"temperature",
"98",
"F",
"respiratory rate",
"min",
"pulse",
"67 min",
"blood pressure",
"98 mm Hg",
"physical examination",
"unremarkable",
"Laboratory testing shows",
"Hb",
"gm dL Total count",
"WBC",
"400 mm3 Differential count",
"Neutrophils",
"80",
"Lymphocytes",
"Monocytes",
"5",
"ESR",
"mm",
"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 58-year-old female, being treated on the medical floor for community-acquired pneumonia with levofloxacin, develops watery diarrhea. She reports at least 9 episodes of diarrhea within the last two days, with lower abdominal discomfort and cramping. Her temperature is 98.6° F (37° C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her physical examination is unremarkable. Laboratory testing shows:
Hb% 13 gm/dL
Total count (WBC): 13,400/mm3
Differential count:
Neutrophils: 80%
Lymphocytes: 15%
Monocytes: 5%
ESR: 33 mm/hr
What is the most likely diagnosis?
Choose one of the following::
A. Ulcerative colitis
B. C. difficile colitis
C. Irritable bowel syndrome
D. Giardiasis | [
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A 7-year-old girl presents to her primary care physician for a routine check-up. The physician allows the medical student to perform a physical examination. The medical student notes hearing impairment as well as the findings show in Figures A and B. Radiographs show indications of multiple old fractures of the humerus that have healed. After questioning the girl’s parents, the medical student learns that in addition, the patient is extremely picky with her food and eats a diet consisting mainly of cereal and pasta. What is the most likely etiology of the patient’s disease? | Deficiency of type 1 collagen | {
"A": "Decreased bone mineral density",
"B": "Defective mineralization of cartilage",
"C": "Deficiency of type 1 collagen",
"D": "Dietary deficiency of ascorbic acid"
} | step2&3 | C | [
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"medical student notes hearing impairment",
"findings show",
"Radiographs show indications of multiple old fractures",
"humerus",
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"pasta",
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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 7-year-old girl presents to her primary care physician for a routine check-up. The physician allows the medical student to perform a physical examination. The medical student notes hearing impairment as well as the findings show in Figures A and B. Radiographs show indications of multiple old fractures of the humerus that have healed. After questioning the girl’s parents, the medical student learns that in addition, the patient is extremely picky with her food and eats a diet consisting mainly of cereal and pasta. What is the most likely etiology of the patient’s disease?
Choose one of the following::
A. Decreased bone mineral density
B. Defective mineralization of cartilage
C. Deficiency of type 1 collagen
D. Dietary deficiency of ascorbic acid | [
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} |
A 47-year-old man comes to the physician because of abdominal pain and foul-smelling, watery diarrhea for several days. He has not had nausea, vomiting, or blood in the stool. He has a history of alcohol use disorder and recently completed a 7-day course of clindamycin for pneumonia. He has not traveled out of the United States. Which of the following toxins is most likely to be involved in the pathogenesis of this patient's symptoms? | Clostridioides difficile cytotoxin | {
"A": "Shiga toxin",
"B": "Cholera toxin",
"C": "Cereulide toxin",
"D": "Clostridioides difficile cytotoxin"
} | step1 | D | [
"year old man",
"physician",
"abdominal pain",
"smelling",
"watery diarrhea",
"days",
"not",
"nausea",
"vomiting",
"blood in",
"stool",
"history of alcohol use disorder",
"recently completed",
"7-day course",
"clindamycin",
"pneumonia",
"not traveled out of",
"United States",
"following toxins",
"most likely to",
"involved",
"pathogenesis",
"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 47-year-old man comes to the physician because of abdominal pain and foul-smelling, watery diarrhea for several days. He has not had nausea, vomiting, or blood in the stool. He has a history of alcohol use disorder and recently completed a 7-day course of clindamycin for pneumonia. He has not traveled out of the United States. Which of the following toxins is most likely to be involved in the pathogenesis of this patient's symptoms?
Choose one of the following::
A. Shiga toxin
B. Cholera toxin
C. Cereulide toxin
D. Clostridioides difficile cytotoxin | [
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A 6-year-old boy presents to the clinic because of monosymptomatic enuresis for the past month. Urinalysis, detailed patient history, and fluid intake, stool, and voiding diary from a previous visit all show no abnormalities. The parent and child are referred for education and behavioral therapy. Enuresis decreases but persists. Both the patient and his mother express concern and want this issue to resolve as soon as possible. Which of the following is the most appropriate next step in management? | Enuresis alarm | {
"A": "Behavioral therapy",
"B": "DDAVP",
"C": "Enuresis alarm",
"D": "Oxybutynin"
} | step2&3 | C | [
"year old boy presents",
"clinic",
"of",
"enuresis",
"past month",
"Urinalysis",
"detailed patient history",
"fluid intake",
"stool",
"voiding diary",
"previous visit",
"show",
"abnormalities",
"parent",
"child",
"referred",
"education",
"behavioral therapy",
"Enuresis decreases",
"patient",
"mother",
"concern",
"issue to resolve",
"possible",
"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 6-year-old boy presents to the clinic because of monosymptomatic enuresis for the past month. Urinalysis, detailed patient history, and fluid intake, stool, and voiding diary from a previous visit all show no abnormalities. The parent and child are referred for education and behavioral therapy. Enuresis decreases but persists. Both the patient and his mother express concern and want this issue to resolve as soon as possible. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Behavioral therapy
B. DDAVP
C. Enuresis alarm
D. Oxybutynin | [
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A 32-year-old homeless woman is brought to the emergency department by ambulance 30 minutes after the police found her on the sidewalk. On arrival, she is unresponsive. Her pulse is 76/min, respirations are 6/min, and blood pressure is 110/78 mm Hg. Examination shows cool, dry skin. The pupils are pinpoint and react sluggishly to light. Intravenous administration of a drug is initiated. Two minutes after treatment is started, the patient regains consciousness and her respirations increase to 12/min. The drug that was administered has the strongest effect on which of the following receptors? | μ-receptor | {
"A": "Ryanodine receptor",
"B": "μ-receptor",
"C": "GABAA receptor",
"D": "5-HT2A receptor"
} | step1 | B | [
"year old homeless woman",
"brought",
"emergency department",
"ambulance 30 minutes",
"police found",
"sidewalk",
"arrival",
"unresponsive",
"pulse",
"76 min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"Examination shows cool",
"dry skin",
"pupils",
"pinpoint",
"light",
"Intravenous",
"drug",
"initiated",
"Two minutes after treatment",
"started",
"patient regains consciousness",
"respirations increase",
"min",
"drug",
"administered",
"strongest effect",
"following receptors"
] | 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 32-year-old homeless woman is brought to the emergency department by ambulance 30 minutes after the police found her on the sidewalk. On arrival, she is unresponsive. Her pulse is 76/min, respirations are 6/min, and blood pressure is 110/78 mm Hg. Examination shows cool, dry skin. The pupils are pinpoint and react sluggishly to light. Intravenous administration of a drug is initiated. Two minutes after treatment is started, the patient regains consciousness and her respirations increase to 12/min. The drug that was administered has the strongest effect on which of the following receptors?
Choose one of the following::
A. Ryanodine receptor
B. μ-receptor
C. GABAA receptor
D. 5-HT2A receptor | [
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An infectious disease investigator is evaluating the diagnostic accuracy of a new interferon-gamma-based assay for diagnosing tuberculosis in patients who have previously received a Bacillus Calmette-Guérin (BCG) vaccine. Consenting participants with a history of BCG vaccination received an interferon-gamma assay and were subsequently evaluated for tuberculosis by sputum culture. Results of the study are summarized in the table below.
Tuberculosis, confirmed by culture No tuberculosis Total
Positive interferon-gamma assay 90 6 96
Negative interferon-gamma assay 10 194 204
Total 100 200 300
Based on these results, what is the sensitivity of the interferon-gamma-based assay for the diagnosis of tuberculosis in this study?" | 90/100 | {
"A": "194/200",
"B": "90/100",
"C": "90/96",
"D": "194/204"
} | step1 | B | [
"infectious disease investigator",
"evaluating",
"diagnostic accuracy",
"new interferon-gamma based assay",
"diagnosing tuberculosis",
"patients",
"received",
"Bacillus Calmette",
"vaccine",
"Consenting participants",
"history of BCG vaccination received",
"interferon-gamma assay",
"evaluated",
"tuberculosis",
"sputum culture",
"Results",
"study",
"table",
"Tuberculosis",
"confirmed by culture",
"tuberculosis Total Positive interferon-gamma assay 90",
"Negative",
"100",
"Based",
"results",
"sensitivity",
"interferon-gamma based assay",
"diagnosis",
"tuberculosis",
"study"
] | 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 infectious disease investigator is evaluating the diagnostic accuracy of a new interferon-gamma-based assay for diagnosing tuberculosis in patients who have previously received a Bacillus Calmette-Guérin (BCG) vaccine. Consenting participants with a history of BCG vaccination received an interferon-gamma assay and were subsequently evaluated for tuberculosis by sputum culture. Results of the study are summarized in the table below.
Tuberculosis, confirmed by culture No tuberculosis Total
Positive interferon-gamma assay 90 6 96
Negative interferon-gamma assay 10 194 204
Total 100 200 300
Based on these results, what is the sensitivity of the interferon-gamma-based assay for the diagnosis of tuberculosis in this study?"
Choose one of the following::
A. 194/200
B. 90/100
C. 90/96
D. 194/204 | [
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Several patients at a local US hospital present with chronic secretory diarrhea. Although there are multiple potential causes of diarrhea present in these patients, which of the following is most likely the common cause of their chronic secretory diarrhea? | Medications | {
"A": "Lymphocytic colitis",
"B": "Medications",
"C": "Lactose intolerance",
"D": "Carcinoid tumor"
} | step1 | B | [
"Several patients",
"local",
"hospital present",
"chronic secretory",
"multiple potential causes",
"diarrhea present",
"patients",
"following",
"most likely",
"common cause",
"chronic secretory"
] | 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: Several patients at a local US hospital present with chronic secretory diarrhea. Although there are multiple potential causes of diarrhea present in these patients, which of the following is most likely the common cause of their chronic secretory diarrhea?
Choose one of the following::
A. Lymphocytic colitis
B. Medications
C. Lactose intolerance
D. Carcinoid tumor | [
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} |
A 27-year-old woman with sickle cell disease and at 39-weeks' gestation is brought to the emergency department in active labor. She has had multiple episodes of acute chest syndrome and has required several transfusions in the past. She has a prolonged vaginal delivery complicated by postpartum bleeding, and she receives a transfusion of 1 unit of packed red blood cells. One hour later, the patient experiences acute flank pain. Her temperature is 38.7°C (101.6°F), pulse is 115/min, respirations are 24/min, and blood pressure is 95/55 mm Hg. Foley catheter shows dark brown urine. Further evaluation of this patient is most likely to show which of the following? | Positive direct Coombs test | {
"A": "Serum antibodies against class I HLA antigens",
"B": "Positive direct Coombs test",
"C": "Positive blood cultures",
"D": "Low levels of serum IgA immunoglobulins"
} | step1 | B | [
"27 year old woman",
"sickle cell disease",
"weeks",
"gestation",
"brought",
"emergency department",
"active labor",
"multiple episodes of acute chest syndrome",
"required",
"transfusions",
"past",
"prolonged vaginal delivery complicated",
"postpartum bleeding",
"receives",
"transfusion of",
"packed red blood cells",
"One hour later",
"patient experiences acute flank",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"95 55 mm Hg",
"Foley catheter shows dark",
"Further evaluation",
"patient",
"most likely to show",
"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 27-year-old woman with sickle cell disease and at 39-weeks' gestation is brought to the emergency department in active labor. She has had multiple episodes of acute chest syndrome and has required several transfusions in the past. She has a prolonged vaginal delivery complicated by postpartum bleeding, and she receives a transfusion of 1 unit of packed red blood cells. One hour later, the patient experiences acute flank pain. Her temperature is 38.7°C (101.6°F), pulse is 115/min, respirations are 24/min, and blood pressure is 95/55 mm Hg. Foley catheter shows dark brown urine. Further evaluation of this patient is most likely to show which of the following?
Choose one of the following::
A. Serum antibodies against class I HLA antigens
B. Positive direct Coombs test
C. Positive blood cultures
D. Low levels of serum IgA immunoglobulins | [
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A 17-year-old man is brought by his mother to his pediatrician in order to complete medical clearance forms prior to attending college. During the visit, his mother asks about what health risks he should be aware of in college. Specifically, she recently saw on the news that some college students were killed by a fatal car crash. She therefore asks about causes of death in this population. Which of the following is true about the causes of death in college age individuals? | More of them die from homicide than cancer | {
"A": "More of them die from suicide than injuries",
"B": "More of them die from homicide than suicide",
"C": "More of them die from cancer than suicide",
"D": "More of them die from homicide than cancer"
} | step1 | D | [
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"pediatrician",
"order to complete medical clearance forms prior to attending college",
"visit",
"mother",
"health risks",
"aware",
"college",
"recently saw",
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"college students",
"killed",
"fatal car crash",
"causes of death",
"population",
"following",
"true",
"causes of death",
"college age individuals"
] | 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 17-year-old man is brought by his mother to his pediatrician in order to complete medical clearance forms prior to attending college. During the visit, his mother asks about what health risks he should be aware of in college. Specifically, she recently saw on the news that some college students were killed by a fatal car crash. She therefore asks about causes of death in this population. Which of the following is true about the causes of death in college age individuals?
Choose one of the following::
A. More of them die from suicide than injuries
B. More of them die from homicide than suicide
C. More of them die from cancer than suicide
D. More of them die from homicide than cancer | [
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A 7-month old boy, born to immigrant parents from Greece, presents to the hospital with pallor and abdominal distention. His parents note that they recently moved into an old apartment building and have been concerned about their son's exposure to chipped paint from the walls. On physical exam, the patient is found to have hepatosplenomegaly and frontal skull bossing. Hemoglobin electrophoresis reveals markedly increased HbF and HbA2 levels. What would be the most likely findings on a peripheral blood smear? | Microcytosis and hypochromasia of erythrocytes | {
"A": "Basophilic stippling of erythrocytes",
"B": "Microcytosis and hypochromasia of erythrocytes",
"C": "Schistocytes and normocytic erythrocytes",
"D": "Sickling of erythrocytes"
} | step2&3 | B | [
"month old boy",
"born",
"immigrant parents",
"Greece",
"presents",
"hospital",
"pallor",
"abdominal distention",
"parents note",
"recently moved",
"old apartment building",
"concerned",
"son's exposure",
"chipped paint",
"walls",
"physical exam",
"patient",
"found to",
"hepatosplenomegaly",
"frontal skull bossing",
"Hemoglobin electrophoresis reveals markedly increased HbF",
"HbA2 levels",
"most likely findings",
"peripheral blood smear"
] | 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-month old boy, born to immigrant parents from Greece, presents to the hospital with pallor and abdominal distention. His parents note that they recently moved into an old apartment building and have been concerned about their son's exposure to chipped paint from the walls. On physical exam, the patient is found to have hepatosplenomegaly and frontal skull bossing. Hemoglobin electrophoresis reveals markedly increased HbF and HbA2 levels. What would be the most likely findings on a peripheral blood smear?
Choose one of the following::
A. Basophilic stippling of erythrocytes
B. Microcytosis and hypochromasia of erythrocytes
C. Schistocytes and normocytic erythrocytes
D. Sickling of erythrocytes | [
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A 51-year-old woman comes to the physician because of progressively worsening lower back pain. The pain radiates down the right leg to the lateral side of the foot. She has had no trauma, urinary incontinence, or fever. An MRI of the lumbar spine shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination? | Weak achilles tendon reflex | {
"A": "Difficulty walking on heels",
"B": "Exaggerated patellar tendon reflex",
"C": "Weak achilles tendon reflex",
"D": "Diminished sensation of the anterior lateral thigh\n\""
} | step1 | C | [
"year old woman",
"physician",
"worsening lower back pain",
"pain radiates",
"right leg",
"lateral side of",
"foot",
"trauma",
"urinary incontinence",
"fever",
"MRI of",
"lumbar spine shows disc degeneration",
"herniation",
"level",
"following",
"most likely finding",
"physical examination"
] | 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 woman comes to the physician because of progressively worsening lower back pain. The pain radiates down the right leg to the lateral side of the foot. She has had no trauma, urinary incontinence, or fever. An MRI of the lumbar spine shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination?
Choose one of the following::
A. Difficulty walking on heels
B. Exaggerated patellar tendon reflex
C. Weak achilles tendon reflex
D. Diminished sensation of the anterior lateral thigh
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A 52-year-old woman comes to the physician because of a 4-month history of progressive pain and stiffness of the fingers of her right hand that is worse at the end of the day. She works as a hair dresser and has to take frequent breaks to rest her hand. She has hypertension, for which she takes hydrochlorothiazide. Two weeks ago, she completed a course of oral antibiotics for a urinary tract infection. Her sister has systemic lupus erythematosus. She drinks one to two beers daily and occasionally more on weekends. Over the past 2 weeks, she has been taking ibuprofen as needed for the joint pain. Her vital signs are within normal limits. Physical examination shows swelling, joint-line tenderness, and decreased range of motion of the right first metacarpophalangeal joint as well as the 2nd and 4th distal interphalangeal joints of the right hand. Discrete, hard, mildly tender swellings are palpated over the 2nd and 4th distal interphalangeal joints of the right hand. Which of the following is the most likely underlying mechanism for these findings? | Degenerative disease of the joints | {
"A": "Bacterial infection of the joint space",
"B": "Autoimmune-mediated cartilage erosion",
"C": "Degenerative disease of the joints",
"D": "Calcium pyrophosphate dihydrate crystal precipitation in the joints"
} | step2&3 | C | [
"year old woman",
"physician",
"4 month history",
"progressive pain",
"stiffness of",
"fingers",
"right hand",
"worse",
"end",
"day",
"works",
"hair dresser",
"to take frequent breaks to rest",
"hand",
"hypertension",
"takes hydrochlorothiazide",
"Two weeks",
"completed",
"course",
"oral antibiotics",
"urinary tract infection",
"sister",
"systemic lupus erythematosus",
"drinks one",
"two beers daily",
"occasionally",
"weekends",
"past 2 weeks",
"taking ibuprofen as needed",
"joint pain",
"vital signs",
"normal",
"Physical examination shows swelling",
"joint line tenderness",
"decreased range of motion",
"right first metacarpophalangeal joint",
"2nd",
"4th distal interphalangeal joints of the right hand",
"Discrete",
"hard",
"mildly tender swellings",
"palpated",
"2nd",
"4th distal interphalangeal joints of the right hand",
"following",
"most likely underlying mechanism",
"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 52-year-old woman comes to the physician because of a 4-month history of progressive pain and stiffness of the fingers of her right hand that is worse at the end of the day. She works as a hair dresser and has to take frequent breaks to rest her hand. She has hypertension, for which she takes hydrochlorothiazide. Two weeks ago, she completed a course of oral antibiotics for a urinary tract infection. Her sister has systemic lupus erythematosus. She drinks one to two beers daily and occasionally more on weekends. Over the past 2 weeks, she has been taking ibuprofen as needed for the joint pain. Her vital signs are within normal limits. Physical examination shows swelling, joint-line tenderness, and decreased range of motion of the right first metacarpophalangeal joint as well as the 2nd and 4th distal interphalangeal joints of the right hand. Discrete, hard, mildly tender swellings are palpated over the 2nd and 4th distal interphalangeal joints of the right hand. Which of the following is the most likely underlying mechanism for these findings?
Choose one of the following::
A. Bacterial infection of the joint space
B. Autoimmune-mediated cartilage erosion
C. Degenerative disease of the joints
D. Calcium pyrophosphate dihydrate crystal precipitation in the joints | [
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A 51-year-old man presents to his dermatologist because of severe stomatitis and superficial skin erosions over his trunk. His condition started 2 months ago and was unresponsive to oral antibiotics and antiherpetic medications. He has no history of a similar rash. His medical history is remarkable for type 2 diabetes mellitus and essential hypertension. The physical examination reveals numerous flaccid blisters and bullae which rupture easily. Nikolsky's sign is positive. Which of the following best represents the etiology of this patient’s condition? | Anti-desmoglein-3 antibodies | {
"A": "Increased mitotic activity of basal and suprabasal cells",
"B": "Cutaneous T cell lymphoma",
"C": "Anti-desmoglein-3 antibodies",
"D": "Dermatophyte infection"
} | step2&3 | C | [
"year old man presents",
"dermatologist",
"severe stomatitis",
"superficial skin",
"trunk",
"condition started 2 months",
"unresponsive",
"oral antibiotics",
"medications",
"history",
"similar rash",
"medical history",
"type 2 diabetes mellitus",
"essential hypertension",
"physical examination reveals numerous flaccid",
"bullae",
"rupture easily",
"Nikolsky's sign",
"positive",
"following best represents",
"etiology",
"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 51-year-old man presents to his dermatologist because of severe stomatitis and superficial skin erosions over his trunk. His condition started 2 months ago and was unresponsive to oral antibiotics and antiherpetic medications. He has no history of a similar rash. His medical history is remarkable for type 2 diabetes mellitus and essential hypertension. The physical examination reveals numerous flaccid blisters and bullae which rupture easily. Nikolsky's sign is positive. Which of the following best represents the etiology of this patient’s condition?
Choose one of the following::
A. Increased mitotic activity of basal and suprabasal cells
B. Cutaneous T cell lymphoma
C. Anti-desmoglein-3 antibodies
D. Dermatophyte infection | [
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A 50-year-old male presents to his primary care physician for a routine check-up. He reports that he is doing well overall without any bothersome symptoms. His past medical history is significant only for hypertension, which has been well controlled with losartan. Vital signs are as follows: T 37.0 C, HR 80, BP 128/76, RR 14, SpO2 99%. Physical examination does not reveal any concerning abnormalities. The physician recommends a fecal occult blood test at this visit to screen for the presence of any blood in the patient's stool that might be suggestive of an underlying colorectal cancer. Which of the following best describes this method of disease prevention? | Secondary prevention | {
"A": "Primordial prevention",
"B": "Primary prevention",
"C": "Secondary prevention",
"D": "Tertiary prevention"
} | step1 | C | [
"50 year old male presents",
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"routine check-up",
"reports",
"well overall",
"symptoms",
"past medical history",
"significant only",
"hypertension",
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"losartan",
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"follows",
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"99",
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"visit to screen",
"presence",
"blood",
"patient's stool",
"suggestive of",
"underlying colorectal cancer",
"following best",
"method",
"disease prevention"
] | 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 50-year-old male presents to his primary care physician for a routine check-up. He reports that he is doing well overall without any bothersome symptoms. His past medical history is significant only for hypertension, which has been well controlled with losartan. Vital signs are as follows: T 37.0 C, HR 80, BP 128/76, RR 14, SpO2 99%. Physical examination does not reveal any concerning abnormalities. The physician recommends a fecal occult blood test at this visit to screen for the presence of any blood in the patient's stool that might be suggestive of an underlying colorectal cancer. Which of the following best describes this method of disease prevention?
Choose one of the following::
A. Primordial prevention
B. Primary prevention
C. Secondary prevention
D. Tertiary prevention | [
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A 57-year-old man presents to the emergency department because of pain in the center of his chest that is radiating down his left arm and up the left side of his neck. The pain started suddenly 30 minutes ago while the patient was at work. The patient describes the pain as squeezing in nature, 10/10 in intensity, and is associated with nausea and difficulty breathing. He has had type 2 diabetes mellitus for 15 years, hypertension for 10 years, and dyslipidemia, but he denies any history of a cardiac problem. He has a 40-pack-year history of smoking but does not drink alcohol. Vital signs include: blood pressure 80/40 mm Hg, regular pulse 90/min, and temperature 37.2°C (98.9°F). Chest auscultation reveals diffuse bilateral rales with no murmurs. ECG reveals convex ST-segment elevation in leads V1 to V6 and echocardiogram shows anterolateral hypokinesis, retrograde blood flow into the left atrium, and an ejection fraction of 45%. Which of the following best describe the mechanism of this patient’s illness? | Occlusion of the left anterior descending artery with rupture of a papillary muscle | {
"A": "Occlusion of the left anterior descending artery with rupture of a papillary muscle",
"B": "Occlusion of the left anterior descending artery with interventricular septal rupture",
"C": "Ventricular free wall rupture",
"D": "Mitral leaflet thickening and fibrosis"
} | step2&3 | A | [
"57 year old man presents",
"emergency department",
"pain",
"center",
"chest",
"radiating",
"left arm",
"left side of",
"neck",
"pain started",
"30 minutes",
"patient",
"work",
"patient",
"pain",
"squeezing",
"nature",
"10",
"intensity",
"associated with nausea",
"difficulty breathing",
"type 2 diabetes mellitus",
"years",
"hypertension",
"10 years",
"dyslipidemia",
"denies",
"history",
"cardiac problem",
"40 pack-year history of smoking",
"not drink alcohol",
"Vital signs include",
"blood pressure 80 40 mm Hg",
"regular pulse 90 min",
"temperature",
"98 9F",
"Chest auscultation reveals diffuse bilateral rales",
"murmurs",
"ECG reveals convex ST-segment elevation",
"leads V1",
"V6",
"echocardiogram shows anterolateral hypokinesis",
"retrograde blood",
"left atrium",
"ejection fraction",
"following best",
"mechanism",
"patients illness"
] | 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 57-year-old man presents to the emergency department because of pain in the center of his chest that is radiating down his left arm and up the left side of his neck. The pain started suddenly 30 minutes ago while the patient was at work. The patient describes the pain as squeezing in nature, 10/10 in intensity, and is associated with nausea and difficulty breathing. He has had type 2 diabetes mellitus for 15 years, hypertension for 10 years, and dyslipidemia, but he denies any history of a cardiac problem. He has a 40-pack-year history of smoking but does not drink alcohol. Vital signs include: blood pressure 80/40 mm Hg, regular pulse 90/min, and temperature 37.2°C (98.9°F). Chest auscultation reveals diffuse bilateral rales with no murmurs. ECG reveals convex ST-segment elevation in leads V1 to V6 and echocardiogram shows anterolateral hypokinesis, retrograde blood flow into the left atrium, and an ejection fraction of 45%. Which of the following best describe the mechanism of this patient’s illness?
Choose one of the following::
A. Occlusion of the left anterior descending artery with rupture of a papillary muscle
B. Occlusion of the left anterior descending artery with interventricular septal rupture
C. Ventricular free wall rupture
D. Mitral leaflet thickening and fibrosis | [
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} |
A 29-year-old African American female presents to your office with extreme fatigue and bilateral joint pain. Serologies demonstrate the presence of rheumatoid factor along with anti-Smith and anti-dsDNA antibodies. A VDRL syphilis test is positive. You order a coagulation profile, which reveals normal bleeding time, normal PT, and prolonged PTT as well as normal platelet count. Further evaluation is most likely to reveal which of the following? | History of multiple spontaneous abortions | {
"A": "Palmar rash",
"B": "HLA-B27 positivity",
"C": "Factor VIII deficiency",
"D": "History of multiple spontaneous abortions"
} | step1 | D | [
"29 year old African American female presents",
"office",
"extreme fatigue",
"bilateral joint pain",
"Serologies",
"presence",
"rheumatoid factor",
"Smith",
"anti-dsDNA antibodies",
"VDRL syphilis",
"positive",
"order",
"coagulation profile",
"reveals normal bleeding time",
"normal PT",
"prolonged PTT",
"normal platelet count",
"Further evaluation",
"most likely to reveal",
"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 29-year-old African American female presents to your office with extreme fatigue and bilateral joint pain. Serologies demonstrate the presence of rheumatoid factor along with anti-Smith and anti-dsDNA antibodies. A VDRL syphilis test is positive. You order a coagulation profile, which reveals normal bleeding time, normal PT, and prolonged PTT as well as normal platelet count. Further evaluation is most likely to reveal which of the following?
Choose one of the following::
A. Palmar rash
B. HLA-B27 positivity
C. Factor VIII deficiency
D. History of multiple spontaneous abortions | [
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A 31-year-old man comes to the physician because of a 5-day history of fever, chills, and dyspnea. His temperature is 38.9°C (102°F) and pulse is 90/min. Cardiac examination shows a murmur. In addition to other measures, cardiac catheterization is performed. A graph showing the results of the catheterization is shown. This patient most likely has which of the following valvular heart defects? | Aortic regurgitation | {
"A": "Mitral stenosis",
"B": "Mitral regurgitation",
"C": "Aortic regurgitation",
"D": "Aortic stenosis\n\""
} | step1 | C | [
"31 year old man",
"physician",
"5-day history",
"fever",
"chills",
"dyspnea",
"temperature",
"pulse",
"90 min",
"Cardiac examination shows",
"murmur",
"measures",
"cardiac catheterization",
"performed",
"graph showing",
"results",
"catheterization",
"shown",
"patient",
"likely",
"following valvular heart defects"
] | 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 man comes to the physician because of a 5-day history of fever, chills, and dyspnea. His temperature is 38.9°C (102°F) and pulse is 90/min. Cardiac examination shows a murmur. In addition to other measures, cardiac catheterization is performed. A graph showing the results of the catheterization is shown. This patient most likely has which of the following valvular heart defects?
Choose one of the following::
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic regurgitation
D. Aortic stenosis
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} |
A 54-year-old woman comes to the physician because of a painful skin lesion on her right leg for 1 month. It initially started out as a small red spot but has rapidly increased in size during this period. She remembers an ant bite on her leg prior to the lesion occurring. She was treated for anterior uveitis 8 months ago with corticosteroids. She has Crohn's disease, type 2 diabetes mellitus, and hypertension. Current medications include insulin, mesalamine, enalapril, and aspirin. She returned from Wisconsin after visiting her son 2 months ago. Her temperature is 37.6°C (98°F), pulse is 98/min, and blood pressure is 126/88 mm Hg. Examination shows pitting pedal edema of the lower extremities. There is a 4-cm tender ulcerative lesion on the anterior right leg with a central necrotic base and purplish irregular borders. There are dilated tortuous veins in both lower legs. Femoral and pedal pulses are palpated bilaterally. Which of the following is the most likely diagnosis? | Pyoderma gangrenosum | {
"A": "Ecthyma gangrenosum",
"B": "Pyoderma gangrenosum",
"C": "Blastomycosis",
"D": "Basal cell carcinoma\n\""
} | step2&3 | B | [
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"right leg",
"1 month",
"initially started out",
"small red spot",
"rapidly increased in size",
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"type 2 diabetes mellitus",
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"Current medications include insulin",
"mesalamine",
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"98 min",
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"88 mm Hg",
"Examination shows pitting pedal edema of",
"lower extremities",
"4 cm tender ulcerative lesion",
"anterior right leg",
"central necrotic base",
"irregular borders",
"dilated tortuous veins",
"lower legs",
"Femoral",
"pedal pulses",
"palpated",
"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 54-year-old woman comes to the physician because of a painful skin lesion on her right leg for 1 month. It initially started out as a small red spot but has rapidly increased in size during this period. She remembers an ant bite on her leg prior to the lesion occurring. She was treated for anterior uveitis 8 months ago with corticosteroids. She has Crohn's disease, type 2 diabetes mellitus, and hypertension. Current medications include insulin, mesalamine, enalapril, and aspirin. She returned from Wisconsin after visiting her son 2 months ago. Her temperature is 37.6°C (98°F), pulse is 98/min, and blood pressure is 126/88 mm Hg. Examination shows pitting pedal edema of the lower extremities. There is a 4-cm tender ulcerative lesion on the anterior right leg with a central necrotic base and purplish irregular borders. There are dilated tortuous veins in both lower legs. Femoral and pedal pulses are palpated bilaterally. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Ecthyma gangrenosum
B. Pyoderma gangrenosum
C. Blastomycosis
D. Basal cell carcinoma
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A primary care physician is recently receiving more negative online reviews from his patients. He is increasingly feeling tired and has written 2 wrong prescriptions over the past month alone. Currently, on his panel, he has a list of 1,051 patients, half of whom are geriatric patients. He spends approx. 51 hours per week visiting about 20 patients a day. He has no history of a serious illness and takes no medications. An evaluation by a psychiatrist shows no primary psychiatric disorders. According to recent national surveys, which of the following do physicians more frequently recognize as a contributor to this physician’s current condition? | Excessive bureaucratic tasks | {
"A": "The number of patients on his panel",
"B": "Excessive bureaucratic tasks",
"C": "Working too many hours",
"D": "Concern over online reputation"
} | step2&3 | B | [
"primary care physician",
"recently receiving more negative",
"reviews",
"patients",
"feeling tired",
"written 2 wrong prescriptions",
"past month alone",
"Currently",
"panel",
"list",
"patients",
"half",
"geriatric patients",
"spends",
"hours per week visiting",
"20 patients",
"day",
"history",
"serious illness",
"takes",
"medications",
"evaluation",
"psychiatrist shows",
"primary psychiatric",
"recent national surveys",
"following",
"physicians",
"frequently",
"physicians current 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 primary care physician is recently receiving more negative online reviews from his patients. He is increasingly feeling tired and has written 2 wrong prescriptions over the past month alone. Currently, on his panel, he has a list of 1,051 patients, half of whom are geriatric patients. He spends approx. 51 hours per week visiting about 20 patients a day. He has no history of a serious illness and takes no medications. An evaluation by a psychiatrist shows no primary psychiatric disorders. According to recent national surveys, which of the following do physicians more frequently recognize as a contributor to this physician’s current condition?
Choose one of the following::
A. The number of patients on his panel
B. Excessive bureaucratic tasks
C. Working too many hours
D. Concern over online reputation | [
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A 42-year-old Caucasian woman is enrolled in a randomized controlled trial to study cardiac function in the setting of several different drugs. She is started on verapamil and instructed to exercise at 50% of her VO2 max while several cardiac parameters are being measured. During this experiment, which of the following represents the relative conduction speed through the heart from fastest to slowest? | Purkinje fibers > atria > ventricles > AV node | {
"A": "Atria > Purkinje fibers > ventricles > AV node",
"B": "AV node > ventricles > atria > Purkinje fibers",
"C": "Purkinje fibers > atria > ventricles > AV node",
"D": "Purkinje fibers > AV node > ventricles > atria"
} | step2&3 | C | [
"year old Caucasian woman",
"enrolled",
"randomized controlled trial to study cardiac",
"setting",
"different drugs",
"started",
"verapamil",
"to exercise",
"50",
"VO2",
"several cardiac parameters",
"measured",
"experiment",
"following represents",
"relative conduction speed",
"heart",
"fastest",
"slowest"
] | 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 Caucasian woman is enrolled in a randomized controlled trial to study cardiac function in the setting of several different drugs. She is started on verapamil and instructed to exercise at 50% of her VO2 max while several cardiac parameters are being measured. During this experiment, which of the following represents the relative conduction speed through the heart from fastest to slowest?
Choose one of the following::
A. Atria > Purkinje fibers > ventricles > AV node
B. AV node > ventricles > atria > Purkinje fibers
C. Purkinje fibers > atria > ventricles > AV node
D. Purkinje fibers > AV node > ventricles > atria | [
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} |
A 7-year-old boy comes to the physician because of a generalized rash for 3 days. Over the past 5 days, he has also had a high fever and a sore throat. His 16-year-old sister was treated for infectious mononucleosis 2 weeks ago. He returned from a summer camp a week ago. His immunizations are up-to-date. Three years ago, he required intubation after an allergic reaction to dicloxacillin. The patient appears ill. His temperature is 38.2°C (100.8°F). Examination shows circumferential oral pallor. Cervical lymphadenopathy is present. There is tonsillar erythema and exudate. A confluent, blanching, punctate erythematous rash with a rough texture is spread over his trunk and extremities. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 12,000/mm3, and erythrocyte sedimentation rate is 43 mm/h. Which of the following is the most appropriate next step in management? | Azithromycin therapy | {
"A": "Acyclovir therapy",
"B": "Amoxicillin therapy",
"C": "Azithromycin therapy",
"D": "Cephalexin therapy"
} | step2&3 | C | [
"year old boy",
"physician",
"of",
"generalized rash",
"3 days",
"past",
"days",
"high fever",
"sore throat",
"year old sister",
"treated",
"infectious mononucleosis 2 weeks",
"returned",
"summer camp",
"week",
"immunizations",
"date",
"Three years",
"required intubation",
"allergic reaction",
"dicloxacillin",
"patient appears ill",
"temperature",
"100",
"Examination shows circumferential oral pallor",
"Cervical lymphadenopathy",
"present",
"tonsillar erythema",
"exudate",
"confluent",
"blanching",
"punctate erythematous rash",
"texture",
"spread",
"trunk",
"extremities",
"hemoglobin concentration",
"g/dL",
"leukocyte count",
"mm3",
"erythrocyte sedimentation rate",
"mm/h",
"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 7-year-old boy comes to the physician because of a generalized rash for 3 days. Over the past 5 days, he has also had a high fever and a sore throat. His 16-year-old sister was treated for infectious mononucleosis 2 weeks ago. He returned from a summer camp a week ago. His immunizations are up-to-date. Three years ago, he required intubation after an allergic reaction to dicloxacillin. The patient appears ill. His temperature is 38.2°C (100.8°F). Examination shows circumferential oral pallor. Cervical lymphadenopathy is present. There is tonsillar erythema and exudate. A confluent, blanching, punctate erythematous rash with a rough texture is spread over his trunk and extremities. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 12,000/mm3, and erythrocyte sedimentation rate is 43 mm/h. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Acyclovir therapy
B. Amoxicillin therapy
C. Azithromycin therapy
D. Cephalexin therapy | [
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A 30-year-old woman comes to the physician because of a swelling on her neck for 5 months. It has gradually enlarged in size and is mildly painful. She has also had intermittent episodes of throbbing headache, sweating, and palpitations over the past 3 months. Menses occur at regular 28-day intervals and last for 4–5 days. She does not smoke, occasionally consumes alcohol on weekends. She appears thin and pale. Her temperature is 38.7°C (101.7°F), pulse is 112/min, and blood pressure is 140/90 mm Hg. Examination shows a firm, 3-cm swelling on the neck that moves with swallowing; there is no lymphadenopathy. Cardiopulmonary examination shows no abnormalities. Laboratory studies show:
Hemoglobin 13 g/dL
Leukocyte count 9500/mm3
Platelet count 230,000/mm3
Serum
Na+ 136 mEq/L
K+ 3.5 mEq/L
Cl- 104 mEq/L
TSH 2.3 μU/mL
Calcitonin 300 ng/dL (Normal < 5 ng/dL)
An electrocardiogram shows sinus tachycardia. Which of the following laboratory abnormalities is most likely to be seen?" | Increased plasma metanephrines | {
"A": "Increased serum gastrin",
"B": "Increased serum cortisol",
"C": "Increased serum T3 levels",
"D": "Increased plasma metanephrines"
} | step2&3 | D | [
"30 year old woman",
"physician",
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"neck",
"5 months",
"enlarged",
"size",
"mildly painful",
"intermittent episodes of throbbing",
"sweating",
"palpitations",
"past 3 months",
"Menses occur",
"regular",
"day intervals",
"last",
"days",
"not smoke",
"occasionally",
"alcohol",
"weekends",
"appears thin",
"pale",
"temperature",
"pulse",
"min",
"blood pressure",
"90 mm Hg",
"Examination shows",
"firm",
"3",
"swelling",
"neck",
"moves",
"swallowing",
"lymphadenopathy",
"Cardiopulmonary examination shows",
"abnormalities",
"Laboratory studies show",
"Hemoglobin",
"g dL Leukocyte",
"mm3 Platelet count",
"Serum",
"K",
"2",
"Calcitonin 300 ng dL",
"Normal",
"5 ng/dL",
"electrocardiogram shows sinus tachycardia",
"following laboratory abnormalities",
"most likely to",
"seen"
] | 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 woman comes to the physician because of a swelling on her neck for 5 months. It has gradually enlarged in size and is mildly painful. She has also had intermittent episodes of throbbing headache, sweating, and palpitations over the past 3 months. Menses occur at regular 28-day intervals and last for 4–5 days. She does not smoke, occasionally consumes alcohol on weekends. She appears thin and pale. Her temperature is 38.7°C (101.7°F), pulse is 112/min, and blood pressure is 140/90 mm Hg. Examination shows a firm, 3-cm swelling on the neck that moves with swallowing; there is no lymphadenopathy. Cardiopulmonary examination shows no abnormalities. Laboratory studies show:
Hemoglobin 13 g/dL
Leukocyte count 9500/mm3
Platelet count 230,000/mm3
Serum
Na+ 136 mEq/L
K+ 3.5 mEq/L
Cl- 104 mEq/L
TSH 2.3 μU/mL
Calcitonin 300 ng/dL (Normal < 5 ng/dL)
An electrocardiogram shows sinus tachycardia. Which of the following laboratory abnormalities is most likely to be seen?"
Choose one of the following::
A. Increased serum gastrin
B. Increased serum cortisol
C. Increased serum T3 levels
D. Increased plasma metanephrines | [
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A 31-year-old G3P1 woman who is at 37 weeks of gestation is brought into the emergency department by her husband after repeated twitching. According to the husband, they were watching TV when she suddenly became unresponsive and her hands and legs started shaking. The episode lasted about 5 minutes and she “seemed to be sleeping afterwards.” Her past medical history is significant for pregnancy induced hypertension. The patient is tired but responsive and denies urinary incontinence, paresthesia, fever, upper respiratory signs, or new medication changes. She denies a history of seizures. Her temperature is 99°F (37°C), blood pressure is 186/97 mmHg, pulse is 96/min, and respirations are 12/min. Physical examination demonstrates a lethargic patient with moderate right upper quadrant tenderness. What is the most appropriate next step for this patient? | Intravenous magnesium sulfate | {
"A": "Emergency cesarean section",
"B": "Expectant management",
"C": "Intravenous infusion of oxytocin",
"D": "Intravenous magnesium sulfate"
} | step1 | D | [
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"watching TV",
"unresponsive",
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"blood pressure",
"97 mmHg",
"pulse",
"96 min",
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"lethargic patient",
"moderate right upper quadrant tenderness",
"most appropriate next step",
"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 31-year-old G3P1 woman who is at 37 weeks of gestation is brought into the emergency department by her husband after repeated twitching. According to the husband, they were watching TV when she suddenly became unresponsive and her hands and legs started shaking. The episode lasted about 5 minutes and she “seemed to be sleeping afterwards.” Her past medical history is significant for pregnancy induced hypertension. The patient is tired but responsive and denies urinary incontinence, paresthesia, fever, upper respiratory signs, or new medication changes. She denies a history of seizures. Her temperature is 99°F (37°C), blood pressure is 186/97 mmHg, pulse is 96/min, and respirations are 12/min. Physical examination demonstrates a lethargic patient with moderate right upper quadrant tenderness. What is the most appropriate next step for this patient?
Choose one of the following::
A. Emergency cesarean section
B. Expectant management
C. Intravenous infusion of oxytocin
D. Intravenous magnesium sulfate | [
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A 65-year-old man was picked up by the security personnel for voiding urine and defecating at an inappropriate place in the community. On questioning, he was making offensive remarks and behaving inappropriately. On physical examination, the physician observed an ataxic gait and amnesia. Initial urine drug screen is negative for any drugs of abuse. Which is the most likely pathological finding present in this patient? | Pick bodies | {
"A": "Drug abuse",
"B": "Lewy bodies",
"C": "Pick bodies",
"D": "Amyloid plaques"
} | step1 | C | [
"65 year old man",
"picked",
"security personnel",
"voiding urine",
"inappropriate place",
"community",
"questioning",
"making",
"remarks",
"physical examination",
"physician observed",
"ataxic gait",
"amnesia",
"Initial urine drug screen",
"negative",
"drugs of abuse",
"most likely pathological finding 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 65-year-old man was picked up by the security personnel for voiding urine and defecating at an inappropriate place in the community. On questioning, he was making offensive remarks and behaving inappropriately. On physical examination, the physician observed an ataxic gait and amnesia. Initial urine drug screen is negative for any drugs of abuse. Which is the most likely pathological finding present in this patient?
Choose one of the following::
A. Drug abuse
B. Lewy bodies
C. Pick bodies
D. Amyloid plaques | [
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A 52-year-old man undergoes an exercise stress test for a 1-week history of squeezing substernal chest pain that is aggravated by exercise and relieved by rest. During the test, there is a substantial increase in the breakdown of glycogen in the muscle cells. Which of the following changes best explains this intracellular finding? | Activation of phosphorylase kinase | {
"A": "Decrease in protein kinase A",
"B": "Activation of phosphorylase kinase",
"C": "Increase in glucose-6-phosphate",
"D": "Inactivation of glycogen synthase kinase"
} | step1 | B | [
"year old man",
"exercise stress test",
"1-week history of",
"chest pain",
"aggravated by exercise",
"relieved by rest",
"test",
"increase",
"breakdown",
"glycogen",
"muscle cells",
"following changes best",
"intracellular 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: A 52-year-old man undergoes an exercise stress test for a 1-week history of squeezing substernal chest pain that is aggravated by exercise and relieved by rest. During the test, there is a substantial increase in the breakdown of glycogen in the muscle cells. Which of the following changes best explains this intracellular finding?
Choose one of the following::
A. Decrease in protein kinase A
B. Activation of phosphorylase kinase
C. Increase in glucose-6-phosphate
D. Inactivation of glycogen synthase kinase | [
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A 35-year-old man presents to the general practitioner with a skin rash that has been present for 2 days. The rash appeared suddenly and has progressively gotten worse. It started off as an erythematous lesion on the back of his hands and also over his nose. The lesions over his hands have become bullous and tense. He has never experienced similar symptoms before. He just got back from a canoeing trip during a very hot and sunny weekend. Physical exam is significant for erythematous, vesicular lesions over the nape of the neck and bridge of the nose as well as tense bullae over the dorsum of both hands. The attending physician suspects a defect in the synthesis of heme and orders some blood tests. Which of the following precursors will most likely be elevated in this patient? | Uroporphyrinogen III | {
"A": "Uroporphyrinogen III",
"B": "Hydroxymethylbilane",
"C": "Porphobilinogen",
"D": "δ-Aminolevulinic acid"
} | step1 | A | [
"35 year old man presents",
"general practitioner",
"skin rash",
"present",
"2 days",
"rash appeared",
"gotten worse",
"started",
"erythematous",
"back of",
"hands",
"nose",
"lesions",
"hands",
"bullous",
"tense",
"never experienced similar symptoms",
"got back",
"canoeing trip",
"very hot",
"sunny weekend",
"Physical exam",
"significant",
"erythematous",
"vesicular lesions",
"nape",
"neck",
"bridge of",
"nose",
"tense bullae",
"dorsum of",
"hands",
"attending physician suspects",
"defect",
"synthesis",
"heme",
"orders",
"blood tests",
"following precursors",
"most likely",
"elevated",
"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 35-year-old man presents to the general practitioner with a skin rash that has been present for 2 days. The rash appeared suddenly and has progressively gotten worse. It started off as an erythematous lesion on the back of his hands and also over his nose. The lesions over his hands have become bullous and tense. He has never experienced similar symptoms before. He just got back from a canoeing trip during a very hot and sunny weekend. Physical exam is significant for erythematous, vesicular lesions over the nape of the neck and bridge of the nose as well as tense bullae over the dorsum of both hands. The attending physician suspects a defect in the synthesis of heme and orders some blood tests. Which of the following precursors will most likely be elevated in this patient?
Choose one of the following::
A. Uroporphyrinogen III
B. Hydroxymethylbilane
C. Porphobilinogen
D. δ-Aminolevulinic acid | [
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A 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department because of vaginal bleeding for the past hour. The patient reports that she felt contractions prior to the onset of the bleeding, but the contractions stopped after the bleeding started. She also has severe abdominal pain. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her pulse is 110/min, respirations are 17/min, and blood pressure is 90/60 mm Hg. Examination shows diffuse abdominal tenderness with no rebound or guarding; no contractions are felt. The fetal heart rate shows recurrent variable decelerations. Which of the following is the most likely diagnosis? | Uterine rupture | {
"A": "Abruptio placentae",
"B": "Vasa previa",
"C": "Uterine rupture",
"D": "Uterine inertia"
} | step2&3 | C | [
"year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation",
"emergency department",
"of vaginal bleeding",
"past hour",
"patient reports",
"felt contractions prior to",
"onset of",
"bleeding",
"contractions stopped",
"bleeding started",
"severe abdominal",
"first child",
"delivered",
"lower segment transverse cesarean",
"fetal heart rate",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"90 60 mm Hg",
"Examination shows diffuse abdominal tenderness",
"rebound",
"guarding",
"contractions",
"felt",
"fetal heart rate shows recurrent variable decelerations",
"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 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department because of vaginal bleeding for the past hour. The patient reports that she felt contractions prior to the onset of the bleeding, but the contractions stopped after the bleeding started. She also has severe abdominal pain. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her pulse is 110/min, respirations are 17/min, and blood pressure is 90/60 mm Hg. Examination shows diffuse abdominal tenderness with no rebound or guarding; no contractions are felt. The fetal heart rate shows recurrent variable decelerations. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Abruptio placentae
B. Vasa previa
C. Uterine rupture
D. Uterine inertia | [
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A 5-year-old boy is brought to the emergency department by his parents for difficulty breathing. He was playing outside in the snow and had progressive onset of wheezing and gasping. His history is notable for eczema and nut allergies. The patient has respirations of 22/min and is leaning forward with his hands on his legs as he is seated on the table. Physical examination is notable for inspiratory and expiratory wheezes on exam. A nebulized medication is started and begins to relieve his breathing difficulties. Which of the following is increased in this patient as a result of this medication? | Cyclic AMP | {
"A": "Cyclic GMP",
"B": "Cyclic AMP",
"C": "Protein kinase C",
"D": "ATP"
} | step1 | B | [
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"playing outside",
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"gasping",
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"started",
"begins to relieve",
"breathing difficulties",
"following",
"increased",
"patient",
"result",
"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 5-year-old boy is brought to the emergency department by his parents for difficulty breathing. He was playing outside in the snow and had progressive onset of wheezing and gasping. His history is notable for eczema and nut allergies. The patient has respirations of 22/min and is leaning forward with his hands on his legs as he is seated on the table. Physical examination is notable for inspiratory and expiratory wheezes on exam. A nebulized medication is started and begins to relieve his breathing difficulties. Which of the following is increased in this patient as a result of this medication?
Choose one of the following::
A. Cyclic GMP
B. Cyclic AMP
C. Protein kinase C
D. ATP | [
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A 78-year-old male with history of coronary artery disease, status post coronary stent placement currently on aspirin and clopidogrel was found down in his bathroom by his wife. His GCS score was 3 and an accurate physical exam is limited. A stat non-contrast CT scan of his brain demonstrated a large right parietal intracranial hemorrhage with surrounding edema. He was promptly transferred to the intensive care unit (ICU) for monitoring. Over the next day, his mental status continues to worsen but repeat CT scan shows no new bleeding. In addition, the patient’s urinary output has been >200 cc/hr over the last several hours and increasing. His temperature is 99.0 deg F (37.2 deg C), blood pressure is 125/72 mmHg, pulse is 87/min, and respirations are 13/min. Which of the following values would most likely correspond to the patient’s urine specific gravity, urine osmolality, plasma osmolality, and serum sodium? | Low, Low, High, High | {
"A": "Low, High, High, High",
"B": "Low, Low, High, Low",
"C": "Low, Low, High, High",
"D": "High, Low, Low, High"
} | step2&3 | C | [
"year",
"male",
"history of coronary artery disease",
"status coronary currently",
"aspirin",
"clopidogrel",
"found",
"bathroom",
"wife",
"GCS score",
"3",
"accurate physical exam",
"limited",
"stat non contrast CT scan of",
"brain",
"large right parietal intracranial",
"surrounding edema",
"transferred",
"intensive care unit",
"monitoring",
"next day",
"mental status continues to worsen",
"repeat CT scan shows",
"new bleeding",
"addition",
"patients urinary output",
"200 cc",
"hours",
"increasing",
"temperature",
"99 0 deg F",
"37 2",
"blood pressure",
"72 mmHg",
"pulse",
"87 min",
"respirations",
"min",
"following values",
"most likely",
"patients urine specific gravity",
"urine osmolality",
"plasma osmolality",
"serum sodium"
] | 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 78-year-old male with history of coronary artery disease, status post coronary stent placement currently on aspirin and clopidogrel was found down in his bathroom by his wife. His GCS score was 3 and an accurate physical exam is limited. A stat non-contrast CT scan of his brain demonstrated a large right parietal intracranial hemorrhage with surrounding edema. He was promptly transferred to the intensive care unit (ICU) for monitoring. Over the next day, his mental status continues to worsen but repeat CT scan shows no new bleeding. In addition, the patient’s urinary output has been >200 cc/hr over the last several hours and increasing. His temperature is 99.0 deg F (37.2 deg C), blood pressure is 125/72 mmHg, pulse is 87/min, and respirations are 13/min. Which of the following values would most likely correspond to the patient’s urine specific gravity, urine osmolality, plasma osmolality, and serum sodium?
Choose one of the following::
A. Low, High, High, High
B. Low, Low, High, Low
C. Low, Low, High, High
D. High, Low, Low, High | [
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A 53-year-old woman comes to the physician for a follow-up examination. One month ago, she was diagnosed with carcinoma of the left breast. She underwent a lumpectomy for a 2.1-cm mass and sentinel lymph node biopsy 2 weeks ago. The biopsy of the breast mass showed margin-free invasive ductal carcinoma; immunohistochemistry showed the carcinoma is estrogen-receptor and progesterone-receptor negative, and HER2-receptor positive. The lymph node biopsy was negative for metastases. Examination shows a healing surgical incision over the left breast. There is no palpable axillary lymphadenopathy. Her physician decides to initiate treatment with appropriate pharmacotherapy. Which of the following is the most appropriate next step in management? | Echocardiography | {
"A": "Echocardiography",
"B": "Fundoscopy",
"C": "X-ray of the chest",
"D": "Endometrial biopsy"
} | step2&3 | A | [
"year old woman",
"physician",
"follow-up examination",
"One month",
"diagnosed",
"carcinoma of the left breast",
"lumpectomy",
"mass",
"sentinel lymph node biopsy",
"weeks",
"biopsy of",
"breast mass showed margin free invasive ductal carcinoma",
"immunohistochemistry showed",
"carcinoma",
"estrogen-receptor",
"progesterone-receptor negative",
"HER2 receptor positive",
"lymph node biopsy",
"negative",
"metastases",
"Examination shows",
"healing",
"left",
"palpable axillary lymphadenopathy",
"physician",
"to initiate treatment",
"appropriate pharmacotherapy",
"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 53-year-old woman comes to the physician for a follow-up examination. One month ago, she was diagnosed with carcinoma of the left breast. She underwent a lumpectomy for a 2.1-cm mass and sentinel lymph node biopsy 2 weeks ago. The biopsy of the breast mass showed margin-free invasive ductal carcinoma; immunohistochemistry showed the carcinoma is estrogen-receptor and progesterone-receptor negative, and HER2-receptor positive. The lymph node biopsy was negative for metastases. Examination shows a healing surgical incision over the left breast. There is no palpable axillary lymphadenopathy. Her physician decides to initiate treatment with appropriate pharmacotherapy. Which of the following is the most appropriate next step in management?
Choose one of the following::
A. Echocardiography
B. Fundoscopy
C. X-ray of the chest
D. Endometrial biopsy | [
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Three weeks after birth, an infant girl develops episodes of apnea. She has become increasingly lethargic over the past two days, and experienced two episodes of apnea lasting 10 seconds each within the last day. She was born at 31 weeks of gestation and weighed 1600-g (3-lb 8-oz). Apgar scores were 4 and 7 at 1 and 5 minutes, respectively. She takes no medications. Her temperature is 36.7°C (98.0°F), pulse is 185/min, respirations are 60/min and irregular, and blood pressure is 70/35 mm Hg. She appears pale. Physical examination shows no abnormalities. Laboratory studies show a hemoglobin of 6.5 g/dL, a reticulocyte count of 0.5%, and a mean corpuscular volume of 92 μm3. Leukocyte count, platelet count, total bilirubin and indirect bilirubin are all within reference range. Which of the following is the most likely underlying mechanism of this patient's anemia? | Impaired erythropoietin production | {
"A": "Defective δ-aminolevulinic acid synthase",
"B": "Bone marrow suppression",
"C": "Glucose-6-phosphate dehydrogenase deficiency",
"D": "Impaired erythropoietin production"
} | step2&3 | D | [
"Three weeks after birth",
"infant girl",
"episodes of apnea",
"lethargic",
"past two days",
"two episodes of apnea lasting 10 seconds",
"last day",
"born",
"31 weeks of gestation",
"1600 g",
"8 oz",
"Apgar scores",
"5 minutes",
"takes",
"medications",
"temperature",
"36",
"98",
"pulse",
"min",
"respirations",
"60 min",
"irregular",
"blood pressure",
"70 35 mm Hg",
"appears pale",
"Physical examination shows",
"abnormalities",
"Laboratory studies show a hemoglobin",
"g/dL",
"reticulocyte count",
"0.5",
"mean corpuscular volume",
"m3",
"Leukocyte",
"platelet count",
"total bilirubin",
"indirect bilirubin",
"reference range",
"following",
"most likely underlying mechanism",
"patient's anemia"
] | 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: Three weeks after birth, an infant girl develops episodes of apnea. She has become increasingly lethargic over the past two days, and experienced two episodes of apnea lasting 10 seconds each within the last day. She was born at 31 weeks of gestation and weighed 1600-g (3-lb 8-oz). Apgar scores were 4 and 7 at 1 and 5 minutes, respectively. She takes no medications. Her temperature is 36.7°C (98.0°F), pulse is 185/min, respirations are 60/min and irregular, and blood pressure is 70/35 mm Hg. She appears pale. Physical examination shows no abnormalities. Laboratory studies show a hemoglobin of 6.5 g/dL, a reticulocyte count of 0.5%, and a mean corpuscular volume of 92 μm3. Leukocyte count, platelet count, total bilirubin and indirect bilirubin are all within reference range. Which of the following is the most likely underlying mechanism of this patient's anemia?
Choose one of the following::
A. Defective δ-aminolevulinic acid synthase
B. Bone marrow suppression
C. Glucose-6-phosphate dehydrogenase deficiency
D. Impaired erythropoietin production | [
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A 45-year-old woman presents to the physician with a 6-month history of progressive shortness of breath. She now has to stop to rest three or four times whenever she climbs the stairs to her apartment on the third floor. She reports chronic, nonproductive cough and wheezing, for which she uses ipratropium inhalers. She has a 25 pack-year smoking history. On examination, the blood pressure is 130/80 mm Hg, the pulse rate is 95/min, the temperature is 36.6°C (97.8°F), and the respiratory rate is 26/min. Chest auscultation reveals bilateral crepitations. Cardiac auscultation reveals normal S1 and S2 without murmurs or added sounds. Arterial blood gas analysis shows:
pH 7.36 (reference: 7.35–7.45)
HCO3- 32 mEq/L (reference 22–28 mEq/L)
Pco2 48 mm Hg (reference: 33–45 mm Hg)
Po2 63 mm Hg (reference: 75–105 mm Hg)
O2 saturation 91% (reference: 94–99%)
Which of the following would you expect to find in this patient? | Decreased diffusing capacity of the lungs for carbon monoxide (DLCO) | {
"A": "Decreased lung residual volume",
"B": "Decreased diffusing capacity of the lungs for carbon monoxide (DLCO)",
"C": "Shift of the flow volume loop to the right",
"D": "Decreased lung compliance"
} | step1 | B | [
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"now",
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"four times",
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"reports chronic",
"nonproductive cough",
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"uses ipratropium inhalers",
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"95 min",
"temperature",
"36",
"97",
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"Chest auscultation reveals bilateral crepitations",
"Cardiac auscultation reveals normal S1",
"S2",
"murmurs",
"added sounds",
"Arterial blood gas analysis shows",
"pH 7 36",
"reference",
"HCO3",
"mEq/L",
"reference",
"mEq/L",
"Pco2 48 mm Hg",
"reference",
"mm Hg",
"Po2 63 mm Hg",
"reference",
"mm Hg",
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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 woman presents to the physician with a 6-month history of progressive shortness of breath. She now has to stop to rest three or four times whenever she climbs the stairs to her apartment on the third floor. She reports chronic, nonproductive cough and wheezing, for which she uses ipratropium inhalers. She has a 25 pack-year smoking history. On examination, the blood pressure is 130/80 mm Hg, the pulse rate is 95/min, the temperature is 36.6°C (97.8°F), and the respiratory rate is 26/min. Chest auscultation reveals bilateral crepitations. Cardiac auscultation reveals normal S1 and S2 without murmurs or added sounds. Arterial blood gas analysis shows:
pH 7.36 (reference: 7.35–7.45)
HCO3- 32 mEq/L (reference 22–28 mEq/L)
Pco2 48 mm Hg (reference: 33–45 mm Hg)
Po2 63 mm Hg (reference: 75–105 mm Hg)
O2 saturation 91% (reference: 94–99%)
Which of the following would you expect to find in this patient?
Choose one of the following::
A. Decreased lung residual volume
B. Decreased diffusing capacity of the lungs for carbon monoxide (DLCO)
C. Shift of the flow volume loop to the right
D. Decreased lung compliance | [
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A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder? | Dependent | {
"A": "Antisocial",
"B": "Dependent",
"C": "Histrionic",
"D": "Schizotypal"
} | step1 | B | [
"27 year old man",
"brought",
"psychiatrist",
"mother",
"concerned",
"distant",
"longer",
"out",
"afraid",
"outside",
"ever",
"teenager",
"large crowds",
"public transportation",
"now works",
"home",
"rarely leaves",
"house",
"mandatory business",
"following personality disorders",
"most likely",
"associated with",
"patient's disorder"
] | 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 is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?
Choose one of the following::
A. Antisocial
B. Dependent
C. Histrionic
D. Schizotypal | [
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A 26-year-old woman presents with sudden-onset pain in her lower back. She says she was exercising in the gym several hours ago when she felt a sharp pain. The pain is radiating down the side of her leg and into her foot. On physical exam, her vital signs are as follows: HR 95, BP 120/70, T 37.2 degrees C. She has extreme pain shooting down her leg with a straight leg raise. Her sensation to light touch and pin-prick is intact throughout. Which of the following is the most likely diagnosis? | Disc herniation | {
"A": "Disc herniation",
"B": "Osteomyelitis",
"C": "Spinal stenosis",
"D": "Ankylosing spondylitis"
} | step2&3 | A | [
"year old woman presents",
"sudden-onset pain",
"lower back",
"exercising",
"hours",
"felt",
"sharp pain",
"pain",
"radiating",
"side",
"leg",
"foot",
"physical exam",
"vital signs",
"follows",
"95",
"BP",
"70",
"T",
"degrees C",
"extreme pain",
"leg",
"straight leg raise",
"sensation",
"light touch",
"pin prick",
"intact",
"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 26-year-old woman presents with sudden-onset pain in her lower back. She says she was exercising in the gym several hours ago when she felt a sharp pain. The pain is radiating down the side of her leg and into her foot. On physical exam, her vital signs are as follows: HR 95, BP 120/70, T 37.2 degrees C. She has extreme pain shooting down her leg with a straight leg raise. Her sensation to light touch and pin-prick is intact throughout. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Disc herniation
B. Osteomyelitis
C. Spinal stenosis
D. Ankylosing spondylitis | [
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A 34-year-old man with AIDS comes to the physician because of a 2-day history of decreasing vision and seeing black spots in his right eye. He has no pain and the left eye is asymptomatic. He was treated for fungal esophagitis 6 months ago with fluconazole. He was diagnosed with Kaposi's sarcoma 2 years ago. Current medications include efavirenz, tenofovir, emtricitabine, azithromycin, trimethoprim-sulfamethoxazole, multivitamins, and a nutritional supplement. He is 170 cm (5 ft 7 in) tall and weighs 45 kg (99 lbs);BMI is 15.6 kg/m2. His temperature is 37°C (98.6°F), pulse is 89/min, and blood pressure is 110/70 mm Hg. Examination shows cervical lymphadenopathy. There are multiple violaceous plaques seen over his trunk and extremities. Fundoscopic examination shows granular yellow-white opacities around the retinal vessels and multiple areas of dot-blot hemorrhages. His CD4+ T-lymphocyte count is 36/mm3. Which of the following is the most likely diagnosis? | Cytomegalovirus retinitis | {
"A": "Cytomegalovirus retinitis",
"B": "Toxoplasma retinitis",
"C": "HIV retinopathy",
"D": "Varicella zoster retinitis"
} | step2&3 | A | [
"year old man",
"AIDS",
"physician",
"2-day history",
"decreasing vision",
"seeing black spots",
"right eye",
"pain",
"left eye",
"asymptomatic",
"treated",
"fungal esophagitis",
"months",
"fluconazole",
"diagnosed",
"Kaposi's sarcoma 2 years",
"Current medications include efavirenz",
"tenofovir",
"emtricitabine",
"azithromycin",
"trimethoprim-sulfamethoxazole",
"multivitamins",
"nutritional supplement",
"5 ft",
"tall",
"kg",
"99 lbs",
"BMI",
"kg/m2",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"70 mm Hg",
"Examination shows cervical lymphadenopathy",
"multiple violaceous plaques seen",
"trunk",
"extremities",
"Fundoscopic examination shows granular yellow white opacities",
"retinal vessels",
"multiple areas",
"dot-blot hemorrhages",
"CD4",
"lymphocyte count",
"36 mm3",
"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 34-year-old man with AIDS comes to the physician because of a 2-day history of decreasing vision and seeing black spots in his right eye. He has no pain and the left eye is asymptomatic. He was treated for fungal esophagitis 6 months ago with fluconazole. He was diagnosed with Kaposi's sarcoma 2 years ago. Current medications include efavirenz, tenofovir, emtricitabine, azithromycin, trimethoprim-sulfamethoxazole, multivitamins, and a nutritional supplement. He is 170 cm (5 ft 7 in) tall and weighs 45 kg (99 lbs);BMI is 15.6 kg/m2. His temperature is 37°C (98.6°F), pulse is 89/min, and blood pressure is 110/70 mm Hg. Examination shows cervical lymphadenopathy. There are multiple violaceous plaques seen over his trunk and extremities. Fundoscopic examination shows granular yellow-white opacities around the retinal vessels and multiple areas of dot-blot hemorrhages. His CD4+ T-lymphocyte count is 36/mm3. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Cytomegalovirus retinitis
B. Toxoplasma retinitis
C. HIV retinopathy
D. Varicella zoster retinitis | [
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A 45-year old man comes to the physician because of a painless neck lump and a 2-month history of difficulty swallowing. He has a history of recurrent nephrolithiasis and episodic hypertension. Physical examination shows a 3 × 3-cm, nontender nodule at the level of the thyroid cartilage. A photomicrograph of a section of tissue obtained by core needle biopsy of the nodule is shown. Which of the following is the most likely diagnosis? | Medullary carcinoma | {
"A": "Follicular carcinoma",
"B": "Non-Hodgkin lymphoma",
"C": "Papillary carcinoma",
"D": "Medullary carcinoma"
} | step1 | D | [
"year old man",
"physician",
"painless neck lump",
"2 month history",
"difficulty swallowing",
"history of recurrent nephrolithiasis",
"episodic hypertension",
"Physical examination shows",
"3",
"3",
"nontender nodule",
"the level of",
"thyroid cartilage",
"photomicrograph",
"section",
"tissue obtained",
"core needle biopsy",
"nodule",
"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 painless neck lump and a 2-month history of difficulty swallowing. He has a history of recurrent nephrolithiasis and episodic hypertension. Physical examination shows a 3 × 3-cm, nontender nodule at the level of the thyroid cartilage. A photomicrograph of a section of tissue obtained by core needle biopsy of the nodule is shown. Which of the following is the most likely diagnosis?
Choose one of the following::
A. Follicular carcinoma
B. Non-Hodgkin lymphoma
C. Papillary carcinoma
D. Medullary carcinoma | [
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A 17-year-old boy is brought to the physician because of increasing pain and swelling of his right knee for 12 days. He has had episodes of pain with urination for 3 weeks. He had a painful, swollen left ankle joint that resolved without treatment one week ago. His mother has rheumatoid arthritis. He is sexually active with 2 female partners and uses condoms inconsistently. He appears anxious. His temperature is 38°C (100.4°F), pulse is 68/min, and blood pressure is 100/80 mm Hg. Examination shows bilateral inflammation of the conjunctiva. The right knee is tender, erythematous, and swollen; range of motion is limited by pain. There is tenderness at the left Achilles tendon insertion site. Genital examination shows no abnormalities. Laboratory studies show:
Hemoglobin 14.5 g/dL
Leukocyte count 12,300/mm3
Platelet count 310,000/mm3
Erythrocyte sedimentation rate 38 mm/h
Serum
Urea nitrogen 18 mg/dL
Glucose 89 mg/dL
Creatinine 1.0 mg/dL
Urine
Protein negative
Blood negative
WBC 12–16/hpf
RBC 1–2/hpf
An ELISA test for HIV is negative. Arthrocentesis is done. The synovial fluid is cloudy and a Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 26,000/mm3 and 75% neutrophils. Which of the following is the most likely diagnosis?" | Reactive arthritis | {
"A": "Septic arthritis",
"B": "Lyme arthritis",
"C": "Reactive arthritis",
"D": "Syphilitic arthritis\n\""
} | step2&3 | C | [
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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 17-year-old boy is brought to the physician because of increasing pain and swelling of his right knee for 12 days. He has had episodes of pain with urination for 3 weeks. He had a painful, swollen left ankle joint that resolved without treatment one week ago. His mother has rheumatoid arthritis. He is sexually active with 2 female partners and uses condoms inconsistently. He appears anxious. His temperature is 38°C (100.4°F), pulse is 68/min, and blood pressure is 100/80 mm Hg. Examination shows bilateral inflammation of the conjunctiva. The right knee is tender, erythematous, and swollen; range of motion is limited by pain. There is tenderness at the left Achilles tendon insertion site. Genital examination shows no abnormalities. Laboratory studies show:
Hemoglobin 14.5 g/dL
Leukocyte count 12,300/mm3
Platelet count 310,000/mm3
Erythrocyte sedimentation rate 38 mm/h
Serum
Urea nitrogen 18 mg/dL
Glucose 89 mg/dL
Creatinine 1.0 mg/dL
Urine
Protein negative
Blood negative
WBC 12–16/hpf
RBC 1–2/hpf
An ELISA test for HIV is negative. Arthrocentesis is done. The synovial fluid is cloudy and a Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 26,000/mm3 and 75% neutrophils. Which of the following is the most likely diagnosis?"
Choose one of the following::
A. Septic arthritis
B. Lyme arthritis
C. Reactive arthritis
D. Syphilitic arthritis
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Subsets and Splits