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Answer the following medical question with one of the provided options: | Q:A neonate born at 33 weeks is transferred to the NICU after a complicated pregnancy and C-section. A week after being admitted, he developed a fever and become lethargic and minimally responsive to stimuli. A lumbar puncture is performed that reveals the following: Appearance Cloudy Protein 64 mg/dL Glucose 22 mg/dL Pressure 330 mm H20 Cells 295 cells/mm³ (> 90% PMN) A specimen is sent to microbiology and reveals gram-negative rods. Which of the following is the next appropriate step in management?? {'A': 'Provide supportive measures only', 'B': 'MRI scan of the head', 'C': 'Start the patient on IV ceftriaxone', 'D': 'Start the patient on IV cefotaxime', 'E': 'Start the patient on oral rifampin'}, | D: Start the patient on IV cefotaxime |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman presents to the dermatology clinic for a follow-up of worsening acne. She has previously tried topical tretinoin as well as topical and oral antibiotics with no improvement. She recently moved to the area for college and says the acne has caused significant emotional distress when it comes to making new friends. She has no significant past medical or surgical history. Family and social history are also noncontributory. The patient’s blood pressure is 118/77 mm Hg, the pulse is 76/min, the respiratory rate is 17/min, and the temperature is 36.6°C (97.9°F). Physical examination reveals erythematous skin lesions including both open and closed comedones with inflammatory lesions overlying her face, neck, and upper back. The patient asks about oral isotretinoin. Which of the following is the most important step in counseling this patient prior to prescribing oral isotretinoin?? {'A': 'Avoid direct sunlight, from 10am to 2pm', 'B': 'Wear a wide-brimmed hat outdoors', 'C': 'Use non-comedogenic sunscreen daily with SPF of at least 45', 'D': 'Document 2 negative urine or blood pregnancy tests before beginning oral isotretinoin', 'E': 'Apply topical retinoids in the evening before bed'}, | D: Document 2 negative urine or blood pregnancy tests before beginning oral isotretinoin |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to the physician for a routine examination. He feels well. His pulse is 80/min and blood pressure is 140/85 mm Hg. Cardiac examination shows a holosystolic murmur in the 4th intercostal space along the left sternal border that gets louder during inspiration. The increase of this patient's murmur is best explained by which of the following hemodynamic changes?? {'A': 'Increased peripheral vascular resistance', 'B': 'Increased right ventricular stroke volume', 'C': 'Decreased pulmonary vessel capacity', 'D': 'Decreased left ventricular venous return', 'E': 'Increased systemic venous compliance'}, | B: Increased right ventricular stroke volume |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents with a dry cough. The patient’s mother states that the cough started a week ago and has not improved. She says the patient will have fits of forceful coughing that will last for minutes, followed by gasping as he catches his breath. Occasionally, the patient will vomit after one of these episodes. Past medical history is significant for a recent upper respiratory infection 4 weeks ago that has resolved. No current medications. Patient immunization status is incomplete because his mother believes they are harmful. Vitals are temperature 37.0°C (98.6°F), blood pressure 105/65 mm Hg, pulse 101/min, respiratory rate 27/min, and oxygen saturation 99% on room air. Cardiac exam is normal. Lungs are clear to auscultation. There are conjunctival hemorrhages present bilaterally. Which of the following correctly describes the stage of this patient’s most likely diagnosis?? {'A': 'Catarrhal stage', 'B': 'Paroxysmal stage', 'C': 'Convalescent stage', 'D': 'Intermittent stage', 'E': 'Persistent stage'}, | B: Paroxysmal stage |
Answer the following medical question with one of the provided options: | Q:A 28-year-old primigravid woman is brought to the emergency department after complaining of severe abdominal pain for 3 hours. She has had no prenatal care. There is no leakage of amniotic fluid. Since arrival, she has had 5 contractions in 10 minutes, each lasting 70 to 90 seconds. Pelvic examination shows a closed cervix and a uterus consistent in size with a 38-week gestation. Ultrasound shows a single live intrauterine fetus in a breech presentation consistent with a gestational age of approximately 37 weeks. The amniotic fluid index is 26 and the fetal heart rate is 92/min. The placenta is not detached. She is scheduled for an emergency lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The infant is delivered and APGAR score is noted to be 8 at 1 minute. The doctor soon notices cyanosis of the lips and oral mucosa, which does not resolve when the infant cries. The infant is foaming at the mouth and drooling. He also has an intractable cough. Which of the following is the most likely diagnosis?? {'A': 'Esophageal atresia', 'B': 'Esophageal stricture', 'C': 'Achalasia', 'D': 'Pulmonary hypoplasia', 'E': 'Defective swallowing reflex'}, | A: Esophageal atresia |
Answer the following medical question with one of the provided options: | Q:A 16 year-old female is being evaluated for shortness of breath. For the last year she has had shortness of breath and subjective wheezing with exercise and intermittent coughing at night. She reports waking up from sleep coughing 1-2 times per month. She now skips gym class because of her symptoms. She denies any coughing, chest tightness, or shortness of breath on the day of her visit. On exam, her lungs are clear to auscultation bilaterally, with normal inspiratory to expiratory duration ratio. Her pulmonary function tests (PFTs) show normal FEV1 and FVC based on her age, gender, and height. She is told to inhale a medication, and her PFTs are repeated, now showing a FEV1 79% of her previous reading. The patient is diagnosed with asthma. Which of the following medications was used to diagnose the patient?? {'A': 'Methacholine', 'B': 'Pilocarpine', 'C': 'Bethanechol', 'D': 'Carbachol', 'E': 'Physostigmine'}, | A: Methacholine |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man is admitted to the hospital for treatment of burn wounds on his upper extremities. Analgesic therapy with an opioid drug is begun. Shortly after, the patient develops chills, diaphoresis, nausea, and abdominal pain. On further questioning, the patient reports that he has been smoking opium at home to help him ""deal with the depression and pain.” This patient was most likely given which of the following opioid drugs?"? {'A': 'Morphine', 'B': 'Hydrocodone', 'C': 'Fentanyl', 'D': 'Oxycodone', 'E': 'Butorphanol'}, | E: Butorphanol |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of heartburn for the past 2 years. He has no chest pain, dysphagia, weight loss, or fever. He has no history of any serious illnesses. He takes omeprazole daily. Vital signs are within normal limits. Body mass index (BMI) is 34 kg/m2. Physical exam shows no abnormalities. An endoscopic image of the lower esophageal sphincter is shown. Which of the following is the most important next step in management?? {'A': 'Endoscopic mucosal ablation therapy', 'B': 'Esophagectomy', 'C': 'High-dose pantoprazole', 'D': 'Laparoscopic Nissen fundoplication', 'E': 'Multiple endoscopic biopsies'}, | E: Multiple endoscopic biopsies |
Answer the following medical question with one of the provided options: | Q:A 25-year-old male is brought into the emergency department by emergency medical services. The patient has a history of bipolar disease complicated by polysubstance use. He was found down in his apartment at the bottom of a staircase lying on his left arm. He was last seen several hours earlier by his roommate. He is disoriented and unable to answer any questions, but is breathing on his own. His vitals are HR 55, T 96.5, RR 18, BP 110/75. You decide to obtain an EKG as shown in Figure 1. What is the next best step in the treatment of this patient?? {'A': 'Intubation', 'B': 'Epinephrine', 'C': 'Albuterol', 'D': 'Insulin', 'E': 'Calcium gluconate'}, | E: Calcium gluconate |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman is brought to the emergency department because of a 1-day history of double vision and rapidly worsening pain and swelling of her right eye. She had an upper respiratory tract infection a week ago after which she has had nasal congestion, recurrent headaches, and a purulent nasal discharge. She took antibiotics for her respiratory tract infection but did not complete the course. She has asthma treated with theophylline and inhaled β-adrenergic agonists and corticosteroids. She appears to be in severe distress. Her temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 130/80 mm Hg. Ophthalmic examination of the right eye shows proptosis and diffuse edema, erythema, and tenderness of the eyelids. Right eye movements are restricted and painful in all directions. The pupils are equal and reactive to light. There is tenderness to palpation over the right cheek and purulent nasal discharge in the right nasal cavity. The left eye shows no abnormalities. Laboratory studies show a leukocyte count of 12,000/mm3. Which of the following provides the strongest indication for administering intravenous antibiotics to this patient?? {'A': 'Worsening of ocular pain', 'B': 'Leukocytosis', 'C': 'Pain with eye movements', 'D': 'Purulent nasal discharge and right cheek tenderness', 'E': 'Fever\n"'}, | C: Pain with eye movements |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man with a 60 pack-year smoking history is referred by his primary care physician for a pulmonary function test (PFT). A previously obtained chest x-ray is shown below. Which of the following will most likely appear in his PFT report?? {'A': 'Residual volume increased, total lung capacity decreased', 'B': 'Residual volume increased, total lung capacity increased', 'C': 'Residual volume decreased, total lung capacity increased', 'D': 'Residual volume normal, total lung capacity normal', 'E': 'Residual volume normal, total lung capacity decreased'}, | B: Residual volume increased, total lung capacity increased |
Answer the following medical question with one of the provided options: | Q:Fourteen days after a laparoscopic cholecystectomy for cholelithiasis, a 45-year-old woman comes to the emergency department because of persistent episodic epigastric pain for 3 days. The pain radiates to her back, occurs randomly throughout the day, and is associated with nausea and vomiting. Each episode lasts 30 minutes to one hour. Antacids do not improve her symptoms. She has hypertension and fibromyalgia. She has smoked 1–2 packs of cigarettes daily for the past 10 years and drinks 4 cans of beer every week. She takes lisinopril and pregabalin. She appears uncomfortable. Her temperature is 37°C (98.6° F), pulse is 84/min, respirations are 14/min, and blood pressure is 127/85 mm Hg. Abdominal examination shows tenderness to palpation in the upper quadrants without rebound or guarding. Bowel sounds are normal. The incisions are clean, dry, and intact. Serum studies show: AST 80 U/L ALT 95 U/L Alkaline phosphatase 213 U/L Bilirubin, total 1.3 mg/dL Direct 0.7 mg/dL Amylase 52 U/L Abdominal ultrasonography shows dilation of the common bile duct and no gallstones. Which of the following is the most appropriate next step in management?"? {'A': 'Counseling on alcohol cessation', 'B': 'Endoscopic retrograde cholangiopancreatography', 'C': 'Proton pump inhibitor therapy', 'D': 'Reassurance and follow-up in 4 weeks', 'E': 'CT scan of the abdomen'}, | B: Endoscopic retrograde cholangiopancreatography |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman presents to the office complaining of an extreme, nonradiating stabbing pain in the epigastric region after having a meal. She states that it has happened several times in the past week approximately 30 minutes after eating and spontaneously resolves. A day before, the patient went to urgent care with the same complaint, but the abdominal X-ray was normal. Surgical history is remarkable for a total knee arthroplasty procedure 6 months ago. She has lost 34 kg (75 lb) since the operation because of lifestyle changes. The vital signs are normal. Laparoscopic surgical scars are well healed. Endoscopy shows benign mucosa to the proximal duodenum. A barium swallow study reveals an extremely narrowed duodenum. Which of the following structures is most likely responsible for this patient’s current symptoms?? {'A': 'Superior mesenteric artery', 'B': 'Pylorus of the stomach', 'C': 'Gastroduodenal artery', 'D': 'Gallbladder', 'E': 'Inferior mesenteric artery'}, | A: Superior mesenteric artery |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man is seen in the emergency department for back pain that has been getting progressively worse over the last 4 days. Upon further questioning, he also notes that he has been having a tingling and burning sensation rising up from his feet to his knees bilaterally. The patient states he is having difficulty urinating and having bowel movements over the last several days. His temperature is 97.4°F (36.3°C), blood pressure is 122/80 mmHg, pulse is 85/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for weak leg flexion bilaterally along with decreased anal sphincter tone. Which of the following is the best next step in management?? {'A': 'CT', 'B': 'Emergency surgery', 'C': 'Lumbar puncture', 'D': 'MRI', 'E': 'Pulmonary function tests'}, | D: MRI |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents with a long history of ulcers on the bottom of his feet. He recalls having a similar looking ulcer on the side of his penis when he was 19 years old for which he never sought treatment. The patient denies any fever, chills, or constitutional symptoms. He reports multiple sexual partners and a very promiscuous sexual history. He has also traveled extensively as a writer since he was 19. The patient is afebrile, and his vital signs are within normal limits. A rapid plasma reagin (RPR) test is positive, and the result of a Treponema pallidum particle agglutination (TP-PA) is pending. Which of the following findings would most likely be present in this patient?? {'A': 'Hyperreflexia', 'B': 'Wide-based gait with a low step', 'C': "Positive Romberg's sign", 'D': 'Memory loss', 'E': 'Agraphesthesia'}, | C: Positive Romberg's sign |
Answer the following medical question with one of the provided options: | Q:A 44-year-old man presents for a checkup. The patient says he has to urinate quite frequently but denies any dysuria or pain on urination. Past medical history is significant for diabetes mellitus type 2 and hypertension, both managed medically, as well as a chronic mild cough for the past several years. Current medications are metformin, aspirin, rosuvastatin, captopril, and furosemide. His vital signs are an irregular pulse of 74/min, a respiratory rate of 14/min, a blood pressure of 130/80 mm Hg, and a temperature of 36.7°C (98.0°F). His BMI is 32 kg/m2. On physical examination, there are visible jugular pulsations present in the neck bilaterally. Laboratory findings are significant for the following: Glycated Hemoglobin (Hb A1c) 7.5% Fasting Blood Glucose 120 mg/dL Serum Electrolytes Sodium 138 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum Creatinine 1.3 mg/dL Blood Urea Nitrogen 18 mg/dL Which of the following is the next best step in the management of this patient?? {'A': 'Stop metformin.', 'B': 'Replace captopril with valsartan.', 'C': 'Start rosiglitazone.', 'D': 'Stop furosemide.', 'E': 'Start exenatide.'}, | E: Start exenatide. |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents to the clinic with complaints of constipation for the past 2 weeks. She reports that it has been getting increasingly difficult to pass stool to the point that she would go for 2-3 days without going to the bathroom. Prior to this, she passed stool every day without difficulty. She denies weight changes, headaches, chest pain, or abdominal pain but endorses fatigue. Her past medical history is significant for 2 episodes of kidney stones within the past 3 months. A physical examination is unremarkable. Laboratory studies are done and the results are shown below: Serum: Na+: 138 mEq/L Cl-: 97 mEq/L K+: 3.9 mEq/L HCO3-: 24 mEq/L BUN: 10 mg/dL Glucose: 103 mg/dL Creatinine: 1.1 mg/dL Thyroid-stimulating hormone: 3.1 uU/mL Ca2+: 12.1 mg/dL Phosphate: 1.2 mg/dL (Normal: 2.5-4.5 mg/dL) What is the most likely explanation for this patient’s low phosphate levels?? {'A': 'Chronic renal disease caused by recurrent renal stones', 'B': 'Defective G-coupled calcium-sensing receptors in multiple tissues', 'C': 'Hereditary malfunction of phosphate absorption at the small brush border', 'D': 'Increase in calcium-sodium cotransporter activity at the distal convoluted tubule (DCT)', 'E': 'Inhibition of sodium-phosphate cotransporter at the proximal convoluted tubule (PCT)'}, | E: Inhibition of sodium-phosphate cotransporter at the proximal convoluted tubule (PCT) |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the emergency department with a complaint of rectal bleeding. He describes blood mixed in with the stool, which is associated with a change in his normal bowel habit such that he is going more frequently than normal. He also has some crampy left-sided abdominal pain and weight loss. His symptoms started 2 months ago, but he thought they are due to lack of dietary fiber intake and excess consumption of red meat. He has had type 2 diabetes mellitus for 35 years for which he takes metformin. He also uses daily low-dose aspirin for cardioprotection and occasional naproxen for knee pain. His family history is irrelevant. On examination, his abdomen and digital rectal examination are normal. Colonoscopy shows an ulcerating mucosal lesion with a narrow bowel lumen and biopsy shows a moderately differentiated adenocarcinoma. Which of the following is the greatest risk factor for colorectal cancer in this patient?? {'A': 'Lack of dietary fiber intake', 'B': 'Increasing age', 'C': 'Low-dose aspirin use', 'D': 'Metformin use', 'E': 'Naproxen use'}, | B: Increasing age |
Answer the following medical question with one of the provided options: | Q:A 2-year-old male presents to the emergency department for fatigue and lethargy. Upon presentation, the patient is found to be severely dehydrated. The patient's mother says that he has been having non-bloody diarrhea for a day. She also says that the patient has not received any vaccinations after 6 months and currently attends a daycare center. The responsible microbe is isolated and its structure is analyzed. Which of the following organisms is most likely responsible for the symptoms seen in this child.? {'A': 'Campylobacter jejuni', 'B': 'Salmonella', 'C': 'Shigella', 'D': 'Rotavirus', 'E': 'Norovirus'}, | D: Rotavirus |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is brought to the physician by his mother for the evaluation of delay in attaining developmental milestones. He could sit upright by 14 months and has not been able to walk without support. He can build a tower of 3 blocks and cannot use utensils to feed himself. He speaks in unclear 2-word phrases and cannot draw a circle yet. His mother has noticed him hitting his head against the wall on multiple occasions. He is at 20th percentile for height and at 50th percentile for weight. Vitals signs are within normal limits. Examination shows multiple lacerations of his lips and tongue. There are multiple healing wounds over his fingers. Neurological examination shows increased muscle tone in all extremities. Laboratory studies show: Hemoglobin 10.1 g/dL Mean corpuscular volume 103 μm3 Serum Na+ 142 mEq/L Cl- 101 mEq/: K+ 4.1 mEq/L Creatinine 1.6 mg/dL Uric acid 12.3 mg/dL Which of the following is the most likely cause of this patient's findings?"? {'A': 'FMR1 gene mutation', 'B': 'MECP2 gene mutation', 'C': 'Branched-chain alpha-ketoacid dehydrogenase complex deficiency', 'D': 'Hypoxanthine-guanine phosphoribosyltransferase deficiency', 'E': 'Microdeletion of paternal chromosome 15'}, | D: Hypoxanthine-guanine phosphoribosyltransferase deficiency |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man presents with the complaint of loose and watery stools for the past 3 days. He is now having bowel movements four to five times a day. He denies any blood or mucus in the stool. He also complains of abdominal pain and fatigue. Furthermore, he feels nauseous and does not feel like drinking anything. His urine is visibly yellow and low in volume. He recently returned from a trip to South America where he enjoyed all the local delicacies. He is most concerned about his urine color and volume. Which segment of the nephron is primarily responsible for these changes?? {'A': 'Glomerulus', 'B': 'Proximal convoluted tubule', 'C': 'Proximal straight tubule', 'D': 'Loop of Henle', 'E': 'Distal tubule'}, | D: Loop of Henle |
Answer the following medical question with one of the provided options: | Q:A 19-year-old male presents to the ER with generalized tonic-clonic seizures. He does not have a prior history of seizures and has not taken any drugs except for his daily asthma medication. Which of the following is associated with seizures:? {'A': 'Albuterol', 'B': 'Ipratropium', 'C': 'Cromolyn', 'D': 'Theophylline', 'E': 'Prednisone'}, | D: Theophylline |
Answer the following medical question with one of the provided options: | Q:Please refer to the summary above to answer this question This patient is at greatest risk of damage to which of the following cardiovascular structures?" "Patient Information Age: 44 years Gender: M, self-identified Ethnicity: Caucasian Site of Care: office History Reason for Visit/Chief Concern: “I am thirsty all the time, and it's getting worse.” History of Present Illness: 6-month history of increased thirst has had to urinate more frequently for 4 months; urinates every 3–4 hours feels generally weaker and more tired than usual has also had a 1-year history of joint pain in the hands Past Medical History: gastroesophageal reflux disease tension headaches Social History: has smoked one-half pack of cigarettes daily for 15 years occasionally drinks two or three beers on weekends used to be sexually active with his husband but has been losing interest in sexual activity for the past 6 months Medications: pantoprazole, amitriptyline, multivitamin Allergies: no known drug allergies Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 37.2°C (99.0°F) 78/min 16/min 127/77 mm Hg – 188 cm (6 ft 2 in) 85 kg (187 lb) 24 kg/m2 Appearance: no acute distress HEENT: sclerae anicteric; no oropharyngeal erythema or exudate Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops Abdominal: no tenderness, guarding, masses, or bruits; the liver span is 15 cm Pelvic: small, firm testes; no nodules or masses Extremities: tenderness to palpation and stiffness of the metacarpophalangeal joints of both hands Skin: diffusely hyperpigmented Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits"? {'A': 'Pulmonary valve', 'B': 'Cardiac septum', 'C': 'Coronary artery', 'D': 'Cardiac conduction system', 'E': 'Temporal artery\n"'}, | D: Cardiac conduction system |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman presents with altered taste and a gritty sensation in her eyes for the last month. She mentions that she needs to drink water frequently and often feels that her mouth and throat are dry. On physical examination, she has bilateral enlargement of the parotid glands and dry conjunctivae. Her physical examination and laboratory findings suggest a diagnosis of sicca syndrome. In addition to non-pharmacological measures, a drug is prescribed to improve symptoms related to dryness of mouth by increasing salivation. Which of the following is the mechanism of action of the drug that most likely is being prescribed to this patient?? {'A': 'Selective M3 muscarinic receptor antagonist', 'B': 'Selective M1 muscarinic receptor antagonist', 'C': 'Selective M2 muscarinic receptor agonist', 'D': 'Selective M2 muscarinic receptor antagonist', 'E': 'Selective M3 muscarinic receptor agonist'}, | E: Selective M3 muscarinic receptor agonist |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man with alcoholism comes to the emergency department because of vomiting blood for 6 hours. He has had 3–4 episodes in which he has vomited dark red blood during this period. He has had no epigastric pain or tarry stools. On arrival, his temperature is 37.3°C (99.1°F), pulse is 134/min, and blood pressure is 80/50 mm Hg. He is resuscitated with 0.9% saline and undergoes an emergency upper endoscopy, which shows actively bleeding varices. Band ligation of the varices is done and hemostasis is achieved. He is diagnosed with Child class B cirrhosis. He is concerned about the possibility of recurrence of such an episode. He is asked to abstain from alcohol, to which he readily agrees. In addition to non-selective beta-blocker therapy, which of the following is the most appropriate recommendation to prevent future morbidity and mortality from this condition?? {'A': 'Octreotide therapy', 'B': 'Terlipressin', 'C': 'Transjugular intrahepatic portosystemic shunt', 'D': 'Variceal sclerotherapy', 'E': 'Variceal ligation'}, | E: Variceal ligation |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man presents to his primary care practitioner for 2 months of rectal bleeding. He also reports occasional diarrhea and abdominal pain. His family history is relevant for his father and uncle, who died from complications of colorectal cancer. Colonoscopy shows more than 10 colorectal adenomas. Which of the following genes is most likely affected in this patient?? {'A': 'RAS', 'B': 'TP53', 'C': 'APC', 'D': 'hMLH1', 'E': 'PPAR'}, | C: APC |
Answer the following medical question with one of the provided options: | Q:A 36-year-old male is taken to the emergency room after jumping from a building. Bilateral fractures to the femur were stabilized at the scene by emergency medical technicians. The patient is lucid upon questioning and his vitals are stable. Pain only at his hips was elicited. Cervical exam was not performed. What is the best imaging study for this patient?? {'A': 'Lateral radiograph (x-ray) of hips', 'B': 'Computed tomagraphy (CT) scan of his hips and lumbar area', 'C': 'Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area', 'D': 'Magnetic resonance imaging (MRI) of hips, knees, lumbar, and cervical area', 'E': 'AP and lateral radiographs of hips'}, | C: Anterior-posterior (AP) and lateral radiographs of hips, knees, lumbar, and cervical area |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents to the dermatology clinic to have a basal cell carcinoma excised from his upper back. The lesion measures 2.3 x 3.2 cm. He has a medical history significant for hypertension and diabetes mellitus type II, for which he takes lisinopril and metformin, respectively. He has had a basal cell carcinoma before which was excised in the clinic without complications. Which of the following modes of anesthesia should be used for this procedure?? {'A': 'Local anesthesia', 'B': 'Peripheral nerve block', 'C': 'Spinal anesthesia', 'D': 'Moderate sedation', 'E': 'General anesthesia'}, | A: Local anesthesia |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man is brought to the physician by his wife because of strange behavior and emotional outbursts for the past 6 months. He was previously healthy and physically active, but he recently started binge-eating candy and stopped exercising. He was fired from his job for inappropriate behavior after he undressed in the office and made lewd remarks to several female coworkers. He claims there is nothing wrong with his behavior. On mental status examination, he is alert and irritable but cooperative. Short-term recall is normal but he has some word-finding difficulties. Babinski reflex is positive bilaterally. This patient's symptoms are most likely due to a degenerative process in which of the following regions of the brain?? {'A': 'Frontal cortex', 'B': 'Substantia nigra', 'C': 'Caudate nucleus', 'D': 'Hippocampus', 'E': 'Corona radiata'}, | A: Frontal cortex |
Answer the following medical question with one of the provided options: | Q:A 10-month-old infant is brought in by his parents because he is vomiting and not passing stool. His parents say he has vomited multiple times over the past couple of hours, but the most recent vomit was green. The patient has no significant past medical history. On physical examination, the patient is irritable and crying. On palpation in the periumbilical region, an abdominal mass is present. Emergency laparotomy is performed, which shows a part of the patient’s intestine folded into the section adjacent to it. Which of the following is the most likely diagnosis for this patient?? {'A': 'Hirschsprung’s disease', 'B': 'Meckel’s diverticulum', 'C': 'Duodenal atresia', 'D': 'Pyloric stenosis', 'E': 'Intussusception'}, | E: Intussusception |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman comes to the physician because of increased urinary frequency and pain on urination for two days. She has had three similar episodes over the past year that resolved with antibiotic treatment. She has no history of serious illness. She is sexually active with one male partner; they do not use barrier contraception. Upon questioning, she reports that she always urinates and cleans herself after sexual intercourse. She drinks 2–3 liters of fluid daily. Her only medication is a combined oral contraceptive. Her temperature is 36.9°C (98.4°F), pulse is 65/min, and blood pressure is 122/65 mm Hg. Examination shows mild tenderness to palpation in the lower abdomen. The remainder of the examination shows no abnormalities. Urinalysis shows WBCs and rare gram-positive cocci. Which of the following is the most appropriate recommendation to prevent similar episodes in the future?? {'A': 'Daily intake of cranberry juice', 'B': 'Postcoital vaginal probiotics', 'C': 'Treatment of the partner with intramuscular ceftriaxone', 'D': 'Postcoital oral amoxicillin-clavulanate', 'E': 'Daily oral trimethoprim-sulfamethoxazole\n"'}, | E: Daily oral trimethoprim-sulfamethoxazole " |
Answer the following medical question with one of the provided options: | Q:A patient presents to the emergency department with arm pain. The patient recently experienced an open fracture of his radius when he fell from a ladder while cleaning his house. Surgical reduction took place and the patient's forearm was put in a cast. Since then, the patient has experienced worsening pain in his arm. The patient has a past medical history of hypertension and asthma. His current medications include albuterol, fluticasone, loratadine, and lisinopril. His temperature is 99.5°F (37.5°C), blood pressure is 150/95 mmHg, pulse is 90/min, respirations are 19/min, and oxygen saturation is 99% on room air. The patient's cast is removed. On physical exam, the patient's left arm is tender to palpation. Passive motion of the patient's wrist and fingers elicits severe pain. The patient's left radial and ulnar pulse are both palpable and regular. The forearm is soft and does not demonstrate any bruising but is tender to palpation. Which of the following is the next best step in management?? {'A': 'Ibuprofen and reassurance', 'B': 'Replace the cast with a sling', 'C': 'Radiography', 'D': 'Measurement of compartment pressure', 'E': 'Emergency fasciotomy'}, | E: Emergency fasciotomy |
Answer the following medical question with one of the provided options: | Q:A 4-month-old boy is brought to the pediatrician for a wellness visit. Upon examination, the physician notes severe burns on the sun-exposed areas of the skin, including the face (especially the ears and nose), dorsal aspect of the hands, shoulders, and dorsal aspect of his feet. The child has very fair skin and blond hair. The parents insist that the child has not spent any extraordinary amount of time in the sun, but they admit that they rarely apply sunscreen. Which of the following physical factors is the most likely etiology for the burns?? {'A': 'Infrared radiation', 'B': 'Child abuse', 'C': 'UV-B radiation', 'D': 'Ionizing radiation', 'E': 'Gamma radiation'}, | C: UV-B radiation |
Answer the following medical question with one of the provided options: | Q:Three days after undergoing an open cholecystectomy, a 73-year-old man has fever and abdominal pain. He has hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. He had smoked one pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, ipratropium, and tamsulosin. He appears acutely ill and lethargic. His temperature is 39.5°C (103.1°F), pulse is 108/min, respirations are 18/min, and blood pressure is 110/84 mm Hg. He is oriented only to person. Examination shows a 10-cm subcostal incision that appears dry and non-erythematous. Scattered expiratory wheezing is heard throughout both lung fields. His abdomen is distended with tenderness to palpation over the lower quadrants. Laboratory studies show: Hemoglobin 10.1 g/dl Leukocyte count 19,000/mm3 Serum Glucose 180 mg/dl Urea Nitrogen 25 mg/dl Creatinine 1.2 g/dl Lactic acid 2.5 mEq/L (N = 0.5 - 2.2 mEq/L) Urine Protein 1+ RBC 1–2/hpf WBC 32–38/hpf Which of the following is the most likely underlying mechanism of this patient's current condition?"? {'A': 'Wound contamination', 'B': 'Impaired alveolar ventilation', 'C': 'Peritoneal inflammation', 'D': 'Bladder outlet obstruction', 'E': 'Intraabdominal abscess formation'}, | D: Bladder outlet obstruction |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to his primary care physician complaining of increasingly frequent headaches. He also reports that his hats and wedding ring do not fit anymore. His temperature is 99°F (37.2°C), blood pressure is 145/80 mmHg, pulse is 85/min, and respirations are 16/min. Physical examination is notable for frontal bossing, a prominent jaw, and an enlarged tongue. A chest radiograph reveals mild cardiomegaly. Serum insulin-like growth factor 1 levels are significantly elevated. Which of the following conditions is this patient at greatest risk for?? {'A': 'Pheochromocytoma', 'B': 'Medullary thyroid carcinoma', 'C': 'Osteoid osteoma', 'D': 'Carpal tunnel syndrome', 'E': 'Osteosarcoma'}, | D: Carpal tunnel syndrome |
Answer the following medical question with one of the provided options: | Q:A 78-year-old man presents to the clinic complaining of shortness of breath at rest and with exertion. He also complains of difficulty breathing while lying down. He also is concerned because he startles from sleep and feels like he is choking. These symptoms have been bothering him for the last several weeks and they are getting worse. He has been afebrile with no known sick contacts. 6 months ago, he had an acute myocardial infarction from which he recovered and until recently had felt well. He has a history of hyperlipidemia for which he takes atorvastatin. His temperature is 37.0°C (98.6°F), the pulse is 85/min, the respiratory rate is 14/min, and the blood pressure is 110/75 mm Hg. On physical examination, his heart has a regular rate and rhythm. He has bilateral crackles in both lungs. An echocardiogram is performed and shows a left ventricular ejection fraction of 33%. What medication should be started?? {'A': 'Niacin', 'B': 'Captopril', 'C': 'Verapamil', 'D': 'Levofloxacin', 'E': 'Nitroglycerin'}, | B: Captopril |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man is brought in by his daughter who is concerned about his recent memory impairment. The patient’s daughter says she has noticed impairment in memory and functioning for the past month. She says that he has forgotten to pay bills and go shopping, and, as a result, the electricity was cut off due to non-payment. She also says that last week, he turned the stove on and forgot about it, resulting in a kitchen fire. The patient has lived by himself since his wife died last year. He fondly recalls living with his wife and how much he misses her. He admits that he feels ‘down’ most days of the week living on his own and doesn’t have much energy. When asked about the kitchen fire and problems with the electricity, he gets defensive and angry. At the patient’s last routine check-up 3 months ago, he was healthy with no medical problems. His vital signs are within normal limits. On physical examination, the patient appears to have a flat affect. Which of the following is the most likely diagnosis in this patient?? {'A': 'Pseudodementia', 'B': 'Dementia', 'C': 'Delirium', 'D': 'Both dementia and delirium', 'E': 'Pick’s disease'}, | A: Pseudodementia |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman comes to the physician because of a 3-day history of fever, fatigue, loss of appetite, cough, and chest pain. Physical examination shows diffuse inspiratory crackles over the left lung field. An x-ray of the chest shows hilar lymphadenopathy and well-defined nodules with central calcifications. Urine studies show the presence of a polysaccharide antigen. A biopsy specimen of the lung shows cells with basophilic, crescent-shaped nuclei and pericellular halos located within macrophages. This patient's history is most likely to show which of the following?? {'A': 'Treatment with inhaled glucocorticoids', 'B': 'Visit to Arizona desert', 'C': 'Recent trip to Brazil', 'D': 'Previous mycobacterial infection', 'E': 'Exposure to bat droppings'}, | E: Exposure to bat droppings |
Answer the following medical question with one of the provided options: | Q:Researchers are studying the relationship between heart disease and alcohol consumption. They review the electronic medical records of 500 patients at a local hospital during the study period and identify the presence or absence of acute coronary syndrome (ACS) and the number of alcoholic drinks consumed on the day of presentation. They find that there is a lower prevalence of acute coronary syndrome in patients who reported no alcohol consumption or 1 drink daily compared with those who reported 2 or more drinks. Which of the following is the most accurate description of this study type?? {'A': 'Randomized controlled trial', 'B': 'Case-control study', 'C': 'Cross-sectional study', 'D': 'Retrospective study', 'E': 'Prospective study'}, | C: Cross-sectional study |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man presents to his primary care provider for abdominal pain. He reports that he has had a dull, burning pain for several months that has progressively gotten worse. He also notes a weight loss of about five pounds over that time frame. The patient endorses nausea and feels that the pain is worse after meals, but he denies any vomiting or diarrhea. He has a past medical history of hypertension, and he reports that he has been under an unusual amount of stress since losing his job as a construction worker. His home medications include enalapril and daily ibuprofen, which he takes for lower back pain he developed at his job. The patient drinks 1-2 beers with dinner and has a 25-pack-year smoking history. His family history is significant for colorectal cancer in his father and leukemia in his grandmother. On physical exam, the patient is moderately tender to palpation in the epigastrium. A fecal occult test is positive for blood in the stool. Which of the following in the patient’s history is most likely causing this condition?? {'A': 'Physiologic stress', 'B': 'Alcohol use', 'C': 'Medication use', 'D': 'Smoking history', 'E': 'Family history of cancer'}, | C: Medication use |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man being treated for major depressive disorder returns to his psychiatrist complaining that he has grown weary of the sexual side effects. Which other medication used to treat major depressive disorder may be appropriate as a stand-alone or add-on therapy?? {'A': 'Paroxetine', 'B': 'Venlafaxine', 'C': 'Aripiprazole', 'D': 'Buproprion', 'E': 'Cyproheptadine'}, | D: Buproprion |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man presents to the emergency department with a severe pulsatile headache for an hour. He says that he is having palpitations as well. He adds that he has had several episodes of headache in the past which resolved without seeking medical attention. He is a non-smoker and does not drink alcohol. He denies use of any illicit drugs. He looks scared and anxious. His temperature is 37°C (98.6°F), respirations are 25/min, pulse is 107/min, and blood pressure is 221/161 mm Hg. An urgent urinalysis reveals elevated plasma metanephrines. What is the next best step in the management of this patient?? {'A': 'Propranolol followed by phenoxybenzamine', 'B': 'Phenoxybenzamine followed by propanolol', 'C': 'Amlodipine', 'D': 'Emergent surgery', 'E': 'Hydralazine'}, | B: Phenoxybenzamine followed by propanolol |
Answer the following medical question with one of the provided options: | Q:An investigator is comparing the risk of adverse effects among various antiarrhythmic medications. One of the drugs being studied primarily acts by blocking the outward flow of K+ during myocyte repolarization. Further investigation shows that the use of this drug is associated with a lower rate of ventricular tachycardia, ventricular fibrillation, and torsade de points when compared to similar drugs. Which of the following drugs is most likely being studied?? {'A': 'Esmolol', 'B': 'Sotalol', 'C': 'Procainamide', 'D': 'Verapamil', 'E': 'Amiodarone'}, | E: Amiodarone |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents with fatigue, progressive abdominal distention and yellow skin coloration for the past 2 weeks. He denies fever, chills, or other symptoms. Past medical history is unremarkable. He reports heavy alcohol consumption for the past several years but says he quit recently. On physical examination, the patient appears jaundiced and is ill-appearing. There is shifting dullness presents on abdominal percussion with a positive fluid wave. Sclera are icteric. Bilateral gynecomastia is present. Laboratory findings are significant for the following: Hgb 13 g/dL Leukocyte count 4,500/mm3 Platelets 86,000/mm3 Aspartate transaminase (AST) 108 U/L Alanine transaminase (ALT) 55 U/L GGT 185 U/L Urea 23 mg/dL Iron 120 μg/dL Ferritin 180 μg/dL Transferrin saturation 40% Which of the following is the most likely diagnosis in this patient?? {'A': 'Hemochromatosis', 'B': 'Chronic viral hepatitis', 'C': 'Alcoholic liver disease', 'D': 'Hepatic adenoma', 'E': 'Non alcoholic fatty liver disease'}, | C: Alcoholic liver disease |
Answer the following medical question with one of the provided options: | Q:A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare resulted in increased hospitalization. Using this patient population, the sociodemographics, health status, and hospital use were assessed. Next year, patient satisfaction with health care providers was assessed using 5 items from the Consumer Assessment of Health Plans Survey. Which of the following best describes this study design?? {'A': 'Cross-sectional study', 'B': 'Prospective case-control', 'C': 'Prospective cohort', 'D': 'Retrospective case-control', 'E': 'Retrospective cohort'}, | C: Prospective cohort |
Answer the following medical question with one of the provided options: | Q:A 16-year-old man presents to the emergency department complaining of episodes of pounding headache, chest fluttering, and excessive sweating. He has a past history of kidney stones that are composed of calcium oxalate. He does not smoke or drink alcohol. Family history reveals that his mother died of thyroid cancer. Vital signs reveal a temperature of 37.1°C (98.7°F), blood pressure of 200/110 mm Hg and pulse of 120/min. His 24-hour urine calcium, serum metanephrines, and serum normetanephrines levels are all elevated. Mutation of which of the following genes is responsible for this patient's condition?? {'A': 'BRAF', 'B': 'RET proto-oncogene', 'C': 'BCR-ABL', 'D': 'BCL2', 'E': 'HER-2/neu (C-erbB2)'}, | B: RET proto-oncogene |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents to his primary care physician for fatigue. The patient states that he has not been sleeping well and requests sleep medication to help him with his fatigue. He recently changed his diet to try to increase his energy and has been on a vegetarian diet for the past several months. The patient has no significant past medical history. He smokes 1 pack of cigarettes per day and drinks 5 alcoholic beverages per day. The patient has lost 12 pounds since his last visit 1 month ago. Physical exam demonstrates a tired man. He appears thin, and his skin and sclera are icteric. Abdominal ultrasound is notable for a thin-walled and enlarged gallbladder. A urine sample is collected and is noted to be amber in color. Which of the following is the most likely diagnosis?? {'A': 'Autoimmune hemolytic anemia', 'B': 'Cholangiocarcinoma', 'C': 'Gallbladder adenocarcinoma', 'D': 'Iron deficiency anemia', 'E': 'Pancreatic adenocarcinoma'}, | E: Pancreatic adenocarcinoma |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man comes to the emergency department because of a 3-hour history of pain and redness of both eyes. He has new blurry vision and difficulty opening his eyes in bright surroundings. He has not had any recent trauma. He uses contact lenses daily. He had surgery on his left eye 6 months ago after a penetrative trauma caused by a splinter. His vital signs are within normal limits. Physical examination shows congestion of the perilimbal conjunctivae bilaterally. Visual acuity is decreased bilaterally. Ocular movements are normal. Slit-lamp examination shows a cornea with normal contours and leukocytes in the anterior chambers of both eyes. The eyelids, eyelashes, and lacrimal ducts show no abnormalities. Which of the following is the most likely cause of this patient's condition?? {'A': 'Reactivation of herpes zoster virus', 'B': 'Autoimmune reaction against retinal antigens', 'C': 'Corneal infection with Pseudomonas aeruginosa', 'D': 'Impaired drainage of aqueous humor', 'E': 'Age-related denaturation of lens proteins'}, | B: Autoimmune reaction against retinal antigens |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman presents with shortness of breath and chest pain for the past week. She says her chest pain is aggravated by deep breathing and she becomes short of breath while walking upstairs in her home. She also has been feeling feverish and fatigued for the past week, as well as pain in her wrists, hands, and left knee. Review of systems is significant for a 4.5 kg (10.0 lb) weight loss over the previous month Past medical history consists of 2 spontaneous abortions, both of which occurred in the 1st trimester. On physical examination, there is a pink rash present on over her face, which is aggravated by exposure to sunlight. There are decreased breath sounds on the right. A chest radiograph is performed which reveals evidence of a right pleural effusion. Serum ANA and anti-dsDNA autoantibodies are positive. Urinalysis is unremarkable. Errors with which of the following is most likely to lead to her disease?? {'A': 'Cytotoxic CD8+ T cells', 'B': 'Intrinsic pathway', 'C': 'Necrosis', 'D': 'Fas-FasL interaction', 'E': 'Bcl-2 overexpression'}, | D: Fas-FasL interaction |
Answer the following medical question with one of the provided options: | Q:An investigator is studying severely ill patients who experience hypoglycemia and ketonuria during times of fasting. The investigator determines that during these episodes, amino acids liberated from muscle proteins are metabolized to serve as substrates for gluconeogenesis. Nitrogen from this process is transported to the liver primarily in the form of which of the following molecules?? {'A': 'Pyruvate', 'B': 'Arginine', 'C': 'Alanine', 'D': 'α-ketoglutarate', 'E': 'Glutamate'}, | C: Alanine |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man presents to the emergency room with an acute myocardial infarction. Twenty-four hours after admission to the cardiac intensive care unit, he develops oliguria. Laboratory tests show that his serum BUN is 59 mg/dL and his serum creatinine is 6.2 mg/dL. Renal biopsy reveals necrosis of the proximal tubules and thick ascending limb of Henle's loop. Which of the following would you most likely observe on a microscopic examination of this patient's urine?? {'A': 'White blood cell casts', 'B': 'Fatty casts', 'C': 'Muddy brown casts', 'D': 'Hyaline casts', 'E': 'Broad waxy casts'}, | C: Muddy brown casts |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man comes to the physician because of episodic palpitations for the past 2 months. He has the feeling that sometimes his heart “skips a beat”. His father has a history of atrial fibrillation and myocardial infarction. He has smoked one pack of cigarettes daily for 5 years. He drinks 1–2 beers on the weekends. His vital signs are within normal limits. Physical examination reveals a regular pulse. Cardiopulmonary examination shows no abnormalities. Serum studies, including electrolytes and creatinine, are within normal limits. An excerpt of 24h Holter monitoring is shown. Echocardiography is normal. Which of the following is the most appropriate next step in management?? {'A': 'Diltiazem therapy', 'B': 'Coronary angiography', 'C': 'Metoprolol therapy', 'D': 'Permanent pacemaker placement', 'E': 'Smoking cessation'}, | E: Smoking cessation |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman is rushed to the emergency room after falling on her right elbow while walking down the stairs. She cannot raise her right arm. Her vital signs are stable, and the physical examination reveals loss of sensation over the upper lateral aspect of the right arm and shoulder. A radiologic evaluation shows a fracture of the surgical neck of the right humerus. Which of the following muscles is supplied by the nerve that is most likely damaged?? {'A': 'Infraspinatus', 'B': 'Teres minor', 'C': 'Supraspinatus', 'D': 'Teres major', 'E': 'Subscapularis'}, | B: Teres minor |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man presents to his gastroenterologist for trouble swallowing. The patient states that whenever he eats solids, he regurgitates them back up. Given this patient's suspected diagnosis, the gastroenterologist performs a diagnostic test. Several hours later, the patient presents to the emergency department with chest pain and shortness of breath. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 60/min, respirations are 12/min, and oxygen saturation is 99% on room air. On physical exam, the patient demonstrates a normal cardiopulmonary exam. His physical exam demonstrates no tenderness of the neck, a normal oropharynx, palpable crepitus above the clavicles, and minor lymphadenopathy. Which of the following is the best next step in management?? {'A': 'Barium swallow', 'B': 'Urgent surgery', 'C': 'Magnetic resonance imaging', 'D': 'Gastrografin swallow', 'E': 'Ultrasound'}, | D: Gastrografin swallow |
Answer the following medical question with one of the provided options: | Q:A four-year-old boy is brought to his pediatrician by his mother for recurrent nosebleeds. The mother reports that the boy has had five nosebleeds within the past 2 weeks, each lasting between 15 and 20 minutes. The patient was born at term and has been hospitalized twice for pneumonia treatment. There is no family history of serious illness. The patient is at the 8th percentile for height and the 30th percentile for weight. Vital signs are within normal limits. Examination shows a small, thin child with two flat, dark brown areas of hyperpigmentation across the upper back and a similar discoloration on the left buttock. There is bilateral esotropia. Laboratory studies show a hemoglobin concentration of 9.3 g/dL, mean corpuscular volume of 107 μm3, leukocyte count of 3,800/mm3, and platelet count of 46,000/mm3. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Defect in DNA crosslink repair', 'B': 'Mutation in WAS protein', 'C': 'Parvovirus B19 infection', 'D': 'Recent history of NSAID use', 'E': 'Postviral autoimmune reaction'}, | A: Defect in DNA crosslink repair |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man presents to the physician with numbness and weakness in both legs for about a day. He also mentions that both thighs ache. His past medical history is not significant except for some diarrhea about 3 weeks ago. On physical examination, his temperature is 37.2ºC (99.0ºF), pulse rate is 108/min and respiratory rate is 14/min. His blood pressure is 122/82 mm Hg and 100/78 mm Hg in supine and upright positions, respectively. His neurologic evaluation reveals the presence of bilateral symmetrical weakness of the lower limbs, the absence of deep tendon reflexes, and negative Babinski sign. His sensorium and higher brain functions are normal. Which of the following options best explains the pathophysiological mechanism underlying the patient’s clinical features?? {'A': 'Genetic overexpression of K+ channels in skeletal muscle', 'B': 'Decreased neuronal excitability', 'C': 'Decreased threshold for the generation and propagation of the action potential', 'D': 'Toxin-mediated blockade of voltage-gated fast Na+ channels', 'E': 'Autoantibody-mediated destruction of Ca2+ channels in the nerve endings at the neuromuscular junction'}, | B: Decreased neuronal excitability |
Answer the following medical question with one of the provided options: | Q:Confident of your performance on Step 1 given your extensive utilization of Medbullets, you preemptively start to ponder your future specialty choice. You come across an analysis of lifestyle factors and how they affect medical student specialty choices. Image A depicts two scatter plots comparing the relationship between median income and weekly work hours on the difficulty of matching into specific specialties. Both associations are statistically significant. Which statement best describes the results?? {'A': 'The harder the specialty is to match into, the higher the weekly work hours', 'B': 'The easier the specialty is to match into, the higher the median income', 'C': 'Weekly work hours has a stronger correlation with matching difficulty than median income', 'D': 'Median income has a stronger correlation with matching difficulty than weekly work hours', 'E': 'The higher the median income of a specialty the shorter the weekly work hours'}, | D: Median income has a stronger correlation with matching difficulty than weekly work hours |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man undergoes parathyroidectomy for treatment-resistant hyperparathyroidism. The procedure is complicated by brisk bleeding from an artery that travels along the external branch of the superior laryngeal nerve. To stop the bleeding, the artery is ligated at its origin. Which of the following is most likely the origin of the artery that was injured in this patient?? {'A': 'Subclavian artery', 'B': 'Internal carotid artery', 'C': 'External carotid artery', 'D': 'Thyrocervical trunk', 'E': 'Ascending pharyngeal artery\n"'}, | C: External carotid artery |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency department with a progressively worsening cough, wheezes, and chest tightness over the last 2 days. He has a history of moderate persistent asthma and his maintenance regimen consists of an inhaled corticosteroid, a long-acting beta-agonist, and albuterol as rescue therapy. He has not improved with his rescue inhaler despite increased use. He reports prior exposure to a person who had symptoms of a respiratory infection. His temperature is 37.4°C (99.3°F), blood pressure is 101/68 mm Hg, heart rate is 99/min, and respiratory rate is 32/min. Physical examination reveals widespread polyphonic wheezes but equal air entry. His oxygen saturation is 92% on room air. The presence of which of the following categorizes this patient’s condition as life-threatening?? {'A': 'Peak expiratory flow rate (PEFR) >70%', 'B': 'Dyspnea that limits usual daily activity', 'C': 'Symptoms lasting for > 3 days after starting treatment', 'D': 'Respiratory alkalosis', 'E': 'Respiratory acidosis'}, | E: Respiratory acidosis |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?? {'A': 'Schizophrenia', 'B': 'Delusional disorder', 'C': 'Paranoid personality disorder', 'D': 'Schizoid personality disorder', 'E': 'Schizophreniform disorder'}, | A: Schizophrenia |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to his pediatrician's office by his parents for a scheduled visit. His father tells the physician that he has observed, on several occasions, that his son has difficulty breathing. This is more prominent when he is outside playing with his friends. These symptoms are increased during the spring and winter seasons, and, of late, the boy has one such episode almost every week. During these episodes, he usually wheezes, coughs, and seems to be winded as if something was restricting his ability to breathe. These symptoms have not affected his sleep at night. This breathlessness does not limit his daily activities, and whenever he does have an episode it subsides after he gets some rest. He does not have any other pertinent medical history and is not on any medication. His physical examination does not reveal any significant findings. The pediatrician checks his expiratory flow rate in the office and estimates it to be around 85% after conducting it three times. Which of the following drugs is the pediatrician most likely to start this patient on?? {'A': 'Inhaled salmeterol', 'B': 'Inhaled albuterol', 'C': 'High-dose budesonide', 'D': 'Low-dose fluticasone', 'E': 'Oral prednisone'}, | B: Inhaled albuterol |
Answer the following medical question with one of the provided options: | Q:An 18-year-old man presents with bloody diarrhea and weight loss. He undergoes endoscopic biopsy which shows pseudopolyps. Biopsies taken during the endoscopy show inflammation only involving the mucosa and submucosa. He is diagnosed with an inflammatory bowel disease. Which of the following was most likely found?? {'A': 'Skip lesions', 'B': 'Noncaseating granuloma', 'C': 'Fistulas and strictures', 'D': 'Rectal involvement', 'E': 'Cobblestone mucosa'}, | D: Rectal involvement |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man presents to his primary care provider complaining of bilateral arm numbness. He was involved in a motor vehicle accident 3 months ago. His past medical history is notable for obesity and psoriatic arthritis. He takes adalimumab. His temperature is 99.3°F (37.4°C), blood pressure is 130/85 mmHg, pulse is 90/min, and respirations are 18/min. On exam, superficial skin ulcerations are found on his fingers bilaterally. His strength is 5/5 bilaterally in shoulder abduction, arm flexion, arm extension, wrist extension, finger abduction, and thumb flexion. He demonstrates loss of light touch and pinprick response in the distal tips of his 2nd and 5th fingertips and over the first dorsal web space. Vibratory sense is intact in the bilateral upper and lower extremities. Which of the following nervous system structures is most likely affected in this patient?? {'A': 'Ventral white commissure', 'B': 'Ventral horns', 'C': 'Cuneate fasciculus', 'D': 'Anterior corticospinal tract', 'E': 'Spinocerebellar tract'}, | A: Ventral white commissure |
Answer the following medical question with one of the provided options: | Q:A 46-year-old Caucasian male with past medical history of HIV (CD4: 77/mm^3), hypertension, hyperlipidemia, and osteoarthritis presents to the emergency department with sudden weakness of his right hand. He reports that the weakness has gradually been getting worse and that this morning he dropped his cup of coffee. He has never had anything like this happen to him before, although he was hospitalized last year for pneumonia. He reports inconsistent adherence to his home medications, which include raltegravir, tenofovir, emtricitabine, TMP-SMX, hydrochlorothiazide, pravastatin, and occasional ibuprofen. His father died of a myocardial infarction at the age of 60, and his mother suffered a stroke at the age of 72. The patient's temperature is 102.6°F (39.2°C), blood pressure is 156/92 mmHg, pulse is 88/min, and respirations are 18/min. On neurological exam, he has 3/5 strength in the distal muscles of the right extremity with preserved sensation. His neurological exam is normal in all other extremities. Which of the following is the best next step in management?? {'A': 'Lumbar puncture', 'B': 'Serology for Toxoplasma-specific IgG antibodies', 'C': 'Head CT', 'D': 'Empiric treatment with pyrimethamine-sulfadiazine', 'E': 'Empiric treatment with itraconazole'}, | C: Head CT |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl comes to the physician because of a 12-hour history of profuse watery diarrhea with flecks of mucus that started shortly after she returned from a trip to South America. She has not had any fever or nausea. Pulse is 104/min and blood pressure is 110/65 mm Hg. Physical examination shows dry mucous membranes and decreased skin turgor. Stool culture shows gram-negative, comma-shaped, flagellated bacilli. Therapy with oral rehydration solution is initiated. Which of the following is the most likely mechanism of this patient's diarrhea?? {'A': 'Reduced ability of water absorption in the colon due to rapid intestinal transit', 'B': 'Fluid and electrolyte loss due to inflammation of luminal surface epithelium', 'C': 'Luminal chloride hypersecretion due to overactivation of adenylate cyclase', 'D': 'Impaired intestinal motility due to degeneration of autonomic nerves', 'E': 'Excessive water excretion due to osmotically active solutes in the lumen'}, | C: Luminal chloride hypersecretion due to overactivation of adenylate cyclase |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl comes to her primary care physician for an annual check-up. She has no specific complaints. Her medical history is significant for asthma. She uses an albuterol inhaler as needed. She has no notable surgical history. Her mom had breast cancer and her grandfather died of colon cancer. She received all her childhood scheduled vaccinations up to age 8. She reports that she is doing well in school but hates math. She is sexually active with her boyfriend. They use condoms consistently, and they both tested negative recently for gonorrhea, chlamydia, syphilis and human immunodeficiency virus. She asks about birth control. In addition to educating the patient on her options for contraception, which of the following is the best next step in management?? {'A': 'Cytology and human papilloma virus (HPV) testing now and then every 3 years', 'B': 'Cytology and HPV testing now and then every 5 years', 'C': 'Cytology now and then every 3 years', 'D': 'No HPV-related screening as the patient is low risk', 'E': 'No HPV-related screening and administer HPV vaccine'}, | E: No HPV-related screening and administer HPV vaccine |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy with beta thalassemia requires regular blood transfusions a few times per month because of persistent anemia. He is scheduled for a splenectomy in the next several months. Samples obtained from the boy’s red blood cells show a malformed protein with a length of 160 amino acids (in normal, healthy red blood cells, the functional protein has a length of 146 amino acids). Which of the following best accounts for these findings?? {'A': 'Frameshift mutation', 'B': 'Missense mutation', 'C': 'Nonsense mutation', 'D': 'Silent mutation', 'E': 'Splice site mutation'}, | E: Splice site mutation |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the physician because she has been unable to conceive for 2 years. The patient also reports monthly episodes of pelvic and back pain accompanied by painful diarrhea for 6 years. She takes naproxen for the pain, which has provided some relief. Menses have occurred at regular 28-day intervals since menarche at the age of 11 years and last for 7 days. She is sexually active with her husband and does not use contraception. Pelvic and rectal examination shows no abnormalities. A hysterosalpingogram is unremarkable. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Endometrial tissue outside the uterine cavity', 'B': 'Smooth muscle tumor arising from the myometrium', 'C': 'Primary failure of the ovaries', 'D': 'Scarring of the fallopian tubes', 'E': 'Increased secretion of androgens and luteinizing hormone'}, | A: Endometrial tissue outside the uterine cavity |
Answer the following medical question with one of the provided options: | Q:A 41-year-old man presents to his primary care provider because of chest pain with activity for the past 6 months. Past medical history is significant for appendectomy at age 12 and, hypertension, and diabetes mellitus type 2 that is poorly controlled. He takes metformin and lisinopril but admits that he is bad at remembering to take them everyday. His father had a heart attack at 41 and 2 stents were placed in his heart. His mother is healthy. He drinks alcohol occasionally and smokes a half of a pack of cigarettes a day. He is a sales executive and describes his work as stressful. Today, the blood pressure is 142/85 and the body mass index (BMI) is 28.5 kg/m2. A coronary angiogram shows > 75% narrowing of the left anterior descending coronary artery. Which of the following is most significant in this patient?? {'A': 'Diabetes mellitus', 'B': 'Hypertension', 'C': 'Family history', 'D': 'Obesity', 'E': 'Smoking'}, | A: Diabetes mellitus |
Answer the following medical question with one of the provided options: | Q:A 56-year-old man is brought to the emergency department 30 minutes after falling from a height of 3 feet onto a sharp metal fence pole. He is unconscious. Physical examination shows a wound on the upper margin of the right clavicle in the parasternal line that is 3-cm-deep. Which of the following is the most likely result of this patient's injury?? {'A': 'Rotator cuff tear due to supraspinatus muscle injury', 'B': 'Pneumothorax due to pleural injury', 'C': 'Trapezius muscle paresis due to spinal accessory nerve injury', 'D': 'Hemathorax due to azygos vein injury', 'E': 'Traumatic aneurysm due to internal carotid artery injury'}, | B: Pneumothorax due to pleural injury |
Answer the following medical question with one of the provided options: | Q:A 12-hour-old newborn is urgently transferred to the neonatal intensive care unit because he is found to be cyanotic and appears blue in all four extremities. He was born to a 42-year-old G1P1 mother who underwent no prenatal screening because she did not show up to her prenatal care visits. She has poorly controlled diabetes and hypertension. On physical exam, the infant is found to have slanted eyes, a flattened head, a large tongue, and a single palmar crease bilaterally. Furthermore, a single, loud S2 murmur is appreciated in this patient. Radiography shows a large oblong-shaped heart shadow. Based on this presentation, the neonatologist starts a medication that will temporarily ensure this patient's survival pending definitive fixation of the defect. The substance that was most likely administered in this case also has which of the following effects?? {'A': 'Decreased platelet aggregation', 'B': 'Increased bronchial tone', 'C': 'Increased uterine tone', 'D': 'Vascular vasoconstriction', 'E': 'Vascular vasodilation'}, | E: Vascular vasodilation |
Answer the following medical question with one of the provided options: | Q:A syndrome caused by chromosomal anomalies is being researched in the immunology laboratory. Several congenital conditions are observed among the participating patients, mostly involving the thymus and the heart. Common facial features of affected individuals are shown in the image below. Flow cytometry analysis of patient samples reveals a CD19+ and CD3- result. What kind of congenital anomaly is generally observed in these patients, specifically in the thymus?? {'A': 'Deformation', 'B': 'Agenesis', 'C': 'Aplasia', 'D': 'Malformation', 'E': 'Disruption'}, | C: Aplasia |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents to the emergency department with confusion and a change in his behavior. The patient was in his usual state of health 3 days ago. He became more confused and agitated this morning thus prompting his presentation. The patient has a past medical history of depression, hypertension, diabetes, and Parkinson disease and is currently taking fluoxetine, lisinopril, insulin, metformin, and selegiline (recently added to his medication regimen for worsening Parkinson symptoms). He also takes oxycodone and clonazepam for pain and anxiety; however, he ran out of these medications last night. His temperature is 101°F (38.3°C), blood pressure is 111/78 mmHg, pulse is 117/min, respirations are 22/min, and oxygen saturation is 99% on room air. Physical exam is notable for an irritable, sweaty, and confused elderly man. Neurological exam reveals hyperreflexia of the lower extremities and clonus. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Bacterial infection', 'B': 'Electrolyte abnormality', 'C': 'Medication complication', 'D': 'Substance withdrawal', 'E': 'Viral infection'}, | C: Medication complication |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man presents to the physician with difficulty in breathing for 3 hours. There is no history of chest pain, cough or palpitation. He is a chronic smoker and underwent elective cholecystectomy one month back. There is no history of chronic or recurrent cough, wheezing or breathlessness. His temperature is 38.2°C (100.8°F), pulse is 108/min, blood pressure is 124/80 mm Hg, and respirations are 25/min. His arterial oxygen saturation is 98% in room air as shown by pulse oximetry. After a detailed physical examination, the physician orders a plasma D-dimer level, which was elevated. A contrast-enhanced computed tomography (CT) of the chest shows a filling defect in a segmental pulmonary artery on the left side. Which of the following signs is most likely to have been observed by the physician during the physical examination of this patient’s chest?? {'A': 'Bilateral wheezing', 'B': 'Systolic murmur at the left sternal border', 'C': 'S3 gallop', 'D': 'Pleural friction rub', 'E': 'Localized rales'}, | E: Localized rales |
Answer the following medical question with one of the provided options: | Q:A 2250-g (5.0-lb) male newborn and a 2900-g (6.4-lb) male newborn are delivered at 36 weeks' gestation to a 24-year-old, gravida 1, para 1 woman. The mother had no prenatal care. Examination of the smaller newborn shows low-set ears, retrognathia, and right-sided clubfoot. The hematocrit is 41% for the smaller newborn and 69% for the larger newborn. This pregnancy was most likely which of the following?? {'A': 'Dichorionic-diamniotic monozygotic', 'B': 'Monochorionic-diamniotic monozygotic', 'C': 'Conjoined twins', 'D': 'Dichorionic-monoamniotic monozygotic', 'E': 'Monochorionic-monoamniotic monozygotic'}, | B: Monochorionic-diamniotic monozygotic |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man presents to his primary care physician for back pain. His back pain worsens with standing for a prolonged period of time or climbing down the stairs and improves with sitting. Medical history is significant for hypertension, type II diabetes mellitus, and hypercholesterolemia. Neurologic exam demonstrates normal tone, 5/5 strength, and a normal sensory exam throughout the bilateral lower extremity. Skin exam is unremarkable and dorsalis pedis and posterior tibialis pulses are 3+. Which of the following is the best next step in management?? {'A': 'Ankle-brachial index', 'B': 'MRI of the lumbosacral spine', 'C': 'Naproxen', 'D': 'Radiography of the lumbosacral spine', 'E': 'Surgical spinal decompression'}, | B: MRI of the lumbosacral spine |
Answer the following medical question with one of the provided options: | Q:An 11-month-old boy presents with the recent loss of appetite and inability to gain weight. His diet consists mainly of cow’s milk and fruits. Family history is unremarkable. Physical examination shows conjunctival pallor. Laboratory findings are significant for the following: Hemoglobin 9.1 g/dL Mean corpuscular volume 75 μm3 Mean corpuscular hemoglobin 20 pg/cell Red cell distribution width 18% The patient is presumptively diagnosed with iron deficiency anemia (IDA) and ferrous sulfate syrup is prescribed. Which of the following laboratory values would most likely change 1st in response to this treatment?? {'A': 'Normalization of hemoglobin', 'B': '↑ reticulocyte count', 'C': 'Anisocytosis', 'D': '↓ mean corpuscular hemoglobin', 'E': '↓ Mentzer index'}, | B: ↑ reticulocyte count |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman presents to the office with a complaint of generalized weakness that has been getting worse over the last few months. She says that she just does not have the energy for her daily activities. She gets winded quite easily when she takes her dog for a walk in the evening. She says that her mood is generally ok and she gets together with her friends every weekend. She works as a teacher at a local elementary school and used to have frequent headaches while at work. Her husband is a commercial pilot and is frequently away for extended periods of time. Her only son is a sophomore in college and visits her every other week. She has had issues in the past with hypertension, but her blood pressure is currently well-controlled because she is compliant with her medication. She is currently taking atorvastatin and lisinopril. The blood pressure is 130/80 mm Hg, the pulse is 90/min, the temperature is 36.7°C (98.0°F), and the respirations are 16/min. On examination, she appears slightly pale and lethargic. Her ECG today is normal and recent lab work shows the following: Serum creatinine 1.5 mg/dL Estimated GFR 37.6 mL/min Hemoglobin (Hb%) 9 mg/dL Mean corpuscular hemoglobin (MCH) 27 pg Mean corpuscular hemoglobin concentration (MCHC) 36 g/dL Mean corpuscular volume (MCV) 85 fL Reticulocyte count 0.1% Erythrocyte count 2.5 million/mm3 Serum iron 160 μg/dL Serum ferritin 150 ng/mL Total iron binding capacity 105 μg/dL Serum vitamin B12 254 pg/mL Serum folic acid 18 ng/mL Thyroid stimulating hormone 3.5 μU/mL Which of the following will most likely help her?? {'A': 'Start oral iron supplements.', 'B': 'Start her on fluoxetine.', 'C': 'Start her on erythropoietin.', 'D': 'Start vitamin B12 with folic acid.', 'E': 'Transfuse red blood cells.'}, | C: Start her on erythropoietin. |
Answer the following medical question with one of the provided options: | Q:A 58-year-old male undergoes a surveillance colonoscopy in which a 2 cm adenoma is identified and removed. Had this adenoma not been excised, the patient would have been at risk of progression to carcinoma. Which of the following is the final mutational step in the progression from adenoma to carcinoma?? {'A': 'K-ras mutation', 'B': 'COX-2 overexpression', 'C': 'p53 inactivation', 'D': 'APC mutation', 'E': 'SMAD 2/4 loss'}, | C: p53 inactivation |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man is brought to the emergency department by his roommates for aggressive and unusual behavior. His roommates state that he has been under a lot of stress lately from his final exams and has been more reclusive. They state that this evening he was very irritable and was yelling at his computer prior to breaking it, followed by him spending several hours at the gym. His temperature is 101°F (38.3°C), blood pressure is 137/98 mmHg, pulse is 120/min, respirations are 23/min, and oxygen saturation is 99% on room air. Physical exam is notable for an irritable young man. Cardiopulmonary exam is notable for tachycardia and bilateral clear breath sounds. Neurological exam reveals dilated pupils. The patient is notably diaphoretic and speaks very rapidly during the physical exam and is aggressive. He is given haloperidol, diphenhydramine, and diazepam for sedation and placed in soft restraints. His symptoms resolved over the next 10 hours in the emergency department. Which of the following is the most likely diagnosis?? {'A': 'Caffeine intoxication', 'B': 'Cocaine intoxication', 'C': 'Lisdexamfetamine intoxication', 'D': 'Phencyclidine intoxication', 'E': 'Schizophrenia'}, | C: Lisdexamfetamine intoxication |
Answer the following medical question with one of the provided options: | Q:A 9-month-old boy is brought to the physician because of increased irritability, continual crying, and fever for 1 day. His mother has noticed that he refuses to lie down on his right side and keeps tugging at his right ear. One week ago, he had a runny nose that has since improved. He was born at term and has been otherwise healthy. He was exclusively breastfed until 2 months of age and is currently bottle-fed with some solid foods introduced. He has been attending a daycare center for the past 5 months. His temperature is 38.4°C (101.1°F) and pulse is 144/min. Otoscopic examination in this child is most likely to show which of the following?? {'A': 'Bulging erythematous tympanic membrane', 'B': 'Retracted opacified tympanic membrane', 'C': 'Erythematous external auditory canal', 'D': 'Vesicles in the ear canal', 'E': 'Brown mass within the ear canal'}, | A: Bulging erythematous tympanic membrane |
Answer the following medical question with one of the provided options: | Q:An 11-year-old girl is brought to the office by her mother due to complaint of intermittent and severe periumbilical pain for 1 day. She does not have any significant past medical history. She provides a history of a recent school trip to the suburbs. On physical examination, there is a mild tenderness around the umbilicus without any distension or discharge. There is no rebound tenderness. Bowel sounds are normal. An abdominal imaging shows enlarged mesenteric lymph nodes, and she is diagnosed with mesenteric lymphadenitis. However, incidentally, a mass of tissue was seen joining the inferior pole of both kidneys as shown in the image. Which of the following is best describes this renal anomaly?? {'A': 'Fused kidneys ascend beyond superior mesenteric artery.', 'B': 'Increased risk of developing renal vein thrombosis', 'C': 'Association with ureteropelvic junction obstruction (UPJO)', 'D': 'Kidneys are usually non-functional.', 'E': 'Rapid progression to acute renal failure'}, | C: Association with ureteropelvic junction obstruction (UPJO) |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the clinic for his annual physical examination. He was diagnosed with a rare arrhythmia a couple of years ago following an episode of dizziness. A mutation in the gene encoding for the L-type calcium channel protein was identified by genetic testing. He feels fine today. His vitals include: blood pressure 122/89 mm Hg, pulse 90/min, respiratory rate 14/min, and temperature 36.7°C (98.0°F). The cardiac examination is unremarkable. The patient has been conducting some internet research on how the heart works and specifically asks you about his own “ventricular action potential”. Which of the following would you expect to see in this patient?? {'A': 'Abnormal phase 1', 'B': 'Abnormal phase 4', 'C': 'Abnormal phase 3', 'D': 'Abnormal phase 2', 'E': 'Abnormal phase 0'}, | D: Abnormal phase 2 |
Answer the following medical question with one of the provided options: | Q:A 27-year-old female has a history of periodic bloody diarrhea over several years. Colonoscopy shows sigmoid colon inflammation, and the patient complains of joint pain in her knees and ankles. You suspect inflammatory bowel disease. Which of the following would suggest a diagnosis of Crohn disease:? {'A': 'Left lower quadrant pain', 'B': 'Jaundice', 'C': 'Loss of large bowel haustra', 'D': 'Mucosal and submucosal ulcerations', 'E': 'Perianal fistula'}, | E: Perianal fistula |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man is in the middle of an ascent up a mountain, at an elevation of about 4,500 meters. This is the 4th day of his expedition. His friend notices that in the last few hours, he has been coughing frequently and appears to be short of breath. He has used his albuterol inhaler twice in the past 4 hours, but it does not seem to help. Within the past hour, he has coughed up some frothy, slightly pink sputum and is now complaining of nausea and headache. Other than his asthma, which has been well-controlled on a steroid inhaler, he is healthy. Which of the following is the most likely cause of this man’s symptoms?? {'A': 'Pulmonary embolism', 'B': 'Non-cardiogenic pulmonary edema', 'C': 'Acute heart failure', 'D': 'An acute asthma exacerbation', 'E': 'Pneumothorax'}, | B: Non-cardiogenic pulmonary edema |
Answer the following medical question with one of the provided options: | Q:Researchers are investigating the mechanism of cell apoptosis and host defense in mice. They have observed that mice with certain gene deletions are not able to fight the induced viral infection. They identify a cell that is able to destroy target cells infected with viruses by exocytosis of granule contents, which induces the activation of caspases. Which type of cell is responsible for this process?? {'A': 'Macrophages', 'B': 'Neutrophils', 'C': 'CD8+ lymphocytes', 'D': 'CD4+ lymphocytes', 'E': 'Eosinophils'}, | C: CD8+ lymphocytes |
Answer the following medical question with one of the provided options: | Q:A 10-year-old boy is brought into your clinic by his mother for sunburns that have not been healing. The mother states that he easily gets sunburned. The mother admits she gave birth to him at home and has never taken him to see a doctor. The patient walks with a wide stance gait and appears unstable on his feet. He has an extensive erythematous, scaling, hyperkeratotic rash on his face, neck, arms and legs. After extensive workup, the patient is found to have a genetic disorder that results in defective absorption of an important vitamin. Which of the following is likely to be low if measured?? {'A': 'Niacin', 'B': 'Vitamin A', 'C': 'Vitamin K', 'D': 'Folate', 'E': 'Vitamin B12'}, | A: Niacin |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought to a psychiatrist by his mother upon referral from his pediatrician. The mother describes that for the past 2 years her son has experienced episodes of repetitive blinking and sudden jerking of the arms. Additionally, she notes that he often clears his throat and occasionally makes grunting noises. These symptoms have waxed and waned in frequency, but they have persisted for the past 2 years since they first developed. The patient is otherwise healthy without any coexisting medical issues. Which of the following agents would be effective at reducing the severity and frequency of this patient's current symptoms?? {'A': 'Baclofen', 'B': 'Valproic acid', 'C': 'Fluphenazine', 'D': 'Sertraline', 'E': 'Gabapentin'}, | C: Fluphenazine |
Answer the following medical question with one of the provided options: | Q:A 63-year-old woman comes to the physician because of worsening shortness of breath, cough, and a 4-kg (8.8-lb) weight loss over the last year. She has no history of serious illness and takes no medications. She has smoked one pack of cigarettes daily for 35 years. Her temperature is 37°C (98.6°F), pulse is 92/min, respirations are 20/min, blood pressure is 124/78 mm Hg, and pulse oximetry on room air shows an oxygen saturation of 93%. Physical examination shows decreased breath sounds. A flow-volume loop obtained via pulmonary function testing is shown. Which of the following is the most likely cause of this patient's respiratory symptoms?? {'A': 'Chronic obstructive pulmonary disease', 'B': 'Idiopathic pulmonary fibrosis', 'C': 'Endotracheal neoplasm', 'D': 'Chronic asthma', 'E': 'Unilateral mainstem obstruction'}, | A: Chronic obstructive pulmonary disease |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl presents to the gynecologist's office due to lack of menarche. She has been sexually active with 1 male lifetime partner and always uses a condom. Her mother believes that breast development started at 11 years old. On exam, she is a well-appearing, non-hirsute teenager with Tanner V breast and pubic hair development. Her pelvic exam reveals normal external genitalia, a shortened vagina, and the cervix is unable to be visualized. Initial laboratory testing for hormone levels and karyotype is normal, and imaging confirms what you suspect on exam. What is the most likely cause of her lack of menstruation?? {'A': '5-alpha reductase deficiency', 'B': 'Androgen insensitivity', 'C': 'Müllerian agenesis', 'D': 'Premature ovarian failure', 'E': 'Turner syndrome'}, | C: Müllerian agenesis |
Answer the following medical question with one of the provided options: | Q:A 15-year-old boy is brought to the physician with an ongoing pruritic rash for 1 week. The rash is on his right forearm (refer to the image). He has not had a similar rash in the past. He has no history of allergies, and he is not taking any medications. He frequently enjoys gardening in their backyard. They have no household pets. The physical examination reveals no other abnormalities. Given the most likely diagnosis, which of the following is the most appropriate treatment of the condition described in this case?? {'A': 'Oral acitretin', 'B': 'Oral terbinafine', 'C': 'Topical clotrimazole', 'D': 'Topical hydrocortisone', 'E': 'Topical salicylic acid'}, | C: Topical clotrimazole |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl comes to the emergency department with a 5-day history of severe abdominal pain, cramping, nausea, and vomiting. She also has pain with urination. She is sexually active with one male partner, and they use condoms inconsistently. She experienced a burning pain when she last had sexual intercourse 3 days ago. Menses occur at regular 28-day intervals and last 5 days. Her last menstrual period was 3 weeks ago. Her temperature is 38.5°C (101.3°F), pulse is 83/min, and blood pressure is 110/70 mm Hg. Physical examination shows abdominal tenderness in the lower quadrants. Pelvic examination shows cervical motion tenderness and purulent cervical discharge. Laboratory studies show a leukocyte count of 15,000/mm3 and an erythrocyte sedimentation rate of 100 mm/h. Which of the following is the most likely diagnosis?? {'A': 'Pyelonephritis', 'B': 'Ectopic pregnancy', 'C': 'Ovarian cyst rupture', 'D': 'Appendicitis', 'E': 'Pelvic inflammatory disease'}, | E: Pelvic inflammatory disease |
Answer the following medical question with one of the provided options: | Q:A 30-year-old African American woman comes to the physician because of a 3-month history of increasing shortness of breath, cough, and intermittent fever. She works in a local factory that manufactures components for airplanes. She drinks 2–3 glasses of wine daily and has smoked half a pack of cigarettes daily for the past 5 years. Physical examination shows a purple rash on her cheeks and nose. An x-ray of the chest shows bilateral hilar adenopathy and a calcified nodule in the left lower lobe. A bronchoalveolar lavage shows a CD4:CD8 T-lymphocyte ratio of 10:1 (N=2:1). A biopsy of the nodule shows a noncaseating granuloma. Which of the following is the strongest predisposing factor for the development of this patient's condition?? {'A': 'Race', 'B': 'Exposure to beryllium', 'C': 'Alcohol consumption', 'D': 'Smoking', 'E': 'Exposure to acid-fast bacilli\n"'}, | A: Race |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman visits her primary care provider with the results of a recent colonoscopy, which was ordered after 3 episodes of rectal bleeding in the last month. Her grandmother, mother, and sister all have been diagnosed with nonpolyposis colorectal cancer, at ages 65, 50, and 40 years, respectively. Colonoscopy for this patient revealed a large, flat, right-sided adenoma. Histopathological examination of the lesion showed villous histology and high-grade dysplasia. Which of the following helps explain the condition of this patient?? {'A': 'Chromosomal instability', 'B': 'Microsatellite instability', 'C': 'DNA hypermethylation', 'D': 'Chemical carcinogenicity', 'E': 'Environmental carcinogenicity'}, | B: Microsatellite instability |
Answer the following medical question with one of the provided options: | Q:Two days after admission to the hospital, a 74-year-old man develops confusion and headache. He has also been vomiting over the past hour. His temperature is 36.7°C (98°F), pulse is 98/min, respirations are 22/min, and blood pressure is 140/80 mm Hg. He is lethargic and oriented only to person. Examination shows flushed skin. Fundoscopic examination shows bright red retinal veins. Serum studies show: Na+ 138 mEq/L K+ 3.5 mEq/L Cl- 100 mEq/L HCO3- 17 mEq/L Creatinine 1.2 mg/dL Urea nitrogen 19 mg/dL Lactate 8.0 mEq/L (N = 0.5 - 2.2 mEq/L) Glucose 75 mg/dL Arterial blood gas analysis on room air shows a pH of 7.13. This patient's current presentation is most likely due to treatment for which of the following conditions?"? {'A': 'Alzheimer disease', 'B': 'Hypertensive crisis', 'C': 'Tension headache', 'D': 'Major depressive disorder', 'E': 'Acute dystonia'}, | B: Hypertensive crisis |
Answer the following medical question with one of the provided options: | Q:A 24-year-old Turkish female presents to your office for a routine examination. She recently started a new job and has been tired most of the time. She does not have any dizziness and has not lost consciousness. She follows a well-balanced diet and is not vegetarian. She recalls that other family members have had similar symptoms in the past. On physical exam her temperature is 99°F (37.2°C), blood pressure is 115/78 mmHg, pulse is 100/min, respirations are 22/min, and pulse oximetry is 99% on room air. On physical exam, you notice conjunctival pallor. Labs are obtained and the results are shown below: Hemoglobin: 10.2 g/dL Hematocrit: 34% Leukocyte count: 5,000 cells/mm^3 with normal differential Platelet count: 252,000/mm^3 Mean corpuscular hemoglobin concentration: 20.4% Mean corpuscular volume: 65 µm^3 Peripheral blood smear is shown in the image provided. The cause of her anemia is most likely associated with which of the following?? {'A': 'Point mutation on chromosome 11', 'B': 'X-linked defect in ALA synthase', 'C': 'Inhibition of ALA dehydratase', 'D': 'Blood loss', 'E': 'Malnutrition'}, | A: Point mutation on chromosome 11 |
Answer the following medical question with one of the provided options: | Q:A 43-year-old man is brought to the emergency department by his wife because of a 1-hour history of confusion and strange behavior. She reports that he started behaving in an agitated manner shortly after eating some wild berries that they had picked during their camping trip. His temperature is 38.7°C (101.7°F). Physical examination shows warm, dry skin and dry mucous membranes. His pupils are dilated and minimally reactive to light. His bowel sounds are decreased. The patient is admitted and pharmacotherapy is initiated with a drug that eventually results in complete resolution of all of his symptoms. This patient was most likely administered which of the following drugs?? {'A': 'Scopolamine', 'B': 'Rivastigmine', 'C': 'Atropine', 'D': 'Physostigmine', 'E': 'Neostigmine'}, | D: Physostigmine |
Answer the following medical question with one of the provided options: | Q:A 35-year-old G1 is brought to the emergency department because of sharp pains in her abdomen. She is at 30 weeks gestation based on ultrasound. She complains of feeling a little uneasy during the last 3 weeks of her pregnancy. She mentions that her abdomen has not been enlarging as expected and her baby is not moving as much as during the earlier part of the pregnancy. If anything, she noticed her abdomen has decreased in size. While she is giving her history, the emergency medicine physician notices that she is restless and is sweating profusely. An ultrasound is performed and her blood is sent for type and match. The blood pressure is 90/60 mm Hg, the pulse is 120/min, and the respiratory rate is 18/min. The fetal ultrasound is significant for no fetal heart motion or fetal movement. Her blood work shows the following: hemoglobin, 10.3 g/dL; platelet count, 1.1*10(5)/ml; bleeding time, 10 minutes; PT, 25 seconds; and PTT, 45 seconds. Which of the following would be the best immediate course of management for this patient?? {'A': 'IV fluids', 'B': 'Initiation of labor', 'C': 'D-dimer assay', 'D': 'Fresh frozen plasma', 'E': 'Low-molecular-weight heparin'}, | A: IV fluids |
Answer the following medical question with one of the provided options: | Q:A 21-year-old G1P0 woman presents to the labor and delivery ward at 39 weeks gestation for elective induction of labor. She requests a labor epidural. An epidural catheter is secured at the L4-L5 space. She exhibits no hemodynamic reaction to lidocaine 1.5% with epinephrine 1:200,000. A continuous infusion of bupivacaine 0.0625% is started. After 5 minutes, the nurse informs the anesthesiologist that the patient is hypotensive to 80/50 mmHg with a heart rate increase from 90 bpm to 120 bpm. The patient is asymptomatic and fetal heart rate has not changed significantly from baseline. She says that her legs feel heavy but is still able to move them. What is the most likely cause of the hemodynamic change?? {'A': 'Bainbridge reflex', 'B': 'Intrathecal infiltration of local anesthetic', 'C': 'Local anesthetic systemic toxicity', 'D': 'Spinal anesthesia', 'E': 'Sympathetic blockade'}, | E: Sympathetic blockade |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents to her gynecologist for a routine visit. She has no complaints during this visit. She had an abnormal pap test 6 years ago that showed atypical squamous cells of undetermined significance. The sample was negative for human papillomavirus. On her follow-up Pap test 3 years later, there was no abnormality. The latest pap test results show atypical glandular cells with reactive changes in the cervical epithelium. The gynecologist decides to perform a colposcopy, and some changes are noted in this study of the cervical epithelium. The biopsy shows dysplastic changes in the epithelial cells. Which of the following is the next best step in the management of this patient?? {'A': 'Loop electrosurgical excision procedure', 'B': 'Cold knife conization', 'C': 'Follow-up pap smear in one year', 'D': 'Follow-up pap smear in 3 years', 'E': 'Repeat colposcopy in 6 months'}, | B: Cold knife conization |
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