question stringlengths 245 1.26k | subject stringclasses 1
value | choices sequence | answer class label 4
classes |
|---|---|---|---|
An 84-year-old female is diagnosed with a third recurrence of breast cancer that has now metastasized to the brain and lungs. She does not wish to pursue further treatment at this time despite being advised that this is a terminal condition. Her family insists on trying both radiation and chemotherapy in hopes that the... | professional_medicine | [
"agree with the family since they have the patient's best interest in mind",
"convince the patient to try either radiation or chemotherapy",
"disregard the family's wishes",
"protect the patient's autonomy"
] | 3D |
A cohort study is conducted to compare the incidence of adverse effects of a recently approved antihypertensive pharmacotherapy with that of conventional therapy. A total of 20,000 patients are enrolled. Twelve thousand are prescribed the recently approved therapy, and 8,000 are prescribed conventional therapy. Patient... | professional_medicine | [
"Publication bias",
"Selection bias",
"Type I error",
"Type II error"
] | 1B |
A 55-year-old man is brought to the emergency department by his wife because he told her he did not want to live anymore. During the past 6 weeks, he has experienced fatigue, loss of interest in usual activities, a 7-kg (15-lb) weight loss, and insomnia. He has no history of serious medical or psychiatric illness. Vita... | professional_medicine | [
"Divalproex",
"Fluoxetine",
"Lamotrigine",
"Lithium carbonate"
] | 1B |
A 14-year-old girl with a 9-year history of type 1 diabetes mellitus is brought to the physician by her mother for a follow-up examination. She has been admitted to the hospital twice in the past 3 months because of diabetic ketoacidosis. She previously had been compliant with monitoring her blood glucose concentration... | professional_medicine | [
"Countertransference",
"Identification with the aggressor",
"Projection",
"Splitting"
] | 0A |
A 70-year-old woman comes to the office for an annual health maintenance examination. She describes a 1-year history of slowly progressive fatigue, diffuse muscle aches, and generalized pain. Medical history is significant for osteoporosis diagnosed 5 years ago. Medications include alendronate and calcium supplementati... | professional_medicine | [
"Electromyography and nerve conduction studies",
"MRI of the cervical spine",
"Serum antinuclear antibody assay",
"Serum 25-hydroxyvitamin D assay"
] | 3D |
A 6-day-old breast-fed boy is brought to the emergency department by his mother because of poor weight gain and irritability since delivery, and a 2-hour history of vomiting. Physical examination shows jaundice and hepatomegaly. A reducing substance test result of the urine is positive, and a glucose oxidase test resul... | professional_medicine | [
"Fructose 1,6-bisphosphate",
"Galactose 1-phosphate",
"Glucose 1-phosphate",
"Glucose 6-phosphate"
] | 1B |
For 8 weeks, a 52-year-old man with a 5-year history of type 2 diabetes mellitus has had deep burning pain in the ball of his right foot and big toe when the foot is raised above chest concentration. He also has cramping in his right calf when he walks more than 50 feet. He has smoked two packs of cigarettes daily for ... | professional_medicine | [
"Aortoiliac stenosis",
"Femoral popliteal stenosis",
"Mononeuropathy",
"Vasculitis"
] | 1B |
A 56-year-old man comes to the emergency department because of a 4-day history of colicky right flank pain that radiates to the groin and hematuria. Ultrasound examination of the kidneys shows right-sided hydronephrosis and a dilated ureter. Which of the following is most likely to be found on urinalysis? | professional_medicine | [
"Glucose",
"Leukocyte casts",
"Oval fat bodies",
"Uric acid crystals"
] | 3D |
A 45-year-old man with AIDS comes to the community health center because of a 1-week history of fever, chills, sweating, mild shortness of breath, and nonproductive cough. Medical history is also remarkable for pneumonia 3 years ago that required hospitalization. Today, he says that he lost his job 6 months ago, is now... | professional_medicine | [
"Arrange a direct admission to the hospital for this patient",
"Continue with obtaining a thorough history and examining this patient",
"Place masks on the patient and yourself and then continue to evaluate him",
"Send this patient for chest x-rays, and while they are being obtained examine the next patient"
... | 2C |
A 19-year-old woman noticed a mass in her left breast 2 weeks ago while doing monthly breast self-examination. Her mother died of metastatic breast cancer at the age of 40 years. Examination shows large dense breasts; a 2-cm, firm, mobile mass is palpated in the upper outer quadrant of the left breast. There are no cha... | professional_medicine | [
"Fibroadenoma",
"Fibrocystic changes of the breast",
"Infiltrating ductal carcinoma",
"Intraductal papilloma"
] | 0A |
A 2-week-old newborn is brought to the physician because his lips have turned blue on three occasions during feeding; he also sweats during feeding. He was born at 38 weeks' gestation and weighed 2466 g (5 lb 7 oz); he currently weighs 2778 g (6 lb 2 oz). His temperature is 37.8°C (100°F), pulse is 170/min, respiration... | professional_medicine | [
"Anomalous coronary vessels",
"Atrial septal defect",
"Endocardial fibroelastosis",
"Tetralogy of Fallot"
] | 3D |
A 72-year-old woman comes to the physician because of a 3-day history of fever, shortness of breath, difficulty swallowing, chest pain, and cough. She is frail. Physical examination shows tachypnea and equal pulses bilaterally. Percussion of the chest shows dullness over the right lower lung field. Laboratory studies s... | professional_medicine | [
"Alveolar proteinosis",
"Aspiration",
"Cigarette smoking",
"Emphysema"
] | 1B |
A 24-year-old woman comes to the office for a routine health maintenance examination. She has been generally healthy for the past year. She is 155 cm (5 ft 1 in) tall and weighs 68 kg (150 lb); BMI is 28 kg/m2 . Vital signs are temperature 37.0°C (98.6°F), pulse 60/min, respirations 18/min, and blood pressure 118/54 mm... | professional_medicine | [
"Bone marrow",
"Lateral thigh",
"Lower abdomen",
"Vulva"
] | 3D |
An obese 33-year-old woman has had four 12-hour episodes of severe, sharp, penetrating pain in the right upper quadrant of the abdomen associated with vomiting but no fever. She has no diarrhea, dysuria, or jaundice and is asymptomatic between episodes. There is slight tenderness to deep palpation in the right upper qu... | professional_medicine | [
"Supine and erect x-rays of the abdomen",
"Upper gastrointestinal series",
"Ultrasonography of the upper abdomen",
"CT scan of the abdomen"
] | 2C |
A 25-year-old man with Down syndrome and mild mental retardation is brought to the office by his parents. He is their only child, and they are concerned that his current lifestyle is increasing his risk for coronary artery disease and stroke. The patient has a systolic murmur and also underwent surgical repair of an at... | professional_medicine | [
"Advise the parents not to influence their son's decision in this matter",
"Arrange for evaluation of their son's competency",
"Enroll their son in a smoking cessation program",
"Initiate a family meeting to discuss the parents' concerns with their son"
] | 3D |
A 21-year-old woman comes to the physician for preconceptional advice. She is recently married and would like to conceive within the next year. She does not eat meat, fish, or dairy products and wishes to decrease the risks of her diet on her baby. Menses occur at regular 28-day intervals and last 5 days. She does not ... | professional_medicine | [
"Adjusting diet to include more sources of protein during the first trimester",
"Beginning folic acid supplementation prior to conception",
"Calcium supplementation during the first trimester",
"Iron supplementation during the first trimester"
] | 1B |
A grossly obese 65-year-old male presents to the office with tingling and painful itching in the anterolateral region of the thigh. The patient loses weight, and the symptoms disappear. This paresthesia is most consistent with compression of the | professional_medicine | [
"anterior femoral cutaneous nerve",
"genitofemoral nerve",
"iliohypogastric nerve",
"lateral femoral cutaneous nerve"
] | 3D |
A 12-year-old girl is brought to the physician because of a 2-month history of intermittent yellowing of the eyes and skin. Physical examination shows no abnormalities except for jaundice. Her serum total bilirubin concentration is 3 mg/dL, with a direct component of 1 mg/dL. Serum studies show a haptoglobin concentrat... | professional_medicine | [
"Decreased activity of UDP glucuronosyltransferase",
"Gallstones",
"Increased hemolysis",
"Increased serum alkaline phosphatase activity"
] | 0A |
A 63-year-old man is brought to the emergency department because of a 4-day history of increasingly severe left leg pain and swelling of his left calf. He also has a 1-month history of increasingly severe upper midthoracic back pain. During this time, he has had a 9-kg (20-lb) weight loss despite no change in appetite.... | professional_medicine | [
"Carcinoid syndrome",
"Hypercoagulability from advanced malignancy",
"Multiple endocrine neoplasia",
"Splenic artery aneurysm and embolic disease of the left lower extremity"
] | 1B |
A 63-year-old woman with hypertension has her son call your office to make an appointment for evaluation of vaginal bleeding. Her general physician recently retired. The son tells you that his mother has been deaf since infancy and that he uses sign language to communicate with her. Which of the following is the most a... | professional_medicine | [
"Have the patient bring her son to the appointment to interpret",
"Arrange for a certified interpreter",
"Provide the patient with writing materials during the appointment",
"Talk with the patient face-to-face, enunciating carefully so that she may lip read"
] | 1B |
A 4-year-old boy with cystic fibrosis is brought to the emergency department 20 minutes after being found unconscious in his yard by his parents. He had been playing outside all afternoon; the outside temperature was 95°F. He had been feeling well lately with no recent acute exacerbations of cystic fibrosis. On arrival... | professional_medicine | [
"Adrenal insufficiency with salt wasting",
"Impaired sweat gland function with reduced ability to regulate heat loss",
"Invasion of the central nervous system by gram-negative organisms",
"Mucous plugging of the airway resulting in secondary infection with Pseudomonas species"
] | 1B |
A 37-year-old woman, gravida 5, para 4, at 34 weeks' gestation comes to the emergency department because of vaginal bleeding for 2 hours. She has had no prenatal care. Her second child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate; her other three children were d... | professional_medicine | [
"Abruptio placentae",
"Amniotic fluid embolism",
"Latent phase of labor",
"Placenta previa"
] | 3D |
A previously healthy 32-year-old man is brought to the emergency department after being found unconscious on the floor at his workplace. On arrival, he is obtunded. He is intubated and mechanical ventilation is begun. Examination shows flaccid paralysis on the right. A CT scan of the head shows a large evolving cerebra... | professional_medicine | [
"Arrange for the regional organ procurement organization to address the issue with the patient's family",
"Delay further consideration of the issue until after 24 hours of aggressive care",
"Delay further consideration of the issue until the family seems ready",
"Initiate organ donation at this time"
] | 0A |
A 52-year-old woman begins pharmacotherapy after being diagnosed with type 2 diabetes mellitus. Four weeks later, her hepatic glucose output is decreased, and target tissue glucose uptake and utilization are increased. Which of the following drugs was most likely prescribed for this patient? | professional_medicine | [
"Acarbose",
"Glyburide",
"Metformin",
"Nateglinide"
] | 2C |
A 64-year-old male presents to the emergency room with a bloody nose that has been dripping out his nares for the past 2 hours. He denies any trauma, recent upper respiratory illness, or history of prior bloody nose. Past medical history is unremarkable, and he takes no medications. He has a blood pressure of 180/90 mm... | professional_medicine | [
"anterior turbinate",
"ethmoid sinus",
"Kiesselbach plexus",
"posterior nasal pharynx"
] | 2C |
A 25-year-old female is admitted to the hospital for the evaluation of fainting spells, which have been occurring several times a day for 10 days. These occur without warning and are not associated with any injury. The patient is evaluated during one of these falls, manifesting no change in heart rate, blood pressure, ... | professional_medicine | [
"basilar migraine",
"cardioinhibitory syncope",
"malingering",
"vasodepressor syncope"
] | 2C |
A 31-year-old woman comes to the office for initial prenatal care. She is 12 weeks pregnant by date of her last menstrual period. This is her fourth pregnancy; she has three healthy children. Her last pregnancy resulted in cesarean delivery because of fetal distress during labor. Her history includes heavy use of alcoh... | professional_medicine | [
"Amniocentesis is recommended to rule out congenital HIV infection",
"Breast-feeding will increase the risk for transmitting HIV to the infant",
"Immediate termination of pregnancy will decrease her risk for progression to AIDS",
"Repeat cesarean delivery may increase the risk for vertical transmission of HIV... | 1B |
A 60-year-old man has had painful skin with exfoliation of the skin and mucous membranes for 1 day. He has been taking allopurinol and probenecid for 2 weeks because of gouty arthritis. There is diffuse exfoliation of the skin with oozing of serous fluid. The mucous membranes of the mouth are erythematous and exfoliate... | professional_medicine | [
"Erythema multiforme",
"Pemphigus erythematosus",
"Staphylococcal scalded-skin syndrome",
"Toxic epidermal necrolysis"
] | 3D |
A 27-year-old man comes to the office with his wife because of a recent episode of loss of muscle control. He says, "I was at a reception, someone told a joke, and when I laughed, my legs collapsed!" His wife tells you that he recovered in a few seconds and he did not lose consciousness. He has a long history of sleepi... | professional_medicine | [
"Narcolepsy",
"Primary hypersomnia",
"A seizure disorder",
"Sleep paralysis"
] | 0A |
A 47-year-old man comes to the emergency department because of a 3-day history of increasing pain, tenderness, and swelling near the fingernail of his right index finger. He rates the pain as an 8 on a 10-point scale. He has not had fever or chills, and he has not sustained any trauma to the finger. Medical history is ... | professional_medicine | [
"Incision and drainage",
"Oral cefazolin therapy",
"Topical neomycin therapy",
"Warm-water soaks"
] | 0A |
A randomized controlled trial is conducted to assess the risk for development of gastrointestinal adverse effects using azithromycin compared with erythromycin in the treatment of pertussis in children. Of the 100 children with pertussis enrolled, 50 receive azithromycin, and 50 receive erythromycin. Results show vomit... | professional_medicine | [
"0.1",
"0.2",
"0.33",
"0.67"
] | 1B |
A 42-year-old man comes to the office for preoperative evaluation prior to undergoing adrenalectomy scheduled in 2 weeks. One month ago, he received care in the emergency department for pain over his right flank following a motor vehicle collision. At that time, blood pressure was 160/100 mm Hg and CT scan of the abdom... | professional_medicine | [
"Labetalol",
"A loading dose of potassium chloride",
"Nifedipine",
"Phenoxybenzamine"
] | 3D |
A 36-year-old male presents to the office with a 3-week history of low back pain. He denies any recent trauma but says that he climbs in and out of his truck numerous times a day for his job. Examination of the patient in the prone position reveals a deep sacral sulcus on the left, a posterior inferior lateral angle on... | professional_medicine | [
"left-on-left sacral torsion",
"left-on-right sacral torsion",
"right unilateral sacral flexion",
"right-on-right sacral torsion"
] | 3D |
A previously healthy 32-year-old woman comes to the physician 8 months after her husband was killed in a car crash. Since that time, she has had a decreased appetite and difficulty falling asleep. She states that she is often sad and cries frequently. She has been rechecking the door lock five times before leaving her ... | professional_medicine | [
"Dopamine",
"Glutamate",
"Norepinephrine",
"Serotonin"
] | 3D |
A 44-year-old man comes to the office because of a 3-day history of sore throat, nonproductive cough, runny nose, and frontal headache. He says the headache is worse in the morning and ibuprofen does provide some relief. He has not had shortness of breath. Medical history is unremarkable. He takes no medications other ... | professional_medicine | [
"Allergic rhinitis",
"Epstein-Barr virus",
"Mycoplasma pneumoniae",
"Rhinovirus"
] | 3D |
A 22-year-old male marathon runner presents to the office with the complaint of right-sided rib pain when he runs long distances. Physical examination reveals normal heart and lung findings and an exhalation dysfunction at ribs 4-5 on the right. Which of the following muscles or muscle groups will be most useful in cor... | professional_medicine | [
"anterior scalene",
"latissimus dorsi",
"pectoralis minor",
"quadratus lumborum"
] | 2C |
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