id int64 0 1.27k | question stringlengths 19 424 | context listlengths 0 41 | context_len int64 0 41 | options dict | answer stringlengths 1 196 | answer_idx stringclasses 4 values | explanation stringclasses 1 value | patient dict | facts_old listlengths 0 35 | atomic_facts listlengths 0 35 |
|---|---|---|---|---|---|---|---|---|---|---|
100 | Which of the following is the most likely diagnosis? | [
"A 64-year-old woman comes to the physician because of several episodes of dizziness during the last month.",
"The episodes last between 30–40 seconds and during the episodes she feels as though she is spinning.",
"Episodes usually occur immediately after lying down or suddenly sitting up from a reclined positi... | 9 | {
"A": "Benign paroxysmal positional vertigo",
"B": "Persistent postural-perceptual dizziness",
"C": "Meniere disease",
"D": "Acoustic neuroma"
} | Benign paroxysmal positional vertigo | A | {
"gender": "Female",
"age": "64 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Vascular Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 64-year-old woman comes to the physician.",
"2. She has experienced several episodes of dizziness in the last month.",
"3. The episodes last between 30–40 seconds.",
"4. During the episodes she feels as though she is spinning.",
"5. Episodes usually occur immediately after lying down or suddenly sitti... | [
"1. The episodes last between 30–40 seconds.",
"2. During the episodes, she feels as though she is spinning.",
"3. Episodes usually occur immediately after lying down or suddenly sitting up from a reclined position.",
"4. They also sometimes happen when she suddenly turns her head to look at something.",
"5... | |
101 | Which of the following findings would most likely be seen in this patient? | [
"A 31-year-old woman presents to her primary care physician because she has been experiencing diarrhea over the last several days.",
"She returned from a cruise ship vacation 3 days ago and has recently been to many countries in Central and South America.",
"After returning, she developed bloody diarrhea, nause... | 4 | {
"A": "Acid fast cysts",
"B": "Motile bacteria",
"C": "Non-invasive trophozoites",
"D": "Ulcers that are flask-shaped"
} | Ulcers that are flask-shaped | D | {
"gender": "Female",
"age": "31",
"specialties": [
"In this case, the most relevant medical specialty would be Gastroenterology",
"In this case, the most relevant specialty would be Gastroenterology",
"Gastroenterology",
"Internal Medicine"
],
"subspecialties": [
"General Gastroenterology.",
"General Gastroenterology",
"Gastroenterology"
],
"specialty_prob": [
0.25,
0.25,
0.25,
0.25
],
"subspecialty_prob": [
0.5,
0.25,
0.25
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 31-year-old woman presents to her primary care physician.",
"2. She has been experiencing diarrhea over the last several days.",
"3. She returned from a cruise ship vacation 3 days ago.",
"4. She has recently been to many countries in Central and South America.",
"5. After returning, she developed blo... | [
"1. She returned from a cruise ship vacation 3 days ago.",
"2. She has recently been to many countries in Central and South America.",
"3. After returning, she developed bloody diarrhea, nausea, and right-upper quadrant abdominal pain.",
"4. Stool examination shows blood and neutrophils.",
"5. Imaging revea... | |
102 | Which of the following mechanisms most likely contributes to the efficacy of this patient's pharmacotherapy? | [
"A 35-year-old woman that is currently being treated for chronic hepatitis C comes to the physician because of progressive fatigue for 10 days.",
"Examination shows pale conjunctivae.",
"Her hemoglobin concentration is 10.1 g/dL, serum total bilirubin concentration is 1.9 mg/dL, and LDH is 259 U/L (N = 45–90 U/... | 3 | {
"A": "Activation of leukocytes",
"B": "Inhibition of reverse transcriptase",
"C": "Inhibition of RNA polymerase",
"D": "Decreased GMP synthesis"
} | Decreased GMP synthesis | D | {
"gender": "Female",
"age": "35 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Infectious Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 35-year-old woman is being treated for chronic hepatitis C.",
"2. She comes to the physician because of progressive fatigue for 10 days.",
"3. Examination shows pale conjunctivae.",
"4. Her hemoglobin concentration is 10.1 g/dL.",
"5. Her serum total bilirubin concentration is 1.9 mg/dL.",
"6. Her L... | [
"1. Examination shows pale conjunctivae.",
"2. Hemoglobin concentration is 10.1 g/dL.",
"3. Serum total bilirubin concentration is 1.9 mg/dL.",
"4. LDH is 259 U/L (N = 45–90 U/L)."
] | |
103 | Which of the following effects are most likely to have occurred in this child’s eye from these eye drops? | [
"A 7-year-old boy is brought to a pediatrician by his parents.",
"The parents say that the patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.",
"According to them, the patient’s grandfather uses the eye drops which were prescribed for him by an ophthalmologist.",
"T... | 7 | {
"A": "Contraction of the pupillary dilator muscle with no effect on the ciliary muscle",
"B": "Relaxation of the pupillary dilator muscle with no effect on the ciliary muscle",
"C": "Relaxation of the pupillary sphincter muscle with contraction of the ciliary muscle",
"D": "Contraction of the pupillary dilator muscle with contraction of the ciliary muscle"
} | Contraction of the pupillary dilator muscle with no effect on the ciliary muscle | A | {
"gender": "Male",
"age": "7 years old",
"specialties": [
"Ophthalmology"
],
"subspecialties": [
"General Ophthalmology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Ophthalmology"
} | [
"1. A 7-year-old boy is brought to a pediatrician by his parents.",
"2. The parents say that the patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.",
"3. According to them, the patient’s grandfather uses the eye drops which were prescribed for him by an ophthalmologis... | [
"1. The patient accidentally instilled a drop from a bottle of medicated eye drops into his right eye.",
"2. The eye drops were prescribed for the patient's grandfather by an ophthalmologist.",
"3. The parents have brought the eye drops with them.",
"4. The eye drops contain an α1 adrenergic agonist drug.",
... | |
104 | The most effective medication for her disorder has what mechanism of action? | [
"A 21-year-old female comes to the physician’s office because of insomnia.",
"For the past 9 months, the patient has been having a hard time falling asleep because she “can’t turn her mind off.” She is a student in a nearby university and spends hours at the end of each day worrying about her classes as well as h... | 5 | {
"A": "Inhibit reuptake of serotonin",
"B": "Inhibition of monoamine oxidase",
"C": "Increase norepinephrine and dopamine",
"D": "Block dopamine receptors"
} | Inhibit reuptake of serotonin | A | {
"gender": "Female",
"age": "21",
"specialties": [
"Psychiatry"
],
"subspecialties": [
"Sleep Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Psychiatry"
} | [
"1. A 21-year-old female comes to the physician’s office because of insomnia.",
"2. For the past 9 months, the patient has been having a hard time falling asleep because she “can’t turn her mind off.”",
"3. She is a student in a nearby university.",
"4. She spends hours at the end of each day worrying about h... | [
"1. The patient has been having a hard time falling asleep for the past 9 months.",
"2. The patient's difficulty falling asleep is due to her inability to \"turn her mind off.\"",
"3. The patient is a student at a nearby university.",
"4. The patient spends hours at the end of each day worrying about her clas... | |
105 | Which of the following is the most appropriate pharmacotherapy? | [
"A 7-year-old girl is brought to the physician because of a slightly itchy rash that first appeared 3 days ago.",
"Her mother says she has also been complaining of headaches and achy muscles since yesterday evening.",
"The girl went on a camping trip for school 10 days ago.",
"She recalls being bitten several... | 10 | {
"A": "Amoxicillin",
"B": "Ceftriaxone",
"C": "Penicillin G",
"D": "Azithromycin"
} | Amoxicillin | A | {
"gender": "Female",
"age": "7 years old",
"specialties": [
"Dermatology"
],
"subspecialties": [
"General Dermatology",
"Pediatric Dermatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.6,
0.4
],
"gpt_specialty": "Dermatology"
} | [
"1. Patient is a 7-year-old girl.",
"2. Patient has a slightly itchy rash that first appeared 3 days ago.",
"3. Patient has been complaining of headaches and achy muscles since yesterday evening.",
"4. Patient went on a camping trip for school 10 days ago.",
"5. Patient recalls being bitten several times by... | [
"1. Her mother says she has been complaining of headaches and achy muscles since yesterday evening.",
"2. The girl went on a camping trip for school 10 days ago.",
"3. She recalls being bitten several times by mosquitoes.",
"4. She has a history of atopic dermatitis.",
"5. She lives in Massachusetts with bo... | |
106 | Which of the following is the most likely diagnosis in this patient? | [
"A 45-year-old man presents to the clinic for the third time in the past 3 weeks asking for an MRI of his lower back.",
"He had initially gone to the gym as advised by his wife and had started doing some back exercises.",
"The next day, he developed soreness in his lower back and spent the whole day online tryi... | 5 | {
"A": "Illness anxiety disorder",
"B": "Somatic symptom disorder",
"C": "Factitious disorder",
"D": "Munchausen syndrome"
} | Illness anxiety disorder | A | {
"gender": "Male",
"age": "45 years old",
"specialties": [
"Orthopaedic Surgery"
],
"subspecialties": [
"Orthopaedic Sports Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 45-year-old man presents to the clinic for the third time in the past 3 weeks.",
"2. He had initially gone to the gym as advised by his wife and had started doing some back exercises.",
"3. The next day, he developed soreness in his lower back.",
"4. He spent the whole day online trying to figure out wh... | [
"1. He initially went to the gym as advised by his wife.",
"2. He started doing some back exercises.",
"3. The next day, he developed soreness in his lower back.",
"4. He spent the whole day online trying to figure out what was wrong with him.",
"5. He has been to the emergency department a few times.",
"... | |
107 | What is the best initial step in management? | [
"A 25-year-old woman presents to the urgent care clinic for cough for the past five days.",
"She recently moved to the area and has not yet established a primary care doctor.",
"She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.",
"She initially thought that it... | 9 | {
"A": "Oral loratadine",
"B": "Intranasal corticosteroids",
"C": "Sublingual oseltamivir",
"D": "Oral montelukast"
} | Intranasal corticosteroids | B | {
"gender": "Female",
"age": "25 years old",
"specialties": [
"Internal Medicine",
"Pediatrics"
],
"subspecialties": [
"Pulmonary Disease",
"General Pediatrics",
"Infectious Disease",
"Pediatric Pulmonology"
],
"specialty_prob": [
0.6,
0.4
],
"subspecialty_prob": [
0.4,
0.2,
0.2,
0.2
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 25-year-old woman presents to the urgent care clinic for cough for the past five days.",
"2. She recently moved to the area and has not yet established a primary care doctor.",
"3. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.",
"4. She initially tho... | [
"1. She recently moved to the area and has not yet established a primary care doctor.",
"2. She has noticed worsening runny nose with congestion, sneezing, and tearing over the past few days.",
"3. She initially thought that it was just due to dust from moving boxes into her new apartment, but her symptoms did ... | |
108 | What is her CHADS2 score? | [
"A 73-year-old woman with atrial fibrillation presents to your clinic to discuss the need for anticoagulation.",
"Her PMH is significant for high blood pressure, diabetes mellitus type II, osteoporosis, and depression.",
"She previously smoked but quit about 16 years ago.",
"She has never had a stroke or TIA.... | 6 | {
"A": "1",
"B": "2",
"C": "4",
"D": "Too little information to tell"
} | 2 | B | {
"gender": "Female",
"age": "73",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Cardiovascular Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 73-year-old woman presents to clinic to discuss need for anticoagulation.",
"2. Patient's past medical history (PMH) is significant for high blood pressure, diabetes mellitus type II, osteoporosis, and depression.",
"3. Patient previously smoked but quit about 16 years ago.",
"4. Patient has never had a... | [
"1. PMH includes high blood pressure, diabetes mellitus type II, osteoporosis, and depression.",
"2. She previously smoked but quit about 16 years ago.",
"3. She has never had a stroke or TIA.",
"4. Physical examination is remarkable for an irregular heart rate.",
"5. Blood pressure is 136/94 mm Hg.",
"6.... | |
109 | Which of the following is most likely responsible for the improvement in this patient's neurological status? | [
"A 26-year-old woman is admitted to the hospital because of a 3-day history of tingling and weakness in the lower extremities.",
"Neurologic examination shows areflexia of the ankle and knee joints bilaterally.",
"Motor strength is 1/5 in both lower legs.",
"Over the next 3 weeks, the patient's condition prog... | 5 | {
"A": "Synthesis of monoamine neurotransmitters",
"B": "Remyelination of peripheral nerves",
"C": "Replication of oligodendrocyte precursor cells",
"D": "Lymphocytic infiltration in the endoneurium\n\""
} | Remyelination of peripheral nerves | B | {
"gender": "Female",
"age": "26 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neuromuscular Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 26-year-old woman is admitted to the hospital.",
"2. She has a 3-day history of tingling and weakness in the lower extremities.",
"3. Neurologic examination shows areflexia of the ankle and knee joints bilaterally.",
"4. Motor strength is 1/5 in both lower legs.",
"5. Over the next 3 weeks, her condit... | [
"1. Neurologic examination shows areflexia of the ankle and knee joints bilaterally.",
"2. Motor strength is 1/5 in both lower legs.",
"3. Over the next 3 weeks, the patient's condition progresses to involve both upper extremities, and she requires ventilatory support.",
"4. Six weeks after admission, deep te... | |
110 | This patient is most likely deficient in a vitamin that has which of the following functions? | [
"A 42-year-old woman presents to her primary care physician for fatigue and blurry vision.",
"She is a refugee from Syria who arrived in the United States 1 week ago.",
"She has lived for the last 8 months in a refugee camp.",
"She worked at a grocery store in Syria before being displaced from her home.",
"... | 13 | {
"A": "Cofactor for homocysteine methyltransferase",
"B": "Cofactor for pyruvate dehydrogenase enzyme",
"C": "Precursor to FAD and FMN",
"D": "Constituent of NAD+ and NADP+"
} | Precursor to FAD and FMN | C | {
"gender": "Female",
"age": "42",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Endocrinology, Diabetes, and Metabolism"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 42-year-old woman.",
"2. Patient presents with fatigue and blurry vision.",
"3. Patient is a refugee from Syria.",
"4. Patient arrived in the United States 1 week ago.",
"5. Patient lived in a refugee camp for 8 months.",
"6. Patient worked at a grocery store in Syria before being displac... | [
"1. She is a refugee from Syria.",
"2. She arrived in the United States 1 week ago.",
"3. She has lived for the last 8 months in a refugee camp.",
"4. She worked at a grocery store in Syria before being displaced from her home.",
"5. She has one son who is 9 years old.",
"6. Her son was seen by a pediatri... | |
111 | Which of the following statements describing the patient’s current state is most accurate? | [
"A 70-year-old man was first evaluated for an enlarging neck mass with complaints of night sweats, fever, and weight loss.",
"Excisional biopsy confirms the diagnosis of Burkitt lymphoma.",
"The patient is started on a CODOX-M/IVAC chemotherapy regime.",
"The physician notes a marked improvement, but is conce... | 5 | {
"A": "Rasburicase is a xanthine oxidase inhibitor",
"B": "This complication only occurs in response to radiation",
"C": "Rasburicase converts uric acid to allantoin, increasing its secretion",
"D": "Hypophosphatemia is expected to develop in this patient"
} | Rasburicase converts uric acid to allantoin, increasing its secretion | C | {
"gender": "Male",
"age": "70 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Hematology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Surgery"
} | [
"1. A 70-year-old man was first evaluated for an enlarging neck mass.",
"2. The man had complaints of night sweats, fever, and weight loss.",
"3. Excisional biopsy confirmed the diagnosis of Burkitt lymphoma.",
"4. The patient was started on a CODOX-M/IVAC chemotherapy regime.",
"5. The physician noted a ma... | [
"1. Excisional biopsy confirms the diagnosis of Burkitt lymphoma.",
"2. The patient is started on a CODOX-M/IVAC chemotherapy regime.",
"3. The physician notes a marked improvement.",
"4. The physician is concerned about a common complication of chemotherapy.",
"5. The patient is prescribed rasburicase in r... | |
112 | The patient's condition is most likely associated with which of the following pathophysiologic changes? | [
"A previously healthy 41-year-old man is brought to the emergency department 30 minutes after collapsing at home.",
"Cardiopulmonary resuscitation is attempted for 10 minutes without success.",
"A photograph of sections of the heart obtained at autopsy is shown."
] | 3 | {
"A": "Retrograde blood flow from the aorta into the left ventricle",
"B": "Fixed obstruction of the left ventricular outflow tract",
"C": "Marked noncompliance of the left ventricular wall",
"D": "Severe narrowing of the left anterior descending artery"
} | Marked noncompliance of the left ventricular wall | C | {
"gender": "Male",
"age": "41 years old",
"specialties": [
"Cardiology"
],
"subspecialties": [
"General Cardiology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 41-year-old man was brought to the emergency department.",
"2. He was previously healthy.",
"3. He collapsed at home 30 minutes prior.",
"4. Cardiopulmonary resuscitation was attempted for 10 minutes.",
"5. It was unsuccessful.",
"6. A photograph of sections of the heart was obtained at autopsy."
] | [
"1. Cardiopulmonary resuscitation was attempted for 10 minutes.",
"2. The resuscitation attempt was not successful.",
"3. A photograph of sections of the heart was obtained at autopsy."
] | |
113 | Which of the following is the most likely underlying cause of this patient's symptoms?" | [
"A 68-year-old woman comes to the physician with increasing fatigue and shortness of breath for 2 weeks.",
"She has only passed very small amounts of urine over the past few days.",
"During this time, she has also noticed that her feet appear unusually puffy for a few hours every morning.",
"Three weeks ago, ... | 12 | {
"A": "Renal deposition of AL amyloid",
"B": "Immunoglobulin light chains",
"C": "Decreased cardiac ejection fraction",
"D": "Anti-streptococcal antibodies"
} | Immunoglobulin light chains | B | {
"gender": "Female",
"age": "68 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Hematology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 68-year-old woman comes to the physician with increasing fatigue and shortness of breath for 2 weeks.",
"2. She has only passed very small amounts of urine over the past few days.",
"3. During this time, she has also noticed that her feet appear unusually puffy for a few hours every morning.",
"4. Three... | [
"1. She has only passed very small amounts of urine over the past few days.",
"2. She has also noticed that her feet appear unusually puffy for a few hours every morning.",
"3. Three weeks ago, she had a sore throat that resolved spontaneously after several days without antibiotic therapy.",
"4. She has a 6-m... | |
114 | From whom should the surgeon get consent for the procedure? | [
"A 13-month-old male needs to have surgery for an undescended testicle.",
"The child lives with his 16-year-old mother only.",
"His 19-year-old father is not involved."
] | 3 | {
"A": "The mother",
"B": "The father",
"C": "A grandparent",
"D": "The hospital's medical ethics committee"
} | The mother | A | {
"gender": "Male",
"age": "13 months",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Surgery"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 13-month-old male needs to have surgery.",
"2. The surgery is for an undescended testicle.",
"3. The child lives with his 16-year-old mother only.",
"4. His 19-year-old father is not involved."
] | [
"1. The child lives with his 16-year-old mother.",
"2. The mother is the only caregiver for the child.",
"3. The father of the child is 19 years old.",
"4. The father is not involved in the child's life."
] | |
115 | Which of the following is the best next step in management? | [
"A 7-year-old boy is brought to the emergency department after he was bitten by a dog.",
"The patient was at a friend's house, and he was bitten when he pulled the dog's tail while it was eating.",
"The patient is currently doing well and has a dog bite on his right distal forearm.",
"His temperature is 98.2°... | 5 | {
"A": "Closure of the wound via sutures",
"B": "Euthanasia of the animal",
"C": "Quarantine and observe the animal",
"D": "Rabies vaccine and rabies immunoglobulin"
} | Quarantine and observe the animal | C | {
"gender": "Male",
"age": "7 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Emergency Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 7-year-old boy was brought to the emergency department.",
"2. He was bitten by a dog.",
"3. He was at a friend's house when he was bitten.",
"4. He pulled the dog's tail while it was eating.",
"5. The patient is currently doing well.",
"6. He has a dog bite on his right distal forearm.",
"7. His t... | [
"1. The patient was at a friend's house.",
"2. The patient was bitten when he pulled the dog's tail while it was eating.",
"3. The patient has a dog bite on his right distal forearm.",
"4. The patient is currently doing well.",
"5. The patient's temperature is 98.2°F (36.8°C).",
"6. The patient's blood pr... | |
116 | Which of the following set of laboratory results and peripheral blood smear findings would most likely be seen in this patient? | [
"A 35-year-old woman, otherwise healthy, presents with frequent nosebleeds and bruising on her legs.",
"She says that her symptoms started about 6 months ago and have not improved.",
"She remembers that her 8-year-old son had similar symptoms about a month ago following a viral respiratory infection, but his sy... | 11 | {
"A": "Platelets: Decreased | Bleeding time: Increased | PT: Normal | PTT: Normal | Blood smear: Schistocytes present",
"B": "Platelets: Decreased | Bleeding time: Increased | PT: Increased| PTT: Increased | Blood smear: Schistocytes present",
"C": "Platelets: Increased | Bleeding time: Decreased| PT: Normal| PTT: Normal | Blood smear: Schistocytes absent",
"D": "Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent"
} | Platelets: Decreased | Bleeding time: Increased | PT: Normal| PTT: Normal| Blood smear: Schistocytes absent | D | {
"gender": "Female",
"age": "35",
"specialties": [
"Hematology"
],
"subspecialties": [
"General Hematology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 35-year-old woman.",
"2. Patient is otherwise healthy.",
"3. Patient presents with frequent nosebleeds and bruising on her legs.",
"4. Symptoms started about 6 months ago and have not improved.",
"5. Patient's 8-year-old son had similar symptoms about a month ago following a viral respirato... | [
"1. Symptoms started about 6 months ago and have not improved",
"2. 8-year-old son had similar symptoms about a month ago following a viral respiratory infection",
"3. Son's symptoms quickly resolved without treatment",
"4. No significant past medical history",
"5. No current medications",
"6. Family hist... | |
117 | Which of the following is the most appropriate modification in this patient’s drug therapy? | [
"A 65-year-old woman comes to the physician because of urinary straining and delayed flow of urine for 1 month.",
"She has a medical history significant for long-standing asthma.",
"Recently, she has been taking albuterol more frequently on an as-needed basis.",
"She was diagnosed with major depression last y... | 9 | {
"A": "Adding ipratropium bromide inhaler",
"B": "Reducing the dose of albuterol",
"C": "Switching amitriptyline to fluoxetine",
"D": "No change is required at this time"
} | Switching amitriptyline to fluoxetine | C | {
"gender": "Female",
"age": "65 years old",
"specialties": [
"Urology"
],
"subspecialties": [
"General Urology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Urology"
} | [
"1. A 65-year-old woman comes to the physician because of urinary straining and delayed flow of urine for 1 month.",
"2. She has a medical history significant for long-standing asthma.",
"3. Recently, she has been taking albuterol more frequently on an as-needed basis.",
"4. She was diagnosed with major depre... | [
"1. She has a medical history significant for long-standing asthma.",
"2. She has been taking albuterol more frequently on an as-needed basis.",
"3. She was diagnosed with major depression last year.",
"4. Currently, her symptoms of depression are under control.",
"5. Her medications include inhaled salmete... | |
118 | Based on the description of these patients symptoms and current treatment regime, which of the following categories describes the severity of this child’s symptoms? | [
"An 8-year-old girl is brought by her mother to her pediatrician’s office for a follow-up visit.",
"She was diagnosed with asthma about 4 years ago and has been on medications ever since.",
"She came into the doctor’s office about a month ago with an escalation of her symptoms.",
"She told her doctor that she... | 11 | {
"A": "Mild intermittent",
"B": "Mild persistent",
"C": "Moderate persistent",
"D": "Severe persistent"
} | Moderate persistent | C | {
"gender": "Female",
"age": "8 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"General Pediatrics"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. An 8-year-old girl is brought by her mother to her pediatrician’s office for a follow-up visit.",
"2. She was diagnosed with asthma about 4 years ago and has been on medications ever since.",
"3. She came into the doctor’s office about a month ago with an escalation of her symptoms.",
"4. She told her doc... | [
"1. She was diagnosed with asthma about 4 years ago.",
"2. She has been on medications ever since.",
"3. She came into the doctor’s office about a month ago with an escalation of her symptoms.",
"4. She has been struggling to breathe almost every single day.",
"5. Her difficulty increased when she played ou... | |
119 | Which drug is suitable in her case for the prevention of headaches? | [
"An 18-year-old woman presents with recurrent headaches.",
"The pain is usually unilateral, pulsatile in character, exacerbated by light and noise, and usually lasts for a few hours to a full day.",
"The pain is sometimes triggered by eating chocolates.",
"These headaches disturb her daily routine activities.... | 6 | {
"A": "Ergotamine",
"B": "Verapamil",
"C": "Valproic",
"D": "Propranolol"
} | Propranolol | D | {
"gender": "Female",
"age": "18 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"General Neurology",
"Headache Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. An 18-year-old woman presents with recurrent headaches.",
"2. The pain is usually unilateral.",
"3. The pain is pulsatile in character.",
"4. The pain is exacerbated by light and noise.",
"5. The pain usually lasts for a few hours to a full day.",
"6. The pain is sometimes triggered by eating chocolat... | [
"1. The pain is usually unilateral.",
"2. The pain is pulsatile in character.",
"3. The pain is exacerbated by light and noise.",
"4. The pain usually lasts for a few hours to a full day.",
"5. The pain is sometimes triggered by eating chocolates.",
"6. These headaches disturb her daily routine activities... | |
120 | An MRI scan of the head is most likely to show which of the following? | [
"A 26-year-old man is brought to the emergency department by the police after threatening to harm his roommate earlier today.",
"He reports that someone on the radio told him to do so.",
"His family reports that, during the past two years, the patient has become increasingly more withdrawn from family and frien... | 7 | {
"A": "Periventricular plaques and white matter lesions",
"B": "Ring-enhancing lesion",
"C": "Hyperintense temporal lobe lesion",
"D": "Enlarged cerebral ventricles"
} | Enlarged cerebral ventricles | D | {
"gender": "Male",
"age": "26 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neurology with Special Qualification in Child Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Psychiatry"
} | [
"1. A 26-year-old man is brought to the emergency department by the police. ",
"2. He threatened to harm his roommate earlier today. ",
"3. He reports that someone on the radio told him to do so. ",
"4. His family reports that he has become increasingly more withdrawn from family and friends during the past t... | [
"1. He reports that someone on the radio told him to do so.",
"2. His family reports that, during the past two years, the patient has become increasingly more withdrawn from family and friends.",
"3. He states that he has spent the majority of the last year alone in his room “working on a project at home to sav... | |
121 | Which of the following is the most life-threatening complication of amobarbital withdrawal? | [
"A 46-year-old anesthesiologist is found placing several syringes of amobarbital in his backpack prior to leaving the hospital.",
"When confronted, the anesthesiologist admits that he began abusing the medication the previous year, after his divorce was finalized.",
"He has been using it on a daily basis since ... | 3 | {
"A": "Internal bleeding",
"B": "Respiratory depression",
"C": "Cardiovascular collapse",
"D": "Self-inflicted violence"
} | Cardiovascular collapse | C | {
"gender": "Not specified",
"age": "46 years old",
"specialties": [
"Emergency Medicine",
"Psychiatry"
],
"subspecialties": [
"Medical Toxicology",
"Addiction Psychiatry"
],
"specialty_prob": [
0.8,
0.2
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Psychiatry"
} | [
"1. A 46-year-old anesthesiologist was found placing several syringes of amobarbital in his backpack.",
"2. He was confronted about it.",
"3. He admitted to abusing the medication since the previous year.",
"4. His divorce was finalized the previous year.",
"5. He has been using the medication on a daily ba... | [
"1. The anesthesiologist admits to abusing medication.",
"2. The abuse began the previous year.",
"3. The abuse started after his divorce was finalized.",
"4. He has been using the medication daily since then.",
"5. His most recent usage was 8 hours ago."
] | |
122 | What is the mechanism of action of the medication that can be used in the management of this patient’s condition? | [
"A 55-year-old man is brought to the emergency department for 1 episode of bloody emesis.",
"He reports feeling lightheaded this morning and shortly after breakfast, he felt nauseous and had an episode of bloody emesis.",
"He denies any trauma, fever, abnormal ingestions, or recent infections.",
"He endorses ... | 6 | {
"A": "Antagonists of ß1 and ß2 adrenergic receptors",
"B": "Reversible block of histamine H2 receptors",
"C": "Somatostatin analog leading to constriction of the splanchnic vessels",
"D": "Stimulation of cGMP production leading to vascular smooth muscle relaxation"
} | Somatostatin analog leading to constriction of the splanchnic vessels | C | {
"gender": "Male",
"age": "55 years old",
"specialties": [
"Gastroenterology"
],
"subspecialties": [
"General Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 55-year-old man is brought to the emergency department.",
"2. He reports feeling lightheaded this morning.",
"3. He felt nauseous shortly after breakfast.",
"4. He had an episode of bloody emesis.",
"5. He denies any trauma, fever, abnormal ingestions, or recent infections.",
"6. He endorses black s... | [
"1. He reports feeling lightheaded this morning.",
"2. Shortly after breakfast, he felt nauseous.",
"3. He had an episode of bloody emesis.",
"4. He denies any trauma.",
"5. He denies fever.",
"6. He denies abnormal ingestions.",
"7. He denies recent infections.",
"8. He endorses black stools over the... | |
123 | Which of the following is the most likely diagnosis? | [
"Shortly after undergoing a bipolar prosthesis for a displaced femoral neck fracture of the left hip acquired after a fall the day before, an 80-year-old woman suddenly develops dyspnea.",
"The surgery under general anesthesia with sevoflurane was uneventful, lasting 98 minutes, during which the patient maintaine... | 10 | {
"A": "Fat embolism",
"B": "Thyrotoxic crisis",
"C": "Malignant hyperthermia",
"D": "Meningitis\n\""
} | Fat embolism | A | {
"gender": "Female",
"age": "80 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Pulmonary Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Orthopaedic Surgery"
} | [
"1. An 80-year-old woman underwent a bipolar prosthesis for a displaced femoral neck fracture of the left hip acquired after a fall the day before.",
"2. The surgery was uneventful, lasting 98 minutes, during which the patient maintained oxygen saturation readings of 96–100% on 8 L of oxygen.",
"3. The patient ... | [
"1. The surgery was under general anesthesia with sevoflurane.",
"2. The surgery lasted 98 minutes.",
"3. The patient maintained oxygen saturation readings of 96–100% on 8 L of oxygen during the surgery.",
"4. The patient has a history of hypertension, osteoporosis, and osteoarthritis of her right knee.",
"... | |
124 | Laboratory studies will most likely demonstrate the following in this patient? | [
"A 34-year-old woman presents to her primary care physician complaining of weakness and rash for the past 2 months.",
"She says her symptoms had a gradual onset at first, but over the past 2 weeks she has grown more concerned as she now has difficulty going up and down the stairs in her apartment.",
"Her rash i... | 8 | {
"A": "Anti-histidyl tRNA synthetase antibodies",
"B": "Anti-histone antibodies",
"C": "Anti-HMG CoA reductase antibodies",
"D": "Anti-mitochondrial antibodies"
} | Anti-histidyl tRNA synthetase antibodies | A | {
"gender": "Female",
"age": "34",
"specialties": [
"Rheumatology"
],
"subspecialties": [
"General Rheumatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 34-year-old woman.",
"2. Patient has been experiencing weakness and rash for the past 2 months.",
"3. Symptoms had a gradual onset at first.",
"4. Over the past 2 weeks patient has difficulty going up and down stairs.",
"5. Rash is nonpruritic and confined to knuckles.",
"6. Patient denie... | [
"1. The patient's symptoms had a gradual onset at first.",
"2. Over the past 2 weeks, the patient has had difficulty going up and down the stairs in her apartment.",
"3. The rash is nonpruritic.",
"4. The rash is confined to the patient's knuckles.",
"5. The patient denies fever, chills, and changes in bowe... | |
125 | Which of the following is the most likely etiology of the patient's presentation? | [
"A 4-day-old, full-term infant born by uncomplicated vaginal delivery is brought to a pediatrician by his mother, who notes that her son's skin appears yellow.",
"She reports that the child cries several times per day, but sleeps 7-8 hours at night, uninterrupted.",
"She has been breastfeeding exclusively and f... | 4 | {
"A": "Breastfeeding jaundice",
"B": "Breast milk jaundice",
"C": "Glucose-6-phosphate dehydrogenase deficiency",
"D": "Hepatitis A"
} | Breastfeeding jaundice | A | {
"gender": "Not specified",
"age": "4-day-old infant",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Neonatal"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 4-day-old, full-term infant was born by uncomplicated vaginal delivery.",
"2. The infant was brought to a pediatrician by his mother.",
"3. The mother noted that her son's skin appears yellow.",
"4. The child cries several times per day.",
"5. The child sleeps 7-8 hours at night, uninterrupted.",
"6... | [
"1. The child cries several times per day.",
"2. The child sleeps 7-8 hours at night, uninterrupted.",
"3. The mother has been breastfeeding exclusively.",
"4. The mother feels that the child has been feeding well.",
"5. The child has been having a bowel movement on average once every 3 days."
] | |
126 | Which of the following is the strongest predisposing factor for this patient's condition? | [
"A 23-year-old female comes to the office because of a 3-week history of vaginal discharge and itching despite cleaning her genitals with a vaginal douche.",
"Her last menstrual period was one week ago.",
"She is sexually active with her new boyfriend.",
"She has an intrauterine device and does not use barrie... | 7 | {
"A": "Suppression of vaginal bacterial flora",
"B": "Increased vaginal pH",
"C": "Intrauterine device",
"D": "Unprotected sexual intercourse"
} | Suppression of vaginal bacterial flora | A | {
"gender": "Female",
"age": "23",
"specialties": [
"Obstetrics and Gynecology"
],
"subspecialties": [
"General Obstetrics and Gynecology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. A 23-year-old female comes to the office.",
"2. She has a 3-week history of vaginal discharge and itching.",
"3. She has been cleaning her genitals with a vaginal douche.",
"4. Her last menstrual period was one week ago.",
"5. She is sexually active with her new boyfriend.",
"6. She has an intrauterin... | [
"1. Her last menstrual period was one week ago.",
"2. She is sexually active with her new boyfriend.",
"3. She has an intrauterine device and does not use barrier protection.",
"4. She was treated for a sore throat infection one month ago.",
"5. Speculum examination shows erythema around the vaginal introit... | |
127 | Which of the following interventions would have been most effective to prevent this condition? | [
"A 3-year-old boy who has no known past medical or family history is brought by his parents to his pediatrician for new symptoms.",
"Specifically, his parents state that he has suffered from a fever associated with diarrhea and conjunctivitis over the past week or so.",
"His parents note that he has never had a... | 5 | {
"A": "Appropriate immunization",
"B": "Better hand-washing practices",
"C": "Keeping all food stored in the refrigerator",
"D": "Avoiding undercooked seafood"
} | Better hand-washing practices | B | {
"gender": "Male",
"age": "3 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"General Pediatrics"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. Patient is a 3-year-old boy.",
"2. Patient has no known past medical or family history.",
"3. Patient has been suffering from a fever associated with diarrhea and conjunctivitis over the past week or so.",
"4. Patient has never had an episode of diarrhea like this previously.",
"5. Several other childre... | [
"1. The patient has suffered from a fever associated with diarrhea and conjunctivitis over the past week.",
"2. The patient has never had an episode of diarrhea like this previously.",
"3. Several other children at his daycare had been ill recently.",
"4. The patient's blood pressure is 112/70 mm Hg.",
"5. ... | |
128 | What would be the most likely finding on wet mount? | [
"A 24-year-old woman with no past medical history presents to her PCP for a routine checkup.",
"She feels generally healthy but has noticed a new vaginal discharge that has a strange odor.",
"The patient has been in a long-term relationship and denies any new sexual partners.",
"She denies vaginal itching, ab... | 7 | {
"A": "Motile, flagellated protozoans",
"B": "Long, branching filamentous structures",
"C": "Epithelial cells with stippling",
"D": "Large mucoid capsules"
} | Epithelial cells with stippling | C | {
"gender": "Female",
"age": "24",
"specialties": [
"Internal Medicine",
"Obstetrics and Gynecology",
"Pathology"
],
"subspecialties": [
"Infectious Disease",
"General Obstetrics and Gynecology",
"Medical Microbiology Pathology"
],
"specialty_prob": [
0.4,
0.4,
0.2
],
"subspecialty_prob": [
0.4,
0.4,
0.2
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. A 24-year-old woman presents to her PCP for a routine checkup.",
"2. She feels generally healthy.",
"3. She has noticed a new vaginal discharge with a strange odor.",
"4. She has been in a long-term relationship.",
"5. She denies any new sexual partners.",
"6. She denies vaginal itching, abnormal mens... | [
"1. The patient feels generally healthy.",
"2. The patient has noticed a new vaginal discharge with a strange odor.",
"3. The patient has been in a long-term relationship.",
"4. The patient denies any new sexual partners.",
"5. The patient denies vaginal itching.",
"6. The patient denies abnormal menstrua... | |
129 | Laboratory studies show: | Hemoglobin 13.5 g/dL | Leukocyte count 9,520/mm3 | Platelet count 853,000/mm3 | Serum | Na+ 136 mEq/L | K+ 3.7 mEq/L | Cl- 96 mEq/L | Ca2+ 11.0 mg/dL | HCO3- 25 mEq/L | Glucose 102 mg/dL | Creatinine 1.0 mg/dL | Uric acid 10.5 mg/dL | Further evaluation of this patient is most likely to show which of the following? | [
"A 50-year-old African-American woman comes to the physician because of right elbow pain for the past 12 hours.",
"The pain is currently at 7 out of 10 in intensity.",
"She has not had any trauma to the right elbow.",
"She also reports general malaise.",
"She had a miscarriage at the age of 37 years.",
"O... | 13 | {
"A": "Mutation in Janus kinase 2 gene",
"B": "Howell-Jolly bodies",
"C": "Antibodies against citrullinated peptides",
"D": "Anti-phospholipid antibodies"
} | Mutation in Janus kinase 2 gene | A | {
"gender": "Female",
"age": "50",
"specialties": [
"Rheumatology"
],
"subspecialties": [
"General Rheumatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 50-year-old African-American woman.",
"2. Patient has right elbow pain for the past 12 hours.",
"3. Pain is currently at 7 out of 10 in intensity.",
"4. Patient has not had any trauma to the right elbow.",
"5. Patient also reports general malaise.",
"6. Patient had a miscarriage at the ag... | [
"1. The pain is currently at 7 out of 10 in intensity.",
"2. She has not had any trauma to the right elbow.",
"3. She also reports general malaise.",
"4. She had a miscarriage at the age of 37 years.",
"5. One year ago, she had carpal tunnel syndrome that was treated with a volar splint.",
"6. Three month... | |
130 | Which of the following is a treatment option for the patient’s most likely diagnosis? | [
"A 64-year-old man is brought to his primary care physician by his daughter for forgetfulness.",
"The patient’s daughter reports that over the past 2 weeks the patient has become more confused.",
"He did not remember to pick up his car from the body shop last week, and yesterday, he did not show up to his grand... | 16 | {
"A": "Alteplase",
"B": "Burr hole",
"C": "Donepezil",
"D": "Thiamine supplementation"
} | Burr hole | B | {
"gender": "Male",
"age": "64 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neurology with Special Qualification in Child Neurology",
"General Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. A 64-year-old man is brought to his primary care physician by his daughter. ",
"2. The daughter reports that the patient has become more confused over the past 2 weeks. ",
"3. The patient did not remember to pick up his car from the body shop last week. ",
"4. The patient did not show up to his grandson’s... | [
"1. The patient's daughter reports increased confusion over the past 2 weeks.",
"2. The patient forgot to pick up his car from the body shop last week.",
"3. The patient did not attend his grandson's birthday party.",
"4. The patient's mailbox was stuffed with unopened letters.",
"5. The patient claims to b... | |
131 | Which of the following is the most likely diagnosis? | [
"A 60-year-old man presents to the physician for a follow-up examination.",
"During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.",
"He has no complaints other than fatigue for several months.",
"There is no history of serious illness.",... | 10 | {
"A": "Acute lymphoid leukemia",
"B": "Chronic myeloid leukemia",
"C": "Hairy cell leukemia",
"D": "Burkitt lymphoma"
} | Chronic myeloid leukemia | B | {
"gender": "Male",
"age": "60",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Hematology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 60-year-old man presents to the physician for a follow-up examination.",
"2. During the previous visit, splenomegaly was detected on the abdominal exam, which has been confirmed by abdominal ultrasound.",
"3. He has no complaints other than fatigue for several months.",
"4. There is no history of seriou... | [
"1. Splenomegaly was detected during the previous visit.",
"2. The splenomegaly was confirmed by abdominal ultrasound.",
"3. The patient has been experiencing fatigue for several months.",
"4. There is no history of serious illness.",
"5. The patient's only medication is acetaminophen for knee pain.",
"6.... | |
132 | Which of the following enzymes is most likely impaired? | [
"A 55-year-old man comes to the physician because of balance problems.",
"He follows a vegan diet and does not eat meat, eggs, or dairy.",
"Physical examination shows pale oral mucosa and conjunctivae.",
"Neurologic examination shows normal strength in all extremities and decreased sense to vibration in his l... | 5 | {
"A": "Succinate dehydrogenase",
"B": "Propionyl-CoA carboxylase",
"C": "Pyruvate carboxylase",
"D": "Methylmalonyl-CoA mutase"
} | Methylmalonyl-CoA mutase | D | {
"gender": "Male",
"age": "55",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neurology with Special Qualification in Child Neurology",
"Balance problems could be related to a neurological issue. The subspecialty that would be most relevant for this patient is General Neurology."
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. A 55-year-old man comes to the physician because of balance problems.",
"2. He follows a vegan diet and does not eat meat, eggs, or dairy.",
"3. Physical examination shows pale oral mucosa and conjunctivae.",
"4. Neurologic examination shows normal strength in all extremities.",
"5. Neurologic examinati... | [
"1. He follows a vegan diet.",
"2. He does not eat meat, eggs, or dairy.",
"3. Physical examination shows pale oral mucosa.",
"4. Physical examination shows pale conjunctivae.",
"5. Neurologic examination shows normal strength in all extremities.",
"6. Neurologic examination shows decreased sense to vibra... | |
133 | Which of the following is the next best step in management? | [
"A 32-year-old woman presents to her primary care physician for generalized fatigue.",
"She states that she is doing well but that she always feels tired.",
"She started exercising to have more energy, finds that she tires easily, and has not felt motivated to return to the gym.",
"She is doing well and is ex... | 9 | {
"A": "Vitamin B9",
"B": "Vitamin B12",
"C": "Iron",
"D": "Assess for depression"
} | Iron | C | {
"gender": "Female",
"age": "32 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Hematology",
"General Internal Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 32-year-old woman presents to her primary care physician for generalized fatigue.",
"2. She states that she is doing well but that she always feels tired.",
"3. She started exercising to have more energy, finds that she tires easily, and has not felt motivated to return to the gym.",
"4. She is doing we... | [
"1. The patient states that she is doing well but always feels tired.",
"2. She started exercising to have more energy, but finds that she tires easily and has not felt motivated to return to the gym.",
"3. She is excelling at her job.",
"4. She recently started a vegan diet to try and become healthy.",
"5.... | |
134 | The hormone responsible for the observed laboratory changes most likely increases glucose transport into which of the following types of cells? | [
"A 28-year-old woman, gravida 1, para 0, at 24 weeks' gestation comes to the physician for a prenatal visit.",
"She feels well.",
"She has no history of medical illness and takes no medications.",
"Her fasting serum glucose is 91 mg/dL.",
"One hour after drinking a concentrated glucose solution, her serum g... | 5 | {
"A": "Spermatocytes",
"B": "Islet cells",
"C": "Adipocytes",
"D": "Placental cells"
} | Adipocytes | C | {
"gender": "Female",
"age": "28 years old",
"specialties": [
"Obstetrics and Gynecology"
],
"subspecialties": [
"General Obstetrics and Gynecology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. A 28-year-old woman comes to the physician for a prenatal visit.",
"2. She is gravida 1, para 0, and at 24 weeks' gestation.",
"3. She feels well.",
"4. She has no history of medical illness.",
"5. She takes no medications.",
"6. Her fasting serum glucose is 91 mg/dL.",
"7. One hour after drinking a... | [
"1. She feels well.",
"2. She has no history of medical illness.",
"3. She takes no medications.",
"4. Her fasting serum glucose is 91 mg/dL.",
"5. One hour after drinking a concentrated glucose solution, her serum glucose concentration is 94 mg/dL."
] | |
135 | Which of the following risk factors is associated with the most likely diagnosis? | [
"A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand.",
"The patient works as a school teacher in Alaska and regularly goes hiking and camping.",
"She recently returned from a camping trip where she hiked through tall brush and... | 9 | {
"A": "Female sex living in a Northern latitude",
"B": "Hiking in tick-infested woods",
"C": "Consuming meats cooked over a campfire",
"D": "Central cervical spine trauma"
} | Consuming meats cooked over a campfire | C | {
"gender": "Female",
"age": "27 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neuromuscular Medicine",
"Neurology with Special Qualification in Child Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. A 27-year-old woman presents to the emergency department with weakness of her legs which has progressed to an inability for her to stand.",
"2. The patient works as a school teacher in Alaska and regularly goes hiking and camping.",
"3. She recently returned from a camping trip where she hiked through tall ... | [
"1. The patient works as a school teacher in Alaska.",
"2. The patient regularly goes hiking and camping.",
"3. The patient recently returned from a camping trip where she hiked through tall brush and drank from mountain streams.",
"4. The patient was involved in a motor vehicle accident 2 days ago but did no... | |
136 | Which of the following reaction is favored under this condition? | [
"An 18-year-old male presents to the emergency room smelling quite heavily of alcohol and is unconscious.",
"A blood test reveals severe hypoglycemic and ketoacidemia.",
"A previous medical history states that he does not have diabetes.",
"The metabolism of ethanol in this patient's hepatocytes resulted in an... | 4 | {
"A": "Pyruvate to acetyl-CoA",
"B": "Citrate to isocitrate",
"C": "Oxaloacetate to malate",
"D": "Oxaloacetate to phosphoenolpyruvate"
} | Oxaloacetate to malate | C | {
"gender": "Male",
"age": "18",
"specialties": [
"Emergency Medicine"
],
"subspecialties": [
"General Emergency Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. An 18-year-old male presents to the emergency room.",
"2. The patient smells quite heavily of alcohol.",
"3. The patient is unconscious.",
"4. A blood test reveals severe hypoglycemic and ketoacidemia.",
"5. The patient does not have diabetes according to their medical history.",
"6. The metabolism of... | [
"1. A blood test reveals severe hypoglycemia.",
"2. A blood test reveals ketoacidemia.",
"3. The patient does not have diabetes according to previous medical history.",
"4. The metabolism of ethanol in the patient's hepatocytes resulted in an increase of the [NADH]/[NAD+] ratio."
] | |
137 | Which of the following is the most appropriate next step in management?" | [
"A previously healthy 7-year-old girl is brought to the physician for a well-child examination.",
"She feels well.",
"She emigrated from India 3 months ago.",
"There is no family history of serious illness.",
"Her immunizations are up-to-date.",
"She is at 60th percentile for height and weight.",
"Her t... | 9 | {
"A": "Perform acid-fast stain on induced sputum",
"B": "Administer isoniazid",
"C": "Perform tuberculin skin test",
"D": "Administer isoniazid, rifampin, ethambutol and pyrazinamide"
} | Administer isoniazid | B | {
"gender": "Female",
"age": "7 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Infectious Diseases"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. Patient is a 7-year-old girl.",
"2. Patient feels well.",
"3. Patient emigrated from India 3 months ago.",
"4. No family history of serious illness.",
"5. Immunizations are up-to-date.",
"6. Patient is at 60th percentile for height and weight.",
"7. Temperature is 37°C (98.6°F).",
"8. Pulse is 90/... | [
"1. She feels well.",
"2. She emigrated from India 3 months ago.",
"3. There is no family history of serious illness.",
"4. Her immunizations are up-to-date.",
"5. She is at 60th percentile for height and weight.",
"6. Her temperature is 37°C (98.6°F), pulse is 90/min, and respirations are 26/min.",
"7.... | |
138 | Based on the study results, which of the following statements best addresses the mother's question?" | [
"Please refer to the summary above to answer this question | An 8-year-old boy is brought to the physician by his mother for a well-child examination at a clinic for low-income residents.",
"Although her son's elementary school offers free afterschool programming, her son has not been interested in attending.",
... | 4 | {
"A": "The patient's family history of psychiatric illness prevents any conclusions from being drawn from the study.",
"B": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased bipolar disorder risk in adults.",
"C": "High-quality afterschool programming should be free of charge for low-income children to improve adult mental health.",
"D": "High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.\n\""
} | High-quality afterschool programming for low-income 8-year-olds may correlate with decreased ADHD risk in adults.
" | D | {
"gender": "Male",
"age": "8 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"General Pediatrics"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Psychiatry"
} | [
"1. An 8-year-old boy is brought to the physician by his mother.",
"2. The examination is at a clinic for low-income residents.",
"3. The son's elementary school offers free afterschool programming.",
"4. The son has not been interested in attending the afterschool programming.",
"5. The son's maternal gran... | [
"1. The son's elementary school offers free afterschool programming.",
"2. The son has not been interested in attending the afterschool programming.",
"3. Both the son's maternal and paternal grandmothers have major depressive disorder.",
"4. The mother is curious about the benefits of afterschool programming... | |
139 | Which of the following is the child most likely to develop? | [
"Two days after delivery, a 2450-g (5-lb 6-oz) male newborn has three episodes of green vomitus.",
"He has passed urine twice a day, but has not yet passed stool.",
"He was born at 34 weeks' gestation.",
"He appears irritable.",
"His temperature is 37.3°C (99.1°F), pulse is 161/min, respirations are 56/min,... | 11 | {
"A": "Infertility",
"B": "Alzheimer's disease",
"C": "Asthma",
"D": "Necrotizing enterocolitis"
} | Infertility | A | {
"gender": "Male",
"age": "Newborn",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. Two days after delivery, a 2450-g (5-lb 6-oz) male newborn has had three episodes of green vomitus.",
"2. He has passed urine twice a day, but has not yet passed stool.",
"3. He was born at 34 weeks' gestation.",
"4. He appears irritable.",
"5. His temperature is 37.3°C (99.1°F).",
"6. His pulse is 16... | [
"1. He has passed urine twice a day",
"2. He has not yet passed stool",
"3. He was born at 34 weeks' gestation",
"4. He appears irritable",
"5. His temperature is 37.3°C (99.1°F)",
"6. His pulse is 161/min",
"7. His respirations are 56/min",
"8. His blood pressure is 62/44 mm Hg",
"9. Examination sh... | |
140 | Which of the following is most likely a cause of this baby’s symptoms? | [
"A 6-week-old boy is brought to see his pediatrician.",
"His mother says that he has not been feeding well and forcefully vomited after every feed over the past 4 days.",
"The infant was born at 39 weeks gestation via spontaneous vaginal delivery.",
"He is up to date on all vaccines and is meeting all develop... | 9 | {
"A": "Deficiency of nitric oxide synthase",
"B": "Antibiotic use",
"C": "Inadequate myenteric plexus innervation",
"D": "Telescoping of the proximal bowel into a distal segment"
} | Antibiotic use | B | {
"gender": "Male",
"age": "6 weeks",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Surgery",
"Pediatric Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 6-week-old boy is brought to see his pediatrician.",
"2. His mother says that he has not been feeding well and forcefully vomited after every feed over the past 4 days.",
"3. The infant was born at 39 weeks gestation via spontaneous vaginal delivery.",
"4. He is up to date on all vaccines and is meeting... | [
"1. His mother reports poor feeding and forceful vomiting after feeds for the past 4 days.",
"2. The infant was born at 39 weeks gestation via spontaneous vaginal delivery.",
"3. He is up to date on all vaccines.",
"4. He is meeting all developmental milestones.",
"5. A week after delivery, he developed a r... | |
141 | Which of the following is most likely associated with the cause of this patient's symptoms? | [
"A 67-year-old man presents to his primary care physician because he has been feeling increasingly short of breath.",
"Specifically, after retirement he has been going on daily morning walks with his wife; however, over the last year he feels that his endurance has decreased.",
"His medical history is significa... | 6 | {
"A": "Increased risk of lung cancer",
"B": "Increased risk of tuberculosis",
"C": "Mesothelioma",
"D": "Lung rheumatoid nodules"
} | Lung rheumatoid nodules | D | {
"gender": "Male",
"age": "67 years old",
"specialties": [
"Pulmonary Disease"
],
"subspecialties": [
"General Pulmonary Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 67-year-old man presents to his primary care physician.",
"2. He has been feeling increasingly short of breath.",
"3. After retirement he has been going on daily morning walks with his wife.",
"4. Over the last year he feels that his endurance has decreased.",
"5. His medical history is significant fo... | [
"1. After retirement, he has been going on daily morning walks with his wife.",
"2. Over the last year, he feels that his endurance has decreased.",
"3. His medical history is significant for well-controlled hypertension.",
"4. His medical history is otherwise unremarkable.",
"5. He reveals that he worked i... | |
142 | Which of the following is the most likely cause of this patient’s recent condition? | [
"A 75-year-old woman is brought to the emergency department because of vomiting, abdominal pain, and constipation for the past 2 days.",
"She has urinated frequently over the past week and has become excessively thirsty during this time.",
"She has no significant past medical history.",
"She is a 30-pack-year... | 10 | {
"A": "Adenocarcinoma",
"B": "Bronchoalveolar carcinoma",
"C": "Large-cell carcinoma",
"D": "Squamous cell carcinoma"
} | Squamous cell carcinoma | D | {
"gender": "Female",
"age": "75 years old",
"specialties": [
"Gastroenterology",
"Internal Medicine"
],
"subspecialties": [
"General Gastroenterology",
"Gastroenterology"
],
"specialty_prob": [
0.8,
0.2
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 75-year-old woman is brought to the emergency department.",
"2. She has been vomiting, having abdominal pain, and constipated for the past 2 days.",
"3. She has been urinating frequently over the past week and has become excessively thirsty during this time.",
"4. She has no significant past medical his... | [
"1. She has urinated frequently over the past week.",
"2. She has become excessively thirsty during this time.",
"3. She has no significant past medical history.",
"4. She is a 30-pack-year smoker.",
"5. She appears confused.",
"6. Her blood pressure is 95/70 mm Hg.",
"7. Her pulse is 110/min.",
"8. H... | |
143 | The virulence factor responsible for the edema seen in this patient has a mechanism of action similar to which of the following enzymes? | [
"A 23-year-old woman comes to the physician because of a painless lesion on the arm that first appeared 5 days after she visited a petting zoo.",
"The lesion began as a small papule and then became a blister that has since ulcerated.",
"Her temperature is 38.3°C (101°F).",
"Examination shows a black eschar wi... | 5 | {
"A": "Adenylate cyclase",
"B": "Catalase",
"C": "Guanylate cyclase",
"D": "SNARE protein"
} | Adenylate cyclase | A | {
"gender": "Female",
"age": "23 years old",
"specialties": [
"Dermatology"
],
"subspecialties": [
"General Dermatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Dermatology"
} | [
"1. A 23-year-old woman comes to the physician.",
"2. She has a painless lesion on her arm.",
"3. The lesion first appeared 5 days after she visited a petting zoo.",
"4. The lesion began as a small papule.",
"5. The lesion then became a blister.",
"6. The blister has since ulcerated.",
"7. Her temperatu... | [
"1. The lesion began as a small papule.",
"2. The lesion then became a blister.",
"3. The blister has since ulcerated.",
"4. Her temperature is 38.3°C (101°F).",
"5. Examination shows a black eschar on the left upper arm.",
"6. The eschar has edematous borders.",
"7. There is axillary lymphadenopathy."
... | |
144 | A genetic defect, in which of the following proteins is most likely responsible for this patient’s condition? | [
"A 54-year-old man with a history of hypertension presents 6 days after being admitted for new-onset atrial fibrillation with the rapid ventricular rate with a painful lesion on his left leg.",
"He says his heart rate has been well-controlled since starting metoprolol and warfarin in the hospital but says he has ... | 4 | {
"A": "Factor V",
"B": "Factor XII",
"C": "Protein C",
"D": "Factor VIII"
} | Protein C | C | {
"gender": "Male",
"age": "54 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Hematology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 54-year-old man has a history of hypertension.",
"2. He was admitted 6 days ago for new-onset atrial fibrillation with a rapid ventricular rate.",
"3. He has been taking metoprolol and warfarin since being admitted.",
"4. His heart rate has been well-controlled since starting the medications.",
"5. He... | [
"1. Patient reports well-controlled heart rate since starting metoprolol and warfarin.",
"2. Patient has developed a painful lesion on his left leg.",
"3. Blood pressure is 114/78 mm Hg.",
"4. Heart rate is 84/min.",
"5. Respiratory rate is 15/min.",
"6. Physical examination reveals a large, dark lesion o... | |
145 | The patient’s condition is most likely caused by antibodies against which of the following compounds? | [
"A 35-year-old patient presents to the dermatologist with a new skin rash.",
"The patient has noticed new bumps on her arm over the past 1 month.",
"The bumps are about 0.5 cm in diameter and are filled with a clear fluid.",
"They extend on both arms but are not in her mouth or torso.",
"The lesions do not ... | 8 | {
"A": "Desmoglein",
"B": "Hemidesmosomes",
"C": "Double-stranded DNA",
"D": "U1 ribonucleotide polypeptide"
} | Hemidesmosomes | B | {
"gender": "Not specified",
"age": "35 years old",
"specialties": [
"Dermatology"
],
"subspecialties": [
"General Dermatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Dermatology"
} | [
"1. Patient is 35 years old.",
"2. Patient presents to dermatologist with new skin rash.",
"3. Patient has noticed new bumps on arm over past 1 month.",
"4. Bumps are 0.5 cm in diameter and filled with clear fluid.",
"5. Bumps extend on both arms but not in mouth or torso.",
"6. Lesions do not pop with pr... | [
"1. The patient has noticed new bumps on her arm over the past 1 month.",
"2. The bumps are about 0.5 cm in diameter and are filled with a clear fluid.",
"3. The bumps extend on both arms but are not in her mouth or torso.",
"4. The lesions do not pop with pressure but remain tense.",
"5. Her skin does not ... | |
146 | Which of the following confirmatory tests is most appropriate? | [
"A 59-year-old woman presents to the emergency department because of shortness of breath.",
"She has been experiencing an increasing inability to breathe following strenuous activity.",
"This includes climbing stairs and walking a few blocks down the street.",
"During the day, her breathing becomes more prono... | 10 | {
"A": "Pulmonary function test",
"B": "Biopsy of cardiac tissue",
"C": "Chest X-ray",
"D": "No further testing required"
} | Biopsy of cardiac tissue | B | {
"gender": "Female",
"age": "59",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Pulmonary Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. Patient is a 59-year-old female.",
"2. Patient presents to the emergency department with shortness of breath.",
"3. Patient has increasing inability to breathe following strenuous activity, such as climbing stairs and walking a few blocks.",
"4. Patient's breathing becomes more pronounced when she takes a... | [
"1. She has been experiencing an increasing inability to breathe following strenuous activity.",
"2. This includes climbing stairs and walking a few blocks down the street.",
"3. During the day, her breathing becomes more pronounced when she takes her a nap or lies down to sleep at night.",
"4. Another concer... | |
147 | What is the most likely diagnosis? | [
"A 30-year-old previously healthy male presents to your office with complaints of facial pressure and rhinorrhea for the past 3 weeks.",
"The patient reports that several weeks prior, he had a “common cold” which resolved.",
"However, he has since developed worsening facial pressure, especially over his cheeks ... | 6 | {
"A": "Acute viral rhinosinusitis",
"B": "Acute bacterial rhinosinusitis",
"C": "Allergic rhinitis",
"D": "Chronic rhinosinusitis"
} | Acute bacterial rhinosinusitis | B | {
"gender": "Male",
"age": "30",
"specialties": [
"Otolaryngology"
],
"subspecialties": [
"General Otolaryngology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Otolaryngology"
} | [
"1. Patient is a 30-year-old male.",
"2. Patient is previously healthy.",
"3. Patient has had complaints of facial pressure and rhinorrhea for the past 3 weeks.",
"4. Patient had a \"common cold\" several weeks prior which resolved.",
"5. Patient has worsening facial pressure, especially over his cheeks and... | [
"1. The patient had a \"common cold\" several weeks prior which resolved.",
"2. The patient has developed worsening facial pressure, especially over his cheeks and forehead.",
"3. The patient reports over 1 week of green tinged rhinorrhea.",
"4. The patient's temperature is 100.1 deg F (37.8 deg C).",
"5. T... | |
148 | Based on these findings, which of the following nerves is most likely injured in this patient? | [
"A 25-year-old man is brought to the emergency department 30 minutes after he was involved in a motorcycle collision.",
"Physical examination shows a deep laceration on the volar surface of the distal left forearm.",
"Neurological examination shows loss of abduction and opposition of the left thumb.",
"The ra... | 4 | {
"A": "Posterior interosseous nerve",
"B": "Axillary nerve",
"C": "Median nerve",
"D": "Ulnar nerve"
} | Median nerve | C | {
"gender": "Male",
"age": "25 years old",
"specialties": [
"Orthopaedic Surgery"
],
"subspecialties": [
"General Orthopaedic Surgery"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 25-year-old man was brought to the emergency department.",
"2. He was involved in a motorcycle collision 30 minutes prior.",
"3. Physical examination revealed a deep laceration on the volar surface of the distal left forearm.",
"4. Neurological examination showed loss of abduction and opposition of the ... | [
"1. Physical examination shows a deep laceration on the volar surface of the distal left forearm.",
"2. Neurological examination shows loss of abduction and opposition of the left thumb.",
"3. The radial and ulnar pulses are palpable."
] | |
149 | Which of the following is the most likely location of his intestinal bleeding? | [
"A 70-year-old man presents to the emergency department after several episodes of bloody stools that started 6 hours ago.",
"The patient denies nausea, vomiting, or diarrhea.",
"On examination, he is pale and cachectic.",
"The patient’s abdomen is nontender to palpation on the exam.",
"His heart rate is 120... | 6 | {
"A": "Ascending colon",
"B": "Sigmoid colon",
"C": "Stomach",
"D": "Ileum"
} | Sigmoid colon | B | {
"gender": "Male",
"age": "70 years old",
"specialties": [
"Gastroenterology"
],
"subspecialties": [
"General Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 70-year-old man presents to the emergency department.",
"2. The patient had several episodes of bloody stools that started 6 hours ago.",
"3. The patient denies nausea, vomiting, or diarrhea.",
"4. On examination, the patient is pale and cachectic.",
"5. The patient's abdomen is nontender to palpation... | [
"1. The patient denies nausea.",
"2. The patient denies vomiting.",
"3. The patient denies diarrhea.",
"4. On examination, the patient is pale.",
"5. On examination, the patient is cachectic.",
"6. The patient’s abdomen is nontender to palpation.",
"7. The patient's heart rate is 120/min.",
"8. The pa... | |
150 | Which of the following is the most likely diagnosis? | [
"A 48-year-old man comes to the physician because of a 4-month history of persistent cough productive of white phlegm.",
"He coughs consistently throughout the day, and he has not noticed any particular triggers that make it worse.",
"He has also recently experienced some shortness of breath with exertion.",
... | 10 | {
"A": "Asbestosis",
"B": "Hypersensitivity pneumonitis",
"C": "Asthma",
"D": "Chronic bronchitis"
} | Chronic bronchitis | D | {
"gender": "Male",
"age": "48 years old",
"specialties": [
"Pulmonary Disease",
"Internal Medicine"
],
"subspecialties": [
"General Pulmonary Disease",
"Pulmonary Disease"
],
"specialty_prob": [
0.8,
0.2
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is 48 years old.",
"2. Patient has had a persistent cough for 4 months.",
"3. Cough is productive of white phlegm.",
"4. Cough is consistent throughout the day.",
"5. Patient has not noticed any particular triggers that make it worse.",
"6. Patient has recently experienced shortness of breath ... | [
"1. He coughs consistently throughout the day.",
"2. He has not noticed any particular triggers that make it worse.",
"3. He has recently experienced some shortness of breath with exertion.",
"4. He has not had any weight loss, fever, or chills.",
"5. He had similar symptoms last year, which lasted about 6 ... | |
151 | What is the best immediate treatment for this patient? | [
"A 26-year-old female with no significant past medical history presents to the emergency department complaining of chest pain.",
"She states that she was visiting her boyfriend in the hospital and, approximately 10 minutes ago, she developed chest pain associated with sweating, palpitations, nausea, and chills.",... | 7 | {
"A": "Morphine, oxygen, nitrogylcerin, aspirin, beta blockers, ACE inhibitor, and heparin",
"B": "Alprazolam, reassurance, encouraging patient to slow breathing",
"C": "Albuterol breathing treatment",
"D": "Cognitive behavioral therapy"
} | Alprazolam, reassurance, encouraging patient to slow breathing | B | {
"gender": "Female",
"age": "26",
"specialties": [
"Emergency Medicine",
"Internal Medicine"
],
"subspecialties": [
"General Emergency Medicine",
"Cardiovascular Disease"
],
"specialty_prob": [
0.6,
0.4
],
"subspecialty_prob": [
0.6,
0.4
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 26-year-old female presents to the emergency department.",
"2. She has no significant past medical history.",
"3. She was visiting her boyfriend in the hospital.",
"4. Approximately 10 minutes ago, she developed chest pain.",
"5. The chest pain is associated with sweating, palpitations, nausea, and ch... | [
"1. The patient was visiting her boyfriend in the hospital.",
"2. Approximately 10 minutes ago, she developed chest pain.",
"3. The chest pain was associated with sweating, palpitations, nausea, and chills.",
"4. The patient appears very nervous.",
"5. She states that she is scared that she is dying.",
"6... | |
152 | Which of the following responses by the treating physician is the most appropriate? | [
"A 36-year-old woman is brought to the emergency department by her sister 1 hour after she was found unconscious at home.",
"She appears lethargic.",
"Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 5/min, and blood pressure is 120/70 mm Hg.",
"Urine toxicology screening is positive for al... | 7 | {
"A": "\"\"\"Why don't you go ahead and ask her directly? She is currently in the psychiatric ward.\"\"\"",
"B": "\"\"\"Her urine toxicology screening was positive for alcohol, benzodiazepines, and barbiturates.\"\"\"",
"C": "\"\"\"I'm not the right person to ask. Please ask her primary care physician.\"\"\"",
"D": "\"\"\"I understand your concern, but I am unable to provide information about this situation.\"\"\""
} | """I understand your concern, but I am unable to provide information about this situation.""" | D | {
"gender": "Female",
"age": "36 years old",
"specialties": [
"Emergency Medicine"
],
"subspecialties": [
"General Emergency Medicine",
"Toxicology",
"Medical Toxicology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.6,
0.2,
0.2
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 36-year-old woman was brought to the emergency department by her sister 1 hour after she was found unconscious at home. ",
"2. She appears lethargic. ",
"3. Her temperature is 37°C (98.6°F). ",
"4. Her pulse is 80/min. ",
"5. Her respirations are 5/min. ",
"6. Her blood pressure is 120/70 mm Hg. ",
... | [
"1. She appears lethargic.",
"2. Her temperature is 37°C (98.6°F).",
"3. Her pulse is 80/min.",
"4. Her respirations are 5/min.",
"5. Her blood pressure is 120/70 mm Hg.",
"6. Urine toxicology screening is positive for alcohol, benzodiazepines, and barbiturates.",
"7. The patient's condition improves wi... | |
153 | Which of the following best describes the mechanism of rejection that happened in this patient? | [
"A 40-year-old man presents to a clinic for a regular follow-up.",
"He was diagnosed with Wilson’s disease 20 years ago and underwent a human leukocyte antigen–matched liver transplant 15 years ago.",
"Today he is feeling fine and has no complaints except for a new, mild jaundice that his wife noticed a few wee... | 5 | {
"A": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to donor T cells.",
"B": "Donor allogeneic MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by unprocessed donor allogeneic MHC molecules to recipient T cells.",
"C": "Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells.",
"D": "Recipient MHC molecules are taken up by donor APCs and processed into peptides, and then the peptides are presented by donor allogeneic MHC molecules to recipient T cells."
} | Donor allogeneic MHC molecules are taken up by recipient APCs and processed into peptides, and then the peptides are presented by recipient MHC molecules to recipient T cells. | C | {
"gender": "Male",
"age": "40",
"specialties": [
"Immunology",
"Internal Medicine"
],
"subspecialties": [
"General Allergy and Immunology",
"Nephrology"
],
"specialty_prob": [
0.75,
0.25
],
"subspecialty_prob": [
0.75,
0.25
],
"gpt_specialty": "Pathology"
} | [
"1. A 40-year-old man presents to a clinic for a regular follow-up.",
"2. He was diagnosed with Wilson’s disease 20 years ago.",
"3. He underwent a human leukocyte antigen–matched liver transplant 15 years ago.",
"4. He is feeling fine and has no complaints except for a new, mild jaundice.",
"5. His wife no... | [
"1. Diagnosed with Wilson’s disease 20 years ago",
"2. Underwent a human leukocyte antigen–matched liver transplant 15 years ago",
"3. Feeling fine today with no complaints except for mild jaundice",
"4. Wife noticed the new jaundice a few weeks ago",
"5. Denies changes in stool or urine color",
"6. Not h... | |
154 | Which of the following was most likely prescribed during the previous visit? | [
"A 6-year-old boy is brought to his pediatrician due to increased shortness of breath.",
"His mother is particularly disturbed because her son wakes up breathless one or 2 nights every week.",
"He was diagnosed with asthma 2 years ago.",
"Over the past few months, he has not been able to participate in any sp... | 12 | {
"A": "Inhaled beclomethasone",
"B": "Inhaled ipratropium bromide",
"C": "Nebulized theophylline",
"D": "Inhaled salmeterol"
} | Inhaled beclomethasone | A | {
"gender": "Male",
"age": "6 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Pulmonology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 6-year-old boy is brought to his pediatrician due to increased shortness of breath.",
"2. His mother reports that her son wakes up breathless one or 2 nights every week.",
"3. He was diagnosed with asthma 2 years ago.",
"4. Over the past few months, he has not been able to participate in any sport.",
... | [
"1. The patient wakes up breathless one or 2 nights every week.",
"2. He was diagnosed with asthma 2 years ago.",
"3. He has not been able to participate in any sport.",
"4. He is using his inhaler more than 3 times a week.",
"5. On examination, the patient appears to be in slight distress.",
"6. The pati... | |
155 | How do you expect the venous pH, arterial pCO2, and venous pCO2 to respond? | [
"A 25-year-old medical student enrolls in an exercise research study.",
"Spirometry testing, along with arterial and venous blood gases, are performed immediately before and after 15 minutes of exercising on a stationary bicycle."
] | 2 | {
"A": "Venous pH decreases, arterial pCO2 decreases, venous pCO2 decreases",
"B": "Venous pH increases, arterial pCO2 decreases, venous pCO2 increases",
"C": "Venous pH increases, arterial pCO2 increases, venous pCO2 increases",
"D": "Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases"
} | Venous pH decreases, arterial pCO2 stays the same, venous pCO2 increases | D | {
"gender": "study",
"age": "study",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Pulmonary Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 25-year-old medical student enrolls in an exercise research study.",
"2. Spirometry testing is performed immediately before and after 15 minutes of exercising on a stationary bicycle.",
"3. Arterial and venous blood gases are performed immediately before and after 15 minutes of exercising on a stationary ... | [
"1. Spirometry testing is performed.",
"2. Arterial blood gases are tested.",
"3. Venous blood gases are tested.",
"4. The tests are performed immediately before exercising.",
"5. The tests are performed immediately after 15 minutes of exercising on a stationary bicycle."
] | |
156 | Which of the following enzymes contributes most to maintaining a normal serum glucose level in this patient? | [
"A 38-year-old imprisoned man is brought to the physician after going on a hunger strike for 36 hours.",
"During this time, he has only had two cups of water.",
"Physical examination shows dry mucous membranes.",
"His serum glucose concentration is 70 mg/dL."
] | 4 | {
"A": "Phosphoenolpyruvate carboxykinase",
"B": "Hydroxymethylglutaryl-CoA lyase",
"C": "Glycogen phosphorylase",
"D": "Phosphofructokinase-1"
} | Phosphoenolpyruvate carboxykinase | A | {
"gender": "Male",
"age": "38 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Endocrinology, Diabetes, and Metabolism"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 38-year-old man is imprisoned.",
"2. He has gone on a hunger strike for 36 hours.",
"3. During this time, he has only had two cups of water.",
"4. He is brought to the physician.",
"5. Physical examination shows dry mucous membranes.",
"6. His serum glucose concentration is 70 mg/dL."
] | [
"1. He has only had two cups of water.",
"2. Physical examination shows dry mucous membranes.",
"3. His serum glucose concentration is 70 mg/dL."
] | |
157 | Which of the following best describes the most likely diagnosis? | [
"A 27-year-old man presents to the emergency department with a chief concern of abdominal pain and diarrhea.",
"The patient states that for the past 4 days he has experienced abdominal pain, diarrhea, weakness and a subjective fever.",
"He also endorses a weight loss of 11 pounds during this time.",
"The pati... | 12 | {
"A": "ANCA positivity",
"B": "ASCA positivity",
"C": "Dilated vascular structure in the anal canal",
"D": "Mucosal disruption"
} | ASCA positivity | B | {
"gender": "Male",
"age": "27 years old",
"specialties": [
"Gastroenterology"
],
"subspecialties": [
"General Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. Patient is 27 years old.",
"2. Patient presents to the emergency department with abdominal pain and diarrhea.",
"3. Patient has experienced abdominal pain, diarrhea, weakness and a subjective fever for the past 4 days.",
"4. Patient has lost 11 pounds during this time.",
"5. Patient has a past medical h... | [
"1. The patient has experienced abdominal pain, diarrhea, weakness, and a subjective fever for the past 4 days.",
"2. The patient has experienced a weight loss of 11 pounds during the past 4 days.",
"3. The patient has a past medical history of celiac disease, constipation, and depression.",
"4. The patient's... | |
158 | Which of the following is the mechanism of action of the medication? | [
"A previously healthy 31-year-old man is rushed to the emergency department after an all-night binge that included smoking, alcohol, and cocaine.",
"He complains of chest fluttering, fatigue, and lightheadedness.",
"His past medical and family history are noncontributory.",
"Social history is positive for occ... | 8 | {
"A": "Gamma-aminobutyric acid receptor agonist",
"B": "Slowing of the atrioventricular (AV) node conduction time",
"C": "Blocking of sodium/potassium adenosine triphosphatase pump",
"D": "Prolongation of repolarization phase of cardiac action potential"
} | Slowing of the atrioventricular (AV) node conduction time | B | {
"gender": "Male",
"age": "31 years old",
"specialties": [
"Emergency Medicine"
],
"subspecialties": [
"Medical Toxicology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 31-year-old man is rushed to the emergency department.",
"2. He had an all-night binge that included smoking, alcohol, and cocaine.",
"3. He complains of chest fluttering, fatigue, and lightheadedness.",
"4. His past medical and family history are noncontributory.",
"5. Social history is positive for ... | [
"1. Patient complains of chest fluttering, fatigue, and lightheadedness.",
"2. Past medical and family history are noncontributory.",
"3. Social history is positive for occasional smoking and social drinking.",
"4. Blood pressure at the hospital is 110/70 mm Hg.",
"5. Heart rate at the hospital is 160/min a... | |
159 | Which of the following drugs would most likely achieve the desired effect? | [
"A scientist is studying how animals regulate their blood pressure in response to various stimuli.",
"In particular, she is interested in how much a novel compound that binds to both alpha-1 and beta-1 adrenergic receptors will affect blood pressure.",
"She studies this question in non-human primates, but finds... | 4 | {
"A": "Dobutamine",
"B": "Hexamethonium",
"C": "Metoprolol",
"D": "Scopolamine"
} | Hexamethonium | B | {
"gender": "study",
"age": "study",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Nephrology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Physical Medicine and Rehabilitation"
} | [
"1. A scientist is studying how animals regulate their blood pressure in response to various stimuli.",
"2. She is interested in how much a novel compound that binds to both alpha-1 and beta-1 adrenergic receptors will affect blood pressure.",
"3. She studies this question in non-human primates.",
"4. Her res... | [
"1. The researcher is interested in a novel compound that binds to alpha-1 and beta-1 adrenergic receptors.",
"2. The researcher studies the compound's effect on blood pressure in non-human primates.",
"3. The animals' heart rates start to decrease several minutes after administration of the novel compound.",
... | |
160 | Based on the information provided in the drug advertisement, which of the following patients with HCC would be an appropriate treatment candidate and benefit the most from treatment with Noxbinle 100 mg in comparison to Metalimus 100 mg? | [
"A hepatologist has learned about the survival benefit of Noxbinle (tumorolimus) in hepatocellular carcinoma (HCC) patients from a fellow physician.",
"She is looking at a list of HCC patients on her hospital's hepatology consult service and trying to identify candidates who might derive more survival benefits fr... | 2 | {
"A": "Non-cirrhotic patient with a history of hepatitis B and alcohol dependence",
"B": "Alcoholic patient with severe cirrhosis on immunosuppressive therapy",
"C": "Patient with severe cirrhosis, history of hepatitis C, and kidney stones",
"D": "Patient with severe cirrhosis, history of hepatitis C, and asthma"
} | Patient with severe cirrhosis, history of hepatitis C, and asthma | D | {
"gender": "study",
"age": "study",
"specialties": [
"Hepatology"
],
"subspecialties": [
"General Hepatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A hepatologist has learned about the survival benefit of Noxbinle (tumorolimus).",
"2. The survival benefit is for hepatocellular carcinoma (HCC) patients.",
"3. The hepatologist learned about the survival benefit from a fellow physician.",
"4. The hepatologist is looking at a list of HCC patients on her ... | [
"1. She is looking at a list of HCC patients.",
"2. The list is for her hospital's hepatology consult service.",
"3. She is trying to identify candidates for Noxbinle.",
"4. She is trying to identify candidates for Metalimus.",
"5. She is trying to identify candidates who might derive more survival benefits... | |
161 | In this fetus, what other renal structure would be expected to be absent? | [
"An error occurs during the embryologic development of the kidney.",
"It is found that the fetus lacks proper ureters, major and minor calyces, and renal pelvises."
] | 2 | {
"A": "Collecting ducts",
"B": "Ductus deferens",
"C": "Distal convoluted tubule",
"D": "Bowman's capsule"
} | Collecting ducts | A | {
"gender": "study",
"age": "study",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Nephrology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Medical Genetics and Genomics"
} | [
"1. An error occurs during the embryologic development of the kidney.",
"2. It is found that the fetus lacks proper ureters.",
"3. It is found that the fetus lacks major calyces.",
"4. It is found that the fetus lacks minor calyces.",
"5. It is found that the fetus lacks renal pelvises."
] | [
"1. The fetus lacks proper ureters.",
"2. The fetus lacks major calyces.",
"3. The fetus lacks minor calyces.",
"4. The fetus lacks renal pelvises."
] | |
162 | Which of the following is most likely to achieve this desired effect? | [
"An investigator is studying the effects of tissue hypoxia on skeletal muscles.",
"Skeletal muscle hypoxia is induced by decreasing oxygen delivery to peripheral tissues."
] | 2 | {
"A": "Decrease the serum 2,3-bisphosphoglycerate concentration",
"B": "Increase the serum hydrogen ion concentration",
"C": "Increase the arterial partial pressure of carbon dioxide",
"D": "Increase the serum temperature"
} | Decrease the serum 2,3-bisphosphoglycerate concentration | A | {
"gender": "study",
"age": "study",
"specialties": [
"Anesthesiology"
],
"subspecialties": [
"Critical Care Medicine"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. An investigator is studying the effects of tissue hypoxia.",
"2. Tissue hypoxia affects skeletal muscles.",
"3. Skeletal muscle hypoxia is induced by decreasing oxygen delivery.",
"4. Oxygen delivery is decreased to peripheral tissues."
] | [
"1. Skeletal muscle hypoxia",
"2. Induced by decreasing oxygen delivery",
"3. To peripheral tissues"
] | |
163 | Which histological finding would place her at the highest risk of developing esophageal adenocarcinoma in the near future? | [
"A 48-year-old woman presents to the doctor’s office complaining of frequent episodes of severe heartburn and chest pain.",
"It feels like food is getting stuck in her throat somewhere.",
"She wakes up at night in fits of coughing and in pain.",
"Antacids and other over the counter remedies do not improve the... | 6 | {
"A": "The presence of inflammatory cells in the body of the stomach",
"B": "The presence of metaplasia at the Z line",
"C": "The presence of goblet cells at the Z line",
"D": "The presence of high grade dysplasia at the Z line"
} | The presence of high grade dysplasia at the Z line | D | {
"gender": "Female",
"age": "48 years old",
"specialties": [
"Gastroenterology"
],
"subspecialties": [
"General Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 48-year-old woman presents to the doctor's office.",
"2. She is complaining of frequent episodes of severe heartburn and chest pain.",
"3. She feels like food is getting stuck in her throat somewhere.",
"4. She wakes up at night in fits of coughing and in pain.",
"5. Antacids and other over the counte... | [
"1. Patient feels like food is getting stuck in her throat.",
"2. Patient wakes up at night in fits of coughing and in pain.",
"3. Antacids and other over the counter remedies do not improve the discomfort.",
"4. Physician feels that the patient has acid reflux.",
"5. Physician recommends upper gastrointest... | |
164 | Which of the following is the most likely vector of this patient's condition? | [
"A 26-year-old man comes to the physician because of a 3-week history of malaise and recurrent fever.",
"He has also had a 4.5-kg (10-lb) weight loss over the past 3 months.",
"He came back from his honeymoon in Kenya 6 months ago.",
"He appears ill.",
"His temperature is 39°C (102.2°F).",
"He is alert an... | 8 | {
"A": "Tsetse fly",
"B": "Sand fly",
"C": "Freshwater snail",
"D": "Anopheles mosquito"
} | Sand fly | B | {
"gender": "Male",
"age": "26 years old",
"specialties": [
"Infectious Disease"
],
"subspecialties": [
"General Infectious Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 26-year-old man comes to the physician.",
"2. He has a 3-week history of malaise and recurrent fever.",
"3. He has had a 4.5-kg (10-lb) weight loss over the past 3 months.",
"4. He came back from his honeymoon in Kenya 6 months ago.",
"5. He appears ill.",
"6. His temperature is 39°C (102.2°F).",
... | [
"1. He has had a 4.5-kg (10-lb) weight loss over the past 3 months.",
"2. He came back from his honeymoon in Kenya 6 months ago.",
"3. He appears ill.",
"4. His temperature is 39°C (102.2°F).",
"5. He is alert and oriented to person, time, and place.",
"6. Physical examination shows generalized lymphadeno... | |
165 | Which best describes the principal action(s) of prazosin? | [
"A 68-year-old Caucasian male presents to your office complaining of urinary hesitancy and decreased urinary flow.",
"His blood pressure is measured to be 168/95.",
"You prescribe prazosin."
] | 3 | {
"A": "Relaxation of urinary sphincter and reduction of peripheral vascular resistance",
"B": "Relaxation of urinary sphincter and suppression of renin release",
"C": "Contraction of urinary bladder wall smooth muscle and suppression of renin release",
"D": "Contraction of urinary bladder wall smooth muscle and reduction of peripheral vascular resistance"
} | Relaxation of urinary sphincter and reduction of peripheral vascular resistance | A | {
"gender": "Male",
"age": "68",
"specialties": [
"Urology"
],
"subspecialties": [
"General Urology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Urology"
} | [
"1. A 68-year-old Caucasian male presents to your office.",
"2. The patient is complaining of urinary hesitancy and decreased urinary flow.",
"3. The patient's blood pressure is measured to be 168/95.",
"4. You prescribe prazosin."
] | [
"1. Blood pressure is measured to be 168/95.",
"2. Prazosin is prescribed."
] | |
166 | Which of the following is the next best step in the management of this patient? | [
"A 4-year-old boy is referred to the infectious disease clinic for recurrent pneumonia.",
"Although he has had several previous hospital admissions and received multiple courses of antibiotic therapy, he continues to get sick.",
"On his most recent hospital admission, the boy presented with mild fever, right-si... | 10 | {
"A": "CD4+ cell count",
"B": "Bone marrow biopsy",
"C": "Dihydrorhodamine (DHR) test",
"D": "Adenosine deaminase levels"
} | Dihydrorhodamine (DHR) test | C | {
"gender": "Male",
"age": "4 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Infectious Diseases"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 4-year-old boy is referred to the infectious disease clinic for recurrent pneumonia.",
"2. He has had several previous hospital admissions and received multiple courses of antibiotic therapy.",
"3. He continues to get sick.",
"4. On his most recent hospital admission, the boy presented with mild fever, ... | [
"1. The patient has had several previous hospital admissions.",
"2. The patient has received multiple courses of antibiotic therapy.",
"3. On his most recent hospital admission, the boy presented with mild fever.",
"4. On his most recent hospital admission, the boy presented with right-sided chest pain.",
"... | |
167 | Which of the following will most likely be found on physical exam? | [
"A 72-year-old man is being transported by emergency medical services to the emergency department for a stroke code.",
"He was found on the ground by his daughter earlier today, and he was last known to be without neurological deficits two hours prior to presentation.",
"His temperature is 99°F (37.2°C), blood ... | 4 | {
"A": "Contralateral hemiparesis",
"B": "Contralateral lower extremity weakness",
"C": "Hemineglect",
"D": "Wernicke aphasia"
} | Contralateral lower extremity weakness | B | {
"gender": "Male",
"age": "72 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Vascular Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 72-year-old man is being transported by emergency medical services to the emergency department for a stroke code.",
"2. He was found on the ground by his daughter earlier today.",
"3. He was last known to be without neurological deficits two hours prior to presentation.",
"4. His temperature is 99°F (37... | [
"1. He was found on the ground by his daughter earlier today.",
"2. He was last known to be without neurological deficits two hours prior to presentation.",
"3. His temperature is 99°F (37.2°C).",
"4. His blood pressure is 185/105 mmHg.",
"5. His pulse is 102/min.",
"6. His respirations are 18/min.",
"7... | |
168 | This medication is associated with an increased risk of which of the following complications? | [
"A 33-year-old G1P0 at 39 weeks gestation is admitted to the labor and delivery floor for induction of labor.",
"She feels well and is no acute distress.",
"She is accompanied by her husband.",
"Her past medical history is notable for major depressive disorder and generalized anxiety disorder.",
"She takes ... | 7 | {
"A": "Placental abruption",
"B": "Vasa previa",
"C": "Placenta accreta",
"D": "Preeclampsia"
} | Placental abruption | A | {
"gender": "Female",
"age": "33",
"specialties": [
"Obstetrics and Gynecology"
],
"subspecialties": [
"General Obstetrics and Gynecology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. Patient is 33 years old.",
"2. Patient is G1P0.",
"3. Patient is 39 weeks gestation.",
"4. Patient is admitted to labor and delivery floor for induction of labor.",
"5. Patient feels well and is in no acute distress.",
"6. Patient is accompanied by her husband.",
"7. Patient has past medical history... | [
"1. She feels well and is in no acute distress.",
"2. She is accompanied by her husband.",
"3. Her past medical history includes major depressive disorder and generalized anxiety disorder.",
"4. She takes sertraline.",
"5. Her temperature is 99.2°F (37.3°C).",
"6. Her blood pressure is 120/75 mmHg.",
"7... | |
169 | Which drug has been prescribed? | [
"A 57-year-old Caucasian male presents to your office with heart palpitations and shortness of breath.",
"On exam, he is tachycardic and his rhythm is irregularly irregular.",
"He fails standard pharmacologic therapy and you refer to cardiology, where he is started on an antiarrhythmic medication.",
"The acti... | 4 | {
"A": "Flecanide",
"B": "Mexiletine",
"C": "Diltiazem",
"D": "Sotalol"
} | Sotalol | D | {
"gender": "Male",
"age": "57",
"specialties": [
"Cardiology"
],
"subspecialties": [
"General Cardiology",
"Cardiovascular Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 57-year-old Caucasian male presents to office with heart palpitations and shortness of breath.",
"2. On exam, he is tachycardic and his rhythm is irregularly irregular.",
"3. He fails standard pharmacologic therapy.",
"4. Referred to cardiology.",
"5. Started on an antiarrhythmic medication.",
"6. A... | [
"1. On exam, the patient is tachycardic.",
"2. On exam, the patient's rhythm is irregularly irregular.",
"3. The patient fails standard pharmacologic therapy.",
"4. The patient is referred to cardiology.",
"5. In cardiology, the patient is started on an antiarrhythmic medication.",
"6. The action of the a... | |
170 | Which of the following is the most likely diagnosis? | [
"A 2-year-old girl is brought to the physician because of abdominal distention and twitching of her feet, which her mother noticed a week ago.",
"The patient has also had a low-grade fever for 5 days.",
"She has not had a bowel movement in 3 days.",
"She was born at term and has been healthy since.",
"She i... | 10 | {
"A": "Hodgkin lymphoma",
"B": "Hepatoblastoma",
"C": "Nephroblastoma",
"D": "Neuroblastoma"
} | Neuroblastoma | D | {
"gender": "Female",
"age": "2 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Oncology",
"Pediatric Nephrology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"gpt_specialty": "Pediatrics"
} | [
"1. Patient is a 2-year-old girl.",
"2. Mother noticed abdominal distention and twitching of feet a week ago.",
"3. Patient has had a low-grade fever for 5 days.",
"4. Patient has not had a bowel movement in 3 days.",
"5. Patient was born at term and has been healthy since.",
"6. Patient is at the 40th pe... | [
"1. The patient has had a low-grade fever for 5 days.",
"2. She has not had a bowel movement in 3 days.",
"3. She was born at term and has been healthy since.",
"4. She is at the 40th percentile for height and 20th percentile for weight.",
"5. Her temperature is 38.1°C (100.6°F).",
"6. Her pulse is 128/mi... | |
171 | Which of the following additional findings is most likely in this patient? | [
"A 53-year-old man is brought to the emergency department by his wife after the sudden onset of dizziness, nausea, and left-sided weakness.",
"His blood pressure is 165/95 mm Hg.",
"Neurological examination shows decreased muscle tone and hyperreflexia in the right upper and lower extremities.",
"His gait is ... | 6 | {
"A": "Ptosis and inability to look up with the right eye",
"B": "Winging of the left scapula and weakness turning the head to the right",
"C": "Difficulty chewing and deviation of the jaw to the left",
"D": "Inability to smell vanilla or coffee"
} | Difficulty chewing and deviation of the jaw to the left | C | {
"gender": "Male",
"age": "53",
"specialties": [
"Neurology"
],
"subspecialties": [
"Vascular Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 53-year-old man is brought to the emergency department by his wife.",
"2. The man has sudden onset of dizziness, nausea, and left-sided weakness.",
"3. His blood pressure is 165/95 mm Hg.",
"4. Neurological examination shows decreased muscle tone and hyperreflexia in the right upper and lower extremitie... | [
"1. His blood pressure is 165/95 mm Hg.",
"2. Neurological examination shows decreased muscle tone in the right upper and lower extremities.",
"3. Neurological examination shows hyperreflexia in the right upper and lower extremities.",
"4. His gait is unsteady.",
"5. He falls to the left when attempting to ... | |
172 | Which of the following would you expect to see upon chest X-ray: | [
"A 38-year-old African American female presents to her primary care physician with uveitis, cough, and arthralgias in her ankles and legs.",
"Bloodwork reveals elevated angiotensin converting enzyme levels, and skin PPD testing shows no observable induration after 48 hours.",
"The patient demonstrates reduced F... | 4 | {
"A": "Enlarged hilar lymph nodes",
"B": "Kerley B Lines",
"C": "Bilateral diaphragmatic elevation.",
"D": "Fluid in alveolar walls"
} | Enlarged hilar lymph nodes | A | {
"gender": "Female",
"age": "38",
"specialties": [
"Rheumatology",
"Internal Medicine"
],
"subspecialties": [
"General Rheumatology",
"Rheumatology"
],
"specialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"subspecialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is 38 years old.",
"2. Patient is African American.",
"3. Patient is female.",
"4. Patient presents to primary care physician with uveitis, cough, and arthralgias in ankles and legs.",
"5. Bloodwork reveals elevated angiotensin converting enzyme levels.",
"6. Skin PPD testing shows no observab... | [
"1. Bloodwork reveals elevated angiotensin converting enzyme levels.",
"2. Skin PPD testing shows no observable induration after 48 hours.",
"3. The patient demonstrates reduced FEV1 upon spirometry.",
"4. The patient demonstrates reduced FVC upon spirometry.",
"5. FEV1/FVC is 85%."
] | |
173 | A mutation of which of the following genes is most likely responsible for this patient's condition? | [
"A previously healthy 41-year-old man comes to the physician for evaluation of a 1-month history of painless, intermittent bleeding on defecation, which he discovered while wiping.",
"His younger sister was recently diagnosed with endometrial cancer, and his mother was diagnosed with gastric cancer at 58 years of... | 6 | {
"A": "MLH1",
"B": "TP53",
"C": "DCC",
"D": "KRAS"
} | MLH1 | A | {
"gender": "Male",
"age": "41 years old",
"specialties": [
"Colon and Rectal Surgery",
"Colorectal Surgery"
],
"subspecialties": [
"General Colon and Rectal Surgery",
"General Colorectal Surgery"
],
"specialty_prob": [
0.8,
0.2
],
"subspecialty_prob": [
0.8,
0.2
],
"gpt_specialty": "Colon and Rectal Surgery"
} | [
"1. A 41-year-old man comes to the physician for evaluation of a 1-month history of painless, intermittent bleeding on defecation.",
"2. He discovered the bleeding while wiping.",
"3. His younger sister was recently diagnosed with endometrial cancer.",
"4. His mother was diagnosed with gastric cancer at 58 ye... | [
"1. His younger sister was recently diagnosed with endometrial cancer.",
"2. His mother was diagnosed with gastric cancer at 58 years of age.",
"3. Physical examination shows no abnormalities.",
"4. Test of the stool for occult blood is positive.",
"5. Colonoscopy shows a tumor in the ascending colon.",
"... | |
174 | This medication has which of the following mechanisms of action? | [
"A 49-year-old woman presents to her pulmonologist for a follow-up visit.",
"She reports a longstanding history of chronic dyspnea and fatigue.",
"Her past medical history is notable for asthma.",
"She has a known mutation in the BMPR2 gene.",
"She was recently trialed on nifedipine but stopped due to sever... | 9 | {
"A": "Endothelin-1 receptor antagonist",
"B": "Beta-2-adrenergic receptor agonist",
"C": "Phospholipase A2 antagonist",
"D": "Phosphodiesterase type 5 antagonist"
} | Endothelin-1 receptor antagonist | A | {
"gender": "Female",
"age": "49",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Pulmonary Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 49-year-old woman.",
"2. Patient has longstanding history of chronic dyspnea and fatigue.",
"3. Patient has past medical history of asthma.",
"4. Patient has known mutation in BMPR2 gene.",
"5. Patient was recently trialed on nifedipine but stopped due to severe lower extremity edema.",
"... | [
"1. She reports chronic dyspnea and fatigue.",
"2. Her past medical history includes asthma.",
"3. She has a known mutation in the BMPR2 gene.",
"4. She was trialed on nifedipine but stopped due to severe lower extremity edema.",
"5. She does not smoke or drink alcohol.",
"6. Her temperature is 99.4°F (37... | |
175 | Which of the following is the most appropriate next step in treatment?" | [
"A 14-year-old girl is brought to the physician by her mother for the evaluation of recurrent episodes of nose bleeding for several months.",
"The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.",
"Menses occur at regular 27-day intervals with h... | 7 | {
"A": "Oral prednisone",
"B": "Intravenous immunoglobulins",
"C": "Tranexamic acid",
"D": "Desmopressin"
} | Desmopressin | D | {
"gender": "Female",
"age": "14 years old",
"specialties": [
"Otolaryngology"
],
"subspecialties": [
"General Otolaryngology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Otolaryngology"
} | [
"1. A 14-year-old girl is brought to the physician by her mother.",
"2. The girl has had recurrent episodes of nose bleeding for several months.",
"3. The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.",
"4. The girl's menses occur at regular... | [
"1. The episodes occur unexpectedly and stop after a few minutes by elevating the upper body and bending the head forward.",
"2. Menses occur at regular 27-day intervals with heavy flow.",
"3. Her last menstrual period was 3 weeks ago.",
"4. Vital signs are within normal limits.",
"5. Physical examination s... | |
176 | Which of the following is the most probable cause of the newborn’s condition? | [
"A 29-year-old G3P2 undergoes a cesarean section at 38 weeks gestation and delivers a boy weighing 4570 g with Apgar scores of 5 and 8 at 1 and 5 minutes, respectively.",
"The current pregnancy was complicated by gestational diabetes with poor glycemic control.",
"The newborn’s heart rate is 122/min, the respir... | 5 | {
"A": "Microangiopathy",
"B": "Hyperinsulinemia",
"C": "Hyperglycemia",
"D": "Polycythemia"
} | Hyperinsulinemia | B | {
"gender": "Male",
"age": "29 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Neonatal"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. Patient is 29 years old. ",
"2. Patient is G3P2. ",
"3. Patient underwent cesarean section at 38 weeks gestation. ",
"4. Patient delivered a boy. ",
"5. Boy weighed 4570 g. ",
"6. Apgar scores at 1 and 5 minutes were 5 and 8, respectively. ",
"7. Current pregnancy was complicated by gestational diab... | [
"1. The current pregnancy was complicated by gestational diabetes with poor glycemic control.",
"2. The newborn’s heart rate is 122/min.",
"3. The newborn’s respiratory rate is 31/min.",
"4. The newborn’s temperature is 36.4℃ (97.5℉).",
"5. On examination, the newborn is pale.",
"6. On examination, the ne... | |
177 | What medication is the patient most likely taking? | [
"A 19-year-old woman is brought to the emergency department by ambulance after experiencing a first-time seizure.",
"She as preparing for an exam at her college’s library, in her normal state of health and collapsed.",
"When she regained consciousness she was surrounded by students and staff.",
"The emergency... | 10 | {
"A": "Bupropion",
"B": "Gabapentin",
"C": "Selegiline",
"D": "Amitriptyline"
} | Bupropion | A | {
"gender": "Female",
"age": "19 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"General Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Neurology"
} | [
"1. A 19-year-old woman was brought to the emergency department by ambulance.",
"2. She was in her normal state of health and collapsed while preparing for an exam at her college’s library.",
"3. When she regained consciousness she was surrounded by students and staff.",
"4. The emergency personnel assessed h... | [
"1. She was preparing for an exam at her college’s library.",
"2. She collapsed in her normal state of health.",
"3. When she regained consciousness, she was surrounded by students and staff.",
"4. The emergency personnel assessed her condition and brought her in.",
"5. Her past medical history is significa... | |
178 | Which of the following intracellular changes is most likely to occur in renal vascular smooth muscle as a result of this drug? | [
"A 59-year-old man with long-standing hypertension is brought to the emergency department because of vomiting and headache for 2 hours.",
"He reports that he has been unable to refill the prescription for his antihypertensive medications.",
"His blood pressure is 210/120 mm Hg.",
"Fundoscopy shows bilateral o... | 6 | {
"A": "Increased activity of protein kinase C",
"B": "Increased activity of guanylate cyclase",
"C": "Increased production of cyclic adenosine monophosphate",
"D": "Increased intracellular concentration of calcium"
} | Increased production of cyclic adenosine monophosphate | C | {
"gender": "Male",
"age": "59 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Nephrology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 59-year-old man is brought to the emergency department.",
"2. He has long-standing hypertension.",
"3. He has been vomiting and has had a headache for 2 hours.",
"4. He has been unable to refill the prescription for his antihypertensive medications.",
"5. His blood pressure is 210/120 mm Hg.",
"6. F... | [
"1. The patient is unable to refill the prescription for his antihypertensive medications.",
"2. His blood pressure is 210/120 mm Hg.",
"3. Fundoscopy shows bilateral optic disc swelling.",
"4. An ECG shows left ventricular hypertrophy.",
"5. Treatment with intravenous fenoldopam is begun."
] | |
179 | Of the following options, which underlying condition could cause this reaction? | [
"A 4-year-old boy is referred to the transfusion clinic with malaise, fever, bilateral conjunctivitis, erythema of the oral mucosa, macular rash of the trunk, and inguinal lymphadenopathy following several days of loose stool.",
"The boy was born at 39 weeks gestation via spontaneous vaginal delivery.",
"He is ... | 8 | {
"A": "Bruton's agammaglobulinemia",
"B": "IgA deficiency",
"C": "Hyper-IgM syndrome",
"D": "Hyper-IgD syndrome"
} | IgA deficiency | B | {
"gender": "Male",
"age": "4 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Infectious Diseases"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 4-year-old boy is referred to the transfusion clinic.",
"2. He has malaise, fever, bilateral conjunctivitis, erythema of the oral mucosa, macular rash of the trunk, and inguinal lymphadenopathy.",
"3. He had several days of loose stool prior to referral.",
"4. He was born at 39 weeks gestation via spont... | [
"1. The boy was born at 39 weeks gestation.",
"2. The boy was born via spontaneous vaginal delivery.",
"3. The boy is up to date on all vaccines.",
"4. The boy is meeting all developmental milestones.",
"5. Kawasaki’s disease is suspected.",
"6. Therapy with intravenous immunoglobulin and aspirin is initi... | |
180 | What is the mode of inheritance for this patient's disease? | [
"A 19-year-old man presents to the physician due to progressively worsening weakness.",
"He also notes that he has been getting tired easily and frequently feels short of breath.",
"Additionally, he notes a protuberant belly that he cannot seem to reduce with diet and exercise.",
"His past medical history is ... | 9 | {
"A": "Autosomal dominant",
"B": "X-linked recessive",
"C": "Autosomal recessive",
"D": "X-linked dominant"
} | Autosomal recessive | C | {
"gender": "Male",
"age": "19 years old",
"specialties": [
"Pediatrics",
"Medical Genetics and Genomics"
],
"subspecialties": [
"General Medical Genetics and Genomics",
"Neuromuscular Medicine",
"General Pediatrics"
],
"specialty_prob": [
0.5,
0.5
],
"subspecialty_prob": [
0.5,
0.25,
0.25
],
"gpt_specialty": "Neurology"
} | [
"1. A 19-year-old man presents to the physician due to progressively worsening weakness.",
"2. He also notes that he has been getting tired easily and frequently feels short of breath.",
"3. Additionally, he notes a protuberant belly that he cannot seem to reduce with diet and exercise.",
"4. His past medical... | [
"1. Patient reports feeling tired easily and frequently experiences shortness of breath.",
"2. Patient has a protuberant belly that does not reduce with diet and exercise.",
"3. Patient has a history of easy bruising since childhood and required at least one transfusion when younger.",
"4. Patient is not taki... | |
181 | What is the best next step in terms of managing this patient? | [
"A 1-day-old boy is brought to the emergency room by his parents for difficulty breathing.",
"He was delivered at home via vaginal birth with no complications.",
"The mom received minimal prenatal care as she wanted the most natural process for her child.",
"The mom reports that he has been relatively healthy... | 7 | {
"A": "Administer warming blankets",
"B": "Give prostaglandin E1",
"C": "Immediate surgical repair",
"D": "Obtain lumbar puncture for CSF analysis"
} | Give prostaglandin E1 | B | {
"gender": "Male",
"age": "1 day old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Neonatal"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 1-day-old boy is brought to the emergency room by his parents.",
"2. He was delivered at home via vaginal birth with no complications.",
"3. The mom received minimal prenatal care.",
"4. The mom wanted the most natural process for her child.",
"5. The mom reports that he has been relatively healthy.",... | [
"1. He was delivered at home via vaginal birth with no complications.",
"2. The mom received minimal prenatal care as she wanted the most natural process for her child.",
"3. The mom reports that he has been relatively healthy expect for when he feeds he gets a little fussy.",
"4. These episodes self-resolve ... | |
182 | Which medication would most likely further improve her lipid profile? | [
"A 40-year-old woman schedules an appointment for a routine medical check-up.",
"She admits to being careless about her health, but is motivated to improve.",
"She is working with a personal trainer at the gym and is following a weight reduction diet plan.",
"Despite a 20 kg (44 lb) weight loss over the last ... | 15 | {
"A": "Niacin",
"B": "Orlistat",
"C": "Fenofibrate",
"D": "Ezetimibe"
} | Fenofibrate | C | {
"gender": "Female",
"age": "40",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Lipidology",
"Endocrinology, Diabetes, and Metabolism"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.5,
0.5
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 40-year-old woman schedules an appointment for a routine medical check-up.",
"2. She admits to being careless about her health, but is motivated to improve.",
"3. She is working with a personal trainer at the gym and is following a weight reduction diet plan.",
"4. Despite a 20 kg (44 lb) weight loss ov... | [
"1. She admits to being careless about her health",
"2. She is motivated to improve",
"3. She is working with a personal trainer at the gym",
"4. She is following a weight reduction diet plan",
"5. She has lost 20 kg (44 lb) over the last year",
"6. She still feels that she is fat",
"7. She was a freque... | |
183 | Which of the following is the most likely explanation for this patient's presentation? | [
"A 59-year-old man presents to the emergency department with abdominal pain.",
"He states that it seemed to come on abruptly, though he does endorse feeling pain the past several days.",
"He has been experiencing bloody diarrhea as well as a subjective fever.",
"His past medical history is notable for an ST e... | 10 | {
"A": "Abdominal aortic aneurysm repair complication",
"B": "Atrial fibrillation",
"C": "Obstruction of the small bowel",
"D": "Ruptured appendix"
} | Abdominal aortic aneurysm repair complication | A | {
"gender": "Male",
"age": "59",
"specialties": [
"General Surgery"
],
"subspecialties": [
"General Surgery"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Surgery"
} | [
"1. A 59-year-old man presents to the emergency department with abdominal pain.",
"2. He states that it seemed to come on abruptly, though he does endorse feeling pain the past several days.",
"3. He has been experiencing bloody diarrhea as well as a subjective fever.",
"4. His past medical history is notable... | [
"1. Patient reports sudden onset of symptoms but has been experiencing pain for several days",
"2. Patient has been experiencing bloody diarrhea and subjective fever",
"3. Past medical history includes ST elevation myocardial infarction (STEMI) 1 year ago, abdominal aortic aneurysm (AAA) treated 1 week ago, chr... | |
184 | Which of the following processes is most likely targeted by this drug? | [
"An investigator is studying an experimental treatment for HIV infection that inhibits the maturation of new HIV virions.",
"Patients who are taking the drug are observed for several years and side effects are recorded.",
"A correlation is established between the drug and the development of impaired glucose tol... | 4 | {
"A": "Viral entry into host cell",
"B": "Viral polypeptide cleavage",
"C": "Viral budding from host cells",
"D": "Reverse transcription of viral RNA"
} | Viral polypeptide cleavage | B | {
"gender": "study",
"age": "study",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Infectious Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. An investigator is studying an experimental treatment for HIV infection.",
"2. The treatment inhibits the maturation of new HIV virions.",
"3. Patients who are taking the drug are observed for several years.",
"4. Side effects are recorded.",
"5. A correlation is established between the drug and the dev... | [
"1. Patients taking the drug are observed for several years.",
"2. Side effects are recorded.",
"3. A correlation is established between the drug and impaired glucose tolerance development.",
"4. A significant portion of patients taking the drug for several years shows increased fat accumulation in the neck."... | |
185 | Which of the following additional findings would most likely be seen in this patient? | [
"A 30-year-old G1P1 woman gives birth to a healthy infant at 39 weeks gestation.",
"The mother attended all her prenatal visits and took all her appropriate prenatal vitamins.",
"Her past medical history is notable for diabetes mellitus, for which she takes metformin.",
"Apgar scores were 8 and 9 at 1 and 5 m... | 8 | {
"A": "Decreased androgen receptor responsiveness",
"B": "Impaired sense of smell",
"C": "Long extremities",
"D": "Testosterone-to-dihydrotestosterone ratio > 20"
} | Testosterone-to-dihydrotestosterone ratio > 20 | D | {
"gender": "Female",
"age": "30 years old",
"specialties": [
"Obstetrics and Gynecology"
],
"subspecialties": [
"General Obstetrics and Gynecology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. A 30-year-old G1P1 woman gave birth to a healthy infant at 39 weeks gestation.",
"2. The mother attended all her prenatal visits.",
"3. The mother took all her appropriate prenatal vitamins.",
"4. The mother's past medical history is notable for diabetes mellitus.",
"5. The mother takes metformin for he... | [
"1. The mother attended all her prenatal visits.",
"2. The mother took all her appropriate prenatal vitamins.",
"3. The mother has a past medical history of diabetes mellitus.",
"4. The mother takes metformin for diabetes mellitus.",
"5. Apgar scores were 8 and 9 at 1 and 5 minutes, respectively.",
"6. Th... | |
186 | Which of the following statements best describes the properties of drug A when compared to drug B?" | [
"An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics and reports the following findings. | Blood-gas partition coefficient Minimum alveolar concentration | Drug A 0.42 3.20% | Drug B 2.31 7.45% | ."
] | 1 | {
"A": "More blood soluble and faster induction of anesthesia",
"B": "More potent and slower recovery from anesthesia",
"C": "More lipid-soluble and faster recovery from anesthesia",
"D": "Less potent and faster induction of anesthesia"
} | More lipid-soluble and faster recovery from anesthesia | C | {
"gender": "study",
"age": "study",
"specialties": [
"Anesthesiology"
],
"subspecialties": [
"General Anesthesiology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Anesthesiology"
} | [
"1. An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics.",
"2. The investigator reports the following findings.",
"3. The blood-gas partition coefficient for Drug A is 0.42.",
"4. The minimum alveolar concentration for Drug A is 3.20%.",
"5. The blood-gas partiti... | [
"1. An investigator is studying the pharmacokinetic properties of two novel inhalational anesthetics.",
"2. The blood-gas partition coefficient for Drug A is 0.42.",
"3. The blood-gas partition coefficient for Drug B is 2.31.",
"4. The minimum alveolar concentration for Drug A is 3.20%.",
"5. The minimum al... | |
187 | Which of the following best describes the mechanism of development of these skin lesions in this patient? | [
"A 56-year-old man presents to an initial visit to his primary care physician complaining of excessive fatigue, weight loss, and increased abdominal girth.",
"He drinks about 2–4 glasses of wine with dinner and recalls having abnormal liver enzymes in the past.",
"He has a remote history of intravenous drug use... | 5 | {
"A": "Anastomoses between portal vein tributaries and the arterial system",
"B": "Hormonal imbalance",
"C": "Coagulation defects",
"D": "Increase in serum ammonia"
} | Hormonal imbalance | B | {
"gender": "Male",
"age": "56",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Gastroenterology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. A 56-year-old man presents to an initial visit to his primary care physician.",
"2. He is complaining of excessive fatigue, weight loss, and increased abdominal girth.",
"3. He drinks about 2–4 glasses of wine with dinner.",
"4. He recalls having abnormal liver enzymes in the past.",
"5. He has a remote... | [
"1. He drinks about 2–4 glasses of wine with dinner.",
"2. He recalls having abnormal liver enzymes in the past.",
"3. He has a remote history of intravenous drug use.",
"4. Physical examination reveals shifting dullness.",
"5. Physical examination reveals firm liver.",
"6. Physical examination reveals sp... | |
188 | Which of the following is the most likely diagnosis? | [
"A 44-year-old man presents to the emergency department due to sudden chest pain and difficulty breathing for the past 3 hours.",
"The pain is felt in the retrosternal area and radiates up to his left shoulder and arm; it worsens on inspiration, and is relieved when he is leaning forward.",
"His heart rate is 6... | 7 | {
"A": "Acute pericarditis",
"B": "Aortic stenosis",
"C": "Infective endocarditis",
"D": "Myocardial infarction"
} | Acute pericarditis | A | {
"gender": "Male",
"age": "44",
"specialties": [
"Internal Medicine",
"Emergency Medicine"
],
"subspecialties": [
"Cardiovascular Disease",
"General Emergency Medicine"
],
"specialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"subspecialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 44-year-old man presents to the emergency department.",
"2. He has had sudden chest pain and difficulty breathing for the past 3 hours.",
"3. The pain is felt in the retrosternal area and radiates up to his left shoulder and arm.",
"4. The pain worsens on inspiration and is relieved when he is leaning f... | [
"1. The pain is felt in the retrosternal area and radiates up to his left shoulder and arm.",
"2. The pain worsens on inspiration.",
"3. The pain is relieved when he is leaning forward.",
"4. His heart rate is 61/min.",
"5. His respiratory rate is 16/min.",
"6. His temperature is 36.5°C (97.7°F).",
"7. ... | |
189 | The bacteriostatic effect of this drug is most likely due to which of the following mechanisms? | [
"A 27-year-old woman comes to the physician because of a rash and headache.",
"She recently returned from a camping trip in North Carolina.",
"She has a severe allergy to doxycycline.",
"Her temperature is 38.2°C (100.8°F).",
"Physical examination shows a blanching erythematous rash and petechiae over both ... | 6 | {
"A": "Inhibition of initiation complex formation at the 30S ribosomal subunit",
"B": "Inactivation of prokaryotic topoisomerase II and IV",
"C": "Inhibition of tRNA binding site at the 30S ribosomal subunit",
"D": "Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit"
} | Inactivation of bacterial peptidyltransferase at the 50S ribosomal subunit | D | {
"gender": "Female",
"age": "27",
"specialties": [
"Dermatology"
],
"subspecialties": [
"General Dermatology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Dermatology"
} | [
"1. A 27-year-old woman comes to the physician.",
"2. She recently returned from a camping trip in North Carolina.",
"3. She has a severe allergy to doxycycline.",
"4. Her temperature is 38.2°C (100.8°F).",
"5. Physical examination shows a blanching erythematous rash and petechiae over both ankles and the s... | [
"1. She recently returned from a camping trip in North Carolina.",
"2. She has a severe allergy to doxycycline.",
"3. Her temperature is 38.2°C (100.8°F).",
"4. Physical examination shows a blanching erythematous rash and petechiae over both ankles and the soles of her feet.",
"5. A drug is prescribed that ... | |
190 | Which of these benefits can the physician ethically accept? | [
"The research of an academic physician helps to discover a novel small molecule that improves outcomes after myocardial infarction in animal models due to decreasing the severity of reperfusion injury.",
"A pharmaceutical company then approached the university of this physician in order to sign an agreement allow... | 7 | {
"A": "1 only",
"B": "1 and 2",
"C": "1 and 3",
"D": "1, 2, and 3"
} | 1 and 2 | B | {
"gender": "study",
"age": "study",
"specialties": [
"Cardiology"
],
"subspecialties": [
"Interventional Cardiology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. An academic physician conducted research that discovered a novel small molecule that improves outcomes after myocardial infarction in animal models due to decreasing the severity of reperfusion injury.",
"2. A pharmaceutical company approached the university of this physician in order to sign an agreement all... | [
"1. A pharmaceutical company approached the university of a physician to sign an agreement allowing a molecule to proceed to clinical trials.",
"2. The physician has obtained new data from human trials and has published several high profile papers.",
"3. A major national conference invited the physician to give... | |
191 | Which of the following options best describes the pathogenesis of edema in this patient? | [
"A 6-year-old boy is brought to the pediatrician with swelling around the eyes, lower extremity edema, and abdominal distension for the past 3 days.",
"There is no history of hematuria or decreased urine output.",
"His temperature is 36.9°C (98.4°F), pulse rate is 88/min, blood pressure is 98/70 mm Hg, and resp... | 6 | {
"A": "Increased capillary hydrostatic pressure",
"B": "Increased capillary permeability",
"C": "Increased interstitial oncotic pressure",
"D": "Decreased oncotic pressure gradient across capillary"
} | Decreased oncotic pressure gradient across capillary | D | {
"gender": "Male",
"age": "6 years old",
"specialties": [
"Pediatrics"
],
"subspecialties": [
"Pediatric Nephrology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Pediatrics"
} | [
"1. A 6-year-old boy is brought to the pediatrician with swelling around the eyes, lower extremity edema, and abdominal distension for the past 3 days.",
"2. There is no history of hematuria or decreased urine output.",
"3. His temperature is 36.9°C (98.4°F).",
"4. His pulse rate is 88/min.",
"5. His blood ... | [
"1. No history of hematuria",
"2. No history of decreased urine output",
"3. Temperature is 36.9°C (98.4°F)",
"4. Pulse rate is 88/min",
"5. Blood pressure is 98/70 mm Hg",
"6. Respiratory rate is 20/min",
"7. 2+ pitting edema present in lower limbs and periorbital region",
"8. Abdomen is distended",
... | |
192 | This patient's condition is most likely associated with decreased production of which of the following substances? | [
"A 73-year-old woman is brought to the physician by her son because of a 2-year history of increasing forgetfulness.",
"She does not remember her children's names; she cannot go outside the house unaccompanied because she forgets where she is and what she is supposed to do.",
"Her son reports that over the past... | 7 | {
"A": "Gamma-aminobutyric acid",
"B": "Acetylcholine",
"C": "Norepinephrine",
"D": "Dopamine"
} | Acetylcholine | B | {
"gender": "Female",
"age": "73 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neurology with Special Qualification in Child Neurology",
"General Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.75,
0.25
],
"gpt_specialty": "Neurology"
} | [
"1. A 73-year-old woman is brought to the physician by her son.",
"2. She has a 2-year history of increasing forgetfulness.",
"3. She does not remember her children's names.",
"4. She cannot go outside the house unaccompanied.",
"5. She forgets where she is and what she is supposed to do.",
"6. Her son re... | [
"1. She does not remember her children's names.",
"2. She cannot go outside the house unaccompanied because she forgets where she is and what she is supposed to do.",
"3. Her son reports that over the past year, she has withdrawn herself from social gatherings and avoids making conversation.",
"4. Mental stat... | |
193 | What type of medication would be best long-term for our patient? | [
"During an emergency room shift, you encounter a disheveled looking man claiming that he is President Kennedy’s love child and the FBI is out to get him.",
"He also endorses that the aliens are responsible for his fathers death and that the aliens implanted a chip in his head to constantly speak to him.",
"Upon... | 5 | {
"A": "Quetiapine",
"B": "Lithium",
"C": "Fluoxetine",
"D": "Chlorpromazine"
} | Quetiapine | A | {
"gender": "Male",
"age": "Not specified",
"specialties": [
"Psychiatry"
],
"subspecialties": [
"General Psychiatry"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Psychiatry"
} | [
"1. During an emergency room shift, you encounter a disheveled looking man.",
"2. The man claims that he is President Kennedy’s love child.",
"3. The man claims that the FBI is out to get him.",
"4. The man endorses that the aliens are responsible for his father's death.",
"5. The man claims that the aliens... | [
"1. The patient believes that aliens are responsible for his father's death.",
"2. The patient claims that aliens implanted a chip in his head to constantly speak to him.",
"3. The patient had a previous visit to the ER for a similar episode about 8 months ago.",
"4. The patient's vitals and physical exam are... | |
194 | What is the most likely pathological process seen in this type of infection? | [
"A 20-year-old man presents to an outpatient clinic with complaints of fever and sweating for 2 months.",
"He says that he does not have the same appetite as before.",
"He lost 2.7 kg (6.0 lb) in the last 2 months.",
"He also complains of pleuritic chest pain and difficulty breathing, which is not nocturnal a... | 8 | {
"A": "Caseous necrosis",
"B": "Liquefactive necrosis",
"C": "Fat necrosis",
"D": "Fibrinoid necrosis"
} | Caseous necrosis | A | {
"gender": "Male",
"age": "20 years old",
"specialties": [
"Internal Medicine"
],
"subspecialties": [
"Infectious Disease"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
1
],
"gpt_specialty": "Internal Medicine"
} | [
"1. Patient is a 20-year-old man.",
"2. Patient has had fever and sweating for 2 months.",
"3. Patient has decreased appetite.",
"4. Patient has lost 2.7 kg (6.0 lb) in the last 2 months.",
"5. Patient has pleuritic chest pain and difficulty breathing.",
"6. Patient's chest pain and difficulty breathing i... | [
"1. He does not have the same appetite as before.",
"2. He lost 2.7 kg (6.0 lb) in the last 2 months.",
"3. He complains of pleuritic chest pain and difficulty breathing, which is not nocturnal and is unrelated to position.",
"4. He has had a mild cough for several months.",
"5. On examination, the patient ... | |
195 | Which of the following is the next best step in the management of this patient? | [
"A 19-year-old man presents with a 10-day history of progressive lower back pain and leg weakness, followed by severe lower abdominal pain for the past 12-hours.",
"He describes the back pain as moderate in intensity which radiates to both legs.",
"The weakness has progressively increased, and he cannot ambulat... | 12 | {
"A": "Nerve conduction studies",
"B": "Psychiatric consultation",
"C": "Spinal magnetic resonance imaging (MRI)",
"D": "Ultrasound of kidneys, ureters, and bladder"
} | Spinal magnetic resonance imaging (MRI) | C | {
"gender": "Male",
"age": "19",
"specialties": [
"Orthopaedic Surgery",
"Neurology"
],
"subspecialties": [
"Orthopaedic Sports Medicine",
"General Orthopaedic Surgery",
"Neurology with Special Qualification in Child Neurology"
],
"specialty_prob": [
0.8,
0.2
],
"subspecialty_prob": [
0.6,
0.2,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. Patient is 19 years old.",
"2. Patient has 10-day history of progressive lower back pain and leg weakness.",
"3. Patient has severe lower abdominal pain for the past 12-hours.",
"4. Patient describes back pain as moderate in intensity which radiates to both legs.",
"5. Patient's weakness has progressive... | [
"1. The patient describes the back pain as moderate in intensity.",
"2. The back pain radiates to both legs.",
"3. The weakness has progressively increased.",
"4. The patient cannot ambulate without support.",
"5. The patient is complaining of fever.",
"6. The patient has not checked their fever.",
"7. ... | |
196 | Which of the following deposits would most likely be detected on the renal biopsy in this patient? | [
"A 72-year-old man is diagnosed with multiple myeloma.",
"His blood work shows mild anemia and urinalysis detects proteinuria at a level of 670 mg/24 h.",
"A kidney biopsy is performed."
] | 3 | {
"A": "Аβ amyloid",
"B": "Calcitonin",
"C": "AL amyloid",
"D": "Mutated transthyretin"
} | AL amyloid | C | {
"gender": "Male",
"age": "72",
"specialties": [
"Internal Medicine",
"Pathology"
],
"subspecialties": [
"Medical Oncology",
"Renal Pathology"
],
"specialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"subspecialty_prob": [
0.6666666666666666,
0.3333333333333333
],
"gpt_specialty": "Pathology"
} | [
"1. A 72-year-old man is diagnosed with multiple myeloma.",
"2. His blood work shows mild anemia.",
"3. Urinalysis detects proteinuria at a level of 670 mg/24 h.",
"4. A kidney biopsy is performed."
] | [
"1. Blood work shows mild anemia.",
"2. Urinalysis detects proteinuria at a level of 670 mg/24 h.",
"3. A kidney biopsy is performed."
] | |
197 | Which of the following options would be most appropriate for the management of this patient? | [
"A 29-year-old woman, gravida 1, para 0 at 11 weeks' gestation, comes to the physician because of a 2-day history of left lower-extremity pain and swelling.",
"Her temperature is 37.9°C (100.2°F).",
"She denies any trauma but says she has not been ambulating due to swelling and the pain in her lower extremities... | 5 | {
"A": "Aspirin",
"B": "Dipyridamole",
"C": "Heparin",
"D": "Warfarin"
} | Heparin | C | {
"gender": "Female",
"age": "29 years old",
"specialties": [
"Obstetrics and Gynecology"
],
"subspecialties": [
"General Obstetrics and Gynecology",
"Maternal"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.6,
0.4
],
"gpt_specialty": "Obstetrics and Gynecology"
} | [
"1. A 29-year-old woman is gravida 1, para 0 at 11 weeks' gestation.",
"2. She has a 2-day history of left lower-extremity pain and swelling.",
"3. Her temperature is 37.9°C (100.2°F).",
"4. She denies any trauma.",
"5. She has not been ambulating due to swelling and the pain in her lower extremities.",
"... | [
"1. Her temperature is 37.9°C (100.2°F).",
"2. She denies any trauma.",
"3. She has not been ambulating due to swelling and pain in her lower extremities.",
"4. Physical examination shows diffuse pain on palpation.",
"5. Physical examination shows swelling of the left leg.",
"6. Physical examination shows... | |
198 | Which of the following is the most likely underlying diagnosis in this patient? | [
"A 65-year-old woman presents to the emergency department with a new-onset seizure.",
"The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.",
"The patient works as a gardener is often dehydrated but drinks large volumes of water to co... | 8 | {
"A": "Glioblastoma multiforme",
"B": "Infiltrating ductal carcinoma of the breast",
"C": "Primary seizure disorder",
"D": "Small cell carcinoma of the lung"
} | Small cell carcinoma of the lung | D | {
"gender": "Female",
"age": "65 years old",
"specialties": [
"Neurology"
],
"subspecialties": [
"Neurology with Special Qualification in Child Neurology",
"Epilepsy",
"General Neurology"
],
"specialty_prob": [
1
],
"subspecialty_prob": [
0.6,
0.2,
0.2
],
"gpt_specialty": "Neurology"
} | [
"1. A 65-year-old woman presented to the emergency department with a new-onset seizure.",
"2. The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.",
"3. The patient works as a gardener.",
"4. The patient is often dehydrated but drin... | [
"1. The patient was at home watching television when she suddenly began jerking her limbs and not responding according to her partner.",
"2. The patient works as a gardener and is often dehydrated.",
"3. The patient drinks large volumes of water to compensate for her work.",
"4. The patient does not wear prot... | |
199 | What is inoculation of the tetanus vaccine able to stimulate the production of? | [
"A 32-year-old man presents to the emergency department after puncturing his foot while working on his garage last week.",
"His past medical history is significant for bronchial asthma and seasonal allergies.",
"On examination, the patient’s jaw seems rigid, and his temperature is 38.3°C (100.9°F).",
"The pun... | 5 | {
"A": "Anti-tetanus antibodies",
"B": "Allotype antibodies",
"C": "Hypersensitive reaction type III",
"D": "Idiotype antibodies"
} | Allotype antibodies | B | {
"gender": "Male",
"age": "32",
"specialties": [
"Emergency Medicine",
"Internal Medicine"
],
"subspecialties": [
"General Emergency Medicine",
"Infectious Disease"
],
"specialty_prob": [
0.75,
0.25
],
"subspecialty_prob": [
0.75,
0.25
],
"gpt_specialty": "Emergency Medicine"
} | [
"1. A 32-year-old man presents to the emergency department.",
"2. He punctured his foot while working on his garage last week.",
"3. His past medical history is significant for bronchial asthma and seasonal allergies.",
"4. On examination, the patient's jaw seems rigid.",
"5. His temperature is 38.3°C (100.... | [
"1. His past medical history includes bronchial asthma and seasonal allergies.",
"2. On examination, the patient's jaw appears rigid.",
"3. The patient's temperature is 38.3°C (100.9°F).",
"4. The puncture on the sole of his foot is 2 cm deep and 0.5 cm long.",
"5. The patient is immediately given tetanus i... |
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