Medical large language models are easily distracted
Paper • 2504.01201 • Published • 3
Datasets:
id stringlengths 9 9 | question stringlengths 222 2.41k | options dict | answer stringclasses 4
values | distractor stringlengths 56 246 | target stringclasses 4
values | clean_question stringlengths 83 2.28k | fixed_template bool 1
class |
|---|---|---|---|---|---|---|---|
dev-00000 | A 21-year-old sexually active male complains of fever, pain during urination, and inflammation and pain in the right knee. A culture of the joint fluid shows a bacteria that does not ferment maltose and has no polysaccharide capsule. The physician orders antibiotic therapy for the patient. The patient joked that the Wi... | {
"A": "Gentamicin",
"B": "Ciprofloxacin",
"C": "Ceftriaxone",
"D": "Trimethoprim"
} | C | The patient joked that the Wi‑Fi signal in the dorm was a fluoroquinolone, slicing through the thick walls with the same relentless precision as the drug. | B | A 21-year-old sexually active male complains of fever, pain during urination, and inflammation and pain in the right knee. A culture of the joint fluid shows a bacteria that does not ferment maltose and has no polysaccharide capsule. The physician orders antibiotic therapy for the patient. The mechanism of action of ac... | false |
dev-00001 | A 5-year-old girl is brought to the emergency department by her mother because of multiple episodes of nausea and vomiting that last about 2 hours. During this period, she has had 6–8 episodes of bilious vomiting and abdominal pain. The vomiting was preceded by fatigue. The girl feels well between these episodes. She h... | {
"A": "Cyclic vomiting syndrome",
"B": "Gastroenteritis",
"C": "Hypertrophic pyloric stenosis",
"D": "Gastroesophageal reflux disease"
} | A | The patient said that the rush‑hour traffic was a real pyloric stenosis, squeezing the cars together like a tight valve. | C | A 5-year-old girl is brought to the emergency department by her mother because of multiple episodes of nausea and vomiting that last about 2 hours. During this period, she has had 6–8 episodes of bilious vomiting and abdominal pain. The vomiting was preceded by fatigue. The girl feels well between these episodes. She h... | false |
dev-00002 | A 40-year-old woman presents with difficulty falling asleep, diminished appetite, and tiredness for the past 6 weeks. She says that, despite going to bed early at night, she is unable to fall asleep. She denies feeling anxious or having disturbing thoughts while in bed. Even when she manages to fall asleep, she wakes u... | {
"A": "Diazepam",
"B": "Paroxetine",
"C": "Zolpidem",
"D": "Trazodone"
} | D | The patient said that the office printer was a real zolpidem, putting everyone to sleep with its painfully slow speed. | C | A 40-year-old woman presents with difficulty falling asleep, diminished appetite, and tiredness for the past 6 weeks. She says that, despite going to bed early at night, she is unable to fall asleep. She denies feeling anxious or having disturbing thoughts while in bed. Even when she manages to fall asleep, she wakes u... | false |
dev-00003 | A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, ... | {
"A": "Obtain an abdominal CT scan",
"B": "Obtain a urine analysis and urine culture",
"C": "Begin intravenous treatment with ceftazidime",
"D": "No treatment is necessary"
} | B | The patient joked that the office printer’s output looked like a CT scan, with every page rendered in perfect axial slices. | A | A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 102 deg F (39.4 deg C), blood pressure is 114/82 mmHg, ... | false |
dev-00004 | A 19-year-old boy presents with confusion and the inability to speak properly. The patient's mother says that, a few hours ago, she noticed a change in the way he talked and that he appeared to be in a daze. He then lost consciousness, and she managed to get him to the hospital. She is also concerned about the weight h... | {
"A": "Hypoperfusion",
"B": "Hyperglycemia",
"C": "Metabolic acidosis",
"D": "Hypokalemia"
} | A | The patient joked that the office party’s playlist was a real “anion gap,” leaving everyone wondering what was missing. | C | A 19-year-old boy presents with confusion and the inability to speak properly. The patient's mother says that, a few hours ago, she noticed a change in the way he talked and that he appeared to be in a daze. He then lost consciousness, and she managed to get him to the hospital. She is also concerned about the weight h... | false |
dev-00005 | A 41-year-old woman presents to her primary care physician with complaints of fatigue and weakness. She denies any personal history of blood clots or bleeding problems in her past, but she says that her mother has had to be treated for breast cancer recently and is starting to wear her down. Her past medical history is... | {
"A": "Vitamin B12 deficiency",
"B": "Folate deficiency",
"C": "Iron deficiency",
"D": "Intravascular hemolysis"
} | C | The patient joked that the office printer was showing signs of pernicious anemia because it kept “losing its ink” despite regular refills. | A | A 41-year-old woman presents to her primary care physician with complaints of fatigue and weakness. She denies any personal history of blood clots or bleeding problems in her past, but she says that her mother has had to be treated for breast cancer recently and is starting to wear her down. Her past medical history is... | false |
dev-00006 | A 59-year-old woman with stage IV lung cancer comes to the physician because of progressively worsening weakness in the past 3 months. She has had a 10.5-kg (23-lb) weight loss during this period. Her BMI is 16 kg/m2. She appears thin and has bilateral temporal wasting. The patient joked that the office printer’s jamme... | {
"A": "Cytochrome c-mediated activation of proteases",
"B": "Lipase-mediated degradation of triglycerides",
"C": "TNF-α-mediated activation of caspases",
"D": "Proteasomal degradation of ubiquitinated proteins"
} | D | The patient joked that the office printer’s jammed sheets went through a “TNF‑α‑mediated caspase cascade” before finally disappearing into the recycling bin. | C | A 59-year-old woman with stage IV lung cancer comes to the physician because of progressively worsening weakness in the past 3 months. She has had a 10.5-kg (23-lb) weight loss during this period. Her BMI is 16 kg/m2. She appears thin and has bilateral temporal wasting. Which of the following is the most likely primary... | false |
dev-00007 | A 67-year-old man presents to the emergency department with a fever and altered mental status. The patient has a history of Alzheimer dementia and is typically bed bound. His son found him confused with a warm and flushed complexion thus prompting his presentation. The patient has a past medical history of dementia, di... | {
"A": "Exertional heat stroke",
"B": "Neuroleptic malignant syndrome",
"C": "Non-exertional heat stroke",
"D": "Septic shock"
} | C | The patient said that the concert was a real hyperthermia of excitement, with the crowd heating up the room just by dancing. | A | A 67-year-old man presents to the emergency department with a fever and altered mental status. The patient has a history of Alzheimer dementia and is typically bed bound. His son found him confused with a warm and flushed complexion thus prompting his presentation. The patient has a past medical history of dementia, di... | false |
dev-00008 | A 32-year-old man presents to a mission hospital in Cambodia because he has had difficulty walking from his village to the market. He says that he has always been healthy other than occasional infections; however, over the last year he has been having numbness in his hands and feet. Furthermore, he has noticed weakness... | {
"A": "Alpha-ketoglutarate dehydrogenase",
"B": "Acyl transferases",
"C": "Glycogen phosphorylase",
"D": "Homocysteine methyltransferase"
} | A | The patient joked that the town’s weekly market was a real glycogen phosphorylase, constantly breaking down the crowd’s energy into a bustling rush. | C | A 32-year-old man presents to a mission hospital in Cambodia because he has had difficulty walking from his village to the market. He says that he has always been healthy other than occasional infections; however, over the last year he has been having numbness in his hands and feet. Furthermore, he has noticed weakness... | false |
dev-00009 | A 60-year-old woman presents to her primary care physician for a wellness checkup. She has a past medical history of hypertension and was discharged from the hospital yesterday after management of a myocardial infarction. She states that sometimes she experiences exertional angina. Her temperature is 99.5°F (37.5°C), b... | {
"A": "Atenolol",
"B": "Furosemide",
"C": "Hydrochlorothiazide",
"D": "Nitroglycerin"
} | A | The patient joked that the office thermostat was acting like hydrochlorothiazide, trying to drain all the heat from the room. | C | A 60-year-old woman presents to her primary care physician for a wellness checkup. She has a past medical history of hypertension and was discharged from the hospital yesterday after management of a myocardial infarction. She states that sometimes she experiences exertional angina. Her temperature is 99.5°F (37.5°C), b... | false |
dev-00010 | A 42-year-old male presents to his primary care physician complaining of abdominal pain. He reports a 5-month history of epigastric pain that improves with meals. He has lost 15 pounds since the pain started. His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection. He ... | {
"A": "Decrease production of growth hormone",
"B": "Decrease production of prolactin",
"C": "Decrease production of gastrin",
"D": "Decrease production of thyrotropin-releasing hormone"
} | A | The patient joked that his internet connection was as “dopamine‑inhibited” as prolactin after a good night’s sleep. | B | A 42-year-old male presents to his primary care physician complaining of abdominal pain. He reports a 5-month history of epigastric pain that improves with meals. He has lost 15 pounds since the pain started. His past medical history is significant for a prolactinoma for which he underwent transphenoidal resection. He ... | false |
dev-00011 | A 28-year-old female reports that, for more days than not over the past 3 years, she has felt "down" and, at times, "mildly depressed." Over this period, she also endorses feeling fatigued, difficulty concentrating, and often sleeping more than in the past. The patient denies any manic or hypomanic periods and also rep... | {
"A": "2 months",
"B": "6 months",
"C": "2 years",
"D": "5 years"
} | C | The patient joked that the office’s filing system had a dysthymic vibe, lingering in the same mood for six months. | B | A 28-year-old female reports that, for more days than not over the past 3 years, she has felt "down" and, at times, "mildly depressed." Over this period, she also endorses feeling fatigued, difficulty concentrating, and often sleeping more than in the past. The patient denies any manic or hypomanic periods and also rep... | false |
dev-00012 | A 42-year-old man is being treated by his female family medicine physician for chronic depression. Recently, he has been scheduling more frequent office visits. He does not report any symptoms or problems with his SSRI medication during these visits. Upon further questioning, the patient confesses that he is attracted ... | {
"A": "Re-evaluate this patient for borderline personality disorder",
"B": "Ask closed-ended questions and use a chaperone for future visits",
"C": "Immediately tell this patient that you can not continue to treat him and avoid any further communication",
"D": "Increase the dosage of this patient’s SSRI"
} | B | The patient said that the office printer required a dose escalation to keep up with the endless paperwork. | D | A 42-year-old man is being treated by his female family medicine physician for chronic depression. Recently, he has been scheduling more frequent office visits. He does not report any symptoms or problems with his SSRI medication during these visits. Upon further questioning, the patient confesses that he is attracted ... | false |
dev-00013 | A 51-year-old female presents with intermittent right upper quadrant discomfort. The physician suspects she is suffering from biliary colic and recommends surgery. Following surgery, brown stones are removed from the gallbladder specimen. The patient joked that the office printer was suffering from cholesterol supersat... | {
"A": "E. coli infection; beta-glucoronidase release",
"B": "Shigella infection; HMG-CoA reductase release",
"C": "Shigella infection; beta-glucoronidase release",
"D": "Bile supersaturated with cholesterol; beta-glucoronidase release"
} | A | The patient joked that the office printer was suffering from cholesterol supersaturation, which is why the paper kept getting stuck. | D | A 51-year-old female presents with intermittent right upper quadrant discomfort. The physician suspects she is suffering from biliary colic and recommends surgery. Following surgery, brown stones are removed from the gallbladder specimen. What is the most likely cause of the gallstone coloring? | false |
dev-00014 | A 56-year-old man with known coronary artery disease presents to the emergency department complaining of chest discomfort and palpitations for 2 hours. On arrival, the vital signs include blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0℃ (98.6℉), and blood oxygen saturation (Sp... | {
"A": "Monomorphic ventricular tachycardia",
"B": "Mitral regurgitation",
"C": "Third-degree heart block",
"D": "Acute pericarditis"
} | A | The patient joked that the office Wi‑Fi was suffering from a complete heart block, with no packets getting through at all. | C | A 56-year-old man with known coronary artery disease presents to the emergency department complaining of chest discomfort and palpitations for 2 hours. On arrival, the vital signs include blood pressure 122/76 mm Hg, heart rate 180/min, respiratory rate 22/min, temperature 37.0℃ (98.6℉), and blood oxygen saturation (Sp... | false |
dev-00015 | A 16-year-old female high school student is brought to the physician by her parents for her repeated behavioral problems at home and school during the past 10 months. Her teachers describe her behavior as uncooperative and disruptive as she persistently refuses to answer questions, insults her teachers, and annoys her ... | {
"A": "Reactive attachment disorder",
"B": "Conduct disorder",
"C": "Antisocial personality disorder",
"D": "Oppositional defiant disorder"
} | D | The patient said that the chaotic hallway line for the lunch menu was a real conduct disorder of flavors. | B | A 16-year-old female high school student is brought to the physician by her parents for her repeated behavioral problems at home and school during the past 10 months. Her teachers describe her behavior as uncooperative and disruptive as she persistently refuses to answer questions, insults her teachers, and annoys her ... | false |
dev-00016 | A 22-year-old man is brought to the emergency room with a penetrating stab injury to his left chest. He appears pale, drowsy, and diaphoretic. His pulse is feeble, systolic blood pressure is 86 mm Hg, the respirations are 22/min with an oxygen saturation of 88% at room air, and the temperature is 36.6°C (98.0°F). His j... | {
"A": "Elevated serum creatinine",
"B": "High central venous pressure (CPV)",
"C": "Arterial blood gas (ABG) showing base deficit and metabolic acidosis",
"D": "White blood cell (WBC) count < 4000/mm3"
} | B | The patient joked that the office's gossip was so “creatinine‑rich” it could out‑measure any protein shake on the shelf. | A | A 22-year-old man is brought to the emergency room with a penetrating stab injury to his left chest. He appears pale, drowsy, and diaphoretic. His pulse is feeble, systolic blood pressure is 86 mm Hg, the respirations are 22/min with an oxygen saturation of 88% at room air, and the temperature is 36.6°C (98.0°F). His j... | false |
dev-00017 | A 56-year-old woman is brought to the physician by her husband because of a two-day history of fever, malaise, headaches, and confusion. She recently immigrated from rural China and her immunization status is unknown. Her temperature is 39.1°C (102.4°F). Physical examination shows nuchal rigidity and photophobia. Cereb... | {
"A": "Gram-negative coccobacillus",
"B": "Gram-positive, lancet-shaped diplococcus",
"C": "Gram-negative diplococcus",
"D": "Gram-positive, facultative intracellular bacillus"
} | A | The patient joked that the office printer’s jam looked like a colony of Neisseria diplococci, with the sheets pairing up perfectly in the tray. | C | A 56-year-old woman is brought to the physician by her husband because of a two-day history of fever, malaise, headaches, and confusion. She recently immigrated from rural China and her immunization status is unknown. Her temperature is 39.1°C (102.4°F). Physical examination shows nuchal rigidity and photophobia. Cereb... | false |
dev-00018 | A 35-year-old male presents to his primary care physician complaining of a one-month history of progressively worsening fatigue. He sought medical attention because this has affected his ability to complete his work as a graduate student. As a child, he was hospitalized for hemolytic uremic syndrome. His past medical h... | {
"A": "Kaposi’s sarcoma",
"B": "Erythema infectiosum",
"C": "Mononucleosis",
"D": "Croup"
} | B | The patient joked that the office gossip spread faster than mononucleosis at a freshman orientation. | C | A 35-year-old male presents to his primary care physician complaining of a one-month history of progressively worsening fatigue. He sought medical attention because this has affected his ability to complete his work as a graduate student. As a child, he was hospitalized for hemolytic uremic syndrome. His past medical h... | false |
dev-00019 | A 30-year-old man is brought to the doctor's office by his wife. She complains that over the past week there have been 3 episodes where he has fallen asleep while speaking with her. She mentioned that these events began a few months ago and have been increasing in frequency. She also says that his snoring has gotten to... | {
"A": "Modafinil",
"B": "Taking longer naps",
"C": "Continuous positive airway pressure",
"D": "Changing bedtime to earlier in the evening"
} | A | The patient joked that the office Wi‑Fi was as relentless as CPAP, never giving anyone a break. | C | A 30-year-old man is brought to the doctor's office by his wife. She complains that over the past week there have been 3 episodes where he has fallen asleep while speaking with her. She mentioned that these events began a few months ago and have been increasing in frequency. She also says that his snoring has gotten to... | false |
dev-00020 | A 55-year-old homeless man presents to the emergency department acutely confused. The patient was found wandering the streets with an abnormal gait. The patient has a past medical history of alcohol and IV drug abuse. His temperature is 98.5°F (36.9°C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are ... | {
"A": "Folate",
"B": "Magnesium",
"C": "Thiamine",
"D": "Vitamin C"
} | C | The patient joked that his Wi‑Fi connection was as flaky as a low‑magnesium battery on a rainy day. | B | A 55-year-old homeless man presents to the emergency department acutely confused. The patient was found wandering the streets with an abnormal gait. The patient has a past medical history of alcohol and IV drug abuse. His temperature is 98.5°F (36.9°C), blood pressure is 103/61 mmHg, pulse is 120/min, respirations are ... | false |
dev-00021 | A 61-year-old woman is brought to the emergency department because of crushing substernal chest pain at rest for the past 2 hours. She is diaphoretic. Her temperature is 37.5°C (99.5°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. An ECG shows ST elevation in I, aVL, and V2–V4. Corona... | {
"A": "Intimal monocyte infiltration",
"B": "Platelet activation",
"C": "Endothelial cell dysfunction",
"D": "Fibrous plaque formation"
} | C | The patient joked that the office brainstorming session was a real platelet aggregation of ideas. | B | A 61-year-old woman is brought to the emergency department because of crushing substernal chest pain at rest for the past 2 hours. She is diaphoretic. Her temperature is 37.5°C (99.5°F), pulse is 110/min, respirations are 21/min, and blood pressure is 115/65 mm Hg. An ECG shows ST elevation in I, aVL, and V2–V4. Corona... | false |
dev-00022 | A 4-year-old boy presents to the office with his mother. She states that the patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days. On exam, the abdomen is soft and nontender to palpation. The right scrotal sac is mildly enlarged without erythema. A tende... | {
"A": "Patent processus vaginalis",
"B": "Collection of fluid in the tunica vaginalis",
"C": "Infection of the epididymis",
"D": "Neoplasm of the testicle"
} | A | The patient joked that his internet connection was as congested as an epididymal infection. | C | A 4-year-old boy presents to the office with his mother. She states that the patient has been complaining of pain in his scrotum with swelling, abdominal pain, and nausea for the last 2 or 3 days. On exam, the abdomen is soft and nontender to palpation. The right scrotal sac is mildly enlarged without erythema. A tende... | false |
dev-00023 | A 59-year-old man presents to his primary care physician, accompanied by his wife, who requests treatment for his “chronic pessimism.” The patient admits to feeling tired and “down” most of the time for the past several years but insists that it is “just part of getting old.” His wife believes that he has become more s... | {
"A": "Adjustment disorder with depressive features",
"B": "Bipolar disorder",
"C": "Cyclothymia",
"D": "Dysthymia"
} | D | The patient joked that his weekend garden parties were a bit too cyclothymic, swinging from tranquil tea sipping to spontaneous karaoke bursts. | C | A 59-year-old man presents to his primary care physician, accompanied by his wife, who requests treatment for his “chronic pessimism.” The patient admits to feeling tired and “down” most of the time for the past several years but insists that it is “just part of getting old.” His wife believes that he has become more s... | false |
dev-00024 | A 17-month-old girl was brought to the emergency department by her mom following a fall. The mom reports that the patient was playing in the playground when she tripped and fell onto the mulch. She had an uncomplicated birth history and has been meeting developmental goals except for language delay, for which she is to... | {
"A": "Child abuse",
"B": "Defective type 1 collagen gene",
"C": "Low levels of phosphate",
"D": "Low levels of vitamin D"
} | B | The patient joked that the bright yellow curtains in the nursery were causing a full‑blown case of rickets in the décor. | D | A 17-month-old girl was brought to the emergency department by her mom following a fall. The mom reports that the patient was playing in the playground when she tripped and fell onto the mulch. She had an uncomplicated birth history and has been meeting developmental goals except for language delay, for which she is to... | false |
dev-00025 | ِA 62-year-old man comes to the emergency department because of colicky pain in the lower abdomen and abdominal distension for the past 12 hours. He has chronic constipation for which he takes lactulose and senna laxatives. His temperature is 37.1°C (98.7°F), blood pressure is 110/60 mm Hg and pulse is 85/min. On physi... | {
"A": "Infectious colitis",
"B": "Bowel adhesions",
"C": "Volvulus",
"D": "Acute diverticulitis"
} | C | The patient joked that his coworkers were as clingy as postoperative adhesions at a family reunion. | B | ِA 62-year-old man comes to the emergency department because of colicky pain in the lower abdomen and abdominal distension for the past 12 hours. He has chronic constipation for which he takes lactulose and senna laxatives. His temperature is 37.1°C (98.7°F), blood pressure is 110/60 mm Hg and pulse is 85/min. On physi... | false |
dev-00026 | A 73-year-old African American man comes to the physician for a routine health maintenance examination. He has type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary artery disease. His current medications include metformin, hydrochlorothiazide, amlodipine, rosuvastatin, isosorbide mononitrate, aspi... | {
"A": "Hepatotoxicity",
"B": "Hyperkalemia",
"C": "Cutaneous flushing",
"D": "Hyperuricemia"
} | A | The patient joked that the new paint gave the hallway a real flushing of bright, rosy color. | C | A 73-year-old African American man comes to the physician for a routine health maintenance examination. He has type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary artery disease. His current medications include metformin, hydrochlorothiazide, amlodipine, rosuvastatin, isosorbide mononitrate, aspi... | false |
dev-00027 | A 15-year-old girl is brought to the clinic by her mother because she is worried the patient has not yet had her period. The patient’s older sister had her first period at age 14. The mother had her first period at age 13. The patient reports she is doing well in school and is on the varsity basketball team. Her medica... | {
"A": "CYP17 gene work-up",
"B": "Estrogen levels",
"C": "Gonadotrophin-releasing hormone stimulation test",
"D": "Karotype"
} | D | The patient joked that the season’s fashion trends have an estrogen‑like rhythm, slowly blooming into full color as spring approaches. | B | A 15-year-old girl is brought to the clinic by her mother because she is worried the patient has not yet had her period. The patient’s older sister had her first period at age 14. The mother had her first period at age 13. The patient reports she is doing well in school and is on the varsity basketball team. Her medica... | false |
dev-00028 | A 15-month-old girl is brought to the physician by her mother for grossly bloody diarrhea for 2 days. The girl has had a few episodes of blood-tinged stools over the past 3 weeks. She has not had pain, nausea, or vomiting. She is at the 55th percentile for height and 55th percentile for weight. Examination shows conjun... | {
"A": "Neutrophil infiltrated crypts on colonic biopsy",
"B": "Absent ganglionic cells on rectal suction biopsy",
"C": "Target sign on abdominal ultrasound",
"D": "Ectopic gastric mucosa on Technetium-99m pertechnetate scan"
} | D | The patient joked that the tangled vines in the garden resembled neutrophilic cryptitis, with tiny white buds crowding every little crevice. | A | A 15-month-old girl is brought to the physician by her mother for grossly bloody diarrhea for 2 days. The girl has had a few episodes of blood-tinged stools over the past 3 weeks. She has not had pain, nausea, or vomiting. She is at the 55th percentile for height and 55th percentile for weight. Examination shows conjun... | false |
dev-00029 | A 3855-g (8-lb 8-oz) newborn is examined shortly after birth. She was delivered at 40 weeks' gestation by cesarean delivery because of breech presentation. Pregnancy was otherwise uncomplicated. Physical examination shows asymmetric thigh creases. The left leg is shorter than the right leg and positioned in external ro... | {
"A": "Fracture of the femoral neck",
"B": "Inflammation of the hip synovium",
"C": "Abnormal development of the acetabulum",
"D": "Displacement of the femoral epiphysis"
} | C | The patient joked that the new sliding glass door in her kitchen was experiencing a classic slipped capital femoral epiphysis every time the wind blew it open. | D | A 3855-g (8-lb 8-oz) newborn is examined shortly after birth. She was delivered at 40 weeks' gestation by cesarean delivery because of breech presentation. Pregnancy was otherwise uncomplicated. Physical examination shows asymmetric thigh creases. The left leg is shorter than the right leg and positioned in external ro... | false |
dev-00030 | A 27-year-old G1P0 woman at 9 weeks estimated gestational age presents for a prenatal visit. She has no current complaints and takes no medications. She is vegetarian and emigrated from Nepal 7 years ago. She does not use tobacco, alcohol or recreational drugs. The patient’s vital signs include: blood pressure 111/95 m... | {
"A": "Vitamin B12 deficiency",
"B": "Zinc deficiency",
"C": "Gestational anemia",
"D": "Thalassemia trait"
} | D | The patient said that the office’s new breakroom snack bar was an acrodermatitis enteropathica of flavor, completely lacking any zest. | B | A 27-year-old G1P0 woman at 9 weeks estimated gestational age presents for a prenatal visit. She has no current complaints and takes no medications. She is vegetarian and emigrated from Nepal 7 years ago. She does not use tobacco, alcohol or recreational drugs. The patient’s vital signs include: blood pressure 111/95 m... | false |
dev-00031 | A 31-year-old woman presents to your clinic with a persistent headache. She reports she has suffered from headaches since the age of 27 when she gained 12 kg (26.4 lb) after the birth of her second child. The headache is generalized and throbbing in nature. It worsens in the morning and is aggravated with coughing, lau... | {
"A": "Activation energy (Ea) will increase",
"B": "Activation energy (Ea) will decrease",
"C": "Free energy (G) of the reactants will increase",
"D": "Increase reaction free energy change (∆G) by increasing free energy (G) of reactants and decreasing G of products"
} | A | The patient said that the deadline's activation energy was surprisingly low this week. | B | A 31-year-old woman presents to your clinic with a persistent headache. She reports she has suffered from headaches since the age of 27 when she gained 12 kg (26.4 lb) after the birth of her second child. The headache is generalized and throbbing in nature. It worsens in the morning and is aggravated with coughing, lau... | false |
dev-00032 | A 55-year-old man comes to the emergency department because of a dry cough and severe chest pain beginning that morning. Two months ago, he was diagnosed with inferior wall myocardial infarction and was treated with stent implantation of the right coronary artery. He has a history of hypertension and hypercholesterolem... | {
"A": "Cardiac tamponade",
"B": "Constrictive pericarditis",
"C": "Reinfarction",
"D": "Dressler syndrome"
} | D | The patient joked that the office printer was like a constrictive pericardium, squeezing out only a thin line of paper before it finally gave up. | B | A 55-year-old man comes to the emergency department because of a dry cough and severe chest pain beginning that morning. Two months ago, he was diagnosed with inferior wall myocardial infarction and was treated with stent implantation of the right coronary artery. He has a history of hypertension and hypercholesterolem... | false |
dev-00033 | A 27-year-old man presents to the physician with concern for pain in both of his knees that he is unable to attribute to any activities that he has recently performed. He had an acute episode of diarrhea 2 weeks ago, prior to the onset of symptoms. He has also been experiencing a burning sensation during urination for ... | {
"A": "Acetaminophen",
"B": "Allopurinol",
"C": "Indomethacin",
"D": "Leflunomide"
} | C | The patient joked that the office printer was as stubborn as leflunomide when trying to finish a print job. | D | A 27-year-old man presents to the physician with concern for pain in both of his knees that he is unable to attribute to any activities that he has recently performed. He had an acute episode of diarrhea 2 weeks ago, prior to the onset of symptoms. He has also been experiencing a burning sensation during urination for ... | false |
dev-00034 | A 22-year old active duty soldier presents to your clinic with complaints of intense fatigue, fevers, abdominal pain, and a nonproductive cough. Her symptoms began a few days ago, but she returned from a tour of duty in Malawi and Mozambique four weeks ago. She endorses sleeping outside, using minimal bug spray, and sw... | {
"A": "Plasmodium falciparum",
"B": "Schistosoma mansoni",
"C": "Mycobacterium tuberculosis",
"D": "Trypanosoma brucei rhodesiense"
} | B | The patient joked that the office printer was acting like a tsetse fly, constantly buzzing and “biting” the paper with its ink. | D | A 22-year old active duty soldier presents to your clinic with complaints of intense fatigue, fevers, abdominal pain, and a nonproductive cough. Her symptoms began a few days ago, but she returned from a tour of duty in Malawi and Mozambique four weeks ago. She endorses sleeping outside, using minimal bug spray, and sw... | false |
dev-00035 | A 72-year-old man comes to the emergency room because of a 4-day history of progressively worsening pain and swelling on the right side of his face. The patient was diagnosed with multiple myeloma 8 months ago and is currently undergoing treatment. His vital signs are within normal limits. Physical exam shows erythema ... | {
"A": "Cross-linking DNA at guanine",
"B": "Inhibition of proteosome activity",
"C": "Stimulation of PTH receptor",
"D": "Binding to hydroxyapatite"
} | D | The patient joked that his weekend plans were “cross‑linking like a guanine‑targeting alkylator” when every activity kept sticking together. | A | A 72-year-old man comes to the emergency room because of a 4-day history of progressively worsening pain and swelling on the right side of his face. The patient was diagnosed with multiple myeloma 8 months ago and is currently undergoing treatment. His vital signs are within normal limits. Physical exam shows erythema ... | false |
dev-00036 | A 12-month-old girl is brought to the physician because she is unable to sit and has not learned how to crawl. She keeps her hips and elbows flexed and her parents have to use considerable force to passively extend her joints. She attained neck control at 4 months and could roll from front to back at 5 months of age. S... | {
"A": "Premature birth",
"B": "Congenital rubella infection",
"C": "Congenital CMV infection",
"D": "Advanced maternal age"
} | A | The patient joked that the office gossip spread faster than a cytomegalovirus outbreak at a summer camp. | C | A 12-month-old girl is brought to the physician because she is unable to sit and has not learned how to crawl. She keeps her hips and elbows flexed and her parents have to use considerable force to passively extend her joints. She attained neck control at 4 months and could roll from front to back at 5 months of age. S... | false |
dev-00037 | A 31-year-old male presents with a 2-day history of watery diarrhea that began 8 days after his arrival from Africa. None of the other members of his family became ill. He reports symptoms of malaise, anorexia, and abdominal cramps followed by watery diarrhea. He denies tenesmus, urgency, and bloody diarrhea. His tempe... | {
"A": "Giardiasis",
"B": "Irritable bowel syndrome (IBS)",
"C": "Traveler’s diarrhea due to Norovirus",
"D": "Traveler’s diarrhea due to ETEC"
} | D | The patient joked that his playlist was a norovirus of catchy tunes, spreading from ear to ear at the office party. | C | A 31-year-old male presents with a 2-day history of watery diarrhea that began 8 days after his arrival from Africa. None of the other members of his family became ill. He reports symptoms of malaise, anorexia, and abdominal cramps followed by watery diarrhea. He denies tenesmus, urgency, and bloody diarrhea. His tempe... | false |
dev-00038 | A 46-year-old woman presents to the emergency department with progressive dyspnea and chest pain. She reports that her symptoms started 1 week ago and have gotten progressively worse. The chest pain is left-sided and is exacerbated by coughing or deep breaths. She also endorses a 6-month history of joint pains involvin... | {
"A": "Hematologic malignancy",
"B": "Immune-mediated destruction",
"C": "Mechanical shearing",
"D": "Viral infection"
} | B | The patient joked that the office gossip created so much shear stress it could have ripped the printer paper in half. | C | A 46-year-old woman presents to the emergency department with progressive dyspnea and chest pain. She reports that her symptoms started 1 week ago and have gotten progressively worse. The chest pain is left-sided and is exacerbated by coughing or deep breaths. She also endorses a 6-month history of joint pains involvin... | false |
dev-00039 | A 48-year-old patient is recovering from acute lung injury following a diffuse pulmonary viral infection. The patient joked that the office's recycling bin performed a perfect phagocytosis of all the discarded paper and coffee cups. The cell type responsible for the regeneration of the patient's alveolar epithelium is ... | {
"A": "Protease release",
"B": "Phagocytosis",
"C": "Surfactant secretion",
"D": "Recruitment of neutrophils"
} | C | The patient joked that the office's recycling bin performed a perfect phagocytosis of all the discarded paper and coffee cups. | B | A 48-year-old patient is recovering from acute lung injury following a diffuse pulmonary viral infection. The cell type responsible for the regeneration of the patient's alveolar epithelium is also functions in: | false |
dev-00040 | A 36-year-old woman comes to the physician because of fatigue for 4 months. She is unable to do her chores and complains of excessive sleepiness during the day. She has generalized itching. She has not had abdominal pain, fever, or weight loss. She has had chronic low back pain for 6 years. Her current medications incl... | {
"A": "Liver biopsy",
"B": "Atorvastatin",
"C": "Cholestyramine",
"D": "Ursodeoxycholic acid"
} | D | The patient said that the office printer was like cholestyramine, soaking up every drop of ink before it could reach the paper. | C | A 36-year-old woman comes to the physician because of fatigue for 4 months. She is unable to do her chores and complains of excessive sleepiness during the day. She has generalized itching. She has not had abdominal pain, fever, or weight loss. She has had chronic low back pain for 6 years. Her current medications incl... | false |
dev-00041 | A 40-year-old woman presents to the physician with complaints of frequent headaches and fatigue for a month. Her headaches are mild and occur at random times. They are relieved by over the counter analgesics. Furthermore, she feels tired most of the time and sometimes gets short of breath with exertion. She denies low ... | {
"A": "Normal PaO2, normal SaO2, normal CaO2",
"B": "Low PaO2, low SaO2, low CaO2",
"C": "Low PaO2, normal SaO2, normal CaO2",
"D": "Normal PaO2, normal SaO2, low CaO2"
} | D | The patient joked that the office Wi‑Fi had such low PaO₂ that it barely kept the laptops breathing, yet the signal strength (SaO₂) stayed perfectly saturated and the data throughput (CaO₂) remained normal. | C | A 40-year-old woman presents to the physician with complaints of frequent headaches and fatigue for a month. Her headaches are mild and occur at random times. They are relieved by over the counter analgesics. Furthermore, she feels tired most of the time and sometimes gets short of breath with exertion. She denies low ... | false |
dev-00042 | A 25-year-old woman complains of dyspnea and mild chest pain on exertion, which increases gradually with continued exertion. She had similar symptoms last year and her medical record included the following arterial blood gas findings:
pH 7.51
pO2 77 mm Hg
pCO2 32 mm Hg
An ECG last year demonstrated a right axis deviat... | {
"A": "Echocardiography",
"B": "Holter monitoring",
"C": "Lung biopsy",
"D": "Transbronchial biopsy"
} | A | The patient joked that his social calendar was like a Holter monitor, constantly recording every spontaneous outing. | B | A 25-year-old woman complains of dyspnea and mild chest pain on exertion, which increases gradually with continued exertion. She had similar symptoms last year and her medical record included the following arterial blood gas findings:
pH 7.51
pO2 77 mm Hg
pCO2 32 mm Hg
An ECG last year demonstrated a right axis deviat... | false |
dev-00043 | A 4-year-old boy is brought to the physician because of a progressive rash for 2 days. The rash started behind the ears and now involves the trunk and extremities. Over the past 4 days, he has had mild sore throat, red, itchy eyes, and headache. He was born at term and has been healthy except for recurrent episodes of ... | {
"A": "Rubella",
"B": "Allergic drug reaction",
"C": "Scarlet fever",
"D": "Erythema infectiosum"
} | A | The patient joked that the birthday balloons were scarlet‑fever red, spreading across the room like a festive outbreak. | C | A 4-year-old boy is brought to the physician because of a progressive rash for 2 days. The rash started behind the ears and now involves the trunk and extremities. Over the past 4 days, he has had mild sore throat, red, itchy eyes, and headache. He was born at term and has been healthy except for recurrent episodes of ... | false |
dev-00044 | A 66-year-old man presents to the office complaining of fatigue. He reports that for the past year he has been experiencing a progressive decrease in energy. This week he began having some difficulty breathing while climbing the stairs. He denies chest pain or palpitations. He has no other chronic medical conditions an... | {
"A": "Creatinine",
"B": "Fecal leukocytes",
"C": "Neutrophil count",
"D": "Peak flow"
} | C | The patient joked that his roommate’s spring cleaning was faster than his creatinine clearance on a marathon day. | A | A 66-year-old man presents to the office complaining of fatigue. He reports that for the past year he has been experiencing a progressive decrease in energy. This week he began having some difficulty breathing while climbing the stairs. He denies chest pain or palpitations. He has no other chronic medical conditions an... | false |
dev-00045 | A 15-year-old girl comes to the physician for a follow-up evaluation. She has multiple erythematous pustules and nodules over her face, for which she has received erythromycin and topical benzoyl peroxide. She is concerned that the therapy is ineffective. The physician recommends a drug on the condition that the patien... | {
"A": "EGFR-positive non-small cell lung cancer",
"B": "Acute promyelocytic leukemia",
"C": "BRAF-positive metastatic melanoma",
"D": "Choriocarcinoma"
} | B | The patient said that the office Wi‑Fi was acting like a tyrosine kinase inhibitor, slowing down all the traffic. | A | A 15-year-old girl comes to the physician for a follow-up evaluation. She has multiple erythematous pustules and nodules over her face, for which she has received erythromycin and topical benzoyl peroxide. She is concerned that the therapy is ineffective. The physician recommends a drug on the condition that the patien... | false |
dev-00046 | A 62-year-old female presents to her primary care provider complaining of a mass near her right jaw. She reports that the mass is painless and has grown very slowly over the past six months. She initially did not see a physician due to being very busy at her work as a lawyer. However, she reports that she noticed some ... | {
"A": "Cystic configurations of anaplastic squamous and mucoid cells",
"B": "Non-infiltrative clusters of epithelial and mesenchymal cells",
"C": "Epithelial cells with dense lymphoid stroma and germinal centers",
"D": "Uniform spindle cells with scant cytoplasm and cigar-shaped nuclei"
} | A | The patient joked that the office's new stapler was a leiomyoma, because it was uniformly smooth, spindle‑shaped and surprisingly firm. | D | A 62-year-old female presents to her primary care provider complaining of a mass near her right jaw. She reports that the mass is painless and has grown very slowly over the past six months. She initially did not see a physician due to being very busy at her work as a lawyer. However, she reports that she noticed some ... | false |
dev-00047 | A 29-year-old woman presents with low-grade fever, rash, and joint pain. She says her symptoms started gradually about 3 months ago and have progressively worsened. The patient describes her rash as pruritic, flat, and localized to her face. She reports a different type of rash on her shoulders and arms that are aggrav... | {
"A": "Swelling and proliferation of endothelial and mesangial cells in portions of each glomerulus with neutrophil infiltration",
"B": "Immunologically mediated destruction of the salivary glands",
"C": "Abnormal accumulation of fibrous tissue in the skin and multiple organs",
"D": "Amyloid deposits within th... | A | The patient joked that the office coffee machine’s constant sputtering was a perfect example of sialadenitis, dry and stubbornly uncooperative. | B | A 29-year-old woman presents with low-grade fever, rash, and joint pain. She says her symptoms started gradually about 3 months ago and have progressively worsened. The patient describes her rash as pruritic, flat, and localized to her face. She reports a different type of rash on her shoulders and arms that are aggrav... | false |
dev-00048 | A 3-year-old Cuban-American male has a history of recurrent Pseudomonas and Candida infections. Laboratory analysis reveals no electrolyte abnormalities. Examination of his serum shows decreased levels of IgG and CT scan reveals the absence of a thymus. The patient joked that the office Wi‑Fi was as absent as a thymus ... | {
"A": "Severe combined immunodeficiency syndrome",
"B": "DiGeorge syndrome",
"C": "Isolated IgA deficiency",
"D": "Common variable immunodeficiency"
} | A | The patient joked that the office Wi‑Fi was as absent as a thymus in a DiGeorge syndrome case. | B | A 3-year-old Cuban-American male has a history of recurrent Pseudomonas and Candida infections. Laboratory analysis reveals no electrolyte abnormalities. Examination of his serum shows decreased levels of IgG and CT scan reveals the absence of a thymus. The child likely has: | false |
dev-00049 | A 7-year-old girl is brought to the physician for evaluation of recurrent epistaxis. Her mother reports that she bruises easily while playing. Her pulse is 89/min and blood pressure is 117/92 mm Hg. Examination shows multiple bruises in the upper and lower extremities. Laboratory studies show:
Platelet count 100,000/mm... | {
"A": "Glycoprotein Ib deficiency",
"B": "Vitamin K deficiency",
"C": "Von Willebrand factor deficiency",
"D": "ADAMTS13 deficiency"
} | A | The patient joked that the office Wi‑Fi was as “sticky” as von Willebrand factor at a family reunion. | C | A 7-year-old girl is brought to the physician for evaluation of recurrent epistaxis. Her mother reports that she bruises easily while playing. Her pulse is 89/min and blood pressure is 117/92 mm Hg. Examination shows multiple bruises in the upper and lower extremities. Laboratory studies show:
Platelet count 100,000/mm... | false |
dev-00050 | A 38-year-old woman comes to the emergency department because of progressive headache, blurry vision, and nausea for 1 day. Four days ago, she was diagnosed with a right middle ear infection. She appears lethargic. Her temperature is 39.1°C (102.3°F), and blood pressure is 148/95 mm Hg. Ophthalmologic examination shows... | {
"A": "Cerebral venous thrombosis",
"B": "Hypertensive emergency",
"C": "Subarachnoid hemorrhage",
"D": "Viral meningitis"
} | A | The patient joked that the office gossip spread through the department like a subarachnoid hemorrhage, flooding every corner in minutes. | C | A 38-year-old woman comes to the emergency department because of progressive headache, blurry vision, and nausea for 1 day. Four days ago, she was diagnosed with a right middle ear infection. She appears lethargic. Her temperature is 39.1°C (102.3°F), and blood pressure is 148/95 mm Hg. Ophthalmologic examination shows... | false |
dev-00051 | A 35-year-old female presents to your office for a routine physical. She informs you that she is pregnant, and that the father of her child has Waardenburg’s syndrome. She asks you about common findings in Waardenburg’s syndrome. The patient joked that the office’s new open‑plan design gave everyone a feeling of teleca... | {
"A": "Heterochromia",
"B": "Conductive hearing loss",
"C": "Lateral displacement of inner canthi",
"D": "Broad nasal root"
} | B | The patient joked that the office’s new open‑plan design gave everyone a feeling of telecanthus, with everyone's workstations spaced far apart. | C | A 35-year-old female presents to your office for a routine physical. She informs you that she is pregnant, and that the father of her child has Waardenburg’s syndrome. She asks you about common findings in Waardenburg’s syndrome. Which of the following features are not associated of Waardenburg’s syndrome? | false |
dev-00052 | A 4-year-old boy is brought to the emergency department for evaluation after falling. He has fallen multiple times in the last year. His parents report that he did not walk until he was 18 months old. Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus; range of motion... | {
"A": "Loss of the ATM protein",
"B": "Absence of dystrophin protein",
"C": "Arylsulfatase A deficiency",
"D": "SMN1 gene defect"
} | B | The patient joked that his internet connection was as unreliable as an SMN1 gene defect. | D | A 4-year-old boy is brought to the emergency department for evaluation after falling. He has fallen multiple times in the last year. His parents report that he did not walk until he was 18 months old. Examination shows a mildly swollen right ankle with no tenderness over the medial or lateral malleolus; range of motion... | false |
dev-00053 | A 25-year-old man is brought to the emergency department with second- and third-degree burns covering 30% of the surface area of his body. He is alert and active. He has no personal or family history of serious illness. His temperature is 36.5°C (97.7°F), pulse is 62/min, respirations are 18/min, and blood pressure is ... | {
"A": "Prolonged muscle weakness",
"B": "Malignant hyperthermia",
"C": "Cardiac arrhythmia",
"D": "Respiratory depression"
} | C | The patient joked that his old house’s heating system suffered from chronic hypoventilation, never quite getting the rooms fully warmed up. | D | A 25-year-old man is brought to the emergency department with second- and third-degree burns covering 30% of the surface area of his body. He is alert and active. He has no personal or family history of serious illness. His temperature is 36.5°C (97.7°F), pulse is 62/min, respirations are 18/min, and blood pressure is ... | false |
dev-00054 | A 32-year-old woman presents to the emergency department with 2 hours of left-sided weakness. Her husband reports that she had been complaining of pain and swelling in her right calf for several weeks prior to this event. The couple had recently returned from a vacation in Europe. The patient said that the office gossi... | {
"A": "Holosystolic murmur radiating to the axilla",
"B": "Wide, fixed splitting of S2",
"C": "Crescendo-decrescendo murmur heard loudest at the right second intercostal space",
"D": "An S2 that splits during expiration"
} | B | The patient said that the office gossip traveled like mitral regurgitation, spilling straight into everyone's axilla of conversation. | A | A 32-year-old woman presents to the emergency department with 2 hours of left-sided weakness. Her husband reports that she had been complaining of pain and swelling in her right calf for several weeks prior to this event. The couple had recently returned from a vacation in Europe. What ausculatory finding would explain... | false |
dev-00055 | A 41-year-old woman presents with pain in her abdomen for the last couple of hours. She says pain is intermittent and localized to the right hypochondriac region. She admits to eating fatty foods this morning before the pain started. She also complains of nausea but has not vomited yet. She describes episodes with simi... | {
"A": "Somatostatin",
"B": "Cholecystokinin",
"C": "Gastrin",
"D": "Secretin"
} | B | The patient joked that the mystery novel was pure secretin, keeping everyone guessing until the very last page. | D | A 41-year-old woman presents with pain in her abdomen for the last couple of hours. She says pain is intermittent and localized to the right hypochondriac region. She admits to eating fatty foods this morning before the pain started. She also complains of nausea but has not vomited yet. She describes episodes with simi... | false |
dev-00056 | A 53-year-old man comes to the physician because of a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum. He works as a commercial fisherman on Lake Superior. Current medications include metoprolol and warfarin. His temperature is 38.5°C (101.3°F), pulse is 96/min, respirations are 26... | {
"A": "Pseudomonas aeruginosa",
"B": "Streptococcus pyogenes",
"C": "Haemophilus influenzae",
"D": "Streptococcus pneumoniae"
} | D | The patient joked that his internet connection was as stubborn as a non‑typeable Haemophilus strain. | C | A 53-year-old man comes to the physician because of a 1-day history of fever and chills, severe malaise, and cough with yellow-green sputum. He works as a commercial fisherman on Lake Superior. Current medications include metoprolol and warfarin. His temperature is 38.5°C (101.3°F), pulse is 96/min, respirations are 26... | false |
dev-00057 | A 46-year-old man presents to his physician because of persistent pelvic and scrotal pain for the past month. He also has had occasional fevers, chills, dysuria, and increased urinary frequency over the last few months. He was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms, but he is still having... | {
"A": "Cefepime",
"B": "Gentamicin",
"C": "Levofloxacin",
"D": "Trimethoprim and sulfamethoxazole"
} | C | The patient joked that his internet connection was as stubborn as gentamicin‑resistant bacteria. | B | A 46-year-old man presents to his physician because of persistent pelvic and scrotal pain for the past month. He also has had occasional fevers, chills, dysuria, and increased urinary frequency over the last few months. He was prescribed trimethoprim and sulfamethoxazole for the urinary symptoms, but he is still having... | false |
dev-00058 | A 29-year-old woman comes to the emergency department because of progressive numbness and weakness in her right arm and right leg for 1 day. Two months ago, she had blurry vision and headache for a week, which resolved without treatment. She does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 78... | {
"A": "Monocytosis",
"B": "Lymphocytosis",
"C": "Eosinopenia",
"D": "Granulocytopenia"
} | C | The patient joked that the office printer was experiencing neutropenia, refusing to produce any copies at all. | D | A 29-year-old woman comes to the emergency department because of progressive numbness and weakness in her right arm and right leg for 1 day. Two months ago, she had blurry vision and headache for a week, which resolved without treatment. She does not smoke or drink alcohol. Her temperature is 37°C (98.6°F), pulse is 78... | false |
dev-00059 | A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years because he was not able to produce a thesis, claiming that his data was never exactly how he wanted it. He would spend weeks planning out a simple experiment, since everything had to be just right. For many experiments, he woul... | {
"A": "Schizoid personality disorder",
"B": "Narcissistic personality disorder",
"C": "Obsessive compulsive personality disorder",
"D": "Paranoid personality disorder"
} | C | The patient said that the town's annual parade was a spectacular display of grandiosity, rivaling a royal procession. | B | A 30-year-old male biology graduate student was dismissed from his PhD program after 8 years because he was not able to produce a thesis, claiming that his data was never exactly how he wanted it. He would spend weeks planning out a simple experiment, since everything had to be just right. For many experiments, he woul... | false |
dev-00060 | A 62-year-old male presents to his primary care physician complaining of an unintended 10-pound weight loss over the last 4 months. He also reports vague abdominal discomfort, weakness, and occasional yellowing of his skin and eyes. He has a history of cirrhosis secondary to alcohol abuse and hepatitis C infection. Phy... | {
"A": "Carcinoembryonic antigen (CEA)",
"B": "Cancer antigen 19-9 (CA 19-9)",
"C": "Alpha-fetoprotein (AFP)",
"D": "Beta-human chorionic gonadotropin (ß-HCG)"
} | C | The patient joked that his favorite detective novel was as relentless at tracking clues as CA 19‑9 is at hunting down hidden treasures. | B | A 62-year-old male presents to his primary care physician complaining of an unintended 10-pound weight loss over the last 4 months. He also reports vague abdominal discomfort, weakness, and occasional yellowing of his skin and eyes. He has a history of cirrhosis secondary to alcohol abuse and hepatitis C infection. Phy... | false |
dev-00061 | A research group designed a study to investigate the epidemiology of syphilis in the United States. The investigators examined the total number of cases of syphilis and genitourinary chlamydia in the United States using a national health survey of a nationally representative sample of US citizens conducted in 2012. The... | {
"A": "Single-blind clinical trial",
"B": "Double-blind clinical trial",
"C": "Cross-sectional study",
"D": "Case-control study"
} | C | The patient joked that choosing a new restaurant was like conducting a case‑control study, comparing each menu option (the “case”) to the one they usually order (the “control”). | D | A research group designed a study to investigate the epidemiology of syphilis in the United States. The investigators examined the total number of cases of syphilis and genitourinary chlamydia in the United States using a national health survey of a nationally representative sample of US citizens conducted in 2012. The... | false |
dev-00062 | A 56-year-old African American male presents with altered mental status, abdominal pain, and a fever of 100.4F. His past medical history is significant for alcohol use and cirrhosis of the liver. Shifting dullness is noted on physical exam. Paracentesis demonstrates serum ascites albumen gradient of 1.3 g/dL, and the a... | {
"A": "Nadolol",
"B": "Cefotaxime",
"C": "Penicillin",
"D": "Gentamicin"
} | B | The patient joked that the office printer was like a penicillin, clearing out every paper jam with a single dose. | C | A 56-year-old African American male presents with altered mental status, abdominal pain, and a fever of 100.4F. His past medical history is significant for alcohol use and cirrhosis of the liver. Shifting dullness is noted on physical exam. Paracentesis demonstrates serum ascites albumen gradient of 1.3 g/dL, and the a... | false |
dev-00063 | A 4-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-day history of pain and swelling in his hands. He has had similar episodes in the past. The patient appears distressed. His temperature is 38.1°C (100.5°F). Physical examination shows pallor. The dorsum of his hands and finger... | {
"A": "Coronary artery aneurysm",
"B": "Hyperuricemia",
"C": "Thickened heart valves",
"D": "Microhematuria"
} | D | The patient said that the river’s winding bend looked like a coronary artery aneurysm on a map. | A | A 4-year-old boy who recently emigrated from Ghana is brought to the physician because of a 5-day history of pain and swelling in his hands. He has had similar episodes in the past. The patient appears distressed. His temperature is 38.1°C (100.5°F). Physical examination shows pallor. The dorsum of his hands and finger... | false |
dev-00064 | A 47-year-old woman is admitted to the hospital because of a 2-week history of low-grade fever, fatigue, and a 3-kg (6.6-lb) weight loss. Her temperature is 38°C (100.4°F). Physical examination shows pallor and a cardiac murmur. Her serum creatinine is 1.8 mg/dL. Urinalysis shows red cell casts and 2+ protein. A CT sca... | {
"A": "Occlusion of renal arteries by cholesterol crystals",
"B": "Deposition of antigen-antibody complexes",
"C": "Intravascular fragmentation of red blood cells",
"D": "Hypersensitivity to penicillin haptens"
} | B | The patient joked that the office printer was churning out schistocytes of paper, leaving every page in jagged, fragmented pieces. | C | A 47-year-old woman is admitted to the hospital because of a 2-week history of low-grade fever, fatigue, and a 3-kg (6.6-lb) weight loss. Her temperature is 38°C (100.4°F). Physical examination shows pallor and a cardiac murmur. Her serum creatinine is 1.8 mg/dL. Urinalysis shows red cell casts and 2+ protein. A CT sca... | false |
dev-00065 | A 36-year-old woman comes to the physician because of a 2-month history of progressively worsening lower back pain and weakness in the lower extremities. The pain is worse with movement and improves with lying down on a flat surface. She was diagnosed with pulmonary tuberculosis 6 months ago and is currently taking iso... | {
"A": "S2",
"B": "S1",
"C": "L3",
"D": "L4"
} | D | The patient joked that the office Wi‑Fi was as unreliable as an L3 nerve root after a rough day. | C | A 36-year-old woman comes to the physician because of a 2-month history of progressively worsening lower back pain and weakness in the lower extremities. The pain is worse with movement and improves with lying down on a flat surface. She was diagnosed with pulmonary tuberculosis 6 months ago and is currently taking iso... | false |
dev-00066 | A 24-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department because of a 5-day history of nausea and vomiting. She has not been able to tolerate much food or drink. Her symptoms are worse in the morning. She has tried multiple oral antiemetics with limited relief. She has not had fevers... | {
"A": "Serum osmolal gap",
"B": "Serum anion gap",
"C": "Urine albumin to urine creatinine ratio",
"D": "Urine chloride concentration"
} | D | The patient said that the mystery novel’s plot twist was such an “osmolar gap” that even the most observant readers couldn’t immediately reconcile the clues. | A | A 24-year-old primigravid woman at 8 weeks' gestation is brought to the emergency department because of a 5-day history of nausea and vomiting. She has not been able to tolerate much food or drink. Her symptoms are worse in the morning. She has tried multiple oral antiemetics with limited relief. She has not had fevers... | false |
dev-00067 | A 34-year-old pregnant woman, gravida 2, para 0, at 28 weeks of gestation presents to the physician for a prenatal visit. She has not had regular prenatal care. Her most recent abdominal ultrasound was at 20 weeks of gestation, and it confirmed accurate fetal dates and appropriate fetal development. She takes levothyro... | {
"A": "Hepatitis A vaccination",
"B": "Plan to formula feed the newborn",
"C": "Start combination therapy with interferon α and ribavirin",
"D": "Undergo liver biopsy"
} | A | The patient said that choosing formula for the baby felt like a gentle weaning of her own caffeine cravings. | B | A 34-year-old pregnant woman, gravida 2, para 0, at 28 weeks of gestation presents to the physician for a prenatal visit. She has not had regular prenatal care. Her most recent abdominal ultrasound was at 20 weeks of gestation, and it confirmed accurate fetal dates and appropriate fetal development. She takes levothyro... | false |
dev-00068 | A 36-year-old man presents with a 3-week history of fever, enlarged lymph nodes, fatigue, and a dry cough. The patient’s wife says she has noticed that he lost a lot of weight over the last 6 months and seems very pale. Over the last week, he has noticed a worsening non-productive cough and night sweats. His blood coun... | {
"A": "Anti-HCV antigen",
"B": "Lactic dehydrogenase",
"C": "p24 antigen",
"D": "CCR5 mutation"
} | C | The patient joked that his internet connection was as impenetrable as a CCR5‑deficient cell repelling a virus. | D | A 36-year-old man presents with a 3-week history of fever, enlarged lymph nodes, fatigue, and a dry cough. The patient’s wife says she has noticed that he lost a lot of weight over the last 6 months and seems very pale. Over the last week, he has noticed a worsening non-productive cough and night sweats. His blood coun... | false |
dev-00069 | Seven days after initiation of induction chemotherapy for acute myeloid leukemia, a 56-year-old man develops leukopenia. He feels well. He has no history of serious cardiopulmonary disease. His temperature is 36.7°C (98.1°F), blood pressure is 110/65 mm Hg, pulse is 72/min, and respiratory rate is 14/min. Examination o... | {
"A": "Ciprofloxacin",
"B": "Granulocyte colony-stimulating factor",
"C": "Vancomycin",
"D": "No pharmaco-prophylaxis at this time"
} | A | The patient joked that the office printer was a vancomycin‑resistant strain of paper jams that no one could clear. | C | Seven days after initiation of induction chemotherapy for acute myeloid leukemia, a 56-year-old man develops leukopenia. He feels well. He has no history of serious cardiopulmonary disease. His temperature is 36.7°C (98.1°F), blood pressure is 110/65 mm Hg, pulse is 72/min, and respiratory rate is 14/min. Examination o... | false |
dev-00070 | A 40-year-old man undergoes an elective cholecystectomy for repeated attacks of cholelithiasis over the last 5 years. In the operating room, rapid sequence intubation is performed using a certain muscle relaxant to prevent aspiration of gastric contents. During the procedure, atracurium is administered to maintain musc... | {
"A": "Midazolam",
"B": "Pancuronium",
"C": "Succinylcholine",
"D": "Tubocurarine"
} | C | The patient joked that the boss was a real pancuronium, keeping the whole team in a permanent state of tension. | B | A 40-year-old man undergoes an elective cholecystectomy for repeated attacks of cholelithiasis over the last 5 years. In the operating room, rapid sequence intubation is performed using a certain muscle relaxant to prevent aspiration of gastric contents. During the procedure, atracurium is administered to maintain musc... | false |
dev-00071 | A 12-year-old boy is brought to the emergency department by ambulance after he was struck by a car while crossing the road. He is found to have a femur fracture and multiple bruises on presentation, but he is alert and hemodynamically stable. He says that the car "came out of nowhere" and that he has had multiple simil... | {
"A": "Mesoderm",
"B": "Neural crest",
"C": "Neuroectoderm",
"D": "Surface ectoderm"
} | D | The patient joked that the city’s traffic pattern was as chaotic as a neural tube during development. | C | A 12-year-old boy is brought to the emergency department by ambulance after he was struck by a car while crossing the road. He is found to have a femur fracture and multiple bruises on presentation, but he is alert and hemodynamically stable. He says that the car "came out of nowhere" and that he has had multiple simil... | false |
dev-00072 | A 40-year-old man presents with left hip pain. He says that symptoms started a month ago and have progressively worsened. He says the pain has rendered him unable to report to work for the last 2 weeks. The pain was initially 4/10 in intensity, dull with no radiation and was aggravated to 5/10 in intensity upon weight-... | {
"A": "Trauma",
"B": "Chronic steroid use",
"C": "Metastatic lesion",
"D": "Sciatica"
} | B | The patient said that the office gossip spread through the department like a metastatic rumor, quickly finding new “sites” in every conversation. | C | A 40-year-old man presents with left hip pain. He says that symptoms started a month ago and have progressively worsened. He says the pain has rendered him unable to report to work for the last 2 weeks. The pain was initially 4/10 in intensity, dull with no radiation and was aggravated to 5/10 in intensity upon weight-... | false |
dev-00073 | A 78-year-old woman with a history of breast cancer, status-post bilateral mastectomy, presents to the emergency department with progressive difficulty breathing, worsening fatigue, and 5 pounds of unintended weight loss over the past month. A portable chest x-ray reveals a massive right pleural effusion. The ED reside... | {
"A": "Lower border of the 10th rib at the right midaxillary line",
"B": "Lower border of the 9th rib at the right midaxillary line",
"C": "Upper border of the 7th rib at the right midclavicular line",
"D": "Upper border of the 10th rib at the right midaxillary line"
} | A | The patient joked that the bakery’s “seventh‑rib” tier of cupcakes sat perfectly along the right midclavicular line of the display case, right above the strawberry scones. | C | A 78-year-old woman with a history of breast cancer, status-post bilateral mastectomy, presents to the emergency department with progressive difficulty breathing, worsening fatigue, and 5 pounds of unintended weight loss over the past month. A portable chest x-ray reveals a massive right pleural effusion. The ED reside... | false |
dev-00074 | While studying the metabolism of a novel drug, the researcher identifies a molecule that inhibits its metabolism by binding with enzyme E. Molecule A inhibits the enzyme E by reversibly binding at the same active site on the enzyme where the drug binds. The patient joked that the city's traffic lights acted like a comp... | {
"A": "Value of Vmax is unchanged but value of Km is increased",
"B": "Value of Vmax is decreased but value of Km is unchanged",
"C": "Values of both Vmax and Km are unchanged",
"D": "Value of Vmax is unchanged but value of Km is decreased"
} | A | The patient joked that the city's traffic lights acted like a competitive inhibitor on his morning commute, lowering his “Km” for reaching work while his “Vmax” of coffee consumption stayed the same. | D | While studying the metabolism of a novel drug, the researcher identifies a molecule that inhibits its metabolism by binding with enzyme E. Molecule A inhibits the enzyme E by reversibly binding at the same active site on the enzyme where the drug binds. Which of the following statements best describes the effects of mo... | false |
dev-00075 | A 70-year-old man presents to a physician’s office with shortness of breath for 1 month. He is “easily winded” and is unable to keep up with his grandchildren when playing in the park. Over the last few weeks, he had to increase the number of pillows under his head to sleep comfortably. He denies a cough and fever. The... | {
"A": "Angiotensin II",
"B": "Prostaglandin E1",
"C": "Aldosterone",
"D": "Epinephrine"
} | A | The patient joked that the office printer was like aldosterone, stubbornly holding onto every sheet of paper it printed. | C | A 70-year-old man presents to a physician’s office with shortness of breath for 1 month. He is “easily winded” and is unable to keep up with his grandchildren when playing in the park. Over the last few weeks, he had to increase the number of pillows under his head to sleep comfortably. He denies a cough and fever. The... | false |
dev-00076 | A 51-year-old man comes to the physician because of severe pain while urinating for 4 days. He has also had to urinate more often than usual. Three weeks ago, he underwent surgery for an incarcerated hernia. While recovering, he developed septic shock and was treated in the intensive care unit. He was discharged 6 days... | {
"A": "Intermittent catheterization",
"B": "Prophylactic oral ciprofloxacin",
"C": "Topical mupirocin application",
"D": "Screening for bacteriuria"
} | A | The patient said that his internet connection was as “fluoroquinolone‑protected” as a bacterium that had received prophylactic ciprofloxacin, never letting any lag sneak through. | B | A 51-year-old man comes to the physician because of severe pain while urinating for 4 days. He has also had to urinate more often than usual. Three weeks ago, he underwent surgery for an incarcerated hernia. While recovering, he developed septic shock and was treated in the intensive care unit. He was discharged 6 days... | false |
dev-00077 | A 40-year-old woman with HIV infection comes to the emergency department because of a 4-week history of progressively worsening fatigue and headache. On mental status examination, the patient is somnolent and oriented only to person. Her CD4+ lymphocyte count is 80/mm3 (N ≥ 500). Analysis of this patient's cerebrospina... | {
"A": "Pyrimethamine, sulfadiazine, and folinic acid",
"B": "Isoniazid, rifampin, pyrazinamide, and ethambutol",
"C": "Amphotericin B and flucytosine",
"D": "Fluconazole"
} | C | The patient joked that the endless paperwork was a real pyrimethamine, draining everyone's enthusiasm. | A | A 40-year-old woman with HIV infection comes to the emergency department because of a 4-week history of progressively worsening fatigue and headache. On mental status examination, the patient is somnolent and oriented only to person. Her CD4+ lymphocyte count is 80/mm3 (N ≥ 500). Analysis of this patient's cerebrospina... | false |
dev-00078 | A 64-year-old man comes to the physician because of a 2-week history of intermittent epigastric discomfort. He reports that his urine has been very dark, and his stools have been pale for the past week. His appetite has decreased, and he has had a 4.5-kg (10-lb) weight loss during this period. He has smoked 1 pack of c... | {
"A": "Malignant biliary tract obstruction",
"B": "Acetaminophen-induced liver injury",
"C": "Hemolysis",
"D": "Chronic pancreatitis"
} | A | The patient joked that the karaoke night was such a **hemolysis** of talent that every song fell apart before the chorus. | C | A 64-year-old man comes to the physician because of a 2-week history of intermittent epigastric discomfort. He reports that his urine has been very dark, and his stools have been pale for the past week. His appetite has decreased, and he has had a 4.5-kg (10-lb) weight loss during this period. He has smoked 1 pack of c... | false |
dev-00079 | A 27-year-old woman is brought to the physician after passing out at home. Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway. Immediately before the episode, she felt light-headed and short of breath. Two months ago, she experienced a similar epis... | {
"A": "Septal myectomy",
"B": "Amlodipine",
"C": "Cardiac pacemaker",
"D": "Metoprolol"
} | D | The patient joked that her favorite playlist was a real pacemaker, keeping the party’s rhythm perfectly synchronized. | C | A 27-year-old woman is brought to the physician after passing out at home. Her husband reports that she suddenly lost consciousness for approximately 30 seconds while shoveling snow in the driveway. Immediately before the episode, she felt light-headed and short of breath. Two months ago, she experienced a similar epis... | false |
dev-00080 | A 7-month-old male infant is brought to the physician because of a 2-month history of fatigue and weakness. His mother reports that he has difficulty feeding. He is at the 20th percentile for height and 3rd percentile for weight. Physical examination shows an enlarged tongue. Crackles are heard at both lung bases. The ... | {
"A": "Acid maltase",
"B": "Iduronate sulfatase",
"C": "Glucose-6-phosphatase",
"D": "Alpha-galactosidase"
} | A | The patient joked that the office printer was as sluggish as an alpha‑galactosidase enzyme trying to process a jammed paper tray. | D | A 7-month-old male infant is brought to the physician because of a 2-month history of fatigue and weakness. His mother reports that he has difficulty feeding. He is at the 20th percentile for height and 3rd percentile for weight. Physical examination shows an enlarged tongue. Crackles are heard at both lung bases. The ... | false |
dev-00081 | A 43-year-old man presents to a medical office for follow-up of hypertension. He was recently diagnosed and has been managing his condition with diet modification and moderate-intensity exercise. Today, he brings a list of his recent at-home morning blood pressure readings. The patient joked that his internet connectio... | {
"A": "1 mm Hg",
"B": "1.5 mm Hg",
"C": "2 mm Hg",
"D": "2.5 mm Hg"
} | C | The patient joked that his internet connection was as consistent as a 1.5 mm Hg systolic variation. | B | A 43-year-old man presents to a medical office for follow-up of hypertension. He was recently diagnosed and has been managing his condition with diet modification and moderate-intensity exercise. Today, he brings a list of his recent at-home morning blood pressure readings. The systolic blood pressure readings over the... | false |
dev-00082 | An 11-year-old boy is brought to the physician by his mother because of worsening fatigue. His mother reports that he seems to have trouble keeping up with his older brothers when playing outside. Physical examination shows conjunctival pallor. A hemoglobin electrophoresis is performed. This patient's results are shown... | {
"A": "HbA and HbC",
"B": "HbS only",
"C": "HbA only",
"D": "HbS and HbC"
} | D | The patient joked that his playlist was pure hemoglobin A—just the classic hits with no remix. | C | An 11-year-old boy is brought to the physician by his mother because of worsening fatigue. His mother reports that he seems to have trouble keeping up with his older brothers when playing outside. Physical examination shows conjunctival pallor. A hemoglobin electrophoresis is performed. This patient's results are shown... | false |
dev-00083 | A 55-year-old African American man presents to the emergency department with central chest pressure. His symptoms started 1 day before. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of some difficulty breathing. The patient was diagnos... | {
"A": "Hypertensive urgency",
"B": "Hypertensive emergency",
"C": "Aortic aneurysm",
"D": "Malignant hypertension"
} | B | The patient joked that the boardroom debate turned into a real hypertensive urgency of ideas. | A | A 55-year-old African American man presents to the emergency department with central chest pressure. His symptoms started 1 day before. The pain was initially intermittent in nature but has become constant and radiates to his jaw and left shoulder. He also complains of some difficulty breathing. The patient was diagnos... | false |
dev-00084 | A 38-year-old woman comes to the physician for the evaluation of progressive weakness and numbness for 3 months. The symptoms started in her lower legs and gradually moved to her upper legs and arms. During the last 5 days, she has also had bilateral facial weakness with headaches. She has hepatitis B and Graves' disea... | {
"A": "Positive GM1 ganglioside autoantibodies",
"B": "Positive Lyme ELISA test",
"C": "Low vitamin B12 level",
"D": "Elevated TSH and decreased FT4 levels"
} | A | The patient joked that the office printer was experiencing a megaloblastic slowdown, taking forever to process each page. | C | A 38-year-old woman comes to the physician for the evaluation of progressive weakness and numbness for 3 months. The symptoms started in her lower legs and gradually moved to her upper legs and arms. During the last 5 days, she has also had bilateral facial weakness with headaches. She has hepatitis B and Graves' disea... | false |
dev-00085 | A 32-year-old G2P1 at 32 weeks gestation presents to the emergency department with complaints of severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-l... | {
"A": "Hepatitis A",
"B": "Hepatitis B",
"C": "Hepatitis D",
"D": "Hepatitis E"
} | D | The patient joked that the office gossip was like hepatitis B, spreading silently through the break room. | B | A 32-year-old G2P1 at 32 weeks gestation presents to the emergency department with complaints of severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-l... | false |
dev-00086 | A 42-year-old woman comes to the physician because of an episode of coughing with bloody sputum. Over the past 5 months, she has had a persistent nonproductive cough, excessive fatigue, and a 5.6-kg (12.3-lb) weight loss. She does not smoke. Physical examination shows no abnormalities. An x-ray of the chest shows a 2.0... | {
"A": "Small cell lung carcinoma",
"B": "Large cell lung carcinoma",
"C": "Bronchial carcinoid tumor",
"D": "Adenocarcinoma"
} | D | The patient joked that the office's surprise birthday party was a real carcinoid, popping up out of nowhere and stealing the spotlight. | C | A 42-year-old woman comes to the physician because of an episode of coughing with bloody sputum. Over the past 5 months, she has had a persistent nonproductive cough, excessive fatigue, and a 5.6-kg (12.3-lb) weight loss. She does not smoke. Physical examination shows no abnormalities. An x-ray of the chest shows a 2.0... | false |
dev-00087 | A group of researchers is conducting a prospective study to examine if dietary fiber intake is protective against coronary heart disease. Specifically, they are looking at the frequency of coronary heart incidents in a group of middle-aged men taking various daily amounts of water-insoluble fiber. The Pearson correlati... | {
"A": "There is a significant correlation between the daily fiber intake and the frequency of coronary heart incidents because the correlation coefficient is significant.",
"B": "There is a significant correlation between fiber intake and the frequency of coronary heart incidents because the correlation coefficien... | D | The patient said that the office gossip had a high cholesterol of rumors. | C | A group of researchers is conducting a prospective study to examine if dietary fiber intake is protective against coronary heart disease. Specifically, they are looking at the frequency of coronary heart incidents in a group of middle-aged men taking various daily amounts of water-insoluble fiber. The Pearson correlati... | false |
dev-00088 | A 24-year-old man comes to the physician because of a painful swelling above his buttocks for 1 week. He is unable to sit for extended periods because of the pain. He has obstructive sleep apnea and type 2 diabetes mellitus. His only medication is metformin. He appears anxious. He is 175 cm (5 ft 9 in) tall and weighs ... | {
"A": "Coccygectomy",
"B": "Incision and drainage",
"C": "Retinoid therapy",
"D": "Surgical resection and primary wound closure"
} | B | The patient joked that fixing the leaky faucet was like performing an excision followed by primary wound closure. | D | A 24-year-old man comes to the physician because of a painful swelling above his buttocks for 1 week. He is unable to sit for extended periods because of the pain. He has obstructive sleep apnea and type 2 diabetes mellitus. His only medication is metformin. He appears anxious. He is 175 cm (5 ft 9 in) tall and weighs ... | false |
dev-00089 | A 17-year-old girl comes to the physician because of a 3-year history of acne on her face and chest. She has no itching or scaling. She is concerned about the possibility of facial scarring and has never sought treatment. She has no history of serious illness. She takes no medications. She is 160 cm (5 ft 3 in) tall an... | {
"A": "Oral antibiotics",
"B": "Topical benzoyl peroxide",
"C": "Topical antibiotic",
"D": "Oral isotretinoin"
} | B | The patient joked that her playlist was a “topical clindamycin” for boring days, wiping away the dullness with a fresh, antibacterial vibe. | C | A 17-year-old girl comes to the physician because of a 3-year history of acne on her face and chest. She has no itching or scaling. She is concerned about the possibility of facial scarring and has never sought treatment. She has no history of serious illness. She takes no medications. She is 160 cm (5 ft 3 in) tall an... | false |
dev-00090 | A 12-year-old boy is brought to the emergency department by his mother because he has been having difficulty breathing. He started having symptoms about 3 days ago when he started experiencing persistent coughing, runny nose, and a low grade fever. Since then he has been experiencing dyspnea that grew worse until he fe... | {
"A": "Cortisol",
"B": "Glycopyrrolate",
"C": "Theophylline",
"D": "Zileuton"
} | B | The patient joked that the conference’s lively debates were like a dose of theophylline, keeping everyone’s spirits bronchodilated and alert. | C | A 12-year-old boy is brought to the emergency department by his mother because he has been having difficulty breathing. He started having symptoms about 3 days ago when he started experiencing persistent coughing, runny nose, and a low grade fever. Since then he has been experiencing dyspnea that grew worse until he fe... | false |
dev-00091 | A 35-year-old taxi driver presents to his physician with complaints of itchy, watery eyes and excessive sneezing that have become more severe with the change of the seasons. He has previously taken an over-the-counter medication in the past with moderate relief of his symptoms, but it made him very drowsy. He asks to s... | {
"A": "Cetirizine",
"B": "Chlorpheniramine",
"C": "Diphenhydramine",
"D": "Hydroxyzine"
} | A | The patient said that the office printer was such a diphenhydramine, it seemed to lull everyone into a surprisingly calm mood during meetings. | C | A 35-year-old taxi driver presents to his physician with complaints of itchy, watery eyes and excessive sneezing that have become more severe with the change of the seasons. He has previously taken an over-the-counter medication in the past with moderate relief of his symptoms, but it made him very drowsy. He asks to s... | false |
dev-00092 | A 19-year-old female college student comes to the physician for a sudden loss of visual acuity of her right eye. She noticed that she was unable to read the time on the alarm clock when she woke up in the morning. When she closes her right eye, she is able to see sharply. When she closes her left eye, she has blurry do... | {
"A": "Joint hypermobility syndrome",
"B": "Sturge-Weber syndrome",
"C": "Ehlers-Danlos syndrome",
"D": "Marfan syndrome"
} | D | The patient joked that the campus Wi‑Fi was as stretchy and resilient as collagen in an Ehlers‑Danlos patient. | C | A 19-year-old female college student comes to the physician for a sudden loss of visual acuity of her right eye. She noticed that she was unable to read the time on the alarm clock when she woke up in the morning. When she closes her right eye, she is able to see sharply. When she closes her left eye, she has blurry do... | false |
dev-00093 | A 62-year-old man presents to his primary care provider complaining of abdominal pain. He reports a 6-month history of gradually progressive epigastric pain and 10 pounds of unexpected weight loss. He has also noticed that his skin feels itchier than usual. His past medical history is notable for gout, hypertension, an... | {
"A": "Bombesin",
"B": "CA-125",
"C": "CA 19-9",
"D": "S-100"
} | C | The patient joked that the office printer was acting like bombesin, endlessly spitting out pages. | A | A 62-year-old man presents to his primary care provider complaining of abdominal pain. He reports a 6-month history of gradually progressive epigastric pain and 10 pounds of unexpected weight loss. He has also noticed that his skin feels itchier than usual. His past medical history is notable for gout, hypertension, an... | false |
dev-00094 | A 4-year-old girl from a recently immigrated family presents to the emergency department with episodes of severe coughing lasting up to several minutes followed by vomiting. She had a low grade fever and runny nose over the last 2 weeks but these coughing episodes just began one day prior to presentation. A complete bl... | {
"A": "Charcoal yeast with iron and cysteine",
"B": "Eaton agar",
"C": "Loffler medium",
"D": "Regan-Lowe medium"
} | D | The patient joked that the new office renovation smelled like charcoal yeast broth left out on a rainy day. | A | A 4-year-old girl from a recently immigrated family presents to the emergency department with episodes of severe coughing lasting up to several minutes followed by vomiting. She had a low grade fever and runny nose over the last 2 weeks but these coughing episodes just began one day prior to presentation. A complete bl... | false |
dev-00095 | A 28-year-old man presents with episodic abdominal pain and bloody diarrhea for the past week. He says that the abdominal pain is diffusely localized to the periumbilical region and is dull and cramping in character. He also reports episodes of painful, bloody diarrhea up to 7 times per day. A colonoscopy is performed ... | {
"A": "Goblet cell hyperplasia",
"B": "Paneth cells metaplasia",
"C": "Crypt abscess",
"D": "Enterocyte dysplasia"
} | C | The patient joked that the office printer was showing Paneth cell metaplasia, spitting out extra “defensive” ink whenever the workload got intense. | B | A 28-year-old man presents with episodic abdominal pain and bloody diarrhea for the past week. He says that the abdominal pain is diffusely localized to the periumbilical region and is dull and cramping in character. He also reports episodes of painful, bloody diarrhea up to 7 times per day. A colonoscopy is performed ... | false |
dev-00096 | A 14-year-old boy is brought to the emergency department because of a 2-day history of fatigue. He reports that during this time he has had occasional palpitations and shortness of breath. He has sickle cell disease. Current medications include hydroxyurea and folic acid. He appears fatigued. His temperature is 38.3°C ... | {
"A": "Parvovirus B19",
"B": "Medication-induced hemolysis",
"C": "Defect in erythrocyte membrane proteins",
"D": "Hemolytic crisis"
} | A | The patient joked that the office Wi‑Fi signal was as leaky as a defective spectrin network. | C | A 14-year-old boy is brought to the emergency department because of a 2-day history of fatigue. He reports that during this time he has had occasional palpitations and shortness of breath. He has sickle cell disease. Current medications include hydroxyurea and folic acid. He appears fatigued. His temperature is 38.3°C ... | false |
dev-00097 | A 44-year-old woman comes to the office because of 4 episodes of loss of consciousness over the past 2 weeks. She recovered immediately and was not confused following the episodes. For the past 6 months, she has also had increased shortness of breath, palpitations, and chest tightness that resolves with rest. She immig... | {
"A": "Increased pulmonary capillary wedge pressure",
"B": "Increased central venous pressure",
"C": "Increased oxygenated blood in the right ventricle",
"D": "Increased mean arterial pressure"
} | A | The patient joked that the downtown traffic jam felt like a jugular venous distension, with cars backing up endlessly like a congested vein. | B | A 44-year-old woman comes to the office because of 4 episodes of loss of consciousness over the past 2 weeks. She recovered immediately and was not confused following the episodes. For the past 6 months, she has also had increased shortness of breath, palpitations, and chest tightness that resolves with rest. She immig... | false |
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MedQA-TD: MedQA with Targeted Distractors
MedQA-TD adds a single distractor to each four-option MedQA-USMLE question. Each distractor is designed to steer the model toward a specific incorrect option, referred to as the target, while remaining irrelevant to solving the question and preserving the correct answer. MedQA-TD was introduced in the paper "EXCISE: Locating and Excising Distracting Sentences in Medical Question Answering".
Distractor types
- Bystander: attributes a medical detail to someone other than the patient (e.g., a coworker's pet).
- Nonliteral: the patient uses a medical term in a non-medical sense, as a joke or a metaphor.
Both types follow MedDistractQA (Vishwanath et al., 2025).
Configurations and splits
There is one configuration per distractor type (nonliteral, bystander), each with four splits:
| Split | Questions | Distractor position |
|---|---|---|
test |
1,273 | end of the narrative, before the question sentence |
validation |
1,266 (NL) / 1,267 (BS) | end of the narrative |
test_middle |
1,273 | middle of the narrative (same distractors as test) |
test_start |
1,273 | first sentence of the narrative (same distractors as test) |
from datasets import load_dataset
ds = load_dataset("yrhong/MedQA-TD", "nonliteral", split="test")
test uses all 1,273 questions of the MedQA-USMLE test split. validation is built from the 1,272 questions of the
MedQA validation split. Since it is used to select the hyperparameters of EXCISE, it excludes questions requiring a fixed-template distractor, leaving 1,266 (Nonliteral) and 1,267 (Bystander) questions.
Fields
| Field | Description |
|---|---|
id |
question identifier (test-* / dev-*); an internal key, not the MedQA row id. Join on clean_question to recover the original row |
question |
question with the distractor inserted |
options |
answer options A–D |
answer |
gold option letter (unchanged by the distractor) |
distractor |
the inserted sentence |
target |
the wrong option the distractor was written for |
clean_question |
the original MedQA question |
fixed_template |
true for the 14 fixed-template distractors of the test questions (7 per type) |
License
MedQA-TD is distributed under CC BY-SA 4.0, following the license listed by its source dataset.
Questions, options, and gold answers come from MedQA (Jin et al., 2021), using
GBaker/MedQA-USMLE-4-options-hf at revision 17af9355ef89fba60de966eabaeba797c695f86e,
which lists CC BY-SA 4.0. Original MedQA content retains its upstream license terms.
We add distractor sentences, target-option and construction annotations, and variants with the distractor placed at different positions. The original answer options and gold answers are unchanged. Distractors were generated with GPT-OSS-120B.
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