options dict | answer stringlengths 1 120 | question stringlengths 188 3.83k | answer_idx stringclasses 7
values |
|---|---|---|---|
{
"A": "Asthma exacerbation",
"B": "Carcinoid syndrome",
"C": "Panic attack",
"D": "Reaction to food additive",
"E": "Systemic mastocytosis",
"F": "Thyrotoxicosis",
"G": null,
"H": null,
"I": null
} | Reaction to food additive | A 23-year-old woman is brought to the emergency department by her friends 30 minutes after the sudden onset ofnausea, facial flushing, and chest pressure while eating at a Thai restaurant. She does not have any known allergiesto foods or medications. She had asthma during childhood but has not required treatment for 5 ... | D |
{
"A": "Advise the patient that there is no proof that these alternative therapies work and that she is essentially",
"B": "Agree to the alternative therapies and schedule a follow-up visit in 6 months",
"C": "Ask the patient if she would be willing to return to the office in 2 weeks to discuss treatment options ... | Ask the patient if she would be willing to return to the office in 2 weeks to discuss treatment options again | A 45-year-old woman returns to the office to discuss results of a fine-needle aspiration biopsy of a 0.5-cm rightbreast mass obtained 1 week ago. She is unaccompanied. Medical history is unremarkable and she takes nomedications. Her mother and maternal aunt were diagnosed with breast cancer at the ages of 45 and 52 yea... | C |
{
"A": "Common peroneal neuropathy",
"B": "Femoral neuropathy",
"C": "L2 radiculopathy",
"D": "L4 radiculopathy",
"E": "Obturator neuropathy",
"F": "S1 radiculopathy",
"G": null,
"H": null,
"I": null
} | S1 radiculopathy | A 47-year-old woman comes to the office because of a 2-month history of progressive weakness and numbness ofher right leg. She has a 3-year history of type 2 diabetes mellitus treated with metformin. She has worked as a stockperson in a storeroom for 12 years; she often moves and lifts heavy objects and sometimes crawl... | F |
{
"A": "Adenovirus",
"B": "Borrelia burgdorferi",
"C": "Coxsackievirus",
"D": "Ehrlichia chaffeensis",
"E": "Parvovirus B19",
"F": null,
"G": null,
"H": null,
"I": null
} | Parvovirus B19 | A 30-year-old woman comes to the office because of a 3-day history of joint pain in her hands and a rash over her chest andarms that is slowly resolving. The joint pain in her hands has persisted and is exacerbated by writing or typing. She rates thepain as a 3 on a 10-point scale. The patient is a preschool teacher an... | E |
{
"A": "Hepatic adenoma",
"B": "Hepatocellular cancer",
"C": "Hydatid cyst",
"D": "Metastatic ovarian cancer",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Hepatic adenoma | A 34-year-old woman comes to the office because of a 1-month history of worsening right upper quadrant abdominal pain and discomfort. She describes the pain as a dull ache and says it is not affected by eating or defecating. She has not had nausea or changes in appetite or bowel habits. She feels the pain constantly wh... | A |
{
"A": "Bleeding time",
"B": "Erythrocyte count",
"C": "Serum concentration of C3",
"D": "Serum IgA concentration",
"E": "Serum rheumatoid factor assay",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum concentration of C3 | A 12-year-old girl is brought to the emergency department by her mother because of a 1-week history of worsening swelling in her legs. The patient also noticed blood in her urine yesterday. The bleeding has not recurred. She had an upper respiratory tract infection and sore throat 1 week ago that caused her to miss sev... | C |
{
"A": "Chronic obstructive pulmonary disease",
"B": "Diabetes mellitus",
"C": "Endocarditis",
"D": "Hyperthyroidism",
"E": "Perimenopause",
"F": null,
"G": null,
"H": null,
"I": null
} | Hyperthyroidism | A 45-year-old woman comes to the office because she has noticed during the past several months that her fingernails havebecome white, increasingly brittle, and seem to lift off her nail beds easily. During this time, she also has had episodes offeeling warm and perspiring. Medical history is remarkable for intravenous ... | D |
{
"A": "γ-Aminobutyric acid",
"B": "Dopamine",
"C": "Glutamate",
"D": "Norepinephrine",
"E": "Serotonin",
"F": null,
"G": null,
"H": null,
"I": null
} | Serotonin | A 48-year-old man comes to the clinic because of a 10-year history of recurrent, intrusive thoughts that his house will bebroken into and damaged by criminals or accidentally destroyed by a fire when he is not home. These thoughts haveworsened during the past 2 months. He reports now spending 4 hours daily checking tha... | E |
{
"A": "Matching",
"B": "Post hoc analysis",
"C": "Randomization",
"D": "Standardization",
"E": "Stratification",
"F": null,
"G": null,
"H": null,
"I": null
} | Stratification | Researchers from a large neurology center are conducting a study to examine the relationship between stress levels andfibromyalgia-related pain. Two hundred patients with fibromyalgia are randomly selected from the center for participation inthe study. During recruitment, a baseline interview is conducted with each par... | E |
{
"A": "He has iron deficiency anemia",
"B": "His daily glucose control is better than recorded",
"C": "His glucometer is reading falsely high and should be replaced",
"D": "His hemoglobin A1c is likely a result of laboratory error and should be repeated",
"E": "His sickle cell disease is affecting his hemogl... | His sickle cell disease is affecting his hemoglobin A1c | A 12-year-old boy with sickle cell disease and type 1 diabetes mellitus is brought to the office by his mother for an initialvisit. The family recently moved to the area. Type 1 diabetes mellitus was diagnosed in the patient 6 years ago. Since thattime, he has been treated with insulin and dietary management. His insul... | E |
{
"A": "They will be released to his new physician promptly",
"B": "They will be released when he makes a payment on his account",
"C": "They will be released when he pays his balance in full",
"D": "They will be released when his new physician contacts your office and requests them",
"E": null,
"F": null,
... | They will be released to his new physician promptly | A 35-year-old man, who has been your patient for the past year, comes to the office to request that a copy of his medicalrecords be sent to another physician in town. The patient has an overdue account balance of $750, which he has not paid forseveral months. He signs an office form authorizing release of health inform... | A |
{
"A": "Decreased production of factor VII",
"B": "Defective platelet aggregation",
"C": "Deficiency of thrombopoietin",
"D": "Inhibition of vitamin K epoxide reductase",
"E": "Splenic sequestration",
"F": null,
"G": null,
"H": null,
"I": null
} | Decreased production of factor VII | A 47-year-old man is admitted to the intensive care unit because of lower gastrointestinal bleeding. He has a history ofalcohol-induced cirrhosis. Physical examination shows marked ascites and splenomegaly; the spleen tip is palpated 4 cmbelow the left costal margin. Results of laboratory studies are shown:Serum BloodC... | A |
{
"A": "Osteitis deformans (Paget disease)",
"B": "Parkinson disease",
"C": "Progressive supranuclear palsy",
"D": "Sarcopenia",
"E": "Systemic sclerosis (scleroderma)",
"F": null,
"G": null,
"H": null,
"I": null
} | Systemic sclerosis (scleroderma) | A 57-year-old woman comes to the office for a preoperative evaluation 2 weeks before undergoing scheduled laparoscopiccholecystectomy. Medical history is otherwise unremarkable and the patient takes no medications. Family history issignificant for stable angina in her father and rheumatoid arthritis in her mother. The ... | E |
{
"A": "Blood transfusions",
"B": "Exposure to toxic chemicals",
"C": "International travel",
"D": "Tobacco use",
"E": "Unprotected sexual intercourse",
"F": null,
"G": null,
"H": null,
"I": null
} | Unprotected sexual intercourse | A 32-year-old man comes to the office because of a 10-day history of a red rash that has spread over his entire torso. He saysthe rash is not itchy or painful. He reports having a flu-like illness nearly 5 weeks ago, with associated headache, neckstiffness, muffled hearing, and a canker sore on his tongue. All of these... | E |
{
"A": "Asbestos",
"B": "Legionella pneumophila",
"C": "Mold spores",
"D": "Mycoplasma pneumoniae",
"E": "Respiratory syncytial virus",
"F": null,
"G": null,
"H": null,
"I": null
} | Mold spores | The nurse at a local elementary school contacts you about 12 children he has seen in the past 2 weeks. All of the children hadsimilar symptoms of nasal congestion, sneezing, nonproductive coughing, and eye irritation. None of the children had fevers.Several teachers and support staff have reported having the same sympt... | C |
{
"A": "Antisocial personality disorder",
"B": "Borderline personality disorder",
"C": "Conduct disorder",
"D": "Narcissistic personality disorder",
"E": "Schizotypal personality disorder",
"F": null,
"G": null,
"H": null,
"I": null
} | Antisocial personality disorder | A 20-year-old man comes to the office at the request of his family for an examination 1 day after a motor vehicle accident forwhich he was at fault. The patient was arrested for the third time after police discovered he had been driving under theinfluence of alcohol. He has been your patient since early adolescence, an... | A |
{
"A": "Administer amobarbital and then interview the patient",
"B": "Ask the patient to provide a narrative with detailed description of the incident and of his symptoms",
"C": "Interview the patient under hypnosis",
"D": "Interview the patient while paying close attention to his willingness to make eye contac... | Ask the patient to provide a narrative with detailed description of the incident and of his symptoms | A 45-year-old man comes to the office for an initial appointment because he would like you to fill out and sign a legaldocument at the request of his attorney. The patient works as a limousine driver. He states that he is filing a lawsuit againstthe limousine company that employs him because he developed post-traumatic... | B |
{
"A": "Chest x-ray",
"B": "ECG",
"C": "Serum anti-streptolysin O titer",
"D": "Serum C-reactive protein concentration",
"E": "Serum thyroid-stimulating hormone (TSH) concentration",
"F": null,
"G": null,
"H": null,
"I": null
} | ECG | A 39-year-old woman comes to the office because of gradually increasing shortness of breath while doing her usualhousehold activities. She also reports fatigue, a feeling of heaviness in her chest with exertion, trouble sleeping, and the veryrecent onset of a rapid heart beat and fluttering in her chest. She says, "I w... | B |
{
"A": "Acute tubular necrosis",
"B": "Decreased intravascular volume",
"C": "Medication-related interstitial nephritis",
"D": "Neurogenic bladder",
"E": "Pyelonephritis",
"F": null,
"G": null,
"H": null,
"I": null
} | Decreased intravascular volume | A 10-year-old boy with a traumatic brain injury sustained during infancy is examined in the nursing care facility where he resides because he has had no urine output during the past 24 hours. During the past 4 days, he has had decreasing urine output, intermittent fever, rhinorrhea, and cough. As a result of his brain ... | B |
{
"A": "Narcolepsy",
"B": "Primary hypersomnia",
"C": "A seizure disorder",
"D": "Sleep paralysis",
"E": "Vasovagal syndrome",
"F": null,
"G": null,
"H": null,
"I": null
} | Narcolepsy | A 27-year-old man comes to the office with his wife because of a recent episode of loss of muscle control. He says, "I was ata reception, someone told a joke, and when I laughed, my legs collapsed!" His wife says that he recovered in a few secondsand he did not lose consciousness. He has a long history of sleepiness an... | A |
{
"A": "Address confounding",
"B": "Demonstrate causality",
"C": "Minimize ascertainment bias",
"D": "Reduce recall bias",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Minimize ascertainment bias | A study is being conducted to assess mesothelioma in shipyard workers. A large shipyard firm has provided the asbestosexposure records of all employees during the past 50 years. The health insurer for the workers has provided claims data thatdocuments all chest x-rays and diagnoses of mesothelioma among current workers... | C |
{
"A": "Explain the daughter's concerns to the patient and persuasively present the advantages of further evaluation",
"B": "Explain to the daughter that no significant treatment will result from further testing and recommend having a home",
"C": "Obtain consultation with an oncologist to assess the patient's nee... | Reassure the daughter and recommend hospice care consultation | An 88-year-old man with osteoarthritis is brought to the office by his daughter because of a 2-day history of severe low backpain and inability to walk. He says he has not fallen and does not recall any trauma to his back. Five years ago, he underwentbilateral hip replacement. His pain and mobility improved following t... | D |
{
"A": "Campylobacter jejuni",
"B": "Candida albicans",
"C": "Enterovirus",
"D": "Giardia lamblia",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Campylobacter jejuni | A 23-year-old man comes to the office because of a 7-day history of fever, crampy abdominal pain, and diarrhea. He says theabdominal pain worsens with oral intake. He has been having 8 to 10 episodes of diarrhea daily. He has not traveled recently andhas had no sick contacts. Medical history is unremarkable and he take... | A |
{
"A": "Blood cultures",
"B": "CD4+ T-lymphocyte count",
"C": "Human leukocyte antigen-B27 assay",
"D": "Serum rheumatoid factor assay",
"E": "Stool culture",
"F": null,
"G": null,
"H": null,
"I": null
} | Human leukocyte antigen-B27 assay | A 23-year-old man comes to the office because of a 7-day history of fever, crampy abdominal pain, and diarrhea. He says theabdominal pain worsens with oral intake. He has been having 8 to 10 episodes of diarrhea daily. He has not traveled recently andhas had no sick contacts. Medical history is unremarkable and he take... | C |
{
"A": "Ductography",
"B": "Excisional biopsy of glandular tissue",
"C": "Repeat mammography",
"D": "Repeat ultrasonography of the right breast",
"E": "No further workup is indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | Ductography | A 46-year-old woman, gravida 1, para 1, comes to the office because of a 2-week history of black discharge from her rightnipple. The patient had mammography and ultrasonography of the breasts 2 months ago for evaluation of increasedglandularity, palpated in the upper outer quadrant of the right breast, noted at her mos... | A |
{
"A": "Individuals who take Drug X have an equal risk of dying from this type of cancer",
"B": "Individuals who take Drug X have four times the risk of dying from this type of cancer",
"C": "Individuals who take Drug X have three times the risk of dying from this type of cancer",
"D": "Individuals who take Dru... | Individuals who take Drug X have two times the risk of dying from this type of cancer | A physician is conducting a retrospective review of a trial involving the use of Drug X in patients with a specific disease. It isknown that Drug X is associated with an increased probability of cancer in patients who use the drug. A total of600 individuals with a specific disease were included in the trial. Of the par... | D |
{
"A": "Bacterial endotoxin",
"B": "Bacterial exotoxin",
"C": "Immunoglobulin E antibody",
"D": "Immunoglobulin G antibody",
"E": "Viral capsid",
"F": "Viral coat",
"G": null,
"H": null,
"I": null
} | Bacterial exotoxin | A 23-year-old woman is brought to the emergency department by her friend because of headache, vomiting, and diarrhea that developed rapidly 6 hours ago. She also has had associated fever, chills, generalized muscle pain, and diffuse rash. The patient previously was healthy and has had no known exposure to anyone who ha... | B |
{
"A": "Age",
"B": "Gender",
"C": "History of osteoarthritis",
"D": "Previous occupation",
"E": "Use of pravastatin",
"F": null,
"G": null,
"H": null,
"I": null
} | Age | A 68-year-old man comes to the office because of a 4-week history of increasing stiffness in his shoulders and upper arms. He is an avid golfer and has been unable to play in the morning because of the stiffness. He says that the stiffness is somewhat improved in the afternoon. He also has felt fatigued and sometimes "... | A |
{
"A": "Airway occlusion",
"B": "Encephalitis",
"C": "Medication-induced suppression of central respiratory drive",
"D": "Meningitis",
"E": "Ongoing nonconvulsive seizure activity",
"F": null,
"G": null,
"H": null,
"I": null
} | Medication-induced suppression of central respiratory drive | A 16-month-old girl is brought to the emergency department by emergency medical technicians because of a generalizedtonic-clonic seizure that began 25 minutes ago and has continued despite administration of 0.5 mg/kg rectal diazepam10 minutes ago. The patient was at home at the time of the seizure. In the emergency dep... | C |
{
"A": "Adverse effect of medications",
"B": "Bone marrow metastases",
"C": "Gastrointestinal blood loss",
"D": "Hemodilution",
"E": "Hemolytic anemia",
"F": null,
"G": null,
"H": null,
"I": null
} | Adverse effect of medications | A 32-year-old woman comes to the emergency department because of a 3-day history of fatigue and postural light-headedness. She also reports nausea with one episode of vomiting this morning and adds that her stools and urine have beendarker than usual lately. Medical history is significant for stage III-B Hodgkin lympho... | A |
{
"A": "Chlamydial pneumonia",
"B": "Group B streptococcal sepsis",
"C": "Meconium aspiration syndrome",
"D": "Respiratory distress syndrome",
"E": "Transient tachypnea of newborn",
"F": null,
"G": null,
"H": null,
"I": null
} | Transient tachypnea of newborn | A male neonate, who was born at 36 weeks' gestation 2 hours ago in the labor and delivery unit of the hospital, now showssigns of respiratory difficulty. The mother, an 18-year-old primigravid woman, smoked one pack of cigarettes dailythroughout her pregnancy. She received prenatal care during most of the pregnancy. On... | E |
{
"A": "Colonoscopy",
"B": "Esophagogastroduodenoscopy",
"C": "Lower gastrointestinal barium study",
"D": "Ultrasonography of the appendix",
"E": "Upper gastrointestinal barium study with small-bowel follow-through",
"F": null,
"G": null,
"H": null,
"I": null
} | Colonoscopy | A 26-year-old woman comes to the office 1 day after she passed bloody mucus with her stool. She noticed mild abdominalcramping and some constipation preceding the episode; she has not had diarrhea or melanotic stools. She has not had anyexposure to unusual or poorly kept food or to any known infectious agents. She says... | A |
{
"A": "Cerebellar tumor",
"B": "Drug-related ataxia",
"C": "Epidural hematoma",
"D": "Juvenile-onset parkinsonism",
"E": "Multiple sclerosis",
"F": null,
"G": null,
"H": null,
"I": null
} | Cerebellar tumor | A 15-year-old girl is brought to the office by her parents because of a 2-month history of progressively worsening gaitdisturbance. She has fallen several times, once striking her head and causing a brief loss of consciousness. Her parents statethat she has had behavioral changes during this time. Medical history is re... | A |
{
"A": "Acute cholecystitis",
"B": "Acute pancreatitis",
"C": "Cholangitis",
"D": "Hepatitis",
"E": "Liver abscess",
"F": null,
"G": null,
"H": null,
"I": null
} | Cholangitis | A 70-year-old man is brought to the emergency department by his son because of a 2-day history of right upper quadrant abdominal pain, chills, and confusion. He has vomited twice during this time despite decreased food intake. The patient has hypertension controlled with hydrochlorothiazide. Medical and surgical histor... | C |
{
"A": "Adverse effect of fluoxetine therapy",
"B": "Bereavement reaction",
"C": "Early Parkinson disease",
"D": "Increase in alcohol consumption",
"E": "Mini-strokes",
"F": null,
"G": null,
"H": null,
"I": null
} | Adverse effect of fluoxetine therapy | A 70-year-old woman comes to the office because of worsening tremor of her hands. The tremor has been present for most of her life and initially was mild and would occur only when she was tired or stressed. During the past month the shaking has become more noticeable and frequent. She is now embarrassed to eat with oth... | A |
{
"A": "Bone marrow biopsy",
"B": "Pericardiocentesis",
"C": "Pleurodesis",
"D": "Thoracentesis",
"E": "Video-assisted thoracoscopy",
"F": null,
"G": null,
"H": null,
"I": null
} | Thoracentesis | A 70-year-old woman comes to the office because of a 1-month history of gradually worsening shortness of breath. Medicalhistory is significant for hypertension and hyperlipidemia. Routine medications are atorvastatin and lisinopril. The patientappears to be in respiratory distress. Vital signs are temperature 36.7°C (9... | D |
{
"A": "Arteriography of the abdomen",
"B": "Blood cultures",
"C": "MRI of the abdomen",
"D": "Ultrasonography of the abdomen",
"E": "No additional studies are needed",
"F": null,
"G": null,
"H": null,
"I": null
} | Ultrasonography of the abdomen | A 67-year-old man, who has been recovering in the hospital following surgical repair of a contained ruptured abdominalaortic aneurysm 10 days ago, suddenly develops severe abdominal pain. He does not have chest pain or shortness of breath.The patient's postoperative course had been uncomplicated until 4 days ago, when ... | D |
{
"A": "Atrial septal defect with development of pulmonary hypertension",
"B": "Chronic mitral regurgitation secondary to rheumatic heart disease",
"C": "Coarctation of the aorta",
"D": "Congenital aortic stenosis",
"E": "Mitral stenosis complicated by atrial fibrillation",
"F": null,
"G": null,
"H": nu... | Mitral stenosis complicated by atrial fibrillation | A 31-year-old woman, gravida 3, para 2, who is at 32 weeks' gestation, is admitted to the hospital because of a 1-week historyof progressive dyspnea and wheezing. She says her heart is "racing" and she is coughing up a small amount of blood-streakedsputum. Medical history is significant for hypothyroidism, for which sh... | E |
{
"A": "Accumulation of calcium carbonate and hemoglobin breakdown products in the bile ducts",
"B": "Decreased gastric myoelectrical activity",
"C": "Decreased gastric pH",
"D": "Increased cholecystokinin activity",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Decreased gastric myoelectrical activity | A 70-year-old man is admitted to the hospital through the emergency department because of a 12-hour history of severenausea and four episodes of vomiting of undigested food. During the past week, he has had worsening nausea, heartburnfollowing meals, and early satiety. Medical history is significant for type 2 diabetes... | B |
{
"A": "DEXA scan",
"B": "Electromyography and nerve conduction studies",
"C": "MRI of the cervical spine",
"D": "Serum antinuclear antibody assay",
"E": "Serum 25-hydroxyvitamin D assay",
"F": "No additional evaluation is indicated",
"G": null,
"H": null,
"I": null
} | Serum 25-hydroxyvitamin D assay | A 70-year-old woman comes to the office for an annual health maintenance examination. She describes a 1-year history ofslowly progressive fatigue, diffuse muscle aches, and generalized pain. Medical history is significant for osteoporosisdiagnosed 5 years ago. Medications include alendronate and calcium supplementation... | E |
{
"A": "Abnormalities of diffusion of oxygen",
"B": "Hypoventilation",
"C": "Obstructive lung disease",
"D": "Ventilation-perfusion mismatch and shunt",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Ventilation-perfusion mismatch and shunt | A 22-year-old man comes to the emergency department because of a 4‐day history of cough productive of green sputum as well as fever, chills, and rigors. He also has had a 3‐day history of progressive shortness of breath; he now has shortness of breath at rest. He was evaluated in an urgent care center 1 day ago and was... | D |
{
"A": "Ask the physician if he is sober, and if he says yes, allow him to complete his shift",
"B": "Explain to the physician that you suspect he is intoxicated and ask him to submit to a blood sample to check his blood",
"C": "Relieve the physician of duty and alert the hospital's patient safety officer",
"D"... | Relieve the physician of duty and alert the hospital's patient safety officer | A 33-year-old male physician reports for a shift in the emergency department. A nurse alerts you that he noticed a faint odorof alcohol near the physician. When approached, the physician appears tired and more disheveled than usual. There is anodor of alcohol on his breath. He is a skilled and talented physician with n... | C |
{
"A": "CT scan of the hips",
"B": "MRI of the hips",
"C": "Radionuclide bone scan",
"D": "Plain x-ray of the left hip",
"E": "Skeletal survey",
"F": null,
"G": null,
"H": null,
"I": null
} | Plain x-ray of the left hip | A 60-year-old man comes to the office because of a 1-year history of progressive left groin pain. The pain is worse withexercise and is relieved with rest. He says the pain is beginning to affect his ability to carry out his daily activities. He says,"It even hurts when I'm turning over in bed." He does not recall any ... | D |
{
"A": "Stage 1: High Sensitivity, Low Specificity; Stage 2: High Sensitivity, Low Specificity",
"B": "Stage 1: High Sensitivity, Low Specificity; Stage 2: Low Sensitivity, High Specificity",
"C": "Stage 1: Low Sensitivity, High Specificity; Stage 2: High Sensitivity, Low Specificity",
"D": "Stage 1: Low Sensit... | Stage 1: High Sensitivity, Low Specificity; Stage 2: Low Sensitivity, High Specificity | A 2-stage screening program for ovarian cancer is being designed. Which of the following sets of sensitivity and specificity ismost likely preferred for Stage 1 and Stage 2 of the program? | B |
{
"A": "Inform the patient that she must find a new physician",
"B": "Maintain the dose of oxycodone and add naproxen",
"C": "Order a urine toxicology screening",
"D": "Report the patient's unauthorized drug use to the police",
"E": "Switch oxycodone to sustained-release morphine",
"F": null,
"G": null,
... | Order a urine toxicology screening | A 35-year-old woman comes to the office for follow-up of chronic pelvic pain. The patient has had deep pelvic pain sinceundergoing total abdominal hysterectomy and radiation therapy for treatment of cervical cancer 5 years ago. She reports constant,severe aching pain; she rates the pain at its maximum as a 10 on a 10‐p... | C |
{
"A": "\"I am concerned that you are abusing pain medicine. I would like for you to consider a substance use disorder",
"B": "\"I cannot be your physician any longer because of your drug use disorder. I'm going to give you 30 days to find a new",
"C": "\"I would like to know where you have been getting the metha... | "I am concerned that you are abusing pain medicine. I would like for you to consider a substance use disorder | A 35-year-old woman comes to the office for follow-up of chronic pelvic pain. The patient has had deep pelvic pain sinceundergoing total abdominal hysterectomy and radiation therapy for treatment of cervical cancer 5 years ago. She reports constant,severe aching pain; she rates the pain at its maximum as a 10 on a 10‐p... | A |
{
"A": "Bacterial vaginosis",
"B": "Cesarean delivery",
"C": "Chlamydial cervicitis",
"D": "Postpartum endometritis",
"E": "Use of an IUD",
"F": null,
"G": null,
"H": null,
"I": null
} | Chlamydial cervicitis | A 24-year-old woman, gravida 1, para 1, comes to the office because she and her husband have been trying to conceive forthe past year without success. She gave birth to her first child at age 18 years by cesarean delivery following fetal distress.She then developed postpartum endometritis that resolved with intravenous... | C |
{
"A": "Ankle brachial index",
"B": "Arteriography",
"C": "ECG",
"D": "Echocardiography",
"E": "MUGA scan",
"F": null,
"G": null,
"H": null,
"I": null
} | Ankle brachial index | Patient InformationAge: 62 yearsGender: M, self-identifiedEthnicity: white, self-identifiedSite of Care: officeHistoryReason for Visit/Chief Concern: "My legs hurt when I walk, and it's getting worse."History of Present Illness: 3-month history of worsening leg pain, pain exacerbated by walking; peak intensity after 1 ... | A |
{
"A": "D-Dimer assay results should be used to determine the need for ordering CT angiography for patients suspected of",
"B": "False-negative D-dimer assay results are common in patients with confirmed pulmonary embolism",
"C": "False-positive D-dimer assay results are rarely encountered",
"D": "A negative D-... | A negative D-dimer assay has a high negative predictive value for excluding the diagnosis of pulmonary embolism | In determining the usefulness of a D-dimer assay in ruling out pulmonary embolism as a diagnosis in a 27-year-old womanwith pleuritic chest pain and nonproductive cough, a recent study in the medical literature is reviewed. The study evaluatesthe use of D-dimer assay in 1500 patients (705 female and 795 male) ranging i... | D |
{
"A": "It is appropriate because it can prove that the patient is not blind",
"B": "It is appropriate because the medical student's intent is to help the patient",
"C": "It is inappropriate because it is invasive and could be painful",
"D": "It is inappropriate because the physician would not be stating the tr... | It is inappropriate because the physician would not be stating the truth | A 45-year-old man is admitted to the hospital because of a 6-hour history of bilateral vision loss. He is otherwiseasymptomatic. He has no history of serious illness and takes no medications. Vital signs are within normal limits. Physicalexamination findings are consistent with psychogenic blindness. A medical student ... | D |
{
"A": "All factors appeared to have an effect on HCV transmission",
"B": "Fetal electrode monitoring was protective against HCV",
"C": "Infant HIV infection was the only significantly associated factor",
"D": "Maternal chorioamnionitis was the most significantly associated factor",
"E": "No factor was signif... | Infant HIV infection was the only significantly associated factor | A 5-week-old infant is brought to the office by his mother for an initial well-child visit. He was born at 37 weeks' gestationvia cesarean delivery because of chorioamnionitis. The infant had fetal distress that was documented by fetal monitoringduring labor. The mother became jaundiced in the immediate postpartum peri... | C |
{
"A": "Arrange a direct admission to the hospital for this patient",
"B": "Continue with obtaining a thorough history and examining this patient",
"C": "Place masks on the patient and yourself and then continue to evaluate him",
"D": "Send this patient for chest x-rays, and while they are being obtained examin... | Place masks on the patient and yourself and then continue to evaluate him | A 45-year-old man comes to the community health center because of a 1-week history of fever, chills, sweating, mildshortness of breath, and nonproductive cough. Medical history is remarkable for AIDS and pneumonia 3 years ago thatrequired hospitalization. Today, he says that he lost his job 6 months ago and cannot affo... | C |
{
"A": "Lumbar puncture for examination of cerebrospinal fluid",
"B": "MRI of the brain",
"C": "Repeat CT scan of the head in 1 week",
"D": "Sleep-deprived electroencephalography",
"E": "No further evaluation is necessary",
"F": null,
"G": null,
"H": null,
"I": null
} | No further evaluation is necessary | A 45-year-old man comes to the office for a follow-up examination 2 days after he was seen in the emergency department fora generalized tonic-clonic seizure. He was prescribed chlordiazepoxide upon being discharged but did not fill theprescription. The patient says that this was his third seizure in the past 2 years; p... | E |
{
"A": "The risk for inpatient mortality is greater for patients with hypotension than for those without hypotension",
"B": "The risk for inpatient mortality is increased more by hypoxemia than by hypotension",
"C": "The risk for inpatient mortality is increased when there is a pulmonary infiltrate present on che... | The risk for inpatient mortality is greater for patients with hypotension than for those without hypotension | A case-control study is conducted to assess risk factors predicting inpatient mortality among geriatric patients withcommunity-acquired pneumonia. Results of the study include the odds ratios shown below, which were calculated from amultivariable logistic regression equation:Predictor Variables:Hypotension (systolic bl... | A |
{
"A": "Plasma renin activity",
"B": "Serum aldosterone concentration",
"C": "Serum free metanephrine concentration",
"D": "Serum parathyroid hormone concentration",
"E": "No study is indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | Serum free metanephrine concentration | A 38-year-old man comes to the office because of a 2-month history of intermittent episodes of hot flushes, chest discomfort,and excessive sweating, with associated panic. The episodes have been increasing in frequency and now are occurring daily.The patient says there is no specific precipitating cause of the episodes... | C |
{
"A": "\"College is full of many great once-in-a-lifetime opportunities. You should go.\"",
"B": "\"Everyone makes mistakes. In your case, though, that doesn't mean you always mess things up.\"",
"C": "\"If you find yourself needing some guidance, call me.\"",
"D": "\"You're overreacting. You just need to give... | "Everyone makes mistakes. In your case, though, that doesn't mean you always mess things up." | A 19-year-old woman is referred to the office by her counselor for evaluation of possible depression. The counselor describesthe patient as polite, conscientious, cooperative, open to therapy, and always present and on time for her weekly sessions.The patient's relationship with her high school boyfriend ended 6 months... | B |
{
"A": "Displacement of the nucleus pulposus",
"B": "Hypertrophy of the facet joints",
"C": "Osteophyte formation",
"D": "Spondylolisthesis",
"E": "Thickening of ligamentum flavum",
"F": null,
"G": null,
"H": null,
"I": null
} | Displacement of the nucleus pulposus | A 35-year-old man comes to the office because of 1-week history of mid low back pain that radiates down his right leg. Thepain began after the patient lifted a heavy box onto his truck. He rates his current pain as an 8 on a 10-point scale. He hasbeen unable to find a comfortable position and has been sleeping in a rec... | A |
{
"A": "Alzheimer disease",
"B": "Amyotrophic lateral sclerosis",
"C": "Cortical basal ganglionic degeneration",
"D": "Neurosyphilis",
"E": "Vascular dementia",
"F": null,
"G": null,
"H": null,
"I": null
} | Vascular dementia | A 71-year-old woman is brought to the emergency department by her daughter for evaluation of her mental status. Thedaughter says, "I visited mom today for the first time in 6 months; her memory has worsened, her bills are unpaid, and herhouse is unusually messy." The patient says, "I'm perfectly healthy." Medical histo... | E |
{
"A": "Discussing a new treatment regimen for the patient's seizure disorders",
"B": "Evaluating the patient for depressive disorder",
"C": "Evaluating the patient's ability/desire to stop drinking alcoholic beverages",
"D": "Instructing the patient to stop driving",
"E": null,
"F": null,
"G": null,
"H... | Instructing the patient to stop driving | A 45-year-old woman with a history of seizure disorder comes to the office because she has had seizures daily for the past 3weeks, despite adhering to her medication regimen. Medical history is also significant for borderline hypertension for thepast year and alcohol use disorder. She admits that she has been drinking ... | D |
{
"A": "1%",
"B": "10%",
"C": "40%",
"D": "90%",
"E": "99%",
"F": null,
"G": null,
"H": null,
"I": null
} | 90% | A randomized controlled trial is conducted to assess the effectiveness of a new combination-drug antihypertensive therapy(Drug X) compared with a standard antihypertensive single-drug therapy. Study participants include 140 women (70%) and60 men (30%) ages 30 to 60 years, with baseline blood pressure measurements of 15... | D |
{
"A": "Essepro should be prescribed because she can get it for free",
"B": "Essepro should not be prescribed because it can worsen her psoriasis",
"C": "Essepro should not be prescribed because it is similar to her other medications",
"D": "Essepro should not be prescribed because the patient has severe liver ... | Essepro should not be prescribed because the patient has severe liver disease | Essepro™ (lesystolol) Reduces Blood Pressure SignificantlyNo significant interactions with commonly used medications were observed. No significant interactions with hydrochlorthiazide, furosemide, losartan orlisinopril. No significant interactions with digoxin, warfarin or simvastatin. Drugs that inhibit CYP2C9 can inc... | D |
{
"A": "Eustachian tube dysfunction",
"B": "Mucosal edema",
"C": "Nasal polyps",
"D": "Oral contraceptive use",
"E": "Tonsillar hyperplasia",
"F": null,
"G": null,
"H": null,
"I": null
} | Mucosal edema | A 19-year-old woman comes to her university's health center because of a 1-week history of nasal stuffiness, occasional clearrhinorrhea, and a mild sore throat. Two days ago, she began to feel hot, but she has not taken her temperature. Medicalhistory is unremarkable and her only medication is an oral contraceptive. Sh... | B |
{
"A": "Fibromyalgia",
"B": "Myasthenia gravis",
"C": "Polymyositis",
"D": "Scleroderma",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Polymyositis | A 40-year-old woman comes to the office because of a 2-month history of fatigue, and generalized aching and weakness ofthe proximal muscles of all four extremities. The patient initially noticed the weakness only while she was getting in and outof her car, but during the past 2 weeks, the weakness has progressed, so th... | C |
{
"A": "2",
"B": "8",
"C": "13",
"D": "25",
"E": "33",
"F": null,
"G": null,
"H": null,
"I": null
} | 13 | A new diagnostic test for HIV infection is developed. The new serum biomarker concentration is measured in 711 men andwomen, ages 25 to 65 years. Of these individuals, 336 were previously determined to have HIV and 375 do not have HIV.Stratified results of the new serum biomarker test are shown:Serum Biomarker Concentr... | C |
{
"A": "CT scan of the neck",
"B": "Fine-needle aspiration of the nodule",
"C": "Radionuclide thyroid scan",
"D": "Thyroidectomy",
"E": "Observation only",
"F": null,
"G": null,
"H": null,
"I": null
} | Fine-needle aspiration of the nodule | A 40-year-old man comes to the office for a preemployment physical examination. The patient has been generally healthy.Medical history is unremarkable and he takes no routine medications. Vital signs are normal. Physical examination shows apalpable nodule in the right lobe of the thyroid gland. Serum thyroid-stimulatin... | B |
{
"A": "Bacterial culture of sputum",
"B": "CT scan of the chest",
"C": "Fungal culture of the blood",
"D": "Serologic study for Coccidioides immitis",
"E": "Sputum cytologic study",
"F": "Urine assay for Legionella antigen",
"G": null,
"H": null,
"I": null
} | Serologic study for Coccidioides immitis | A 35-year-old man was admitted to the hospital 3 days ago because of pneumonia, but he has shown no clinical improvementdespite ceftriaxone and azithromycin therapy. Upon admission, the patient exhibited blood-streaked sputum and chest x-rayshowed hilar adenopathy. Medical history is otherwise unremarkable. The patient... | D |
{
"A": "Advise the parents not to influence their son's decision in this matter",
"B": "Arrange for evaluation of their son's competency",
"C": "Enroll their son in a smoking cessation program",
"D": "Initiate a family meeting to discuss the parents' concerns with their son",
"E": "Obtain legal advice regardi... | Initiate a family meeting to discuss the parents' concerns with their son | A 25-year-old man is brought to the office by his parents. The patient has Down syndrome and mild intellectualdevelopmental disorder. He is their only child, and they are concerned that his current lifestyle is increasing his risk forcoronary artery disease and stroke. The patient has a systolic murmur and also underwe... | D |
{
"A": "Acute viral illness",
"B": "Chronic sinusitis",
"C": "Essential hypertension",
"D": "Her alcohol intake",
"E": "Over-the-counter cold medication",
"F": null,
"G": null,
"H": null,
"I": null
} | Over-the-counter cold medication | A 45-year-old woman comes to the office because of a 3-day history of nasal congestion, headache, sore throat, and generalmalaise. She has developed a cough during the past 24 hours that is mildly productive of clear sputum. Except for occasionalseasonal allergies, she has no previous history of medical problems. She t... | E |
{
"A": "Cystoscopy",
"B": "Echocardiography",
"C": "MRI of the abdomen",
"D": "Renal ultrasonography",
"E": "No additional study is indicated",
"F": null,
"G": null,
"H": null,
"I": null
} | No additional study is indicated | A 41-year-old woman comes to the emergency department because of a 3-day history of fever and a 2-day history ofworsening flank pain with frequent and painful urination. She describes the pain as constant and says it worsens when shecoughs or lies on her right side. She rates the pain as a 5 on a 10-point scale; ibupro... | E |
{
"A": "Parasympathetic overactivity",
"B": "Parasympathetic underactivity",
"C": "Postsynaptic neuromuscular junction defect",
"D": "Presynaptic neuromuscular junction defect",
"E": "Sympathetic overactivity",
"F": "Sympathetic underactivity",
"G": null,
"H": null,
"I": null
} | Sympathetic underactivity | A 41-year-old woman is brought to the emergency department by her husband because of nausea and dizziness that begansuddenly 4 hours ago. She says she feels like the room is spinning. She has not vomited. She recalls receiving a blow to theleft side of her neck 1 week ago when her dog jumped on her, but she has had no ... | F |
{
"A": "Echocardiography",
"B": "HIV antibody study",
"C": "Serum B-type natriuretic peptide concentration",
"D": "Toxicology screening of the urine",
"E": "Urine protein concentration",
"F": null,
"G": null,
"H": null,
"I": null
} | Urine protein concentration | A 34-year-old woman comes to the office because of a 3- to 4-week history of swelling of her legs and a 9-kg (20-lb) weightgain. Medical history is significant for sickle cell trait and mild anemia. She has been taking 800 mg of ibuprofen three timesdaily for Achilles tendinitis diagnosed 1 month ago. She has smoked fi... | E |
{
"A": "Carbamazepine",
"B": "Lamotrigine",
"C": "Levetiracetam",
"D": "Topiramate",
"E": "Zonisamide",
"F": null,
"G": null,
"H": null,
"I": null
} | Topiramate | A 54-year-old woman comes to the office because she has had intermittent shooting pain over her right cheek and jaw duringthe past 3 weeks. Each episode of pain lasts for 1 second or less. The pain is often triggered by cold air, chewing, tactilestimulation, and brushing her teeth. She has had no trauma to the face or ... | D |
{
"A": "Application of ice to the right lower extremity",
"B": "Cyclobenzaprine therapy",
"C": "Measurement of lower extremity compartment pressures",
"D": "MRI of the right lower extremity",
"E": "Nonsteroidal anti-inflammatory drug therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Measurement of lower extremity compartment pressures | A 25-year-old man, who was admitted to the hospital 5 hours ago because of nausea, light-headedness, and muscle aches thatbegan after he completed a marathon, now reports worsening pain in his right leg. On admission, the patient reported onlymild muscle aching, but he now rates the pain in his right lower extremity as... | C |
{
"A": "Atrial fibrillation",
"B": "Cor pulmonale",
"C": "Systemic hypertension",
"D": "Tricuspid valve regurgitation",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | Systemic hypertension | A 9-year-old boy is brought to the office by his parents to establish care after recently moving to the area. The patient has notbeen evaluated by a physician in 4 years. He has been generally healthy. Medical history is significant for pneumonia at age3 years. He takes no medications. He is at the 25th percentile for ... | C |
{
"A": "Admission to the hospital for observation",
"B": "Diagnostic laparoscopy",
"C": "Dilatation and curettage",
"D": "Follow-up pelvic ultrasonography in 1 week",
"E": "Serial serum β-hCG concentrations",
"F": null,
"G": null,
"H": null,
"I": null
} | Serial serum β-hCG concentrations | A 25-year-old woman comes to the office because of a 2-day history of right lower quadrant abdominal pain and vaginalspotting. She describes the abdominal pain as cramping and rates it as a 4 on a 10-point scale. Medical history isunremarkable and the patient takes no medications. Menses are typically irregular but she... | E |
{
"A": "Anorexia",
"B": "Depressed mood",
"C": "History of psychosis",
"D": "Multiparity",
"E": null,
"F": null,
"G": null,
"H": null,
"I": null
} | History of psychosis | A 32-year-old woman, gravida 4, para 4, comes to the office 1 week after an uncomplicated vaginal delivery of a 3020-g (6-lb11-oz) term female newborn. She has been breast-feeding her daughter since birth. The patient says that she cries frequentlyfor no reason, is irritable, and is worried about her infant's long-term... | C |
{
"A": "Prescribe atorvastatin",
"B": "Prescribe cholestyramine",
"C": "Recommend diet and low-impact exercise",
"D": "Refer the patient to a cardiologist",
"E": "Repeat fasting laboratory studies in 1 month",
"F": null,
"G": null,
"H": null,
"I": null
} | Recommend diet and low-impact exercise | A 47-year-old man comes to the office to establish care. He recently moved to the area and has not been evaluated by aphysician for more than 3 years. He reports a 1-year history of bilateral knee pain that worsens after prolonged standing, buthe otherwise has felt well. Medical history is unremarkable and his only med... | C |
{
"A": "Arrange for transjugular intrahepatic portal vein shunting",
"B": "Begin intravenous vasopressin therapy",
"C": "Do endotracheal intubation",
"D": "Do upper endoscopy",
"E": "Insert an esophageal tube for balloon tamponade",
"F": null,
"G": null,
"H": null,
"I": null
} | Do endotracheal intubation | A 37-year-old man comes to the emergency department because he has felt nauseated and light-headed for the past hour.Medical history is significant for esophageal varices secondary to alcohol-related cirrhosis and ascites treated withspironolactone. He drinks eight to ten alcoholic beverages daily. While you are obtain... | C |
{
"A": "Administration of broad-spectrum antibiotics",
"B": "Initiation of tube feedings",
"C": "Pain reduction",
"D": "Physical therapy",
"E": "Psychological evaluation for post-traumatic stress disorder",
"F": null,
"G": null,
"H": null,
"I": null
} | Pain reduction | A 25-year-old man was admitted to the hospital yesterday with a massive hemothorax sustained as a result of a stab wound. Left lateral thoracotomy was done because more than 2 L of blood returned following chest tube placement. The thoracotomy disclosed a bleeding intercostal vessel that was repaired by suture ligation... | C |
{
"A": "Add furosemide therapy and reevaluate in 4 weeks",
"B": "Add prednisone therapy",
"C": "Add streptomycin and cycloserine therapy",
"D": "Order bronchoscopy for brushings and cytology",
"E": "Order echocardiography",
"F": null,
"G": null,
"H": null,
"I": null
} | Order echocardiography | A 45-year-old man returns to the office for ongoing treatment of tuberculous pericarditis. Pericardiocentesis 9 weeks agoshowed a serosanguineous effusion; culture of the effusion was positive for Mycobacterium tuberculosis, and therapy withisoniazid, rifampin, and ethambutol was initiated. During the past 2 weeks, he ... | E |
{
"A": "Compression stockings",
"B": "Surgical ligation of the largest veins",
"C": "Venography",
"D": "Venous duplex ultrasonography",
"E": "Warfarin therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Compression stockings | A 40-year-old woman, gravida 2 para 2, comes to the office because of bulging veins in her legs that have slowly become more visible since she first noticed them 2 years ago. She says they seem to worsen when she stands for long periods of time, but she reports no associated pain. She is concerned that this problem may... | A |
{
"A": "Future fertility plans",
"B": "Hypertension",
"C": "Obesity",
"D": "Patient age",
"E": "Stage of disease",
"F": null,
"G": null,
"H": null,
"I": null
} | Stage of disease | A 39-year-old woman, gravida 2, para 2, comes to the community-based health center because of a 6-month history of a copious, foul-smelling vaginal discharge. She also reports spotting that began 6 months ago and has progressed to heavy bleeding during the past 3 weeks. Medical history is significant for an abnormal Pa... | E |
{
"A": "Aiding with metabolism of glucose",
"B": "Decreasing pulse rate",
"C": "Decreasing serum LDL-cholesterol concentration",
"D": "Lowering blood pressure",
"E": "Suppressing appetite",
"F": null,
"G": null,
"H": null,
"I": null
} | Lowering blood pressure | A 28-year-old man comes to the office for an annual health maintenance examination. He says he has been generally healthy. Three months ago he began walking three times weekly for at least 30 minutes, and he has eliminated salt from his diet after a blood pressure measurement at a local pharmacy was 160/96 mm Hg. Medic... | D |
{
"A": "Obtain a urethral swab for potassium hydroxide preparation",
"B": "Order urinalysis and urine culture",
"C": "Prescribe ceftriaxone and doxycycline therapy",
"D": "Prescribe metronidazole therapy",
"E": "Reassure the patient that no treatment is necessary",
"F": null,
"G": null,
"H": null,
"I"... | Prescribe metronidazole therapy | A 22-year-old man comes to the office for evaluation 3 days after his girlfriend was diagnosed with trichomoniasis vaginalis. The patient has not had urethral discharge, dysuria, testicular pain, or genital skin lesions. He has been monogamous with his girlfriend and has been dating her for the past 6 months. He previo... | D |
{
"A": "Antiretroviral therapy",
"B": "Liquid nitrogen therapy applied to the tongue lesions",
"C": "Micafungin therapy",
"D": "Surgical excision of the tongue lesions",
"E": "Systemic chemotherapy with liposomal doxorubicin",
"F": null,
"G": null,
"H": null,
"I": null
} | Antiretroviral therapy | A 25-year-old man comes to the office because he has had a "coating" on his tongue during the past 2 weeks and has had an unintentional 4.5-kg (10-lb) weight loss during the past 6 months. He has not had oral pain or difficulty swallowing. Medical history is unremarkable and he takes no medications. He has smoked one p... | A |
{
"A": "Recommend behavioral therapy",
"B": "Recommend psychoanalytic psychotherapy",
"C": "Recommend that the patient avoid any stressful activities that cause the problem",
"D": "Review the patient's sexual history",
"E": "Reassure the patient that her symptoms will resolve in time",
"F": null,
"G": nul... | Recommend behavioral therapy | A 24-year-old recent college graduate comes to the office because of a 3-year history of increased frequency of urination and occasional incontinence whenever she travels. She says the urinary symptoms typically begin a few days before she is going to fly and they stop the day after she arrives at her destination. She ... | A |
{
"A": "Incision and drainage",
"B": "Intravenous methylprednisolone therapy",
"C": "Oral nystatin therapy",
"D": "Salt water gargle",
"E": "Tonsillectomy",
"F": null,
"G": null,
"H": null,
"I": null
} | Incision and drainage | A 22-year-old woman comes to the emergency department because of a 5-day history of sore throat and fever. During the past 3 days, she also has noticed a change in her voice and has had increased pain with swallowing. She has been taking acetaminophen since her symptoms began. Medical history is unremarkable and she ta... | A |
{
"A": "There is no evidence of a familial coagulation defect",
"B": "Half of their daughters will have a clinically evident coagulation disorder",
"C": "The sons of their daughters will be at risk for a clinically evident coagulation disorder",
"D": "Their sons will be at risk for a clinically evident coagulat... | The sons of their daughters will be at risk for a clinically evident coagulation disorder | A 26-year-old man, who is admitted to the hospital to undergo cholecystectomy, bleeds excessively during the procedure and then develops a large wound hematoma. Medical history discloses that he has always tended to bruise excessively with trauma. His wounds oozed blood for 3 days following a dental extraction, which w... | C |
{
"A": "Administer an epidural injection of methylprednisolone",
"B": "Order MRI of the lumbosacral spine",
"C": "Order x-rays of the lumbosacral spine",
"D": "Recommend beginning a weight loss program",
"E": "Recommend decreasing physical activity",
"F": null,
"G": null,
"H": null,
"I": null
} | Recommend beginning a weight loss program | A 29-year-old woman, gravida 3, para 3, comes to the office because of a 1-year history of recurrent low back pain. Rest and analgesics typically resolve the pain within 2 weeks. However, the pain recurs every 2 to 3 months. Medical history is remarkable for gestational diabetes during her pregnancies. She takes no med... | D |
{
"A": "Determination of serum thyroid-stimulating hormone and prolactin concentrations",
"B": "CT scan of the pelvis",
"C": "Endometrial biopsy",
"D": "Hysteroscopy with dilatation and curettage",
"E": "Trial of hormone replacement therapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Endometrial biopsy | A 46-year-old woman comes to the office because of a 4-month history of irregular vaginal bleeding that occurs every 2 weeks and lasts 3 to 5 days. Until 5 months ago when she missed a period, her periods had occurred at regular 30-day intervals and lasted for 5 days. She has not had vaginal pain or discharge, headache... | C |
{
"A": "Biofeedback-based stress reduction program",
"B": "More rigorous and consistent exercise program",
"C": "Smoking cessation program",
"D": "Strict low-calorie diet",
"E": "Strict low-fat diet",
"F": null,
"G": null,
"H": null,
"I": null
} | Smoking cessation program | A 36-year-old woman is referred to the office for evaluation of a fasting serum total cholesterol concentration of 249 mg/dL. She has a family history of early coronary artery disease (CAD) and her father died suddenly at age 46 years of myocardial infarction. She tells you that she has never had chest pain. She is not... | C |
{
"A": "Adjustment of the ventilator settings",
"B": "Insertion of bilateral chest tubes",
"C": "Intravenous dopamine",
"D": "Intravenous low-molecular-weight heparin",
"E": "1-L bolus of intravenous 0.9% saline",
"F": "Needle decompression",
"G": null,
"H": null,
"I": null
} | Adjustment of the ventilator settings | A 57-year-old man was admitted to the intensive care unit from the emergency department 3 hours ago for treatment of an acute exacerbation of chronic obstructive pulmonary disease. He was brought to the emergency department by ambulance following a 2-hour history of severe shortness of breath and non-productive cough. ... | A |
{
"A": "Colonoscopy",
"B": "Excision and drainage",
"C": "Internal banding",
"D": "Oral docusate",
"E": "Sclerotherapy",
"F": null,
"G": null,
"H": null,
"I": null
} | Oral docusate | A 32-year-old woman comes to the office because of a 2-week history of burning rectal pain and bleeding. She says, "The pain is like being burned with a hot poker." The pain is at its worst when she has a bowel movement and for approximately 20 minutes after defecation. She rates the pain at its worst as an 8 on a 10-p... | D |
{
"A": "Administer the meningococcal vaccine",
"B": "Prescribe doxycycline",
"C": "Prescribe penicillin",
"D": "Prescribe rifampin",
"E": "Assure the patient that no anti-infective prophylaxis is necessary",
"F": null,
"G": null,
"H": null,
"I": null
} | Prescribe rifampin | A 16-year-old girl is brought to the office by her mother because she is concerned that she may have contracted meningitis from her soccer teammate, who was diagnosed with meningococcal meningitis and admitted to the hospital yesterday. The patient's soccer team traveled to a neighboring state to participate in a tourn... | D |
{
"A": "Exchange transfusion",
"B": "Increased dose of hydroxyurea",
"C": "Initiation of erythropoietin therapy",
"D": "Iron supplementation",
"E": "Transfusion of packed red blood cells",
"F": null,
"G": null,
"H": null,
"I": null
} | Transfusion of packed red blood cells | A 27-year-old nulligravid woman comes to the office because of a 1-month history of daily vaginal bleeding associated with lower abdominal pain and, more recently, shortness of breath. Three days ago, she also developed aching pain of her sternum, which she rates as a 10 on a 10-point scale. During the 6 months prior t... | E |
{
"A": "Obtain CT scan of the chest",
"B": "Obtain a swallowing evaluation",
"C": "Place a percutaneous endoscopic gastrostomy (PEG) tube",
"D": "Prescribe fludrocortisone",
"E": "Prescribe prophylactic levofloxacin",
"F": null,
"G": null,
"H": null,
"I": null
} | Obtain a swallowing evaluation | A 67-year-old man with Parkinson disease is admitted to the hospital for treatment of pneumonia. The patient's daughter, who is visiting the patient, says he has had increased lethargy for the past day and decreased ambulation during the past 6 months. She also says that there are times during the day when his tremors ... | B |
{
"A": "Adenosine ",
"B": "Digoxin ",
"C": "Enalapril ",
"D": "Lidocaine ",
"E": "Metoprolol",
"F": null,
"G": null,
"H": null,
"I": null
} | Metoprolol | A 47-year-old man is admitted to the hospital through the emergency department because of the sudden onset of palpitations, left-sided chest pain, light-headedness, and shortness of breath that began while he was watching television 2 hours ago. Medical history is remarkable for paroxysmal atrial fibrillation. The pati... | E |
{
"A": "Bone marrow aspiration and complete blood count",
"B": "CT scan of the chest, abdomen, and pelvis",
"C": "Echocardiography",
"D": "Fine-needle aspiration biopsy of the thyroid gland",
"E": "Nerve conduction studies",
"F": null,
"G": null,
"H": null,
"I": null
} | Echocardiography | A 23-year-old man comes to the clinic to establish care after moving to the area for his first job since graduating from college. He has felt well. Medical history is remarkable for Hodgkin lymphoma diagnosed 10 years ago, which was treated with radiation therapy and a chemotherapy regimen of vinblastine, doxorubicin, ... | C |
{
"A": "Prescribe fluoxetine",
"B": "Prescribe methylphenidate",
"C": "Prescribe risperidone",
"D": "Refer the patient to a child psychiatrist",
"E": "Refer the patient to a dietician",
"F": null,
"G": null,
"H": null,
"I": null
} | Refer the patient to a child psychiatrist | A 5-year-old boy returns to the office with his mother to discuss results of studies done to evaluate his behavior of eating dirt. The patient sits quietly while his mother answers questions about his health. She says her son seems healthy, although he does not seem to be as active as other children his age. He has sai... | D |
{
"A": "Acetaminophen-oxycodone therapy and referral for physical therapy",
"B": "Admission to the hospital for pain control",
"C": "Electromyography and nerve conduction studies",
"D": "MRI of the thoracic spine",
"E": "Technetium 99m scan",
"F": null,
"G": null,
"H": null,
"I": null
} | MRI of the thoracic spine | A 55-year-old woman is brought to the office by her husband because of increasingly severe pain in her mid back for the past week. She says the pain is especially severe with walking. Her husband says she has been favoring her right leg for the past 3 days. Ibuprofen no longer controls the pain. She enjoys gardening bu... | D |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.