src/data/questions.js

export const sampleQuestions = {
  step1: [
    {
      id: 1,
      text: "A 32-year-old woman with a history of systemic lupus erythematosus (SLE) presents to the clinic with a 3-day history of shortness of breath and pleuritic chest pain. Physical examination reveals decreased breath sounds at the right lung base. Which of the following is the most likely diagnosis?",
      options: [
        { label: 'A', text: 'Pulmonary embolism' },
        { label: 'B', text: 'Pleural effusion' },
        { label: 'C', text: 'Acute myocardial infarction' },
        { label: 'D', text: 'Pneumothorax' },
        { label: 'E', text: 'Acute respiratory distress syndrome' }
      ],
      image: null
    },
    {
      id: 2,
      text: "A 45-year-old male with type 2 diabetes mellitus and hypertension is found to have a serum creatinine of 2.1 mg/dL (normal: 0.7-1.3 mg/dL) and urine protein of 3.2 g/24 hours. His blood pressure is 156/98 mmHg despite treatment with an ACE inhibitor. Which medication should be added to his regimen?",
      options: [
        { label: 'A', text: 'Thiazide diuretic' },
        { label: 'B', text: 'Beta-blocker' },
        { label: 'C', text: 'Angiotensin II receptor blocker' },
        { label: 'D', text: 'Calcium channel blocker' },
        { label: 'E', text: 'Aldosterone antagonist' }
      ],
      image: null
    },
    {
      id: 3,
      text: "A 28-year-old woman at 20 weeks gestation presents with nausea, vomiting, and fatigue. Laboratory studies show hemoglobin of 8.2 g/dL (normal: 12-16 g/dL), MCV of 72 fL (normal: 80-100 fL), and serum iron of 25 μg/dL (normal: 50-150 μg/dL). Which of the following is the most appropriate initial treatment?",
      options: [
        { label: 'A', text: 'Blood transfusion' },
        { label: 'B', text: 'Ferrous sulfate supplementation' },
        { label: 'C', text: 'Vitamin B12 injections' },
        { label: 'D', text: 'Folic acid supplementation only' },
        { label: 'E', text: 'Erythropoietin therapy' }
      ],
      image: null
    },
    {
      id: 4,
      text: "A 52-year-old man with a 20-year history of smoking presents with a 3-month history of nonproductive cough and weight loss of 8 kg. Chest X-ray shows a 2-cm peripheral nodule in the right lower lobe. Which of the following is the next best step in management?",
      options: [
        { label: 'A', text: 'Repeat chest X-ray in 3 months' },
        { label: 'B', text: 'CT scan of the chest with contrast' },
        { label: 'C', text: 'Sputum cytology' },
        { label: 'D', text: 'Chest CT with bronchoscopy' },
        { label: 'E', text: 'Immediate thoracotomy' }
      ],
      image: null
    },
    {
      id: 5,
      text: "A 6-year-old boy is brought to the emergency department with a 2-day history of fever, sore throat, and difficulty swallowing. Physical examination reveals bilateral enlargement of the palatine tonsils with gray-white exudate. Which is the most likely organism?",
      options: [
        { label: 'A', text: 'Streptococcus pneumoniae' },
        { label: 'B', text: 'Group A Streptococcus' },
        { label: 'C', text: 'Haemophilus influenzae' },
        { label: 'D', text: 'Epstein-Barr virus' },
        { label: 'E', text: 'Corynebacterium diphtheriae' }
      ],
      image: null
    },
    {
      id: 6,
      text: "A 34-year-old woman presents with a 6-month history of progressive difficulty with memory and concentration, along with frequent headaches. MRI shows multiple white matter lesions. CSF analysis reveals elevated protein and oligoclonal bands. Which disease is most likely?",
      options: [
        { label: 'A', text: 'Multiple sclerosis' },
        { label: 'B', text: 'Lyme disease' },
        { label: 'C', text: 'Neurosyphilis' },
        { label: 'D', text: 'Progressive multifocal leukoencephalopathy' },
        { label: 'E', text: 'Herpes simplex encephalitis' }
      ],
      image: null
    },
    {
      id: 7,
      text: "A 67-year-old man with a history of benign prostatic hyperplasia and frequent urinary tract infections presents with dysuria and urinary frequency. Urinalysis shows pyuria and bacteriuria. Urine culture is pending. Which antibiotic is most appropriate for empiric treatment?",
      options: [
        { label: 'A', text: 'Nitrofurantoin' },
        { label: 'B', text: 'Trimethoprim-sulfamethoxazole' },
        { label: 'C', text: 'Amoxicillin' },
        { label: 'D', text: 'Doxycycline' },
        { label: 'E', text: 'Metronidazole' }
      ],
      image: null
    },
    {
      id: 8,
      text: "A 4-year-old boy presents with fever, joint pain, and a new cardiac murmur. Laboratory studies show elevated ESR and CRP. There is a history of untreated strep throat 3 weeks ago. Which cardiac valve is most commonly affected in acute rheumatic fever?",
      options: [
        { label: 'A', text: 'Tricuspid valve' },
        { label: 'B', text: 'Pulmonary valve' },
        { label: 'C', text: 'Mitral valve' },
        { label: 'D', text: 'Aortic valve' },
        { label: 'E', text: 'Multiple valves equally' }
      ],
      image: null
    },
    {
      id: 9,
      text: "A 58-year-old woman with chronic kidney disease (Stage 3b) comes for routine follow-up. Her most recent blood pressure reading is 148/92 mmHg. Current medications include metoprolol and lisinopril. Which medication should be added to improve her cardiovascular and renal outcomes?",
      options: [
        { label: 'A', text: 'Amlodipine' },
        { label: 'B', text: 'Losartan' },
        { label: 'C', text: 'Hydrochlorothiazide' },
        { label: 'D', text: 'Spironolactone' },
        { label: 'E', text: 'Enalapril' }
      ],
      image: null
    },
    {
      id: 10,
      text: "A 40-year-old man presents with intermittent abdominal pain, bloating, and alternating diarrhea and constipation for the past 2 years. Physical examination is unremarkable. Laboratory and colonoscopy results are normal. Which diagnosis is most likely?",
      options: [
        { label: 'A', text: 'Inflammatory bowel disease' },
        { label: 'B', text: 'Irritable bowel syndrome' },
        { label: 'C', text: 'Celiac disease' },
        { label: 'D', text: 'Colorectal cancer' },
        { label: 'E', text: 'Lactose intolerance' }
      ],
      image: null
    }
  ],
  step2: [
    {
      id: 1,
      text: "A 56-year-old man with a 3-year history of type 2 diabetes mellitus presents to the clinic complaining of intermittent episodes of severe chest pain, shortness of breath, and palpitations over the past week. On examination, you note an irregular heart rhythm. An ECG shows atrial fibrillation with a ventricular rate of 115 bpm. Which of the following is the initial management step?",
      options: [
        { label: 'A', text: 'Immediate synchronized cardioversion' },
        { label: 'B', text: 'Rate control with IV metoprolol and anticoagulation' },
        { label: 'C', text: 'Amiodarone IV infusion' },
        { label: 'D', text: 'Digoxin loading followed by maintenance' },
        { label: 'E', text: 'Observe and schedule elective cardioversion' }
      ],
      image: null
    },
    {
      id: 2,
      text: "A 45-year-old woman presents with a 4-week history of persistent cough, fever, night sweats, and unintentional weight loss of 6 kg. She is a lifelong non-smoker. Chest X-ray shows an infiltrate in the right upper lobe. You suspect tuberculosis. What is the next best step?",
      options: [
        { label: 'A', text: 'Start anti-TB therapy immediately' },
        { label: 'B', text: 'Obtain sputum samples for acid-fast bacilli smear and culture' },
        { label: 'C', text: 'Perform a tuberculin skin test' },
        { label: 'D', text: 'Order a high-resolution CT scan' },
        { label: 'E', text: 'Administer bronchodilators' }
      ],
      image: null
    },
    {
      id: 3,
      text: "A 28-year-old primigravida at 32 weeks gestation presents with sudden onset of severe headache, visual disturbances, and upper abdominal pain. Blood pressure is 165/105 mmHg. Laboratory studies show proteinuria (3.5 g/24 hours), thrombocytopenia (80,000/μL), and elevated liver enzymes. What is the immediate management?",
      options: [
        { label: 'A', text: 'Start magnesium sulfate and plan delivery' },
        { label: 'B', text: 'Administer labetalol and observe' },
        { label: 'C', text: 'Order a CT head and discharge home' },
        { label: 'D', text: 'Start antihypertensive therapy and expectant management' },
        { label: 'E', text: 'Perform immediate cesarean delivery without other interventions' }
      ],
      image: null
    },
    {
      id: 4,
      text: "A 65-year-old man with a history of COPD and 40 pack-years of smoking presents with hemoptysis. Chest X-ray shows a 3-cm mass in the left upper lobe. CT scan with contrast is obtained. Which finding would be most concerning for advanced disease?",
      options: [
        { label: 'A', text: 'Mass confined to the lung parenchyma' },
        { label: 'B', text: 'Mediastinal lymph node involvement' },
        { label: 'C', text: 'Small effusion' },
        { label: 'D', text: 'Atelectasis' },
        { label: 'E', text: 'No findings' }
      ],
      image: null
    },
    {
      id: 5,
      text: "A 52-year-old woman is referred to psychiatry after presenting to the ED with depressed mood, anhedonia, insomnia, and suicidal ideation for 3 weeks. She denies manic symptoms. She has never been treated for depression. Which medication is most appropriate to initiate first?",
      options: [
        { label: 'A', text: 'Sertraline' },
        { label: 'B', text: 'Fluoxetine' },
        { label: 'C', text: 'Bupropion' },
        { label: 'D', text: 'Tricyclic antidepressant' },
        { label: 'E', text: 'Monoamine oxidase inhibitor' }
      ],
      image: null
    },
    {
      id: 6,
      text: "A 38-year-old woman with systemic lupus erythematosus presents with acute kidney injury (creatinine 2.8 mg/dL, up from baseline of 1.0) and proteinuria (4.5 g/24 hours). Urinalysis shows RBC casts. Complement levels are low. What is the most likely histologic finding on kidney biopsy?",
      options: [
        { label: 'A', text: 'Type I (endocapillary) glomerulonephritis' },
        { label: 'B', text: 'Type II (membranous) glomerulonephritis' },
        { label: 'C', text: 'Type III (focal proliferative) glomerulonephritis' },
        { label: 'D', text: 'Type IV (diffuse proliferative) glomerulonephritis' },
        { label: 'E', text: 'Type V (membranous) glomerulonephritis' }
      ],
      image: null
    },
    {
      id: 7,
      text: "A 19-year-old college student presents with acute mental status changes, fever, headache, and neck stiffness. CSF analysis shows elevated protein, low glucose, and pleocytosis with neutrophil predominance. Gram stain is pending. What is the immediate next step in management?",
      options: [
        { label: 'A', text: 'Start vancomycin, ceftriaxone, and dexamethasone' },
        { label: 'B', text: 'Wait for Gram stain and culture results' },
        { label: 'C', text: 'Start acyclovir pending PCR' },
        { label: 'D', text: 'Discharge with outpatient follow-up' },
        { label: 'E', text: 'Start antibiotics only after culture confirmation' }
      ],
      image: null
    },
    {
      id: 8,
      text: "A 72-year-old man with a history of myocardial infarction and atrial fibrillation on warfarin presents with acute dyspnea and chest pain. ECG shows ST elevation in leads II, III, and aVF. Which complication is this patient at highest risk for?",
      options: [
        { label: 'A', text: 'Acute mitral regurgitation' },
        { label: 'B', text: 'Right ventricular infarction' },
        { label: 'C', text: 'Cardiogenic shock' },
        { label: 'D', text: 'Ventricular free wall rupture' },
        { label: 'E', text: 'Ventricular aneurysm formation' }
      ],
      image: null
    },
    {
      id: 9,
      text: "A 48-year-old man with poorly controlled hypertension and diabetes presents with a serum creatinine of 4.2 mg/dL and a GFR of 12 mL/min/1.73m². He requires dialysis. Which modality offers the best cardiovascular outcomes?",
      options: [
        { label: 'A', text: 'Hemodialysis three times weekly' },
        { label: 'B', text: 'Peritoneal dialysis' },
        { label: 'C', text: 'Nocturnal hemodialysis' },
        { label: 'D', text: 'Conservative management without dialysis' },
        { label: 'E', text: 'Immediate kidney transplantation' }
      ],
      image: null
    },
    {
      id: 10,
      text: "A 35-year-old woman with a known diagnosis of polycystic ovary syndrome presents with amenorrhea for 6 months and weight gain of 8 kg. Laboratory studies show elevated testosterone and normal TSH. What is the most likely additional diagnosis?",
      options: [
        { label: 'A', text: 'Androgen-secreting tumor' },
        { label: 'B', text: 'Cushing syndrome' },
        { label: 'C', text: 'Primary ovarian insufficiency' },
        { label: 'D', text: 'Insulin resistance' },
        { label: 'E', text: 'Congenital adrenal hyperplasia' }
      ],
      image: null
    }
  ]
}