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Answer the following medical question with one of the provided options: | Q:A 51-year-old woman with Sjogren’s syndrome presents to her physician for suddenly developed palpitations. She feels more anxious than usual and has had difficulty sleeping well for the past 2 weeks. She has lost 2 kg (4.4 lb) since her last routine appointment 6 months ago. She also has had diarrhea and often feels like her heart is beating very quickly. On physical examination, her skin appears warm and moist. Her reflexes are hyperactive. Her thyroid is moderately enlarged and is non-tender. She has mild dry eyes and dry mouth. Her blood pressure is 136/88 mm Hg, pulse is 76/min, respirations are 17/min and temperature is 36.7°C (98.1°F). Which of the following pathologic findings is this patient likely to have?? {'A': 'Lymphoma', 'B': 'Silent thyroiditis', 'C': 'Chronic lymphocytic thyroiditis', 'D': 'Granulomatous thyroiditis', 'E': 'Fibrous thyroiditis'}, | C: Chronic lymphocytic thyroiditis |
Answer the following medical question with one of the provided options: | Q:A 46-year-old male presents with his wife to his primary care provider for depression and strange movements. His wife reports that her husband has not been himself for the last two months. Whereas he was previously outgoing and “the life of the party,” the patient is now irritable and withdrawn. He is a partner at an accounting firm, but his colleagues are threatening his job if he continues to perform poorly at work. The patient cannot explain the recent changes to his mood and tearfully admits he fears there is something seriously wrong with him. His wife says that she thinks he is getting worse. The patient’s past medical history is significant for hypertension, for which he takes lisinopril. His family history is unknown as he was adopted. The patient met his mother once, and never knew his father but was told he died in his 50's. He drinks a few glasses of wine per week and has never smoked. On physical exam, the patient has a flat affect with facial grimace and sudden jerky movements of his upper extremities. Which of the following is most likely to be seen on further workup?? {'A': 'Positive 14-3-3 CSF assay', 'B': 'Alpha-synuclein aggregates on brain biopsy', 'C': 'Neurofibrillary tangles on brain biopsy', 'D': 'Frontotemporal atrophy on head CT', 'E': 'Dorsal striatum atrophy on head CT'}, | E: Dorsal striatum atrophy on head CT |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man presents to the office for an annual physical examination. He has no complaints at this visit. His chart states that he has a history of hypertension, chronic obstructive pulmonary disease (emphysema), Raynaud’s disease, and glaucoma. He is a 30 pack-year smoker. His medications included lisinopril, tiotropium, albuterol, nifedipine, and latanoprost. The blood pressure is 139/96 mm Hg, the pulse is 86/min, the respiration rate is 16/min, and the temperature is 37.2°C (99.1°F). On physical examination, his pupils are equal, round, and reactive to light. The cardiac auscultation reveals an S4 gallop without murmur, and the lungs are clear to auscultation bilaterally. However, the inspection of the chest wall shows an enlarged anterior to posterior diameter. Which of the following is the most appropriate screening test for this patient?? {'A': 'Low-dose CT', 'B': 'Chest radiograph', 'C': 'Magnetic resonance imaging', 'D': 'Bronchoalveolar lavage with cytology', 'E': 'Pulmonary function tests'}, | A: Low-dose CT |
Answer the following medical question with one of the provided options: | Q:A 46-year-old woman presents to the emergency department complaining of abdominal pain, nausea, and vomiting approximately 4 hours after a fatty meal. She reports that this has happened before, but this episode is worse. The vomit was non-bilious and did not contain any blood. She recalls frequent episodes of vague epigastric pain that often wakes her up during the night. Over the counter omeprazole and a small meal or snack would provide some relief in the past. The patient also mentions recent anorexia and early satiety. She takes over the counter ibuprofen several times a week for headaches. Blood pressure is 125/82 mm Hg, pulse is 102/min, and respiratory rate is 19/min. On physical examination, she has hypoactive bowel sounds, and her abdomen seems grossly distended and tympanic on percussion. Which of the following is most consistent with a duodenal ulcer?? {'A': 'Non-bilious vomiting', 'B': 'Early satiety', 'C': 'Ibuprofen use', 'D': 'Omeprazole provides relief of the symptoms', 'E': 'Food ingestion provides relief of the symptoms'}, | E: Food ingestion provides relief of the symptoms |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man presents to a physician because of extreme fatigue, palpitations, fever, and weight loss. He developed these symptoms gradually over the past 3 months. His blood pressure is 110/80 mm Hg, heart rate is 109/min, respiratory rate is 17/min, and temperature is 38.1°C (100.6°F). The patient is emaciated and pale. There are conjunctival hemorrhages and several bruises noted in the inner cubital area bilaterally. There are also a few lesions on the left foot. The cardiac examination reveals a holosystolic murmur best heard at the 4th intercostal space at the left sternal edge. Two blood cultures grew Staphylococcus aureus, and echocardiography shows a tricuspid valve aneurysm. Which of the following would most likely be revealed in a detailed history from this patient?? {'A': 'Percutaneous nephrostomy for acute ureterolithiasis 5 months ago', 'B': 'Lung abscess evacuation 3 months ago', 'C': 'Catheterization of the urinary bladder', 'D': 'Chronic intravenous drug usage', 'E': 'Adenoidectomy 6 months ago'}, | D: Chronic intravenous drug usage |
Answer the following medical question with one of the provided options: | Q:An 18-month-old boy of Ashkenazi-Jewish descent presents with loss of developmental milestones. On ocular exam, a cherry-red macular spot is observed. No hepatomegaly is observed on physical exam. Microscopic exam shows lysosomes with onion-skin appearance. What is the most likely underlying biochemical abnormality?? {'A': 'Accumulation of ceramide trihexoside', 'B': 'Accumulation of galactocerebroside', 'C': 'Accumulation of sphingomyelin', 'D': 'Accumulation of GM2 ganglioside', 'E': 'Accumulation of glucocerebroside'}, | D: Accumulation of GM2 ganglioside |
Answer the following medical question with one of the provided options: | Q:A 21-year-old woman presents to her primary care doctor for an initial visit. She is a Syrian refugee and arrived in the United States 2 weeks ago. She has been living in refugee camps throughout Jordan and Turkey for the past 2 years. She has a 3-year-old son and reports that she has limited her food intake in order to ensure that her son has adequate nutrition. She reports decreased vision most noticeable over the past 6 months that is worse in low-light settings. She also reports severe dry eyes that have not improved with eye drops. She has no known past medical history and takes no medications. Her body mass index is 18.1 kg/m^2. On exam, she appears lethargic but is able to respond to questions appropriately. She has dry mucous membranes and decreased skin turgor. Her conjunctiva appears dry, thickened, and wrinkled. There is a small corneal ulcer on the lateral aspect of the left eye. This patient's symptoms are most consistent with a deficiency in a vitamin that contributes to which of the following processes?? {'A': 'Collagen synthesis', 'B': 'T-cell differentiation', 'C': 'Clotting factor synthesis', 'D': 'Cystathionine synthesis', 'E': 'Methylation reactions'}, | B: T-cell differentiation |
Answer the following medical question with one of the provided options: | Q:Three days after delivery, a 1100-g (2-lb 7-oz) newborn has a tonic seizure that lasts for 25 seconds. She has become increasingly lethargic over the past 18 hours. She was born at 31 weeks' gestation. Antenatal period was complicated by chorioamnionitis. Apgar scores were 3 and 6 at 1 and 5 minutes, respectively. She appears ill. Her pulse is 123/min, respirations are 50/min and irregular, and blood pressure is 60/30 mm Hg. Examination shows a tense anterior fontanelle. The pupils are equal and react sluggishly to light. Examination shows slow, conjugate back and forth movements of the eyes. Muscle tone is decreased in all extremities. The lungs are clear to auscultation. Which of the following is the most likely diagnosis?? {'A': 'Galactosemia', 'B': 'Spinal muscular atrophy', 'C': 'Phenylketonuria', 'D': 'Congenital hydrocephalus', 'E': 'Intraventricular hemorrhage'}, | E: Intraventricular hemorrhage |
Answer the following medical question with one of the provided options: | Q:A researcher is studying the ability of breast cancer cells to metastasize. Neoplastic cells obtained from 30 patients with stage IV ductal carcinoma of the breast are tagged with a fluorescent antibody. The cells are then inserted into a medium resembling normal human tissue. After 2 weeks, all samples show in vitro hematogenous invasion and migration away from the original site of insertion. Which of the following properties is most likely responsible for the ability of these neoplastic cells to metastasize?? {'A': 'Loss of cellular polarity', 'B': 'Overexpression of HER2/neu', 'C': 'Increase in N:C ratio', 'D': 'Presence of fibrous tissue capsule', 'E': 'Release of matrix metalloproteinase'}, | E: Release of matrix metalloproteinase |
Answer the following medical question with one of the provided options: | Q:A newlywed couple comes to your office for genetic counseling. Both potential parents are known to be carriers of the same Cystic Fibrosis (CF) mutation. What is the probability that at least one of their next three children will have CF if they are all single births?? {'A': '0', 'B': '1/64', 'C': '27/64', 'D': '37/64', 'E': '1'}, | D: 37/64 |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman makes an appointment at her physician’s office for a regular health check-up. She does not have any complaints and mentions that she has started to train for an upcoming marathon and hydrates exclusively with electrolyte solutions. She has been trying unsuccessfully to quit smoking for a few years now. She has hypercholesterolemia, which is controlled with a low-cholesterol diet. Family history is significant for hypertension in both of her parents. Her father died of myocardial infarction a few years ago. The vital signs include heart rate 55/min, respiratory rate 16/min, temperature 37.6 °C (99.68 °F), and blood pressure 120/88 mm Hg. The physical exam findings are within normal limits. A routine electrocardiogram (ECG) is done and is shown below. The abnormal wave seen on the ECG tracing represents which of the following mechanical events?? {'A': 'Ventricular depolarization', 'B': 'Period between ventricular depolarization and repolarization', 'C': 'Ventricular repolarization', 'D': 'Atrial depolarization', 'E': 'Atrial repolarization'}, | C: Ventricular repolarization |
Answer the following medical question with one of the provided options: | Q:A 21-year-old female presents to her primary care doctor for prenatal counseling before attempting to become pregnant for the first time. She is an avid runner, and the physician notes her BMI of 17.5. The patient complains of chronic fatigue, which she attributes to her busy lifestyle. The physician orders a complete blood count that reveals a Hgb 10.2 g/dL (normal 12.1 to 15.1 g/dL) with an MCV 102 µm^3 (normal 78 to 98 µm^3). A serum measurement of a catabolic derivative of methionine returns elevated. Which of the following complications is the patient at most risk for if she becomes pregnant?? {'A': 'Hyperemesis gravidarum', 'B': 'Gestational diabetes', 'C': 'Placenta previa', 'D': 'Placenta abruptio', 'E': 'Placenta accreta'}, | D: Placenta abruptio |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl is admitted to the emergency department with severe retrosternal chest pain. The pain began suddenly after an episode of self-induced vomiting following a large meal. The patient’s parents say that she is very restricted in the foods she eats and induces vomiting frequently after meals. Vital signs are as follows: blood pressure 100/60 mm Hg, heart rate 98/min, respiratory rate 14/min, and temperature 37.9℃ (100.2℉). The patient is pale and in severe distress. Lungs are clear to auscultation. On cardiac examination, a crunching, raspy sound is auscultated over the precordium that is synchronous with the heartbeat. The abdomen is soft and nontender. Which of the following tests would most likely confirm the diagnosis in this patient?? {'A': 'Upper endoscopy', 'B': 'ECG', 'C': 'Echocardiography', 'D': 'Contrast esophagram', 'E': 'Measurement of D-dimer'}, | D: Contrast esophagram |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman comes to the physician for a 2-month history of fatigue, intermittent left-sided flank pain, and diffuse extremity pain. She was treated for a prolactinoma 5 years ago and has had recurrent antral and duodenal peptic ulcers despite medical therapy. Her only medication is omeprazole. Physical examination shows a moderately distended abdomen that is diffusely tender to palpation. There is mild left-sided costovertebral angle tenderness. Serum studies show a calcium of 12 mg/dL, phosphorus of 2 mg/dL, and parathyroid hormone level of 826 pg/mL. An ultrasound of the abdomen shows multiple kidney stones in the left ureteropelvic junction. This patient is most likely to have which of the following protein abnormalities?? {'A': 'Inactivation of RET proto-oncogene', 'B': 'Altered merlin protein expression', 'C': 'Altered menin protein', 'D': 'Mutation of VHL tumor suppressor', 'E': 'Mutation in C-Kit protein'}, | C: Altered menin protein |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the physician with a history of bright red blood in her stools for 3 days. She has defecated once per day. She does not have fever, pain on defecation, or abdominal pain. She was treated for a urinary tract infection with levofloxacin around 3 months ago. Menses occur at regular intervals of 28–30 days and lasts 3–4 days. Her father died of colon cancer 4 years ago. Her only medication is an iron supplement. She is 162 cm (5 ft 4 in) tall and weighs 101.2 kg (223 lbs); BMI is 38.3 kg/m2. Her temperature is 36.5°C (97.7°F), pulse is 89/min, and blood pressure is 130/80 mm Hg. Rectal examination shows anal skin tags. Anoscopy shows multiple enlarged bluish veins above the dentate line at 7 and 11 o'clock positions. When asked to exhale through a closed nostril a mass prolapses but spontaneously reduces when breathing normally. Which of the following is the most appropriate next step in management?? {'A': 'Docusate therapy', 'B': 'Topical diltiazem', 'C': 'Propranolol therapy', 'D': 'Infrared coagulation', 'E': 'Hemorrhoidectomy'}, | A: Docusate therapy |
Answer the following medical question with one of the provided options: | Q:A 73-year-old female with no past medical history is hospitalized after she develops a fever associated with increasing shortness of breath. She states that 1 week prior, she had a cold which seemed to be resolving. Yesterday, however, she noticed that she started to feel feverish, measured her temperature to be 101.5°F (38.6°C), and also developed an unproductive dry cough and difficulty breathing. On exam, her temperature is 100.8°F (38.2°C), blood pressure is 110/72 mmHg, pulse is 96/min, and respirations are 16/min. Her exam demonstrates decreased breath sounds at the right lung base. The chest radiograph shows a right-sided pleural effusion with an opacity in the right lower lobe that is thought to be a bacterial pneumonia. Which of the following can be expected on a sample of the effusion fluid?? {'A': 'Clear fluid', 'B': 'Hypocellular fluid', 'C': 'Malignant cells', 'D': 'Protein-rich fluid', 'E': 'Specific gravity of 1.010'}, | D: Protein-rich fluid |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man comes to the physician because of burning pain in his neck and arms for a year. He has also had paresthesias in his hands during this period. He has had increasing weakness in both hands during the past 3 months. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. He was involved in a motor vehicle collision 3 years ago. Current medications include metformin, sitagliptin, enalapril, atorvastatin, and aspirin. He has had 7 sexual partners in his lifetime; he uses condoms inconsistently. He is oriented to time, place, and person. Vital signs are within normal limits. The pupils are equal and reactive to light. Examination of the upper extremities shows decreased muscle strength, absent reflexes, and decreased hand grip with fasciculations bilaterally. Sensation to temperature and pain is absent over the chest and bilateral upper arms. Vibration and joint position sensations are present in the upper limbs. Cranial nerve examination shows no focal findings. Examination of the lower extremities show no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Tabes dorsalis', 'B': 'Cervical disk prolapse', 'C': 'Brown-Séquard syndrome', 'D': 'Multiple sclerosis', 'E': 'Syringomyelia'}, | E: Syringomyelia |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman comes to the physician for evaluation of nausea and fatigue. Her last menstrual period was 8 weeks ago. She has a history of bipolar disorder controlled by a drug known to sometimes cause hypothyroidism and nephrogenic diabetes insipidus. She does not smoke cigarettes or drink alcohol. A urine pregnancy test is positive. An ultrasound of the pelvis shows a viable intrauterine pregnancy. The fetus is most likely at increased risk for which of the following anomalies?? {'A': 'Abnormal placentation', 'B': 'Aplasia cutis', 'C': 'Atrialization of the right ventricle', 'D': 'Neural tube defects', 'E': 'Hypoplastic or absent limbs'}, | C: Atrialization of the right ventricle |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman is brought to the emergency department after briefly losing consciousness while walking her dog. She spontaneously regained consciousness 20 seconds later. She has a history of atrial fibrillation. Current medications include metoprolol. She reports that she forgot to take her medication the day before and took double the dose this morning instead. A decrease in which of the following most likely contributed to this patient's episode?? {'A': 'Phosphorylation of myosin light chains in vascular smooth muscle cells', 'B': 'Activity of protein kinase C in cardiomyocytes', 'C': 'Activity of protein kinase A in vascular smooth muscle cells', 'D': 'Activity of adenylyl cyclase in cardiomyocytes', 'E': 'Diastolic efflux of calcium in cardiomyocytes'}, | D: Activity of adenylyl cyclase in cardiomyocytes |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man is witnessed falling off his bicycle. The patient rode his bicycle into a curb and hit his face against a rail. The patient did not lose consciousness and is ambulatory at the scene. There is blood in the patient's mouth and one of the patient's teeth is found on the sidewalk. The patient is transferred to the local emergency department. Which of the following is the best method to transport this patient's tooth?? {'A': 'Submerged in milk', 'B': 'Submerged in normal saline', 'C': 'Submerged in water', 'D': 'Wrapped in sterile gauze', 'E': 'Wrapped in gauze soaked in normal saline'}, | A: Submerged in milk |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man presents to his primary care physician because of abdominal pain that started after he went camping several months ago and drank from a mountain stream. This past year, he also went on a trip around the world, eating local foods at each stop. Furthermore, he has had a history of cholelithiasis and had his gallbladder removed 3 years ago. Otherwise, his medical history is significant for well-controlled hypertension and diabetes. Based on clinical suspicion, an endoscopy and biopsy was performed showing a mix of mononuclear cells and a motile, urease-positive, oxidase-positive, spiral shaped organism. The changes seen on biopsy in this patient most likely predispose him to which of the following pathologies?? {'A': 'Esophageal adenocarcinoma', 'B': 'Gallbladder adenocarcinoma', 'C': 'Colon adenocarcinoma', 'D': 'MALT lymphoma', 'E': 'Pancreatic adenocarcinoma'}, | D: MALT lymphoma |
Answer the following medical question with one of the provided options: | Q:A 46-year-old man comes to the physician because of a 1-week history of headache, muscle pain, and recurrent fever spikes that occur without a noticeable rhythm. Two weeks ago, he returned from a 5-week-long world trip during which he climbed several mountains in India, Africa, and Appalachia. Chemoprophylaxis with chloroquine was initiated one week prior to the trip. Physical examination shows jaundice. The spleen is palpated 2 cm below the left costal margin. His hemoglobin concentration is 10 g/dL. A photomicrograph of a peripheral blood smear is shown. Which of the following agents is the most likely cause of this patient's findings?? {'A': 'Trypanosoma cruzi', 'B': 'Plasmodium falciparum', 'C': 'Chikungunya virus', 'D': 'Trypanosoma brucei', 'E': 'Leishmania donovani'}, | B: Plasmodium falciparum |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman comes to the emergency department because of progressive numbness and weakness in her left arm and left leg for 2 days. During this period, she has also had urinary urgency and incontinence. Three months ago, she had blurry vision, difficulty distinguishing colors, and headache for one week, all of which have resolved. The patient has smoked a half pack of cigarettes daily for 10 years and drinks four glasses of wine each week. Her temperature is 37°C (98.6°F), pulse is 78/min, respirations are 14/min, and blood pressure is 110/68 mm Hg. Examination shows 3/5 strength in the left arm and leg, and 5/5 strength on the right side. Upon flexion of the neck, the patient experiences a shooting electric sensation that travels down the spine. MRI of the brain shows gadolinium-enhancing lesions in the right central sulcus, cervical spinal cord, and optic nerve. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Administer lorazepam', 'B': 'Administer IV methylprednisolone', 'C': 'Plasmapheresis', 'D': 'Administer tissue plasminogen activator', 'E': 'Glatiramer acetate therapy'}, | B: Administer IV methylprednisolone |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman comes to the emergency department because of upper abdominal pain and nausea for the past hour. The patient rates the pain as an 8 to 9 on a 10-point scale. She has had an episode of nonbloody vomiting since the pain started. She has a history of type 2 diabetes mellitus, hypertension, and osteoporosis. The patient has smoked 2 packs of cigarettes daily for 40 years. She drinks 5–6 alcoholic beverages daily. Current medications include glyburide, lisinopril, and oral vitamin D supplements. Her temperature is 38.5°C (101.3°F), pulse is 110/min, and blood pressure is 138/86 mm Hg. Examination shows severe epigastric tenderness to palpation with guarding but no rebound. Ultrasonography of the abdomen shows diffuse enlargement of the pancreas; no gallstones are visualized. The patient is admitted to the hospital for pain control and intravenous hydration. Which of the following is the most appropriate next step in the management of this patient’s pain?? {'A': 'Patient-controlled intravenous hydromorphone', 'B': 'Transdermal bupivacaine on request', 'C': 'Oral acetaminophen every 6 hours', 'D': 'Oral gabapentin every 24 hours', 'E': 'Transdermal fentanyl every 72 hours'}, | A: Patient-controlled intravenous hydromorphone |
Answer the following medical question with one of the provided options: | Q:The patient undergoes a mammogram, which shows a 6.5mm sized mass with an irregular border and spiculated margins. A subsequent core needle biopsy of the mass shows infiltrating ductal carcinoma with HER2-positive, estrogen-negative, and progesterone-negative immunohistochemistry staining. Blood counts and liver function tests are normal. Laboratory studies show: Hemoglobin 12.5 g/dL Serum Na+ 140 mEq/L Cl- 103 mEq/L K+ 4.2 mEq/L HCO3- 26 mEq/L Ca2+ 8.9 mg/dL Urea Nitrogen 12 mg/dL Glucose 110 mg/dL Alkaline Phosphatase 25 U/L Alanine aminotransferase (ALT) 15 U/L Aspartate aminotransferase (AST) 13 U/L Which of the following is the most appropriate next step in management?"? {'A': 'Breast-conserving therapy and sentinel lymph node biopsy', 'B': 'Trastuzumab therapy', 'C': 'Whole-body PET/CT', 'D': 'Bilateral mastectomy with lymph node dissection', 'E': 'Bone scan'}, | A: Breast-conserving therapy and sentinel lymph node biopsy |
Answer the following medical question with one of the provided options: | Q:A recent study examined trends in incidence and fatality of ischemic stroke in a representative sample of Scandinavian towns. The annual incidence of ischemic stroke was calculated to be 60 per 2,000 people. The 1-year case fatality rate for ischemic stroke was found to be 20%. The health department of a town in southern Sweden with a population of 20,000 is interested in knowing the 1-year mortality conferred by ischemic stroke. Based on the study's findings, which of the following estimates the annual mortality rate for ischemic stroke per 20,000?? {'A': '12 people', 'B': '120 people', 'C': '400 people', 'D': '60 people', 'E': '600 people'}, | B: 120 people |
Answer the following medical question with one of the provided options: | Q:An infectious disease chairperson of a large hospital determines that the incidence of Clostridioides difficile infections at the hospital is too high. She proposes an initiative to restrict the usage of clindamycin in the hospital to determine if that lowers the incidence of C. difficile infections. She puts in place a requirement that an infectious disease fellow needs to approve any prescription of clindamycin. After 2 months, she reviews the hospital infection data and determines that the incidence of C. difficile infections has decreased, but not to the extent that she had hoped. Consequently, she decides to include fluoroquinolone antibiotics in the antibiotic restriction and examine the data again in another 2 months. Which of the following best describes the process being used by the infectious disease chairperson?? {'A': 'High reliability organization', 'B': 'Root cause analysis', 'C': 'Failure mode and effects analysis', 'D': 'Plan, do, study, act cycle', 'E': 'Lean process improvement'}, | D: Plan, do, study, act cycle |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man with coronary artery disease comes to the physician because of intermittent episodes of substernal chest pain and shortness of breath. The episodes occur only when walking up stairs and resolves after resting for a few minutes. He is a delivery man and is concerned because the chest pain has impacted his ability to work. His pulse is 98/min and blood pressure is 132/77 mm Hg. Physical examination is unremarkable. An ECG shows no abnormalities. A drug that blocks which of the following receptors is most likely to prevent future episodes of chest pain from occurring?? {'A': 'Alpha-2 adrenergic receptors', 'B': 'Angiotensin II receptors', 'C': 'Aldosterone receptors', 'D': 'M2 muscarinic receptors', 'E': 'Beta-1 adrenergic receptors'}, | E: Beta-1 adrenergic receptors |
Answer the following medical question with one of the provided options: | Q:A previously healthy 3-month-old girl is brought to the physician because of fever, irritability, and rash for 3 days. The rash started around the mouth before spreading to the trunk and extremities. Her temperature is 38.6°C (101.5°F). Examination shows a diffuse erythematous rash with flaccid bullae on the neck, flexural creases, and buttocks. Gentle pressure across the trunk with a gloved finger creates a blister. Oropharyngeal examination shows no abnormalities. Which of the following is the most likely underlying mechanism of these skin findings?? {'A': 'Toxin-induced cleavage of desmoglein', 'B': 'Bacterial production of erythrogenic toxin', 'C': 'Bacterial invasion of the epidermis', 'D': 'Autoantibody deposition in stratum spinosum', 'E': 'Autoantibody binding of hemidesmosomes'}, | A: Toxin-induced cleavage of desmoglein |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man comes to the physician for a follow-up examination. Four days ago, he injured his right knee while playing soccer. Increased laxity of the right knee joint is noted when the knee is flexed to 30° and an abducting force is applied to the lower leg. The examination finding in this patient is most likely caused by damage to which of the following structures?? {'A': 'Posterior cruciate ligament', 'B': 'Lateral collateral ligament', 'C': 'Lateral meniscus', 'D': 'Medial collateral ligament', 'E': 'Anterior cruciate ligament'}, | D: Medial collateral ligament |
Answer the following medical question with one of the provided options: | Q:A 63-year-old woman presents to her primary care doctor with increased urinary frequency. She has noticed that over the past 6 months, she has had to urinate more often than usual. Several times per day, she develops a rapid-onset need to urinate and has occasionally been unable to reach the restroom. These symptoms have caused her a lot of distress and impacted her work as a grocery store clerk. She has tried pelvic floor exercises, decreasing her caffeine consumption, and has intentionally lost 20 pounds in an effort to alleviate her symptoms. She denies urinary hesitancy or hematuria. Her past medical history is notable for rheumatoid arthritis for which she takes methotrexate. She does not smoke or drink alcohol. Her temperature is 98.8°F (37.1°C), blood pressure is 124/68 mmHg, pulse is 89/min, and respirations are 19/min. She is well-appearing and in no acute distress. Which of the following interventions would be most appropriate in this patient?? {'A': 'Intermittent catheterization', 'B': 'Oxybutynin', 'C': 'Pessary placement', 'D': 'Tamsulosin', 'E': 'Topical estrogen'}, | B: Oxybutynin |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man presents to the behavioral health clinic for an evaluation after seeing animal-shaped clouds in the form of dogs, cats, and monkeys. The patient says that these symptoms have been present for more than 2 weeks. Past medical history is significant for simple partial seizures for which he takes valproate, but he has not had his medication adjusted in several years. His vital signs include: blood pressure of 124/76 mm Hg, heart rate of 98/min, respiratory rate of 12/min, and temperature of 37.1°C (98.8°F). On physical examination, the patient is alert and oriented to person, time, and place. Affect is not constricted or flat. Speech is of rapid rate and high volume. Pupils are equal and reactive bilaterally. The results of a urine drug screen are as follows: Alcohol positive Amphetamine negative Benzodiazepine negative Cocaine positive GHB negative Ketamine negative LSD negative Marijuana negative Opioids negative PCP negative Which of the following is the most likely diagnosis in this patient?? {'A': 'Cocaine intoxication', 'B': 'Illusion', 'C': 'Visual hallucination', 'D': 'Delusion', 'E': 'Alcohol withdrawal'}, | B: Illusion |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care physician with a 1 week history of persistent dry cough and worsening shortness of breath. He says that he has also been experiencing some abdominal pain and weakness. He has never experienced these symptoms before. His past medical history is significant for persistent ventricular tachycardia, and he started a new medication to control this arrhythmia about 1 month prior to presentation. Chest radiograph reveals patchy opacification bilaterally, and computed tomography (CT) scan shows diffuse ground glass changes. The drug that is most likely responsible for this patient's symptoms has which of the following mechanisms of action?? {'A': 'Beta-adrenergic blocker', 'B': 'Calcium channel blocker', 'C': 'Potassium channel blocker', 'D': 'Sodium channel blocker with prolonged refractory period', 'E': 'Sodium channel blocker with shortened refractory period'}, | C: Potassium channel blocker |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is brought to the emergency room by his mother with fever and difficulty breathing after receiving the BCG vaccine. He has never had a reaction to a vaccine before. He has a history of 2 salmonella infections over the past 2 years. He was born at 35 weeks’ gestation and spent one day in the neonatal intensive care unit. His parents' family histories are unremarkable. His temperature is 101°F (38.3°C), blood pressure is 80/55 mmHg, pulse is 135/min, and respirations are 24/min. On examination, he appears acutely ill. He has increased work of breathing with intercostal retractions. A petechial rash is noted on his trunk and extremities. A serological analysis in this patient would most likely reveal decreased levels of which of the following cytokines?? {'A': 'Interferon alpha', 'B': 'Interferon gamma', 'C': 'Interleukin 1', 'D': 'Interleukin 12', 'E': 'Tumor necrosis factor alpha'}, | B: Interferon gamma |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman with metastatic breast cancer comes to the physician for a follow-up examination. She had a mastectomy 6 months ago and received chemotherapy with doxorubicin and paclitaxel. A CT scan of the chest shows new metastases in the lungs and liver. Adjuvant therapy is initiated with a drug that inhibits the formation of deoxythymidine monophosphate and results in the accumulation of deoxyuridine triphosphate. The patient is advised to avoid folic acid supplementation while receiving this drug in order to prevent the toxic effects of this drug. Which of the following drugs was most likely given?? {'A': 'Hydroxyurea', 'B': 'Leflunomide', 'C': 'Azathioprine', 'D': 'Mycophenolate mofetil', 'E': 'Capecitabine'}, | E: Capecitabine |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy with a history of cerebral palsy is brought to the neurology clinic by his mother with progressive tightness in the lower extremities. Although the patient has been intermittently undergoing physiotherapy for the past 2 years at a specialized center, the patient’s mother is concerned he cannot yet climb the stairs. The neurologist recommends a different treatment, which involves multiple intramuscular injections of a drug in the muscles of the lower extremities to relieve tightness. The neurologist says this treatment approach is also often used to relieve headaches and reduce facial wrinkles. Which of the following is most likely the mechanism of action of this drug?? {'A': 'Acts as a superantigen', 'B': 'Stimulates adenylate cyclase', 'C': 'Reduces neurotransmitter GABA', 'D': 'Blocks the release of acetylcholine', 'E': 'Interferes with the 60s ribosomal subunit'}, | D: Blocks the release of acetylcholine |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman, gravida 3, para 2, at 32 weeks' gestation comes to the physician for a follow-up examination 2 days after an increased blood pressure measurement. She now reports having a headache and visual disturbances for the past 12 hours. Her only medication is a prenatal vitamin. Her temperature is 36.7°C (98.1°F), pulse is 90/min, and blood pressure is 164/80 mm Hg. Her blood pressure at her first-trimester prenatal visit was 110/70 mm Hg. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.5 g/dL Platelet count 285,000/mm3 Serum Creatinine 1.0 mg/dL Urine Blood negative Protein negative Which of the following is the most likely primary component in the pathogenesis of this patient's condition?"? {'A': 'Vasogenic cerebral edema', 'B': 'Increase in circulating plasma volume', 'C': 'Hyperperfusion of placental tissue', 'D': 'Abnormal remodeling of spiral arteries', 'E': 'Overactivation of the coagulation cascade'}, | D: Abnormal remodeling of spiral arteries |
Answer the following medical question with one of the provided options: | Q:Five days after being admitted to the hospital for a scald wound, a 2-year-old boy is found to have a temperature of 40.2°C (104.4°F). He does not have difficulty breathing, cough, or painful urination. He initially presented one hour after spilling a pot of boiling water on his torso while his mother was cooking dinner. He was admitted for fluid resuscitation, nutritional support, pain management, and wound care, and he was progressing well until today. He has no other medical conditions. Other than analgesia during this hospital stay, he does not take any medications. He appears uncomfortable but not in acute distress. His pulse is 150/min, respirations are 41/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows uneven, asymmetrical scalding covering his anterior torso in arrow-like patterns with surrounding erythema and purulent discharge. The remainder of the examination shows no abnormalities. His hemoglobin is 13.4 g/dL, platelet count is 200,000/mm3, and leukocyte count is 13,900/mm3. Which of the following is the most appropriate initial pharmacological treatment for this patient?? {'A': 'Amoxicillin/clavulanic acid and ceftriaxone', 'B': 'Ampicillin/sulbactam and daptomycin', 'C': 'Piperacillin/tazobactam and cefepime', 'D': 'Vancomycin and metronidazole', 'E': 'Vancomycin and cefepime'}, | E: Vancomycin and cefepime |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician because of severe burning with urination for the past 3 days. During this period, he has had clear urethral discharge early in the morning. He has no history of serious illness, except for a rash following treatment with erythromycin 20 years ago. The patient takes no medications. He is sexually active with one male and one female partner; they use condoms inconsistently. His younger brother was diagnosed with Crohn disease at the age of 24 years. The patient does not smoke. He drinks one to two beers on weekends. He appears well. Temperature is 36.8°C (98°F), pulse is 75/min, and blood pressure is 135/78 mm Hg. Physical examination shows no abnormalities. Gram stain of a urethral swab shows neutrophils but no organisms. Which of the following is the most likely causal pathogen?? {'A': 'Neisseria gonorrhoeae', 'B': 'Adenovirus', 'C': 'Trichomonas vaginalis', 'D': 'Chlamydia trachomatis', 'E': 'Herpes simplex virus\n"'}, | D: Chlamydia trachomatis |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man presents to the emergency department with confusion. The patient’s wife states that her husband has become more somnolent over the past several days and now is very confused. The patient has no complaints himself, but is answering questions inappropriately. The patient has a past medical history of diabetes and hypertension. His temperature is 98.3°F (36.8°C), blood pressure is 127/85 mmHg, pulse is 138/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused man with dry mucous membranes. Initial laboratory studies are ordered as seen below. Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 3.0 mEq/L HCO3-: 23 mEq/L BUN: 30 mg/dL Glucose: 1,299 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.2 mg/dL Which of the following is the most appropriate initial treatment for this patient?? {'A': 'Insulin', 'B': 'Insulin and normal saline', 'C': 'Insulin and potassium', 'D': 'Insulin, normal saline, and potassium', 'E': 'Normal saline and potassium'}, | E: Normal saline and potassium |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman presents to her gynecologist complaining of mild pelvic discomfort and a frothy, yellowish discharge from her vagina for the past 2 weeks. She also complains of pain during sexual intercourse and sometimes after urination. Her past medical history is noncontributory. She takes oral contraceptives and a multivitamin daily. She has had two male sexual partners in her lifetime and uses condoms inconsistently. Today, her vitals are normal. On pelvic exam, she has vulvovaginal erythema and a 'strawberry cervix' that is tender to motion, with minimal green-yellow malodorous discharge. A swab of the vaginal wall is analyzed for pH at bedside. Vaginal pH is 5.8. Which of the following is the most likely diagnosis for this patient?? {'A': 'Vulvovaginal candidiasis', 'B': 'Atrophic vaginitis', 'C': 'Bacterial vaginosis', 'D': 'Chlamydia', 'E': 'Trichomoniasis'}, | E: Trichomoniasis |
Answer the following medical question with one of the provided options: | Q:A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?? {'A': 'Lithium', 'B': 'Valproic acid', 'C': 'Risperidone', 'D': 'Haloperidol', 'E': 'Diphenhydramine'}, | A: Lithium |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man presents for physical and preventive health screening, specifically for prostate cancer. He has not been to the doctor in a long time. Past medical history is significant for hypertension that is well-managed. Current medication is hydrochlorothiazide. He has one uncle who died of prostate cancer. He drinks one or two alcoholic drinks on the weekends and does not smoke. Today his temperature is 37.0°C (98.6°F), blood pressure is 125/75 mm Hg, pulse is 82/min, respiratory rate is 15/min, and oxygen saturation is 99% on room air. There are no significant findings on physical examination. Which of the following would be the most appropriate recommendation for prostate cancer screening in this patient?? {'A': 'No screening indicated at this time', 'B': 'Digital rectal examination', 'C': 'Serum PSA level', 'D': 'Transrectal ultrasound (TRUS)', 'E': 'Contrast CT of the abdomen and pelvis'}, | C: Serum PSA level |
Answer the following medical question with one of the provided options: | Q:A 3-year-old male is evaluated for frequent nose bleeds. Physical examination shows diffuse petechiae on the patient’s distal extremities. Peripheral blood smear shows an absence of platelet clumping. An ELISA binding assay reveals that platelet surfaces are deficient in GpIIb/IIIa receptors. Which of the following anticoagulants pharmacologically mimics this condition?? {'A': 'Abciximab', 'B': 'Aspirin', 'C': 'Warfarin', 'D': 'Clopidogrel', 'E': 'Cilostazol'}, | A: Abciximab |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man complains of lower back pain that began approximately 6 months ago. He is unsure why he is experiencing this pain and notices that this pain is worse in the morning after waking up and improves with physical activity. Ibuprofen provides significant relief. He denies bowel and bladder incontinence or erectile dysfunction. Physical exam is notable for decreased chest expansion, decreased spinal range of motion, 5/5 strength in both lower extremities, 2+ patellar reflexes bilaterally, and an absence of saddle anesthesia. Which of the following is the most appropriate next test for this patient?? {'A': 'ESR', 'B': 'HLA-B27', 'C': 'MRI sacroiliac joint', 'D': 'Radiograph sacroiliac joint', 'E': 'Slit-lamp examination'}, | D: Radiograph sacroiliac joint |
Answer the following medical question with one of the provided options: | Q:A genetic population study is being conducted to find the penetrance of a certain disease. This disease is associated with impaired iron metabolism and primarily affects the liver. Patients often present with diabetes and bronze skin pigmentation. After a genetic screening of 120 inhabitants with a family history of this disease, 40 were found to have the disease-producing genotype, but only 10 presented with symptoms. What are the chances of the screened patients with said genotype developing the disease phenotype? ? {'A': '3%', 'B': '25%', 'C': '4%', 'D': '40%', 'E': '0.4%'}, | B: 25% |
Answer the following medical question with one of the provided options: | Q:A previously healthy 9-year-old, Caucasian girl presents to your office with severe abdominal pain. Her mother also mentions that she has been urinating significantly less lately. History from the mother reveals that the girl suffers from acne vulgaris, mild scoliosis, and had a bout of diarrhea 3 days ago after a family barbecue. Lab work is done and is notable for a platelet count of 97,000 with a normal PT and PTT. The young girl appears dehydrated, yet her serum electrolyte levels are normal. What is the most likely etiology of this girl's urinary symptoms?? {'A': 'Hypothalamic dysfucntion', 'B': 'Surreptitious laxative use', 'C': 'Toxic shock syndrome', 'D': 'Shiga toxin production from Shigella', 'E': 'Shiga-like toxin production from EHEC'}, | E: Shiga-like toxin production from EHEC |
Answer the following medical question with one of the provided options: | Q:A 55-year-old male presents to his primary care physician with right upper quadrant pain that has progressed over the last three months with unexplained weakness and joint pains that have been "out of the ordinary" over the last year. On history, you note the patient lives a sedentary lifestyle, rarely leaves the house, has controlled diabetes diagnosed 15 years ago, and has documented cardiomyopathy. On physical exam the man appears non-toxic, sclera are icteric, cornea appear normal, generalized pain is elicited on palpation of the right upper quadrant, and skin appears quite bronzed on his extremities. What is this patient most at risk for ten to fifteen years later due to his underlying condition?? {'A': 'Colonic adenocarcinoma', 'B': 'Pulmonary fibrosis', 'C': 'Prostatic adenocarcinoma', 'D': 'Hepatocellular carcinoma', 'E': 'Movement disorders'}, | D: Hepatocellular carcinoma |
Answer the following medical question with one of the provided options: | Q:A 6-month-old girl has a weak cry, poor suck, ptosis, and constipation. Her condition began 2 days ago with a single episode of abundant watery stool and elevated temperature. The child was born at term to a healthy 26-year-old mother with an uneventful antenatal course and puerperium. The infant was exclusively breastfed till 5 months of age, after which she began receiving grated potatoes, pumpkin, carrots, and apples, in addition to the breastfeeding. She does not receive any fluids other than breast milk. The last new food item to be introduced was homemade honey that her mother added several times to grated sour apples as a sweetener 2 weeks before the onset of symptoms. The vital signs are as follows: blood pressure 70/40 mm Hg, heart rate 98/min, respiratory rate 29/min, and temperature 36.4°C (98.2°F). On physical examination, she is lethargic and has poor head control. A neurologic examination reveals ptosis and facial muscle weakness, widespread hypotonia, and symmetrically decreased upper and lower extremity reflexes. Which of the following options is a part of the pathogenesis underlying the patient’s condition?? {'A': 'Hypocalcemia due to a decrease in breast milk consumption', 'B': 'Hyperkalemia due to increased dietary intake', 'C': "Vegetative form of Clostridium botulinum spores in the patient's colon", 'D': 'Dehydration due to the absence of additional fluid intake', 'E': 'Development of antibodies against the acetylcholine receptor'}, | C: Vegetative form of Clostridium botulinum spores in the patient's colon |
Answer the following medical question with one of the provided options: | Q:A 16-year-old male comes to his doctor worried that he has not yet gone through puberty. He feels that his genitals are less developed than they should be for his age. On physical exam, you note an absence of facial hair and that his voice has not yet deepened. Your exam confirms that he is Tanner Stage 1. On a thorough review of systems, you learn that the patient has lacked a sense of smell from birth. Which of the following is implicated in the development of this patient's underlying condition?? {'A': 'Chromosomal duplication', 'B': 'Expansile suprasellar tumor', 'C': 'Exposure to radiation', 'D': 'Failure of normal neuronal migration during development', 'E': 'Defect in steroid production'}, | D: Failure of normal neuronal migration during development |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman presents to a physician with weakness and fatigue for a week. She mentions that she has been taking oral fluconazole for the last 4 weeks for the treatment of tinea capitis. She also says that she loves coffee and usually consumes 4–6 cups of coffee every day. On physical examination, her vital signs are stable and examination of all systems, including nervous system, is normal. Her laboratory evaluation reveals that her serum potassium level is 3.1 mmol/L (3.1 mEq/L). The physician orders an ECG. Which of the following findings is most likely to be present?? {'A': 'Widening of QRS complexes', 'B': 'Tall peaked T waves', 'C': 'Disappearing P waves', 'D': 'Depression of ST segment', 'E': 'Shortened QT interval'}, | D: Depression of ST segment |
Answer the following medical question with one of the provided options: | Q:A 4-month-old girl is brought to the physician because she has been regurgitating and vomiting 10–15 minutes after feeding for the past 3 weeks. She is breastfed and formula-fed. She was born at 38 weeks' gestation and weighed 2966 g (6 lb 9 oz). She currently weighs 5878 g (12 lb 15 oz). She appears healthy. Vital signs are within normal limits. Examination shows a soft and nontender abdomen and no organomegaly. Which of the following is the most appropriate next best step in management?? {'A': 'Esophageal pH monitoring', 'B': 'Upper endoscopy', 'C': 'Ultrasound of the abdomen', 'D': 'Pantoprazole therapy', 'E': 'Positioning therapy'}, | E: Positioning therapy |
Answer the following medical question with one of the provided options: | Q:A 44-year-old man presents to his primary care physician due to a tremor. His tremor has been progressively worsening over the course of several weeks and he feels embarrassed and anxious about going to social events. He says these movements are involuntary and denies having an urge to have these movements. Medical history is significant for depression which is being treated with escitalopram. His mother is currently alive and healthy but his father committed suicide and had a history of depression. Physical examination is remarkable for impaired saccade initiation and brief, abrupt, and non-stereotyped movements involved the right arm. He also has irregular finger tapping. Which of the following is the best treatment for this patient's symptoms?? {'A': 'Carbidopa-levodopa', 'B': 'Cognitive behavioral therapy', 'C': 'Deutetrabenazine', 'D': 'Switch to sertraline', 'E': 'Valproic acid'}, | C: Deutetrabenazine |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents to the emergency department by ambulance following a motor vehicle accident. He was a restrained passenger. At the hospital, he is bleeding heavily from a large wound in his left leg. A review of medical records reveals a history of atrial fibrillation for which he takes warfarin. His international normalized ratio (INR) 2 days ago was 2.6. On physical exam he is cool and clammy. The vital signs include: heart rate 130/min and blood pressure 96/54 mm Hg. Aggressive resuscitation with intravenous normal saline is begun. Which of the following is the next best step to correct this patient's underlying coagulopathy?? {'A': 'Give cryoprecipitate', 'B': 'Give fresh frozen plasma (FFP)', 'C': 'Give intravenous vitamin K', 'D': 'Give packed red blood cells', 'E': 'Give platelets'}, | B: Give fresh frozen plasma (FFP) |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the physician because of worsening fatigue and shortness of breath. Her symptoms began 8 months ago and have progressively worsened since then. She had recurrent episodes of joint pain and fever during childhood. She does not smoke or drink alcohol. She emigrated from the Congo with her parents when she was 12 years old. Her temperature is 37.4°C (99.3°F), pulse is 90/min and regular, respirations are 18/min, and blood pressure is 140/90 mm Hg. There is an opening snap followed by a diastolic murmur at the fifth left intercostal space in the midclavicular line. If left untreated, this patient is at greatest risk for which of the following complications?? {'A': 'Nephritic syndrome', 'B': 'Esophageal compression', 'C': 'Bleeding from intestinal angiodysplasia', 'D': 'Left ventricular hypertrophy', 'E': 'Ventricular tachycardia'}, | B: Esophageal compression |
Answer the following medical question with one of the provided options: | Q:A 2-day-old boy is evaluated in the newborn nursery after the nurse witnessed the child convulsing. The child was born at 39 weeks gestation to a healthy 32-year-old G1P0 woman. Initial examination after birth was notable for a cleft palate. The child’s temperature is 99°F (37.2°C), blood pressure is 100/60 mmHg, pulse is 115/min, and respirations are 18/min. On exam, he appears somnolent. His face demonstrates periorbital fullness, hypoplastic nares, and small dysmorphic ears. A series of labs are drawn and shown below: Hemoglobin: 13.1 g/dL Hematocrit: 40% Leukocyte count: 4,000/mm^3 with normal differential Platelet count: 200,000/mm^3 Serum: Na+: 140 mEq/L Cl-: 100 mEq/L K+: 3.8 mEq/L HCO3-: 25 mEq/L BUN: 19 mg/dL Glucose: 110 mg/dL Creatinine: 1.0 mg/dL Ca2+: 7.9 mg/dL Phosphate: 4.7 mg/dL This patient is deficient in a hormone that has which of the following functions?? {'A': 'Activates 1-alpha-hydroxylase', 'B': 'Activates 24-alpha-hydroxylase', 'C': 'Activates 25-alpha-hydroxylase', 'D': 'Inhibits 1-alpha-hydroxylase', 'E': 'Inhibits 25-alpha-hydroxylase'}, | A: Activates 1-alpha-hydroxylase |
Answer the following medical question with one of the provided options: | Q:A 65-year-old female with chronic renal failure presents with recent onset of bone pain. Serum analysis reveals decreased levels of calcium and elevated levels of parathyroid hormone. One of the mechanisms driving the elevated PTH is most similar to that seen in:? {'A': 'End stage liver failure', 'B': 'Insufficient Ca intake', 'C': 'Parathyroid adenoma', 'D': 'Decreased functioning of the calcium-sensing receptor (CASR)', 'E': 'Sarcoidosis'}, | A: End stage liver failure |
Answer the following medical question with one of the provided options: | Q:A 41-year-old woman with subclinical hypothyroidism comes to the physician because of a 6-month history of progressively worsening headaches and irregular menses. Her menses had previously occurred at regular 30-day intervals with moderate flow, but her last menstrual period was 12 weeks ago. She also reports that her interest in sexual intercourse has recently decreased. Her serum prolactin level is elevated. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Bromocriptine', 'B': 'Estrogen', 'C': 'Methyldopa', 'D': 'Metoclopromide', 'E': 'L-thyroxine'}, | A: Bromocriptine |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy presents to the office with allergic rhinitis. He reports symptoms of sneezing, nasal congestion, itching, and postnasal drainage every September at the start of the school year. He has a family history of childhood asthma and eczema. He has not tried any medications for his allergies. Which of the following medications is the most appropriate next step to manage the patient's symptoms?? {'A': 'Intranasal antihistamines', 'B': 'Intranasal cromolyn sodium', 'C': 'Intranasal decongestants', 'D': 'Intranasal corticosteroids', 'E': 'Oral antihistamines'}, | D: Intranasal corticosteroids |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman comes to the emergency department because of fever, watery diarrhea, and abdominal cramping for the past 24 hours. She recently went to an international food fair. Her temperature is 39°C (102.2°F). Physical examination shows increased bowel sounds. Stool cultures grow gram-positive, spore-forming, anaerobic rods that produce alpha toxin. The responsible organism also causes which of the following physical examination findings?? {'A': 'Diffuse, flaccid bullae', 'B': 'Facial paralysis', 'C': 'Subcutaneous crepitus', 'D': 'Rose spots', 'E': 'Petechial rash'}, | C: Subcutaneous crepitus |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman comes to the physician for preconceptional advice. She has been married for 2 years and would like to conceive within the next year. Menses occur at regular 30-day intervals and last 4 days with normal flow. She does not smoke or drink alcohol and follows a balanced diet. She takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 55 kg (121 lb); BMI is 21.5 kg/m2. Physical examination, including pelvic examination, shows no abnormalities. She has adequate knowledge of the fertile days of her menstrual cycle. Which of the following is most appropriate recommendation for this patient at this time?? {'A': 'Begin folate supplementation', 'B': 'Begin high-dose vitamin A supplementation', 'C': 'Begin vitamin B12 supplementation', 'D': 'Begin iron supplementation', 'E': 'Gain 2 kg prior to conception'}, | A: Begin folate supplementation |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman with a history of depression is brought to the emergency department by her husband 45 minutes after ingesting an unknown amount of a termite poison in a suicide attempt. She has abdominal pain, nausea, and vomiting. Her husband reports that she has had two episodes of watery diarrhea on the way to the emergency department. A distinct, garlic-like odor on the breath is noted on examination. An ECG shows sinus tachycardia and QTc prolongation. Administration of which of the following is most appropriate?? {'A': 'N-acetylcysteine', 'B': 'Fomepizole', 'C': 'Deferoxamine', 'D': 'Physostigmine', 'E': 'Dimercaprol'}, | E: Dimercaprol |
Answer the following medical question with one of the provided options: | Q:A 30-year-old patient comes to the emergency room with a chief complaint of left chest pain and a productive cough with purulent sputum for 1 week. He also complains of shortness of breath. He said he had been previously diagnosed with influenza but did not follow the doctor’s instructions. His vitals include: heart rate 70/min, respiratory rate 22/min, temperature 38.7°C (101.7°F), blood pressure 120/60 mm Hg, and SO2 80%. His hemogram and chest X-ray findings are as follows: Hemoglobin 14 mg/dL Hematocrit 45% Leukocyte count 12,000/mm3 Neutrophils 82% Lymphocytes 15% Monocytes 3% Platelet count 270,000/mm3 Chest X-ray alveolar infiltrates in the left base with air bronchograms What is the most likely diagnosis?? {'A': 'Sarcoidosis', 'B': 'Pneumonia', 'C': 'Histoplasmosis', 'D': 'Lung cancer', 'E': 'Tuberculosis'}, | B: Pneumonia |
Answer the following medical question with one of the provided options: | Q:While playing in the woods with friends, a 14-year-old African-American male is bitten by an insect. Minutes later he notices swelling and redness at the site of the insect bite. Which substance has directly led to the wheal formation?? {'A': 'IFN-gamma', 'B': 'Histamine', 'C': 'IL-22', 'D': 'Arachidonic acid', 'E': 'IL-4'}, | B: Histamine |
Answer the following medical question with one of the provided options: | Q:A 76-year-old male with a history of chronic uncontrolled hypertension presents to the emergency room following an episode of syncope. He reports that he felt lightheaded and experienced chest pain while walking his dog earlier in the morning. He notes that he has experienced multiple similar episodes over the past year. A trans-esophageal echocardiogram demonstrates a thickened, calcified aortic valve with left ventricular hypertrophy. Which of the following heart sounds would likely be heard on auscultation of this patient?? {'A': 'Diastolic rumble following an opening snap with an accentuated S1', 'B': 'Early diastolic high-pitched blowing decrescendo murmur that is loudest at the left sternal border', 'C': 'Crescendo-decrescendo murmur radiating to the carotids that is loudest at the right upper sternal border', 'D': 'Holosystolic murmur radiating to the axilla that is loudest at the apex', 'E': 'Midsystolic click that is most prominent that is loudest at the apex'}, | C: Crescendo-decrescendo murmur radiating to the carotids that is loudest at the right upper sternal border |
Answer the following medical question with one of the provided options: | Q:A 43-year-old Caucasian male spent the past month on a business trip in the Caribbean. Two weeks following his return, he began experiencing diarrhea, pain in his abdomen, and a headache. He presents to the hospital and is noted to be febrile with prominent rose-colored spots on his chest and abdomen. Following recovery, the patient may become a carrier of the bacteria with the bacteria heavily localized to the:? {'A': 'Gallbladder', 'B': 'Spleen', 'C': 'CD4 T-helper cells', 'D': 'Lungs', 'E': 'Sensory ganglia'}, | A: Gallbladder |
Answer the following medical question with one of the provided options: | Q:A clinical study is studying new genetic gene-based therapies for children and adults with sickle cell disease. The patients were informed that they were divided into two age groups since younger patients suffer from different complications of the disease. The pediatric group is more likely to suffer from which of the complications? I. Splenic sequestration II. Avascular necrosis III. Pulmonary hypertension IV. Acute chest syndrome V. Nephropathy? {'A': 'I, II', 'B': 'I, IV, V', 'C': 'I, II, IV', 'D': 'III, IV', 'E': 'I, IV'}, | E: I, IV |
Answer the following medical question with one of the provided options: | Q:A 21-year-old Cambodian patient with a history of rheumatic heart disease presents to his primary care physician for a routine check-up. He reports being compliant with monthly penicillin G injections since being diagnosed with rheumatic fever at age 15. He denies any major side effects from the treatment, except for the inconvenience of organizing transportation to a physician's office every month. On exam, the patient is found to have a loud first heart sound and a mid-diastolic rumble that is best heard at the apex. Which of the following is the next best step?? {'A': 'Stop penicillin therapy', 'B': 'Stop penicillin therapy in 4 years', 'C': 'Decrease frequency of injections to bimonthly', 'D': 'Switch to intramuscular cefotaxime, which has fewer side effects', 'E': 'Continue intramuscular penicillin therapy'}, | E: Continue intramuscular penicillin therapy |
Answer the following medical question with one of the provided options: | Q:A 56-year-old woman presents to the emergency department with muscle weakness. She reports her symptoms have progressively worsened over the course of 2 weeks and are most significant in her lower extremities. She also notices increased urinary frequency. Approximately 1 month ago she was diagnosed with a calcium phosphate nephrolithiasis. Medical history is significant for rheumatoid arthritis diagnosed approximately 10 years ago treated with methotrexate, and type II diabetes mellitus treated with metformin. Her temperature is 98.6°F (37°C), blood pressure is 138/92 mmHg, pulse is 92/min, and respirations are 17/min. On physical exam, there is mild tenderness to palpation of the metacarpophalangeal and proximal interphalangeal joints. There is 4/5 power throughout the lower extremity. Laboratory testing is shown. Serum: Na+: 137 mEq/L Cl-: 106 mEq/L K+: 2.9 mEq/L HCO3-: 18 mEq/L Glucose: 115 mg/dL Creatinine: 1.0 mg/dL Urine pH: 5.6 Which of the following is the best next step in management?? {'A': 'Administer hydrochlorothiazide', 'B': 'Administer intravenous insulin', 'C': 'Administer intravenous sodium bicarbonate', 'D': 'Begin potassium replacement therapy with dextrose', 'E': 'Increase the methotrexate dose'}, | C: Administer intravenous sodium bicarbonate |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the office for a regular follow-up. She was diagnosed with type 2 diabetes mellitus 4 years ago. Her last blood test showed a fasting blood glucose level of 6.6 mmol/L (118.9 mg/dL) and HbA1c of 5.1%. No other significant past medical history. Current medications are metformin and a daily multivitamin. No significant family history. The physician wants to take her blood pressure measurements, but the patient states that she measures it every day in the morning and in the evening and even shows him a blood pressure diary with all the measurements being within normal limits. Which of the following statements is correct?? {'A': 'The physician should not measure the blood pressure in this patient and should simply make a note in a record showing the results from the patient’s diary.', 'B': 'The physician should not measure the blood pressure in this patient because she does not have hypertension or risk factors for hypertension.', 'C': 'The physician has to measure the patient’s blood pressure because it is a standard of care for any person with diabetes mellitus who presents for a check-up.', 'D': 'The physician should not measure the blood pressure in this patient because the local standards of care in the physician’s office differ from the national standards of care so measurements of this patient’s blood pressure can not be compared to diabet', 'E': 'Assessment of blood pressure only needs to be done at the initial visit; it is not necessary to measure blood pressure in this patient at any follow-up appointments.'}, | C: The physician has to measure the patient’s blood pressure because it is a standard of care for any person with diabetes mellitus who presents for a check-up. |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman is brought to the emergency department for right hip pain 1 hour after she fell while walking around in her house. She has been unable to stand or walk since the fall. She has hypertension and gout. Her sister died of multiple myeloma at the age of 55 years. Current medications include amlodipine and febuxostat. She does not smoke cigarettes. She drinks a glass of wine daily. Her temperature is 37.3°C (99.1°F), pulse is 101/min, and blood pressure is 128/86 mm Hg. Examination shows right groin tenderness. Range of motion of the right hip is limited by pain. The remainder of the examination shows no abnormalities. A complete blood count and serum creatinine concentration are within the reference range. An x-ray of the hip shows a linear fracture of the right femoral neck. She is scheduled for surgery. Which of the following is the most likely underlying cause of this patient's fracture?? {'A': 'Reduced osteoblastic activity', 'B': 'Monoclonal antibody production', 'C': 'Interrupted vascular supply', 'D': 'Impaired bone mineralization', 'E': 'Defective osteoclast function'}, | A: Reduced osteoblastic activity |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man presents as a new patient at an outpatient clinic. He has never seen a physician before, but was motivated by his 40-year-old brother's recent heart attack and seeks to optimize his health. In particular, he read that uncontrolled atherosclerosis can lead to a heart attack. Which molecule is downregulated in response to the advent of atherosclerosis?? {'A': 'Serotonin', 'B': 'Thromboxane A2', 'C': 'Nitric oxide', 'D': 'Interleukin 1', 'E': 'Tumor necrosis factor'}, | C: Nitric oxide |
Answer the following medical question with one of the provided options: | Q:A newborn is brought to the emergency department by his parents with violent vomiting. It started about 3 days ago and has slowly gotten worse. He vomits after most feedings but seems to keep some formula down. His mother notes that he is eager to feed between episodes and seems to be putting on weight. Other than an uncomplicated course of chlamydia conjunctivitis, the infant has been healthy. He was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. The physical exam is significant for a palpable mass in the right upper quadrant. What is the first-line confirmatory diagnostic test and associated finding?? {'A': 'Abdominal X-ray; ‘double bubble’ sign', 'B': 'Barium upper GI series; GE junction and portion of the stomach in thorax', 'C': 'Barium upper GI series; bird beak sign and corkscrewing', 'D': 'Air enema; filling defect and coil spring sign', 'E': 'Abdominal ultrasound; elongated pyloric channel and muscle hypertrophy'}, | E: Abdominal ultrasound; elongated pyloric channel and muscle hypertrophy |
Answer the following medical question with one of the provided options: | Q:A 32-year-old pregnant woman presents to the clinic with complaints of cramping, abdominal pain, and severe watery diarrhea for the past 3 days. She also is nauseous and complains of fever and malaise. She was started on a 7-day course of amoxicillin after being admitted to the hospital for pyelonephritis 5 days ago. The vital signs include heart rate 98/min, respiratory rate 16/min, temperature 38.9°C (102.0°F), and blood pressure 92/56 mm Hg. Physical examination reveals abdominal distention with diffuse tenderness. Laboratory studies show a peripheral white blood cell (WBC) count of 15,000/mm3 and stool guaiac positive for occult blood. Which of the following is the best pharmacotherapy for her condition?? {'A': 'Metronidazole', 'B': 'Rifaximin', 'C': 'IV metronidazole plus oral vancomycin', 'D': 'Oral vancomycin', 'E': 'Oral nitazoxanide'}, | D: Oral vancomycin |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman (gravida 3 para 1) with no prenatal care delivers a boy at 37 weeks gestation. His Apgar score is 5 at 1 minute and 8 at 5 minutes. His weight is 2.1 kg (4.2 lb) and length is 47 cm (1 ft 7 in). The mother’s history is significant for chronic pyelonephritis, atrial fibrillation, and gastroesophageal reflux disease. She has a 5-pack-year smoking history and also reports alcohol consumption during pregnancy. Examination of the infant shows a short depressed nasal bridge, wide nose, brachydactyly, and a short neck. Ophthalmoscopy reveals bilateral cataracts. What is the most likely cause of the newborn’s symptoms?? {'A': 'Omeprazole', 'B': 'Gentamicin', 'C': 'Alcohol', 'D': 'Atenolol', 'E': 'Warfarin'}, | E: Warfarin |
Answer the following medical question with one of the provided options: | Q:An 8-year-old girl is brought to the physician because of repetitive involuntary movements, including neck twisting, grimacing, grunting, and blinking, for the past 18 months. Her symptoms seem to improve with concentration and worsen with fatigue. During the past 3 months, they have become so severe that she has missed many school days. Her mother says she also has too much anxiety about her involuntary movements to see her friends and prefers staying home in her room. Her birth and development until 18 months ago were normal. Her father suffers from bipolar disorder. Vital signs are within normal limits. Mental status examination shows intact higher mental function and thought processes. Neurological examination shows multiple motor and vocal tics. Physical examination is otherwise within normal limits. Which of the following is the most appropriate initial pharmacotherapy for this condition?? {'A': 'Buspirone', 'B': 'Alprazolam', 'C': 'Risperidone', 'D': 'Fluoxetine', 'E': 'Chlorpromazine'}, | C: Risperidone |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man presents to his primary care provider with increased urinary frequency. Over the past 3 months, he has been urinating 2-3 times more often than usual. He has started to feel dehydrated and has increased his water intake to compensate. He works as a bank teller. He has a 25-pack-year smoking history and drinks 8-10 beers per week. His temperature is 98°F (36.8°C), blood pressure is 114/68 mmHg, pulse is 100/min, and respirations are 18/min. Capillary refill is 3 seconds. His mucous membranes appear dry. The patient is instructed to hold all water intake. Urine specific gravity is 1.002 after 12 hours of water deprivation. The patient is given desmopressin but his urine specific gravity remains relatively unchanged. Which of the following is the most appropriate pharmacologic treatment for this patient's condition?? {'A': 'Desmopressin', 'B': 'Furosemide', 'C': 'Mannitol', 'D': 'Metolazone', 'E': 'Spironolactone'}, | D: Metolazone |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy comes to the physician because of a nonpruritic rash on his chest for 1 week. He returned from a trip to Puerto Rico 10 days ago. He started using a new laundry detergent after returning. He has type 1 diabetes mellitus controlled with insulin. His mother has Hashimoto thyroiditis, and his sister has severe facial acne. Examination of the skin shows multiple, nontender, round, hypopigmented macules on the chest and trunk. There is fine scaling when the lesions are scraped with a spatula. Which of the following is the most likely underlying mechanism of this patient's symptoms?? {'A': 'Autoimmune destruction of melanocytes', 'B': 'Increased sebum production', 'C': 'Increased growth of Malassezia globosa', 'D': 'Antigen uptake by Langerhans cells', 'E': 'Infection with Trichophyton rubrum'}, | C: Increased growth of Malassezia globosa |
Answer the following medical question with one of the provided options: | Q:A pharmaceutical company conducts a randomized clinical trial in an attempt to show that their new anticoagulant drug prevents more thrombotic events following total knee arthroplasty than the current standard of care. However, a significant number of patients are lost to follow-up or fail to complete treatment according to the study arm to which they were assigned. Several patients in the novel drug arm are also switched at a later time to a novel anticoagulant or warfarin per their primary care physician. All patients enrolled in the study are subsequently analyzed based on the initial group they were assigned to and there is a significant improvement in outcome of the new drug. What analysis most appropriately describes this trial?? {'A': 'As treated', 'B': 'Intention to treat', 'C': 'Modified intention to treat', 'D': 'Non-inferiority', 'E': 'Per protocol'}, | B: Intention to treat |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man comes to the physician for evaluation of a rash on the elbows for several months. A biopsy of the affected area shows a thinned stratum granulosum as well as retained nuclei and spongiotic clusters of neutrophils in the stratum corneum. This patient's skin findings are most likely associated with which of the following conditions?? {'A': 'Seronegative spondylarthropathy', 'B': 'Hypersensitivity to gliadin', 'C': 'Infection with hepatitis C virus', 'D': 'Hashimoto thyroiditis', 'E': 'Insulin resistance'}, | A: Seronegative spondylarthropathy |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman is brought to the emergency department 1 hour after being involved in a motor vehicle collision. She was riding a bike when she lost control and hit a car on the opposite side of the road. On arrival, she is unconscious. She has a history of intravenous heroin use. Her pulse is 56/min, respirations are 8/min and irregular, and blood pressure is 196/102 mm Hg. Examination shows a 2-cm laceration over the left cheek and a 3-cm laceration over the left chest. There are multiple abrasions over her face and chest. She opens her eyes and flexes her extremities to painful stimuli. The pupils are dilated and react sluggishly to light. There are decreased breath sounds over the left lung. The trachea is central. There is no jugular venous distention. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. The left knee and right ankle are swollen; range of motion is limited. Two large-bore peripheral intravenous catheters are inserted. She is intubated and mechanical ventilation is initiated. A focused assessment with sonography in trauma is negative. An occlusive dressing is applied over the left chest wound. She is scheduled for a noncontrast CT scan of the brain. Which of the following is the underlying cause of this patient's hypertension?? {'A': 'Elevated sympathetic response', 'B': 'Reduced parasympathetic response', 'C': 'Increased intrathoracic pressure', 'D': 'Brainstem compression', 'E': 'Posttraumatic vasospasm'}, | A: Elevated sympathetic response |
Answer the following medical question with one of the provided options: | Q:A 28-year-old female presents to her primary care physician because of pain on her right foot. She says that the pain began 2 weeks ago and gets worse with weight bearing. She has been training for a marathon, and this pain has limited her training. On exam, there are no signs of inflammation or deformities on her foot. Compression of the forefoot with concomitant pressure on the interdigital space reproduces the pain on the plantar surface between the third and fourth toes and produces an audible click. What is the cause of this patient's condition?? {'A': 'A bony outgrowth', 'B': 'Inflammation of the bursa', 'C': 'A benign neuroma', 'D': 'A metatarsal compression fracture', 'E': 'Inflammation and scarring of the plantar fascia'}, | C: A benign neuroma |
Answer the following medical question with one of the provided options: | Q:A 68-year-old Caucasian male complains of severe headache and pain while chewing. Upon examination, he is found to have a left visual field deficit. Laboratory results show elevated erythrocyte sedimentation rate. Which of the following drugs would be the best choice for treatment of this patient?? {'A': 'Propranolol', 'B': 'Prednisone', 'C': 'Sumatriptan', 'D': 'Pilocarpine', 'E': 'Clopidogrel'}, | B: Prednisone |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman comes to the physician because of involuntary, rhythmic movements of her hands for the past 5 months. Her symptoms initially affected her left hand only, but now both hands are affected. She also reports that her symptoms are worse at rest and that performing tasks such as tying her shoelaces and writing have become more difficult. Her husband thinks that she has been more withdrawn lately. She used to drink a half a bottle of sherry every day for the past 18 years but has not consumed alcohol in the past year. She has chronic liver disease, hypertension, and peripheral artery disease. Current medications include aspirin and propanolol. She appears anxious. She is oriented to time, place, and person. Her temperature is 37°C (98.6°F), pulse is 98/min, and blood pressure is 144/82 mm Hg. Examination shows a rhythmic, low-frequency tremor that is more prominent in the left hand. Range of motion in the arms and legs is normal. Increased resistance to passive flexion and extension is present in the left upper limb. Muscle strength is 4/5 in all limbs. Sensations to pinprick and light touch are preserved. The finger-to-nose test is normal bilaterally. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Copper accumulation in the basal ganglia', 'B': 'Increased serum free T4 levels', 'C': 'Infarction of the red nucleus', 'D': 'Cerebellar infarction', 'E': 'Degeneration of the substantia nigra'}, | E: Degeneration of the substantia nigra |
Answer the following medical question with one of the provided options: | Q:During an experiment conducted to alter the infectivity of common viruses that affect humans, an investigator successfully increases the host range of human immunodeficiency virus (HIV). The new strain of the virus can infect fibroblast-like cells in addition to the usual target of HIV. Which of the following is the most likely explanation for the increase in the host range of the virus?? {'A': 'Mutation of the gene coding for viral surface glycoproteins', 'B': 'Point mutations in the hemagglutinin gene', 'C': 'Increased rate of budding out of host cells', 'D': 'Reassortment of genetic material between segments of two viruses', 'E': 'Excessive activity of viral RNA polymerase'}, | A: Mutation of the gene coding for viral surface glycoproteins |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man with congestive heart failure presents to the emergency department complaining of worsening shortness of breath. These symptoms have worsened over the last 3 days. He has a blood pressure of 126/85 mm Hg and heart rate of 82/min. Physical examination is notable for bibasilar crackles. A chest X-ray reveals bilateral pulmonary edema. His current medications include metoprolol succinate and captopril. You wish to add an additional medication targeted towards his symptoms. Of the following, which statement is correct regarding loop diuretics?? {'A': 'Loop diuretics decrease sodium, magnesium, and chloride but increase calcium', 'B': 'Loop diuretics inhibit the action of the Na+/K+/Cl- cotransporter', 'C': 'Loop diuretics can cause ammonia toxicity', 'D': 'Loop diuretics can cause metabolic acidosis', 'E': 'Loop diuretics can cause hyperlipidemia'}, | B: Loop diuretics inhibit the action of the Na+/K+/Cl- cotransporter |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man comes to the physician because his skin has been progressively yellowing for the past 4 weeks. He also reports low appetite and difficulty fitting into his pants because of his swollen legs over the past several months. There is no personal or family history of serious illness. He does not smoke and drinks 1 to 2 beers on special occasions. He used to be sexually active with multiple female partners but has lost interest in sexual intercourse recently. He is 178 cm (5 ft 10 in) tall and weighs 68 kg (150 lb); his BMI is 22 kg/m2. Vital signs are within normal limits. Physical examination shows yellowing of the skin and sclera as well as erythema of the palms. There is bilateral enlargement of breast tissue. Cardiopulmonary examinations show no abnormalities. The abdomen is distended. The liver is palpated 2 to 3 cm below the right costal margin. On percussion of the left abdomen, a thrill can be felt on the right side. Hepatojugular reflux is absent. There is bilateral edema below the knees. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Chronic viral hepatitis', 'B': 'Congestive hepatopathy', 'C': 'Primary biliary cirrhosis', 'D': 'Autoimmune hepatitis', 'E': 'Non-alcoholic steatohepatitis'}, | A: Chronic viral hepatitis |
Answer the following medical question with one of the provided options: | Q:A 45-year-old male presents to his primary care physician for complaints of dizziness. The patient reports he experiences room-spinning dizziness lasting several hours at a time, approximately 2-3 times a month, starting 3 months ago. Upon questioning, the patient also reports right sided diminished hearing, tinnitus, and a sensation of ear fullness. Her temperature is 99 deg F (37.2 deg C), pulse 70/min, respirations 12, blood pressure 130 mmHg/85 mmHg, SpO2 99%. You decide to order an audiometric evaluation. What is the most likely finding of the audiogram?? {'A': 'Low frequency sensorineural hearing loss', 'B': 'High frequency sensorineural hearing loss', 'C': 'Low frequency conductive hearing loss', 'D': 'High frequency conductive hearing loss', 'E': 'Normal audiogram'}, | A: Low frequency sensorineural hearing loss |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician for a follow-up examination 1 week after being admitted to the hospital for oral candidiasis and esophagitis. His CD4+ T lymphocyte count is 180 cells/μL. An HIV antibody test is positive. Genotypic resistance assay shows the virus to be susceptible to all antiretroviral therapy regimens and therapy with dolutegravir, tenofovir, and emtricitabine is initiated. Which of the following sets of laboratory findings would be most likely on follow-up evaluation 3 months later? $$$ CD4 +/CD8 ratio %%% HIV RNA %%% HIV antibody test $$$? {'A': '↓ ↑ negative', 'B': '↑ ↑ negative', 'C': '↑ ↓ positive', 'D': '↓ ↑ positive', 'E': '↓ ↓ negative'}, | C: ↑ ↓ positive |
Answer the following medical question with one of the provided options: | Q:A 21-year-old U.S. born first year medical student with no prior hospital or healthcare work presents to the physician for a routine physical exam. The patient is HIV negative, denies drug use, and denies sick contacts. The physician places a purified protein tuberculin test in the patient's right forearm intradermally. What is the proper time to read the test and induration diameter that would indicate a positive test result?? {'A': '24 hours and 18mm diameter', 'B': '36 hours and 7mm diameter', 'C': '48 hours and 11mm diameter', 'D': '72 hours and 16mm diameter', 'E': '96 hours and 14mm diameter'}, | D: 72 hours and 16mm diameter |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is brought to the emergency department for nausea and vomiting for 1 day. His maternal uncle had a seizure disorder and died in childhood. He appears fatigued. Respirations are 32/min. Examination shows diffuse weakness in the extremities. Serum studies show a low pH, elevated lactate concentration, and normal blood glucose. A metabolic condition characterized by a defect in oxidative phosphorylation is suspected. Microscopic examination of a muscle biopsy specimen of this patient is most likely to show which of the following findings?? {'A': 'Fibrofatty replacement of normal muscle fibers', 'B': 'Muscle atrophy with perimysial inflammation', 'C': 'Intermyofibrillar accumulation of glycogen', 'D': 'Endomysial inflammation with T cell infiltration', 'E': 'Subsarcolemmal accumulation of mitochondria'}, | E: Subsarcolemmal accumulation of mitochondria |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy presents to your office with loss of his peripheral vision. His mother discovered this because he was almost struck by a vehicle that "he couldn't see at all". In addition, he has been complaining of a headache for the last several weeks and had an episode of vomiting 2 days ago. He has a family history of migraines in his mother and grandmother. He is currently in the 80th percentile for height and weight. On physical exam his temperature is 99°F (37.2°C), blood pressure is 110/75 mmHg, pulse is 100/min, respirations are 19/min, and pulse oximetry is 99% on room air. He is uncooperative for the rest of the physical exam. During workup, a lesion is found in this patient. Which of the following would most likely be seen during histopathologic analysis?? {'A': 'Rosettes and small blue cells', 'B': 'Eosinophilic, corkscrew fibers', 'C': 'Perivascular rosettes with rod-shaped blepharoplasts', 'D': 'Cholesterol crystals and calcification', 'E': 'Round nuclei with clear cytoplasm'}, | D: Cholesterol crystals and calcification |
Answer the following medical question with one of the provided options: | Q:Researchers are experimenting with hormone levels in mice in fasting and fed states. To test hormone levels in the fed state, the mice are given an oral glucose load and various hormones are measured in a blood sample. Researchers are most interested in the hormone whose blood levels track evenly with C-peptide levels. The hormone the researchers are most interested in is responsible for which of the following actions in the body?? {'A': 'Fatty acid synthesis', 'B': 'Fatty acid breakdown', 'C': 'Protein catabolism', 'D': 'Ketogenesis', 'E': 'Lipolysis'}, | A: Fatty acid synthesis |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman presents because of a painful mass she first noticed on her neck 1 week ago (see image). The mass has grown over the last few days. She has no history of serious illness and takes no medications. On physical exam, her temperature is 38.0°C (100.4°F), pulse is 86/min, respirations are 12/min, blood pressure is 135/80 mm Hg. The mass is tender and relatively soft and mobile. The overlying skin is warm. On her right ear, there is a series of small and healing skin punctures left by the bite of her neighbor’s kitten 3 weeks ago. No other mass is detected in the neck, supraclavicular, axillary, or inguinal regions. Oral examination reveals several discolored teeth. Her lungs are clear to auscultation and heart sounds are normal. Which of the following is the most appropriate diagnostic study at this time?? {'A': 'Culture for facultative anaerobes', 'B': 'Histologic evaluation for Reed-Sternburg cells', 'C': 'The Monospot test for Epstein-Barr virus', 'D': 'Toxoplasma IgG using enzyme-linked immunosorbent assay', 'E': 'Warthin-Starry silver stain for Bartonella henselae'}, | E: Warthin-Starry silver stain for Bartonella henselae |
Answer the following medical question with one of the provided options: | Q:A 26-year-old female who is 12 weeks pregnant presents to her primary care physician because she is concerned about her acne. While she has struggled with acne for most of her adult life, the acne has become more severe in the past few months. She has used benzoyl peroxide, salicylic acid, and topical antibiotics in the past but these treatments have had little effect. The patient would like to try minocycline, which worked for a friend of hers. The physician responds that this drug cannot be given to pregnant women, and offers to start the patient on the drug after she delivers the baby. Minocycline may to toxic to the fetus through which mechanism?? {'A': 'Inhibition of bone growth', 'B': 'Formation of renal cysts', 'C': 'Atrialization of the ventricle', 'D': 'Scarring of the bile ducts', 'E': 'Gray coloring of the skin'}, | A: Inhibition of bone growth |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents with a draining abscess on his left jaw. The patient states that he had a “bad tooth” a few weeks ago which has progressed to his current condition. His vital signs include: blood pressure 110/80 mm Hg, heart rate 85/min, and temperature 37.9°C (100.3°F). On physical examination, the patient has a 4 cm abscess on the left maxillary line that is draining a granulous, purulent material. Which of the following is the most likely causative organism of this abscess?? {'A': 'Enveloped, double stranded DNA virus', 'B': 'Gram-positive cocci in clusters', 'C': 'Gram-positive cocci in chains', 'D': 'Gram-positive, branching rod', 'E': 'Aerobic gram-negative rod'}, | D: Gram-positive, branching rod |
Answer the following medical question with one of the provided options: | Q:A 30-year-old obese female presents with new-onset headaches, ringing in her ears, and blurry vision. Ibuprofen and avoidance of light has not relieved her symptoms. She denies a history of recent trauma, fever, chills, and fatigue. Past medical history is significant for type 2 diabetes mellitus managed with metformin. She has had 20/20 vision her whole life and wonders if she might need to get eyeglasses. She has 2 healthy school-age children. Her temperature is 36.8°C (98.2°F), heart rate is 90/min, respiratory rate is 15/min, and blood pressure is 135/80 mm Hg. Physical exam is notable for decreased lateral eye movement, and the funduscopic findings are shown in the picture. Laboratory findings are within normal limits and brain imaging is normal. Lumbar puncture demonstrates an elevated opening pressure and normal CSF composition. Which of the following is a side effect of the medication used to treat this condition?? {'A': 'Kidney stones', 'B': 'Elevated liver function tests', 'C': 'Rhabdomyolysis', 'D': 'Decreased white blood cell count', 'E': 'Pancreatitis'}, | A: Kidney stones |
Answer the following medical question with one of the provided options: | Q:A 28-year-old gravida 1 para 1 woman is being seen in the hospital for breast tenderness. She reports that both breasts are swollen and tender. She is also having difficulty getting her newborn to latch. The patient gave birth 4 days ago by uncomplicated vaginal delivery. During her pregnancy, the patient developed gestational diabetes but was otherwise healthy. She took folate and insulin. She attended all her pre-natal appointments. Upon examination, the patient has a low grade fever, but all other vital signs are stable. Bilateral breasts appear engorged and are tender to palpation. There is no erythema, warmth, or induration. A lactation nurse is brought in to assist the patient and her newborn with more effective breastfeeding positions. The patient says a neighbor told her that breastmilk actually lacks in nutrients, and she asks what the best option is for the health of her newborn. Which of the following components is breastmilk a poor source of?? {'A': 'Immunoglobulin A', 'B': 'Lysozymes', 'C': 'Phosphorus', 'D': 'Vitamin D', 'E': 'Whey protein'}, | D: Vitamin D |
Answer the following medical question with one of the provided options: | Q:A 5-month-old boy is brought to the pediatrician by his parents, who began noticing that the infant was not able to hold his head upright when sitting or in a prone position. Upon examination, the infant has a musty odor, fair skin with patches of eczema, and blue eyes. The pediatrician orders laboratory tests and prescribes a special diet. Which of the following substances should be included in this diet?? {'A': 'Large neutral amino acids', 'B': 'L-carnitine', 'C': 'Thiamine', 'D': 'Malate', 'E': 'Arginine'}, | A: Large neutral amino acids |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man comes to the emergency department because of a 3-week history of intermittent swelling of his left arm and feeling of fullness in his head that is exacerbated by lying down and bending over to tie his shoes. Physical examination shows left-sided facial edema and distention of superficial veins in the neck and left chest wall. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Right heart failure', 'B': 'Cervical rib', 'C': 'Apical lung tumor', 'D': 'Subclavian steal syndrome', 'E': 'Mediastinal lymphoma'}, | C: Apical lung tumor |
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