question stringlengths 182 2.58k | answer_text stringlengths 1 128 | options dict | meta_info stringclasses 2
values | answer stringclasses 4
values | metamap_phrases listlengths 8 116 |
|---|---|---|---|---|---|
A junior orthopaedic surgery resident is completing a carpal tunnel repair with the department chairman as the attending physician. During the case, the resident inadvertently cuts a flexor tendon. The tendon is repaired without complication. The attending tells the resident that the patient will do fine, and there is ... | Tell the attending that he cannot fail to disclose this mistake | {
"A": "Disclose the error to the patient and put it in the operative report",
"B": "Tell the attending that he cannot fail to disclose this mistake",
"C": "Report the physician to the ethics committee",
"D": "Refuse to dictate the operative report"
} | step1 | B | [
"junior orthopaedic surgery resident",
"completing",
"carpal tunnel repair",
"department chairman",
"attending physician",
"case",
"resident",
"cuts",
"flexor tendon",
"tendon",
"repaired",
"complication",
"attending",
"resident",
"patient",
"fine",
"need to report",
"minor complic... |
A 67-year-old man with transitional cell carcinoma of the bladder comes to the physician because of a 2-day history of ringing sensation in his ear. He received this first course of neoadjuvant chemotherapy 1 week ago. Pure tone audiometry shows a sensorineural hearing loss of 45 dB. The expected beneficial effect of t... | Cross-linking of DNA | {
"A": "Inhibition of proteasome",
"B": "Hyperstabilization of microtubules",
"C": "Generation of free radicals",
"D": "Cross-linking of DNA"
} | step1 | D | [
"67 year old man",
"transitional cell carcinoma of the bladder",
"physician",
"2-day history",
"ringing sensation",
"ear",
"received",
"first course",
"neoadjuvant chemotherapy 1 week",
"Pure tone audiometry shows",
"sensorineural hearing loss",
"dB",
"expected beneficial effect",
"drug",
... |
A 39-year-old woman is brought to the emergency department because of fevers, chills, and left lower quadrant pain. Her temperature is 39.1°C (102.3°F), pulse is 126/min, respirations are 28/min, and blood pressure is 80/50 mm Hg. There is blood oozing around the site of a peripheral intravenous line. Pelvic examinatio... | Lactose-fermenting, gram-negative rods forming pink colonies on MacConkey agar | {
"A": "Coagulase-positive, gram-positive cocci forming mauve-colored colonies on methicillin-containing agar",
"B": "Encapsulated, gram-negative coccobacilli forming grey-colored colonies on charcoal blood agar",
"C": "Spore-forming, gram-positive bacilli forming yellow colonies on casein agar",
"D": "Lactose-... | step1 | D | [
"year old woman",
"brought",
"emergency department",
"fevers",
"chills",
"left lower quadrant pain",
"temperature",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"80 50 mm Hg",
"blood",
"site of",
"peripheral line",
"Pelvic examination shows mucopurulent discharge",
"cer... |
A 68-year-old male comes to the physician for evaluation of right flank pain. He has a history of diabetes and peripheral artery disease. His blood pressure is 160/90 mm Hg. Physical examination shows abdominal tenderness and right flank tenderness. An ultrasound shows dilation of the right ureter and renal pelvis. Whi... | Common iliac artery aneurysm | {
"A": "Renal artery stenosis",
"B": "Benign prostatic hyperplasia",
"C": "Common iliac artery aneurysm",
"D": "Urethral stricture"
} | step1 | C | [
"68 year old male",
"physician",
"evaluation",
"right flank pain",
"history",
"diabetes",
"peripheral artery disease",
"blood pressure",
"90 mm Hg",
"Physical examination shows abdominal tenderness",
"right",
"ultrasound shows dilation of",
"right ureter",
"renal pelvis",
"following",
... |
A 23-year-old woman comes to the physician because she is embarrassed about the appearance of her nails. She has no history of serious illness and takes no medications. She appears well. A photograph of the nails is shown. Which of the following additional findings is most likely in this patient? | Silvery plaques on extensor surfaces | {
"A": "Silvery plaques on extensor surfaces",
"B": "Flesh-colored papules in the lumbosacral region",
"C": "Erosions of the dental enamel",
"D": "Holosystolic murmur at the left lower sternal border"
} | step1 | A | [
"23 year old woman",
"physician",
"embarrassed",
"appearance of",
"nails",
"history",
"serious illness",
"takes",
"medications",
"appears well",
"photograph",
"nails",
"shown",
"following additional findings",
"most likely",
"patient"
] |
A 7-year-old boy is brought to his pediatrician’s office for a follow-up visit. He was diagnosed with asthma when he was 3 years old and has since been on treatment for the condition. He is currently on a β-agonist inhaler because of exacerbation of his symptoms. He has observed that his symptoms are more prominent in ... | IL-4 | {
"A": "IL-2",
"B": "IL-10",
"C": "IL-13",
"D": "IL-4"
} | step2&3 | D | [
"year old boy",
"brought",
"pediatricians office",
"follow-up visit",
"diagnosed",
"asthma",
"3 years old",
"since",
"on treatment",
"condition",
"currently",
"agonist inhaler",
"exacerbation",
"symptoms",
"observed",
"symptoms",
"more prominent",
"new flowers",
"mother",
"back... |
A 29-year-old man presents to the emergency department due to central chest pain over the past 3 days which is constant and unrelated to exertion. The pain is sharp, severe, increases when lying down, and improves with leaning forward. The pain also radiates to his shoulders and neck. The patient has no past medical hi... | Ibuprofen + colchicine +/- omeprazole | {
"A": "Indomethacin +/- omeprazole",
"B": "Ibuprofen + colchicine +/- omeprazole",
"C": "Pericardiocentesis",
"D": "Pericardiectomy"
} | step2&3 | B | [
"29 year old man presents",
"emergency department due to central chest pain",
"past 3 days",
"constant",
"unrelated",
"exertion",
"pain",
"sharp",
"severe",
"increases",
"lying",
"improves",
"forward",
"pain",
"radiates",
"shoulders",
"neck",
"patient",
"past medical history",
... |
A 46-year-old man is brought to the emergency department for evaluation of altered mental status. He was found on the floor in front of his apartment. He is somnolent but responsive when aroused. His pulse is 64/min, respiratory rate is 15/min, and blood pressure is 120/75 mm Hg. On physical examination, an alcoholic s... | Benzodiazepine intoxication
" | {
"A": "Hypoglycemia",
"B": "Ethanol intoxication",
"C": "Cannabis intoxication",
"D": "Benzodiazepine intoxication\n\""
} | step2&3 | D | [
"year old man",
"brought",
"emergency department",
"evaluation of altered mental status",
"found on",
"floor",
"apartment",
"somnolent",
"responsive",
"aroused",
"pulse",
"64 min",
"respiratory rate",
"min",
"blood pressure",
"75 mm Hg",
"physical examination",
"alcoholic smell",
... |
A 62-year-old patient has been hospitalized for a week due to a stroke. One week into the hospitalization, he develops a fever and purulent cough. His vitals include: heart rate 88/min, respiratory rate 20/min, temperature 38.4°C (101.1°F), and blood pressure 110/85 mm Hg. On physical examination, he has basal crackles... | Staphylococcus aureus | {
"A": "Streptococcus pneumoniae",
"B": "Mycobacterium tuberculosis",
"C": "Haemophilus influenzae",
"D": "Staphylococcus aureus"
} | step1 | D | [
"62 year old patient",
"hospitalized",
"week",
"stroke",
"One week",
"hospitalization",
"fever",
"purulent cough",
"include",
"heart rate 88 min",
"respiratory rate 20 min",
"temperature",
"4C",
"blood pressure",
"85 mm Hg",
"physical examination",
"basal crackles",
"right side of"... |
A 3-week-old male newborn is brought to the physician because of an inward turning of his left forefoot. He was born at 38 weeks' gestation by cesarean section because of breech presentation. The pregnancy was complicated by oligohydramnios. Examination shows concavity of the medial border of the left foot with a skin ... | Reassurance | {
"A": "Foot abduction brace",
"B": "Arthrodesis of the forefoot",
"C": "Reassurance",
"D": "Tarsometatarsal capsulotomy"
} | step2&3 | C | [
"3 week old male newborn",
"brought",
"physician",
"inward turning",
"left forefoot",
"born",
"weeks",
"gestation",
"cesarean section",
"breech presentation",
"pregnancy",
"complicated",
"oligohydramnios",
"Examination shows concavity of",
"medial border",
"left foot",
"skin crease",... |
A 72-year-old woman is admitted to the intensive care unit for shortness of breath and palpitations. A cardiac catheterization is performed and measurements of the left ventricular volume and pressure at different points in the cardiac cycle are obtained. The patient's pressure-volume loop (gray) is shown with a normal... | Increased ventricular wall stiffness | {
"A": "Mitral valve regurgitation",
"B": "Increased systemic vascular resistance",
"C": "Increased ventricular wall stiffness",
"D": "Impaired left ventricular contractility"
} | step1 | C | [
"72 year old woman",
"admitted to",
"intensive care unit",
"shortness of breath",
"palpitations",
"cardiac catheterization",
"performed",
"measurements",
"left ventricular volume",
"pressure",
"different points",
"cardiac cycle",
"obtained",
"patient's pressure-volume loop",
"gray",
"s... |
A 22-year-old woman is brought to the emergency department because of a 2-day history of fever, intermittent rigors, and night sweats. She also has a 1-month history of progressive fatigue. Five weeks ago, she was hospitalized and received intravenous antibiotics for treatment of bacterial meningitis while visiting rel... | Chloramphenicol | {
"A": "Doxycycline",
"B": "Trimethoprim/sulfamethoxazole",
"C": "Linezolid",
"D": "Chloramphenicol"
} | step1 | D | [
"year old woman",
"brought",
"emergency department",
"2-day history",
"fever",
"intermittent rigors",
"night sweats",
"1 month history",
"progressive fatigue",
"Five weeks",
"hospitalized",
"received intravenous antibiotics",
"treatment",
"bacterial meningitis",
"visiting relatives",
"... |
An otherwise healthy 50-year-old man comes to the physician because of a 6-month history of increasingly frequent episodes of upper abdominal pain, nausea, vomiting, and diarrhea. He has had a 3.2-kg (7-lb) weight loss during this time. Physical examination shows bilateral pitting pedal edema. An endoscopy shows promin... | Proliferation of gastric mucus-producing cells | {
"A": "Serotonin-secreting gastric tumor",
"B": "Proliferation of gastric mucus-producing cells",
"C": "Excessive somatostatin secretion",
"D": "Ectopic secretion of gastrin"
} | step1 | B | [
"healthy 50 year old man",
"physician",
"of",
"month history",
"frequent episodes",
"upper abdominal pain",
"nausea",
"vomiting",
"diarrhea",
"3.2 kg",
"weight loss",
"time",
"Physical examination shows bilateral pitting pedal edema",
"endoscopy shows prominent rugae",
"gastric",
"Biop... |
A 27-year-old man presents to the emergency department. He was brought in by staff from the homeless shelter when they found him unresponsive. The patient is a known IV drug abuser but otherwise has an unknown past medical history. He currently attends a methadone clinic. His temperature is 99.5°F (37.5°C), blood press... | Insulin, potassium, IV fluids, and glucose | {
"A": "Insulin, potassium, IV fluids, and glucose",
"B": "IV fluids only",
"C": "Oral rehydration",
"D": "Supportive therapy and close monitoring"
} | step2&3 | A | [
"27 year old man presents",
"emergency department",
"brought",
"staff",
"homeless shelter",
"found",
"unresponsive",
"patient",
"known IV drug abuser",
"unknown past medical history",
"currently attends",
"methadone clinic",
"temperature",
"99",
"blood pressure",
"97 48 mmHg",
"pulse... |
A 65-year-old woman schedules an appointment with her physician for evaluation of weight loss and weakness. The weakness is more noticeable when climbing stairs and combing hair. The weakness improves after brief exercise. She also has bladder incontinence for the past 4 weeks and was given an anticholinesterase agent ... | Paraneoplastic syndrome from small cell carcinoma of the lung | {
"A": "Duchenne muscular dystrophy",
"B": "Hypothyroidism",
"C": "Myasthenia gravis",
"D": "Paraneoplastic syndrome from small cell carcinoma of the lung"
} | step1 | D | [
"65 year old woman schedules",
"appointment",
"physician",
"evaluation of weight loss",
"weakness",
"weakness",
"more",
"climbing stairs",
"combing hair",
"weakness improves",
"brief exercise",
"bladder incontinence",
"past 4 weeks",
"given",
"anticholinesterase agent",
"improvement",
... |
A healthy 23-year-old male is undergoing an exercise stress test as part of his physiology class. If blood were to be sampled at different locations before and after the stress test, which area of the body would contain the lowest oxygen content at both time points? | Coronary sinus | {
"A": "Inferior vena cava",
"B": "Coronary sinus",
"C": "Pulmonary artery",
"D": "Pulmonary vein"
} | step1 | B | [
"healthy 23 year old male",
"exercise stress test",
"part of",
"physiology class",
"blood",
"to",
"sampled",
"different locations",
"stress test",
"area",
"body",
"contain",
"lowest oxygen content",
"time points"
] |
A 45-year-old G5P4105 presents to her gynecologist’s office with six months of increasingly heavy periods. She now soaks one super absorbent tampon every two hours for five days each cycle. Her cycles have also become irregular, with intermenstrual bleeding for the last two months. She now experiences significant dysme... | Globular 10-week sized uterus | {
"A": "Globular 10-week sized uterus",
"B": "Adnexal mass",
"C": "Irregular 14-week sized uterus",
"D": "No remarkable physical exam finding"
} | step2&3 | A | [
"year old",
"presents",
"gynecologists office",
"six months",
"heavy periods",
"now soaks one",
"absorbent tampon",
"two hours",
"five",
"cycle",
"cycles",
"irregular",
"intermenstrual bleeding",
"two months",
"now experiences significant dysmenorrhea",
"400 mg ibuprofen",
"four hour... |
A man is brought into the emergency department by the police department. The officer state that the man has been arrested multiple times for public alcohol intoxication, but recently became homeless. On exam, the man is behaving erratically. His vitals are all within normal limits. He appears confused and has a slurred... | Fomepizole | {
"A": "Ethanol",
"B": "Naltrexone",
"C": "Naloxone",
"D": "Fomepizole"
} | step2&3 | D | [
"man",
"brought",
"emergency department",
"police department",
"state",
"man",
"arrested multiple times",
"public alcohol intoxication",
"recently",
"homeless",
"exam",
"man",
"normal limits",
"appears confused",
"slurred speech",
"gait exam",
"patient",
"ataxic",
"stand",
"sup... |
A medical research study is evaluating an investigational novel drug (medication 1) compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days ... | 20 | {
"A": "5",
"B": "16",
"C": "20",
"D": "50"
} | step2&3 | C | [
"medical",
"evaluating",
"investigational novel drug",
"medication 1",
"compared",
"standard therapy",
"medication 2",
"patients presenting",
"emergency department",
"myocardial infarction",
"study enrolled",
"total",
"subjects",
"1 500",
"study arm",
"Follow-up",
"conducted",
"day... |
A 67-year-old man is hospitalized after several days of fever and increasing shortness of breath. Respiratory viral panel returns positive for influenza A and the patient is started on a standard five day course of oseltamivir. Despite therapy, his shortness of breath continues to worsen and his oxygen saturation decre... | Proliferation of surfactant-secreting cells | {
"A": "Sweeping of debris out of the alveoli by ciliated cells",
"B": "Excess mucus production by goblet cells",
"C": "Proliferation of surfactant-secreting cells",
"D": "Proliferation of club cells"
} | step1 | C | [
"67 year old man",
"hospitalized",
"days",
"fever",
"increasing shortness of breath",
"Respiratory viral panel returns positive",
"influenza A",
"patient",
"started",
"standard five day course",
"oseltamivir",
"therapy",
"shortness of breath continues to worsen",
"oxygen saturation decreas... |
A 56-year-old man with a history of hypertension presents to his physician with progressive fatigue and new onset muscle cramps. He has had no recent changes to his medication regimen, which includes hydrochlorothiazide, lisinopril, and amlodipine. His temperature is 98.0°F (36.7°C), blood pressure is 174/111 mmHg, pul... | Aldosterone excess | {
"A": "Aldosterone excess",
"B": "Catecholamine-secreting mass",
"C": "Cortisol excess",
"D": "Impaired kidney perfusion"
} | step2&3 | A | [
"year old man",
"history of hypertension presents",
"physician",
"progressive fatigue",
"new onset muscle cramps",
"recent changes",
"medication regimen",
"includes hydrochlorothiazide",
"lisinopril",
"amlodipine",
"temperature",
"98",
"36",
"blood pressure",
"mmHg",
"pulse",
"70 min... |
A 15-year-old woman presents with fever, altered mental status and a petechial rash on her lower extremities and back since yesterday evening. She also says she has been nauseous for the past 3 hours and has vomited twice. The patient mentions she has had heavy menstrual bleeding for the past few days. Her blood pressu... | Variable β-sequence of the T cell receptor | {
"A": "B7 receptor",
"B": "Variable β-sequence of the T cell receptor",
"C": "CD3",
"D": "IgCAM"
} | step1 | B | [
"year old woman presents",
"fever",
"altered mental status",
"petechial rash",
"lower extremities",
"back",
"evening",
"nauseous",
"past",
"hours",
"vomited twice",
"patient",
"heavy menstrual bleeding",
"past",
"days",
"blood pressure",
"95 80 mm Hg",
"temperature",
"40",
"phy... |
A 17-year-old girl is referred by her dentist for a suspected eating disorder. She has been visiting the same dentist since childhood and for the past 2 years has had at least 2 visits for dental caries. She eventually admitted to him that she regularly induces vomiting by putting her fingers down her throat. She says ... | Patients with this disorder are not further sub-typed | {
"A": "Patients with this disorder are not further sub-typed",
"B": "Patients do not usually initiate treatment",
"C": "Patients can have a history of both anorexia and bulimia",
"D": "Patients will typically have a BMI between 17–18.5 kg/m2"
} | step2&3 | A | [
"year old girl",
"referred by",
"dentist",
"suspected eating disorder",
"visiting",
"same dentist",
"childhood",
"past",
"years",
"visits",
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"admitted",
"induces vomiting",
"putting",
"fingers",
"throat",
"last",
"years",
"purging",
"week",
"recently",
"indu... |
A 23-year-old primigravida presents for a regular prenatal care visit at 16 weeks gestation. She complains of increased fatigability, but is otherwise well. She takes folic acid, iron, and vitamin D supplementation. Her vital signs are as follows: blood pressure, 110/70 mm Hg; heart rate, 86/min; respiratory rate, 13/m... | No tests required | {
"A": "Serum iron level",
"B": "Serum B12 level",
"C": "Transferrin",
"D": "No tests required"
} | step2&3 | D | [
"23 year old primigravida presents",
"regular prenatal visit",
"weeks gestation",
"increased fatigability",
"well",
"takes folic acid",
"iron",
"vitamin",
"supplementation",
"vital signs",
"follows",
"blood pressure",
"70 mm Hg",
"heart rate",
"min",
"respiratory rate",
"min",
"tem... |
A healthy 19-year-old man presents to his primary care provider complaining of painless “blisters” in his mouth. He reports that he noticed a white film on his tongue and the sides of his mouth 2 days ago while brushing his teeth. The film was easily brushed off. He also complains of a bitter metallic taste in his mout... | Disruption of cell membrane permeability | {
"A": "Disruption of cell membrane permeability",
"B": "Disruption of microtubule formation",
"C": "Inhibition of 14-alpha-demethylase",
"D": "Inhibition of beta-glucan synthase"
} | step1 | A | [
"healthy",
"year old man presents",
"primary care provider",
"painless blisters",
"mouth",
"reports",
"white film",
"tongue",
"sides",
"mouth 2 days",
"brushing",
"teeth",
"film",
"easily brushed",
"bitter metallic",
"mouth",
"denies pain",
"burning",
"dysphagia",
"hoarseness",... |
A 57-year-old female with a past medical history of alcoholism presents to the emergency room vomiting bright red blood. She is accompanied by her partner, who reports that she had been complaining of black and tarry stools for the past several days. Vital signs are temperature 37 degrees celsius, heart rate 141 beats ... | Nadalol | {
"A": "Phentolamine",
"B": "Prazosin",
"C": "Nifedipine",
"D": "Nadalol"
} | step1 | D | [
"57 year old female",
"past medical presents",
"emergency room vomiting bright red blood",
"partner",
"reports",
"black",
"tarry stools",
"past",
"days",
"Vital signs",
"temperature",
"degrees celsius",
"heart rate",
"beats per minute",
"blood pressure 90 60",
"respiratory rate 20",
... |
A 56-year-old man presents to the emergency department for progressively worsening fatigue, malaise, fever, and abdominal pain. He reports that his symptoms began approximately 1 week ago and he has noticed episodes of diarrhea. He recently started melatonin and magnesium supplementation in hopes of improving his sleep... | Liver transplantation | {
"A": "Adding dopamine to his treatment regimen",
"B": "Adding lisinopril to his treatment regimen",
"C": "Liver transplantation",
"D": "Transjugular intrahepatic portosystemic shunting"
} | step2&3 | C | [
"year old man presents",
"emergency department",
"worsening fatigue",
"malaise",
"fever",
"abdominal pain",
"reports",
"symptoms began approximately",
"week",
"episodes of diarrhea",
"recently started melatonin",
"magnesium supplementation",
"hopes",
"improving",
"sleep",
"Medical hist... |
A 21-year-old man comes to the physician because of pruritus and a hypopigmented rash on his upper body for 5 days. He first noticed the symptoms after returning from a business trip last week in the Bahamas. While he was there, he visited a couple of beaches and went hiking with some coworkers. The rash initially star... | Potassium hydroxide preparation | {
"A": "Wood lamp examination",
"B": "Skin culture",
"C": "Potassium hydroxide preparation",
"D": "Skin biopsy"
} | step2&3 | C | [
"21-year-old man",
"physician",
"pruritus",
"hypopigmented rash",
"upper body",
"5 days",
"first",
"symptoms",
"returning",
"business trip",
"week",
"Bahamas",
"visited",
"couple",
"beaches",
"hiking",
"coworkers",
"rash initially started",
"single lesion",
"upper back",
"sin... |
A 5-year-old female is brought to a speech therapist for continuing work on improving her communication skills. She is only able to verbalize two word sentences and has generalized developmental delay. When she was born it was noticed that she had a high pitched mewing cry and subsequent physical exam revealed microcep... | 5 | {
"A": "5",
"B": "7",
"C": "18",
"D": "21"
} | step1 | A | [
"5 year old female",
"brought",
"speech therapist",
"continuing work",
"improving",
"communication skills",
"only able to",
"two word sentences",
"generalized developmental delay",
"born",
"high pitched",
"cry",
"subsequent physical exam revealed microcephaly",
"prominent epicanthal folds"... |
A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph is shown. He has had diabetes mellitus for 2 years which is not well controlled with medications. Lab studies show a transferrin sat... | Deposition of calcium pyrophosphate (CPP) crystals | {
"A": "Deposition of urate crystals",
"B": "Deposition of calcium pyrophosphate (CPP) crystals",
"C": "Inflammatory rheumatological syndrome",
"D": "Pathogenic inoculation of microbes"
} | step2&3 | B | [
"59 year old man",
"evaluated",
"progressive joint pain",
"swelling",
"tenderness",
"first",
"second",
"third",
"joints of",
"hands",
"hand radiograph",
"shown",
"diabetes mellitus",
"years",
"not well controlled with medications",
"Lab studies show",
"transferrin saturation",
"88"... |
A 54-year-old male makes an appointment with his primary care physician due to chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends. He has well-controlled hypertension and diabetes but has otherwise been healthy. He does not smoke but drinks socially with his fr... | Caspase-9 | {
"A": "Caspase-9",
"B": "CD15",
"C": "Cyclin-dependent kinase 4",
"D": "Ras pathway transcription factors"
} | step1 | A | [
"54 year old male makes",
"appointment",
"primary care physician",
"chronic fatigue",
"left",
"unable to",
"physically demanding activities",
"friends",
"well-controlled hypertension",
"diabetes",
"healthy",
"not smoke",
"drinks",
"friends",
"Physical exam reveals enlarged nodules",
"n... |
A 55-year-old truck driver is brought to a physician by his wife. She states that her husband developed a fever and began feeling weak 3 days ago, but has refused medical help. He has been unable to go to work because of his symptoms. The patient has been previously hospitalized for a tricuspid valve replacement surger... | Friable irregular masses attached to the valve | {
"A": "Bicuspid valve",
"B": "Friable irregular masses attached to the valve",
"C": "Papillary muscle rupture",
"D": "Annular calcification"
} | step1 | B | [
"55 year old truck driver",
"brought",
"physician",
"wife",
"states",
"husband",
"fever",
"began feeling weak",
"days",
"refused medical help",
"unable to go to work",
"symptoms",
"patient",
"hospitalized",
"tricuspid valve replacement surgery 1 year",
"takes aspirin daily",
"medical... |
A 26-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which she was a restrained passenger. On arrival, she is lethargic and incoherent. She has severe facial lacerations and is in respiratory distress. Her pulse is 130/min, respirations ar... | Thoracic aortic rupture | {
"A": "Diaphragmatic rupture",
"B": "Traumatic bronchial rupture",
"C": "Thoracic aortic rupture",
"D": "Tension pneumothorax"
} | step2&3 | C | [
"year old woman",
"brought",
"emergency department 20 minutes",
"involved",
"high speed motor vehicle collision",
"restrained passenger",
"arrival",
"lethargic",
"incoherent",
"severe facial lacerations",
"respiratory distress",
"pulse",
"min",
"respirations",
"29 min",
"blood pressure... |
A 26-year-old G1P0 woman presents to her primary care physician’s office with feelings of anxiety and trouble with sleep. She finds it difficult initiating sleep, occasionally has palpitations, and feels fatigued. She denies having similar symptoms in the past or starting any new medications or illicit drugs. She is cu... | Propylthiouracil | {
"A": "Methimazole",
"B": "Propylthiouracil",
"C": "Radioiodine therapy",
"D": "Thyroidectomy"
} | step1 | B | [
"year old",
"woman presents",
"primary care physicians office",
"feelings",
"anxiety",
"sleep",
"finds",
"difficult initiating sleep",
"occasionally",
"palpitations",
"feels fatigued",
"denies",
"similar symptoms",
"past",
"starting",
"new medications",
"illicit drugs",
"currently ... |
A 54-year-old woman with a past medical history of mental retardation, hypertension, and diabetes presents to the emergency department with a change in her behavior. Her caretakers state that the patient’s gait suddenly became ataxic, and she became less responsive than her normal non-verbal baseline. Her temperature i... | Rheumatoid arthritis | {
"A": "Cerebral palsy",
"B": "Diabetes mellitus",
"C": "Down syndrome",
"D": "Rheumatoid arthritis"
} | step2&3 | D | [
"54 year old woman",
"past medical history of mental retardation",
"hypertension",
"diabetes presents",
"emergency department",
"change in",
"behavior",
"caretakers state",
"patients gait",
"ataxic",
"less responsive than",
"normal non-verbal baseline",
"temperature",
"98",
"36",
"bloo... |
A 24-year-old man is brought to the emergency department 15 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he has rapid, shallow breathing and appears anxious. His pulse is 135/min, respirations are 30/min and shallow, and palpable systolic blood pressure is 80 mm Hg. He ... | A drop in systolic blood pressure of 14 mmHg during inspiration | {
"A": "Tracheal deviation toward the right side",
"B": "Hemoptysis",
"C": "A drop in systolic blood pressure of 14 mmHg during inspiration",
"D": "Paradoxical motion of part of the chest with breathing\n\""
} | step2&3 | C | [
"year old man",
"brought",
"emergency department 15 minutes",
"sustained",
"stab wound",
"left chest",
"clavicle",
"arrival",
"rapid",
"shallow breathing",
"appears anxious",
"pulse",
"min",
"respirations",
"30/min",
"shallow",
"palpable systolic blood pressure",
"80 mm Hg",
"int... |
A 40-year-old man presents to his primary-care doctor for a follow-up of his hypertension. He is asymptomatic at his office visit and denies any new complaints. He has a 10-year history of hypertension that remains poorly controlled on maximum doses of lisinopril, hydrochlorothiazide, and amlodipine. His past medical h... | MR angiography of the brain | {
"A": "Colonoscopy",
"B": "Esophagogastroduodenoscopy",
"C": "Liver function tests",
"D": "MR angiography of the brain"
} | step2&3 | D | [
"40 year old man presents",
"primary-care doctor",
"follow-up",
"hypertension",
"asymptomatic",
"office visit",
"denies",
"new complaints",
"a 10 year history of hypertension",
"poorly controlled",
"maximum doses",
"lisinopril",
"hydrochlorothiazide",
"amlodipine",
"past medical history"... |
A 17-year-old female is brought to the emergency room by her father because she has been experiencing shortness of breath and chest pain. She says that the chest pain is worse when she breathes or coughs. Furthermore, on the way to the hospital she noticed that there were specks of blood on a tissue that she coughed in... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "Autosomal partial dominance",
"C": "X-linked dominant",
"D": "X-linked recessive"
} | step1 | A | [
"year old female",
"brought",
"emergency room",
"father",
"experiencing shortness of breath",
"chest pain",
"chest pain",
"worse",
"coughs",
"hospital",
"blood",
"tissue",
"coughed",
"previous medical history",
"not recall",
"provoked",
"symptoms",
"presentation",
"temperature",
... |
A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The n... | Anti-B antibodies | {
"A": "RBC sickling",
"B": "Anti-D antibodies",
"C": "Biliary duct malformation",
"D": "Anti-B antibodies"
} | step2&3 | D | [
"2-day old male newborn",
"brought",
"physician",
"of yellowing",
"the skin",
"sclerae",
"hours",
"well",
"born",
"weeks",
"estation ",
"ncomplicated aginal ",
".1 g ",
"z)",
"other ",
"edical insurance ",
"ot eceive renatal care.",
"ewborn'",
"ar-o d b other h",
"ckle cell... |
A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Pr... | Positive emission tomography (PET) of chest now | {
"A": "CT chest without contrast in 24 months",
"B": "Positive emission tomography (PET) of chest now",
"C": "Right middle lobectomy now",
"D": "Bronchoscopy-guided biopsy now"
} | step2&3 | B | [
"50 year old man presents",
"primary care doctor following",
"inguinal hernia repair",
"patient reports",
"pain",
"lower abdomen",
"groin",
"constipation",
"states",
"usual diet",
"denies",
"use",
"alcohol",
"tobacco",
"illicit drugs",
"returned to work",
"ship attendant",
"Preoper... |
A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for ep... | Esophageal fibrosis | {
"A": "Decreased lower esophageal tone",
"B": "Esophageal fibrosis",
"C": "Increased lower esophageal tone",
"D": "Spastic cricopharyngeal muscle"
} | step2&3 | B | [
"year old woman presents",
"complaints",
"retrosternal burning associated with eating",
"past",
"years",
"getting worse",
"past medical history",
"unknown",
"first time seeing",
"doctor",
"states",
"healthy",
"review of systems",
"notable",
"episodic hand",
"worse",
"winter",
"chro... |
A 67-year-old man with chronic kidney disease comes to the physician because of worsening fatigue and shortness of breath on exertion for 6 months. He has a 20-year history of poorly-controlled type 2 diabetes mellitus. Current medications include metformin and insulin. His pulse is 105/min. Examination shows conjuncti... | JAK/STAT | {
"A": "PI3K/Akt/mTOR",
"B": "MAP kinase",
"C": "JAK/STAT",
"D": "IP3"
} | step1 | C | [
"67 year old man",
"chronic kidney disease",
"physician",
"worsening fatigue",
"shortness of breath",
"exertion",
"months",
"year history of poorly controlled type 2 diabetes mellitus",
"Current medications include metformin",
"insulin",
"pulse",
"min",
"Examination shows conjunctival pallor... |
A 47-year-old woman comes to the physician because of progressive muscle weakness for five months. She feels that the muscles in her shoulders and hips have been getting weaker and sometimes feel sore. She now has difficulty getting up from chairs, climbing stairs, and combing her hair. She has also noticed new difficu... | Intrafascicular infiltration on muscle biopsy | {
"A": "Intrafascicular infiltration on muscle biopsy",
"B": "Perifascicular and perivascular infiltration on muscle biopsy",
"C": "Positive anti-acetylcholine receptor antibodies",
"D": "Dystrophin gene mutation on genetic analysis"
} | step2&3 | A | [
"year old woman",
"physician",
"of progressive muscle weakness",
"five months",
"feels",
"muscles",
"shoulders",
"hips",
"getting weaker",
"sometimes feel sore",
"now",
"difficulty getting",
"chairs",
"climbing stairs",
"combing",
"hair",
"new difficulty",
"swallowing solid foods",... |
A 36-year-old woman comes to the clinic because of tearing and a foreign body sensation in her eyes bilaterally, which has gradually worsened over the last several weeks. She also notes having occasional palpitations, nervousness, sweating, and heat intolerance. Her past medical history is unremarkable. She reports a 2... | Treatment with radioactive iodine | {
"A": "External orbital radiation",
"B": "Selenium supplementation",
"C": "Systemic corticosteroids",
"D": "Treatment with radioactive iodine"
} | step1 | D | [
"36 year old woman",
"clinic",
"tearing",
"foreign body sensation in",
"eyes",
"worsened",
"weeks",
"notes",
"occasional palpitations",
"nervousness",
"sweating",
"heat intolerance",
"past medical history",
"unremarkable",
"reports",
"20 smoking history",
"currently",
"daily smoker... |
A 52-year-old man with a history of gastric cancer that was treated with subtotal gastrectomy dies in a motor vehicle collision. At autopsy, examination of the spinal cord shows unilateral atrophy of the neurons in the area indicated by the arrow. Neurological examination of the patient when he was still alive would mo... | Decreased positional sense in the ipsilateral leg | {
"A": "Decreased sense of temperature in the ipsilateral arm",
"B": "Decreased strength of the contralateral leg",
"C": "Decreased vibratory sense in the ipsilateral arm",
"D": "Decreased positional sense in the ipsilateral leg"
} | step1 | D | [
"year old man",
"history of gastric cancer",
"treated with subtotal gastrectomy",
"motor vehicle collision",
"autopsy",
"examination",
"spinal cord shows unilateral atrophy",
"neurons",
"area indicated",
"arrow",
"Neurological examination of",
"patient",
"alive",
"most likely",
"shown",
... |
A 25-year-old woman presents to her physician with a four month history of fatigue and weakness. The weakness has been progressive to the point where she cannot climb stairs and stand from a sitting position. She has only had one menstrual period in the last four months and has never been pregnant. She smokes a pack of... | MRI of the adrenal glands | {
"A": "MRI of the adrenal glands",
"B": "MRI of the chest",
"C": "Low dose dexamethasone suppression test",
"D": "Inferior petrosal sinus sampling"
} | step2&3 | A | [
"year old woman presents",
"physician",
"four month history",
"fatigue",
"weakness",
"weakness",
"progressive",
"point",
"climb stairs",
"stand",
"sitting position",
"only",
"one menstrual period",
"four months",
"never",
"pregnant",
"smokes",
"pack",
"cigarettes",
"day",
"no... |
A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as w... | Normal light microscopy findings | {
"A": "Mesangial proliferation on light microscopy",
"B": "Subepithelial dense deposits on electron microscopy",
"C": "Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence",
"D": "Normal light microscopy findings"
} | step2&3 | D | [
"5 year old boy",
"brought",
"physician",
"facial swelling",
"started 5 days",
"Two weeks",
"sore throat",
"resolved",
"temperature",
"98",
"pulse",
"min",
"blood pressure",
"67 mm Hg",
"Examination shows pitting edema",
"upper",
"lower extremities",
"periorbital edema",
"abdomen... |
An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse ... | Immunoglobulin- IgM | {
"A": "Immunoglobulin- IgG",
"B": "Immunoglobulin- IgD",
"C": "Immunoglobulin- IgA",
"D": "Immunoglobulin- IgM"
} | step1 | D | [
"month old boy",
"brought",
"clinic",
"mother",
"rash",
"trunk",
"past 2 days",
"notes",
"eating less",
"more",
"usual",
"birth history",
"immunizations",
"date",
"Vital signs include",
"temperature",
"100",
"pulse",
"98 min",
"respiratory rate",
"min",
"rash features thin ... |
A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any sympt... | Serum antibodies against hemagglutinin | {
"A": "Serum antibodies against hemagglutinin",
"B": "Downregulation of ICAM-1 expression",
"C": "Protease-resistant antibodies in nasal secretions",
"D": "Homozygous mutation in the CCR5 gene"
} | step1 | A | [
"75 year old woman",
"brought",
"emergency department",
"son",
"2-day history",
"fever",
"headache",
"malaise",
"dry cough",
"patient lives with",
"son",
"family",
"son reports",
"members",
"family",
"similar symptoms",
"past week",
"not",
"symptoms",
"result",
"polymerase ch... |
A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5°C (101.3°F). Physical ex... | Positive latex agglutination test | {
"A": "Positive latex agglutination test",
"B": "Positive PCR for HSV-2 DNA",
"C": "Presence of tachyzoites",
"D": "Increased adenosine deaminase concentration"
} | step1 | A | [
"year old man",
"HIV infection",
"brought",
"emergency department",
"roommate",
"2-week history",
"worsening headache",
"vomiting",
"Current include trimethoprim-sulfamethoxazole",
"dolutegravir",
"tenofovir emtricitabine",
"temperature",
"Physical examination shows nuchal rigidity",
"Brud... |
A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detecte... | Using mortality rates in the analysis | {
"A": "Using survival rates in the analysis",
"B": "Using mortality rates in the analysis",
"C": "Increasing the number of screened individuals",
"D": "Decreasing the number of screened individuals"
} | step1 | B | [
"A type",
"fatal adrenal cancer",
"average survival rate",
"years",
"onset",
"significant symptoms",
"patients",
"4 year asymptomatic period prior to",
"clinical symptoms",
"adrenal cancer",
"new screening test",
"cancer",
"now",
"detected 2 years prior to",
"clinical symptoms",
"new o... |
A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg... | Silicosis | {
"A": "Berylliosis",
"B": "Silicosis",
"C": "Asbestosis",
"D": "Talcosis"
} | step1 | B | [
"60 year old man presents",
"office",
"shortness of breath",
"shortness of breath started",
"year",
"exacerbated",
"physical activity",
"working",
"glass manufacturing industry",
"20 years",
"vital signs include",
"heart rate 72 min",
"respiratory rate 30/min",
"blood pressure",
"80 mm H... |
A 38-year-old G4P3 presents to her obstetrician’s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but woul... | Prominent occiput | {
"A": "Cleft palate",
"B": "Epicanthal folds",
"C": "Micropthlamia",
"D": "Prominent occiput"
} | step2&3 | D | [
"year old",
"presents",
"obstetricians office",
"20 week anatomy ultrasound",
"reports",
"feels well",
"not experienced",
"contractions",
"vaginal bleeding",
"reports good fetal movement",
"patient",
"prenatal screening earlier",
"pregnancy",
"religious reasons",
"now",
"anatomy ultras... |
An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is tal... | Olanzapine | {
"A": "Diphenhydramine",
"B": "Lorazepam",
"C": "Olanzapine",
"D": "Physical restraints"
} | step2&3 | C | [
"83 year old man",
"admitted",
"hospital",
"fever",
"weakness",
"decreased responsiveness",
"diagnosed",
"urosepsis based",
"urinalysis",
"culture",
"started",
"ceftriaxone",
"intravenous fluids",
"hospital",
"improving",
"evening",
"patient",
"irritable",
"talking",
"present",... |
A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respira... | Right-sided analgesia | {
"A": "Spastic paralysis at the level of lesion",
"B": "Right-sided Horner's syndrome",
"C": "Contralateral corticospinal tract involvement",
"D": "Right-sided analgesia"
} | step1 | D | [
"40 year old",
"well",
"brought",
"emergency department",
"assistant",
"complaint",
"left-sided weakness",
"chiropractic neck",
"never felt",
"before",
"Past medical history",
"blood pressure",
"75 mm Hg",
"pulse",
"min",
"respiratory rate",
"min",
"temperature 36",
"98",
"T2 w... |
A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use... | Chlamydia trachomatis infection | {
"A": "Neisseria gonorrhoeae infection",
"B": "Testicular tumor",
"C": "Chlamydia trachomatis infection",
"D": "Varicocele"
} | step2&3 | C | [
"healthy",
"year old man",
"physician",
"right-sided",
"dull",
"throbbing scrotal pain",
"12 hours",
"burning sensation",
"urination",
"increased urinary frequency",
"past 3 days",
"not",
"urethral discharge",
"sexually active",
"one female partner",
"not use condoms",
"Vital signs",... |
A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He ... | Glanzmann’s thrombasthenia | {
"A": "Von Willebrand disease",
"B": "Glanzmann’s thrombasthenia",
"C": "Bernard-Soulier disease",
"D": "Scurvy"
} | step1 | B | [
"4 month old infant",
"brought",
"office",
"parents due to sudden nose bleeding",
"trauma",
"kind",
"month history",
"multiple bruising",
"measures",
"diameter",
"hands",
"feet",
"red spots",
"appeared",
"upper",
"lower extremities",
"trauma",
"prior bleeding history",
"relevant ... |
A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affectin... | Resistance to clotting factor degradation | {
"A": "Elevated serum homocysteine",
"B": "Thrombin inhibitor deficiency",
"C": "Auto-antibodies directed against phospholipids",
"D": "Resistance to clotting factor degradation"
} | step1 | D | [
"35 year old Caucasian female presents",
"emergency room",
"unilateral leg swelling",
"reports",
"painful left-sided leg swelling",
"redness earlier",
"day",
"healthy",
"takes",
"medications",
"denies",
"recent prolonged travel",
"experienced",
"similar episode affecting",
"opposite leg ... |
A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open an... | Fluoxetine | {
"A": "Fluoxetine",
"B": "Aspirin",
"C": "Ventriculoperitoneal shunt",
"D": "Memantine"
} | step2&3 | A | [
"year old man",
"brought",
"physician",
"daughter",
"increasing forgetfulness",
"past",
"weeks",
"living",
"to live",
"daughter",
"unable to perform",
"daily activities",
"left",
"front door wide open",
"tap water running",
"multiple occasions",
"not sleep well",
"wakes up 67 times... |
A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He... | Rotator cuff injury | {
"A": "Trauma",
"B": "Rheumatoid arthritis",
"C": "Osteoarthritis",
"D": "Rotator cuff injury"
} | step1 | D | [
"27 year old man presents",
"emergency room",
"left shoulder pain",
"several weeks",
"pain often worsens",
"to sleep",
"left side",
"several pain medications",
"pain medications helped",
"amateur tennis",
"practices",
"weekends",
"denies",
"trauma",
"practice sessions",
"examination of... |
A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout h... | Citalopram | {
"A": "Citalopram",
"B": "Lithium",
"C": "Propranolol",
"D": "Quetiapine"
} | step2&3 | A | [
"23 year old college student presents",
"clinic",
"history",
"intermittent chest discomfort",
"reports",
"month",
"past",
"months",
"he",
"pisodes of ",
"eeling ",
"hest ",
"pisodes,",
"eels hortness of breath,",
"eels hakiness ",
"rms ",
"egs,",
"weats ",
"eeds o hange ",
... |
A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. Which of the following is the strongest predisposin... | Maternal diabetes | {
"A": "Maternal oligohydramnios",
"B": "Intrauterine alcohol exposure",
"C": "Maternal diabetes",
"D": "Chromosome 18 trisomy"
} | step1 | C | [
"stillborn infant",
"delivered",
"weeks",
"gestation",
"year old woman",
"mother",
"prenatal care",
"Examination",
"stillborn shows",
"small pelvis",
"shallow intergluteal cleft",
"club feet",
"x-ray shows the absence of",
"sacrum",
"lumbar vertebrae",
"following",
"strongest predisp... |
A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to hims... | Conversion of aminolevulinic acid to porphobilinogen | {
"A": "Conversion of ferrous iron to ferric iron",
"B": "Conversion of porphobilinogen to hydroxymethylbilane",
"C": "Conversion of aminolevulinic acid to porphobilinogen",
"D": "Conversion of uroporphyrinogen III to coproporphyrinogen III"
} | step1 | C | [
"3 year old boy",
"brought",
"pediatrician",
"abdominal pain",
"constipation",
"weeks",
"mother",
"irritable recently",
"vocabulary consists",
"50 words",
"not use sentences",
"Physical examination shows pale conjunctivae",
"abdominal tenderness",
"refers",
"name",
"unable to name body... |
A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family histo... | Prostate cancer | {
"A": "Diabetes",
"B": "Parkinson disease",
"C": "Polycystic ovarian syndrome",
"D": "Prostate cancer"
} | step1 | D | [
"year old woman",
"obstetrics",
"gynecology clinic",
"to",
"husband",
"last",
"years",
"2 children",
"previous marriage",
"tested",
"causes",
"male infertility",
"prior abdominal surgery",
"family history",
"endocrine abnormalities",
"Based",
"history",
"panel",
"tests",
"obtai... |
A 48-year-old female presents for a follow-up appointment to discuss her ultrasound results. She presented with a lump in her neck 2 weeks ago. On examination, a thyroid nodule was present; the nodule was fixed, immobile, and non-tender. Ultrasound showed a hypoechoic nodule with a size of 2 cm. Histological examinatio... | Inferior thyroid arteries | {
"A": "Trachea",
"B": "Cervical lymph nodes",
"C": "Inferior thyroid arteries",
"D": "Thyrohyoid muscle"
} | step2&3 | C | [
"48 year old female presents",
"follow-up appointment to discuss",
"ultrasound results",
"presented",
"lump",
"neck",
"weeks",
"examination",
"thyroid nodule",
"present",
"nodule",
"fixed",
"immobile",
"non-tender",
"Ultrasound showed",
"nodule",
"size of",
"Histological examinatio... |
A 10-year-old Caucasian female with Turner's syndrome underwent an abdominal imaging study and was discovered that the poles of her kidneys were fused inferiorly. Normal ascension of kidney during embryological development would be prevented by which of the following anatomical structures? | Inferior mesenteric artery | {
"A": "Superior mesenteric artery",
"B": "Inferior mesenteric artery",
"C": "Celiac artery",
"D": "Splenic artery"
} | step1 | B | [
"A 10 year old Caucasian female",
"Turner's syndrome",
"abdominal imaging study",
"discovered",
"poles of",
"kidneys",
"fused",
"Normal",
"kidney",
"embryological development",
"prevented",
"following anatomical structures"
] |
In order to assess the feasibility and evaluate the outcomes of cerclage wiring as a supportive approach to osteosynthesis in femur fractures, a group of orthopedic surgeons studied 14 patients with primary and periprosthetic fractures of the thigh bone. Parameters such as patient demographic, type of implant, number o... | Lack of risk calculation | {
"A": "No prevalence assessment",
"B": "Low number of patients",
"C": "Ascertainment bias",
"D": "Lack of risk calculation"
} | step1 | D | [
"order to assess",
"evaluate",
"outcomes",
"cerclage wiring",
"supportive approach",
"osteosynthesis",
"femur fractures",
"a group",
"orthopedic surgeons studied",
"patients",
"primary",
"periprosthetic fractures of",
"thigh bone",
"Parameters",
"as patient demographic",
"type of impla... |
A 35-year-old female is brought to the emergency department after being found unconscious. The patient is found to have a blood glucose level of 35 mg/dL. Hgb A1c was found to be 5.1%. C-peptide level was found to be decreased. The patient returned to her baseline after glucose replacement. She states that she has neve... | Factitious disorder | {
"A": "Insulinoma",
"B": "Factitious disorder",
"C": "Hypothyroidism",
"D": "Somatization disorder"
} | step2&3 | B | [
"35 year old female",
"brought",
"emergency department",
"found unconscious",
"patient",
"found to",
"blood glucose level",
"35 mg/dL",
"Hgb A1c",
"found to",
"5",
"C-peptide level",
"found to",
"decreased",
"patient returned",
"baseline",
"glucose replacement",
"states",
"never"... |
A 48-year-old woman with chronic tension headaches comes to the physician because of several episodes of bilateral flank pain and reddish urine within the past month. Current medications include aspirin, which she takes almost daily for headaches. Her temperature is 37.4°C (99.3°F) and her blood pressure is 150/90 mm H... | Vasoconstriction of the medullary vessels | {
"A": "Tubular lumen obstruction by protein casts",
"B": "Necrotizing inflammation of the renal glomeruli",
"C": "Bacterial infection of the renal parenchyma",
"D": "Vasoconstriction of the medullary vessels"
} | step1 | D | [
"48 year old woman",
"chronic tension headaches",
"physician",
"of several episodes",
"bilateral flank pain",
"urine",
"past month",
"Current medications include aspirin",
"takes almost daily",
"headaches",
"temperature",
"4C",
"99",
"blood pressure",
"90 mm Hg",
"Physical examination ... |
A 48-year-old man seeks evaluation at a clinic with a complaint of breathlessness for the past couple of weeks. He says that he finds it difficult to walk a few blocks and has to rest. He also complains of a cough for the past 3 months, which is dry and hacking in nature. The medical history is relevant for an idiopath... | Decreased FEV1 and FVC with normal FEV1/FVC ratio | {
"A": "Decreased FEV1 and normal FVC",
"B": "Decreased FEV1 and FVC with decreased FEV1/FVC ratio",
"C": "Decreased FEV1 and FVC with normal FEV1/FVC ratio",
"D": "Increased FEV1 and FVC"
} | step1 | C | [
"48 year old man",
"evaluation",
"clinic",
"complaint",
"breathlessness",
"past couple",
"weeks",
"finds",
"difficult to walk",
"few blocks",
"to rest",
"cough",
"past 3 months",
"dry",
"nature",
"medical history",
"relevant",
"idiopathic arrhythmia",
"takes amiodarone daily",
... |
A 2,300 g (5 lb) male newborn is delivered to a 29-year-old primigravid woman. The mother has HIV and received triple antiretroviral therapy during pregnancy. Her HIV viral load was 678 copies/mL 1 week prior to delivery. Labor was uncomplicated. Apgar scores were 7 and 8 at 1 and 5 minutes respectively. Physical exami... | Administer zidovudine | {
"A": "Administer zidovudine",
"B": "HIV DNA testing",
"C": "HIV RNA testing",
"D": "Reassurance and follow-up"
} | step2&3 | A | [
"2 300 g",
"5",
"male newborn",
"delivered",
"29 year old primigravid woman",
"mother",
"HIV",
"received triple antiretroviral therapy",
"pregnancy",
"HIV viral load",
"copies/mL 1 week prior to delivery",
"Labor",
"uncomplicated",
"Apgar scores",
"8",
"1",
"5 minutes",
"Physical",... |
A 59-year-old man comes to the emergency department because of excruciating left knee pain for 4 days. He underwent a total knee arthroplasty of his left knee joint 4 months ago. He has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. His temperature is 38.1°C (100.6°... | Staphylococcus epidermidis | {
"A": "Staphylococcus epidermidis",
"B": "Escherichia coli",
"C": "Staphylococcus aureus",
"D": "Pseudomonas aeruginosa"
} | step1 | A | [
"59 year old man",
"emergency department",
"of excruciating left knee pain",
"4 days",
"total knee arthroplasty",
"left",
"joint",
"months",
"hypertension",
"osteoarthritis",
"Current medications include glucosamine",
"amlodipine",
"meloxicam",
"temperature",
"100",
"pulse",
"97 min"... |
A 55-year-old man comes to the physician because of a 3-month history of a progressively growing mass in his axilla. During this period, he has had recurrent episodes of low-grade fever lasting for 7 to 10 days, and an 8-kg (18-lb) weight loss. His only medication is a multivitamin. Physical examination shows nontender... | Secretion of γ-interferon by activated T-lymphocytes | {
"A": "Excessive intake of dietary ergocalciferol",
"B": "Induction of focal osteolysis by tumor cells",
"C": "Secretion of γ-interferon by activated T-lymphocytes",
"D": "Production of PTH-related peptide by malignant cells"
} | step1 | C | [
"55 year old man",
"physician",
"3 month history",
"mass",
"axilla",
"period",
"recurrent episodes of low-grade fever",
"7",
"10 days",
"kg",
"weight loss",
"only medication",
"multivitamin",
"Physical examination shows nontender",
"right axillary",
"cervical",
"inguinal lymphadenopa... |
A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despi... | Dense fibroinflammatory infiltrate | {
"A": "Diffuse infiltrate of lymphoid cells destroying thyroid follicles",
"B": "Dense fibroinflammatory infiltrate",
"C": "Pleomorphic undifferentiated infiltrative cells with necrosis",
"D": "Stromal amyloid deposition"
} | step1 | B | [
"65 year old man presents",
"primary care physician",
"neck mass",
"first",
"firm mass",
"anterior aspect of",
"neck approximately",
"months",
"mass",
"painless",
"not increased in size",
"then",
"occasional fatigue",
"gained 10 pounds",
"past",
"months",
"change in",
"diet",
"ex... |
A 48-year-old Caucasian female presents to her primary care physician for evaluation of progressive weakness and shortness of breath. She has had progressive shortness of breath over the last year with an intermittent non-productive cough. In addition, she complains of difficulty raising her arms to brush her hair. Her... | Muscle biopsy | {
"A": "Muscle biopsy",
"B": "CT scan",
"C": "Serum ANA titer",
"D": "Skin biopsy"
} | step2&3 | A | [
"48 year old Caucasian female presents",
"primary care physician",
"evaluation",
"progressive weakness",
"shortness of breath",
"progressive shortness of breath",
"last year",
"intermittent non-productive cough",
"addition",
"difficulty",
"arms to brush",
"hair",
"temperature",
"99",
"pu... |
A 41-year-old man presents to his primary care provider with abdominal pain. He says that the pain “comes and goes” throughout the day and usually lasts 20-30 minutes per episode. He can point to the spot 1-2 inches above the umbilicus where he feels the pain. He denies any feeling of regurgitation or nighttime cough b... | Urease-producing organism in the small intestine | {
"A": "Mucosal defect in the stomach",
"B": "Urease-producing organism in the small intestine",
"C": "PAS-positive material in the small intestine",
"D": "Crypt abscesses in the large intestine"
} | step2&3 | B | [
"year old man presents",
"primary care provider",
"abdominal pain",
"pain",
"goes",
"day",
"usually lasts 20",
"episode",
"point",
"spot",
"inches",
"umbilicus",
"feels",
"pain",
"denies",
"feeling",
"regurgitation",
"nighttime cough",
"nausea",
"reports",
"used to eat three ... |
A 5-year-old female presents to the pediatrician for a routine office visit. The patient is in kindergarten and doing well in school. She is learning to read and is able to write her first name. Her teacher has no concerns. The patient’s mother is concerned that the patient is a picky eater and often returns home from ... | Absent Barr bodies on buccal smear | {
"A": "Absent Barr bodies on buccal smear",
"B": "Elevated serum alkaline phosphatase level",
"C": "Elevated serum TSH level",
"D": "Mass in the sella turcica"
} | step2&3 | A | [
"5 year old female presents",
"pediatrician",
"routine office visit",
"patient",
"kindergarten",
"well",
"school",
"learning to read",
"able to write",
"first name",
"teacher",
"concerns",
"patients mother",
"concerned",
"patient",
"picky eater",
"often returns home",
"school",
"... |
A 61-year-old man was started on rosuvastatin 40 mg 8 weeks ago and presents today for a follow-up. He complains of pain in his legs and general weakness. On physical exam, he has full range of motion of his extremities but complains of pain. His blood pressure is 126/84 mm Hg and heart rate is 74/min. The decision is... | Restart rosuvastatin at a lower dose | {
"A": "Restart rosuvastatin at a lower dose",
"B": "Initiate fenofibrate",
"C": "Initiate a different statin",
"D": "Initiate fish oils"
} | step2&3 | A | [
"61 year old man",
"started",
"rosuvastatin 40 mg",
"weeks",
"presents today",
"follow-up",
"pain",
"legs",
"general weakness",
"physical exam",
"full range of motion",
"extremities",
"pain",
"blood pressure",
"84 mm Hg",
"heart rate",
"74 min",
"decision",
"made to stop",
"sta... |
An unidentified surgical specimen is received for histopathologic analysis. A portion of the specimen is cut and stained with hematoxylin and eosin. The remainder is analyzed and is found to contains type II collagen and chondroitin sulfate. Which of the following structures is most likely the origin of this surgical s... | Larynx | {
"A": "Blood vessel",
"B": "Pinna",
"C": "Lens",
"D": "Larynx"
} | step1 | D | [
"unidentified surgical specimen",
"received",
"histopathologic analysis",
"portion",
"specimen",
"cut",
"stained",
"hematoxylin",
"eosin",
"analyzed",
"found",
"contains type II collagen",
"chondroitin sulfate",
"following structures",
"most likely",
"origin",
"surgical specimen"
] |
A 70-year-old woman is brought to the emergency department for the evaluation of abdominal pain, nausea, and vomiting for 1 day. Computed tomography shows a small bowel perforation. The patient is prepared for emergent exploratory laparotomy. She is sedated with midazolam, induced with propofol, intubated, and maintain... | Increase PEEP | {
"A": "Increase the FiO2",
"B": "Increase the tidal volume",
"C": "Increase PEEP",
"D": "Increase the respiratory rate"
} | step2&3 | C | [
"70 year old woman",
"brought",
"emergency department",
"evaluation",
"abdominal",
"nausea",
"vomiting",
"1 day",
"Computed tomography shows",
"small bowel perforation",
"patient",
"prepared",
"emergent exploratory laparotomy",
"sedated",
"midazolam",
"induced",
"propofol",
"intuba... |
A 42-year-old man with AIDS comes to the physician for intermittent fever, nonproductive cough, malaise, decreased appetite, abdominal pain, and a 3.6-kg (8-lb) weight loss over the past month. He has not seen a doctor since he became uninsured 2 years ago. His temperature is 38.3°C (100.9°F). Abdominal examination sho... | Azithromycin and ethambutol | {
"A": "Voriconazole",
"B": "Amphotericin B and itraconazole",
"C": "Erythromycin",
"D": "Azithromycin and ethambutol"
} | step1 | D | [
"year old man",
"AIDS",
"physician",
"intermittent fever",
"nonproductive cough",
"malaise",
"decreased appetite",
"abdominal pain",
"3.6 kg",
"weight loss",
"past month",
"not seen",
"doctor",
"uninsured",
"years",
"temperature",
"3C",
"100 9F",
"Abdominal examination shows mild... |
A 49-year-old woman comes to the physician for a scheduled colposcopy. Two weeks ago, she had a routine Pap smear that showed atypical squamous cells. Colposcopy shows an area of white discoloration of the cervix with application of acetic acid solution. Biopsy of this area shows carcinoma-in-situ. Activation of which ... | E2F transcription factors | {
"A": "JAK2 tyrosine kinase",
"B": "E2F transcription factors",
"C": "Phosphoprotein p53",
"D": "Cyclin-dependent kinase inhibitors"
} | step1 | B | [
"year old woman",
"physician",
"scheduled colposcopy",
"Two weeks",
"routine Pap smear",
"showed atypical squamous cells",
"Colposcopy shows",
"area of white discoloration",
"cervix",
"application",
"acetic acid solution",
"Biopsy",
"area shows carcinoma-in-situ",
"Activation",
"followin... |
A 40-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The patient reports that he first noticed the swelling several weeks ago, but it is not always present. He has hypertension treated with enalapril. His father was diagnosed with a seminoma at the age of 25 years. The... | Imbalance of fluid secretion and resorption by the tunica vaginalis | {
"A": "Patent processus vaginalis",
"B": "Dilation of the pampiniform plexus",
"C": "Twisting of the spermatic cord",
"D": "Imbalance of fluid secretion and resorption by the tunica vaginalis"
} | step2&3 | D | [
"40 year old man",
"physician",
"evaluation of",
"painless right-sided scrotal swelling",
"patient reports",
"first",
"swelling",
"weeks",
"not always present",
"hypertension treated with enalapril",
"father",
"diagnosed",
"seminoma",
"age",
"years",
"patient",
"smoked",
"pack",
... |
A 36-year-old nursing home worker presents to the clinic with the complaints of breathlessness, cough, and night sweats for the past 2 months. She further expresses her concerns about the possibility of contracting tuberculosis as one of the patients under her care is being treated for tuberculosis. A PPD skin test is ... | Decreased ALA synthesis | {
"A": "Inhibition of ferrochelatase",
"B": "Increased homocysteine degradation",
"C": "Increased GABA production",
"D": "Decreased ALA synthesis"
} | step1 | D | [
"36 year old nursing presents",
"clinic",
"complaints",
"breathlessness",
"cough",
"night sweats",
"past 2 months",
"further",
"concerns",
"possibility",
"contracting tuberculosis",
"one",
"patients",
"care",
"treated",
"tuberculosis",
"PPD skin test",
"reads",
"mm",
"day 3",
... |
A 16-year-old girl is brought to the emergency department with constant abdominal pain over the past 8 hours. The pain is in her right lower quadrant (RLQ), which is also where it began. She has had no nausea or vomiting despite eating a snack 2 hours ago. She had a similar episode last month which resolved on its own.... | Reassurance | {
"A": "Methotrexate",
"B": "Nitrofurantoin",
"C": "Reassurance",
"D": "Referral for surgery"
} | step2&3 | C | [
"year old girl",
"brought",
"emergency department",
"constant abdominal",
"past 8 hours",
"pain",
"right lower quadrant",
"began",
"nausea",
"vomiting",
"eating",
"snack",
"hours",
"similar episode",
"month",
"resolved",
"menstrual cycles",
"days",
"35",
"vaginal bleeding",
"... |
A 70-year-old man is brought to the emergency department by staff of the group home where he resides because of worsening confusion for the past week. He has a history of major depressive disorder and had an ischemic stroke 4 months ago. Current medications are aspirin and sertraline. He is lethargic and disoriented. H... | ↓ ↑ ↓ | {
"A": "↓ ↓ ↓",
"B": "↑ ↓ normal",
"C": "↓ ↑ ↑",
"D": "↓ ↑ ↓"
} | step1 | D | [
"70 year old man",
"brought",
"emergency department",
"staff",
"group home",
"resides",
"worsening confusion",
"past week",
"history of major depressive disorder",
"ischemic stroke",
"months",
"Current medications",
"aspirin",
"sertraline",
"lethargic",
"disoriented",
"pulse",
"min... |
A 76-year-old man with chronic obstructive pulmonary disease (COPD) presents complaining of 3 weeks of cough and progressive dyspnea on exertion in the setting of a 20 pound weight loss. He is a 60 pack-year smoker, worked as a shipbuilder 30 years ago, and recently traveled to Ohio to visit family. Chest radiograph sh... | Lower lobe cavitary mass | {
"A": "Nodular mass spreading along pleural surfaces",
"B": "Honeycombing",
"C": "Air bronchogram",
"D": "Lower lobe cavitary mass"
} | step1 | D | [
"76 year old man",
"chronic obstructive pulmonary disease",
"presents complaining of",
"weeks",
"cough",
"progressive dyspnea on exertion",
"setting",
"20 pound weight loss",
"60 pack-year smoker",
"worked",
"30 years",
"recently traveled",
"Ohio to visit family",
"Chest radiograph shows i... |
A 34-year-old male suffers from inherited hemophilia A. He and his wife have three unaffected daughters. What is the probability that the second daughter is a carrier of the disease? | 100% | {
"A": "0%",
"B": "25%",
"C": "50%",
"D": "100%"
} | step1 | D | [
"year old male suffers",
"inherited hemophilia A",
"wife",
"three unaffected daughters",
"probability",
"second daughter",
"carrier of",
"disease"
] |
A 31-year-old female patient complains of numbness and tingling in her left hand, weakness, difficulty with walking, dizziness, and bladder dysfunction. She said that about a year ago, she had trouble with her vision, and that it eventually recovered in a few days. On physical exam, bilateral internuclear ophthalmopleg... | Oligoclonal IgG bands on electrophoresis | {
"A": "Presence of 14-3-3 protein",
"B": "Decreased glucose with neutrophilic predominance",
"C": "Oligoclonal IgG bands on electrophoresis",
"D": "Decreased IgG CSF concentration"
} | step2&3 | C | [
"31 year old female patient",
"numbness",
"tingling",
"left hand",
"weakness",
"difficulty",
"walking",
"dizziness",
"bladder dysfunction",
"year",
"vision",
"recovered",
"days",
"physical exam",
"bilateral internuclear ophthalmoplegia",
"hyperreflexia",
"patella",
"bilateral clonu... |
A 22-year-old primigravida presents for a regular prenatal visit at 16 weeks gestation. She is concerned about the results of a dipstick test she performed at home, which showed 1+ glucose. She does not know if her liquid consumption has increased, but she urinates more frequently than before. The course of her pregna... | No tests required | {
"A": "HbA1c measurement",
"B": "No tests required",
"C": "Urinalysis",
"D": "Oral glucose tolerance test"
} | step2&3 | B | [
"year old primigravida presents",
"regular prenatal visit",
"weeks gestation",
"concerned",
"results",
"dipstick test",
"performed at home",
"showed 1",
"glucose",
"not",
"liquid consumption",
"increased",
"more frequently",
"course",
"pregnancy",
"unremarkable",
"significant co-morb... |
A 57-year-old man comes to the physician because of a 3-week history of abdominal bloating and increased frequency of stools. He describes the stools as bulky, foul-smelling, and difficult to flush. He also has a 4-month history of recurrent dull upper abdominal pain that usually lasts for a few days, worsens after mea... | Abdominal CT scan | {
"A": "Abdominal CT scan",
"B": "Endoscopic ultrasonography",
"C": "Abdominal ultrasound",
"D": "Upper gastrointestinal endoscopy"
} | step2&3 | A | [
"57 year old man",
"physician",
"3 week history",
"abdominal bloating",
"increased frequency of stools",
"stools",
"bulky",
"foul-smelling",
"difficult to flush",
"4 month history",
"recurrent dull upper",
"usually",
"days",
"worsens",
"meals",
"not relieved with antacids",
"a 10 kg"... |
A 69-year-old male with a history of metastatic small cell lung carcinoma on chemotherapy presents to his oncologist for a follow-up visit. He has responded well to etoposide and cisplatin with plans to undergo radiation therapy. However, he reports that he recently developed multiple “spots” all over his body. He deni... | Interleukin 11 | {
"A": "Interleukin 2",
"B": "Interleukin 8",
"C": "Interleukin 11",
"D": "Granulocyte colony stimulating factor"
} | step1 | C | [
"male",
"history of metastatic small cell lung carcinoma",
"chemotherapy presents",
"oncologist",
"follow-up visit",
"well",
"etoposide",
"cisplatin",
"plans to",
"radiation therapy",
"reports",
"recently",
"multiple spots",
"body",
"denies",
"bleeding",
"gums",
"joint swelling",
... |
A 62-year-old man presents to the emergency department with shortness of breath. The patient says he feels as if he is unable to take a deep breath. The patient has a past medical history of COPD and a 44-pack-year smoking history. The patient has been admitted before for a similar presentation. His temperature is 98.7... | BiPAP | {
"A": "BiPAP",
"B": "Chest tube placement",
"C": "Intubation",
"D": "Needle decompression"
} | step2&3 | A | [
"62 year old man presents",
"emergency department",
"shortness of breath",
"patient",
"feels",
"unable to take",
"deep breath",
"patient",
"past medical COPD",
"pack-year smoking history",
"patient",
"admitted before",
"similar presentation",
"temperature",
"98",
"blood pressure",
"m... |
A 76-year-old man is brought to the physician by his wife because of low back pain and weakness for the past 4 weeks. He says that the pain is sharp, radiates to his left side, and has a burning quality. He has had a cough occasionally productive of blood-streaked sputum for the past 2 months. He has had 3.2-kg (7.0-lb... | Intravenous dexamethasone therapy | {
"A": "Radiation therapy",
"B": "Intravenous dexamethasone therapy",
"C": "Intravenous acyclovir therapy",
"D": "Intravenous ceftriaxone and azithromycin therapy"
} | step2&3 | B | [
"76 year old man",
"brought",
"physician",
"wife",
"low back pain",
"weakness",
"past 4 weeks",
"pain",
"sharp",
"radiates",
"left side",
"burning quality",
"cough occasionally productive of blood streaked sputum",
"past",
"months",
"3.2 kg",
"0",
"weight loss",
"time",
"now un... |
An elderly man presents to his physician with complaints of difficulty breathing, easy fatigability, and bilateral leg swelling which began 2 months ago. His breathlessness worsens while walking, climbing the stairs, and lying flat on his back. He also finds it difficult to sleep well at night, as he often wakes up to ... | Decrease in transmembrane sodium gradient | {
"A": "Decrease in transmembrane sodium gradient",
"B": "Preferential dilatation of capacitance vessels",
"C": "Inhibition of aldosterone-mediated sodium reabsorption",
"D": "Reduction in myocardial contractility"
} | step1 | A | [
"elderly man presents",
"physician",
"complaints",
"difficulty breathing",
"easy fatigability",
"bilateral leg swelling",
"began 2 months",
"breathlessness worsens",
"walking",
"climbing",
"stairs",
"lying flat on",
"back",
"finds",
"difficult to sleep well",
"night",
"often wakes up... |
A 30-year-old man presents to his primary care physician with complaints of excessive fatigue and weakness for the last several weeks. He also complains of abdominal pain and constipation for the same duration. On further questioning, he reports that he has lost 8 pounds in the last 2 weeks. Past medical history and fa... | Start him on both hydrocortisone and fludrocortisone therapy | {
"A": "Administer intravenous fludrocortisone",
"B": "Start him on androgen replacement treatment",
"C": "Start him on both hydrocortisone and fludrocortisone therapy",
"D": "Order an ACTH stimulation test"
} | step2&3 | C | [
"30 year old man presents",
"primary care physician",
"complaints",
"excessive fatigue",
"weakness",
"weeks",
"abdominal pain",
"constipation",
"same duration",
"further questioning",
"reports",
"lost",
"pounds",
"2 weeks",
"Past medical history",
"family history",
"temperature",
"... |
A 53-year-old man presents to his physician’s office with a persistent cough which he has had over the last few months. He was diagnosed with chronic obstructive pulmonary disease (COPD) the previous year and since then has been on a short-acting β-agonist to help alleviate his symptoms. Since his diagnosis, he has qui... | Doxycycline | {
"A": "Doxycycline",
"B": "Ciprofloxacin",
"C": "Erythromycin",
"D": "Antibiotics would not be appropriate at this time"
} | step2&3 | A | [
"year old man presents",
"physicians office",
"persistent cough",
"last",
"months",
"diagnosed",
"chronic obstructive pulmonary disease",
"previous year",
"since then",
"short acting",
"agonist to help",
"symptoms",
"diagnosis",
"quit smoking",
"habit",
"30 years",
"used to smoke",
... |
A 28-year-old female visits her physician for workup of a new onset diastolic murmur found on physical examination. Past medical history is insignificant. Her temperature is 37.0 degrees C, blood pressure is 115/75 mm Hg, pulse is 76/min, and respiratory rate is 16/min. The patient denies dyspnea, fatigue, and syncope.... | Acute arterial occlusion | {
"A": "Abrupt hypotension",
"B": "Sudden cardiac death",
"C": "Acute arterial occlusion",
"D": "Septic embolism"
} | step2&3 | C | [
"year old female visits",
"physician",
"workup",
"new onset diastolic murmur found",
"physical examination",
"Past medical history",
"temperature",
"0 degrees C",
"blood pressure",
"75 mm Hg",
"pulse",
"76 min",
"respiratory rate",
"min",
"patient denies dyspnea",
"fatigue",
"syncope... |
A 52-year-old fisherman presents to the clinic for an evaluation of a pigmented lesion on his neck. He states that he first noticed the lesion last year, but he believes that it has been slowly growing in size. Dermatopathology determines that the lesion contains neoplastic cells of melanocytic origin. Which of the fol... | Brown-black color in one area of the lesion to red-white in a different area | {
"A": "Brown-black color in one area of the lesion to red-white in a different area",
"B": "Macule that is 5mm in diameter",
"C": "Well-circumscribed papule with smooth borders",
"D": "Itching and pain to palpation"
} | step1 | A | [
"year old fisherman presents",
"clinic",
"evaluation",
"pigmented lesion",
"neck",
"states",
"first",
"lesion",
"year",
"slowly",
"size",
"lesion contains neoplastic cells",
"melanocytic origin",
"following characteristics",
"lesion",
"likely",
"found",
"physical examination"
] |
Two days after being admitted to the hospital following a fall, a 77-year-old woman complains of fatigue and headaches. During the fall she sustained a right-sided subdural hematoma. She has hypertension and hyperlipidemia. Her medications prior to admission were hydrochlorothiazide and atorvastatin. Vital signs are wi... | Fluid restriction | {
"A": "Head elevation",
"B": "Tolvaptan",
"C": "Desmopressin",
"D": "Fluid restriction"
} | step2&3 | D | [
"Two days",
"admitted",
"hospital following",
"fall",
"year old woman",
"fatigue",
"headaches",
"fall",
"sustained",
"right-sided subdural hematoma",
"hypertension",
"hyperlipidemia",
"medications prior to admission",
"hydrochlorothiazide",
"atorvastatin",
"Vital signs",
"normal limi... |
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