question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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A 2-day-old infant male is brought to the emergency department with a 5-hour history of vomiting and irritability. He was born at home and had unreliable prenatal care because his parents have been experiencing housing instability. About a day after birth, he started to become lethargic and was feeding poorly. His pare... | Enlarges hemolytic area of Staphylococcus aureus | {
"A": "Creates a green zone of hemolysis on blood agar",
"B": "Enlarges hemolytic area of Staphylococcus aureus",
"C": "Produces lipooligosaccharide rather than lipopolysaccharide",
"D": "Produces toxin that increases cAMP levels",
"E": "Tumbling motility in broth at 22 degrees"
} | step1 | B |
A 58-year-old man with hypertension and dyslipidemia comes to the physician for a routine health maintenance examination. He says he feels well. He is 180 cm (5 ft 11 in) tall and weighs 103 kg (227 lb); BMI is 32 kg/m2. His BMI last year was 27 kg/m2. When asked about his diet, he says, “Being overweight runs in my fa... | Rationalization | {
"A": "Rationalization",
"B": "Primitive idealization",
"C": "Fantasy",
"D": "Distortion",
"E": "Intellectualization"
} | step1 | A |
A 27-year-old college student presents to his physician for constant fatigue. The patient states that for the past several weeks he has felt oddly fatigued and has struggled to complete his work. He is a foreign exchange student and is concerned he will fail out of his academic program. He has experienced some occasion... | Viral core antibody | {
"A": "CAGE questions",
"B": "Direct influenza antigen",
"C": "Uretheral swab and culture",
"D": "Viral core antibody",
"E": "Viral surface antibody"
} | step2&3 | D |
A 63-year-old woman comes to the physician because of a 6-month history of fatigue and shortness of breath on exertion in addition to a 1-month history of ankle swelling. She has a history of sleep apnea. Examination of the lower extremities shows bilateral pitting pedal and ankle edema. Cardiac examination shows a wid... | Increased capillary hydrostatic pressure | {
"A": "Localized lymphatic obstruction",
"B": "Dermal accumulation of glycosaminoglycans",
"C": "Thrombus formation in a deep vein",
"D": "Increased capillary hydrostatic pressure",
"E": "Decreased plasma oncotic pressure\n\""
} | step1 | D |
A 62-year-old man presents with bright red blood in his stool which occurred 2 times this week. He denies fever, weight loss, pain, pruritus or urinary symptoms. Past medical history is significant for gastroesophageal reflux disease, and recent appendicitis, status post laparoscopic appendectomy complicated by deliriu... | The vascular protrusion drains into the superior rectal vein. | {
"A": "This patient has peptic ulcer disease.",
"B": "The vascular protrusion drains into the superior rectal vein.",
"C": "The vascular protrusion drains into the inferior vena cava.",
"D": "The vascular protrusion drains into the inferior rectal vein.",
"E": "Fecal leukocytes and a stool culture are requir... | step1 | B |
A 55-year-old woman presents to the office because she has been feeling weak. For the past 2 years, she has been urinating a considerable volume every time she goes to the bathroom. She has no past medical history. Her heart rate is 86/min, respiratory rate is 15/min, temperature is 37.4°C (99.3°F), and blood pressure ... | Adenoma | {
"A": "Adenoma",
"B": "Carcinoma",
"C": "Decreased calcitriol concentration",
"D": "Glandular hyperplasia",
"E": "Phosphate retention"
} | step1 | A |
A 35-year-old woman presents to a psychiatrist for an initial consultation. She reports that for the past 3 years, she has experienced several periods of depressed mood. The episodes do not coincide with any specific life events and seem to resolve after 4-6 weeks. During these episodes, she experiences a depressed moo... | Cyclothymic disorder | {
"A": "Bipolar I disorder",
"B": "Bipolar II disorder",
"C": "Cyclothymic disorder",
"D": "Persistent depressive disorder",
"E": "Schizoaffective disorder"
} | step1 | C |
A 76-year-old woman comes to the physician for a routine examination. She has a history of hypertension well controlled with diet and exercise. She has no history of smoking or illicit drug use. She walks one mile daily. Her pulse is 68/min, respirations are 16/min, and blood pressure is 119/76 mm Hg. Physical examinat... | Increased lung compliance | {
"A": "Increased lung compliance",
"B": "Increased vital capacity",
"C": "Decreased residual volume",
"D": "Increased chest wall compliance",
"E": "Decreased A-a gradient"
} | step1 | A |
A 32-year-old man jumps off a 3 story building during a suicide attempt. Paramedics arrive quickly, and he is taken to the hospital where several stable lumbar fractures and a shattered right calcaneus are found. He undergoes surgery and his calcaneus is repaired with 11 screws. Which of the following statements best d... | He will have pain with inversion and eversion of his foot. | {
"A": "He will not be able to plantar flex his foot.",
"B": "He will not be able to point his toe.",
"C": "He will have a foot drop.",
"D": "He will have pain with inversion and eversion of his foot.",
"E": "He will have pain while dorsiflexing his foot."
} | step1 | D |
A 46-year-old man comes to the emergency department because of a 4-week history of fatigue and headache that have gotten progressively worse. He has allergic asthma treated with inhaled salbutamol. He immigrated to the USA from Thailand 9 years ago. He lives by himself and works as a waiter in a restaurant. He has had ... | Amphotericin B and flucytosine | {
"A": "Pyrimethamine, sulfadiazine, and folinic acid",
"B": "Amphotericin B and flucytosine",
"C": "Fluconazole",
"D": "Vancomycin and meropenem",
"E": "Valacyclovir"
} | step2&3 | B |
A previously healthy 16-year-old boy comes to the physician because of a 5-day history of pain at the back of his left ankle. His mother had a myocardial infarction at 54 years. His BMI is 23 kg/m2. There is tenderness above the left posterior calcaneus and a firm, 3-cm, skin-colored nodule that moves with the left Ach... | Low-density lipoprotein | {
"A": "Uric acid",
"B": "Rheumatoid factor",
"C": "Angiotensin converting enzyme",
"D": "Low-density lipoprotein",
"E": "Triglycerides"
} | step1 | D |
A 3-year-old boy presents with episodic diarrhea with malodorous stools, stunted growth, occasional abdominal cramps, and an itchy rash. His mother says that these symptoms developed approximately 2 years ago. The patient was exclusively breastfed up to the age of 7 months. Supplementary feeding was started with non-st... | Villous atrophy and crypt hypertrophy | {
"A": "Granulomas in the submucous tissue",
"B": "Crypt abscesses",
"C": "Villous atrophy and crypt hypertrophy",
"D": "Mucosal eosinophilia",
"E": "Villous hyperplasia"
} | step1 | C |
An 18-year-old patient is visiting the pediatrician with her mother for her annual exam before college starts. Her height and weight are appropriate for her age, and she is up to date on all her vaccinations and has no medical complaints. She is doing well in school and has a part-time job stocking shelves at a clothin... | Avoidant personality disorder | {
"A": "Schizotypal personality disorder",
"B": "Generalized anxiety disorder",
"C": "Avoidant personality disorder",
"D": "Paranoid personality disorder",
"E": "Dependent personality disorder"
} | step1 | C |
A 15-year-old girl comes to the physician because of a 2-week history of genital lesions. She has no history of serious illness. She is sexually active with 2 male partners and uses condoms inconsistently. Vital signs are within normal limits. Pelvic examination shows multiple hyperkeratotic exophytic papules over the ... | Vaccination | {
"A": "Condoms",
"B": "Anti-HIV prophylaxis",
"C": "Spermicidal foam",
"D": "Famciclovir therapy",
"E": "Vaccination"
} | step2&3 | E |
A 48-year-old woman comes to the emergency department because of a 1-day history of fever, vomiting, and abdominal pain. Two weeks ago, while visiting Guatemala, she had an emergency appendectomy under general inhalational anesthesia. During the surgery, she received a transfusion of 1 unit of packed red blood cells. H... | Adverse effect of anesthetic | {
"A": "Acalculous inflammation of the gallbladder",
"B": "Virus-mediated hepatocellular injury",
"C": "Trauma to the bile duct",
"D": "Adverse effect of anesthetic",
"E": "Gram-negative bacteria in the bloodstream"
} | step1 | D |
A 10-year-old African American girl with known sickle cell disease becomes acutely anemic in the setting of underlying infection. Her mother denies any previous history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. The patient’s past medic... | Hemolytic transfusion reaction; discontinue transfusion | {
"A": "Minor allergic reaction; administer antihistamines",
"B": "Nonhemolytic febrile reaction; administer antihistamines",
"C": "Minor allergic reaction; discontinue transfusion",
"D": "Hemolytic transfusion reaction; administer antihistamines",
"E": "Hemolytic transfusion reaction; discontinue transfusion... | step2&3 | E |
A 46-year-old woman comes to the physician because of severe muscle and joint pain for 5 months. The pain varies in location and intensity. She also has joint stiffness in the morning and reports fatigue throughout the day that she attributes to not sleeping well. She reports a tingling sensation in her lower limbs. He... | Amitriptyline | {
"A": "Bupropion",
"B": "Temazepam",
"C": "Vitamin B12",
"D": "Amitriptyline",
"E": "Methotrexate\n\""
} | step2&3 | D |
A 68-year-old man presents with difficulty breathing for the last 3 hours. Upon asking about other symptoms, he mentions that he had a cough for the last 4 months which he attributes to his smoking. He says he had frequent nasal stuffiness and headaches over the last 3 months, for which he takes over-the-counter cold m... | Papilledema | {
"A": "Bilateral pedal edema",
"B": "Distended veins over lower abdomen",
"C": "Papilledema",
"D": "Positive Adson test",
"E": "Sensory loss over the ulnar aspect of right forearm and right hand"
} | step1 | C |
A 40-year-old obese man with a history of diabetes and chronic kidney disease presents with one day of excruciating pain, swelling, and redness in his greater toe. He denies any inciting trauma or similar prior episodes. Vital signs are stable. On examination, the right first toe is grossly erythematous and edematous, ... | Monosodium urate | {
"A": "Cholesterol",
"B": "Calcium phosphate",
"C": "Calcium oxalate",
"D": "Monosodium urate",
"E": "Copper"
} | step2&3 | D |
An obese 42-year-old female presents to her primary care physician with a complaint of left knee pain for the past 3 months. She describes the pain as affecting the inside part of the knee as well as the front of her knee, below the kneecap. She denies any inciting injury or trauma to the knee but reports that the pain... | Pes anserine bursitis | {
"A": "Stress fracture of proximal tibia",
"B": "Medial meniscus tear",
"C": "Medical collateral ligament (MCL) sprain",
"D": "Pes anserine bursitis",
"E": "Patellar tendonitis"
} | step2&3 | D |
A 24-year-old woman comes to the physician’s office with concerns about a recent pregnancy. She and her boyfriend had intercourse for the first time a few weeks ago. Two weeks ago she missed her menstrual period. She took several over the counter pregnancy tests that confirmed her pregnancy. She is tearful about the pr... | Mifepristone | {
"A": "Megestrol",
"B": "Tamoxifen",
"C": "Terbutaline",
"D": "Mifepristone",
"E": "Copper intrauterine device"
} | step1 | D |
A 25-year-old woman comes to the physician because of periodic painful double vision for 3 days. Her symptoms occur only when looking sideways. She has myopia and has been wearing corrective lenses for 10 years. Ten days ago, she lost her balance and fell off her bike, for which she went to a hospital. A CT scan of the... | Demyelination of the medial longitudinal fasciculus | {
"A": "Demyelination of the medial longitudinal fasciculus",
"B": "Compressive tumor of the pons",
"C": "Oxidative damage due to thiamine deficiency",
"D": "Subdural hematoma extending into the orbit",
"E": "Infarction of the brainstem"
} | step2&3 | A |
A 63-year-old man presents to the clinic for left calf pain when walking a distance of more than 200 m. He has had this pain for more than 8 months now, and he rates it as 7 out of 10. The pain subsides with rest. The patient has had a history of diabetes mellitus for the past 2 years which is well controlled. A percut... | Cilostazol | {
"A": "Cilostazol",
"B": "Pentoxifylline",
"C": "Femoral embolectomy",
"D": "Femoral-to-popliteal bypass graft",
"E": "Interventional endovascular treatment"
} | step2&3 | A |
A 72-year-old woman comes to the physician because of a 1-month history of frequent headaches, double vision, fatigue, and myalgias. Physical examination shows pallor, tenderness to palpation over the temples, and inward deviation of the left eye. Laboratory studies show an erythrocyte sedimentation rate of 65 mm/h. Te... | Thoracic aortic aneurysm | {
"A": "Pulmonary hypertension",
"B": "Lower extremity gangrene",
"C": "Palpable purpura",
"D": "Posterior uveitis",
"E": "Thoracic aortic aneurysm"
} | step1 | E |
A 22-year-old woman comes to the physician because of yellow vaginal discharge, pruritus, and pain with urination for the past 6 days. Three weeks ago, she had an episode of acute bacterial rhinosinusitis that was treated with a 10-day course of amoxicillin. She has been sexually active with multiple male partners over... | Flagellated protozoa | {
"A": "Obligate intracellular organisms",
"B": "Gram-negative diplococci",
"C": "Positive whiff test",
"D": "Pseudohyphae",
"E": "Flagellated protozoa"
} | step2&3 | E |
A 15-year-old female presents to her pediatrician’s office for severe menstrual cramping. The patient underwent menarche at age 11, and her periods were irregular every 2-3 months for two years. After that, her cycles became roughly regular every 28-35 days, but she has had extremely painful cramps and often has to mis... | NSAIDs | {
"A": "Von Willebrand factor antigen assay",
"B": "Pelvic ultrasound",
"C": "MRI of the pelvis",
"D": "NSAIDs",
"E": "Increased exercise"
} | step2&3 | D |
A 34-year-old woman is brought to the emergency department following a high-speed motor vehicle collision in which she was the restrained driver. On arrival, she has a cervical collar in place and is unresponsive. Her temperature is 36.7°C (98°F), pulse is 70/min, and blood pressure is 131/76 mm Hg. Her pupils are dila... | Corneal reflex test | {
"A": "Electroencephalography",
"B": "Magnetic resonance angiography",
"C": "Deep tendon reflex testing",
"D": "Transcranial Doppler ultrasonography",
"E": "Corneal reflex test"
} | step2&3 | E |
A previously healthy 17-year-old female college student comes to the emergency department because of a 1-day history of fever, chills, and severe headache. Her temperature is 39.4°C (103°F). Physical examination shows nuchal rigidity and photophobia. Blood cultures are obtained and a lumbar puncture is performed. A Gra... | Adhesive pili | {
"A": "Protein A",
"B": "Lipooligosaccharides",
"C": "Adhesive pili",
"D": "Biofilm formation",
"E": "Polysaccharide capsule"
} | step1 | C |
A 74-year-old man was admitted to the intensive care ward due to progressive dyspnea, cough with pink sputum, and diaphoresis. He had 2 myocardial infarctions at the age of 66 and 69 years and suffers from chronic heart failure. At the time of presentation, his vital signs are as follows: blood pressure 90/50 mm Hg, he... | Brownish inclusions in the pulmonary macrophages on H&E staining | {
"A": "Brownish inclusions in the pulmonary macrophages on H&E staining",
"B": "Areas with 'ghost cells' surrounded by macrophages in the cardiac tissue",
"C": "Positive Prussian-blue staining of the kidney tissue",
"D": "Ground-glass hepatocytes",
"E": "Positive Congo-red staining of the cardiac tissue"
} | step1 | A |
Please refer to the summary above to answer this question
A cardiologist at another institution is trying to replicate the table in the abstract with a very similar study that he is conducting. After collecting data on changes in plaque volume, LDL-C levels, FEV1/FVC ratio, and ACQ scores from baseline to 12-month foll... | Analysis of variance | {
"A": "Pearson correlation analysis",
"B": "Chi-square test",
"C": "Analysis of variance",
"D": "Meta-analysis",
"E": "Kaplan-Meier analysis"
} | step2&3 | C |
A 35-year-old woman comes to the physician because of intermittent episodes of heart palpitations for 3 weeks. The palpitations are accompanied by chest pain that is sharp and localized to the left 3rd intercostal space. The patient does not smoke. She drinks one to two glasses of wine on the weekends. She appears nerv... | Propranolol | {
"A": "Propranolol",
"B": "Digoxin",
"C": "Amiodarone",
"D": "Warfarin",
"E": "Diltiazem"
} | step2&3 | A |
A 78-year-old right-handed man is brought to the emergency department by his daughter for sudden onset speech changes. The patient lives with his daughter and was chatting with her when suddenly his speech became distorted with random and disconnected words that made no sense. He seems to be physically frustrated that ... | Left frontal lobe | {
"A": "Left frontal lobe",
"B": "Left internal capsule",
"C": "Left temporal lobe",
"D": "Right frontal lobe",
"E": "Right temporal lobe"
} | step1 | A |
A 68-year-old woman presents with an intermittent throbbing headache with an onset approximately 3 weeks ago. The pain is bilateral, “band-like,” and extends to the neck. The patient rates the 4 points out of 10 on a visual scale. The headache is not accompanied by nausea, vomiting, photophobia, or phonophobia, and is ... | Dilation of the intracerebral arterioles | {
"A": "Meningeal irritation by blood products originating from a chronic subdural hematoma",
"B": "Dissection of an intracerebral vessel",
"C": "Pressure created by the content of the paranasal sinuses",
"D": "Meningeal irritation by a growing intracranial neoplasm",
"E": "Dilation of the intracerebral arter... | step1 | E |
A 31-year-old male comes to your office for his annual exam. He states that he received all of his recommended vaccinations prior to beginning college, but has not had any vaccines in the past 13 years. His medical history is significant for intermittent, exercise-induced asthma. He has been sexually active in the past... | Tetanus, diphtheria, and acellular pertussis booster (Tdap) vaccine | {
"A": "Pneumococcal vaccine",
"B": "Meningococcal vaccine",
"C": "Tetanus, diphtheria, and acellular pertussis booster (Tdap) vaccine",
"D": "Haemophilus influenza B (HIB) vaccine",
"E": "Human papillomavirus (HPV) vaccine"
} | step2&3 | C |
A 24-year-old woman presents to the emergency department with a 2-week history of a foot ulcer. She says that she punctured her foot with a rusty nail while she was playing tennis and that the puncture wound has since progressed to a non-healing ulcer. Over the last 2 days, she has also been experiencing a fever and dr... | Gram-negative bacilli | {
"A": "Gram-negative bacilli",
"B": "Gram-negative diplococci",
"C": "Gram-positive bacilli",
"D": "Gram-positive cocci in chains",
"E": "Gram-positive cocci in clusters"
} | step1 | A |
A 23-year-old man comes to the physician because of a 1-week history of anorexia, nausea, upper abdominal pain, and dark-colored urine. He recently returned from a trip to Belize. His temperature is 38.3°C (100.9°F). Physical examination shows scleral icterus and tender hepatomegaly. Serum studies show markedly elevate... | Increased breakdown of intracellular RNA | {
"A": "Upregulated expression of exogenously synthesized antigens",
"B": "Enhanced macrophage phagocytic function",
"C": "Differentiation of T cells into TH1 cells",
"D": "Activation of eukaryotic initiation factor 2",
"E": "Increased breakdown of intracellular RNA"
} | step1 | E |
A 42-year-old man comes to the physician because of progressive fatigue and shortness of breath for 1 month. He has been unable to practice with his recreational soccer team and has had to rest frequently when walking to work. His only medication is ibuprofen for joint pain. Physical examination shows tanned skin. Ther... | HLA-A3 | {
"A": "HLA-B27",
"B": "HLA-DR3",
"C": "HLA-DR4",
"D": "HLA-B8",
"E": "HLA-A3"
} | step1 | E |
A 32-year-old Caucasian woman is referred to a gastroenterologist by her family physician for 8 months of abdominal pain, foul-smelling diarrhea with floating, bulky stools, weight loss, and macrocytic anemia. Her personal history is relevant for allergic rhinitis. Physical examination shows grouped, erythematous papul... | Gluten-free diet | {
"A": "Amitriptyline",
"B": "Octreotide",
"C": "Lactose-free diet",
"D": "Gluten-free diet",
"E": "Methysergide maleate"
} | step2&3 | D |
A 62-year-old woman with small-cell lung cancer comes to the physician because of a painful, burning red rash on her face and hands that developed 30 minutes after going outside to do garden work. She wore a long-sleeved shirt and was exposed to direct sunlight for about 10 minutes. The patient is light-skinned and has... | Cell injury due to drug metabolites | {
"A": "Degranulation of presensitized mast cells",
"B": "Formation of drug-induced autoantibodies",
"C": "Lymphocyte-mediated allergic reaction",
"D": "Accumulation of porphobilinogen",
"E": "Cell injury due to drug metabolites"
} | step1 | E |
A 54-year-old man is brought to the emergency department after he was found outside in the middle of a blizzard. On presentation, he is conscious but does not know where he is nor how he got there. His wife is contacted and says that he has been getting increasingly confused over the past 6 weeks. This progressed from ... | Can be transmitted on medical equipment even after autoclaving instruments | {
"A": "Can be transmitted on medical equipment even after autoclaving instruments",
"B": "Contains genetic material but is unable to survive independent from a host",
"C": "Has a cell wall containing peptidoglycan",
"D": "Associated with longstanding hypertension",
"E": "Leads to intracellular aggregations o... | step1 | A |
A 5-year-old boy is brought to his pediatrician due to sore throat and fever. He was in his usual state of health until 3 days ago when he began to complain of a sore throat as well as general malaise. The patient's past medical history reveals recurrent upper respiratory infections but no skin or soft tissue infection... | Hypoparathyroidism | {
"A": "Abnormal expression of autoimmune regulator (AIRE)",
"B": "Delayed separation of the umbilical cord",
"C": "Hypoparathyroidism",
"D": "Partial albinism",
"E": "Thrombocytopenic purpura"
} | step1 | C |
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... | Diminished ovarian reserve | {
"A": "Pelvic inflammatory disease",
"B": "Asherman's syndrome",
"C": "Diminished ovarian reserve",
"D": "Hypogonadotropic hypogonadism",
"E": "Premature ovarian failure"
} | step2&3 | C |
A 25-year-old female is brought to the emergency department by her family. They found her somnolent next to her computer and scattered pill bottles over two hours ago. The family cannot recall the types of pill bottles that they found and did not bring them to the ED. The patient's past medical history is notable for a... | N-acetylcysteine | {
"A": "N-acetylcysteine",
"B": "Blood acetaminophen levels",
"C": "Charcoal",
"D": "IV fluids",
"E": "Syrup of ipecac"
} | step2&3 | A |
A 27-year-old man and his wife come to the physician for preconception genetic counseling. The patient and his wife are asymptomatic and have no history of serious illness. The patient's older brother died at age 13 from heart failure and his 6-year-old nephew currently has severe muscle weakness. Genetic testing in th... | Gonadal mosaicism | {
"A": "Variable expressivity",
"B": "Maternal uniparental disomy",
"C": "Gonadal mosaicism",
"D": "Dominant negative mutation",
"E": "Incomplete penetrance"
} | step1 | C |
A 58-year-old Caucasian female presents to her primary care physician with concerns about several recent health changes. The patient has recently gained weight and can't seem to exercise like she used to. She also notes that her thinking seems slow. Physical examination shows thickened, dry skin. Serum analysis confirm... | High TSH | {
"A": "High T4 and T3",
"B": "Low T4 and T3",
"C": "High TSH",
"D": "Hypercholesterolemia",
"E": "Low TSH"
} | step1 | C |
A 33-year-old woman at 17-weeks gestation comes to the physician for evaluation of a painless mass in the right breast for the last 3 weeks that has not increased in size. Physical examination shows dense breasts and a 2.5-cm rubbery, mobile mass that is nontender in the upper outer quadrant of the right breast. A biop... | Fibroadenoma | {
"A": "Fibroadenoma",
"B": "Normal pregnancy-related changes",
"C": "Fibrocystic changes of the breast",
"D": "Fat necrosis",
"E": "Phyllodes tumor"
} | step1 | A |
A 27-year-old male presents for emergency surgery to reattach his left arm, severed during a high-speed car accident, and has lost significant amounts of blood. His wife arrives within minutes to the hospital exclaiming that under no circumstance should he receive any blood transfusions during surgery. After reviewing ... | Respect the patient's written instructions and do not adminster a blood transfusion | {
"A": "Administer a blood transfusion to save the patient's life",
"B": "Call the ethics board of the hospital to discuss the issue",
"C": "Respect the patient's written instructions and do not adminster a blood transfusion",
"D": "Convince the wife to administer a blood transfusion to her husband",
"E": "Re... | step1 | C |
The parents of a 14-year-old patient are concerned and have questions about the use of insulin for their son’s recently diagnosed type 1 diabetes. The patient has developed an upper respiratory infection while at school. He is coughing and has a runny nose. His temperature is 37.8° C (100.2° F) and vital signs are with... | Increase the frequency of blood glucose checks. | {
"A": "Increase the frequency of blood glucose checks.",
"B": "Reduce the insulin dose.",
"C": "Continue same regimen.",
"D": "Hold insulin until the patient gets better.",
"E": "Increase the insulin dose to double."
} | step1 | A |
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 | {
"A": "Hyperplasia",
"B": "Hypertrophy",
"C": "Atrophy",
"D": "Metaplasia",
"E": "Dysplasia"
} | step1 | A |
A 21-month-old boy is brought to the physician for a well-child examination. His mother noticed deformities in both of his legs since he started walking independently. He has been healthy apart from an upper respiratory tract infection 6 months ago. He was delivered at 38 weeks' gestation. His 6-year-old sister was tre... | Reassurance and follow-up | {
"A": "Vitamin D supplementation",
"B": "Reassurance and follow-up",
"C": "X-ray of the lower extremities",
"D": "Bracing of the lower extremities",
"E": "Tibial osteotomy"
} | step2&3 | B |
A 30-year-old woman presents to an outpatient clinic for a scheduled gynecologic check-up. The patient appears well and has no specific complaints. She is current with her Pap smears, all of which have been normal. Her menstrual periods are regular and usually last 3–4 days. She denies any recent travel or a history of... | No further intervention | {
"A": "No further intervention",
"B": "Electrocautery and cryofreezing",
"C": "Colposcopy and biopsy",
"D": "Administration of oral contraceptives",
"E": "Administration of antibiotics"
} | step2&3 | A |
A 1900-g (4-lb 3-oz) newborn is delivered at term to a 36-year-old primigravid woman. Pregnancy was complicated by polyhydramnios. Apgar scores are 7 and 7 at 1 and 5 minutes, respectively. He is at the 2nd percentile for head circumference and 15th percentile for length. Examination shows a prominent posterior part of... | Ventricular septal defect | {
"A": "Cataracts",
"B": "Ventricular septal defect",
"C": "Ebstein's anomaly",
"D": "Pheochromocytoma",
"E": "Holoprosencephaly"
} | step2&3 | B |
A 51-year-old man presents to his primary care provider complaining of fatigue, weight loss, and intermittent fevers for the past 6 months. He has had sexual intercourse with multiple men and women over the past year and does not use barrier protection. His last screen for sexually transmitted diseases was 10 years ago... | Lipodystrophy | {
"A": "Hepatotoxicity",
"B": "Lipodystrophy",
"C": "Megaloblastic anemia",
"D": "Myelosuppression",
"E": "Peripheral neuropathy"
} | step1 | B |
A 68-year-old man presents to his primary care physician with complaints of increased fatigue and back pain for the past year. His symptoms are progressively getting worse over the past few months despite adequate rest and trial of over the counter analgesics. His back pain is constant and non-radiating in nature. He d... | Overflow proteinuria | {
"A": "Overflow proteinuria",
"B": "Transient (functional) proteinuria",
"C": "Tubular proteinuria",
"D": "Orthostatic proteinuria",
"E": "Isolated proteinuria"
} | step1 | A |
A 68-year-old postmenopausal woman presents to the clinic for a dual-energy X-ray absorptiometry (DEXA) scan. The patient states that she has mild joint pain, which she attributes to osteoarthritis, but she notes no recent fractures. She says that her mother had osteoporosis and she is concerned that she may develop it... | T-score of -1.6 | {
"A": "T-score of 1.2",
"B": "T-score of -0.8",
"C": "Z-score of -2.0",
"D": "T-score of -1.6",
"E": "T-score of -2.7"
} | step1 | D |
An investigator is studying the growth pattern of a particular bacterial strain that caused a respiratory disease outbreak in children in rural Venezuela. The bacteria are found to be able to grow in a specialized culture that contains sheep blood, cystine, and potassium tellurite; the colonies are black and have a shi... | Corynebacterium diphtheriae | {
"A": "Legionella pneumophila",
"B": "Mycobacterium tuberculosis",
"C": "Haemophilus influenzae",
"D": "Bordetella pertussis",
"E": "Corynebacterium diphtheriae"
} | step1 | E |
A 7-month-old boy is brought to the physician because of a 2-month history of fatigue, weakness, and difficulty feeding. He was delivered at term to a 32-year-old woman. He is not able to sit upright on his own. He is at the 75th percentile for height and 25th percentile for weight. His temperature is 37.7°C (99.8°F), ... | Lysosomal acid maltase | {
"A": "Muscle glycogen phosphorylase",
"B": "Very-long-chain acyl-CoA dehydrogenase",
"C": "Lysosomal acid maltase",
"D": "Glucose-6-phosphatase",
"E": "Glycogen debranching enzyme"
} | step2&3 | C |
A 4-year-old boy with acute lymphoblastic leukemia is admitted to the hospital to undergo allogeneic bone marrow transplantation. Two weeks after the conditioning regimen is started, he develops a temperature of 38.5°C (101.3°F). Laboratory studies show:
Hemoglobin 8 g/dL
Leukocyte count 1400/mm3
Segmented neutrophils ... | Granulocyte-macrophage colony-stimulating factor | {
"A": "Alkylating chemotherapeutic agent",
"B": "Transforming growth factor-β",
"C": "Erythropoietin",
"D": "Interleukin-5",
"E": "Granulocyte-macrophage colony-stimulating factor"
} | step1 | E |
A 27-year-old female is brought to the emergency department by police when she attacked her date outside of a pizza restaurant. The patient refused to explain her behavior to the police. She seemed to be responding to internal stimuli when being initially interviewed. The patient has a past medical history of depressio... | ANA and anti-dsDNA levels | {
"A": "IM haloperidol",
"B": "Haloperidol depot",
"C": "Clozapine",
"D": "Urine toxicology",
"E": "ANA and anti-dsDNA levels"
} | step2&3 | E |
A 68-year-old man presents to the emergency department because of fever, abdominal pain, and rapidly progressive distension of the abdomen. His appendix was removed for an abscess 3 days ago. The complete blood count showed leukocytosis. Anaerobic culture of the peritoneal fluid needle aspirate showed a gram-negative p... | Bacteroides fragilis | {
"A": "Bacteroides fragilis",
"B": "Campylobacter jejuni",
"C": "Clostridium perfringens",
"D": "Salmonella serotype typhi",
"E": "Shigella sonnei"
} | step1 | A |
A 31-year-old female patient presents with significant swelling and redness of her fingers that is causing her significant pain. Her right knee has also been stiff and slightly swollen for the past 6 weeks. She is overall fatigued and has difficulty moving around but has not sought medical attention until now. On physi... | Psoriatic arthritis | {
"A": "Gout",
"B": "Reactive arthritis",
"C": "Psoriatic arthritis",
"D": "Enteropathic arthropathies",
"E": "Dermatomyositis"
} | step2&3 | C |
A 44-year-old woman presents to her primary care physician because she has been having fever, chest pain, and cough for the last several weeks. She presented to the physician because she discovered blood in her sputum after coughing. She recently returned from a year of traveling abroad, but has otherwise been healthy.... | Required for dehydrogenase enzymes | {
"A": "Required for collagen hydroxylation",
"B": "Required for dehydrogenase enzymes",
"C": "Required for methionine processing",
"D": "Required for methylmalonyl-CoA processing",
"E": "Required for transketolase function"
} | step1 | B |
A 51-year-old Asian woman presents to her primary care provider with abdominal pain. On examination, she is found to have rebound tenderness in the lower right quadrant of her abdomen. Further workup suggests ovarian cancer, which is confirmed later in the week to be stage 4 with confirmed distant metastases in the lun... | Sentinel node - right lumbar trunk - cisterna chyli - thoracic duct - left subclavian vein - systemic circulation | {
"A": "Sentinel node - left lumbar trunk - cisterna chyli - right bronchomediastinal trunk - right lymphatic duct - right subclavian vein - systemic circulation",
"B": "Sentinel node - left lumbar trunk - cisterna chyli - thoracic duct - left subclavian vein - systemic circulation",
"C": "Sentinel node - right l... | step1 | E |
A 49-year-old man comes to the physician because of a 1-week history of diarrhea and abdominal bloating. His stools are bulky, foul-smelling, and difficult to flush. Over the past 6 months, he has had recurrent dull epigastric pain that is triggered by meals and lasts for a few days. He drinks 6 to 8 beers daily. Abdom... | Granulation tissue | {
"A": "Simple ductal epithelium",
"B": "Calcified ductal cells",
"C": "Granulation tissue",
"D": "Pyogenic membrane",
"E": "Columnar mucinous epithelium"
} | step1 | C |
An 80-year-old African American man is brought to the emergency department in a confused state with history of general illness for the past week. He is known to be hypertensive, but noncompliant with medications for the last 20 years. Physical examination reveals dry skin, ecchymoses, and conjunctival pallor. His blood... | Angiotensin-converting-enzyme inhibitor (ACEI) | {
"A": "Angiotensin-converting-enzyme inhibitor (ACEI)",
"B": "Angiotensin II receptor blocker (ARB)",
"C": "Calcium channel blocker (CCB)",
"D": "Beta-blocker (BB)",
"E": "Thiazide"
} | step2&3 | A |
A 4-month-old boy is brought to the pediatrician by his parents. He presents to the pediatric ward with fever, dyspnea, and cough, which he developed 3 days ago. His mother also reports he had poor weight gain despite a good appetite during the past 2 months as well as frequent stools with an unpleasant smell. He was b... | Abnormal CFTR protein | {
"A": "Neutrophil elastase damages lung tissue due to lack of alpha-1-antitrypsin.",
"B": "Abnormal CFTR protein",
"C": "Eosinophils infiltrate blood vessel walls.",
"D": "Electron transport chain in mitochondria is disrupted due to lack of glycerol-3-phosphate dehydrogenase.",
"E": "Due to mutations in dyne... | step1 | B |
A 15-year-old girl is brought to the physician by her mother because of worsening grades over the past year. Since she started high school one year ago, her academic performance has decreased. She also has had difficulty finding friends at the new school. She is afraid that her classmates will make fun of her and think... | Fluoxetine | {
"A": "Clomipramine",
"B": "Phenelzine",
"C": "Clonazepam",
"D": "Fluoxetine",
"E": "Propranolol"
} | step2&3 | D |
A 3-year-old boy is brought to the clinic by his parents because he ‘hasn’t been himself lately’ and reportedly gets tired very easily from his swimming classes in comparison to the other kids. He also ‘can’t catch his breath’ at times. The mother also reports that he seems to be slightly shorter than other children hi... | Endocardial cushion | {
"A": "Aortopulmonary septum",
"B": "Endocardial cushion",
"C": "Infundibular septum",
"D": "3rd pharyngeal arch",
"E": "Rathke’s pouch"
} | step1 | B |
A 26-year-old woman developed rapidly progressive septic shock associated with nuchal rigidity, petechiae, and purpura. She tested positive for both Kernig and Brudzinski's signs and shows signs of confusion, dyspnea, and hypotension. The blood culture results confirmed the presence of Neisseria meningitidis, and a com... | Tumor necrosis factor-α | {
"A": "Tumor necrosis factor-α",
"B": "Interleukin-5",
"C": "Interleukin-12",
"D": "Interferon-α",
"E": "Interleukin-4"
} | step1 | A |
A 35-year-old man comes to the physician because of episodes of difficulty swallowing for the past 3 months. He feels solid food getting stuck in his chest behind the sternum when he eats. Drinking does not cause any difficulty swallowing. He has no coughing or nasal regurgitation. He has no hoarseness or weight loss. ... | Eosinophilic esophagitis | {
"A": "Achalasia",
"B": "Diffuse esophageal spasm",
"C": "Eosinophilic esophagitis",
"D": "Esophageal reflux disease",
"E": "Schatzki’s ring"
} | step2&3 | C |
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 | {
"A": "Exertional heat stroke",
"B": "Malignant hyperthermia",
"C": "Neuroleptic malignant syndrome",
"D": "Status epilepticus",
"E": "Thyroid storm"
} | step2&3 | A |
A 67-year-old man is brought to the hospital by his relatives. He complains of early satiety, abdominal discomfort after food intake, and abdominal bloating. These symptoms have been present since the patient was 52, but they were milder at that time so he paid little attention to them since. Tingling and decreased sen... | Impaired methylation of myelin phospholipids | {
"A": "Chronic bilirubin toxicity",
"B": "Chronic hyperglycemia",
"C": "Chronic acetaldehyde influence",
"D": "Impaired methylation of myelin phospholipids",
"E": "Influence of pseudo-neurotransmitters"
} | step1 | D |
A four-day-old neonate is brought to the pediatrician with vaginal discharge for the last two days. Her mother is concerned about the blood-tinged discharge but states that her daughter has been feeding and voiding well. The neonate was delivered at 39 weeks gestation by an uncomplicated vaginal delivery, and she and h... | Reassurance | {
"A": "Vaginal exam under anesthesia",
"B": "Report to child protective services",
"C": "Vaginal culture",
"D": "Warm water irrigation of the vagina",
"E": "Reassurance"
} | step2&3 | E |
A 53-year-old male presents to his primary care physician complaining of fatigue and joint and muscle pain. He reports a 6-month history of slowly progressive tiredness associated with dull achy pain in his knees, hips, and shoulders. His past medical history is notable for hypertension, diabetes, and stable angina. He... | Sofosbuvir and simeprevir | {
"A": "Sofosbuvir and simeprevir",
"B": "Interferon-alpha",
"C": "Interferon-gamma",
"D": "Ribavirin",
"E": "Lamivudine"
} | step1 | A |
A 40-year-old woman presents to her family physician with a 3-week history of swollen neck. The small, round, and painless swelling, which was detected 3 weeks ago in the middle of her neck, has now increased in size. The swelling is associated with sweaty palms and soles, insomnia, irritability, nervousness, and fatig... | Silent thyroiditis | {
"A": "Graves' disease",
"B": "De Quervain’s thyroiditis",
"C": "Silent thyroiditis",
"D": "Hashimoto’s thyroiditis",
"E": "Riedel's thyroiditis"
} | step1 | C |
A 27-year-old woman with no past medical history presents to the emergency department with recurrent wrist and neck pain for the last 2 months. She reports that her fingers feel stiff in the morning and the symptoms tend to improve as the day progresses. She denies any recent trauma or other inciting events. Family his... | Anti-cyclic citrullinated peptide (anti-CCP) antibody | {
"A": "Synovial fluid analysis",
"B": "Anti-cyclic citrullinated peptide (anti-CCP) antibody",
"C": "Rheumatoid factor",
"D": "CT scan",
"E": "X-ray of cervical spine"
} | step2&3 | B |
A 66-year-old man comes to the physician because of fatigue and swelling of his legs and feet for 6 weeks. During this time he has felt like his eyes have been unusually puffy in the mornings and his urine has been frothy. He has hypertension and rheumatoid factor-positive rheumatoid arthritis. Current medications incl... | Increased serum amyloid A production | {
"A": "Adverse effect of ibuprofen",
"B": "Decreased cardiac ejection fraction",
"C": "Renal deposition of AL amyloid",
"D": "Increased serum amyloid A production",
"E": "Renal deposition of anti-dsDNA immune complexes"
} | step2&3 | D |
A 35-year-old woman presents with an unsteady and broad-based gait, dysmetria, and intention tremor in the distal upper extremities. Her past medical history is relevant for depression, personality changes, and declining work performance, for which she has been put on leave from her current job as an elementary school ... | Copper | {
"A": "Arsenic",
"B": "Iron",
"C": "Copper",
"D": "Lead",
"E": "Mercury"
} | step1 | C |
A 6-year-old Russian boy who recently immigrated to the United States presents to your office with fever and dyspnea. On examination of the oropharynx, you note a grayish-white pseudomembrane and uneven elevation of the soft palate. The patient displays marked enlargement of the cervical lymph nodes. Which of the follo... | Gram-positive bacteria producing exotoxin that acts via ADP ribosylation | {
"A": "Yeast with pseudohyphae",
"B": "Gram-positive bacteria producing exotoxin that acts via ADP ribosylation",
"C": "Gram-positive cocci with hyaluronic acid capsule",
"D": "Gram-negative encapsulated bacteria producing IgA protease",
"E": "Gram-negative bacteria producing exotoxin that inactivates elonga... | step1 | B |
A 17-year-old male presents to the emergency department after a motor vehicle accident. The patient was an unrestrained driver in a head-on collision. He has a past medical history of asthma, depression, and anxiety. He is not currently taking any medications. His temperature is 99.5°F (37.5°C), blood pressure is 90/60... | Syringomyelia | {
"A": "Cervical spine fracture",
"B": "Intracranial hemorrhage",
"C": "Syringomyelia",
"D": "Brachial plexopathy",
"E": "Conversion disorder"
} | step2&3 | C |
A 62-year-old woman with a history of hypertension and type 2 diabetes mellitus comes to the physician for a routine health maintenance examination. She has smoked 1 pack of cigarettes daily for the last 15 years. Current medications include glyburide and amlodipine. The physician prescribes a medication that decreases... | Increased creatine kinase concentration | {
"A": "Increased creatine kinase concentration",
"B": "Decreased glucose concentration",
"C": "Increased lactate concentration",
"D": "Increased triglyceride concentration",
"E": "Increased bradykinin concentration"
} | step1 | A |
A 21-year-old woman comes to the physician for evaluation of excess hair growth on her face. Menses occur irregularly at 45 to 65-day intervals. She is 159 cm (5 ft 3 in) tall and weighs 59 kg (130 lb); BMI is 23 kg/m2. Physical examination shows facial acne and growth of coarse dark hair on the face, chest, and lower ... | Hyperplasia of the adrenal cortex | {
"A": "Hyperproliferation of theca interna cells",
"B": "Exogenous anabolic steroid use",
"C": "Compression of the infundibular stalk",
"D": "Ovarian fibrosis and multiple cystic follicles",
"E": "Hyperplasia of the adrenal cortex"
} | step1 | E |
A 64-year-old man with coronary artery disease and hypertension comes to the physician for a follow-up examination. His blood pressure ranged from 160/100 mm Hg to 150/94 mm Hg on his previous 3 visits over the past 4 months. Current medications include aspirin, atorvastatin, hydrochlorothiazide, and metoprolol. Three ... | Hyperplasia of juxtaglomerular cells | {
"A": "Hyperplasia of juxtaglomerular cells",
"B": "Dilation of efferent arteriole",
"C": "Mesangial expansion and glomerular basement membrane thickening",
"D": "Decreased prostaglandin synthesis by macula densa",
"E": "Decreased reabsorption of bicarbonate at proximal tubule"
} | step1 | A |
A 65-year-old woman is brought to the emergency department by her husband after he found her with nausea, headache, and agitation 1 hour ago. When he left their lakeside cabin 6 hours before to go ice fishing and get more firewood, she did not have any symptoms. She has chronic migraines, hypertension, and type 2 diabe... | Hyperbaric oxygen therapy | {
"A": "Intravenous nitroprusside",
"B": "Intranasal sumatriptan",
"C": "Hyperbaric oxygen therapy",
"D": "100% oxygen therapy",
"E": "Heliox therapy"
} | step2&3 | C |
A 62-year-old Caucasian male presents to the emergency room with severe substernal chest pain, diaphoresis, and nausea. Imaging reveals transmural myocardial infarction in the posterior 1/3 of the ventricular septum. Which of this patient's coronary arteries is most likely occluded? | Right main | {
"A": "Left circumflex",
"B": "Left anterior descending",
"C": "Diagonal perforators",
"D": "Septal perforators",
"E": "Right main"
} | step1 | E |
A previously healthy, 24-year-old man comes to the physician because of a 6-week history of loose, nonbloody stools. He also reports abdominal pain, intermittent nausea, and fever. He has not had vomiting, tenesmus, or rectal pain. His vital signs are within normal limits. Abdominal examination reveals tenderness of th... | Formation of noncaseating granulomas | {
"A": "Neutrophilic inflammation of the crypts",
"B": "Neutrophil-rich pseudomembranes",
"C": "Formation of noncaseating granulomas",
"D": "Inflammation limited to the mucosa and submucosa",
"E": "Presence of pseudopolyps"
} | step1 | C |
A 65-year-old man presents with pain in his left thigh for a week. He describes the pain as dull and constant, boring in nature, and localized deep below the thigh muscle. He says it is worse at night. Physical examination is significant for tenderness and warmth over the anterior aspect of the left thigh. A plain radi... | Osteitis deformans | {
"A": "Osteomalacia",
"B": "Ewing's sarcoma",
"C": "Osteitis deformans",
"D": "Osteochondritis dissecans",
"E": "Osteitis fibrosa cystica"
} | step1 | C |
A 15-year-old boy is brought to the emergency department because of severe abdominal pain and vomiting for 8 hours. He has had around 3–4 episodes of greenish colored vomit during this period. He has major depressive disorder with psychosis. His mother has Graves' disease. Current medications include sertraline and hal... | Dantrolene | {
"A": "Propranolol",
"B": "Dantrolene",
"C": "Bromocriptine",
"D": "Cyproheptadine",
"E": "Surgical embolectomy"
} | step2&3 | B |
After a T cell progenitor leaves the bone marrow, most of its development takes place in the thymus. It passes through several stages during its maturation. Positive selection is an important process during maturation of T lymphocytes, and it ensures the preservation of self-major histocompatibility complex (MHC)-restr... | Double-positive T cell | {
"A": "Double-negative pro-T cell",
"B": "Pre-T cell",
"C": "Double-positive T cell",
"D": "Single-positive CD4+ T cell",
"E": "Single-positive CD8+ T cell"
} | step1 | C |
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... | Posttraumatic stress disorder | {
"A": "Acute stress disorder",
"B": "Performance anxiety",
"C": "Schizophrenia",
"D": "Posttraumatic stress disorder",
"E": "Panic attack"
} | step2&3 | D |
A patient with a1-antitrypsin deficiency is warned by his physician that his increasing dyspnea may be worsened by his continued cigarette smoking. Which of the following factors, released by both neutrophils and alveolar macrophages, is responsible for the patient's condition? | Elastase | {
"A": "Major Basic Protein",
"B": "Antibodies against alpha-3 segment of collagen IV (COL4A3)",
"C": "Mucus",
"D": "Surfactant",
"E": "Elastase"
} | step1 | E |
A 54-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with type 2 diabetes mellitus 1 year ago. His only medication is metformin. His serum glucose is 186 mg/dL and his hemoglobin A1c is 7.6%. The physician prescribes an additional antidiabetic drug and counsels the pat... | Rosiglitazone | {
"A": "Empagliflozin",
"B": "Liraglutide",
"C": "Rosiglitazone",
"D": "Glyburide",
"E": "Sitagliptin"
} | step1 | C |
A 19-year-old woman is brought into the emergency department after collapsing during a cheerleading practice session. Her vitals taken by the emergency medical services (EMS) include blood pressure 88/55 mm Hg, pulse 55/min. She was given a liter of isotonic fluid while en route to the hospital. At the emergency depart... | Cognitive-behavioral therapy | {
"A": "Cognitive-behavioral therapy",
"B": "In-patient medical therapy",
"C": "In-patient psychiatric therapy",
"D": "Antidepressants",
"E": "Appetite stimulants"
} | step2&3 | A |
A 45-year-old man comes to the physician for a routine health maintenance examination. He was diagnosed with HIV 15 years ago. He was taking triple antiretroviral therapy but stopped a few months ago because he was feeling well. He lives in Wyoming. Vital signs are within normal limits. Cardiopulmonary examination show... | Trimethoprim, sulfamethoxazole, azithromycin | {
"A": "Trimethoprim and sulfamethoxazole",
"B": "Azithromycin and itraconazole",
"C": "Azithromycin and amphotericin B",
"D": "Trimethoprim, sulfamethoxazole, azithromycin",
"E": "Dapsone, pyrimethamine, itraconazole, azithromycin"
} | step2&3 | D |
A 32-year-old male presents to the emergency department because of fever and diarrhea. He was in his normal state of health until 2 weeks ago when he went abroad on a vacation. During his trip he went kayaking, visited spas, interacted with local animals, and ate local foods. Since returning he has had 3-day history of... | Is transmitted by air conditioning | {
"A": "Can form an endospore",
"B": "Has a rabbit reservoir",
"C": "Has no cell wall",
"D": "Is more common in parrot owners",
"E": "Is transmitted by air conditioning"
} | step1 | E |
A 14-year-old boy presents to the emergency department with hand pain after falling from his skateboard one day ago. He reports that he lost his balance while attempting a new trick and fell on his outstretched hands. He has been icing his hand and taking several tablets of ibuprofen every few hours, but the pain and s... | Radiograph of the wrist | {
"A": "Reassurance and pain management",
"B": "Radiograph of the wrist",
"C": "MRI of the wrist",
"D": "Thumb spica cast",
"E": "Radial gutter cast"
} | step2&3 | B |
A 22-year-old woman comes to the physician for the evaluation of irregular menstrual bleeding. Menses have occurred at 45- to 90-day intervals since menarche at the age of 15 years. Her last menstrual period was 5 weeks ago. The patient reports that she was too embarrassed to discuss this issue with anyone until now. O... | Clomiphene therapy | {
"A": "In vitro fertilization with patient's egg",
"B": "Progesterone therapy",
"C": "Bromocriptine therapy",
"D": "Clomiphene therapy",
"E": "Leuprolide therapy"
} | step2&3 | D |
A 56-year-old man comes to the emergency department because of nausea and shortness of breath that started while he was at work one hour ago. He also reports lightheadedness that started earlier in the day. He has type 2 diabetes mellitus, for which he takes metformin and sitagliptin. He has smoked 1 pack of cigarettes... | Acute inferior myocardial infarction | {
"A": "Viral myocarditis",
"B": "Acute pericarditis",
"C": "Acute inferior myocardial infarction",
"D": "Saddle pulmonary embolus",
"E": "Second-degree AV block"
} | step1 | C |
A 27-year-old man with a history of cocaine abuse comes to the physician 2 weeks after undergoing successful arthroscopic repair of a torn medial collateral ligament in his left knee. There were no complications. He was discharged with prescriptions for oxycodone and acetaminophen. He complains of severe pain that prev... | Request further information about which drugs he has taken recently and in the past | {
"A": "Prescribe a long-acting opioid for better pain relief if he is willing to sign a pain contract",
"B": "Request further information about which drugs he has taken recently and in the past",
"C": "Request consent for urine test to assess current drug use",
"D": "Prescribe a short course of oxycodone and s... | step1 | B |
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 | {
"A": "Botox",
"B": "Carbamazepine",
"C": "Vitamin B12",
"D": "Methylprednisolone",
"E": "Ceftriaxone"
} | step2&3 | A |
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