question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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A 76-year-old woman visits a physician for a general medical examination. She is asymptomatic. Six months prior, she had a cerebral stroke with left hemiparesis, from which she has almost completely recovered with physiotherapy. She has a history of hypertension and atrial fibrillation (AF). She has no significant isch... | International normalized ratio | {
"A": "Echocardiogram",
"B": "Electrocardiogram",
"C": "International normalized ratio",
"D": "Partial thromboplastin time",
"E": "Serum drug levels"
} | step2&3 | C |
A 4-year-old boy is brought to his primary care physician for a physical prior to beginning a preschool program. He is found to be delayed in reaching normal childhood cognitive and social milestones, which is consistent with observations at previous check-ups. Physically, he is also found to be significantly overweigh... | P/D1 cells | {
"A": "D cells",
"B": "G cells",
"C": "I cells",
"D": "P/D1 cells",
"E": "L cells"
} | step1 | D |
Accurate and rapid identification of individuals with tuberculosis (TB) is crucial to accomplishing the goal of the World Health Organization (WHO) to eliminate this disease. One of the key strategies for the detection of TB is the use of tuberculin skin testing as a globally pertinent screening method, due to its low ... | Negative predictive value | {
"A": "Convergent validity",
"B": "Discriminant validity",
"C": "Positive predictive value",
"D": "Negative predictive value",
"E": "Test specificity"
} | step1 | D |
A 55-year-old caucasian male is transferred to a tertiary care hospital from a small county hospital where he presented with jaundice and severe abdominal pain that radiates to the back. While in the county hospital, he did not develop fever, and his vital signs were stable for the 48 hours he spent at there. Initial l... | CA 19-9 | {
"A": "CA 125",
"B": "Alpha-fetoprotein",
"C": "Desmin",
"D": "CA 27-29",
"E": "CA 19-9"
} | step2&3 | E |
A one-week-old, full-term infant born by uncomplicated vaginal delivery is brought to a pediatrician by his mother, who notes that her daughter's skin appears yellow. She reports that the child cries several times per day and sleeps 7-8 hours at night, uninterrupted. She has been breastfeeding exclusively and feels tha... | Continue normal breast feeding | {
"A": "Phototherapy",
"B": "Phenobarbital administration",
"C": "Plasma exchange",
"D": "Switch from breast milk to formula",
"E": "Continue normal breast feeding"
} | step2&3 | E |
A 35-year-old woman arrives to the clinic complaining of progressive urinary leakage that has occurred for the past 1 year. At first, she would notice leakage only during athletic exercise, but now the incontinence occurs even when she laughs or coughs. The patient states that she goes to the bathroom more frequently t... | Urethral hypermobility | {
"A": "Diabetic polyuria",
"B": "Overactive detrusor muscle",
"C": "Primary polydipsia",
"D": "Urethral hypermobility",
"E": "Vescicovaginal fistula"
} | step2&3 | D |
A 24-year-old woman presents to the emergency department after an episode of altered mental status. She was at a party when she suddenly fell to the floor. Her friends state that she was not responsive and was acting oddly. After the episode, the patient seemed confused and had no memory of the event. The patient has a... | IV fluids and mannitol | {
"A": "Diazepam",
"B": "Electroencelphalography",
"C": "IV fluids and mannitol",
"D": "Phenytoin",
"E": "Supportive therapy and observation"
} | step2&3 | C |
A 47-year-old woman presents to a physician for evaluation of vomiting and diarrhea for 2 days. Her symptoms began following a company picnic a few days ago. Initially, she was unable to tolerate any solids or liquids by mouth, but now has been able to drink sips of water. She had a mild headache, which was relieved wi... | Proximal tubule | {
"A": "Collecting duct",
"B": "Distal tubule",
"C": "Descending limb of loop of Henle",
"D": "Proximal tubule",
"E": "Ascending limb of loop of Henle"
} | step1 | D |
A one-week-old boy presents with yellow sclerae, severe lethargy, and decreased muscle tone. His mother notes that the symptoms started shortly after birth and have been progressively worsening. The patient is breast fed and takes no medications. His labs are within normal limits with the exception of his liver functio... | Absence of UDP-glucuronosyltransferase-1A1 | {
"A": "Deficiency in glucose-6-phosphate dehydrogenase",
"B": "Absence of UDP-glucuronosyltransferase-1A1",
"C": "Alteration in the ankyrin protein",
"D": "Reduction in UDP-glucuronosyltransferase-1A1 activity",
"E": "Deficiency in glucocerebrosidase"
} | step1 | B |
A researcher is conducting an experiment on the mouse kidney to study the relative concentrations between the tubular fluid and plasma of a number of substances along the proximal convoluted tubule. Based on the graph shown in figure A, which of the following best describes the tubular fluid-to-plasma concentration rat... | B | {
"A": "A",
"B": "B",
"C": "C",
"D": "D",
"E": "E"
} | step1 | B |
A 62-year-old man comes to the emergency department because of right-sided back pain, nausea, and dark urine. He reports alternating episodes of decreased urine output followed by a temporary increase in urine output for the past 2 days. In the past year, he has had two urinary tract infections. He has Crohn disease an... | Malabsorption of fatty acids | {
"A": "Parathyroid gland adenoma",
"B": "Excess vitamin D",
"C": "Recurrent urinary tract infections",
"D": "Malabsorption of fatty acids",
"E": "High urine pH"
} | step2&3 | D |
An 8-year-old boy is brought to the physician because he has excessively dry skin. His mother says that he has had dry, scaly skin since he was 6 months old. She says it is worse in winter and better in summer. There is no associated itching, redness, or discharge. Examination reveals generalized fine scales with coars... | Ichthyosis vulgaris | {
"A": "Psoriasis",
"B": "Lichen simplex",
"C": "Ichthyosis vulgaris",
"D": "Pityriasis versicolor",
"E": "X-linked ichthyosis"
} | step2&3 | C |
A 29-year-old woman, gravida 3, para 2, at 24 weeks' gestation comes to the emergency department because of vaginal bleeding and mild pelvic pain for 2 hours. Her current pregnancy was achieved by means of in vitro fertilization due to azoospermia in her partner. Prenatal course has been uncomplicated with regular pren... | Cervical trauma | {
"A": "Pedunculated cervical growth",
"B": "Inflammation of the cervix",
"C": "Cervical trauma",
"D": "Fetal vessels overlying cervical os",
"E": "Premature separation of the placenta"
} | step2&3 | C |
A 16-year-old boy is rushed to the emergency room with acute vomiting and abdominal pain that began earlier today. His parents say that the boy was doing well until two days ago when he told them that he was feeling unwell. He has diabetes and takes insulin but stopped taking it when he began to feel poorly two days ag... | Administer IV fluids and insulin | {
"A": "Administer IV fluids and insulin",
"B": "Administer IV antibiotics",
"C": "Administer IV fluids with oral antidiabetic medications",
"D": "Administer IV bicarbonate",
"E": "Administer potassium and magnesium"
} | step2&3 | A |
A 28-year-old male presents to the emergency department with chest pain. He reports that one hour ago he was climbing the stairs in his home when he suddenly developed excruciating chest pain. He describes the pain as ripping and radiating to the back. The patient’s past medical history is significant for a heart murmu... | Late systolic crescendo murmur at the apex with mid-systolic click | {
"A": "Holosystolic, high-pitched blowing murmur at the lower left sternal border",
"B": "Late systolic crescendo murmur at the apex with mid-systolic click",
"C": "Mid-diastolic murmur at the apex with opening snap",
"D": "Mid-diastolic murmur at the left lower sternal border",
"E": "Systolic ejection murmu... | step2&3 | B |
A mother brings her 6-year-old daughter to the pediatrician to discuss her child's sleeping troubles. Three times now in the last month the child has begun screaming and crying in the middle of the night. When the parents rush to the child's room, they find her crying inconsolably. They try to ask her what is wrong, bu... | They occur only during non-REM sleep | {
"A": "They will be persistent into adulthood",
"B": "They occur only during non-REM sleep",
"C": "They can occur any time during the sleep cycle",
"D": "They are associated with child abuse",
"E": "They are associated with later development of a mood disorder"
} | step1 | B |
An 18-year-old woman comes to the physician because of a pruritic rash on her back for the past 2 hours. This morning, she started a course of ceftriaxone for treatment of pyelonephritis. A photograph of the rash is shown. This patient's skin findings are most likely associated with which of the following? | Hyperpermeability of superficial dermal microvasculature | {
"A": "Perivascular cutaneous polymorphonuclear infiltration",
"B": "Direct tissue damage by irradiated antibiotic agent",
"C": "Cytotoxic T-cell destruction of antigen-tagged cells",
"D": "Hyperpermeability of superficial dermal microvasculature",
"E": "Mast cell activation in subcutaneous tissues"
} | step1 | D |
Two hours after admission to the hospital for dialysis, a 63-year-old woman has severe pain in her lower back. The pain is 8 out of 10 in intensity and radiates down the legs. She underwent a laparoscopic cholecystectomy 4 years ago. She has hypertension, chronic kidney disease, type 2 diabetes mellitus, and major depr... | Secondary hyperparathyroidism | {
"A": "Tertiary hyperparathyroidism",
"B": "Secondary hyperparathyroidism",
"C": "Elder abuse",
"D": "Pseudohypoparathyroidism",
"E": "Primary hyperparathyroidism"
} | step2&3 | B |
A 50-year-old man comes to the physician because of swelling of his legs for 2 months. Three months ago, he was diagnosed with hypertension and started on a new medication. His blood pressure is 145/95 mm Hg. Physical examination shows 2+ edema in both lower extremities. Laboratory studies are within the reference rang... | Amlodipine | {
"A": "Losartan",
"B": "Lisinopril",
"C": "Spironolactone",
"D": "Hydrochlorothiazide",
"E": "Amlodipine"
} | step1 | E |
An investigator is studying the function of different enzymes in various human cell types. A subset of normal human cells with an elevated intracellular concentration of bisphosphoglycerate mutase is harvested and isolated. Which of the following is most likely to be absent in these cells? | α-ketoglutarate dehydrogenase | {
"A": "α-ketoglutarate dehydrogenase",
"B": "Pyruvate kinase",
"C": "Glutathione reductase",
"D": "Lactic acid dehydrogenase",
"E": "Carbonic anhydrase"
} | step1 | A |
A 28-year-old woman is brought to the emergency room after a motor vehicle accident. On arrival, she is stable and says that she hit a car at an intersection that "came out of nowhere". She states that she had similar close encounters with other cars these past few weeks but was able to avoid collisions with those. She... | Decreased progesterone | {
"A": "Decreased oxytocin",
"B": "Decreased progesterone",
"C": "Increased follicle stimulating hormone",
"D": "Increased human chorionic gonadotropin",
"E": "Increased progesterone"
} | step1 | B |
A 23-year-old woman comes to the physician because of a 2-month history of episodic headaches associated with dizziness, nausea, and vomiting. Over-the-counter pain medications have failed to reduce her symptoms. An MRI of the brain shows isolated dilation of the left lateral ventricle. This dilatation is most likely c... | Interventricular foramen | {
"A": "Arachnoid villi",
"B": "Interventricular foramen",
"C": "Median aperture",
"D": "Lateral apertures",
"E": "Cerebral aqueduct"
} | step1 | B |
A 20-day-old child is brought to the emergency department by her parents. They are concerned about lethargy and easy bruising. Her mother reports that she has been eating less for the past few days. Today she was difficult to arouse. She normally nurses four-five times a day, but ate less yesterday and this morning. Th... | Vitamin K deficiency | {
"A": "Group B streptococcus (GBS) infection",
"B": "Hepatitis B infection",
"C": "Thyroid stimulating hormone deficiency",
"D": "Vitamin D deficiency",
"E": "Vitamin K deficiency"
} | step1 | E |
A 10-year-old boy is brought to the physician because of a generalized, non-itchy rash for 2 days. He has also had a fever and sore throat for 4 days. He has not received any routine childhood vaccinations. Examination shows a flushed face except around his mouth. A diffuse, papular, erythematous rash that blanches wit... | Mitral valve regurgitation | {
"A": "Hemolytic anemia",
"B": "Coronary artery aneurysms",
"C": "Encephalitis",
"D": "Mitral valve regurgitation",
"E": "Minimal change disease"
} | step1 | D |
A 32-year-old man presents to the emergency department with fever, nausea, and vomiting. The patient states that his symptoms started last night and have persisted to this morning. He has a past medical history of asthma, and his current medications include albuterol and fluticasone. His temperature is 102°F (38.9°C), ... | IV fluids and monitoring | {
"A": "Acyclovir",
"B": "Amphotericin and 5-flucytosine",
"C": "Ceftriaxone",
"D": "Ceftriaxone and vancomycin",
"E": "IV fluids and monitoring"
} | step2&3 | E |
A 64-year-old man comes to the physician with a 1-week history of sore mouth. He says that swallowing is not painful. He has had asthma for more than 20 years. His only medication is a high-dose combination salmeterol/fluticasone inhaler. His temperature is 37.1°C (98.8°F), pulse is 74/min, respirations are 14/min, and... | Nystatin | {
"A": "Azithromycin",
"B": "Fluconazole",
"C": "Isotretinoin",
"D": "Nystatin",
"E": "Penicillin V"
} | step2&3 | D |
A 56-year-old woman is brought to the emergency department because of a 2-day history of fever, chills, nausea, and flank pain. She has multiple sclerosis and a chronic indwelling bladder catheter for neurogenic bladder dysfunction. One week ago, she was discharged from the hospital after treatment for a multiple scler... | Pyoverdine | {
"A": "Lipoteichoic acid",
"B": "K capsule",
"C": "Urease",
"D": "Toxin B",
"E": "Pyoverdine"
} | step1 | E |
A 26-year-old man comes to the physician for episodic fever, recurrent night sweats, and a 6-kg (14.2-lb) weight loss over the past 2 months. He reports that the fever lasts for 7 to 10 days, then subsides completely for about a week before returning again. His temperature is 39°C (102.2°F). Physical examination shows ... | Cells staining positive for CD15 and CD30 | {
"A": "Cells staining positive for tartrate-resistant acid phosphatase",
"B": "Cells staining positive for CD15 and CD30",
"C": "Cells with BCR-ABL rearrangement",
"D": "Cells overexpressing Bcl-2",
"E": "Cells with t(8;14) chromosomal translocation"
} | step1 | B |
A 25-year-old woman comes to the physician for the evaluation of nausea for the last two weeks. During this period, she has had increased urinary frequency and fatigue. She also reports two episodes of non-bloody vomiting. There is no personal history of serious illness. Her last menstrual period was 6 weeks ago. Physi... | Crown-rump length | {
"A": "Ratio of head to abdominal circumference",
"B": "Serum β-hCG levels",
"C": "Femoral length",
"D": "Crown-rump length",
"E": "Biparietal length"
} | step2&3 | D |
A 6-week-old male infant is brought to the physician by his mother because of a 2-day history of recurrent nonbilious vomiting. Vomiting occurs almost immediately after most feeds. Each time, he becomes irritable while feeding and refuses to finish the bottle. He was born at 37 weeks' gestation and weighed 3300 g (7 lb... | Elongated and thickened pylorus on abdominal ultrasound | {
"A": "Dilated colon segment on abdominal x-ray",
"B": "A high serum 17-hydroxyprogesterone concentration",
"C": "Detection of rotavirus antigen on enzyme immunoassay (EIA)",
"D": "Elongated and thickened pylorus on abdominal ultrasound",
"E": "Tripple bubble sign on abdominal x-ray"
} | step2&3 | D |
A 5-year-old Syrian immigrant and her family present for an immigration physical. Her mother describes photophobia, bilateral lacrimation, eye itching, and eyelid swelling for the last week. She is known to have an allergy to cephalosporins. She was born at 39 weeks gestation via spontaneous vaginal delivery. She has m... | The child should be administered a single dose of oral azithromycin. | {
"A": "A third-generation cephalosporin would be the best treatment option in case the child did not have an actual allergy.",
"B": "The child should be treated with topical bacitracin.",
"C": "The best treatment option is oral tetracycline.",
"D": "The child should be administered a single dose of oral azithr... | step1 | D |
Three days after induction chemotherapy, a 9-year-old boy is admitted to the hospital for fever and neutropenia. He was initially diagnosed with t(9;22)-positive acute T cell lymphoblastic leukemia following workup for fatigue and pancytopenia. He is fully conscious. His blood pressure is 110/65 mm Hg, temperature is 3... | Cytogenetics | {
"A": "Age",
"B": "Cytogenetics",
"C": "Fever and neutropenia",
"D": "Initial presentation",
"E": "Immunological subtype"
} | step2&3 | B |
A 45-year-old homeless man comes to the emergency department because of progressive neck pain for 3 days. He also reports headaches and numbness in both hands. Over the past 4 months, he has had intermittent lower back pain after waking up. The back pain improves with movement. He also has recurrent episodes of gout in... | Intravenous ciprofloxacin and vancomycin therapy | {
"A": "Lumbar puncture",
"B": "Intravenous ciprofloxacin and vancomycin therapy",
"C": "Surgical debridement",
"D": "Oral indomethacin therapy",
"E": "Bone scintigraphy\n\""
} | step2&3 | B |
A 1-month-old girl is brought to the emergency department with persistent vomiting, dehydration, and irritability. Over the past week, she has been projectile vomiting after most feedings. Initially, the vomiting would occur just once or twice a day, but now it occurs after every feed. However, her appetite hasn’t decr... | Metabolic alkalosis | {
"A": "Respiratory alkalosis",
"B": "Metabolic acidosis",
"C": "Metabolic alkalosis",
"D": "Respiratory acidosis",
"E": "Mixed respiratory and metabolic acidosis"
} | step2&3 | C |
A 10-year-old girl is brought to a clinic by her parents after 1 week of difficulty breathing, dry cough, and low-grade fevers. She has also developed shallow erythematous ulcers inside of her mouth. There is no history of chills, rigors, or headaches. Her appetite has decreased. The girl has been HIV-positive since bi... | pol gene mutation | {
"A": "Ineffective CD8 cytotoxicity",
"B": "gag gene mutation",
"C": "env gene mutation",
"D": "pol gene mutation",
"E": "Decreased viral replication"
} | step1 | D |
A 68-year-old man presents to the emergency department with confusion. The patient lives in a nursing home and has Alzheimer dementia at baseline. His nurse noticed that he was more confused than usual and was somnolent for the past 12 hours. The patient’s nurse also noticed that he was soiling his diapers more frequen... | Alendronate | {
"A": "Alendronate",
"B": "Calcitonin",
"C": "Furosemide",
"D": "IV fluids",
"E": "Teriparatide"
} | step2&3 | A |
A 68-year-old woman is referred to the outpatient psychiatry clinic from the medical clinic. The patient is being treated for urge incontinence but is being referred for psychiatric evaluation to help with some of her old avoidance behavior. For the 3 months that she had her urinary symptoms, she avoided places like lo... | She fears not being able to escape similar situations. | {
"A": "She fears not being able to escape similar situations.",
"B": "Her symptoms need to last for at least 1 month.",
"C": "She requires only one fear or avoidance situation to meet criteria for this condition.",
"D": "Patients may have accompanying social phobia.",
"E": "The condition always occurs in the... | step1 | A |
A 55-year-old male presents to the emergency department with dyspnea and palpitations. He does not smoke cigarettes or consume alcohol, and past medical history is insignificant. Blood pressure is 115/75 mmHG and heart rate is 125/min. Heart rhythm is irregularly irregular. After initial treatment with IV digoxin the p... | Vagal stimulation | {
"A": "Blockade of beta-adrenergic receptors",
"B": "Calcium channel blockade",
"C": "Blockade of Na-K-ATPase on cardiac myocytes",
"D": "Vagal stimulation",
"E": "Increased ventricular contractility"
} | step1 | D |
Public health researchers are reviewing data from an outbreak of hepatitis A that was traced to contaminated produce from a popular restaurant. A case series investigation with prospective and retrospective follow-up found that 500 individuals dined at the restaurant during the week of study. The incidence of hepatitis... | 4% | {
"A": "4%",
"B": "5%",
"C": "10%",
"D": "20%",
"E": "25%"
} | step1 | A |
A 30-year-old man is brought to the emergency room by ambulance after being involved in a motor vehicle collision. He was driving a motorcycle and collided with a bus. The EMT personnel found the patient alert with anterograde amnesia for the several minutes preceding the accident. Vital signs are within normal limits.... | Tearing of the middle meningeal artery | {
"A": "Tearing of the middle meningeal artery",
"B": "Dural arteriovenous fistula",
"C": "Tearing of bridging veins",
"D": "Charcot-Bouchard microaneurysm",
"E": "Arteriovenous malformation"
} | step1 | A |
A 42-year-old man presents to his primary care physician for a follow-up visit. He has type 1 diabetes mellitus, for which he takes insulin. He complains of frequent episodes of waking up in the middle of his sleep. When he wakes up, he feels excessive sweating, hand tremors, and weakness. His morning blood glucose is ... | Reducing daily insulin dose | {
"A": "Reassurance",
"B": "Adding diazepam",
"C": "Adding pramlintide",
"D": "Increasing daily insulin dose",
"E": "Reducing daily insulin dose"
} | step2&3 | E |
A researcher conducts multiple experiments to establish an infection and disease model for Clostridium perfringens in chickens. To ensure that all instruments are free of the pathogenic organism, he uses a disinfectant that oxidizes and denatures proteins. Which of the following disinfectants did the researcher most li... | Chlorine dioxide | {
"A": "Chlorine dioxide",
"B": "Isopropyl alcohol",
"C": "Phenol",
"D": "Povidone-iodine",
"E": "Benzalkonium chloride"
} | step1 | A |
A 23-year-old woman visits her obstetrician for an antenatal appointment. She is at the 24th week of gestation. She has had type 1 diabetes mellitus for 5 years and is on insulin. She also has mitral stenosis, for which she has been advised to undergo a balloon valvotomy. Her temperature is 37.1°C (98.7°F), blood press... | Transient hypertrophic cardiomyopathy | {
"A": "Hypertrophic obstructive cardiomyopathy",
"B": "Transient hypertrophic cardiomyopathy",
"C": "Tetralogy of Fallot",
"D": "Ebstein anomaly",
"E": "Mitral valve prolapse"
} | step2&3 | B |
A 63-year-old man presents to the physician with a complaint of back pain for the past 2 months. The pain is present throughout the day, and even at night when he lies down. He also complains of difficulty walking upstairs and says he recently started to wear adult diapers because he seems to have difficulty controllin... | Spinal metastasis | {
"A": "Syringomyelia",
"B": "Spinal metastasis",
"C": "Herniated disc",
"D": "Epidural abscess",
"E": "Spinal hematoma"
} | step1 | B |
An 18-year-old college student presents to the student health clinic complaining of excessive sleepiness. He first noticed the daytime sleepiness about a year ago but reports that it significantly worsened once he started college. He reports that he goes to bed around 9 p.m. and wakes up for class at 8 a.m.. He naps be... | Modafinil | {
"A": "Clomipramine",
"B": "Dextroamphetamine",
"C": "Methylpenidate",
"D": "Modafinil",
"E": "Sleep deprivation"
} | step2&3 | D |
A 63-year-old woman with end-stage renal disease complains of feeling lightheaded after her hemodialysis sessions for the past month. She worries she might eventually lose her balance and fall. She has had diabetes mellitus for 22 years. Her medications include folic acid, vitamin B12, amlodipine, and erythropoietin. A... | Cooling the dialysate | {
"A": "Cooling the dialysate",
"B": "Eating heavier meals during dialysis",
"C": "Increasing salt intake",
"D": "Increasing ultrafiltration",
"E": "Steroid administration"
} | step2&3 | A |
A 34-year-old woman presents to the emergency room with a fever. She developed worsening malaise and diaphoresis over the past 48 hours. Her maximum temperature was 102°F (38.9°C) taken the night before presentation. Her past medical history is notable for major depressive disorder, obesity, fibromyalgia, and severe te... | Increased tryptophan intake | {
"A": "Decreased carbohydrate intake",
"B": "Increased tryptophan intake",
"C": "Medication change",
"D": "Surreptitious diuretic abuse",
"E": "Surreptitious opiate abuse"
} | step1 | B |
A 47-year-old man presents with hemoptysis, diffuse muscle pain, and shortness of breath. He has had these symptoms before but did not seek treatment. His past medical history is not known as he is not typically followed by a doctor and is homeless. His temperature is 99.0°F (37.2°C), blood pressure is 154/94 mmHg, pul... | Methylprednisolone, plasmapheresis, and cyclophosphamide | {
"A": "Methylprednisolone",
"B": "Methylprednisolone and cyclophosphamide",
"C": "Methylprednislone, IVIG, and cyclophosphamide",
"D": "Methylprednisolone, plasmapheresis, and cyclophosphamide",
"E": "Plasmapheresis and cyclophosphamide"
} | step2&3 | D |
A 39-year-old woman presents with headaches, constipation, increased thirst, and increased urinary frequency. Her blood pressure is 160/100 mm Hg and pulse is 67/min. Blood tests reveal high blood glucose and low potassium level. Abdominal CT scan shows a well-circumscribed homogeneous mass in the left adrenal gland. T... | Intracellular receptors | {
"A": "Intracellular receptors",
"B": "Tyrosine kinase receptors",
"C": "cAMP pathway",
"D": "cGMP pathway",
"E": "JAK/STAT pathway"
} | step1 | A |
A 55-year-old man presents to the emergency department with a headache. He states that this is the worst headache he has ever had and that his symptoms have not been improving. The patient complains of pain in his jaw that is worse when he chews. He has a past medical history of insomnia and is currently taking alprazo... | IV steroids | {
"A": "CT head",
"B": "Ibuprofen",
"C": "IV steroids",
"D": "Lumbar puncture",
"E": "Temporal artery biopsy"
} | step2&3 | C |
A 34-year-old man with acute lymphocytic leukemia presents for follow-up in the oncology clinic after his second cycle of chemotherapy. In addition to intermittent nausea, he has mild weakness, tingling, and numbness in his left hand. With his affected hand, he is able to grip, but occasionally drops small objects. His... | Blocks microtubule formation | {
"A": "Covalently X-links DNA",
"B": "Blocks microtubule formation",
"C": "Intercalates between DNA",
"D": "Modifies DNA transcription and protein synthesis",
"E": "Blocks tyrosine kinase"
} | step1 | B |
A 1-day-old infant is in the neonatal intensive care unit due to respiratory failure from pulmonary hypoplasia. The mother is a healthy 32-year-old woman who did not have regular prenatal exams. On physical examination, you notice low-set ears and retrognathia with abnormal extremity development. Which of the following... | Posterior urethral valves | {
"A": "Hepatosplenomegaly",
"B": "Macroorchidism",
"C": "Posterior urethral valves",
"D": "Rocker bottom feet",
"E": "Duodenal atresia"
} | step1 | C |
A 47-year-old woman with metastatic breast cancer who is undergoing chemotherapy comes to the physician for a follow-up exam. She reports extreme fatigue since beginning her chemotherapy regimen. Her pulse is 98/min, respirations are 16/min, and blood pressure is 132/84 mm Hg. Her hemoglobin is 10.4 g/dL, leukocyte cou... | Filgrastim | {
"A": "Aldesleukin",
"B": "Interferon beta",
"C": "Filgrastim",
"D": "Romiplostim",
"E": "Sargramostim"
} | step1 | C |
A male newborn born at 27 weeks' gestation is evaluated for rapid breathing and hypoxia shortly after birth. His mother had no prenatal care. Cardiopulmonary examination shows normal heart sounds, intercostal retractions, and nasal flaring. An x-ray of the chest shows low lung volumes, air bronchograms, and diffuse gro... | Hyaline membranes lining the alveoli on lung biopsy | {
"A": "Bilateral pleural effusions on lung ultrasound",
"B": "Corkscrew-shaped organisms on umbilical cord culture",
"C": "Hyaline membranes lining the alveoli on lung biopsy",
"D": "Meconium-stained fluid on deep suctioning",
"E": "Patent ductus arteriosus on echocardiography"
} | step1 | C |
A 38-year-old woman is brought to the emergency department because of three 1-hour episodes of severe, sharp, penetrating abdominal pain in the right upper quadrant. During these episodes, she has had nausea and vomiting. She has no diarrhea, dysuria, or hematuria and is asymptomatic between episodes. She has hypertens... | Choledocholithiasis | {
"A": "Acute hepatitis A",
"B": "Choledocholithiasis",
"C": "Autoimmune hepatitis",
"D": "Cholecystitis",
"E": "Pancreatitis\n\""
} | step2&3 | B |
A 31-year-old G1-P0 woman at 28-weeks gestation presents with shortness of breath and nonspecific right-sided chest pain that is worse with inspiration. She works as a graduate student at the local university, and she informs you that she recently returned to the west coast from a trip to New York for an Economics conf... | V/Q scan | {
"A": "D-dimer",
"B": "ECG",
"C": "Chest radiography",
"D": "V/Q scan",
"E": "CT pulmonary angiogram"
} | step2&3 | D |
An otherwise healthy 29-year-old man presents to his family physician with a slowly growing left neck mass for the past 5 weeks. He denies fever or recent upper respiratory tract infections. His temperature is 37.1°C (98.7°F), the blood pressure is 115/72 mm Hg, and the pulse are 82/min. On examination, a 4-cm (1.5 in)... | Cyclophosphamide | {
"A": "Vinblastine",
"B": "Bleomycin",
"C": "Cyclophosphamide",
"D": "Doxorubicin",
"E": "Etoposide"
} | step2&3 | C |
An 18-year-old woman is brought to the emergency department because of lightheadedness and a feeling of dizziness. She has had nausea, occasional episodes of vomiting, myalgia, and a generalized rash for the past week. She also reports feeling lethargic. She has no shortness of breath. There is no family history of ser... | Currently menstruating | {
"A": "Recent treatment with sulfonamides",
"B": "Recent hiking trip",
"C": "Intravenous heroin abuse",
"D": "Exposure to a patient with mengingococcemia",
"E": "Currently menstruating"
} | step2&3 | E |
A 62-year-old man presents to the emergency department for evaluation of a low-grade fever, worsening fatigue, and mild intermittent abdominal pain that is not affected by eating. He reports that over the last 6 months he slept a lot more than usual and lost 14.9 kg (33 lbs) without trying to lose weight. He also compl... | Group D streptococci | {
"A": "Viridans streptococci",
"B": "Treponema pallidum",
"C": "Malignant colonic neoplasm",
"D": "Collagen vascular disease",
"E": "Group D streptococci"
} | step1 | E |
A 33-year-old woman presents to the clinic for follow-up of her AIDS treatment with highly active anti-retroviral therapy (HAART). She is in good spirits and has been fully compliant with her medications and clinic visits. Other medications include prophylactic co-trimoxazole. Recent blood studies show the following:
H... | Sargramostim | {
"A": "Filgrastim",
"B": "Interleukin 3",
"C": "Platelet-derived growth factor",
"D": "Sargramostim",
"E": "Thrombopoietin"
} | step1 | D |
A 77-year-old woman is brought to the emergency department by her husband because of increasing confusion and unusual behavior for 2 days. She has been mumbling to herself and wandering around the neighborhood. These symptoms are worse in the evenings and she has hardly slept at night. She has not been eating or drinki... | Check serum electrolytes | {
"A": "Perform lumbar puncture",
"B": "Check serum TSH level",
"C": "Check serum electrolytes",
"D": "Perform CT scan of the head",
"E": "Perform chest x-ray"
} | step2&3 | C |
A 39-year-old woman comes to the physician because of fever, generalized fatigue, and chills for 1 week. She has been having dull right-side abdominal pain during this period. She has nausea. She has no history of travel outside the United States. She has type 1 diabetes mellitus. Current medications include insulin an... | Perform percutaneous drainage
" | {
"A": "Discontinue the oral contraceptive",
"B": "Obtain hepatoiminodiacetic acid scan",
"C": "Perform endoscopic retrograde cholangiopancreatography",
"D": "Administer metronidazole",
"E": "Perform percutaneous drainage\n\""
} | step2&3 | E |
A 57-year-old man presents to his primary care physician for follow-up of his diabetes. He was diagnosed with type 2 diabetes 3 months ago and has been started on metformin and lifestyle modifications. The patient does not have any current complaints except for occasional numbness in both hands and feet. His HbA1C is 8... | Add a sulfonylurea | {
"A": "Start basal-bolus insulin",
"B": "Continue metformin monotherapy",
"C": "Add a sulfonylurea",
"D": "Add an alpha-glucosidase inhibitor",
"E": "Add a thiazolidinedione"
} | step2&3 | C |
A 42-year-old chronic alcoholic man was admitted to the hospital for inappropriate behavior and disturbed memory. He presents with severe retrograde memory loss, confusion, and confabulation. Neurologic examination showed horizontal nystagmus. He also has bilateral pretibial pitting edema and perioral erythema. CT stud... | Alpha-Ketoglutarate + NAD+ + CoA <=> Succinyl-CoA + CO2 + NADH | {
"A": "Alpha-Ketoglutarate + NAD+ + CoA <=> Succinyl-CoA + CO2 + NADH",
"B": "Acetyl-CoA + Oxaloacetate + H2O <=> Citrate + CoA + H+",
"C": "Succinate + FAD (enzyme bound) <=> Fumarate + FADH2",
"D": "Isocitrate + NAD+ <=> Alpha-Ketoglutarate + CO2 + NADH",
"E": "Succinyl-CoA + Pi + GDP <=> Succinate + GTP +... | step1 | A |
A 28-year-old woman, gravida 2, para 1, at 40 weeks gestation is brought to the emergency department by her husband. She is in active labor and has lost a lot of blood in the past 2 hours, but appears alert and cooperative. At the hospital, her blood pressure is 88/65 mm Hg, the pulse is 110/min, and the respirations a... | Treat and transfer the patient after she makes a written request | {
"A": "After stabilizing the patient, allow the family to leave in their car to go to a different facility",
"B": "Decline admission and refer the patient to the closest capable emergency department",
"C": "Disregard patient’s request and treat until delivery is complete",
"D": "Treat and transfer the patient ... | step2&3 | D |
A 7-year-old boy is brought to your office with complaints of wheezing and dyspnea. Laboratory work reveals eosinophilia and positive skin tests for allergens. Which of the following types of drugs would be an effective treatment in this patient? | Muscarinic antagonist | {
"A": "Beta-2 antagonist",
"B": "Histone deacetylase inhibitor",
"C": "VEGF inhibitor",
"D": "Muscarinic antagonist",
"E": "Anticoagulant"
} | step1 | D |
A 16-year-old healthy female presents to her pediatrician concerned that she has not had a menstrual period. She has no past medical history and takes no medications. She plays volleyball and gets good grades in school. Her BMI is 22 kg/m2. Physical examination reveals normal female external genitalia and pubic hair al... | Failure of paramesonephric duct development | {
"A": "Pituitary tumor",
"B": "Absence of second X chromosome",
"C": "Mutation in enzyme that metabolizes testosterone",
"D": "Androgen receptor mutation",
"E": "Failure of paramesonephric duct development"
} | step1 | E |
A 61-year-old nulliparous woman comes to the physician for a follow-up examination. Her last Pap smear 3 years ago showed atypical squamous cells of undetermined significance. HPV testing was negative at that time. On questioning, she has had fatigue and an increase in abdominal girth despite a 5-kg (11.0-lb) weight lo... | Elevated serum CA-125 level | {
"A": "Proliferation of endometrial glands",
"B": "Elevated serum CA-125 level",
"C": "Elevated serum beta-hCG level",
"D": "Prolonged prothrombin time",
"E": "Cervical dysplasia on Pap smear"
} | step2&3 | B |
An unresponsive 92-year-old man is brought to the emergency department by ambulance and is quickly followed by his grand-daughter. Approx. 1 month ago, he had a radical prostatectomy, pelvic radiation, and several rounds of chemotherapy for aggressive prostate cancer in Nicaragua and was discharged from the hospital wi... | Ultrasound | {
"A": "Renal biopsy",
"B": "Ultrasound",
"C": "Abdominal-pelvic CT scan",
"D": "Blood analysis",
"E": "Urine analysis"
} | step2&3 | B |
A 51-year-old man presents to his primary care provider for intermittent shaking of his hands. He reports that for the last several years he has noticed this "shaking" when he brushes his teeth and prepares a cup of coffee in the morning. The shaking then gradually improves over the course of the day. His past medical ... | Propranolol | {
"A": "Alprazolam",
"B": "Primidone",
"C": "Propranolol",
"D": "Topiramate",
"E": "Trihexyphenidyl"
} | step2&3 | C |
A pediatrician notices that 9 of her patients this year have developed paralysis after a flu-like illness. They range in age from 7 to 11, and most of them had no abnormal activities prior to developing the paralysis. These patients concern her because she has not seen this type of paralytic illness in over 20 years of... | Hypothesis testing cannot be performed | {
"A": "Different interventions with 2 or more variables can be studied",
"B": "Hypothesis testing cannot be performed",
"C": "It should be reported in terms of odds ratio",
"D": "It should be reported in terms of relative risk",
"E": "Participants act as their own controls"
} | step1 | B |
A 3-year-old boy is brought to the emergency department by ambulance after a motor vehicle accident. He is unconscious upon arrival and is found to have severe internal bleeding due to trauma. He is taken for emergency surgery and severely damaged tissues are removed. After surgery, the boy is taken into the PICU for r... | Cell wall cross-linking inhibitor | {
"A": "30S ribosome inhibitor",
"B": "50S ribosome inhibitor",
"C": "Cell wall cross-linking inhibitor",
"D": "DNA gyrase inhibitor",
"E": "Folate metabolism inhibitor"
} | step1 | C |
A 25-year-old man presents to his primary care provider complaining of several weeks of intense itching, particularly localized around his anus. Of note, the patient denies any recent travel, sexual contacts, fever, dysuria, or diarrhea. His temperature is 98.1°F (36.7°C), blood pressure is 110/70 mmHg, pulse is 65/min... | Pyrantel pamoate | {
"A": "Amphotericin B",
"B": "Diethylcarbamazine",
"C": "Ivermectin",
"D": "Praziquantel",
"E": "Pyrantel pamoate"
} | step1 | E |
A 21-year-old female presents to the office after a health screening in which she was found to have high blood pressure. At the office, the blood pressure is 168/114 mm Hg. You have seen the patient in the past for amenorrhea and infertility issues, but she denies taking any medication at this time. On examination, the... | Central fusion of the inferior poles of the kidneys | {
"A": "Central fusion of the inferior poles of the kidneys ",
"B": "Genetic predisposition to essential hypertension",
"C": "Neuroendocrine tumor of the adrenal gland",
"D": "Oral contraceptive use",
"E": "Chronic corticosteroid use"
} | step1 | A |
A 25-year-old African American man presents to his primary care provider for routine blood work. He is a well-known case of sickle cell disease treated with hydroxyurea and tramadol as needed for pain. He does not smoke or drink alcohol. The patient asks if his disease can adversely affect his kidneys because his frien... | Impaired urine concentration ability | {
"A": "Transitional cell carcinoma",
"B": "Membranous glomerulonephritis",
"C": "Proximal renal tubular acidosis",
"D": "Impaired urine diluting ability",
"E": "Impaired urine concentration ability"
} | step2&3 | E |
A gunshot victim is brought to the Emergency Department and appears to be in shock. You note a penetrating wound at the level of L3. Assuming the bullet remained at this level, which vascular structure might have been injured? | Inferior vena cava | {
"A": "Inferior vena cava",
"B": "Internal iliac artery",
"C": "Internal iliac vein",
"D": "Renal artery",
"E": "Portal vein"
} | step1 | A |
A clinical trial is conducted to test the efficacy of a new drug, A, to treat tinea versicolor. A total of 500 participants are recruited for the study and are randomized into 2 groups in equal numbers. Group 1, the study treatment group, is given drug A, while group 2, the control group, is given the current standard ... | 250/25 | {
"A": "25/250",
"B": "250/25",
"C": "190/250",
"D": "165/250",
"E": "355/500"
} | step1 | B |
A 38-year-old woman is being evaluated by her primary care physician for chronic, widespread pain that started around 5 months ago. This pain has been accompanied by sleeping issues. Her friend recommended that she try yoga to relieve the pain, but she says this has not helped her at all. Se says the symptoms have begu... | Paroxetine | {
"A": "Low-dose prednisolone",
"B": "High-dose prednisolone",
"C": "Paroxetine",
"D": "Allopurinol",
"E": "Gabapentin"
} | step2&3 | C |
A 3rd year resident in good standing with his residency training program would like to work more hours outside his residency obligations to gain more experience and pay for his medical school loans. He currently works and trains 60 hours per week as a resident and has a 10-hour shift external to his residency program o... | He may work longer shifts | {
"A": "He is already overcommitting and must reduce the number of hours",
"B": "He is not allowed to work outside the scope of his residency training",
"C": "He may work longer shifts",
"D": "He may work more hours on Sundays",
"E": "He may work up to 20 more hours"
} | step2&3 | C |
A 29-year-old man presents to the emergency department after a motor vehicle accident. On presentation, he is found to have scalp and trunk lacerations that are still actively bleeding. He has no past medical history and does not take any medications. On presentation, his temperature is 98.6°F (37°C), blood pressure is... | Increased norepinephrine at the sinoatrial node | {
"A": "Baroreceptor-mediated vasodilation",
"B": "Chemoreceptor-mediated vasoconstriction",
"C": "Increased acetylcholine at the sinoatrial node",
"D": "Increased atrial natriuretic peptide release",
"E": "Increased norepinephrine at the sinoatrial node"
} | step1 | E |
A 14-year-old teenager presents to his pediatrician complaining of frequent headaches and excessive fatigue during soccer practice. His mother notes that he seems to have gained a lot of weight despite the fact that he eats a healthy, well-balanced diet. His teachers have also become concerned because he leaves class t... | Surgical resection | {
"A": "Chemotherapy, surgical resection and radiation",
"B": "Chemotherapy and radiation",
"C": "Chemotherapy",
"D": "Surgical resection",
"E": "Hormone replacement therapy"
} | step2&3 | D |
Hypoxia-inducible factor 1-alpha (HIF-1a) is a transcription factor with increased activity under conditions of cellular hypoxia. In normoxia, von Hippel-Lindau (VHL) protein hydroxylates prolyl residues on oxygen-dependent degradation domains of HIF-1a, targeting it for proteasomal degradation. Hydroxylation by VHL is... | A Western blot will show increased HIF-1α compared to a normoxic control. | {
"A": "A Northern blot will show increased HIF-1α, compared to a hypoxic control cell.",
"B": "A Northern blot will show increased HIF-1α, compared to a normoxic control cell.",
"C": "A Southern blot will show increased HIF-1α, compared to a hypoxic control cell.",
"D": "A Southern blot will show increased HIF... | step1 | E |
A 25-year-old primigravida is admitted to the hospital at 36 weeks gestation after a generalized tonic-clonic seizure. She is conscious, but lethargic and complains of a headache that started 2 hours prior to the seizure. She denies alcohol intake or drug use. She has no history of convulsive disorders and the antepart... | Proteinuria | {
"A": "Elevated transaminases",
"B": "Leukocytosis",
"C": "Hematuria",
"D": "Hyponatremia",
"E": "Proteinuria"
} | step2&3 | E |
A 3-year-old male is brought by his mother to the pediatrician's office. The mother and child are refugees from Somalia and arrived in the United States one week ago. They were recently placed in temporary housing. The mother reports that the child has been chronically tired and subdued since before their arrival in th... | Relative protein intake | {
"A": "Total caloric intake",
"B": "Relative protein intake",
"C": "Relative carbohydrate intake",
"D": "Relative fat intake",
"E": "Vitamin intake"
} | step1 | B |
A 42-year-old woman presents to her obstetrician for a prenatal care appointment at 10 weeks gestation. The patient recently found out she was pregnant after having unprotected intercourse with her husband for the past year. She states that she is feeling well and has experienced some nausea and vomiting. She is curren... | Cell-free DNA testing | {
"A": "Amniocentesis",
"B": "Cell-free DNA testing",
"C": "Chorionic villus sampling",
"D": "Iron and vitamin D supplementation",
"E": "Regular follow up appointments"
} | step2&3 | B |
A 6-year-old boy is brought to the physician because of abdominal distention, fatigue, and night sweats over the past 4 months. He also has a 2-month history of post-prandial fullness and recurrent nonbilious vomiting. He appears pale. Abdominal examination shows hepatosplenomegaly and shifting dullness; there is mild ... | Macrophage | {
"A": "Neutrophil",
"B": "Human immunodeficiency virus",
"C": "B lymphocytes",
"D": "Macrophage",
"E": "Epstein-Barr virus"
} | step1 | D |
A 14-year-old boy is brought to the emergency department by his mother after falling from the jungle gym and developing severe left knee pain and swelling. On presentation, he is found to be in pain with a hot, swollen, erythematous left knee. His past medical history is significant for abnormal coagulation lab tests b... | Factor XII | {
"A": "Factor VII",
"B": "Factor VIII",
"C": "Factor IX",
"D": "Factor X",
"E": "Factor XII"
} | step1 | E |
A 52-year-old man with Crohn disease comes to the physician because of a 1-week history of dysuria and urinary urgency. He had been treated for urinary tract infections twice in the past 6 months. He is currently taking infliximab. Cystoscopy shows pearl-like plaques on the bladder wall. Biopsy of these lesions shows a... | Night blindness | {
"A": "Carpopedal spasm",
"B": "Perifollicular hemorrhage",
"C": "Photodermatitis",
"D": "Night blindness",
"E": "Intracranial hypertension"
} | step1 | D |
A 26-year-old gravida 2 para 1 at 24 weeks gestation is admitted to the labor and delivery suite with mild abdominal cramps, uterine contractions, and a watery vaginal discharge. She has a history of preterm birth. The vital signs are as follows: blood pressure 125/80 mm Hg; heart rate 100/min; respiratory rate 13/min;... | Type II pneumocytes | {
"A": "Type I pneumocytes",
"B": "Goblet cells",
"C": "Bronchial epithelial cells",
"D": "Type II pneumocytes",
"E": "Vascular smooth myocytes"
} | step1 | D |
A 55-year-old man is brought to the emergency department after collapsing at the grocery store and losing consciousness for 1 minute following a sudden onset of palpitations. He has no chest pain or dizziness. He has a history of hypertension, type 2 diabetes mellitus, and is currently being treated as an outpatient fo... | Prolonged QT interval | {
"A": "Hypomagnesemia",
"B": "Brugada syndrome",
"C": "Prolonged QT interval",
"D": "Accessory conduction pathway",
"E": "Hyperkalemia"
} | step1 | C |
A 56-year-old patient is being treated with oral amoxicillin for community-acquired pneumonia. The plasma clearance of the drug is calculated as 15.0 L/h. Oral bioavailability of the drug is 75%. Sensitivity analysis of a sputum culture shows a minimal inhibitory concentration of 1 μg/mL for the causative pathogen. The... | 480 mg | {
"A": "270 mg",
"B": "480 mg",
"C": "135 mg",
"D": "240 mg",
"E": "540 mg\n\""
} | step1 | B |
A 5-year-old boy is brought to his pediatrician’s office by his parents after they noticed blood in his urine. The child has been complaining of difficulty in passing urine and has lower abdominal pain. He seems more bloated than usual. On some occasions, he starts crying while passing urine, primarily because of a bur... | Gastroenteritis | {
"A": "Gastroenteritis",
"B": "Painful dermatomal vesicles",
"C": "Lymphadenopathy",
"D": "Vesicular rash",
"E": "Plantar warts"
} | step1 | A |
A 46-year-old woman presents with difficulty initiating sleep, as well as frequent nighttime awakenings. She reports making multiple mistakes at her office job, has an inability to concentrate, and feels sleepy throughout the day. She is worried that her sleeping troubles will cause her to get fired. Which of the follo... | Triazolam | {
"A": "Citalopram",
"B": "Chlordiazepoxide",
"C": "Triazolam",
"D": "Diazepam",
"E": "Modafinil"
} | step1 | C |
A 5-year-old girl is brought to her pediatrician for evaluation of difficulties noted at school. Her kindergarten teacher voiced her concern that the child ‘spaces out’ often and thinks she may have ADHD. The parents deny any history of head trauma or infection. Her blood pressure is 106/74 mm Hg, the heart rate is 69/... | GI upset | {
"A": "Nystagmus",
"B": "GI upset",
"C": "Facial rash and blood in the urine",
"D": "Profound leukopenia increasing the risk for severe infection",
"E": "Weight gain and change in hair color"
} | step2&3 | B |
A 75-year-old man comes to the physician for the evaluation of progressive shortness of breath and fatigue over the past month. He reports that he cannot climb more than one flight of stairs without experiencing shortness of breath and dizziness. He has hypertension and hyperlipidemia. He has smoked one pack of cigaret... | Aortic valve stenosis | {
"A": "Aortic valve regurgitation",
"B": "Tricuspid valve stenosis",
"C": "Mitral valve prolapse",
"D": "Mitral valve stenosis",
"E": "Aortic valve stenosis"
} | step2&3 | E |
A 56-year-old man comes to the physician for a follow-up examination 1 week after a temporal artery biopsy was performed to evaluate headache and blurry vision. He has a 12-year history of hypertension treated with lisinopril. Results of the testing show decreased concentrations of arginine in vascular endothelial cell... | Increased production of nitric oxide | {
"A": "Increased binding of calcium to calmodulin",
"B": "Increased phosphorylation of myosin",
"C": "Increased production of nitric oxide",
"D": "Decreased production of cyclic guanosine monophosphate",
"E": "Decreased concentration of bradykinin"
} | step1 | C |
While traveling abroad a physician is asked to attend a meeting regarding healthcare in the region. The rate of chlamydial infection is exceptionally high in the area, and the local government is wanting to test a new treatment for these infections. To test the new therapy, the physician is asked to oversee the operati... | “I can not help you due to the ethical principle of nonmaleficence.” | {
"A": "“I can not help you due to the ethical principle of autonomy.”",
"B": "“I will accept your proposal.”",
"C": "“I can not help you due to the ethical principle of justice.”",
"D": "“I can not help you due to the ethical principle of nonmaleficence.”",
"E": "“I can not help you due to the ethical princi... | step1 | D |
A 48-year-old woman comes to the physician because of a 7-day history of progressively worsening shortness of breath. She has a history of asthma and has frequent exacerbations despite receiving maximal medical therapy. Physical examination shows scattered expiratory wheezing. Laboratory studies show a leukocyte count ... | IL-4 | {
"A": "IL-28",
"B": "C5a",
"C": "TGF-β",
"D": "IFN-α",
"E": "IL-4"
} | step1 | E |
A 29-year-old G1P0 female presents at 22 weeks gestation for her first prenatal care appointment. Physical exam demonstrates a uterine size greater than expected for her gestational age and taut, shiny skin with scattered striae on her abdomen. Ultrasound examination of the fetus reveals 2.5 L of amniotic fluid (normal... | Duodenal atresia | {
"A": "Renal agenesis",
"B": "Pulmonary hypoplasia",
"C": "Duodenal atresia",
"D": "Posterior urethral valve",
"E": "Polycystic kidney disease"
} | step1 | C |
A 68-year-old woman presents to the emergency room with chest pain. She reports sudden severe and crushing substernal chest pain that started 1 hour ago. Her past medical history is notable for hypertension, hyperlipidemia, diabetes mellitus, obesity, and a prior myocardial infarction requiring a coronary artery bypass... | Beta-1 adrenergic receptor | {
"A": "Alpha-1 adrenergic receptor",
"B": "Alpha-2 adrenergic receptor",
"C": "Beta-1 adrenergic receptor",
"D": "Beta-2 adrenergic receptor",
"E": "D2 receptor"
} | step1 | C |
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