question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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A medical student decides to join an immunology research center, which specifically works on capsular polysaccharide vaccine development against bacteria, such as Haemophilus influenzae type b (Hib), Neisseria meningitidis, and Streptococcus pneumoniae. As a member of a research team working on the Hib vaccine, he asks... | Conjugation with a protein carrier provides effective protection to infants | {
"A": "Conjugation with a protein carrier generates IgG2 dominant antibody responses",
"B": "Conjugation with a protein carrier generates IgM dominant antibody responses",
"C": "Polysaccharides conjugated with proteins are T cell-independent antigens",
"D": "Conjugation with a protein carrier improves vaccine ... | step1 | E |
An investigator is studying the pattern of glutamate release from presynaptic nerve terminals in human volunteers with Alzheimer disease. The concentration of glutamate in the CA1 region of the hippocampus is measured using magnetic resonance spectroscopy after Schaffer collateral fibers are electrically stimulated. Wh... | Influx of calcium | {
"A": "Activation of G protein-coupled receptors",
"B": "Synthesis of glutamine",
"C": "Accumulation of cAMP",
"D": "Opening of ligand-gated ion channels",
"E": "Influx of calcium"
} | step1 | E |
A 24-year-old woman presents to a physician with a history of exposure to a close friend who was diagnosed with meningococcal meningitis. She was told by her friend that she need to see a physician because she needs to be treated as well, even if she is not having symptoms yet. She currently denies any headaches, visio... | Rifampin alters normal gastrointestinal flora, which leads to a decrease in the enterohepatic circulation of estrogens. | {
"A": "Rifampin alters normal gastrointestinal flora, which leads to a decrease in the enterohepatic circulation of estrogens.",
"B": "Rifampin inhibits CYP3A4, which metabolizes progestins.",
"C": "Rifampin alters normal gastrointestinal flora, which leads to a decrease in the enterohepatic circulation of proge... | step1 | A |
A 38-year-old woman comes to the physician because of a 1-month history of a painless, nonpruritic skin lesion on her right thigh. She initially thought it was an insect bite, but it has slowly increased in size over the past weeks. Her temperature is 36.7°C (98°F), pulse is 75/min, and blood pressure is 128/76 mm Hg. ... | Dermatofibroma | {
"A": "Dysplastic nevus",
"B": "Dermatofibroma",
"C": "Cherry hemangioma",
"D": "Actinic keratosis",
"E": "Seborrheic keratosis"
} | step2&3 | B |
A previously healthy 3-year-old boy is brought to the physician by his parents because of fever and a rash for 6 days. His temperature is 38.9°C (102°F). Examination shows right-sided anterior cervical lymphadenopathy, bilateral conjunctival injection, erythema of the tongue and lips, and a maculopapular rash involving... | Coronary artery aneurysm | {
"A": "Coronary artery aneurysm",
"B": "Rapidly progressive glomerulonephritis",
"C": "Hearing loss",
"D": "Retinopathy",
"E": "Peripheral neuropathy"
} | step1 | A |
A 25-year-old man is brought to the emergency department by police. He was found at a local celebration acting very strangely and was reported by other patrons of the event. The patient is very anxious and initially is hesitant to answer questions. He denies any substance use and states that he was just trying to have ... | Marijuana | {
"A": "Alcohol",
"B": "Benzodiazepines",
"C": "Marijuana",
"D": "Cocaine",
"E": "Phencyclidine"
} | step2&3 | C |
A 75-year-old with hypertension and atrial fibrillation comes to the emergency department because of a 2-hour history of severe abdominal pain and nausea. He has smoked 1 pack of cigarettes daily for the past 45 years. The patient undergoes emergency laparotomy and is found to have dusky discoloration of the hepatic co... | Superior mesenteric artery | {
"A": "Median sacral artery",
"B": "Inferior mesenteric artery",
"C": "Celiac artery",
"D": "Internal iliac artery",
"E": "Superior mesenteric artery"
} | step1 | E |
A group of researchers from Italy conducted a case register study that included all patients from a city who had an International Classification of Diseases diagnosis and contacts with specialist psychiatric services over a 10-year period. Mortality was studied in relation to age, sex, diagnosis, care pattern, and regi... | The observed number of deaths divided by the expected number of deaths | {
"A": "The total number of deaths divided by the mid-year population",
"B": "The number of deaths in a specific age group divided by a mid-year population in that age group",
"C": "The total number of expected deaths divided by a standard population",
"D": "The observed number of deaths divided by the expected... | step1 | D |
A 10-year-old boy is brought to the emergency room by his grandparents. He is in a wheelchair with soft restraints because he has been violent and had been trying to hurt himself that day. The child’s parents died in a car accident 1 month ago. His grandparents also brought the medications he stopped taking after his p... | Hypoxanthine-guanine phosphoribosyl transferase of the purine metabolism pathway | {
"A": "Hypoxanthine-guanine phosphoribosyl transferase of the pyrimidine metabolism pathway",
"B": "Aminolevulinic acid synthetase of the heme metabolism pathway",
"C": "Adenosine deaminase of the purine metabolism pathway",
"D": "Hypoxanthine-guanine phosphoribosyl transferase of the purine metabolism pathway... | step1 | D |
A 34-year-old woman with poorly controlled Crohn disease comes to the physician because of a 2-week history of hair loss and a rash on her face. She has also noticed that food has recently tasted bland to her. She had to undergo segmental small bowel resection several times because of intestinal obstruction and fistula... | Zinc | {
"A": "Retinoic acid",
"B": "Niacin",
"C": "Cobalamin",
"D": "Iron",
"E": "Zinc"
} | step1 | E |
A 23-year-old woman, gravida 2, para 1, at 20 weeks of gestation comes to the physician for a routine prenatal exam. Her last pregnancy was unremarkable and she gave birth to a healthy rhesus (RhD) positive girl. Her past medical history is notable for a blood transfusion after a car accident with a complex femur fract... | Repeat antibody screening at 28 weeks. Administer anti-D immunoglobulin at 28 weeks and after delivery if the newborn is Rh(D) positive. | {
"A": "Administer anti-D immunoglobulin now and repeat antibody screening shortly before delivery.",
"B": "Repeat antibody screening at 28 weeks. Administer anti-D immunoglobulin at 28 weeks and after delivery if the newborn is Rh(D) positive.",
"C": "Repeat antibody screening at 28 weeks and administer anti-D i... | step2&3 | B |
A 52-year-old man presents to the physician because of ongoing shortness of breath, which is more prominent when he lies down. Occasionally, he experiences palpitations, especially during strenuous activities. In addition to this, he has been experiencing difficulty in digestion and often experiences regurgitation and ... | Parasitic infection | {
"A": "Alcohol abuse",
"B": "Hypertensive changes",
"C": "Parasitic infection",
"D": "Myocardial infarction",
"E": "Bacterial infection"
} | step2&3 | C |
A 33-year-old woman presents to her primary care physician with bilateral joint pain. She says that the pain has been slowly worsening over the past 3 days. Otherwise, she complains of fatigue, a subjective fever, and a sunburn on her face which she attributes to gardening. The patient is an immigrant from Spain and wo... | Decreased complement levels | {
"A": "Decreased anti-dsDNA antibodies",
"B": "Decreased complement levels",
"C": "Increased anti-centromere antibodies",
"D": "Increased anti-cyclic citrullinated peptide antibodies",
"E": "Increased anti-topoisomerase antibodies"
} | step2&3 | B |
A 40-year-old man comes to the emergency department with a 4-day history of left leg pain. Over the weekend, he scraped his left thigh when he fell on a muddy field while playing flag football with some friends. Since that time, he has had progressively worsening redness and pain in his left thigh. Past medical history... | Food-borne illness | {
"A": "Bacterial endocarditis",
"B": "Bacterial pneumonia",
"C": "Bacterial sinusitis",
"D": "Food-borne illness",
"E": "Urinary tract infection"
} | step2&3 | D |
A 75-year-old man presents to the emergency department with a racing heart and lightheadedness for 3 hours. He has had similar episodes in the past, but the symptoms never lasted this long. He denies chest pain, shortness of breath, headaches, and fevers. He had a myocardial infarction 4 years ago and currently takes c... | Inhibition of vitamin K-dependent clotting factors | {
"A": "Activation of the antithrombin enzyme",
"B": "Inhibition of the cyclooxygenase enzyme",
"C": "Inhibition of the ADP receptors",
"D": "Inhibition of vitamin K-dependent clotting factors",
"E": "Blockage of glycoprotein IIb/IIIa receptors"
} | step1 | D |
A 31-year-old man, who was hospitalized for substance-induced psychosis two days prior, has had episodic neck stiffness and pain for the past 8 hours. These episodes last for approximately 25 minutes and are accompanied by his neck rotating to the right. During the last episode, he was able to relieve the stiffness by ... | Benztropine | {
"A": "Benztropine",
"B": "Physical therapy",
"C": "Dantrolene",
"D": "Baclofen",
"E": "Propranolol"
} | step2&3 | A |
A 31-year-old man presents to his primary care physician with fevers, chills, and night sweats. After a physical exam and a series of laboratory tests, the patient undergoes a lymph node biopsy (Image A). Three days later, while awaiting treatment, he presents to his physician complaining of generalized swelling and is... | Minimal change disease | {
"A": "Rapidly progresive glomerulonephritis",
"B": "Amyloidosis",
"C": "Membranoproliferative glomerulonephritis",
"D": "Focal segmental glomerulosclerosis",
"E": "Minimal change disease"
} | step2&3 | E |
A microbiologist has isolated several colonies of Escherichia coli on an agar plate. The microbiologist exposes the agar plate to ciprofloxacin, which destroys all of the bacteria except for one surviving colony. Which of the following is the most likely mechanism of antibiotic resistance in the surviving colony? | Mutation of DNA gyrase | {
"A": "Replacement of D-alanine",
"B": "Mutation of DNA gyrase",
"C": "Inactivation by bacterial transferase",
"D": "Production of β-lactamase",
"E": "Modification of surface binding proteins"
} | step1 | B |
A 48-year-old man is brought to the emergency department by his son with a fever over the past day. The patient’s son adds that his father has been having some behavioral problems, as well, and that he was complaining about bugs crawling over his skin this morning even though there were no insects. Past medical history... | Diazepam | {
"A": "Chlorpromazine",
"B": "Clonidine",
"C": "Diazepam",
"D": "Haloperidol",
"E": "Phenytoin"
} | step2&3 | C |
Eight weeks after starting a new weight-loss medication, a 43-year-old woman with obesity comes to the physician because of greasy diarrhea, excessive belching, and flatulence. She also complains of progressively worsening night-time vision. She has had no fever, chills, or vomiting. Physical examination shows dry, sca... | Inhibition of lipase | {
"A": "Stimulation of monoamine neurotransmitter release",
"B": "Inhibition of serotonin reuptake",
"C": "Stimulation of norepinephrine release",
"D": "Inhibition of lipase",
"E": "Secretion of glucose-dependent insulin"
} | step1 | D |
A 70-year-old man with chronic heart failure presents to the emergency department due to difficulty in breathing. The patient is a known hypertensive for 20 years maintained on amlodipine and telmisartan. The physician notes that he is also being given a diuretic that blocks the Na+ channels in the cortical collecting ... | Triamterene | {
"A": "Furosemide",
"B": "Hydrochlorothiazide",
"C": "Triamterene",
"D": "Acetazolamide",
"E": "Eplerenone"
} | step1 | C |
A 59-year-old man with a history of sickle cell disease presents to the emergency department for evaluation of his fever and night sweats. He is extremely lethargic and is unable to provide an adequate history to his physician. His wife noted that roughly 3 days ago, her husband mentioned that something bit him, but sh... | Dog bite | {
"A": "Cat bite",
"B": "Human bite",
"C": "Spider bite",
"D": "Fish bite",
"E": "Dog bite"
} | step1 | E |
A 30-year-old woman comes to the physician because of increasing weakness in both legs for 7 days. She also reports a tingling sensation in her legs that is exacerbated by taking a hot shower. She is sexually active with one male partner and does not use condoms. Her temperature is 37.8°C (100.1°F). Physical examinatio... | Presence of immunoglobulin bands on cerebrospinal fluid immunofixation | {
"A": "Positive antibody response to cardiolipin-cholesterol-lecithin antigen in the serum",
"B": "Oligodendrocytes that stain positive for polyomavirus proteins on brain biopsy",
"C": "Presence of immunoglobulin bands on cerebrospinal fluid immunofixation",
"D": "Identification of gram-positive cocci in group... | step1 | C |
A group of investigators is studying the association between a fire retardant chemical used on furniture and interstitial lung disease. They use hospital records to identify 50 people who have been diagnosed with interstitial lung disease. They also identify a group of 50 people without interstitial lung disease who ar... | Case-control study | {
"A": "Case-control study",
"B": "Cross-sectional study",
"C": "Case series",
"D": "Retrospective cohort study",
"E": "Randomized controlled trial"
} | step1 | A |
A 41-year-old man is brought to the emergency department after a suicide attempt. His wife found him on the bathroom floor with an empty bottle of medication next to him. He has a history of major depressive disorder. His only medication is nortriptyline. His pulse is 127/min and blood pressure is 90/61 mm Hg. Examinat... | Sodium bicarbonate | {
"A": "Atropine",
"B": "Naloxone",
"C": "Cyproheptadine",
"D": "Ammonium chloride",
"E": "Sodium bicarbonate"
} | step1 | E |
A 23-year-old woman presents to the hospital for elective surgery. However, due to an unexpected bleeding event, the physician had to order a blood transfusion to replace the blood lost in the surgery. After this, the patient became irritable and had difficulty breathing, suggesting an allergic reaction, which was imme... | Low IgA, normal IgG, and IgM | {
"A": "High IgM, low IgA, and IgE",
"B": "Low IgA, high IgG, normal IgE",
"C": "Low IgA, normal IgG, and IgM",
"D": "High IgE, normal IgA, and IgG",
"E": "Normal serum immunoglobulin values"
} | step1 | C |
A 21-year-old man is brought to the emergency department 30 minutes after being found unconscious in his apartment by his mother. On arrival, he is unable to provide history. The mother reports that there is no history of serious illness in the family. The patient appears drowsy and dehydrated. His temperature is 38.5°... | Elevated serum creatine kinase | {
"A": "Low serum potassium",
"B": "Low serum lactate dehydrogenase",
"C": "Low blood urea nitrogen",
"D": "Elevated serum calcium",
"E": "Elevated serum creatine kinase"
} | step2&3 | E |
A 30-year-old G4P3 woman at 38 weeks gestation is admitted to the labor and delivery unit complaining of contractions every 5 minutes for the past hour. Her previous births have been via uncomplicated caesarean sections, but she wishes to attempt vaginal delivery this time. Her prenatal care is notable for gestational ... | Elevate posterior fornix | {
"A": "Uterine artery ligation",
"B": "Hysterectomy",
"C": "Intravenous oxytocin",
"D": "Elevate posterior fornix",
"E": "Red blood cell transfusion"
} | step2&3 | D |
A 42-year-old man comes to the physician to establish care. He recently moved to the area and has not been to a primary care physician for over 5 years. He has no history of serious illness, but has intermittent bilateral knee pain for which he takes 650 mg acetaminophen every other day. He is married with three childr... | Insulin resistance | {
"A": "Autoimmune liver damage",
"B": "Congestive hepatopathy",
"C": "Insulin resistance",
"D": "Acetaminophen use",
"E": "Alcohol use"
} | step2&3 | C |
A 16-year-old boy is brought to the emergency department by ambulance from a soccer game. During the game, he was about to kick the ball when another player collided with his leg from the front. He was unable to stand up after this collision and reported severe knee pain. On presentation, he was found to have a mild kn... | Runs posteriorly from the medial femoral condyle | {
"A": "Runs anteriorly from the lateral femoral condyle",
"B": "Runs anteriorly from the medial femoral condyle",
"C": "Runs medially from the lateral femoral condyle",
"D": "Runs posteriorly from the lateral femoral condyle",
"E": "Runs posteriorly from the medial femoral condyle"
} | step1 | E |
A 64-year-old male with a past medical history of two myocardial infarctions presents to the emergency room with shortness of breath. He notes that he stopped taking his furosemide two weeks prior, because he ran out of pills. On exam, his oxygen saturation is 78%, his lungs have crackles throughout, and jugular venous... | Increased Aa gradient, decreased surface area for diffusion, increased diffusion distance | {
"A": "Normal Aa gradient, decreased surface area for diffusion, normal diffusion distance",
"B": "Decreased Aa gradient, decreased surface area for diffusion, normal diffusion distance",
"C": "Decreased Aa gradient, increased surface area for diffusion, decreased diffusion distance",
"D": "Increased Aa gradie... | step1 | E |
A 50-year-old man presents to the office with complaints of fever and chills for 4 weeks. He adds that he is fatigued all the time and has generalized weakness. He has drenching night sweats and has had 2 episodes of non-bilious vomiting over the past few days. He traveled to the Netherlands for 4 days a month ago. His... | Babesiosis | {
"A": "Malaria",
"B": "Babesiosis",
"C": "Anaplasmosis",
"D": "Tuberculosis",
"E": "Lyme disease"
} | step1 | B |
A 41-year-old woman presents with shortness of breath that is worse when she lies on her left side. About 10 days ago, she had an episode of unexplained loss of consciousness. Past medical history is negative and family history is irrelevant. Clinical examination shows a diastolic murmur, which is prominent when she li... | Atrial myxoma | {
"A": "Rheumatic fever",
"B": "Innocent murmur",
"C": "Subacute infective endocarditis",
"D": "Non-bacterial thrombotic endocarditis",
"E": "Atrial myxoma"
} | step2&3 | E |
A 25-year-old man presents with painless swelling of the neck for the past week. He reports no recent fevers, night sweats, or weight loss. His past medical history is significant for human immunodeficiency virus (HIV) infection, which was diagnosed last year. He also experienced a head trauma 5 years ago, which has be... | Classical Hodgkin’s lymphoma (HL) | {
"A": "Acute lymphoid leukemia (ALL)",
"B": "Classical Hodgkin’s lymphoma (HL)",
"C": "HIV lymphadenopathy",
"D": "Mononucleosis",
"E": "Phenytoin-induced adenopathy"
} | step2&3 | B |
A 67-year-old woman presents to her primary care physician for urinary incontinence. She has been waking up every morning with her underwear soaked in urine. She notices that at work if she does not take regular bathroom breaks her underwear will have some urine in it. She urinates 5 to 11 times per day but she claims ... | Bethanechol and intermittent straight catheterization | {
"A": "Bethanechol and intermittent straight catheterization",
"B": "Bethanechol during the day and oxybutynin at night",
"C": "No recommendations needed",
"D": "Oxybutynin and scheduled bathroom breaks",
"E": "Reduce fluid intake and discontinue diuretics"
} | step2&3 | A |
A 55-year-old man presents into the emergency department with a severe cough and difficulty breathing. He says that he finds himself out of breath after taking a few steps, and has to sit down and rest, in order to continue. He also says that, at night, he has the greatest difficulty in breathing and usually uses at le... | Echocardiogram | {
"A": "Angiography",
"B": "Computed Tomography (CT)",
"C": "Echocardiogram",
"D": "Stress test",
"E": "Cardiac biopsy"
} | step2&3 | C |
A 2-day-old boy delivered at 34 weeks gestation is found to have a murmur on routine exam. He is lying supine and is not cyanotic. He has a pulse of 195/min, and respirations of 59/min. He is found to have a nonradiating continuous machine-like murmur at the left upper sternal border. S1 and S2 are normal. The peripher... | Indomethacin | {
"A": "Indomethacin",
"B": "Thiazide diuretic",
"C": "Aspirin",
"D": "Penicillin",
"E": "Reassurance"
} | step2&3 | A |
A 12-year-old girl is brought to your psychiatry office by her parents, who are concerned that she has not made any friends since starting middle school last year. The girl tells you that she gets nervous around other children, as she cannot tell what they are feeling, when they are joking, or what she has in common wi... | Boys are more commonly affected than girls | {
"A": "Boys are more commonly affected than girls",
"B": "Impaired attention is a key feature of the disorder",
"C": "Intellectual disability is a key feature of the disorder",
"D": "It is usually associated with a family history of schizophrenia",
"E": "Typical age of onset is 3-5 years of age"
} | step1 | A |
Four days after admission to the hospital for pneumonia, a 68-year-old woman develops abdominal pain and watery, foul-smelling diarrhea. Current medications include intravenous ceftriaxone and oral azithromycin. Stool cultures grow gram-positive, anaerobic rods. She is moved to an isolated hospital room. Sterilization ... | Chlorine-based solution | {
"A": "Chlorine-based solution",
"B": "Chlorhexidine-based solution",
"C": "Iodine-based solution",
"D": "Isopropanol-based solution",
"E": "Quaternary amine-based solution"
} | step1 | A |
A 1-month-old girl is brought to the pediatrician by her parents. They are concerned that she becomes lethargic and irritated between meals. They found that feeding her often with small servings helps. She was born at 39 weeks via spontaneous vaginal delivery and is meeting all developmental milestones. Her mother has ... | Alanine | {
"A": "Alanine",
"B": "Adenosine diphosphate",
"C": "Adenosine monophosphate",
"D": "Fructose 1,6-bisphosphate",
"E": "Fructose 2,6-bisphosphate"
} | step1 | A |
A 4-year-old boy presents for a routine checkup. The patient’s parents say he was doing well until a few weeks ago at which time he started to complain of daily abdominal cramps and occasional muscle pains. His mother also noticed that he has been less active than usual. The parents deny any complaints of headaches or ... | Dimercaptosuccinic acid (DMSA), also known as succimer | {
"A": "Trientine",
"B": "Calcium disodium edetate (EDTA)",
"C": "Dimercaprol",
"D": "Penicillamine",
"E": "Dimercaptosuccinic acid (DMSA), also known as succimer"
} | step1 | E |
A 39-year-old woman with poorly controlled systemic lupus erythematosus (SLE) presents to her rheumatologist for a follow-up visit. She has had intermittent myalgias, arthralgias, fatigue, and skin rashes over the past 10 years that have acutely worsened over the past year. She works as a school teacher but reports tha... | Femoral neck fracture | {
"A": "Femoral neck fracture",
"B": "Femoral shaft fracture",
"C": "Meniscal tear",
"D": "Osgood-Schlatter disease",
"E": "Proximal phalanx fracture"
} | step1 | A |
A 40-year-old woman presents with severe shortness of breath. The patient is unable to provide a history due to her breathing difficulties. The patient’s roommate says that she came home and found her in this state. She also says that they both occasionally take sleeping pills to help them fall asleep. Physical examina... | Alveolar hypoventilation | {
"A": "Alveolar hypoperfusion",
"B": "Alveolar hypoventilation",
"C": "Impaired gas diffusion",
"D": "Left-to-right blood shunt",
"E": "Right-to-left blood shunt"
} | step1 | B |
A 74-year-old woman is brought to her primary care doctor by her adult son. The son says she has been very difficult at home and is "losing it". He seems very frustrated about her diminishing ability to take care of herself the way she used to and no longer thinks he can trust her watching his children. At her last vis... | Ask the son to step out so you can speak with the patient alone | {
"A": "Discuss with the son the challenges of having a parent with dementia",
"B": "Complete a mini-mental exam",
"C": "Assess the patient's risk for depression",
"D": "Order a head CT",
"E": "Ask the son to step out so you can speak with the patient alone"
} | step1 | E |
An investigator is studying the effects of different gastrointestinal regulatory substances. A healthy subject is asked to eat a meal at hour 0, and the pH of stomach contents and rate of stomach acid secretions are measured over the next 4 hours. Results of the study are shown. Which of the following mechanisms most l... | Increased activity of D cells | {
"A": "Increased vagal stimulation",
"B": "Increased activity of D cells",
"C": "Increased activation of H2 receptors",
"D": "Increased activity of enterochromaffin-like cells",
"E": "Increased activity of I cells"
} | step1 | B |
A 45-year-old woman comes to the physician with a lump on her throat that has steadily increased in size over the past 5 months. She does not have difficulties swallowing, dyspnea, or changes in voice. Examination shows a 3-cm, hard swelling on the left side of her neck that moves with swallowing. There is no cervical ... | Capsular invasion | {
"A": "Undifferentiated giant cells",
"B": "Capsular invasion",
"C": "Psammoma bodies",
"D": "Infiltration of atypical lymphoid tissue",
"E": "Orphan Annie nuclei\n\""
} | step2&3 | B |
A 53-year-old female patient comes to the physician’s office for her annual check-up visit. She has no complaints and her past medical history is notable for diabetes and hypertension. During this visit, the patient undergoes screening procedures per guidelines including a mammogram. On the screening mammogram a spicul... | Tumor stage | {
"A": "Tumor grade",
"B": "Tumor stage",
"C": "Age",
"D": "History of diabetes",
"E": "Location of the tumor on the breast"
} | step1 | B |
A 2-month-old girl is brought to the pediatrician by her concerned father. He states that ever since her uncomplicated delivery she has failed to gain weight, has had chronic diarrhea, and has had multiple bacterial and viral infections. During the course of the workup, an absent thymic shadow is noted and a lymph node... | Adenosine deaminase deficiency | {
"A": "Defect in WASP gene",
"B": "Defect in ATM gene",
"C": "Adenosine deaminase deficiency",
"D": "NADPH oxidase deficiency",
"E": "Defect in BTK gene"
} | step1 | C |
A 1-year-old boy is brought to the clinic by his parents for a regular check-up. His weight, height, and head size were found to be in the lower percentile ranges on standard growth curves. His hair is tangled and has a dry, brittle texture. Genetic testing reveals that the patient has a connective tissue disorder caus... | ATP7A | {
"A": "ATP7A",
"B": "COL1A2",
"C": "COL5A1",
"D": "FBN1",
"E": "ATP7B"
} | step1 | A |
A 15-year-old girl is brought to the physician because she has not had a menstrual period. There is no personal or family history of serious illness. She is 165 cm (5 ft 5 in) tall and weighs 57 kg (125 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Examination of the breasts shows a secondary mound formed... | Gonadectomy | {
"A": "Spironolactone therapy",
"B": "Gonadectomy",
"C": "Testosterone therapy",
"D": "Vaginal dilatory therapy",
"E": "Prednisolone therapy"
} | step2&3 | B |
A 51-year-old man presents the emergency room with chest pain. He mentions that the pain started several hours ago and radiates to his left neck and shoulder. He also mentions that he has some difficulty in breathing. He says that he has had similar chest pains before, but nothing seemed to be wrong at that time. He wa... | Gastritis | {
"A": "ECG changes",
"B": "Hypercholesterolemia",
"C": "Gastritis",
"D": "Increased pulse rate",
"E": "Age above 50 years"
} | step1 | C |
A 45-year-old woman presents to the physician for a follow-up visit. She has no specific complaints at this visit however, she has noticed that she is more tired than usual these days. At first, she ignored it and attributed it to stress but she feels weaker each week. She is sometimes out of breath while walking for l... | Decreased iron-binding capacity | {
"A": "Increased iron-binding capacity",
"B": "Low ferritin levels",
"C": "Increased iron levels",
"D": "Decreased iron-binding capacity",
"E": "Normal iron-binding capacity"
} | step2&3 | D |
An 89-year-old woman is brought to the emergency department by her husband because of diarrhea and weakness for 4 days. She has 2–3 loose stools every day. She has also had 3 episodes of vomiting. She complains of a headache and blurry vision. Three weeks ago, she returned from a cruise trip to the Bahamas. She has con... | Measure serum drug concentration | {
"A": "Perform hemodialysis",
"B": "Perform CT scan of the abdomen",
"C": "Perform C. difficile toxin assay",
"D": "Measure serum drug concentration",
"E": "Administer oral activated charcoal"
} | step2&3 | D |
A 45-year-old woman is brought to the emergency department by her husband due to upper abdominal pain, nausea, and vomiting for the past couple of hours. She had similar episodes in the past, which were often precipitated by food but resolved spontaneously. Her temperature is 38.3°C (101.0°F), heart rate is 96/min, blo... | Acute calculous cholecystitis | {
"A": "Acute calculous cholecystitis",
"B": "Acute acalculous cholecystitis",
"C": "Biliary colic",
"D": "Acute pancreatitis",
"E": "Ascending cholangitis"
} | step1 | A |
A mother brings her 18-year-old daughter to your office because she has not menstruated yet. They recently immigrated from another country, and do not have any previous medical records. The adolescent girl looks relatively short, but otherwise looks healthy. She has no complaints except for mild intermittent lower abdo... | Muellerian agenesis | {
"A": "Primary ovarian insufficiency (POI)",
"B": "Muellerian agenesis",
"C": "Hyperprolactinemia",
"D": "Turner syndrome",
"E": "Androgen insensitivity"
} | step1 | B |
A 62-year-old woman with a pancreatic insulinoma is being prepared for a laparoscopic enucleation of the tumor. After induction of general anesthesia, preparation of a sterile surgical field, and port placement, the surgeon needs to enter the space posterior to the stomach to access the pancreatic tumor. Which of the f... | Gastrohepatic ligament | {
"A": "Phrenoesophageal ligament",
"B": "Gastrohepatic ligament",
"C": "Phrenicocolic ligament",
"D": "Ligamentum venosum",
"E": "Falciform ligament\n\""
} | step1 | B |
A 55-year-old man is brought to the emergency room by his wife for severe abdominal pain for the past 1 hour. He is unable to give more information about the nature of his pain. His wife says that he has peptic ulcer disease and is being treated with antacids without a good response. She adds that he vomited repeatedly... | Perforated gastric peptic ulcer | {
"A": "Duodenal peptic ulcer",
"B": "Gastric peptic ulcer",
"C": "Pancreatitis",
"D": "Perforated gastric peptic ulcer",
"E": "Choledocholithiasis"
} | step2&3 | D |
A 62-year-old man presents with episodes of palpitations for the past 3 weeks. He says that he has episodes where he feels his heart is ‘racing and pounding’, lasting 1–2 hours on average. Initially, he says the episodes would happen 1–2 times per week but now happen almost every day. This last episode has been constan... | Begin warfarin and heparin | {
"A": "Begin aspirin therapy",
"B": "Begin clopidogrel",
"C": "Carotid endarterectomy",
"D": "Begin warfarin and heparin",
"E": "Begin warfarin"
} | step2&3 | D |
In 2005, a group of researchers believed that prophylactically removing the ovaries and fallopian tubes (bilateral salpingo-oophorectomy) in BRCA-mutation positive women would reduce the chance that they developed breast cancer. To test this hypothesis, they reviewed a database of women who were known to be BRCA-mutati... | Case-control | {
"A": "Retrospective cohort",
"B": "Meta-analysis",
"C": "Cross-sectional",
"D": "Case-control",
"E": "Genome-wide association study"
} | step1 | D |
A 64-year-old man with a history of type 2 diabetes mellitus is referred to a urologist. The patient has had pain when urinating and difficulty starting a stream of urine for over 4 months now. He is bothered because he has to urinate about 9 times every day, including several times when he wakes up at night. A digital... | Extending fine striations | {
"A": "Lamellated calcification",
"B": "‘Popcorn’ pattern",
"C": "Subsolid component",
"D": "Extending fine striations",
"E": "Doubling time of < 1 month"
} | step2&3 | D |
A 35-year-old man presents with a 7 month history of insomnia. The patient admitted to having trouble sleeping from a young age but became more aware of how much this is affecting his health after attending a sleep conference earlier this year. He is worried that his health has suffered because of this, and he is also ... | Generalized anxiety disorder | {
"A": "Generalized anxiety disorder",
"B": "Adjustment disorder",
"C": "Social anxiety ",
"D": "Agoraphobia",
"E": "Normal worry"
} | step2&3 | A |
A 3-year-old girl is brought to the cardiologist because of sweating and respiratory distress while eating. She is at the 30th percentile for height and 15th percentile for weight. Echocardiography shows a defect in the membranous portion of the interventricular septum and a moderately decreased left ventricular ejecti... | Systolic murmur that increases with hand clenching | {
"A": "Systolic murmur that increases with hand clenching",
"B": "Wide, fixed splitting of the second heart sound",
"C": "Systolic murmur that increases with forced exhalation against a closed glottis",
"D": "Diastolic murmur preceded by opening snap",
"E": "Continuous murmur that is loudest at the second he... | step1 | A |
A 58-year-old man comes to the emergency department because of increasing shortness of breath and a nonproductive cough for the last week. Three weeks ago, he had a fever and a cough for 6 days after he returned from a trip to Southeast Asia. He has had a 4-kg (9-lb) weight loss over the past 3 months. He has bronchial... | Blunting of costophrenic angle | {
"A": "Elevation of diaphragm",
"B": "Ground glass appearance",
"C": "Widened intercostal spaces",
"D": "Deep sulcus sign",
"E": "Blunting of costophrenic angle"
} | step2&3 | E |
A 58-year-old man is brought to the emergency department because of sudden-onset right-sided body numbness for 1 hour. He reports that he has a 15-year history of hypertension treated with hydrochlorothiazide. He is alert and oriented to time, place, and person. Neurological examination shows decreased sensation to lig... | Ventral thalamus | {
"A": "Parietal lobe",
"B": "Posterior limb of the internal capsule",
"C": "Lateral medulla",
"D": "Basal pons",
"E": "Ventral thalamus"
} | step1 | E |
A 9-year-old boy is brought in by his mother because of bruising on his torso and limbs. The patient’s mother denies any other symptoms and says he is otherwise healthy. Physical examination shows multiple petechiae and bruising on the torso and extremities bilaterally. The remainder of the physical exam is unremarkabl... | Von Willebrand disease | {
"A": "Acute lymphoblastic leukemia",
"B": "Hemophilia B",
"C": "Immune thrombocytopenic purpura",
"D": "Von Willebrand disease",
"E": "Hemophilia A"
} | step1 | D |
A 31-year-old man comes to the physician because of a 4-week history of a painless lump near the left wrist and tingling pain over his left hand. Physical examination shows a transilluminating, rubbery, fixed, non-tender mass over the lateral volar aspect of the left wrist. There is decreased sensation to pinprick on t... | Flexor pollicis longus tendon | {
"A": "Ulnar artery",
"B": "Extensor pollicis brevis tendon",
"C": "Flexor pollicis longus tendon",
"D": "Flexor carpi radialis tendon",
"E": "Ulnar nerve"
} | step1 | C |
A 52-year-old man comes to the physician for the evaluation of a painless right-sided scrotal swelling. The swelling started several weeks ago but is not always present. Physical examination shows an 8-cm, soft, cystic nontender right-sided scrotal mass that transilluminates. The mass does not increase in size on cough... | Imbalance of fluid secretion and resorption by tunica vaginalis | {
"A": "Imbalance of fluid secretion and resorption by tunica vaginalis",
"B": "Failure of processus vaginalis to obliterate",
"C": "Extension of abdominal contents through the inguinal canal",
"D": "Dilation and tortuosity of veins in the pampiniform plexus",
"E": "Primary germ cell neoplasia of the testicle... | step1 | A |
A 40-year-old patient is brought into the emergency department after suffering a motor vehicle crash where he was pinned underneath his motorcycle for about 30 minutes before a passerby called 911. While evaluating him per your institution's trauma guidelines, you discover pain upon palpation of his right lower extremi... | Emergent fasciotomy | {
"A": "Emergent fasciotomy",
"B": "Venous doppler",
"C": "Arteriogram",
"D": "External fixation",
"E": "Internal fixation"
} | step2&3 | A |
An 18-month-old boy is brought to the physician by his mother because of a 2-day history of fever and a pruritic rash that started on his trunk and then progressed to his face and extremities. He has not received any childhood vaccinations because his parents believe that they are dangerous. His temperature is 38.0°C (... | Varicella | {
"A": "Nonbullous impetigo",
"B": "Varicella",
"C": "Herpes zoster",
"D": "Rubella",
"E": "Erythema infectiosum"
} | step1 | B |
A 43-year-old male is brought to the emergency department after his son found him vomiting bright red blood. He is visibly intoxicated, and hospital records indicate a long history of alcohol substance abuse treated with antabuse (disulfiram). Vital signs include T 98.4, HR 89, BP 154/92, and RR 20. EGD is notable for ... | Conservative management with IV fluid hydration and observation | {
"A": "Cyanoacrylate injection and ligation with banding, IV fluid hydration, and NPO",
"B": "Conservative management with IV fluid hydration and observation",
"C": "Barium swallow to characterize the depth of mucosal involvement",
"D": "Esophageal manometry and impedance studies",
"E": "Calcium channel bloc... | step2&3 | B |
A medical student is preparing a patient for an appendectomy. He is asked by the surgeon to disinfect the patient’s skin with a chlorhexidine-isopropyl alcohol solution before the procedure. Recent studies have shown that this solution substantially reduces the risk of surgical site infections compared with a povidone-... | Its activity depends on pH and is greatly reduced in the presence of organic matter | {
"A": "Bactericidal at low concentrations",
"B": "Protein coagulation/denaturation",
"C": "Cell wall damage by free radical release",
"D": "Attack of free-sulfur amino acids, nucleotides, and fatty acids within the bacteria",
"E": "Its activity depends on pH and is greatly reduced in the presence of organic ... | step1 | E |
A 19-year-old man with a past medical history significant only for facial acne presents with increased inguinal pruritis. Relevant social history includes participation in school wrestling. He has no significant family history. Other than the pruritic rash, a review of systems is negative. On physical examination, ther... | Tinea cruris | {
"A": "Tinea corporis",
"B": "Tinea cruris",
"C": "Candidal balanitis",
"D": "Pityriasis rosea",
"E": "Tinea unguium"
} | step2&3 | B |
A 6-week-old girl is brought to the pediatrician for a post-natal visit. She was born at 38 weeks gestation to a 25-year-old woman via an uncomplicated spontaneous vaginal delivery. The mother reports that prenatal screening revealed no developmental abnormalities and that the baby has been gaining weight, feeding, sto... | The baby’s oocytes are arrested in prophase | {
"A": "The baby has not yet developed oocytes",
"B": "The baby’s oocytes are arrested in prophase",
"C": "The baby’s oocytes are arrested in metaphase",
"D": "The baby’s oocytes are arrested in interphase",
"E": "The baby’s oocytes are fully matured"
} | step1 | B |
A 7-year-old boy is brought to the physician because of a 3-week history of burning sensation in his mouth. One year ago, a peripheral blood smear performed during workup of fatigue revealed erythrocytes without central pallor. His father had gallstones, for which he underwent a cholecystectomy at the age of 26 years. ... | Folic acid supplementation | {
"A": "Pneumococcal vaccine and antibiotic prophylaxis",
"B": "Red blood cell transfusions",
"C": "Gluten-free diet",
"D": "Vitamin B12 injections",
"E": "Folic acid supplementation"
} | step1 | E |
An experimental new drug in the treatment of diabetes mellitus type 2 was found to increase the levels of incretins by preventing their degradation at the endothelium. This further increased glucose-dependent insulin production. Which of the following drugs has a mechanism of action most similar to this new experimenta... | Sitagliptin | {
"A": "Exenatide",
"B": "Sitagliptin",
"C": "Glimepiride",
"D": "Canagliflozin",
"E": "Pioglitazone"
} | step1 | B |
A 60-year-old man with severe persistent asthma since the age of 14 presents with an acute exacerbation of shortness of breath, wheezing, and coughing over the last several days. His asthmatic symptoms are usually well controlled with regular high-dose inhaled triamcinolone, but over the last week or so he has develope... | Airway remodeling | {
"A": "Airway epithelial shedding",
"B": "Airway smooth muscle atrophy",
"C": "Airway remodeling",
"D": "Airway inflammation",
"E": "Airway hyperresponsiveness"
} | step1 | C |
A 75-year-old man is admitted to the hospital because of a 3-day history of a productive cough and shortness of breath. His temperature is 38°C (100.4°F) and respirations are 32/min. Crackles are heard over the right upper and the entire left lung fields. Sputum culture confirms infection with Streptococcus pneumoniae.... | Platelet activating factor | {
"A": "Immunoglobulin E",
"B": "Platelet activating factor",
"C": "Interferon-gamma",
"D": "Interleukin-10",
"E": "Leukotriene D4"
} | step1 | B |
A 2-month-old infant is brought to the emergency department by her mother due to a fall. Tearfully, the patient’s mother describes witnessing her child fall from the changing table. The patient was born prematurely at 36 weeks estimated gestational age via vacuum-assisted vaginal delivery. The patient is afebrile. Her ... | CT scan of the head | {
"A": "CT scan of the head",
"B": "Involvement of social services",
"C": "Informing the police",
"D": "Family counseling",
"E": "Rule out medical conditions"
} | step2&3 | A |
A researcher is interested in identifying the most effective treatment for uncomplicated urinary tract infections (UTI) in women between the ages of 18 and 50. Of 200 consecutive women who present to the emergency room for such a UTI, 50 are randomized to each of the following: nitrofurantoin 100 mg every 12 hours for ... | Factorial design study | {
"A": "Parallel study",
"B": "Factorial design study",
"C": "Non-crossover study",
"D": "Between patient study",
"E": "Cluster randomized trial"
} | step1 | B |
A 31-year-old man comes to the emergency department because of acute onset neck pain and enlargement. Specifically, he reports that he has been experiencing pain and swelling of the anterior portion of his neck near the midline. Otherwise, he says that he has been getting tired easily and feels cold often. Physical exa... | Iodine deficiency | {
"A": "HLA-B8 risk factor",
"B": "Increased 131-iodine uptake",
"C": "Iodine deficiency",
"D": "Presence of embryological remnant",
"E": "Proliferation of fibroinflammatory cells"
} | step1 | C |
A 25-year-old man presents to the office because of extreme fatigue for the past 2 days. He is also worried about his skin looking yellow. He does not have any other complaints and denies fever and headache. He admits to using illicit intravenous drugs in the past. He does not have any immunization records because he m... | Acute hepatitis B | {
"A": "Past hepatitis B infection",
"B": "Chronic hepatitis B",
"C": "Acute hepatitis A",
"D": "Acute hepatitis D superinfection",
"E": "Acute hepatitis B"
} | step1 | E |
A 29-year-old female presents to her primary care provider with an aching pain in her left leg that has progressively gotten worse over several days. She recently had an unfortunate sporting incident resulting in large bruises along both legs and lower thighs. An X-ray after the event was negative for fracture. Past me... | Antibodies directed against phospholipids | {
"A": "Antibodies directed against platelet glycoprotein IIb/IIIa",
"B": "Antibodies directed against phospholipids",
"C": "Antibodies directed against endothelial cells",
"D": "Vitamin K deficiency",
"E": "Disseminated intravascular coagulation"
} | step1 | B |
A 22-year-old woman with a history of asthma visits her physician for worsening shortness of breath. She states that she feels as though her “lungs are falling apart,” noting that her lung function has been steadily deteriorating. She further states that she has visited a number of other physicians who prescribed sever... | Prednisone | {
"A": "Isoniazid",
"B": "Fluconazole",
"C": "Caspofungin",
"D": "Prednisone",
"E": "Surgical resection of the infiltrates"
} | step2&3 | D |
A 30-year-old man is brought to the emergency department with complaints of fever (41.5℃ (106.7℉)) and diarrhea for the past 12 hours. There is no history of headaches, vomiting, or loss of consciousness. The past medical history is unobtainable due to a language barrier (the patient recently immigrated from abroad), b... | Streptococcus pneumoniae | {
"A": "Staphylococcus aureus",
"B": "Streptococcus pyogene",
"C": "Streptococcus pneumoniae",
"D": "Neisseria meningitidis",
"E": "Non-typeable H. influenzae"
} | step1 | C |
A 12-year-old girl is brought to the emergency department 3 hours after the sudden onset of colicky abdominal pain and vomiting. The patient also manifests symptoms of redness and swelling of the face and lips without pruritus. Her symptoms began following a tooth extraction earlier in the morning. She had a similar ep... | Complement inhibitor deficiency | {
"A": "Autoantibody-mediated tissue damage",
"B": "Complement inhibitor deficiency",
"C": "Drug-induced bradykinin excess",
"D": "Leukotriene overproduction",
"E": "Mast-cell activation"
} | step2&3 | B |
A healthy 21-year-old man undergoes physical fitness testing prior to long-term submarine deployment. To evaluate his pulmonary function, lung and thoracic compliance are measured at different system pressures. A graph of the relationship between his lung volume and transpulmonary pressure is shown. The dotted line in ... | Functional residual capacity | {
"A": "Inspiratory capacity",
"B": "Vital capacity",
"C": "Tidal volume",
"D": "Functional residual capacity",
"E": "Total lung capacity"
} | step1 | D |
A 3-day-old boy is brought to the emergency department because of a 4-hour history of somnolence, poor feeding, and one episode of vomiting. He is exclusively breastfed. His serum glucose concentration is 88 mg/dL and his serum ammonia concentration is 850 μmol/L (N<90). Urinalysis shows an increased orotic acid to cre... | Ornithine and carbamoyl phosphate to citrulline | {
"A": "Ornithine and carbamoyl phosphate to citrulline",
"B": "Orotic acid to uridine monophosphate",
"C": "Pyruvate to acetyl-coenzyme A",
"D": "Glutamate and acetyl-coenzyme A to N-acetylglutamate",
"E": "Arginine to urea and ornithine"
} | step1 | A |
A 31-year-old woman comes to the physician because of dragging pelvic pain and a 3 kg (6 lb 9 oz) weight loss over the past 6 months. Menses occur at irregular 30- to 45-day intervals; her last menstrual period was 5 weeks ago. Her temperature is 38°C (100.4°F), heart rate is 102/min, and blood pressure is 128/84 mm Hg... | Germ cells | {
"A": "Ovarian epithelial cells",
"B": "Germ cells",
"C": "Chorionic epithelial cells",
"D": "Endometrial cells",
"E": "Stromal cells"
} | step1 | B |
A 55-year-old man comes to the emergency department with the complaint of pain in his right toe for the past hour. The pain is so severe that it woke him up. The patient has smoked a pack of cigarettes daily for the last 40 years and binge drinks alcohol after work and on the weekends. He underwent an appendectomy when... | Organic acids competing with urate for tubular secretion | {
"A": "Organic acids competing with urate for tubular secretion",
"B": "Increased renal reabsorption of urate",
"C": "Lysis of large numbers of cells",
"D": "Deficiency of HGPRT",
"E": "High-purine diet"
} | step2&3 | A |
A 33-year-old man presents to the infectious diseases clinic for follow-up. He was recently admitted to the hospital with fever, shortness of breath, and cough, and was found to have Pneumocystic jirovecii pneumonia and a new diagnosis of HIV. His CD4 count is 175, viral load is pending. As part of routine laboratory s... | Treat with three weekly injections of penicillin, obtain titers in 6 months | {
"A": "Perform lumbar puncture, treat based on presence or absence of CNS disease",
"B": "Treat with three weekly injections of penicillin, obtain titers in 3 months",
"C": "Treat with three weekly injections of penicillin, obtain titers in 6 months",
"D": "Treat with a single injection of penicillin, obtain t... | step2&3 | C |
A 67-year old man presents to his primary care physician for his yearly checkup. He has not noticed any major changes in his health over the last year but says that unfortunately, he stopped exercising because he has been stressed by work. His past medical history is significant for obesity, hypertension, diabetes, hyp... | Cholelithiasis | {
"A": "Acanthosis nigricans",
"B": "Cholelithiasis",
"C": "Decreased vitamin D absorption",
"D": "Hepatotoxicity",
"E": "Teratogenicity"
} | step1 | B |
A 29-year-old woman presents to her OB/GYN for a preconception visit. She wishes to become pregnant within the next several months. A thorough history reveals that the patient suffers from phenylketonuria (PKU). She recalls being instructed by prior physicians to follow a diet that avoids certain foods; however, she ad... | 3 months prior to conception, begin a restricted diet to lower phenylalanine levels to below 6 mg/dL | {
"A": "Even with appropriate treatment, your condition will prevent you from becoming pregnant",
"B": "Improved PKU treatment will decrease the risks of spontaneous abortion and intrauterine fetal death",
"C": "3 months prior to conception, begin a restricted diet to lower phenylalanine levels to below 6 mg/dL",... | step2&3 | C |
A 47-year-old man presents to his family physician with a sudden onset of severe pain and redness in his eyes that started this morning. He is having difficulty seeing properly and is extremely worried about losing his vision. Further history reveals that he has had progressive lower back pain for over 2 months now. Th... | Aortic regurgitation | {
"A": "Dry mouth",
"B": "Conjunctivitis",
"C": "Malabsorption",
"D": "Aortic regurgitation",
"E": "Hemochromatosis"
} | step2&3 | D |
A 38-year-old woman presents to her physician’s clinic for recurrent episodes of chest pain that wakes her from her sleep. While usually occurring late at night, she has also had similar pains during the day at random times, most recently while sitting at her desk in her office and at other times while doing the dishes... | Isosorbide dinitrate | {
"A": "Aspirin",
"B": "Digoxin",
"C": "Isosorbide dinitrate",
"D": "Heparin",
"E": "Propranolol"
} | step2&3 | C |
A 16-year-old male presents to his pediatrician with complaints of malaise, fatigue, sore throat, and fever over the last several days. His vital signs are as follows: T 39.1 C, HR 82, BP 122/76, RR 14, and SpO2 99%. Physical examination is significant for splenomegaly, tonsillar exudate, and posterior auricular lympha... | Bed rest and activity limitation | {
"A": "Bed rest and activity limitation",
"B": "Acyclovir",
"C": "Ganciclovir",
"D": "Amoxicillin",
"E": "Prednisone"
} | step2&3 | A |
A 75-year-old man comes to the physician because of a 7-day history of nausea and vomiting. Over the past 2 days, he has also been feeling weak and tired. When standing up after sitting for a while, he feels dizzy. He says he has to go to the bathroom more often than usual, and that he is urinating “a normal amount” ea... | Osmotic diuresis | {
"A": "Diuretic overdose",
"B": "Osmotic diuresis",
"C": "Gastroinstestinal fluid loss",
"D": "Excess production of aldosterone",
"E": "Insufficient production of antidiuretic hormone"
} | step2&3 | B |
A 38-year-old woman presents to her primary care physician for her yearly exam. Her only complaint is difficulty losing weight. Her BMI is 34 kg/m^2. In addition to a standard physical exam, the physician orders a glucose tolerance test. The woman's fasting blood glucose level is 120 mg/dL and two-hour post 75g glucose... | Peroxisome proliferator-activated receptor gamma | {
"A": "Catecholamines",
"B": "Glucagon",
"C": "Glucocorticoids",
"D": "Peroxisome proliferator-activated receptor gamma",
"E": "TNF-alpha"
} | step1 | D |
A 35-year-old male presents to the emergency department for evaluation of hemoptysis. A chest X-ray reveals bilateral focal pulmonary consolidation. On further questioning, he admits having hematuria. Urinalysis shows RBC casts and 400 mL of urine is excreted in 24 hours. What is the most likely cause of hemoptysis and... | Anti-glomerular basement membrane antibodies | {
"A": "Anti-Smith antibodies",
"B": "Anti-neutrophil antibodies",
"C": "Anti-mitochondrial antibodies",
"D": "Anti-nuclear antibodies",
"E": "Anti-glomerular basement membrane antibodies"
} | step1 | E |
A 34-year-old man comes to the physician with a 2-month history of difficulty concentrating at work. He is worried he may lose his job due to poor performance. He feels constantly tired but attributes his fatigue to waking up early most mornings and being unable to fall back asleep. His wife has noticed that he has bee... | Major depressive disorder | {
"A": "Major depressive disorder",
"B": "Persistent depressive disorder",
"C": "Adjustment disorder",
"D": "Acute stress disorder",
"E": "Post traumatic stress disorder"
} | step1 | A |
A 25-year-old female presents to her primary care physician complaining of double vision. She first started seeing double after a long day at her work as a radiation technologist. Since then, her vision has appeared to worsen in the evenings. She has also felt worsening fatigue despite no change in her work hours or sl... | Pyridostigmine | {
"A": "Pyridostigmine",
"B": "Physostigmine",
"C": "Edrophonium",
"D": "Hydrocortisone",
"E": "Azathioprine"
} | step1 | A |
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