id stringlengths 36 36 | question stringlengths 150 2.58k | choices listlengths 4 4 | correct_answer stringlengths 3 136 | correct_option stringclasses 4
values |
|---|---|---|---|---|
37474697-a091-4020-a6a8-8dd03fd5200b | A 6-year-old African American boy is referred to the hospital by his family physician for jaundice, normocytic anemia, and severe bone pain. He has a history of several episodes of mild bone pain in the past treated with over the counter analgesics. On physical examination, the child is icteric with nonspecific pain in... | [
"Sickle cell trait",
"Sickle cell disease",
"Hemoglobin F",
"HbC"
] | Sickle cell disease | B |
976572e5-514a-45db-94cc-37f6ca7f649e | A 28-year-old male presents with a recent onset of upsetting dreams, anxiety, and disturbing flashbacks. The patient reports that he returned from active duty in Iraq 3 months ago and was adjusting to life back at home until about 7 weeks ago when he began having intense fear of loud noises and seeing sudden flashbacks... | [
"Acute stress disorder",
"Performance anxiety",
"Posttraumatic stress disorder",
"Panic attack"
] | Posttraumatic stress disorder | C |
16f7f4cb-3ecf-433c-9569-d13134b3fe6b | A 66-year-old woman presents with urinary incontinence, difficulty urinating, incomplete voiding, and dull pain in the suprapubic region. She reports that she has not urinated for the past 2 days and that the urine leakage occurs during both day and night and is not associated with physical exertion. The medical histor... | [
"Installing a vaginal pessary",
"Bladder catheterization",
"Cystostomy",
"Prescribing prostaglandin E2"
] | Bladder catheterization | B |
9ca7e8ab-aa33-4683-a644-716aeeeef3bf | A 45-year-old woman presents with sudden-onset dyspnea. Her past medical history is significant for varicose veins in her lower extremities, well-controlled diabetes mellitus type 2, and a 25 pack-year smoking history. The patient currently takes metformin and pioglitazone. Family history is significant for her sister ... | [
"Distal peripheral microembolism",
"Necrotizing fasciitis",
"Protein S deficiency",
"Waldenström macroglobulinemia"
] | Protein S deficiency | C |
133eebcb-8578-4daa-a620-36c47a946539 | 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"
] | Biliary atresia | B |
f8424230-77bc-45b1-a856-0c2938264520 | A 65-year-old man presents to his primary care physician with a neck mass. He first noticed a firm mass on the anterior aspect of his neck approximately 4 months ago. The mass is painless and has not increased in size since then. He has also noticed occasional fatigue and has gained 10 pounds in the past 4 months despi... | [
"Diffuse infiltrate of lymphoid cells destroying thyroid follicles",
"Dense fibroinflammatory infiltrate",
"Pleomorphic undifferentiated infiltrative cells with necrosis",
"Stromal amyloid deposition"
] | Dense fibroinflammatory infiltrate | B |
81d384f1-f030-4e38-8bfd-4cea9e34c746 | A 42-year-old woman comes to the emergency department because of a 2-day history of right upper abdominal pain and nausea. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2. Her temperature is 38.5°C (101.3°F). Physical examination shows a distended abdomen and right upper quadrant tendernes... | [
"Autodigestion of pancreatic parenchyma",
"Fistula between the gallbladder and small intestine",
"Infection with a hepatotropic virus",
"Obstruction of the cystic duct"
] | Obstruction of the cystic duct | D |
d8368d5a-347a-4704-a77c-e7343f53924b | A 7-year-old woman presents shortly after her birthday with red scaly plaques over both ears. Her mother reports that the patient recently received a pair of fashionable silver earrings from her older sister as a birthday present. Physical examination is only significant for erythema and tenderness over the lobules of ... | [
"Type I–anaphylactic hypersensitivity reaction",
"Type III–immune complex-mediated hypersensitivity reaction",
"Type IV–cell-mediated (delayed) hypersensitivity reaction",
"Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions"
] | Type IV–cell-mediated (delayed) hypersensitivity reaction | C |
34d2b9ac-377e-47ed-98a6-02dca21dab4c | A 28-year-old woman presents to her primary care physician for evaluation of amenorrhea. Her last period occurred 4 months ago but she has not had sex in the last year and home pregnancy tests have come back negative. She first started having periods at age 13 and her periods have been unremarkable up until they stoppe... | [
"Inhibition of gonadotropin-releasing hormone release",
"Intrauterine scar tissue accumulation",
"Nondisjunction of chromosomes",
"Nutritional imbalance"
] | Inhibition of gonadotropin-releasing hormone release | A |
9f52a6b1-98b7-459a-90b9-2950e4ad1998 | A 44-year-old African-American woman comes to the physician for a routine examination. She is concerned about cancer because her uncle died of metastatic melanoma 1 year ago. She has no history of serious illness and does not take any medication. She has been working in a law firm for the past 20 years and travels to t... | [
"Desmoplastic",
"Nodular",
"Acral lentiginous",
"Superficial spreading"
] | Acral lentiginous | C |
9ac0dcaa-d511-4f50-abab-a7ac91daf3dc | A 59-year-old man comes to the emergency department because of excruciating left knee pain for 4 days. He underwent a total knee arthroplasty of his left knee joint 4 months ago. He has hypertension and osteoarthritis. Current medications include glucosamine, amlodipine, and meloxicam. His temperature is 38.1°C (100.6°... | [
"Staphylococcus epidermidis",
"Escherichia coli",
"Staphylococcus aureus",
"Pseudomonas aeruginosa"
] | Staphylococcus epidermidis | A |
9a7fcd22-d31a-4c41-8c8e-a4e72d01c7be | An 18-year-old male is brought in by fire rescue. The patient was an unrestrained passenger in a motor vehicle crash and was ejected from the vehicle after collision. Upon arrival to the trauma bay, the patient has a Glasgow coma scale (GCS) of 6. He is rapidly intubated, and vitals are a temperature of 99.5°F (37.5°C)... | [
"Air embolization",
"Tension pneumothorax",
"Disseminated intravascular coagulation",
"Coagulopathy of trauma"
] | Disseminated intravascular coagulation | C |
00473922-ec53-4ee5-ad09-77e8e3704bba | A 45-year-old woman is brought to the emergency department by her husband due to upper abdominal pain, nausea, and vomiting for the past couple of hours. She had similar episodes in the past, which were often precipitated by food but resolved spontaneously. Her temperature is 38.3°C (101.0°F), heart rate is 96/min, blo... | [
"Acute calculous cholecystitis",
"Acute acalculous cholecystitis",
"Acute pancreatitis",
"Ascending cholangitis"
] | Acute calculous cholecystitis | A |
11b8de14-8adf-447f-9872-a5cbc11f2f6b | 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"
] | Racemic epinephrine and intramuscular corticosteroid therapy | B |
35a328ba-aeff-450f-b622-6f81979aa3a7 | A 63-year-old patient presents to the emergency department because of severe left leg pain and tingling. His condition started suddenly 30 minutes ago. He has had hypertension for the past 10 years for which he takes bisoprolol. He does not smoke or drink alcohol. His temperature is 37.1°C (98.7°F), the blood pressure ... | [
"Vasculitis",
"Hyperhomocysteinemia",
"Arterial emboli",
"Arterial trauma"
] | Arterial emboli | C |
a3d8bdac-83af-43f0-bb40-98df3819a658 | A 25-year-old female with Hodgkin's lymphoma presents with a several day history of edema. Lab studies show:
Serum Na+: 140 mmol/L
Serum K+: 3.5 mmol/L
Serum albumin: 1.9 g/dL
Total serum bilirubin: 1.0 mg/dL
Serum creatinine: 1.2 mg/dL
Urinalysis shows 4+ proteinuria and fatty casts. What is the most likely diagnosi... | [
"Focal segmental glomerulosclerosis",
"Membranous nephropathy",
"Minimal change disease",
"Amyloidosis"
] | Minimal change disease | C |
09afde96-95bb-47d1-b5b3-ec8d0ff3dfb7 | A man is brought into the emergency department by the police department. The officer state that the man has been arrested multiple times for public alcohol intoxication, but recently became homeless. On exam, the man is behaving erratically. His vitals are all within normal limits. He appears confused and has a slurred... | [
"Ethanol",
"Naltrexone",
"Naloxone",
"Fomepizole"
] | Fomepizole | D |
5674aaec-cf0f-455f-b132-5d3abf69d948 | 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"
] | Seek a court order for neoadjuvant chemotherapy | D |
ac5dca49-ae57-45a1-88b4-194d33e1d3b0 | A 52-year-old man is brought to the emergency department because of worsening shortness of breath for 6 hours. For the past 5 days, he has had intermittent stabbing pain in the middle of his chest that worsens with lying down or taking deep breaths. He has also had a runny nose and a dry cough for the past 2 weeks. He ... | [
"Dilation of the atria and ventricles",
"Occlusion of a coronary artery",
"Accumulation of fluid in the pericardial space",
"Fibrous thickening of the pericardium"
] | Accumulation of fluid in the pericardial space | C |
4306df5c-fdd5-4eb5-b65d-53b8c0b90eb8 | A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regul... | [
"Deep venous thrombosis",
"Eruption of seborrheic keratoses",
"Increased bleeding",
"Osteoporosis"
] | Deep venous thrombosis | A |
af5801c4-ce07-493a-b73e-5646d2be7a58 | A 68-year-old woman is referred to the outpatient psychiatry clinic from the medical clinic. The patient is being treated for urge incontinence but is being referred for psychiatric evaluation to help with some of her old avoidance behavior. For the 3 months that she had her urinary symptoms, she avoided places like lo... | [
"She fears not being able to escape similar situations.",
"Her symptoms need to last for at least 1 month.",
"She requires only one fear or avoidance situation to meet criteria for this condition.",
"Patients may have accompanying social phobia."
] | She fears not being able to escape similar situations. | A |
3cb97e94-22f3-4061-b270-e54a7543487a | A 75-year-old man is admitted to the hospital because of a 3-day history of a productive cough and shortness of breath. His temperature is 38°C (100.4°F) and respirations are 32/min. Crackles are heard over the right upper and the entire left lung fields. Sputum culture confirms infection with Streptococcus pneumoniae.... | [
"Platelet activating factor",
"Interferon-gamma",
"Interleukin-10",
"Leukotriene D4"
] | Platelet activating factor | A |
6d42e037-66be-4501-a11a-c03562bb25ac | A 47-year-old man presents to the emergency department with fever, fatigue, and loss of appetite for 1 week, followed by right shoulder pain, generalized abdominal pain, and paroxysmal cough. He has had diabetes mellitus for 15 years, for which he takes metformin and gliclazide. His vital signs include a temperature of... | [
"Metronidazole and paromomycin",
"Cholecystectomy",
"Antibiotics and drainage",
"Endoscopic retrograde cholangiopancreatography (ERCP)"
] | Antibiotics and drainage | C |
f72819d2-6151-4704-a695-7721432f6114 | A 64-year-old male presents to his primary care physician with a complaint of bilateral knee pain that has been present for the past several years but has worsened recently. He reports pain with climbing stairs and with extended walks of greater than 100 yards. The pain worsens with activity throughout the day and is a... | [
"Complete blood count (CBC)",
"Erythrocyte sedimentation rate (ESR)",
"MRI of the knee",
"No further work-up needed"
] | No further work-up needed | D |
eeb5ddde-b2a8-4797-b7c0-25dcb5ba9a9e | A 67-year-old woman presents to her primary care physician for urinary incontinence. She has been waking up every morning with her underwear soaked in urine. She notices that at work if she does not take regular bathroom breaks her underwear will have some urine in it. She urinates 5 to 11 times per day but she claims ... | [
"Bethanechol and intermittent straight catheterization",
"Bethanechol during the day and oxybutynin at night",
"No recommendations needed",
"Reduce fluid intake and discontinue diuretics"
] | Bethanechol and intermittent straight catheterization | A |
8f46d133-1e1b-43ea-a5cc-67bfc4c87838 | A 37-year-old woman with an HIV infection comes to the physician for a follow-up examination. Six months ago, combined antiretroviral therapy consisting of dolutegravir, tenofovir, and emtricitabine was initiated. Laboratory studies show a decrease in the CD4 count and an increase in the viral load despite ongoing trea... | [
"Efavirenz",
"Ritonavir",
"Raltegravir",
"Lamivudine\n\""
] | Efavirenz | A |
2dbf4754-a455-4cde-a886-4e4315707a20 | A 55-year-old man comes to the physician because of a 6-week history of tingling pain in the sole of his right foot when he raises it above chest level during exercises. He reports that he started exercising regularly 2 months ago and that his right calf cramps when he uses the incline feature on the treadmill, forcing... | [
"Femoropopliteal artery stenosis",
"Acute thrombosis of right popliteal vein",
"Lumbar spinal stenosis",
"Aortoiliac artery stenosis\n\""
] | Femoropopliteal artery stenosis | A |
14a1ac13-4e5f-444e-aba1-1f1e94af4ce5 | A 61-year-old man presents to his primary care provider complaining of abdominal pain and constipation. He reports a 4-day history of steady right lower quadrant pain. He has had one small bowel movement in 4 days. Normally he has a bowel movement once a day. His medical history is notable for poorly controlled hyperte... | [
"Alpha-1-antitrypsin deficiency",
"Autosomal recessive polycystic kidney disorder",
"Ehlers-Danlos syndrome",
"Goodpasture syndrome"
] | Ehlers-Danlos syndrome | C |
2ae2e902-c147-4d5e-a8c2-dca196ac94d5 | A 42-year-old woman with a history of depression and headaches presents to the emergency room with severe, pulsating pain around the crown of her head beginning 12 hours ago. She last took ibuprofen 2 hours ago but did not feel any improvement in the pain. She has been nauseous and unable to get out of bed and is curre... | [
"No treatment necessary",
"100% oxygen",
"Propranolol",
"Sumatriptan"
] | Sumatriptan | D |
74917db3-03b8-4438-9f08-a9750e1cde6a | A 14-year-old girl is brought to the physician by her father because of fever, chills, abdominal pain, and profuse non-bloody diarrhea. Her symptoms began one week ago, when she had several days of low-grade fever and constipation. She returned from Indonesia 2 weeks ago, where she spent the summer with her grandparent... | [
"Giardia lamblia",
"Schistosoma mansoni",
"Salmonella typhi",
"Clostridium perfringens"
] | Salmonella typhi | C |
ce7d5e5e-6e88-4e5c-b9ad-da217d2c5deb | 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"
] | Levofloxacin | A |
7e8d8ff2-a400-4000-a492-4a32e0a06317 | A 31-year-old woman is brought to the emergency department with fever, right upper quadrant pain, and myalgia. Her boyfriend says she recently returned from a trip to Southeast Asia. She appears ill and is lethargic. Her temperature is 39°C (102.2°F). Physical examination shows jaundice and tender hepatomegaly. Laborat... | [
"Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei",
"Cystic spaces with scattered areas of cellular debris",
"Basophilic adipocyte remnants, filled with calcifications",
"Engorged hepatocytes with red blood cell infiltration\n\""
] | Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei | A |
904d6b56-16f7-464b-baf9-06c769f38569 | A 27-year-old male suddenly develops severe abdominal cramping and bloody diarrhea. The patient reports consuming undercooked ground beef four days prior to the onset of the symptoms. Which of the following best describes the toxin-mediated mechanism of this disease process? | [
"Depolymerization of actin filaments in gastrointestinal mucosal cells, leading to mucosal cell death",
"Increased pH of gastrointestinal lumen resulting in reduced mucosal absorption",
"Increased intracellular cAMP in gastrointestinal mucosal cells, resulting in decreased absorption and increased secretion in ... | Inhibition of the 60S ribosomal subunit, resulting in decreased protein synthesis in gastrointestinal mucosal cells | D |
a6412987-43d5-4282-aa4b-3573395c2d27 | A 65-year-old man, known to have chronic obstructive lung disease for the last 3 years, presents to the emergency department with a cough, breathing difficulty, and increased expectoration for a day. There is no history of fever. His regular medications include inhaled salmeterol and inhaled fluticasone propionate. He ... | [
"Oral prednisone",
"Supplemental oxygen",
"Montelukast",
"Nebulized N-acetylcysteine"
] | Oral prednisone | A |
a3d64d49-6f0e-4a21-b6d0-ad5663996105 | A 42-year-old man is brought to the emergency department because of a 2-day history of dyspnea, chest pain, and hemoptysis that were preceded by 4 days of myalgia and a low-grade fever. He is currently visiting the United States as a tourist from Turkey, where he works at a factory that processes sheep wool and hide. A... | [
"Glutamate capsule",
"Toxin B",
"IgA protease",
"Sulfatides"
] | Glutamate capsule | A |
18201d6b-93e2-442f-9880-ea704f059a95 | An experimental new drug in the treatment of diabetes mellitus type 2 was found to increase the levels of incretins by preventing their degradation at the endothelium. This further increased glucose-dependent insulin production. Which of the following drugs has a mechanism of action most similar to this new experimenta... | [
"Sitagliptin",
"Glimepiride",
"Canagliflozin",
"Pioglitazone"
] | Sitagliptin | A |
28e46118-fe25-4865-b9ab-06544d88d73c | A 62-year-old woman presents to the emergency department for vision changes. About 90 minutes ago she was on the couch watching television with her husband when she suddenly noticed that she couldn't see the screen normally. She also felt a little dizzy. She has never had anything like this happen before. Her general p... | [
"Internal carotid artery",
"Anterior cerebral artery",
"Posterior cerebral artery",
"Basilar artery"
] | Posterior cerebral artery | C |
a28a1709-9153-4835-a9e2-4ebf50bf57ee | A 65-year-old man presents with left-sided numbness, diplopia, and blurring of vision. The diplopia is more prominent on his left-side lateral gaze. He denies having fever, headache, ocular pain, lacrimation, changes in color vision, or limb weakness. He has a past medical history of type-2 diabetes mellitus, hypertens... | [
"Cavernous sinus",
"Corticospinal tract before pyramidal decussation",
"Frontal eye field",
"Medial longitudinal fasciculus"
] | Medial longitudinal fasciculus | D |
98b9e582-040f-42b7-b6ae-29eb93081bf8 | A 27-year-old woman, gravida 1, para 0, at 38 weeks' gestation is admitted to the hospital for active labor. The pregnancy was complicated by gestational diabetes and fetal weight is estimated to be at the 90th percentile for gestational age. During delivery, there is an arrest in the second stage of labor, and a vacuu... | [
"Urge incontinence",
"Vesicovaginal fistula",
"Fecal incontinence",
"Stress incontinence"
] | Fecal incontinence | C |
69002be2-fc83-46f4-99e4-0d45d65470fc | A 4-year-old boy is brought to his primary care physician for a physical prior to beginning a preschool program. He is found to be delayed in reaching normal childhood cognitive and social milestones, which is consistent with observations at previous check-ups. Physically, he is also found to be significantly overweigh... | [
"D cells",
"G cells",
"P/D1 cells",
"L cells"
] | P/D1 cells | C |
a8240c19-4381-4415-8583-37271e7ea0b0 | 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"
] | Ketamine | B |
574bbe62-f46f-47ae-83ce-21822a73ab27 | 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"
] | Inhibition of beta-tubulin polymerization | A |
9fec6473-c91b-4b77-b7ab-1f1952fed5cc | A clinical trial is conducted to test the efficacy of a new drug, A, to treat tinea versicolor. A total of 500 participants are recruited for the study and are randomized into 2 groups in equal numbers. Group 1, the study treatment group, is given drug A, while group 2, the control group, is given the current standard ... | [
"25/250",
"250/25",
"190/250",
"355/500"
] | 250/25 | B |
1aeec493-71ab-4000-973d-966a2d890ccc | 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"
] | Chlamydia trachomatis infection | C |
29c472f2-1a25-4bfb-8663-4d50a1417df7 | A 25-year-old man presents to his primary care provider complaining of several weeks of intense itching, particularly localized around his anus. Of note, the patient denies any recent travel, sexual contacts, fever, dysuria, or diarrhea. His temperature is 98.1°F (36.7°C), blood pressure is 110/70 mmHg, pulse is 65/min... | [
"Amphotericin B",
"Ivermectin",
"Praziquantel",
"Pyrantel pamoate"
] | Pyrantel pamoate | D |
f41482dd-3261-45fe-bfde-1380b38001d9 | An 89-year-old woman sees her neurologist for a follow-up evaluation. Three months ago, she presented with complaints about facial asymmetry. Her daughter has noticed that her mother’s mouth is droops downwards on the right side of her face and that she cannot close her right eye well. The same side also lacks wrinkles... | [
"Botox",
"Carbamazepine",
"Methylprednisolone",
"Ceftriaxone"
] | Botox | A |
6cd22f7e-3b34-4b1d-85fd-a0671592a0f4 | 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"
] | Prominent occiput | D |
ba0279c6-c0cc-4f92-8ac3-70c37042ed8f | 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"
] | Increased PTH, decreased calcium, increased phosphate, decreased calcitriol | A |
9ced8467-1e7c-4113-8d31-aca107ffed07 | 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"
] | Decreased acetylcholine release | A |
50a0b5ae-99a7-48dd-9134-391e3cee8eb1 | A 35-year-old woman comes to the physician for sleeping problems and the inability to concentrate for 3 months. She says she is worried because she and her husband have been trying to conceive for more than a year with no success. Conception by in vitro fertilization was attempted once 3 months ago but was unsuccessful... | [
"Pelvic inflammatory disease",
"Diminished ovarian reserve",
"Hypogonadotropic hypogonadism",
"Premature ovarian failure"
] | Diminished ovarian reserve | B |
ae71e680-fdc8-4d97-972f-ec5bc9997265 | A 60-year-old woman is brought to the clinic by her daughter for evaluation. The daughter reports that her mother has recently been having difficulty combing her hair in the mornings. The patient’s family history is significant for an ischemic stroke in her father. The patient’s past medical history is positive for div... | [
"Jaw claudication",
"Heliotrope rash",
"Gastroesophageal reflux",
"Pink plaques with silvery scales"
] | Jaw claudication | A |
42d00daf-cf7b-43c9-a462-a29e04227fdd | A 3-year-old boy is brought to the emergency department by ambulance after a motor vehicle accident. He is unconscious upon arrival and is found to have severe internal bleeding due to trauma. He is taken for emergency surgery and severely damaged tissues are removed. After surgery, the boy is taken into the PICU for r... | [
"30S ribosome inhibitor",
"50S ribosome inhibitor",
"Cell wall cross-linking inhibitor",
"DNA gyrase inhibitor"
] | Cell wall cross-linking inhibitor | C |
891f8387-286a-413f-b446-f7d769a42e0a | A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation presents to the emergency department for clear vaginal discharge that started roughly 26 hours ago. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of any serious illnesses. She does not drink a... | [
"Administer ampicillin and perform amnioinfusion",
"Administer ampicillin and progesterone",
"Administer betamethasone, ampicillin, and proceed with cesarean section",
"Administer betamethasone, ampicillin, and proceed with induction of labor"
] | Administer betamethasone, ampicillin, and proceed with cesarean section | C |
b0b112e1-920a-4071-a675-d4d256f7cedb | A 72-year-old Caucasian male presents to your office with dysphagia and halitosis. If this patient is also found to have cricopharyngeal muscle dysfunction, which of the following is the most likely cause of his presenting symptoms? | [
"Gastroesophageal reflux disease",
"Esophageal candidiasis",
"Meckel's diverticulum",
"Zenker's diverticulum"
] | Zenker's diverticulum | D |
fa919aa4-66c3-4a99-99f1-548b4aa734c9 | A 60-year-old woman presents to a physician for worsening shortness of breath and increasing abdominal distention over the last 3 months. She says that the shortness of breath is worse on exertion and improves with rest. While she could previously walk to the nearby store for her groceries, she now has to drive because... | [
"Binding to the alpha subunit of the insulin receptor",
"Closure of ATP-sensitive K-channels in the pancreatic beta-cell",
"Increased gene expression of GLUT-4",
"Glucagon-like peptide-1 receptor agonist"
] | Increased gene expression of GLUT-4 | C |
7642b5a4-fcfe-4426-8f91-8c57f78eb3a0 | A 39-year-old woman, with a history of thyroidectomy and primary hyperparathyroidism presents for surgical evaluation for a right adrenal mass. Preoperatively, which of the following medications should she receive to prevent a hypertensive emergency intraoperatively? | [
"Atenolol",
"Labetolol",
"Nifedipine",
"Phenoxybenzamine"
] | Phenoxybenzamine | D |
d63658bd-5859-4724-a1b3-ab62d5b2142a | A 36-year-old recent immigrant from India presents with a face similar to that seen in the image A. Examination of his face reveals skin that is thick and contains many lesions. The patient complains that he has experienced a loss of sensation in his toes and fingertips, which has caused him to injure himself often. Bi... | [
"Acid-fast",
"Catalase-negative",
"Thermophiles",
"Tennis-racket shaped"
] | Acid-fast | A |
3565291d-18a0-4b82-8a9b-76fbb6a7a999 | A 60-year-old man presents to his local walk-in clinic with 1 week of fever, chills, night sweats, anorexia, malaise, progressive shortness of breath, and sharp chest pain. He is found with a blood pressure of 100/80 mm Hg, a heart rate of 84/min, an elevated respiratory rate, and a holosystolic heart murmur III/VI. Hi... | [
"Staphylococcus aureus",
"Escherichia coli",
"Haemophilus aphrophilus",
"Streptococcus bovis"
] | Streptococcus bovis | D |
7383a72e-47d2-441c-9d44-bb103dc4b70b | A 1-month-old girl is brought to the pediatrician by her parents. They are concerned that she becomes lethargic and irritated between meals. They found that feeding her often with small servings helps. She was born at 39 weeks via spontaneous vaginal delivery and is meeting all developmental milestones. Her mother has ... | [
"Alanine",
"Adenosine monophosphate",
"Fructose 1,6-bisphosphate",
"Fructose 2,6-bisphosphate"
] | Alanine | A |
f9e698d7-223c-45f9-a741-2454d7dae03d | A 7-year-old girl is brought to the emergency department with a 10-day history of fever and sore throat that acutely worsened over the past 2 days. Her sore throat is worse on the right side. She has difficulty swallowing and opening her mouth due to pain. She has also noticed a change in the quality of her voice over ... | [
"Intravenous dexamethasone therapy",
"Incision and drainage with intravenous ampicillin-sulbactam therapy",
"Needle aspiration and oral clindamycin therapy",
"Intravenous ampicillin-sulbactam therapy"
] | Incision and drainage with intravenous ampicillin-sulbactam therapy | B |
bcbb3f00-c2c7-4f46-a49f-bc6d08c4cf7b | A researcher is testing an unknown compound, X, and seeing the effect it has on renal function. When she applies compound X to the cells, she finds that the urinary concentration of sodium and the pH decreases while the urinary potassium increases. Which of the following correctly states:
1) the cells of the kidney thi... | [
"Distal convoluted tubule; atrial natriuretic peptide",
"Distal convoluted tubule; hydrochlorothiazide",
"Principal cells; aldosterone",
"Principal cells; spironolactone"
] | Principal cells; aldosterone | C |
fca5c709-5aeb-4052-9178-5c25429de197 | A 33-year-old man presents to the emergency department with altered mental status. He was at work as a construction worker when his coworkers found him down at the work site. The patient recently underwent anesthesia for an appendectomy several months ago. He also has a past medical history of schizophrenia well contro... | [
"Exertional heat stroke",
"Malignant hyperthermia",
"Neuroleptic malignant syndrome",
"Thyroid storm"
] | Exertional heat stroke | A |
8ff029c3-638b-49ad-a8dd-1f6786a5aa29 | 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"
] | TSC1 gene on chromosome 9 | C |
54098c80-8945-4c1e-baeb-0fe73fb53cca | A 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and ‘bruising on his feet’. The patient states that his symptoms started about a week ago and have steadily worsened. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the um... | [
"Discharge with clinical surveillance and ultrasound every 6 months",
"Elective endovascular repair",
"Elective open surgical repair",
"Emergency open surgical repair"
] | Emergency open surgical repair | D |
90fdda9b-6c9a-447a-8e99-75707bf33e76 | A previously healthy 46-year-old woman comes to the physician because of progressive shortness of breath, fatigue, and chest pain during exercise for the last 6 months. She does not smoke. Her maternal uncle had similar symptoms. Cardiac examination shows wide splitting of S2. The second component of S2 is loud and bes... | [
"Increased right ventricular preload",
"Increased left ventricular preload",
"Increased right ventricular afterload",
"Increased left-to-right shunting"
] | Increased right ventricular afterload | C |
5dc371fc-e851-4c94-8f4e-86ba9c03bbae | A 70-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 3 years. Initially, he used to forget his children's names or forget to lock the house door. During the past year, he has gotten lost twice while returning from the grocery store and was unable to tell passer... | [
"γ-aminobutyric acid",
"Acetylcholine",
"Dopamine",
"Glutamate"
] | Acetylcholine | B |
a86f29bf-baee-4e94-9ddb-2d1607866305 | 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"
] | Natural killer cells | C |
311ff64f-2dbe-4570-8a23-54fc822cf287 | A 17-year-old girl is brought to the pediatrician by her father for evaluation. He is concerned that she has not undergone puberty yet, while all of her classmates at school have. The patient herself feels well overall, with no specific complaints. Examination shows vital signs of T 98.9, HR 71, and BP 137/92. The phys... | [
"Aromatase enzyme deficiency",
"Hypokalemia",
"XY karyotype",
"Hypercortisolism"
] | Hypokalemia | B |
fcb176c9-3789-4330-b506-67a7a82fe411 | A 21-year-old female presents to the office after a health screening in which she was found to have high blood pressure. At the office, the blood pressure is 168/114 mm Hg. You have seen the patient in the past for amenorrhea and infertility issues, but she denies taking any medication at this time. On examination, the... | [
"Central fusion of the inferior poles of the kidneys ",
"Genetic predisposition to essential hypertension",
"Neuroendocrine tumor of the adrenal gland",
"Oral contraceptive use"
] | Central fusion of the inferior poles of the kidneys | A |
10f251b0-12a6-40ef-88ad-378598d030c2 | 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"
] | Aromatic amines | B |
d0971fa8-b8d5-4d62-b2a6-df1ace0dee4b | A post-mortem lung examination of a 68-year-old male overweight male with evidence of chronic lower extremity edema, a 60 pack-year smoking history and daily productive cough would be most likely to reveal: | [
"Hypereosinophilia",
"Reid Index > 50%",
"Non-caseating granulomas",
"Evidence of a necrotizing infection"
] | Reid Index > 50% | B |
651fb354-32bf-492e-9db1-45e02b83fd0a | A 6-month-old boy presents to a pediatrician for the evaluation of recurrent bacterial infections. He has a history of a variety of bacterial infections since birth. Physical examination reveals light-colored skin with silver-colored hair. The pediatrician suspects an immunodeficiency disorder and decides to order seve... | [
"Acquired immunodeficiency syndrome (AIDS)",
"Common variable immunodeficiency",
"Chediak-Higashi syndrome",
"Leukocyte adhesion deficiency–1"
] | Chediak-Higashi syndrome | C |
bd59ffc9-5649-4976-9cc2-147c2ca9381d | A 30-year-old female presents to her primary care provider complaining of 4 days of fever, malaise, dyspnea, and productive cough and has recently developed pleuritic chest pain. Her past medical history is notable for asthma and takes albuterol as needed. She does not smoke but drinks alcohol socially. Her family hist... | [
"Random assortment",
"Random nucleotide addition",
"VDJ recombination",
"Isotype switching"
] | Isotype switching | D |
2b4d5437-3aa5-4582-8637-6aac32f197c0 | A 77-year-old woman presents to the emergency room with the complaints of fever, malaise, and night sweats. She recently observed an enlargement of her axillary lymph nodes, which she examines on a weekly basis. She has a remote history of breast cancer in her 60s that was treated with radiation and chemotherapy. She a... | [
"Travel to Africa",
"Axillary lymph node involvement",
"Previous radiation therapy",
"Previous breast cancer"
] | Previous radiation therapy | C |
e06f4acf-18f2-4f10-a851-01a44aa85ce7 | A 40-year-old woman comes to the physician because of a 6-month history of difficulty sleeping and fatigue. Menses occur at irregular 35- to 50-day intervals and last 3–7 days. Her last menstrual period was 5 weeks ago. She has had an unintentional 10-kg (22-lb) weight gain over this period. She also reports decreased ... | [
"Adrenalectomy",
"Polychemotherapy and radiation therapy",
"Transsphenoidal hypophysectomy",
"Partial nephrectomy"
] | Adrenalectomy | A |
5432f150-06a0-4d47-a8e6-fc15eb74ed40 | A previously healthy 2-year-old boy is brought to the physician because of a 10-day history of unsteady gait, frequent falls, and twitching of the extremities. Physical examination shows bilateral saccadic eye movement in all directions and brief, involuntary muscle contractions of the trunk and limbs. There is an ill-... | [
"Numerous immature lymphocytes in a starry sky pattern",
"Abortive glomeruli and tubules in a spindle cell stroma",
"Small blue cells arranged in rosettes around a central neuropil",
"Hepatocytes in fetal and embryonic stages of differentiation"
] | Small blue cells arranged in rosettes around a central neuropil | C |
7ea68890-678c-422f-84e5-bf7cb1a002a0 | A 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and ‘heartburn’, which he states have become more troublesome over the past year. His past medical history is significant for hypertension and GERD. He takes lisinopril for hypertension and has failed multiple different therapies for... | [
"Lifestyle modification",
"Combined antacid therapy",
"Continue on Omeprazole",
"Surgical gastropexy"
] | Surgical gastropexy | D |
93fba59c-f7f1-40a9-ac25-8d095ed2a813 | A 29-year-old man is referred by his marriage counselor to the outpatient psychiatry clinic. The patient’s wife is with him and states that her husband is always complaining and critical of others. He was recently fired from his job to which he claims that his boss was jealous of his hard work. He also does not trust h... | [
"Schizotypal personality disorder",
"Obsessive-compulsive personality disorder",
"Antisocial personality disorder",
"Personality disorder not otherwise specified"
] | Schizotypal personality disorder | A |
74d7e20a-21ab-4f08-8933-dd1960fbc90f | A 56-year-old man is brought to the emergency room after a motor vehicle accident. The patient’s vitals are as follows: blood pressure 80/40 mm Hg, heart rate 111/min, respiratory rate 39/min, and temperature 37.1°C (98.8℉). On physical examination, the patient is unconscious with a GCS of 9/15 and is cyanotic. There a... | [
"The patient’s closest relatives (spouse, child or parent), who must be brought to the hospital as fast as possible",
"One of the witnesses at the scene of the car accident, who should be brought to the hospital as fast as possible",
"The hospital ethics committee",
"Informed consent is not needed in this cas... | Informed consent is not needed in this case | D |
1276ba97-827e-49e6-be6e-c3cdd4520343 | A 47-year-old woman is brought to the emergency department by paramedics. She was found unconscious on a park bench by a bystander. Her history is unobtainable. Vitals include a pulse of 64/min, a respiratory rate of 7/min, and a blood pressure of 110/70 mm Hg. On examination, the patient is unresponsive to voice and t... | [
"Diabetic ketoacidosis",
"Diuretic overdose",
"Hyperventilation",
"Opioid overdose"
] | Opioid overdose | D |
c97f50ef-0641-4760-b4d9-f30aa2f07b1a | An immunology expert is delivering a talk on innate immunity. While talking about inflammasomes, he describes the process via an example: products of cellular stress are detected by NLRP3, which includes NOD-, LRR-, and pyrin domain-containing 3; the latter interacts with apoptosis-associated speck-like protein contain... | [
"Adenosine deaminase",
"Caspase 1",
"Protein phosphatase",
"Tyrosine kinase"
] | Caspase 1 | B |
937c04e2-1ab3-4599-96c5-5b6f4b1952cb | A researcher evaluates healthy breast tissue from 100 women, 50 women that were pregnant at the time of the study and 50 age-matched non-pregnant women. The breast tissue in pregnant women contained an increased number of acinar glands with epithelial proliferation compared to the non-pregnant women. Which process caus... | [
"Hyperplasia",
"Hypertrophy",
"Atrophy",
"Metaplasia"
] | Hyperplasia | A |
d6b4752c-47c9-4eb6-a6f9-fe533a2b49fe | A 60-year-old man comes to the physician for a routine physical examination. He lives in a group home and takes no medications. During the appointment, he frequently repeats the same information and needs to be reminded why he is at the doctor's office. He says that he is a famous poet and recently had a poem published... | [
"Consumption of undercooked meat",
"Chronic hypertension",
"Alcohol use disorder",
"Spirochete infection"
] | Alcohol use disorder | C |
b029c0fe-919a-4455-86aa-90ce9dadc624 | 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"
] | Mixing study | A |
6a02da61-0ee5-49a4-ac1b-8503738d8526 | An 8-year-old boy is brought to the physician because he has excessively dry skin. His mother says that he has had dry, scaly skin since he was 6 months old. She says it is worse in winter and better in summer. There is no associated itching, redness, or discharge. Examination reveals generalized fine scales with coars... | [
"Psoriasis",
"Lichen simplex",
"Ichthyosis vulgaris",
"Pityriasis versicolor"
] | Ichthyosis vulgaris | C |
81f25cca-df57-489f-a8e7-e5df0554f2ad | A 27-year-old graduate student is bitten by a coral snake while he was hiking alone through the woods and dies 2 hours later from respiratory failure. His body was discovered 7 hours later by a group of campers who promptly called the police. On arrival, the police found his body to be cold and stiff. Which of the foll... | [
"Activation of muscle contraction by neurotoxins",
"Effect of low temperature on muscle proteins",
"Inhibition of cross-bridge cycling",
"Depletion of intracellular calcium"
] | Inhibition of cross-bridge cycling | C |
20f79418-bd13-416e-8dfc-5ad06c311be5 | A 55-year-old man presents with bloody nasal secretions and shortness of breath. He reports he has lost 4 kg (8.8 lb) in the last two months with no changes in his diet. He has also been suffering from mild to moderate joint pain in the left knee for the last year. His past medical history is unremarkable. His vitals i... | [
"Anti-citrullinated protein antibodies",
"Erythrocyte sedimentation rate",
"Anti-histone bodies",
"Antineutrophil cytoplasmic antibodies"
] | Antineutrophil cytoplasmic antibodies | D |
7c6b42ba-18cf-46fb-8655-688f949d5b10 | A previously healthy 18-year-old army recruit is brought to a military treatment facility because of a 3-week history of right foot pain. He recently started basic infantry training and has been running several kilometers daily. Initially, the pain only occurred while running, but now it is also present at rest. The pa... | [
"Rest and acetaminophen",
"Ultrasonography",
"Technetium bone scan",
"Internal fixation"
] | Rest and acetaminophen | A |
f7ca95cd-0aaf-4e28-8f22-acaf160aac0a | A 27-year-old male presents to the psychiatrist requesting help with his compulsions as they are interfering with his life. He explains that he has this fear that something terrible will happen to his house if he does not check every appliance, outlet, window and door lock, faucet, and light fixture before he leaves. H... | [
"Decreases the degradation of norepinephrine and serotonin",
"Increases the release of norepinephrine and serotonin by alpha 2 receptor antagonism",
"Blocks only norepinephrine reuptake",
"Blocks reuptake of norepinephrine and serotonin"
] | Blocks reuptake of norepinephrine and serotonin | D |
523b1338-211d-4d69-b5ff-94347cb7962f | A 19-year-old man is brought to the emergency department because of severe right shoulder pain and inability to move the shoulder after a fall while climbing outdoors. Examination shows the right upper extremity is externally rotated and slightly abducted. There is loss of the the normal rounded appearance of the shoul... | [
"Medial aspect of the upper arm",
"Lateral aspect of the shoulder",
"Skin above the clavicle",
"Dorsal aspect of forearm and hand"
] | Lateral aspect of the shoulder | B |
4e643852-59f0-47ad-b2ce-30dc530ce309 | A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph is shown. He has had diabetes mellitus for 2 years which is not well controlled with medications. Lab studies show a transferrin sat... | [
"Deposition of urate crystals",
"Deposition of calcium pyrophosphate (CPP) crystals",
"Inflammatory rheumatological syndrome",
"Pathogenic inoculation of microbes"
] | Deposition of calcium pyrophosphate (CPP) crystals | B |
2cb87c66-2da2-4aa0-8d57-dc8953e52427 | A 52-year-old man is brought to the emergency department for recurrent vomiting that began 5 hours ago. He describes the vomitus as bloody and containing black specks. He drinks 10–12 beers daily and has not seen a physician in 15 years. He appears pale. His temperature is 36.7°C (98.1°F), pulse is 122/min, and blood p... | [
"Systemic vascular resistance",
"Fractional tissue oxygen extraction",
"Carotid baroreceptor firing activity",
"Cardiac inotropy"
] | Carotid baroreceptor firing activity | C |
21ca8dee-90a2-4a88-a9ed-5f99f41cfe53 | A 62-year-old man is brought to his primary care physician by his wife who is concerned about the patient's frequent falls. Approximately 6 months ago, she started noticing that he was walking more slowly than usual. He has fallen more than 6 times in the past month, and she is worried that he will sustain a serious in... | [
"Accumulations of beta-pleated sheets",
"Atrophy of the caudate nucleus",
"Intracellular inclusions of alpha-synuclein",
"Intracellular inclusions of hyperphosphorylated tau"
] | Intracellular inclusions of alpha-synuclein | C |
4b35bece-dd78-47bf-8bdb-75ca244369c5 | A 35-year-old man returns to the clinic to follow up for his chronic stomach pain. At the last visit a few months ago, he explained that he had been experiencing discomfort in his upper abdomen for awhile. He had never vomited up any blood and had not had any substantial weight loss. He did not take any medications, di... | [
"Gastroesophgeal sphincter dysfunction",
"Nonsteroidal anti-inflammatory drugs",
"Heliobacter pylori infection",
"Excessive gastrin"
] | Heliobacter pylori infection | C |
4d26c6ee-d43c-45b4-b571-ebe10111df6e | A 41-year-old man presents to his primary care provider with abdominal pain. He says that the pain “comes and goes” throughout the day and usually lasts 20-30 minutes per episode. He can point to the spot 1-2 inches above the umbilicus where he feels the pain. He denies any feeling of regurgitation or nighttime cough b... | [
"Mucosal defect in the stomach",
"Urease-producing organism in the small intestine",
"PAS-positive material in the small intestine",
"Crypt abscesses in the large intestine"
] | Urease-producing organism in the small intestine | B |
ba4f8678-f1f9-4d31-a22e-227c99bebb16 | A 10-year-old boy is brought to the emergency room by his grandparents. He is in a wheelchair with soft restraints because he has been violent and had been trying to hurt himself that day. The child’s parents died in a car accident 1 month ago. His grandparents also brought the medications he stopped taking after his p... | [
"Hypoxanthine-guanine phosphoribosyl transferase of the pyrimidine metabolism pathway",
"Aminolevulinic acid synthetase of the heme metabolism pathway",
"Hypoxanthine-guanine phosphoribosyl transferase of the purine metabolism pathway",
"Thymidylate synthetase of the pyrimidine metabolism pathway"
] | Hypoxanthine-guanine phosphoribosyl transferase of the purine metabolism pathway | C |
7ed939c7-ac4a-4f3b-b1bd-ce0b3338621f | A 32-year-old woman presents to the emergency department with complaints of a headache. The last menstrual period was 4 months ago. She also reports having a mild headache for 1 month. There has been a grape-like mass protruding from her vagina for the last 15 days. On examination, the fundus of the uterus is at the le... | [
"69XXY",
"23XX",
"47XYY",
"46XX"
] | 46XX | D |
04d42ccd-571e-49bb-808e-7c7f363f1c01 | A 24-year-old man, who recently migrated from a developing country, presents to a physician because of a 2-year history of cough, blood in his sputum, fever, and weight loss. His sputum smear and culture confirm the diagnosis of pulmonary tuberculosis due to Mycobacterium tuberculosis. His Mantoux test is 2 mm × 3 mm, ... | [
"Stop antiretroviral therapy and continue antitubercular therapy",
"Change antitubercular therapy to isoniazid-rifampin-pyrazinamide-ethambutol-streptomycin",
"Change antitubercular therapy to isoniazid-rifampin-ethambutol-streptomycin",
"Continue antitubercular therapy and antiretroviral therapy without any ... | Continue antitubercular therapy and antiretroviral therapy without any change | D |
fd44f546-3d88-43ba-b888-12d4631ca40e | A healthy 23-year-old male is undergoing an exercise stress test as part of his physiology class. If blood were to be sampled at different locations before and after the stress test, which area of the body would contain the lowest oxygen content at both time points? | [
"Inferior vena cava",
"Coronary sinus",
"Pulmonary artery",
"Pulmonary vein"
] | Coronary sinus | B |
f3385312-6aa6-4b23-825d-79476aa36bf1 | A 61-year-old man presents to the clinic with complaints of excessive thirst, frequent urination, and partial visual loss in both eyes for 1 day. His family history is significant for type 2 diabetes mellitus in his mother and cousin. His weight is 112 kg ( 246.9 lb), height 187 cm (6 ft 1 in), blood pressure: 150/90 m... | [
"There is a disruption of primary active transport of glucose in the proximal renal tubules",
"Secondary active transporters fail to completely reabsorb glucose in the renal tubules",
"There is a disruption of passive transport of the glucose in the proximal renal tubules",
"Glucosuria results from increased ... | Secondary active transporters fail to completely reabsorb glucose in the renal tubules | B |
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