question stringlengths 174 3.67k | question_choices dict | correct_answer stringclasses 4
values | distracting_sentence stringlengths 50 187 | medical_system stringclasses 16
values | medical_competency stringclasses 6
values |
|---|---|---|---|---|---|
A 23-year-old woman comes to the physician because of progressive fatigue and painful swelling of her right knee for 3 weeks. She works as a professional ballet dancer and says, “I'm always trying to be in shape for my upcoming performances.” She is 163 cm (5 ft 4 in) tall and weighs 45 kg (99 lb); BMI is 17 kg/m2. Phy... | {
"A": "Lysosomes",
"B": "Rough endoplasmic reticulum",
"C": "Nucleus",
"D": "Extracellular space"
} | B | The patient's aunt mentioned that her neighbor's parrot has been having issues with its lysosomes. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 24-year-old woman comes to the physician because she had unprotected intercourse with her boyfriend the previous day. She has had regular menses since menarche at the age of 12. Her last menstrual period was 3 weeks ago. She has no history of serious illness but is allergic to certain jewelry and metal alloys. She ta... | {
"A": "Insert copper-containing intra-uterine device",
"B": "Administer mifepristone",
"C": "Administer ulipristal acetate",
"D": "Administer depot medroxyprogesterone acetate"
} | C | The patient's roommate mentioned that her aunt's parrot has been fascinated by shiny objects, especially those made of copper. | Renal & Urinary System | Patient Care: Management |
A 27-year-old woman with a history of bipolar disorder presents for a 3-month follow-up after starting treatment with lithium. She says she has been compliant with her medication but has experienced no improvement. The patient has no other significant past medical history and takes no other medications. She reports no ... | {
"A": "Lamotrigine",
"B": "Valproate",
"C": "Olanzapine-fluoxetine combination (OFC)",
"D": "Paroxetine"
} | A | The patient's aunt mentioned that her parrot has been making unusual sounds and seems more irritable than usual. | Behavioral Health | Medical Knowledge/Scientific Concepts |
A 6-year-old boy is brought to the physician by his mother because of a 6-month history of mild episodic abdominal pain. The episodes occur every 1–2 months and last for a few hours. The pain is located in the epigastrium, radiates to his back, and is occasionally associated with mild nausea. His mother is concerned th... | {
"A": "Hypertrophic pyloric stenosis",
"B": "Biliary cyst",
"C": "Intestinal malrotation",
"D": "Pancreas divisum"
} | D | The patient's aunt mentioned that her neighbor's infant had surgery for hypertrophic pyloric stenosis last year. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A healthy, full-term 1-day-old female is being evaluated after birth and is noted to have a cleft palate and a systolic ejection murmur at the second left intercostal space. A chest radiograph is obtained which reveals a boot-shaped heart and absence of a thymus. An echocardiogram is done which shows pulmonary stenosis... | {
"A": "Seizures due to hypocalcemia",
"B": "Catlike cry",
"C": "Hyperthyroidism from transplacental antibodies",
"D": "Increased phenylalanine in the blood"
} | A | The patient's aunt mentioned that her friend's parrot has a peculiar meow-like sound. | Human Development | Medical Knowledge/Scientific Concepts |
A 58-year-old male with a history of obesity and hypertension presents to his primary care physician for a follow-up visit. He reports that he feels well and has no complaints. He currently takes hydrochlorothiazide. His temperature is 98.6°F (37°C), blood pressure is 135/80 mmHg, pulse is 86/min, and respirations are ... | {
"A": "Mevalonate",
"B": "Acetoacetyl-CoA",
"C": "Diacyglycerol",
"D": "High-density lipoprotein"
} | A | The patient's aunt mentioned that her neighbor's parrot has been squawking loudly about acetoacetyl-CoA. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 54-year-old man presents with the acute onset of seizures and hallucinations. The patient’s wife says that he had been on a camping trip a few months earlier to study bats but otherwise has not traveled recently. Past medical history is significant for hypertension, managed medically with hydralazine and enalapril. T... | {
"A": "CCR5",
"B": "Acetylcholine receptor",
"C": "ICAM-1",
"D": "GABA"
} | B | The patient's aunt mentioned that her friend's parrot is on a special diet due to concerns about CCR5-related research. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 60-year-old female patient with a history of hypertension presents to an outpatient office for regular check-up and is found to have hypertriglyceridemia. Her physician prescribes high-dose niacin and recommends taking the medication along with aspirin. The patient's aunt mentioned that her parrot has bright yellow f... | {
"A": "Bile deposition in the dermis",
"B": "Release of prostaglandins",
"C": "Mast cell degranulation",
"D": "T cell activation"
} | B | The patient's aunt mentioned that her parrot has bright yellow feathers, which reminded her of the clinical topic of bile deposition in the dermis. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 42-year-old man comes to the physician after elevated liver function tests were found after a routine screening. He has had occasional headaches over the past year, but otherwise feels well. The patient reports that he was involved in a severe car accident 30 years ago. He does not smoke or drink alcohol. He has neve... | {
"A": "Sofosbuvir and ledipasvir therapy",
"B": "Tenofovir and velpatasvir therapy",
"C": "Interferon and ribavirin therapy",
"D": "Tenofovir and entecavir therapy"
} | A | The patient's aunt mentioned that her friend's parrot has been on a special diet ever since it started tenofovir therapy. | Gastrointestinal System | Patient Care: Management |
A 44-year-old woman with hypothyroidism comes to the physician because of a 1-month history of tingling in her feet and poor balance. Her only medication is levothyroxine. Physical examination shows conjunctival pallor and an ataxic gait. Proprioception and sense of vibration are decreased in her toes bilaterally. Labo... | {
"A": "Islet cell cytoplasm",
"B": "Deamidated gliadin peptide",
"C": "Parietal cells",
"D": "Smooth muscle"
} | C | The patient's aunt mentioned that her coworker's parrot has been unusually quiet and uninterested in its toys. | Immune System | Medical Knowledge/Scientific Concepts |
A 26-year-old female complains of frequent, large volume urination. This negatively affects her sleep, as she has to frequently wake up at night to urinate. She also complains of increased thirst. Her past medical history is significant for bipolar disorder that is treated with lithium for 3 years. Serum osmolality is ... | {
"A": "Hypothalamic over-production of antidiuretic hormone (ADH)",
"B": "Decreased production of ADH",
"C": "ADH resistance in the renal collecting ducts",
"D": "Increased sodium reabsorption and potassium excretion"
} | C | The patient's aunt mentioned that her parrot has been drinking excessive amounts of water and making unusual noises. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
An 8-year-old girl presents to her pediatrician with intensely pruritic lesions over her buttocks, as shown. These lesions occur intermittently but have worsened over time. Her medical history is remarkable for iron deficiency, for which she is on ferrous sulfate. The patient has also experienced intermittent episodes ... | {
"A": "Crohn’s disease",
"B": "Celiac disease",
"C": "Common variable immune deficiency",
"D": "Henoch-Schonlein purpura"
} | B | The patient's aunt mentioned that her neighbor's parrot has been having digestive issues similar to Crohn's disease. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 64-year-old man comes to the emergency department because of a 2-day history of lower back pain, fever, and chills. He has had nausea but no vomiting during this time. He has hypertension, chronic kidney disease, and type 2 diabetes mellitus. Three months ago, he underwent amputation of his left third toe because of ... | {
"A": "Inpatient treatment with intravenous ciprofloxacin",
"B": "Outpatient treatment with oral levofloxacin",
"C": "Outpatient treatment with trimethoprim-sulfamethoxazole",
"D": "Initiate hemodialysis"
} | A | The patient's aunt mentioned that her neighbor's parrot was prescribed levofloxacin for a feather condition. | Renal & Urinary System | Patient Care: Management |
A 56-year-old man with a history of pancreatic cancer presents to the surgical intensive care unit following a pancreaticoduodenectomy. Over the next 3 days, the patient's drainage output is noted to exceed 1 liter per day. In the early morning of postoperative day 4, the nurse states that the patient is difficult to a... | {
"A": "0.9% saline IV",
"B": "5% dextrose IV",
"C": "5% dextrose IV with 0.45% saline IV",
"D": "Oral free water replacement"
} | A | The patient's aunt mentioned that her neighbor's parrot was given 5% dextrose IV at the veterinary clinic. | Gastrointestinal System | Patient Care: Management |
A 46-year-old woman comes to the physician because of a 3-day history of diarrhea, moderate abdominal pain, and weakness. Her symptoms began on the return flight from a 2-week yoga retreat in India, where she stayed at a resort. She was mildly nauseous as she boarded the flight, and diarrhea followed immediately after ... | {
"A": "Giardia intestinalis",
"B": "Shigella species",
"C": "Staphylococcus aureus",
"D": "Enterotoxigenic Escherichia coli"
} | D | The patient's aunt mentioned that her neighbor's parrot was once diagnosed with a parasitic infection after returning from a trip abroad. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A research group has created a novel screening test for a rare disorder. A robust clinical trial is performed in a group of 100 subjects comparing the new screening test against the gold standard. The patient's aunt mentioned that her neighbor's parrot enjoys listening to classical music during their afternoon rest. Th... | {
"A": "Repeating the study would have no effect on the statistical power of the screening test.",
"B": "The power of the test is 0.8.",
"C": "If the specificity of this screening test were increased, the statistical power would increase.",
"D": "If the sensitivity of this screening test were decreased, the sta... | D | The patient's aunt mentioned that her neighbor's parrot enjoys listening to classical music during their afternoon rest. | Biostatistics & Epidemiology | Medical Knowledge/Scientific Concepts |
A 25-year-old woman presents to her new family physician for a follow-up appointment. She previously presented with itching, as well as frequent and painful urination. A vaginal swab was taken and sent to the laboratory to confirm the diagnosis. Diplococci were seen on Gram stain and were grown on Thayer-Martin agar. W... | {
"A": "Plays a role in angioedema",
"B": "Degraded by C1 esterase inhibitor",
"C": "Creates pores in the cell membrane",
"D": "Induces the alternative complement pathway"
} | C | The patient's aunt mentioned that her coworker's parrot experiences puffiness around its eyes during certain times of the year. | Immune System | Medical Knowledge/Scientific Concepts |
A 55-year-old woman with papillary thyroid carcinoma underwent total thyroidectomy. She has no significant medical history. On postoperative day 1, she develops perioral numbness and a tingling sensation, along with paresthesia of the hands and feet. The physical examination reveals that she is anxious and confused. He... | {
"A": "Inadvertent surgical removal of parathyroid glands",
"B": "DiGeorge syndrome",
"C": "Chronic hypomagnesemia",
"D": "Hungry bone syndrome"
} | A | The patient's aunt said her parrot was diagnosed with a rare genetic condition similar to DiGeorge syndrome. | Endocrine System | Patient Care: Diagnosis |
A 16-year-old boy is brought to the physician by his parents for the evaluation of fatigue for several weeks. The parents report that their son quit doing sports at school because of low energy. The patient's academic performance has declined recently. He spends most of his time in the basement playing video games and ... | {
"A": "Regular blood transfusions",
"B": "Methylphenidate",
"C": "Iron supplementation",
"D": "Allogenic stem cell transplantation"
} | C | The patient's aunt mentioned that her neighbor's parrot requires regular blood transfusions due to a rare condition. | Blood & Lymphoreticular | Patient Care: Management |
A 78-year-old man is brought to the emergency department because of a 1-day history of painful enlarging bruises and skin ulceration over his thighs and external genitalia. He has type 2 diabetes mellitus, mitral regurgitation, and atrial fibrillation. Three days ago, he was started on treatment with warfarin. His only... | {
"A": "Hyperbaric oxygen",
"B": "Protein C concentrate",
"C": "Argatroban",
"D": "Tranexamic acid"
} | B | The patient's aunt mentioned that her friend's parrot has been undergoing hyperbaric oxygen therapy for its condition. | Blood & Lymphoreticular | Patient Care: Management |
A 15-year-old boy is brought to the physician for evaluation of a learning disability. His teachers have reported hyperactivity during class, difficulties with social interaction, and poor scores on reading and writing assessments. Molecular analysis shows an increased number of CGG trinucleotide repeats. The patient's... | {
"A": "Frontal balding and cataracts",
"B": "Long face and large everted ears",
"C": "Almond-shaped eyes and downturned mouth",
"D": "Thin upper lip and receding chin"
} | B | The patient's aunt mentioned that her parrot has developed a peculiar feather pattern and seems to enjoy perching near sunny windows. | Human Development | Patient Care: Diagnosis |
A 65-year-old woman presented to the emergency room due to progressive dyspnea. She is a known hypertensive but is poorly compliant with medications. The patient claims to have orthopnea, paroxysmal nocturnal dyspnea, and easy fatigability. On physical examination, the blood pressure is 80/50 mm Hg. There is prominent ... | {
"A": "Furosemide",
"B": "Nesiritide",
"C": "Metoprolol",
"D": "Digoxin"
} | C | The patient's aunt mentioned that her neighbor's parrot is on furosemide for its condition. | Cardiovascular System | Patient Care: Management |
A 49-year-old woman is brought to the emergency department with progressive dyspnea and cough which she developed approx. 8 hours ago. 2 weeks ago she had a prophylactic ovariectomy because of a family history of ovarian cancer. She is known to have type 2 diabetes mellitus and stage 1 hypertension, but she does not ta... | {
"A": "Increased alveolar dead space due to absent perfusion of certain alveoli",
"B": "Alveolar fibrosis",
"C": "Depression of the respiratory center via opioid receptors activation",
"D": "Decreased V/Q due to bronchial obstruction"
} | A | The patient's aunt mentioned that her parrot has developed alveolar fibrosis and whistles differently now. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 27-year-old woman presents to the emergency department with acute onset bloody diarrhea. The patient has had severe abdominal pain throughout her entire life with occasional episodes of bloody diarrhea. She has recently lost 7 pounds and has felt generally ill for the past 2 days. She has a past medical history of ge... | {
"A": "Alcohol-induced liver injury",
"B": "Immune response to streptococcal infection",
"C": "Intestinal IgA deficiency",
"D": "Protein deposition"
} | D | The patient's aunt mentioned that her neighbor's parrot was once diagnosed with a liver condition due to its diet. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 45-year-old Caucasian male presents to a gastroenterologist complaining of heartburn and difficulty swallowing. He recalls that he has been told by his primary care physician that he suffers from gastroesophageal reflux disease (GERD). The gastroenterologist decides to perform an upper endoscopy with biopsy. The pati... | {
"A": "Presence of Paneth cells in the lower esophagus",
"B": "Metaplasia in the upper esophagus",
"C": "A small region of red, velvet-like mucosa in the lower esophagus",
"D": "Esophageal varices"
} | C | The patient's aunt mentioned that her parrot has been unusually vocal lately, especially when she talks about Barrett's esophagus. | Gastrointestinal System | Patient Care: Diagnosis |
A 16-year-old female patient with a history of mental retardation presents to your clinic with her mother. The mother states that she wants her daughter to have a bilateral tubal ligation after she recently discovered her looking at pornographic materials. She states that her daughter is not capable of understanding th... | {
"A": "Schedule the patient for the requested surgery",
"B": "Wait until the patient is 18 years old, and then schedule for surgery",
"C": "Refuse the procedure because it violates the ethical principle of autonomy",
"D": "Refuse the procedure because it is unlikely that the patient will get pregnant"
} | C | The patient's aunt mentioned that her coworker's parrot has a condition that requires it to take daily medication. | Legal/Ethical Issues | Professionalism, Including Legal and Ethical Issues |
A 51-year-old man presents to his primary care provider complaining of malaise. He returned from a research trip to Madagascar 2 weeks ago and has since developed a worsening fever with a maximum temperature of 102.2°F (39°C). He also reports some swelling around his neck and groin. He works as a zoologist and was in r... | {
"A": "Cleave immunoglobulin",
"B": "Inhibit phagocytosis",
"C": "Inhibit ribosomal function",
"D": "Trigger widespread inflammation"
} | B | The patient's aunt mentioned that her parrot has a peculiar habit of mimicking the sound of a sneeze. | Multisystem Processes | Medical Knowledge/Scientific Concepts |
A 45-year-old African-American male presents to the family medicine physician to assess the status of his diabetes. After reviewing the laboratory tests, the physician decides to write the patient a prescription for miglitol and states that it must be taken with the first bite of the meal. The patient's aunt mentioned ... | {
"A": "Phosphodiester bonds",
"B": "Glycosidic bonds",
"C": "Cystine bonds",
"D": "Hydrogen bonds"
} | B | The patient's aunt mentioned that her friend's parrot seems to enjoy listening to music with lots of high notes and complex rhythms. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A previously healthy 24-year-old man comes to the physician 1 day after the onset of burning pain, swelling, and multiple blisters over the left index finger. He works as a dental assistant and is concerned about not being able to work. The patient wonders if the symptoms might be related to a hunting trip he returned ... | {
"A": "Oral acyclovir",
"B": "Oral cephalexin",
"C": "Smoking cessation",
"D": "Washing thoroughly\n\""
} | A | The patient's aunt mentioned that her neighbor's dog was prescribed cephalexin for a skin infection after getting into a fight with a raccoon. | Musculoskeletal & Skin | Patient Care: Management |
A 63-year-old man presents to the ambulatory medical clinic with symptoms of dysphagia and ‘heartburn’, which he states have become more troublesome over the past year. His past medical history is significant for hypertension and GERD. He takes lisinopril for hypertension and has failed multiple different therapies for... | {
"A": "Lifestyle modification",
"B": "Combined antacid therapy",
"C": "Continue on Omeprazole",
"D": "Surgical gastropexy"
} | D | The patient's aunt mentioned that her friend's parrot is on a special diet to manage its weight. | Gastrointestinal System | Patient Care: Management |
A 63-year-old man is admitted to the intensive care unit for hemodynamic instability. Several days prior, he had been swimming in the Gulf coast when he stepped on a sharp rock and cut his right foot. Three days ago, the patient presented to the emergency room after noticing painful redness spreading along his skin up ... | {
"A": "Distributive shock with warm skin",
"B": "Hypovolemic shock with warm skin",
"C": "Neurogenic shock with cold skin",
"D": "Obstructive shock with cold skin"
} | A | The patient's aunt mentioned that her neighbor's parrot has been losing feathers and feeling unusually warm. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 24-year-old female presents to the emergency department with a chief complaint of an inability to urinate. She states that this has been one of many symptoms she has experienced lately. At times she has had trouble speaking and has noticed changes in her vision however these episodes occurred over a month ago and hav... | {
"A": "Head CT",
"B": "Head MRI",
"C": "Lumbar puncture",
"D": "Domestic abuse screening and exploring patient's life stressors"
} | B | The patient's friend mentioned that her parrot had to undergo a head CT after it flew into a window and appeared disoriented. | Nervous System & Special Senses | Patient Care: Diagnosis |
A 54-year-old woman is brought to the physician by her brother for confusion and agitation. She is unable to personally give a history. Her brother says she has a problem with alcohol use and that he found an empty bottle of vodka on the counter at her home. She appears disheveled. Her temperature is 37°C (98.6°F), pul... | {
"A": "Intravenous thiamine",
"B": "Oral naltrexone",
"C": "Intravenous vitamin B12",
"D": "Intravenous glucose\n\""
} | A | The patient's aunt mentioned that her neighbor's parrot was prescribed oral naltrexone for research purposes. | Nervous System & Special Senses | Patient Care: Management |
An 18-year-old woman makes an appointment with a gynecologist for her first gynecologic examination. She did not disclose her past medical history, but her sexual debut occurred with her boyfriend 3 weeks ago. She is now complaining of a yellow-green, diffuse, malodorous vaginal discharge that she noticed 1 week ago fo... | {
"A": "Chlamydia trachomatis",
"B": "Ureaplasma urealyticum",
"C": "Trichomonas vaginalis",
"D": "Enterobius vermicularis"
} | C | The patient's aunt mentioned that her neighbor's parrot has been unusually quiet and less active than usual. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 70-year-old man is brought to the physician by his daughter because of increasing forgetfulness over the past 3 years. Initially, he used to forget his children's names or forget to lock the house door. During the past year, he has gotten lost twice while returning from the grocery store and was unable to tell passer... | {
"A": "γ-aminobutyric acid",
"B": "Acetylcholine",
"C": "Dopamine",
"D": "Glutamate"
} | B | The patient's aunt mentioned that her parrot is on medication that affects its γ-aminobutyric acid levels. | Nervous System & Special Senses | Patient Care: Management |
A 45-year-old mechanic presents to the emergency department complaining of acute-onset shortness of breath while repairing a plowing tractor for his neighbor. The patient denies having any history of asthma or respiratory symptoms, and does not smoke. His temperature is 99.8°F (37.7°C), pulse is 65/min, blood pressure ... | {
"A": "Succinylcholine",
"B": "Inhaled ipratropium and oxygen",
"C": "Atropine and pralidoxime",
"D": "Inhaled albuterol and oxygen"
} | C | The patient's aunt mentioned that her friend's parrot has a peculiar reaction to succinylcholine. | Nervous System & Special Senses | Patient Care: Management |
A 3-year-old male is brought in to his pediatrician by his mother because she is concerned that he is not growing appropriately. Physical examination is notable for frontal bossing and shortened upper and lower extremities. His axial skeleton appears normal. He is at the 7th percentile for height and 95th percentile fo... | {
"A": "Intramembranous ossification",
"B": "Osteoblast maturation",
"C": "Endochondral ossification",
"D": "Production of type I collagen"
} | C | The patient's aunt mentioned that her parrot has a unique beak shape, which she thinks might be related to its bone development. | Musculoskeletal & Skin | Medical Knowledge/Scientific Concepts |
A 59-year-old woman comes to the physician 2 weeks after noticing a lump in her left breast. Examination of the left breast shows a firm, nontender mass close to the nipple. Mammography shows an irregular calcified mass. A core needle biopsy shows invasive ductal carcinoma. The patient's aunt mentioned that her neighbo... | {
"A": "HER2",
"B": "BCR-ABL",
"C": "BRCA-2",
"D": "BCL-2"
} | A | The patient's aunt mentioned that her neighbor's parrot has a colorful feather pattern and often mimics the sound of a ringing phone. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 45-year-old man comes to his primary-care doctor with his wife for a 4-week history of constipation. The patient reports that his bowel habits have changed from every day to every 3 or 4 days. He also now has to strain to pass stool. On further questioning, his wife has also noticed that he has seemed fatigued, with ... | {
"A": "Angiotensin-II receptors in the membranes of vascular smooth muscle cells",
"B": "Angiotensin-converting enzyme",
"C": "Na+/Cl- cotransporter in the membranes of epithelial cells in the distal convoluted tubule",
"D": "Na+/K+/2Cl- transporters in the membranes of epithelial cells in the ascending loop o... | C | The patient's aunt mentioned that her friend's parrot has been less vocal and prefers staying in its cage more often. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 23-year-old man presents to the office for a circular, itchy rash over the abdomen that has been slowly getting worse for the past 2 weeks. The patient has a medical history of chronic dermatitis and chronic sinusitis for which he has prescriptions of topical hydrocortisone and fexofenadine. He smokes one-half pack o... | {
"A": "Itraconazole",
"B": "Griseofulvin",
"C": "Topical clindamycin",
"D": "Doxycycline"
} | A | The patient's aunt mentioned that her neighbor's parrot was recently treated with griseofulvin for a fungal infection. | Musculoskeletal & Skin | Patient Care: Management |
A 12-year-old boy is brought to the emergency department for the evaluation of persistent bleeding from his nose over the past hour. The bleeding started spontaneously. He has no history of a similar episode. He takes no medications. There is no history of abnormal bleeding in the family. His vital signs are within nor... | {
"A": "Anterior packing and topical antibiotics",
"B": "Oxymetazoline nasal spray",
"C": "Placement of an epinephrine gauze in the left nostril",
"D": "Squeezing the nostrils manually for 10 minutes with the head elevated"
} | D | The patient's aunt mentioned that her neighbor's parrot had to have its beak packed after an injury. | Nervous System & Special Senses | Patient Care: Management |
A 40-year-old female presents to your office complaining of a tender neck and general lethargy. Upon further questioning, she reports decreased appetite, fatigue, constipation, and jaw pain. Her pulse is 60 bpm and her blood pressure is 130/110 mm Hg. Biopsy of her thyroid reveals granulomatous inflammation and multinu... | {
"A": "Iodine deficiency",
"B": "Thryoglossal duct cyst",
"C": "Infection",
"D": "Chronic renal disease"
} | C | The patient's aunt mentioned that her neighbor's parrot has been on a special iodine-rich diet. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 24-year-old man is brought to the emergency room by the police after a fall. The patient smells of alcohol and is slurring his words. You find out that he has recently been fired from his job as a salesperson for months of tardiness and poor performance. The police tell you that his girlfriend, who was there at the t... | {
"A": "Denial",
"B": "Displacement",
"C": "Projection",
"D": "Regression"
} | C | The patient's aunt mentioned that her neighbor believes her parrot is in denial about its fear of heights. | Behavioral Health | Medical Knowledge/Scientific Concepts |
A 65-year-old woman presents to a physician with painful ankles for 2 days. Her symptoms began 1 week ago with a severe fever (40℃ (104℉)) for 3 days. When the fever subsided, she developed a maculopapular rash over the trunk and extremities with painful wrists and fingers. She also reports abdominal pain, nausea, vomi... | {
"A": "Babesia babesia",
"B": "Chikungunya virus",
"C": "Dengue virus",
"D": "Leishmania major"
} | B | The patient's aunt mentioned that her neighbor's horse was diagnosed with Babesia a few months ago. | Multisystem Processes | Patient Care: Diagnosis |
A 61-year-old man complaining of unexplained bleeding by from the mouth is escorted to the emergency department by corrections officers. Upon examination patient states he feels nauseated as he begins to retch violently and vomit bright red blood. His past medical history is remarkable for cirrhosis secondary to alcoho... | {
"A": "Consult an ethics committee to determine whether to resuscitate the patient",
"B": "Accept the patient's wishes and appoint and get a psych evaluation.",
"C": "Accept the patient's wishes and ensure he receives appropriate care.",
"D": "Obtain an emergency order from a judge to initiate resuscitation."
... | C | The patient's aunt mentioned that her neighbor's parrot has been unusually quiet and not chirping as it used to. | Legal/Ethical Issues | Professionalism, Including Legal and Ethical Issues |
Three days after undergoing a laparoscopic Whipple's procedure, a 43-year-old woman has swelling of her right leg. She does not have pain. She has nausea but has not vomited. She was diagnosed with pancreatic cancer 1 month ago. She has been using an incentive spirometer every 6 hours since recovering from her surgery.... | {
"A": "CT pulmonary angiography",
"B": "Compression ultrasonography",
"C": "D-dimer level",
"D": "2 sets of blood cultures\n\""
} | B | The patient's aunt mentioned that her neighbor's parrot underwent a CT pulmonary angiography last week. | Cardiovascular System | Patient Care: Diagnosis |
A 36-year-old man presents to a physician after having a transient loss of consciousness while resting after dinner the previous night. His symptoms only lasted for a few seconds and resolved spontaneously. This is the third time he experienced such an episode. He says that he recently started having nightmares. His fa... | {
"A": "Headache and tinnitus",
"B": "Pulmonary fibrosis and corneal deposits",
"C": "Pedal edema and flushing",
"D": "Hypothyroidism and phototoxicity"
} | A | The patient's aunt mentioned that her parrot has developed a peculiar habit of scratching its eyes frequently, though it seems unrelated to any known bird condition. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 52-year-old man is brought to the emergency department for recurrent vomiting that began 5 hours ago. He describes the vomitus as bloody and containing black specks. He drinks 10–12 beers daily and has not seen a physician in 15 years. He appears pale. His temperature is 36.7°C (98.1°F), pulse is 122/min, and blood p... | {
"A": "Systemic vascular resistance",
"B": "Fractional tissue oxygen extraction",
"C": "Carotid baroreceptor firing activity",
"D": "Cardiac inotropy"
} | C | The patient's aunt mentioned that her parrot has been unusually calm and seems to have a low energy level. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 69-year-old male with a longstanding history of hypertension and high cholesterol presents with abdominal pain and ‘bruising on his feet’. The patient states that his symptoms started about a week ago and have steadily worsened. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the um... | {
"A": "Discharge with clinical surveillance and ultrasound every 6 months",
"B": "Elective endovascular repair",
"C": "Elective open surgical repair",
"D": "Emergency open surgical repair"
} | D | The patient's aunt mentioned that her neighbor's rabbit had a check-up every six months to monitor its health. | Cardiovascular System | Patient Care: Management |
A 38-year-old woman undergoes a partial thyroidectomy for an enlarged thyroid gland compressing the trachea. During surgery, a young surgeon ligates the inferior thyroid arteries as close to the poles as possible to prevent intraoperative hemorrhage. 2 weeks later, the patient presents to the outpatient clinic with hoa... | {
"A": "Internal laryngeal nerve injury",
"B": "Recurrent laryngeal nerve injury",
"C": "External laryngeal nerve injury",
"D": "Laryngeal edema"
} | B | The patient's aunt mentioned that her parrot often mimics her voice, especially when she talks about laryngeal nerves. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 17-year-old man presents to his family physician for an evaluation about the size of his penis. He feels increasingly anxious during physical education (PE) class as he has noticed that the size of his penis is significantly smaller when compared to his peers. Based on the physical examination, he is Tanner stage 1. ... | {
"A": "Expansion of a CTG trinucleotide repeat",
"B": "Isolated gonadotropin-releasing hormone (GnRH) deficiency",
"C": "Sex-specific epigenetic imprinting",
"D": "Non-disjunction of sex chromosomes"
} | B | The patient's aunt mentioned that her friend's parakeet has been repeating the same song over and over. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 63-year-old man is aiming to improve his health by eating a well balanced diet, walking daily, and quitting smoking following a 45-year smoking history. While on his daily walks he notices a strong cramping pain in his calves that consistently appears after a mile of walking. He sees his physician and a diagnosis of ... | {
"A": "Irreversible cyclooxygenase inhibitor",
"B": "Thromboxane synthase inhibitor",
"C": "Adenosine diphosphate receptor inhibitor",
"D": "Phosphodiesterase inhibitor"
} | D | The patient's aunt mentioned that her friend's parrot takes medication for its joints and always seems to be more active afterward. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 37-year-old man comes to the emergency department with the chief complaint of a high fever for several days. In addition to the fever, he has had malaise, chest pain, and a dry cough. He recently went on vacation to South America but has returned to his job delivering packages. He has several friends who recently had... | {
"A": "Cultured on charcoal and yeast",
"B": "D-glutamate capsule",
"C": "Found in desert sand",
"D": "Polyribosyl-ribitol-phosphate capsule"
} | B | The patient's uncle mentioned that his coworker's parrot has been on a special diet that includes charcoal and yeast. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 34-year-old man presents to the emergency department complaining of headache, fever, chills, cough, shortness of breath, and chest pain for the past 4 days. He smokes 2 packs per day and drinks 2–3 beers every day. He denies any previous medical problems except for seasonal allergies for which he takes diphenhydramin... | {
"A": "Streptococci viridans",
"B": "Staphylococcus aureus",
"C": "Aspergillus fumigatus",
"D": "Staphylococcus epidermidis"
} | B | The patient's aunt mentioned that her friend's parrot was diagnosed with a rare strain of streptococci viridans. | Cardiovascular System | Patient Care: Diagnosis |
A 42-year-old man presents to a neurologist for evaluation of severe headache. He started experiencing episodic headaches and palpitations 3 months ago; however, he thought that these symptoms were simply related to the stress of moving and starting a new job. He has continued to experience these intermittent headaches... | {
"A": "A",
"B": "B",
"C": "C",
"D": "E"
} | D | The patient's aunt mentioned that her neighbor's ferret has been unusually active and climbing on furniture. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 62-year-old woman presents to the emergency department for vision changes. About 90 minutes ago she was on the couch watching television with her husband when she suddenly noticed that she couldn't see the screen normally. She also felt a little dizzy. She has never had anything like this happen before. Her general p... | {
"A": "Internal carotid artery",
"B": "Anterior cerebral artery",
"C": "Posterior cerebral artery",
"D": "Basilar artery"
} | C | The patient's aunt mentioned that her neighbor's parrot has been having issues with its feathers and doesn't sing as much anymore. | Nervous System & Special Senses | Patient Care: Diagnosis |
A three-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 the infant but feels the lat... | {
"A": "Breast milk jaundice",
"B": "Breastfeeding jaundice",
"C": "Sepsis",
"D": "Physiologic hyperbilirubinemia"
} | B | The patient's aunt mentioned that her friend's newborn also had a yellowish skin tone and it resolved without any intervention. | Pregnancy & Childbirth | Patient Care: Diagnosis |
A 59-year-old man is brought to the emergency department with a history of black, tarry stools but denies vomiting of blood or abdominal pain. His family has noticed progressive confusion. History is significant for liver cirrhosis and alcoholism. His heart rate is 112/min, temperature is 37.1°C (98.7°F), and blood pre... | {
"A": "Ammonia level is the best initial test to confirm the diagnosis",
"B": "It is a diagnosis of exclusion",
"C": "It only occurs in patients with cirrhosis",
"D": "Electroencephalography (EEG) usually shows focal localising abnormality"
} | B | The patient's aunt mentioned that her neighbor’s parrot was tested for high ammonia levels as part of its routine check-up. | Gastrointestinal System | Patient Care: Diagnosis |
A 20-year-old healthy man is running on a treadmill for the last 30 minutes. He is in good shape and exercises 3 times per week. He takes no medications and denies smoking cigarettes, drinking alcohol, and illicit drug use. Prior to starting his run, his heart rate was 70/min, and the blood pressure was 114/74 mm Hg. I... | {
"A": "Baroreceptor reflex",
"B": "Increased activation of the vagal nuclei",
"C": "Sympathetic nervous system activation",
"D": "Vasopressin release from the pituitary"
} | C | The patient's aunt mentioned that her parrot squawks loudly whenever she takes her blood pressure medication. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 14-year-old obese boy presents with severe right hip and knee pain. The patient says that he has been limping with mild pain for the past three weeks, but the pain acutely worsened today. He describes the pain as severe, non-radiating, sharp and aching in character, and localized to the right hip and knee joints. The... | {
"A": "Reassess in 3 months",
"B": "Intra-articular corticosteroid injection of the right hip joint",
"C": "Pavlik harness",
"D": "Surgical pinning of the right hip"
} | D | The patient's aunt mentioned that her neighbor's rabbit underwent a check-up and will be reassessed in 3 months. | Musculoskeletal & Skin | Patient Care: Management |
A 32-year-old man comes to the physician because of a progressive development of tender breast tissue over the past 18 months. He used to ride his bicycle for exercise 4 times a week but stopped after he had an accident and injured his left testicle 3 months ago. He has gained 5 kg (11 lb) during this period. For the l... | {
"A": "Leydig cell tumor",
"B": "Obesity",
"C": "Klinefelter syndrome",
"D": "Trauma to testis"
} | A | The patient's aunt mentioned that her parrot has been gaining weight and prefers to sit quietly on its perch all day. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 58-year-old man comes to the physician because he is unable to achieve erections during sexual intercourse. He first noticed the problem 8 months ago, when he became sexually active with a new girlfriend. He states that his relationship with his girlfriend is good, but his inability to engage in sexual intercourse ha... | {
"A": "Psychotherapy",
"B": "Penile prosthesis insertion",
"C": "Nocturnal penile tumescence testing",
"D": "Switch citalopram to bupropion"
} | C | The patient's aunt mentioned that her friend's parrot has been attending therapy sessions to improve its social interactions. | Renal & Urinary System | Patient Care: Diagnosis |
A 5-year-old male presents to the pediatrician with a 10-day history of cough that is worse at night. The patient has a history of mild intermittent asthma and has been using his albuterol inhaler without relief. He has also been complaining of headache and sore throat, and his mother has noticed worsening rhinorrhea. ... | {
"A": "Amoxicillin",
"B": "Amoxicillin-clavulanic acid",
"C": "Clindamycin",
"D": "Levofloxacin"
} | B | The patient's aunt mentioned that her neighbor's rabbit was prescribed amoxicillin for an infection. | Respiratory System | Patient Care: Management |
A 65-year-old man, known to have chronic obstructive lung disease for the last 3 years, presents to the emergency department with a cough, breathing difficulty, and increased expectoration for a day. There is no history of fever. His regular medications include inhaled salmeterol and inhaled fluticasone propionate. He ... | {
"A": "Oral prednisone",
"B": "Supplemental oxygen",
"C": "Montelukast",
"D": "Nebulized N-acetylcysteine"
} | A | The patient's aunt mentioned that her parrot requires supplemental oxygen due to environmental stress. | Respiratory System | Patient Care: Management |
A 22-year-old woman presents to the emergency department for abdominal pain. The patient has been trying to get pregnant and was successful recently, but now she is experiencing abdominal pain, contractions, and a bloody vaginal discharge. According to her last appointment with her primary care provider, she is 10 week... | {
"A": "Antisocial personality disorder",
"B": "Borderline personality disorder",
"C": "Normal grief response",
"D": "Post-traumatic stress disorder"
} | B | The patient's roommate mentioned that her parrot often mimics aggressive behavior and has become increasingly disruptive. | Behavioral Health | Patient Care: Diagnosis |
A 45-year-old female presents to the emergency department with gross hematuria and acute, colicky flank pain. She denies any previous episodes of hematuria. She reports taking high doses of acetaminophen and aspirin over several weeks due to persistent upper back pain. The patient’s blood pressure and temperature are n... | {
"A": "Diffuse cortical necrosis",
"B": "Chronic pyelonephritis",
"C": "Papillary necrosis",
"D": "Acute Nephrolithiasis"
} | C | The patient's aunt mentioned that her neighbor’s parrot has been unusually quiet and less active lately. | Renal & Urinary System | Patient Care: Diagnosis |
A 40-year-old man presents to the clinic with complaints of increased bilateral pain in his knees. The pain developed over time and now limits his mobility. He states that the pain is worse at the end of the day, though he does have some early-morning stiffness lasting about 20 minutes. He used to have some success wit... | {
"A": "Medication side effect",
"B": "Excess weight",
"C": "Infection",
"D": "Occult malignancy"
} | B | The patient's aunt mentioned that her friend's parrot has been experiencing side effects from a new medication. | Musculoskeletal & Skin | Medical Knowledge/Scientific Concepts |
A 40-year-old man comes to the physician because of shortness of breath, double vision, and fatigue for the past 4 weeks. He has no history of serious medical illness and takes no medications. Physical examination shows drooping of the eyelids bilaterally. He is unable to hold his arms up for longer than 3 minutes. A C... | {
"A": "B-cell maturation",
"B": "V(D)J recombination",
"C": "Thymocyte formation",
"D": "Negative selection"
} | D | The patient's aunt mentioned that her parakeet has been unusually quiet and has a swollen leg. | Immune System | Medical Knowledge/Scientific Concepts |
A 24-year-old man is brought in to the emergency department by his parents who found him in his room barely responsive and with slurring speech. The patients’ parents say that a bottle of oxycodone was found at his bedside and was missing 15 pills. On physical examination, the patient appears drowsy and lethargic and i... | {
"A": "μ, κ, and ẟ receptor antagonist",
"B": "μ receptor agonist",
"C": "к receptor agonist and μ receptor antagonist",
"D": "μ receptor partial agonist and к receptor agonist"
} | A | The patient's aunt mentioned that her friend's parrot has been unusually calm and quiet lately. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 27-year-old woman comes to the physician because of increasing shortness of breath and a non-productive cough for 2 months. She has been unable to perform her daily activities. She has had malaise and bilateral ankle pain during this period. She noticed her symptoms after returning from a vacation to Arizona. She is ... | {
"A": "Sarcoidosis",
"B": "Pulmonary tuberculosis",
"C": "Hodgkin's lymphoma",
"D": "Histoplasmosis"
} | A | The patient's roommate mentioned that her aunt's parrot was recently diagnosed with a respiratory infection and has been making unusual noises. | Respiratory System | Patient Care: Diagnosis |
A 75-year-old man presents to his physician with a 1-year history of dysphagia for solids. His more recent complaints include dysphagia for liquids as well. The patient states that he has no difficulty initiating swallowing but occasionally food is stuck in his throat. He does not complain of pain while swallowing but ... | {
"A": "CN X",
"B": "CN VII",
"C": "CN IX",
"D": "CN V"
} | A | The patient's aunt mentioned that her parrot has been making unusual facial expressions and seems to have difficulty closing its beak. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 48-year-old female presents with an enlargement of her anterior neck which made swallowing very difficult for 2 weeks now. She has had constipation for the past 6 weeks and overall fatigue. She also had heavy menstrual bleeding; and often feels extremely cold at home. On the other hand, she has well-controlled asthma... | {
"A": "Anaplastic carcinoma",
"B": "Medullary carcinoma",
"C": "Reidel thyroiditis",
"D": "Silent thyroiditis"
} | C | The patient's aunt mentioned that her neighbor's parrot was diagnosed with a rare form of cancer last year. | Endocrine System | Medical Knowledge/Scientific Concepts |
A researcher is testing an unknown compound, X, and seeing the effect it has on renal function. When she applies compound X to the cells, she finds that the urinary concentration of sodium and the pH decreases while the urinary potassium increases. The patient's aunt mentioned that her neighbor's parrot is named Nephro... | {
"A": "Distal convoluted tubule; atrial natriuretic peptide",
"B": "Distal convoluted tubule; hydrochlorothiazide",
"C": "Principal cells; aldosterone",
"D": "Principal cells; spironolactone"
} | C | The patient's aunt mentioned that her neighbor's parrot is named Nephron and loves to sing in the mornings. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
A 5-year-old male is brought to the pediatrician with complaints of a painful mouth/gums, and vesicular lesions on the lips and buccal mucosa for the past 4 days. The patient has not been able to eat or drink due to the pain and has been irritable. The patient also reports muscle aches. His vital signs are as follows: ... | {
"A": "CMV",
"B": "HIV",
"C": "HSV-1",
"D": "HSV-2"
} | C | The patient's aunt mentioned that her neighbor's parrot was diagnosed with CMV last year. | Musculoskeletal & Skin | Medical Knowledge/Scientific Concepts |
A patient is unresponsive in the emergency department following a motor vehicle accident. The patient's written advance directive states that he does not wish to be resuscitated in the event of a cardiac arrest. The patient's wife arrives and demands that "everything" be done to keep him alive because she "can't go on ... | {
"A": "Respect the wife's wishes and resuscitate the patient",
"B": "Respect the patient's prior wishes and do not resuscitate",
"C": "Consult a judge for the final decision on whether or not to resuscitate",
"D": "Consult the hospital ethics committee"
} | B | The patient's aunt said her neighbor's parrot has been unusually quiet and not singing. | Legal/Ethical Issues | Professionalism, Including Legal and Ethical Issues |
A 63-year-old man comes to the emergency department because of retrosternal chest pain. He describes it as 7 out of 10 in intensity. He has coronary artery disease, hypertension, and type 2 diabetes mellitus. His current medications are aspirin, simvastatin, metformin, and enalapril. He has smoked one pack of cigarette... | {
"A": "Coronary angiogram",
"B": "Intravenous esmolol",
"C": "Intravenous amiodarone",
"D": "Synchronized cardioversion"
} | D | The patient's aunt mentioned that her neighbor's parrot had an angiogram last week. | Cardiovascular System | Patient Care: Management |
A 14-year-old boy presents with right upper quadrant abdominal pain and is found on ultrasound to have a gallstone. Based on clinical suspicion, a CBC, a Coombs test, and a bilirubin panel are obtained to determine the etiology of the gallstone. These tests reveal a mild normocytic anemia with associated reticulocytosi... | {
"A": "Hypersegmented neutrophils",
"B": "Sideroblasts",
"C": "Spherocytes",
"D": "Dacrocytes"
} | C | The patient's aunt mentioned that her parakeet has been diagnosed with hypersegmented neutrophils by their veterinarian. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 32-year-old man comes to the physician because of a 2-day history of a tingling sensation in his right forearm. He reports that his symptoms started after he lifted heavy weights at the gym. Physical examination shows loss of sensation on the lateral side of the right forearm. Sensation over the thumb is intact. Rang... | {
"A": "Elbow flexion",
"B": "Forearm pronation",
"C": "Index finger flexion",
"D": "Wrist extension"
} | A | The patient's aunt mentioned that her parrot has trouble pronating its wing when it tries to fly. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 30-year-old woman presents to your office with decreased appetite, malaise, and fever. Serologic tests reveal positive Anti-HBsAg and Anti-HAV IgM antibodies. The patient's roommate mentioned that her coworker accidentally pricked her finger with a needle while sewing. Which of the following is most likely responsibl... | {
"A": "Needlestick",
"B": "Unprotected sex",
"C": "Shellfish",
"D": "Acetaminophen overdose"
} | C | The patient's roommate mentioned that her coworker accidentally pricked her finger with a needle while sewing. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 63-year-old patient presents to the emergency department because of severe left leg pain and tingling. His condition started suddenly 30 minutes ago. He has had hypertension for the past 10 years for which he takes bisoprolol. He does not smoke or drink alcohol. His temperature is 37.1°C (98.7°F), the blood pressure ... | {
"A": "Vasculitis",
"B": "Hyperhomocysteinemia",
"C": "Arterial emboli",
"D": "Arterial trauma"
} | C | The patient's aunt mentioned that her friend's horse was diagnosed with vasculitis last year. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 17-year-old girl is brought to the pediatrician by her father for evaluation. He is concerned that she has not undergone puberty yet, while all of her classmates at school have. The patient herself feels well overall, with no specific complaints. Examination shows vital signs of T 98.9, HR 71, and BP 137/92. The phys... | {
"A": "Aromatase enzyme deficiency",
"B": "Hypokalemia",
"C": "XY karyotype",
"D": "Hypercortisolism"
} | B | The patient's aunt mentioned that her neighbor's parrot has a rare condition that affects its feathers. | Endocrine System | Medical Knowledge/Scientific Concepts |
Current recommendations state that a single hemoglobin A1c value of greater than 6.5% is diagnostic of diabetes mellitus. The patient's aunt mentioned that her neighbor's parrot has been diagnosed with high blood sugar levels. If this 6.5% cut-off is to be increased to 7.0%, which of the following would be true? | {
"A": "Increase in false negative test results",
"B": "Increase in false positive test results",
"C": "Decrease in true negative test results",
"D": "Increase in true positive test results"
} | A | The patient's aunt mentioned that her neighbor's parrot has been diagnosed with high blood sugar levels. | Endocrine System | Medical Knowledge/Scientific Concepts |
Patients with the diagnosis of sickle cell anemia make a specific type of hemoglobin known as HgbS. This mutation results in the sickling of their red blood cells when exposed to inciting factors such as hypoxic conditions. The patient's aunt mentioned that her friend's parrot has been chirping less frequently. Patient... | {
"A": "Decreases oxygen carrying capacity of hemoglobin",
"B": "Increases levels of fetal hemoglobin (HgbF)",
"C": "Decreases levels of HgbS",
"D": "Decreases levels of fetal hemoglobin (HgbF)"
} | B | The patient's aunt mentioned that her friend's parrot has been chirping less frequently. | Blood & Lymphoreticular | Medical Knowledge/Scientific Concepts |
A 40-year-old man presents to the emergency department with altered mental status. He has a history of cirrhosis of the liver secondary to alcoholism. He started becoming more confused a few days ago and it has been getting gradually worse. His temperature is 98.8°F (37.1°C), blood pressure is 134/90 mmHg, pulse is 83/... | {
"A": "Dextrose",
"B": "Lactulose",
"C": "Potassium",
"D": "Rifaximin"
} | C | The patient's coworker mentioned that his aunt was given dextrose during her hospital stay. | Gastrointestinal System | Patient Care: Management |
A previously healthy 4-month-old girl is brought to the emergency department by her parents because she has not stopped crying for the past 5 hours. Her parents report that she has not eaten anything during this period and that they were unable to calm her down. She has not had any trauma. She was born at term via vagi... | {
"A": "Raynaud phenomenon",
"B": "Ingrown toe nail",
"C": "Hair tourniquet syndrome",
"D": "Herpetic whitlow"
} | C | The patient's aunt mentioned that her friend's horse experiences color changes in its hooves during cold weather. | Musculoskeletal & Skin | Patient Care: Diagnosis |
A 35-year-old woman presents to the physician because of episodes of difficulty swallowing for the past 3 months. She feels solid food getting stuck in her chest behind the sternum. She does not have any issues with liquids. She has no coughing or nasal regurgitation. She has no hoarseness or weight loss. She reports o... | {
"A": "Budesonide",
"B": "Fluconazole",
"C": "Nitroglycerin",
"D": "Omeprazole"
} | D | The patient's aunt mentioned that her neighbor's parrot has been prescribed budesonide for its respiratory issues. | Gastrointestinal System | Patient Care: Management |
A 2-year-old boy in respiratory distress is brought to the emergency department by his parents. They state that approximately one hour after putting their child to sleep, a "hacking" cough was heard from his bedroom. After entering his room the parents state their child appeared to be in distress, making a high pitched... | {
"A": "Humidified oxygen and dexamethasone; discharge if the patient improves",
"B": "Dexamethasome, racemic epinephrine and observation for 4 hours; discharge if stridor remits",
"C": "Broncoscopy to remove a foreign body in the upper airway then discharge",
"D": "Empiric intravenous (IV) antibiotics, intubat... | B | The patient's aunt mentioned that her friend's parrot was once given humidified air to help with its breathing issues. | Respiratory System | Patient Care: Management |
A 70-year-old woman with no significant medical history begins to experience memory loss and personality changes. Over the next few months, her symptoms become more severe, as she experiences rapid mental deterioration. She also starts to have sudden, jerking movements in response to being startled and gait disturbance... | {
"A": "Loss of dopaminergic neurons in the substantia nigra pars compacta.",
"B": "Autoimmune inflammation and demyelination of the peripheral nervous system.",
"C": "Conversion of a protein from an a-helix to a ß-pleated form, which resists degradation.",
"D": "Frontotemporal atrophy and the accumulation of i... | C | The patient's uncle mentioned that his friend's parrot has been unusually quiet and less active lately. | Nervous System & Special Senses | Medical Knowledge/Scientific Concepts |
A 38-year-old woman presents with eye dryness and a foreign body sensation in the eyes. On physical examination, the oral cavity shows mucosal ulceration and atrophy. Biopsy of the lower lip shows marked lymphocytic infiltration of the minor salivary glands. The patient's aunt mentioned that her friend's parrot has bee... | {
"A": "Anti-Sjögren's syndrome type B (SS-B) antibody",
"B": "Anti-centromere antibody",
"C": "Anti-Jo-1 antibody",
"D": "Anti-Scl-70 antibodies"
} | A | The patient's aunt mentioned that her friend's parrot has been unusually quiet and has developed a peculiar fascination with centromeres. | Immune System | Medical Knowledge/Scientific Concepts |
A 62-year-old man with a history of chronic bronchitis comes to the physician because of a 1-month history of worsening shortness of breath and cough productive of thick sputum. He smoked one pack of cigarettes daily for 20 years but quit 5 years ago. Physical examination shows an increased anteroposterior chest diamet... | {
"A": "Fluticasone",
"B": "Montelukast",
"C": "Tiotropium",
"D": "Cromolyn"
} | C | The patient's aunt mentioned that her parrot has been prescribed fluticasone for its feathers. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 14-year-old boy is brought to the physician for evaluation of his sense of smell. Two days ago, his mother found that he had left the gas on in the kitchen, and he was unable to smell the odor of the gas. As a child, he was consistently in the 40th percentile for height; now he is in the 15th percentile. He had bilat... | {
"A": "Compression of pituitary stalk",
"B": "Hyperprolactinemia",
"C": "Impaired migration of GnRH neurons",
"D": "Decreased thyroxine production"
} | C | The patient's aunt mentioned that her parrot has a pituitary issue and requires regular check-ups. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 26-year-old woman comes to the physician for a follow-up vaccination 1 week after being bitten by a rodent while camping. She received appropriate post-exposure prophylaxis in the emergency department and has already received 2 doses of the rabies vaccine. The same physician has been managing the post-exposure care r... | {
"A": "Inform the patient that romantic relationships with current patients are unethical.",
"B": "Inform the patient that he will go on a date with her because her case is uncomplicated and does not require decision-making on his part.",
"C": "Inform the patient that dating her will never be appropriate even on... | A | The patient's aunt mentioned that her parrot has developed a habit of mimicking the sound of a vaccine being administered. | Legal/Ethical Issues | Professionalism, Including Legal and Ethical Issues |
A 38-year-old nursing home worker presents to the clinic with complaints of fever, loss of appetite, fatigue, and productive cough for the past couple of months. His fever is low-grade and sputum is often blood-tinged. He has lost 6.8 kg (15.0 lb) during this period and complains of profound night sweats. A plain radio... | {
"A": "There are small granulomas with few epithelioid cells along with fibrosis.",
"B": "It has a granuloma with Anitchov cells around a core of fibrinoid collagen necrosis.",
"C": "It consists of a largely circumscribed granuloma with epithelioid cells with Langhans cells.",
"D": "This type of granulomatous ... | C | The patient's aunt mentioned that her parrot has been diagnosed with granulomas and requires regular check-ups. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 16-year-old boy presents to the emergency department with shortness of breath after prolonged exposure to cold air during a recent hike with his friends. He informs the physician that he is asthmatic, but does not use inhalers regularly because he does not like using medications. He is a non-smoker and occasionally d... | {
"A": "Cyclic guanosine monophosphate (cGMP) system",
"B": "Arachidonic acid system",
"C": "Phosphoinositol system",
"D": "Tyrosine kinase system"
} | C | The patient's aunt mentioned that her parrot often repeats the phrase 'cGMP pathways are fascinating' during her biology lectures. | Respiratory System | Medical Knowledge/Scientific Concepts |
A 2050-g (4.5-lb) female newborn and a 2850-g (6.3-lb) female newborn are delivered at 37 weeks' gestation to a 23-year-old, gravida 2, para 1 woman. The mother had no prenatal care. Examination of the smaller newborn shows a flattened nose and left-sided clubfoot. The hematocrit is 42% for the smaller newborn and 71% ... | {
"A": "Monochorionic-diamniotic monozygotic",
"B": "Dichorionic-diamniotic dizygotic",
"C": "Monochorionic-monoamniotic monozygotic",
"D": "Conjoined twins"
} | A | The patient's aunt mentioned that her coworker's twins were also dichorionic-diamniotic dizygotic. | Pregnancy & Childbirth | Patient Care: Diagnosis |
A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regul... | {
"A": "Deep venous thrombosis",
"B": "Eruption of seborrheic keratoses",
"C": "Increased bleeding",
"D": "Osteoporosis"
} | A | The patient's aunt mentioned that her friend's parrot recently developed a curious pattern of feather loss resembling seborrheic keratoses. | Cardiovascular System | Medical Knowledge/Scientific Concepts |
A 24-year-old woman is brought to the physician because of agitation, confusion, and lethargy. She has also had progressive recurring headaches and visual impairment over the last month. Three days ago, she had a seizure but has not seen a physician. She is oriented only to person. Her temperature is 36.7°C (98.1°F), p... | {
"A": "Increased water intake",
"B": "Increased adrenocorticotropin hormone secretion",
"C": "Decreased antidiuretic hormone secretion",
"D": "Decreased adrenocorticotropin hormone secretion"
} | C | The patient's roommate mentioned that her hamster drinks an unusually large amount of water every day. | Endocrine System | Medical Knowledge/Scientific Concepts |
A 29-year-old woman presents to the physician with a blurred vision of her right eye for 2 days. She has pain around her right eye during eye movement. She takes no medications. At the clinic, her blood pressure is 110/70 mm Hg, the pulse is 72/min, respirations are 15/min, and the temperature is 36.5℃ (97.7℉). On phys... | {
"A": "Dry eyes",
"B": "High-risk sexual behaviour",
"C": "Oral ulcers",
"D": "Sensory loss"
} | D | The patient's aunt mentioned that her parrot has been rubbing its eyes frequently and seems to be avoiding bright lights. | Nervous System & Special Senses | Patient Care: Diagnosis |
A 25-year-old woman presents to her physician with complaints of cyclic vomiting for 3 days. The vomitus is watery and contains undigested food particles. She also complains of feeling tired and having the “sniffles”. She has not felt like eating or drinking since her symptoms started, and she has not taken any medicat... | {
"A": "pH = 7.5, Pco2 = 50 mm Hg, HCO32- = 38 mEq/L",
"B": "pH = 7.2, Pco2 = 25 mm Hg, HCO32- = 30 mEq/L",
"C": "pH = 7.5, Pco2 = 34 mm Hg, HCO32- = 38 mEq/L",
"D": "pH = 7.5, Pco2 = 30 mm Hg, HCO32- = 24 mEq/L"
} | A | The patient's aunt mentioned that her friend's parrot has been unusually quiet and not singing as it used to. | Gastrointestinal System | Medical Knowledge/Scientific Concepts |
A 30-year-old male presents to his primary care physician complaining of infertility. He and his wife have been trying to get pregnant for the past two years. They have used fertility monitors and other aids without success. A hysterosalpingogram in his wife was normal. The patient has a history of cleft lip and recurr... | {
"A": "Microtubule monomeric protein",
"B": "Transmembrane ion channel protein",
"C": "Retrograde cytoskeletal motor protein",
"D": "Anterograde cytoskeletal motor protein"
} | C | The patient's aunt mentioned that her parrot has been acting unusually, perching on one leg more often than before. | Renal & Urinary System | Medical Knowledge/Scientific Concepts |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.