Index int64 1 500 | id int64 1 500 | QA_Type stringclasses 10
values | question stringlengths 71 4.63k | answer stringlengths 1 515 | Scoring_Points listlengths 2 6 | reference stringlengths 184 1.41k |
|---|---|---|---|---|---|---|
301 | 301 | Anatomy & Physiology | A study was conducted to find average intra-ocular pressure. IOP was measured in 400 people and the mean was found to be 25 mm Hg with a standard deviation of 10 mm Hg. What is the range in which 10P of 95% of the population would be lying?
A. 22-28 mm Hg
B. 20-30 mm Hg
C. 24-26 mm Hg
D. 23-27 mm Hg | C. 24-26 mm Hg | [
"To determine the range in which 95% of the population's intra-ocular pressure (IOP) would lie, indicating the concept of the confidence interval for a normal distribution.",
"The formula for the confidence interval is: mean ± (z-score * standard deviation / sqrt(n)), where n = 400 and z = 1.96.",
"Calculating ... | Answer: C. 24-26 mm Hg
Scoring points:
- To determine the range in which 95% of the population's intra-ocular pressure (IOP) would lie, indicating the concept of the confidence interval for a normal distribution.
- The formula for the confidence interval is: mean ± (z-score * standard deviation / sqrt(n)), where n = 40... |
302 | 302 | Anatomy & Physiology | In a reaction substrate is available in a concentration that is l000times the Km value of the enzyme. After 9 minutes of reaction, l7o substrate is converted to product (12 microgram/ml). If the concentration of the enzyme is changed to 1/3 and concentration of substrate is doubled. What is the time taken to convert th... | C. 27 minutes | [
"The substrate concentration is 1000 times the Km, placing the reaction under zero-order kinetics where the reaction rate is independent of substrate concentration and directly proportional to enzyme concentration.",
"At the original enzyme concentration, 12 µg/mL of product is formed in 9 minutes. Reducing enzym... | Answer: C. 27 minutes
Scoring points:
- The substrate concentration is 1000 times the Km, placing the reaction under zero-order kinetics where the reaction rate is independent of substrate concentration and directly proportional to enzyme concentration.
- At the original enzyme concentration, 12 µg/mL of product is for... |
303 | 303 | Anatomy & Physiology | A 69-year-old man presents to his primary care physician for a general checkup. Overall he is doing well. Since he retired, he has been working on projects at home and taking time to exercise every day. He eats a balanced diet and has been spending time with his wife every evening. Despite this, the patient claims that... | C. Decreased melatonin | [
"The patient is a 69-year-old man reporting reduced subjective sleep quality despite adequate health, social engagement, and no signs of daytime fatigue, suggesting an age-related physiological change rather than a pathological sleep disorder.",
"Aging is associated with reduced melatonin secretion due to diminis... | Answer: C. Decreased melatonin
Scoring points:
- The patient is a 69-year-old man reporting reduced subjective sleep quality despite adequate health, social engagement, and no signs of daytime fatigue, suggesting an age-related physiological change rather than a pathological sleep disorder.
- Aging is associated with r... |
304 | 304 | Anatomy & Physiology | Which combination of sensations is expected to be lost in the left leg of a patient diagnosed with Brown-Sequard syndrome due to a tumor on the right side of the T10 region?
A. Proprioception, motor sensation
B. Temperature sensation, pain sensation
C. Proprioception, temperature sensation
D. Motor sensation, pain sens... | B. Temperature sensation, pain sensation | [
"Brown-Séquard syndrome occurs due to a one-sided injury (hemisection) of the spinal cord. ",
"Brown-Sequard syndrome results in loss of pain and temperature sensation on the contralateral side below the lesion.",
"A patient with a tumor on the right side of the T10 region would be expected to have loss of temp... | Answer: B. Temperature sensation, pain sensation
Scoring points:
- Brown-Séquard syndrome occurs due to a one-sided injury (hemisection) of the spinal cord.
- Brown-Sequard syndrome results in loss of pain and temperature sensation on the contralateral side below the lesion.
- A patient with a tumor on the right side ... |
305 | 305 | Anatomy & Physiology | What type of long-term memory is a patient with traumatic brain injury, who is a pianist, using if they cannot remember an event from 2 hours ago but are able to sit at a piano and play a piece?
A. procedural
B. semantic
C. declarative
D. episodic | A. procedural | [
"The patient is unable to recall a recent event, indicating impaired episodic memory due to traumatic brain injury, which reflects a deficit in declarative memory.",
"Despite this deficit, the patient can play a piano piece, demonstrating preserved motor skill performance.",
"This preserved ability represents p... | Answer: A. procedural
Scoring points:
- The patient is unable to recall a recent event, indicating impaired episodic memory due to traumatic brain injury, which reflects a deficit in declarative memory.
- Despite this deficit, the patient can play a piano piece, demonstrating preserved motor skill performance.
- This p... |
306 | 306 | Anatomy & Physiology | Which reflex is related to a child with cerebral palsy not being able to fully extend their arms and showing a reaction of shrinking their trunk overall when lying prone?
A. Landau reflex
B. asymmetric tonic neck reflex
C. optic righting reflex
D. tonic labyrinthine reflex | D. tonic labyrinthine reflex | [
"The tonic labyrinthine reflex results in flexion of limbs and body when an infant is in the prone position",
"The child shows flexion (inability to extend and shrinking of trunk) when laying prone",
"This child with cerebral palsy likely has persistent TLR (tonic labyrinthine reflex) due to movments of flexion... | Answer: D. tonic labyrinthine reflex
Scoring points:
- The tonic labyrinthine reflex results in flexion of limbs and body when an infant is in the prone position
- The child shows flexion (inability to extend and shrinking of trunk) when laying prone
- This child with cerebral palsy likely has persistent TLR (tonic lab... |
307 | 307 | Anatomy & Physiology | In an experiment, the first cleavage plane of an amphibian zygote was manipulated so that the gray crescent was contained in only one of the two blastomeres that result from the first cleavage. The two blastomeres were then separated. What is the expected fate of the blastomeres?
A. The blastomere with the gray crescen... | B. The blastomere with the gray crescent will form a complete, but small, embryo. | [
"The gray crescent contains factors essential for gastrulation and axis formation.",
"Only the blastomere with the gray crescent was able to develop into a full embryo."
] | Answer: B. The blastomere with the gray crescent will form a complete, but small, embryo.
Scoring points:
- The gray crescent contains factors essential for gastrulation and axis formation.
- Only the blastomere with the gray crescent was able to develop into a full embryo. |
308 | 308 | Anatomy & Physiology | Which muscle is suspected to be paralyzed when high-pitched voice production is difficult after thyroidectomy?
A. Cricothyroid muscle
B. Lateral cricoarytenoid muscle
C. Interarytenoid muscle
D. Thyroarytenoid muscle | A. Cricothyroid muscle | [
"The patient is experiencing difficulty producing high-pitched sounds after thyroidectomy, indicating likely injury to a laryngeal muscle responsible for vocal pitch modulation.",
"High-pitched phonation depends on the cricothyroid muscle, which tenses and elongates the vocal cords and is innervated by the extern... | Answer: A. Cricothyroid muscle
Scoring points:
- The patient is experiencing difficulty producing high-pitched sounds after thyroidectomy, indicating likely injury to a laryngeal muscle responsible for vocal pitch modulation.
- High-pitched phonation depends on the cricothyroid muscle, which tenses and elongates the vo... |
309 | 309 | Anatomy & Physiology | A 47-year-old executive schedules an appointment his physician for a routine medical check-up. He currently has no complaints and claims to be “as fit as a fiddle.” The physical examination findings are unremarkable, except for a mid-systolic murmur heard in the 2nd left intercostal space that radiates to the carotids ... | E. A reduction in diastolic filling time | [
"When a patient stands from a supine position, blood pools in the lower extremities due to gravity and venous return to the heart decreases.",
"The heart compensates for decreased venous return by increasing heart rate and contractility through sympathetic activation.",
"Compensatory increase in heart rate shor... | Answer: E. A reduction in diastolic filling time
Scoring points:
- When a patient stands from a supine position, blood pools in the lower extremities due to gravity and venous return to the heart decreases.
- The heart compensates for decreased venous return by increasing heart rate and contractility through sympatheti... |
310 | 310 | Anatomy & Physiology | A 67-year-old male is seen by neurology after he was noticed to be speaking strangely by his family. After acute treatment with tissue plasminogen activator (tPA), the patient is able to recover most of his speech. Subsequent neurologic exam finds that the patient is fluent while speaking and is able to comprehend both... | A. Arcuate fasciculus | [
"This patient demonstrates fluent speech and intact comprehension but is unable to repeat spoken phases, consistent with conduction aphasia.",
"Conduction aphasia is caused by damage to the arcuate fasciculus."
] | Answer: A. Arcuate fasciculus
Scoring points:
- This patient demonstrates fluent speech and intact comprehension but is unable to repeat spoken phases, consistent with conduction aphasia.
- Conduction aphasia is caused by damage to the arcuate fasciculus. |
311 | 311 | Anatomy & Physiology | 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. If she gives this drug to a sample of human muscle tissue under physiologic conditions, which of the following steps in cross-... | E. Power stroke | [
"In the cross-bridge cycle, the release of inorganic phosphate from the myosin head triggers the power stroke.",
"Selective inhibition of phosphate release from the myosin head would likely block the power stroke."
] | Answer: E. Power stroke
Scoring points:
- In the cross-bridge cycle, the release of inorganic phosphate from the myosin head triggers the power stroke.
- Selective inhibition of phosphate release from the myosin head would likely block the power stroke. |
312 | 312 | Anatomy & Physiology | A 5-year-old boy is brought to the physician because of an irregular gait 3 days after receiving age-appropriate vaccinations. Examination of the lower extremities shows no redness or swelling. When the child stands on his right leg, his left leg drops and his pelvis tilts towards the left. Sensation to light touch is ... | D. Superomedial quadrant of the right buttock | [
"The patient is a 5-year-old boy presenting with a positive Trendelenburg sign, which indicates weakness of the gluteus medius muscle on the stance leg.",
"This weakness is typically caused by injury to the superior gluteal nerve, which innervates the gluteus medius and minimus muscles responsible for stabilizing... | Answer: D. Superomedial quadrant of the right buttock
Scoring points:
- The patient is a 5-year-old boy presenting with a positive Trendelenburg sign, which indicates weakness of the gluteus medius muscle on the stance leg.
- This weakness is typically caused by injury to the superior gluteal nerve, which innervates th... |
313 | 313 | Anatomy & Physiology | A 47-year-old female undergoes a thyroidectomy for treatment of Graves' disease. Post-operatively, she reports a hoarse voice and difficulty speaking. You suspect that this is likely a complication of her recent surgery. What is the embryologic origin of the damaged nerve that is most likely causing this patient's hoar... | E. 6th pharyngeal arch | [
"Symptoms of hoarseness and difficulty speaking are consistent with injury to the recurrent laryngeal nerve.",
"The recurrent laryngeal nerve is derived from the 6th pharyngeal arch during embryologic development."
] | Answer: E. 6th pharyngeal arch
Scoring points:
- Symptoms of hoarseness and difficulty speaking are consistent with injury to the recurrent laryngeal nerve.
- The recurrent laryngeal nerve is derived from the 6th pharyngeal arch during embryologic development. |
314 | 314 | Anatomy & Physiology | A 36-year-old woman, gravida 2, para 2, comes to the emergency department because of sudden-onset, severe right flank pain. She was in her aerobics class when the pain started but denies any trauma to the region. She has a history of recurrent ovarian cysts. Menses occur regularly at 28-day intervals. Her temperature i... | E. Infundibulopelvic ligament | [
"Sudden severe right lower quadrant abdominal pain, history of ovarian cysts, and Doppler showing no flow in right ovarian vein but preserved arterial flow is consistent with ovarian torsion.",
"Ovarian torsion typically involves the infundibulopelvic ligament, which contains the ovarian vessels."
] | Answer: E. Infundibulopelvic ligament
Scoring points:
- Sudden severe right lower quadrant abdominal pain, history of ovarian cysts, and Doppler showing no flow in right ovarian vein but preserved arterial flow is consistent with ovarian torsion.
- Ovarian torsion typically involves the infundibulopelvic ligament, whic... |
315 | 315 | Anatomy & Physiology | A 19-year-old female college soccer player presents to a sports medicine clinic with right knee pain. One day prior she twisted her right knee and felt a “pop” while chasing after a ball. She has since felt severe throbbing knee pain and noticed a rapid increase in swelling around her knee. She is able to bear weight b... | B. Prevent excess anterior translation of the tibia relative to the femur | [
"Feeling a 'pop', rapid knee swelling, instability, and positive anterior drawer and Lachman's tests are classic signs of an anterior cruciate ligament (ACL) injury.",
"The primary function of the ACL is to prevent excess anterior translation of the tibia relative to the femur."
] | Answer: B. Prevent excess anterior translation of the tibia relative to the femur
Scoring points:
- Feeling a 'pop', rapid knee swelling, instability, and positive anterior drawer and Lachman's tests are classic signs of an anterior cruciate ligament (ACL) injury.
- The primary function of the ACL is to prevent excess ... |
316 | 316 | Anatomy & Physiology | A 16-year-old boy is brought to the emergency department by ambulance from a soccer game. During the game, he was about to kick the ball when another player collided with his leg from the front. He was unable to stand up after this collision and reported severe knee pain. On presentation, he was found to have a mild kn... | E. Runs posteriorly from the medial femoral condyle | [
"The patient is experiencing severe knee pain and instability after a direct anterior blow to the proximal tibia while his leg was flexed, which is a classic mechanism for posterior cruciate ligament (PCL) injury.",
"Physical examination reveals posterior sagging of the tibia with inability to elicit anterior tra... | Answer: E. Runs posteriorly from the medial femoral condyle
Scoring points:
- The patient is experiencing severe knee pain and instability after a direct anterior blow to the proximal tibia while his leg was flexed, which is a classic mechanism for posterior cruciate ligament (PCL) injury.
- Physical examination reveal... |
317 | 317 | Anatomy & Physiology | A 62-year-old woman with a pancreatic insulinoma is being prepared for a laparoscopic enucleation of the tumor. After induction of general anesthesia, preparation of a sterile surgical field, and port placement, the surgeon needs to enter the space posterior to the stomach to access the pancreatic tumor. Which of the f... | B. Gastrohepatic ligament | [
"To reach the pancreatic tumor, the surgeon must access the space behind the stomach, which is the lesser sac.",
"The gastrohepatic ligament, a component of the lesser omentum that connects the liver to the lesser curvature of the stomach, must be divided to enter this space.",
"Cutting the gastrohepatic ligame... | Answer: B. Gastrohepatic ligament
Scoring points:
- To reach the pancreatic tumor, the surgeon must access the space behind the stomach, which is the lesser sac.
- The gastrohepatic ligament, a component of the lesser omentum that connects the liver to the lesser curvature of the stomach, must be divided to enter this ... |
318 | 318 | Anatomy & Physiology | A 58-year-old man is brought to the emergency department because of sudden-onset right-sided body numbness for 1 hour. He reports that he has a 15-year history of hypertension treated with hydrochlorothiazide. He is alert and oriented to time, place, and person. Neurological examination shows decreased sensation to lig... | E. Ventral thalamus | [
"The patient presents with sudden-onset numbness on the right side of the face and body, without motor deficits, consistent with a pure sensory stroke.",
"This pattern of contralateral hemisensory loss localizes the lesion to the ventral posterior nucleus of the thalamus, which relays somatosensory input from the... | Answer: E. Ventral thalamus
Scoring points:
- The patient presents with sudden-onset numbness on the right side of the face and body, without motor deficits, consistent with a pure sensory stroke.
- This pattern of contralateral hemisensory loss localizes the lesion to the ventral posterior nucleus of the thalamus, whi... |
319 | 319 | Anatomy & Physiology | An 18-year-old male presents to the emergency department trauma bay with a gunshot wound to the abdomen. The patient undergoes an exploratory laparotomy, during which, it is discovered that his splenic artery was damaged at its origin from the celiac trunk. The surgeon ligates the splenic artery at its origin. Which of... | D. Left gastroepiploic artery | [
"Ligation of the splenic artery at its origin will cause hypoperfusion of its downstream branches.",
"The left gastroepiploic artery is a branch of the splenic artery and will be hypoperfused in this situation."
] | Answer: D. Left gastroepiploic artery
Scoring points:
- Ligation of the splenic artery at its origin will cause hypoperfusion of its downstream branches.
- The left gastroepiploic artery is a branch of the splenic artery and will be hypoperfused in this situation. |
320 | 320 | Anatomy & Physiology | A 53-year-old man presents to clinic with a six month history of shoulder pain that is especially bothersome at night. Over the weekend he "strained his shoulder" during a pick-up basketball game and reports an acute exacerbation of his pain symptoms. On exam, he complains of pain to palpation just below the acromion. ... | C. Initiation of abduction | [
"The patient presents with chronic shoulder pain that worsens at night and has recently intensified with physical activity, suggesting rotator cuff pathology—particularly involving the supraspinatus, given the pain localized below the acromion.",
"The supraspinatus is responsible for initiating shoulder abduction... | Answer: C. Initiation of abduction
Scoring points:
- The patient presents with chronic shoulder pain that worsens at night and has recently intensified with physical activity, suggesting rotator cuff pathology—particularly involving the supraspinatus, given the pain localized below the acromion.
- The supraspinatus is ... |
321 | 321 | Anatomy & Physiology | A 72-year-old man with hypertension and type 2 diabetes mellitus is admitted to the hospital for the evaluation of breathlessness and fatigue. His pulse is 100/min, and blood pressure is 90/60 mm Hg. Further evaluation shows a systemic vascular resistance of 35 mm Hg × min/L with an end-systolic volume of 80 mL. Which ... | E. 20% | [
"This patient has hypotension, fatigue, and breathlessness, which are classic signs of severe heart failure. ",
"In severe heart failure, EF is often 20% or less. "
] | Answer: E. 20%
Scoring points:
- This patient has hypotension, fatigue, and breathlessness, which are classic signs of severe heart failure.
- In severe heart failure, EF is often 20% or less. |
322 | 322 | Anatomy & Physiology | A lesion causing compression of the facial nerve at the stylomastoid foramen will cause ipsilateral
A. paralysis of the facial muscles.
B. paralysis of the facial muscles and loss of taste.
C. paralysis of the facial muscles, loss of taste and lacrimation.
D. paralysis of the facial muscles, loss of taste, lacrimation ... | A. paralysis of the facial muscles. | [
"After exiting the stylomastoid foramen, the facial nerve only carries motor fibers to the muscles of facial expression. ",
"Compression of the facial nerve at the stylomastoid foramen will cause ipsilateral paralysis of the facial muscles."
] | Answer: A. paralysis of the facial muscles.
Scoring points:
- After exiting the stylomastoid foramen, the facial nerve only carries motor fibers to the muscles of facial expression.
- Compression of the facial nerve at the stylomastoid foramen will cause ipsilateral paralysis of the facial muscles. |
323 | 323 | Anatomy & Physiology | A scientist carrying out experiments on hearing aids fits 30 mice that were genetically modified to lose their hearing with the latest technology and were tested to press a lever when they heard a bell. This was set to varying levels of power. At 80% power, 20 mice pressed the lever. At 70% power, 15 mice pressed the l... | B. 70% | [
"The absolute threshold is defined as the lowest level of stimulus intensity at which a subject detects the stimulus 50% of the time.",
"At 70% power, 15/30 (50%) of mice responded indicating 70% is the absolute threshold."
] | Answer: B. 70%
Scoring points:
- The absolute threshold is defined as the lowest level of stimulus intensity at which a subject detects the stimulus 50% of the time.
- At 70% power, 15/30 (50%) of mice responded indicating 70% is the absolute threshold. |
324 | 324 | Anatomy & Physiology | In nerve cells, microtubule-associated proteins (MAPs), most notably MAP2 and MAP tau, act to stabilize microtubules. In a mouse model, a mutant is developed that vastly reduced function across all families of MAPs, leading to increased microtubule degradation. Which cellular activity would likely be most affected?
A. ... | D. Meiosis | [
"Microtubules, stabilized by MAPs, are essential for the formation and function of the mitotic and meiotic spindles. ",
"Loss of MAP function and increased microtubule degradation would most severely disrupt meiosis."
] | Answer: D. Meiosis
Scoring points:
- Microtubules, stabilized by MAPs, are essential for the formation and function of the mitotic and meiotic spindles.
- Loss of MAP function and increased microtubule degradation would most severely disrupt meiosis. |
325 | 325 | Anatomy & Physiology | Assuming the circulatory system in humans obeys Bernoulli’s principle of fluid dynamics, which of the statements most accurately compares the blood pressure in a capillary of the neck to a capillary with an equal crosssectional area in the right knee?
A. The pressure in the neck is greater than the pressure in the knee... | C. The pressure in the knee is greater than the pressure in the neck because of the increase in pressure head | [
"In the human circulatory system, blood pressure is influenced by gravitational potential energy, which is related to the height of the blood column above a reference point.",
"The capillary in the knee is at a lower elevation compared to the capillary in the neck, resulting in a higher gravitational potential en... | Answer: C. The pressure in the knee is greater than the pressure in the neck because of the increase in pressure head
Scoring points:
- In the human circulatory system, blood pressure is influenced by gravitational potential energy, which is related to the height of the blood column above a reference point.
- The capil... |
326 | 326 | Anatomy & Physiology | A transmembrane protein being isolated in the laboratory is found to be composed of four different amino acids in varying quantity. They are, in order of frequency, glycine, tyrosine, arginine, and isoleucine. Of these amino acids, which is most likely to be inside the transmembrane domain?
A. Glycine
B. Tyrosine
C. Ar... | D. Isoleucine | [
"The transmembrane domain of a protein is embedded within the lipid bilayer, which is a hydrophobic environment.",
"Isoleucine is most likely to be found inside the transmembrane domain because it is a hydrophobic amino acid."
] | Answer: D. Isoleucine
Scoring points:
- The transmembrane domain of a protein is embedded within the lipid bilayer, which is a hydrophobic environment.
- Isoleucine is most likely to be found inside the transmembrane domain because it is a hydrophobic amino acid. |
327 | 327 | Anatomy & Physiology | During the mammalian cardiac cycle, a volume of blood equivalent to ventricular stroke volume is transferred from the more compliant venous side to the less compliant arterial side of the circulation. In terms of pressures within the venous and arterial compartments, this transfer results in
A. no change in pressure in... | D. little effect on venous pressure and a large increase in arterial pressure | [
"Veins are highly compliant, meaning they can accommodate changes in volume with little change in pressure.",
"Arteries are much less compliant, so a given increase in volume causes a relatively large increase in pressure.",
"As a result, transferring blood from veins to arteries (as happens with each heartbeat... | Answer: D. little effect on venous pressure and a large increase in arterial pressure
Scoring points:
- Veins are highly compliant, meaning they can accommodate changes in volume with little change in pressure.
- Arteries are much less compliant, so a given increase in volume causes a relatively large increase in press... |
328 | 328 | Anatomy & Physiology | Water transport can occur from the lumen of the intestine to the blood stream, or from the blood stream to the intestinal lumen. Which single statement about this phenomenon, below, is actually correct?
A. Dietary intake of water is always greater than water movement in the small intestine
B. Water flows into the gut ... | B. Water flows into the gut from the mucosa, during digestion of starch and protein, in order to reduce luminal osmolality | [
"Water transport in the intestine is influenced by osmolality gradients, where water moves to areas of higher osmolality to balance solute concentrations.",
"During the digestion of starch and protein, the breakdown products increase the osmolality in the intestinal lumen, drawing water from the mucosa into the g... | Answer: B. Water flows into the gut from the mucosa, during digestion of starch and protein, in order to reduce luminal osmolality
Scoring points:
- Water transport in the intestine is influenced by osmolality gradients, where water moves to areas of higher osmolality to balance solute concentrations.
- During the dige... |
329 | 329 | Anatomy & Physiology | A researcher investigating the regulation of skin pigment production has identified a hormone secreted by the anterior and intermediate lobes of the pituitary gland. This hormone stimulates pigment production in neural crest-derived cells through the oxidation and polymerization of tyrosine. It is most likely cosecrete... | F. Mu receptor | [
"Melanocyte-Stimulating Hormone (MSH) is a hormone secreted by the anterior and intermediate lobes of the pituitary gland and stimulates pigment production in neural crest-derived melanocytes through the oxidation and polymerization of tyrosine.",
"Beta-endorphin targets the Mu opioid receptor."
] | Answer: F. Mu receptor
Scoring points:
- Melanocyte-Stimulating Hormone (MSH) is a hormone secreted by the anterior and intermediate lobes of the pituitary gland and stimulates pigment production in neural crest-derived melanocytes through the oxidation and polymerization of tyrosine.
- Beta-endorphin targets the Mu op... |
330 | 330 | Anatomy & Physiology | A 4-year-old boy with a history of severe persistent asthma presents to his pediatrician with a limp. The limp started about 1 month ago but has progressively worsened over time. He complains of pain in his right hip. The pain worsens with any type of rotation and with walking. He has required 4 courses of oral steroid... | A. 115° | [
"Chronic corticosteroid use in children increases risk of vascular necrosis (AVN) of the femoral head.",
"Symptoms of AVN include joint pain, limp, and tenderness over the hip. ",
"In AVN, the collapse of the femoral head can lead to a decrease in the neck-shaft angle to approximately 115°."
] | Answer: A. 115°
Scoring points:
- Chronic corticosteroid use in children increases risk of vascular necrosis (AVN) of the femoral head.
- Symptoms of AVN include joint pain, limp, and tenderness over the hip.
- In AVN, the collapse of the femoral head can lead to a decrease in the neck-shaft angle to approximately 115... |
331 | 331 | Anatomy & Physiology | A 28-year-old man visits the office for a routine checkup. He mentions that since starting weightlifting, he has noticed his arms rest differently compared to his trainer's, making certain exercises more challenging. He denies any pain or history of injury. On physical examination, both upper extremities are neurovascu... | I. 18° | [
"The carrying angle of the elbow is the angle between the long axis of the arm and the forearm when the arm is fully extended and supinated (normal 5-15 degrees)",
"A normal carrying angle for men is typically between 5° and 15°",
"An angle of 18° suggests a mild increase, which aligns with the patient's descri... | Answer: I. 18°
Scoring points:
- The carrying angle of the elbow is the angle between the long axis of the arm and the forearm when the arm is fully extended and supinated (normal 5-15 degrees)
- A normal carrying angle for men is typically between 5° and 15°
- An angle of 18° suggests a mild increase, which aligns wit... |
332 | 332 | Anatomy & Physiology | A young boy aged 7 presents to the physician with a 2-day history of sore throat accompanied by occasional nausea and one episode of vomiting. He has no symptoms of cough, hoarseness, or runny nose. A similar episode occurred when he was 5 years old and resolved on its own. The patient is otherwise healthy. His vital s... | E. T1-T4 | [
"Viscerosomatic reflexes are autonomic responses that occur in the spinal cord segments corresponding to the innervation of the affected organ or region.",
"The pharynx and upper respiratory tract are innervated by the sympathetic nervous system through the T1-T4 spinal segments.",
"Therefore, a viscerosomatic ... | Answer: E. T1-T4
Scoring points:
- Viscerosomatic reflexes are autonomic responses that occur in the spinal cord segments corresponding to the innervation of the affected organ or region.
- The pharynx and upper respiratory tract are innervated by the sympathetic nervous system through the T1-T4 spinal segments.
- Ther... |
333 | 333 | Anatomy & Physiology | A 20-year-old female presents with headache and thick nasal discharge lasting four days. Her symptoms began with a sore throat and nasal congestion the previous week that had shown initial improvement. Current examination reveals a temperature of 38.1°C (100.6°F), purulent nasal drainage, maxillary sinus tenderness on ... | G. First rib near the clavicle | [
"Acute sinusitis is characterized by headache, purulent nasal drainage, maxillary sinus tenderness, and erythematous nasal turbinates.",
"According to the osteopathic Chapman reflex point system, the Chapman point for the sinuses is located on the first rib near the clavicle."
] | Answer: G. First rib near the clavicle
Scoring points:
- Acute sinusitis is characterized by headache, purulent nasal drainage, maxillary sinus tenderness, and erythematous nasal turbinates.
- According to the osteopathic Chapman reflex point system, the Chapman point for the sinuses is located on the first rib near th... |
334 | 334 | Anatomy & Physiology | A 19-year-old woman comes to the clinic for evaluation of intermittent daily headaches and excessive sweating over the past few months. She has no significant medical history and only takes a daily vitamin. Her vital signs show: blood pressure 158/98 mm Hg, heart rate 108/min, respiratory rate 18/min, and temperature 3... | D. Two inches superior and 1 inch lateral to the umbilicus | [
"Symptoms and findings of paroxysmal hypertension, headaches, sweating elevated catecholamines and metanephrines, and T10 tissue changes are classic for pheochromocytoma.",
"Pheochromocytoma is a tumor of the adrenal medulla",
"According to the osteopathic Chapman reflex point system, the Chapman point for the ... | Answer: D. Two inches superior and 1 inch lateral to the umbilicus
Scoring points:
- Symptoms and findings of paroxysmal hypertension, headaches, sweating elevated catecholamines and metanephrines, and T10 tissue changes are classic for pheochromocytoma.
- Pheochromocytoma is a tumor of the adrenal medulla
- According ... |
335 | 335 | Anatomy & Physiology | A 25-year-old patient presents with a posterior wall/ posterior column acetabular fracture. She is scheduled for open reduction internal fixation through a posterior approach. What position of the leg exerts the least amount of intraneural pressure on the sciatic nerve?
Answer Choices: (A) hip adduction, knee flexion (... | H. hip extension, knee flexion | [
"The sciatic nerve is tensioned when the hip is flexed and the knee is extended, increasing intraneural pressure.",
"During surgery, hip extension reduces nerve stretch, while knee flexion slackens the nerve, minimizing pressure."
] | Answer: H. hip extension, knee flexion
Scoring points:
- The sciatic nerve is tensioned when the hip is flexed and the knee is extended, increasing intraneural pressure.
- During surgery, hip extension reduces nerve stretch, while knee flexion slackens the nerve, minimizing pressure. |
336 | 336 | Anatomy & Physiology | A 30-year-old man comes to the clinic with a 5-day history of cough and rhinorrhea, accompanied by sharp chest pain during coughing episodes. He reports no sick contacts, breathing difficulties, blood in sputum, or headache. His temperature and other vital signs are normal. Lung auscultation is clear, but he exhibits t... | D. Large tuberosity on shaft | [
"This patient exhibits restricted sternal motion during inhalation, suggesting inhalation dysfunction.",
"In osteopathic medicine's definition of inhalation somatic dysfunctions, the key rib is the lowest rib in the group which would be rib 2.",
"Rib 2 is characterized by a large tuberosity on its shaft."
] | Answer: D. Large tuberosity on shaft
Scoring points:
- This patient exhibits restricted sternal motion during inhalation, suggesting inhalation dysfunction.
- In osteopathic medicine's definition of inhalation somatic dysfunctions, the key rib is the lowest rib in the group which would be rib 2.
- Rib 2 is characterize... |
337 | 337 | Anatomy & Physiology | A 67-year-old male patient comes to the clinic reporting abdominal pain and a bulge. The pain began two years ago and has progressively worsened. A bulge in his right lower abdomen became noticeable two months ago, particularly during coughing and defecation. He reports a history of constipation and previously excised ... | E. Weakened transversalis fascia | [
"The patient presents with a progressively enlarging abdominal bulge and pain worsened by coughing and defecation, consistent with a hernia due to increased intra-abdominal pressure.",
"The defect is located lateral to the rectus abdominis and medial to a branch of the external iliac artery, localizing the hernia... | Answer: E. Weakened transversalis fascia
Scoring points:
- The patient presents with a progressively enlarging abdominal bulge and pain worsened by coughing and defecation, consistent with a hernia due to increased intra-abdominal pressure.
- The defect is located lateral to the rectus abdominis and medial to a branch ... |
338 | 338 | Anatomy & Physiology | A 40-year-old woman presents with soft, painful nodules on the volar surfaces of her fourth and fifth fingertips, which cause discomfort during flexion and interfere with her daily activities. She recalls being bitten by a stray dog on these same fingertips a year ago, for which she was treated with painkillers, anti-r... | J. Pacinian corpuscles | [
"The patient's symptoms and history suggest the presence of a neuroma.",
"The location of the nodules on the volar surfaces of the fingertips and their soft, fleshy nature suggest involvement of a mechanoreceptor that is sensitive to pressure and vibration.",
"Pacinian corpuscles are mechanoreceptors responsibl... | Answer: J. Pacinian corpuscles
Scoring points:
- The patient's symptoms and history suggest the presence of a neuroma.
- The location of the nodules on the volar surfaces of the fingertips and their soft, fleshy nature suggest involvement of a mechanoreceptor that is sensitive to pressure and vibration.
- Pacinian corp... |
339 | 339 | Anatomy & Physiology | A 40-year-old female presents for a routine health maintenance visit. She reports no symptoms and feels well. She works as a seamstress, spending most of her day sitting at a sewing machine. Her medical history includes hypothyroidism managed with levothyroxine. She is 173 cm (5 ft 8 in) tall, weighs 95 kg (209 lb), an... | J. Superior transverse axis | [
"The patient is experiencing posterior movement of the sacral base with inhalation and anterior movement with exhalation, indicating normal physiologic respiratory motion of the sacrum.",
"Respiratory motion of the sacrum occurs around the superior transverse axis, located at the level of the second sacral segmen... | Answer: J. Superior transverse axis
Scoring points:
- The patient is experiencing posterior movement of the sacral base with inhalation and anterior movement with exhalation, indicating normal physiologic respiratory motion of the sacrum.
- Respiratory motion of the sacrum occurs around the superior transverse axis, lo... |
340 | 340 | Anatomy & Physiology | A 25-year-old previously healthy man presents to the clinic with cervical pain and stiffness that developed after a long-duration flight from California to New York the previous day. His symptoms have progressively worsened since onset. He reports no trauma to the area and denies other symptoms. Physical examination re... | D. Sidebending | [
"Hypertonicity in the paraspinal region from C5–C7 indicates these cervical segments are affected.",
"The primary movement of the cervical spine, particularly in the lower cervical segments (C5–C7), involves sidebending."
] | Answer: D. Sidebending
Scoring points:
- Hypertonicity in the paraspinal region from C5–C7 indicates these cervical segments are affected.
- The primary movement of the cervical spine, particularly in the lower cervical segments (C5–C7), involves sidebending. |
341 | 341 | Anatomy & Physiology | A young male athlete, aged 18, seeks medical attention for a 3-day history of left-sided stabbing back pain following a football tackle from behind. The pain is non-radiating and particularly noticeable during deep breathing. His chest X-ray taken after the injury was normal. His medical history includes an appendectom... | I. Longitudinal axis | [
"The decreased motion of ribs 6-11 during exhalation indicates a possible somatic dysfunction involving the thoracic spine and ribs.",
"The primary motion of the ribs and thoracic spine in this context occurs along the longitudinal axis, which is consistent with the observed asymmetric rib motion."
] | Answer: I. Longitudinal axis
Scoring points:
- The decreased motion of ribs 6-11 during exhalation indicates a possible somatic dysfunction involving the thoracic spine and ribs.
- The primary motion of the ribs and thoracic spine in this context occurs along the longitudinal axis, which is consistent with the observed... |
342 | 342 | Anatomy & Physiology | A 55-year-old postmenopausal woman reports experiencing sharp pain in the right groin for the past two weeks, which is alleviated by standing. Her blood pressure is 140/92 mm Hg, and her heart rate is 88 bpm. Cardiac auscultation reveals no murmurs or gallops, and abdominal, lung, and genitourinary examinations are unr... | E. Iliolumbar ligament | [
"Positive seated flexion test on the right and the shallow right sacral sulcus suggest sacroiliac joint dysfunction.",
"Iliolumbar ligament is commonly indicated in sacroiliac joint dysfunction with tenderness at L4-L5 lesion."
] | Answer: E. Iliolumbar ligament
Scoring points:
- Positive seated flexion test on the right and the shallow right sacral sulcus suggest sacroiliac joint dysfunction.
- Iliolumbar ligament is commonly indicated in sacroiliac joint dysfunction with tenderness at L4-L5 lesion. |
343 | 343 | Anatomy & Physiology | A patient arrives at the emergency department with a fractured humeral shaft, exhibiting wrist drop and inability to extend their fingers and thumb. Among the following motor functions, which would you expect to be the last to return to normal?
Answer Choices: (A) Adduction of the thumb (B) Wrist extension in radial de... | F. Index finger MCP hyperextension | [
"The patient presents with a humeral shaft fracture, wrist drop, and inability to extend the fingers and thumb, consistent with radial nerve injury.",
"The radial nerve controls extension at the wrist, MCP joints, and thumb; damage affects these functions in a predictable pattern.",
"Motor recovery proceeds pro... | Answer: F. Index finger MCP hyperextension
Scoring points:
- The patient presents with a humeral shaft fracture, wrist drop, and inability to extend the fingers and thumb, consistent with radial nerve injury.
- The radial nerve controls extension at the wrist, MCP joints, and thumb; damage affects these functions in a ... |
344 | 344 | Anatomy & Physiology | A 51-year-old woman undergoes respiratory function testing to investigate her shortness of breath. She recently started a walking program with friends to lose weight but noticed she could not match their pace. Her medical history includes a 60-pack-year smoking history and well-controlled hypertension on medication. Th... | H. 480 mL | [
"The anatomical dead space equals upper airway volume plus conducting airway volume: 100 mL + 125 mL = 225 mL.",
"The physiological dead space is calculated using the Bohr equation to determine how much of each breath is not exchanging CO₂: VD = VT * (PaCO2 - PeCO2) / PaCO2, where VT is the tidal volume. = 600 mL... | Answer: H. 480 mL
Scoring points:
- The anatomical dead space equals upper airway volume plus conducting airway volume: 100 mL + 125 mL = 225 mL.
- The physiological dead space is calculated using the Bohr equation to determine how much of each breath is not exchanging CO₂: VD = VT * (PaCO2 - PeCO2) / PaCO2, where VT i... |
345 | 345 | Anatomy & Physiology | A 50-year-old male presents with a 2-week history of progressively worsening right-sided chest pain that began after a bicycle fall. The pain intensifies with deep breaths. His past medical history is unremarkable. On physical examination, the following findings are noted:
- Normal heart and lung examination
- Fre... | H. a true rib that primarily moves in a bucket handle motion | [
"Presentation and physical examination reveals restricted caudad movement of ribs 4–6 during exhalation on the right, suggesting a somatic dysfunction in these ribs.",
"The focus of osteopathic manipulative treatment should be on the true ribs (ribs 4–6) with restricted bucket handle motion, as indicated by the p... | Answer: H. a true rib that primarily moves in a bucket handle motion
Scoring points:
- Presentation and physical examination reveals restricted caudad movement of ribs 4–6 during exhalation on the right, suggesting a somatic dysfunction in these ribs.
- The focus of osteopathic manipulative treatment should be on the t... |
346 | 346 | Anatomy & Physiology | A 33-year-old pregnant woman at 37 weeks gestation presents to OB-triage for evaluation of uterine contractions and is admitted for labor induction. After being roomed, an anesthetic procedure is performed that involves catheter placement in the spine. Following the procedure, the patient retains full mobility of her l... | D. Sacral canal | [
"The patient retains full mobility of her lower extremities and can feel her uterine contractions, indicating that the anesthetic effect is limited to the pelvic floor and perineum.",
"The lack of sensation in the pelvic floor and perineum suggests that the anesthetic was administered to a location affecting the ... | Answer: D. Sacral canal
Scoring points:
- The patient retains full mobility of her lower extremities and can feel her uterine contractions, indicating that the anesthetic effect is limited to the pelvic floor and perineum.
- The lack of sensation in the pelvic floor and perineum suggests that the anesthetic was adminis... |
347 | 347 | Anatomy & Physiology | A 41-year-old farmer seeks medical attention due to muscle weakness and excessive salivation that has gradually worsened over a 2-month period following his switch to new fertilizers and insecticides for his corn fields. Physical examination reveals bilateral upper and lower extremity muscle strength of 3/5, excessive ... | G. CN IX | [
"The patient presents with cholinergic toxicity due to chronic organophosphate exposure, evidenced by muscle weakness, excessive salivation, tearing, and miosis.",
"Organophosphate poisoning leads to acetylcholine accumulation and overstimulation of parasympathetic pathways, including those innervated by cranial ... | Answer: G. CN IX
Scoring points:
- The patient presents with cholinergic toxicity due to chronic organophosphate exposure, evidenced by muscle weakness, excessive salivation, tearing, and miosis.
- Organophosphate poisoning leads to acetylcholine accumulation and overstimulation of parasympathetic pathways, including t... |
348 | 348 | Anatomy & Physiology | A 33-year-old man undergoes a radical thyroidectomy for thyroid cancer. During the operation, moderate hemorrhaging requires ligation of several vessels in the left side of the neck. Postoperatively, serum studies show a calcium concentration of 7.5 mg/dL, albumin concentration of 4 g/dL, and parathyroid hormone concen... | C. Branch of the thyrocervical trunk | [
"The patient now has hypocalcemia with elevated PTH, suggesting parathyroid ischmia or infarction",
" The parathyroid glands are most commonly supplied by the inferior thyroid artery",
" The inferior thyroid artery is a branch of the thyrocervical trunk"
] | Answer: C. Branch of the thyrocervical trunk
Scoring points:
- The patient now has hypocalcemia with elevated PTH, suggesting parathyroid ischmia or infarction
- The parathyroid glands are most commonly supplied by the inferior thyroid artery
- The inferior thyroid artery is a branch of the thyrocervical trunk |
349 | 349 | Anatomy & Physiology | During a clinical study examining the effects of exercise, men between the ages of 20 and 30 years are evaluated during a 15- minute session on a treadmill. The average pulse for the last 2 minutes of the session is 175/min. During the last minute of exercise, various measurements are taken. Compared with the measureme... | D. Total peripheral resistance | [
"During exercise, thee is widespread vasodilation of the working muscles",
" Vasodilation results in decreased TPR after exercise"
] | Answer: D. Total peripheral resistance
Scoring points:
- During exercise, thee is widespread vasodilation of the working muscles
- Vasodilation results in decreased TPR after exercise |
350 | 350 | Anatomy & Physiology | A 54-year-old man comes to the physician for a follow-up examination 10 days after undergoing a stereotactic brain operation to remove a small tumor. The operation was successful. During the procedure, he was under conscious sedation. The patient recalls that at one point during the operation he experienced a sudden, i... | A. Amygdala | [
"The amygdala is responsible for processing emotions, including fear",
" Stimulation of the amygdala can invoke fear response",
" This patient's amygdala was likely stimulated, resulting in feeling of fear"
] | Answer: A. Amygdala
Scoring points:
- The amygdala is responsible for processing emotions, including fear
- Stimulation of the amygdala can invoke fear response
- This patient's amygdala was likely stimulated, resulting in feeling of fear |
351 | 351 | Disease Diagnosis | A 40 year male complaining of hot flushes each time he baths. Hb: 20%gm, Platelet: 89,000/mL, WBC: 30,000/mL, Investigation revealed JAK2 mutation. What is the most likely diagnosis?
A. PMF
B. CML
C. PCV
D. Essential thrombocytosis | C. PCV | [
"This patient is presenting with the symptom of flushing after hot shower which can be seen in polycythemia vera.",
"This patient's laboratory values are significant for elevated hemoglobin and leukocytosis. ",
"The major diagnostic findings of elevated hemogobin >16.5 g/dL in a male patient and the presence of... | Answer: C. PCV
Scoring points:
- This patient is presenting with the symptom of flushing after hot shower which can be seen in polycythemia vera.
- This patient's laboratory values are significant for elevated hemoglobin and leukocytosis.
- The major diagnostic findings of elevated hemogobin >16.5 g/dL in a male patie... |
352 | 352 | Disease Diagnosis | Postrenal transplant patient presents with diarrhoea after 3 months; it was showing organism measuring 2-6 micron meter and kinoyn stain positive. Most likely it is caused by:
A. Balantidium coli
B. Clostridium difficile
C. Cystoisospora belli
D. Cryptosporidium hominis | D. Cryptosporidium hominis | [
"Renal transplant patients due to their need for immunosuppression are at risk for opportunistic infections. ",
"A positive kinyoun stain and size of 2-6 microns is suggested of a small acid fast organism.",
"Crytosporidium hominis is an example of an opportunistic infection that causes diarrhea in post transpl... | Answer: D. Cryptosporidium hominis
Scoring points:
- Renal transplant patients due to their need for immunosuppression are at risk for opportunistic infections.
- A positive kinyoun stain and size of 2-6 microns is suggested of a small acid fast organism.
- Crytosporidium hominis is an example of an opportunistic infe... |
353 | 353 | Disease Diagnosis | A 28 year old man has lenticonus and end stage renal disease now. His maternal uncle also died of the same illness. What is the most likely diagnosis?
A. Autosomal dominant polycystic kidney disease
B. Autosomal recessive polycystic kidney disease
C. Oxalosis
D. Alport syndrome | D. Alport syndrome | [
"Lenticonus and end-stage renal disease in a young male are key findings in Alport syndrome.",
"The presence of a male family member who also has the disease suggests a genetic cause specifically an X-linked pattern of inheritance, as the patient and a maternal uncle are both affected while sparing the patient's ... | Answer: D. Alport syndrome
Scoring points:
- Lenticonus and end-stage renal disease in a young male are key findings in Alport syndrome.
- The presence of a male family member who also has the disease suggests a genetic cause specifically an X-linked pattern of inheritance, as the patient and a maternal uncle are both ... |
354 | 354 | Disease Diagnosis | A child presented with abdominal distension, hepatomegaly, doll like facies and recurrent episodes of hypoglycemia. Which of the following is the most likely diagnosis?
A. Menkes disease
B. Down syndrome
C. Von gierke disease
D. Lesch nyhan syndrome | C. Von gierke disease | [
"Abdominal distension, hepatomegaly, and recurrent episodes of hypoglycemia in a young child is suggestive of a glycogen storage disorder. ",
"No kinky hair for buzzword of Menkes disease, no characteristic appearance for down syndrome, no self mutilation for lesch nyhan syndrome",
"Common symptoms of type I gl... | Answer: C. Von gierke disease
Scoring points:
- Abdominal distension, hepatomegaly, and recurrent episodes of hypoglycemia in a young child is suggestive of a glycogen storage disorder.
- No kinky hair for buzzword of Menkes disease, no characteristic appearance for down syndrome, no self mutilation for lesch nyhan sy... |
355 | 355 | Disease Diagnosis | A child has bilirubin of 4 mg. Conjugated bilirubin and alkaline phosphatase are normal, bile salts and bile in urine are absent. However urobilinogen in urine is raised. What is the likely diagnosis –
A. Obstructive jaundice
B. Rotor's syndrome
C. Biliary cholestasis
D. Hemolytic jaundice | D. Hemolytic jaundice | [
"A total bilirubin of 4mg/dl with a normal conjugated bilirubin is suggestive of unconjugated hyperbilirubinemia. ",
"Causes of unconjugated hyperbilirubinemia include increased bilirubin production, impaired hepatic uptake, and defective conjugation. ",
"The presence of urobilinogen, which is a byproduct of bi... | Answer: D. Hemolytic jaundice
Scoring points:
- A total bilirubin of 4mg/dl with a normal conjugated bilirubin is suggestive of unconjugated hyperbilirubinemia.
- Causes of unconjugated hyperbilirubinemia include increased bilirubin production, impaired hepatic uptake, and defective conjugation.
- The presence of uro... |
356 | 356 | Disease Diagnosis | A 6-year old girl presents with fever tor the past 5 days, generalized erythematous rash, strawberry tongue and cervical lymphadenopathy. The most likely diagnosis is: (Asked twice)
A. Kimura disease
B. Kawasaki disease
C. Scarlet fever
D. Rosie-Dorfman syndrome | B. Kawasaki disease | [
"Kawasaki disease classically presents in children aged 6 months to 6 years old with a prolonged fever > 5 days.. ",
"Kawaskai disease can should be suspected in a young children with a prolonged fever and additional symptoms of generalized erthematous rash, strawberry tongue, and cervical lymphadenopathy."
] | Answer: B. Kawasaki disease
Scoring points:
- Kawasaki disease classically presents in children aged 6 months to 6 years old with a prolonged fever > 5 days..
- Kawaskai disease can should be suspected in a young children with a prolonged fever and additional symptoms of generalized erthematous rash, strawberry tongue... |
357 | 357 | Disease Diagnosis | A 32 weeks pregnant female presented with labor pains and minimal vaginal discharge, on analysis of the cervicovaginal discharge showed presence of fetal fibronectin. What is the probable diagnosis?
A. Preterm labour
B. IUGR
C. IUD
D. Cervical infection | A. Preterm labour | [
"Fetal fibronectin is normally absent in vagnal secretions between 22 and 37 week gestation. ",
"Presence of fetal fibronectin in a preganant women of 32 weeks gestation is abnormal and signals disruption of the maternal-fetal interface of the placeta. ",
"Presence of fetal fibronectin on vaginal discharge anal... | Answer: A. Preterm labour
Scoring points:
- Fetal fibronectin is normally absent in vagnal secretions between 22 and 37 week gestation.
- Presence of fetal fibronectin in a preganant women of 32 weeks gestation is abnormal and signals disruption of the maternal-fetal interface of the placeta.
- Presence of fetal fibr... |
358 | 358 | Disease Diagnosis | An I.V. drug abuser presents with fever for 10 days. CXR shows B/L lower lobe consolidation with necrosis and right sided pyopneumothorax. Probable diagnosis is:
A. MV endocarditis due to viridans Streptococci
B. TV endocarditis due to Staph. aureus
C. Tuberculosis
D. Pneumocystis jirovecii infection | B. TV endocarditis due to Staph. aureus | [
"Infective endocarditis should be suspected in a patient with a history of IV drug use, prolonged fever, and pulmonary findings like necrosis or pyopneumothorax. ",
"Chest X-ray findings are suggestive of septic pulmonary emboli which are associated with right sided endocarditis like tricupid valve. ",
"Most co... | Answer: B. TV endocarditis due to Staph. aureus
Scoring points:
- Infective endocarditis should be suspected in a patient with a history of IV drug use, prolonged fever, and pulmonary findings like necrosis or pyopneumothorax.
- Chest X-ray findings are suggestive of septic pulmonary emboli which are associated with r... |
359 | 359 | Disease Diagnosis | A breast fed child presents with hypernatremia (Serum sodium > 170m Eq/L). His urine sodium is 70 mEq/L. Which of the following is the most likely cause –
A. Diabetes insipidus
B. Acute necrosis
C. Severe dehydration
D. Excessive intake of sodium | D. Excessive intake of sodium | [
"With hypernatremia, it can be due to increased Na concentration or decreased blood volume.",
"Therefore, it can be diabetes insipidus, severe dehydration or excessive intake of sodium.",
"Only excessive intake of sodium can cause increased urine sodium with hypernatremia. "
] | Answer: D. Excessive intake of sodium
Scoring points:
- With hypernatremia, it can be due to increased Na concentration or decreased blood volume.
- Therefore, it can be diabetes insipidus, severe dehydration or excessive intake of sodium.
- Only excessive intake of sodium can cause increased urine sodium with hypernat... |
360 | 360 | Disease Diagnosis | A child with 22-25 stool/day, 3 day old pneumonitis, no passage of urine from 36 hours. low B.P. Blood pH – 7.21. Urine Na+–18 meq/L, S. Urea 120, serum Creatinine 1.2 indicate –
A. Acute cortical necrosis
B. Acute tubular necrosis
C. Pre–renal Azotemia
D. Acute medullary necrosis | C. Pre–renal Azotemia | [
"The child has not passed urine for 36 hours, suggesting anuria, which is a key feature of acute kidney injury.",
"BUN to Creatinine ratio is calculated by 120 divided by 1.2 = 100 which is >20 which is more likely to be pre-renal acute kidney injury(AKI). (This is a feature to differentiate pre-renal cause, acut... | Answer: C. Pre–renal Azotemia
Scoring points:
- The child has not passed urine for 36 hours, suggesting anuria, which is a key feature of acute kidney injury.
- BUN to Creatinine ratio is calculated by 120 divided by 1.2 = 100 which is >20 which is more likely to be pre-renal acute kidney injury(AKI). (This is a featur... |
361 | 361 | Disease Diagnosis | 14 year old child with blindness, sensorineural hearing loss, progressive hematuria, hypeension with similar family history in father
A. Alport syndrome
B. Goldenhar syndrome
C. Goodpasture syndrome
D. Nager syndrome | A. Alport syndrome | [
"Alport syndrome is characterized by progressive renal failure, sensorineural hearing loss, vision issues including blindenss or other findings like anterior lenticonus. ",
"Alport syndrome has most commonly a X-linked pattern of inheritance which is suggested by the presence of a paternal familial history in thi... | Answer: A. Alport syndrome
Scoring points:
- Alport syndrome is characterized by progressive renal failure, sensorineural hearing loss, vision issues including blindenss or other findings like anterior lenticonus.
- Alport syndrome has most commonly a X-linked pattern of inheritance which is suggested by the presence ... |
362 | 362 | Disease Diagnosis | A 50 years old patient presented with progressive jaundice. Liver function test was done in which conju!gated serum bilirubin-4.8% and total bilirubin-6.7%, alkaline phosphatase- 550 IU, SGOT-50, SGPT-65. Most probable diagnosis is;
A. Jaundice due to choledocholithiasis
B. Dubin-Johnson syndrome
C. Viral hepatitis
D. ... | A. Jaundice due to choledocholithiasis | [
"Labs are significant for direct hyperbilirubinemia, elevated alkaline phhopshatase, and mild increases in SGOT and SGPT is suggestive of a obstrucive extra-hepatic cause of jaundice. ",
"Without other symptoms such as weight loss in this mid-aged patient, which may indicate head of pancreas cancer which is a mal... | Answer: A. Jaundice due to choledocholithiasis
Scoring points:
- Labs are significant for direct hyperbilirubinemia, elevated alkaline phhopshatase, and mild increases in SGOT and SGPT is suggestive of a obstrucive extra-hepatic cause of jaundice.
- Without other symptoms such as weight loss in this mid-aged patient, ... |
363 | 363 | Disease Diagnosis | A 24 years old college student while playing hockey injured his right knee. This patient presents after 3 months with instability of knee joint in it full extension without instability at 90 degree of flexion. The structure most commonly damaged is:
A. Posterolatilal pa of anterior cruciate ligament
B. Anteromedial pa ... | A. Posterolatilal pa of anterior cruciate ligament | [
"The anterior cruciate ligament has two bundles with the posteriorlateral part of the ACL responsible for stability in full knee extension.",
"The patient is experiencing ongoing knee instability after an injury while in full extension without instability at 90 degrees of flexion which suggests injury to his post... | Answer: A. Posterolatilal pa of anterior cruciate ligament
Scoring points:
- The anterior cruciate ligament has two bundles with the posteriorlateral part of the ACL responsible for stability in full knee extension.
- The patient is experiencing ongoing knee instability after an injury while in full extension without i... |
364 | 364 | Disease Diagnosis | A 10 year old child presented with headache, vomiting, gait instability and diplopia. On examination he had papilledema and gait ataxia. The most probable diagnosis is –
A. Hydrocephalus
B. Brain stem tumour
C. Suprasellar tumour
D. Midline posterior fossa tumour | D. Midline posterior fossa tumour | [
"Increased intracranial pressure is suggested by the clinical features of headache, vomiting, diplopia.",
"Increased intracranial pressure is also associated with exam findings of papilledemia. ",
"Gait ataxia and diplopia are associated with lesions in the posterior fossa including the cerebellum.",
"Gait a... | Answer: D. Midline posterior fossa tumour
Scoring points:
- Increased intracranial pressure is suggested by the clinical features of headache, vomiting, diplopia.
- Increased intracranial pressure is also associated with exam findings of papilledemia.
- Gait ataxia and diplopia are associated with lesions in the post... |
365 | 365 | Disease Diagnosis | A 26 years old healthy female got pregnant for 1st time and LSCS was done for fetal distress. Mild hypertension was present during pregnancy. Two days after delivery she had headache and seizures but proteinuria was not seen. CT scan shows 2 x 3 cm parasagittal hematoma. Diagnosis is:
A. Eclampsia
B. Hypeensive intracr... | C. Sagittal sinus thrombosis | [
"A post partum patient with hypertension headahce seizures may cause worry for eclampsia but lack of proteinuria points more to sagittal sinus thrombosis.",
"CT scan showing a parasagittal hematoma is consistent with sagittal sinus thrombosis. "
] | Answer: C. Sagittal sinus thrombosis
Scoring points:
- A post partum patient with hypertension headahce seizures may cause worry for eclampsia but lack of proteinuria points more to sagittal sinus thrombosis.
- CT scan showing a parasagittal hematoma is consistent with sagittal sinus thrombosis. |
366 | 366 | Disease Diagnosis | A patient comes to ED with fever and headache. On examination he has neck stiffness. CSF analysis was done:- Parameter Finding Normal range Glucose (mg/dl) 55 50-80 Protein (g/L) 0.50 0.18-0.45 ICT (cmH2O) 35 5-20 WBC 25 (predominantly lymphocytes) <5 Most likely diagnosis is-
A. TB
B. N. Gonorrhea
C. Cryptococcus
D. C... | D. Coxsackie | [
"A patient with fever, headache, and neck stiffness is concerning for meningitis. ",
"CSF analysis with normal glucose, mildly elevated protein, elevated WBC with predominantly lymphocytes, and elevated opening pressure is suggestive of a viral meningitis. ",
"Coxsackie is a common cause of viral meningitis. "... | Answer: D. Coxsackie
Scoring points:
- A patient with fever, headache, and neck stiffness is concerning for meningitis.
- CSF analysis with normal glucose, mildly elevated protein, elevated WBC with predominantly lymphocytes, and elevated opening pressure is suggestive of a viral meningitis.
- Coxsackie is a common ... |
367 | 367 | Disease Diagnosis | A young adult presents 2 days after trauma to the eye with proptosis and pain in the right eye. On examination, hi is found to have a bruise on the right eye and forehead. The most likely diagnosis is:
A. Fracture sphenoid bone
B. Cavernous sinus thrombosis
C. Internal carotid aery aneurysm
D. Carotico-cavernous fistul... | D. Carotico-cavernous fistula | [
"Patient is presenting with unilateral proptosis and eye pain after a recent trauma to the eye suggesting a post traumatic complication. ",
"Carotico-cavernous fistula can cause unilateral proptosis and pain due to an abnormal connection between the carotid artery and cavernous sinus and can have a delayed presen... | Answer: D. Carotico-cavernous fistula
Scoring points:
- Patient is presenting with unilateral proptosis and eye pain after a recent trauma to the eye suggesting a post traumatic complication.
- Carotico-cavernous fistula can cause unilateral proptosis and pain due to an abnormal connection between the carotid artery a... |
368 | 368 | Disease Diagnosis | A 37-year-old machinist presents to his primary care physician with eye problems. He has felt a mass in his eye that has persisted for the past month. The patient has a medical history of blepharitis treated with eye cleansing and squamous cell carcinoma of the skin treated with Mohs surgery. His temperature is 99.5°F ... | A. Chalazion | [
"The patient presents with a firm, rubbery, and painless mass in his eyelid which is characteristic of a chalazion. ",
"The lack of tenderness, erythema, or warmth suggest there is no acute infection.",
"The patient's history of blepharitis is relevant as this is a risk factor for Meibomian gland bloackage whci... | Answer: A. Chalazion
Scoring points:
- The patient presents with a firm, rubbery, and painless mass in his eyelid which is characteristic of a chalazion.
- The lack of tenderness, erythema, or warmth suggest there is no acute infection.
- The patient's history of blepharitis is relevant as this is a risk factor for Me... |
369 | 369 | Disease Diagnosis | A 27-year-old woman presents to her primary care physician with pain in her hands, shoulders, and knees. The pain has lasted for several months but seems to have worsened recently. Any activity such as opening jars, walking, or brushing her teeth is painful. The patient has a medical history of a suicide attempt in col... | B. Anti-dsDNA antibodies | [
"This female patient is presenting with persistant arthralgias which worsens with activity and other vague historical findings which are of unclear signifciance like depression and possible prior malar rash versus photosensitity with a sunburn history. ",
"Labs are significant for anemia, leukopenia, thrombocytop... | Answer: B. Anti-dsDNA antibodies
Scoring points:
- This female patient is presenting with persistant arthralgias which worsens with activity and other vague historical findings which are of unclear signifciance like depression and possible prior malar rash versus photosensitity with a sunburn history.
- Labs are signi... |
370 | 370 | Disease Diagnosis | A 69-year-old man presents to his primary care provider for a general checkup. He has a medical history of type 2 diabetes mellitus, hypertension, depression, obesity, and a myocardial infarction 7 years ago. The patient's prescribed medications are metoprolol, aspirin, lisinopril, hydrochlorothiazide, fluoxetine, metf... | C. Heart sound before S1 | [
"Patient has history of high blood pressure which increases afterload of the heart",
"This causes left ventricular hypertrophy (LVH).",
"LVH is associated with fourth heart sound, or S4, which is a low-frequency sound heard late in diastole, just before the first heart sound (S1), and is often described as an \... | Answer: C. Heart sound before S1
Scoring points:
- Patient has history of high blood pressure which increases afterload of the heart
- This causes left ventricular hypertrophy (LVH).
- LVH is associated with fourth heart sound, or S4, which is a low-frequency sound heard late in diastole, just before the first heart so... |
371 | 371 | Disease Diagnosis | A newborn boy is evaluated in the hospital nursery 2 hours after birth. The patient was born at 39 weeks of gestation to a 30-year-old primigravid via vaginal delivery. The patient’s mother received routine prenatal care and the pregnancy was uncomplicated. The patient’s anatomy ultrasound at 20 weeks of gestation was ... | B. 5p | [
"A genetic syndrome is suggested with the symtpoms of poor muscle tone, low birth weight, and distinct facial features. ",
"Distinctive facial like wide nasal bridge, down slanting, palpebral fissures, and high pitched or cat-like cry are characteristic of Cri-du-chat syndrome. ",
"Cri-du-chat syndrome is cause... | Answer: B. 5p
Scoring points:
- A genetic syndrome is suggested with the symtpoms of poor muscle tone, low birth weight, and distinct facial features.
- Distinctive facial like wide nasal bridge, down slanting, palpebral fissures, and high pitched or cat-like cry are characteristic of Cri-du-chat syndrome.
- Cri-du-c... |
372 | 372 | Disease Diagnosis | A 67-year-old man presents to the emergency room with difficulty speaking for the past 1 hour. He was having dinner at home with his wife when he suddenly noticed he had difficulty eating and speaking. He also noticed a new-onset weakness on his left side. His medical history is significant for type 2 diabetes mellitus... | A. Anterior spinal artery | [
"Patient presents with sudden onset of difficulty speaking, difficulty eating, and new unilateral weakness are suggesitive of a stroke emergency. ",
"The patient is experiencing left sided motor and sensory symptoms and tongue deviation to right. ",
"Contralateral hemiparesis, contralateral loss of propriocepti... | Answer: A. Anterior spinal artery
Scoring points:
- Patient presents with sudden onset of difficulty speaking, difficulty eating, and new unilateral weakness are suggesitive of a stroke emergency.
- The patient is experiencing left sided motor and sensory symptoms and tongue deviation to right.
- Contralateral hemipa... |
373 | 373 | Disease Diagnosis | A 62-year-old patient has been hospitalized for a week due to a stroke. One week into the hospitalization, he develops a fever and purulent cough. His vitals include: heart rate 88/min, respiratory rate 20/min, temperature 38.4°C (101.1°F), and blood pressure 110/85 mm Hg. On physical examination, he has basal crackles... | E. Staphylococcus aureus | [
"A hospitalized patient who develops a new fever, purulent cough, and has a new consolidation on chest x-ray is suspicious for a hospital acquired pneumonia. ",
"High neutrophil percent while low lymphocyte percent is more likely bacterial caused.",
"Bacterial caused hospital acquired pneumonia in a non-venilat... | Answer: E. Staphylococcus aureus
Scoring points:
- A hospitalized patient who develops a new fever, purulent cough, and has a new consolidation on chest x-ray is suspicious for a hospital acquired pneumonia.
- High neutrophil percent while low lymphocyte percent is more likely bacterial caused.
- Bacterial caused hosp... |
374 | 374 | Disease Diagnosis | A 5-year-old female is brought to a speech therapist for continuing work on improving her communication skills. She is only able to verbalize two word sentences and has generalized developmental delay. When she was born it was noticed that she had a high pitched mewing cry and subsequent physical exam revealed microcep... | A. 5 | [
"High pitched or cat-like cry are characteristic of Cri-du-chat syndrome. ",
"Cri-du-chat syndrome is also associated with microcephaly, developmental delay, and distincitve facial features. ",
"Cri-du-chat syndrome is caused by a deletion on chromosome 5p."
] | Answer: A. 5
Scoring points:
- High pitched or cat-like cry are characteristic of Cri-du-chat syndrome.
- Cri-du-chat syndrome is also associated with microcephaly, developmental delay, and distincitve facial features.
- Cri-du-chat syndrome is caused by a deletion on chromosome 5p. |
375 | 375 | Disease Diagnosis | 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... | E. Anti-B antibodies | [
"Patient is a neonate with unconjugated hyperbilirubinemia with the history of a vaginal delivery to a mother without prenatal care. ",
"Anemia and elevated reticulocyte are consistent with high RBC turnover which can occur in hemolysis. ",
"There is no Rh incompatibility but there is the potential for ABO inco... | Answer: E. Anti-B antibodies
Scoring points:
- Patient is a neonate with unconjugated hyperbilirubinemia with the history of a vaginal delivery to a mother without prenatal care.
- Anemia and elevated reticulocyte are consistent with high RBC turnover which can occur in hemolysis.
- There is no Rh incompatibility but... |
376 | 376 | Disease Diagnosis | 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... | C. Bartter's syndrome | [
"Renal tubular disorders are characterized by symptoms like polyuria, polydipsia, low weight/growth, and generalized weakness in a young child or infant. ",
"Elevated plasma renin activity and plasma aldosterone are seen in renal tubular disorders where there is volume depletion. ",
"Elevated urine calcium is s... | Answer: C. Bartter's syndrome
Scoring points:
- Renal tubular disorders are characterized by symptoms like polyuria, polydipsia, low weight/growth, and generalized weakness in a young child or infant.
- Elevated plasma renin activity and plasma aldosterone are seen in renal tubular disorders where there is volume depl... |
377 | 377 | Disease Diagnosis | A 13-year-old boy is brought to the emergency department by his mother because of a 6-hour history of severe eye pain and blurry vision. He wears soft contact lenses and has not removed them for 2 days. Ophthalmologic examination shows a deep corneal ulcer, severe conjunctival injection, and purulent discharge on the r... | D. Gram-negative, oxidase-positive bacilli | [
"The patient has unilateral eye pain, conjunctival injection, purulent discharge, and blurry vision secondary to a corneal ulcer after prolonged contact use. ",
"Prolonged contact lens wearing without removal increases the risk of a pseudomonal infection. ",
"Pseudomonas is a gram negative bacili which is oxida... | Answer: D. Gram-negative, oxidase-positive bacilli
Scoring points:
- The patient has unilateral eye pain, conjunctival injection, purulent discharge, and blurry vision secondary to a corneal ulcer after prolonged contact use.
- Prolonged contact lens wearing without removal increases the risk of a pseudomonal infectio... |
378 | 378 | Disease Diagnosis | 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... | B. Elbow flexion | [
"Musculocutaneous nerve injury is associated with sensory loss over the lateral forearm and preserved thumb sensation and can occur due to injuries from heavy weight lifting. ",
"Other findings in a musculocutaneous nerve injury include weakness in elbow flexion due to its innervation of the biceps and brachialis... | Answer: B. Elbow flexion
Scoring points:
- Musculocutaneous nerve injury is associated with sensory loss over the lateral forearm and preserved thumb sensation and can occur due to injuries from heavy weight lifting.
- Other findings in a musculocutaneous nerve injury include weakness in elbow flexion due to its inner... |
379 | 379 | Disease Diagnosis | 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 | [
"Discordant birth weights with disrepencies in the hemocrit levels is consistent with twin-twin transfusion syndrome. ",
"The smaller newborn has other findings that can occur in TTTS due to oligohydraminos including flattened nose and clubfoot.",
"TTTS is seen in monochrrionic-diamniotic monozygotic pregnancie... | Answer: A. Monochorionic-diamniotic monozygotic
Scoring points:
- Discordant birth weights with disrepencies in the hemocrit levels is consistent with twin-twin transfusion syndrome.
- The smaller newborn has other findings that can occur in TTTS due to oligohydraminos including flattened nose and clubfoot.
- TTTS is ... |
380 | 380 | Disease Diagnosis | A 71-year-old woman with type 2 diabetes mellitus and hypertension comes to the emergency department because of a 3-day history of intermittent abdominal pain, vomiting, and obstipation. She has had multiple episodes of upper abdominal pain over the past year. She has smoked 1 pack of cigarettes daily for the past 30 y... | B. Inflammation of the gallbladder wall | [
"The elderly patient presents with symptoms of a small bowel obstruction supported by exam and imaging findings of high-pitched bowel sounds and dilated bowel with air-fluid levels. ",
"Branching radiolucencies in the right infra-diaphragmatic region is pneumobilia. ",
"Pneumobilia in the setting of a small bow... | Answer: B. Inflammation of the gallbladder wall
Scoring points:
- The elderly patient presents with symptoms of a small bowel obstruction supported by exam and imaging findings of high-pitched bowel sounds and dilated bowel with air-fluid levels.
- Branching radiolucencies in the right infra-diaphragmatic region is pn... |
381 | 381 | Disease Diagnosis | A 63-year-old man from the countryside presents with leg swelling and right upper abdominal tenderness. He reports a history of myocardial infarction 4 years ago, but he has no supporting documentation. At the moment, his only medication is aspirin. He also stated that he used to have ‘high blood sugars’ when checked i... | B. Increased peak tricuspid regurgitation | [
"The patient has pertinent findings of leg swelling, right upper abdominal tenderness, jugular vein distension, and ascities which can be seen in right heart failure. ",
"A systolic murmur best heard at the 4th intercostal space is likely tricupsid regurgitation which can lead to right sided heart failure. ",
"... | Answer: B. Increased peak tricuspid regurgitation
Scoring points:
- The patient has pertinent findings of leg swelling, right upper abdominal tenderness, jugular vein distension, and ascities which can be seen in right heart failure.
- A systolic murmur best heard at the 4th intercostal space is likely tricupsid regur... |
382 | 382 | Disease Diagnosis | A 3-year-old girl is brought to the cardiologist because of sweating and respiratory distress while eating. She is at the 30th percentile for height and 15th percentile for weight. Echocardiography shows a defect in the membranous portion of the interventricular septum and a moderately decreased left ventricular ejecti... | A. Systolic murmur that increases with hand clenching | [
"A pediatric patient with sweating and respiratory distress while eating, failure to thrive are concerning for a cardiac defect, specifically a VSD with the echo findings of a defect in the membranous portion of the interventricular septum.",
"Symptomatic VSD can have left-to-right shunting leading to heart fail... | Answer: A. Systolic murmur that increases with hand clenching
Scoring points:
- A pediatric patient with sweating and respiratory distress while eating, failure to thrive are concerning for a cardiac defect, specifically a VSD with the echo findings of a defect in the membranous portion of the interventricular septum.... |
383 | 383 | Disease Diagnosis | A 35-year-old male presents to the emergency department for evaluation of hemoptysis. A chest X-ray reveals bilateral focal pulmonary consolidation. On further questioning, he admits having hematuria. Urinalysis shows RBC casts and 400 mL of urine is excreted in 24 hours. What is the most likely cause of hemoptysis and... | E. Anti-glomerular basement membrane antibodies | [
"Hemoptysis, bilateral pulmonary consolidations, hematuria, and urinary RBC casts are characteristic of Goodpasture's syndrome. ",
"Goodpasture's kidney findings include glomerulonehpritis which is caused by the presence of anti-glomerular basement membrane antiboides. "
] | Answer: E. Anti-glomerular basement membrane antibodies
Scoring points:
- Hemoptysis, bilateral pulmonary consolidations, hematuria, and urinary RBC casts are characteristic of Goodpasture's syndrome.
- Goodpasture's kidney findings include glomerulonehpritis which is caused by the presence of anti-glomerular basement... |
384 | 384 | Disease Diagnosis | A 14-year-old boy is brought to the emergency department by his mother after falling from the jungle gym and developing severe left knee pain and swelling. On presentation, he is found to be in pain with a hot, swollen, erythematous left knee. His past medical history is significant for abnormal coagulation lab tests b... | E. Factor XII | [
"Bleeding disorder is suggested by the patient's knee pain and swelling after injury and history of abnormal coagulation tests.",
"Prolonged PTT with normal PT and bleeding time suggests an intrinsic pathway defect. ",
"Decreased bradykinin is specific for a factor XII defect as it leads to the profection of br... | Answer: E. Factor XII
Scoring points:
- Bleeding disorder is suggested by the patient's knee pain and swelling after injury and history of abnormal coagulation tests.
- Prolonged PTT with normal PT and bleeding time suggests an intrinsic pathway defect.
- Decreased bradykinin is specific for a factor XII defect as it ... |
385 | 385 | Disease Diagnosis | A 52-year-old man with Crohn disease comes to the physician because of a 1-week history of dysuria and urinary urgency. He had been treated for urinary tract infections twice in the past 6 months. He is currently taking infliximab. Cystoscopy shows pearl-like plaques on the bladder wall. Biopsy of these lesions shows a... | D. Night blindness | [
"Patient's with inflammatory bowel disease like Crohns disease can lead to malabsorption and hence fat soluble vitamin deficiences like A, D, E, or K. ",
"Pearl-like plaques on the bladder wall which demonstrate hyperkeratosis are signs of squamous metaplasia which is classically seen in vitamin A deficiencies. "... | Answer: D. Night blindness
Scoring points:
- Patient's with inflammatory bowel disease like Crohns disease can lead to malabsorption and hence fat soluble vitamin deficiences like A, D, E, or K.
- Pearl-like plaques on the bladder wall which demonstrate hyperkeratosis are signs of squamous metaplasia which is classica... |
386 | 386 | Disease Diagnosis | A 5-year-old boy is brought to his pediatrician’s office by his parents after they noticed blood in his urine. The child has been complaining of difficulty in passing urine and has lower abdominal pain. He seems more bloated than usual. On some occasions, he starts crying while passing urine, primarily because of a bur... | A. Gastroenteritis | [
"Patient is having hematuria, dysuria, and suprpubic pain which can suggest hemorrhagic cystitis. ",
"Hemorrhagic cystits can be caused by Adenovirus which is a double stranded DNA virus. ",
"Adenovirus is also a common cause of gastroenteriitis in pediatric patients. "
] | Answer: A. Gastroenteritis
Scoring points:
- Patient is having hematuria, dysuria, and suprpubic pain which can suggest hemorrhagic cystitis.
- Hemorrhagic cystits can be caused by Adenovirus which is a double stranded DNA virus.
- Adenovirus is also a common cause of gastroenteriitis in pediatric patients. |
387 | 387 | Disease Diagnosis | Three patients present to the pediatrician for routine well-child visits. The first child’s mother reports that he seems to be breastfeeding well and voids at least eight times per day. His stools are a yellow color, and he does not seem to be straining. In the office, he can lift his head and chest when in the prone p... | E. Ages 2 months, 6 months, and 12 months | [
"The first patient is meeting the milestones of a 2 month infant including lifting his head wile prone, tracking objects to midline.",
"Rolling from supine to prone, transfer of rattle to other hand, and no word language use is consistent with a slightly older child of 6 months. ",
"Milestones like playing with... | Answer: E. Ages 2 months, 6 months, and 12 months
Scoring points:
- The first patient is meeting the milestones of a 2 month infant including lifting his head wile prone, tracking objects to midline.
- Rolling from supine to prone, transfer of rattle to other hand, and no word language use is consistent with a slightly... |
388 | 388 | Disease Diagnosis | A 27-year-old man presents to the emergency department due to a change in his skin color. The patient went on a long hike this morning, and his girlfriend noticed that his skin had changed color when they were driving home. The patient has a past medical history of marijuana use, IV drug use, alcohol use, and asthma. H... | C. Hyperpigmentation of the liver | [
"Patient is experiencing jaundice confirmed with labs that are significant for predominantly direct hyperbilirubinemia. ",
"While he has a history of IV drug use which could raise the question of a chronic liver disease like hepatitis, the patient is otherwise healthy with a normal cardiac, pulmonary, abdominal, ... | Answer: C. Hyperpigmentation of the liver
Scoring points:
- Patient is experiencing jaundice confirmed with labs that are significant for predominantly direct hyperbilirubinemia.
- While he has a history of IV drug use which could raise the question of a chronic liver disease like hepatitis, the patient is otherwise h... |
389 | 389 | Disease Diagnosis | A 54-year-old male presents to his primary care physician complaining of fatigue. He reports that he recently went on a vacation to South America with his family but just wanted to stay in his hotel all day due to fatigue. His past medical history is notable for hyperlipidemia and hypertension. He takes lovastatin and ... | D. Tartrate-resistant acid phosphatase | [
"Findings on history and physical exam of fatigue, mild splenomegaly, and pancytopenia suggest a hematologic disorder. ",
"Inability to obtain a bone marrow sample after several attempts is called a Dry tap which is characteristic of Hairy Cell Leukemia. ",
"Hairy cell leukemia is a type of chronic B-cell lymph... | Answer: D. Tartrate-resistant acid phosphatase
Scoring points:
- Findings on history and physical exam of fatigue, mild splenomegaly, and pancytopenia suggest a hematologic disorder.
- Inability to obtain a bone marrow sample after several attempts is called a Dry tap which is characteristic of Hairy Cell Leukemia.
-... |
390 | 390 | Disease Diagnosis | A 27-year-old female presents to her physician with a palpable thyroid nodule. Iodine uptake testing shows that the nodule has decreased iodine uptake compared with the rest of the thyroid gland. A fine-needle aspiration is performed and the physician calls telling the patient that she has a neoplasm of the thyroid. Wh... | A. Papillary carcinoma | [
"Palpable thyroid nodule with decreased iodine uptake compared to the rest of the thyroid tissue indicates a 'cold' nodule.",
"Malignancy is most commonly presents as a cold nodule. ",
"The most common neoplasm of the thyroid is papillary carcinoma. "
] | Answer: A. Papillary carcinoma
Scoring points:
- Palpable thyroid nodule with decreased iodine uptake compared to the rest of the thyroid tissue indicates a 'cold' nodule.
- Malignancy is most commonly presents as a cold nodule.
- The most common neoplasm of the thyroid is papillary carcinoma. |
391 | 391 | Disease Diagnosis | A 27-year-old man presents to the emergency department after a motor vehicle accident. The patient has a past medical history of asthma and cocaine use. His current medications include albuterol and ibuprofen. His temperature is 99.5°F (37.5°C), blood pressure is 70/35 mmHg, pulse is 150/min, respirations are 19/min, a... | A. Hemolytic anemia and ataxia | [
"Hypotension, tachycardia, and respiratory distress immediately following a blood transfusion is indicative of an acute transfusion reaction. ",
"A patient with Ataxia-telangiectasia have both a neurologic dysfunction (crebellar ataxia) with an immune defciency like IgA deficiency. ",
"These patient would have ... | Answer: A. Hemolytic anemia and ataxia
Scoring points:
- Hypotension, tachycardia, and respiratory distress immediately following a blood transfusion is indicative of an acute transfusion reaction.
- A patient with Ataxia-telangiectasia have both a neurologic dysfunction (crebellar ataxia) with an immune defciency lik... |
392 | 392 | Disease Diagnosis | A 3-year-old boy is brought to the emergency room by his mother after she found him somnolent at home next to multiple open pill bottles. The boy had seemingly opened several different pill bottles that were in a cabinet in his parent’s bathroom. The mother has brought the empty bottles to the emergency room, and they ... | C. pH 7.36, PCO2 22 mmHg, and HCO3- 16 mEq/L | [
"Patient is found somulent with suspected toxic ingestion of pills. ",
"Vitals are signifciant for hyperventilation, ataxia or swaying, and ear discomfort(tinnitus) are suggestive of a salicylate or aspirin toxicity. ",
"Salicylate toxicity causes a mixed acid base disorder with a ealry respiratory alkalosis fr... | Answer: C. pH 7.36, PCO2 22 mmHg, and HCO3- 16 mEq/L
Scoring points:
- Patient is found somulent with suspected toxic ingestion of pills.
- Vitals are signifciant for hyperventilation, ataxia or swaying, and ear discomfort(tinnitus) are suggestive of a salicylate or aspirin toxicity.
- Salicylate toxicity causes a mi... |
393 | 393 | Disease Diagnosis | A 52-year-old woman presents with a complaint of headache for the past 10 days. Her headache is diffuse, dull in character, moderate in intensity, and is worse in the morning. It is not associated with fever and sensitivity to light or sound. She experiences occasional nausea but no vomiting. She did not have similar h... | C. Melanoma | [
"The patient is having symptoms of new headache and nausea with exam findings of papilledema which suggests increased intracranial pressure. ",
"The patient in her workup recieved a brain MRI and was found to have a solitary lesion in the left temporal region with hemorrhage, a characteristic finding of a brain m... | Answer: C. Melanoma
Scoring points:
- The patient is having symptoms of new headache and nausea with exam findings of papilledema which suggests increased intracranial pressure.
- The patient in her workup recieved a brain MRI and was found to have a solitary lesion in the left temporal region with hemorrhage, a chara... |
394 | 394 | Disease Diagnosis | A 5-year-old boy is brought to the emergency department by his mother because of a sudden loss of consciousness. He has asthma and has been hospitalized multiple times. His mother has type 2 diabetes mellitus. He is somnolent and diaphoretic. Serum studies show a glucose concentration of 22 mg/dL and a potassium concen... | E. Factitious disorder imposed on another | [
"The patient is brought to the hospital by his mother and presents with loss of consciousness, hypoglyccemia and hypokalemia which initally improves with dextrose administration. ",
"Serum studies are significant for elevated insulin but the absense of C peptide, suggesting an exogenous source of insulin. ",
"T... | Answer: E. Factitious disorder imposed on another
Scoring points:
- The patient is brought to the hospital by his mother and presents with loss of consciousness, hypoglyccemia and hypokalemia which initally improves with dextrose administration.
- Serum studies are significant for elevated insulin but the absense of C... |
395 | 395 | Disease Diagnosis | A 45-year-old woman comes to the physician because of fatigue, abdominal cramps, watery diarrhea, and a weight loss of 4 kg (8.8 lb) over the last 4 months. She has recently avoided drinking alcohol and eating spicy food because it worsens her diarrhea and causes episodes of heart palpitations and reddening of the face... | E. Pulmonic valve stenosis | [
"The patient presents with fatigue, abdominal cramping, watery diarrhea, and weight loss, flushing, palpitations triggered by alcohol which is suggestive of Carcinoid syndrome. ",
"The diagnosis is confirmed with the presence of increased urine 5-hydroxyindoleacetic acid which is a byproduct of serotonin. ",
"... | Answer: E. Pulmonic valve stenosis
Scoring points:
- The patient presents with fatigue, abdominal cramping, watery diarrhea, and weight loss, flushing, palpitations triggered by alcohol which is suggestive of Carcinoid syndrome.
- The diagnosis is confirmed with the presence of increased urine 5-hydroxyindoleacetic a... |
396 | 396 | Disease Diagnosis | A 25-year-old woman presents to her primary care provider for evaluation of a "painful mass in my left groin." She says that her symptoms began 4 days ago as a painful mass that slowly enlarged, ruptured, and ulcerated. However, she denies fever, chills, dysuria, or hematuria. Three weeks prior to her current symptoms ... | C. PCR positive for Chlamydia trachomatis | [
"The patient has a history of unprotected sex with a new male partner. ",
"A painless genital ulcer followed by painful ulcerated inguinal lymphadenopathy is classic for lymphogranuloma venerem. ",
"lymphogranuloma venerem is caused by Chlamydia trachomatis. ",
"Diagnosis of chlamydia is made by positive resu... | Answer: C. PCR positive for Chlamydia trachomatis
Scoring points:
- The patient has a history of unprotected sex with a new male partner.
- A painless genital ulcer followed by painful ulcerated inguinal lymphadenopathy is classic for lymphogranuloma venerem.
- lymphogranuloma venerem is caused by Chlamydia trachomat... |
397 | 397 | Disease Diagnosis | A 25-year-old female with Hodgkin's lymphoma presents with a several day history of edema. Lab studies show:
Serum Na+: 140 mmol/L
Serum K+: 3.5 mmol/L
Serum albumin: 1.9 g/dL
Total serum bilirubin: 1.0 mg/dL
Serum creatinine: 1.2 mg/dL
Urinalysis shows 4+ proteinuria and fatty casts. What is the most likely diagnosi... | C. Minimal change disease | [
"Patient presenting with edema, proteinuria, urine fatty casts, and hypoalbuminemia is suggesitve of nephrotic syndrome. ",
"In a young paitent the most likely cause of nephrotic syndrome is minimal change disease. ",
"There is an association between Hodgkins lymphoma and nephrotic syndrome. "
] | Answer: C. Minimal change disease
Scoring points:
- Patient presenting with edema, proteinuria, urine fatty casts, and hypoalbuminemia is suggesitve of nephrotic syndrome.
- In a young paitent the most likely cause of nephrotic syndrome is minimal change disease.
- There is an association between Hodgkins lymphoma an... |
398 | 398 | Disease Diagnosis | A 32-year-old woman presents to the emergency department with complaints of a headache. The last menstrual period was 4 months ago. She also reports having a mild headache for 1 month. There has been a grape-like mass protruding from her vagina for the last 15 days. On examination, the fundus of the uterus is at the le... | E. 46XX | [
"Female patient with delayed menstrual cycle, headache and grape-like mass protruding from her vaginal is consistent with a complete molar pregnancy. ",
"A complete hydatidiform mole is created from the fertilization of a empty ovum is fertilized by one (will duplicate) or two sperm (both contribute). ",
"46XX ... | Answer: E. 46XX
Scoring points:
- Female patient with delayed menstrual cycle, headache and grape-like mass protruding from her vaginal is consistent with a complete molar pregnancy.
- A complete hydatidiform mole is created from the fertilization of a empty ovum is fertilized by one (will duplicate) or two sperm (bot... |
399 | 399 | Disease Diagnosis | A 62-year-old Caucasian male presents to the emergency room with severe substernal chest pain, diaphoresis, and nausea. Imaging reveals transmural myocardial infarction in the posterior 1/3 of the ventricular septum. Which of this patient's coronary arteries is most likely occluded?
A. Left circumflex
B. Left anterior ... | E. Right main | [
"The patient is having symptoms of a myocardial infarction with chest pain, diaphoresis, and nausea. ",
"The angiography described reports the posterior 1/3 of the ventricular septum is affected which is supplied by the posterior descending artery. ",
"The posterior descending artery arises most commonly from t... | Answer: E. Right main
Scoring points:
- The patient is having symptoms of a myocardial infarction with chest pain, diaphoresis, and nausea.
- The angiography described reports the posterior 1/3 of the ventricular septum is affected which is supplied by the posterior descending artery.
- The posterior descending arter... |
400 | 400 | Disease Diagnosis | A 46-year-old man is brought to the emergency department 15 minutes after being involved in a motor vehicle collision where he was the unrestrained driver. On arrival, he is unconscious. His respirations are 24/min, and palpable systolic blood pressure is 60 mm Hg, and pulse is 141/min and irregularly irregular. Examin... | A. Cardiac contusion | [
"The patient is brought to the emergency department after suffering blunt trauma from a motor vehicle accident with severe injuries given his presentation with unconsciousness, hypotension, and tachycardia. ",
"Ecchymosis of his chest wall and presence of an arrhythmia suggests significant blunt cardiac trauma. "... | Answer: A. Cardiac contusion
Scoring points:
- The patient is brought to the emergency department after suffering blunt trauma from a motor vehicle accident with severe injuries given his presentation with unconsciousness, hypotension, and tachycardia.
- Ecchymosis of his chest wall and presence of an arrhythmia sugge... |
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