question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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|---|---|---|---|---|
A 38-year-old man presents with progressive tiredness and shortness of breath on exertion. Past medical history is significant for peptic ulcer disease diagnosed 2 years ago for which he is not compliant with his medications. He reports a 10-pack-year smoking history and occasionally alcohol use. His vital signs includ... | ↓ hemosiderin stores | {
"A": "Hypocellularity with fatty infiltration",
"B": "↑ megakaryocytes",
"C": "↓ hemosiderin stores",
"D": "Ringed sideroblasts",
"E": "Myeloblasts with immature precursors"
} | step2&3 | C |
A 27-year-old G3P1010 makes an appointment with her gynecologist for evaluation of profuse bleeding, which began two days ago. She is 13 weeks pregnant based on the date of her last menstrual period. She is dizzy and weak, and is unable to move around the house and perform her daily tasks. Initially, she had only light... | Dilation and curettage | {
"A": "Antibiotics",
"B": "Bed rest and analgesics",
"C": "Magnesium sulfate",
"D": "Methotrexate",
"E": "Dilation and curettage"
} | step2&3 | E |
An otherwise healthy 25-year-old woman comes to the physician because of a 2-day history of pain and swelling of her right knee joint and left wrist. She went camping with her new boyfriend 3 weeks ago but does not recall any tick bites. Her temperature is 37.8°C (100.0°F). Examination of the right knee shows swelling,... | Sexually transmitted infection | {
"A": "Autoantibody production",
"B": "Intravenous drug use",
"C": "Sexually transmitted infection",
"D": "HLA-B 27 positivity",
"E": "Bacterial pharyngitis\n\""
} | step1 | C |
A 54-year-old man comes to the clinic for management of his gastroesophageal reflux disease (GERD). He is currently on cimetidine for his condition and reports that his GERD initially improved. However, following his recent move to Michigan, he is experiencing more frequent episodes of chest pain (4-5 times a week). Th... | Irreversible inhibition of H+/K+-ATPase at parietal cells | {
"A": "Irreversible inactivation of cyclooxygenase enzyme",
"B": "Irreversible inhibition of H+/K+-ATPase at parietal cells",
"C": "Irreversible inhibition of histamine H2 receptors",
"D": "Reversible inhibition of H+/K+-ATPase at parietal cells",
"E": "Reversible inhibition of histamine H2 receptors"
} | step1 | B |
A 7-year-old boy is brought to the physician by his mother for evaluation of progressively worsening swelling around the eyes. He has no history of major medical illness. He had a sore throat and cough 2 weeks ago that resolved spontaneously. Physical examination shows moderate periorbital edema and 2+ pitting edema of... | Fatty casts and albumin | {
"A": "Hyaline casts and immunoglobulins",
"B": "Red blood cell casts and acanthocytes",
"C": "Fatty casts and albumin",
"D": "White blood cell casts and eosinophils",
"E": "Granular casts and tubular epithelial cells"
} | step1 | C |
Background: There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography.
Methods: In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented... | Measurement bias | {
"A": "Measurement bias",
"B": "Recall bias",
"C": "Lead-time bias",
"D": "Selection bias",
"E": "Length-time bias"
} | step2&3 | A |
A 45-year-old woman comes to the emergency department because of intermittent chest pain and palpitations. She also complains of dyspnea on exertion and has had a 4.5-kg (10-lb) weight loss in the past 2 months despite normal appetite. She has no history of serious medical illness. Cardiac examination shows an irregula... | Nests of atypical melanocytes | {
"A": "Nonencapsulated groups of well-differentiated skeletal muscle cells",
"B": "Clusters of bland cells without mitotic activity",
"C": "Mixture of cells from different germinal layers",
"D": "Encapsulated cluster of mature fat cells",
"E": "Nests of atypical melanocytes"
} | step1 | E |
A 58-year-old woman comes to the physician because of intermittent painful retrosternal dullness for 4 weeks. The pain is recurrent and occurs when she exerts herself or when she is outside during cold weather. She also experiences shortness of breath and palpitations during these episodes. The symptoms resolve spontan... | Myocardial perfusion scan under pharmacological stress | {
"A": "Myocardial perfusion scan under pharmacological stress",
"B": "Upper endoscopy",
"C": "Coronary angiography",
"D": "Echocardiography at rest",
"E": "Repeat ECG under treadmill stress"
} | step2&3 | A |
A 24-year-old primigravida presents to her physician at 20 weeks gestation. She was diagnosed with asymptomatic bacteriuria at her last appointment 2 weeks ago, and was treated with amoxicillin. She has no concurrent diseases and no complaints. Her vital signs are as follows: blood pressure 110/80 mm Hg, heart rate 82/... | Urine culture should be performed in this patient again. | {
"A": "This patient does not require further urinary tests unless she becomes symptomatic.",
"B": "Urinalysis should be performed on each subsequent antenatal visit to screen for possible recurrence of bacteriuria.",
"C": "Urine culture should be performed in this patient again.",
"D": "Perform urine dipstick ... | step2&3 | C |
A 36-year-old G3P2 woman with no significant past medical history delivers a 3.7 kg (8 lb, 3 oz) baby boy following an uncomplicated pregnancy. On physical examination in the delivery room, the pediatrician notes that the baby has upslanting palpebral fissures, epicanthal folds, a flat facial profile, small ears, a sin... | Omphalocele | {
"A": "Tetralogy of Fallot",
"B": "Omphalocele",
"C": "Congenital cataracts",
"D": "Cleft lip",
"E": "Macroorchidism"
} | step2&3 | B |
A 52-year-old woman presents with a complaint of headache for the past 10 days. Her headache is diffuse, dull in character, moderate in intensity, and is worse in the morning. It is not associated with fever and sensitivity to light or sound. She experiences occasional nausea but no vomiting. She did not have similar h... | Melanoma | {
"A": "Breast cancer",
"B": "Lung cancer",
"C": "Melanoma",
"D": "Multiple myeloma",
"E": "Thyroid cancer"
} | step2&3 | C |
A previously healthy 27-year-old woman comes to the physician because of a 2-month history of depressed mood and fatigue. During this time, she has had a 5-kg (11-lb) weight gain. She reports trouble concentrating at her job as a preschool teacher and has missed work several times in recent weeks due to generalized fat... | Tachycardia | {
"A": "Decreased libido",
"B": "Hypotension",
"C": "Urinary retention",
"D": "Tachycardia",
"E": "QTc prolongation"
} | step1 | D |
A 37-year-old woman presents to her primary care physician after returning from her honeymoon in Cancun. A few days ago, she began to notice an eruption of small red bumps that cover her torso, back, and buttocks. The patient first thought she had acne, but became worried when the rash continued to itch. The patient de... | Blue-green pigment | {
"A": "Pink colonies",
"B": "Blue-green pigment",
"C": "Alpha-hemolysis",
"D": "Yellow sulfur granules",
"E": "Red pigment"
} | step1 | B |
A 30-year-old female presents to her primary care provider complaining of 4 days of fever, malaise, dyspnea, and productive cough and has recently developed pleuritic chest pain. Her past medical history is notable for asthma and takes albuterol as needed. She does not smoke but drinks alcohol socially. Her family hist... | Isotype switching | {
"A": "Affinity maturation",
"B": "Random assortment",
"C": "Random nucleotide addition",
"D": "VDJ recombination",
"E": "Isotype switching"
} | step1 | E |
A 27-year-old graduate student is bitten by a coral snake while he was hiking alone through the woods and dies 2 hours later from respiratory failure. His body was discovered 7 hours later by a group of campers who promptly called the police. On arrival, the police found his body to be cold and stiff. Which of the foll... | Inhibition of cross-bridge cycling | {
"A": "Activation of muscle contraction by neurotoxins",
"B": "Reduced affinity of myosin head for actin filament",
"C": "Effect of low temperature on muscle proteins",
"D": "Inhibition of cross-bridge cycling",
"E": "Depletion of intracellular calcium"
} | step1 | D |
A 28-year-old G1P0 woman at 12 weeks estimated gestational age presents with malaise, joint pain, fever, and chills for the past 3 days. Physical examination reveals a mild lace-like rash and arthritis. The patient mentions her friend who is a medical student told her that her symptoms are suggestive of a parvovirus B1... | It can lead to hydrops fetalis secondary to fetal anemia. | {
"A": "It can lead to hydrops fetalis secondary to fetal anemia.",
"B": "It can cause aplastic crisis in the neonate.",
"C": "Physical malformations are frequently associated with congenital infection.",
"D": "Fetal loss occurs in more than 40% of primary infections.",
"E": "The neonate may be born with a ty... | step1 | A |
A 52-year-old man with hypertension and hyperlipidemia comes to the emergency department 30 minutes after the sudden onset of substernal chest pain while sitting in a chair at home. He reports drinking 2 glasses of whiskey earlier that day, after a stressful day at work. Current medications include hydrochlorothiazide ... | Coronary artery vasospasm | {
"A": "Coronary artery vasospasm",
"B": "Coronary artery vasodilation",
"C": "Atherosclerotic coronary artery narrowing",
"D": "Atherosclerotic plaque rupture",
"E": "Pericardial inflammation"
} | step1 | A |
A 5-year-old boy is brought to the emergency department by his mother because of a sudden loss of consciousness. He has asthma and has been hospitalized multiple times. His mother has type 2 diabetes mellitus. He is somnolent and diaphoretic. Serum studies show a glucose concentration of 22 mg/dL and a potassium concen... | Factitious disorder imposed on another
" | {
"A": "Malingering",
"B": "Glucagonoma",
"C": "Primary adrenal insufficiency",
"D": "Conversion disorder",
"E": "Factitious disorder imposed on another\n\""
} | step1 | E |
A 66-year-old woman presents with urinary incontinence, difficulty urinating, incomplete voiding, and dull pain in the suprapubic region. She reports that she has not urinated for the past 2 days and that the urine leakage occurs during both day and night and is not associated with physical exertion. The medical histor... | Bladder catheterization | {
"A": "Installing a vaginal pessary",
"B": "Bladder catheterization",
"C": "Cystostomy",
"D": "Prescribing bethanechol",
"E": "Prescribing prostaglandin E2"
} | step2&3 | B |
A 69-year-old man presents to his primary care physician with hip and back pain. The patient states that this weekend he had a barbecue. When he was lifting a heavy object he suddenly felt pain in his lower back. He describes the pain as in his buttocks but states that at times it travels down his leg. The patient stat... | Straight leg raise | {
"A": "Palpating the paraspinus muscle",
"B": "Flexion, abduction, and external rotation of the thigh",
"C": "Straight leg raise",
"D": "Internal rotation of the extended hip",
"E": "Radiography"
} | step2&3 | C |
A 61-year-old woman presents to an outpatient clinic with fatigue and mild neck pain for a month. She adds that she is having difficulty swallowing. She denies trouble with her breathing but endorses 5–10 lb of unintentional weight loss over the past few months. On physical exam, the patient’s fingernails appear flat a... | Plummer-Vinson syndrome | {
"A": "Plummer-Vinson syndrome",
"B": "Esophageal squamous cell carcinoma",
"C": "Zenker’s diverticulum",
"D": "Scleroderma",
"E": "Achalasia"
} | step2&3 | A |
A 65-year-old female patient comes to the physician’s office for her annual check-up. The patient’s only complaint is that she feels her vision has been getting more blurry over the past year. The patient has a past medical history of diabetes diagnosed 20 years ago and osteoarthritis. Her medications include metformin... | Sorbitol dehydrogenase | {
"A": "Aldose reductase",
"B": "Sorbitol dehydrogenase",
"C": "Galactocerebrosidase",
"D": "Arylsulfatase A",
"E": "Sphingomyelinase"
} | step1 | B |
A 3-year-old boy is brought to the physician for the evaluation of recurrent skin lesions. The episodes of lesions started at the age of 2 months and multiple treatment options have been attempted without success. He has also had several episodes of respiratory tract infections, enlarged lymph nodes, and recurrent feve... | Chronic granulomatous disease | {
"A": "Chronic granulomatous disease",
"B": "Ataxia-telangiectasia",
"C": "Atopic dermatitis",
"D": "Wiskott-Aldrich syndrome",
"E": "Chediak-Higashi syndrome"
} | step2&3 | A |
A 53-year-old man presents to clinic with a six month history of shoulder pain that is especially bothersome at night. Over the weekend he "strained his shoulder" during a pick-up basketball game and reports an acute exacerbation of his pain symptoms. On exam, he complains of pain to palpation just below the acromion. ... | Initiation of abduction | {
"A": "Initiation of adduction",
"B": "External rotation",
"C": "Initiation of abduction",
"D": "Completion of abduction",
"E": "Internal rotation"
} | step1 | C |
A 58-year-old woman comes to the physician because of a 3-month history of left knee pain as well as stiffness upon waking for about 10–15 minutes. The pain is worse after standing a lot at work and when she climbs stairs. There is no history of trauma. She has hypercholesterolemia and hypertension. Her mother died of ... | Osteophytes with joint-space narrowing on x-ray | {
"A": "Osteophytes with joint-space narrowing on x-ray",
"B": "Calcification of synovia and cartilage on ultrasound",
"C": "Diffuse lytic-sclerotic bone lesions on x-ray",
"D": "Joint effusion and pannus on ultrasound",
"E": "Fluid-filled pouch on ultrasound"
} | step2&3 | A |
A 6-month-old boy presents to a pediatrician for the evaluation of recurrent bacterial infections. He has a history of a variety of bacterial infections since birth. Physical examination reveals light-colored skin with silver-colored hair. The pediatrician suspects an immunodeficiency disorder and decides to order seve... | Chediak-Higashi syndrome | {
"A": "Acquired immunodeficiency syndrome (AIDS)",
"B": "Common variable immunodeficiency",
"C": "Chediak-Higashi syndrome",
"D": "Congenital thymic aplasia",
"E": "Leukocyte adhesion deficiency–1"
} | step1 | C |
A 48-year-old man with type II diabetes mellitus complicated by peripheral neuropathy presents to the emergency department for a foot wound that he noticed. He denies any pain, fevers, or chills. His temperature is 101°F (38.3°C), blood pressure is 150/80 mmHg, pulse is 80/min, and respirations are 22/min. An ulcer wit... | CT angiography of the chest and give oxygen | {
"A": "Complete blood count, type and screen, and order 1 unit of blood",
"B": "CT angiography of the chest and give oxygen",
"C": "D-dimer and lower extremity Dopper ultrasound",
"D": "Deep wound culture and start piperacillin-tazobactam",
"E": "Erythrocyte sedimentation rate and give oxycodone"
} | step2&3 | B |
A 56-year-old man comes to the physician because of a 1-day history of sudden severe pain in his right great toe. Four months ago, he had an episode of severe joint pain involving his left knee that lasted several days and resolved with over-the-counter analgesics. He has a history of hypertension treated with hydrochl... | Inhibition of xanthine oxidase | {
"A": "Increased conversion of uric acid to allantoin",
"B": "Inhibition of phospholipase A",
"C": "Inhibition of xanthine oxidase",
"D": "Increased renal excretion of urate",
"E": "Inhibition of cyclooxygenase"
} | step1 | C |
A 45-year-old man presents to the emergency department with severe dyspnea, wheezing, and palpitations. His symptoms began approx. 20 minutes after being stung by a bee on the left arm. Past medical history is significant for hypertension for which he takes labetalol. While being questioned, the patient becomes obtunde... | Administer glucagon | {
"A": "Administer dopamine",
"B": "Administer glucagon",
"C": "Administer dexamethasone",
"D": "Administer diphenhydramine and ranitidine",
"E": "Administer norepinephrine"
} | step2&3 | B |
A 74-year-old man has been treated for prostate cancer for the past 6 months. He is on an experimental drug (drug X) that is used to reduce the action of testosterone by blocking the androgen receptor. Since the initiation of therapy, the growth of the cancerous tissue has slowed. This medication is known to be excrete... | Flutamide | {
"A": "Leuprolide",
"B": "Finasteride",
"C": "Flutamide",
"D": "Terazosin",
"E": "Anastrozole"
} | step1 | C |
A 74-year-old man was admitted to the hospital after falling down several stairs. He is a known alcoholic. He was started on IV fluids and received a head CT, which was negative. It was decided that he would be watched for one day before being discharged, after a negative work-up. Suddenly, he is unable to move his arm... | Hyponatremia | {
"A": "Hyponatremia",
"B": "Hypernatremia",
"C": "Hypokalemia",
"D": "Hyperkalemia",
"E": "Hypochloremia"
} | step1 | A |
A previously healthy 67-year-old man comes to the physician for routine health maintenance evaluation. He works at a community center and volunteers at a local homeless shelter. A tuberculin skin test shows an induration of 14 mm. An x-ray of the chest is normal. Treatment with an antimycobacterial drug is initiated. T... | Accumulation of S-adenosylmethionine | {
"A": "Accumulation of S-adenosylmethionine",
"B": "Intracellular accumulation of sorbitol",
"C": "Segmental demyelination of peripheral axons",
"D": "Impaired breakdown of glucose to ATP",
"E": "Degeneration of the dorsal columns"
} | step1 | A |
A 64-year-old male presents to his primary care physician with a complaint of bilateral knee pain that has been present for the past several years but has worsened recently. He reports pain with climbing stairs and with extended walks of greater than 100 yards. The pain worsens with activity throughout the day and is a... | No further work-up needed | {
"A": "Complete blood count (CBC)",
"B": "Erythrocyte sedimentation rate (ESR)",
"C": "Rheumatoid factor (RF)",
"D": "MRI of the knee",
"E": "No further work-up needed"
} | step2&3 | E |
A 4-year-old girl is brought to the physician because of pallor and rash for 2 days. She had a 4-day history of diarrhea and vomiting that subsided two days ago. One month ago, she had a 3-day episode of high fever, followed by a rash with bright red discoloration over her cheeks for two days before subsiding without t... | Escherichia coli infection | {
"A": "Escherichia coli infection",
"B": "Parvovirus B19 infection",
"C": "Disseminated intravascular coagulation",
"D": "Immune thrombocytopenic purpura",
"E": "Thrombotic thrombocytopenic purpura"
} | step2&3 | A |
A 76-year-old man presents to the physician because of dyspepsia and weight loss over the past 6 months. He has no history of any serious illnesses and takes no medications. A diagnostic workup including endoscopy and biopsy shows gastric adenocarcinoma. Before further workup and staging, the biopsy results are discuss... | Determining patient’s life-expectancy without treatment | {
"A": "A trial of life-extending treatment",
"B": "Determining patient’s life-expectancy without treatment",
"C": "Establishing the presence of metastasis",
"D": "Follow-up until significant cognitive or functional disability develops",
"E": "No further steps are required because the patient already qualifie... | step2&3 | B |
A 29-year-old female presents to the clinic for a regular check-up. She has no specific complaints. Vital signs include: blood pressure is 130/80 mm Hg, heart rate is 76/min, respiratory rate is 15/min, and temperature is 36.8°C (98.2°F). Her physical examination is within normal limits. The woman’s complete blood coun... | These cells transform to macrophages when they migrate to peripheral tissues. | {
"A": "These cells transform to macrophages when they migrate to peripheral tissues.",
"B": "These cells are responsible for the production of antibodies.",
"C": "These cells express CD25 on their surfaces.",
"D": "These cells normally constitute 25–40% of total leucocyte count.",
"E": "These cells have lymp... | step1 | A |
A 23-year-old woman presents to the emergency department with abdominal pain. The patient states she has pain in the right side of her abdomen which started yesterday and has been worsening. She has experienced a few episodes of vomiting and diarrhea during this time. The patient has a past medical history of constipat... | ß-hCG | {
"A": "Abdominal radiograph",
"B": "ß-hCG",
"C": "CT scan",
"D": "Stool occult blood",
"E": "Ultrasound"
} | step2&3 | B |
A 24-year-old Asian woman is admitted to the hospital at 30 weeks gestation with nausea, vomiting, and right upper quadrant pain. She is gravida 2 para 0 with a history of the same complaints in her last pregnancy which ended with a stillbirth at the 31st week. Her older sister had preeclampsia in both of her pregnanci... | History in the previous pregnancy | {
"A": "The patient’s age",
"B": "The patient’s race",
"C": "Nulliparity",
"D": "History in the previous pregnancy",
"E": "History of preeclampsia in a sibling"
} | step2&3 | D |
A 44-year-old obese African-American male presents to clinic with complaints of 3 days of fatigue and dark urine. He has had several similar episodes since birth, all of which resolved spontaneously. He has a 5-year history of poorly controlled type II diabetes mellitus and was started on glipizide one week ago. Prior ... | Medication | {
"A": "Viral Infection",
"B": "Bacterial Infection",
"C": "Food",
"D": "Medication",
"E": "Idiopathic"
} | step2&3 | D |
A 32-year-old woman comes to the physician because of fatigue and joint pain for the past 4 months. Examination shows erythema with scaling on both cheeks that spares the nasolabial folds and two 1-cm ulcers in the oral cavity. Further evaluation of this patient is most likely to show which of the following findings? | Decreased lymphocyte count | {
"A": "Decreased lymphocyte count",
"B": "Increased platelet count",
"C": "Increased complement component 3",
"D": "Increased prothrombin time",
"E": "Decreased gamma globulin"
} | step1 | A |
A 66-year-old male with a history of myocardial infarction presents to your primary care office with complaints of dyspnea on exertion and swollen feet and ankles. On exam, you note an elevated JVP and 2+ pitting edema of bilateral lower extremities. What is the most likely explanation for this patient's lower extremit... | Increase in capillary pressure | {
"A": "Increase in capillary pressure",
"B": "Decrease in plasma proteins",
"C": "Increase in capillary permeability",
"D": "Increase in colloid osmotic pressure",
"E": "Increase in interstitial fluid pressure"
} | step1 | A |
A 49-year-old man comes to the physician for a routine health maintenance examination. He feels well and has no history of serious illness. He has smoked one pack of cigarettes daily for the past 25 years and drinks two to three glasses of wine weekly. This patient should be counseled about increased risk for which of ... | Pancreatic adenocarcinoma | {
"A": "Pancreatic adenocarcinoma",
"B": "Gastric MALT lymphoma",
"C": "Esophageal varices",
"D": "Porcelain gallbladder",
"E": "Hepatic steatosis"
} | step1 | A |
A 40-year-old woman comes to the physician because of a 6-month history of difficulty sleeping and fatigue. Menses occur at irregular 35- to 50-day intervals and last 3–7 days. Her last menstrual period was 5 weeks ago. She has had an unintentional 10-kg (22-lb) weight gain over this period. She also reports decreased ... | Adrenalectomy | {
"A": "Metyrapone therapy",
"B": "Adrenalectomy",
"C": "Polychemotherapy and radiation therapy",
"D": "Transsphenoidal hypophysectomy",
"E": "Partial nephrectomy"
} | step2&3 | B |
A scientist observes a myocyte beating in cell culture. Which step is the most direct necessary component of relaxation for this cell? | Efflux of calcium ions | {
"A": "Influx of sodium ions",
"B": "Efflux of potassium ions",
"C": "Influx of calcium ions from the sacroplasmic reticulum",
"D": "Influx of calcium ions from outside the myocyte",
"E": "Efflux of calcium ions"
} | step1 | E |
Two days after admission to the hospital for treatment of acute myelogenous leukemia, a 35-year-old man develops nausea, vomiting, fatigue, and muscle cramps. He has a history of diet-controlled type 2 diabetes mellitus. He has smoked one-half pack of cigarettes daily for 15 years and reports occasionally using marijua... | Intravenous hydration | {
"A": "Urine alkalinization",
"B": "Corticosteroids",
"C": "Rasburicase",
"D": "Allopurinol",
"E": "Intravenous hydration"
} | step2&3 | E |
The menses are 4 weeks overdue in a 23-year-old sexually active woman, thus she is scheduled for an ultrasound examination. The result is shown in the exhibit. What is the function of the structure marked with the green arrow? | Embryonic hematopoiesis | {
"A": "Removal of nitrogenous waste",
"B": "Embryonic hematopoiesis",
"C": "Production of amniotic fluid",
"D": "Production of progesterone",
"E": "Gas exchange"
} | step1 | B |
A 49-year-old man comes to the physician because he has had multiple falls and multiple episodes of dizziness over the past 6 weeks. There is no personal or family history of serious illness. He drinks one pint of rum daily. He works as a foreman in a factory that produces industrial solvents. He is alert and oriented ... | Cerebellar degeneration | {
"A": "Korsakoff syndrome",
"B": "Subacute combined degeneration",
"C": "Methanol poisoning",
"D": "Cerebellar degeneration",
"E": "Wernicke's encephalopathy"
} | step2&3 | D |
A 7-year-old girl is brought to the physician by her mother for a well-child examination. The mother reports that she had her first menstrual period 1 week ago. She has no history of serious illness. Immunizations are up-to-date. Physical examination shows Tanner stage 3 breast development and pubic hair. Without treat... | Short stature | {
"A": "Delayed skeletal maturity",
"B": "Short stature",
"C": "Genu varum",
"D": "Osteoporosis",
"E": "Coarse facial features"
} | step1 | B |
A 67-year-old man presents to his primary care physician for a follow up appointment. He was released from the hospital 1 week ago for an appropriately managed ST-elevation myocardial infarction (STEMI); however, he has not filled any of his prescriptions and did not attend his follow up appointment as scheduled. The p... | Metoprolol succinate | {
"A": "Atenolol",
"B": "Hydrochlorothiazide",
"C": "Lisinopril",
"D": "Metoprolol succinate",
"E": "Propranolol"
} | step2&3 | D |
A 61-year-old man comes to the emergency department because of a 2-day history of a productive cough and worsening shortness of breath. He has had frequent episodes of a productive cough over the past 3 years. He had smoked 2 packs of cigarettes daily for 30 years but quit 1 year ago. He appears distressed. Pulse oxime... | Prednisone and albuterol | {
"A": "Prednisone and albuterol",
"B": "Albuterol and montelukast",
"C": "Prednisone and tiotropium",
"D": "Albuterol and theophylline",
"E": "Roflumilast and prednisone"
} | step1 | A |
An investigator is studying cellular regeneration of epithelial cells. She has obtained a tissue sample from a normal thyroid gland for histopathologic examination. It shows follicles lined by a single layer of cube-like cells with large central nuclei. Which of the following parts of the female reproductive tract is a... | Ovaries | {
"A": "Ovaries",
"B": "Vagina",
"C": "Fallopian tubes",
"D": "Vulva",
"E": "Cervix"
} | step1 | A |
A 22-year-old woman comes to the physician for a routine health examination. She feels well but asks for advice about smoking cessation. She has smoked one pack of cigarettes daily for 7 years. She has tried to quit several times without success. During the previous attempts, she has been extremely nervous and also gai... | Varenicline | {
"A": "Diazepam",
"B": "Nicotine patch",
"C": "Varenicline",
"D": "Motivational interviewing",
"E": "Fluoxetine"
} | step2&3 | C |
A hospitalized 34-year-old man with severe diarrhea and bloating for 1 month is diagnosed with celiac disease based on serology and duodenal biopsy. He has no history of any serious illnesses and takes no medications. He has no history of recent travel. His vital signs are within normal limits. Physical examination is ... | Avoiding all dairy products | {
"A": "Avoiding all dairy products",
"B": "Diphenoxylate",
"C": "Empirical therapy with metronidazole",
"D": "Prednisone",
"E": "Restriction of soy products"
} | step2&3 | A |
A 70-year-old man presents to the Emergency Department after 3 days of shortness of breath, orthopnea, and lower limb edema. His personal history is significant for a myocardial infarction 6 years ago that required revascularization and hypertension. His medication consists of simvastatin and lisinopril. In the ED, he... | Fractional excretion of urea (FEUrea) | {
"A": "Sulfosalicylic acid test",
"B": "Urine sodium content",
"C": "Fractional excretion of sodium Na+ (FENa+)",
"D": "Fractional excretion of urea (FEUrea)",
"E": "Nitrates in urine"
} | step2&3 | D |
A 26-year-old Caucasian woman is admitted to the emergency department after 4 days of fever, malaise, vomiting, and nausea for which she has been taking ibuprofen and diclofenac. She has also noticed a decrease in urination. Her family and past medical history are unremarkable. Her temperature is 38.2°C (100.7°F), bloo... | Diffuse maculopapular rash | {
"A": "Livedo reticularis",
"B": "Janeway lesions",
"C": "Diffuse maculopapular rash",
"D": "Malar rash",
"E": "Erythema nodosum"
} | step2&3 | C |
A 59-year-old woman presents to the outpatient clinic for worsening symptoms of congestive heart failure. She states that while she used to be able to go for short walks, she is no longer able to do so. Now, even simple tasks like getting ready in the morning have become burdensome for her. When she gets tired, sitting... | New York Heart Association Class III | {
"A": "New York Heart Association Class I",
"B": " New York Heart Association Class IIa",
"C": "New York Heart Association Class IIb",
"D": "New York Heart Association Class III",
"E": "New York Heart Association Class IV"
} | step2&3 | D |
A 36-year-old woman comes to the physician for intermittent stabbing face pain. The pain typically occurs in waves of several individual episodes lasting about one second. It is bilateral, but rarely occurs on both sides simultaneously. Touching her face or brushing her teeth can trigger an attack. Four months ago, she... | Multiple periventricular sclerotic plaques | {
"A": "Gingival swelling, erythema, and pus drainage",
"B": "Multiple periventricular sclerotic plaques",
"C": "Erythematous papules in the V2/V3 nerve distribution",
"D": "Photophobia and phonophobia",
"E": "Rhinorrhea, lacrimination, and ptosis"
} | step2&3 | B |
A 23-year-old woman, gravida 2, para 1, at 28 weeks' gestation comes to the physician for a routine prenatal examination. Her previous pregnancy was uncomplicated and she gave birth to a healthy boy. Her blood group is A, Rh-negative. The father's blood group is B, Rh-positive. Administration of which of the following ... | Anti-D IgG | {
"A": "Anti-A IgG",
"B": "Anti-D IgG",
"C": "Anti-B IgG",
"D": "Anti-D IgM",
"E": "Anti-A IgM"
} | step1 | B |
A 61-year-old man presents to the clinic with complaints of excessive thirst, frequent urination, and partial visual loss in both eyes for 1 day. His family history is significant for type 2 diabetes mellitus in his mother and cousin. His weight is 112 kg ( 246.9 lb), height 187 cm (6 ft 1 in), blood pressure: 150/90 m... | Secondary active transporters fail to completely reabsorb glucose in the renal tubules | {
"A": "Yeasts metabolize glucogenic amino acids which are filtered in the urine into glucose",
"B": "There is a disruption of primary active transport of glucose in the proximal renal tubules",
"C": "Secondary active transporters fail to completely reabsorb glucose in the renal tubules",
"D": "There is a disru... | step1 | C |
A 65-year-old male presents to his primary care physician for stiffness in his arm. He states that he has been having trouble combing his hair and reaching objects that are high on the shelf. The patient has a past medical history of diabetes mellitus type II, obesity, and hypertension. His current medications include ... | Adhesive capsulitis | {
"A": "Rotator cuff impingement",
"B": "Adhesive capsulitis",
"C": "Biceps tendinopathy",
"D": "Glenohumeral osteoarthritis",
"E": "Subacromial bursitis"
} | step2&3 | B |
A 52-year-old man presents to the clinic with a headache and dizziness for the past month. The patient reports that about 4 weeks ago he developed a “nagging” headache. He thought he had a cold, so he tried over the counter ibuprofen that provided only mild and temporary relief. Recently, he also started feeling dizzy ... | Toxic exposure | {
"A": "Medication side effect",
"B": "Myeloproliferative neoplasm",
"C": "Neuronal hyperexcitability",
"D": "Toxic exposure",
"E": "Viral infection"
} | step2&3 | D |
A 20-year-old woman comes to the clinic for her first follow-up visit after being diagnosed with bipolar I disorder 1-month ago. At that time, she was acutely severely manic and was brought to the emergency department by her concerned boyfriend. She was started on lithium, and after subsequent improvement, she was disc... | Adjust dosage of medication throughout the pregnancy | {
"A": "Adjust dosage of medication throughout the pregnancy",
"B": "Supplement all patients with 5mg of daily folic acid",
"C": "Low-dose polytherapy is preferred over monotherapy",
"D": "Discontinue the medication when conception is confirmed",
"E": "Switch to valproate as it has safest pregnancy profile"
} | step2&3 | A |
A 19-year-old female presents to the emergency room with 6 days of lower abdominal pain. She states that her symptoms have progressed and she now feels feverish as well. She also notes an episode of nonbloody diarrhea 2 days ago and has been increasingly nauseous. While being evaluated in the emergency room, she vomits... | Intravenous cefotetan and doxycycline with inpatient admission | {
"A": "Intramuscular ceftriaxone and oral doxycycline with outpatient follow-up",
"B": "Intravenous cefotetan and doxycycline with inpatient admission",
"C": "Oral vancomycin with outpatient follow-up",
"D": "Methotrexate with outpatient follow-up",
"E": "Exploratory laparotomy"
} | step2&3 | B |
A 72-year-old man with hypertension and type 2 diabetes mellitus is admitted to the hospital for the evaluation of breathlessness and fatigue. His pulse is 100/min, and blood pressure is 90/60 mm Hg. Further evaluation shows a systemic vascular resistance of 35 mm Hg × min/L with an end-systolic volume of 80 mL. Which ... | 20% | {
"A": "30%",
"B": "15%",
"C": "35%",
"D": "25%",
"E": "20%"
} | step1 | E |
A 24-year-old woman presents to the office for evaluation of intermittent vertigo for the past 2 days. She complains of vomiting and complete hearing loss in her left ear. The patient believes she had an ear infection in the same ear but never sought out treatment. She has a past medical history of uterine fibroids. Sh... | Amoxicillin | {
"A": "Ofloxacin",
"B": "Cefepime",
"C": "Cefotaxime",
"D": "Amoxicillin",
"E": "Cephalexin"
} | step2&3 | D |
A 52-year-old woman presents to the emergency department due to severe pain of her first metatarsophalangeal (MTP) joint. This pain started acutely, and she describes the pain as sharp. Her medical history is significant for obesity, hypertension, inflammatory bowel disease, and extensive alcohol use. She takes a numbe... | Inhibitor of xanthine oxidase | {
"A": "Antibody to soluble factor",
"B": "Inhibitor of microtubule polymerization",
"C": "Inhibitor of proximal tubule reabsorption",
"D": "Inhibitor of xanthine oxidase",
"E": "Recombinant enzyme"
} | step1 | D |
A 59-year-old man complains of chest pain that has been present for 4 hours on the 5th day of hospitalization for acute myocardial infarction. 5 days ago, he had a burning sensation in his chest and discomfort in his left shoulder. Upon initial presentation to the hospital’s emergency department, he was diagnosed with ... | Creatine kinase (CK-MB) | {
"A": "Alanine aminotransferase",
"B": "Alkaline phosphatase",
"C": "Creatine kinase (CK-MB)",
"D": "Lactate dehydrogenase",
"E": "Troponin T"
} | step2&3 | C |
A 16-year-old girl comes to the emergency department because of left wrist pain and swelling for 5 hours. She fell on an outstretched hand while playing basketball. She ignored it initially as she thought it was just a bruise, but the pain and swelling worsened throughout the day. The analgesic spray she used did not p... | Thumb spica cast and repeat x-rays in 2 weeks | {
"A": "Open reduction and internal fixation",
"B": "Corticosteroid injections",
"C": "Thumb spica cast and repeat x-rays in 2 weeks",
"D": "Rest, ice, and repeat x-rays in 2 weeks",
"E": "Percutaneous pinning\n\""
} | step2&3 | C |
A 46-year-old man comes to the physician with a 1-week history of yellowish discoloration of his eyes, generalized fatigue, and pruritus. He was diagnosed with ulcerative colitis 7 years ago. At the time of diagnosis, a pANCA test was also positive. Physical examination shows scleral icterus and multiple scratch marks ... | Periductal concentric scarring and fibrosis | {
"A": "Periductal concentric scarring and fibrosis",
"B": "Periportal lymphocytic infiltration and piecemeal necrosis",
"C": "Diffuse fibrosis with PAS-staining globules",
"D": "Irregular ductal glands lined by atypical and pleomorphic cells",
"E": "Ductopenia and fibrotic degeneration of periportal hepatocy... | step1 | A |
A 29-year-old woman presents to her primary care doctor with a lesion on her left labia. She first noticed the lesion 3 days ago. The patient describes the lesion as painful and swollen. She denies vaginal discharge. Her past medical history is notable for mild intermittent asthma, gout, and obesity. She uses an albute... | Haemophilus ducreyi | {
"A": "Klebsiella granulomatis",
"B": "Herpes simplex virus type 2",
"C": "Haemophilus ducreyi",
"D": "Gardnerella vaginalis",
"E": "Treponema pallidum"
} | step1 | C |
A 67-year-old man presents with feelings of nervousness and anxiety. He mentions that lately, he has been feeling increasingly restless and is unable to control feelings of nervousness pertaining to all his daily tasks. He noticed that these feelings were more prominent in the last 2 months but have been present on and... | Buspirone | {
"A": "Diazepam",
"B": "Zolpidem",
"C": "Ramelteon",
"D": "Buspirone",
"E": "Alprazolam"
} | step2&3 | D |
Two hours after undergoing open cholecystectomy for complicated cholecystitis, a 48-year-old woman develops dizziness, lethargy, abdominal pain, and nausea. She has systemic lupus erythematosus and hypertension. Prior to hospitalization, her medications included nifedipine and prednisolone. Her pulse is 112/min and blo... | Hyponatremia | {
"A": "Normal anion gap metabolic acidosis",
"B": "Hyperkalemia",
"C": "Hyperglycemia",
"D": "Hypernatremia",
"E": "Hyponatremia"
} | step1 | E |
A 28-year-old woman, gravida 2, para 1, at 40 weeks of gestation is admitted to the hospital in active labor. The patient has attended many prenatal appointments and followed her physician's advice about screening for diseases, laboratory testing, diet, and exercise. Her pregnancy has been uncomplicated. She has no his... | Reassurance | {
"A": "Amnioinfusion",
"B": "Induced vaginal delivery",
"C": "Reassurance",
"D": "Repositioning",
"E": "Urgent cesarean delivery"
} | step2&3 | C |
A 63-year-old female complains of weakness, light-headedness, palpitations, and soreness of the tongue. She has a past medical history of Hashimoto’s thyroiditis. Her hematocrit is 29%. On peripheral blood smear, you notice neutrophils with 7 lobes and large oval-shaped red blood cells. On physical exam, you notice the... | Anti-intrinsic factor antibodies | {
"A": "Atrophy of G cells",
"B": "Anti-intrinsic factor antibodies",
"C": "Decreased methylmalonic acid levels",
"D": "Antithrombotic state",
"E": "B12 malabsorption due to Diphyllobothrium latum"
} | step2&3 | B |
A 45-year-old man presents to the doctor’s office with shortness of breath, cough, and fatigue for 3 days. This has been progressively worsening. He has a medical history significant for chronic obstructive pulmonary disease and osteoarthritis. He takes albuterol, ipratropium and aspirin. He smoked 2 and a half packs p... | Relapse | {
"A": "Precontemplation",
"B": "Contemplation",
"C": "Preparation",
"D": "Maintenance",
"E": "Relapse"
} | step2&3 | E |
A 28-year-old man reports to his physician that he is having second thoughts about his long-term compatibility with his wife ever since they relocated to a new city. He admits that he has noticed himself flirting with some of the female co-workers at his new workplace. When he goes on a dinner date with his wife after ... | Projection | {
"A": "Displacement",
"B": "Dissociation",
"C": "Projection",
"D": "Reaction formation",
"E": "Repression"
} | step2&3 | C |
A 25-year-old, G2P2L2 woman presents with a complaint of missed menstrual cycle for 4 weeks. Her previous menstrual cycles were regular, occurring every 28–35 days consistently. The patient does not have any other complaints currently. Her past medical history reveals two uncomplicated and normal vaginal deliveries at ... | Oral mifepristone + misoprostol | {
"A": "Dilatation and evacuation (D&E)",
"B": "Oxytocin-induced labor",
"C": "Manual uterine aspiration",
"D": "Dilatation and curettage (D & C) after vacuum evacuation",
"E": "Oral mifepristone + misoprostol"
} | step2&3 | E |
A 77-year-old man comes to your office for a routine visit. He is doing well, and his only complaint is the recent appearance of several brown greasy appearing lesions on his forehead (figure A) that he can't seem to peel off. What is the most likely diagnosis? | Seborrheic keratosis | {
"A": "Melanoma",
"B": "Seborrheic keratosis",
"C": "Keloid",
"D": "Acanthosis nigricans",
"E": "Erythema nodosum"
} | step1 | B |
A 72-year-old man presents to his primary care physician with a 6-month history of shortness of breath. He says that he used to enjoy playing golf with his friends but now he cannot walk for long enough to play. The shortness of breath is now starting to complicate his ability to get around in daily life. His past medi... | Increased residual volume and decreased 1 second forced expiratory volume | {
"A": "Decreased residual volume and decreased 1 second forced expiratory volume",
"B": "Decreased residual volume and increased 1 second forced expiratory volume",
"C": "Increased residual volume and decreased 1 second forced expiratory volume",
"D": "Increased residual volume and increased 1 second forced ex... | step1 | C |
A 67-year-old male comes into the ED complaining of dyspnea and a heavy feeling in his chest. He reports that over the past month he has become more easily “winded" to the point that he now sleeps in his living room because he can’t make it up the stairs. A review of systems is notable for headaches and fatigue. On phy... | Lymphoma | {
"A": "Congestive heart failure",
"B": "Hypoalbuminemia",
"C": "Liver cirrhosis",
"D": "Lymphoma",
"E": "Nephrotic syndrome"
} | step2&3 | D |
A 29-year-old G4P0 woman presents following a spontaneous pregnancy loss in the 18th week of her pregnancy. This is her fourth loss in the second trimester and she is concerned about her inability to have a successful pregnancy. She is otherwise healthy and has no acute complaints. Her vitals are unremarkable and exam ... | Hysterosalpingogram | {
"A": "Anti-cardiolipin antibodies",
"B": "Karotyping",
"C": "Hysterosalpingogram",
"D": "Prolactin level",
"E": "TSH level"
} | step2&3 | C |
A 22-year-old woman presents to her primary care physician in April for seasonal allergies. She has suffered from seasonal allergies for the past 2 years and takes diphenhydramine as needed when her symptoms worsen. She has not yet seen a physician for her allergies. She reports that diphenhydramine has been helpful in... | Relative lipophobicity | {
"A": "Alpha-adrenergic antagonism",
"B": "Beta-adrenergic antagonism",
"C": "Muscarinic antagonism",
"D": "Relative lipophobicity",
"E": "Serotonergic antagonism"
} | step1 | D |
A 55-year-old male visited his primary care physician complaining of chest pain and progressive shortness of breath worsened by exertion. His vital signs were within normal limits. He reports that he worked in a naval shipyard for 10 years during his twenties. A CT scan of his chest shows diffuse thickening of the pleu... | Pleural effusion | {
"A": "Pneumothorax",
"B": "Pleural effusion",
"C": "Systemic inflammatory response syndrome",
"D": "Bronchioalveolar carcinoma",
"E": "Bronchiectasis"
} | step1 | B |
A 56-year-old man recently diagnosed with cirrhosis secondary to alcohol use presents to the clinic for a follow up evaluation. He states that he has abstained from alcohol and attends a support group regularly. He has not taken any new medications or encountered any sick contacts. The patient's blood pressure is 110/7... | Nadolol | {
"A": "Endoscopic sclerotherapy",
"B": "Ligation",
"C": "Metoprolol",
"D": "Nadolol",
"E": "Repeat endoscopy"
} | step2&3 | D |
A 70-year-old man is brought to the emergency department by his wife for incomprehensible speech. Upon first inspection you note the man is drooling and his eyes are tearing excessively. The patient's wife explains that the man was tilling the fields on the family beet farm when she found him collapsed on a pile of fre... | 2-pralidoxime | {
"A": "Sublingual atropine drops",
"B": "Neostigmine",
"C": "Physostigmine",
"D": "2-pralidoxime",
"E": "Intubation"
} | step2&3 | D |
A 75-year-old man presents to the physician for his annual blood pressure visit and blood work. He has no complaints other than occasional knee pain. The past medical history includes hypertension. He has had knee osteoarthritis for several years and takes occasional acetaminophen for pain control. His diet is full of ... | Chronic lymphocytic leukemia (CLL) | {
"A": "Chronic lymphocytic leukemia (CLL)",
"B": "Monoclonal B cell lymphocytosis (MBL)",
"C": "Monoclonal gammopathy of undetermined significance (MGUS)",
"D": "Multiple myeloma (MM)",
"E": "Polycythemia vera (PV)"
} | step2&3 | A |
A 60-year-old man comes to the physician because of a 2-month history of cough productive of yellow sputum with occasional streaks of blood. He has a history of pulmonary tuberculosis. He is afebrile. Pulmonary examination shows inspiratory crackles at the left infraclavicular area. An x-ray of his chest shows a radiop... | Opportunistic colonization | {
"A": "Hypersensitivity reaction",
"B": "Asbestos inhalation",
"C": "Neoplastic transformation",
"D": "Opportunistic colonization",
"E": "Abscess formation"
} | step1 | D |
An 11-month-old boy is brought to the emergency department by his mother after she observed jerking movements of his arms and legs for about 30 seconds earlier that morning. He has not had fever, cough, or a runny nose. He has been healthy, except for occasional eczema. He was delivered at home in Romania. His mother h... | Dietary restriction of phenylalanine | {
"A": "Levothyroxine therapy during pregnancy",
"B": "Dietary restriction of phenylalanine",
"C": "Daily allopurinol intake",
"D": "Avoidance of fasting states",
"E": "High doses of vitamin B6"
} | step2&3 | B |
A researcher hypothesizes that low birth weight is related to obesity later in life. He conducts a study with a 95% confidence interval with a p-value of 0.049 to disprove his null hypothesis. He rejects his null hypothesis and concludes that low birth weight is associated with obesity. Which of the following statement... | A type 2 error is not possible in this case. | {
"A": "Confidence interval should have been 90%.",
"B": "A type 2 error is not possible in this case.",
"C": "Null hypothesis should not have been rejected.",
"D": "A type 2 error has been made.",
"E": "A type 1 error has been made."
} | step1 | B |
A 52-year-old woman presents to her primary care physician for abdominal pain and diarrhea. The patient states that she has been experiencing watery diarrhea for weeks now. During this same period she states she has been constantly thirsty and does not have the same energy levels that she once had. The patient has a pa... | Impaired iron absorption | {
"A": "Enterotoxin",
"B": "Impaired iron absorption",
"C": "Increased serotonin production",
"D": "Invasive bacterial infection",
"E": "Normal flora destruction"
} | step2&3 | B |
A 3-week-old newborn is brought to the physician by his parents because of poor feeding, irritability, and frequent vomiting over the past week. The vomitus is greenish in color and smells strange. His parents have tried to feed him every 4 hours, but the patient often spits up or refuses to eat. The patient was born a... | Rectal suction biopsy | {
"A": "CT scan of the abdomen",
"B": "Transabdominal ultrasonography",
"C": "Barium enema",
"D": "Anorectal manometry",
"E": "Rectal suction biopsy"
} | step2&3 | E |
A 13-year-old boy is brought to the physician because of progressive left leg pain for 2 months, which has started to interfere with his sleep. His mother has been giving him ibuprofen at night for “growing pains,” but his symptoms have not improved. One week before the pain started, the patient was hit in the thigh by... | Ewing sarcoma | {
"A": "Osteosarcoma",
"B": "Chondrosarcoma",
"C": "Osteochondroma",
"D": "Ewing sarcoma",
"E": "Osteoid osteoma"
} | step2&3 | D |
A 55-year-old male with a history of stage I colon cancer status-post left hemicolectomy presents to your office for follow-up. You intend to discuss the results from his recent surveillance colonoscopy, which showed no remaining cancer, no polyps, and a well-healed anastmosis. During your meeting, you note that the pa... | "I really haven't thought about the colonoscopy until today. Worrying before getting the results wasn't going to help anything." | {
"A": "\"Last week I volunteered for the local Cancer Society. Helping other cancer patients just makes me feel better.\"",
"B": "\"Oh, doctor, I'm just so grateful to be seeing you. I just know you've cured my cancer. I probably don't even need to check anymore.\"",
"C": "\"I'm sorry I was late today. I also di... | step1 | E |
A 67-year-old man is brought to the emergency department with severe, crushing, retrosternal chest pain for the last 45 minutes. The pain radiates to his left shoulder and is associated with sweating. The past medical history is significant for hypercholesterolemia, for which he takes lovastatin. He smoked as a youth b... | Hemoptysis | {
"A": "Hemoptysis",
"B": "Easy fatigability",
"C": "Persistent ST-segment elevation",
"D": "Persistent inspiratory crackles",
"E": "Shortness of breath"
} | step1 | A |
A 65-year-old male presents to his pulmonologist for a follow-up visit. He has a history of chronic progressive dyspnea over the past five years. He uses oxygen at home and was seen in the emergency room two months prior for an exacerbation of his dyspnea. He was discharged following stabilization. His past medical his... | Disulfide bond cleavage | {
"A": "DNA hydrolysis",
"B": "Disulfide bond cleavage",
"C": "Endothelin-1 antagonism",
"D": "Osmotic hydration of airway lumen",
"E": "Reduction in airway surface tension"
} | step1 | B |
A 36-year-old woman, gravida 3, para 2, at 42 weeks' gestation comes to the physician for induction of labor. Her pregnancy has been uncomplicated. Her two other children were born after uncomplicated vaginal deliveries at 41 and 42 weeks' gestation, respectively. Her only medication is a prenatal vitamin. She is 165 c... | Meconium aspiration | {
"A": "Polyhydramnios",
"B": "Acute respiratory distress syndrome",
"C": "Caudal regression syndrome",
"D": "Meconium aspiration",
"E": "Placental abruption"
} | step2&3 | D |
The only immunoglobulin found as a dimer has what primary function? | Inhibiting bacterial adherance and colonization of mucous membranes | {
"A": "Protect against invasive helminth infection",
"B": "Protect against viral infections",
"C": "Provide an initial humoral immune response to newly presenting bacterial antigens",
"D": "Inhibiting bacterial adherance and colonization of mucous membranes",
"E": "Provides the most specific recognition to c... | step1 | D |
A 47-year-old woman is brought to the emergency department by paramedics. She was found unconscious on a park bench by a bystander. Her history is unobtainable. Vitals include a pulse of 64/min, a respiratory rate of 7/min, and a blood pressure of 110/70 mm Hg. On examination, the patient is unresponsive to voice and t... | Opioid overdose | {
"A": "COPD exacerbation",
"B": "Diabetic ketoacidosis",
"C": "Diuretic overdose",
"D": "Hyperventilation",
"E": "Opioid overdose"
} | step1 | E |
A 72-year-old woman with a 40 pack-year history of smoking presents to your office with jaundice. After a thorough workup, you determine that the patient has pancreatic cancer. Which of the following is the most appropriate initial statement to inform the patient of her condition? | "I have bad news I need to share with you. Please sit down so we can discuss." | {
"A": "\"Have you ever heard of pancreatic cancer?\"",
"B": "\"I have bad news I need to share with you. Please sit down so we can discuss.\"",
"C": "\"Have you designated a healthcare proxy?\"",
"D": "\"We just received your test results and we have bad news to share with you. The resident will be in to expla... | step1 | B |
A 40-year-old man is referred to an optometrist. He complains of mild vision impairment over the last 6 months. His vision has continued to slowly deteriorate and his condition is now affecting his night driving. Past medical history is significant for well-controlled schizophrenia. He takes a low-potency typical antip... | Slit-lamp examination | {
"A": "Decrease medication dosage",
"B": "Reassurance",
"C": "Ocular examination under anesthesia",
"D": "Refer to ophthalmologist",
"E": "Slit-lamp examination"
} | step1 | E |
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