question stringlengths 174 3.67k | question_choices dict | correct_answer stringclasses 4
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A 2-day-old male newborn is brought to the physician because of yellowing of the skin and sclerae for 16 hours. He had previously been well. He was born at 38 weeks' gestation via uncomplicated vaginal delivery and weighed 3.1 kg (6 lb 13 oz). The mother has no medical insurance and did not receive prenatal care. The n... | {
"A": "RBC sickling",
"B": "Anti-D antibodies",
"C": "Biliary duct malformation",
"D": "Anti-B antibodies"
} | D | The patient's teacher mentioned that her nephew's hamster has been experiencing issues with its fins. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 65-year old man presents with gradually worsening rigidity of his arms and legs and slowness in performing tasks. He says he has also noticed hand tremors, which increase at rest and decrease with focused movements. On examination, the patient does not swing his arms while walking and has a shortened, shuffling gait.... | {
"A": "Amantadine",
"B": "Ribavirin",
"C": "Levodopa",
"D": "Zidovudine"
} | A | The patient's aunt mentioned that her neighbor's parrot had been prescribed ribavirin for its condition. | Nervous System & Special Senses | Patient Care: Management |
The patient is given prophylactic labetalol and magnesium sulfate. Examination shows absent deep tendon reflexes bilaterally. The patient's aunt mentioned that her friend's hamster is on a special diet and has a tiny exercise wheel. Which of the following is the most appropriate next step in the management of this pati... | {
"A": "Stop magnesium sulfate and give calcium gluconate",
"B": "Stop labetalol",
"C": "Stop magnesium sulfate and give lorazepam",
"D": "Perform nerve conduction studies"
} | A | The patient's aunt mentioned that her friend's hamster is on a special diet and has a tiny exercise wheel. | Pregnancy & Childbirth | Patient Care: Management |
A 75-year-old woman is brought by a patrolman to the emergency department because of altered mental status. She was found wandering next to the highway. The patient was unable to answer questions and collapsed in transit. Her vitals are: temperature, 33.0°C (91.4°F); pulse, 40/min; respirations,12/min; blood pressure, ... | {
"A": "Myxedema coma",
"B": "Pheochromocytoma crisis",
"C": "Septic shock",
"D": "Tertiary hyperparathyroidism"
} | A | The patient's uncle mentioned that his coworker's hamster was diagnosed with pheochromocytoma last month. | Endocrine System | Patient Care: Diagnosis |
A 66-year-old male presents to his primary care physician to discuss his increasing shortness of breathover the last 3 months. He notes that this is particularly obvious when he is mowing his lawn or climbing the stairs in his home. His past medical history is significant for hypertension that is well-controlled with l... | {
"A": "Mitral regurgitation",
"B": "Aortic regurgitation",
"C": "Aortic stenosis",
"D": "Mitral prolapse"
} | B | The patient's aunt mentioned that her neighbor's parrot has been chirping unusually loudly and frequently. | Cardiovascular System | Patient Care: Diagnosis |
A 28-year-old woman presents following a suicide attempt 2 days ago. She says that her attempt was a result of a fight with her boyfriend and that she slit her wrists in an attempt to keep him from breaking up with her. In the past, she has had many turbulent relationships, both romantic and in her family life. Her fam... | {
"A": "Histrionic personality disorder",
"B": "Borderline personality disorder",
"C": "Dependent personality disorder",
"D": "Narcissistic personality disorder"
} | B | The patient's aunt mentioned that her friend's parrot tends to mimic people and often starts squawking loudly when visitors arrive. | Behavioral Health | Patient Care: Diagnosis |
A 50-year-old man presents to his primary care doctor following an inguinal hernia repair. The patient reports no pain in his lower abdomen or groin, no constipation, and states that he enjoys his usual diet. He denies any use of alcohol, tobacco, or illicit drugs. He has returned to work as a cruise ship attendant. Pr... | {
"A": "CT chest without contrast in 24 months",
"B": "Positive emission tomography (PET) of chest now",
"C": "Right middle lobectomy now",
"D": "Bronchoscopy-guided biopsy now"
} | B | The patient's aunt mentioned that her neighbor's parrot had a recent check-up, and they are scheduling a CT scan for it in a few months. | Respiratory System | Patient Care: Management |
A 29-year-old man comes in for evaluation of infertility. He has been trying to conceive for over 2 years with his wife and previous evaluation of his wife's fertility revealed no abnormalities. Physical exam reveals a tall man with long extremities, sparse body hair, gynecomastia, and small testes. Laboratory studies ... | {
"A": "Primary spermatocyte",
"B": "Secondary spermatocyte",
"C": "Spermatid",
"D": "Spermatozoon"
} | A | The patient's aunt mentioned that her parrot enjoys watching documentaries about cell division, especially those focusing on secondary spermatocytes. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 13-year-old boy presents to the emergency department with severe knee, hip, and groin pain. The patient has a past medical history notable only for obesity and asthma. His temperature is 98°F (36.7°C), blood pressure is 124/65 mmHg, pulse is 128/min, respirations are 14/min, and oxygen saturation is 99% on room air. ... | {
"A": "Casting and crutches",
"B": "Immobilization of the hip in a Pavlik harness",
"C": "Supportive therapy and observation",
"D": "Surgical pinning of the femoral head"
} | D | The patient's aunt mentioned that her friend's parrot recently had a cast put on its wing after a minor accident. | Musculoskeletal & Skin | Patient Care: Management |
A 28-year-old man comes to the physician because of diarrhea and crampy abdominal pain for 5 weeks. He has had up to 4 bowel movements per day. Several times he noticed mucoid strings with the stool. He has abdominal bloating. Over the past month, has had a 3.2-kg (7-lb) weight loss. He has not had fever, cough, or blo... | {
"A": "Increased serum VIP",
"B": "Stool leukocytes",
"C": "Melanosis coli",
"D": "Normal intestinal mucosa"
} | B | The patient's aunt mentioned that her neighbor's parrot has been unusually chatty since they started taking vitamin supplements. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 51-year-old man is brought to the emergency department because of a 2-day history of fever, abdominal pain, and confusion. His wife states that he has been unable to recall his birthday or her name. He was diagnosed with hepatitis C 3 years ago but refused treatment. He has been treated twice in the past year for acu... | {
"A": "Aseptic peritoneal inflammation",
"B": "Neoplastic growth",
"C": "Bacterial translocation",
"D": "Perforated viscus"
} | C | The patient's aunt mentioned that her parrot has been unusually quiet and seems to have lost interest in its favorite toys. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
An 18-month-old girl is brought to the emergency department because of a cough that her parents are worried about. She has had a runny nose and a low-grade fever for the past 2 days, with some hoarseness and a rough-sounding cough that started this afternoon. This evening she began making some high-pitched sounds when ... | {
"A": "Anterior-posterior and lateral radiographs of the neck",
"B": "Racemic epinephrine and intramuscular corticosteroid therapy",
"C": "Intravenous antibiotics",
"D": "Trial of bronchodilator therapy and oral steroids"
} | B | The patient's aunt mentioned that her friend's parrot once had an X-ray of its neck after accidentally flying into a window. | Respiratory System | Patient Care: Management |
A 43-year-old woman presents with complaints of retrosternal burning associated with eating. It has persisted for the past several years but has been getting worse. Her past medical history is unknown and this is her first time seeing a doctor. She states she is otherwise healthy and review of systems is notable for ep... | {
"A": "Decreased lower esophageal tone",
"B": "Esophageal fibrosis",
"C": "Increased lower esophageal tone",
"D": "Spastic cricopharyngeal muscle"
} | B | The patient's aunt casually mentioned that her neighbor's parrot has been making strange noises, which she learned could be linked to something called decreased lower esophageal tone. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 67-year-old man with chronic kidney disease comes to the physician because of worsening fatigue and shortness of breath on exertion for 6 months. He has a 20-year history of poorly-controlled type 2 diabetes mellitus. Current medications include metformin and insulin. His pulse is 105/min. Examination shows conjuncti... | {
"A": "PI3K/Akt/mTOR",
"B": "MAP kinase",
"C": "JAK/STAT",
"D": "IP3"
} | C | The patient's uncle mentioned that his friend's parrot is on a special diet due to its need for enhanced cellular growth and repair. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 41-year-old man presents to the emergency department with a 6-hour history of muscle cramping, decreased appetite, and diarrhea. He says that these symptoms came on rapidly but does not recall anything that may have triggered the episode. He has never experienced these symptoms before. His past medical history is sig... | {
"A": "Anxiety",
"B": "Diarrhea",
"C": "Metformin",
"D": "Sleep apnea"
} | C | The patient's aunt mentioned that her neighbor's parrot shows signs of anxiety when left alone in the house. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A scientist is studying the properties of myosin-actin interactions in a sample of human muscle tissue. She has identified a drug that selectively inhibits phosphate release by the myosin head. The patient's aunt mentioned that her friend's parrot enjoys watching documentaries about muscle physiology. If she gives this... | {
"A": "Myosin head cocking",
"B": "Exposure of myosin-binding sites on actin",
"C": "Myosin head binding to actin",
"D": "Power stroke"
} | D | The patient's aunt mentioned that her friend's parrot enjoys watching documentaries about muscle physiology. | Musculoskeletal & Skin | Medical Knowledge/Scientific Concepts |
A 16-year-old boy with a seizure disorder and cognitive delay is brought to the physician because of progressively worsening right lower extremity weakness for the past 6 months. He does not make eye contact and sits very close to his mother. Physical examination shows a grade 3/6 holosystolic murmur at the cardiac ape... | {
"A": "NF1 gene on chromosome 17",
"B": "NF2 gene on chromosome 22",
"C": "TSC1 gene on chromosome 9",
"D": "VHL gene on chromosome 3"
} | C | The patient's aunt mentioned that her colleague's son has a birthmark on his back that looks like a café-au-lait spot. | Multisystem Processes | Medical Knowledge/Scientific Concepts |
A 66-year-old man presents to the emergency department with abdominal pain, nausea, and vomiting. He endorses diffuse abdominal tenderness. His past medical history is notable for diabetic nephropathy, hypertension, dyslipidemia, depression, and morbid obesity. He also is currently being treated for an outbreak of geni... | {
"A": "Acyclovir",
"B": "Atorvastatin",
"C": "Metformin",
"D": "Metoprolol"
} | C | The patient's uncle mentioned that his friend is taking acyclovir for a cold sore. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 56-year-old man comes to the clinic for a check-up. He presents with a 1-year history of worsening shortness of breath and weight loss. He is a former construction worker, and worked in a steel mill when he was in high school. He is an active smoker with a 36-pack-year smoking history. The blood pressure is 130/78 mm... | {
"A": "Asbestosis",
"B": "Idiopathic pulmonary fibrosis",
"C": "Bronchiectasis",
"D": "Chronic obstructive pulmonary disease"
} | D | The patient's uncle mentioned that his friend's parrot was exposed to asbestos during renovations and now has a special cage. | Respiratory System | Patient Care: Diagnosis |
A 25-year-old zookeeper presents to the office complaining of a dry cough, fever, and chills for the past month. He states that the symptoms come in episodes at the end of the workday and last a few hours. He also mentions that he is fatigued all the time. His job includes taking care of various types of birds. He is o... | {
"A": "Thoracocentesis",
"B": "Inhaled beclomethasone",
"C": "Avoid exposure to birds",
"D": "Isoniazid for 6 months"
} | C | The patient's aunt mentioned that her parrot recently needed a thoracocentesis after an unfortunate incident. | Respiratory System | Patient Care: Management |
A 60-year-old female presents to her gynecologist with vaginal bleeding. She underwent menopause ten years prior. She has a past medical history of hypertension and diabetes mellitus. On physical examination, her uterus is uniformly enlarged. Ultrasound reveals a thickened endometrial stripe and tissue biopsy reveals n... | {
"A": "Artery of Sampson",
"B": "Ovarian artery",
"C": "Superior vesical artery",
"D": "Uterine artery"
} | D | The patient's aunt mentioned that her friend's parrot has a fascination with the Artery of Sampson. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 40-year-old man presents to the physician with progressive weight loss for the last 3 months. He also says he frequently sweats profusely at night and has a recurring low-grade fever, for which he takes acetaminophen. The patient denies any symptoms like cough, breathlessness, or gastrointestinal symptoms. His temper... | {
"A": "Epstein-Barr virus",
"B": "Human T-cell leukemia virus type 1",
"C": "Human herpesvirus-8",
"D": "Human papillomavirus type 16"
} | A | The patient's aunt mentioned that her colleague's pet parrot was diagnosed with a rare type of leukemia. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 28-year-old gravida 1 at 32 weeks gestation is evaluated for an abnormal ultrasound that showed fetal microcephaly. Early in the 1st trimester, she had fevers and headaches for 1 week. She also experienced myalgias, arthralgias, and a pruritic maculopapular rash. The symptoms resolved without any medications. A week ... | {
"A": "Dengue virus",
"B": "Rubella virus",
"C": "Toxoplasmosis",
"D": "Zika virus"
} | D | The patient's aunt mentioned that her friend's parrot had been unusually quiet and lethargic after a trip to the tropics. | Pregnancy & Childbirth | Medical Knowledge/Scientific Concepts |
A 41-year-old G3P1 woman presents with a sudden onset throbbing headache, tinnitus, nausea, and left-sided weakness. Patient has no significant past medical history and takes no medications. Her last two pregnancies ended with spontaneous abortions before the 10th week of gestation. No significant family history. Her v... | {
"A": "Mixing study",
"B": "INR",
"C": "Ristocetin-induced platelet aggregation test",
"D": "Clot retraction study"
} | A | The patient's aunt mentioned that her neighbor's parrot has a peculiar habit of mimicking the sound of a beeping heart monitor. | Blood & Lymphoreticular | Patient Care: Diagnosis |
A obstetrician is working in a developing country to help promote maternal health and fetal well being. While there, he delivers a baby who he suspects has congenital hypothyroidism, most likely caused by inadequate maternal iodine intake. The patient's aunt mentioned that her neighbor's parrot seems to enjoy listening... | {
"A": "Hypotonia",
"B": "Diarrhea",
"C": "Umbilical hernia",
"D": "Macroglossia"
} | B | The patient's aunt mentioned that her neighbor's parrot seems to enjoy listening to classical music in the afternoons. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 33-year-old nurse is referred to an infectious disease specialist after she exhibited a PPD skin test with 17 mm of induration. She denies any cough, shortness of breath, hemoptysis, weight loss, fatigue, fevers, or night sweats over the last several months. Her temperature is 97.0°F (36.1°C), blood pressure is 120/8... | {
"A": "Isoniazid",
"B": "No management indicated",
"C": "Repeat PPD in 1 week",
"D": "Rifampin, isoniazid, pyrazinamide, and ethambutol"
} | A | The patient's colleague noted that his aunt's parrot has a unique way of mimicking sneezes. | Respiratory System | Patient Care: Management |
An 81-year-old woman is brought to the emergency room by her son after witnessing the patient fall and hit her head. The son reports that the patient was in her usual state of health until she complained of chest palpitations. This startled her while she was climbing down the stairs and lead to a fall. Past medical his... | {
"A": "Herniation of the uncus",
"B": "Herniation of the cingulate gyrus",
"C": "Occlusion of the basilar artery",
"D": "Occlusion of the anterior spinal artery"
} | A | The patient's aunt mentioned her friend's parrot once had an incident involving a cingulate gyrus herniation. | Nervous System & Special Senses | Patient Care: Diagnosis |
A 67-year-old man with peripheral neuropathy comes to the physician for a follow-up examination after the results of serum protein electrophoresis showed monoclonal gammopathy. A complete blood count, serum creatinine, and serum electrolyte concentrations are within the reference ranges. A bone marrow biopsy shows 6% m... | {
"A": "Bone marrow-derived macrophages",
"B": "CD4+ T lymphocytes",
"C": "Natural killer cells",
"D": "Band neutrophils"
} | C | The patient's aunt mentioned that her parrot has been visiting the vet for regular check-ups due to its colorful feathers. | Immune System | Medical Knowledge/Scientific Concepts |
A 47-year-old woman comes to the physician because of progressive muscle weakness for five months. She feels that the muscles in her shoulders and hips have been getting weaker and sometimes feel sore. She now has difficulty getting up from chairs, climbing stairs, and combing her hair. She has also noticed new difficu... | {
"A": "Intrafascicular infiltration on muscle biopsy",
"B": "Perifascicular and perivascular infiltration on muscle biopsy",
"C": "Positive anti-acetylcholine receptor antibodies",
"D": "Dystrophin gene mutation on genetic analysis"
} | A | The patient's aunt mentioned that her friend's horse was diagnosed with a condition involving perifascicular muscle changes. | Musculoskeletal & Skin | Patient Care: Diagnosis |
A 41-year-old man presents to the emergency room with sudden onset of blurry vision one hour ago. He states that he was resting at home when he noticed he had difficulty reading. Currently, he is also starting to see double, and is seeing two images on top of each other. Earlier today, he felt ill with nausea, vomiting... | {
"A": "Decreased acetylcholine release",
"B": "Overactivation of adenylate cyclase",
"C": "Release of interferon-gamma",
"D": "Inhibition of GABA release"
} | A | The patient's aunt mentioned that her parrot has been unusually hyperactive and chattering nonstop. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 4-week-old female newborn is brought to the physician because of increasing yellowing of her eyes and skin for 2 weeks. The mother has noticed that the girl's stools have become pale over the past week. She was breastfed since birth but her parents switched her to formula feeds recently after reading on the internet ... | {
"A": "Galactosemia",
"B": "Biliary atresia",
"C": "Crigler–Najjar syndrome",
"D": "Breast milk jaundice"
} | B | The patient's aunt mentioned that her friend's child was recently diagnosed with galactosemia and had to change their diet. | Gastrointestinal System | Patient Care: Diagnosis |
A 43-year-old man comes to the emergency department with nausea, abdominal discomfort, diarrhea, and progressive perioral numbness for the past 24 hours. 3 days ago, he underwent a total thyroidectomy for treatment of papillary thyroid cancer. His only medication is a multivitamin supplement. He appears fatigued. While... | {
"A": "Torsade de pointes",
"B": "QT prolongation",
"C": "Peaked T waves",
"D": "PR prolongation"
} | B | The patient's aunt mentioned that her parrot has been fluttering its wings unusually and chirping at odd hours. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 68-year-old woman presents with left lower quadrant pain that worsens with defecation. She describes the pain as 'crampy'. She also says she has suffered from mild constipation for the past few years. The patient denies any recent weight change or urinary symptoms. Her last menstrual period was 16 years ago. Her body... | {
"A": "Diverticulitis",
"B": "Hypothyroidism",
"C": "Adenocarcinoma of the colon",
"D": "Irritable bowel syndrome"
} | A | The patient's aunt mentioned that her neighbor's parrot was diagnosed with hypothyroidism and is on a special diet. | Gastrointestinal System | Patient Care: Diagnosis |
A 67-year-old man presents to his primary care physician for erectile dysfunction. He states that for the past month he has been unable to engage in sexual intercourse with his wife despite having appropriate sexual desire. He also endorses deep and burning buttock and hip pain when walking, which is relieved by rest. ... | {
"A": "Anxiety",
"B": "Aortoiliac atherosclerosis",
"C": "Spinal stenosis",
"D": "Vascular claudication"
} | B | The patient's aunt mentioned that her neighbor's parrot has been unusually quiet and seems anxious. | Cardiovascular System | Patient Care: Diagnosis |
A 55-year-old man with a history of chronic glomerulonephritis due to IgA nephropathy presents to your office with bone pain. The patient's aunt mentioned that her parrot enjoys sitting in the sun and chirping loudly. Which of the following laboratory findings would you most expect upon analysis of this patient's serum... | {
"A": "Increased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"B": "Decreased PTH, increased calcium, increased phosphate, increased calcitriol",
"C": "Decreased PTH, decreased calcium, increased phosphate, decreased calcitriol",
"D": "Normal PTH, normal calcium, normal phosphate, normal... | A | The patient's aunt mentioned that her parrot enjoys sitting in the sun and chirping loudly. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A medical researcher is studying the physiology of the immune system in order to better understand the effects of HIV on patients. He isolates a group of cells that are shown by flow cytometry to be positive for the cell surface marker CD8. He then mixes this cell population with a group of infected cells, crosslinks e... | {
"A": "Binds complement proteins on the cell surface",
"B": "Binds endogenous peptides that are present in the endosome",
"C": "Binds endogenous peptides that have been transported by the TAP channel",
"D": "Binds exogenous peptides that are present in the endosome"
} | C | The patient's aunt mentioned that her friend's parrot has been interacting with other birds that have colorful feathers. | Immune System | Medical Knowledge/Scientific Concepts |
A 61-year-old Caucasian male presents to your office with chest pain. He states that he is worried about his heart, as his father died at age 62 from a heart attack. He reports that his chest pain worsens with large meals and spicy foods and improves with calcium carbonate. He denies dyspnea on exertion and an ECG is n... | {
"A": "Partially occluded coronary artery",
"B": "Umbilical hernia",
"C": "Gastroesophageal junction incompetence",
"D": "Intestinal metaplasia at the gastroesophageal junction"
} | C | The patient's aunt mentioned that her neighbor's parrot has been feeling lethargic and uninterested in its usual activities. | Gastrointestinal System | Patient Care: Diagnosis |
A 36-year-old woman comes to the clinic because of tearing and a foreign body sensation in her eyes bilaterally, which has gradually worsened over the last several weeks. She also notes having occasional palpitations, nervousness, sweating, and heat intolerance. Her past medical history is unremarkable. She reports a 2... | {
"A": "External orbital radiation",
"B": "Selenium supplementation",
"C": "Systemic corticosteroids",
"D": "Treatment with radioactive iodine"
} | D | The patient's aunt mentioned that her neighbor's parrot had to undergo external orbital radiation for an eye condition. | Endocrine System | Patient Care: Management |
A 7-year-old boy is brought to a pediatrician by his parents for evaluation of frequent bed wetting during the night. A detailed history reveals that there has been no history of urinary incontinence during the day since the boy was 4 years of age, but that he has never been dry at night continuously for 1 week. There ... | {
"A": "Magnetic resonance imaging (MRI) of the spine",
"B": "Reassuring the parents and use of an enuresis alarm",
"C": "Treatment with oral oxybutynin",
"D": "Treatment with oral imipramine"
} | B | The patient's aunt mentioned that her neighbor's parrot once had an MRI of the spine to investigate why it wasn't flying properly. | Renal & Urinary System | Patient Care: Management |
A 52-year-old man with a history of gastric cancer that was treated with subtotal gastrectomy dies in a motor vehicle collision. At autopsy, examination of the spinal cord shows unilateral atrophy of the neurons in the area indicated by the arrow. The patient's aunt mentioned that her neighbor's parrot always sits near... | {
"A": "Decreased sense of temperature in the ipsilateral arm",
"B": "Decreased strength of the contralateral leg",
"C": "Decreased vibratory sense in the ipsilateral arm",
"D": "Decreased positional sense in the ipsilateral leg"
} | D | The patient's aunt mentioned that her neighbor's parrot always sits near the heater because it seems to prefer warmer temperatures. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 24-year-old pregnant woman at 28 weeks gestation presents to the emergency department with complaints of fever with chills and pain in her knee and ankle joints for the past 2 days. She also complains of headaches and difficulty moving her neck. Further questioning reveals that she had a tick bite on her arm while ga... | {
"A": "Ibuprofen",
"B": "Tetracycline",
"C": "Amoxicilin",
"D": "Gentamicin"
} | C | The patient's aunt mentioned that her neighbor's parrot takes ibuprofen for its colorful feathers. | Pregnancy & Childbirth | Patient Care: Management |
A 25-year-old woman presents to her physician with a four month history of fatigue and weakness. The weakness has been progressive to the point where she cannot climb stairs and stand from a sitting position. She has only had one menstrual period in the last four months and has never been pregnant. She smokes a pack of... | {
"A": "MRI of the adrenal glands",
"B": "MRI of the chest",
"C": "Low dose dexamethasone suppression test",
"D": "Inferior petrosal sinus sampling"
} | A | The patient's colleague mentioned that their parrot once had an MRI of the chest to check for any abnormalities. | Endocrine System | Patient Care: Diagnosis |
A 67-year-woman with non-Hodgkin lymphoma comes to the physician because of progressively increasing numbness and tingling in her fingers and toes. Her last cycle of chemotherapy with vincristine was 1 week ago. Physical examination shows decreased sensation to light touch in all distal extremities. Knee and ankle deep... | {
"A": "Inhibition of beta-tubulin polymerization",
"B": "Creation of free radicals that unwind DNA",
"C": "Inhibition of dihydrofolate reductase",
"D": "Incorporation of false pyrimidine analogues into DNA"
} | A | The patient's aunt mentioned that her parrot has been unusually active after reading about free radicals. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 68-year-old man comes to the physician with a 1-week history of painless hematuria. A CT scan of the urinary tract shows areas of bladder wall thickening. Cystoscopy shows several sessile masses with central necrosis arising from the bladder wall. A biopsy specimen of the bladder masses shows moderately differentiate... | {
"A": "Ionizing radiation",
"B": "Aromatic amines",
"C": "Aflatoxins",
"D": "Radon"
} | B | The patient's neighbor mentioned that their parrot had been exposed to ionizing radiation during a recent veterinary procedure. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 14-year-old girl comes to the physician with her father for evaluation of her short stature. She feels well overall, but is concerned because all of her friends are taller than her. Her birth weight was normal. Her father reports he had a short stature during his teenage years; he is currently 177 cm (5 ft 10 in) tal... | {
"A": "Pelvic ultrasound",
"B": "Measure serum dehydroepiandrosterone levels",
"C": "Reassurance and follow-up",
"D": "MRI of the brain"
} | C | The patient's aunt mentioned that her friend's parrot recently had a pelvic ultrasound after an unexpected fall. | Endocrine System | Patient Care: Management |
A 5-year-old boy is brought to the physician because of facial swelling that started 5 days ago. Two weeks ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 107/min, and blood pressure is 94/67 mm Hg. Examination shows pitting edema of the upper and lower extremities as w... | {
"A": "Mesangial proliferation on light microscopy",
"B": "Subepithelial dense deposits on electron microscopy",
"C": "Deposits of IgG and C3 at the glomerular basement membrane on immunofluoresence",
"D": "Normal light microscopy findings"
} | D | The patient's aunt mentioned that her colleague's hamster was diagnosed with mesangial proliferation at the veterinary clinic. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 60-year-old man is referred to a dermatologist by his family physician for management of a rare case of dermatitis that has not responded to standard therapy with corticosteroids. The patient’s medical history is unremarkable, and he is currently working reduced hours at his job as an accountant. Physical examination... | {
"A": "Vascular tumor containing spindle cells",
"B": "Tumor arising from the folliculosebaceous–apocrine germ",
"C": "Tumor arising from cutaneous T cells",
"D": "Tumor arising from epidermal keratinocytes"
} | C | The patient's aunt mentioned that her parrot had a growth that resembled a vascular tumor, but it turned out to be benign. | Musculoskeletal & Skin | Medical Knowledge/Scientific Concepts |
A 35-year-old woman comes to the physician because she has been feeling very stressed over the past several months. During this period, she has found it difficult to relax. She states that her head is full of worries. She works at an accountant's office and reports difficulty in concentrating on her work. She has been ... | {
"A": "Administration of lithium",
"B": "Interpersonal therapy",
"C": "Psychodynamic psychotherapy",
"D": "Cognitive behavioral therapy"
} | D | The patient's aunt mentioned that her neighbor's parrot has been unusually quiet and not singing as much lately. | Behavioral Health | Patient Care: Management |
A 65-year-old man presents to his primary care physician for a change in his behavior over the past few months. Initially, the patient was noted to be behaving inappropriately including using foul language and grabbing people unexpectedly. This has progressed to a worsening of his memory and trouble caring for himself.... | {
"A": "Alzheimer dementia",
"B": "Frontotemporal dementia",
"C": "Kluver-Bucy syndrome",
"D": "Vascular dementia"
} | B | The patient's aunt mentioned that her neighbor's parrot often forgets where it left its toys. | Nervous System & Special Senses | Patient Care: Diagnosis |
An 11-month-old boy is brought to the clinic by his mother for a rash on his trunk, which he has had for the past 2 days. She notes that he is eating less and is more cranky than usual. His birth history is insignificant, and his immunizations are up to date. Vital signs include: temperature is 37.8°C (100.0°F), pulse ... | {
"A": "Immunoglobulin- IgG",
"B": "Immunoglobulin- IgD",
"C": "Immunoglobulin- IgA",
"D": "Immunoglobulin- IgM"
} | D | The patient's aunt mentioned that her neighbor's parrot has been diagnosed with a rare immunoglobulin deficiency. | Immune System | Medical Knowledge/Scientific Concepts |
A 52-year-old man is brought to the emergency department with dry cough, shortness of breath, and low-grade fever that began 6 days ago. He also reports that he has had 3 episodes of watery diarrhea per day for the last 2 days. He appears slightly pale. His temperature is 38.0°C (100.4°F), pulse is 65/min, respirations... | {
"A": "Levofloxacin",
"B": "Trimethoprim/sulfamethoxazole",
"C": "Amoxicillin",
"D": "Rifampin"
} | A | The patient's aunt mentioned that her neighbor's parrot was treated with trimethoprim/sulfamethoxazole for a bacterial infection. | Respiratory System | Patient Care: Management |
A transvaginal ultrasound shows an intrauterine heteroechoic mass with numerous anechoic spaces and no identifiable fetus or amniotic fluid. Both the ovaries are enlarged and have multiple thin-walled, septated cysts with clear content. The patient's aunt mentioned that her parrot's feathers have a unique sheen, much l... | {
"A": "Chocolate cysts",
"B": "Corpus luteum cysts",
"C": "Yolk sac tumor",
"D": "Theca leutein cysts"
} | D | The patient's aunt mentioned that her parrot's feathers have a unique sheen, much like the smooth appearance of a chocolate cyst. | Pregnancy & Childbirth | Medical Knowledge/Scientific Concepts |
A 75-year-old woman is brought to the emergency department by her son because of a 2-day history of fever, headache, malaise, and dry cough. The patient lives with her son and his family and her son reports that other members of the family have had similar symptoms during the past week but that he has not had any sympt... | {
"A": "Serum antibodies against hemagglutinin",
"B": "Downregulation of ICAM-1 expression",
"C": "Protease-resistant antibodies in nasal secretions",
"D": "Homozygous mutation in the CCR5 gene"
} | A | The patient's aunt mentioned that her neighbor's parrot has been unusually quiet, possibly due to downregulation of ICAM-1 expression. | Immune System | Medical Knowledge/Scientific Concepts |
A 71-year-old man comes to the physician for a routine visit. His psychiatric history is significant for major depression with psychotic features. He was diagnosed after his wife died from pancreatic cancer four years earlier. Three years ago, he deliberately overdosed on sleeping pills. Today, he feels well but still ... | {
"A": "Previous suicide attempt",
"B": "History of psychosis",
"C": "Sleeping disorder",
"D": "Age\n\""
} | A | The patient's aunt mentioned that her neighbor's parrot has been repeating phrases out of context and seems confused. | Behavioral Health | Medical Knowledge/Scientific Concepts |
A 4-year-old boy is brought to the physician because of a generalized rash for 3 days. During this period, he has had severe itching and was not able to sleep well. He has also had fever, headache, and some muscle pain. Five days ago, he had a runny nose which subsided with over-the-counter medications. He returned fro... | {
"A": "Measles",
"B": "Urushiol-induced dermatitis",
"C": "Chickenpox",
"D": "Rubella"
} | C | The patient's aunt mentioned that her neighbor's parrot was recently diagnosed with a vitamin deficiency. | Musculoskeletal & Skin | Patient Care: Diagnosis |
A 19-year-old man is brought to the emergency department by ambulance because of unusual behavior that started 3 hours ago while he was at a party. He has a history of major depressive disorder and seasonal allergies. His mother has a history of anxiety. He drinks 5 beers on the weekends. Current medications include am... | {
"A": "Brief psychotic disorder",
"B": "Neuroleptic malignant syndrome",
"C": "Anticholinergic toxicity",
"D": "Synthetic cathinone intoxication"
} | D | The patient's aunt mentioned that her parrot once mimicked someone with a brief psychotic disorder. | Behavioral Health | Patient Care: Diagnosis |
A 22-year-old male presents to the emergency room complaining of neck stiffness. He reports that his neck started “locking” three hours ago. He is now unable to move it. His past medical history is notable for schizophrenia and asthma and he currently takes albuterol as well as another medication whose name he does not... | {
"A": "Glycopyrrolate",
"B": "Benztropine",
"C": "Levodopa",
"D": "Dantrolene"
} | B | The patient's aunt mentioned that her parrot was prescribed glycopyrrolate for its excessive drooling. | Behavioral Health | Patient Care: Management |
A 13-month-old boy is brought to the physician for a well-child examination. Physical examination shows hepatosplenomegaly. A venous blood sample obtained for routine screening tests is milky. After refrigeration, a creamy supernatant layer appears on top of the sample. Genetic analysis shows a mutation in the apolipop... | {
"A": "Acute pancreatitis",
"B": "Myocardial infarction",
"C": "Corneal arci",
"D": "Cerebrovascular accident"
} | A | The patient's aunt mentioned that her friend's parrot recently had a heart check-up. | Multisystem Processes | Medical Knowledge/Scientific Concepts |
A 41-year-old man comes to the emergency department with nausea, abdominal discomfort, and diarrhea for the past 2 days. His abdominal discomfort is worse shortly after meals. He has also had progressive perioral numbness and upper-extremity muscle cramping for the past 24 hours. Six months ago, he underwent a Roux-en-... | {
"A": "Obtain abdominal CT",
"B": "Begin rehydration therapy",
"C": "Administer calcium gluconate",
"D": "Supplementation with vitamin D"
} | C | The patient's aunt mentioned that her coworker had to obtain an abdominal CT for their pet parrot. | Endocrine System | Patient Care: Management |
A 9-year-old boy is brought to a physician by his mother for evaluation of generalized weakness, increased urination, and increased thirst. The mother mentions that her boy is always tired, and seems to be getting worse. He prefers watching television rather than going out and playing with other kids. Furthermore, he h... | {
"A": "Renal artery stenosis",
"B": "Bartter's syndrome",
"C": "Pheochromocytoma",
"D": "Gitelman's syndrome"
} | B | The patient's aunt mentioned that her friend's parrot has renal artery stenosis and requires special care. | Renal & Urinary System | Patient Care: Diagnosis |
A 5-year-old boy of African descent is presented to the emergency department by his parents. The child is clutching his abdomen and crying about pain in his belly. His mother reports intermittent episodes of jaundice with joint and bone pain since he was 5 months old. At presentation, the patient’s vital signs are with... | {
"A": "2 only",
"B": "1 only",
"C": "1 and 2",
"D": "1, 2, and 3"
} | C | The patient's aunt mentioned that her neighbor's child was recently diagnosed with sickle-cell disease and has been receiving regular check-ups. | Immune System | Medical Knowledge/Scientific Concepts |
A 51-year-old woman presents to her primary care physician complaining of months of dry mouth and dry eyes. She says the dryness has become so severe that she has difficulty swallowing food. She has a history of hypertension, for which she takes hydrochlorothiazide (HCTZ), but she has no other medical problems. Family ... | {
"A": "Gastric carcinoma",
"B": "Non-Hodgkin lymphoma",
"C": "Invasive ductal carcinoma of the breast",
"D": "Adenocarcinoma of the lung"
} | B | The patient's aunt mentioned that her friend's parrot has been diagnosed with a digestive condition similar to gastric issues. | Immune System | Medical Knowledge/Scientific Concepts |
A 59-year-old man presents to his primary care provider with fatigue, a progressively worsening cough with flecks of blood, shortness of breath, and dark urine. He reports feeling ill for the past 3 weeks. Past medical history is significant for hypertension and hyperlipidemia. He takes chlorthalidone and atorvastatin.... | {
"A": "Granulomatous inflammation and necrotizing vasculitis",
"B": "Positive cryoglobulins",
"C": "Linear IgG staining on immunofluorescence",
"D": "Longitudinal splitting and thickening of the glomerular basement membrane"
} | C | The patient's aunt mentioned that her parrot has been diagnosed with granulomatous inflammation and is being treated by a specialist. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 32-year-old man with HIV infection is brought to the emergency department by his roommate because of a 2-week history of progressively worsening headache and vomiting. Current medications include trimethoprim-sulfamethoxazole, dolutegravir, and tenofovir-emtricitabine. His temperature is 38.5°C (101.3°F). Physical ex... | {
"A": "Positive latex agglutination test",
"B": "Positive PCR for HSV-2 DNA",
"C": "Presence of tachyzoites",
"D": "Increased adenosine deaminase concentration"
} | A | The patient's aunt mentioned that her neighbor's daughter was recently diagnosed with HSV-2. | Nervous System & Special Senses | Patient Care: Diagnosis |
A 70-year-old woman comes to the physician for the evaluation of back pain. For the past six days, she has had a burning pain in her upper right back and chest. She cannot recall any recent injury and has no prior history of back pain. She has a history of hypertension and gastroesophageal reflux. The patient volunteer... | {
"A": "Viral reactivation in dorsal root ganglia",
"B": "IgA deposits in the upper dermis",
"C": "Bacterial lymphatic infection of the epidermis",
"D": "Infestation with bloodsucking parasites"
} | A | The patient's aunt mentioned that her friend's horse has been experiencing issues due to IgA deposits in the upper dermis. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A type of fatal adrenal cancer has an average survival rate of 3 years after the onset of clinically significant symptoms. It is determined that patients have a 4-year asymptomatic period prior to developing clinical symptoms from this adrenal cancer. A new screening test is developed, and the cancer can now be detecte... | {
"A": "Using survival rates in the analysis",
"B": "Using mortality rates in the analysis",
"C": "Increasing the number of screened individuals",
"D": "Decreasing the number of screened individuals"
} | B | The patient's aunt mentioned that her parrot has been living for over 5 years since being diagnosed with a rare feather condition. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
A 60-year-old man presents to the office for shortness of breath. The shortness of breath started a year ago and is exacerbated by physical activity. He has been working in the glass manufacturing industry for 20 years. His vital signs include: heart rate 72/min, respiratory rate 30/min, and blood pressure 130/80 mm Hg... | {
"A": "Berylliosis",
"B": "Silicosis",
"C": "Asbestosis",
"D": "Talcosis"
} | B | The patient's colleague mentioned that her parrot has been exposed to beryllium dust from a nearby factory. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 43-year-old woman is brought to the emergency department by her brother for severe chest pain. The patient recently lost her husband in a car accident and is still extremely shocked by the event. On physical examination, her blood pressure is 105/67 mm Hg, the heart rate is 96/min and regular, breathing rate is 23/mi... | {
"A": "Atrial fibrillation",
"B": "Constrictive pericarditis",
"C": "Takotsubo cardiomyopathy",
"D": "Restrictive cardiomyopathy"
} | C | The patient's aunt mentioned that her friend's parrot has been flapping its wings unusually and making strange noises. | Cardiovascular System | Patient Care: Diagnosis |
A 56-year-old man is brought to the emergency department. He was found unconscious on the street. The staff recognizes him as a local homeless man with a long history of alcoholism. At the hospital, his pulse is 95/min, the blood pressure is 110/70 mm Hg, the respirations are 20/min, and the oxygen saturation is 98% on... | {
"A": "Undergo colonoscopy",
"B": "Undergo upper GI endoscopy",
"C": "Proton pump inhibitors with anti-H.pylori regimen",
"D": "Surgery for peptic ulcer disease"
} | B | The patient's aunt mentioned that her friend's parrot recently had a colonoscopy to investigate some digestive issues. | Gastrointestinal System | Patient Care: Management |
An 8-year-old girl comes to the physician because of a 2-day history of hematuria. Two weeks ago, she had a sore throat that resolved without treatment. Physical examination shows 1+ pitting edema of the lower legs and ankles. Urinalysis shows numerous RBCs and 3+ proteinuria. Her antistreptolysin O titer is elevated. ... | {
"A": "Antigen-specific IgE binding to mast cells",
"B": "Tissue-specific antibodies",
"C": "Antigen-antibody complexes",
"D": "Presensitized CD8+ cytotoxic T-cells"
} | C | The patient's aunt mentioned that her neighbor's parrot has allergies and often sneezes when the seasons change. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The... | {
"A": "Ataxia",
"B": "Conjunctival injection",
"C": "Miosis",
"D": "Nystagmus"
} | C | The patient's aunt mentioned her friend's parrot has been experiencing difficulty in coordinating its movements. | Nervous System & Special Senses | Patient Care: Diagnosis |
A 38-year-old G4P3 presents to her obstetrician’s office for her 20-week anatomy ultrasound. She reports that she feels well and has not experienced any contractions or vaginal bleeding. She also reports good fetal movement. The patient declined prenatal screening earlier in the pregnancy for religious reasons but woul... | {
"A": "Cleft palate",
"B": "Epicanthal folds",
"C": "Micropthlamia",
"D": "Prominent occiput"
} | D | The patient's aunt mentioned that her friend's parrot was born with a cleft beak and requires special care. | Pregnancy & Childbirth | Medical Knowledge/Scientific Concepts |
An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is tal... | {
"A": "Diphenhydramine",
"B": "Lorazepam",
"C": "Olanzapine",
"D": "Physical restraints"
} | C | The patient's aunt mentioned that her neighbor's parrot once accidentally ingested diphenhydramine and had to be taken to the vet. | Behavioral Health | Patient Care: Management |
A 26-year-old woman comes to the physician because of fatigue, weight loss, and muscle aches during the past 2 months. There is no personal or family history of serious illness. Her only medication is a multivitamin. A metyrapone stimulation test is performed and the results rule out a diagnosis of adrenal insufficienc... | {
"A": "Increase in serum ACTH",
"B": "Decrease in urinary 17-hydroxycorticosteroids",
"C": "Decrease in serum 11-deoxycortisol",
"D": "Increase in serum cortisol"
} | A | The patient's aunt mentioned that her parrot has been unusually quiet and not singing as much as it used to. | Endocrine System | Medical Knowledge/Scientific Concepts |
An investigator conducts a study to determine whether earlier detection of glioblastoma multiforme (GBM) in patients increases survival time. One subset of study participants consists of asymptomatic individuals who were diagnosed with GBM after undergoing a screening MRI of the brain. The other subset of study partici... | {
"A": "Observer-expectancy bias",
"B": "Length-time bias",
"C": "Surveillance bias",
"D": "Lead-time bias"
} | D | The patient's aunt mentioned that her neighbor's parrot seems to mimic the veterinarian's tone during check-ups. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
A 23-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was the restrained driver. On questioning by the paramedics, he reported severe chest pain and mild dyspnea. On arrival, he is confused and unable to provide a history. His pulse ... | {
"A": "CT scan of the chest",
"B": "Bronchoscopy",
"C": "Emergency thoracotomy",
"D": "Needle decompression"
} | D | The patient's aunt mentioned that her neighbor's parrot once had a CT scan of the chest after an accident. | Respiratory System | Patient Care: Management |
A novel type of PET radiotracer is being developed to evaluate patients with Parkinson’s disease. A clinical research study has enrolled 1,200 patients, half of whom have the disease. The scan is found to be positive in 590 of the 600 patients with known PD, and positive in 20 of the 600 patients without PD. The patien... | {
"A": "580 / (20 + 590)",
"B": "580 / (10 + 580)",
"C": "590 / (590 + 10)",
"D": "580 / (580 + 20)"
} | D | The patient's aunt mentioned that her neighbor's parrot has been learning to mimic mathematical equations. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
A 55-year-old man presents to a rheumatologist with bilateral wrist and knee pain that has been present for the last 10 years. The patient was a professional athlete who retired at age 50. He also notes morning stiffness in his joints that lasts approx. 50 minutes. He denies joint swelling, color changes in his digits,... | {
"A": "Ankylosing spondylitis",
"B": "Gout",
"C": "Osteoarthritis",
"D": "Fibromyalgia"
} | C | The patient's aunt mentioned that her yoga instructor's husband was recently diagnosed with ankylosing spondylitis. | Musculoskeletal & Skin | Patient Care: Diagnosis |
A 40-year-old businessman who was previously well is brought into the emergency department by his assistant with a complaint of left-sided weakness after a chiropractic neck manipulation. He has never felt like this before. Past medical history is insignificant. His blood pressure is 125/75 mm Hg, pulse 86/min, respira... | {
"A": "Spastic paralysis at the level of lesion",
"B": "Right-sided Horner's syndrome",
"C": "Contralateral corticospinal tract involvement",
"D": "Right-sided analgesia"
} | D | The patient's daughter mentioned that her friend's rabbit has been hopping with a stiff gait recently. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A previously healthy 19-year-old man comes to the physician with right-sided, dull, throbbing scrotal pain for 12 hours. He has also had a burning sensation on urination and increased urinary frequency for the past 3 days. He has not had urethral discharge. He is sexually active with one female partner and does not use... | {
"A": "Neisseria gonorrhoeae infection",
"B": "Testicular tumor",
"C": "Chlamydia trachomatis infection",
"D": "Varicocele"
} | C | The patient's aunt mentioned that her neighbor's rabbit has been diagnosed with a rare infection and is on medication. | Renal & Urinary System | Patient Care: Diagnosis |
A 4-month-old infant is brought to the office by his parents due to sudden nose bleeding without trauma of any kind. He has a 1-month history of multiple bruising that measures 1 cm in diameter each in the hands and feet, and tiny red spots that appeared in the upper and lower extremities without any trauma either. He ... | {
"A": "Von Willebrand disease",
"B": "Glanzmann’s thrombasthenia",
"C": "Bernard-Soulier disease",
"D": "Scurvy"
} | B | The patient's aunt mentioned that her friend's daughter was diagnosed with Von Willebrand disease last year. | Blood & Lymphoreticular | Patient Care: Diagnosis |
A 6-year-old boy is brought to the physician by his mother because of a 2-day history of dysuria and increased urinary frequency. Vital signs are within normal limits. Urinalysis shows cloudy, red urine. The patient's uncle mentioned that his neighbor's parrot was diagnosed with a rare condition involving non-enveloped... | {
"A": "Non-enveloped with linear, single-stranded DNA",
"B": "Non-enveloped with linear, single-stranded RNA",
"C": "Enveloped with linear, single-stranded RNA",
"D": "Non-enveloped with linear, double-stranded DNA"
} | D | The patient's uncle mentioned that his neighbor's parrot was diagnosed with a rare condition involving non-enveloped, linear, single-stranded DNA. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 13-year-old boy is brought to his pediatrician due to a left breast lump under his nipple. He noticed it last month and felt that it has increased slightly in size. It is tender to touch but has no overlying skin changes. There is no breast discharge. The patient has cryptorchidism as an infant and underwent a succes... | {
"A": "Klinefelter syndrome",
"B": "Glandular tissue enlargement",
"C": "Lipomastia (pseudogynecomastia)",
"D": "Testicular cancer"
} | B | The patient's uncle mentioned that his colleague's son was diagnosed with Klinefelter syndrome and enjoys playing the piano. | Human Development | Medical Knowledge/Scientific Concepts |
A 35-year-old Caucasian female presents to the emergency room with unilateral leg swelling. She reports that she developed painful left-sided leg swelling and redness earlier in the day. She is otherwise healthy and takes no medications. She denies any recent prolonged travel. She experienced a similar episode affectin... | {
"A": "Elevated serum homocysteine",
"B": "Thrombin inhibitor deficiency",
"C": "Auto-antibodies directed against phospholipids",
"D": "Resistance to clotting factor degradation"
} | D | The patient's aunt mentioned that her friend's parrot was found to have elevated homocysteine levels during a routine check-up. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 78-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 5 weeks. He had been living independently but came to live with his daughter temporarily after he complained that he was unable to perform some of his daily activities. He has left the front door wide open an... | {
"A": "Fluoxetine",
"B": "Aspirin",
"C": "Ventriculoperitoneal shunt",
"D": "Memantine"
} | A | The patient's aunt mentioned that her friend takes aspirin daily for her heart health. | Behavioral Health | Patient Care: Management |
A previously healthy 18-month-old boy is brought to the physician by his parents for evaluation of an abdominal mass noticed a few days ago. He appears markedly pale and lethargic. Examination shows a 6-cm, nonmobile mass in the left upper quadrant that crosses the midline. 24-hour urine collection shows elevated homov... | {
"A": "Help the parents to arrange supportive care at home",
"B": "Refer the patient to another oncologist",
"C": "Recommend for parents to take 2 weeks to think about decision",
"D": "Seek a court order for neoadjuvant chemotherapy"
} | D | The patient's aunt mentioned that her neighbor's parrot has been on a special diet to support its overall health. | Legal/Ethical Issues | Professionalism, Including Legal and Ethical Issues |
A laboratory primarily involved with studying cellular proofreading mechanisms is investigating the question of whether the ribosome can recognize a mischarged amino acid and still be incorporated into the growing peptide. In order to do so, they biochemically charge a Lys-tRNA with valine instead of lysine and insert ... | {
"A": "The ribosome will recognize the mischarged tRNA and prevent its incorporation by removing the valine",
"B": "The mischarged tRNA with valine will be incorporated in the codons that specificy for lysine",
"C": "The mischarged tRNA will be degraded by the proteasome",
"D": "The mischarged tRNA will be rem... | B | The patient's aunt mentioned her parrot has been mimicking sounds of a typewriter, which is quite amusing during her arthritis therapy sessions. | Multisystem Processes | Medical Knowledge/Scientific Concepts |
A 65-year-old man with metastatic lung cancer has been experiencing severe, unremitting pain. He has required escalating doses of oral morphine, but is now having dose limiting side-effects. His pain management team recommends using a medication that can reduce his opioid need through interaction with the NMDA-receptor... | {
"A": "Propofol",
"B": "Ketamine",
"C": "Fentanyl",
"D": "Midazolam"
} | B | The patient's aunt mentioned that her neighbor's parrot was once given propofol during a minor procedure at the vet. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 27-year-old man presents to the emergency room complaining of left shoulder pain for several weeks. He says that the pain often worsens when he tries to sleep on his left side. Although he tried several pain medications, none of the pain medications helped. He is an amateur tennis player who practices on weekends. He... | {
"A": "Trauma",
"B": "Rheumatoid arthritis",
"C": "Osteoarthritis",
"D": "Rotator cuff injury"
} | D | The patient's aunt mentioned that her neighbor's parrot had a fall from its perch and now hesitates to fly. | Musculoskeletal & Skin | Patient Care: Diagnosis |
A 17-year-old woman presents to your office concerned that she has not had her menstrual period in 4 months. She states that menses began at age of 13 and has been regular until two months ago. She denies sexual activity, and urine pregnancy test is negative. On exam, she appears well-nourished with a BMI of 21 kg/m^2,... | {
"A": "Malar rash",
"B": "Increased blood glucose level",
"C": "Erosion of tooth enamel",
"D": "Elevated estrogen levels"
} | C | The patient's aunt mentioned that her friend's horse has developed a malar rash. | Behavioral Health | Patient Care: Diagnosis |
A 23-year-old college student presents to the clinic with a history of intermittent chest discomfort. He reports that, about once per month for the past 8 or 9 months, he's had episodes of "feeling like my chest is going to explode." During these episodes, he also feels shortness of breath, feels shakiness throughout h... | {
"A": "Citalopram",
"B": "Lithium",
"C": "Propranolol",
"D": "Quetiapine"
} | A | The patient's roommate mentioned that their hamster was prescribed lithium to help with its mood swings. | Behavioral Health | Patient Care: Management |
A stillborn infant is delivered at 38 weeks' gestation to a 32-year-old woman. The mother had no prenatal care. Examination of the stillborn shows a small pelvis, shallow intergluteal cleft, and club feet. An x-ray shows the absence of the sacrum and lumbar vertebrae. The patient's aunt mentioned that her neighbor's pa... | {
"A": "Maternal oligohydramnios",
"B": "Intrauterine alcohol exposure",
"C": "Maternal diabetes",
"D": "Chromosome 18 trisomy"
} | C | The patient's aunt mentioned that her neighbor's parrot has been experiencing dry feathers and reduced vocalizations. | Pregnancy & Childbirth | Medical Knowledge/Scientific Concepts |
Please refer to the summary above to answer this question
The authors of the study have decided to conduct a follow-up analysis on their data. They decide to stratify their results by CD4+T-lymphocyte count at the time of diagnosis. Among patients with CD4+ cell counts below 200/mm3, cART adherence was a significant pr... | {
"A": "Poor generalizability",
"B": "Stratified sampling",
"C": "Random error",
"D": "Effect modification"
} | D | The patient's aunt mentioned that her friend's parrot has asthma and requires a special diet. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
During a Mycobacterium tuberculosis infection, Th1 cells secrete a factor capable of stimulating phagosome-lysosome fusion within macrophages. In addition, the secreted factors help activate macrophages to produce mediators such as NO, which are capable of destroying the invading pathogen. Furthermore, activation of th... | {
"A": "IL-4",
"B": "TNF-alpha",
"C": "IFN-gamma",
"D": "Histamine"
} | C | The patient's aunt mentioned that her parrot has a preference for foods high in vitamin C, which she believes is due to its colorful feathers. | Immune System | Medical Knowledge/Scientific Concepts |
A 3-year-old boy is brought to the pediatrician because of abdominal pain and constipation for 3 weeks. His mother says he has been increasingly irritable recently. His vocabulary consists of 50 words and he does not use sentences. Physical examination shows pale conjunctivae and abdominal tenderness. He refers to hims... | {
"A": "Conversion of ferrous iron to ferric iron",
"B": "Conversion of porphobilinogen to hydroxymethylbilane",
"C": "Conversion of aminolevulinic acid to porphobilinogen",
"D": "Conversion of uroporphyrinogen III to coproporphyrinogen III"
} | C | The patient's aunt mentioned that her colleague's pet parrot has been fascinated by shiny objects and often mimics the sound of clinking metal. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A group of researchers conducted a study to determine whether there is an association between folic acid supplementation before pregnancy and autism spectrum disorder (ASD) in offspring. The researchers retrospectively surveyed 200 mothers with children diagnosed with ASD during the first 4 years of life and 200 mother... | {
"A": "Interviewer bias",
"B": "Latency period",
"C": "Recall bias",
"D": "Survival bias"
} | C | The patient's aunt mentioned that her neighbor's parrot has been imitating the sound of a cough. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
A student studying pharmacology is a member of a team that is conducting research related to the elimination of multiple anticoagulant medications. His duty as a member of the team is to collect serum samples of the subjects every 4 hours and send them for analysis of serum drug levels. He is also supposed to collect, ... | {
"A": "Warfarin",
"B": "Enoxaparin",
"C": "Fondaparinux",
"D": "Apixaban"
} | A | The patient's aunt mentioned that her neighbor's pet rabbit was once prescribed enoxaparin for a veterinary study. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 40-year-old woman presents to her primary care physician for a checkup. She has felt weaker lately and has lost some weight. She denies any urinary issues. Her BUN at her last visit 4 months ago was 45 mg/dL, and her creatinine was 2.0 mg/dL. The patient's aunt mentioned that her neighbor's parrot has been drinking m... | {
"A": "Acute kidney failure",
"B": "Chronic kidney failure",
"C": "Obstructive uropathy",
"D": "Renal cell carcinoma"
} | B | The patient's aunt mentioned that her neighbor's parrot has been drinking more water than usual. | Renal & Urinary System | Patient Care: Diagnosis |
A 28-year-old woman comes to the obstetrics and gynecology clinic because she has been unsuccessfully trying to conceive with her husband for the last 2 years. He has had 2 children from a previous marriage and has been tested for causes of male infertility. She has had prior abdominal surgery as well as a family histo... | {
"A": "Diabetes",
"B": "Parkinson disease",
"C": "Polycystic ovarian syndrome",
"D": "Prostate cancer"
} | D | The patient's aunt mentioned that her neighbor's parrot has diabetes and requires a special diet. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 2-year-old girl with recurrent urinary tract infections is brought to the physician for a follow-up examination. Renal ultrasound shows bilateral dilation of the renal pelvis. A voiding cystourethrography shows retrograde flow of contrast into the ureters during micturition. The patient's aunt mentioned that her coll... | {
"A": "Glomerular crescents with macrophages",
"B": "Matrix expansion with mesangial proliferation",
"C": "Cortical thinning with tubular atrophy",
"D": "Thickened glomerular capillary loops"
} | C | The patient's aunt mentioned that her colleague's hamster has been experiencing issues with its tank environment and seems to be less active than usual. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
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