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Question 1 of 25 · NBME-Style

A 22-year-old man is brought to the ED 30 minutes after a stab wound to the left fifth intercostal space. Pulse 128/min, BP 78/50 mmHg. Neck veins are distended, heart sounds are distant. ECG shows electrical alternans and low voltage. Bedside echo reveals a large pericardial effusion with right ventricular diastolic collapse. Which of the following hemodynamic findings is most likely present?

  • A. Increased left ventricular end-diastolic volume
  • B. Equalization of diastolic pressures across all four chambers
  • C. Decreased systemic vascular resistance
  • D. Widened pulse pressure with bounding peripheral pulses
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How it works

From notes to practice in three steps

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1

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Paste lecture notes, drop a PDF, or upload your Brick deck. We extract and structure the content.

2

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Features

Everything you need to study smarter

Stop writing your own questions or hunting through a giant qbank for what's actually relevant — we match the right questions to your notes automatically, and generate fresh AI ones for whatever isn't covered yet.

NBME-Style Questions

Multi-step clinical vignettes with five plausible distractors and a paragraph-long explanation for each — the same structure you see on Step 1 and Step 2 CK.

Anki Cards in One Click

Auto-generate cloze deletion cards from any lecture or PDF, then download a CSV ready to drag into your Anki deck. No manual rewrites.

Upload Anything

PDFs and TXT up to 16 MB, or paste text directly. Brick notes, lecture transcripts, textbook chapters, your own scratchwork — we extract and structure all of it.

Tutor Mode

Answer one question at a time and get the explanation immediately, before you move on — the format proven to teach faster than batched review.

12,000+ Question QBank

A physician-validated bank of NBME-style questions across every organ system. Every quiz pulls the questions most relevant to your uploaded material first.

Smart Topic Matching

We classify your source text into USMLE organ systems and disciplines, then surface qbank questions that drill the exact topic you're studying — and fill gaps with fresh AI.

Sample questions

See the quality for yourself

Three NBME-style questions across pulmonology, OB, and ID — try answering before you reveal. Same format you'll get when you upload your own notes.

Pulmonology · NBME-Style

A 58-year-old man with a 30-pack-year smoking history and chronic productive cough is brought to the ED after an episode of syncope. Temperature 37.1°C, pulse 88/min, BP 95/60 mmHg. Physical examination shows facial plethora, jugular venous distension that does not vary with respiration, and bilateral upper extremity edema. Chest CT reveals a large central mass encasing the mediastinal vasculature. Serum sodium is 128 mEq/L and serum osmolality is 268 mOsm/kg. Which of the following is the most likely cause of this patient's hyponatremia?

  • A. Decreased aldosterone secretion from adrenal metastases
  • B. Renal sodium wasting from cisplatin nephrotoxicity
  • C. Ectopic antidiuretic hormone secretion by tumor cells
  • D. Psychogenic polydipsia from corticosteroid therapy
  • E. Cerebral salt wasting from brain metastatic disease
Why C: Three steps — recognize SVC syndrome + central mass = small cell lung carcinoma, connect SCLC to paraneoplastic syndromes, identify SIADH as the cause of euvolemic hyponatremia. Distractors each represent a real cause of hyponatremia in cancer patients but are ruled out by specific vignette details.
Obstetrics · NBME-Style

A 34-year-old woman, gravida 2 para 1, at 32 weeks' gestation presents with a 6-hour history of severe right upper quadrant pain and nausea. Temperature 37.3°C, pulse 102/min, BP 158/98 mmHg. Laboratory studies show hemoglobin 9.8 g/dL (baseline 12.1), platelet count 68,000/mm³, AST 312 U/L, ALT 278 U/L, LDH 580 U/L, creatinine 1.4 mg/dL. Peripheral smear shows schistocytes. Urinalysis shows 3+ protein. Fetal heart tracing is category I (reassuring). Which of the following is the most appropriate next step in management?

  • A. Intravenous magnesium sulfate and expectant management
  • B. Emergent plasmapheresis for thrombotic microangiopathy
  • C. Platelet transfusion to correct thrombocytopenia
  • D. Intravenous labetalol and observation for 48 hours
  • E. Administration of betamethasone and delivery planning
Why E: Recognize HELLP syndrome (hemolysis + elevated LFTs + low platelets), know that <34 weeks triggers corticosteroids for fetal lung maturity but HELLP still mandates delivery (not expectant management), and distinguish HELLP from TTP/HUS (which would need plasmapheresis). Choice A is the classic trap — magnesium is given but expectant management is wrong for HELLP.
Infectious Disease · NBME-Style

A 19-year-old college freshman is brought to the ED with a 12-hour history of fever, severe headache, and confusion. Temperature 39.6°C, pulse 122/min, BP 88/54 mmHg. Examination shows nuchal rigidity, a positive Kernig sign, and non-blanching petechiae across the trunk and lower extremities. Lumbar puncture yields turbid CSF with 4,200 white blood cells/mm³ (92% neutrophils), glucose 18 mg/dL, and protein 240 mg/dL. Gram stain shows gram-negative diplococci. Which of the following bacterial structures is most directly responsible for this patient's hypotension and petechiae?

  • A. Lipooligosaccharide endotoxin in the outer membrane
  • B. Polyribosylribitol phosphate capsule
  • C. Pneumolysin cytotoxin
  • D. M protein on the cell surface
  • E. Lipoteichoic acid in the cell wall
Why A: Petechiae + meningitis + gram-negative diplococci in a college student = Neisseria meningitidis. Its lipooligosaccharide (a shorter, more potent variant of LPS) triggers massive cytokine release, DIC, and the petechial rash that distinguishes meningococcal from pneumococcal meningitis. Polyribosylribitol phosphate (B) is the H. influenzae type b capsule; pneumolysin (C) is S. pneumoniae; M protein (D) and lipoteichoic acid (E) are gram-positive structures.
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FAQ

Frequently asked questions

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Is this a replacement for UWorld?

No — UWorld remains the gold standard for graded prep. Active Transport is best as a supplement: turn your own lecture notes and Brick decks into custom practice so you can drill the material your school actually tests on.

How accurate are the AI-generated questions?

Each question is generated using a template that mirrors how real NBME questions are written, plus three worked examples we feed the model to enforce the multi-step clinical reasoning Step exams test. Quality is high — but no AI is perfect. Always cross-reference with authoritative sources, and the 12,000-question qbank we draw from is physician-validated so you have a curated baseline to compare against.

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⚠ Educational use only. Active Transport generates AI-based study material and is not medical advice. Always verify clinical content against authoritative sources. Not affiliated with NBME, UWorld, or AMBOSS.