options dict | answer stringlengths 1 120 | question stringlengths 188 3.83k | answer_idx stringclasses 7
values |
|---|---|---|---|
{
"A": "Bacterial vaginosis",
"B": "Cytomegalovirus",
"C": "Epstein-Barr virus",
"D": "HIV",
"E": "Human papillomavirus",
"F": null,
"G": null,
"H": null,
"I": null
} | HIV | A 27-year-old primigravid woman comes to the physician for her first prenatal visit 10 weeks after a home pregnancy test was positive. She feels well, and her pregnancy has been uncomplicated. She previously used an oral contraceptive but discontinued it 3 months ago. She has no history of sexually transmitted diseases... | D |
{
"A": "Complete the study because she signed the consent form",
"B": "Discuss withdrawal with the institutional review board",
"C": "Negotiate her withdrawal with the principal investigator",
"D": "Wait to withdraw until after the investigator consults with an ethics team",
"E": "Withdraw from the study now"... | Withdraw from the study now | An investigator would like to decrease the incidence of type 2 diabetes mellitus among adult patients with risk factors including obesity, decreased physical activity, and family history of diabetes mellitus. A total of 200 men and women aged 30 to 64 years will be enrolled in a regular exercise program for 6 months. A... | E |
{
"A": "Discontinuation of acetaminophen therapy",
"B": "Intravenous administration of fluids",
"C": "Measurement of postvoid residual volume",
"D": "Oral trimethoprim-sulfamethoxazole therapy",
"E": "Renal biopsy",
"F": null,
"G": null,
"H": null,
"I": null
} | Measurement of postvoid residual volume | A 70-year-old man comes to the clinic because of a 3-day history of fatigue, dark urine, decreased urine output, mild pain with urination, and a low-grade fever. He has gout, hypertension, and osteoarthritis. His medications are allopurinol, hydrochlorothiazide, and acetaminophen. Temperature is 37.9Β°C (100.2Β°F), pulse... | C |
{
"A": "Colchicine",
"B": "Infliximab",
"C": "Ketorolac",
"D": "Methylprednisolone",
"E": "Vancomycin",
"F": null,
"G": null,
"H": null,
"I": null
} | Vancomycin | A 52-year-old woman comes to the physician because of a 2-day history of severe pain and markedly decreased range of motion in her right elbow. She has rheumatoid arthritis in her elbows, wrists, and hands. She reports episodes of moderate pain approximately four times yearly. Previous treatment with naproxen, methotre... | E |
{
"A": "1",
"B": "3",
"C": "5",
"D": "10",
"E": "16",
"F": null,
"G": null,
"H": null,
"I": null
} | 5 | Abstract:Objective:In patients with cirrhosis and acute bleeding esophageal varices, how do endoscopic sclerotherapy and emergency portacaval shuntcompare for control of bleeding and survival?MethodsDesign: Randomized controlled trial (San Diego Bleeding Esophageal Varices Study). ClinicalTrials.gov NCT00690027.Allocat... | C |
{
"A": "The allocation was concealed",
"B": "EPCS is available only at specialty centers",
"C": "The follow-up period was too short",
"D": "The patients were not blinded",
"E": "Unmeasured confounders were not controlled by the study design",
"F": null,
"G": null,
"H": null,
"I": null
} | EPCS is available only at specialty centers | Abstract:Objective:In patients with cirrhosis and acute bleeding esophageal varices, how do endoscopic sclerotherapy and emergency portacaval shuntcompare for control of bleeding and survival?MethodsDesign: Randomized controlled trial (San Diego Bleeding Esophageal Varices Study). ClinicalTrials.gov NCT00690027.Allocat... | B |
{
"A": "The 95% confidence interval for the difference in survival between EPCS and EST for Child-Pugh class A patients includes 0 years",
"B": "EPCS is more effective than EST in decreasing hospital readmissions for variceal bleeding requiring",
"C": "The median survival after EPCS is statistically significantly... | EPCS is more effective than EST in decreasing hospital readmissions for variceal bleeding requiring | Abstract:Objective:In patients with cirrhosis and acute bleeding esophageal varices, how do endoscopic sclerotherapy and emergency portacaval shuntcompare for control of bleeding and survival?MethodsDesign: Randomized controlled trial (San Diego Bleeding Esophageal Varices Study). ClinicalTrials.gov NCT00690027.Allocat... | B |
{
"A": "Cardiovascular disease",
"B": "Chronic kidney disease",
"C": "HIV-related malignancy",
"D": "NonβHIV-related malignancy",
"E": "Opportunistic infection",
"F": null,
"G": null,
"H": null,
"I": null
} | Cardiovascular disease | A 42-year-old man comes to the office as a new patient. Three weeks ago, he was hospitalized for treatment of community-acquired pneumonia and diagnosed with HIV infection. He has no other history of serious illness and takes no medications. Vital signs are within normal limits. Examination shows no abnormalities. CD4+... | A |
{
"A": "Education on sleep hygiene",
"B": "Mirtazapine therapy",
"C": "Sertraline therapy",
"D": "Setting a date for smoking cessation",
"E": "Zolpidem therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Education on sleep hygiene | A 40-year-old divorced woman comes to the office because of a 1-year history of difficulty sleeping. She says she sometimes does not fall asleep before 2 AM and does not feel rested at 6:30 AM when she has to get up and get her children ready for school. Sometimes she wakes after 1 to 2 hours of sleep and cannot fall b... | A |
{
"A": "Determination of hemoglobin A1c",
"B": "Measurement of cerebrospinal fluid 14-3-3 protein concentration",
"C": "Measurement of cerebrospinal fluid beta amyloid concentration",
"D": "Measurement of cerebrospinal fluid methylmalonic acid concentration",
"E": "Measurement of serum angiotensin-converting ... | Measurement of cerebrospinal fluid 14-3-3 protein concentration | A 58-year-old woman is brought to the office by her husband because of a 6-week history of increasing confusion. Her husband says that, initially, she had difficulty doing βnormalβ things, such as preparing meals. Since then, she has become progressively less able to care for herself or even use a telephone. During thi... | B |
{
"A": "Place the feet in front of a dry space heater",
"B": "Rub the feet with a steaming hot towel",
"C": "Submerge the feet in a moderately warm whirlpool",
"D": "Wrap the feet in a room-temperature wet-to-dry dressing",
"E": "Observation only",
"F": null,
"G": null,
"H": null,
"I": null
} | Submerge the feet in a moderately warm whirlpool | A 38-year-old woman is brought to the emergency department by paramedics 90 minutes after she fell through ice into a stream while hiking. She was stuck in the ice until emergency responders rescued her. On arrival, she has severe pain in her feet. She has no history of serious illness and takes no medications. Tempera... | C |
{
"A": "Factor replacement therapy",
"B": "Methotrexate therapy",
"C": "Plasmapheresis",
"D": "Prednisone therapy",
"E": "Splenectomy",
"F": null,
"G": null,
"H": null,
"I": null
} | Prednisone therapy | A 52-year-old woman comes to the emergency department because of a 1-day history of bleeding gums and moderate pain in her knees. She first noticed the gum bleeding while brushing her teeth this morning; she has been unable to stop the bleeding. She has systemic lupus erythematosus with inflammatory arthritis and Rayna... | D |
{
"A": "Glomerulonephritis",
"B": "Myocarditis",
"C": "Pneumonia",
"D": "Rheumatic fever",
"E": "Systemic lupus erythematosus",
"F": null,
"G": null,
"H": null,
"I": null
} | Myocarditis | A 13-year-old boy is brought to the emergency department because of a 3-day history of progressive fatigue, shortness of breath, and difficulty walking up stairs. He had been well until 1 week ago, when he developed rhinorrhea, cough, and a sore throat. These symptoms resolved spontaneously 2 days ago. He has no histor... | B |
{
"A": "Duodenal atresia",
"B": "Intussusception",
"C": "Meconium ileus",
"D": "Necrotizing enterocolitis",
"E": "Volvulus",
"F": null,
"G": null,
"H": null,
"I": null
} | Volvulus | A 10-day-old female newborn is brought to the emergency department because of a 2-day history of bilious vomiting. She was born at term following an uncomplicated pregnancy and spontaneous vaginal delivery. She was 50.8 cm (20 in) in length and weighed 3260 g (7 lb 3 oz) at birth. Examination following delivery showed ... | E |
{
"A": "Absence of resource stewardship",
"B": "Ageism",
"C": "Health care disparities",
"D": "Health care fraud and abuse",
"E": "Lack of access to care",
"F": null,
"G": null,
"H": null,
"I": null
} | Absence of resource stewardship | An 85-year-old man with severe dementia, Alzheimer type, is admitted to the hospital because of a nonhealing ulceron his right second toe. He lives in a nursing care facility and has been bedridden for the past 3 years. He has type 2diabetes mellitus, hypertension, and peripheral vascular disease. His medications are m... | A |
{
"A": "Assessment of medical decision-making capacity",
"B": "Electromyography and nerve conduction studies",
"C": "Involuntary hospital admission",
"D": "Oxygen therapy by nasal canula",
"E": "Pulmonary function testing",
"F": null,
"G": null,
"H": null,
"I": null
} | Assessment of medical decision-making capacity | A 62-year-old woman with myasthenia gravis comes to the office because of a 2-week history of falling. She saysher legs "give out" once daily; she falls to the ground but does not hit her head. She took pyridostigmine until2 weeks ago when she decided that it no longer worked. Respirations are 30/min. Examination shows... | A |
{
"A": "50% Dextrose",
"B": "Flumazenil",
"C": "Lorazepam",
"D": "Naloxone",
"E": "Vitamin B1 (thiamine)",
"F": null,
"G": null,
"H": null,
"I": null
} | Vitamin B1 (thiamine) | A 55-year-old man is brought to the emergency department by paramedics 45 minutes after his daughter found himunresponsive in his apartment. Paramedics initiated intravenous fluid warming and resuscitation at the scene. Thepatient has major depressive disorder, hypertension, and alcoholism. His medications are chlordia... | E |
{
"A": "Epididymitis",
"B": "Testicular torsion",
"C": "Testicular tumor",
"D": "Torsion of the appendix testis",
"E": "Urinary tract infection",
"F": "Varicocele",
"G": null,
"H": null,
"I": null
} | Testicular torsion | A 16-year-old boy is brought to the emergency department because of a 6-hour history of severe right-sided scrotalpain. He has not had penile discharge, fever, abdominal pain, vomiting, or diarrhea. He has no history of similar painor any trauma to the region. He is sexually active with one female partner and uses cond... | B |
{
"A": "Erythrocyte sedimentation rate",
"B": "Serum ALT activity",
"C": "Serum calcium concentration",
"D": "Serum C-reactive protein concentration",
"E": "Serum creatine kinase activity",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum creatine kinase activity | A 64-year-old man comes to the clinic because of a 2-week history of severe pain and generalized muscle weakness.He has hypercholesteremia and hypertension. Three months ago, he had a myocardial infarction. At that time, hebegan atorvastatin therapy. Other medications are clopidogrel, lisinopril, and amiodarone. He is ... | E |
{
"A": "Administer an injection of epinephrine",
"B": "Admit the patient to the hospital for intravenous vancomycin therapy",
"C": "Cleanse the site and apply ice",
"D": "Obtain an ophthalmologist consultation",
"E": "Prescribe oral clindamycin",
"F": null,
"G": null,
"H": null,
"I": null
} | Cleanse the site and apply ice | A 23-year-old man who is on active duty in the US Army comes to the clinic 1 hour after sustaining a bee sting tohis right cheek. The patient reports continued pain at the site of the sting, but he has not had shortness of breath,throat tightness, loss of vision, or other neurologic symptoms. Medical history is unremar... | C |
{
"A": "Electroconvulsive therapy",
"B": "Imipramine therapy",
"C": "Mirtazapine therapy",
"D": "Sertraline therapy",
"E": "Transcranial magnetic stimulation",
"F": null,
"G": null,
"H": null,
"I": null
} | Electroconvulsive therapy | A 32-year-old man is brought to the emergency department after being found by his wife in their bedroom with agun in his hands. His wife reports that the patient βhas not been himselfβ since their son was stillborn 6 months ago.She says that during the past month, he hardly has slept and has not showered or shaved; he ... | A |
{
"A": "Abdominal aortic aneurysm",
"B": "Breast cancer",
"C": "Chlamydia trachomatis infection",
"D": "Colon cancer",
"E": "Hepatitis C",
"F": null,
"G": null,
"H": null,
"I": null
} | Hepatitis C | A 60-year-old woman comes to the office as a new patient. She recently moved to the area. She feels well. She hashypertension treated with amlodipine and asthma well controlled with inhaled fluticasone and inhaled albuterol asneeded. According to the medical records she brought with her, a mammography 6 months ago show... | E |
{
"A": "Pretreatment with an antihistamine",
"B": "Pretreatment with a corticosteroid",
"C": "Skin testing with benzylpenicilloyl polylysine prior to treatment",
"D": "Use of a nonpenicillin antibiotic to treat the pharyngitis",
"E": "Use of a single injection of benzathine penicillin to treat the pharyngitis... | Use of a nonpenicillin antibiotic to treat the pharyngitis | A 12-year-old girl is brought to the physician for a follow-up examination 8 days after starting a course of oralpenicillin for streptococcal pharyngitis. Temperature is 38.6Β°C (101.5Β°F). Examination shows an erythematousmorbilliform rash, urticaria, mild swelling of the hands and feet, arthralgias, and lymphadenopathy... | D |
{
"A": "Conduct interdisciplinary rounds in a quieter location",
"B": "Encourage questions from all team members",
"C": "Implement a checklist for standardizing patient rounds",
"D": "Use computers during rounds to review medications",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Encourage questions from all team members | A 45-year-old woman is hospitalized for management of Staphylococcus aureus endocarditis with persistentbacteremia. The patient is discussed during interdisciplinary rounds, which includes physicians, nurses, pharmacists,and social workers. During rounds, a pharmacy student notices that the patient missed two doses of ... | B |
{
"A": "Test of the stool for occult blood",
"B": "Complete blood count",
"C": "Measurement of serum thyroid-stimulating hormone concentration",
"D": "Serum lipid studies",
"E": "No further evaluation is necessary",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum lipid studies | A 37-year-old man comes to the physician for a routine health maintenance examination. He has no history ofserious illness and takes no medications. He does not smoke cigarettes, and he exercises four times weekly. Hismother died of colon cancer at the age of 76 years. He is 183 cm (6 ft 0 in) tall and weighs 100 kg (2... | D |
{
"A": "Addition of clindamycin to the medication regimen",
"B": "Addition of vancomycin to the medication regimen",
"C": "CT scan of the abdomen",
"D": "Doppler ultrasonography of the lower extremities",
"E": "Repeat blood cultures and fungal cultures",
"F": null,
"G": null,
"H": null,
"I": null
} | CT scan of the abdomen | A 35-year-old woman is evaluated for a persistent fever 4 days after admission to the hospital for treatment ofpyelonephritis. She has type 2 diabetes mellitus poorly controlled with insulin. She has received ciprofloxacin sinceadmission. Results of initial blood cultures are pending. Temperature is 40.0Β°C (104.0Β°F), p... | C |
{
"A": "Administer an additional 1-L bolus of 0.9% saline",
"B": "Administer intravenous hydrocortisone",
"C": "Administer intravenous voriconazole",
"D": "Begin a continuous infusion of norepinephrine",
"E": "Order CT scan of the head",
"F": null,
"G": null,
"H": null,
"I": null
} | Begin a continuous infusion of norepinephrine | A 23-year-old man is being evaluated in the intensive care unit because of steadily decreasing blood pressure sincehe was admitted 2 hours ago for treatment of septic shock caused by pneumonia. Medical history is remarkable forcystic fibrosis and severe obstructive lung disease. In the emergency department, the patient... | D |
{
"A": "Gestational diabetes",
"B": "Hypothyroidism",
"C": "Intrauterine growth restriction",
"D": "Placenta previa",
"E": "Preterm labor",
"F": null,
"G": null,
"H": null,
"I": null
} | Gestational diabetes | A 32-year-old nulligravid woman comes to the office for counseling prior to conception. Menses occur at irregular40- and 60-day intervals. She has impaired glucose tolerance controlled by diet. She takes no medications. She is165 cm (5 ft 5 cm) tall and weighs 84 kg (185 lb); BMI is 31 kg/mΒ². Vital signs are within nor... | A |
{
"A": "Comply with the parentsβ wishes",
"B": "Inform the parents that everything the patient tells the physician is confidential",
"C": "Inform the parents that if the patientβs toxicology screening is positive, it must be reported to the police",
"D": "Inform the parents that the physician cannot deceive the... | Inform the parents that the physician cannot deceive the patient | A 17-year-old girl is brought to the physician by her parents because they are concerned she is using illicit drugs.They report that, βshe just isnβt herself anymore.β She has no history of serious illness and takes no medications. Sheis upset about being βtrickedβ to come to the doctor. Physical examination shows no a... | D |
{
"A": "Acute glomerulonephritis",
"B": "Acute interstitial nephritis",
"C": "Acute kidney injury",
"D": "Acute obstructive uropathy",
"E": "Intravascular volume depletion",
"F": null,
"G": null,
"H": null,
"I": null
} | Acute kidney injury | A 52-year-old woman with type 2 diabetes mellitus comes to the office for a follow-up examination. Two weeksago, she was treated with amoxicillin for a urinary tract infection. At that time, her blood pressure was 165/98 mmHg, and serum creatinine concentration was 1.2 mg/dL; lisinopril therapy was also begun. During t... | C |
{
"A": "Idiopathic juvenile osteoporosis",
"B": "Juvenile Paget disease",
"C": "Osteogenesis imperfecta",
"D": "Osteomalacia",
"E": "Rickets",
"F": null,
"G": null,
"H": null,
"I": null
} | Osteogenesis imperfecta | A 15-year-old girl is brought to the emergency department by her father because of a 2-hour history of right leg painthat began after she fell from her bicycle. Medical history is remarkable for bilateral hearing loss, a fracture of thehumerus at age 8 years, and multiple rib fractures. She takes no medications. Family... | C |
{
"A": "βAre finances tight at home?β",
"B": "βHow do you think he will react?β",
"C": "βIs there somebody else who can pick you up?β",
"D": "βWas there a problem with your birth control?β",
"E": "βWill he try to force you to do something you arenβt comfortable with?β",
"F": null,
"G": null,
"H": null,
... | βHow do you think he will react?β | A 22-year-old primigravid woman at 10 weeksβ gestation comes to the emergency department (ED) because of a 3-day history of persistent vomiting. She is treated with intravenous hydration, pyridoxine, and doxylamine. As theresident physician prepares the patient for discharge, he asks who will be picking her up from the... | B |
{
"A": "Aortic dissection",
"B": "Aortic embolism",
"C": "Pericardial tamponade",
"D": "Right ventricular failure",
"E": "Ventricular rupture",
"F": null,
"G": null,
"H": null,
"I": null
} | Aortic embolism | Five days after admission to the hospital for management of an ST-elevation myocardial infarction, a 59-year-oldman has the sudden onset of severe abdominal and bilateral lower extremity pain, cyanosis of the lower body, andparesthesias. On hospital days 1 and 2, he received vasopressor and inotropic therapy. On hospit... | B |
{
"A": "Echocardiography",
"B": "High-resolution CT scan of the chest",
"C": "Lung biopsy",
"D": "Serum antiglomerular basement membrane antibody assay",
"E": "Thoracic PET scan",
"F": null,
"G": null,
"H": null,
"I": null
} | High-resolution CT scan of the chest | A 75-year-old man comes to the clinic because of a 2-year history of progressive shortness of breath. He also hashad an occasional dry cough for the past 6 months. He has not had chest pain, palpitations, or swelling of his legs.Medical history is unremarkable, and the patient takes no medications. He has smoked one pa... | B |
{
"A": "K+ is Decreased, Clβ» is decreased, HCOΒ³β» is decreased",
"B": "K+ is Decreased, Clβ» is decreased, HCOΒ³β» is increased",
"C": "K+ is Decreased, Clβ» is increased, HCOΒ³β» is decreased",
"D": "K+ is Increased, Clβ» is decreased, HCOΒ³β» is increased",
"E": "K+ is Increased, Clβ» is increased, HCOΒ³β» is decreased"... | KβΊ Decreased Clβ» decreased HCOΒ³β» increased | A previously healthy 20-year-old woman, who is a sophomore in college, is brought to the emergency departmentby her roommates because of an 8-hour history of weakness and vomiting blood and a 2-day history of dizziness.She has no history of similar symptoms. She says she overeats in response to the stress of her classe... | B |
{
"A": "Adjustment of the warfarin dosage to maintain an INR between 1.5 and 2.0",
"B": "Ciprofloxacin therapy",
"C": "Cystoscopy",
"D": "Discontinuation of hydrochlorothiazide therapy",
"E": "Finasteride therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Cystoscopy | A 58-year-old man comes to the clinic for a follow-up examination 3 months after beginning warfarin therapy fordeep venous thrombosis. He noted blood in his urine 1 week ago but has not seen any since that time. He has not hadpain, fever, or increased urinary frequency. He has not sustained any recent trauma. His proth... | C |
{
"A": "Bed rest",
"B": "Closed reduction followed by traction",
"C": "Hip spica hinge brace",
"D": "Limited weight bearing with use of crutches",
"E": "Operative reduction and internal fixation",
"F": null,
"G": null,
"H": null,
"I": null
} | Operative reduction and internal fixation | A 32-year-old woman is brought to the emergency department immediately after being involved in a motor vehiclecollision. She was the unrestrained driver. On arrival, she says she has severe pain in her right groin. Onexamination, any movement of the right hip produces pain. An x-ray of the pelvis shows a completely dis... | E |
{
"A": "Alcohol cessation",
"B": "Smoking cessation",
"C": "Weight loss program",
"D": "Antihypertensive therapy",
"E": "Cholesterol-lowering therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Antihypertensive therapy | A 57-year-old man comes to the physician 1 week after he had a 45-minute episode of slurred speech andclumsiness of his right hand. The episode occurred during his daily walk; the symptoms resolved during the next 24hours. He has no history of similar symptoms. He has a 20-year history of hypertension and a 15-year his... | D |
{
"A": "Haemophilus influenzae",
"B": "Influenza A virus",
"C": "Legionella pneumophila",
"D": "Mycobacterium tuberculosis",
"E": "Pseudomonas aeruginosa",
"F": "Streptococcus pneumoniae",
"G": null,
"H": null,
"I": null
} | Influenza A virus | A 27-year-old primigravid woman at 21 weeksβ gestation comes to the emergency department because of a 2-dayhistory of moderate headache, shortness of breath, nausea, vomiting, muscle aches, and malaise. She also has hadcough occasionally productive of sputum. Pregnancy had been uncomplicated. She has no history of seri... | B |
{
"A": "Attention-deficit/hyperactivity disorder",
"B": "Expressive language disorder",
"C": "Intellectual developmental disorder",
"D": "Learning disorder",
"E": "Social anxiety disorder (social phobia)",
"F": "Normal behavior",
"G": null,
"H": null,
"I": null
} | Learning disorder | A 7-year-old boy is brought to the physician because of a 1-year history of poor performance in school. His parentssay that he is bright, has many friends, and seems to want to do well in school. His teachers report that he seemsfrustrated with his own progress and his inability to meet the expectations of his parents.... | D |
{
"A": "Cerumen impaction",
"B": "Ear canal trauma",
"C": "Otitis externa",
"D": "Polychondritis",
"E": "Seborrheic dermatitis",
"F": null,
"G": null,
"H": null,
"I": null
} | Otitis externa | A 23-year-old woman who is an active-duty enlisted airman in the US Air Force comes to the base clinic because ofa 4-week history of an itchy sensation in her right ear. She has not had ringing in her ears or hearing loss. She worksas a fuel specialist and at first attributed her symptom to the earplugs she uses when s... | C |
{
"A": "CT scan of the sinuses",
"B": "Gram stain and culture of nasal discharge",
"C": "Ibuprofen and decongestant therapy",
"D": "Trimethoprim-sulfamethoxazole therapy",
"E": "X-ray of the sinuses",
"F": null,
"G": null,
"H": null,
"I": null
} | Ibuprofen and decongestant therapy | A 34-year-old woman who is on active duty in the US Army comes to the military urgent care clinic because of a 4-day history of headache, purulent nasal discharge, and left facial pain. She has not had fever or chills. She haschronic bilateral knee pain, which she attributes to multiple parachute jumps while she was as... | C |
{
"A": "Bronchospasm",
"B": "Laryngeal braking",
"C": "Subglottic mass",
"D": "Tracheal collapse",
"E": "Upper airway compression",
"F": null,
"G": null,
"H": null,
"I": null
} | Tracheal collapse | A 16-year-old boy with VATER syndrome is brought to the physician because of 2-week history of harsh cough thatbegan with a common cold. He receives no medications. Temperature is 37Β°C (98.6Β°F), pulse is 70/min, respirationsare 20/min, and blood pressure is 112/64 mm Hg. Examination shows a harsh vibratory sound in the... | D |
{
"A": "Accept the surgeonβs answer and only pursue further action if there is another complaint",
"B": "Determine whether other staff have noticed anything different about the surgeonβs behavior",
"C": "Inform the surgeon that he should consider retirement",
"D": "Instruct the surgeon to take a temporary leave... | Instruct the surgeon to take a temporary leave of absence and undergo a medical evaluation | A chief medical officer at a hospital has received several reports that one of her colleagues, a 64-year-old malesurgeon, has βnot been acting like himselfβ recently. An administrative assistant says that during the past 6 months,the surgeonβs dictations have become hard to follow and appear to be missing information; ... | D |
{
"A": "CT scan of the cervical spine",
"B": "Electromyography and nerve conduction studies",
"C": "Lumbar puncture for examination of cerebrospinal fluid",
"D": "Measurement of serum Lyme (Borrelia burgdorferi) antibody concentration",
"E": "MRI of the brain",
"F": null,
"G": null,
"H": null,
"I": nu... | MRI of the brain | A 33-year-old woman is admitted to the hospital because of visual field loss following a 48-hour history of acute eyepain. She also has a 3-week history of numbness and a feeling of "heaviness" in both legs. She has no history ofserious illness and takes no medications. Six weeks ago, she returned from a hiking expedit... | E |
{
"A": "Amyloid plaque imaging",
"B": "Determination of ApoE allele status",
"C": "Measurement of beta-amyloid in the cerebrospinal fluid",
"D": "MRI of the brain with volumetric analysis",
"E": "No additional diagnostic studies are indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | No additional diagnostic studies are indicated | A 68-year-old woman comes to the office because she is concerned about developing Alzheimer disease. She saysshe has had increasing difficulty recalling names of people and objects during the past 6 months. She has not haddifficulty with her activities of daily living, finances, or shopping. She teaches part-time at a ... | E |
{
"A": "Add carbamazepine to the medication regimen",
"B": "Add dantrolene to the medication regimen",
"C": "Add haloperidol to the medication regimen",
"D": "Discontinue paroxetine and duloxetine",
"E": "Switch from duloxetine to olanzapine",
"F": null,
"G": null,
"H": null,
"I": null
} | Discontinue paroxetine and duloxetine | A 55-year-old man with major depressive disorder is brought to the emergency department 1 1/2 hours after he wasfound by his brother in his home acting strangely. On arrival, he is babbling incoherently and cannot answerquestions. There are two empty pill bottles in his pockets; one is for paroxetine and the other is f... | D |
{
"A": "Begin clonazepam therapy",
"B": "Begin risperidone therapy",
"C": "Begin sertraline therapy",
"D": "Determine whether the patient has friends or family who can monitor him at home",
"E": "Determine whether the patient has had thoughts of harming others",
"F": "Determine whether the patient is adhere... | Determine whether the patient has had thoughts of harming others | A 32-year-old man comes to the office for a follow-up examination 2 months after he was diagnosed withhypertension. He arrives late for the appointment, stating that he had to make sure no one followed him here becausesome "drug dealers" are after him. He insists that he be seen in an examination room with no windows. ... | E |
{
"A": "Cervical carcinoma",
"B": "External hemorrhoids",
"C": "Rectal carcinoma",
"D": "Rectal polyps",
"E": "Vulvar carcinoma",
"F": null,
"G": null,
"H": null,
"I": null
} | Vulvar carcinoma | An 87-year-old woman, gravida 2, para 2, is brought to the emergency department from a skilled nursing carefacility because of profuse vaginal bleeding for 2 days. At the age of 41 years, she underwent a cold knife conebiopsy for cervical dysplasia. Annual follow-up Pap smears until the age of 65 years showed no abnorm... | E |
{
"A": "CT scan of the neck",
"B": "Fine-needle aspiration biopsy",
"C": "Reexamination in 3 months",
"D": "Surgical excision",
"E": "Ultrasonography of the thyroid gland",
"F": null,
"G": null,
"H": null,
"I": null
} | Ultrasonography of the thyroid gland | A 47-year-old woman comes to the office for a routine health maintenance examination. She feels well and has nohistory of serious illness. Examination shows a 2-cm, soft, nontender nodule in the right lobe of the thyroid gland.There is no lymphadenopathy. Her serum thyroid-stimulating hormone concentration is within th... | E |
{
"A": "Lopinavir-ritonavir and trimethoprim-sulfamethoxazole",
"B": "Lopinavir-ritonavir only",
"C": "Penicillin",
"D": "Trimethoprim-sulfamethoxazole only",
"E": "Zidovudine (AZT)",
"F": null,
"G": null,
"H": null,
"I": null
} | Zidovudine (AZT) | A 1-hour-old male newborn is examined in the hospital nursery. He was born at term to a 22-year-old woman,gravida 1, para 1, with HIV infection. The mother took antiretroviral therapy throughout her pregnancy, and her HIVviral load was consistently <1000 copies/mL. She received intravenous zidovudine (AZT) during labor... | E |
{
"A": "Biopsy of the pituitary gland",
"B": "Cabergoline therapy",
"C": "Gamma knife radiation to the pituitary gland",
"D": "Oral contraceptive therapy",
"E": "Transsphenoidal pituitary surgery",
"F": null,
"G": null,
"H": null,
"I": null
} | Cabergoline therapy | A 25-year-old woman comes to the office because she has not had a menstrual period for 6 months. Previously,menses occurred at regular 28-day intervals. She has not had blurred or double vision. She has no history of seriousillness and takes no medications. Temperature is 37.0Β°C (98.6Β°F), pulse is 72/min, and blood pre... | B |
{
"A": "Measurement of prothrombin time and partial thromboplastin time",
"B": "Measurement of stool reducing substances",
"C": "Stool culture",
"D": "Upper gastrointestinal series",
"E": "X-ray of the abdomen",
"F": null,
"G": null,
"H": null,
"I": null
} | X-ray of the abdomen | A 2-week-old boy is evaluated in the neonatal intensive care unit because of temperature instability and decreasedactivity. He was born by cesarean delivery at 30 weeksβ gestation because of premature rupture of membranes. Since birth, he has been fed breast milk by orogastric tube. He was feeding and growing appropria... | E |
{
"A": "The patient received appropriate care under the circumstances",
"B": "The pediatric surgeon at the suburban hospital should have insisted on personally examining the patient and",
"C": "The rural hospital should have sent the patient directly to the downtown university hospital",
"D": "The suburban hosp... | The suburban hospital violated the Emergency Medical Treatment and Active Labor Act (EMTALA) | A 13-month-old boy is brought to a small rural emergency department (ED) near his family's community because of an erythematous, edematous mass in his perianal area that is hot to touch. He has no history of serious illness and receives no medications. Growth and development are appropriate for age. Vaccinations are up... | E |
{
"A": "Interview following amobarbital administration",
"B": "Measurement of serum antiepileptic concentration",
"C": "Measurement of serum creatine kinase activity",
"D": "Neuropsychological testing",
"E": "Video EEG monitoring",
"F": null,
"G": null,
"H": null,
"I": null
} | Video EEG monitoring | A 25-year-old woman is brought to the emergency department by paramedics because of a seizure that began 45minutes ago at home. Intravenous antiepileptic therapy begun en route to the hospital has not stopped her seizure.Her parents report that she initially began crying, then fell to the floor and exhibited asymmetric... | E |
{
"A": "Azithromycin therapy",
"B": "CT angiography",
"C": "Electrocardiography",
"D": "Ibuprofen therapy",
"E": "Prednisone therapy",
"F": "Transthoracic echocardiography",
"G": null,
"H": null,
"I": null
} | Ibuprofen therapy | A 32-year-old woman comes to the emergency department because of a 1-day history of sharp, right-sided chest pain that worsens with coughing and sneezing. Four days ago, she had a mild sore throat and runny nose followed by nonproductive cough 1 day later. Over-the-counter decongestant and aspirin mildly relieved the s... | D |
{
"A": "Gonadal dysgenesis 45,X (Turner syndrome)",
"B": "Hypothalamic hypogonadism",
"C": "Polycystic ovarian syndrome",
"D": "Premature ovarian failure",
"E": "Prolactinoma",
"F": null,
"G": null,
"H": null,
"I": null
} | Hypothalamic hypogonadism | A 30-year-old nulligravid woman, who is a military veteran, comes to the office because she has not had a menstrual period for the past year. She has not had nausea, vomiting, or night sweats. Menses previously occurred at regular 28-day intervals. She is sexually active with one male partner and uses condoms consisten... | B |
{
"A": "Estradiol",
"B": "Follicle-stimulating hormone",
"C": "Ξ²-hCG",
"D": "Luteinizing hormone",
"E": "Progesterone",
"F": null,
"G": null,
"H": null,
"I": null
} | Follicle-stimulating hormone | A 45-year-old woman comes to the office because she has not had a menstrual period for 1 year. Menses previously occurred at regular 30-day intervals. She feels well, has no history of serious illness, and takes no medications. She has smoked one-half pack of cigarettes daily for 20 years. She is sexually active with o... | B |
{
"A": "Amoxicillin as needed for febrile illness",
"B": "Instructions for the parents to palpate the long bones routinely",
"C": "Instructions for the parents to take and record the patientβs pulse daily",
"D": "Low-dose aspirin therapy",
"E": "Oral prophylactic penicillin therapy",
"F": null,
"G": null,... | Oral prophylactic penicillin therapy | A 2-month-old girl is brought to the office by her mother for a routine examination. Newborn screening electrophoresis showed hemoglobin FS. The mother says her daughter has not had fever or pallor. The patient is feeding well and gaining weight appropriately. She receives no medications. She appears well. She is at th... | E |
{
"A": "Air-contrast enema",
"B": "Ultrasonography of the abdomen",
"C": "Upper gastrointestinal series",
"D": "Colonoscopy",
"E": "Esophagogastroduodenoscopy",
"F": null,
"G": null,
"H": null,
"I": null
} | Ultrasonography of the abdomen | A 3-week-old boy is brought to the physician by his mother because of a 5-day history of yellow eyes and skin and white stools. Pregnancy and delivery were uncomplicated. The patient's temperature is 37.1Β°C (98.8Β°F), pulse is 160/min, respirations are 40/min, and blood pressure is 85/50 mm Hg. Examination shows diffuse... | B |
{
"A": "Pulmonary function tests",
"B": "CT scan of the chest",
"C": "Course of prednisone",
"D": "Discontinuation of lisinopril",
"E": "Use of a cough suppressant",
"F": "No change in management is indicated at this time",
"G": null,
"H": null,
"I": null
} | Discontinuation of lisinopril | A 52-year-old woman comes to the physician for a follow-up examination. She received the diagnosis of hypertension 3 weeks ago, and lisinopril therapy was begun at that time. She has had a constant, nonproductive, hacking cough for 2 weeks but has not had any other problems. She has no history of serious illness and ta... | D |
{
"A": "Maternal fever",
"B": "Maternal tachycardia",
"C": "Neonatal acidosis",
"D": "Neonatal arrhythmia",
"E": "Neonatal respiratory depression",
"F": null,
"G": null,
"H": null,
"I": null
} | Neonatal respiratory depression | A 27-year-old primigravid woman at 41 weeks' gestation is admitted to the hospital for induction of labor. She hasreceived cervical ripening agents and is now receiving oxytocin. The cervix is 9 cm dilated and 100% effaced; thevertex is at 0 station. Fetal monitoring shows contractions every 3 minutes and a reassuring ... | E |
{
"A": "EEG",
"B": "Karyotype analysis",
"C": "MRI of the brain",
"D": "Polysomnography",
"E": "Thyroid function tests",
"F": null,
"G": null,
"H": null,
"I": null
} | Polysomnography | A 7-year-old girl is brought to the clinic by her father because of behavior problems at school since she started second grade 6 months ago. Her teacher is concerned because she cannot sit still or complete tasks and is not learning at the same pace as her classmates. Psychoeducational testing shows normal intelligence... | D |
{
"A": "Contact the national organization of the parentsβ religion and insist that the parents speak with a representative on the phone regarding the matter",
"B": "Contact the parentsβ religious advisor to request help in acquiring consent for blood transfusion",
"C": "Proceed with the blood transfusion while ob... | Proceed with the blood transfusion while obtaining an emergency telephone court order | An 8-year-old boy is brought to the emergency department (ED) by ambulance 45 minutes after he was struck by a car while riding his bicycle. He did not lose consciousness but has multiple rib fractures with depression of the left anterior chest wall. His parents have been notified and are on their way to the hospital. ... | C |
{
"A": "Bolus of 0.9% saline",
"B": "Bolus of sodium bicarbonate",
"C": "Intravenous alprostadil (prostaglandin Eβ)",
"D": "Intravenous digoxin",
"E": "Intravenous dopamine",
"F": null,
"G": null,
"H": null,
"I": null
} | Intravenous alprostadil (prostaglandin Eβ) | A female newborn has the onset of tachypnea 4 hours after birth. She was delivered at term to a 24-year-old woman following an uncomplicated pregnancy and delivery. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. Her parents had refused prenatal screening. The patient's temperature is 37.2Β°C (99.0Β°F), pulse... | C |
{
"A": "Diltiazem",
"B": "Lisinopril",
"C": "Propranolol",
"D": "Warfarin",
"E": "No pharmacotherapy is indicated at this time",
"F": null,
"G": null,
"H": null,
"I": null
} | Diltiazem | A 43-year-old woman comes to the office for a follow-up examination 1 week after she was discharged from the hospital following an overnight admission for an episode of crushing, aching chest pain. The pain was located behind her sternum and radiated to her left jaw and shoulder. She also had shortness of breath, palpi... | A |
{
"A": "Adjustment disorder with depressed mood",
"B": "Alcohol use disorder",
"C": "Dependent personality disorder",
"D": "History of physical abuse",
"E": "Panic disorder",
"F": null,
"G": null,
"H": null,
"I": null
} | Alcohol use disorder | A 35-year-old woman is brought to the emergency department by police after they found her wandering the streets and appearing intoxicated. On arrival, she is tremulous and appears distressed. She says she moved out of her abusive boyfriendβs apartment 1 week ago because she was afraid he would kill her. She has no fin... | B |
{
"A": "Administer intravenous morphine",
"B": "Admit the patient to the hospital for further evaluation",
"C": "Initiate a propofol infusion",
"D": "Transition the patient to noninvasive positive pressure ventilation",
"E": "No further action is indicated",
"F": null,
"G": null,
"H": null,
"I": null
... | Administer intravenous morphine | A 76-year-old woman, who is receiving home hospice care because of end-stage metastatic lung cancer diagnosed 1 month ago, is examined at home at the request of her family because of a 3-hour history of labored breathing despite receiving 100% oxygen at 5 L/min via face mask. Pulse is 92/min, respirations are 18/min,... | A |
{
"A": "Carcinoid syndrome",
"B": "Chronic autoimmune (Hashimoto) thyroiditis",
"C": "Familial hypocalciuric hypercalcemia",
"D": "Medullary thyroid carcinoma",
"E": "Parathyroid carcinoma",
"F": null,
"G": null,
"H": null,
"I": null
} | Medullary thyroid carcinoma | A 42-year-old woman comes to the physician because of a 1-month history of moderate constant abdominal pain. She was evaluated in the emergency department 6 weeks ago for renal calculi and was told that her serum calcium concentration was increased. She has labile hypertension treated with hydrochlorothiazide and ena... | D |
{
"A": "Lymph node biopsy",
"B": "Methylprednisolone therapy",
"C": "Penicillin therapy",
"D": "Plasmapheresis",
"E": "Trimethoprim-sulfamethoxazole therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Lymph node biopsy | A 26-year-old woman with common variable immunodeficiency comes to the office because of a 2-month history of night sweats. She also has had a 10-kg (22-lb) weight loss during the past 3 months despite no change in appetite. She has a 15-year history of recurrent sinusitis and otitis media. Her only medication is int... | A |
{
"A": "Abdominal ultrasonography",
"B": "AntiβSaccharomyces cerevisiae antibody testing",
"C": "Nitroblue tetrazolium testing",
"D": "Rectal swab for group B streptococcus",
"E": "Skeletal survey",
"F": "Stool culture for Salmonella enteritidis",
"G": null,
"H": null,
"I": null
} | Skeletal survey | A 9-month-old boy is brought to the office by his mother because of a 6-hour history of persistent fussiness and decreased appetite. Two weeks ago, he was diagnosed with an upper respiratory tract infection. The symptoms have since resolved. He lives with his parents and a pet lizard. His diet consists of cow milk-ba... | E |
{
"A": "CT scan of the abdomen",
"B": "Endoscopic retrograde cholangiopancreatography",
"C": "MR cholangiopancreatography",
"D": "MRI of the pancreas",
"E": "Ultrasonography of the right upper abdominal quadrant",
"F": null,
"G": null,
"H": null,
"I": null
} | Ultrasonography of the right upper abdominal quadrant | A 62-year-old woman is admitted to the hospital because of an 8-hour history of severe right upper abdominal pain, nausea, and fever that began after she ate fried fish and potatoes. During the past 3 years, she has had 12 episodes of similar pain after meals, but it has not lasted as long or been as severe as this epi... | E |
{
"A": "Continuous nebulized albuterol therapy",
"B": "CT scan of the chest without contrast",
"C": "Intravenous aminophylline therapy",
"D": "Pulmonary function testing",
"E": "Pulmonary rehabilitation",
"F": "Titrated oxygen therapy",
"G": null,
"H": null,
"I": null
} | Titrated oxygen therapy | A 63-year-old man with chronic obstructive pulmonary disease comes to the urgent treatment center because of a 4- day history of worsening shortness of breath. Use of his albuterol rescue inhaler has provided no improvement in his symptoms. Medical history otherwise is unremarkable. Additional medications are formoter... | F |
{
"A": "Adenocarcinoma of the colon",
"B": "Cholelithiasis",
"C": "Nephrolithiasis",
"D": "Primary biliary cirrhosis",
"E": "Spontaneous bacterial peritonitis",
"F": null,
"G": null,
"H": null,
"I": null
} | Adenocarcinoma of the colon | A 49-year-old man returns to the office for follow-up 2 weeks after he was evaluated for a 4-month history of intermittent diarrhea associated with cramping abdominal pain, urgency, and fecal incontinence. Since the onset of these symptoms, he has had four to five bowel movements daily that contain blood and mucus. E... | A |
{
"A": "Decreased uptake of glucose by insulin-sensitive tissues",
"B": "Exogenous production of glucose by bacteria",
"C": "Impaired excretion of glucose by the kidneys",
"D": "Increased infusion of intravenous glucose",
"E": "Insulin deficiency",
"F": null,
"G": null,
"H": null,
"I": null
} | Decreased uptake of glucose by insulin-sensitive tissues | A 27-year-old man is examined in the intensive care unit 1 day after he sustained a closed head injury, liver laceration, and pelvic fracture in a motor vehicle collision. He is intubated and mechanically ventilated. He is receiving intravenous midazolam and 5% dextrose in lactated Ringer solution. Temperature is 37.... | A |
{
"A": "Discharge the patient with a plan for home health care and physical therapy",
"B": "Inform the patient that she would need to sign out against medical advice",
"C": "Inform the patient that transfer to a long-term care facility is most suitable for her",
"D": "Request psychiatric evaluation of the patie... | Discharge the patient with a plan for home health care and physical therapy | A 72-year-old woman is evaluated in the acute rehabilitation facility where she has been receiving physical therapy since sustaining a stroke 2 weeks ago that resulted in moderate left hemiparesis. A swallowing study obtained on admission to the facility showed no abnormalities and she has been progressing well with ... | A |
{
"A": "Cushing syndrome",
"B": "Fibromuscular dysplasia",
"C": "Hyperaldosteronism",
"D": "Hypothyroidism",
"E": "Obstructive sleep apnea",
"F": null,
"G": null,
"H": null,
"I": null
} | Hyperaldosteronism | A 46-year-old woman comes to the office for an annual health maintenance examination. She reports a 6-week history of fatigue, which she attributes to working full time and caring for her three children. Her blood pressure has been consistently high as measured at home with her husband's automated cuff, with many rea... | C |
{
"A": "Cellulitis",
"B": "Dermatophytosis",
"C": "Erysipelas",
"D": "Erythema nodosum",
"E": "Herpes zoster",
"F": "Necrotizing fasciitis",
"G": null,
"H": null,
"I": null
} | Necrotizing fasciitis | A 50-year-old woman is brought to the emergency department because of a 3-day history of severely painful lesions over her right leg and temperatures to 38.7Β°C (101.7Β°F). She has a 12-year history of type 2 diabetes mellitus. Her only medication is insulin. On arrival, temperature is 39.3Β°C (102.8Β°F). Examination of ... | F |
{
"A": "Corticosteroid therapy",
"B": "Taking frequent breaks from the paper-bleaching area",
"C": "Undergoing monthly pulmonary function testing",
"D": "Using a respirator at work",
"E": "Washing daily after work with a chlorhexidine-based solution",
"F": null,
"G": null,
"H": null,
"I": null
} | Using a respirator at work | A 37-year-old woman comes to the office for a routine health maintenance examination. For the past 6 years, she has worked in a paper mill factory that uses liquid chlorine to bleach the paper. The patient is concerned about her exposure to toxic substances. Vital signs are within normal limits. Examination shows no ... | D |
{
"A": "Enalapril",
"B": "Metoprolol",
"C": "Propranolol",
"D": "Spironolactone",
"E": "Valsartan",
"F": null,
"G": null,
"H": null,
"I": null
} | Spironolactone | A 57-year-old man with alcohol use disorder comes to the emergency department because of a 3-day history of worsening abdominal pain and distention. Medical history is remarkable for alcoholic cirrhosis, hypertension, hyperlipidemia, and a laparoscopic cholecystectomy 10 years ago. The patient also has had several pr... | D |
{
"A": "Apheresis",
"B": "Ezetimibe therapy",
"C": "Gemfibrozil therapy",
"D": "Metformin therapy",
"E": "Recommendation for weight loss",
"F": null,
"G": null,
"H": null,
"I": null
} | Gemfibrozil therapy | A 48-year-old man is admitted to the hospital 2 hours after the onset of severe abdominal pain, nausea, and vomiting. The pain radiates to the back but improves when he bends forward. He has no history of serious illness and takes no medications. He does not smoke cigarettes. He drinks two 12-oz beers weekly. He appear... | C |
{
"A": "Glucose",
"B": "Vitamin Bβ (thiamine)",
"C": "Vitamin Bβ (riboflavin)",
"D": "Vitamin Bβ (pyridoxine)",
"E": "Vitamin Bββ (cyanocobalamin)",
"F": null,
"G": null,
"H": null,
"I": null
} | Vitamin Bβ (thiamine) | A 57-year-old man is admitted to the hospital 30 minutes after he was found wandering in the streets. Fingerstick blood glucose concentration obtained by paramedics prior to transport was 68 mg/dL. The patient's medical history is unknown. Temperature is 35.8Β°C (96.5Β°F), pulse is 80/min, respirations are 16/min, and ... | B |
{
"A": "Conduct a nursing in-service regarding DVT prophylaxis",
"B": "Develop an institutional policy with standardized orders for DVT prophylaxis",
"C": "Encourage early ambulation during the postoperative period",
"D": "Prescribe low-molecular-weight heparin for all postoperative patients",
"E": "No interv... | Develop an institutional policy with standardized orders for DVT prophylaxis | Three days after an operation for uterine cancer, a hospitalized 67-year-old woman develops edema of the right lower extremity. Doppler ultrasonography shows a deep venous thrombosis (DVT). Review of the patient's record indicates that no DVT prophylaxis was initiated perioperatively. Which of the following is the be... | B |
{
"A": "Absolute risk reduction is 1%",
"B": "Absolute risk reduction is 10%",
"C": "Number needed to treat is 4",
"D": "Number needed to treat is 25",
"E": "Relative risk reduction is 25%",
"F": "Relative risk reduction is 75%",
"G": null,
"H": null,
"I": null
} | Absolute risk reduction is 1% | A clinical trial is performed to assess the efficacy of aspirin in decreasing the risk for myocardial infarction. Twenty-two thousand male physicians with no history of coronary artery disease are randomly assigned to receive aspirin (325 mg/d) or a placebo. After following the subjects for 5 years, results show that ... | A |
{
"A": "No action is required",
"B": "Review the MRI to determine the correct operative site",
"C": "Ask the surgeon to continue the operation only after the discrepancy is resolved",
"D": "Change the operative consent to match the surgeon's actions",
"E": "Call the waiting room to confirm the correct operati... | Ask the surgeon to continue the operation only after the discrepancy is resolved | An 18-year-old man is being prepared to undergo left temporal craniotomy for meningioma. General anesthesia has been administered. The surgeon reviews the patient's most recent MRI findings, which are hanging on a view box in the operating room, and prepares to clip the hair from the patient's right scalp. The circul... | C |
{
"A": "Continuation of mechanical ventilation at the current setting",
"B": "Administration of cyclophosphamide",
"C": "Administration of dexamethasone",
"D": "Extracorporeal membrane oxygenation",
"E": "Application of positive end-expiratory pressure",
"F": null,
"G": null,
"H": null,
"I": null
} | Application of positive end-expiratory pressure | A 52-year-old man is brought to the emergency department because of a 2-day history of severe, progressive shortness of breath associated with exacerbation of his chronic cough. He has a 6-week history of pneumonia, which has responded slowly to treatment. Prior to the onset of his current symptoms, he had minimally ... | E |
{
"A": "Cardiac monitoring",
"B": "Chest x-ray",
"C": "Echocardiography",
"D": "EEG",
"E": "Measurement of serum imipramine concentration",
"F": null,
"G": null,
"H": null,
"I": null
} | Cardiac monitoring | A 14-year-old boy is brought to the emergency department by his parents 30 minutes after the sudden onset of confusion, sweating, and pallor. He has enuresis treated with imipramine. His parents refilled his prescription for imipramine 3 days ago and noted today that the bottle is empty. On arrival, the patient is aw... | A |
{
"A": "CT scan of the abdomen and pelvis",
"B": "Digital angiography of the aorta",
"C": "Duplex ultrasonography of the abdomen",
"D": "X-ray of the abdomen",
"E": "No diagnostic imaging is indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | Duplex ultrasonography of the abdomen | A 65-year-old man with mild hypertension comes to the veteransβ administration outpatient clinic because he is concerned about having an abdominal aortic aneurysm. He says he feels well. His medications are metoprolol and lisinopril. His older brother, who was "seemingly in good health," recently underwent emergency ... | C |
{
"A": "Serum protein electrophoresis",
"B": "Echocardiography",
"C": "Bone scan",
"D": "Colonoscopy",
"E": "Esophagogastroduodenoscopy",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum protein electrophoresis | A 57-year-old man comes to the physician because of a 1-month history of fatigue and moderate low back pain. He also has had a mildly decreased appetite resulting in a 1.8-kg (4-lb) weight loss during this period. He has a 1-week history of headache. He has had no fever, sweating, or chills. He has hypertension well ... | A |
{
"A": "Breast cancer",
"B": "Endometrial cancer",
"C": "Obesity",
"D": "Osteoporosis",
"E": "Unplanned pregnancy",
"F": null,
"G": null,
"H": null,
"I": null
} | Osteoporosis | A 38-year-old woman, gravida 1, para 1, comes to the office because she has been unable to conceive for the past year. She and her husband have had unprotected sexual intercourse three times weekly during this time. They have a 6-year-old daughter. During the past year, menses have occurred at irregular 90- to 120-da... | D |
{
"A": "Bernard-Soulier syndrome",
"B": "Glanzmann thrombasthenia",
"C": "Hemophilia A",
"D": "Hereditary hemorrhagic telangiectasia",
"E": "von Willebrand disease",
"F": null,
"G": null,
"H": null,
"I": null
} | von Willebrand disease | A 27-year-old man comes to the physician because of a 1-month history of progressive fatigue and episodes of moderate abdominal pain. He has a 4-year history of recurrent nosebleeds that have increased in frequency despite undergoing cauterization of the nasal mucosa 6 months ago. He takes no medications. His sister ... | E |
{
"A": "Avoidant personality disorder",
"B": "Generalized anxiety disorder",
"C": "Illness anxiety disorder (hypochondriasis)",
"D": "Persistent depressive disorder (dysthymia)",
"E": "Social anxiety disorder (social phobia)",
"F": null,
"G": null,
"H": null,
"I": null
} | Generalized anxiety disorder | A 37-year-old woman comes to the office for a follow-up examination 3 weeks after testing confirmed a mass in her left breast to be benign. She says that despite the test results, she has had anxiety, insomnia, and a preoccupation with cancer since noticing the lump. Two weeks ago, she had a 20-minute episode of mark... | B |
{
"A": "Cefotaxime",
"B": "Clindamycin",
"C": "Metronidazole",
"D": "Oxacillin",
"E": "Vancomycin",
"F": "No pharmacotherapy is indicated at this time",
"G": null,
"H": null,
"I": null
} | Cefotaxime | A 55-year-old man comes to the emergency department because of a 6-hour history of diffuse abdominal pain and subjective fever. His most recent bowel movement 4 hours ago was loose but not bloody. He reports no chills or urinary symptoms. Medical history is remarkable for gastroesophageal reflux disease and alcoholic... | A |
{
"A": "Folic acid",
"B": "Iron",
"C": "Magnesium",
"D": "Vitamin Bβ (riboflavin)",
"E": "Vitamin D",
"F": "Zinc",
"G": null,
"H": null,
"I": null
} | Vitamin D | A 45-year-old man is brought to the emergency department because of moderate chest pain after a generalized tonic-clonic seizure 30 minutes ago. He has seizure disorder for which he has taken carbamazepine and phenobarbital for the past 20 years. X-ray of the chest shows generalized osteopenia with several rib fractur... | E |
{
"A": "Ketorolac 0.5% solution, 1 drop in right eye, four times daily",
"B": "Ketorolac .5% solution, 1 drop in right eye QID",
"C": "Ketorolac 0.5% solution, 1 drop OD four times daily",
"D": "Ketorolac 0.5% solution, 1 drop OD, QID",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Ketorolac 0.5% solution, 1 drop in right eye, four times daily | A 32-year-old man comes to the office because of a 2-day history of redness of the right eye. He has not had sensitivity to light or the sensation of a foreign body in the eye. He has no history of serious illness and takes no medications. Examination of the right eye shows erythema and clear discharge. Examination o... | A |
{
"A": "Pubic Hair Development: Delayed; Breast Development: delayed",
"B": "Pubic Hair Development: Delayed; Breast Development: normal",
"C": "Pubic Hair Development: Normal; Breast Development: delayed",
"D": "Pubic Hair Development: Normal; Breast Development: normal",
"E": null,
"F": null,
"G": null,... | Pubic Hair Development: Normal; Breast Development: normal | A 14-year-old girl is brought to the physician by her mother for a well-child examination. Vital signs are within normal limits. On breast examination, the areolae are 3 cm in diameter and form a secondary mound bilaterally. Cardiopulmonary and abdominal examinations show no abnormalities. Pelvic examination shows da... | D |
{
"A": "Condoms with spermicidal foam",
"B": "Diaphragm with spermicidal foam",
"C": "Oral contraceptive therapy",
"D": "Subdermal contraceptive implant",
"E": "Vaginal contraceptive ring",
"F": null,
"G": null,
"H": null,
"I": null
} | Subdermal contraceptive implant | A healthy 19-year-old woman comes to the clinic requesting advice regarding contraception. Menses occur at regular 28-day intervals with heavy flow. She is sexually active and has had three lifetime male partners. She has smoked one-half pack of cigarettes daily for 2 years. She lives in a college dormitory and says ... | D |
{
"A": "Appendicitis",
"B": "Ectopic pregnancy",
"C": "Ovarian torsion",
"D": "Pyelonephritis",
"E": "Tubo-ovarian abscess",
"F": null,
"G": null,
"H": null,
"I": null
} | Tubo-ovarian abscess | A previously healthy 17-year-old girl comes to the emergency department because of a 3-day history of moderateright lower quadrant pain, fever, and loss of appetite. She has not had abnormal vaginal discharge. Four months ago,she was treated with oral antibiotics for cystitis. She currently takes no medications. Menses... | E |
{
"A": "Estrogen and progestin therapy",
"B": "Gonadectomy",
"C": "Gonadotropin-releasing hormone agonist therapy",
"D": "Progestin therapy only",
"E": "No further management is indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | Gonadectomy | A 15-year-old girl is brought to the office because she has never had a menstrual period. She has no history ofserious illness and receives no medications. Growth and development are appropriate for age. Breast developmentbegan at the age of 10 years. She has never been sexually active. She is at the 90th percentile fo... | B |
{
"A": "Amlodipine",
"B": "Doxazosin",
"C": "Hydrochlorothiazide",
"D": "Lisinopril",
"E": "Metoprolol",
"F": null,
"G": null,
"H": null,
"I": null
} | Hydrochlorothiazide | A 50-year-old man returns to the office for a follow-up examination. During the past 2 months, he has had increased blood pressure readings during several checks at the office and at home. He says he has felt well. He has major depressive disorder and gout. Medications are fluoxetine and allopurinol. His maternal grand... | C |
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