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train-00600 | A 34-year-old man comes to the physician for a 2-month history of an itchy rash on his forearm. He feels well otherwise and has not had any fever or chills. He returned from an archaeological expedition to Guatemala 4 months ago. Skin examination shows a solitary, round, pink-colored plaque with central ulceration on t... | Treponema pallidum | Trypanosoma brucei | Ancylostoma duodenale | Leishmania braziliensis | 3 | |
train-00601 | A 59-year-old woman comes to the physician because of a 1-month history of episodic cough and shortness of breath. The cough is nonproductive and worsens when she climbs stairs and during the night. She has not had chest pain or palpitations. Eight weeks ago, she had fever, sore throat, and nasal congestion. She has a ... | Pneumonia | Gastroesophageal reflux disease | Asthma | Chronic bronchitis | 2 | |
train-00602 | A 2850-g (6-lb 5-oz) newborn is delivered at term to a 19-year-old primigravid woman via normal spontaneous vaginal delivery. The mother has had no prenatal care. Examination of the newborn in the delivery room shows a small, retracted jaw and hypoplasia of the zygomatic arch. This patient's condition is most likely ca... | Facial nerve | Incus | Greater horn of hyoid | Platysma | 1 | |
train-00603 | A 52-year-old woman comes to the emergency department because of epigastric abdominal pain that started after her last meal and has become progressively worse over the past 6 hours. She has had intermittent pain similar to this before, but it has never lasted this long. Her temperature is 39°C (102.2°F). Examination sh... | Dilated common bile duct with intrahepatic biliary dilatation | Gallstone in the cystic duct | Fistula formation between the gallbladder and bowel | Decreased echogenicity of the liver | 1 | |
train-00604 | A 15-year-old boy is brought to the physician by his father because he has been waking up frequently during the night to urinate. Apart from occasional headaches, he has no other complaints. His family recently emigrated from Tanzania and his medical history is unknown. His father was diagnosed with sickle cell disease... | Clear cell renal carcinoma | Renal papillary necrosis | Functional asplenia | Ischemic stroke
" | 1 | |
train-00605 | A 71-year-old woman comes to the physician because of an 8-month history of fatigue. Laboratory studies show a hemoglobin concentration of 13.3 g/dL, a serum creatinine concentration of 0.9 mg/dL, and a serum alkaline phosphatase concentration of 100 U/L. Laboratory evaluation of which of the following parameters would... | Cancer antigen 27-29 | Ferritin | Gamma-glutamyl transpeptidase | Calcitriol | 2 | |
train-00606 | A laboratory physician investigates the chromosomes of a fetus with a suspected chromosomal anomaly. She processes a cell culture obtained by amniocentesis. Prior to staining and microscopic examination of the fetal chromosomes, a drug that blocks cell division is added to the cell culture. In order to arrest chromosom... | Trichomonas vaginitis | Acute gouty arthritis | Herpes zoster | Testicular cancer | 1 | |
train-00607 | Following gastric surgery, a 45-year-old woman complains of severe nausea and vomiting on the 2nd postoperative day. On physical examination, her vitals are stable and examination of the abdomen reveals no significant abnormality. The patient is already receiving a maximum dosage of ondansetron. Metoclopramide is given... | Inhibition of dopamine receptors in the area postrema | Stimulation of motilin receptors in gastrointestinal smooth muscle | Enhancement of small intestinal and colonic motility by dopamine antagonism | Decreased esophageal peristaltic amplitude | 0 | |
train-00608 | A 32-year-old woman is found unconscious on the office floor just before lunch by her colleagues. She had previously instructed them on the location of an emergency kit in case this ever happened so they are able to successfully inject her with the substance inside. Her past medical history is significant for type 1 di... | Promotes gluconeogenesis in the liver | Promotes glucose release from skeletal muscles | Promotes glucose uptake in muscles | Promotes glycogen formation in the liver | 0 | |
train-00609 | A 6-year-old girl is brought to the physician because of a generalized pruritic rash for 3 days. Her mother has noticed fluid oozing from some of the lesions. She was born at term and has been healthy except for an episode of bronchitis 4 months ago that was treated with azithromycin. There is no family history of seri... | Vitamin A therapy | Rapid strep test | Tzanck test | Calamine lotion | 3 | |
train-00610 | A 3-month-old boy is brought to the emergency room by his mother for 2 days of difficulty breathing. He was born at 35 weeks gestation but has otherwise been healthy. She noticed a cough and some trouble breathing in the setting of a runny nose. His temperature is 100°F (37.8°C), blood pressure is 64/34 mmHg, pulse is ... | No further testing needed | Polymerase chain reaction | Sputum culture | Viral culture | 0 | |
train-00611 | A 2200-g (4-lbs 13-oz) female newborn is delivered at term to a 37-year-old gravida 2, para 1 woman. The newborn is at the 10th percentile for length, 14th percentile for weight, and 3rd percentile for head circumference. Examination shows “punched-out“ skin lesions on the scalp, cleft lip, and a small chin. There is a... | Polydactyly | Webbed neck | Single palmar crease | Hypoplastic philtrum | 0 | |
train-00612 | A 39-year-old woman presents to the emergency department with fever, cough, and shortness of breath. She reports developing flu-like symptoms 7 days ago but progressively worsened to the point where she experiences dyspnea on exertion. Her cough is accompanied by a mild amount of yellow sputum. Past medical history is ... | Decreased anion gap | Leukocytosis with left-shift | Neutropenia | Positive HIV serology | 2 | |
train-00613 | A 72-year-old man presents to his primary care physician complaining of pain and bulging in his groin. He is otherwise healthy and has never had surgery. He is referred to a general surgeon, and is scheduled for an elective hernia repair the following week. On closer inspection in the operating room, the surgeon notes ... | Indirect femoral hernia | Direct incisional hernia | Isolated rectus diastasis | Direct inguinal hernia | 3 | |
train-00614 | A 65-year-old man comes to the physician for evaluation of a neck mass and weight loss. He first noticed the growing mass 2 months ago. The mass is not painful. He also has decreased appetite and intermittent abdominal pain. He has lost 10 kg (22 lb) of weight over the past 3 months. Sometimes, he wakes up in the morni... | Osteoblastic metastasis | Ectopic vitamin D production | Multivitamin overdose | Osteolytic metastasis | 1 | |
train-00615 | A 29-year-old African American woman presents with incidentally noted bilateral hilar lymphadenopathy on a recent chest radiograph for the evaluation of pneumonia 1 month earlier. Upon questioning, she reports a cough, dyspnea, and angina. The report provided by a previous ophthalmologic consultation did not demonstrat... | Type I–anaphylactic hypersensitivity reaction | Type III–immune complex-mediated hypersensitivity reaction | Type IV–cell-mediated (delayed) hypersensitivity reaction | Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions | 2 | |
train-00616 | Ten days after starting a new medication, a 60-year-old man is brought to the emergency department after a 3-minute episode of myoclonic jerking movements and urinary incontinence. After regaining consciousness, the patient had no recollection of what happened and seemed confused. He has bipolar disorder, which has bee... | Valproic acid | Theophylline | Celecoxib | Metoprolol | 2 | |
train-00617 | A previously healthy 2-year-old boy is brought to the emergency department because of a 2-day history of fever and pain in the left lower extremity. His mother says that he has refused to walk for the last two days and has had a poor appetite. He returned from a weekend camping trip about a month ago. His maternal cous... | Vancomycin therapy | Synovial fluid drainage plus cefazolin therapy | Arthroscopic drainage of hip | Doxycycline therapy
" | 1 | |
train-00618 | A 51-year-old male presents to his primary care provider for a normal check-up. He reports that he “hasn’t felt like himself” recently. He describes feeling down for the past 8 months since his mother passed away. He has had trouble sleeping and has unintentionally lost 15 pounds. He feels guilty about his mother’s dea... | Norepinephrine and serotonin reuptake | Amine degradation | Norepinephrine and dopamine reuptake | Dopamine receptor activation | 0 | |
train-00619 | A 35-year-old man arrives at the emergency department within minutes after a head-on motor vehicle accident. He suffered from blunt abdominal trauma, several lacerations to his face as well as lacerations to his upper and lower extremities. The patient is afebrile, blood pressure is 45/25 mmHg and pulse is 160/minute. ... | Hb 5 g/dL, Hct 20% | Hb 15 g/dL, Hct 45% | Hb 20 g/dL, Hct 60% | Hb 17 g/dL, Hct 20% | 1 | |
train-00620 | A 28-year-old man comes to the physician because of a 3-month history of pain in his left shoulder. He is physically active and plays baseball twice a week. The pain is reproduced when the shoulder is externally rotated against resistance. Injury of which of the following tendons is most likely in this patient? | Teres major | Pectoralis major | Infraspinatus | Supraspinatus | 2 | |
train-00621 | A 58-year-old woman presents to the physician with a throbbing headache. She says she had it for the last year and it’s usually located in the right temporal area. There is localized tenderness over the scalp. During the last 2 weeks, she experienced 3 episodes of transient loss of vision on the right side, without ocu... | Amyloidosis | Dermatomyositis | Polymyalgia rheumatica | Sjogren’s syndrome | 2 | |
train-00622 | A researcher is studying proteins that contribute to intestinal epithelial permeability. He has isolated intestinal tissue from several mice. After processing the tissue into its individual components, he uses a Western blot analysis to identify a protein that forms part of a multi-protein complex at the apical aspect ... | Integrin | Connexon | Desmoglein | Claudin | 3 | |
train-00623 | A 38-year-old woman is evaluated for a difficult-to-control hypertension. Her symptoms include sleep interruption because of frequent waking up for voiding and frequent headaches. She has smoked 10 cigarettes daily for the past 5 years. Family history is insignificant. Her vital signs include a blood pressure of 170/96... | Renal angiogram | Adrenal venous sampling | Left laparoscopic adrenalectomy | Treatment with eplerenone | 1 | |
train-00624 | A 43-year-old woman comes to the office with a 3-day history of a rash. She's had a rash across her neck, shoulders, and the palms of her hands for the past five days. She's also had large-volume watery diarrhea for the same period of time. Past medical history is notable for acute myeloid leukemia, for which she recei... | Pre-existing host antibodies against graft antigens | Host antibodies that have developed against graft antigens | Host CD8+ T cells against graft antigens | Graft T cells against host antigens | 3 | |
train-00625 | A 27-year-old man who recently emigrated as a refugee from Somalia presents with fever, weight loss, fatigue, and exertional chest pain. He says his symptoms began 3 weeks ago and that his appetite has decreased and he has lost 3 kg (6.6 lb) in the last 3 weeks. He denies any history of cardiac disease. His past medica... | Bartonella serology | Q fever serology | Peripheral blood smear | Epstein-Barr virus heterophile antibody | 0 | |
train-00626 | Four days after having been admitted to the hospital for a pulmonary contusion and whiplash injury sustained in a motor vehicle collision, a 66-year-old woman complains of severe pain in her right flank and muscle spasms. She also has nausea with two episodes of vomiting and abdominal bloating. Her pain had previously ... | Small bowel perforation | Spinal cord injury | Retroperitoneal hemorrhage | Acute mesenteric ischemia
" | 2 | |
train-00627 | A 65-year-old man comes to the physician because of a 2-week history of chest pain that begins after walking at a brisk pace for 2 blocks. The pain does not radiate anywhere and is hard to localize. He has had similar episodes in the past 6 months and was prescribed sublingual nitroglycerin, which helps relieve the pai... | Decreased venous pooling | Coronary arterial vasodilation | Increased atherosclerotic plaque stability | Decreased end-diastolic pressure
" | 3 | |
train-00628 | A 34-year-old woman presents with confusion, drowsiness, and headache. The patient’s husband says her symptoms began 2 days ago and have progressively worsened with an acute deterioration of her mental status 2 hours ago. The patient describes the headaches as severe, localized to the frontal and periorbital regions, a... | CSF shows a positive acid-fast bacillus stain | CSF shows gram negative diplococci | CSF India ink stain shows encapsulated yeast cells | Multiple ring-enhancing lesions are seen on a CT scan | 2 | |
train-00629 | A 55-year-old male is started on nitrate therapy for treatment of stable angina. He experiences significant and immediate relief of his symptoms within minutes of starting therapy. Approximately 48 hours after initiating this new medication, he notes return of chest pain and pressure with exertion that no longer respon... | Transdermal nitroglycerin patch placed at 7AM then removed and replaced with another at 7PM | PO regular-release isosorbide dinitrate taken at 8AM, noon, and 5PM | Transdermal nitroglycerin patch placed at bedtime and removed at 7AM without replacement | PO extended release isosorbide-5-mononitrate once daily at 8AM | 0 | |
train-00630 | A 68-year-old woman comes to the physician for a follow-up visit for elevated blood pressure. Two weeks ago, her blood pressure was 154/78 mm Hg at a routine visit. Subsequent home blood pressure measurements at days 5, 10, and 14 have been: 156/76 mm Hg, 158/80 mm Hg, and 160/80 mm Hg. She has trouble falling asleep b... | Increase in kidney size | Decrease in arterial compliance | Decrease in baroreceptor sensitivity | Increase in aldosterone production | 1 | |
train-00631 | An 9-month-old infant is brought to the physician because of a generalized nonpruritic rash for 2 days. The rash began on her trunk and spread to her extremities. Five days ago, she was taken to the emergency department for fever of 40.5°C (104.9°F) and a 1-minute generalized tonic-clonic seizure. She was born at term ... | Kawasaki disease | Impetigo | Roseola infantum | Rubella | 2 | |
train-00632 | An 11-month-old boy is brought to the physician by his adoptive mother for the evaluation of seizures and musty-smelling urine. His immunizations are up-to-date. His height and weight are both below the 10th percentile. He is pale and has blue eyes. He cannot pull himself up from a seated position to stand and does not... | Variable expressivity | Pleiotropy | Incomplete penetrance | Loss of heterozygosity | 1 | |
train-00633 | A 24-year-old woman is in the intensive care unit for the management of a severe acute asthma exacerbation. She is currently intubated and sedated, and she is receiving intravenous steroids, continuous nebulized beta-agonists, and anticholinergic therapy via breathing treatments. On hospital day 2, she has a new fever ... | Abnormally rapid clearance of the medicines by the kidney | Abnormally rapid metabolism of the medicines by the liver | Inactivation of the medicine in the target tissue | Low bioavailability of the medicines | 2 | |
train-00634 | A 53-year-old Asian woman comes to the physician because of a 2-month history of severe pain in her right leg while walking. She used to be able to walk a half-mile (800-m) to the grocery store but has been unable to walk 200 meters without stopping because of the pain over the past month. She can continue to walk afte... | Duplex ultrasonography | Nerve conduction studies | Ankle-brachial index | Biopsy of tibial artery | 2 | |
train-00635 | A 27-year-old woman develops progressive difficulty breathing after a long day of chores in a dusty house. These chores included brushing the family dog, vacuuming, dusting, and sweeping. She occasionally gets these episodes once or twice a year and has her medication on hand. Her symptoms are reversed by inhaling a β2... | Bradykinin | Leukotrienes | Endorphins | Serotonin | 1 | |
train-00636 | Nine healthy subjects participate in a study of gastric secretions. Subjects are asked to eat a meal at hour 0, at which time the pH of stomach contents and rate of stomach acid secretions are measured over the next 4 hours. Results of the study are shown. Which of the following mediators is most active at point A in t... | Prostaglandin | Somatostatin | Glucose-dependent insulinotropic peptide | Acetylcholine | 3 | |
train-00637 | A 43-year-old Caucasian woman is admitted to the hospital with acute onset right upper quadrant (RUQ) pain. The pain started 6 hours ago after the patient had a large meal at a birthday party and has progressively worsened. She recalls having similar pain before but not so intense. No significant past medical history. ... | Endoscopic retrograde cholangiopancreatography | Laparoscopic cholecystectomy | Percutaneous cholecystostomy | Shock wave lithotripsy | 1 | |
train-00638 | A 38-year-old man comes to the physician because of severe muscle pain and swelling of his eyelids for 3 days. He has also had fever and chills during this period. For the last 2 days, he has had severe pain in his mouth while chewing. He had an episode of diarrhea a month ago for which he did not seek medical care. He... | Clean drinking water | Cooking meat to 71°C (160°F) | Consume pasteurized dairy products | Metronidazole at the onset of diarrhea | 1 | |
train-00639 | A 28-year-old man comes to the physician for a pre-employment examination. He has no history of serious illness and takes no medications. A screening blood test is performed in which peptides are added to the sample to stimulate in vitro production of interferon-gamma, which is then measured using an enzyme-linked immu... | Staphylococcus aureus | Hepatitis B virus | Mycobacterium tuberculosis | Legionella pneumophila | 2 | |
train-00640 | A 23-year-old woman comes to the physician because of a 5-month history of a pruritic rash on the bilateral upper extremities. She has no history of serious illness and takes no medications. A skin biopsy of the rash shows intraepidermal accumulation of edematous fluid and widening of intercellular spaces between kerat... | Psoriasis vulgaris | Lichen planus | Acanthosis nigricans | Eczematous dermatitis | 3 | |
train-00641 | A 52-year-old man with a 20+ year history of smoking comes in today to talk about quitting. His wife has recently been trying to quit, and she wants him to quit with her. He has been resistant in the past, but he is now very willing to talk with you about it. Today, he seems like he really wants to make a change. What ... | Precontemplation | Contemplation | Preparation | Maintenance | 2 | |
train-00642 | A 28-year-old woman is brought into the clinic by her husband with concerns that she might be depressed. She delivered a healthy newborn a week and a half ago without any complications. Since then, she has been having trouble sleeping, eating poorly, and has stopped playing with the baby. The patient says she feels lik... | Reassurance | Fluoxetine | Amitriptyline | No treatment | 0 | |
train-00643 | A 51-year-old man presents to the emergency department with complaints of upper abdominal pain for the last several hours. He says that the pain travels to his back and is less severe when he leans forward. He is diagnosed with acute pancreatitis following enzyme analysis and CT scan of the abdomen and is subsequently ... | Need no management as this will resolve spontaneously | Octreotide infusion to reduce all gastrointestinal secretions | External percutaneous drainage of the lesion | Endoscopic drainage | 3 | |
train-00644 | A 13-year-old boy is brought to the physician because of a 5-day history of a rash on his chest and back. His mother initially noticed only a few lesions on his back, but since then the rash has spread to his chest. His family returned from a trip to the Caribbean 2 weeks ago. His mother started using a new laundry det... | Autoimmune destruction of melanocytes | Increased sebum production | Increased growth of Malassezia globosa | Exposure to human herpes virus 7 | 2 | |
train-00645 | A 72-year-old woman is brought to the emergency department because of increasing abdominal pain for 6 hours. The pain is dull and diffuse over her abdomen and radiates to her lower back bilaterally. Three weeks ago, she was diagnosed with atrial fibrillation and started on warfarin. Her only other medication is 1 g of ... | Fresh frozen plasma and tranexamic acid | Factor VIII and von Willebrand factor | Phytonadione and prothrombin complex concentrate | Protamine sulfate and hydroxyethyl starch | 2 | |
train-00646 | A 36-year-old man presents to a psychiatrist for management of nicotine dependence. He has been a heavy smoker for the past 20 years. He has unsuccessfully attempted to quit smoking many times. He has seen multiple physicians for nicotine dependence. They prescribed nicotine replacement therapy and varenicline. He has ... | Buprenorphine | Clonidine | Lorazepam | Topiramate | 1 | |
train-00647 | A physician attempts to study cirrhosis in his state. Using a registry of admitted patients over the last 10 years at the local hospital, he isolates all patients who have been diagnosed with cirrhosis. Subsequently, he contacts this group of patients, asking them to complete a survey assessing their prior exposure to ... | Case-control study | Cross-sectional study | Meta-analysis | Randomized controlled trial | 0 | |
train-00648 | A 17-year-old male presents to your office complaining of polyuria, polydipsia, and unintentional weight loss of 12 pounds over the past 3 months. On physical examination, the patient is tachypneic with labored breathing. Which of the following electrolyte abnormalities would you most likely observe in this patient? | Alkalemia | Hyperkalemia | Hypermagnesemia | Hyperphosphatemia | 1 | |
train-00649 | A 54-year-old man comes to the physician because of generalized fatigue and numbness of his legs and toes for 5 months. He has hypertension and hypercholesterolemia. He underwent a partial gastrectomy for peptic ulcer disease 15 years ago. Current medications include amlodipine and atorvastatin. He is a painter. His te... | Oligoclonal bands in cerebrospinal fluid | Elevated methylmalonic acid levels | Basophilic stippling on peripheral smear | Positive rapid plasma reagin test | 1 | |
train-00650 | A 5-year-old male is brought to his pediatrician after recurrent, prolonged upper respiratory infections over a period of several months. Physical exam reveals petechiae on the patient’s legs and arms. Laboratory studies show hemoglobin: 10 g/L, platelet count: 35,000/mm^3, leukocyte count: 6,600/mm^3. A bone marrow as... | TdT, HER-2 | CD19, CD10 | CD30, CD15 | CD4, CD5 | 1 | |
train-00651 | The objective of one case-control study was to assess whether a history of past trauma represents a risk factor for the development of spondyloarthritis. Cases of spondyloarthritis were compared with a random sample taken from the general population in regards to a history of prior trauma. This kind of history, which i... | If the outcome is ascertained through electronic health records | If the outcome is assessed systematically regardless of exposure | If the outcome is ascertained while the exposed status is masked | If the study participants are subjected to identical tests at each visit | 0 | |
train-00652 | A 67-year-old man presents to the emergency department with trouble urinating. The patient states that in general he has had difficulty urinating but recently, it has taken significant effort for him to initiate a urinary stream. He finds himself unable to completely void and states he has suprapubic tenderness as a re... | Constipation | Medication-induced symptoms | Prostatic adenocarcinoma | Worsening benign prostatic hypertrophy | 1 | |
train-00653 | A 26-year-old woman, gravida 2, para 1, at 26 weeks’ gestation, comes to the emergency department because of pain and swelling in her right calf. Physical examination shows an increased circumference of the right calf. The leg is warm and tender on palpation. Dorsiflexion of the right foot elicits calf pain. An ultraso... | Aspirin | Clopidogrel | Heparin | Warfarin | 2 | |
train-00654 | A 4-year-old boy is brought to the physician by his mother because of generalized weakness and difficulty walking for the past month. Laboratory studies show a hemoglobin concentration of 6.6 g/dL, mean corpuscular volume of 74 μm3, platelet count of 150,000/mm3, and serum total bilirubin of 2 mg/dl. An MRI of the spin... | Aplastic anemia | Lead poisoning | Multiple myeloma | Beta-thalassemia
" | 3 | |
train-00655 | A 32-year-old woman comes to the physician because of weight gain, generalized weakness, and irregular menstrual cycles for the past 16 months. She began having symptoms of insomnia and depression 10 months ago. More recently, she has been having difficulties rising from a chair. She has a 2-year history of hypertensio... | MRI of the head with contrast | Measure ACTH levels in inferior petrosal sinuses | High-dose dexamethasone suppression test | CT scan of the abdomen with contrast | 2 | |
train-00656 | A 43-year-old woman is found in the hospital to have a plasma sodium concentration of 126 mg/dL. She was hospitalized after she expressed suicidal ideations and was started on a medication for major depressive disorder. Her past medical history is significant for diabetes for which she is currently taking metformin. He... | Acidophils in the anterior pituitary | Chromophobes in the anterior pituitary | Located in the hypothalamus | Located in the posterior pituitary | 2 | |
train-00657 | A 41-year-old nulliparous woman comes to the physician for an annual pelvic examination and Pap smear. Over the past year she has been feeling healthy. She is sexually active and uses an intrauterine device with copper for contraception. She has smoked one pack of cigarettes daily for 20 years. She is 160 cm (5 ft 3 in... | Leiomyoma | Endometrial cancer | Endometrial hyperplasia | Uterine leiomyosarcoma | 0 | |
train-00658 | A 52-year-old man comes to the physician for a routine health maintenance examination. He feels well. His blood pressure is 125/70 mm Hg. His glomerular filtration rate is calculated to be 105 mL/min/1.73 m2 and glucose clearance is calculated to be 103 mL/min. This patient is most likely being treated with which of th... | Metformin | Canagliflozin | Ifosfamide | Acarbose | 1 | |
train-00659 | An 18-month-old boy is brought in by his parents for a routine check-up. The parents state that the patient still has not had any language development, and they are concerned about developmental delay. Of note, they have also noticed that the patient’s facial features have changed significantly in the last year. The pa... | Chromosomal translocation | Interstitial deletion | Nonsense mutation | Silent mutation | 2 | |
train-00660 | A 29-year-old man is brought to the emergency department 20 minutes after being stabbed in the left thigh. His pulse is 110/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Examination shows a 2-cm wound overlying a pulsatile mass on the left anterior thigh, 4 cm below the inguinal crease. A thrill is ... | Pudendal nerve compression | High-output cardiac failure | Iliac artery aneurysm | Femoral head necrosis | 1 | |
train-00661 | A 69-year-old man presents to his primary care physician for pain when he walks. He states that the pain is the worst in his left great toe but is also present in his hips and knees. He says that his symptoms are worse with activity and tend to improve with rest. His symptoms have progressively worsened over the past s... | Osteoarthritis | Infectious arthritis | Gout | Pseudogout | 0 | |
train-00662 | A 51-year-old woman presents to your office with 2 weeks of fatigue and generalized weakness. She has a past medical history of diabetes, hypertension, and hyperlipidemia. She was recently diagnosed with rheumatoid arthritis and started on disease-modifying therapy. She states she has felt less able to do things she en... | Depression | Iron deficiency | Medication side effect | Vitamin B12 deficiency | 2 | |
train-00663 | A 34-year-old man presents with acute-onset fever and weakness followed by shifting neurologic deficits (aphasia, motor deficits), which have lasted for a few days. His relatives add that his quantity of urine has reduced significantly over the last few days. He has never had any similar symptoms. Laboratory findings a... | The condition is caused by the deficiency of a sodium transporter. | Bleeding time will be normal. | Splenectomy should be performed as early as possible. | Plasmapheresis is the treatment of choice. | 3 | |
train-00664 | A 38-year-old man comes to the physician because of a 1-month history of fever and a cough productive of a moderate amount of yellowish sputum. He has had a 6-kg (13-lb) weight loss during this period. He emigrated from the Middle East around 2 years ago. His father died of lung cancer at the age of 54 years. He has sm... | Perform a high-resolution CT scan of the chest | Collect sputum specimens for acid-fast bacilli smear microscopy, culture, and nucleic acid amplification | Perform transbronchial lung biopsy of the suspected lesion | Perform an interferon-gamma release assay | 1 | |
train-00665 | A 5-year-old girl is brought to the physician by her mother for a 6-week history of fatigue, fever, and recurrent epistaxis. She has a history of duodenal atresia and an atrioventricular septal defect. She is at the 5th percentile for height and 30th percentile for weight. Physical examination shows painless cervical l... | Meiotic nondisjunction | Deletion of a chromosome segment | Uniparental disomy | Unbalanced Robertsonian translocation | 0 | |
train-00666 | A 27-year-old woman, gravida 2, para 1, at 37 weeks' gestation is admitted to the hospital in active labor. She has received routine prenatal care, but she has not been tested for group B streptococcal (GBS) colonization. Pregnancy and delivery of her first child were complicated by an infection with GBS that resulted ... | Obtain vaginal-rectal swab for GBS culture | Administer intrapartum intravenous penicillin | Obtain vaginal-rectal swab for GBS culture and nucleic acid amplification testing | Obtain vaginal-rectal swab for nucleic acid amplification testing | 1 | |
train-00667 | A 55-year-old woman presents with diarrhea and a rash. She reports having some painful reddish nodules on her legs that she noticed a week ago. She also has been having loose stools associated with cramping lower abdominal pain for the past month. This is associated with an urgency to defecate, and defecation helps rel... | Worsening of osteoporosis | Infection | Megaloblastic anemia | Hepatotoxicity | 1 | |
train-00668 | A 7-year-old boy presents to the emergency department with several days of high fever accompanied by runny nose, cough, and red itchy eyes. Upon further history, you learn that the family is undocumented and has not had access to primary health services. Upon physical examination you see a red, slightly bumpy rash exte... | Parotid gland swelling | Posterior auricular lymphadenopathy | Blueberry muffin rash | Koplik spots | 3 | |
train-00669 | A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An e... | St. John’s wort | Chili peppers | Grapefruit juice | Spinach | 2 | |
train-00670 | A 25-year-old gravida 1 para 0 woman visits an OB/GYN for her first prenatal visit and to establish care. She is concerned about the costs related to future prenatal visits, medications, procedures, and the delivery. She has no type of health insurance through her work and has previously been denied coverage by public ... | She may be eligible for Medicaid because she is pregnant | She may be eligible for Medicare based on her higher salary | She may be eligible for Medigap based on her higher salary | She may be eligible for Medigap because she is pregnant | 0 | |
train-00671 | A 19-year-old male with cystic fibrosis is evaluated in the clinic for regular health maintenance. He is compliant with his respiratory therapy, but states that he often "forgets" to take the medications before he eats. A panel of labs is drawn which reveals a moderate vitamin D deficiency. Which of the following elect... | Increased calcium and decreased phosphate | Decreased calcium and increased phosphate | Decreased calcium and decreased phosphate | Normal calcium and decreased phosphate | 2 | |
train-00672 | A 57-year-old male presents with a primary complaint of erectile dysfunction. After proper evaluation, the patient is started on daily administration of sildenafil. This medication directly causes accumulation of which of the following intracellular mediators? | Ca2+ | cGMP | AMP | ANP | 1 | |
train-00673 | A 32-year-old Caucasian female is admitted to the emergency department with a 48-hour history of severe and diffuse abdominal pain, nausea, vomiting, and constipation. Her personal history is unremarkable except for an ectopic pregnancy 5 years ago. Upon admission, she is found to have a blood pressure of 120/60 mm Hg,... | Hernia | Adhesions | Enlarged Peyer’s plaques | Gastrointestinal malignancy | 1 | |
train-00674 | A 32-year-old woman presents with three-days of vaginal burning, itching, and pain with intercourse. She is in a monogamous relationship with her husband and has an intrauterine device for contraception. Her past medical history is unremarkable, except for recently being treated with antibiotics for sinusitis. Pelvic e... | Fluconazole | Itraconazole | Posaconazole | Voriconazole | 0 | |
train-00675 | A 2-week-old female newborn is brought to the physician for the evaluation of red eyes with discharge for 2 days. She was born at 39 weeks' gestation to a 22-year-old woman. Pregnancy and delivery were uncomplicated. The mother received irregular prenatal care during the second half of the pregnancy. The newborn weighe... | Reassurance and follow-up in 1 week | Intravenous acyclovir administration | Oral doxycycline administration | Oral erythromycin administration | 3 | |
train-00676 | A 40-year-old woman was admitted to the surgical service after an uncomplicated appendectomy. She underwent surgery yesterday and had an uneventful postoperative course. However, she now complains that she is unable to completely void. She also complains of pain in the suprapubic area. You examine her and confirm the t... | Oral bethanechol chloride | Intravenous neostigmine methylsulfate | Intravenous furosemide | Catheterization | 3 | |
train-00677 | A 42-year-old woman presents to her family physician with a headache. The patient reports that the symptoms started about 2 hours ago when she woke up and have not improved. She states the pain is moderate, throbbing, tight in character, and is located in the occipital region bilaterally. The patient denies any visual ... | Non-contrast CT of the head and neck | T1/T2 MRI of the head and neck | Administer high-flow oxygen, ibuprofen 200 mg orally, and sumatriptan 6 mg subcutaneously | Recommend lifestyle changes, relaxation techniques, and massage therapy | 3 | |
train-00678 | A 27-year-old man comes to the physician for a follow-up examination. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite has increased. Last year, he had two episod... | Continue paroxetine therapy for 2 years | Discontinue paroxetine | Continue paroxetine therapy for 6 months | Switch from paroxetine to lithium therapy
" | 0 | |
train-00679 | A 15-year-old girl comes to the physician because of a 2-year history of irregular menstrual bleeding. Menses have occurred at irregular 45- to 60-day intervals since menarche at the age of 13 years. Her last menstrual period was 5 weeks ago and lasted for 7 days with heavy flow and no cramping. She is not sexually act... | Pituitary adenoma | Polycystic ovary syndrome | Anovulation | Ovarian insufficiency
" | 2 | |
train-00680 | A 7-year-old boy is brought by his parents to his pediatrician due to progressive fatigue and shortness of breath while playing sports. He is otherwise healthy with no known medical disorders and no other symptoms. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines... | Coarctation of the aorta | Complete atrioventricular septal defect | Atrial septal defect | Double-outlet right ventricle with subaortic ventricular septal defect | 2 | |
train-00681 | A previously healthy 17-year-old boy is brought to the emergency department by his mother for further evaluation after elective removal of his wisdom teeth. During the procedure, the patient had persistent bleeding from the teeth's surrounding gums. Multiple gauze packs were applied with minimal effect. The patient has... | Glanzmann thrombasthenia | Immune thrombocytopenia | Hemophilia | Bernard-Soulier syndrome | 2 | |
train-00682 | A 48-year-old man with a history of diabetes mellitus presents to his primary care physician with lethargy, joint pain, and impotence. Lab evaluation is notable for a ferritin of 1400 ug/L (nl <300 ug/L), increased total iron, increased transferrin saturation, and decreased total iron binding capacity. All of the follo... | It may lead to a decline in cardiac function | It may improve with calcium chelators | It is associated with an increased risk for hepatocellular carcinoma | It results in skin bronzing | 1 | |
train-00683 | A 68-year-old man is brought to the clinic by his daughter who has noticed behavioral changes and frequent headaches for the past 2 weeks. The patient’s daughter says he has been having memory and simple calculation issues, gets upset easily, and his grip strength has dramatically declined. The patient was completely n... | Arteriovenous malformation | Tearing of bridging veins | Tearing of the middle meningeal artery | Dural arteriovenous fistula | 1 | |
train-00684 | A 30-year-old woman, gravida 1, para 0, at 40 weeks' gestation is admitted to the hospital in active labor. Pregnancy was complicated by iron deficiency anemia treated with iron supplements. At the beginning of the first stage of labor, there are coordinated, regular, rhythmic contractions of high intensity that occur ... | Cesarean section | Vacuum-assisted delivery | Observation for another hour | Epidural anesthesia | 2 | |
train-00685 | A 23-year-old woman, gravida 2, para 1, at 26 weeks gestation comes to the physician for a routine prenatal visit. Physical examination shows a uterus consistent in size with a 26-week gestation. Fetal ultrasonography shows a male fetus with a thick band constricting the right lower arm; the limb distal to the constric... | Deformation | Agenesis | Disruption | Malformation | 2 | |
train-00686 | A 47-year-old man presents to the emergency department due to a rash. He states the rash started last night and is very concerning to him. The patient cannot remember being exposed to any environmental stimuli such as new detergents or poison ivy. The patient recently started following with a primary care provider who ... | Erythema multiforme | Herpes simplex virus | Herpes zoster | Steven-Johnson syndrome | 3 | |
train-00687 | A 12-year-old boy presents to the pediatrician with complaints of chronic cough for the past two years. The cough is present during the day, especially after returning from school. His school teacher says he does not cough at school. The cough is absent while he is asleep, although it increases during examinations or w... | Atomoxetine | Clonidine | Haloperidol | Levetiracetam | 2 | |
train-00688 | A 27-year-old woman consults an obstetrician as she is planning to become pregnant. She has been diagnosed with HIV (human immunodeficiency virus) infection recently and is currently taking antiretroviral therapy (HAART), as prescribed by her physician. The obstetrician emphasizes the importance of antenatal and peripa... | Abacavir and Didanosine | Efavirenz and Delavirdine | Lopinavir and Ritonavir | Nelfinavir and Saquinavir | 1 | |
train-00689 | A 1-month-old baby is brought to the emergency department because he had a coughing spell while feeding and turned blue. The mother says that the blue color went away when she picked the baby up and brought his knees to his chest. The physician orders a chest X-ray which shows a boot-shaped heart and he tells the mothe... | Pulmonary stenosis, left ventricular hypertrophy, ventricular septal defect, overriding aorta | Pulmonary regurgitation, left ventricular hypertrophy, ventricular septal defect, overriding aorta | Pulmonary stenosis, right ventricular hypertrophy, atrial septal defect, overriding pulmonary artery | Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta | 3 | |
train-00690 | A 16-year-old girl is brought to the physician by her mother because she has not had her menstrual period yet. At birth, she was found to have partial labial fusion and clitoromegaly. The mother reports that during the pregnancy she had noticed abnormal hair growth on her chin. The girl has severe acne. Three years ago... | Polycystic ovary syndrome | Congenital adrenal hyperplasia | Turner syndrome | Aromatase deficiency | 3 | |
train-00691 | A 6-month-old infant is brought to the physician’s office by his parents due to a fever, cough, and shortness of breath. The cough is dry and has been progressively worsening for the past 48 hours along with the shortness of breath. His fever never exceeded 37.8°C (100.0°F) at home. The parents say that he has also had... | Asthma | Sinusitis | Bronchiolitis | Laryngotracheitis | 2 | |
train-00692 | A 67-year-old woman comes to the physician because of fever, chills, myalgias, and joint pain 1 month after undergoing aortic prosthetic valve replacement due to high-grade aortic stenosis. She does not drink alcohol or use illicit drugs. Her temperature is 39.3°C (102.8°F). She appears weak and lethargic. Physical exa... | Alpha hemolytic, optochin-sensitive diplococci | Novobiocin-sensitive, coagulase-negative cocci | Beta hemolytic, bacitracin-sensitive cocci | Alpha hemolytic, optochin-resistant cocci | 1 | |
train-00693 | A 42-year-old woman presents to her primary care provider with vision loss. She reports that twice over the last 2 weeks she has had sudden “black out” of the vision in her right eye. She notes that both episodes were painless and self-resolved over approximately a minute. The patient’s past medical history is signific... | Check serum inflammatory markers | Emergent referral to ophthalmology | MRI of the brain | Ultrasound of the carotid arteries | 3 | |
train-00694 | A 37-year-old man presents to his primary care provider with dysphagia. He notes that his symptoms began several weeks ago and have worsened over time. He now has trouble swallowing solids and liquids. He denies any other symptoms. He has no significant past medical history. Travel history reveals a recent trip to Sout... | Barium swallow | Endoscopy | Myotomy | Nifurtimox | 0 | |
train-00695 | A 61-year-old woman presents for a routine health visit. She complains of generalized fatigue and lethargy on most days of the week for the past 4 months. She has no significant past medical history and is not taking any medications. She denies any history of smoking or recreational drug use but states that she drinks ... | Transfuse the patient with whole blood | Continue oral ferrous sulfate and supplement with ascorbic acid | Continue oral ferrous sulfate and supplement with omeprazole | Administer iron intravenously | 1 | |
train-00696 | A 41-year-old man with HIV comes to the physician because of rectal bleeding and itching for 2 weeks. During this period, he has also had pain with defecation. Four months ago, he was diagnosed with anogenital warts that were treated with cryotherapy. Over the past year, he has been sexually active with 3 male partners... | Inactivation of VHL gene | Activation of TAX gene | Inactivation of WT1 gene | Inactivation of TP53 gene
" | 3 | |
train-00697 | A 3-year-old child is brought to the emergency department by his parents. The child presents with significant rapid breathing and appears unwell. On examination, his liver size is 1.5 times larger than children of his age, and he has mild pitting edema in his legs. This child is also in the lower weight-age and height-... | Liver failure | Atrial septal defect | Patent foramen ovale | Endocardial cushion syndrome | 1 | |
train-00698 | A neurophysiologist describes the mechanism of a specific type of synaptic transmission to his students. While illustrating this, he points out that when the action potential reaches the presynaptic terminal of a chemical synapse, the voltage-gated Ca2+ channels open. Ca2+ ions trigger the release of neurotransmitters ... | Follicle stimulating hormone | Epinephrine | GABA (γ-amino butyric acid) | Glutamate | 1 | |
train-00699 | A 32-year-old man with a history of major depressive disorder is brought to the emergency department by his wife because of a sudden onset of restlessness and disorientation that developed 3 hours ago. The patient’s wife says that he suddenly started sweating, having tremors, and mumbling to himself. Yesterday, the pat... | Mirtazapine | Bupropion | Sertraline | Lithium | 2 |
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