question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
values | answer_idx stringclasses 5
values |
|---|---|---|---|---|
A 65-year-old man presents with a 6-month history of repeated falls, postural dizziness, progressive fatigue, generalized weakness and a 13.6 kg (30 lb) weight loss. He is a vegetarian. The patient’s family says that he had been high functioning but has had significant behavioral changes over the past year. The patient... | Vitamin B12 deficiency | {
"A": "Hypothyroidism",
"B": "Folate deficiency",
"C": "Vitamin B12 deficiency",
"D": "Parvovirus infection",
"E": "Pernicious anemia"
} | step2&3 | C |
A 42-year-old man presents to establish care with a family physician after having progressively worsening back pain. He has recently migrated from Sweden and has not had any checkups in the last 3 years. He first started having back pain 3 years ago, but his pain has begun to be excruciating in the mornings. He is no l... | Testing for serum ESR and autoantibodies | {
"A": "Testing for serum Ca and PTH",
"B": "Calcium and Vitamin D prescription",
"C": "Testing for serum ESR and autoantibodies",
"D": "Testing for serum ferritin",
"E": "Synovial fluid aspiration"
} | step2&3 | C |
A previously healthy 28-year-old man comes to the emergency department because of dizziness and palpitations for 2 days. Prior to the onset of the symptoms, he attended a bachelor party where he lost several drinking games. An ECG is shown. Which of the following is the most likely diagnosis? | Paroxysmal atrial fibrillation | {
"A": "Hypertrophic obstructive cardiomoyopathy",
"B": "Paroxysmal atrial fibrillation",
"C": "Brugada syndrome",
"D": "Ventricular tachycardia",
"E": "Sick sinus syndrome"
} | step1 | B |
A 45-year-old woman comes to the physician because of fatigue, abdominal cramps, watery diarrhea, and a weight loss of 4 kg (8.8 lb) over the last 4 months. She has recently avoided drinking alcohol and eating spicy food because it worsens her diarrhea and causes episodes of heart palpitations and reddening of the face... | Pulmonic valve stenosis | {
"A": "Proximal muscle wasting",
"B": "Achlorhydria",
"C": "Adrenal medullary mass",
"D": "Multiple peptic ulcers",
"E": "Pulmonic valve stenosis"
} | step1 | E |
A 66-year-old man presents to the emergency department due to a productive cough. His cough has been increasing in frequency and severity over the course of 3 days, and his sputum production has increased in volume. The color of his sputum is yellow-green. He denies any chest pain or palpitations but has experienced wo... | Levofloxacin | {
"A": "Amoxicillin",
"B": "Cefazolin",
"C": "Ceftriaxone",
"D": "Levofloxacin",
"E": "Penicillin"
} | step2&3 | D |
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... | Antineutrophil cytoplasmic antibodies | {
"A": "Anti-citrullinated protein antibodies",
"B": "Erythrocyte sedimentation rate",
"C": "Anti-histone bodies",
"D": "Anti-Ro",
"E": "Antineutrophil cytoplasmic antibodies"
} | step2&3 | E |
A 25-year-old Hispanic male presents with heat intolerance and recent weight loss. Serum analysis shows increased levels of T4 and T3, as well as the presence of thyroglobulin-stimulating immunoglobulins. The patient is found to be tachycardic and has marked edema and waxy discoloration in his legs. Which of the follow... | Exophthalmos | {
"A": "Sympathetic underactivity",
"B": "Anti-thyroglobin antibodies",
"C": "Exophthalmos",
"D": "Increased TSH release",
"E": "Multinucleate giant cells present in the thyroid"
} | step1 | C |
A 3-day-old male is evaluated in the hospital nursery for delayed passage of meconium. His mother is breastfeeding and has started to produce milk. The patient has been feeding well every two hours and is urinating over eight times per day. The patient was born at 35 weeks gestation to a 27-year-old gravida 4. The pati... | Abdominal radiograph | {
"A": "Abdominal CT",
"B": "Abdominal radiograph",
"C": "Contrast enema",
"D": "Upper gastrointestinal series",
"E": "Sweat testing"
} | step2&3 | B |
A 78-year-old woman presents to the office for an annual health check-up with her family physician accompanied by her daughter. She has no complaints during this visit but her daughter states that she is having difficulty locating objects such as the television remote, car keys, and her purse. Her medical history is si... | No treatment is necessary | {
"A": "TMP-SMX",
"B": "Nitrofurantoin",
"C": "Levofloxacin",
"D": "Cephalexin",
"E": "No treatment is necessary"
} | step2&3 | E |
A 45-year-old woman comes to the physician because of a 2-week history of painful ulcers in her mouth. Over the past 2 months, she has had increasing fatigue and difficulties concentrating. She has a history of rheumatoid arthritis and was started on a new medication 4 months ago. Examination shows pallor of the mucosa... | Deficient nitrogenous base production | {
"A": "Deficient heme synthesis",
"B": "Deficient DNA crosslink repair",
"C": "Deficient erythropoietin secretion",
"D": "Deficient nitrogenous base production",
"E": "Deficient β-globin chains"
} | step1 | D |
A 25-year-old woman presents to her primary care provider for evaluation of a "painful mass in my left groin." She says that her symptoms began 4 days ago as a painful mass that slowly enlarged, ruptured, and ulcerated. However, she denies fever, chills, dysuria, or hematuria. Three weeks prior to her current symptoms ... | PCR positive for Chlamydia trachomatis | {
"A": "Donovan bodies on Wright-Giemsa stain",
"B": "Gram-negative rods in school of fish formation on Gram stain",
"C": "PCR positive for Chlamydia trachomatis",
"D": "Positive RPR, VDRL, and FTA-ABS",
"E": "Tzanck smear with multinucleated giant cells"
} | step1 | C |
A 70-year-old hypertensive and hyperlipidemic woman comes to the emergency department with chief complaints of acute onset of impaired speech and comprehension with a right-sided weakness for the last 1.5 hours. The patient was on 2 antihypertensive medications and a statin, but she was not receiving any antiplatelet d... | Decreased ATP | {
"A": "Mitochondrial permeability",
"B": "Caspase activation",
"C": "Lysosomal rupture",
"D": "Severe membrane damage",
"E": "Decreased ATP"
} | step1 | E |
During the normal catabolism of protein, urea and ammonia are produced as waste products. If these waste products are not cleared by the liver and kidneys, hyperammonemia can occur, leading to confusion and delirium. Fortunately, a healthy liver can clear these waste products via the urea cycle. Which of the following ... | NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi | {
"A": "NH3 + HCO3- + 2 ATP --> carbamoyl phosphate + 2 ADP + Pi",
"B": "Carbamoyl phosphate + ornithine --> citrulline+ Pi",
"C": "Citrulline + aspartate + ATP --> arginosuccinate + AMP + PPi",
"D": "Argininosuccinate --> Arginine + fumarate",
"E": "Arginine + H20 --> ornithine + urea"
} | step1 | A |
A 46-year-old man presents with worsening pain in multiple joints for the past 2 weeks. He says the pain is most severe in the proximal parts of his fingers and his wrists, but it has now spread to his elbows, and, occasionally, his knees. He says the joint involvement is symmetric. He also complains of morning joint s... | Methotrexate | {
"A": "Cyclosporine",
"B": "Infliximab",
"C": "Anakinra",
"D": "Methotrexate",
"E": "High-dose prednisone for 60 days"
} | step1 | D |
A previously healthy 29-year-old woman, gravida 1, para 0, at 35 weeks' gestation comes to the physician for a routine prenatal visit. Current medications include folic acid and a multivitamin. A rectovaginal swab culture grows bacitracin-resistant colonies of gram-positive cocci with surrounding areas of clear hemolys... | Administer ampicillin intrapartum | {
"A": "Schedule delivery of the fetus via C-section",
"B": "Abstain from breastfeeding",
"C": "Administer ampicillin intrapartum",
"D": "Perform amniocentesis at 37 weeks",
"E": "Administer intravenous immune globulin postpartum"
} | step1 | C |
A 2-year-old girl is brought in to the office by her parents. They state that their daughter has recently been more irritable than usual, and she occasionally becomes pale and blue. Her parents note that she was diagnosed with a heart murmur, but it was never treated. Physical examination reveals a small child in distr... | Tetralogy of Fallot | {
"A": "Tetralogy of Fallot",
"B": "Transposition of great vessels",
"C": "Pulmonary hypoplasia",
"D": "Atrial septal defect",
"E": "Patent ductus arteriosus"
} | step1 | A |
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)... | Disseminated intravascular coagulation | {
"A": "Fat embolization",
"B": "Air embolization",
"C": "Tension pneumothorax",
"D": "Disseminated intravascular coagulation",
"E": "Coagulopathy of trauma"
} | step1 | D |
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... | Streptococcus bovis | {
"A": "Kingella kingae",
"B": "Staphylococcus aureus",
"C": "Escherichia coli",
"D": "Haemophilus aphrophilus",
"E": "Streptococcus bovis"
} | step1 | E |
A 31-year-old man with a history of schizophrenia is brought to the emergency department by police after being found agitated and attempting to steal from a grocery store. His past medical history is only notable for a recent office note from his primary care doctor for treatment of seasonal allergies. His temperature ... | Cocaine | {
"A": "Alcohol",
"B": "Cocaine",
"C": "Diphenhydramine",
"D": "Haloperidol",
"E": "Marijuana"
} | step2&3 | B |
A 40-year-old obese man presents to his primary care provider with a history of excessive daytime somnolence and easy fatigability. Upon further questioning, it is found that although his sleeping hours are adequate, he does not feel refreshed in the morning. His wife complains that he snores loudly all night. After ru... | This patient's apnea-hypopnea index (AHI) is more than 5. | {
"A": "This patient's apnea-hypopnea index (AHI) is more than 5.",
"B": "Episodes of apnea and hypopnea are more likely to occur during deeper stages of non-rapid eye movement sleep.",
"C": "Mouth opening during sleep breaks the seal between the tongue and the teeth and relieves airway obstruction.",
"D": "The... | step1 | A |
A 70-year-old man presents with cough and progressively worsening shortness of breath for the last 6 months. He feels short of breath even without exertion and states he ‘got winded’ while walking to his bedroom last night. He describes his cough as non-productive and says he can identify no recognizable triggers. No s... | Radial traction on airway wall | {
"A": "Anatomical dead space",
"B": "Lung compliance",
"C": "Physiological dead space",
"D": "Radial traction on airway wall",
"E": "Small airway wall thickness"
} | step1 | D |
Two hours following an elective cholecystectomy, a 43-year-old woman has fever and chills. The patient received cephalexin for antibiotic prophylaxis and one unit of packed red blood cells during the procedure. She underwent a hysterectomy 9 years ago for leiomyomata uteri. She has a 5-year history of hypertension trea... | Transfusion reaction | {
"A": "Adverse effect of medication",
"B": "Malignant hyperthermia",
"C": "Surgical site infection",
"D": "Urinary tract infection",
"E": "Transfusion reaction"
} | step2&3 | E |
The first 24 hours after delivery, a 2888 g (6.37 lb) male newborn is not feeding well, has a high-pitched cry, and is diaphoretic. He was born at 38 weeks' gestation to a 30-year-old woman, gravida 2, para 1, after an uncomplicated labor and delivery. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. The mot... | Oral morphine therapy | {
"A": "Oral morphine therapy",
"B": "Oral clonidine therapy",
"C": "Intravenous ampicillin and gentamicin combination therapy",
"D": "Oral methimazole therapy",
"E": "Dextrose infusion"
} | step2&3 | A |
A 38-year-old woman with a history of systemic lupus erythematosus, obesity, and hyperlipidemia presents to her primary care physician for evaluation of new bilateral blisters on her hands. She says that she first noticed these blisters shortly after returning from a weekend trip to the beach two weeks prior. She denie... | Urine porphyrin levels | {
"A": "Anti dsDNA titers",
"B": "C-reactive protein",
"C": "Anti-hemidesmosome titers",
"D": "Urine porphyrin levels",
"E": "Tzanck smear"
} | step2&3 | D |
A 64-year-old man presents with severe respiratory distress. This has onset over the past 3 weeks, progressively worsening. Past history involves congestive heart failure (CHF). Due to concerns of concurrent pneumonia, sputum studies are ordered. Microscopic examination of his sputum demonstrates heart failure cells (h... | Lysosomes | {
"A": "Endoplasmic reticulum (ER)",
"B": "Ribosomes",
"C": "Lysosomes",
"D": "Golgi apparatus",
"E": "Mitochondria"
} | step1 | C |
A previously healthy 52-year-old woman is brought to the emergency department after sustaining burns over 45% of her body in a house fire. On arrival, she is in acute distress but is fully oriented. Aggressive intravenous fluid resuscitation is begun and the patient is transferred to the intensive care unit of a burn c... | Decreased gastric blood flow | {
"A": "Decreased prostaglandin synthesis",
"B": "Erosion of tortuous submucosal arteriole",
"C": "Bacterial colonization of the gastric antrum",
"D": "Decreased gastric blood flow",
"E": "Increased stomach acid production"
} | step1 | D |
A 45-year-old man presents to his primary care provider after feeling sad and depressed for the past several months. His wife divorced him about 6 months ago and took the kids and moved out of state. Since then he has had difficulty waking up in the morning and getting to work on time. He takes some comfort in food and... | Leaden paralysis | {
"A": "Leaden paralysis",
"B": "Depressive symptoms that are worse in the morning",
"C": "Psychotic features",
"D": "Stereotypies",
"E": "Mania"
} | step1 | A |
A 35-year-old man comes to the emergency department with acute shortness of breath that developed after a 10-hour international flight. His pulse is 124/min and pulse oximetry on room air shows an oxygen saturation of 90%. He weighs 50-kg (110-lb). A diagnosis of pulmonary embolism is suspected and intravenous heparin ... | 1,500 units | {
"A": "3,000 units",
"B": "1,500 units",
"C": "6,000 units",
"D": "Cannot be calculated, as bioavailability is not known",
"E": "30 units"
} | step1 | B |
A 45-year-old man presents to a surgeon with painless swelling over his right leg. He noticed the swelling 6 months ago, but he ignored it because it was painless. However, he is now concerned as the swelling has been increasing in size over the last 6 months. He also mentions that his father and brother have lipomas o... | Telomerase | {
"A": "Alkaline phosphatase",
"B": "DNase",
"C": "RNase",
"D": "Superoxide dismutase",
"E": "Telomerase"
} | step1 | E |
A 24-year-old woman presents to her primary care physician for a wellness visit. She says that she has been generally healthy but has noticed difficulty concentrating, becoming increasingly fatigued, and a 15-pound weight increase over the course of a few months. She also reports mild constipation and joint pain. Appro... | Elevated TSH | {
"A": "Elevated TSH",
"B": "High Patient Health Questionnaire-9 (PHQ-9) score",
"C": "Improved symptoms with carbidopa/levodopa administration",
"D": "Positive anti-CCP antibodies",
"E": "Positive urine toxicology"
} | step2&3 | A |
A 3466-g (7-lb, 10-oz) female newborn is delivered at 38 weeks' gestation to a 32-year-old woman, gravida 2, para 1. Apgar scores are 7 and 8, at 1 and 5 minutes, respectively. The mother has a history of schizophrenia and was treated with lithium until 5 weeks' gestation, when she found out that she was pregnant. The ... | Low levels of parathyroid hormone in serum | {
"A": "Low levels of parathyroid hormone in serum",
"B": "Double bubble sign on abdominal x-ray",
"C": "Chromosome 5p deletion on FISH studies",
"D": "Elongated tricuspid valve leaflets on echocardiography",
"E": "Bilateral cataracts on ocular examination"
} | step2&3 | A |
A 10-year-old boy is brought to his pediatrician after discovering a painless mass in the left testicle. Results from tumor markers and a biopsy are as follows:
AFP 350 ng/mL (normal value < 10 ng/mL)
hCG 0.4 IU/L (normal value < 0.5 IU/L)
Biopsy: Presence of glomeruli-like structures with a central capillary within a ... | Yolk sac tumor | {
"A": "Classic seminoma",
"B": "Choriocarcinoma",
"C": "Teratoma",
"D": "Embryonal carcinoma",
"E": "Yolk sac tumor"
} | step1 | E |
An 80-year-old man presents with severe pain of the right lower extremity. He says that symptoms had an acute onset while he was in the ICU for a COPD exacerbation due to a recent upper respiratory infection, which was treated with nebulized albuterol and ipratropium bromide, continuous oxygen, IV methylprednisolone, a... | Immediate debridement and empiric IV antibiotics | {
"A": "High-dose IV dexamethasone",
"B": "Immediate debridement",
"C": "Immediate debridement and empiric IV antibiotics",
"D": "Biopsy of wound",
"E": "Contrast CT of the chest and abdomen"
} | step2&3 | C |
A 35-year-old woman presents to the emergency department after losing consciousness at work. On presentation, she is found to be somnolent though she is able to be woken by vocal stimuli. She says that over the last 12 hours, she has been experiencing muscle spasms, blurred vision, dry mouth, and hallucinations. She sa... | Physostigmine | {
"A": "Atropine",
"B": "Physostigmine",
"C": "Pralidoxime",
"D": "Pyridostigmine",
"E": "Neostigmine"
} | step1 | B |
A 34-year-old woman presents to the plastic surgery office 3 months following a rhinoplasty procedure. The patient has been recovering well. However, she has noticed a small whistling noise when she respires through her nose, which you appreciate on physical exam. Which of the following is the most likely cause of this... | A septal hematoma causing a perforation | {
"A": "Post-operative swelling",
"B": "A septal hematoma causing a perforation",
"C": "A deviated septum that is now straight, resulting in altered nasal airflow",
"D": "Excessive columellar show resulting in increased nasal airflow",
"E": "A fracture of the bony septum"
} | step2&3 | B |
A 43-year-old woman comes to the physician because of a 1-day history of rash on the trunk and lower extremities. Three days ago, she visited a spa resort with multiple swimming pools and whirlpools. A friend of hers who also visited the spa has developed a similar rash. She does not smoke or drink alcohol and takes no... | Hair follicles | {
"A": "Superfical epidermis",
"B": "Hair follicles",
"C": "Sebaceous glands",
"D": "Papillary dermis",
"E": "Eccrine sweat glands"
} | step1 | B |
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... | Lateral aspect of the shoulder | {
"A": "Medial aspect of the upper arm",
"B": "Lateral aspect of the shoulder",
"C": "Skin above the clavicle",
"D": "Lateral aspect of forearm",
"E": "Dorsal aspect of forearm and hand"
} | step1 | B |
A 25-year-old girl is brought to the emergency room after a suicide attempt. Her mother states that she found a large empty pill bottle next to her. The patient is conscious and tearful. She is currently complaining of severe abdominal pain but refuses to give any other history. She has a blood pressure of 135/86, resp... | Decreased production of PGE2 | {
"A": "Decreased production of PGE2",
"B": "Buildup of a toxic metabolite due to kidney disease",
"C": "Increased stimulation of the vagus nerve",
"D": "Direct irritation of the stomach lining causing inflammation",
"E": "Hypovolemia"
} | step1 | A |
A 32-year-old male presents to the ED with acute-onset chest pain. His blood pressure is 157/90 mmHg and his his pulse is 116/min. He appears anxious and agitated and a careful exam reveals dilated pupils and a perforated nasal septum. An EKG reveals ST segment elevation so he is urgently taken for cardiac intervention... | Blocking reuptake of dopamine and norepinephrine | {
"A": "Blocking reuptake of dopamine and norepinephrine",
"B": "Inhibiting breakdown of biogenic amines",
"C": "Antagonizing the NMDA receptor",
"D": "Activating the acetylcholine receptor",
"E": "Inhibiting the GABA receptor"
} | step1 | A |
A 38-year-old woman comes to the physician because of difficulty falling asleep for the past 2 months. She wakes up frequently during the night and gets up earlier than desired. She experiences discomfort in her legs when lying down at night and feels the urge to move her legs. The discomfort resolves when she gets up ... | Pramipexole | {
"A": "Amitryptiline",
"B": "Pramipexole",
"C": "Codeine",
"D": "Propranolol",
"E": "Escitalopram"
} | step2&3 | B |
A 55-year-old woman is brought to the emergency department because of worsening upper abdominal pain for the past 8 hours. She reports that the pain radiates to her back and is associated with nausea. She has hypertension and hyperlipidemia, for which she takes enalapril, furosemide, and simvastatin. Her temperature is... | Capillary leakage | {
"A": "Abnormal coagulation and fibrinolysis",
"B": "Capillary leakage",
"C": "Decreased cardiac output",
"D": "Increased excretion of water",
"E": "Pseudocyst formation"
} | step2&3 | B |
A 3-year-old boy is brought to his pediatrician for evaluation because his parents have been concerned by a number of troubling signs. Specifically, they have noticed that he has been exhibiting aggressive behavior as well as hyperactivity. In addition, he has had intellectual disability and is slow to hit developmenta... | Heparan sulfate | {
"A": "Cerebroside sulfate",
"B": "Galactocerebroside",
"C": "Glucocerebroside",
"D": "Heparan sulfate",
"E": "Sphingomyelin"
} | step1 | D |
A 21-year-old man with a past medical history significant for Down syndrome presents to the outpatient primary care clinic for a routine follow up and high risk screening. He is relatively high functioning and currently has no additional significant medical conditions. He feels well and a physical examination shows tha... | Acute lymphocytic leukemia | {
"A": "Gastric adenocarcinoma",
"B": "Astrocytoma and cardiac rhabdomyoma",
"C": "Hepatocellular carcinoma",
"D": "Esophageal adenocarcinoma",
"E": "Acute lymphocytic leukemia"
} | step2&3 | E |
A 35-year-old woman presents to the office because she has felt a small painless mass in her neck which has been slowly growing. She has no relevant past medical history. Her vital signs are within normal limits. On physical exam of the thyroid gland, a solitary nodule is palpated. It is fixed to the surrounding tissue... | Papillary carcinoma | {
"A": "Endemic goiter",
"B": "Follicular carcinoma",
"C": "Graves’ disease",
"D": "Hashimoto thyroiditis",
"E": "Papillary carcinoma"
} | step1 | E |
A 4-year-old boy presents to the pediatrician’s office. His mother complains that he has been sleeping poorly, and she has noticed that he often scratches his perianal area. A scotch tape test is found to be positive and mebendazole is prescribed. Into which of the following subsets have the naïve T cells (TH0) develop... | TH2 cells | {
"A": "TH1 cells",
"B": "TH2 cells",
"C": "TH17",
"D": "T0 cells",
"E": "TREGS"
} | step1 | B |
A 69-year-old right-handed man comes to the physician for a routine health maintenance examination. On questioning, he has had some difficulty speaking for 3 months. During a conversation, he often has difficulty repeating what his interlocutor has said. He has hypertension and takes hydrochlorothiazide. His vital sign... | Left middle cerebral | {
"A": "Left middle cerebral",
"B": "Right vertebral",
"C": "Left posterior inferior cerebellar",
"D": "Left posterior cerebral",
"E": "Left penetrating"
} | step1 | A |
An investigator is studying the frequency of polycythemia in a population of a remote, mountainous region. A representative sample of 100 men shows a normal distribution of hemoglobin concentration with a mean concentration of 17 g/dL and a standard error of 0.1 g/dL. Which of the following best represents the probabil... | 15% | {
"A": "30%",
"B": "15%",
"C": "95%",
"D": "99%",
"E": "5%"
} | step1 | B |
A 57-year-old woman comes to the physician because of a 3-month history of fatigue. She also reports generalized itchiness that started approximately 2 months ago. Two weeks ago, she noticed yellowing of her eyes. She does not smoke or drink alcohol. She uses eyedrops for persistent dryness of the eyes. Her vital signs... | Cutaneous xanthomas | {
"A": "Inferior vena cava thrombosis",
"B": "Cutaneous xanthomas",
"C": "Butterfly-shaped vertebrae",
"D": "Increased CA 19-9 levels",
"E": "Kayser-Fleischer rings\n\""
} | step2&3 | B |
A 32-year-old pregnant woman presents to her physician with flu-like symptoms for the past 3 days. She has a runny nose, mild headache, and feels achy. She has a mild fever and diffuse rash over her body. She is concerned about the health of her baby and wants to know if there are any medications that will make her fee... | Wide pulse pressure | {
"A": "Single S2",
"B": "Wide pulse pressure",
"C": "Brachial-femoral delay",
"D": "Double split S2",
"E": "Tricuspid valve regurgitation"
} | step2&3 | B |
An investigator is studying bacterial adaptations to the environment in an infectious isolate and a noninfectious isolate of Hemophilus influenzae type B. Animals exposed to the noninfectious isolate do not develop symptoms of infection. The investigator cultivates the noninfectious isolate in a culture with lysed bact... | Transformation | {
"A": "Conjugation",
"B": "Reassortment",
"C": "Transformation",
"D": "Generalized transduction",
"E": "Recombination"
} | step1 | C |
A 40-year-old female with a past medical history of high cholesterol, high blood pressure, hyperthyroidism, and asthma presents to the primary care clinic today. She has tried several different statins, all of which have resulted in bothersome side effects. Her current medications include hydrochlorothiazide, levothyro... | Timing of the dosing of colesevelam should be separated from this patient’s other medications. | {
"A": "Colesevelam can cause significant flushing and itching.",
"B": "Colesevelam can cause cognitive impairment.",
"C": "Colesevelam can increase the risk of cholelithiasis.",
"D": "Timing of the dosing of colesevelam should be separated from this patient’s other medications.",
"E": "Colesevelam can signif... | step2&3 | D |
A 62-year-old patient with a history of deep venous thrombosis is enrolled in a clinical trial for a new oral anticoagulant. This novel drug has the property where its clearance is relatively predictable based on patient demographics and can easily be extrapolated from other data. Its metabolism and volume of distribut... | 1200 milligrams | {
"A": "150 milligrams",
"B": "430 milligrams",
"C": "600 milligrams",
"D": "1200 milligrams",
"E": "3600 milligrams"
} | step1 | D |
A 7-day-old infant boy presents to an emergency department due to poor feeding. His parents are recent immigrants to the United States. He was born in a traditional home birth and has never seen a medical provider. Mom had no prenatal care, has no medical issues, and is unvaccinated. The baby had been breastfeeding wel... | Clostridium tetani | {
"A": "Clostridium botulinum",
"B": "Clostridium tetani",
"C": "Escherichia coli",
"D": "Group B streptococcus",
"E": "Listeria monocytogenes"
} | step2&3 | B |
A 28-year-old woman presents with facial flushing, weakness, and chronic diarrhea for the past month. She denies any history of smoking, alcohol use, or recreational drug use. The patient was on a trip to Thailand 2 years ago with her family but denies any recent travel. Her blood pressure is 120/88 mm Hg, pulse is 78/... | VIPoma | {
"A": "Vibrio cholera infection",
"B": "VIPoma",
"C": "Rotavirus",
"D": "Campylobacter jejuni",
"E": "Somatostatinoma"
} | step1 | B |
A 69-year-old gentleman presents to his primary care physician for pain in his right shoulder. The patient was helping his son move this past weekend, and he noticed after the move that he had pain and weakness in his right shoulder. The patient thought that this pain was just him being in poor shape so he started goin... | Supraspinatus | {
"A": "Supraspinatus",
"B": "Infraspinatus",
"C": "Teres minor",
"D": "Subscapularis",
"E": "Deltoid"
} | step2&3 | A |
A 9-year-old male visited his primary care physician for a check-up three months after a throat infection. Upon examination, the patient exhibits painless subcutaneous nodules on the back of the wrist, the outside elbow, and the front of the knees, as well as inflammation in the joints of the lower extremities. Which o... | Chorea | {
"A": "Renal failure",
"B": "Hepatomegaly",
"C": "Chorea",
"D": "Pleural effusion",
"E": "Butterfly rash"
} | step1 | C |
A 29-year-old man diagnosed with schizophrenia 4 years ago presents for follow-up to discuss his medication. The patient was diagnosed with schizophrenia 4 years ago and has since tried several antipsychotic medications, none of which have been able to treat his negative symptoms. He has changed to clozapine 2 weeks ag... | Complete blood count | {
"A": "Slit-lamp examination",
"B": "Electrocardiogram",
"C": "Prolactin level",
"D": "Complete blood count",
"E": "Thyroid-stimulating hormone level"
} | step2&3 | D |
A 32-year-old man with HIV comes to the physician because of a 2-month history of weight loss, night sweats, and productive cough. Auscultation of the lungs shows coarse crackles at the right upper posterior field. An x-ray of the chest shows an opacity in the right upper lobe. Sputum analysis shows acid-fast bacilli. ... | Interaction of B7 and CD28 ligands | {
"A": "Secretion of interferon-α",
"B": "Interaction of B7 and CD28 ligands",
"C": "Opsonization by complement proteins",
"D": "Secretion of interleukin-4",
"E": "Generation of reactive oxygen species"
} | step1 | B |
A 7-year-old boy is rushed to the emergency room after losing consciousness 30 mins ago at home. The patient’s mother says that he has had a “running nose” for the past few days However, he did not receive any treatment for it, and his condition rapidly worsened today. He does not have any significant past medical hist... | Adrenocortical insufficiency | {
"A": "Miliary tuberculosis",
"B": "Human immunodeficiency virus infection",
"C": "Hypertrophic cardiomyopathy",
"D": "Adrenocortical insufficiency",
"E": "Pheochromocytoma"
} | step1 | D |
A chronic opioid abuser undergoes emergency surgery. Following the operation, the man is started on a patient controlled analgesia (PCA) thought to be dosed adequately to control his pain in the face of his opioid tolerance. He reports intense pain 6 hours after the conclusion of the surgery. Which agent could have bee... | Ketamine | {
"A": "Ketamine",
"B": "Thiopental",
"C": "Midazolam",
"D": "Propofol",
"E": "Etomidate"
} | step1 | A |
A 3550-g (7.8-lb) male newborn is delivered at term to a 27-year-old, gravida 1, para 1 woman (Rh+). Within the first 24 hours after birth, the newborn develops fever and a yellow discoloration of skin and sclerae. Examination shows loss of flexion in the extremities, splenomegaly, and cyanosis. Laboratory studies show... | Deficiency of ATP | {
"A": "Decrease in the reduced form of glutathione",
"B": "Maternal antibodies against the rhesus D antigen",
"C": "Point mutation in β-globin",
"D": "Deficiency of ATP",
"E": "Osmotically fragile erythrocytes"
} | step1 | D |
A 37-year-old woman presents to the emergency department with confusion, anxiety, sweating, and episodes of vomiting. She is accompanied by her sister who says that her symptoms developed acutely and is unsure about what caused it. She is currently on methimazole, which she last took approximately 1 week ago. Approxima... | Propranolol | {
"A": "Antibiotics",
"B": "Carotid massage",
"C": "Clonazepam",
"D": "Epinephrine",
"E": "Propranolol"
} | step2&3 | E |
A 13-year-old boy is brought to the emergency department because he was vomiting and seemed abnormally sleepy at home. On presentation, he is found to be confused and very lethargic. His parents said that he has had a fever and cough for several days prior to presentation and was given an over the counter medication. P... | Constriction of afferent arteriole and no effect on efferent arteriole | {
"A": "Constriction of afferent arteriole and constriction of efferent arteriole",
"B": "Constriction of afferent arteriole and no effect on efferent arteriole",
"C": "Dilation of afferent arteriole and no effect on efferent arteriole",
"D": "No effect on afferent arteriole and constriction of efferent arterio... | step1 | B |
A 54-year-old woman presents with sudden onset, mild vaginal bleeding for the past day. She says she is postmenopausal, and her last menstrual period was 5 years ago. A detailed workup is performed, and several premalignant lesions are found in her uterus. The patient agrees to a hysterectomy. The surgical team decides... | It competes with acetylcholine for binding sites in the neuromuscular junction | {
"A": "It reduces neuron and muscle tissue excitability",
"B": "It increases GABA linked chloride channel opening",
"C": "It acts on the pain centers in the spinal cord and brain",
"D": "It competes with acetylcholine for binding sites in the neuromuscular junction",
"E": "It persistently depolarizes the cho... | step1 | D |
A 22-year-old woman presents with recurrent episodes of swelling in her face, hands, and neck with occasional abdominal pain. The symptoms usually resolve in 2 to 3 days. She has had these swelling events her whole life; however, they have become more debilitating recently. Last week she had an event that restricted he... | Hereditary angioedema | {
"A": "DiGeorge syndrome",
"B": "Chediak-Higashi syndrome",
"C": "Wiskott-Aldrich syndrome",
"D": "Paroxysmal nocturnal hemoglobinuria",
"E": "Hereditary angioedema"
} | step1 | E |
A 24-year-old woman gravida 2, para 1 at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. Her earlier pregnancy was uncomplicated. This is her 4th prenatal visit. She had an ultrasound scan 2 weeks ago that showed a live intrauterine pregnancy consistent with a 22-week gestation with no ... | Oral glucose challenge test | {
"A": "Oral glucose challenge test",
"B": "Cardiotocography",
"C": "Rh antibody testing",
"D": "Swab for GBS culture",
"E": "Tdap vaccination"
} | step2&3 | A |
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 | {
"A": "Glutamate capsule",
"B": "Toxin B",
"C": "Protein A",
"D": "IgA protease",
"E": "Sulfatides"
} | step1 | A |
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... | Fecal incontinence | {
"A": "Urge incontinence",
"B": "Vesicovaginal fistula",
"C": "Fecal incontinence",
"D": "Small bowel obstruction",
"E": "Stress incontinence"
} | step1 | C |
A 63-year-old man presents to his primary care physician for follow-up. He reports a slow and steady weight gain of 6 pounds over the past 6 months, despite attempts to control his diet and increase his level of exercise. His medications include pravastatin, lisinopril, and hydrochlorothiazide. On exam, his vital signs... | Pancreatic islet cell amyloid deposition | {
"A": "Strong HLA class II gene makeup",
"B": "Pancreatic islet cell amyloid deposition",
"C": "Pancreatic islet cell leukocyte infiltration",
"D": "Auto-antibodies against pancreatic islet cell antigens",
"E": "Unrelated to his abdominal obesity"
} | step1 | B |
A 45-year-old woman comes to the physician for the evaluation of a right breast mass that she noticed 3 weeks ago. It has rapidly increased in size during this period. She does not have pain. Vital signs are within normal limits. Examination shows large dense breasts; a 5-cm, nontender, multinodular mass is palpated in... | Phyllodes tumor | {
"A": "Intraductal papilloma",
"B": "Phyllodes tumor",
"C": "Fibroadenoma",
"D": "Fibrocystic disease of the breast",
"E": "Invasive lobular carcinoma"
} | step2&3 | B |
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? | Zenker's diverticulum | {
"A": "Gastroesophageal reflux disease",
"B": "Esophageal candidiasis",
"C": "Glossopharyngeal nerve damage",
"D": "Meckel's diverticulum",
"E": "Zenker's diverticulum"
} | step1 | E |
A 10-year-old boy is brought to the emergency department because he has not been able to walk since waking up that morning. His mother said that when he tried to get out of bed that he was unable to stand without support. He also complained of prickling in his hands and feet. Three weeks ago, he had a fever, dry cough,... | Intravenous immunoglobulin (IVIG) | {
"A": "Intravenous immunoglobulin (IVIG)",
"B": "Prednisone",
"C": "Botulism antitoxin",
"D": "Intravenous acyclovir",
"E": "Gabapentin"
} | step2&3 | A |
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... | Blocks reuptake of norepinephrine and serotonin | {
"A": "Decreases the degradation of norepinephrine and serotonin",
"B": "Increases the release of norepinephrine and serotonin by alpha 2 receptor antagonism",
"C": "Blocks only norepinephrine reuptake",
"D": "Blocks reuptake of norepinephrine and serotonin",
"E": "Increases presynaptic release of norepineph... | step1 | D |
A 35-year-old Caucasian female presents to the hospital alarmed by her recent truncal weight gain, facial hair growth, and thinning skin. During the physical exam, the physician finds that the patient is hypertensive. Serum analysis reveals hyperglycemia. The physician suspects a pituitary adenoma. Which dexamethasone ... | Low-dose, no change in ACTH; high-dose, decreased ACTH | {
"A": "Low-dose, increased ACTH; high-dose, increased ACTH",
"B": "Low-dose, increased ACTH; high-dose, decreased ACTH",
"C": "Low-dose, decrease in ACTH; high-dose, no change in ACTH",
"D": "Low-dose, no change in ACTH; high-dose, no change in ACTH",
"E": "Low-dose, no change in ACTH; high-dose, decreased A... | step1 | E |
A 24-year-old man with chronic back pain comes to the physician to establish care after moving to Florida. He complains of anxiety, nausea, abdominal cramping, vomiting, and diarrhea for three days. He denies smoking, drinking alcohol, and using illicit drugs. He appears restless. His temperature is 37°C (98.6°F), puls... | Methadone | {
"A": "Lorazepam",
"B": "Naltrexone",
"C": "Methadone",
"D": "Morphine",
"E": "Naloxone\n\""
} | step2&3 | C |
A 53-year-old man comes to the physician because of a 3-month history of cough and progressively worsening difficulty walking up the stairs in his apartment. He has noticed that it is easier for him to climb the stairs after he has exercised. He has also had a 4.6-kg (10.1-lb) weight loss over the past 6 months. He has... | Lambert-Eaton syndrome | {
"A": "Polymyalgia rheumatica",
"B": "Myasthenia gravis",
"C": "Dermatomyositis",
"D": "Hypothyroidism",
"E": "Lambert-Eaton syndrome"
} | step1 | E |
A 78-year-old woman presents to the emergency department with weight loss, abdominal pain, and jaundice. CT demonstrates a mass in the head of the pancreas, and biopsy is planned for the following day. The patient's daughter approaches you outside the room to request that the results of the biopsy not be shared with th... | Inquire why the patient's daughter feels her mother should not be informed of the diagnosis | {
"A": "Ask the patient's son, the documented health care proxy, how he would like to handle the situation",
"B": "Inquire why the patient's daughter feels her mother should not be informed of the diagnosis",
"C": "Offer to explain the diagnosis to the patient without using the word \"cancer\"",
"D": "Order an ... | step1 | B |
A 59-year-old man presents to his primary care provider with fatigue. He has been seen in the emergency room 5 times in the past 2 years for acute alcohol intoxication. His past medical history is notable for diabetes mellitus and gout. He takes metformin, glyburide, and allopurinol. His temperature is 98.6°F (37°C), b... | Erythroblasts with mitochondrial iron deposits | {
"A": "Erythroblasts with mitochondrial iron deposits",
"B": "Erythrocytes lacking central pallor",
"C": "Erythrocytes with a ring of relative pallor",
"D": "Hypochromatic erythrocytes",
"E": "Inclusions of denatured hemoglobin"
} | step1 | A |
A 75-year-old man becomes pulseless in the cardiac intensive care unit 48 hours after admission for ST-elevation myocardial infarction. His blood pressure is 50/20 mm Hg. The ECG monitor shows a tachycardic irregular rhythm with erratic undulations, but no discernible P waves or QRS complexes. During immediate advanced... | Amiodarone | {
"A": "Sotalol",
"B": "Amiodarone",
"C": "Epinephrine",
"D": "Dopamine",
"E": "Atropine"
} | step2&3 | B |
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... | Medial longitudinal fasciculus | {
"A": "Cavernous sinus",
"B": "Corticospinal tract before pyramidal decussation",
"C": "Dorsal column-medial lemniscus",
"D": "Frontal eye field",
"E": "Medial longitudinal fasciculus"
} | step2&3 | E |
A 5-day-old boy is brought to the emergency department because of a 1-day history of poor feeding, irritability, and noisy breathing. The mother did not receive any prenatal care. His respirations are 26/min. Physical examination shows sunken fontanelles, tightly clenched fists, and erythema around the umbilical cord s... | Decreased release of glycine | {
"A": "Decreased release of acetylcholine",
"B": "Inhibition of voltage-gated sodium channels",
"C": "Destruction of Schwann cells",
"D": "Decreased release of glycine",
"E": "Destruction of anterior horn cells"
} | step1 | D |
A 62-year-old woman comes to the physician because of a 6-month history of progressive pain and stiffness of the fingers of her right hand. The stiffness is worse at the end of the day. She recently retired after working for 28 years as a typist at a data entry firm. Physical examination shows swelling, joint-line tend... | Degenerative disease of the joints | {
"A": "Monosodium urate crystal precipitation in the joints",
"B": "Bacterial infection of the joint space",
"C": "Autoimmune-mediated cartilage erosion",
"D": "Calcium pyrophosphate dihydrate crystal precipitation in the joints",
"E": "Degenerative disease of the joints"
} | step1 | E |
An 81-year-old man patient recently moved into an assisted living facility and presents today with itchy blisters in his axilla. He attributes these to a poor diet. He also complains that the nurse practitioner at the facility started him on 4 new medications, in addition to his existing prescriptions. On physical exam... | Bullous pemphigoid | {
"A": "Staphylococcal scalded skin syndrome",
"B": "Toxic epidermal necrolysis",
"C": "Bullous pemphigoid",
"D": "Pemphigus vulgaris",
"E": "Cicatricial pemphigoid"
} | step2&3 | C |
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 | {
"A": "Rest and acetaminophen",
"B": "Ultrasonography",
"C": "Technetium bone scan",
"D": "CT scan",
"E": "Internal fixation"
} | step2&3 | A |
Thirty minutes after delivery, a 3600-g (7-lb 15-oz) newborn has noisy breathing, bluish discoloration of her lips, and intermittent respiratory distress. She was born at 38 weeks' gestation and required bag-mask resuscitation immediately after delivery. Pregnancy was uncomplicated. Her mother has noticed the bluish li... | Passage of a catheter through the nasal cavity not possible | {
"A": "Diffuse reticulogranular densities on chest x-ray",
"B": "Boot-shaped heart on chest x-ray",
"C": "Passage of a gastric catheter through the mouth not possible",
"D": "Passage of a catheter through the nasal cavity not possible",
"E": "Scaphoid abdomen"
} | step2&3 | D |
A 3-year-old girl is brought to the emergency department by her mother 30 minutes after the sudden onset of shortness of breath, dizziness, abdominal pain, and urticaria. The symptoms began 5 minutes after she ate a peanut butter sandwich. Her respirations are 36/min and blood pressure is 84/50 mm Hg. There is stridor ... | Increased Ca2+ influx in phase 4 | {
"A": "Increased Ca2+ influx in phase 4",
"B": "Increased Na+ influx in phase 3",
"C": "Decreased Ca2+ influx in phase 0",
"D": "Increased K+ efflux in phase 4",
"E": "Decreased K+ efflux during phase 3\n\""
} | step1 | A |
A 3-day-old boy is admitted to the neonatal intensive care unit for seizures. He was born to a 33-year-old woman at 31 weeks gestation via cesarean section. His birth weight was 1400 grams. Vital signs are significant for systemic hypotension, bradycardia, and hypoventilation. On physical exam, the patient has an alter... | Cranial ultrasonography | {
"A": "Complete blood count",
"B": "Cranial ultrasonography",
"C": "Electroencephalography",
"D": "Head CT",
"E": "MRI of the head"
} | step2&3 | B |
A 39-year-old man seeks an evaluation in the emergency room due to an episode of syncope at work. He says that he has felt increasing shortness of breath while exercising over the past 6 months. He is a well-built man in mild distress. The vital signs include heart rate 98/min, respiratory rate 18/min, temperature 36.5... | Hypertrophic cardiomyopathy | {
"A": "Aortic dissection",
"B": "Aortic stenosis",
"C": "Cardiac tamponade",
"D": "Hypertrophic cardiomyopathy",
"E": "Third-degree heart block"
} | step1 | D |
A 26-year-old nullipara presents to her physician for a routine check-up at 18 weeks gestation. She has no co-morbidities. Her only complaints are fatigability and a depressed mood for the past 2 weeks. Her vital signs are as follows: blood pressure, 125/80 mm Hg; heart rate, 87/min; respiratory rate, 14/min; and tempe... | No specific management required | {
"A": "Prescribe levothyroxine 50 mcg daily",
"B": "No specific management required",
"C": "Recommend additional anti-TPO test",
"D": "Prescribe methimazole 10 mg daily",
"E": "Recommend additional T3 assessment"
} | step2&3 | B |
A 42-year-old man presents to your office complaining of right-sided facial swelling that has progressively worsened over the last month after returning from a trip to India. On examination, the patient has an obvious distortion of the facial features on the right without erythema or lymphadenopathy. A neurological exa... | Benign salivary gland tumor composed of stromal and epithelial tissue | {
"A": "Benign cystic tumor with stroma resembling lymph node tissue",
"B": "Benign salivary gland tumor composed of stromal and epithelial tissue",
"C": "An infection with paramyxovirus",
"D": "Malignant tumor composed of squamous and mucinous cells",
"E": "Sialolithiasis that has progressed to a S. aureus i... | step1 | B |
A 15-year-old boy is brought to the physician by his mother. His mother reports multiple instances over the past month when she walked into his room while he was masturbating. She is worried he may be going through some sort of “problem.” He is currently in 9th grade; his mother says that he is the captain of his high ... | Reassure the mother | {
"A": "Advise the patient to stop masturbating",
"B": "Measure serum testosterone level",
"C": "Refer the patient for behavioral therapy",
"D": "Reassure the mother",
"E": "Prescribe sertraline"
} | step1 | D |
A 64-year-old man presents to the clinic with easy fatigability and breathlessness when climbing stairs for the last 2 weeks. He also mentions that he occasionally has bouts of cough at night after about 2–3 hours of sleep which is relieved when he sits upright. He denies shortness of breath at rest, palpitations, and ... | Sacubitril | {
"A": "Etanercept",
"B": "Ivabradine",
"C": "Moxonidine",
"D": "Sacubitril",
"E": "Aliskiren"
} | step2&3 | D |
A 69-year-old man presents to his primary care physician for trouble sleeping. The patient states that he recently retired from working the day shift at a cemetery. When the patient retired, his goal was to finally be able to go out with his wife; however, he finds that he is unable to stay awake past 6 pm in the eveni... | Advanced sleep phase disorder | {
"A": "Obstructive sleep apnea",
"B": "Delayed sleep phase disorder",
"C": "Advanced sleep phase disorder",
"D": "Chronic insomnia",
"E": "Normal aging"
} | step2&3 | C |
A 62-year-old woman comes to the physician for a routine health maintenance examination. She feels well. Six months ago, she was vaccinated against influenza. Her last mammography 1 year ago showed no abnormalities. Two years ago, a pap smear and colonoscopy were normal. She has a history of hypertension. Her father di... | Dual-energy x-ray bone absorptiometry | {
"A": "Pap smear",
"B": "Dual-energy x-ray bone absorptiometry",
"C": "Abdominal ultrasonography",
"D": "Low-dose chest CT",
"E": "Transesophageal echocardiography"
} | step2&3 | B |
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... | Minimal change disease | {
"A": "Focal segmental glomerulosclerosis",
"B": "Membranous nephropathy",
"C": "Minimal change disease",
"D": "Amyloidosis",
"E": "Membranoproliferative glomerulonephritis"
} | step2&3 | C |
A 45-year-old man comes to the physician because of mild left-sided abdominal pain when lifting heavy objects that has developed over the past 6 months. He has had a weight loss of 41 kgs (90 lbs) in the past year. Physical examination shows a soft bulge inferior and lateral to the navel on the left. A CT scan of the a... | Rectus abdominis | {
"A": "Psoas major",
"B": "Internal oblique",
"C": "External oblique",
"D": "Rectus abdominis",
"E": "Transverse abdominal\n\""
} | step1 | D |
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 IV–cell-mediated (delayed) hypersensitivity reaction | {
"A": "Type I–anaphylactic hypersensitivity reaction",
"B": "Type II–cytotoxic hypersensitivity reaction",
"C": "Type III–immune complex-mediated hypersensitivity reaction",
"D": "Type IV–cell-mediated (delayed) hypersensitivity reaction",
"E": "Type III and IV–mixed immune complex and cell-mediated hypersen... | step2&3 | D |
A 34-year-old man comes to the physician because of a 3-week history of colicky abdominal pain and diarrhea. He has bowel movements 10–12 times daily; the stool contains blood and mucus. He constantly has the urge to defecate. His vital signs are within normal limits. Examination of the abdomen shows diffuse tenderness... | Colorectal cancer | {
"A": "Hemolytic uremic syndrome",
"B": "Oral ulcers",
"C": "Colorectal cancer",
"D": "Gastric cancer",
"E": "Pancreatic cancer"
} | step1 | C |
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... | 46XX | {
"A": "69XXY",
"B": "45XO",
"C": "23XX",
"D": "47XYY",
"E": "46XX"
} | step1 | E |
A 42-year-old woman comes to the clinic for a routine annual exam. She recently moved from New Jersey, and her medical records show a total colectomy. The patient reports that she has had annual colonoscopies since she was 10 years of age because her father had “a condition with his colon.” What is the genetic inherita... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "Autosomal recessive",
"C": "Multifactorial",
"D": "X-linked dominant",
"E": "X-linked recessive"
} | step1 | A |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.