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Answer the following medical question with one of the provided options: | Q:A 45-year-old woman comes to the physician because of fatigue, irregular menses, and recurrent respiratory infections for the past 6 months. Her blood pressure is 151/82 mm Hg. Physical examination shows a round face, thinning of the skin, and multiple bruises on her arms. Further studies confirm the diagnosis of an ACTH-secreting pituitary adenoma. This patient is at greatest risk for which of the following?? {'A': 'Weight loss', 'B': 'Eosinophilia', 'C': 'Hypoglycemia', 'D': 'Bitemporal hemianopsia', 'E': 'Pathologic fracture'}, | E: Pathologic fracture |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy is brought to the pediatric emergency department by his parents with a complaint of abdominal pain and diarrhea for the past week. He states that for the past two days, he has noticed blood in his stool. His parents note that they attended a neighbor’s barbecue last weekend, but otherwise have not eaten any new foods or changed their usual diet. The patient is admitted to the hospital unit for further work-up. The provider team finds that the patient’s blood is positive for Shiga-like toxin and notes the following lab values: creatinine of 4.2 mg/dL, platelet count of 50,000/mm^3, and hemoglobin of 6.0 g/dL. Which of the following additional lab findings would be consistent with the diagnosis?? {'A': 'Blunting of villi on ileal biopsy', 'B': 'Crypt abscesses and ulcers on colonic biopsy', 'C': 'Microthrombi within glomerular vessels on kidney biopsy', 'D': 'Foamy macrophages in intestinal lamina propria on duodenal biopsy', 'E': 'Sickling of red blood cells on peripheral blood smear'}, | C: Microthrombi within glomerular vessels on kidney biopsy |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman comes to the physician because of involuntary hand movements that improve with alcohol consumption. Physical examination shows bilateral hand tremors that worsen when the patient is asked to extend her arms out in front of her. The physician prescribes a medication that is associated with an increased risk of bronchospasms. This drug has which of the following immediate effects on the cardiovascular system? $$$ Stroke volume %%% Heart rate %%% Peripheral vascular resistance $$$? {'A': '↑ ↑ ↓', 'B': '↓ ↓ ↓', 'C': '↓ ↑ ↑', 'D': '↓ ↓ ↑', 'E': '↑ ↑ ↑'}, | D: ↓ ↓ ↑ |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to the emergency department by her parents with sudden onset shortness of breath. They tell the emergency physician that their daughter was lying on the bed watching television when she suddenly began gasping for air. They observed a bowl of peanuts lying next to her when they grabbed her up and brought her to the emergency department. Her respirations are 25/min, the pulse is 100/min and the blood pressure is 90/65 mm Hg. The physical findings as of now are apparently normal. She is started on oxygen and is sent in for a chest X-ray. Based on her history and physical exam findings, the cause of her current symptoms would be seen on the X-ray at which of the following sites? ? {'A': 'The apical segment of the right upper lobe', 'B': 'The apical segment of the left upper lobe', 'C': 'The superior segment of the right lower lobe', 'D': 'The posterior segment of the right lower lobe', 'E': 'The lingula of the right lower lobe'}, | C: The superior segment of the right lower lobe |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 67-year-old woman comes to your clinic after being admitted to the hospital for 2 weeks after breaking her hip. She has not regularly seen a physician for the past several years because she has been working hard at her long-time job as a schoolteacher. You wonder if she has not been taking adequate preventative measures to prevent osteoporosis and order the appropriate labs. Although she is recovering from surgery well, she is visibly upset because she is worried that her hospital bill will bankrupt her. Which of the following best describes her Medicare coverage?? {'A': 'Medicare Part A will cover the majority of her hospital fees, including inpatient drugs and lab tests.', 'B': 'Medicare Part B will cover the majority of her hospital fees, including inpatient drugs and lab tests.', 'C': 'Medicare Part C will cover the majority of drug costs during her inpatient treatment.', 'D': 'Medicare Part D will cover the cost of drugs during her inpatient treatment.', 'E': 'Medicare is unlikely to cover the cost of her admission because she has not been paying her premium.'}, | A: Medicare Part A will cover the majority of her hospital fees, including inpatient drugs and lab tests. |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman has painless abdominal distension 2 days after admission for acute pancreatitis. Her initial abdominal pain has resolved. Enteral nutrition has been initiated. She has not passed any stool since being admitted to the hospital. She has nausea but no vomiting. Her temperature is 36.7°C (98.1°F), pulse is 95/min, respiratory rate is 17/min, and blood pressure is 100/70 mm Hg. The lungs are clear to auscultation. Abdominal examination shows symmetric distention, absent bowel sounds, and tympanic percussion without tenderness. Laboratory studies show: Serum Na+ 137 mEq/L K+ 3.2 mEq/L Cl− 104 mEq/L HCO3− 23 mEq/L Urea nitrogen 22 mg/dL Creatinine 0.8 mg/dL A supine abdominal X-ray is shown. Which of the following best explains these findings?? {'A': 'Ascites', 'B': 'Ileus', 'C': 'Necrotizing pancreatitis', 'D': 'Pancreatic fluid collection', 'E': 'Pancreatic pseudocyst'}, | B: Ileus |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the changes that occur in the oxygen-hemoglobin dissociation curve of different types of hemoglobin under various conditions. The blood obtained from a male infant shows decreased affinity for 2,3-bisphosphoglyceric acid. Which of the following is the most likely composition of the hemoglobin molecule in this sample?? {'A': 'β4', 'B': 'α2βS2', 'C': 'α2β2', 'D': 'α2δ2', 'E': 'α2γ2\n"'}, | E: α2γ2 " |
Answer the following medical question with one of the provided options: | Q:A research team is studying the effects of a novel drug that was discovered to treat type 2 diabetes. In order to learn more about its effects, they follow patients who are currently taking the drug and determine whether there are adverse effects that exceed anticipated levels and may therefore be drug-related. They discover that the drug causes an excess of sudden cardiac death in 19 patients with renal failure out of 2 million total patients that are followed. Based on these results, an additional warning about this serious adverse effect is added to the investigator brochure for the drug. Which of the following clinical phase studies does this study most likely describe?? {'A': 'Phase I', 'B': 'Phase II', 'C': 'Phase III', 'D': 'Phase IV', 'E': 'Phase V'}, | D: Phase IV |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man presents to a physician with complaints of paresthesia of the lower extremities, which he has had for the last 3 months. He has been frequently fatigued for the past 5 months and also experienced an increased frequency of urination over the last few months. There is no history of a known medical condition or of substance abuse. His physical examination does not reveal any specific abnormality, except that he is obese: his body mass index is 34.6 kg/m2. The patient’s detailed laboratory evaluation reveals a fasting plasma glucose of 160 mg/dL and 2-hour plasma glucose of 270 mg/dL. His physician tells him that his laboratory evaluation suggests a diagnosis of diabetes mellitus type 2. The patient, surprised by this news, asks his physician why he has developed diabetes mellitus even though no one else in his family has ever suffered from it. The physician explains to him that genetic factors play an important role in the development of diabetes mellitus, but that their interactions are complex. Apart from neonatal diabetes mellitus and maturity-onset diabetes of the young (MODY), the development of diabetes mellitus cannot be explained by a single genetic mutation. Which of the following options best explains the genetics of the form of diabetes mellitus from which this man is suffering?? {'A': 'Anticipation', 'B': 'Genomic imprinting', 'C': 'Natural selection', 'D': 'Polygenic inheritance', 'E': 'Synergistic epistasis'}, | D: Polygenic inheritance |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man is brought to the emergency department 1 hour after injuring his genital area when he fell astride his backyard fence. He was trimming a tree from the fence when he lost his balance. His vital signs are within normal limits. Examination shows blood at the urethral meatus, perineal ecchymoses, and a scrotal hematoma. An x-ray of the pelvis shows swelling of the soft tissue but no other abnormalities. Which part of the urinary tract is most likely damaged in this patient?? {'A': 'Penile urethra', 'B': 'Anterior bladder wall', 'C': 'Bulbous urethra', 'D': 'Membranous urethra', 'E': 'Prostatic urethra'}, | C: Bulbous urethra |
Answer the following medical question with one of the provided options: | Q:You are working in the emergency room of a children's hospital when a 4-year-old girl is brought in by ambulance due to "difficulty breathing." The patient had been eating lunch on a school field trip when she suddenly complained of abdominal pain. Shortly thereafter, she was noted to have swelling of the lips, a rapidly developing red rash and difficulty breathing. In the ambulance her blood pressure was persistently 80/50 mmHg despite intramuscular epinephrine. In the course of stabilization and work up of the patient, you note an elevated tryptase level. What is the mechanism behind this elevated tryptase level?? {'A': 'IgG production by plasma cells', 'B': 'IgM mediated complement activation', 'C': 'Cross-linking of IgE on mast cells', 'D': 'Antibody-antigen immune complexes', 'E': 'Cross-linking of IgG on mast cells'}, | C: Cross-linking of IgE on mast cells |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man is brought to the emergency department by his friends because of blurred vision and slurred speech for the past 6 hours. He had some difficulty swallowing his food during lunch and has weakness in both arms. Two weeks ago, he had an upper respiratory infection that resolved spontaneously. He lives independently and returned from his grandparents' farm 2 days ago. He commonly consumes canned vegetables and fruits. He is alert and oriented to person, place, and time. His temperature is 37°C (98.6°F), pulse is 88/min, respirations are 10/min and labored, and blood pressure is 110/70 mm Hg. Examination shows bilateral nystagmus and ptosis. The pupils are dilated and not reactive to light. Muscle strength of the facial muscles and bilateral upper extremities is decreased. Upper extremity deep tendon reflexes are 1+ bilaterally. Cardiopulmonary examination shows no abnormalities. Which of the following is the most likely cause for this patient's symptoms?? {'A': 'Chemical that inhibits acetylcholinesterase', 'B': 'Cell-mediated focal demyelination', 'C': 'Autoantibodies against ACh receptors', 'D': 'Toxin that inhibits ACh release', 'E': 'Autoantibodies against myelin'}, | D: Toxin that inhibits ACh release |
Answer the following medical question with one of the provided options: | Q:An 8-year old boy is brought into clinic for evaluation of possible scoliosis that was newly found on a routine exam at school. On exam, he is also noted to be in the 99th percentile for height and 70th percentile for weight. He appears to have abnormally long extremities as well as an upward lens dislocation on ophthalmologic exam. A mutation leading to a defect in which of the following proteins is the most likely cause of his condition?? {'A': 'Type I collagen', 'B': 'Type IV collagen', 'C': 'Elastin', 'D': 'Fibrillin', 'E': 'ATP7A'}, | D: Fibrillin |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man comes to the physician because of malaise and dark urine for the past 5 days. He has also had recurrent episodes of sinus congestion, productive cough, and fever for 3 months. Additionally, he has noticed a rash on his arms and feet. He has seasonal allergic conjunctivitis treated with ketotifen eye drops. Vital signs are within normal limits. Examination shows several erythematous and necrotic papules on his arms and feet. He has inflamed nasopharyngeal mucosa and a perforated nasal septum. The nasal bridge is collapsed. Laboratory studies show: Hemoglobin 11.3 g/dL Leukocyte count 12000/mm3 Platelet count 270,000/mm3 ESR 55 mm/hr Serum Urea nitrogen 28 mg/dL Creatinine 2.9 mg/dL Anti-DNA antibodies negative Antineutrophil cytoplasmic antibodies positive Urine Protein 2+ Glucose negative RBC 35–37/hpf RBC casts numerous Which of the following biopsy findings is most likely to be observed in this patient?"? {'A': 'Tissue eosinophilia with granulomatous reactions', 'B': 'Nongranulomatous fibrinoid necrosis with infiltration of neutrophils', 'C': 'Immunoglobulin and complement deposits at the dermoepidermal junction', 'D': 'Granulomatous vasculitis of small and medium-sized vessels', 'E': 'Transmural necrotizing arteritis and fibrinoid necrosis in muscles\n"'}, | D: Granulomatous vasculitis of small and medium-sized vessels |
Answer the following medical question with one of the provided options: | Q:A 3-week-old boy is brought to the physician for the evaluation of poor feeding and recurrent episodes of vomiting. He was delivered at term after an uncomplicated pregnancy. He is at the 5th percentile for length and weight. Physical examination shows generalized hypotonia. Urinalysis shows increased propionic acid concentration. The finding on urinalysis is best explained by the breakdown of which of the following substances?? {'A': 'Even-chain fatty acids', 'B': 'Hexose monosaccharides', 'C': 'Branched-chain amino acids', 'D': 'Catechol-containing monoamines', 'E': 'Bicyclic nitrogenous bases'}, | C: Branched-chain amino acids |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man presents to the emergency department with a sudden-onset sensation that the room is spinning causing him to experience several episodes of nausea and vomiting. Upon arriving, the patient’s symptoms have resolved. He states his symptoms occurred as he was going to bed. He has never experienced this before, but felt extremely dizzy for roughly 3 minutes. He currently feels at his baseline. The patient is otherwise healthy and only has a history of eczema. His temperature is 97.7°F (36.5°C), blood pressure is 134/85 mmHg, pulse is 85/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for a healthy man with a normal gait. The patient has a physiologic nystagmus and his cranial nerve exam is unremarkable. The patient’s head is turned to the left and he is laid back on the stretcher, which exacerbates severe symptoms with a nystagmus notable. The patient’s symptoms improve after 2 minutes of being in this position. Which of the following is the most likely diagnosis?? {'A': 'Benign paroxysmal positional vertigo', 'B': 'Labyrinthitis', 'C': 'Meniere disease', 'D': 'Vertebrobasilar stroke', 'E': 'Vestibular neuritis'}, | A: Benign paroxysmal positional vertigo |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the physician because of progressive right knee pain for the past 3 months. He reports that the pain is worse at night and while doing sports at school. He has not had any trauma to the knee or any previous problems with his joints. His vital signs are within normal limits. Examination of the right knee shows mild swelling and tenderness without warmth or erythema; the range of motion is limited. He walks with an antalgic gait. Laboratory studies show an alkaline phosphatase of 180 U/L and an erythrocyte sedimentation rate of 80 mm/h. An x-ray of the right knee is shown. Which of the following is the most likely diagnosis?? {'A': 'Ewing sarcoma', 'B': 'Chordoma', 'C': 'Osteochondroma', 'D': 'Chondrosarcoma', 'E': 'Osteosarcoma\n"'}, | E: Osteosarcoma " |
Answer the following medical question with one of the provided options: | Q:One hour after being admitted to the hospital for sharp, acute chest pain and diaphoresis, a 55-year-old woman with type 2 diabetes mellitus loses consciousness in the emergency department. There are no palpable pulses. Chest compressions are started. The patient has a history of breast cancer that was surgically treated 4 years ago. Prior to admission, the patient was on a long bus ride to visit her sister. Her medications include tamoxifen, atorvastatin, metoprolol, metformin, and insulin. Serum troponin levels are elevated. The cardiac rhythm is shown. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous glucagon therapy', 'B': 'Defibrillation', 'C': 'Coronary angiography', 'D': 'Intravenous epinephrine therapy', 'E': 'Intravenous dextrose therapy'}, | D: Intravenous epinephrine therapy |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents to the opthalmologist for a down- and inward dislocation of the lens in his left eye. On physical exam, the boy has a marfanoid habitus and mental retardation. Biochemical tests were performed to locate the exact defect in this boy. It was found that there was a significant reduction of the conversion of 5,10-methyltetrahydrofolate to 5-methyltetrahydrofolate. Which of the following is the diagnosis?? {'A': 'Marfan syndrome', 'B': 'Homocystinuria', 'C': 'Alkaptonuria', 'D': 'Phenylketonuria', 'E': 'Maple syrup disease'}, | B: Homocystinuria |
Answer the following medical question with one of the provided options: | Q:A 45-year-old gravida 1, para 0 woman is brought to the hospital in labor at 39 weeks gestation. After 4 hours, she gives birth to a healthy appearing baby boy with APGAR scores of 7 at 1 minute and 9 at 5 minutes. She had limited prenatal screening but did have an ultrasound at 35 weeks that showed polyhydramnios. The next day, the neonate vomits greenish-yellow fluid after breastfeeding. This occurs 2 more times that day after feeding and several times between feedings. The next day, the neonate appears weak with difficulty latching to the breast and is dehydrated. The physician on duty is concerned and orders blood work, IV fluids, and the abdominal X-ray shown below. Which of the following disorders is most associated with the newborn’s condition?? {'A': 'Trisomy 18', 'B': 'Trisomy 13', 'C': 'Trisomy 21', 'D': '47 XXY', 'E': '45 XO'}, | C: Trisomy 21 |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents with progressive weakness, exercise intolerance, and occasional dizziness for the past 3 months. Past medical history is unremarkable. She reports an 18-pack-year smoking history and drinks alcohol rarely. Her vital signs include: temperature 36.6°C (97.8°F), blood pressure 139/82 mm Hg, pulse 98/min. Physical examination is unremarkable. Her laboratory results are significant for the following: Hemoglobin 9.2 g/dL Erythrocyte count 2.1 million/mm3 Mean corpuscular volume (MCV) 88 μm3 Mean corpuscular hemoglobin (MCH) 32 pg/cell Leukocyte count 7,500/mm3 Which of the following is the best next step in the management of this patient’s condition?? {'A': 'Serum ferritin level', 'B': 'C-reactive protein (CRP)', 'C': 'Reticulocyte count', 'D': 'Direct antiglobulin test', 'E': 'Bone marrow biopsy'}, | C: Reticulocyte count |
Answer the following medical question with one of the provided options: | Q:A 71-year-old woman presents to the clinic after an X-ray that revealed compression fractures of her L1 and L2 vertebral bodies due to osteoporotic changes. The patient has a history of hypertension for which she takes hydrochlorothiazide, and rheumatoid arthritis, for which she has been taking prednisone for the last 2 years. The patient states that she had a dual-energy X-ray absorptiometry (DEXA) scan 3 years ago that was normal and attributes that finding to regularly taking calcium and vitamin D supplements since then. The patient states that her pain from the fractures is stopping her from participating in her regular activities, such as exercising and gardening. Which of the following is the main cause of her osteoporosis?? {'A': 'Decreased estrogen levels', 'B': 'Hydrochlorothiazide (HCTZ) therapy', 'C': 'Calcium malabsorption', 'D': 'Bone depletion due to chronic corticosteroid use', 'E': 'Undiagnosed hyperparathyroidism'}, | D: Bone depletion due to chronic corticosteroid use |
Answer the following medical question with one of the provided options: | Q:A 24-year-old male is brought in by ambulance to the emergency department after he was found unresponsive at home for an unknown length of time. Upon arrival, he is found to be severely altered and unable to answer questions about his medical history. Based on clinical suspicion, a panel of basic blood tests are obtained including an arterial blood gas, which shows a pH of 7.32, a pCO2 of 70, and a sodium bicarbonate level of 30 mg/dl. Which of the following is most likely the primary disturbance leading to the values found in the ABG?? {'A': 'Metabolic acidosis', 'B': 'Metabolic alkalosis', 'C': 'Respiratory acidosis', 'D': 'Respiratory alkalosis', 'E': 'Mixed alkalosis'}, | C: Respiratory acidosis |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man with hypertension and type 2 diabetes mellitus is brought to the emergency department 20 minutes after the onset of severe anterior chest pain and shortness of breath. He has smoked one pack of cigarettes daily for 30 years. He appears distressed. His pulse is 116/min, respirations are 22/min, and blood pressure is 156/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. A grade 3/6, high-pitched, blowing, diastolic murmur is heard over the right upper sternal border. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Tear in the tunica intima', 'B': 'Fibrofatty plaque in the aortic wall', 'C': 'Obstruction of the pulmonary arteries', 'D': 'Rupture of a bulla in the lung', 'E': 'Perforation of the esophageal wall'}, | A: Tear in the tunica intima |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman comes to the physician because of worsening pain with swallowing for 3 days and a dry sensation in the mouth over the past week. She has a history of asthma controlled with inhaled fluticasone and albuterol. Physical examination shows white plaques on the dorsal surface of the tongue and buccal mucosa that bleed when scraped off. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Triamcinolone', 'B': 'Nystatin', 'C': 'Acyclovir', 'D': 'Griseofulvin', 'E': 'Amphotericin B'}, | B: Nystatin |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman presents with ongoing diplopia for 1 week. She has noticed that her diplopia is more prominent when she looks at objects in her periphery. It does not present when looking straight ahead. She does not have a fever, headache, ocular pain, lacrimation, blurring of vision, or changes in her color vision. She is a college student and is otherwise healthy. The neurological examination reveals that when she looks to the left, her right eye does not adduct while her left eye abducts with nystagmus. Furthermore, when she looks to the right, her left eye does not adduct while her right eye abducts with prominent nystagmus. Her pupils are bilateral, equal and reactive to light and accommodation. The convergence is normal. The rest of the cranial nerve examination is unremarkable. What is the next best step in the management of this patient?? {'A': 'Computed tomography (CT) scan of the head', 'B': 'Lumbar puncture', 'C': 'Magnetic resonance imaging (MRI) of the brain', 'D': 'Ophthalmology referral', 'E': 'Visual evoked potential'}, | C: Magnetic resonance imaging (MRI) of the brain |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is brought to the physician by his mother because of concerns about his recent behavior. Three months ago, the patient first reported hearing loud voices coming from the ceiling of his room. During this time, he has also become increasingly worried that visitors to the house were placing secret surveillance cameras. Mental status examination shows tangential speech with paranoid thoughts. Treatment for this patient's condition predominantly targets which of the following dopaminergic pathways?? {'A': 'Mesolimbic pathway', 'B': 'Thalamocortical pathway', 'C': 'Mesocortical pathway', 'D': 'Corticostriatal pathway', 'E': 'Nigrostriatal pathway'}, | A: Mesolimbic pathway |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman at 30 weeks gestation presents to the obstetrician with the sudden onset of fever, headache, anorexia, fatigue, and malaise. She mentioned that she had eaten ice cream 3 days ago. Blood cultures show gram-positive rods that are catalase-positive and display distinctive tumbling motility in liquid medium. What is the most likely diagnosis?? {'A': 'Brucellosis', 'B': 'Influenza', 'C': 'Listeriosis', 'D': "Legionnaires' disease", 'E': 'Tularaemia'}, | C: Listeriosis |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman presents to the emergency room because of severe back pain after a fall. She says that she was walking home from work when she slipped on a patch of ice on the sidewalk. Since she did not have anything to hold onto, she fell backwards and landed on her posterior iliac crests bilaterally. Immediately after the fall, she started experiencing back pain and tenderness that concerned her enough to call for an ambulance. Her past medical history is significant for arthritis, diabetes, and hypertension. On arrival, her temperature is 99°F (37.2°C), blood pressure is 129/86 mmHg, pulse is 112/min, respirations are 19/min. Physical exam reveals tenderness to palpation over the middle of her lower back. A drug that may have predisposed this patient to this outcome most likely has which of the following mechanisms?? {'A': 'Inhibition of leukotriene and prostaglandin production', 'B': 'Inhibition of circulating cytokine', 'C': 'Inhibition of folate processing', 'D': 'Inhibition of prostaglandin production alone', 'E': 'Stimulation of adipocyte transcription factor'}, | A: Inhibition of leukotriene and prostaglandin production |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman presents for a follow-up visit. She was diagnosed with type 2 diabetes mellitus a month ago but refused to start medications despite counseling due to her fear of gaining weight. She tried exercising and eating healthy in an attempt to ''cure'' her diabetes. She managed to lose 1.8 kg (4 lb) in a month. Today she still complains of increased urinary frequency, the same symptom that leads to her initial suspicion of diabetes. No other significant past medical history. She is happily married and plans on having kids in the next few years. The patient is a non-smoker, denies illicit drug use, and drinks socially. Her vital signs show a pulse of 80/min, a respiratory rate of 16/min, a blood pressure of 120/80 mm Hg, and a temperature of 36.9°C (98.4°F). Her BMI is 33.0 kg/m2. Physical exam findings are unremarkable. Her fingerstick glucose today is 214 mg/dL. Laboratory findings reveal the following: Glycated Hemoglobin (HbA1c) 7.1% Blood glucose (fasting) 130 mg/dL Serum: Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dL Blood urea nitrogen 9 mg/dL Urinalysis shows: Glucose Positive Ketones Negative Leukocytes Negative Nitrites Negative RBCs Negative Casts Negative Which of the following is the best treatment option for this patient?? {'A': 'Start insulin.', 'B': 'Start glipizide.', 'C': 'Start metformin.', 'D': 'Start exenatide.', 'E': 'Start empagliflozin.'}, | C: Start metformin. |
Answer the following medical question with one of the provided options: | Q:A previously healthy 30-year-old woman comes to the physician because of a 6-month history of a recurring rash that typically occurs on exposure to the sun and affects only the face. She also has noticed several nonpainful ulcers on the roof of her mouth. She is sexually active with one male partner and they use condoms inconsistently. Her mother has end-stage renal disease. The patient does not smoke or drink alcohol. Her vital signs are within normal limits. Physical examination shows an erythematous rash across the cheeks that spares the nasolabial folds. There are three small ulcers on the hard palate. Laboratory studies show: Leukocyte count 3,000/mm3 Platelet count 70,000/mm3 Erythrocyte sedimentation rate 80 mm/h Serum Antinuclear antibodies 1:320 Anti-Smith antibodies positive Urine Protein 3+ RBC casts negative RBCs none WBCs 10–15/hpf Which of the following is the most appropriate next step in management?"? {'A': 'Skin biopsy', 'B': 'Renal biopsy', 'C': 'Administration of hydroxychloroquine', 'D': 'Administration of azathioprine', 'E': 'Pathergy skin testing'}, | B: Renal biopsy |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man presents to the emergency room for a fever that has persisted for over 4 days. In addition, he has been experiencing weakness and malaise. His past medical history is significant for a bicuspid aortic valve that was replaced 2 years ago. Physical exam reveals nailbed splinter hemorrhages, tender nodules on his fingers, and retinal hemorrhages. An echocardiogram shows aortic valve vegetations and culture reveals a gram-positive alpha-hemolytic organism that grows as cocci in chains. The organism is then exposed to optochin and found to be resistant. Finally, they are seen to ferment sorbitol. The most likely cause of this patient's symptoms is associated with which of the following?? {'A': 'Colon cancer', 'B': 'Dental procedures', 'C': 'IV drug use', 'D': 'Pneumonia', 'E': 'Sexual activity'}, | B: Dental procedures |
Answer the following medical question with one of the provided options: | Q:A previously healthy 2-year-old boy is brought to the physician by his mother after 2 days of fever, runny nose, hoarseness, and severe, dry cough. He appears restless. His temperature is 38.1°C (100.5°F), and his respiratory rate is 39/min. Examination shows clear rhinorrhea and a barking cough. There is a prolonged inspiratory phase with a harsh stridor upon agitation. An x-ray of the neck shows tapering of the subglottic region. Which of the following is the most likely causal organism?? {'A': 'Adenovirus', 'B': 'Streptococcus pneumoniae', 'C': 'Haemophilus influenzae', 'D': 'Parainfluenza virus', 'E': 'Measles morbillivirus'}, | D: Parainfluenza virus |
Answer the following medical question with one of the provided options: | Q:An 18-month-old boy is presented to the emergency department by his parents due to swelling in his right knee after playing in the park. His parents say there was no obvious injury. After questioning, the mother says that an uncle of hers had similar problems. The vital signs include heart rate 146/min, respiratory rate 26/min, temperature 37.1°C (98.8°F) and blood pressure 90/52 mm Hg. On physical examination, the swelling of the right knee is evident. The rest of the physical findings are unremarkable. The ultrasound is compatible with the hemarthrosis of the right knee. The complete blood count (CBC) results are as follows: Hemoglobin 12.2 g/dL Hematocrit 36% Leukocyte count 7,300/mm3 Neutrophils 45% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 44% Monocytes 2% Platelet count 200,000/mm³ The coagulation test results are as follows: Partial thromboplastin time (activated) 52.0 s Prothrombin time 14.0 s Reticulocyte count 1.2% Thrombin time < 2 seconds deviation from control What is the most likely diagnosis?? {'A': 'Marfan syndrome', 'B': 'Von Willebrand disease', 'C': 'Ehler-Danlos disease', 'D': 'Hemophilia A', 'E': 'Bernard-Soulier disease'}, | D: Hemophilia A |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man presents to the clinic for follow up for treatment of latent tuberculosis. He is a healthcare worker and began isoniazid 3 months ago after a routine PPD yielded a 12-mm induration. He feels otherwise well and attributes this to his vegetarian diet that he has been following for the past 4 years. His past medical history is unremarkable, but his family history is significant for a "liver disease," the specifics of which are unknown. Physical exam shows mildly reduced sensation to pinprick over the distal lower extremities. The abdomen is soft, nontender, and without hepatosplenomegaly. Laboratory studies demonstrate the following: Serum: Hemoglobin: 9.6 g/dL Hematocrit: 34% Leukocyte count: 9,200/mm^3 with normal differential Platelets: 270,000/mm^3 Mean corpuscular volume: 77 µm^3 AST: 92 U/L ALT: 84 U/L Ferritin: 302 ng/mL (normal 15-200 ng/mL) Total iron: 273 µg/dL (normal 50-170 µg/dL) TIBC: 150 µg/dL (normal 250–370 µg/dL) Which of the following is the most appropriate next step in management?? {'A': 'Blood lead levels', 'B': 'Cobalamin supplementation', 'C': 'Pyridoxine supplementation', 'D': 'Serial phlebotomy', 'E': 'Stop isoniazid treatment'}, | C: Pyridoxine supplementation |
Answer the following medical question with one of the provided options: | Q:A case-control study with a focus on risk factors that may influence the development of depression was conducted among the elderly population in one tertiary hospital in Malaysia. The study involved 150 elderly patients diagnosed with depressive illness from the psychiatry ward, as well as another group of 150 elderly patients without any history of depressive illness (but hospitalized for other reasons) at the same ward. The data were collected through questionnaires, and 2 principal investigators (who were also the patients’ attending physicians) acted as interviewers after proper training for the purposes of this study. Multivariate analyses of logistic regression with independent variables were employed to determine the adjusted odds ratio for the risk of developing depression. The study results showed that a lower level of social support, lack of education, and the presence of chronic illnesses highly correlated with depression. In order to maximally avoid bias that may stem from this kind of study design, what should the researchers have done differently to increase the validity of their results?? {'A': 'Used open-ended questions', 'B': 'Included more interviewers', 'C': 'Blinded the investigators', 'D': 'Used Bonferroni correction on data', 'E': 'Used closed testing procedures on the data'}, | C: Blinded the investigators |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman presents with weight gain and a milky-white discharge from her breasts. Patient says she noticed herself gaining weight and a milky white discharge from her breasts. Past medical history is significant for schizophrenia, recently diagnosed and treated with risperidone. No history of headache, nausea, and vomiting. No other current medications. Her last menstrual period was 2 months ago. Review of systems is significant for decreased libido. Patient is afebrile and vital signs are within normal limits. On physical examination, patient had a weight gain of 3 kg (6.6 lb) over the past month. There is bilateral breast tenderness present. A urine pregnancy test is negative. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Decrease in dopamine activity in mesolimbic pathway', 'B': 'Increase in dopamine activity in mesolimbic pathway', 'C': 'Decrease in dopamine activity in tuberoinfundibular pathway', 'D': 'Increase in dopamine activity in tuberoinfundibular pathway', 'E': 'Decrease in dopamine activity in nigrostriatal pathway'}, | C: Decrease in dopamine activity in tuberoinfundibular pathway |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man is brought to the emergency department for the evaluation of severe chest pain for the last hour. The pain travels along the left arm and upper jaw. The patient also reports difficulty breathing and profuse sweating. He has hypertension and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the last 35 years. His medications include enalapril and metformin. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 90/60 mm Hg. An ECG shows ST elevation in the leads II, III, and aVF. Morphine is administered and oxygen supplementation and fluid resuscitation are begun. Shortly after, the patient becomes unstable. Following emergency resuscitation and stabilization, a written advance directive provided by the patient's primary care physician shows a do-not-resuscitate (DNR) order. The patient's wife, who is the power of attorney, disagrees. Which of the following is the most appropriate next step in management of this patient?? {'A': 'Obtain court order to revoke written advance directive', 'B': 'Supportive care only', 'C': 'Reperform resuscitation when needed', 'D': "Contact the patient's oldest child", 'E': 'Contact the ethics committee'}, | B: Supportive care only |
Answer the following medical question with one of the provided options: | Q:An 11-month-old boy is brought to a pediatrician by his parents for evaluation of vomiting and watery diarrhea over the last day. The mother informs the pediatrician that the boy had consumed an apple bought from a fruit vendor on the previous day, but that otherwise there has been no recent change in his diet. There is no history of blood in the stool, flatulence, irritability, or poor appetite. There is no history of recurrent or chronic diarrhea or any other gastrointestinal symptoms. On physical examination, his temperature is 37.6°C (99.6°F), pulse is 120/min, respirations are 24/min, and blood pressure is 92/60 mm Hg. General examination reveals a playful infant with normal skin turgor and no sunken eyes. The pediatrician explains to the parents that he most likely has acute gastroenteritis and that no specific medication is indicated at present. He also instructs the parents about his diet during the illness and reviews the danger signs of dehydration. He suggests a follow-up evaluation after 48 hours or earlier if any complications arise. Which of the following dietary recommendations did the pediatrician make?? {'A': 'Age-appropriate diet', 'B': 'BRAT diet', 'C': 'Plenty of juices and carbonated sodas', 'D': 'Diluted formula milk', 'E': 'Lactose-free diet'}, | A: Age-appropriate diet |
Answer the following medical question with one of the provided options: | Q:A 28-year-old female is brought to the emergency department after being found unconscious outside of a local night club by her friends. On arrival the patient is stuporous. Her temperature is 35°C (95°F), blood pressure is 105/75 mm Hg, pulse is 55/min, and respirations are 10/min. Examination shows dry mucous membranes. The pupils are small and react sluggishly to light. She does not respond to any commands, and painful stimuli cause her to withdraw all extremities. No injection marks can be found on her extremities. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of her symptoms?? {'A': 'Amitriptyline', 'B': 'Phencyclidine', 'C': 'MDMA', 'D': 'Heroin', 'E': 'Cannabis\n"'}, | D: Heroin |
Answer the following medical question with one of the provided options: | Q:A previously healthy 5-year-old boy is brought to the physician because of increasing weakness and a retroauricular rash that started 2 days ago. The rash spread rapidly and involves the trunk and extremities. Last week, he had a mild sore throat, pink eyes, and a headache. His family recently immigrated from Ethiopia. His immunization status is unknown. The patient appears severely ill. His temperature is 38.5°C (101.3°F). Examination shows tender postauricular and suboccipital lymphadenopathy. There is a nonconfluent, maculopapular rash over the torso and extremities. Infection with which of the following is the most likely cause of this patient's symptoms?? {'A': 'Togavirus', 'B': 'Varicella zoster virus', 'C': 'Parvovirus', 'D': 'Human herpesvirus 6', 'E': 'Paramyxovirus'}, | A: Togavirus |
Answer the following medical question with one of the provided options: | Q:A previously healthy 14-year-old girl is brought to the emergency department by her mother because of abdominal pain, nausea, and vomiting for 6 hours. Over the past 6 weeks, she has also had increased frequency of urination, and she has been drinking more water than usual. She has lost 6 kg (13 lb) over the same time period despite having a good appetite. Her temperature is 37.1°C (98.8°F), pulse is 125/min, respirations are 32/min, and blood pressure is 94/58 mm Hg. She appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to show which of the following findings?? {'A': 'Increased arterial pCO2', 'B': 'Increased arterial blood pH', 'C': 'Excess water retention', 'D': 'Serum glucose concentration > 800 mg/dL', 'E': 'Decreased total body potassium'}, | E: Decreased total body potassium |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman with ongoing dyspnea returns to her physician for a follow-up appointment. After an abnormal echocardiogram and pulmonary function testing revealed an isolated reduction in DLCO, a right heart catheterization was ordered to confirm the physician's clinical suspicion. She has family members with similar findings and genetic testing revealed a mutation in the BMPR2 gene. A representative lesion from lung biopsy histology is shown in figure A. Given the patient's clinical presentation and test results, which of the following pharmacologic therapies will the physician most likely provide?? {'A': 'Plasmapheresis', 'B': 'Inhibitor of nitric oxide', 'C': 'Bronchodilator', 'D': 'Immunosuppression', 'E': 'Vasodilator'}, | E: Vasodilator |
Answer the following medical question with one of the provided options: | Q:An infant boy of unknown age and medical history is dropped off in the emergency department. The infant appears lethargic and has a large protruding tongue. Although the infant exhibits signs of neglect, he is in no apparent distress. The heart rate is 70/min, the respiratory rate is 30/min, and the temperature is 35.7°C (96.2°F). Which of the following is the most likely cause of the patient’s physical exam findings?? {'A': 'Mutation in the WT2 gene', 'B': 'Congenital agenesis of an endocrine gland in the anterior neck', 'C': 'Excess growth hormone secondary to pituitary gland tumor', 'D': 'Type I hypersensitivity reaction', 'E': 'Autosomal dominant mutation in the SERPING1 gene'}, | B: Congenital agenesis of an endocrine gland in the anterior neck |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman is brought to the emergency department because of worsening upper abdominal pain for 8 hours. She reports that the pain radiates to the back and is associated with nausea. She has hypertension and hyperlipidemia, for which she takes enalapril, furosemide, and simvastatin. Her temperature is 37.5°C (99.5 °F), blood pressure is 84/58 mm Hg, and pulse is 115/min. The lungs are clear to auscultation. Examination shows abdominal distention with epigastric tenderness and guarding. Bowel sounds are decreased. Extremities are warm. Laboratory studies show: Hematocrit 48% Leukocyte count 13,800/mm3 Platelet count 175,000/mm3 Serum: Calcium 8.0 mg/dL Urea nitrogen 32 mg/dL Amylase 250 U/L An ECG shows sinus tachycardia. Which of the following is the most likely underlying cause of this patient's vital sign abnormalities?"? {'A': 'Hemorrhagic fluid loss', 'B': 'Decreased albumin concentration', 'C': 'Decreased cardiac output', 'D': 'Increased excretion of water', 'E': 'Capillary leakage'}, | E: Capillary leakage |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man with a history of major depressive disorder, asthma, and erectile dysfunction presents to his family physician complaining of depressed mood, amotivation, overeating, and anhedonia. He currently takes no medications. The patient has a 3 pack-year smoking history and would like to quit but has been unsuccessful in the past. His BMI is 29 kg/m^2. The physician suggests starting an antidepressant for the patient's mood symptoms. The patient is reluctant, as he used to take sertraline, but stopped it after his erectile dysfunction worsened. Which of the following antidepressants would be most appropriate for this patient?? {'A': 'Amitriptyline', 'B': 'Bupropion', 'C': 'Citalopram', 'D': 'Mirtazapine', 'E': 'Sertraline'}, | B: Bupropion |
Answer the following medical question with one of the provided options: | Q:A 70-year-old woman presents with a 2-week history of severe fatigue. Over the past month, she has unintentionally lost 2 kg (4.4 lb). Three years ago, she was diagnosed with myelodysplastic syndrome. Currently, she takes no medications other than aspirin for occasional knee pain. She does not smoke or drink alcohol. Her vital signs are within the normal range. On physical examination, her conjunctivae are pale. Petechiae are present on the distal lower extremities and on the soft and hard palates. Palpation reveals bilateral painless cervical lymphadenopathy. Examination of the lungs, heart, and abdomen shows no abnormalities. Laboratory studies show: Hemoglobin 9 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 3000/mm3 Platelet count 20,000/mm3 A Giemsa-stained peripheral blood smear is shown in the image. Which of the following best explains these findings?? {'A': 'Acute myeloid leukemia', 'B': 'Aplastic anemia', 'C': 'Chronic myelogenous leukemia', 'D': 'Hairy cell leukemia', 'E': 'Primary myelofibrosis'}, | A: Acute myeloid leukemia |
Answer the following medical question with one of the provided options: | Q:A 16-year-old man with no significant past medical, surgical, or family history presents to his pediatrician with new symptoms following a recent camping trip. He notes that he went with a group of friends and 1 other group member is experiencing similar symptoms. Over the past 5 days, he endorses significant flatulence, nausea, and greasy, foul-smelling diarrhea. He denies tenesmus, urgency, and bloody diarrhea. The blood pressure is 118/74 mm Hg, heart rate is 88/min, respiratory rate is 14/min, and temperature is 37.0°C (98.6°F). Physical examination is notable for mild, diffuse abdominal tenderness. He has no blood in the rectal vault. What is the patient most likely to report about his camping activities?? {'A': 'Collecting water from a stream, without boiling or chemical treatment', 'B': 'Recent antibiotic prescription', 'C': 'This has been going on for months.', 'D': 'The patient camped as a side excursion from a cruise ship.', 'E': 'The patient camped in Mexico.'}, | A: Collecting water from a stream, without boiling or chemical treatment |
Answer the following medical question with one of the provided options: | Q:A 57-year-old woman comes to the physician because of a 1-month history of multiple swellings in both her axillae. She says they are generally painless, but are sometimes painful on the weekends. She also has increased fatigue, recurring low-grade fevers, and generalized pruritus. She does not smoke. She drinks five to six beers on the weekends. Her temperature is 37°C (98.6°F), pulse is 80/min, respirations are 12/min, and blood pressure is 130/70 mm Hg. Physical examination reveals multiple firm and nontender axillary lymph nodes. A lymph node biopsy shows multinucleate giant lymphocytes with prominent nucleoli that resemble eosinophilic inclusions. Which of the following additional findings would be associated with a poor prognosis in this patient?? {'A': "Mediastinal tumor occupying 7% of the chest's width", 'B': 'Axillary tumor 6 cm across', 'C': 'Nodular lymphocyte predominant type tumor', 'D': 'Leukocyte count of 9,000/mm3', 'E': 'Erythocyte sedimentation rate of 65 mm/h\n"'}, | E: Erythocyte sedimentation rate of 65 mm/h " |
Answer the following medical question with one of the provided options: | Q:A 43-year-old man comes to the emergency room complaining of chest discomfort. He describes the feeling as "tightness," and also reports weakness and palpitations for the past hour. He denies shortness of breath, diaphoresis, or lightheadedness. He has no significant past medical history, and does not smoke, drink, or use illicit drugs. His father had a myocardial infarction at age 72. He is afebrile, heart rate is 125 bpm, and his blood pressure is 120/76. He is alert and oriented to person, place, and time. His electrocardiogram is shown below. Which of the following tests should be ordered in the initial work-up of this patient's condition?? {'A': 'Urine free cortisol level', 'B': 'Blood alcohol level', 'C': 'Chest x-ray', 'D': 'Thyroid stimulating hormone level (TSH)', 'E': 'Urine metanephrines'}, | D: Thyroid stimulating hormone level (TSH) |
Answer the following medical question with one of the provided options: | Q:An 11-year-old African American boy is brought to your office by his parents with a 1-day history of severe left hip pain. It is too painful for him to walk without support. He took ibuprofen, which brought no relief. He has had no chills or sweats. Similar painful episodes in the past required multiple hospitalizations. He returned from a trip to Kenya with his family 2 months ago. His vaccinations are up-to-date. His temperature is 38°C (100.4° F), pulse is 100/min, blood pressure is 120/80 mm Hg. Physical examination shows pale conjunctivae. The abdomen is soft with no organomegaly. Passive movement of the hip causes severe pain. There is tenderness on palpation, but no swelling, warmth, or erythema of the hip. His laboratory studies show a hematocrit of 25% and leukocyte count of 14 000/mm3. A peripheral blood smear would most likely show which of the following?? {'A': 'Trophozoites', 'B': 'Decreased number of thrombocytes', 'C': 'Decreased number of reticulocytes', 'D': 'Howell-Jolly bodies', 'E': 'Gram-negative bacilli\n"'}, | D: Howell-Jolly bodies |
Answer the following medical question with one of the provided options: | Q:A researcher is studying the brains of patients who recently died from stroke-related causes. One specimen has a large thrombus in an area of the brain that is important in relaying many modalities of sensory information from the periphery to the sensory cortex. Which of the following embryologic structures gave rise to the part of the brain in question?? {'A': 'Telencephalon', 'B': 'Diencephalon', 'C': 'Mesencephalon', 'D': 'Metencephalon', 'E': 'Mylencephalon'}, | B: Diencephalon |
Answer the following medical question with one of the provided options: | Q:A 33-year-old man is brought to the emergency department after being involved in a bar fight. Physical examination shows tenderness to palpation over the left side of the back. An x-ray of the chest shows a fracture of the 12th rib on the left side. Further evaluation is most likely to show which of the following injuries?? {'A': 'Liver hematoma', 'B': 'Pneumothorax', 'C': 'Colon perforation', 'D': 'Kidney laceration', 'E': 'Pancreatic transection'}, | D: Kidney laceration |
Answer the following medical question with one of the provided options: | Q:A 71-year-old African American man is brought to the emergency department with a worsening productive cough and dyspnea for 2 days. He has had generalized bone pain for 2 months. He was admitted for pyelonephritis last month. He also received outpatient treatment for pneumonia almost 2 months ago. Over the past 2 months, he has been taking over-the-counter ibuprofen for pain as needed. He appears anxious. The vital signs include: temperature 38.8°C (101.8°F), pulse 95/min, respiratory rate 20/min, and blood pressure 155/90 mm Hg. The conjunctivae are pale. Crackles are heard in the right lower lobe. The cardiac examination shows no abnormalities. The laboratory studies show the following: Hemoglobin 9 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 13,500/mm3 Segmented neutrophils 75% Lymphocytes 25% Platelet count 240,000/mm3 ESR 85 mm/hr Serum Na+ 135 mEq/L K+ 4.2 mEq/L Cl− 113 mEq/L HCO3− 20 mEq/L Ca+ 12.4 mg/dL Albumin 4 g/dL Urea nitrogen 38 mg/dL Creatinine 2.2 mg/dL A chest X-ray shows a right lower lobe opacity and blurring of the ipsilateral diaphragmatic dome. Skull and pelvic X-rays are performed (see image). Which of the following is the most likely underlying cause of this patient’s recent infections?? {'A': 'Advanced age', 'B': 'Hypogammaglobulinemia', 'C': 'NSAID-induced chronic kidney disease', 'D': 'T cell dysfunction', 'E': 'Unresolved pneumonia'}, | B: Hypogammaglobulinemia |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man comes to the physician because of a 4-month history of intermittent headaches. They have been getting progressively worse and no longer respond to ibuprofen. He also complains of weight gain and excessive sweating. Physical examination shows prominent supraorbital ridges, prognathism, macroglossia with thick lips, and disproportionately broad hands and feet. There is decreased peripheral vision bilaterally on visual field testing. An MRI of the brain shows a mass in the sella turcica. Genetic analysis of a biopsy specimen from the mass shows cells that overexpress adenylyl cyclase. Which of the following is the most appropriate pharmacotherapy for this condition?? {'A': 'Methimazole', 'B': 'Octreotide', 'C': 'Leuprolide', 'D': 'Risperidone', 'E': 'Metyrapone'}, | B: Octreotide |
Answer the following medical question with one of the provided options: | Q:A 10-year-old boy comes for a post-operative clinic visit with his ENT surgeon three months after airway reconstruction surgery and placement of a tracheostomy tube. Since the surgery, he says that he has been able to breathe better and is now getting used to tracheostomy care and tracheostomy tube changes. In addition to this surgery, he has had over twenty surgeries to implant hearing aids, reconstruct his cheekbones, and support his jaw to enable him to swallow. He was born with these abnormalities and had difficult breathing, hearing, and eating throughout his childhood. Fortunately, he is now beginning to feel better and is able to attend public school where he is one of the best students in the class. Abnormal development of which of the following structures is most likely responsible for this patient's malformations?? {'A': 'First branchial arch', 'B': 'First branchial pouch', 'C': 'Second branchial arch', 'D': 'Second branchial cleft', 'E': 'Third and fourth branchial pouches'}, | A: First branchial arch |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man presents to the emergency department with a rapid change in his behavior. The patient recently returned from a vacation in rural Mexico and recovered from several episodes of bloody diarrhea. He has had a notable and rapid decline in his memory which started this morning. His personality has also changed, has not been sleeping, and seems generally apathetic. Brief and involuntary muscle twitches have been noted as well. The patient has a past medical history of hypertension and diabetes. His temperature is 99.8°F (37.7°C), blood pressure is 152/98 mmHg, pulse is 97/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused and apathetic man who is not compliant with the neurological exam. The patient is admitted to the ICU; however, during his hospital course, the patient ultimately dies. Which of the following was most likely to be found in this patient upon initial presentation?? {'A': 'Blood in the subarachnoid place', 'B': 'Multifocal infarction on MRI', 'C': 'Neurofibrillary tangles', 'D': 'Sharp wave complexes on EEG', 'E': 'Tear of a bridging vein'}, | D: Sharp wave complexes on EEG |
Answer the following medical question with one of the provided options: | Q:A 71-year-old woman with a past medical history of type 2 diabetes, hypercholesterolemia, and hypertension was admitted to the hospital 8 hours ago with substernal chest pain for management of acute non-ST-elevated myocardial infarction (NSTEMI). The ECG findings noted by ST-depressions and T-wave inversions on anterolateral leads, which is also accompanied by elevated cardiac enzymes. Upon diagnosis, management with inhaled oxygen therapy, beta-blockers and aspirin, and low-molecular-weight heparin therapy were initiated, and she was placed on bed rest with continuous electrocardiographic monitoring. Since admission, she required 2 doses of sublingual nitric oxide for recurrent angina, and the repeat troponin levels continued to rise. Given her risk factors, plans were made for early coronary angiography. The telemetry nurse calls the on-call physician because of her concern with the patient’s mild confusion and increasing need for supplemental oxygen. At bedside evaluation, The vital signs include: heart rate 122/min, blood pressure 89/40 mm Hg, and the pulse oximetry is 91% on 6L of oxygen by nasal cannula. The telemetry and a repeat ECG show sinus tachycardia. She is breathing rapidly, appears confused, and complains of shortness of breath. On physical exam, the skin is cool and clammy and appears pale and dull. She has diffuse bilateral pulmonary crackles, and an S3 gallop is noted on chest auscultation with no new murmurs. She has jugular venous distention to the jaw-line, rapid and faint radial pulses, and 1+ dependent edema. She is immediately transferred to the intensive care unit for respiratory support and precautions for airway security. The bedside sonography shows abnormal hypodynamic anterior wall movement and an ejection fraction of 20%, but no evidence of mitral regurgitation or ventricular shunt. The chest X-ray demonstrates cephalization of pulmonary veins and pulmonary edema. What is the most appropriate next step in the stabilization of this patient?? {'A': 'Insert two large-bore intravenous catheters and start rapid fluid resuscitation', 'B': 'Initiate dopamine therapy and diuresis', 'C': 'Start intravenous fluids and epinephrine therapy', 'D': 'Obtain blood cultures and start preliminary broad-spectrum antibiotics', 'E': 'Intubate the patient and perform an emergency cardiocentesis'}, | B: Initiate dopamine therapy and diuresis |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman is brought to the physician by her husband because of a 1-year history of abnormal behavior. During this time she has been irritable, restless, and has had multiple episodes of hearing voices. Over the past month, she has also had difficulty swallowing. She has a 2-year history of depression. She was let go by her employer 6 months ago because she could no longer handle all her tasks and often forgot about assignments. Her father committed suicide at the age of 50. The patient has smoked one pack of cigarettes daily over the past 20 years. She has a history of smoking cocaine for 8 years but stopped 1 year ago. Vital signs are within normal limits. On mental status examination, she is confused and oriented to person and place only. Neurologic examination shows a delayed return to neutral ankle position after triggering the plantar reflex. Physical examination shows irregular, nonrepetitive, and arrhythmic movements of the neck and head. The patient has poor articulation. Which of the following is the most likely diagnosis?? {'A': 'Sydenham chorea', 'B': 'Parkinson disease', 'C': 'Multiple sclerosis', 'D': 'Drug-induced chorea', 'E': 'Huntington disease'}, | E: Huntington disease |
Answer the following medical question with one of the provided options: | Q:A 64-year-old woman has progressively worsening abdominal pain 5 hours after an open valve replacement with cardiopulmonary bypass. The pain is crampy and associated with an urge to defecate. The patient reports having had 2 bloody bowel movements in the last hour. Her operation was complicated by significant intraoperative blood loss, which prolonged the operation and necessitated 2 transfusions of red blood cells. She has hypercholesterolemia and type 2 diabetes mellitus. The patient received prophylactic perioperative antibiotics and opioid pain management during recovery. Her temperature is 37.9°C (98.9°F), pulse is 95/min, and blood pressure is 115/69 mm Hg. Examination shows a soft abdomen with mild tenderness to palpation in the left quadrants but no rebound tenderness or guarding. Bowel sounds are decreased. Rectal examination shows blood on the examining finger. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Embolization of superior mesenteric artery', 'B': 'Decreased blood flow to the splenic flexure', 'C': 'Small outpouchings in the sigmoid wall', 'D': 'Atherosclerotic narrowing of the intestinal vessels', 'E': 'Infection with Clostridioides difficile'}, | B: Decreased blood flow to the splenic flexure |
Answer the following medical question with one of the provided options: | Q:An 8-month-old boy is brought to the emergency department by his mother. She is concerned that her son has had intermittent periods of severe abdominal pain over the past several days that has been associated with emesis and "currant jelly" stool. Of note, the family lives in a rural part of the state, requiring a 2 hour drive to the nearest hospital. He currently appears to be in significant pain and has vomited twice in the past hour. On physical examination, a sausage-shaped mass is noted on palpation of the right upper quadrant of the abdomen. Ultrasound of the abdomen was consistent with a diagnosis of intussusception. An air-contrast barium enema was performed, which confirmed the diagnosis and also successfully reduced the intussusception. Which of the following is the next best step in the management of this patient?? {'A': 'Discharge to home with follow-up in 3 weeks in an outpatient pediatric gastroenterology clinic', 'B': 'Repeat barium enema q6 hrs to monitor for recurrence', 'C': 'Keep patient NPO and initiate work-up to identify lead-point', 'D': 'Admit to hospital for 24 hour observation for complications and/or recurrence', 'E': 'Pursue urgent surgical reduction with resection of necrotic segments of bowel'}, | D: Admit to hospital for 24 hour observation for complications and/or recurrence |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman presents to her primary care physician with complaints of persistent fatigue, dizziness, and weight loss for the past 3 months. She has a history of hypothyroidism and takes thyroxine replacement. Her blood pressure is 90/60 mm Hg in a supine position and 65/40 mm Hg while sitting, temperature is 36.8°C (98.2°F), and pulse is 75/min. On physical examination, there is a mild increase in thyroid size, with a rubbery consistency. Her skin shows diffuse hyperpigmentation, more pronounced in the oral mucosa and palmar creases. Which of the following best represent the etiology of this patient’s condition?? {'A': 'Autoimmune destruction of the adrenal gland', 'B': '↓ adrenocorticotropic hormone secretion from the pituitary gland', 'C': '↓ corticotropin-releasing hormone secretion from the hypothalamus', 'D': 'Prolonged corticosteroid therapy', 'E': '↑ iron absorption and deposition in the body'}, | A: Autoimmune destruction of the adrenal gland |
Answer the following medical question with one of the provided options: | Q:A 19-year-old man with a history of generalized tonic-clonic seizures comes to the physician for a routine health maintenance examination. He is a known user of intravenous cocaine. His vital signs are within normal limits. Physical examination shows multiple hyperpigmented lines along the forearms. Oral examination shows marked overgrowth of friable, ulcerated gingival mucosa. Which of the following is the most likely cause of this patient's oral examination findings?? {'A': 'Phenytoin', 'B': 'Lamotrigine', 'C': 'Lacosamide', 'D': 'Cyclosporine', 'E': 'Carbamazepine\n"'}, | A: Phenytoin |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man with prostate cancer comes to the physician because of low back pain for 2 weeks and a 4.5-kg (10-lb) weight loss. Physical examination shows localized tenderness over the lumbar spine. An x-ray of the lumbar spine shows several osteoblastic lesions at the level of L2 and L4 vertebrae. Microscopic examination of a bone biopsy specimen from the L4 vertebra shows irregular bone trabeculae and star-shaped cells with long, cytoplasmic processes located deep within the lacunae. Exchange of nutrients and waste products between these cells most likely occurs through which of the following structures?? {'A': 'Macula adherens', 'B': 'Macula communicans', 'C': 'Zonula occludens', 'D': 'Hemidesmosomes', 'E': 'Zonula adherens'}, | B: Macula communicans |
Answer the following medical question with one of the provided options: | Q:A 2-week-old female newborn is brought to the physician because of increasing yellow discoloration of her eyes and skin for 2 days. She was born at 39 weeks' gestation and weighed 3066 g (6 lb 12 oz); she now weighs 3200 g (7 lb 1 oz). She is exclusively breastfed. Her older brother died 3 months after liver surgery. Her temperature is 37.1°C (98.8°F), pulse is 145/min, and respirations are 40/min. Examination shows yellow discoloration extending to the palms and soles. The liver is palpated 1 cm below the right costal margin. Laboratory studies show: Hematocrit 51% Serum Bilirubin Total 16.1 mg/dL Direct 0.7 mg/dL Alkaline phosphatase 22 U/L AST 12 U/L ALT 12 U/L Which of the following is the most likely diagnosis?"? {'A': 'Biliary atresia', 'B': 'Physiologic neonatal jaundice', 'C': 'Isoimmune mediated hemolysis', 'D': 'Breast milk jaundice', 'E': 'Breastfeeding failure jaundice'}, | D: Breast milk jaundice |
Answer the following medical question with one of the provided options: | Q:A researcher is trying to determine whether a newly discovered substance X can be useful in promoting wound healing after surgery. She conducts this study by enrolling the next 100 patients that will be undergoing this surgery and separating them into 2 groups. She decides which patient will be in which group by using a random number generator. Subsequently, she prepares 1 set of syringes with the novel substance X and 1 set of syringes with a saline control. Both of these sets of syringes are unlabeled and the substances inside cannot be distinguished. She gives the surgeon performing the surgery 1 of the syringes and does not inform him nor the patient which syringe was used. After the study is complete, she analyzes all the data that was collected and performs statistical analysis. This study most likely provides which level of evidence for use of substance X?? {'A': 'Level 1', 'B': 'Level 2', 'C': 'Level 3', 'D': 'Level 4', 'E': 'Level 5'}, | A: Level 1 |
Answer the following medical question with one of the provided options: | Q:A 13-year-old boy is brought to a physician with severe fevers and headaches for 3 days. The pain is constant and mainly behind the eyes. He has myalgias, nausea, vomiting, and a rash for one day. Last week, during an academic winter break, he traveled on a tour with his family to several countries, including Brazil, Panama, and Peru. They spent many evenings outdoors without any protection against insect bites. There is no history of contact with pets, serious illness, or use of medications. The temperature is 40.0℃ (104.0℉); the pulse is 110/min; the respiratory rate is 18/min, and the blood pressure is 110/60 mm Hg. A maculopapular rash is seen over the trunk and extremities. Several tender lymph nodes are palpated in the neck on both sides. A peripheral blood smear shows no organisms. Which of the following is most likely responsible for this patient’s presentation?? {'A': 'Babesiosis', 'B': 'Chagas disease', 'C': 'Dengue fever', 'D': 'Malaria', 'E': 'Zika virus'}, | C: Dengue fever |
Answer the following medical question with one of the provided options: | Q:A 34-year-old male comes to his family physician with complaints of joint pain that has been present for over 7 weeks. Prior to the onset of his arthritis, he recalls having a gastrointestinal infection which caused mild diarrhea and abdominal cramps. He recovered well and had no issues until his joint pain started. A prescription for naproxen was previously prescribed but he still does not feel well. He has no significant past medical or family history. On physical examination, his blood pressure is 120/78 mm Hg, respirations are 17/min, pulse is 64/min, and temperature is 36.7°C (98.0°F). Which of the following therapies is likely to be most beneficial in treating this patient’s condition?? {'A': 'Diclofenac', 'B': 'Sulfasalazine', 'C': 'Methotrexate', 'D': 'Ketoprofen', 'E': 'Ceftriaxone'}, | B: Sulfasalazine |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man presents to the emergency department with a 2-day history of fever and altered mentation. He reports fever without chills and rigors and denies sore throat, abdominal pain, headache, loose stool, burning micturition, or seizures. He has a history of tics and is currently on a low dose of haloperidol. At the hospital, his temperature is 39.6°C (103.2°F); the blood pressure is 126/66 mm Hg, and the pulse is 116/min. He is profusely sweating and generalized rigidity is present. He is confused and disoriented. He is able to move all his limbs. Normal deep tendon reflexes are present with bilateral downgoing plantar responses. A brain MRI is unremarkable. Urine toxicology is negative. The white blood cell count is 14,700/mm3. Creatine kinase is 5600 U/L. Lumbar puncture is performed and cerebrospinal fluid (CSF) studies show: CSF opening pressure 22 cm H20 CSF white blood cells 4 cells/mm3 CSF red blood cells 0 cells/mm3 CSF glucose 64 mg/dL CSF protein 48 mg/dL Serum glucose 96 mg/dL What is the most likely diagnosis?? {'A': 'Acute disseminated encephalomyelitis', 'B': 'Cerebral venous sinus thrombosis', 'C': 'Encephalitis', 'D': 'Meningitis', 'E': 'Neuroleptic malignant syndrome'}, | E: Neuroleptic malignant syndrome |
Answer the following medical question with one of the provided options: | Q:A 10-month-old boy is brought to the physician by his mother for evaluation of abnormal growth and skin abnormalities. His mother has also noticed that his eyes do not fully close when sleeping. He is at the 24th percentile for height, 17th percentile for weight, and 29th percentile for head circumference. Physical examination shows wrinkled skin, prominent veins on the scalp and extremities, and circumoral cyanosis. Genetic testing shows a point mutation in a gene that encodes for a scaffold protein of the inner nuclear membrane. The mutation causes a deformed and unstable nuclear membrane, which leads to premature aging. Which of the following is most likely to be the defective protein?? {'A': 'Desmin', 'B': 'Nesprin', 'C': 'Vimentin', 'D': 'Lamin', 'E': 'Plectin\n"'}, | D: Lamin |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man presents to his primary care physician because of a tremor that he has developed over the last several months. He says that the tremor is worst when he is resting but becomes better when he engages in movements such as picking up the remote for his TV. His wife also says that his movements have become slower over the last few months. Physical exam reveals increased resistance to passive motion of his extremities. Gait exam also shows trouble with starting movement and short, shuffling steps. The most likely cause of this patient's symptoms involve the degeneration of a certain subset of neurons. When the substance released by these neurons interact with a G-alpha-s coupled receptor, which of the following effects occurs?? {'A': 'Inhibition of the globus pallidus externus', 'B': 'Inhibition of the globus pallidus internus', 'C': 'Stimulation of the globus pallidus externus', 'D': 'Stimulation of the globus pallidus internus', 'E': 'Stimulation of the subthalamic nucleus'}, | B: Inhibition of the globus pallidus internus |
Answer the following medical question with one of the provided options: | Q:A 49-year-old woman presents to her physician with complaints of breast swelling and redness of the skin over her right breast for the past 1 month. She also mentions that the skin above her right breast appears to have thickened. She denies any pain or nipple discharge. The past medical history is significant for a total abdominal hysterectomy at 45 years of age. Her last mammogram 1 year ago was negative for any pathologic changes. On examination, the right breast was diffusely erythematous with gross edema and tenderness and appeared larger than the left breast. The right nipple was retracted and the right breast was warmer than the left breast. No localized mass was palpated. Which of the following statements best describes the patient’s most likely condition?? {'A': 'It is a benign lesion.', 'B': 'The inflammation is due to obstruction of dermal lymphatic vessels.', 'C': 'The lesion expresses receptors for estrogen and progesterone.', 'D': 'The lesion is due to Streptococcal infection.', 'E': 'It shows predominant lymphatic spread.'}, | B: The inflammation is due to obstruction of dermal lymphatic vessels. |
Answer the following medical question with one of the provided options: | Q:A 36-year-old primigravid woman at 26 weeks' gestation comes to the physician complaining of absent fetal movements for the last 2 days. Pregnancy was confirmed by ultrasonography 14 weeks earlier. She has no vaginal bleeding or discharge. She has a history of type 1 diabetes mellitus controlled with insulin. Vital signs are all within the normal limits. Pelvic examination shows a soft, 2-cm long cervix in the midline with a cervical os measuring 3 cm and a uterus consistent in size with 24 weeks' gestation. Transvaginal ultrasonography shows a fetus with no cardiac activity. Which of the following is the most appropriate next step in management?? {'A': 'Perform cesarean delivery', 'B': 'Plan for oxytocin administration', 'C': 'Administer magnesium sulfate', 'D': 'Perform weekly pelvic ultrasound', 'E': 'Perform dilation and curettage\n"'}, | B: Plan for oxytocin administration |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man presents to his primary care physician complaining of excessive daytime sleepiness. He explains that this problem has worsened slowly over the past few years but is now interfering with his ability to play with his grandchildren. He worked previously as an overnight train conductor, but he has been retired for the past 3 years. He sleeps approximately 8-9 hours per night and believes his sleep quality is good; however, his wife notes that he often snores loudly during sleep. He has never experienced muscle weakness or hallucinations. He has also been experiencing headaches in the morning and endorses a depressed mood. His physical exam is most notable for his large body habitus, with a BMI of 34. What is the best description of the underlying mechanism for this patient's excessive daytime sleepiness?? {'A': 'Insufficient sleep duration', 'B': 'Circadian rhythm sleep-wake disorder', 'C': 'Poor oropharyngeal tone', 'D': 'Deficiency of the neuropeptides, orexin-A and orexin-B', 'E': 'Psychiatric disorder'}, | C: Poor oropharyngeal tone |
Answer the following medical question with one of the provided options: | Q:A previously healthy 5-year-old boy is brought to the physician with a recurring fever and malaise for 3 weeks. He has also had fatigue and loss of appetite. He initially presented 2 weeks ago with a maculopapular rash that has since resolved. At the time, he was given a prescription for amoxicillin-clavulanate. He denies sore throat or myalgias. He is home-schooled and has had no sick contacts. There are no pets at home, but he often visits a feline animal shelter where his mother volunteers. His temperature is 38.4°C (101.2°F). Physical examination shows a 1-cm papular lesion on the back of the right hand. He also has tender, bulky lymphadenopathy of the axillae and groin. Which of the following is the most appropriate next step in management?? {'A': 'Doxycycline therapy', 'B': 'Pyrimethamine therapy', 'C': 'Itraconazole therapy', 'D': 'Azithromycin therapy', 'E': 'Streptomycin therapy'}, | D: Azithromycin therapy |
Answer the following medical question with one of the provided options: | Q:An 8-year-old girl is brought to the physician by her parents because of difficulty sleeping. One to two times per week for the past 2 months, she has woken up frightened in the middle of the night, yelling and crying. She has not seemed confused after waking up, and she is consolable and able to fall back asleep in her parents' bed. The following day, she seems more tired than usual at school. She recalls that she had a bad dream and looks for ways to delay bedtime in the evenings. She has met all her developmental milestones to date. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Sleep terror disorder', 'B': 'Post-traumatic stress disorder', 'C': 'Normal development', 'D': 'Nightmare disorder', 'E': 'Separation anxiety disorder\n"'}, | D: Nightmare disorder |
Answer the following medical question with one of the provided options: | Q:A 56-year-old man who underwent kidney transplantation 6 months ago, presents to the physician because of fever, dyspnea, non-productive cough, and lethargy. He is on no other medications apart from immunosuppressive therapy. On physical examination, the vital signs include: pulse 110/min, blood pressure 126/76 mm Hg, respirations 26/min, oxygen saturation 80% at room air, and temperature 37.7°C (99.9°F). Chest auscultation is normal except for occasional bilateral wheezes. An X-ray of the chest shows diffuse interstitial infiltrates. Bronchoalveolar lavage is performed and methenamine silver staining confirms a parasitic infestation. Which of the following is the most appropriate pharmacotherapy for the patient?? {'A': 'Intravenous pentamidine', 'B': 'Trimethoprim-sulfamethoxazole intravenously', 'C': 'Trimethoprim-sulfamethoxazole orally', 'D': 'High-dose corticosteroids and bronchodilators', 'E': 'Oral dapsone + trimethoprim'}, | B: Trimethoprim-sulfamethoxazole intravenously |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man presents to the clinic complaining of burning bilateral leg pain which has been increasing gradually over the past several months. It worsens when he walks but improves with rest. His past medical and surgical history are significant for hypertension, hyperlipidemia, diabetes, and a 40-pack-year smoking history. His temperature is 99.0°F (37.2°C), blood pressure is 167/108 mm Hg, pulse is 88/min, respirations are 13/min, and oxygen saturation is 95% on room air. Physical exam of the lower extremities reveals palpable but weak posterior tibial and dorsalis pedis pulses bilaterally. Which of the following is the best initial treatment for this patient's symptoms?? {'A': 'Balloon angioplasty with stenting', 'B': 'Exercise and smoking cessation', 'C': 'Femoral-popliteal bypass', 'D': 'Lisinopril and atorvastatin', 'E': 'Lovenox and atorvastatin'}, | B: Exercise and smoking cessation |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman, gravida 2, para 1, comes to the physician because she had a positive pregnancy test at home. During the last two weeks, she has had nausea and two episodes of non-bloody vomiting. She also reports increased urinary frequency. Her pregnancy and delivery of her first child were uncomplicated. Last year, she had two episodes of grand-mal seizure. She is sexually active with her husband and they use condoms inconsistently. She does not smoke or drink alcohol. She does not use illicit drugs. Current medications include valproic acid and a multivitamin. Her vital signs are within normal limits. Physical examination shows no abnormalities. A urine pregnancy test is positive. The child is at increased risk for requiring which of the following interventions?? {'A': 'Cochlear implantation', 'B': 'Kidney transplantation', 'C': 'Respiratory support', 'D': 'Lower spinal surgery', 'E': 'Dental treatment'}, | D: Lower spinal surgery |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man comes to the physician accompanied by his wife because of a 6-month history of worsening episodic upper abdominal pain and an 8-kg (17.6-lb) weight loss. The pain is dull, nonradiating, worse after eating, and occasionally associated with bloating and diarrhea. His symptoms have not improved despite 4 weeks of treatment with omeprazole. He attributes his weight loss to recently eating very small portions and avoiding fatty foods. He has hypertension and hypercholesterolemia. He underwent a coronary artery bypass graft operation for coronary artery disease 8 years ago. Current medications include lisinopril, metoprolol, atorvastatin, and aspirin. He has smoked a pack of cigarettes daily for 20 years and drinks 1–2 beers daily. His pulse is 79/min and blood pressure is 138/89 mm Hg. Examination shows a soft abdomen without tenderness to palpation or guarding. Which of the following is most likely to confirm the diagnosis?? {'A': 'Serum CA 19-9', 'B': 'Right upper quadrant abdominal ultrasound', 'C': 'CT angiography of the abdomen', 'D': 'Endoscopic retrograde cholangiography', 'E': 'Upper endoscopy'}, | C: CT angiography of the abdomen |
Answer the following medical question with one of the provided options: | Q:Five days after admission into the ICU for drug-induced acute kidney injury, a 27-year-old woman develops fever. She is currently on a ventilator and sedatives. Hemodialysis is performed via a catheter placed in the right internal jugular vein. Feeding is via a nasogastric tube. An indwelling urinary catheter shows minimum output. Her blood pressure is 85/45 mm Hg, the pulse is 112/min, the respirations are 32/min, and the temperature is 39.6°C (103.3°F). The examination of the central catheter shows erythema around the insertion site with no discharge. Lung auscultation shows rhonchi. Cardiac examination shows no new findings. A chest CT scan shows bilateral pleural effusions with no lung infiltration. Empirical antibiotic therapy is initiated. Blood cultures obtained from peripheral blood and the catheter tip show S. aureus with a similar antibiogram. Urinary culture obtained from the indwelling catheter shows polymicrobial growth. Which of the following best explains this patient’s recent findings?? {'A': 'Catheter-associated urinary tract infection', 'B': 'Central catheter-related bacteremia', 'C': 'Endocarditis', 'D': 'Naso-gastric tube sinusitis', 'E': 'Ventilator-associated pneumonia'}, | B: Central catheter-related bacteremia |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man presents for his annual check-up. He says he feels well except for occasional abdominal pain. He describes the pain as 4/10–5/10 in intensity, diffusely localized to the periumbilical and epigastric regions, radiating to the groin. The pain occurs 1–2 times a month and always subsides on its own. The patient denies any recent history of fever, chills, nausea, vomiting, change in body weight, or change in bowel and/or bladder habits. His past medical history is significant for hypertension, hyperlipidemia, and peripheral vascular disease, managed with lisinopril and simvastatin. The patient reports a 40-pack-year smoking history and 1–2 alcoholic drinks a day. The blood pressure is 150/100 mm Hg and the pulse is 80/min. Peripheral pulses are 2+ bilaterally in all extremities. Abdominal exam reveals a bruit in the epigastric region along with mild tenderness to palpation with no rebound or guarding. There is also a pulsatile abdominal mass felt on deep palpation at the junction of the periumbilical and the suprapubic regions. The remainder of the physical exam is normal. Laboratory studies show: Serum total cholesterol 175 mg/dL Serum total bilirubin 1 mg/dL Serum amylase 25 U/L Serum alanine aminotransferase (ALT) 20 U/L Serum aspartate aminotransferase (AST) 16 U/L Which of the following is the most likely diagnosis in this patient?? {'A': 'Abdominal aortic aneurysm', 'B': 'Acute pancreatitis', 'C': 'Mesenteric ischemia', 'D': 'Acute gastritis', 'E': 'Diverticulitis'}, | A: Abdominal aortic aneurysm |
Answer the following medical question with one of the provided options: | Q:Six days after undergoing a left hemicolectomy for colorectal carcinoma, a 59-year-old man collapses in the hospital hallway and is unconscious for 30 seconds. Afterwards, he complains of shortness of breath and chest pain with deep inhalation. He has hypertension and hyperlipidemia. He smoked one pack of cigarettes daily for 35 years but quit prior to admission to the hospital. He does not drink alcohol. He is in distress and appears ill. His temperature is 36.5°C (97.7°F), blood pressure is 80/50 mm Hg, and pulse is 135/min and weak. Oxygen saturation is 88% on room air. Physical examination shows elevated jugular venous distention. Cardiac examination shows a regular, rapid heart rate and a holosystolic murmur that increases during inspiration. His abdomen is soft and mildly tender to palpation around the surgical site. Examination of his extremities shows pitting edema of the left leg. His skin is cold and clammy. Further examination is most likely to reveal which of the following findings?? {'A': 'Rapid, aberrant contractions of the atria', 'B': 'Stenosis of the carotid arteries', 'C': 'Dilated right ventricular cavity', 'D': 'Anechoic space between pericardium and epicardium', 'E': 'Reduced regional ventricular wall motion'}, | C: Dilated right ventricular cavity |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman presents to her physician with a complaint of pain and stiffness in her hands. She says that the pain began 6 weeks ago a few days after she had gotten over a minor upper respiratory infection. She admits that the pain is worse in the morning, and she occasionally notes subjective fever but has not taken her temperature. She also admits that her appetite has mildly decreased, but she denies any change in weight. The pain is partially alleviated by ibuprofen, but she has been unsatisfied with the results. She is concerned about her condition as it makes caring for her two young children very difficult. Temperature is 99.4°F (37.4°C), blood pressure is 119/73 mmHg, pulse is 75/min, and respirations are 18/min. Physical examination demonstrates swelling and tenderness over the wrists and metacarpophalangeal joints bilaterally. Bilateral radiographs of the hands demonstrate mild periarticular osteopenia around the left fifth metacarpophalangeal joint. Which of the following is the next best step in management of this patient's acute symptoms?? {'A': 'Anakinra', 'B': 'Etanercept', 'C': 'Methotrexate', 'D': 'Reassurance', 'E': 'Prednisone'}, | E: Prednisone |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl is brought to the physician because of abnormal vaginal bleeding for the past 2 months. Apart from the past 2 months, she has had regular menstrual cycles. She had menarche at the age of 13. She has no personal or family history of any serious illnesses. She takes no medications. Her vital signs are within normal limits. Physical examination shows no abnormal findings. Laboratory studies show elevated serum beta-HCG and AFP levels. An abdominal ultrasound shows a predominantly solid mass in the left ovary. The right ovary and the uterus show no abnormal findings. Which of the following ovarian tumors best explains these findings?? {'A': 'Corpus luteum cyst', 'B': 'Embryonal carcinoma', 'C': 'Fibromas', 'D': 'Krukenberg tumor', 'E': 'Serous cystadenoma'}, | B: Embryonal carcinoma |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy presents with a swollen face and irritability. The patient's mother reports his urine was red this morning. 3 weeks ago, he presented to this same clinic with a ‘sandpaper’ rash and a red tongue with patchy hyperplastic fungiform papillae for which he was given broad-spectrum antibiotics. Laboratory tests reveal proteinuria, elevated antistreptolysin O, and decreased serum C3. Which of the following conditions mentioned below are triggered by a similar mechanism? I. Arthus reaction II. Myasthenia gravis III. Acute rheumatic fever IV. Polyarteritis nodosa V. Rheumatoid arthritis? {'A': 'I, II', 'B': 'III, IV', 'C': 'I, IV, V', 'D': 'II, III, IV', 'E': 'I, IV, V'}, | C: I, IV, V |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman presents to the general medical clinic with a chief complaint of anxiety. She has been having severe anxiety and fatigue for the past seven months. She has difficulty concentrating and her work has suffered, and she has also developed diarrhea from the stress. She doesn't understand why she feels so anxious and is unable to attribute it to anything specific aspect of her life right now. You decide to begin pharmacotherapy. All of the following are suitable mechanisms of drugs that can treat this illness EXCEPT:? {'A': 'A drug that stimulates 5-HT1A receptors', 'B': 'A drug that blocks 5-HT reuptake', 'C': 'A drug that blocks both serotonin and norepinephrine reuptake', 'D': 'A drug that acts as a GABA agonist', 'E': 'A drug that blocks dopamine 2 receptors'}, | E: A drug that blocks dopamine 2 receptors |
Answer the following medical question with one of the provided options: | Q:A 17-year-old female is brought to the emergency room by her parents shortly after a suicide attempt by aspirin overdose. Which of the following acid/base changes will occur FIRST in this patient?? {'A': 'Non-anion gap metabolic acidosis', 'B': 'Anion gap metabolic acidosis', 'C': 'Respiratory acidosis', 'D': 'Metabolic alkalosis', 'E': 'Respiratory alkalosis'}, | E: Respiratory alkalosis |
Answer the following medical question with one of the provided options: | Q:During a humanitarian medical mission in rural Vietnam, a medical resident encounters a 50-year-old man with a year-long history of a pruritic rash on his upper body and face, along with numbness and tingling sensation of both of his palms. He mostly works on his family’s rice farm, where he also takes care of livestock. A physical examination revealed multiple erythematous macules and papules on the face, arms, chest, and back, as well as thinning of the eyebrows and loss of some eyelashes. Additional findings include hypopigmented macules around the elbows, which are insensitive to light touch, temperature, and pinprick. The grip strength is slightly diminished bilaterally with the conservation of both bicipital reflexes. What is the most likely diagnosis?? {'A': 'Cutaneous leishmaniasis', 'B': 'Sporotrichosis', 'C': 'Tinea corporis', 'D': 'Leprosy', 'E': 'Scrofula'}, | D: Leprosy |
Answer the following medical question with one of the provided options: | Q:A 21-year-old female is brought to the emergency department by her roommate. Her roommate says that the patient has been acting “strangely” for the past 10 days. She has noticed that the patient has been moving and talking on the phone at all hours of the night. She doesn’t think that the patient sleeps more than one to two hours a night. She also spends hours pacing up and down the apartment, talking about “trying to save the world.” She also notices that the patient has been speaking very fast. When asking the patient if anything seems different, the patient denies anything wrong, only adding that, “she’s made great progress on her plans." The patient said she has felt like this on one occasion 2 years ago, and she recalled being hospitalized for about 2 weeks. She denies any history of depression, although she said about a year ago she had no energy and had a hard time motivating herself to go to class and see her friends for months. She denies hearing any voices or any visual hallucinations. What is the most likely diagnosis in this patient?? {'A': 'Schizoaffective disorder', 'B': 'Major depressive disorder', 'C': 'Bipolar I disorder', 'D': 'Bipolar II disorder', 'E': 'Dysthymic disorder'}, | C: Bipolar I disorder |
Answer the following medical question with one of the provided options: | Q:An 87-year-old woman is brought to the emergency department 30 minutes after a fall onto a hardwood floor. She landed on her left side and hit the left side of her head. She did not lose consciousness. She has a mild headache over the left temple and severe left hip pain. She has had nasal congestion, a sore throat, and a productive cough for the last 2 days. She has a history of atrial fibrillation, coronary artery disease, hypertension, and osteoporosis. She underwent two coronary artery bypass grafts 5 years ago. She had smoked one pack of cigarettes daily for 30 years but quit 30 years ago. Her current medications include aspirin, apixaban, diltiazem, omeprazole, and vitamin D supplementation. The patient is oriented to person, place, and time. There is a 2-cm ecchymosis over the left temple. Examination of the left hip shows swelling and tenderness; range of motion is limited. Intravenous morphine 2 mg is started. During further examination, the patient complains of dizziness and palpitations. She is diaphoretic and pale. Her skin is cold and clammy. Her pulse is 110/min and faint, respirations are 20/min, and blood pressure is 70/30 mm Hg. Cranial nerves are intact. Cardiac examinations shows no murmurs, rubs, or gallops. An ECG shows absent P waves and nonspecific changes of the ST segment and the T wave. Which of the following is the most likely underlying mechanism for the patient's sudden decline in her condition?? {'A': 'Pulmonary embolism', 'B': 'Cardiac tamponade', 'C': 'Brain herniation', 'D': 'Sepsis', 'E': 'Blood loss'}, | E: Blood loss |
Answer the following medical question with one of the provided options: | Q:A 27-year-old male presents with primary complaints of a palpable mass in his scrotum and mild testicular pain. Physical exam reveals an abnormal appearing scrotum around the left testis, as depicted in image A. Which of the following is the most likely etiology of this presentation?? {'A': 'Compression of the left renal vein at the aortic origin of the superior mesenteric artery', 'B': 'Patent processus vaginalis allowing fluid entry into the scrotum', 'C': 'Neisseria gonorrhoeae Infection of the left testis leading to epididymitis', 'D': 'Unilateral failure of the left testis to descend into the scrotum', 'E': 'Twisting of the spermatic cord secondary to rotation of the left testis'}, | A: Compression of the left renal vein at the aortic origin of the superior mesenteric artery |
Answer the following medical question with one of the provided options: | Q:A 30-month-old boy is brought to the emergency department by his parents. He has burns over his left hand. The mother tells the doctor that the child was playing unobserved in the kitchen and accidentally grabbed a hot spoon, which produced the burn. She also says his pediatrician had expressed concern as to the possibility of autism spectrum disorder during the last visit and had suggested regular follow-up. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. On physical examination, his temperature is 37.0°C (98.6°F), pulse rate is 140/min, and respiratory rate is 28/min. He is irritable and crying excessively. On examination, the skin of the left hand is white-pink with small blisters over the entire dorsal aspect of the hand, but the skin of the palmar surface is undamaged. There is a sharp demarcation between healthy skin above the wrist and the injured skin of the hand. There are no burns or another injury anywhere else on the child. Which of the following is the most likely cause of the burns?? {'A': 'Forced immersion in hot water', 'B': 'Burn as a result of poor supervision', 'C': 'Cigarette burns', 'D': 'Accidental burns', 'E': 'Abusive burn from a hot spoon'}, | A: Forced immersion in hot water |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man is brought to the emergency department for a 5-day-history of worsening dyspnea, orthopnea, and lower leg swelling. He has a history of hypertension, hyperlipidemia, non-alcoholic fatty liver disease, and myocardial infarction 10 years ago. Current medications include metoprolol, lisinopril, ethacrynic acid, eplerenone, and aspirin. He drinks 1 beer daily. He has a 30-pack-year smoking history. He is allergic to sulfonamides. His temperature is 37.0°C (98.6°F), his pulse is 120/min, and his blood pressure is 120/80 mm Hg. Physical examination reveals jugular venous distention and 3+ pitting edema in his lower legs. Crackles are heard at both lung bases. The point of maximal impulse is 2 cm to the left of the midclavicular line in the 6th intercostal space. Which of the following additional findings would be most strongly associated with increased mortality?? {'A': 'Decreased BNP levels', 'B': 'Decreased serum Na+', 'C': 'Decreased QRS complex duration', 'D': 'Increased VO2', 'E': 'Increased heart rate variability'}, | B: Decreased serum Na+ |
Answer the following medical question with one of the provided options: | Q:You have been asked to quantify the relative risk of developing bacterial meningitis following exposure to a patient with active disease. You analyze 200 patients in total, half of which are controls. In the trial arm, 30% of exposed patients ultimately contracted bacterial meningitis. In the unexposed group, only 1% contracted the disease. Which of the following is the relative risk due to disease exposure?? {'A': '[30 / (30 + 70)] / [1 / (1 + 99)]', 'B': '(30 * 99) / (70 * 1)', 'C': '[70 / (30 + 70)] / [99 / (1 + 99)]', 'D': '(70 * 1) / (39 * 99)', 'E': '[1 / (1 + 99)] / 30 / (30 + 70)]'}, | A: [30 / (30 + 70)] / [1 / (1 + 99)] |
Answer the following medical question with one of the provided options: | Q:A father brings in his 7-year-old twin sons because they have a diffuse rash. They have several papules, vesicles, pustules, and crusts on their scalps, torso, and limbs. The skin lesions are pruritic. Other than that, the boys appear to be well. The father reports that several children in school have a similar rash. The family recently returned from a beach vacation but have not traveled internationally. Both boys have stable vital signs within normal limits. What is the most common complication of the infection the boys appear to have?? {'A': 'Hepatitis', 'B': 'Bacterial superinfection of skin lesions', 'C': 'Pneumonia', 'D': 'Encephalitis', 'E': 'Cerebellar ataxia'}, | B: Bacterial superinfection of skin lesions |
Answer the following medical question with one of the provided options: | Q:A 75-year-old female comes to the physician’s office with complaints of right lower quadrant pain. She has been experiencing these symptoms for the last 6 months and they have progressively gotten worse. An ultrasound reveals a large ovarian mass and abdominal and pelvic CT reveals no metastases. Her serum levels of CA-125 are elevated and the biopsy reveals the primary neoplasm as ovarian in origin. Her cancer is characterized as invasive carcinoma without metastasis. Which of the following cellular changes is consistent with this diagnosis?? {'A': 'Appropriate basal to apical differentiation', 'B': 'Intact basement membrane', 'C': 'Loss of E-cadherin', 'D': 'Seeding via capillaries', 'E': 'Increased proliferation of cells with preservation of size and shape'}, | C: Loss of E-cadherin |
Answer the following medical question with one of the provided options: | Q:A 36-year-old African American woman G1P0 at 33 weeks gestation presents to the emergency department because "her water broke." Her prenatal history is remarkable for proteinuria in the absence of hypertension during her third trimester check-up. She denies any smoking, alcohol use, sick contacts, abdominal pain, fever, nausea, vomiting, or diarrhea. Her temperature is 98.6°F (37°C), blood pressure is 150/90 mmHg, pulse is 120/min, and respirations are 26/min. While the on-call obstetrician is on her way to the emergency department, the following labs are obtained: Hemoglobin: 11 g/dL Hematocrit: 35 % Leukocyte count: 9,800/mm^3 with normal differential Platelet count: 400,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 99 mEq/L K+: 3.9 mEq/L HCO3-: 22 mEq/L BUN: 35 mg/dL Glucose: 128 mg/dL Creatinine: 1.2 mg/dL Urine: Epithelial cells: Scant Protein: 2+ Glucose: 1+ WBC: 2/hpf Bacterial: None What is the most likely finding in the neonate after delivery?? {'A': 'Growth retardation', 'B': 'Meconium aspiration', 'C': 'Microcephaly', 'D': 'Seizures', 'E': 'Stillbirth'}, | A: Growth retardation |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. Her first pregnancy and delivery were complicated by iron deficiency anemia and pregnancy-induced hypertension. She has had no routine prenatal care during this pregnancy but was diagnosed with oligohydramnios 4 weeks ago. The remainder of her medical history is not immediately available. A 2400-g (5.4-lb) female newborn is delivered vaginally. Examination of the newborn shows a short, mildly webbed neck and low-set ears. Ocular hypertelorism along with slanted palpebral fissures are noted. A cleft palate and hypoplasia of the nails and distal phalanges are present. There is increased coarse hair on the body and face. Which of the following best explains the clinical findings found in this newborn?? {'A': 'Maternal phenytoin therapy', 'B': 'Fetal posterior urethral valves', 'C': 'Maternal diabetes mellitus', 'D': 'Maternal alcohol intake', 'E': 'Fetal X chromosome monosomy'}, | A: Maternal phenytoin therapy |
Answer the following medical question with one of the provided options: | Q:A 32-year-old female presents to her obstetrician 3 weeks postpartum for failure to lactate. Of note, she has been unable to tolerate cold environments since the birth of her child. Review of systems is positive for fatigue, lightheadedness, and a 3-pound weight gain over the last 3 weeks. Her delivery was complicated by placenta accreta with postpartum blood loss. Her newborn infant is doing well on formula. She denies any personal or family history of thyroid disease. Physical exam is overall unremarkable. On a panel of hormone testing, which of the following levels is most likely to be normal in this patient?? {'A': 'Antidiuretic hormone', 'B': 'Aldosterone', 'C': 'Cortisol', 'D': 'Luteinizing hormone', 'E': 'Thyroid hormone'}, | B: Aldosterone |
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