id stringlengths 36 36 | subject_name stringclasses 1
value | correct_answer stringlengths 1 136 | correct_option int64 1 4 | options dict | question stringlengths 67 3.54k | opa stringlengths 1 153 | opb stringlengths 1 137 | opc stringlengths 1 166 | opd stringlengths 1 129 | cop int64 0 3 | full_question stringlengths 67 3.54k |
|---|---|---|---|---|---|---|---|---|---|---|---|
c9deb4c1-c8d8-4cff-8316-d1ff692ac2d0 | Anti-B antibodies | 4 | {
"1": "RBC sickling",
"2": "Anti-D antibodies",
"3": "Biliary duct malformation",
"4": "Anti-B antibodies"
} | A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The n... | RBC sickling | Anti-D antibodies | Biliary duct malformation | Anti-B antibodies | 3 | A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The n... | |
f04b327c-6ff8-4d9b-9a13-30bbe1ae4ef8 | Amantadine | 1 | {
"1": "Amantadine",
"2": "Ribavirin",
"3": "Levodopa",
"4": "Zidovudine"
} | A 65-year old man presents with gradually worsening rigidity of his arms and legs and slowness in performing tasks. He says he has also noticed hand tremors, which increase at rest and decrease with focused movements. On examination, the patient does not swing his arms while walking and has a shortened, shuffling gait.... | Amantadine | Ribavirin | Levodopa | Zidovudine | 0 | A 65-year old man presents with gradually worsening rigidity of his arms and legs and slowness in performing tasks. He says he has also noticed hand tremors, which increase at rest and decrease with focused movements. On examination, the patient does not swing his arms while walking and has a shortened, shuffling gait.... | |
88a72edb-10a0-4d6f-99dd-c6ff17a37c2a | Stop magnesium sulfate and give calcium gluconate | 1 | {
"1": "Stop magnesium sulfate and give calcium gluconate",
"2": "Stop labetalol",
"3": "Stop magnesium sulfate and give lorazepam",
"4": "Perform nerve conduction studies"
} | The patient is given prophylactic labetalol and magnesium sulfate. Examination shows absent deep tendon reflexes bilaterally. Which of the following is the most appropriate next step in the management of this patient? | Stop magnesium sulfate and give calcium gluconate | Stop labetalol | Stop magnesium sulfate and give lorazepam | Perform nerve conduction studies | 0 | The patient is given prophylactic labetalol and magnesium sulfate. Examination shows absent deep tendon reflexes bilaterally. Which of the following is the most appropriate next step in the management of this patient? | |
c4b6b2b8-9b2a-4dfc-b51e-fcc9eba345cb | Myxedema coma | 1 | {
"1": "Myxedema coma",
"2": "Pheochromocytoma crisis",
"3": "Septic shock",
"4": "Tertiary hyperparathyroidism"
} | A 75-year-old woman is brought by a patrolman to the emergency department because of altered mental status. She was found wandering next to the highway. The patient was unable to answer questions and collapsed in transit. Her vitals are: temperature, 33.0°C (91.4°F); pulse, 40/min; respirations,12/min; blood pressure, ... | Myxedema coma | Pheochromocytoma crisis | Septic shock | Tertiary hyperparathyroidism | 0 | A 75-year-old woman is brought by a patrolman to the emergency department because of altered mental status. She was found wandering next to the highway. The patient was unable to answer questions and collapsed in transit. Her vitals are: temperature, 33.0°C (91.4°F); pulse, 40/min; respirations,12/min; blood pressure, ... | |
230a4a6e-837b-4802-a699-8923e44339a9 | Aortic regurgitation | 2 | {
"1": "Mitral regurgitation",
"2": "Aortic regurgitation",
"3": "Aortic stenosis",
"4": "Mitral prolapse"
} | A 66-year-old male presents to his primary care physician to discuss his increasing shortness of breathover the last 3 months. He notes that this is particularly obvious when he is mowing his lawn or climbing the stairs in his home. His past medical history is significant for hypertension that is well-controlled with l... | Mitral regurgitation | Aortic regurgitation | Aortic stenosis | Mitral prolapse | 1 | A 66-year-old male presents to his primary care physician to discuss his increasing shortness of breathover the last 3 months. He notes that this is particularly obvious when he is mowing his lawn or climbing the stairs in his home. His past medical history is significant for hypertension that is well-controlled with l... | |
1296ce87-f13b-4304-8b2d-0c28d795a2a4 | Borderline personality disorder | 2 | {
"1": "Histrionic personality disorder",
"2": "Borderline personality disorder",
"3": "Dependent personality disorder",
"4": "Narcissistic personality disorder"
} | A 28-year-old woman presents following a suicide attempt 2 days ago. She says that her attempt was a result of a fight with her boyfriend and that she slit her wrists in an attempt to keep him from breaking up with her. In the past, she has had many turbulent relationships, both romantic and in her family life. Her fam... | Histrionic personality disorder | Borderline personality disorder | Dependent personality disorder | Narcissistic personality disorder | 1 | A 28-year-old woman presents following a suicide attempt 2 days ago. She says that her attempt was a result of a fight with her boyfriend and that she slit her wrists in an attempt to keep him from breaking up with her. In the past, she has had many turbulent relationships, both romantic and in her family life. Her fam... | |
d736dcbe-0eaf-4232-bb32-d3757a113be5 | Positive emission tomography (PET) of chest now | 2 | {
"1": "CT chest without contrast in 24 months",
"2": "Positive emission tomography (PET) of chest now",
"3": "Right middle lobectomy now",
"4": "Bronchoscopy-guided biopsy now"
} | A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Pr... | CT chest without contrast in 24 months | Positive emission tomography (PET) of chest now | Right middle lobectomy now | Bronchoscopy-guided biopsy now | 1 | A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Pr... | |
cc0514b4-f23a-45dd-b780-ee9e5d7444de | Primary spermatocyte | 1 | {
"1": "Primary spermatocyte",
"2": "Secondary spermatocyte",
"3": "Spermatid",
"4": "Spermatozoon"
} | A 29-year-old man comes in for evaluation of infertility. He has been trying to conceive for over 2 years with his wife and previous evaluation of his wife's fertility revealed no abnormalities. Physical exam reveals a tall man with long extremities, sparse body hair, gynecomastia, and small testes. Laboratory studies ... | Primary spermatocyte | Secondary spermatocyte | Spermatid | Spermatozoon | 0 | A 29-year-old man comes in for evaluation of infertility. He has been trying to conceive for over 2 years with his wife and previous evaluation of his wife's fertility revealed no abnormalities. Physical exam reveals a tall man with long extremities, sparse body hair, gynecomastia, and small testes. Laboratory studies ... | |
105c9cb4-398e-4d5c-94f4-77b114ad5307 | Surgical pinning of the femoral head | 4 | {
"1": "Casting and crutches",
"2": "Immobilization of the hip in a Pavlik harness",
"3": "Supportive therapy and observation",
"4": "Surgical pinning of the femoral head"
} | A 13-year-old boy presents to the emergency department with severe knee, hip, and groin pain. The patient has a past medical history notable only for obesity and asthma. His temperature is 98°F (36.7°C), blood pressure is 124/65 mmHg, pulse is 128/min, respirations are 14/min, and oxygen saturation is 99% on room air. ... | Casting and crutches | Immobilization of the hip in a Pavlik harness | Supportive therapy and observation | Surgical pinning of the femoral head | 3 | A 13-year-old boy presents to the emergency department with severe knee, hip, and groin pain. The patient has a past medical history notable only for obesity and asthma. His temperature is 98°F (36.7°C), blood pressure is 124/65 mmHg, pulse is 128/min, respirations are 14/min, and oxygen saturation is 99% on room air. ... | |
aa3b481b-2fe3-464c-8c09-127382200244 | Stool leukocytes | 2 | {
"1": "Increased serum VIP",
"2": "Stool leukocytes",
"3": "Melanosis coli",
"4": "Normal intestinal mucosa"
} | A 28-year-old man comes to the physician because of diarrhea and crampy abdominal pain for 5 weeks. He has had up to 4 bowel movements per day. Several times he noticed mucoid strings with the stool. He has abdominal bloating. Over the past month, has had a 3.2-kg (7-lb) weight loss. He has not had fever, cough, or blo... | Increased serum VIP | Stool leukocytes | Melanosis coli | Normal intestinal mucosa | 1 | A 28-year-old man comes to the physician because of diarrhea and crampy abdominal pain for 5 weeks. He has had up to 4 bowel movements per day. Several times he noticed mucoid strings with the stool. He has abdominal bloating. Over the past month, has had a 3.2-kg (7-lb) weight loss. He has not had fever, cough, or blo... | |
3535ba0f-692b-402c-a7f6-ae98c8841a27 | Bacterial translocation | 3 | {
"1": "Aseptic peritoneal inflammation",
"2": "Neoplastic growth",
"3": "Bacterial translocation",
"4": "Perforated viscus"
} | A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acu... | Aseptic peritoneal inflammation | Neoplastic growth | Bacterial translocation | Perforated viscus | 2 | A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acu... | |
11b8de14-8adf-447f-9872-a5cbc11f2f6b | Racemic epinephrine and intramuscular corticosteroid therapy | 2 | {
"1": "Anterior-posterior and lateral radiographs of the neck",
"2": "Racemic epinephrine and intramuscular corticosteroid therapy",
"3": "Intravenous antibiotics",
"4": "Trial of bronchodilator therapy and oral steroids"
} | An 18-month-old girl is brought to the emergency department because of a cough that her parents are worried about. She has had a runny nose and a low-grade fever for the past 2 days, with some hoarseness and a rough-sounding cough that started this afternoon. This evening she began making some high-pitched sounds when ... | Anterior-posterior and lateral radiographs of the neck | Racemic epinephrine and intramuscular corticosteroid therapy | Intravenous antibiotics | Trial of bronchodilator therapy and oral steroids | 1 | An 18-month-old girl is brought to the emergency department because of a cough that her parents are worried about. She has had a runny nose and a low-grade fever for the past 2 days, with some hoarseness and a rough-sounding cough that started this afternoon. This evening she began making some high-pitched sounds when ... | |
c7da9d27-7705-4f6c-80c3-efbc7a2eea3b | Esophageal fibrosis | 2 | {
"1": "Decreased lower esophageal tone",
"2": "Esophageal fibrosis",
"3": "Increased lower esophageal tone",
"4": "Spastic cricopharyngeal muscle"
} | A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for ep... | Decreased lower esophageal tone | Esophageal fibrosis | Increased lower esophageal tone | Spastic cricopharyngeal muscle | 1 | A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for ep... | |
39441fc2-c511-4a36-9488-5b02f159bc96 | JAK/STAT | 3 | {
"1": "PI3K/Akt/mTOR",
"2": "MAP kinase",
"3": "JAK/STAT",
"4": "IP3"
} | A 67-year-old man with chronic kidney disease comes to the physician because of worsening fatigue and shortness of breath on exertion for 6 months. He has a 20-year history of poorly-controlled type 2 diabetes mellitus. Current medications include metformin and insulin. His pulse is 105/min. Examination shows conjuncti... | PI3K/Akt/mTOR | MAP kinase | JAK/STAT | IP3 | 2 | A 67-year-old man with chronic kidney disease comes to the physician because of worsening fatigue and shortness of breath on exertion for 6 months. He has a 20-year history of poorly-controlled type 2 diabetes mellitus. Current medications include metformin and insulin. His pulse is 105/min. Examination shows conjuncti... | |
93a019b9-1629-40b1-b5e6-4a50ba2fb3b1 | Metformin | 3 | {
"1": "Anxiety",
"2": "Diarrhea",
"3": "Metformin",
"4": "Sleep apnea"
} | A 41-year-old man presents to the emergency department with a 6-hour history of muscle cramping, decreased appetite, and diarrhea. He says that these symptoms came on rapidly but does not recall anything that may have triggered the episode. He has never experienced these symptoms before. His past medical history is sig... | Anxiety | Diarrhea | Metformin | Sleep apnea | 2 | A 41-year-old man presents to the emergency department with a 6-hour history of muscle cramping, decreased appetite, and diarrhea. He says that these symptoms came on rapidly but does not recall anything that may have triggered the episode. He has never experienced these symptoms before. His past medical history is sig... | |
374c82db-6498-4b03-86ec-2f68e100107c | Power stroke | 4 | {
"1": "Myosin head cocking",
"2": "Exposure of myosin-binding sites on actin",
"3": "Myosin head binding to actin",
"4": "Power stroke"
} | A scientist is studying the properties of myosin-actin interactions in a sample of human muscle tissue. She has identified a drug that selectively inhibits phosphate release by the myosin head. If she gives this drug to a sample of human muscle tissue under physiologic conditions, which of the following steps in cross-... | Myosin head cocking | Exposure of myosin-binding sites on actin | Myosin head binding to actin | Power stroke | 3 | A scientist is studying the properties of myosin-actin interactions in a sample of human muscle tissue. She has identified a drug that selectively inhibits phosphate release by the myosin head. If she gives this drug to a sample of human muscle tissue under physiologic conditions, which of the following steps in cross-... | |
8ff029c3-638b-49ad-a8dd-1f6786a5aa29 | TSC1 gene on chromosome 9 | 3 | {
"1": "NF1 gene on chromosome 17",
"2": "NF2 gene on chromosome 22",
"3": "TSC1 gene on chromosome 9",
"4": "VHL gene on chromosome 3"
} | A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac ape... | NF1 gene on chromosome 17 | NF2 gene on chromosome 22 | TSC1 gene on chromosome 9 | VHL gene on chromosome 3 | 2 | A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac ape... | |
8ba20a3a-68f1-4bf4-b7a7-bece6b1e0e0a | Metformin | 3 | {
"1": "Acyclovir",
"2": "Atorvastatin",
"3": "Metformin",
"4": "Metoprolol"
} | A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of geni... | Acyclovir | Atorvastatin | Metformin | Metoprolol | 2 | A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of geni... | |
108a1f92-d0f4-4e05-acd8-c651c5f1dcb9 | Chronic obstructive pulmonary disease | 4 | {
"1": "Asbestosis",
"2": "Idiopathic pulmonary fibrosis",
"3": "Bronchiectasis",
"4": "Chronic obstructive pulmonary disease"
} | A 56-year-old man comes to the clinic for a check-up. He presents with a 1-year history of worsening shortness of breath and weight loss. He is a former construction worker, and worked in a steel mill when he was in high school. He is an active smoker with a 36-pack-year smoking history. The blood pressure is 130/78 mm... | Asbestosis | Idiopathic pulmonary fibrosis | Bronchiectasis | Chronic obstructive pulmonary disease | 3 | A 56-year-old man comes to the clinic for a check-up. He presents with a 1-year history of worsening shortness of breath and weight loss. He is a former construction worker, and worked in a steel mill when he was in high school. He is an active smoker with a 36-pack-year smoking history. The blood pressure is 130/78 mm... | |
2a136ac6-f72c-4ab8-a941-efe2a570d7a2 | Avoid exposure to birds | 3 | {
"1": "Thoracocentesis",
"2": "Inhaled beclomethasone",
"3": "Avoid exposure to birds",
"4": "Isoniazid for 6 months"
} | A 25-year-old zookeeper presents to the office complaining of a dry cough, fever, and chills for the past month. He states that the symptoms come in episodes at the end of the workday and last a few hours. He also mentions that he is fatigued all the time. His job includes taking care of various types of birds. He is o... | Thoracocentesis | Inhaled beclomethasone | Avoid exposure to birds | Isoniazid for 6 months | 2 | A 25-year-old zookeeper presents to the office complaining of a dry cough, fever, and chills for the past month. He states that the symptoms come in episodes at the end of the workday and last a few hours. He also mentions that he is fatigued all the time. His job includes taking care of various types of birds. He is o... | |
08c9130e-0221-482f-bf14-b2220f6b0e3a | Uterine artery | 4 | {
"1": "Artery of Sampson",
"2": "Ovarian artery",
"3": "Superior vesical artery",
"4": "Uterine artery"
} | A 60-year-old female presents to her gynecologist with vaginal bleeding. She underwent menopause ten years prior. She has a past medical history of hypertension and diabetes mellitus. On physical examination, her uterus is uniformly enlarged. Ultrasound reveals a thickened endometrial stripe and tissue biopsy reveals n... | Artery of Sampson | Ovarian artery | Superior vesical artery | Uterine artery | 3 | A 60-year-old female presents to her gynecologist with vaginal bleeding. She underwent menopause ten years prior. She has a past medical history of hypertension and diabetes mellitus. On physical examination, her uterus is uniformly enlarged. Ultrasound reveals a thickened endometrial stripe and tissue biopsy reveals n... | |
a3f22aed-ea89-4927-900f-84c3e4b15698 | Epstein-Barr virus | 1 | {
"1": "Epstein-Barr virus",
"2": "Human T-cell leukemia virus type 1",
"3": "Human herpesvirus-8",
"4": "Human papillomavirus type 16"
} | A 40-year-old man presents to the physician with progressive weight loss for the last 3 months. He also says he frequently sweats profusely at night and has a recurring low-grade fever, for which he takes acetaminophen. The patient denies any symptoms like cough, breathlessness, or gastrointestinal symptoms. His temper... | Epstein-Barr virus | Human T-cell leukemia virus type 1 | Human herpesvirus-8 | Human papillomavirus type 16 | 0 | A 40-year-old man presents to the physician with progressive weight loss for the last 3 months. He also says he frequently sweats profusely at night and has a recurring low-grade fever, for which he takes acetaminophen. The patient denies any symptoms like cough, breathlessness, or gastrointestinal symptoms. His temper... | |
b0c15d57-b204-41d0-8bb9-2ff7bea6f2f6 | Zika virus | 4 | {
"1": "Dengue virus",
"2": "Rubella virus",
"3": "Toxoplasmosis",
"4": "Zika virus"
} | A 28-year-old gravida 1 at 32 weeks gestation is evaluated for an abnormal ultrasound that showed fetal microcephaly. Early in the 1st trimester, she had fevers and headaches for 1 week. She also experienced myalgias, arthralgias, and a pruritic maculopapular rash. The symptoms resolved without any medications. A week ... | Dengue virus | Rubella virus | Toxoplasmosis | Zika virus | 3 | A 28-year-old gravida 1 at 32 weeks gestation is evaluated for an abnormal ultrasound that showed fetal microcephaly. Early in the 1st trimester, she had fevers and headaches for 1 week. She also experienced myalgias, arthralgias, and a pruritic maculopapular rash. The symptoms resolved without any medications. A week ... | |
b029c0fe-919a-4455-86aa-90ce9dadc624 | Mixing study | 1 | {
"1": "Mixing study",
"2": "INR",
"3": "Ristocetin-induced platelet aggregation test",
"4": "Clot retraction study"
} | A 41-year-old G3P1 woman presents with a sudden onset throbbing headache, tinnitus, nausea, and left-sided weakness. Patient has no significant past medical history and takes no medications. Her last two pregnancies ended with spontaneous abortions before the 10th week of gestation. No significant family history. Her ... | Mixing study | INR | Ristocetin-induced platelet aggregation test | Clot retraction study | 0 | A 41-year-old G3P1 woman presents with a sudden onset throbbing headache, tinnitus, nausea, and left-sided weakness. Patient has no significant past medical history and takes no medications. Her last two pregnancies ended with spontaneous abortions before the 10th week of gestation. No significant family history. Her ... | |
9aea17b2-ee77-4211-9df5-b1a8e91ceaa9 | Diarrhea | 2 | {
"1": "Hypotonia",
"2": "Diarrhea",
"3": "Umbilical hernia",
"4": "Macroglossia"
} | A obstetrician is working in a developing country to help promote maternal health and fetal well being. While there, he delivers a baby who he suspects has congenital hypothyroidism, most likely caused by inadequate maternal iodine intake. Which of the following signs and symptoms would NOT be expected to be observed i... | Hypotonia | Diarrhea | Umbilical hernia | Macroglossia | 1 | A obstetrician is working in a developing country to help promote maternal health and fetal well being. While there, he delivers a baby who he suspects has congenital hypothyroidism, most likely caused by inadequate maternal iodine intake. Which of the following signs and symptoms would NOT be expected to be observed i... | |
0aa7197e-1a94-4f0e-8998-2acb016b025c | Isoniazid | 1 | {
"1": "Isoniazid",
"2": "No management indicated",
"3": "Repeat PPD in 1 week",
"4": "Rifampin, isoniazid, pyrazinamide, and ethambutol"
} | A 33-year-old nurse is referred to an infectious disease specialist after she exhibited a PPD skin test with 17 mm of induration. She denies any cough, shortness of breath, hemoptysis, weight loss, fatigue, fevers, or night sweats over the last several months. Her temperature is 97.0°F (36.1°C), blood pressure is 120/8... | Isoniazid | No management indicated | Repeat PPD in 1 week | Rifampin, isoniazid, pyrazinamide, and ethambutol | 0 | A 33-year-old nurse is referred to an infectious disease specialist after she exhibited a PPD skin test with 17 mm of induration. She denies any cough, shortness of breath, hemoptysis, weight loss, fatigue, fevers, or night sweats over the last several months. Her temperature is 97.0°F (36.1°C), blood pressure is 120/8... | |
2eeb6bf0-ca38-41f8-902d-e4a8a28285f2 | Herniation of the uncus | 1 | {
"1": "Herniation of the uncus",
"2": "Herniation of the cingulate gyrus",
"3": "Occlusion of the basilar artery",
"4": "Occlusion of the anterior spinal artery"
} | An 81-year-old woman is brought to the emergency room by her son after witnessing the patient fall and hit her head. The son reports that the patient was in her usual state of health until she complained of chest palpitations. This startled her while she was climbing down the stairs and lead to a fall. Past medical his... | Herniation of the uncus | Herniation of the cingulate gyrus | Occlusion of the basilar artery | Occlusion of the anterior spinal artery | 0 | An 81-year-old woman is brought to the emergency room by her son after witnessing the patient fall and hit her head. The son reports that the patient was in her usual state of health until she complained of chest palpitations. This startled her while she was climbing down the stairs and lead to a fall. Past medical his... | |
a86f29bf-baee-4e94-9ddb-2d1607866305 | Natural killer cells | 3 | {
"1": "Bone marrow-derived macrophages",
"2": "CD4+ T lymphocytes",
"3": "Natural killer cells",
"4": "Band neutrophils"
} | A 67-year-old man with peripheral neuropathy comes to the physician for a follow-up examination after the results of serum protein electrophoresis showed monoclonal gammopathy. A complete blood count, serum creatinine, and serum electrolyte concentrations are within the reference ranges. A bone marrow biopsy shows 6% m... | Bone marrow-derived macrophages | CD4+ T lymphocytes | Natural killer cells | Band neutrophils | 2 | A 67-year-old man with peripheral neuropathy comes to the physician for a follow-up examination after the results of serum protein electrophoresis showed monoclonal gammopathy. A complete blood count, serum creatinine, and serum electrolyte concentrations are within the reference ranges. A bone marrow biopsy shows 6% m... | |
c4e33805-60e0-4ba3-9510-5d85fd424614 | Intrafascicular infiltration on muscle biopsy | 1 | {
"1": "Intrafascicular infiltration on muscle biopsy",
"2": "Perifascicular and perivascular infiltration on muscle biopsy",
"3": "Positive anti-acetylcholine receptor antibodies",
"4": "Dystrophin gene mutation on genetic analysis"
} | A 47-year-old woman comes to the physician because of progressive muscle weakness for five months. She feels that the muscles in her shoulders and hips have been getting weaker and sometimes feel sore. She now has difficulty getting up from chairs, climbing stairs, and combing her hair. She has also noticed new difficu... | Intrafascicular infiltration on muscle biopsy | Perifascicular and perivascular infiltration on muscle biopsy | Positive anti-acetylcholine receptor antibodies | Dystrophin gene mutation on genetic analysis | 0 | A 47-year-old woman comes to the physician because of progressive muscle weakness for five months. She feels that the muscles in her shoulders and hips have been getting weaker and sometimes feel sore. She now has difficulty getting up from chairs, climbing stairs, and combing her hair. She has also noticed new difficu... | |
9ced8467-1e7c-4113-8d31-aca107ffed07 | Decreased acetylcholine release | 1 | {
"1": "Decreased acetylcholine release",
"2": "Overactivation of adenylate cyclase",
"3": "Release of interferon-gamma",
"4": "Inhibition of GABA release"
} | A 41-year-old man presents to the emergency room with sudden onset of blurry vision one hour ago. He states that he was resting at home when he noticed he had difficulty reading. Currently, he is also starting to see double, and is seeing two images on top of each other. Earlier today, he felt ill with nausea, vomiting... | Decreased acetylcholine release | Overactivation of adenylate cyclase | Release of interferon-gamma | Inhibition of GABA release | 0 | A 41-year-old man presents to the emergency room with sudden onset of blurry vision one hour ago. He states that he was resting at home when he noticed he had difficulty reading. Currently, he is also starting to see double, and is seeing two images on top of each other. Earlier today, he felt ill with nausea, vomiting... | |
133eebcb-8578-4daa-a620-36c47a946539 | Biliary atresia | 2 | {
"1": "Galactosemia",
"2": "Biliary atresia",
"3": "Crigler–Najjar syndrome",
"4": "Breast milk jaundice"
} | A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet ... | Galactosemia | Biliary atresia | Crigler–Najjar syndrome | Breast milk jaundice | 1 | A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet ... | |
e77f42aa-7ac3-4266-8644-3aa2ef7ab5f9 | QT prolongation | 2 | {
"1": "Torsade de pointes",
"2": "QT prolongation",
"3": "Peaked T waves",
"4": "PR prolongation"
} | A 43-year-old man comes to the emergency department with nausea, abdominal discomfort, diarrhea, and progressive perioral numbness for the past 24 hours. 3 days ago, he underwent a total thyroidectomy for treatment of papillary thyroid cancer. His only medication is a multivitamin supplement. He appears fatigued. While... | Torsade de pointes | QT prolongation | Peaked T waves | PR prolongation | 1 | A 43-year-old man comes to the emergency department with nausea, abdominal discomfort, diarrhea, and progressive perioral numbness for the past 24 hours. 3 days ago, he underwent a total thyroidectomy for treatment of papillary thyroid cancer. His only medication is a multivitamin supplement. He appears fatigued. While... | |
2b309de8-8b38-4dec-bebb-55d8d124699d | Diverticulitis | 1 | {
"1": "Diverticulitis",
"2": "Hypothyroidism",
"3": "Adenocarcinoma of the colon",
"4": "Irritable bowel syndrome"
} | A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as 'crampy'. She also says she has suffered from mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her last menstrual period was 16 years ago. Her body... | Diverticulitis | Hypothyroidism | Adenocarcinoma of the colon | Irritable bowel syndrome | 0 | A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as 'crampy'. She also says she has suffered from mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her last menstrual period was 16 years ago. Her body... | |
411349bf-a8f5-487c-9e0a-bf5d2520572a | Aortoiliac atherosclerosis | 2 | {
"1": "Anxiety",
"2": "Aortoiliac atherosclerosis",
"3": "Spinal stenosis",
"4": "Vascular claudication"
} | A 67-year-old man presents to his primary care physician for erectile dysfunction. He states that for the past month he has been unable to engage in sexual intercourse with his wife despite having appropriate sexual desire. He also endorses deep and burning buttock and hip pain when walking, which is relieved by rest. ... | Anxiety | Aortoiliac atherosclerosis | Spinal stenosis | Vascular claudication | 1 | A 67-year-old man presents to his primary care physician for erectile dysfunction. He states that for the past month he has been unable to engage in sexual intercourse with his wife despite having appropriate sexual desire. He also endorses deep and burning buttock and hip pain when walking, which is relieved by rest. ... | |
ba0279c6-c0cc-4f92-8ac3-70c37042ed8f | Increased PTH, decreased calcium, increased phosphate, decreased calcitriol | 1 | {
"1": "Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"2": "Decreased PTH, increased calcium, increased phosphate, increased calcitriol",
"3": "Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"4": "Normal PTH, normal calcium, normal phosphate, normal... | A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum? | Increased PTH, decreased calcium, increased phosphate, decreased calcitriol | Decreased PTH, increased calcium, increased phosphate, increased calcitriol | Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol | Normal PTH, normal calcium, normal phosphate, normal calcitriol | 0 | A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. Which of the following laboratory findings would you most expect upon analysis of this patient's serum? | |
d99e31e2-d07e-4934-b551-508fd6a67e7c | Binds endogenous peptides that have been transported by the TAP channel | 3 | {
"1": "Binds complement proteins on the cell surface",
"2": "Binds endogenous peptides that are present in the endosome",
"3": "Binds endogenous peptides that have been transported by the TAP channel",
"4": "Binds exogenous peptides that are present in the endosome"
} | A medical researcher is studying the physiology of the immune system in order to better understand the effects of HIV on patients. He isolates a group of cells that are shown by flow cytometry to be positive for the cell surface marker CD8. He then mixes this cell population with a group of infected cells, crosslinks e... | Binds complement proteins on the cell surface | Binds endogenous peptides that are present in the endosome | Binds endogenous peptides that have been transported by the TAP channel | Binds exogenous peptides that are present in the endosome | 2 | A medical researcher is studying the physiology of the immune system in order to better understand the effects of HIV on patients. He isolates a group of cells that are shown by flow cytometry to be positive for the cell surface marker CD8. He then mixes this cell population with a group of infected cells, crosslinks e... | |
e5473df6-a701-47dd-8940-685aa3201b5b | Gastroesophageal junction incompetence | 3 | {
"1": "Partially occluded coronary artery",
"2": "Umbilical hernia",
"3": "Gastroesophageal junction incompetence",
"4": "Intestinal metaplasia at the gastroesophageal junction"
} | A 61-year-old Caucasian male presents to your office with chest pain. He states that he is worried about his heart, as his father died at age 62 from a heart attack. He reports that his chest pain worsens with large meals and spicy foods and improves with calcium carbonate. He denies dyspnea on exertion and an ECG is n... | Partially occluded coronary artery | Umbilical hernia | Gastroesophageal junction incompetence | Intestinal metaplasia at the gastroesophageal junction | 2 | A 61-year-old Caucasian male presents to your office with chest pain. He states that he is worried about his heart, as his father died at age 62 from a heart attack. He reports that his chest pain worsens with large meals and spicy foods and improves with calcium carbonate. He denies dyspnea on exertion and an ECG is n... | |
e26a63dc-7337-4351-b030-3700d671151b | Treatment with radioactive iodine | 4 | {
"1": "External orbital radiation",
"2": "Selenium supplementation",
"3": "Systemic corticosteroids",
"4": "Treatment with radioactive iodine"
} | A 36-year-old woman comes to the clinic because of tearing and a foreign body sensation in her eyes bilaterally, which has gradually worsened over the last several weeks. She also notes having occasional palpitations, nervousness, sweating, and heat intolerance. Her past medical history is unremarkable. She reports a 2... | External orbital radiation | Selenium supplementation | Systemic corticosteroids | Treatment with radioactive iodine | 3 | A 36-year-old woman comes to the clinic because of tearing and a foreign body sensation in her eyes bilaterally, which has gradually worsened over the last several weeks. She also notes having occasional palpitations, nervousness, sweating, and heat intolerance. Her past medical history is unremarkable. She reports a 2... | |
afafc33f-e512-44aa-8d72-a4b38249129c | Reassuring the parents and use of an enuresis alarm | 2 | {
"1": "Magnetic resonance imaging (MRI) of the spine",
"2": "Reassuring the parents and use of an enuresis alarm",
"3": "Treatment with oral oxybutynin",
"4": "Treatment with oral imipramine"
} | A 7-year-old boy is brought to a pediatrician by his parents for evaluation of frequent bed wetting during the night. A detailed history reveals that there has been no history of urinary incontinence during the day since the boy was 4 years of age, but that he has never been dry at night continuously for 1 week. There ... | Magnetic resonance imaging (MRI) of the spine | Reassuring the parents and use of an enuresis alarm | Treatment with oral oxybutynin | Treatment with oral imipramine | 1 | A 7-year-old boy is brought to a pediatrician by his parents for evaluation of frequent bed wetting during the night. A detailed history reveals that there has been no history of urinary incontinence during the day since the boy was 4 years of age, but that he has never been dry at night continuously for 1 week. There ... | |
6778fb18-059c-4543-9756-2828dbadcf85 | Decreased positional sense in the ipsilateral leg | 4 | {
"1": "Decreased sense of temperature in the ipsilateral arm",
"2": "Decreased strength of the contralateral leg",
"3": "Decreased vibratory sense in the ipsilateral arm",
"4": "Decreased positional sense in the ipsilateral leg"
} | A 52-year-old man with a history of gastric cancer that was treated with subtotal gastrectomy dies in a motor vehicle collision. At autopsy, examination of the spinal cord shows unilateral atrophy of the neurons in the area indicated by the arrow. Neurological examination of the patient when he was still alive would mo... | Decreased sense of temperature in the ipsilateral arm | Decreased strength of the contralateral leg | Decreased vibratory sense in the ipsilateral arm | Decreased positional sense in the ipsilateral leg | 3 | A 52-year-old man with a history of gastric cancer that was treated with subtotal gastrectomy dies in a motor vehicle collision. At autopsy, examination of the spinal cord shows unilateral atrophy of the neurons in the area indicated by the arrow. Neurological examination of the patient when he was still alive would mo... | |
1c84ea05-c043-4e5a-b6f3-2a89249e6902 | Amoxicilin | 3 | {
"1": "Ibuprofen",
"2": "Tetracycline",
"3": "Amoxicilin",
"4": "Gentamicin"
} | A 24-year-old pregnant woman at 28 weeks gestation presents to the emergency department with complaints of fever with chills and pain in her knee and ankle joints for the past 2 days. She also complains of headaches and difficulty moving her neck. Further questioning reveals that she had a tick bite on her arm while ga... | Ibuprofen | Tetracycline | Amoxicilin | Gentamicin | 2 | A 24-year-old pregnant woman at 28 weeks gestation presents to the emergency department with complaints of fever with chills and pain in her knee and ankle joints for the past 2 days. She also complains of headaches and difficulty moving her neck. Further questioning reveals that she had a tick bite on her arm while ga... | |
f54879c6-2199-4af0-b55e-2d9ceac446e6 | MRI of the adrenal glands | 1 | {
"1": "MRI of the adrenal glands",
"2": "MRI of the chest",
"3": "Low dose dexamethasone suppression test",
"4": "Inferior petrosal sinus sampling"
} | A 25-year-old woman presents to her physician with a four month history of fatigue and weakness. The weakness has been progressive to the point where she cannot climb stairs and stand from a sitting position. She has only had one menstrual period in the last four months and has never been pregnant. She smokes a pack of... | MRI of the adrenal glands | MRI of the chest | Low dose dexamethasone suppression test | Inferior petrosal sinus sampling | 0 | A 25-year-old woman presents to her physician with a four month history of fatigue and weakness. The weakness has been progressive to the point where she cannot climb stairs and stand from a sitting position. She has only had one menstrual period in the last four months and has never been pregnant. She smokes a pack of... | |
574bbe62-f46f-47ae-83ce-21822a73ab27 | Inhibition of beta-tubulin polymerization | 1 | {
"1": "Inhibition of beta-tubulin polymerization",
"2": "Creation of free radicals that unwind DNA",
"3": "Inhibition of dihydrofolate reductase",
"4": "Incorporation of false pyrimidine analogues into DNA"
} | A 67-year-woman with non-Hodgkin lymphoma comes to the physician because of progressively increasing numbness and tingling in her fingers and toes. Her last cycle of chemotherapy with vincristine was 1 week ago. Physical examination shows decreased sensation to light touch in all distal extremities. Knee and ankle deep... | Inhibition of beta-tubulin polymerization | Creation of free radicals that unwind DNA | Inhibition of dihydrofolate reductase | Incorporation of false pyrimidine analogues into DNA | 0 | A 67-year-woman with non-Hodgkin lymphoma comes to the physician because of progressively increasing numbness and tingling in her fingers and toes. Her last cycle of chemotherapy with vincristine was 1 week ago. Physical examination shows decreased sensation to light touch in all distal extremities. Knee and ankle deep... | |
10f251b0-12a6-40ef-88ad-378598d030c2 | Aromatic amines | 2 | {
"1": "Ionizing radiation",
"2": "Aromatic amines",
"3": "Aflatoxins",
"4": "Radon"
} | A 68-year-old man comes to the physician with a 1-week history of painless hematuria. A CT scan of the urinary tract shows areas of bladder wall thickening. Cystoscopy shows several sessile masses with central necrosis arising from the bladder wall. A biopsy specimen of the bladder masses shows moderately differentiate... | Ionizing radiation | Aromatic amines | Aflatoxins | Radon | 1 | A 68-year-old man comes to the physician with a 1-week history of painless hematuria. A CT scan of the urinary tract shows areas of bladder wall thickening. Cystoscopy shows several sessile masses with central necrosis arising from the bladder wall. A biopsy specimen of the bladder masses shows moderately differentiate... | |
c4b82c46-2b3d-41f2-b870-b438fd762f02 | Reassurance and follow-up | 3 | {
"1": "Pelvic ultrasound",
"2": "Measure serum dehydroepiandrosterone levels",
"3": "Reassurance and follow-up",
"4": "MRI of the brain"
} | A 14-year-old girl comes to the physician with her father for evaluation of her short stature. She feels well overall, but is concerned because all of her friends are taller than her. Her birth weight was normal. Her father reports he had a short stature during his teenage years; he is currently 177 cm (5 ft 10 in) tal... | Pelvic ultrasound | Measure serum dehydroepiandrosterone levels | Reassurance and follow-up | MRI of the brain | 2 | A 14-year-old girl comes to the physician with her father for evaluation of her short stature. She feels well overall, but is concerned because all of her friends are taller than her. Her birth weight was normal. Her father reports he had a short stature during his teenage years; he is currently 177 cm (5 ft 10 in) tal... | |
799161eb-f70c-4ee7-9a19-09dc046effb6 | Normal light microscopy findings | 4 | {
"1": "Mesangial proliferation on light microscopy",
"2": "Subepithelial dense deposits on electron microscopy",
"3": "Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence",
"4": "Normal light microscopy findings"
} | A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as w... | Mesangial proliferation on light microscopy | Subepithelial dense deposits on electron microscopy | Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence | Normal light microscopy findings | 3 | A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as w... | |
c14a62a4-9605-45f8-ac3d-f80bf210e529 | Tumor arising from cutaneous T cells | 3 | {
"1": "Vascular tumor containing spindle cells",
"2": "Tumor arising from the folliculosebaceous–apocrine germ",
"3": "Tumor arising from cutaneous T cells",
"4": "Tumor arising from epidermal keratinocytes"
} | A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient’s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination... | Vascular tumor containing spindle cells | Tumor arising from the folliculosebaceous–apocrine germ | Tumor arising from cutaneous T cells | Tumor arising from epidermal keratinocytes | 2 | A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient’s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination... | |
a441ff07-3b6c-45c3-85dc-cdf95780a40e | Cognitive behavioral therapy | 4 | {
"1": "Administration of lithium",
"2": "Interpersonal therapy",
"3": "Psychodynamic psychotherapy",
"4": "Cognitive behavioral therapy"
} | A 35-year-old woman comes to the physician because she has been feeling very stressed over the past several months. During this period, she has found it difficult to relax. She states that her head is full of worries. She works at an accountant's office and reports difficulty in concentrating on her work. She has been ... | Administration of lithium | Interpersonal therapy | Psychodynamic psychotherapy | Cognitive behavioral therapy | 3 | A 35-year-old woman comes to the physician because she has been feeling very stressed over the past several months. During this period, she has found it difficult to relax. She states that her head is full of worries. She works at an accountant's office and reports difficulty in concentrating on her work. She has been ... | |
fc1ec2e4-eb12-4f23-b423-6dd8cb050bbc | Frontotemporal dementia | 2 | {
"1": "Alzheimer dementia",
"2": "Frontotemporal dementia",
"3": "Kluver-Bucy syndrome",
"4": "Vascular dementia"
} | A 65-year-old man presents to his primary care physician for a change in his behavior over the past few months. Initially, the patient was noted to be behaving inappropriately including using foul language and grabbing people unexpectedly. This has progressed to a worsening of his memory and trouble caring for himself.... | Alzheimer dementia | Frontotemporal dementia | Kluver-Bucy syndrome | Vascular dementia | 1 | A 65-year-old man presents to his primary care physician for a change in his behavior over the past few months. Initially, the patient was noted to be behaving inappropriately including using foul language and grabbing people unexpectedly. This has progressed to a worsening of his memory and trouble caring for himself.... | |
3d893ec4-02f4-4ed4-8abc-eb2b2af0aed2 | Immunoglobulin- IgM | 4 | {
"1": "Immunoglobulin- IgG",
"2": "Immunoglobulin- IgD",
"3": "Immunoglobulin- IgA",
"4": "Immunoglobulin- IgM"
} | An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse ... | Immunoglobulin- IgG | Immunoglobulin- IgD | Immunoglobulin- IgA | Immunoglobulin- IgM | 3 | An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse ... | |
ce7d5e5e-6e88-4e5c-b9ad-da217d2c5deb | Levofloxacin | 1 | {
"1": "Levofloxacin",
"2": "Trimethoprim/sulfamethoxazole",
"3": "Amoxicillin",
"4": "Rifampin"
} | A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0°C (100.4°F), pulse is 65/min, respirations... | Levofloxacin | Trimethoprim/sulfamethoxazole | Amoxicillin | Rifampin | 0 | A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0°C (100.4°F), pulse is 65/min, respirations... | |
d3e80e99-1f33-41e0-a918-6b8bc1924491 | Theca leutein cysts | 4 | {
"1": "Chocolate cysts",
"2": "Corpus luteum cysts",
"3": "Yolk sac tumor",
"4": "Theca leutein cysts"
} | A transvaginal ultrasound shows an intrauterine heteroechoic mass with numerous anechoic spaces and no identifiable fetus or amniotic fluid. Both the ovaries are enlarged and have multiple thin-walled, septated cysts with clear content. Which of the following is the most likely cause of the ovarian findings? | Chocolate cysts | Corpus luteum cysts | Yolk sac tumor | Theca leutein cysts | 3 | A transvaginal ultrasound shows an intrauterine heteroechoic mass with numerous anechoic spaces and no identifiable fetus or amniotic fluid. Both the ovaries are enlarged and have multiple thin-walled, septated cysts with clear content. Which of the following is the most likely cause of the ovarian findings? | |
8ff21f9e-8dfa-4144-8fbe-882b5ba564af | Serum antibodies against hemagglutinin | 1 | {
"1": "Serum antibodies against hemagglutinin",
"2": "Downregulation of ICAM-1 expression",
"3": "Protease-resistant antibodies in nasal secretions",
"4": "Homozygous mutation in the CCR5 gene"
} | A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any sympt... | Serum antibodies against hemagglutinin | Downregulation of ICAM-1 expression | Protease-resistant antibodies in nasal secretions | Homozygous mutation in the CCR5 gene | 0 | A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any sympt... | |
8b8daeb0-fb3c-46a9-b120-63cdf45fbf94 | Previous suicide attempt | 1 | {
"1": "Previous suicide attempt",
"2": "History of psychosis",
"3": "Sleeping disorder",
"4": "Age\n\""
} | A 71-year-old man comes to the physician for a routine visit. His psychiatric history is significant for major depression with psychotic features. He was diagnosed after his wife died from pancreatic cancer four years earlier. Three years ago, he deliberately overdosed on sleeping pills. Today, he feels well but still ... | Previous suicide attempt | History of psychosis | Sleeping disorder | Age
" | 0 | A 71-year-old man comes to the physician for a routine visit. His psychiatric history is significant for major depression with psychotic features. He was diagnosed after his wife died from pancreatic cancer four years earlier. Three years ago, he deliberately overdosed on sleeping pills. Today, he feels well but still ... | |
d6966b96-e48f-4533-8b28-393cd779a930 | Chickenpox | 3 | {
"1": "Measles",
"2": "Urushiol-induced dermatitis",
"3": "Chickenpox",
"4": "Rubella"
} | A 4-year-old boy is brought to the physician because of a generalized rash for 3 days. During this period, he has had severe itching and was not able to sleep well. He has also had fever, headache, and some muscle pain. Five days ago, he had a runny nose which subsided with over-the-counter medications. He returned fro... | Measles | Urushiol-induced dermatitis | Chickenpox | Rubella | 2 | A 4-year-old boy is brought to the physician because of a generalized rash for 3 days. During this period, he has had severe itching and was not able to sleep well. He has also had fever, headache, and some muscle pain. Five days ago, he had a runny nose which subsided with over-the-counter medications. He returned fro... | |
da6afcc0-59af-4d28-89ea-855f7a35181d | Synthetic cathinone intoxication | 4 | {
"1": "Brief psychotic disorder",
"2": "Neuroleptic malignant syndrome",
"3": "Anticholinergic toxicity",
"4": "Synthetic cathinone intoxication"
} | A 19-year-old man is brought to the emergency department by ambulance because of unusual behavior that started 3 hours ago while he was at a party. He has a history of major depressive disorder and seasonal allergies. His mother has a history of anxiety. He drinks 5 beers on the weekends. Current medications include am... | Brief psychotic disorder | Neuroleptic malignant syndrome | Anticholinergic toxicity | Synthetic cathinone intoxication | 3 | A 19-year-old man is brought to the emergency department by ambulance because of unusual behavior that started 3 hours ago while he was at a party. He has a history of major depressive disorder and seasonal allergies. His mother has a history of anxiety. He drinks 5 beers on the weekends. Current medications include am... | |
68964203-2486-4f75-adee-6521c618b126 | Benztropine | 2 | {
"1": "Glycopyrrolate",
"2": "Benztropine",
"3": "Levodopa",
"4": "Dantrolene"
} | A 22-year-old male presents to the emergency room complaining of neck stiffness. He reports that his neck started “locking” three hours ago. He is now unable to move it. His past medical history is notable for schizophrenia and asthma and he currently takes albuterol as well as another medication whose name he does not... | Glycopyrrolate | Benztropine | Levodopa | Dantrolene | 1 | A 22-year-old male presents to the emergency room complaining of neck stiffness. He reports that his neck started “locking” three hours ago. He is now unable to move it. His past medical history is notable for schizophrenia and asthma and he currently takes albuterol as well as another medication whose name he does not... | |
640c81dc-a749-4564-a0b1-3b2499514488 | Acute pancreatitis | 1 | {
"1": "Acute pancreatitis",
"2": "Myocardial infarction",
"3": "Corneal arci",
"4": "Cerebrovascular accident"
} | A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipop... | Acute pancreatitis | Myocardial infarction | Corneal arci | Cerebrovascular accident | 0 | A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipop... | |
ef8ff17b-526f-4bab-8cd8-f7158ba62c71 | Administer calcium gluconate | 3 | {
"1": "Obtain abdominal CT",
"2": "Begin rehydration therapy",
"3": "Administer calcium gluconate",
"4": "Supplementation with vitamin D"
} | A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-... | Obtain abdominal CT | Begin rehydration therapy | Administer calcium gluconate | Supplementation with vitamin D | 2 | A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-... | |
c8c26504-1c2e-4b72-a6e9-75b13699b079 | Bartter's syndrome | 2 | {
"1": "Renal artery stenosis",
"2": "Bartter's syndrome",
"3": "Pheochromocytoma",
"4": "Gitelman's syndrome"
} | A 9-year-old boy is brought to a physician by his mother for evaluation of generalized weakness, increased urination, and increased thirst. The mother mentions that her boy is always tired, and seems to be getting worse. He prefers watching television rather than going out and playing with other kids. Furthermore, he h... | Renal artery stenosis | Bartter's syndrome | Pheochromocytoma | Gitelman's syndrome | 1 | A 9-year-old boy is brought to a physician by his mother for evaluation of generalized weakness, increased urination, and increased thirst. The mother mentions that her boy is always tired, and seems to be getting worse. He prefers watching television rather than going out and playing with other kids. Furthermore, he h... | |
d9623ede-b325-4967-b89c-baa16b53756c | 1 and 2 | 3 | {
"1": "2 only",
"2": "1 only",
"3": "1 and 2",
"4": "1, 2, and 3"
} | A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient’s vital signs are with... | 2 only | 1 only | 1 and 2 | 1, 2, and 3 | 2 | A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient’s vital signs are with... | |
4ce1570f-a7c2-40e3-9134-012b315d070a | Non-Hodgkin lymphoma | 2 | {
"1": "Gastric carcinoma",
"2": "Non-Hodgkin lymphoma",
"3": "Invasive ductal carcinoma of the breast",
"4": "Adenocarcinoma of the lung"
} | A 51-year-old woman presents to her primary care physician complaining of months of dry mouth and dry eyes. She says the dryness has become so severe that she has difficulty swallowing food. She has a history of hypertension, for which she takes hydrochlorothiazide (HCTZ), but she has no other medical problems. Family ... | Gastric carcinoma | Non-Hodgkin lymphoma | Invasive ductal carcinoma of the breast | Adenocarcinoma of the lung | 1 | A 51-year-old woman presents to her primary care physician complaining of months of dry mouth and dry eyes. She says the dryness has become so severe that she has difficulty swallowing food. She has a history of hypertension, for which she takes hydrochlorothiazide (HCTZ), but she has no other medical problems. Family ... | |
4e712707-ae54-4ae3-890b-9d861cc682ce | Linear IgG staining on immunofluorescence | 3 | {
"1": "Granulomatous inflammation and necrotizing vasculitis",
"2": "Positive cryoglobulins",
"3": "Linear IgG staining on immunofluorescence",
"4": "Longitudinal splitting and thickening of the glomerular basement membrane"
} | A 59-year-old man presents to his primary care provider with fatigue, a progressively worsening cough with flecks of blood, shortness of breath, and dark urine. He reports feeling ill for the past 3 weeks. Past medical history is significant for hypertension and hyperlipidemia. He takes chlorthalidone and atorvastatin.... | Granulomatous inflammation and necrotizing vasculitis | Positive cryoglobulins | Linear IgG staining on immunofluorescence | Longitudinal splitting and thickening of the glomerular basement membrane | 2 | A 59-year-old man presents to his primary care provider with fatigue, a progressively worsening cough with flecks of blood, shortness of breath, and dark urine. He reports feeling ill for the past 3 weeks. Past medical history is significant for hypertension and hyperlipidemia. He takes chlorthalidone and atorvastatin.... | |
b85ddebb-4e51-4cb7-a0bf-563f46bff97a | Positive latex agglutination test | 1 | {
"1": "Positive latex agglutination test",
"2": "Positive PCR for HSV-2 DNA",
"3": "Presence of tachyzoites",
"4": "Increased adenosine deaminase concentration"
} | A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5°C (101.3°F). Physical ex... | Positive latex agglutination test | Positive PCR for HSV-2 DNA | Presence of tachyzoites | Increased adenosine deaminase concentration | 0 | A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5°C (101.3°F). Physical ex... | |
dce0d2df-d9ac-4fec-9272-85f6b97a4ed4 | Viral reactivation in dorsal root ganglia | 1 | {
"1": "Viral reactivation in dorsal root ganglia",
"2": "IgA deposits in the upper dermis",
"3": "Bacterial lymphatic infection of the epidermis",
"4": "Infestation with bloodsucking parasites"
} | A 70-year-old woman comes to the physician for the evaluation of back pain. For the past six days, she has had a burning pain in her upper right back and chest. She cannot recall any recent injury and has no prior history of back pain. She has a history of hypertension and gastroesophageal reflux. The patient volunteer... | Viral reactivation in dorsal root ganglia | IgA deposits in the upper dermis | Bacterial lymphatic infection of the epidermis | Infestation with bloodsucking parasites | 0 | A 70-year-old woman comes to the physician for the evaluation of back pain. For the past six days, she has had a burning pain in her upper right back and chest. She cannot recall any recent injury and has no prior history of back pain. She has a history of hypertension and gastroesophageal reflux. The patient volunteer... | |
60942103-d4af-4cd1-beb9-376c75363276 | Using mortality rates in the analysis | 2 | {
"1": "Using survival rates in the analysis",
"2": "Using mortality rates in the analysis",
"3": "Increasing the number of screened individuals",
"4": "Decreasing the number of screened individuals"
} | A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detecte... | Using survival rates in the analysis | Using mortality rates in the analysis | Increasing the number of screened individuals | Decreasing the number of screened individuals | 1 | A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detecte... | |
ffa9c78a-40bd-41ae-a3c1-e6389853f7dc | Silicosis | 2 | {
"1": "Berylliosis",
"2": "Silicosis",
"3": "Asbestosis",
"4": "Talcosis"
} | A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg... | Berylliosis | Silicosis | Asbestosis | Talcosis | 1 | A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg... | |
024b211e-fb0f-42c1-b45a-457d467e0ee0 | Takotsubo cardiomyopathy | 3 | {
"1": "Atrial fibrillation",
"2": "Constrictive pericarditis",
"3": "Takotsubo cardiomyopathy",
"4": "Restrictive cardiomyopathy"
} | A 43-year-old woman is brought to the emergency department by her brother for severe chest pain. The patient recently lost her husband in a car accident and is still extremely shocked by the event. On physical examination, her blood pressure is 105/67 mm Hg, the heart rate is 96/min and regular, breathing rate is 23/mi... | Atrial fibrillation | Constrictive pericarditis | Takotsubo cardiomyopathy | Restrictive cardiomyopathy | 2 | A 43-year-old woman is brought to the emergency department by her brother for severe chest pain. The patient recently lost her husband in a car accident and is still extremely shocked by the event. On physical examination, her blood pressure is 105/67 mm Hg, the heart rate is 96/min and regular, breathing rate is 23/mi... | |
b4d5a5c7-f7c8-4db8-af8a-9db8926dbad9 | Undergo upper GI endoscopy | 2 | {
"1": "Undergo colonoscopy",
"2": "Undergo upper GI endoscopy",
"3": "Proton pump inhibitors with anti-H.pylori regimen",
"4": "Surgery for peptic ulcer disease"
} | A 56-year-old man is brought to the emergency department. He was found unconscious on the street. The staff recognizes him as a local homeless man with a long history of alcoholism. At the hospital, his pulse is 95/min, the blood pressure is 110/70 mm Hg, the respirations are 20/min, and the oxygen saturation is 98% on... | Undergo colonoscopy | Undergo upper GI endoscopy | Proton pump inhibitors with anti-H.pylori regimen | Surgery for peptic ulcer disease | 1 | A 56-year-old man is brought to the emergency department. He was found unconscious on the street. The staff recognizes him as a local homeless man with a long history of alcoholism. At the hospital, his pulse is 95/min, the blood pressure is 110/70 mm Hg, the respirations are 20/min, and the oxygen saturation is 98% on... | |
a355ce3a-8ea6-4fdb-9241-b549d5eaffaf | Antigen-antibody complexes | 3 | {
"1": "Antigen-specific IgE binding to mast cells",
"2": "Tissue-specific antibodies",
"3": "Antigen-antibody complexes",
"4": "Presensitized CD8+ cytotoxic T-cells"
} | An 8-year-old girl comes to the physician because of a 2-day history of hematuria. Two weeks ago, she had a sore throat that resolved without treatment. Physical examination shows 1+ pitting edema of the lower legs and ankles. Urinalysis shows numerous RBCs and 3+ proteinuria. Her antistreptolysin O titer is elevated. ... | Antigen-specific IgE binding to mast cells | Tissue-specific antibodies | Antigen-antibody complexes | Presensitized CD8+ cytotoxic T-cells | 2 | An 8-year-old girl comes to the physician because of a 2-day history of hematuria. Two weeks ago, she had a sore throat that resolved without treatment. Physical examination shows 1+ pitting edema of the lower legs and ankles. Urinalysis shows numerous RBCs and 3+ proteinuria. Her antistreptolysin O titer is elevated. ... | |
9906e85c-e17e-444c-9845-d2b05cf2b6b4 | Miosis | 3 | {
"1": "Ataxia",
"2": "Conjunctival injection",
"3": "Miosis",
"4": "Nystagmus"
} | A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The... | Ataxia | Conjunctival injection | Miosis | Nystagmus | 2 | A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The... | |
6cd22f7e-3b34-4b1d-85fd-a0671592a0f4 | Prominent occiput | 4 | {
"1": "Cleft palate",
"2": "Epicanthal folds",
"3": "Micropthlamia",
"4": "Prominent occiput"
} | A 38-year-old G4P3 presents to her obstetrician’s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but woul... | Cleft palate | Epicanthal folds | Micropthlamia | Prominent occiput | 3 | A 38-year-old G4P3 presents to her obstetrician’s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but woul... | |
90f1f951-8145-42ce-8ea2-77a35b748c3d | Olanzapine | 3 | {
"1": "Diphenhydramine",
"2": "Lorazepam",
"3": "Olanzapine",
"4": "Physical restraints"
} | An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is tal... | Diphenhydramine | Lorazepam | Olanzapine | Physical restraints | 2 | An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is tal... | |
5258d4de-a5fa-4a9b-82a8-04513792c76f | Increase in serum ACTH | 1 | {
"1": "Increase in serum ACTH",
"2": "Decrease in urinary 17-hydroxycorticosteroids",
"3": "Decrease in serum 11-deoxycortisol",
"4": "Increase in serum cortisol"
} | A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficienc... | Increase in serum ACTH | Decrease in urinary 17-hydroxycorticosteroids | Decrease in serum 11-deoxycortisol | Increase in serum cortisol | 0 | A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficienc... | |
baf80dc6-c693-44f5-92d6-decab161e99f | Lead-time bias | 4 | {
"1": "Observer-expectancy bias",
"2": "Length-time bias",
"3": "Surveillance bias",
"4": "Lead-time bias"
} | An investigator conducts a study to determine whether earlier detection of glioblastoma multiforme (GBM) in patients increases survival time. One subset of study participants consists of asymptomatic individuals who were diagnosed with GBM after undergoing a screening MRI of the brain. The other subset of study partici... | Observer-expectancy bias | Length-time bias | Surveillance bias | Lead-time bias | 3 | An investigator conducts a study to determine whether earlier detection of glioblastoma multiforme (GBM) in patients increases survival time. One subset of study participants consists of asymptomatic individuals who were diagnosed with GBM after undergoing a screening MRI of the brain. The other subset of study partici... | |
fa1e9d4a-3491-4a78-936d-e496e89dcea0 | Needle decompression | 4 | {
"1": "CT scan of the chest",
"2": "Bronchoscopy",
"3": "Emergency thoracotomy",
"4": "Needle decompression"
} | A 23-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On questioning by the paramedics, he reported severe chest pain and mild dyspnea. On arrival, he is confused and unable to provide a history. His pulse ... | CT scan of the chest | Bronchoscopy | Emergency thoracotomy | Needle decompression | 3 | A 23-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On questioning by the paramedics, he reported severe chest pain and mild dyspnea. On arrival, he is confused and unable to provide a history. His pulse ... | |
cb550398-547c-4eaf-afd9-0e093fa1e55a | 580 / (580 + 20) | 4 | {
"1": "580 / (20 + 590)",
"2": "580 / (10 + 580)",
"3": "590 / (590 + 10)",
"4": "580 / (580 + 20)"
} | A novel type of PET radiotracer is being developed to evaluate patients with Parkinson’s disease. A clinical research study has enrolled 1,200 patients, half of whom have the disease. The scan is found to be positive in 590 of the 600 patients with known PD, and positive in 20 of the 600 patients without PD. What is th... | 580 / (20 + 590) | 580 / (10 + 580) | 590 / (590 + 10) | 580 / (580 + 20) | 3 | A novel type of PET radiotracer is being developed to evaluate patients with Parkinson’s disease. A clinical research study has enrolled 1,200 patients, half of whom have the disease. The scan is found to be positive in 590 of the 600 patients with known PD, and positive in 20 of the 600 patients without PD. What is th... | |
94958fb3-3511-4574-85b1-6bc1af12d881 | Osteoarthritis | 3 | {
"1": "Ankylosing spondylitis",
"2": "Gout",
"3": "Osteoarthritis",
"4": "Fibromyalgia"
} | A 55-year-old man presents to a rheumatologist with bilateral wrist and knee pain that has been present for the last 10 years. The patient was a professional athlete who retired at age 50. He also notes morning stiffness in his joints that lasts approx. 50 minutes. He denies joint swelling, color changes in his digits,... | Ankylosing spondylitis | Gout | Osteoarthritis | Fibromyalgia | 2 | A 55-year-old man presents to a rheumatologist with bilateral wrist and knee pain that has been present for the last 10 years. The patient was a professional athlete who retired at age 50. He also notes morning stiffness in his joints that lasts approx. 50 minutes. He denies joint swelling, color changes in his digits,... | |
4f071295-eadd-461e-9338-589a324a8576 | Right-sided analgesia | 4 | {
"1": "Spastic paralysis at the level of lesion",
"2": "Right-sided Horner's syndrome",
"3": "Contralateral corticospinal tract involvement",
"4": "Right-sided analgesia"
} | A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respira... | Spastic paralysis at the level of lesion | Right-sided Horner's syndrome | Contralateral corticospinal tract involvement | Right-sided analgesia | 3 | A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respira... | |
1aeec493-71ab-4000-973d-966a2d890ccc | Chlamydia trachomatis infection | 3 | {
"1": "Neisseria gonorrhoeae infection",
"2": "Testicular tumor",
"3": "Chlamydia trachomatis infection",
"4": "Varicocele"
} | A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use... | Neisseria gonorrhoeae infection | Testicular tumor | Chlamydia trachomatis infection | Varicocele | 2 | A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use... | |
ac8c5e66-18e9-4206-8775-37babf026684 | Glanzmann’s thrombasthenia | 2 | {
"1": "Von Willebrand disease",
"2": "Glanzmann’s thrombasthenia",
"3": "Bernard-Soulier disease",
"4": "Scurvy"
} | A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He ... | Von Willebrand disease | Glanzmann’s thrombasthenia | Bernard-Soulier disease | Scurvy | 1 | A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He ... | |
9d1a685a-85de-47f9-a8f1-0d00ac2ea21e | Non-enveloped with linear, double-stranded DNA | 4 | {
"1": "Non-enveloped with linear, single-stranded DNA",
"2": "Non-enveloped with linear, single-stranded RNA",
"3": "Enveloped with linear, single-stranded RNA",
"4": "Non-enveloped with linear, double-stranded DNA"
} | A 6-year-old boy is brought to the physician by his mother because of a 2-day history of dysuria and increased urinary frequency. Vital signs are within normal limits. Urinalysis shows cloudy, red urine. This patient's clinical presentation is best explained by an infection with a virus with which of the following feat... | Non-enveloped with linear, single-stranded DNA | Non-enveloped with linear, single-stranded RNA | Enveloped with linear, single-stranded RNA | Non-enveloped with linear, double-stranded DNA | 3 | A 6-year-old boy is brought to the physician by his mother because of a 2-day history of dysuria and increased urinary frequency. Vital signs are within normal limits. Urinalysis shows cloudy, red urine. This patient's clinical presentation is best explained by an infection with a virus with which of the following feat... | |
56ea6d38-cba8-4018-aa11-f483fcc7b0bd | Glandular tissue enlargement | 2 | {
"1": "Klinefelter syndrome",
"2": "Glandular tissue enlargement",
"3": "Lipomastia (pseudogynecomastia)",
"4": "Testicular cancer"
} | A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a succes... | Klinefelter syndrome | Glandular tissue enlargement | Lipomastia (pseudogynecomastia) | Testicular cancer | 1 | A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a succes... | |
bc012ee9-7036-402e-96cf-c8eb71272c8f | Resistance to clotting factor degradation | 4 | {
"1": "Elevated serum homocysteine",
"2": "Thrombin inhibitor deficiency",
"3": "Auto-antibodies directed against phospholipids",
"4": "Resistance to clotting factor degradation"
} | A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affectin... | Elevated serum homocysteine | Thrombin inhibitor deficiency | Auto-antibodies directed against phospholipids | Resistance to clotting factor degradation | 3 | A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affectin... | |
338b0c1e-e272-43a7-91ba-27f15d2aa3e7 | Fluoxetine | 1 | {
"1": "Fluoxetine",
"2": "Aspirin",
"3": "Ventriculoperitoneal shunt",
"4": "Memantine"
} | A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open an... | Fluoxetine | Aspirin | Ventriculoperitoneal shunt | Memantine | 0 | A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open an... | |
5674aaec-cf0f-455f-b132-5d3abf69d948 | Seek a court order for neoadjuvant chemotherapy | 4 | {
"1": "Help the parents to arrange supportive care at home",
"2": "Refer the patient to another oncologist",
"3": "Recommend for parents to take 2 weeks to think about decision",
"4": "Seek a court order for neoadjuvant chemotherapy"
} | A previously healthy 18-month-old boy is brought to the physician by his parents for evaluation of an abdominal mass noticed a few days ago. He appears markedly pale and lethargic. Examination shows a 6-cm, nonmobile mass in the left upper quadrant that crosses the midline. 24-hour urine collection shows elevated homov... | Help the parents to arrange supportive care at home | Refer the patient to another oncologist | Recommend for parents to take 2 weeks to think about decision | Seek a court order for neoadjuvant chemotherapy | 3 | A previously healthy 18-month-old boy is brought to the physician by his parents for evaluation of an abdominal mass noticed a few days ago. He appears markedly pale and lethargic. Examination shows a 6-cm, nonmobile mass in the left upper quadrant that crosses the midline. 24-hour urine collection shows elevated homov... | |
3b90c044-41b6-4c5a-8a38-6b3d91e02c22 | The mischarged tRNA with valine will be incorporated in the codons that specificy for lysine | 2 | {
"1": "The ribosome will recognize the mischarged tRNA and prevent its incorporation by removing the valine",
"2": "The mischarged tRNA with valine will be incorporated in the codons that specificy for lysine",
"3": "The mischarged tRNA will be degraded by the proteasome",
"4": "The mischarged tRNA will be rem... | A laboratory primarily involved with studying cellular proofreading mechanisms is investigating the question of whether the ribosome can recognize a mischarged amino acid and still be incorporated into the growing peptide. In order to do so, they biochemically charge a Lys-tRNA with valine instead of lysine and insert ... | The ribosome will recognize the mischarged tRNA and prevent its incorporation by removing the valine | The mischarged tRNA with valine will be incorporated in the codons that specificy for lysine | The mischarged tRNA will be degraded by the proteasome | The mischarged tRNA will be removed by the lysyl-tRNA synthetase | 1 | A laboratory primarily involved with studying cellular proofreading mechanisms is investigating the question of whether the ribosome can recognize a mischarged amino acid and still be incorporated into the growing peptide. In order to do so, they biochemically charge a Lys-tRNA with valine instead of lysine and insert ... | |
a8240c19-4381-4415-8583-37271e7ea0b0 | Ketamine | 2 | {
"1": "Propofol",
"2": "Ketamine",
"3": "Fentanyl",
"4": "Midazolam"
} | A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor... | Propofol | Ketamine | Fentanyl | Midazolam | 1 | A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor... | |
3c625851-04ea-451c-8bea-f655e833e363 | Rotator cuff injury | 4 | {
"1": "Trauma",
"2": "Rheumatoid arthritis",
"3": "Osteoarthritis",
"4": "Rotator cuff injury"
} | A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He... | Trauma | Rheumatoid arthritis | Osteoarthritis | Rotator cuff injury | 3 | A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He... | |
92734893-6311-4d0d-bb68-10414f89187b | Erosion of tooth enamel | 3 | {
"1": "Malar rash",
"2": "Increased blood glucose level",
"3": "Erosion of tooth enamel",
"4": "Elevated estrogen levels"
} | A 17-year-old woman presents to your office concerned that she has not had her menstrual period in 4 months. She states that menses began at age of 13 and has been regular until two months ago. She denies sexual activity, and urine pregnancy test is negative. On exam, she appears well-nourished with a BMI of 21 kg/m^2,... | Malar rash | Increased blood glucose level | Erosion of tooth enamel | Elevated estrogen levels | 2 | A 17-year-old woman presents to your office concerned that she has not had her menstrual period in 4 months. She states that menses began at age of 13 and has been regular until two months ago. She denies sexual activity, and urine pregnancy test is negative. On exam, she appears well-nourished with a BMI of 21 kg/m^2,... | |
e3c38784-f0fb-4cde-a060-aa0c549f57a3 | Citalopram | 1 | {
"1": "Citalopram",
"2": "Lithium",
"3": "Propranolol",
"4": "Quetiapine"
} | A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout h... | Citalopram | Lithium | Propranolol | Quetiapine | 0 | A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout h... | |
25d3c3b1-e790-4e65-817a-f8abbaeab303 | Maternal diabetes | 3 | {
"1": "Maternal oligohydramnios",
"2": "Intrauterine alcohol exposure",
"3": "Maternal diabetes",
"4": "Chromosome 18 trisomy"
} | A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. Which of the following is the strongest predisposin... | Maternal oligohydramnios | Intrauterine alcohol exposure | Maternal diabetes | Chromosome 18 trisomy | 2 | A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. Which of the following is the strongest predisposin... | |
dcf460ed-78c2-4651-a3df-325d34f2efad | Effect modification | 4 | {
"1": "Poor generalizability",
"2": "Stratified sampling",
"3": "Random error",
"4": "Effect modification"
} | Please refer to the summary above to answer this question
The authors of the study have decided to conduct a follow-up analysis on their data. They decide to stratify their results by CD4+T-lymphocyte count at the time of diagnosis. Among patients with CD4+ cell counts below 200/mm3, cART adherence was a significant pr... | Poor generalizability | Stratified sampling | Random error | Effect modification | 3 | Please refer to the summary above to answer this question
The authors of the study have decided to conduct a follow-up analysis on their data. They decide to stratify their results by CD4+T-lymphocyte count at the time of diagnosis. Among patients with CD4+ cell counts below 200/mm3, cART adherence was a significant pr... | |
2bada9b6-7b82-4699-8fc5-6202ca8b3359 | IFN-gamma | 3 | {
"1": "IL-4",
"2": "TNF-alpha",
"3": "IFN-gamma",
"4": "Histamine"
} | During a Mycobacterium tuberculosis infection, Th1 cells secrete a factor capable of stimulating phagosome-lysosome fusion within macrophages. In addition, the secreted factors help activate macrophages to produce mediators such as NO, which are capable of destroying the invading pathogen. Furthermore, activation of th... | IL-4 | TNF-alpha | IFN-gamma | Histamine | 2 | During a Mycobacterium tuberculosis infection, Th1 cells secrete a factor capable of stimulating phagosome-lysosome fusion within macrophages. In addition, the secreted factors help activate macrophages to produce mediators such as NO, which are capable of destroying the invading pathogen. Furthermore, activation of th... | |
33384dd6-7732-46a1-87a1-490eb25c022a | Conversion of aminolevulinic acid to porphobilinogen | 3 | {
"1": "Conversion of ferrous iron to ferric iron",
"2": "Conversion of porphobilinogen to hydroxymethylbilane",
"3": "Conversion of aminolevulinic acid to porphobilinogen",
"4": "Conversion of uroporphyrinogen III to coproporphyrinogen III"
} | A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to hims... | Conversion of ferrous iron to ferric iron | Conversion of porphobilinogen to hydroxymethylbilane | Conversion of aminolevulinic acid to porphobilinogen | Conversion of uroporphyrinogen III to coproporphyrinogen III | 2 | A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to hims... | |
ecf615b8-f0b6-4463-a656-8958dada25a3 | Recall bias | 3 | {
"1": "Interviewer bias",
"2": "Latency period",
"3": "Recall bias",
"4": "Survival bias"
} | A group of researchers conducted a study to determine whether there is an association between folic acid supplementation before pregnancy and autism spectrum disorder (ASD) in offspring. The researchers retrospectively surveyed 200 mothers with children diagnosed with ASD during the first 4 years of life and 200 mother... | Interviewer bias | Latency period | Recall bias | Survival bias | 2 | A group of researchers conducted a study to determine whether there is an association between folic acid supplementation before pregnancy and autism spectrum disorder (ASD) in offspring. The researchers retrospectively surveyed 200 mothers with children diagnosed with ASD during the first 4 years of life and 200 mother... | |
8c4ea356-a894-44ce-9668-2e6d6c5a5f48 | Warfarin | 1 | {
"1": "Warfarin",
"2": "Enoxaparin",
"3": "Fondaparinux",
"4": "Apixaban"
} | A student studying pharmacology is a member of a team that is conducting research related to the elimination of multiple anticoagulant medications. His duty as a member of the team is to collect serum samples of the subjects every 4 hours and send them for analysis of serum drug levels. He is also supposed to collect, ... | Warfarin | Enoxaparin | Fondaparinux | Apixaban | 0 | A student studying pharmacology is a member of a team that is conducting research related to the elimination of multiple anticoagulant medications. His duty as a member of the team is to collect serum samples of the subjects every 4 hours and send them for analysis of serum drug levels. He is also supposed to collect, ... | |
486a9f19-5b4b-4b45-9569-170dffce7f72 | Chronic kidney failure | 2 | {
"1": "Acute kidney failure",
"2": "Chronic kidney failure",
"3": "Obstructive uropathy",
"4": "Renal cell carcinoma"
} | A 40-year-old woman presents to her primary care physician for a checkup. She has felt weaker lately and has lost some weight. She denies any urinary issues. Her BUN at her last visit 4 months ago was 45 mg/dL, and her creatinine was 2.0 mg/dL. Her laboratory studies this visit are seen below:
Hemoglobin: 8 g/dL
Hemat... | Acute kidney failure | Chronic kidney failure | Obstructive uropathy | Renal cell carcinoma | 1 | A 40-year-old woman presents to her primary care physician for a checkup. She has felt weaker lately and has lost some weight. She denies any urinary issues. Her BUN at her last visit 4 months ago was 45 mg/dL, and her creatinine was 2.0 mg/dL. Her laboratory studies this visit are seen below:
Hemoglobin: 8 g/dL
Hemat... | |
882fb7b4-541b-485b-8e68-abfe867d451d | Prostate cancer | 4 | {
"1": "Diabetes",
"2": "Parkinson disease",
"3": "Polycystic ovarian syndrome",
"4": "Prostate cancer"
} | A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family histo... | Diabetes | Parkinson disease | Polycystic ovarian syndrome | Prostate cancer | 3 | A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family histo... | |
d57ac981-ff80-4398-8f1c-3c7b5549c2cd | Cortical thinning with tubular atrophy | 3 | {
"1": "Glomerular crescents with macrophages",
"2": "Matrix expansion with mesangial proliferation",
"3": "Cortical thinning with tubular atrophy",
"4": "Thickened glomerular capillary loops"
} | A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. Histologic examination of a kidney biopsy ... | Glomerular crescents with macrophages | Matrix expansion with mesangial proliferation | Cortical thinning with tubular atrophy | Thickened glomerular capillary loops | 2 | A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. Histologic examination of a kidney biopsy ... |
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