question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
values | answer_idx stringclasses 4
values | metamap_phrases listlengths 3 177 |
|---|---|---|---|---|---|
A 28-year-old man is brought to the emergency department because of a 3-day history of fever, chills, and generalized weakness. He has no cough. He was treated for a neck abscess 6 months ago. He takes no medications. He has smoked one pack of cigarettes daily for 10 years and drinks two to three beers daily. He has be... | Intravenous vancomycin therapy | {
"A": "Transesophageal echocardiography",
"B": "Intravenous vancomycin therapy",
"C": "X-ray of the chest",
"D": "CT pulmonary angiogram"
} | step2&3 | B | [
"year old man",
"brought",
"emergency department",
"3-day history",
"fever",
"chills",
"generalized weakness",
"cough",
"treated",
"neck abscess",
"months",
"takes",
"medications",
"smoked one pack",
"cigarettes daily",
"10 years",
"drinks two",
"three beers daily",
"using intrav... |
A 24-year-old woman comes to the physician because of persistent fatigue for the past 4 months. She has no history of major medical illness. Her temperature is 36°C (96.8°F), pulse is 121/min, and blood pressure is 120/78 mm Hg. Physical examination shows pale conjunctivae. A peripheral blood smear is shown. Which of t... | Iron deficiency | {
"A": "Hereditary spherocytosis",
"B": "Vitamin B12 deficiency",
"C": "Iron deficiency",
"D": "β-thalassemia minor"
} | step1 | C | [
"year old woman",
"physician",
"of persistent fatigue",
"past",
"months",
"history of major medical illness",
"temperature",
"96",
"pulse",
"min",
"blood pressure",
"mm Hg",
"Physical examination shows pale conjunctivae",
"peripheral blood smear",
"shown",
"following",
"most likely c... |
A 40-year old man presents to the clinic with vague upper abdominal pain that has been worsening for the last several days. He says that he often gets similar pain but less severe and that it worsens with meals. The pain sometimes radiates to his back. He recently lost 15 kg (33.6 lb) of weight secondary to his lack of... | Pancreas | {
"A": "Pancreas",
"B": "Jejunum",
"C": "Duodenum",
"D": "Gall bladder"
} | step1 | A | [
"40 year old man presents",
"clinic",
"vague upper abdominal pain",
"worsening",
"days",
"often gets similar pain",
"less severe",
"worsens",
"meals",
"pain sometimes radiates",
"back",
"recently lost",
"kg",
"weight secondary to",
"lack of appetite",
"last visit",
"months",
"admit... |
A 36-year-old man presents to his physician for a regular checkup, and he expresses an intent to quit smoking. He is a financial director with a 15-pack-year history of smoking who tried quitting several times. He tried different nicotine replacement products, none of which helped him. The patient has gastrointestinal ... | Bupropion lowers the seizure threshold and it should not be taken by patients with a history of seizure disorder. | {
"A": "Omeprazole interferes with bupropion metabolism and should be taken one hour prior to omeprazole consumption.",
"B": "Bupropion is only effective when used together with nicotine replacement products.",
"C": "Bupropion lowers the seizure threshold and it should not be taken by patients with a history of s... | step2&3 | C | [
"36 year old man presents",
"physician",
"regular checkup",
"intent to quit smoking",
"financial",
"pack-year history of smoking",
"quitting several times",
"different nicotine replacement products",
"helped",
"patient",
"gastrointestinal disease",
"takes omeprazole",
"medical history",
"s... |
A 32-year-old woman, gravida 2, para 0, at 22 weeks' gestation comes to the emergency department for abdominal pain and heavy vaginal bleeding for 2 hours. She has had no prenatal care. Her temperature is 37.2°C (99.0°F), pulse is 102/min, respirations are 16/min, and blood pressure is 138/82 mm Hg. The abdomen is nont... | “I'm sorry for your loss. This must be a difficult situation for you.” | {
"A": "“I'm sorry for your loss. This must be a difficult situation for you.”",
"B": "“Losing a baby is difficult, but I'm sure next time it'll work out.”",
"C": "“Losing a baby is difficult; but I see this every day, and I know you'll get through it.”",
"D": "“I'm sorry for your loss. I can write you a prescr... | step2&3 | A | [
"year old woman",
"gravida 2",
"para 0",
"weeks",
"gestation",
"emergency department",
"abdominal pain",
"heavy vaginal bleeding",
"hours",
"prenatal care",
"temperature",
"99",
"pulse",
"min",
"respirations",
"min",
"blood pressure",
"mm Hg",
"abdomen",
"nontender",
"regular... |
A 78-year-old man comes to the physician because of progressively worsening fatigue and headache for 6 months and occasional abdominal pain. He has not had any changes in his weight. He has a history of hypertension, type 2 diabetes mellitus, and chronic shoulder pain. Current daily medications include hydrochlorothiaz... | Iron deficiency | {
"A": "Folic acid deficiency",
"B": "Intravascular hemolysis",
"C": "Impaired erythropoietin production",
"D": "Iron deficiency"
} | step2&3 | D | [
"year old man",
"physician",
"worsening fatigue",
"headache",
"months",
"occasional abdominal pain",
"not",
"changes in",
"weight",
"history of hypertension",
"type 2 diabetes mellitus",
"chronic shoulder pain",
"Current daily medications include hydrochlorothiazide",
"metformin",
"ibupr... |
A 35-year-old woman comes to the physician for genetic counseling prior to conception. Her younger brother has mild developmental delay, pale complexion, and has to limit his dietary intake of phenylalanine. She has no similar symptoms and is in good health. Her parents are healthy. Which of the following is the most a... | 67% | {
"A": "67%",
"B": "100%",
"C": "75%",
"D": "50%"
} | step1 | A | [
"35 year old woman",
"physician",
"genetic counseling prior to conception",
"younger brother",
"mild developmental delay",
"pale complexion",
"to limit",
"dietary",
"phenylalanine",
"similar symptoms",
"good health",
"parents",
"healthy",
"following",
"most appropriate assessment",
"ca... |
A 23-year-old man presents with swelling of the left knee. He noticed the swelling a day ago while preparing for the college basketball game. He has had approximately 10 different sexual partners in the past 3 months. Synovial fluid tap shows a WBC count of 90,000 cells/mm3. What is the mechanism of action of the drug ... | Cell wall inhibitor | {
"A": "Metabolic inhibitor",
"B": "Cell wall inhibitor",
"C": "Neutrophil migration inhibitor",
"D": "Prostaglandin inhibitor"
} | step1 | B | [
"23 year old man presents",
"swelling of",
"left knee",
"swelling",
"day",
"preparing",
"college basketball game",
"approximately 10 different sexual partners",
"past 3 months",
"Synovial fluid tap shows",
"WBC count",
"90",
"cells/mm3",
"mechanism of action",
"drug",
"indicated",
"t... |
Which of the following patient presentations seen in a pediatric immunology clinic is most consistent with a diagnosis of Bruton's agammaglobulinemia? | A 9-month-old boy who has had recurrent otitis media and pneumococcal pneumonia in the past three months | {
"A": "A 15-month-old girl who has had repeated otitis media, pneumonia, and progressive clumsiness since beginning to walk in the past three months",
"B": "A 10-month-old boy who has had recurrent viral infections as well as hypocalcemia during neonatal period",
"C": "A 4-year-old girl who has had repeated oral... | step1 | D | [
"following patient presentations seen in",
"pediatric immunology clinic",
"most consistent with",
"diagnosis",
"Bruton's agammaglobulinemia"
] |
A 29-year-old man is brought to the emergency department by a concerned neighbor. The patient appears disheveled, has a flat affect, and appears to be having auditory hallucinations. He is alert and oriented to time, person, and place and has an intact long-term and short-term memory. His neighbor says that he never re... | Affective symptoms | {
"A": "Affective symptoms",
"B": "Being single",
"C": "Male sex",
"D": "Negative symptoms"
} | step1 | A | [
"29 year old man",
"brought",
"emergency department",
"neighbor",
"patient appears",
"flat affect",
"appears to",
"auditory hallucinations",
"alert",
"oriented to time",
"person",
"place",
"intact long-term",
"short-term memory",
"neighbor",
"never",
"patient",
"well",
"mostly ke... |
A 23-year-old man comes to the clinic for yellowing of his eyes. The patient has been relatively healthy and just recently started “intermittent fasting” to try to lose weight. He recalls a similar episode 4 years ago when he was recovering from an emergency appendectomy. The patient denies smoking but endorses an epis... | Decreased activity of UDP-glucuronosyltransferase | {
"A": "Autoimmune-mediated fibrosis of biliary tract",
"B": "Chronic viral infection of the liver",
"C": "Decreased activity of UDP-glucuronosyltransferase",
"D": "Defective bilirubin excretion"
} | step1 | C | [
"23 year old man",
"clinic",
"yellowing",
"eyes",
"patient",
"relatively healthy",
"recently started intermittent fasting to",
"to",
"weight",
"recalls",
"similar episode",
"years",
"recovering from",
"emergency appendectomy",
"patient denies smoking",
"episode of binge drinking 2 days... |
A 40-year-old woman comes to the physician because of a 2-month history of increasingly frequent episodes of vertigo and feeling unsteady while walking. She reports that she has had episodic tinnitus in her right ear for the past 3 years. Neurologic examination shows hearing loss in the right ear. An MRI of the brain i... | Hypercellular areas of spindle cells and hypocellular areas of myxoid stroma | {
"A": "Whorls of densely packed cells with areas of lamellated calcification",
"B": "Small blue cells arranged in rosettes around a central neuropil",
"C": "Hypercellular areas of spindle cells and hypocellular areas of myxoid stroma",
"D": "Cells with clear cytoplasm and central round nucleus resembling a fri... | step1 | C | [
"40 year old woman",
"physician",
"of",
"2 month history",
"frequent episodes",
"vertigo",
"feeling unsteady",
"walking",
"reports",
"episodic tinnitus",
"right ear",
"past",
"years",
"Neurologic examination shows hearing loss in",
"right ear",
"MRI of",
"brain",
"shown",
"Pathol... |
A 47-year-old female presents to her primary physician for follow up after an ED visit for nephrolithiasis 1 week prior. CT scan in the ED revealed a 4-mm stone occluding the right ureter. She was able to pass the stone without assistance over the course of 5 hours. Pathology report on the stone states it was composed ... | Decreasing sodium intake | {
"A": "Decreasing calcium intake",
"B": "Decreasing sodium intake",
"C": "Increasing consumption of nuts and seeds",
"D": "Urine acidification with cranberry juice"
} | step2&3 | B | [
"year old female presents",
"primary physician",
"follow up",
"ED visit",
"nephrolithiasis prior",
"CT scan",
"ED revealed",
"4-mm stone occluding",
"right ureter",
"able to pass",
"stone",
"assistance",
"course",
"hours",
"Pathology report",
"stone states",
"calcium oxalate",
"pai... |
A 62-year-old man comes to the physician because of worsening involuntary movements of both arms for the past 7 months. He reports that certain daily activities have become more difficult to perform. His father had a similar condition that was treated with medications. The patient appears anxious. Vital signs are withi... | Propranolol therapy | {
"A": "Deep brain stimulation",
"B": "Thalamotomy",
"C": "Levodopa and carbidopa therapy",
"D": "Propranolol therapy"
} | step2&3 | D | [
"62 year old man",
"physician",
"worsening involuntary movements",
"arms",
"past",
"months",
"reports",
"certain daily activities",
"more difficult to perform",
"father",
"similar condition",
"treated with medications",
"patient appears anxious",
"Vital signs",
"normal limits",
"Examin... |
Ten days after undergoing a cadaveric renal transplant, a 21-year-old man has pain in the right lower abdomen and generalized fatigue. During the past 2 days, he has had decreasing urinary output. He passed 5 liters of urine on the second postoperative day and serum studies showed a creatinine concentration of 2.1 mg/d... | Recipient T-cells in the graft | {
"A": "Recipient T-cells in the graft",
"B": "Drug-induced nephrotoxicity",
"C": "Fibrosis of the glomerular vessels",
"D": "Newly formed anti-HLA antibodies\n\""
} | step2&3 | A | [
"Ten days",
"cadaveric renal transplant",
"21-year-old man",
"pain",
"right lower abdomen",
"generalized fatigue",
"past 2 days",
"decreasing urinary output",
"passed 5 liters",
"urine",
"second postoperative day",
"serum studies showed",
"creatinine concentration",
"2",
"mg dL",
"adul... |
A 58-year-old woman presents to the office for routine follow-up. She recently underwent routine screening for bone density due to a history of hypothyroidism. She also has a history of gastroesophageal reflux disease (GERD) that is being treated with a proton-pump inhibitor (PPI) and more recently with a histamine2 re... | Proton-pump inhibitors | {
"A": "Proton-pump inhibitors",
"B": "Thiazide diuretics",
"C": "Lithium",
"D": "Estrogen"
} | step2&3 | A | [
"58 year old woman presents",
"office",
"routine follow-up",
"recently",
"routine screening",
"bone density due to",
"history of hypothyroidism",
"history of gastroesophageal reflux disease",
"treated with",
"proton-pump inhibitor",
"more recently",
"histamine2 receptor antagonist",
"hyperte... |
A 46-year-old man is brought to the emergency department 15 minutes after being involved in a motor vehicle collision where he was the unrestrained driver. On arrival, he is unconscious. His respirations are 24/min, and palpable systolic blood pressure is 60 mm Hg, and pulse is 141/min and irregularly irregular. Examin... | Cardiac contusion | {
"A": "Cardiac contusion",
"B": "Hemothorax",
"C": "Aortic dissection",
"D": "Pulmonary contusion"
} | step2&3 | A | [
"year old man",
"brought",
"emergency department 15 minutes",
"involved",
"motor vehicle collision",
"driver",
"arrival",
"unconscious",
"respirations",
"min",
"palpable systolic blood pressure",
"60 mm Hg",
"pulse",
"min",
"irregular",
"Examination shows multiple ecchymoses",
"chest... |
A 65-year-old man with a longstanding history of poorly-controlled hypertension and no recent illness or cardiac disease presents to clinic complaining of chest pain that is worse on inspiration and relieved by sitting forward. Vital signs are stable. On exam, you detect a friction rub. Routine labs show K 7.5 and Cr 5... | Broad and waxy casts | {
"A": "Muddy brown granular casts",
"B": "Red blood cell casts",
"C": "Fatty casts",
"D": "Broad and waxy casts"
} | step1 | D | [
"65-year-old man",
"history of poorly controlled hypertension",
"recent illness",
"cardiac disease presents",
"clinic",
"of chest pain",
"worse",
"inspiration",
"relieved by sitting forward",
"Vital signs",
"stable",
"exam",
"detect",
"friction rub",
"Routine labs show K",
"5",
"Cr 5... |
A 56-year-old man of Korean descent visits his primary care provider for an annual health check-up. His personal history is relevant for cigarette smoking and a sedentary lifestyle. He has type-2 diabetes mellitus which is under control with oral medications. Upon physical examination, he is found to have a blood press... | Upper gastointestinal endoscopy | {
"A": "Chest radiograph",
"B": "Upper gastointestinal endoscopy",
"C": "Magnetic resonance imaging of the brain",
"D": "Ultrasound of the neck"
} | step2&3 | B | [
"year old man",
"Korean descent visits",
"primary care provider",
"annual health check-up",
"personal history",
"relevant",
"cigarette smoking",
"sedentary lifestyle",
"type-2 diabetes mellitus",
"control",
"oral medications",
"physical examination",
"found to",
"blood pressure",
"70 mm ... |
A 46-year-old woman presents with a 5-month history of worsening dry cough, occasional shortness of breath, and fatigue. She says she is now having trouble walking a full block. For the past week, she also has noticed bilateral swelling of the lower legs. She denies chest pain, fever, chills, syncope, or bloody sputum.... | Echocardiography | {
"A": "Bronchoalveolar wash",
"B": "Pulmonary function studies",
"C": "Echocardiography",
"D": "Chest CT"
} | step1 | C | [
"year old woman presents",
"month history",
"worsening dry cough",
"occasional shortness of breath",
"fatigue",
"now",
"walking",
"full block",
"past week",
"bilateral swelling of",
"lower legs",
"denies chest pain",
"fever",
"chills",
"syncope",
"bloody sputum",
"Current",
"includ... |
A 67-year-old woman with depression comes to the physician because of easy bruising and bleeding of her gums for the past 2 months. She has been living alone since the death of her husband 1 year ago. She appears thin and has temporal wasting bilaterally. Physical examination shows bruises on her lower legs, swollen gu... | Glycine | {
"A": "Glycine",
"B": "Proline",
"C": "Lysine",
"D": "Arginine"
} | step1 | A | [
"67 year old woman",
"depression",
"physician",
"easy bruising",
"bleeding",
"gums",
"past",
"months",
"living alone",
"death",
"husband",
"year",
"appears thin",
"temporal wasting",
"Physical examination shows bruises",
"lower legs",
"swollen gums",
"petechiae",
"hard palate",
... |
A 49-year-old female with a history of alcoholism was found lying unconscious on a bench at a local park and rushed to the emergency department. Upon arrival, the patient regained consciousness and complained of intense bilateral flank pain and a recent decrease in urination. Urine microscopy demonstrated abundant squa... | Anion gap metabolic acidosis | {
"A": "Anion gap metabolic acidosis",
"B": "Non-anion gap metabolic acidosis",
"C": "Respiratory acidosis",
"D": "Respiratory alkalosis"
} | step1 | A | [
"year old female",
"history of alcoholism",
"found lying unconscious",
"local park",
"rushed",
"emergency department",
"arrival",
"patient regained consciousness",
"intense bilateral flank pain",
"recent decrease",
"urination",
"Urine microscopy",
"abundant square crystals",
"calcium oxala... |
A 53-year-old man comes to the physician for a follow-up appointment three days after being prescribed a selective alpha-1 agonist. He reports improvement in his symptoms and has not experienced any adverse effects. This drug was most likely prescribed for which of the following conditions? | Nasal congestion due to a viral infection | {
"A": "Bronchospasm due to bronchial asthma",
"B": "Urinary hesitancy due to benign prostatic hyperplasia",
"C": "Nasal congestion due to a viral infection",
"D": "Blood pressure management prior to pheochromocytoma excision"
} | step1 | C | [
"year old man",
"physician",
"follow-up appointment three days",
"prescribed",
"selective alpha-1 agonist",
"reports improvement",
"symptoms",
"not experienced",
"adverse effects",
"drug",
"most likely prescribed",
"following conditions"
] |
A 31-year-old woman is brought to the emergency department with fever, right upper quadrant pain, and myalgia. Her boyfriend says she recently returned from a trip to Southeast Asia. She appears ill and is lethargic. Her temperature is 39°C (102.2°F). Physical examination shows jaundice and tender hepatomegaly. Laborat... | Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei | {
"A": "Hepatocytes with shrunken, eosinophilic cytoplasm and pyknotic nuclei",
"B": "Cystic spaces with scattered areas of cellular debris",
"C": "Basophilic adipocyte remnants, filled with calcifications",
"D": "Engorged hepatocytes with red blood cell infiltration\n\""
} | step1 | A | [
"31 year old woman",
"brought",
"emergency department",
"fever",
"right upper quadrant pain",
"myalgia",
"boyfriend",
"recently returned",
"trip",
"Southeast Asia",
"appears ill",
"lethargic",
"temperature",
"Physical examination shows jaundice",
"tender hepatomegaly",
"Laboratory stud... |
A 25-year-old man presents to his primary care physician for pain in his back. The patient describes the pain as feeling worse in the morning. He says it is a general stiffness that improves when he goes to the gym and lifts weights. He also states that his symptoms seem to improve when he leans forward or when he is c... | Punctate bleeding spots when dermatologic scales are removed | {
"A": "Diminished pulses in the lower extremity",
"B": "Narrowing of the spinal canal when standing upright",
"C": "Pain with elevation of his leg while laying down",
"D": "Punctate bleeding spots when dermatologic scales are removed"
} | step2&3 | D | [
"year old man presents",
"primary care physician",
"pain in",
"back",
"patient",
"pain",
"feeling worse",
"morning",
"general stiffness",
"improves",
"goes",
"lifts weights",
"states",
"symptoms",
"to",
"forward",
"cycling",
"patient",
"current smoker",
"sexually active",
"ad... |
A 9-month-old boy is brought to his pediatrician by his mother for a routine health checkup. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. He was breastfed for the first 3 months and then switched to cow’s milk and ... | Proper diet and iron supplementation | {
"A": "Iron supplementation only",
"B": "Proper diet and iron supplementation",
"C": "Multivitamins",
"D": "Proper diet only"
} | step1 | B | [
"month old boy",
"brought",
"pediatrician",
"mother",
"routine health checkup",
"boy",
"born",
"weeks gestation",
"spontaneous vaginal delivery",
"date",
"vaccines",
"meeting",
"developmental milestones",
"breastfed",
"first",
"months",
"then switched",
"cows milk",
"about two mo... |
A 39-year-old woman, with a history of thyroidectomy and primary hyperparathyroidism presents for surgical evaluation for a right adrenal mass. Preoperatively, which of the following medications should she receive to prevent a hypertensive emergency intraoperatively? | Phenoxybenzamine | {
"A": "Atenolol",
"B": "Labetolol",
"C": "Nifedipine",
"D": "Phenoxybenzamine"
} | step2&3 | D | [
"year old woman",
"history of thyroidectomy",
"primary hyperparathyroidism presents",
"surgical evaluation",
"right adrenal mass",
"following medications",
"receive to prevent",
"hypertensive emergency"
] |
A 58-year-old male is diagnosed with hypertension and started on daily propranolol after failing antihypertensive therapy with other medications. Three months later, his blood pressure appears to be adequately controlled on this therapy. While working in his garden one afternoon, the patient is stung by a wasp and expe... | Decreased heart rate | {
"A": "Decreased bronchodilation",
"B": "Increased motility of the gastrointestinal tract",
"C": "Decreased heart rate",
"D": "Increased heart rate"
} | step1 | C | [
"58 year old male",
"diagnosed",
"hypertension",
"started",
"daily propranolol",
"failing antihypertensive",
"medications",
"Three months later",
"blood pressure appears to",
"controlled",
"therapy",
"working",
"garden one afternoon",
"patient",
"stung",
"wasp",
"experiences",
"sev... |
An 8-year-old boy is brought to the physician by his parents for short stature. Neither his clothing nor his shoe size have changed over the past year. He also frequently bumps into obstacles such as furniture and has headaches at night. He is always thirsty for cold water and has been urinating more frequently. Three ... | Craniopharyngioma | {
"A": "Rathke cleft cyst",
"B": "Craniopharyngioma",
"C": "Multiple endocrine neoplasia",
"D": "Pituitary adenoma"
} | step2&3 | B | [
"year old boy",
"brought",
"physician",
"parents",
"short stature",
"clothing",
"shoe size",
"changed",
"past year",
"frequently",
"furniture",
"headaches",
"night",
"always thirsty",
"cold water",
"more frequently",
"Three years",
"asthma attack",
"treated with albuterol",
"on... |
A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation presents to the emergency department for clear vaginal discharge that started roughly 26 hours ago. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of any serious illnesses. She does not drink a... | Administer betamethasone, ampicillin, and proceed with cesarean section | {
"A": "Administer ampicillin and perform amnioinfusion",
"B": "Administer ampicillin and progesterone",
"C": "Administer betamethasone, ampicillin, and proceed with cesarean section",
"D": "Administer betamethasone, ampicillin, and proceed with induction of labor"
} | step2&3 | C | [
"31 year old woman",
"gravida 2",
"para 1",
"weeks",
"gestation presents",
"emergency department",
"clear vaginal discharge",
"started",
"hours",
"pregnancy",
"uncomplicated",
"first child",
"born",
"term",
"vaginal delivery",
"history",
"serious illnesses",
"not drink alcohol",
... |
A 63-year-old man comes to the emergency department because of a 4-day history of lower abdominal pain, fever, and nausea. He has a history of constipation. His temperature is 39.1°C (102.4°C). Abdominal examination shows left lower quadrant tenderness with no guarding or rebound. Laboratory studies show a leukocyte co... | Lysosomal enzymes | {
"A": "Staphylococcal coagulase",
"B": "Lipoteichoic acid",
"C": "Interleukin-3",
"D": "Lysosomal enzymes"
} | step1 | D | [
"63 year old man",
"emergency department",
"4-day history",
"lower abdominal pain",
"fever",
"nausea",
"history",
"constipation",
"temperature",
"4C",
"Abdominal examination shows left lower quadrant tenderness",
"guarding",
"Laboratory studies show",
"leukocyte count",
"mm3",
"CT scan... |
A researcher is studying risk factors for open-angle glaucoma in a group of elderly patients at a primary care clinic. He is curious if patients with diabetes (defined as fasting serum glucose ≥126 mg/dL on two separate readings) are at increased risk of developing open-angle glaucoma over time. Which of the following ... | The future risk of open-angle glaucoma is the same in patients with and those without diabetes | {
"A": "The future risk of open-angle glaucoma is the same in patients with and those without diabetes",
"B": "Having diabetes will not cause changes in risk of future open-angle glaucoma",
"C": "Diabetes is not associated with an increased prevalence of open-angle glaucoma",
"D": "Improved adherence to antidia... | step2&3 | A | [
"researcher",
"studying risk factors",
"open-angle glaucoma",
"a group",
"elderly patients",
"primary care clinic",
"curious",
"patients",
"diabetes",
"defined",
"fasting serum glucose",
"mg dL",
"two separate readings",
"increased risk",
"open-angle glaucoma",
"time",
"following",
... |
Background:
Some patients with severe asthma have frequent exacerbations associated with persistent eosinophilic inflammation despite continuous treatment with high-dose inhaled glucocorticoids with or without oral glucocorticoids.
Methods:
In this randomized, double-blind clinical trial we assigned 576 patients with r... | A type 1 error occurs when the null hypothesis is true but is rejected in error. | {
"A": "A type 1 error occurs when the null hypothesis is true but is rejected in error.",
"B": "A type 1 error occurs when the null hypothesis is false, yet is accepted in error.",
"C": "A type 1 error is a beta (β) error and is usually 0.1 or 0.2.",
"D": "A type 1 error is dependent on the confidence interval... | step2&3 | A | [
"Background",
"patients",
"severe asthma",
"frequent exacerbations associated with persistent eosinophilic",
"continuous treatment",
"high-dose inhaled glucocorticoids",
"oral glucocorticoids",
"Methods",
"randomized",
"double-blind clinical trial",
"assigned",
"patients",
"recurrent asthma ... |
A 30-year-old Japanese woman is brought to the emergency department after fainting at work. She says she was only unconscious for a moment and recovered quickly. She reports increasing fatigue and joint pain for the past 4 months. Her blood pressure is 90/60 mm Hg, and her temperature is 36.6°C (98.0°F). On physical ex... | Myocardial infarction | {
"A": "Myocardial infarction",
"B": "Tongue infarction",
"C": "Palpable purpura",
"D": "Polyneuropathy"
} | step2&3 | A | [
"30 year old Japanese woman",
"brought",
"emergency department",
"fainting",
"work",
"only unconscious",
"recovered",
"reports increasing fatigue",
"joint pain",
"past",
"months",
"blood pressure",
"90 60 mm Hg",
"temperature",
"36",
"98",
"physical examination",
"patient",
"full... |
A 25-year-old woman comes to the physician because of an acute, painful swelling of the left labia that she first noticed that morning. She also reports some pain while sitting and walking. She is sexually active with her boyfriend and states that she has been having pain during vaginal intercourse lately. She has no h... | Incision and drainage | {
"A": "Cryotherapy",
"B": "Incision and drainage",
"C": "Biopsy",
"D": "Trimethoprim-sulfamethoxazole"
} | step2&3 | B | [
"year old woman",
"physician",
"of",
"acute",
"painful swelling",
"the left labia",
"first",
"morning",
"reports",
"pain",
"sitting",
"walking",
"sexually active",
"boyfriend",
"states",
"pain",
"vaginal",
"history",
"serious illness",
"appears",
"temperature",
"100 4F",
... |
A 21-year-old female presents to the clinic requesting prenatal counseling. She was born with a disease that has led her to have recurrent upper respiratory infections throughout her life requiring antibiotic prophylaxis and chest physiotherapy as well as pancreatic enzyme replacement therapy. She marries a man (withou... | 9/100 | {
"A": "9/100",
"B": "1/10",
"C": "81/100",
"D": "9/10"
} | step1 | A | [
"21-year-old female presents",
"clinic requesting prenatal counseling",
"born",
"disease",
"led",
"to",
"recurrent upper respiratory infections",
"life",
"antibiotic prophylaxis",
"chest physiotherapy",
"pancreatic enzyme replacement therapy",
"marries",
"man",
"disease phenotype",
"popu... |
A 45-year-old woman presents to the physician with a history of headache, palpitations, and episodic diaphoresis. She was diagnosed with hypertension in the past and is now regularly taking antihypertensive medication (amlodipine 10 mg once daily). She has had a diffuse thyroid swelling for the past 4 months. She compl... | Multiple endocrine neoplasia (MEN) 2A | {
"A": "Von Hippel-Lindau syndrome",
"B": "Multiple endocrine neoplasia (MEN) 2A",
"C": "Multiple endocrine neoplasia (MEN) 2B",
"D": "Neurofibromatosis"
} | step2&3 | B | [
"year old woman presents",
"physician",
"history of headache",
"palpitations",
"episodic diaphoresis",
"diagnosed",
"hypertension",
"past",
"now",
"taking antihypertensive medication",
"amlodipine 10 mg",
"daily",
"diffuse thyroid swelling",
"past",
"months",
"pain",
"long bones of",... |
A 57-year-old man comes to the physician because of a 1-year history of increasing shortness of breath on exertion and a cough productive of a small amount of grayish-white phlegm. The cough had been initially nonproductive. He has not had fever or chest pain. He is originally from China and visits his family there onc... | Increased alveolar-arterial gradient | {
"A": "Increased alveolar-arterial gradient",
"B": "Bloody pleural effusion",
"C": "Concave flow-volume loop",
"D": "Increased diffusing capacity (DLCO)"
} | step2&3 | A | [
"57 year old man",
"physician",
"of",
"year history",
"increasing shortness",
"breath",
"exertion",
"cough productive",
"small",
"grayish white phlegm",
"cough",
"initially",
"not",
"fever",
"chest pain",
"China",
"visits",
"family",
"year",
"worked",
"car salesman",
"years... |
A 45-year-old woman presents with sudden-onset dyspnea. Her past medical history is significant for varicose veins in her lower extremities, well-controlled diabetes mellitus type 2, and a 25 pack-year smoking history. The patient currently takes metformin and pioglitazone. Family history is significant for her sister ... | Protein S deficiency | {
"A": "Distal peripheral microembolism",
"B": "Necrotizing fasciitis",
"C": "Protein S deficiency",
"D": "Waldenström macroglobulinemia"
} | step1 | C | [
"year old woman presents",
"sudden-onset dyspnea",
"past medical history",
"significant",
"varicose veins",
"lower extremities",
"well-controlled diabetes mellitus type 2",
"pack-year smoking history",
"patient currently takes metformin",
"pioglitazone",
"Family history",
"significant",
"sis... |
A 7-year-old boy is brought to the clinic by his mother with increasing swelling of his right jaw for the past 2 months. She notes that he has been treated several times with different antibiotics, but that they have not helped. She reports no recent history of fever, chills, or night sweats. The boy has no significant... | Epstein barr virus (EBV) | {
"A": "Bartonella henselae",
"B": "Cytomegalovirus (CMV)",
"C": "Epstein barr virus (EBV)",
"D": "Yersinia pestis"
} | step2&3 | C | [
"year old boy",
"brought",
"clinic",
"mother",
"increasing swelling",
"right jaw",
"past",
"months",
"notes",
"treated",
"times with different antibiotics",
"not helped",
"reports",
"recent history",
"fever",
"chills",
"night sweats",
"boy",
"significant medical history",
"Unit... |
A 3-year-old male was brought to the pediatrician with severe lip lacerations, with a portion of his tongue appearing to be bitten off, as well as missing portions of the fingers on his right hand. A family history is notable for two similar cases in male cousins on the mother's side. A urinalysis revealed a high level... | X-linked recessive | {
"A": "X-linked recessive",
"B": "X-linked dominant",
"C": "Autosomal dominant",
"D": "Maternally inherited mitochondrial defect"
} | step1 | A | [
"3 year old male",
"brought",
"pediatrician",
"severe lip lacerations",
"portion",
"tongue appearing to",
"bitten",
"missing portions",
"fingers",
"right hand",
"family history",
"notable",
"two similar cases",
"male cousins",
"mother's side",
"urinalysis revealed",
"high level",
"... |
An asymptomatic 65-year-old woman is found to have T-score of -2.6 SD on routine bone mineral density screening. She has a 10-year history of hypertension and an esophageal stricture due to severe gastroesophageal reflux disease. She was diagnosed with endometrial hyperplasia 20 years ago and treated with medroxyproges... | Deep vein thrombosis
" | {
"A": "Skin infections",
"B": "Osteosarcoma",
"C": "Hypercholesterolemia",
"D": "Deep vein thrombosis\n\""
} | step2&3 | D | [
"asymptomatic 65 year old woman",
"found to",
"T-score",
"2",
"SD",
"routine bone mineral density screening",
"a 10 year history of hypertension",
"esophageal stricture due to severe gastroesophageal reflux disease",
"diagnosed",
"endometrial hyperplasia 20 years",
"treated with medroxyprogester... |
A 28-year-old woman, gravida 1, para 0, at 20 weeks' gestation comes to the physician with her husband for a prenatal visit. Her pregnancy has been uncomplicated. They are planning to travel to Ethiopia next month to visit the husband's family. Medications include folic acid and an iron supplement. Vital signs are with... | Mefloquine | {
"A": "Doxycycline",
"B": "Mefloquine",
"C": "Chloroquine",
"D": "Proguanil"
} | step1 | B | [
"year old woman",
"gravida 1",
"para 0",
"20 weeks",
"gestation",
"physician",
"husband",
"prenatal visit",
"pregnancy",
"uncomplicated",
"planning to travel to Ethiopia next month to visit",
"husband's family",
"Medications include folic acid",
"iron supplement",
"Vital signs",
"norma... |
A 26-year-old man presents to the office complaining of persistent epigastric pain for the past 2 months. He states that his pain is worse a few hours after he eats. His father had similar symptoms. Past medical history is insignificant. He is a non-smoker and does not drink alcohol. The vital signs include blood press... | MEN1 | {
"A": "Gastroesophageal reflux disease",
"B": "Gastric adenocarcinoma, intestinal type",
"C": "VIPoma",
"D": "MEN1"
} | step1 | D | [
"year old man presents",
"office",
"persistent epigastric pain",
"past",
"months",
"states",
"pain",
"worse",
"few hours",
"eats",
"father",
"similar symptoms",
"Past medical history",
"non-smoker",
"not drink alcohol",
"vital signs include blood pressure",
"90 mm Hg",
"heart rate ... |
The parents of a 16-year-old boy with type 1 diabetes mellitus present requesting information about the drug, exenatide, an injectable drug that only needs to be administered once a week. The patient’s blood glucose levels have been difficult to control on his current insulin regimen due to poor adherence to recommende... | Insulin production by the pancreas is insufficient for exenatide to be effective. | {
"A": "Insulin production by the pancreas is insufficient for exenatide to be effective.",
"B": "Exenatide suppresses glucagon secretion, which increases the risk of hypoglycemia.",
"C": "Suppression of appetite makes it even harder for him to gain weight.",
"D": "Exenatide is contraindicated in children below... | step1 | A | [
"parents",
"year old boy",
"type 1 diabetes mellitus present requesting information",
"drug",
"exenatide",
"injectable drug",
"only needs to",
"administered once",
"week",
"patients blood glucose levels",
"difficult",
"control",
"current insulin regimen due to poor adherence",
"recommended... |
A 79-year-old woman comes to the physician for the evaluation of a 2-month history of a non-productive cough and fatigue. During this period, she also has had a 4.5-kg (10-lb) weight loss and has become increasingly short of breath with mild exertion. She has congestive heart failure and hypertension. Three months ago,... | Mesothelioma | {
"A": "Bronchial adenocarcinoma",
"B": "Mesothelioma",
"C": "Nephrotic syndrome",
"D": "Congestive heart failure"
} | step2&3 | B | [
"year old woman",
"physician",
"evaluation",
"month history",
"non-productive cough",
"fatigue",
"period",
"4.5 kg",
"10",
"weight loss",
"short of breath",
"mild exertion",
"congestive heart failure",
"hypertension",
"Three months",
"India",
"3 weeks to attend",
"family wedding",
... |
A 25-year-old woman comes to the physician because of irregular menstrual bleeding. Menses have occurred at 30- to 90-day intervals since menarche at the age of 12 years. Her last menstrual period was 6 weeks ago. She is sexually active with her husband and they do not use condoms. There is no personal or family histor... | Blood glucose and cholesterol level measurements | {
"A": "17-hydroxyprogesterone and cortisol level measurements",
"B": "CA-125 level measurement",
"C": "Blood glucose and cholesterol level measurements",
"D": "TSH and T4 level measurements"
} | step2&3 | C | [
"year old woman",
"physician",
"irregular menstrual bleeding",
"Menses",
"occurred",
"30",
"90 day intervals",
"menarche at",
"age",
"years",
"last menstrual period",
"weeks",
"sexually active",
"husband",
"not use condoms",
"personal",
"family history",
"serious illness",
"5 ft"... |
A 51-year-old woman goes to respiratory function testing in order to evaluate her shortness of breath. She recently joined a walking program with her friends in order to lose weight; however, she noticed that she was not able to keep up with her friends during the program. She has a 60-pack-year history of smoking as w... | 480 mL | {
"A": "480 mL",
"B": "600 mL",
"C": "800 mL",
"D": "1200 mL"
} | step1 | A | [
"year old woman goes",
"respiratory function testing",
"order to evaluate",
"shortness of breath",
"recently",
"walking program",
"friends",
"order to",
"weight",
"not able to keep",
"friends",
"program",
"60 pack-year history of smoking",
"hypertension well-controlled",
"medication",
... |
A 44-year-old woman comes to the physician because of a 6-month history of fatigue, intermittent fever, a 4.0-kg (8.8-lb) weight loss, and a progressive, non-productive cough. She does not smoke. Physical examination shows mild wheezing over bilateral lung fields and enlarged supraclavicular and cervical lymph nodes. A... | Prednisone | {
"A": "Cisplatin",
"B": "Lamivudine",
"C": "Isoniazid",
"D": "Prednisone"
} | step1 | D | [
"year old woman",
"physician",
"month history",
"fatigue",
"intermittent fever",
"4 0 kg",
"8.8",
"weight loss",
"progressive",
"non-productive cough",
"not smoke",
"Physical examination shows mild wheezing",
"bilateral lung fields",
"enlarged supraclavicular",
"cervical lymph nodes",
... |
A 55-year-old nulligravid woman comes to the physician because of a 3-day history of heavy vaginal bleeding, requiring more than 5 pads per day. Menopause occurred 1 year ago. She attained menarche at 10 years of age. She has a history of hypothyroidism and type 2 diabetes mellitus. She has smoked 1 pack of cigarettes ... | Progestin therapy | {
"A": "Total hysterectomy",
"B": "Estrogen vaginal cream",
"C": "Reassurance and follow-up",
"D": "Progestin therapy"
} | step2&3 | D | [
"55 year old nulligravid woman",
"physician",
"3 history",
"heavy vaginal bleeding",
"more",
"pads",
"day",
"Menopause occurred 1 year",
"menarche at 10 years",
"age",
"history of hypothyroidism",
"type 2 diabetes mellitus",
"smoked 1 pack",
"cigarettes daily",
"20 years",
"quit",
"y... |
A 37-year-old woman with an HIV infection comes to the physician for a follow-up examination. Six months ago, combined antiretroviral therapy consisting of dolutegravir, tenofovir, and emtricitabine was initiated. Laboratory studies show a decrease in the CD4 count and an increase in the viral load despite ongoing trea... | Efavirenz | {
"A": "Efavirenz",
"B": "Ritonavir",
"C": "Raltegravir",
"D": "Lamivudine\n\""
} | step1 | A | [
"year old woman",
"HIV infection",
"physician",
"follow-up examination",
"Six months",
"combined antiretroviral consisting",
"dolutegravir",
"tenofovir",
"emtricitabine",
"initiated",
"Laboratory studies show",
"decrease",
"CD4 count",
"increase",
"viral load",
"ongoing treatment",
"... |
A 14-year-old girl presents with sudden drooping of the right side of her face with drooling and excessive tearing. The patient’s mother says that the patient was recently in northern Maine and spent most of her time during the trip outdoors. Physical examination reveals a slight asymmetry of the facial muscles with an... | Ixodes scapularis | {
"A": "Ixodes scapularis",
"B": "Tsetse fly",
"C": "Culicidae",
"D": "Anopheles"
} | step1 | A | [
"year old girl presents",
"sudden",
"of",
"right side",
"face",
"drooling",
"excessive tearing",
"patients mother",
"patient",
"recently",
"northern Maine",
"spent most of",
"time",
"trip outdoors",
"Physical examination reveals",
"slight asymmetry",
"facial",
"whistle",
"close",... |
A 66-year-old man with high blood pressure, high cholesterol, and diabetes presents to the clinic with elevated liver function tests from baseline. He has a blood pressure of 136/92 mm Hg and a heart rate of 69/min. On physical examination, his heart sounds are regular and lung sounds are clear. Current medications inc... | Simvastatin | {
"A": "Metformin",
"B": "Simvastatin",
"C": "Glyburide",
"D": "Lisinopril"
} | step2&3 | B | [
"66 year old man",
"high blood pressure",
"high cholesterol",
"diabetes presents",
"clinic",
"elevated liver function tests",
"baseline",
"blood pressure",
"mm Hg",
"heart rate",
"69 min",
"physical examination",
"heart sounds",
"regular",
"lung sounds",
"clear",
"Current medications... |
A 7 -day-old newborn boy presents to the emergency department with a history of fever, irritability, and generalized erythema. During the first 2 days of clinical manifestations, the parents of the child tried to control the symptoms using acetaminophen; however, the newborn continued to be ill, and blisters were notic... | Scalded skin syndrome | {
"A": "Scarlet fever",
"B": "Scalded skin syndrome",
"C": "Impetigo",
"D": "Pyoderma"
} | step1 | B | [
"day old newborn boy presents",
"emergency department",
"history",
"fever",
"irritability",
"generalized erythema",
"first 2 days of clinical manifestations",
"parents of",
"child",
"to control",
"symptoms using acetaminophen",
"newborn continued to",
"ill",
"blisters",
"buttocks",
"ha... |
A 60-year-old woman presents to the outpatient clinic complaining of severe vulvar itching that has been gradually worsening for the past year. She mentions that she has tried over-the-counter lubricants, but lubricants do not seem to provide substantial relief. Her medical history is remarkable for diet-controlled typ... | Lichen sclerosus | {
"A": "Squamous cell hyperplasia",
"B": "Lichen sclerosus",
"C": "Squamous cell carcinoma of the vulva",
"D": "Lichen planus"
} | step2&3 | B | [
"60 year old woman presents",
"outpatient clinic",
"severe vulvar itching",
"worsening",
"past year",
"over-the-counter lubricants",
"lubricants",
"not",
"to provide",
"relief",
"medical history",
"diet-controlled type 2 diabetes mellitus",
"hypertension treated with hydrochlorothiazide",
... |
A 50-year-old woman with Systemic Lupus Erythematosus (SLE) presents to your clinic with complaints of left eye pain and reduced vision. She notes that she was in her usual state of health until 3 days prior to presentation when she noticed some mild tenderness around her left eye, unrelieved by any pain relievers. Thi... | Bilateral miosis | {
"A": "Bilateral miosis",
"B": "Miosis of the right eye only",
"C": "Miosis of the left eye only",
"D": "Mydriasis of the left eye"
} | step1 | A | [
"50 year old woman",
"Systemic Lupus Erythematosus",
"presents",
"clinic",
"complaints of left eye pain",
"reduced vision",
"notes",
"usual state of health",
"3 days prior to presentation",
"mild tenderness",
"left",
"pain relievers",
"morning",
"woke up",
"unable to see out",
"left ey... |
A 25-year-old woman presents to the emergency department with abdominal pain. She states that she was walking up the stairs at work when she felt sudden and severe abdominal pain followed by nausea and vomiting. Her past medical history is non-contributory and she is not currently taking any medications. Her temperatur... | Laparoscopy | {
"A": "Laparoscopy",
"B": "Laparotomy",
"C": "MRI of the pelvis",
"D": "Observation and serial abdominal exams"
} | step2&3 | A | [
"year old woman presents",
"emergency department",
"abdominal pain",
"states",
"walking",
"stairs",
"work",
"felt sudden",
"severe abdominal followed by nausea",
"vomiting",
"past medical history",
"non contributory",
"not currently taking",
"medications",
"temperature",
"99",
"blood... |
A 65-year-old man comes to the physician because of progressively worsening fatigue for 6 months. During this time, he has also had shortness of breath and palpitations on exertion. He has noticed blood in his stools on three separate occasions in the past 4 months. He has type 2 diabetes mellitus and end-stage renal d... | Arteriovenous malformation in the colonic wall | {
"A": "Inflammation in an outpouching of the colonic wall",
"B": "Symptomatic enlargement of hemorrhoidal plexus",
"C": "Chronic mucosal and submucosal inflammation of the colon",
"D": "Arteriovenous malformation in the colonic wall"
} | step2&3 | D | [
"65 year old man",
"physician",
"worsening fatigue",
"months",
"time",
"shortness of breath",
"palpitations",
"exertion",
"blood in",
"stools",
"three separate occasions",
"past",
"months",
"type 2 diabetes mellitus",
"end-stage renal disease",
"drinks two",
"four beers daily",
"no... |
A 24-year-old woman comes to the emergency department with her boyfriend 2 hours after an episode of loss of consciousness. She was seated and was being tattooed on her right upper flank when she became diaphoretic, pale, and passed out. According to her boyfriend, the patient slipped to the floor and her arms and legs... | Vasovagal syncope | {
"A": "Vasovagal syncope",
"B": "Orthostatic syncope",
"C": "Cardiac arrhythmia",
"D": "Cardiac structural abnormality\n\""
} | step2&3 | A | [
"year old woman",
"emergency department",
"boyfriend",
"hours",
"episode of loss",
"consciousness",
"seated",
"tattooed",
"right flank",
"diaphoretic",
"pale",
"passed out",
"boyfriend",
"patient slipped",
"floor",
"arms",
"legs moved",
"jerky",
"few seconds",
"regained conscio... |
A 15-year-old boy is brought to the emergency department 1 hour after falling from his bicycle. The boy was racing with his cousin when he lost control and fell onto his right side. He has nausea and severe pain in the right shoulder. He is in acute distress. His temperature is 37°C (98.6°F), pulse is 85/min, respirati... | Apply a simple shoulder sling | {
"A": "Perform tension banding",
"B": "Apply a simple shoulder sling",
"C": "Obtain an MRI of the right shoulder",
"D": "Perform arteriography"
} | step2&3 | B | [
"year old boy",
"brought",
"emergency department",
"hour",
"falling",
"bicycle",
"boy",
"racing",
"cousin",
"lost control",
"fell",
"right side",
"nausea",
"severe pain in",
"right shoulder",
"acute distress",
"temperature",
"98",
"pulse",
"85 min",
"respirations",
"min",
... |
A 51-year-old man is brought to the physician by his wife because of a 3-week history of abnormal behavior. His wife reports he has been preoccupied with gambling at the local casino. He becomes restless and irritable when his wife attempts to restrict his gambling. Four months ago, he was diagnosed with Parkinson dise... | Direct activation of dopamine receptors | {
"A": "Peripheral inhibition of DOPA decarboxylase",
"B": "Direct activation of dopamine receptors",
"C": "Selective inhibition of monoamine oxidase B",
"D": "Inhibition of catechol-O-methyl transferase"
} | step1 | B | [
"year old man",
"brought",
"physician",
"wife",
"week history",
"abnormal behavior",
"wife reports",
"gambling",
"local casino",
"restless",
"irritable",
"wife attempts to restrict",
"gambling",
"Four months",
"diagnosed",
"Parkinson disease",
"treatment",
"initiated",
"following... |
A 55-year-old woman with no significant past medical history presents to her primary care doctor with fever, fatigue, and bleeding gums for the past 3 days. She denies any sick contacts. Her temperature is 101°F (38.3°C), blood pressure is 110/70 mmHg, pulse is 96/min, and respirations are 15/min. Physical exam reveals... | Retinoic acid | {
"A": "Ascorbic acid",
"B": "Fresh frozen plasma",
"C": "Retinoic acid",
"D": "Zoledronic acid"
} | step2&3 | C | [
"55 year old woman",
"significant past medical history presents",
"primary care doctor",
"fever",
"fatigue",
"bleeding gums",
"past 3 days",
"denies",
"sick contacts",
"temperature",
"3C",
"blood pressure",
"70 mmHg",
"pulse",
"96 min",
"respirations",
"min",
"Physical exam reveals... |
A 30-year-old man presents to the emergency room complaining of malaise. Two hours prior to presentation, he developed muscle cramps and nausea. He has had 3 episodes of non-bloody watery stools since his symptoms started. He reports that he has experienced similar symptoms multiple times over the past 5 years since he... | Blocking antibody attack on the O antigen | {
"A": "ADP ribosylation of elongation factor 2",
"B": "Blocking antibody attack on the O antigen",
"C": "Cleaving immunoglobulin A molecules",
"D": "Cleaving lecithin"
} | step1 | B | [
"30 year old man presents",
"emergency room",
"malaise",
"Two hours",
"presentation",
"muscle cramps",
"nausea",
"3 episodes of non bloody watery",
"symptoms started",
"reports",
"similar symptoms multiple times",
"past",
"years",
"started working",
"local",
"caretaker",
"medical his... |
A 62-year-old man is brought to the physician by his wife because of difficulties walking for the past year. He has had multiple falls over the past 4 months. Over the past 6 months, he has had progressive urinary urgency and now wears an adult diaper as is not always able to control the urge to void. His appetite has ... | Ventricular shunting | {
"A": "Ventricular shunting",
"B": "Acetazolamide therapy",
"C": "Temporal lobectomy",
"D": "Donepezil therapy"
} | step2&3 | A | [
"62 year old man",
"brought",
"physician",
"wife",
"difficulties walking",
"past year",
"multiple falls",
"past",
"months",
"past 6 months",
"progressive urinary urgency",
"now",
"adult diaper as",
"not always able to control",
"void",
"appetite",
"decreased",
"time period",
"use... |
A 40-year-old woman with Down syndrome comes to the physician for the evaluation of fatigue, progressive clumsiness when using her hands, and difficulty walking for 3 months. During this period, the patient has had several episodes of dizziness as well as double vision. She also reports that she has lost control of her... | Surgical fusion of C1/C2 | {
"A": "Administration of botulism antitoxin",
"B": "Surgical fusion of C1/C2",
"C": "Administration of methylprednisolone",
"D": "Administration of pyridostigmine\n\""
} | step2&3 | B | [
"40 year old woman",
"Down syndrome",
"physician",
"evaluation",
"fatigue",
"progressive clumsiness",
"using",
"hands",
"difficulty walking",
"months",
"period",
"patient",
"several episodes of dizziness",
"double vision",
"reports",
"lost control",
"bladder",
"several occasions",
... |
A 74-year-old woman with a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus is brought to her primary care doctor by her son who is concerned about the patient's ability to manage her activities of daily living. She has been living alone since her husband passed away 2 years ago. She has remained a... | Delirium | {
"A": "Alzheimer dementia",
"B": "Delirium",
"C": "Lewy body dementia",
"D": "Normal pressure hydrocephalus"
} | step1 | B | [
"74 year old woman",
"history of hypertension",
"hyperlipidemia",
"type 2 diabetes mellitus",
"brought",
"primary care doctor",
"son",
"concerned",
"patient's ability to",
"activities of daily living",
"living alone",
"husband passed",
"years",
"active member",
"retirement community's wi... |
A 45-year-old male with a history of diabetes and poorly controlled hypertension presents to his primary care physician for an annual check-up. He reports that he feels well and has no complaints. He takes enalapril and metformin. His temperature is 98.8°F (37.1°C), blood pressure is 155/90 mmHg, pulse is 80/min, and r... | Nifedipine | {
"A": "Metoprolol",
"B": "Verapamil",
"C": "Nifedipine",
"D": "Hydrochlorthiazide"
} | step1 | C | [
"year old male",
"history",
"diabetes",
"poorly controlled hypertension presents",
"primary care physician",
"annual check-up",
"reports",
"feels well",
"complaints",
"takes enalapril",
"metformin",
"temperature",
"98",
"blood pressure",
"90 mmHg",
"pulse",
"80 min",
"respirations"... |
A 29-year-old woman comes to the physician with high-grade fever, headache, and muscle pain. A week ago, she returned from India, where she was working with an NGO to build houses in rural areas. The patient took one dose of chloroquine one week before her trip. She also took a further dose during her trip. She has no ... | Plasmodium falciparum | {
"A": "Plasmodium ovale",
"B": "Plasmodium falciparum",
"C": "Chikungunya virus",
"D": "Hepatitis A virus"
} | step2&3 | B | [
"29 year old woman",
"physician",
"high-grade fever",
"headache",
"muscle pain",
"week",
"returned",
"India",
"working",
"build houses",
"rural areas",
"patient took one dose",
"chloroquine",
"week",
"trip",
"took",
"further dose",
"trip",
"history",
"serious illness",
"tempe... |
A 39-year-old woman presents to the clinic for her annual physical. Although she feels generally healthy she has noticed gaining about 9 kg (20 lb) over the last year. She eats a healthy, varied diet and exercises at the gym 4 days a week, including 20 minutes of aerobic exercise. On further questioning, she has also n... | Thyroid-stimulating hormone (TSH) | {
"A": "Glucose",
"B": "Triiodothyronine (T3)",
"C": "Thyroxine (T4)",
"D": "Thyroid-stimulating hormone (TSH)"
} | step2&3 | D | [
"year old woman presents",
"clinic",
"annual physical",
"feels",
"healthy",
"gaining",
"kg",
"20",
"last year",
"eats",
"healthy",
"varied diet",
"exercises",
"4 days",
"week",
"including 20 minutes",
"aerobic exercise",
"further questioning",
"noted fatigue",
"constipation",
... |
A 38-year-old woman comes to the physician because of persistent diarrhea and fatigue for 1 month. She has had up to 12 watery stools per day. Sometimes she awakens at night because she has to defecate. She has abdominal bloating and cramps. She has had a 2-kg weight loss in the past month. She returned from a trip to ... | Medication abuse | {
"A": "Celiac disease",
"B": "Carcinoid tumor",
"C": "VIPoma",
"D": "Medication abuse"
} | step2&3 | D | [
"year old woman",
"physician",
"persistent diarrhea",
"fatigue",
"month",
"up to",
"watery stools",
"day",
"Sometimes",
"night",
"abdominal bloating",
"cramps",
"2 kg weight loss",
"past month",
"returned",
"trip",
"Costa Rica",
"weeks",
"history of bronchial asthma",
"bulimia ... |
A 21-year-old college student comes to the physician because of daytime fatigue for 2 months. He has problems getting to sleep at night and frequently falls asleep during class. Recently he has started skipping classes altogether. He goes to bed between 11 p.m. and 1 a.m. but cannot fall asleep for 2–3 hours. When he w... | Stop evening exercise | {
"A": "Trial of diphenhydramine",
"B": "Stop evening exercise",
"C": "Alcoholic beverage prior to bedtime",
"D": "Scheduled afternoon naps"
} | step2&3 | B | [
"21-year-old college student",
"physician",
"of daytime fatigue",
"months",
"problems getting to sleep",
"night",
"frequently falls asleep",
"class",
"Recently",
"started skipping classes",
"goes",
"bed",
"m",
"1",
"m",
"fall asleep",
"23 hours",
"wakes up",
"30",
"m",
"feels... |
A 19-year-old man is brought to the physician by his mother because she is worried about his strange behavior. Over the past 3 years, he has been dressing all in black and wears a long black coat, even in the summer. The mother reports that her son has always had difficulties fitting in. He does not have any friends an... | Schizotypal personality disorder | {
"A": "Social anxiety disorder",
"B": "Avoidant personality disorder",
"C": "Schizotypal personality disorder",
"D": "Schizophrenia"
} | step2&3 | C | [
"year old man",
"brought",
"physician",
"mother",
"worried",
"strange behavior",
"past",
"years",
"dressing",
"black",
"long black coat",
"summer",
"mother reports",
"son",
"always",
"difficulties fitting",
"not",
"friends",
"spends most of",
"time",
"room playing",
"games"... |
A 79-year-old man presents to the office due to shortness of breath with moderate exertion and a slightly productive cough. He has a medical history of 25 years of heavy smoking. His vitals include: heart rate 89/min, respiratory rate 27/min, and blood pressure 120/90 mm Hg. The physical exam shows increased resonance ... | Chronic obstructive pulmonary disease (COPD) | {
"A": "Asthma",
"B": "Lymphangioleiomyomatosis",
"C": "Chronic obstructive pulmonary disease (COPD)",
"D": "Heart failure"
} | step1 | C | [
"year old man presents",
"office due to shortness of breath",
"moderate exertion",
"slightly productive cough",
"medical history of",
"years",
"heavy smoking",
"include",
"heart rate",
"min",
"respiratory rate 27 min",
"blood pressure",
"90 mm Hg",
"physical exam shows increased resonance"... |
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