question stringlengths 67 3.54k | answer stringlengths 1 136 | options dict | meta_info stringclasses 2
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A junior orthopaedic surgery resident is completing a carpal tunnel repair with the department chairman as the attending physician. During the case, the resident inadvertently cuts a flexor tendon. The tendon is repaired without complication. The attending tells the resident that the patient will do fine, and there is ... | Tell the attending that he cannot fail to disclose this mistake | {
"A": "Disclose the error to the patient but leave it out of the operative report",
"B": "Disclose the error to the patient and put it in the operative report",
"C": "Tell the attending that he cannot fail to disclose this mistake",
"D": "Report the physician to the ethics committee",
"E": "Refuse to dictate... | step1 | C |
A 67-year-old man with transitional cell carcinoma of the bladder comes to the physician because of a 2-day history of ringing sensation in his ear. He received this first course of neoadjuvant chemotherapy 1 week ago. Pure tone audiometry shows a sensorineural hearing loss of 45 dB. The expected beneficial effect of t... | Cross-linking of DNA | {
"A": "Inhibition of thymidine synthesis",
"B": "Inhibition of proteasome",
"C": "Hyperstabilization of microtubules",
"D": "Generation of free radicals",
"E": "Cross-linking of DNA"
} | step1 | E |
Two weeks after undergoing an emergency cardiac catherization with stenting for unstable angina pectoris, a 61-year-old man has decreased urinary output and malaise. He has type 2 diabetes mellitus and osteoarthritis of the hips. Prior to admission, his medications were insulin and naproxen. He was also started on aspi... | Cholesterol embolization | {
"A": "Renal papillary necrosis",
"B": "Allergic interstitial nephritis",
"C": "Cholesterol embolization",
"D": "Eosinophilic granulomatosis with polyangiitis",
"E": "Polyarteritis nodosa"
} | step2&3 | C |
A 39-year-old woman is brought to the emergency department because of fevers, chills, and left lower quadrant pain. Her temperature is 39.1°C (102.3°F), pulse is 126/min, respirations are 28/min, and blood pressure is 80/50 mm Hg. There is blood oozing around the site of a peripheral intravenous line. Pelvic examinatio... | Lactose-fermenting, gram-negative rods forming pink colonies on MacConkey agar | {
"A": "Coagulase-positive, gram-positive cocci forming mauve-colored colonies on methicillin-containing agar",
"B": "Encapsulated, gram-negative coccobacilli forming grey-colored colonies on charcoal blood agar",
"C": "Spore-forming, gram-positive bacilli forming yellow colonies on casein agar",
"D": "Lactose-... | step1 | D |
A 35-year-old man comes to the physician because of itchy, watery eyes for the past week. He has also been sneezing multiple times a day during this period. He had a similar episode 1 year ago around springtime. He has iron deficiency anemia and ankylosing spondylitis. Current medications include ferrous sulfate, artif... | Ketotifen eye drops | {
"A": "Erythromycin ointment",
"B": "Ketotifen eye drops",
"C": "Warm compresses",
"D": "Fluorometholone eye drops",
"E": "Latanoprost eye drops"
} | step2&3 | B |
A 39-year-old man presents to the emergency department because of progressively worsening chest pain and nausea that started at a local bar 30 minutes prior. The pain radiates to the epigastric area. He has a 5-year history of untreated hypertension. He has smoked 1 pack of cigarettes daily for the past 5 years and sta... | Reassurance and continuous monitoring | {
"A": "Diltiazem",
"B": "Labetalol",
"C": "Nitroglycerin",
"D": "Propranolol",
"E": "Reassurance and continuous monitoring"
} | step2&3 | E |
A 68-year-old male comes to the physician for evaluation of right flank pain. He has a history of diabetes and peripheral artery disease. His blood pressure is 160/90 mm Hg. Physical examination shows abdominal tenderness and right flank tenderness. An ultrasound shows dilation of the right ureter and renal pelvis. Whi... | Common iliac artery aneurysm | {
"A": "Renal artery stenosis",
"B": "Benign prostatic hyperplasia",
"C": "Diabetic nephropathy",
"D": "Common iliac artery aneurysm",
"E": "Urethral stricture"
} | step1 | D |
A 65-year-old man is brought to the emergency department 30 minutes after the onset of acute chest pain. He has hypertension and asthma. Current medications include atorvastatin, lisinopril, and an albuterol inhaler. He appears pale and diaphoretic. His pulse is 114/min and blood pressure is 130/88 mm Hg. An ECG shows ... | Clopidogrel | {
"A": "Nifedipine",
"B": "Enoxaparin",
"C": "Clopidogrel",
"D": "Spironolactone",
"E": "Propranolol\n\""
} | step2&3 | C |
A 37-year-old-woman presents to her primary care physician requesting a new form of birth control. She has been utilizing oral contraceptive pills (OCPs) for the past 8 years, but asks to switch to an intrauterine device (IUD). Her vital signs are: blood pressure 118/78 mm Hg, pulse 73/min and respiratory rate 16/min. ... | Active or recurrent pelvic inflammatory disease (PID) | {
"A": "A history of stroke or venous thromboembolism",
"B": "Current tobacco use",
"C": "Active or recurrent pelvic inflammatory disease (PID)",
"D": "Past medical history of breast cancer",
"E": "Known liver neoplasm"
} | step2&3 | C |
A 23-year-old woman comes to the physician because she is embarrassed about the appearance of her nails. She has no history of serious illness and takes no medications. She appears well. A photograph of the nails is shown. Which of the following additional findings is most likely in this patient? | Silvery plaques on extensor surfaces | {
"A": "Silvery plaques on extensor surfaces",
"B": "Flesh-colored papules in the lumbosacral region",
"C": "Erosions of the dental enamel",
"D": "Pallor of the conjunctival mucosa",
"E": "Holosystolic murmur at the left lower sternal border"
} | step1 | A |
A 24-year-old G2P1 woman at 39 weeks’ gestation presents to the emergency department complaining of painful contractions occurring every 10 minutes for the past 2 hours, consistent with latent labor. She says she has not experienced vaginal discharge, bleeding, or fluid leakage, and is currently taking no medications. ... | It is an HIV-1/HIV2 antibody differentiation immunoassay | {
"A": "It determines the genotype of the virus",
"B": "It is a Southwestern blot, identifying the presence of DNA-binding proteins",
"C": "It is a Northern blot, identifying the presence of RNA",
"D": "It is a Northern blot, identifying the presence of DNA",
"E": "It is an HIV-1/HIV2 antibody differentiation... | step1 | E |
A 72-year-old man comes to the physician because of a 2-month history of fatigue and worsening abdominal pain. During this period, he also has excessive night sweats and shortness of breath on exertion. Over the past 3 months, he has had a 5.6-kg (12-lb) weight loss. He had a myocardial infarction 3 years ago. He has h... | Ruxolitinib | {
"A": "Cladribine",
"B": "Prednisone",
"C": "Imatinib",
"D": "Ruxolitinib",
"E": "Stem cell transplantation"
} | step2&3 | D |
A 20-year-old man comes to the physician because of worsening gait unsteadiness and bilateral hearing loss for 1 month. He has had intermittent tingling sensations on both cheeks over this time period. He has no history of serious medical illness and takes no medications. Audiometry shows bilateral sensorineural hearin... | Meningioma | {
"A": "Renal cell carcinoma",
"B": "Meningioma",
"C": "Astrocytoma",
"D": "Vascular malformations",
"E": "Telangiectasias"
} | step1 | B |
A 47-year-old executive schedules an appointment his physician for a routine medical check-up. He currently has no complaints and claims to be “as fit as a fiddle.” The physical examination findings are unremarkable, except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids ... | A reduction in diastolic filling time | {
"A": "An increase in right atrial pressure",
"B": "An increase in left ventricular end-diastolic pressure",
"C": "An increase in pulmonary capillary wedge pressure",
"D": "A reduction in the slope of the pacemaker potential",
"E": "A reduction in diastolic filling time"
} | step1 | E |
A microbiologist is studying the emergence of a virulent strain of the virus. After a detailed study of the virus and its life cycle, he proposes a theory: Initially, a host cell is co-infected with 2 viruses from the same virus family. Within the host cell, concomitant production of various genome segments from both v... | Rotavirus | {
"A": "Cytomegalovirus",
"B": "Epstein-Barr virus",
"C": "Human immunodeficiency virus",
"D": "Rotavirus",
"E": "Vaccinia virus"
} | step1 | D |
A 59-year-old overweight woman presents to the urgent care clinic with the complaint of severe abdominal pain for the past 2 hours. She also complains of a dull pain in her back with nausea and vomiting several times. Her pain has no relation with food. Her past medical history is significant for recurrent abdominal pa... | Gallbladder cancer | {
"A": "Acute cholecystitis",
"B": "Gallbladder cancer",
"C": "Choledocholithiasis",
"D": "Pancreatitis",
"E": "Duodenal peptic ulcer"
} | step2&3 | B |
A 7-year-old boy is brought to his pediatrician’s office for a follow-up visit. He was diagnosed with asthma when he was 3 years old and has since been on treatment for the condition. He is currently on a β-agonist inhaler because of exacerbation of his symptoms. He has observed that his symptoms are more prominent in ... | IL-4 | {
"A": "IL-5",
"B": "IL-2",
"C": "IL-10",
"D": "IL-13",
"E": "IL-4"
} | step2&3 | E |
A 3-month-old boy is brought the emergency department by his parents after an episode of cyanosis and muscle hypotonia that resolved after 2 minutes. Diagnostic evaluation fails to discover an exact etiology of the boy's symptoms and the episode is classified as a brief resolved unexplained event (BRUE). The risk profi... | Matching | {
"A": "Stratified analysis",
"B": "Blinding",
"C": "Restriction",
"D": "Randomization",
"E": "Matching"
} | step2&3 | E |
A 29-year-old man presents to the emergency department due to central chest pain over the past 3 days which is constant and unrelated to exertion. The pain is sharp, severe, increases when lying down, and improves with leaning forward. The pain also radiates to his shoulders and neck. The patient has no past medical hi... | Ibuprofen + colchicine +/- omeprazole | {
"A": "Indomethacin +/- omeprazole",
"B": "Ibuprofen + colchicine +/- omeprazole",
"C": "Prednisone + colchicine",
"D": "Pericardiocentesis",
"E": "Pericardiectomy"
} | step2&3 | B |
A 46-year-old man is brought to the emergency department for evaluation of altered mental status. He was found on the floor in front of his apartment. He is somnolent but responsive when aroused. His pulse is 64/min, respiratory rate is 15/min, and blood pressure is 120/75 mm Hg. On physical examination, an alcoholic s... | Benzodiazepine intoxication
" | {
"A": "Hypoglycemia",
"B": "Cerebral ischemia",
"C": "Ethanol intoxication",
"D": "Cannabis intoxication",
"E": "Benzodiazepine intoxication\n\""
} | step2&3 | E |
A 77-year-old woman presents to the emergency room with the complaints of fever, malaise, and night sweats. She recently observed an enlargement of her axillary lymph nodes, which she examines on a weekly basis. She has a remote history of breast cancer in her 60s that was treated with radiation and chemotherapy. She a... | Previous radiation therapy | {
"A": "Travel to Africa",
"B": "Axillary lymph node involvement",
"C": "Previous radiation therapy",
"D": "Female gender",
"E": "Previous breast cancer"
} | step1 | C |
A 3-month-old infant is brought to her pediatrician because she coughs and seems to have difficulty breathing while feeding. In addition, she seems to have less energy compared to other babies and appears listless throughout the day. She was born by cesarean section to a G1P1 woman with no prior medical history and had... | 22q11 deletion | {
"A": "22q11 deletion",
"B": "Deletion of genes on chromosome 7",
"C": "Lithium exposure in utero",
"D": "Maternal alcohol consumption",
"E": "Retinoic acid exposure in utero"
} | step1 | A |
A 30-year-old African American woman comes to the physician for the evaluation of a dry cough and chest discomfort for the past 3 days. During this period, the patient has had headaches, muscle aches, joint pain, fever, and chills. Ten days ago, she was hiking with her family in Mississippi. The patient has asthma that... | Histoplasma capsulatum infection | {
"A": "Legionella pneumophila infection",
"B": "Aspergillus fumigatus infection",
"C": "Pneumocystis pneumonia",
"D": "Histoplasma capsulatum infection",
"E": "Blastomyces dermatitidis infection"
} | step2&3 | D |
A 62-year-old patient has been hospitalized for a week due to a stroke. One week into the hospitalization, he develops a fever and purulent cough. His vitals include: heart rate 88/min, respiratory rate 20/min, temperature 38.4°C (101.1°F), and blood pressure 110/85 mm Hg. On physical examination, he has basal crackles... | Staphylococcus aureus | {
"A": "Pseudomona aeruginosa",
"B": "Streptococcus pneumoniae",
"C": "Mycobacterium tuberculosis",
"D": "Haemophilus influenzae",
"E": "Staphylococcus aureus"
} | step1 | E |
A 6-year-old boy is brought to the emergency department by his mother for worsening wheezing and shortness of breath over the past day. He has not had a fever, cough, vomiting, or diarrhea. He has asthma and eczema. He uses a glucocorticoid inhaler and an albuterol inhaler but has missed his medications for the past we... | Intubate with mechanical ventilation | {
"A": "Intubate with mechanical ventilation",
"B": "Perform needle thoracostomy at the 2nd intercostal space",
"C": "Perform bronchoscopy",
"D": "Provide helium and oxygen mixture",
"E": "Provide additional dose of methylprednisolone"
} | step2&3 | A |
A 5-year-old female suffers from recurrent infections by Aspergillus species, Pseudomonas species, and Staphylococcus aureus. The patient's neutrophils are examined in the laboratory and they fail to react during the nitroblue tetrazolium test. Which of the following is most likely dysfunctional in this patient? | Respiratory burst | {
"A": "Lymphocytes",
"B": "Immunoglobulin class switching",
"C": "Superoxide dismutase",
"D": "Myeloperoxidase",
"E": "Respiratory burst"
} | step1 | E |
A 3-year-old boy presents to the emergency department with a ‘cough-like-a-seal bark’ and a high-pitched inspiratory noise that is audible without a stethoscope. His mother reports that his cough has worsened over the last few hours. The patient's blood pressure is 118/78 mm Hg, pulse is 90/min, respiratory rate is 35/... | Steeple sign | {
"A": "Diffuse streaky infiltrates",
"B": "Increased interstitial markings",
"C": "Lobar consolidation in the lingual",
"D": "Thumbprint sign on the lateral image",
"E": "Steeple sign"
} | step2&3 | E |
A 26-year-old woman presents to a gynecologist after a missed period. After performing a complete physical examination and a screening test for pregnancy, her gynecologist informs her that she is pregnant. She is very surprised as she has been taking oral contraceptives regularly. When the gynecologist asks her about t... | Induction of CYP3A4 by rifampin leading to decreased serum levels of ethinylestradiol and progesterone | {
"A": "Induction of CYP3A4 by rifampin leading to decreased serum levels of ethinylestradiol and progesterone",
"B": "Induction of CYP2A6 by rifampin leading to increased inactivation of ethinylestradiol",
"C": "Induction of CYP2E1 by isoniazid leading to decreased serum levels of progesterone",
"D": "Interfer... | step1 | A |
A 4-year-old previously healthy boy presents with 4 days of intermittent vomiting and 5-6 daily loose stools. His mother noted bloody stools and decreased oral intake of food and water over the last 24 hours. He is normally in daycare; however, he has been home for the past 3 days. On physical exam his temperature is 1... | Increased cerebrospinal fluid protein with normal cell count | {
"A": "Gram stain positive CSF",
"B": "Peripheral eosinophilia",
"C": "Xanthochromia on cerebrospinal fluid analysis",
"D": "Increased cerebrospinal fluid protein with normal cell count",
"E": "Oligoclonal bands on cerebrospinal fluid analysis"
} | step1 | D |
A 3-week-old male newborn is brought to the physician because of an inward turning of his left forefoot. He was born at 38 weeks' gestation by cesarean section because of breech presentation. The pregnancy was complicated by oligohydramnios. Examination shows concavity of the medial border of the left foot with a skin ... | Reassurance | {
"A": "Foot abduction brace",
"B": "Osteotomy of the metatarsals",
"C": "Arthrodesis of the forefoot",
"D": "Reassurance",
"E": "Tarsometatarsal capsulotomy"
} | step2&3 | D |
A 42-year-old woman comes to the emergency department because of a 2-day history of right upper abdominal pain and nausea. She is 163 cm (5 ft 4 in) tall and weighs 91 kg (200 lb); her BMI is 34 kg/m2. Her temperature is 38.5°C (101.3°F). Physical examination shows a distended abdomen and right upper quadrant tendernes... | Obstruction of the cystic duct | {
"A": "Autodigestion of pancreatic parenchyma",
"B": "Hypomotility of the gallbadder",
"C": "Fistula between the gallbladder and small intestine",
"D": "Infection with a hepatotropic virus",
"E": "Obstruction of the cystic duct"
} | step1 | E |
A 72-year-old woman is admitted to the intensive care unit for shortness of breath and palpitations. A cardiac catheterization is performed and measurements of the left ventricular volume and pressure at different points in the cardiac cycle are obtained. The patient's pressure-volume loop (gray) is shown with a normal... | Increased ventricular wall stiffness | {
"A": "Mitral valve regurgitation",
"B": "Increased systemic vascular resistance",
"C": "Increased ventricular wall stiffness",
"D": "Impaired left ventricular contractility",
"E": "Aortic stenosis"
} | step1 | C |
A 22-year-old woman is brought to the emergency department because of a 2-day history of fever, intermittent rigors, and night sweats. She also has a 1-month history of progressive fatigue. Five weeks ago, she was hospitalized and received intravenous antibiotics for treatment of bacterial meningitis while visiting rel... | Chloramphenicol | {
"A": "Doxycycline",
"B": "Trimethoprim/sulfamethoxazole",
"C": "Vancomycin",
"D": "Linezolid",
"E": "Chloramphenicol"
} | step1 | E |
An otherwise healthy 50-year-old man comes to the physician because of a 6-month history of increasingly frequent episodes of upper abdominal pain, nausea, vomiting, and diarrhea. He has had a 3.2-kg (7-lb) weight loss during this time. Physical examination shows bilateral pitting pedal edema. An endoscopy shows promin... | Proliferation of gastric mucus-producing cells | {
"A": "Serotonin-secreting gastric tumor",
"B": "Proliferation of gastric mucus-producing cells",
"C": "Neoplasia of submucosal lymphoid tissue",
"D": "Excessive somatostatin secretion",
"E": "Ectopic secretion of gastrin"
} | step1 | B |
A 27-year-old man presents to the emergency department. He was brought in by staff from the homeless shelter when they found him unresponsive. The patient is a known IV drug abuser but otherwise has an unknown past medical history. He currently attends a methadone clinic. His temperature is 99.5°F (37.5°C), blood press... | Insulin, potassium, IV fluids, and glucose | {
"A": "Insulin, IV fluids, and potassium",
"B": "Insulin, potassium, IV fluids, and glucose",
"C": "IV fluids only",
"D": "Oral rehydration",
"E": "Supportive therapy and close monitoring"
} | step2&3 | B |
A 67-year-old man who was diagnosed with arthritis 16 years ago presents with right knee swelling and pain. His left knee was swollen a few weeks ago, but now with both joints affected, he has difficulty walking and feels frustrated. He also has back pain which makes it extremely difficult to move around and be active ... | Psoriatic arthritis | {
"A": "Psoriatic arthritis",
"B": "Arthritis mutilans",
"C": "Rheumatoid arthritis",
"D": "Familial mediterranean fever",
"E": "Mixed connective tissue disease"
} | step2&3 | A |
A 65-year-old woman schedules an appointment with her physician for evaluation of weight loss and weakness. The weakness is more noticeable when climbing stairs and combing hair. The weakness improves after brief exercise. She also has bladder incontinence for the past 4 weeks and was given an anticholinesterase agent ... | Paraneoplastic syndrome from small cell carcinoma of the lung | {
"A": "Botulism",
"B": "Duchenne muscular dystrophy",
"C": "Hypothyroidism",
"D": "Myasthenia gravis",
"E": "Paraneoplastic syndrome from small cell carcinoma of the lung"
} | step1 | E |
A 3-month-old boy presents to his pediatrician with persistent diarrhea, oral candidiasis, and signs and symptoms suggestive of respiratory syncytial virus (RSV) pneumonia. His weight is in the 10th percentile. He is being evaluated for an immunodeficiency disease. Laboratory results for the HIV are negative by PCR. Wh... | Defective T cell function | {
"A": "Defective T cell function",
"B": "Grossly reduced levels of B cells",
"C": "An X-linked inheritance of HLA genes",
"D": "Defective isotype switching",
"E": "Selective IgA deficiency"
} | step1 | A |
A 53-year-old man with recurrent pancreatic adenocarcinoma is enrolled in a clinical trial for a novel chemotherapeutic agent that his physician believes may be beneficial to his condition. The novel drug was previously tested in a small population and is now undergoing a larger phase 3 trial in preparation for FDA app... | 2.67 | {
"A": "0.375",
"B": "0.5",
"C": "2",
"D": "2.5",
"E": "2.67"
} | step1 | E |
A 67-year-old male is seen by neurology after he was noticed to be speaking strangely by his family. After acute treatment with tissue plasminogen activator (tPA), the patient is able to recover most of his speech. Subsequent neurologic exam finds that the patient is fluent while speaking and is able to comprehend both... | Arcuate fasciculus | {
"A": "Arcuate fasciculus",
"B": "Inferior frontal gyrus",
"C": "Superior temporal gyrus",
"D": "Inferior frontal gyrus + superior temporal gyrus",
"E": "Arcuate fasciculus + inferior frontal gyrus + superior temporal gyrus"
} | step1 | A |
A 27-year-old woman presents to the office with concerns about her long struggle with her physical appearance since adolescence. She says she has always been "large" and was constantly targeted by her classmates and coworkers for being so. Her main concern at the moment is her acne and unwanted facial hair on her upper... | Polycystic ovarian syndrome (PCOS) | {
"A": "Hypothyroidism",
"B": "Idiopathic hirsutism",
"C": "Cushing's disease",
"D": "Polycystic ovarian syndrome (PCOS)",
"E": "Ovarian hyperthecosis"
} | step1 | D |
А 43-уеаr-old mаn рrеѕеntѕ wіth tіnglіng аnd numbnеѕѕ of the lowеr lіmbѕ for 2 wееkѕ. Не also сomрlаіnѕ of реrѕіѕtеnt раіn in his legs whісh is not relieved by over-the-counter analgesics. Past medical history is significant for type 2 dіаbеtes mellitus for 2 уеаrѕ, inconsistently managed with mеtformіn аnd glіmеріrіdе... | Strict blood glucose control | {
"A": "Use of atorvastatin",
"B": "Femoro-Ileal artery bypass",
"C": "Strict blood glucose control",
"D": "Strict control of blood pressure",
"E": "Lower limb amputation"
} | step1 | C |
A one-day-old male is evaluated in the hospital nursery for bilious vomiting. The patient has urinated multiple times since birth but has not yet passed meconium. He was born at 38 weeks gestation to a 36-year-old gravida 3 via vaginal delivery. The pregnancy was complicated by gestational diabetes. The patient’s mothe... | Duodenal atresia | {
"A": "Duodenal atresia",
"B": "Intestinal malrotation",
"C": "Meconium ileus",
"D": "Necrotizing enterocolitis",
"E": "Pyloric stenosis"
} | step2&3 | A |
A healthy 23-year-old male is undergoing an exercise stress test as part of his physiology class. If blood were to be sampled at different locations before and after the stress test, which area of the body would contain the lowest oxygen content at both time points? | Coronary sinus | {
"A": "Superior vena cava",
"B": "Inferior vena cava",
"C": "Coronary sinus",
"D": "Pulmonary artery",
"E": "Pulmonary vein"
} | step1 | C |
A 45-year-old G5P4105 presents to her gynecologist’s office with six months of increasingly heavy periods. She now soaks one super absorbent tampon every two hours for five days each cycle. Her cycles have also become irregular, with intermenstrual bleeding for the last two months. She now experiences significant dysme... | Globular 10-week sized uterus | {
"A": "Rectouterine septum nodularity",
"B": "Globular 10-week sized uterus",
"C": "Adnexal mass",
"D": "Irregular 14-week sized uterus",
"E": "No remarkable physical exam finding"
} | step2&3 | B |
A man is brought into the emergency department by the police department. The officer state that the man has been arrested multiple times for public alcohol intoxication, but recently became homeless. On exam, the man is behaving erratically. His vitals are all within normal limits. He appears confused and has a slurred... | Fomepizole | {
"A": "Ethanol",
"B": "Naltrexone",
"C": "Naloxone",
"D": "Flumazenil",
"E": "Fomepizole"
} | step2&3 | E |
A medical research study is evaluating an investigational novel drug (medication 1) compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days ... | 20 | {
"A": "5",
"B": "16",
"C": "20",
"D": "30",
"E": "50"
} | step2&3 | C |
A 55-year-old man comes to the physician because of a 6-week history of tingling pain in the sole of his right foot when he raises it above chest level during exercises. He reports that he started exercising regularly 2 months ago and that his right calf cramps when he uses the incline feature on the treadmill, forcing... | Femoropopliteal artery stenosis | {
"A": "Femoropopliteal artery stenosis",
"B": "Vasculitis of the right popliteal artery",
"C": "Acute thrombosis of right popliteal vein",
"D": "Lumbar spinal stenosis",
"E": "Aortoiliac artery stenosis\n\""
} | step2&3 | A |
A 29-year-old primigravid woman at 35 weeks' gestation is admitted to the hospital in labor. She has no history of serious medical illness. She has had an uncomplicated pregnancy. Her last ultrasound at 22 weeks' gestation was normal. On admission, fetal heartbeats cannot be detected by fetal doppler monitor. Ultrasoun... | Recommend autopsy of the infant | {
"A": "Perform karyotyping of amniotic fluid",
"B": "Recommend autopsy of the infant",
"C": "Obtain photographs, x-ray imaging, and MRI",
"D": "Perform maternal antibody and thrombophilia testing",
"E": "Obtain consent for parental genetic testing"
} | step2&3 | B |
A 67-year-old man is hospitalized after several days of fever and increasing shortness of breath. Respiratory viral panel returns positive for influenza A and the patient is started on a standard five day course of oseltamivir. Despite therapy, his shortness of breath continues to worsen and his oxygen saturation decre... | Proliferation of surfactant-secreting cells | {
"A": "Squamous cell proliferation",
"B": "Sweeping of debris out of the alveoli by ciliated cells",
"C": "Excess mucus production by goblet cells",
"D": "Proliferation of surfactant-secreting cells",
"E": "Proliferation of club cells"
} | step1 | D |
A 65-year-old male is treated for anal carcinoma with therapy including external beam radiation. How does radiation affect cancer cells? | Induces breaks in double-stranded DNA | {
"A": "Induces the formation of thymidine dimers",
"B": "Induces the formation of disulfide bonds",
"C": "Induces G/T and A/C pair formation",
"D": "Induces deamination of cytosine",
"E": "Induces breaks in double-stranded DNA"
} | step1 | E |
A 56-year-old man with a history of hypertension presents to his physician with progressive fatigue and new onset muscle cramps. He has had no recent changes to his medication regimen, which includes hydrochlorothiazide, lisinopril, and amlodipine. His temperature is 98.0°F (36.7°C), blood pressure is 174/111 mmHg, pul... | Aldosterone excess | {
"A": "Aldosterone excess",
"B": "Catecholamine-secreting mass",
"C": "Cortisol excess",
"D": "Impaired kidney perfusion",
"E": "Increased peripheral vascular resistance"
} | step2&3 | A |
A 65-year-old man comes to the physician because of a 1-week history of yellowish discoloration of his skin and generalized pruritus. Examination shows jaundice of the skin and scleral icterus. Urinalysis shows an elevated concentration of bilirubin and a low concentration of urobilinogen. Which of the following is the... | Defective hepatic bile excretion | {
"A": "Absent UDP-glucuronosyltransferase activity",
"B": "Increased hemoglobin breakdown",
"C": "Increased intestinal bilirubin reabsorption",
"D": "Defective hepatic bile excretion",
"E": "Presence of stones within the gallbladder"
} | step1 | D |
A 72-year-old woman is brought to the physician by her daughter because of a 6-month history of worsening short-term memory deficits and social withdrawal. Treatment with galantamine is initiated. Two weeks later, the patient develops vomiting, mild crampy abdominal pain, and watery, nonbloody diarrhea. Which of the fo... | Atropine | {
"A": "Bethanechol",
"B": "Metoclopramide",
"C": "Loperamide",
"D": "Atropine",
"E": "Oxybutynin"
} | step1 | D |
A 61-year-old man with schizophrenia in a locked inpatient psychiatry unit was observed making an unusual smacking motion with his lips, pursing his mouth, and blinking excessively. These symptoms started slowly about 2 weeks ago and have become more pronounced, but they do not seem to bother the patient. He resides in... | Tardive dyskinesia | {
"A": "Akathisia",
"B": "Tardive dyskinesia",
"C": "Acute dystonia",
"D": "Pseudoparkinsonism",
"E": "Palsy"
} | step2&3 | B |
A 17-year-old football player with no significant past medical history, social history, or family history presents to his pediatrician with itching in his groin. He says this started during summer workouts leading up to this season. He denies having any rash anywhere else on his body. The blood pressure is 123/78 mm Hg... | KOH examination of lesion scrapings | {
"A": "Localized ultrasound",
"B": "KOH examination of lesion scrapings",
"C": "Nikolsky's sign on physical exam",
"D": "Gram stain of skin scrapings",
"E": "AFB stain of skin scrapings"
} | step2&3 | B |
An otherwise healthy 26-year-old man comes to the physician for medication counseling after recently being diagnosed with schizophrenia. Risperidone therapy is initiated. This patient is at increased risk for which of the following adverse effects? | Gynecomastia | {
"A": "Agranulocytosis",
"B": "Shortened QT interval",
"C": "Gynecomastia",
"D": "Hypothyroidism",
"E": "Weight loss"
} | step1 | C |
A 15-year-old woman presents with fever, altered mental status and a petechial rash on her lower extremities and back since yesterday evening. She also says she has been nauseous for the past 3 hours and has vomited twice. The patient mentions she has had heavy menstrual bleeding for the past few days. Her blood pressu... | Variable β-sequence of the T cell receptor | {
"A": "B7 receptor",
"B": "Variable β-sequence of the T cell receptor",
"C": "CD40",
"D": "CD3",
"E": "IgCAM"
} | step1 | B |
A 2-year-old boy is brought to the physician for evaluation of pallor and increasing lethargy for 2 days. One week ago, he experienced abdominal pain, vomiting, and bloody diarrhea that have since subsided. The patient's father states that they returned early from a 6-week roadtrip in Mexico because of these symptoms. ... | Hemolytic uremic syndrome | {
"A": "Henoch-Schönlein Purpura",
"B": "Thrombotic thrombocytopenic purpura",
"C": "Hemolytic uremic syndrome",
"D": "Immune thrombocytopenic purpura",
"E": "Disseminated intravascular coagulation\n\""
} | step2&3 | C |
A 17-year-old girl is referred by her dentist for a suspected eating disorder. She has been visiting the same dentist since childhood and for the past 2 years has had at least 2 visits for dental caries. She eventually admitted to him that she regularly induces vomiting by putting her fingers down her throat. She says ... | Patients with this disorder are not further sub-typed | {
"A": "Patients with this disorder are not further sub-typed",
"B": "Patients do not usually initiate treatment",
"C": "Patients can have a history of both anorexia and bulimia",
"D": "Patients will typically have a BMI between 17–18.5 kg/m2",
"E": "Patients usually have significant medical complications"
} | step2&3 | A |
A 14-year-old girl is brought to the physician by her father because of fever, chills, abdominal pain, and profuse non-bloody diarrhea. Her symptoms began one week ago, when she had several days of low-grade fever and constipation. She returned from Indonesia 2 weeks ago, where she spent the summer with her grandparent... | Salmonella typhi | {
"A": "Giardia lamblia",
"B": "Schistosoma mansoni",
"C": "Campylobacter jejuni",
"D": "Salmonella typhi",
"E": "Clostridium perfringens"
} | step1 | D |
A 22-year-old female college student is treated with metronidazole after presenting to student health services with itching, discharge, and pain in her vagina. At a party shortly afterward she experiences facial flushing, nausea, tachycardia, dyspnea, headache, and abdominal cramps after consuming alcohol. Serum levels... | Acetaldehyde | {
"A": "Acetaldehyde",
"B": "Uric acid",
"C": "Cytochrome P-450 enzymes",
"D": "Triglycerides",
"E": "Amylase"
} | step1 | A |
A 23-year-old primigravida presents for a regular prenatal care visit at 16 weeks gestation. She complains of increased fatigability, but is otherwise well. She takes folic acid, iron, and vitamin D supplementation. Her vital signs are as follows: blood pressure, 110/70 mm Hg; heart rate, 86/min; respiratory rate, 13/m... | No tests required | {
"A": "Serum iron level",
"B": "Serum B12 level",
"C": "Transferrin",
"D": "No tests required",
"E": "Total bilirubin"
} | step2&3 | D |
An 80-year-old man is transferred from a step-down unit to a med-surg floor in the hospital. He had undergone a successful hernia surgery 14 hours ago. Before the surgery, he was pre-treated with atropine, scopolamine, and morphine and recovered well in the PACU after the surgery. There were no complications in the ste... | Insert a ‘straight cath’ into the patient’s bladder | {
"A": "Insert a ‘straight cath’ into the patient’s bladder",
"B": "Ultrasound the surgical site",
"C": "Aggressive IV fluids",
"D": "Digital rectal exam",
"E": "Renal ultrasound"
} | step2&3 | A |
A healthy 19-year-old man presents to his primary care provider complaining of painless “blisters” in his mouth. He reports that he noticed a white film on his tongue and the sides of his mouth 2 days ago while brushing his teeth. The film was easily brushed off. He also complains of a bitter metallic taste in his mout... | Disruption of cell membrane permeability | {
"A": "Disruption of cell membrane permeability",
"B": "Disruption of microtubule formation",
"C": "Inhibition of 14-alpha-demethylase",
"D": "Inhibition of beta-glucan synthase",
"E": "Inhibition of squalene epoxidase"
} | step1 | A |
A 56-year-old man presents to the clinic complaining of subacute back pain for the past month. The pain is described as a dull, constant ache that is worse at night. He could not recall any precipitating event except for an amateur weight-lifting competition that he participated in 2 months ago. Past medical history is... | Lytic lesions of the lumbar spine | {
"A": "Blastic lesions of the lumbar spine",
"B": "Bulging disc impinging on lumbar spinal nerve",
"C": "Lytic lesions of the lumbar spine",
"D": "Narrowing of the lumbar disc space",
"E": "Sacroilitis and fusion of the lumbar spine"
} | step1 | C |
A 4-year-old boy is brought to the emergency department because of severe abdominal pain and bilious vomiting for 6 hours. He has not had bowel movements in the past 24 hours. He appears ill. His temperature is 37.8°C (100°F) and pulse is 122/min. Examination shows a distended abdomen. There is tenderness to palpation ... | Perform emergency laparotomy | {
"A": "Get consent from the patient's brother",
"B": "Get consent from the patient",
"C": "Obtain a court order for surgery",
"D": "Perform emergency laparotomy",
"E": "Delay surgery until parental consent"
} | step2&3 | D |
A 3-week-old male newborn is brought to the hospital because of poor weight gain since birth. He was born at 38 weeks' gestation via normal vaginal delivery. He weighed 3005 g (6 lb, 10 oz) at birth and currently weighs 2835 g (6 lb, 4 oz). He has been latching on and breastfeeding well since birth. His mother has a hi... | Transplacental passage of TSH receptor antibodies | {
"A": "Transplacental passage of thyroglobulin antibodies",
"B": "Transplacental passage of thyroid peroxidase antibodies",
"C": "Transplacental passage of TSH receptor antibodies",
"D": "Transplacental viral infection",
"E": "Opiate use in the mother"
} | step2&3 | C |
A 57-year-old female with a past medical history of alcoholism presents to the emergency room vomiting bright red blood. She is accompanied by her partner, who reports that she had been complaining of black and tarry stools for the past several days. Vital signs are temperature 37 degrees celsius, heart rate 141 beats ... | Nadalol | {
"A": "Phentolamine",
"B": "Prazosin",
"C": "Nifedipine",
"D": "Nadalol",
"E": "Doxazosin"
} | step1 | D |
A 65-year-old man with a history of hypertension, obesity, and alcoholic cirrhosis is seen in clinic for follow-up. He feels well and currently drinks 5 glasses of wine each night. Medications include atenolol and lisinopril. On physical exam, temperature is 98.1 deg F (36.7 deg C), blood pressure is 151/82 mmHg, pulse... | Proceed with liver biopsy | {
"A": "Proceed with liver biopsy",
"B": "Refer for surgical resection",
"C": "Refer for radiofrequency ablation",
"D": "Treat with sorafenib",
"E": "Observe and get follow-up imaging in 3 months"
} | step1 | A |
A 66-year-old man is brought to the emergency room by his wife due to abdominal distension and persistent somnolence for the past 2 weeks. The patient’s wife says that he has been sleeping much more than usual for the past 5 days. His bowel and bladder habit have not changed. His past medical history is significant for... | Spontaneous bacterial peritonitis | {
"A": "Spontaneous bacterial peritonitis",
"B": "Metabolic alkalosis",
"C": "Variceal gastrointestinal bleeding",
"D": "Portal vein thrombosis",
"E": "Hypoglycemia"
} | step1 | A |
A 27-year-old man presents to the emergency department after a motor vehicle collision. The patient was the front seat unrestrained driver in a head on collision. The patient’s echocardiogram (ECG) is notable only for sinus tachycardia. His temperature is 99.5°F (37.5°C), blood pressure is 107/58 mmHg, pulse is 120/min... | Cardiac contusion | {
"A": "Cardiac contusion",
"B": "Hemorrhage",
"C": "Myocardial infarction",
"D": "Pulmonary contusion",
"E": "Takotsubo cardiomyopathy"
} | step2&3 | A |
A 56-year-old man presents to the emergency department for progressively worsening fatigue, malaise, fever, and abdominal pain. He reports that his symptoms began approximately 1 week ago and he has noticed episodes of diarrhea. He recently started melatonin and magnesium supplementation in hopes of improving his sleep... | Liver transplantation | {
"A": "Adding dopamine to his treatment regimen",
"B": "Adding lisinopril to his treatment regimen",
"C": "Liver transplantation",
"D": "Switching cefotaxime to ceftriaxone",
"E": "Transjugular intrahepatic portosystemic shunting"
} | step2&3 | C |
A 29-year-old woman presents to the clinic after several months of weight loss. She noticed a 6.8 kg (15 lb) unintentional weight loss over the preceding several months. She has not changed her diet or exercise habits. She also reports feuding with her boyfriend over the temperature of their shared apartment, as she al... | Methimazole | {
"A": "Glucocorticoids",
"B": "Methimazole",
"C": "Propranolol",
"D": "Radioiodine therapy",
"E": "Thyroidectomy"
} | step2&3 | B |
A 21-year-old man comes to the physician because of pruritus and a hypopigmented rash on his upper body for 5 days. He first noticed the symptoms after returning from a business trip last week in the Bahamas. While he was there, he visited a couple of beaches and went hiking with some coworkers. The rash initially star... | Potassium hydroxide preparation | {
"A": "Wood lamp examination",
"B": "Skin culture",
"C": "Potassium hydroxide preparation",
"D": "Skin biopsy",
"E": "Antinuclear antibody testing\n\""
} | step2&3 | C |
A 5-year-old female is brought to a speech therapist for continuing work on improving her communication skills. She is only able to verbalize two word sentences and has generalized developmental delay. When she was born it was noticed that she had a high pitched mewing cry and subsequent physical exam revealed microcep... | 5 | {
"A": "5",
"B": "7",
"C": "13",
"D": "18",
"E": "21"
} | step1 | A |
A 62-year old female comes to the physician because of vaginal spotting and urinary urgency for the past 4 days. She has had no fever, abdominal pain, or diarrhea. Menopause occurred at 52 years of age. Her last Pap smear 1 year ago was normal. She has hypertension, hypercholesterolemia, and diabetes. Medications inclu... | Biopsy of the mass | {
"A": "Pap smear",
"B": "Biopsy of the mass",
"C": "Loop electrosurgical excision procedure",
"D": "Incision and drainage",
"E": "Urine gonorrhea and chlamydia testing"
} | step2&3 | B |
A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph is shown. He has had diabetes mellitus for 2 years which is not well controlled with medications. Lab studies show a transferrin sat... | Deposition of calcium pyrophosphate (CPP) crystals | {
"A": "Deposition of urate crystals",
"B": "Deposition of calcium pyrophosphate (CPP) crystals",
"C": "Degenerative joint disorder",
"D": "Inflammatory rheumatological syndrome",
"E": "Pathogenic inoculation of microbes"
} | step2&3 | B |
A newborn is found to be extremely cyanotic immediately after birth. He then develops progressive respiratory failure and is admitted to the neonatal ICU. A single loud S2 heart sound is appreciated as well as a machine-like murmur at the left upper sternal border. Radiography shows an enlarged "egg-shaped" heart. The ... | Transposition of great vessels | {
"A": "Coarctation of the aorta",
"B": "Persistent truncus arteriosus",
"C": "Tetralogy of Fallot",
"D": "Transposition of great vessels",
"E": "Tricuspid atresia"
} | step1 | D |
A 25-year-old male involved in a knife fight presents with a penetrating wound to the chest. The patient is unconscious and cannot provide any further history. Vitals show a temperature of 37-0°C (98.6°F), blood pressure of 85/55 mm Hg, pulse of 115/min, respirations of 19/min, and oxygen saturation of 92% on room air.... | Interrupted 2-0 polypropylene suture with supporting pledgets | {
"A": "Immediate cardiac transplant",
"B": "Watchful waiting while resuscitative fluids are initiated",
"C": "Interrupted 2-0 polypropylene suture with supporting pledgets",
"D": "Needle thoracostomy over the 2nd intercostal space",
"E": "Surgical adhesive glue"
} | step2&3 | C |
A post-mortem lung examination of a 68-year-old male overweight male with evidence of chronic lower extremity edema, a 60 pack-year smoking history and daily productive cough would be most likely to reveal: | Reid Index > 50% | {
"A": "Hypereosinophilia",
"B": "Reid Index > 50%",
"C": "Non-caseating granulomas",
"D": "Evidence of a necrotizing infection",
"E": "Keratin pearls"
} | step1 | B |
A 54-year-old male makes an appointment with his primary care physician due to chronic fatigue that has left him unable to hike or do other physically demanding activities with his friends. He has well-controlled hypertension and diabetes but has otherwise been healthy. He does not smoke but drinks socially with his fr... | Caspase-9 | {
"A": "Caspase-8",
"B": "Caspase-9",
"C": "CD15",
"D": "Cyclin-dependent kinase 4",
"E": "Ras pathway transcription factors"
} | step1 | B |
A 44-year-old African-American woman comes to the physician for a routine examination. She is concerned about cancer because her uncle died of metastatic melanoma 1 year ago. She has no history of serious illness and does not take any medication. She has been working in a law firm for the past 20 years and travels to t... | Acral lentiginous | {
"A": "Desmoplastic",
"B": "Nodular",
"C": "Acral lentiginous",
"D": "Lentigo maligna",
"E": "Superficial spreading"
} | step1 | C |
A 60-year-old woman is brought to the clinic by her daughter for evaluation. The daughter reports that her mother has recently been having difficulty combing her hair in the mornings. The patient’s family history is significant for an ischemic stroke in her father. The patient’s past medical history is positive for div... | Jaw claudication | {
"A": "Uveitis",
"B": "Jaw claudication",
"C": "Heliotrope rash",
"D": "Gastroesophageal reflux",
"E": "Pink plaques with silvery scales"
} | step2&3 | B |
A 30-year-old woman comes to the physician because she has been unable to conceive for 3 years. Analysis of her husband's semen has shown normal sperm counts during this time. The patient also reports episodic pelvic and back pain accompanied by painful diarrhea for 5 years. She has about one such episode on average pe... | Endometrial tissue outside the uterine cavity | {
"A": "Loss of fallopian tube function following infection",
"B": "Smooth muscle tumor arising from the myometrium",
"C": "Increased secretion of prolactin",
"D": "Endometrial tissue outside the uterine cavity",
"E": "Increased secretion of androgens and luteinizing hormone"
} | step2&3 | D |
A 55-year-old truck driver is brought to a physician by his wife. She states that her husband developed a fever and began feeling weak 3 days ago, but has refused medical help. He has been unable to go to work because of his symptoms. The patient has been previously hospitalized for a tricuspid valve replacement surger... | Friable irregular masses attached to the valve | {
"A": "Thickened valve with multiple small vegetations",
"B": "Bicuspid valve",
"C": "Friable irregular masses attached to the valve",
"D": "Papillary muscle rupture",
"E": "Annular calcification"
} | step1 | C |
A previously healthy 30-year-old woman comes to the physician for the evaluation of pain during sexual intercourse for 6 months. She also reports frequent episodes of crampy pelvic pain that starts one day before menses and lasts for 7 days. Her symptoms are not relieved with pain medication. Menses occur at regular 28... | Laparoscopy | {
"A": "Measurement of CA-125 levels",
"B": "Hysterectomy",
"C": "Laparoscopy",
"D": "Hysteroscopy",
"E": "CT scan of the abdomen and pelvis"
} | step2&3 | C |
A 50-year-old man visits his physician after 20 years of not seeking any medical care. He is concerned about his health after a colleague recently had a heart attack. The patient has no active complaints and says he feels healthy; however, he does not exercise regularly and lives a sedentary lifestyle. He is employed a... | High LDL-cholesterol | {
"A": "Blood pressure reading",
"B": "Patient’s weight",
"C": "High triglyceride levels",
"D": "High LDL-cholesterol",
"E": "Serum glucose level"
} | step1 | D |
A 26-year-old woman is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which she was a restrained passenger. On arrival, she is lethargic and incoherent. She has severe facial lacerations and is in respiratory distress. Her pulse is 130/min, respirations ar... | Thoracic aortic rupture | {
"A": "Diaphragmatic rupture",
"B": "Traumatic bronchial rupture",
"C": "Thoracic aortic rupture",
"D": "Cardiac tamponade",
"E": "Tension pneumothorax"
} | step2&3 | C |
A 26-year-old G1P0 woman presents to her primary care physician’s office with feelings of anxiety and trouble with sleep. She finds it difficult initiating sleep, occasionally has palpitations, and feels fatigued. She denies having similar symptoms in the past or starting any new medications or illicit drugs. She is cu... | Propylthiouracil | {
"A": "Methimazole",
"B": "Observation",
"C": "Propylthiouracil",
"D": "Radioiodine therapy",
"E": "Thyroidectomy"
} | step1 | C |
A 32-year-old woman comes to the physician because of a 3-week history of intermittent loose stools and a 1.2-kg (2.6-lb) weight loss. She immigrated to the US from Uganda 6 weeks ago. Abdominal examination shows diffuse tenderness with no guarding or rebound. The liver is firm and palpable 3 cm below the right costal ... | Freshwater snails | {
"A": "Tsetse flies",
"B": "Undercooked pork meat",
"C": "Undercooked fish meat",
"D": "Dog feces",
"E": "Freshwater snails"
} | step1 | E |
A 3-month-old girl is brought to a pediatrician by her parents. She has central cyanosis without signs of respiratory distress or signs of heart failure. An echocardiogram reveals severe pulmonary outflow obstruction, right ventricular hypertrophy, a ventricular septal defect, and an overriding of the aorta. An electiv... | Normal hemoglobin in patients with tetralogy of Fallot does not rule out iron deficiency anemia. | {
"A": "The tricuspid valve is the most common valve affected by bacterial endocarditis in uncorrected tetralogy of Fallot.",
"B": "Normal hemoglobin in patients with tetralogy of Fallot does not rule out iron deficiency anemia.",
"C": "Cerebral arterial thrombosis is more common than cerebral venous thrombosis."... | step1 | B |
Six days after undergoing surgical repair of a hip fracture, a previously healthy 79-year-old woman is agitated and confused. She is unarousable during the day, but then is awake and impulsive during the night, requiring frequent reorientation. Her husband says that she usually drinks one to two glasses of wine weekly.... | Delirium | {
"A": "Dementia",
"B": "Alcohol withdrawal",
"C": "Opioid intoxication",
"D": "Delirium",
"E": "Urinary tract infection"
} | step1 | D |
A 54-year-old woman with a past medical history of mental retardation, hypertension, and diabetes presents to the emergency department with a change in her behavior. Her caretakers state that the patient’s gait suddenly became ataxic, and she became less responsive than her normal non-verbal baseline. Her temperature i... | Rheumatoid arthritis | {
"A": "Cerebral palsy",
"B": "Diabetes mellitus",
"C": "Down syndrome",
"D": "Hypertension",
"E": "Rheumatoid arthritis"
} | step2&3 | E |
A 24-year-old man is brought to the emergency department 15 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he has rapid, shallow breathing and appears anxious. His pulse is 135/min, respirations are 30/min and shallow, and palpable systolic blood pressure is 80 mm Hg. He ... | A drop in systolic blood pressure of 14 mmHg during inspiration | {
"A": "Tracheal deviation toward the right side",
"B": "Hemoptysis",
"C": "A drop in systolic blood pressure of 14 mmHg during inspiration",
"D": "Herniation of the stomach into the chest",
"E": "Paradoxical motion of part of the chest with breathing\n\""
} | step2&3 | C |
A 40-year-old man presents to his primary-care doctor for a follow-up of his hypertension. He is asymptomatic at his office visit and denies any new complaints. He has a 10-year history of hypertension that remains poorly controlled on maximum doses of lisinopril, hydrochlorothiazide, and amlodipine. His past medical h... | MR angiography of the brain | {
"A": "Colonoscopy",
"B": "Esophagogastroduodenoscopy",
"C": "Liver function tests",
"D": "MR angiography of the brain",
"E": "Serum amylase and lipase"
} | step2&3 | D |
A 17-year-old female is brought to the emergency room by her father because she has been experiencing shortness of breath and chest pain. She says that the chest pain is worse when she breathes or coughs. Furthermore, on the way to the hospital she noticed that there were specks of blood on a tissue that she coughed in... | Autosomal dominant | {
"A": "Autosomal dominant",
"B": "Autosomal recessive",
"C": "Autosomal partial dominance",
"D": "X-linked dominant",
"E": "X-linked recessive"
} | step1 | A |
A 26-year-old male presents to his primary care physician with complaints of burning with urination, penile discharge, and intermittent fevers. A urethral smear shows gram negative diplococci within white blood cells. The organism grows well when cultured on Thayer-Martin agar. The patient is prescribed a course of cef... | Antigenic variation | {
"A": "Exotoxin release",
"B": "Antigenic variation",
"C": "Polysaccharide capsule",
"D": "Bruton's agammaglobulinemia",
"E": "Lack of necessary vaccination"
} | step1 | B |
A 37-year-old man with no significant past medical history is rear-ended in a motor vehicle accident. He reported significant neck pain to emergency responders, but otherwise denies weakness, numbness or tingling in his extremities. His vitals on presentation to the ED are HR 90, BP 140/80, RR 20, SpO2 98%. What is the... | Cervical immobilization | {
"A": "Lateral cervical film",
"B": "Three view cervical spine series",
"C": "Cervical immobilization",
"D": "IV methylprednisolone",
"E": "Observation overnight"
} | step2&3 | C |
A 43-year-old man with a history of schizophrenia, currently controlled with medication, comes in for an appointment with his internist. He is concerned about abnormal discharge from both nipples over the past 3 months. The fluid is white, and he wonders if it could be milk. On further review of systems, he endorses a ... | Bromocriptine | {
"A": "Metoclopramide",
"B": "Haloperidol",
"C": "Bromocriptine",
"D": "Fluphenazine",
"E": "Risperidone"
} | step1 | C |
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