question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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A 5-year-old boy is brought to the physician because of an irregular gait 3 days after receiving age-appropriate vaccinations. Examination of the lower extremities shows no redness or swelling. When the child stands on his right leg, his left leg drops and his pelvis tilts towards the left. Sensation to light touch is ... | Superomedial quadrant of the right buttock | {
"A": "Inferolateral quadrant of the right buttock",
"B": "Inferomedial quadrant of the right buttock",
"C": "Inferomedial quadrant of the left buttock",
"D": "Superomedial quadrant of the right buttock",
"E": "Inferolateral quadrant of the left buttock"
} | step1 | D |
A 2-year-old boy is brought to the physician because of decreased appetite and abdominal pain for the last several weeks. Physical examination shows a well-appearing toddler with a palpable left-sided abdominal mass that does not cross the midline. A CT of the abdomen shows a large, necrotic tumor on the left kidney. H... | Papillary muscles | {
"A": "Carotid body",
"B": "Adrenal medulla",
"C": "Thyroid gland",
"D": "Papillary muscles",
"E": "Anterior pituitary\n\""
} | step1 | D |
A 14-year-old boy is brought to the physician because of an increasing difficulty in hearing over the past several months. His mother says they have to speak at a higher volume for him to understand them. He also complains of having difficulty reading his favorite books because he is not able to see the words clearly. ... | Alport syndrome | {
"A": "Alport syndrome",
"B": "Fabry’s disease",
"C": "Fanconi syndrome",
"D": "Von Hippel-Lindau disease",
"E": "Tuberous sclerosis"
} | step2&3 | A |
A 16-year-old female presents to her primary care physician due to lack of menstruation. She has never had a period and is anxious that she is not “keeping up” with her friends. She states that her breasts began developing when she was 13, and she had a growth spurt around the same time. Review of systems reveals that ... | Vaginal septum | {
"A": "Hypothalamic amenorrhea",
"B": "Hyperprolactinemia",
"C": "Imperforate hymen",
"D": "Vaginal septum",
"E": "Normal development"
} | step2&3 | D |
A 35-year-old man presents to the emergency room due to shortness of breath that started an hour ago while playing football with some friends. He has had similar episodes in the past when he also had to be rushed to the hospital. Physical examination shows body temperature is 37.2°C (98.9°F), pulse rate is 100/min, res... | Asthma attack | {
"A": "Asthma attack",
"B": "Carbon monoxide (CO) poisoning",
"C": "Atelectasis",
"D": "Neuromuscular disease",
"E": "Acute respiratory distress syndrome (ARDS)"
} | step1 | A |
A 48-year-old homeless male is brought to the emergency department, by the police, for altered mental status. Past medical records are unavailable. A physical exam on admission reveals scleral icterus and a flapping tremor of the wrists during extension. The patient is admitted to the hospital and his treatment is star... | Lactulose | {
"A": "Thiamine",
"B": "Lactulose",
"C": "Naloxone",
"D": "Loperamide",
"E": "Rifaximin"
} | step2&3 | B |
A 61-year-old man presents to his primary care provider complaining of abdominal pain and constipation. He reports a 4-day history of steady right lower quadrant pain. He has had one small bowel movement in 4 days. Normally he has a bowel movement once a day. His medical history is notable for poorly controlled hyperte... | Ehlers-Danlos syndrome | {
"A": "Alpha-1-antitrypsin deficiency",
"B": "Autosomal recessive polycystic kidney disorder",
"C": "Ehlers-Danlos syndrome",
"D": "Goodpasture syndrome",
"E": "Menetrier disease"
} | step1 | C |
A 67-year-old man is brought to the emergency department with sudden onset of slurred speech. The patient’s eldest daughter says that he couldn’t move his arm during the episode. Past medical history is significant for hypertension and a hemorrhagic stroke 6 years ago, which was treated surgically. After admission, the... | Contact another family member for consent | {
"A": "Follow the daughter’s wishes to withhold the operation",
"B": "Refer this case to the court",
"C": "Contact another family member for consent",
"D": "Perform the surgery without consent",
"E": "Report the daughter to the police"
} | step1 | C |
A 50-year-old man with congestive heart failure (CHF) was started on an experimental analog of atrial natriuretic peptide. Which of the following would he expect to experience? | Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation | {
"A": "Increased water reabsorption by the renal collecting ducts",
"B": "Vasoconstriction, increased blood pressure, aldosterone release",
"C": "Increased glomerular filtration rate, restricted aldosterone release, vascular smooth muscle dilation",
"D": "Increased renal absorption of sodium and water",
"E":... | step1 | C |
A 56-year-old man is brought to the emergency room after a motor vehicle accident. The patient’s vitals are as follows: blood pressure 80/40 mm Hg, heart rate 111/min, respiratory rate 39/min, and temperature 37.1°C (98.8℉). On physical examination, the patient is unconscious with a GCS of 9/15 and is cyanotic. There a... | Informed consent is not needed in this case | {
"A": "The patient’s closest relatives (spouse, child or parent), who must be brought to the hospital as fast as possible",
"B": "One of the witnesses at the scene of the car accident, who should be brought to the hospital as fast as possible",
"C": "The hospital ethics committee",
"D": "Informed consent is no... | step1 | D |
A group of researchers wants to evaluate how often the human immunodeficiency virus (HIV) is related to high-risk behaviors in female sex workers from their country. An additional aim is to evaluate the association between HIV acquisition and certain sociodemographic factors. The researchers collect data through interv... | Prevalence | {
"A": "Incidence",
"B": "Prevalence",
"C": "Hazard rate",
"D": "Relative risk",
"E": "Attributable risk"
} | step1 | B |
A 53-year-old man comes to the physician because of a 2-month history of multiple episodes of small amounts of blood in his stools. Examination shows pale conjunctivae. His hemoglobin concentration is 8.3 g/dL and mean corpuscular volume is 72μm3. Colonoscopy shows a 2.3-cm polypoid mass in the ascending colon. A photo... | Impaired degradation of β-catenin | {
"A": "Underexpression of COX-2",
"B": "Increased activity of c-KIT",
"C": "Increased phosphorylation of serine and threonine",
"D": "Impaired degradation of β-catenin",
"E": "Abnormal transfer of phosphate to cellular proteins"
} | step1 | D |
A 68-year-old female presents to her primary care physician with a 7-month history of fatigue and low back pain. Her pain is not improved by over the counter analgesics. Laboratory analysis is notable for a calcium level of 11.5 mg/dL, creatinine level of 2.0 mg/dL, and blood urea nitrogen level of 30 mg/dL. Large eosi... | Linear aggregations of red blood cells | {
"A": "Abundant reticulocytes",
"B": "Linear aggregations of red blood cells",
"C": "Schistocytes",
"D": "Leukocytosis with abundant mature myeloid cells",
"E": "Smudge cells"
} | step1 | B |
A 95-year-old woman who is a resident at a long term care facility, got up from her chair, tripped on a rug, and fell on her right knee. She could not get up without assistance and complained of severe pain in her right hip and buttock. The nurse who evaluated her tried to stand her up, but when the patient tried to st... | Oxybutynin | {
"A": "Metformin",
"B": "Oxybutynin",
"C": "Metoprolol",
"D": "Lisinopril",
"E": "Hydrochlorothiazide"
} | step1 | B |
A 26-year-old woman comes to the clinic for an annual wellness examination. She is healthy with no prior history of significant illness. She exercises 3-4 times a week and eats a plant-based diet with no carbonated drinks. When asked if anything is bothering her, she reports that she has been having recurring episodes ... | Alpha-adrenergic agonist | {
"A": "Alpha-adrenergic agonist",
"B": "Competitive blockage of muscarinic receptors",
"C": "Disruption of disulfide bonds",
"D": "Inhibition of phosphodiesterase-5",
"E": "Short acting beta-2 agonist"
} | step1 | A |
A 27-year-old woman was referred to a dermatology clinic due to a changing discoloration of her fingers from white to red to blue. Although she has not had any recent changes in her daily routines, she also complains of increasing fatigue, muscle weakness, and weight loss. She has a blood pressure of 126/77 mm Hg, resp... | Mixed connective tissue disease | {
"A": "Systemic lupus erythematosus (SLE)",
"B": "Mixed connective tissue disease",
"C": "Polymyositis",
"D": "Systemic sclerosis",
"E": "Rheumatoid arthritis"
} | step1 | B |
A 32-year-old woman presents to the physician because she feels depressed, has difficulty sleeping, has a poor appetite, and has had a problem concentrating for the past 3 months. During this time, she has also has had low energy and has lost interest in playing the guitar. During high school, the patient went through ... | Bupropion | {
"A": "Bupropion",
"B": "Citalopram",
"C": "Fluoxetine",
"D": "Mirtazapine",
"E": "Trazodone"
} | step2&3 | A |
A 52-year-old man comes to the physician for an annual physical examination. He reports that his vision has progressively improved over the past 6 months and he no longer needs the glasses he used while driving. He has hypertension and type 2 diabetes mellitus. Current medications include glyburide, hydrochlorothiazide... | Denaturation of lens protein | {
"A": "Decreased susceptibility to glare",
"B": "Denaturation of lens protein",
"C": "Liquefication of the vitreous body",
"D": "Increased ciliary muscle tone",
"E": "Increased lens elasticity"
} | step1 | B |
A 21-year-old woman presents to the emergency room with right arm pain and limited range of motion. She does not recall trauma to the arm. She also complains of diarrhea and nausea. She is sexually active with one male partner and admits to having pain during intercourse. There is vague and diffuse tenderness to palpat... | Somatization disorder | {
"A": "Ulcerative colitis",
"B": "Illness anxiety disorder",
"C": "Somatization disorder",
"D": "Somatoform pain disorder",
"E": "Conversion disorder"
} | step1 | C |
A 22-year-old man presents to a psychiatrist complaining of mood fluctuations. He is accompanied by his mother who reports that the patient recently experienced a 5-day episode of minimal sleep and unusual levels of energy. The patient admits to spending $2,000 of his parent’s money, without asking, on a down payment f... | Bipolar II disorder | {
"A": "Bipolar I disorder",
"B": "Bipolar II disorder",
"C": "Cyclothymic disorder",
"D": "Persistent depressive disorder",
"E": "Schizoaffective disorder"
} | step1 | B |
A 32-year-old woman comes to the emergency department because a 5-week history of abdominal pain and bloody diarrhea that has worsened in the past 24 hours. She was diagnosed with ulcerative colitis 1 year ago but has had difficulty complying with her drug regimen. Her temperature is 38.2°C (100.8°F), pulse is 120/min,... | Abdominal x-ray | {
"A": "Double-contrast barium enema",
"B": "Abdominal CT scan with contrast",
"C": "CT angiography",
"D": "Abdominal x-ray",
"E": "Colonoscopy"
} | step1 | D |
A 55-year-old man recovering from knee replacement surgery complains of breathlessness in the postoperative ward. He has been confined to bed for the past 5 days and is under observation. He felt a sudden difficulty in breathing and called for the ward nurse. He says that he is unable to take deep breaths and has a sha... | Subcutaneous fondaparinux | {
"A": "Subcutaneous fondaparinux",
"B": "CT scan",
"C": "Inferior vena cava filter",
"D": "Ventilation-perfusion scan",
"E": "Lower extremity doppler"
} | step2&3 | A |
A 62-year-old man is brought to his primary care physician by his wife who is concerned about the patient's frequent falls. Approximately 6 months ago, she started noticing that he was walking more slowly than usual. He has fallen more than 6 times in the past month, and she is worried that he will sustain a serious in... | Intracellular inclusions of alpha-synuclein | {
"A": "Accumulations of beta-pleated sheets",
"B": "Atrophy of the caudate nucleus",
"C": "Extracellular aggregates of amyloid beta",
"D": "Intracellular inclusions of alpha-synuclein",
"E": "Intracellular inclusions of hyperphosphorylated tau"
} | step1 | D |
A 16-month-old boy is brought to the physician by his mother for a regular check-up. His mother says that he has not yet begun to walk. He is exclusively breastfed. He is at the 20th percentile for length, 10th percentile for weight, and 50th percentile for head circumference. Physical examination shows erosion of the ... | Impaired growth plate mineralization | {
"A": "Deficiency of cofactor for prolyl and lysyl hydroxylase",
"B": "Defect in type I collagen",
"C": "Impaired growth plate mineralization",
"D": "Impaired osteoclast-mediated bone resorption",
"E": "Mutation of fibroblast growth factor receptor 3"
} | step1 | C |
A 55-year-old man is brought to the emergency department with altered mental status. The patient is in acute distress and cannot provide history due to disorientation. Temperature is 38.7°C (101.6°F), blood pressure is 80/50 mm Hg, pulse is 103/min, respiratory rate is 22/min, and BMI is 20 kg/m2. On examination, his s... | ERCP | {
"A": "ERCP",
"B": "Close monitoring",
"C": "MRCP",
"D": "Percutaneous transhepatic cholangiogram",
"E": "CT abdomen"
} | step2&3 | A |
A 31-year-old woman comes to the physician because of a 5-month history of intermittent flank pain. Over the past 2 years, she has had five urinary tract infections. Her blood pressure is 150/88 mm Hg. Physical examination shows bilateral, nontender upper abdominal masses. Serum studies show a urea nitrogen concentrati... | Autosomal dominant polycystic kidney disease | {
"A": "Medullary sponge kidney",
"B": "Simple renal cysts",
"C": "Autosomal dominant polycystic kidney disease",
"D": "Autosomal recessive polycystic kidney disease",
"E": "Obstructive cystic dysplasia"
} | step1 | C |
A 39-year-old African-American woman presents to the emergency room with hip pain. She has a past medical history significant for sarcoidosis which was recently diagnosed 6 months ago and is currently being treated. She reports that the pain started 2 weeks ago and is localized to the left hip and groin. The pain has b... | MRI of the hip | {
"A": "CT of the hip",
"B": "MRI of the hip",
"C": "Radiograph of the hip",
"D": "Radionuclide scan of the hip",
"E": "Ultrasound of the hip"
} | step2&3 | B |
A 22-year-old man from Nepal presents to the emergency department complaining of swelling and pain in his right testicle. The patient states that he just arrived in the United States to live with his wife, with whom he is monogamous. The patient denies painful urination or urethral discharge, but admits that 10 days ag... | Preventable by a live attenuated vaccine | {
"A": "Preventable by a live attenuated vaccine",
"B": "Dilation of the pampiniform plexus",
"C": "Original presentation in the form of a painless chancre",
"D": "Cause buboes in the inguinal lymph nodes",
"E": "Is a common cause of septic arthritis in this patient’s age group"
} | step1 | A |
A 27-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. The patient reports severe pelvic pain. Pregnancy has been complicated by gestational diabetes. Pregnancy and delivery of her first child were uncomplicated. Current medications include insulin, folic acid, and a... | Sympathetic block | {
"A": "Decreased cardiac contractility",
"B": "Sympathetic block",
"C": "Hypovolemia",
"D": "Acute pulmonary hypertension",
"E": "Aortocaval compression"
} | step2&3 | B |
A 57-year-old woman is brought to the emergency department by ambulance for dysarthria and left-sided facial droop. She is accompanied by her son, who states that the patient had just returned home an hour ago from walking the dog when suddenly the patient stated she felt “strange.” When her son asked her what was wron... | Exchange transfusion | {
"A": "Alteplase",
"B": "Exchange transfusion",
"C": "Hydralazine",
"D": "Naloxone",
"E": "Warfarin"
} | step2&3 | B |
A 58-year-old male is hospitalized after sustaining multiple fractures in a severe automobile accident. Soon after hospitalization, he develops respiratory distress with crackles present bilaterally on physical examination. The patient does not respond to mechanical ventilation and 100% oxygen and quickly dies due to r... | Interstitial edema | {
"A": "Diaphragmatic hypertrophy",
"B": "Proliferation of bronchiolar mucous glands",
"C": "Interstitial edema",
"D": "Large pulmonary embolus",
"E": "Left apical bronchoalveolar carcinoma"
} | step1 | C |
A 6-year-old African American boy is referred to the hospital by his family physician for jaundice, normocytic anemia, and severe bone pain. He has a history of several episodes of mild bone pain in the past treated with over the counter analgesics. On physical examination, the child is icteric with nonspecific pain in... | Sickle cell disease | {
"A": "Sickle cell trait",
"B": "Sickle cell disease",
"C": "Hemoglobin F",
"D": "Hemoglobin SC",
"E": "HbC"
} | step1 | B |
A 55-year-old man presents to the emergency department with complaints of nausea, vomiting, palpitations, and dizziness, which have lasted for the past 3 hours. He was diagnosed with heart failure 1 year ago. During his last visit to his primary care physician, he was doing well and the lab results were normal. He repo... | Inhibition of P-glycoprotein | {
"A": "Drug-induced hypokalemia",
"B": "Increased intestinal absorption of digoxin",
"C": "Inhibition of CYP 3A4 isoenzyme",
"D": "Inhibition of P-glycoprotein",
"E": "Increased enterohepatic circulation of digoxin"
} | step1 | D |
A 36-year-old man is brought to the emergency department 25 minutes after being involved in a high speed motor-vehicle collision in which he was an unrestrained passenger. He has acute myeloid leukemia and is currently receiving chemotherapy. On arrival, his temperature is 37°C (98.6°F), pulse is 63/min, respirations a... | Intubation and mechanical ventilation | {
"A": "Focussed assessment sonography for trauma (FAST)",
"B": "Insertion of intercostal chest tube",
"C": "CT scan of the head and neck",
"D": "X-rays of the extremities",
"E": "Intubation and mechanical ventilation"
} | step2&3 | E |
A 51-year-old woman was recently diagnosed with type II diabetes. Due to the cumulative effects of diabetes, various health screenings and vaccinations are routinely recommended. Which of the following vaccinations or screening measures are recommended in patients with diabetes? | Comprehensive foot exam every year | {
"A": "Urinalysis every 6 months",
"B": "Comprehensive foot exam every year",
"C": "Weekly foot inspections by patient or family member",
"D": "Hepatitis A vaccination series",
"E": "Meningococcal vaccine"
} | step2&3 | B |
A 23-year-old man presents with sudden loss of consciousness while pitching in a baseball game. There is no history of injury. Consciousness is regained after cardiopulmonary resuscitation. Past medical history is negative for any neurological and cardiovascular problems. Physical examination reveals a prominent A wave... | Hypertrophic cardiomyopathy | {
"A": "Dilated cardiomyopathy",
"B": "Hypertrophic cardiomyopathy",
"C": "Aortic stenosis",
"D": "Takotsubo cardiomyopathy",
"E": "Restrictive cardiomyopathy"
} | step1 | B |
A 39-year-old man is brought to the emergency department unconscious following 2 episodes of generalized tonic-clonic seizures. According to the attendants, he has complained of recurrent headaches for the past 2 weeks. There is no history of fever, head trauma, or a seizure disorder. The patient does not smoke cigaret... | Epstein-Barr virus | {
"A": "Epstein-Barr virus",
"B": "Human herpes virus",
"C": "Human papilloma virus",
"D": "Human T-lymphotropic virus",
"E": "Schistosoma haematobium"
} | step2&3 | A |
A 22-year-old woman from a rural area who recently discovered she was pregnant is referred for a cardiology consultation due to cyanosis, dyspnea, and a cardiac murmur revealed at the initial prenatal visit. She is gravida 1, para 0 with an estimated gestational age of 19 weeks. She says that the murmur was found in he... | Decrease in systemic vascular resistance | {
"A": "Increase in pulmonary vascular resistance",
"B": "Increase in heart rate",
"C": "Decrease in systemic vascular resistance",
"D": "Increase in cardiac output",
"E": "Increase in blood volume"
} | step2&3 | C |
A 25-year-old man with a past medical history of constipation and fibromyalgia presents to the emergency department with generalized malaise and severe diarrhea. The patient states that he has not felt well for the past 24 hours and his symptoms are no longer tolerable. He denies taking any medications or illicit drugs... | Clonidine | {
"A": "Clonidine",
"B": "Diazepam taper",
"C": "Haloperidol and diphenhydramine",
"D": "Naloxone",
"E": "Oseltamivir"
} | step2&3 | A |
A 45-year-old woman presents to the clinic with her husband to discuss her most recent problem. She and her husband recently bought a new house in the area. While cleaning the house, they discovered a nest of spiders. She reports blacking out and waking up outside the house with a bandage on her arm. Her husband says t... | Desensitization | {
"A": "Desensitization",
"B": "Paroxetine",
"C": "Metoprolol",
"D": "Alprazolam",
"E": "Psychotherapy"
} | step2&3 | A |
A 67-year-old man is brought to the physician because of increasing forgetfulness, unsteadiness, and falls over the past year. He reports that these symptoms seem to worsen with each fall. Initially, he could not remember directions to his home but now cannot remember recent conversations or appointments he has made. H... | Cognitive training | {
"A": "Warfarin therapy",
"B": "Vitamin E therapy",
"C": "Cerebral shunting",
"D": "Tetrabenazine therapy",
"E": "Cognitive training"
} | step2&3 | E |
A 28-year-old primigravid woman at 39 weeks gestation is admitted to the hospital in active labor. On examination, the cervix is 100% effaced and 10 cm dilated. After 5 minutes of pushing, there is a prolonged deceleration of the fetal heart rate to 90/min. A decision to perform an episiotomy is made to expedite vagina... | External anal sphincter | {
"A": "Obturator externus muscle",
"B": "Skin of the lateral thigh",
"C": "External anal sphincter",
"D": "Skin of the mons pubis",
"E": "Detrusor muscle"
} | step1 | C |
A 55-year-old woman with a history of HIV presents to the emergency department with progressive dyspnea, fever, and dry cough for the past 4 days. She has not been compliant with antiretroviral or prophylactic medication. On evaluation, the patient is in moderate respiratory distress. The temperature is 38.8°C (102.0°F... | Needle thoracostomy | {
"A": "Discontinue antibiotics",
"B": "Administer epinephrine",
"C": "Perform an arterial blood gas",
"D": "Needle thoracostomy",
"E": "Stat chest X-ray"
} | step2&3 | D |
A 22-year-old woman with polycystic ovarian syndrome comes to the emergency department because of a 1-day history of left lower abdominal pain that began suddenly while she was running. Her last menstrual period was 2 weeks ago. Physical examination shows tenderness to palpation over the left adnexa and rebound tendern... | Rectouterine pouch | {
"A": "Lesser sac",
"B": "Rectouterine pouch",
"C": "Hepatorenal space",
"D": "Splenorenal angle",
"E": "Rectovesical pouch"
} | step1 | B |
A 47-year-old woman comes to the physician for a follow-up examination. She has noticed trembling of her hands for the past 5 months. These movements are only present when she reaches to pick up an object or answer the phone. She has a history of major depressive disorder but has been off medications for the past 3 yea... | Cerebellar demyelination | {
"A": "Cerebellar demyelination",
"B": "Degenerated substantia nigra",
"C": "Degenerated caudate nucleus",
"D": "Essential tremor",
"E": "Subthalamic nucleus stroke\n\""
} | step2&3 | A |
A 52-year-old man comes to the physician because of generalized pruritus and raised, erythematous plaques on the skin over his hands, chest, and legs for 6 hours. He reports having clear liquid discharge from his nose and sneezing. He says that his symptoms began suddenly the previous night, 30 minutes after he had din... | Fexofenadine | {
"A": "Diphenhydramine",
"B": "Amoxicillin",
"C": "Fexofenadine",
"D": "Vitamin K",
"E": "Calamine lotion"
} | step2&3 | C |
A 19-year-old man in a 3-month relationship with a woman experiences frequent sexual fantasies about male coworkers. He lives in a conservative community and does not know any openly gay men. Two days ago, he joined a local group considered by many organizations to be a hate group. Together with the other members, he a... | Reaction formation | {
"A": "Acting out",
"B": "Sublimation",
"C": "Reaction formation",
"D": "Intellectualization",
"E": "Projection"
} | step2&3 | C |
A 66-year-old woman presents to her primary care provider with several days of left flank pain radiating to the abdomen and groin. The patient states that she has noticed a pink tinge to her urine as well. Of note, she has not had any fevers, but endorses several months of fatigue and constipation. The patient was prev... | Primary hyperparathyroidism | {
"A": "Primary hyperparathyroidism",
"B": "Pseudohypoparathyroidism",
"C": "Pseudopseudohypoparathyroidism",
"D": "Secondary hyperparathyroidism",
"E": "Tertiary hyperparathyroidism"
} | step1 | A |
A 23-year-old woman presents to her psychiatrist concerned about her mood. She has felt tired and unwilling to engage in any activities lately. She states that her limbs feel heavy all the time and that completing any activity takes tremendous effort. She no longer finds any happiness in activities that she previously ... | Continue current therapy | {
"A": "Add lithium to treatment regimen",
"B": "Change treatment to duloxetine",
"C": "Change treatment to lithium",
"D": "Continue current therapy",
"E": "Electroconvulsive therapy"
} | step2&3 | D |
A 16-year-old patient presents to the physician’s office with an absence of menstruations. Her last period was 6 months ago. Since almost a year and a half ago, she intentionally restricted her diet at the expense of carbohydrates, exercised intensively, and lost 18.0 kg (39.7 lb). She had her menarche at the age of 12... | Decreased adiposity contributes to hypoestrogenemia in this patient | {
"A": "Hypertrophied muscles are the source of additional androgens which interfere with the patient’s menstrual cycle",
"B": "This patient has insulin resistance",
"C": "Decreased adiposity contributes to hypoestrogenemia in this patient",
"D": "The patient is likely to have decreased blood estrogen concentra... | step1 | C |
A 7-year-old girl is brought to the emergency department with a 10-day history of fever and sore throat that acutely worsened over the past 2 days. Her sore throat is worse on the right side. She has difficulty swallowing and opening her mouth due to pain. She has also noticed a change in the quality of her voice over ... | Incision and drainage with intravenous ampicillin-sulbactam therapy | {
"A": "Intravenous dexamethasone therapy",
"B": "Tonsillectomy",
"C": "Incision and drainage with intravenous ampicillin-sulbactam therapy",
"D": "Needle aspiration and oral clindamycin therapy",
"E": "Intravenous ampicillin-sulbactam therapy"
} | step2&3 | C |
A 26-year-old nurse comes to the physician because of a 2-month history of fatigue. She has had a lot of stress at work and has been on sick leave for 2 weeks, but states that she would like to return to work. She has had several episodes of lower abdominal pain. She says, ""I know I have cancer."" She requests a diagn... | Factitious disorder | {
"A": "Factitious disorder",
"B": "Somatic symptom disorder",
"C": "Conversion disorder",
"D": "Primary hyperparathyroidism",
"E": "Acute small bowel hemorrhage"
} | step2&3 | A |
Five days after undergoing an emergency appendectomy under general inhalational anesthesia while on a trip to Haiti, a 43-year-old woman develops low-grade fever, vomiting, and abdominal pain. During the surgery, she received a transfusion of 1 unit of packed red blood cells. Three days after the surgery, she was stabl... | Adverse effect of anesthetic | {
"A": "Adverse effect of anesthetic",
"B": "Gram negative bacteria in the bloodstream",
"C": "Trauma to the bile duct",
"D": "Acalculous inflammation of the gallbladder",
"E": "Excessive lysis of red blood cells"
} | step2&3 | A |
A 56-year-old woman comes to the physician because of a 2-week history of fatigue and painless bruising over her arms and trunk. She has also had several episodes of nosebleeds that resolved with compression after a few minutes. She recently completed treatment for a urinary tract infection. She has had no changes in h... | Bone marrow biopsy | {
"A": "Serum transferrin level",
"B": "Bone marrow biopsy",
"C": "Flow cytometry",
"D": "Peripheral blood smear",
"E": "Serum porphobilinogen level"
} | step2&3 | B |
A 35-year-old man returns to the clinic to follow up for his chronic stomach pain. At the last visit a few months ago, he explained that he had been experiencing discomfort in his upper abdomen for awhile. He had never vomited up any blood and had not had any substantial weight loss. He did not take any medications, di... | Heliobacter pylori infection | {
"A": "Gastric neoplasm",
"B": "Gastroesophgeal sphincter dysfunction",
"C": "Nonsteroidal anti-inflammatory drugs",
"D": "Heliobacter pylori infection",
"E": "Excessive gastrin"
} | step1 | D |
A 32-year-old G1P1 patient presents to her obstetrician after having a positive pregnancy test at home. She reports that she and her husband had been trying to have a child for the past three months. She has no history of sexually transmitted disease, intravenous drug use, or blood transfusions, and she has never trave... | HIV, syphilis, and hepatitis B | {
"A": "HIV, syphilis, and hepatitis B",
"B": "HIV, syphilis, and N. gonorrhea",
"C": "HIV, syphilis, N. gonorrhea and C. trachomatis",
"D": "HIV, hepatitis B, and hepatitis C",
"E": "HIV, syphilis, hepatitis B, N. gonorrhea, and C. trachomatis"
} | step2&3 | A |
A 29-year-old man is referred by his marriage counselor to the outpatient psychiatry clinic. The patient’s wife is with him and states that her husband is always complaining and critical of others. He was recently fired from his job to which he claims that his boss was jealous of his hard work. He also does not trust h... | Schizotypal personality disorder | {
"A": "Schizotypal personality disorder",
"B": "Obsessive-compulsive personality disorder",
"C": "Antisocial personality disorder",
"D": "Narcissistic personality disorder",
"E": "Personality disorder not otherwise specified"
} | step1 | A |
A 24-year-old man is brought to the emergency department by the police. He was found unconscious and covered in bruises outside of a local bar. The patient has a past medical history of polysubstance abuse, depression, multiple suicide attempts, neuropathic pain, and schizophrenia. As part of the patient’s initial work... | Heroin | {
"A": "Alcohol",
"B": "Amitriptyline",
"C": "Cocaine",
"D": "Ethylene glycol",
"E": "Heroin"
} | step2&3 | E |
A 3-year-old girl is brought to the emergency department by her parents for an acute arm injury. The mother reports that they were walking in the park and the patient’s dad was swinging the patient in the air by her arms. The dad reports he then heard a click and the patient immediately began to cry. On examination, th... | Moderate flexion then hyperpronation | {
"A": "Immobilization",
"B": "Moderate flexion then hyperpronation",
"C": "Open reduction",
"D": "Radiograph",
"E": "Supination then maximal extension"
} | step2&3 | B |
A 40-year-old male presents to your office complaining that he is too weak to climb stairs or brush his hair. He denies any headaches or change in vision. A muscle biopsy reveals CD8+ lymphocyte infiltration in the endomysium. Which of the following is the most likely diagnosis? | Polymyositis | {
"A": "Systemic lupus erythematosus",
"B": "Scleroderma",
"C": "Polymyalgia rheumatica",
"D": "Polymyositis",
"E": "Dermatomyositis"
} | step1 | D |
A 6-month-old boy presents to his pediatrician for a wellness examination. The mother reports that her child has difficulty rolling from his back to his front and sitting unsupported. The patient is able to smile and furrow his brow normally, but she has noticed that he has a weak cry and suck. He was born at 38 weeks ... | Anterior horn cell degeneration | {
"A": "Anterior horn cell degeneration",
"B": "Axonal demyelination",
"C": "Decreased acetylcholine receptor density",
"D": "Impaired acetylcholine release",
"E": "Myonecrosis"
} | step2&3 | A |
A 6-day-old male newborn is brought to the physician because he has become increasingly irritable and restless over the past 2 days. During this period, he has had 12 bowel movements. He feeds 10 to 12 times a day. He was born at 38 weeks' gestation and weighed 1800 g (3 lb 15 oz); he currently weighs 1700 g (3 lb 12 o... | Methimazole and propranolol therapy | {
"A": "Methimazole and propranolol therapy",
"B": "Digoxin and furesomide therapy",
"C": "Potassium iodide therapy",
"D": "Naloxone therapy",
"E": "Calcium gluconate therapy"
} | step2&3 | A |
A previously healthy 29-year-old man comes to the emergency department because of burning with urination for several days. He has also had pain in the right ankle for 3 days and pain and swelling in the left knee for 1 day. Two weeks ago, he had several days of fever and bloody diarrhea, for which he was treated with a... | Tenderness at the insertion of the Achilles tendon | {
"A": "Circular erythematous rash with central clearing",
"B": "Pain on passive extension of the fingers",
"C": "Palpable mass in the right lower quadrant",
"D": "Tenderness at the insertion of the Achilles tendon",
"E": "Nontender subcutaneous nodules over the olecranon"
} | step1 | D |
A 36-year-old woman comes to the physician because of a painless lump on her neck for 3 months that has increased in size. She appears healthy. Examination shows a 2.5-cm (1-in) firm, irregular swelling on the left side of the neck that moves with swallowing. There is painless cervical lymphadenopathy. Ultrasound of th... | Papillary carcinoma of the thyroid | {
"A": "Follicular carcinoma of the thyroid",
"B": "Medullary carcinoma of the thyroid",
"C": "Hürthle cell carcinoma of the thyroid",
"D": "Papillary carcinoma of the thyroid",
"E": "Anaplastic carcinoma of the thyroid"
} | step2&3 | D |
A 34-year-old man currently staying at an addiction center presents to the staff psychiatrist with diarrhea and painful muscle cramps. He has been discontinuing heroin over the last month as part of his treatment plan. He is HIV positive, hepatitis B (HBV) positive, and was recently treated for an infection with Strept... | Methadone | {
"A": "Methadone",
"B": "Naloxone",
"C": "Alvimopan",
"D": "Morphine",
"E": "Loperamide"
} | step1 | A |
A 26-year-old man presents to his physician with a history of diarrhea and vomiting for the past 24 hours. On physical examination, his temperature is 36.9ºC (98.4ºF), pulse rate is 110/min, blood pressure is 102/74 mm Hg, and respiratory rate is 16/min. A resident working under the physician plots a Darrow-Yannet diag... | Renin | {
"A": "B-type natriuretic peptide",
"B": "Bradykinin",
"C": "Erythropoietin",
"D": "Renin",
"E": "Vasoactive intestinal peptide"
} | step1 | D |
A 28-year-old female comes to the physician’s office with a complaint of episodic chest pain. She describes the pain as squeezing and tightness in her chest. This pain has been happening every few days for 3 months. She says there is no association of the pain with food or exercise. She is able to climb up to her fourt... | Raynaud's phenomenon | {
"A": "Raynaud's phenomenon",
"B": "Myocardial infarction",
"C": "Aortic dissection",
"D": "Costochondritis",
"E": "Dysphagia"
} | step1 | A |
A 22-year-old gravida 1 presents to her physician at 15 weeks gestation for a prenatal appointment. She complains of a rash involving her chest, face, and arms, a watery nasal discharge, and mild bilateral knee pain. She has had these symptoms for about 5 days. The symptoms do not seem to bother her too much, but she i... | Recommend additional serologic testing for parvovirus B19 | {
"A": "Reassure and recommend vaccination against rubella postpartum",
"B": "Recommend pregnancy termination",
"C": "Arrange a chorionic villus sampling",
"D": "Recommend additional serologic testing for parvovirus B19",
"E": "Test for rubella virus PCR"
} | step2&3 | D |
A 20-year-old woman presents with vaginal discharge, pruritus, and painful micturition for the past 5 days. She is sexually active with multiple partners and admits to using barrier protection inconsistently. Her last menstrual period was 2 weeks ago. The patient denies any fever, chills, abdominal pain, menorrhagia, o... | Trichomonal vaginitis | {
"A": "Urinary tract infection",
"B": "Candida vaginitis",
"C": "Bacterial vaginosis",
"D": "Trichomonal vaginitis",
"E": "Chlamydia infection"
} | step1 | D |
A 47-year-old female undergoes a thyroidectomy for treatment of Graves' disease. Post-operatively, she reports a hoarse voice and difficulty speaking. You suspect that this is likely a complication of her recent surgery. What is the embryologic origin of the damaged nerve that is most likely causing this patient's hoar... | 6th pharyngeal arch | {
"A": "1st pharyngeal arch",
"B": "2nd pharyngeal arch",
"C": "3rd pharyngeal arch",
"D": "4th pharyngeal arch",
"E": "6th pharyngeal arch"
} | step1 | E |
A 15-year-old boy with poorly controlled asthma presents to the emergency room complaining of severe shortness of breath. His mother reports that he had trouble breathing soon after he started playing soccer with some friends and was unable to use his inhaler as it was empty. His family history is notable for emphysema... | Increased adenylate cyclase activity | {
"A": "Decreased leukotriene activity",
"B": "Prevention of mast cell degranulation",
"C": "Activation of muscarinic receptors",
"D": "Decreased phosphodiesterase activity",
"E": "Increased adenylate cyclase activity"
} | step1 | E |
A 55-year-old man presents with a 2-month history of an increasing sensation of fullness in the upper left side of his abdomen. He complains of increasing fatigue and dyspnea. He has no history of serious illness and takes no medications. His temperature is 36.7°C (98.1°F), pulse is 90/min, respiratory rate is 18/min, ... | Cladribine | {
"A": "Cladribine",
"B": "Fludarabine",
"C": "Imatinib",
"D": "Prednisone",
"E": "Thalidomide"
} | step2&3 | A |
A 57-year-old man presents to the emergency department with confusion. His symptoms started a few days ago and have been gradually worsening. Initially, the patient had a fever and a cough which has progressed to abdominal pain, diarrhea, and confusion. His temperature is 102°F (38.9°C), blood pressure is 127/68 mmHg, ... | Urine antigen test | {
"A": "Blood cultures",
"B": "Chest radiography",
"C": "Lung biopsy",
"D": "Sputum culture",
"E": "Urine antigen test"
} | step2&3 | E |
A 45-year-old man presents to the physician because of a 1-day history of progressive pain and blurry vision in his right eye. He is struggling to open this eye because of the pain. His left eye is asymptomatic. He wears contact lenses. He has bronchial asthma treated with inhaled salbutamol. He works as a kindergarten... | Pseudomonas keratitis | {
"A": "Angle-closure glaucoma",
"B": "Epidemic keratoconjunctivitis",
"C": "Herpes simplex keratitis",
"D": "Herpes zoster keratitis",
"E": "Pseudomonas keratitis"
} | step2&3 | E |
A 50-year-old man presents to his physician with chronic cough, aching joints in his hips and lower back, and malaise over the past 2 months. He describes himself as being “generally healthy” before the cough began. Past medical history includes hypertension. The patient takes clopamide and a multivitamin daily. His pa... | Valley fever | {
"A": "Histoplasmosis",
"B": "Mycetoma",
"C": "Blastomycosis",
"D": "Valley fever",
"E": "Chromomycosis"
} | step2&3 | D |
A 22-year-old man with sickle cell disease is brought to the emergency room for acute onset facial asymmetry and severe pain. He was in school when his teacher noted a drooping of his left face. His temperature is 99.9°F (37.7°C), blood pressure is 122/89 mmHg, pulse is 110/min, respirations are 19/min, and oxygen satu... | Exchange transfusion | {
"A": "Alteplase",
"B": "Exchange transfusion",
"C": "Heparin",
"D": "Hydroxyurea",
"E": "Warfarin"
} | step2&3 | B |
A 3-month-old girl is brought to the physician because of a productive cough for 5 days. Over the past month, she has had several episodes of watery stools. She is exclusively breastfed every 3–4 hours for 15–20 minutes. She was delivered vaginally at 38 weeks' gestation at home and has not yet been evaluated by a phys... | Polymerase chain reaction for viral genes | {
"A": "Karyotyping of infant's chromosomes",
"B": "DNA test for CFTR mutation",
"C": "Fluorescent treponemal antibody absorption test",
"D": "Polymerase chain reaction for viral genes",
"E": "T-cell receptor excision circle analysis"
} | step2&3 | D |
A 30-year-old primigravid woman at 22 weeks' gestation is brought to the emergency department by her husband for lethargy, nausea, and vomiting for 4 days. This morning she became drowsy. She returned from a business trip to Sudan 3 weeks ago. She denies eating any seafood while traveling. Medications include iron supp... | Anti-HEV IgM | {
"A": "HBsAg",
"B": "Anti-HAV IgG",
"C": "HCV RNA",
"D": "Anti-HCV IgG",
"E": "Anti-HEV IgM"
} | step2&3 | E |
A 36-year-old man is brought to the emergency department because of multiple episodes of nonbilious emesis for 3 days. The vomitus consists of undigested food and he has also had dark brown emesis twice today. He has been having early satiety during this period. He has had progressive severe episodic epigastric pain an... | Inflammation and edema | {
"A": "Inflammation and edema",
"B": "Abnormal gastric rotation",
"C": "Neoplastic growth",
"D": "Scarring and fibrosis",
"E": "Walled-off pancreatic fluid collection"
} | step2&3 | A |
A 52-year-old man is brought to the emergency department because of worsening shortness of breath for 6 hours. For the past 5 days, he has had intermittent stabbing pain in the middle of his chest that worsens with lying down or taking deep breaths. He has also had a runny nose and a dry cough for the past 2 weeks. He ... | Accumulation of fluid in the pericardial space | {
"A": "Dilation of the atria and ventricles",
"B": "Accumulation of fluid in the pleural cavity",
"C": "Occlusion of a coronary artery",
"D": "Accumulation of fluid in the pericardial space",
"E": "Fibrous thickening of the pericardium"
} | step2&3 | D |
A 70-year-old obese male presents to the emergency department with shortness of breath and cough of sudden onset. The patient states that his symptoms came on while he was sleeping. The patient has a past medical history of type II diabetes and is currently taking lisinopril, metformin, insulin, and fish oil. On physic... | Hydrochlorothiazide | {
"A": "Furosemide",
"B": "Hydrochlorothiazide",
"C": "Renal tubular acidosis type I",
"D": "Renal tubular acidosis type II",
"E": "Renal tubular acidosis type IV"
} | step2&3 | B |
A 23-year-old woman is seen by her primary care physician for fatigue. She says that she has always felt a little short of breath compared to her friends; however, she did not think that it was abnormal until she started trying a new exercise regimen. On physical exam, she is found to have mild conjunctival pallor and ... | It is inhibited by protein kinase A activity | {
"A": "It is stimulated by ATP",
"B": "It is stimulated by citrate",
"C": "It is inhibited by protein kinase A activity",
"D": "It is inhibited by fructose-2,6-bisphosphate",
"E": "It is inhibited by AMP"
} | step1 | C |
A 32-year-old woman comes to the physician because she feels depressed, has difficulty sleeping, a poor appetite, and low concentration for the past 3 months. During this time, she has also had low energy and lost interest in playing the guitar. During high school, the patient went through similar episodes of low mood ... | Bupropion | {
"A": "Duloxetine",
"B": "Trazodone",
"C": "Bupropion",
"D": "Mirtazapine",
"E": "Citalopram"
} | step1 | C |
A 5-month-old boy is brought to the physician with a 3-day history of fever and cough. His mother reports that he has had multiple episodes of loose stools over the past 3 months. He has been treated for otitis media 4 times and bronchiolitis 3 times since birth. He was born at 37 weeks' gestation, and the neonatal per... | Hematopoietic cell transplantation | {
"A": "Hematopoietic cell transplantation",
"B": "Interferon-γ therapy",
"C": "Intravenous immune globulin",
"D": "Leucovorin supplementation",
"E": "Thymic transplantation"
} | step2&3 | A |
Six days after undergoing an aortic valve replacement surgery, a 68-year-old woman has bluish discolorations around the peripheral intravenous catheters and severe right leg pain. She has a history of hypertension and major depressive disorder. She drinks 3 beers daily. Current medications include hydrochlorothiazide, ... | Autoantibody-mediated platelet activation | {
"A": "Deficiency of vitamin K-dependent clotting factors",
"B": "Phagocytosis of autoantibody-opsonized platelets",
"C": "Deficiency of von Willebrand factor",
"D": "Excess circulating thrombin",
"E": "Autoantibody-mediated platelet activation"
} | step2&3 | E |
A 55-year-old man with chronic hepatitis B virus infection comes to the physician because of generalized fatigue and a 5.4 kg (12 lb) weight loss over the past 4 months. Physical examination shows hepatomegaly. Laboratory studies show an α-fetoprotein concentration of 380 ng/ml (N < 10 ng/mL). A CT scan of the abdomen ... | Integration of foreign DNA into host genome
" | {
"A": "Overexpression of secretory hepatitis antigen",
"B": "Intracellular accumulation of misfolded protein",
"C": "Gain of function mutation of a proto-oncogene",
"D": "Viral cytotoxin-induced cellular dysplasia",
"E": "Integration of foreign DNA into host genome\n\""
} | step1 | E |
A 28-year-old woman with no significant past medical history presents to her primary care physician with increased menstrual bleeding over the past three months. She also notes easy bruising and bleeding from her gums when brushing her teeth. She is sexually active with multiple partners and has no history of intraveno... | HIV and HCV testing | {
"A": "Serum factor VIII levels and von Willebrand factor activity",
"B": "Vitamin B12 and folate levels",
"C": "Measurement of ADAMTS13 activity",
"D": "HIV and HCV testing",
"E": "Bone marrow aspiration"
} | step2&3 | D |
A 6-year-old boy is brought in by his parents to a pediatrician’s office for persistent fever. His temperature has ranged from 38.6°C–39.5°C (101.5°F–103.1°F) over the past week. He was diagnosed with a gene defect on chromosome 7, which has caused dysfunction in a transmembrane protein. This defect has resulted in sev... | Pseudomonas | {
"A": "Staphylococcus",
"B": "Pseudomonas",
"C": "Burkholderia",
"D": "Influenza",
"E": "Candida"
} | step2&3 | B |
An 8-week-old male presents with his mother to the pediatrician for a well visit. The patient has been breastfed since birth, and usually feeds for 30 minutes every 2-3 hours. The patient’s mother is concerned that her milk production is not keeping up with the patient’s nutritional requirements. She reports that about... | Reassurance and counseling on positioning | {
"A": "Initiate proton pump inhibitor",
"B": "Obtain abdominal ultrasound",
"C": "Reassurance and counseling on positioning",
"D": "Recommend modification of mother’s diet",
"E": "Switch to hydrolyzed formula"
} | step2&3 | C |
A 27-year-old gentleman is brought into the ED after being stabbed in the back by a knife. In addition to the pain from the wound, he complains of weakness in his left leg. Upon physical examination you find that he has no other visible injuries; however, he has 2/5 strength in the left lower extremity. Complete neurol... | Left cord hemisection | {
"A": "Anterior cord lesion",
"B": "Posterior cord lesion",
"C": "Right cord hemisection",
"D": "Left cord hemisection",
"E": "Complete cord transection"
} | step1 | D |
A 58-year-old African American man presents for his yearly wellness visit. He says he has been unsuccessful at losing weight and would like help. His last colonoscopy was 8 years previously, which was normal. Past medical history is significant for obstructive sleep apnea (OSA) and hypertension. Current medications are... | PSA | {
"A": "PSA",
"B": "Digital rectal exam",
"C": "HbA1C",
"D": "Abdominal ultrasound",
"E": "Flexible sigmoidoscopy"
} | step2&3 | A |
A 34-year-old patient is brought to the emergency room after a motor vehicle accident. An EKG shows sinus tachycardia and chest radiograph reveals an enlarged cardiac silhouette. While observing sinus tachycardia on the patient's telemetry, you note that the radial pulse cannot be palpated during inspiration. What shou... | Pericardiocentesis | {
"A": "IV Heparin",
"B": "Pericardiocentesis",
"C": "Chest CT scan",
"D": "Pericardial window",
"E": "Insert chest tube"
} | step1 | B |
A previously healthy 60-year-old man comes to his physician because of progressively worsening shortness of breath for the past 2 months. He does not experience shortness of breath at rest. He also occasionally has a dry cough. He has not had fever, chills, or night sweats. He has smoked a pack of cigarettes daily for ... | Chronic obstructive pulmonary disease | {
"A": "Interstitial lung disease",
"B": "Hypersensitivity pneumonitis",
"C": "Chronic obstructive pulmonary disease",
"D": "Bronchiectasis",
"E": "Bronchial asthma"
} | step2&3 | C |
A 29-year-old G1P0 woman is giving birth at 38 weeks gestation to a boy via vaginal delivery. As soon as the infant is clear of the vagina, a congenital malformation of the abdomen is observed. The infant is removed from the delivery room for further evaluation. Visual inspection shows loops of intestine protruding ou... | Wrap the intestines in a sterile bowel bag | {
"A": "Wrap the intestines in a sterile bowel bag",
"B": "Transfer the newborn to the NICU",
"C": "Start IV fluids",
"D": "Place the newborn under a warmer",
"E": "Transfer the newborn for immediate surgery"
} | step2&3 | A |
A 54-year-old woman presents with fatigue, malaise, and shortness of breath over the past 5 months. Past medical history is significant for rheumatoid arthritis diagnosed 23 years ago for which she takes naproxen as needed. Her vital signs include: temperature 36.9°C (98.4°F), blood pressure 135/88 mm Hg, pulse 92/min.... | Upregulation of hepcidin | {
"A": "↑ serum transferrin receptors",
"B": "↑ transferrin saturation",
"C": "↑ methylmalonic acid",
"D": "Upregulation of hepcidin",
"E": "↑ reticulocyte count"
} | step2&3 | D |
A six-year-old boy with a history of asthma currently uses an albuterol inhaler as needed to manage his asthma symptoms. His mother brings him into your office because she feels she has had to increase the patient’s use of his inhaler to four times per week for the past month. She also reports that he has woken up thre... | Add fluticasone daily | {
"A": "Maintain current therapy",
"B": "Add cromolyn prior to exercise",
"C": "Add fluticasone daily",
"D": "Add salmeterol twice daily",
"E": "Add zileuton twice daily"
} | step2&3 | C |
A 25-year-old woman comes to the office complaining of pelvic pain and feeling “off” for the past few weeks. She has not had any changes in diet or lifestyle but reports weight loss despite an increase in appetite. In addition, she has been experiencing chest palpitations, increased frequency of diarrhea, and heat into... | Struma ovarii | {
"A": "Meigs syndrome",
"B": "Jod-Basedow phenomenon",
"C": "Dermoid cyst",
"D": "Struma ovarii",
"E": "Immature teratoma"
} | step1 | D |
An otherwise healthy 15-year-old boy presents to the emergency department with extreme fatigue and shortness of breath. His temperature is 36.5°C (97.7°F), the blood pressure is 100/60 mm Hg and the pulse is 100/min. Past medical history is noncontributory and he takes no medication. His father and aunt both suffer fro... | Autosomal dominant | {
"A": "Autosomal recessive",
"B": "Autosomal dominant",
"C": "X-linked recessive",
"D": "X-linked dominant",
"E": "Multifactorial"
} | step2&3 | B |
A 65-year-old male presents to the emergency department from his home complaining of dyspnea. He is alert and oriented. The following arterial blood gas readings are drawn: pH: 7.33 (Normal: 7.35-7.45), pCO2: 70 mmHg (Normal: 35-45 mmHg), HCO3 33 (Normal: 21-26 mEq/L) Which of the following is most likely to have produ... | Chronic obstructive bronchitis | {
"A": "Panic attack",
"B": "Mechanical ventilation",
"C": "Diabetic ketoacidosis",
"D": "Pulmonary embolus",
"E": "Chronic obstructive bronchitis"
} | step1 | E |
A 23-year-old man is admitted to the hospital with fever, chest discomfort, tachypnea, pain, needle-like sensations in the upper extremities, and profuse sweating. He also complains of a gradual decrease in vision over the past 3 months. He is a bodybuilding competitor and has a competition coming up in 1 week. The man... | The drug caused uncoupling of the electron transport chain and oxidative phosphorylation. | {
"A": "The patient’s symptoms are caused by an increased concentration of epinephrine released by the adrenal glands in response to the consumed substance.",
"B": "The drug caused uncoupling of the electron transport chain and oxidative phosphorylation.",
"C": "The patient has a pyretic reaction due to bacterial... | step1 | B |
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