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Answer the following medical question with one of the provided options: | Q:A 44-year-old woman comes to the physician because of a 2-year history of progressive dysphagia. She initially had symptoms only when consuming solid foods, but for the past 2 months she has also had difficulty swallowing liquids. She describes a feeling of food “getting stuck” in her throat. She was diagnosed with gastroesophageal reflux disease 2 years ago and has had episodic pallor of her fingers since adolescence. She has smoked half a pack of cigarettes daily for 24 years. Her only medication is omeprazole. Her pulse is 65/min, respirations are 12/min, and blood pressure is 127/73 mm Hg. Examination shows thickening of the skin of her fingers, with small white papules on her fingertips. There are small dilated blood vessels on her face, lips, and tongue. Cardiopulmonary examination shows no abnormalities. Which of the following is the most likely cause of this patient's dysphagia?? {'A': 'Uncoordinated contractions of the esophagus', 'B': 'Protrusion of thin tissue membranes into the esophagus', 'C': 'Esophageal smooth muscle atrophy and fibrosis', 'D': 'Degeneration of upper and lower motor neurons', 'E': 'Outpouching of the lower pharyngeal mucosa and submucosa\n"'}, | C: Esophageal smooth muscle atrophy and fibrosis |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy is brought to the emergency department by his parents for joint pain following the acute onset of a diffuse, pruritic rash for the past 24 hours. A week ago, he was diagnosed with pharyngitis after returning home from summer camp and is currently taking antibiotics. There is no family history of serious illness. His temperature is 38.5°C (101.3°F), pulse is 90/min, and blood pressure is 110/70 mm Hg. Physical examination shows periorbital edema, generalized lymphadenopathy, and well-circumscribed, erythematous, confluent skin lesions of variable sizes up to several centimeters in width over his entire body. There is pain on passive movement of wrists and ankle joints bilaterally. Urine dipstick shows 1+ proteinuria. There is no hematuria. Which of the following is the most appropriate next step in management?? {'A': 'Switch medication to doxycycline', 'B': 'Discontinue antibiotic', 'C': 'Administer prednisone', 'D': 'Perform allergy testing', 'E': 'Administer diphenhydramine\n"'}, | B: Discontinue antibiotic |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman comes to the physician because of a 6-day history of cough, shortness of breath, and fever. She also reports that she has had 4 episodes of watery diarrhea per day for the last 3 days. She has chronic bronchitis. She has smoked one pack of cigarettes daily for the past 30 years. Her temperature is 39°C (102.2°F) and pulse is 65/min. Examination shows diffuse crackles over the left lower lung field. Laboratory studies show: Hemoglobin 13.8 g/dL Leukocyte count 16,000/mm3 Platelet count 150,000/mm3 Serum Na+ 131 mEq/L Cl- 102 mEq/L K+ 4.7 mEq/L An x-ray of the chest shows consolidation of the left lower lobe. A Gram stain of induced sputum shows numerous neutrophils but no organisms. Which of the following is the most appropriate pharmacotherapy?"? {'A': 'Rifampin', 'B': 'Amoxicillin', 'C': 'Vancomycin', 'D': 'Levofloxacin', 'E': 'Cotrimoxazole'}, | D: Levofloxacin |
Answer the following medical question with one of the provided options: | Q:A 70-year-old woman presents to the office for a yearly physical. She states she has recently started experiencing pain in her legs and her back. Last year, she experienced a fracture of her left arm while trying to lift groceries. The patient states that she does not consume any dairy and does not go outside often because of the pain in her legs and back. Of note, she takes carbamazepine for seizures. On exam, her vitals are within normal limits. You suspect the patient might have osteomalacia. Testing for which of the following is the next best step to confirm your suspicion?? {'A': '7-dehydrocholesterol', 'B': '25-hydroxyvitamin D', 'C': '1,25-hydroxyvitamin D', 'D': 'Pre-vitamin D3', 'E': 'Dietary vitamin D2'}, | B: 25-hydroxyvitamin D |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is brought to the physician for evaluation of developmental delay. He could sit alone at 12 months and started walking with support at the age of 2 years. He can name only very few familiar objects and uses simple two-word sentences. He cannot stack more than 2 blocks. His parents report that he does not like playing with other children. He is at the 80th percentile for head circumference, 85th percentile for height, and 50th percentile for weight. He has a long and narrow face as well as large protruding ears. His thumbs can be passively flexed to the ipsilateral forearm. This patient is at increased risk of developing which of the following conditions?? {'A': 'Acute myeloid leukemia', 'B': 'Aortic dissection', 'C': 'Type 2 diabetes mellitus', 'D': 'Hyperuricemia', 'E': 'Mitral regurgitation'}, | E: Mitral regurgitation |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman is brought to the emergency department because of a 1-day history of lower abdominal pain and vaginal bleeding. Her last menstrual period was 7 weeks ago. A urine pregnancy test is positive. A pelvic ultrasound shows a normal appearing uterus with an empty intrauterine cavity and a minimal amount of free pelvic fluid. Treatment with a drug is begun. Which of the following is the most likely effect of this drug?? {'A': 'Decrease in guanylate', 'B': 'Increase in thymidine monophosphate', 'C': 'Increase in deoxyuridine monophosphate', 'D': 'Decrease in phosphoribosyl pyrophosphate', 'E': 'Increase in tetrahydrofolate polyglutamate'}, | C: Increase in deoxyuridine monophosphate |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man presents to the physician for a routine health-maintenance examination. He feels well; however, he is concerned about the need for prostate cancer screening. He has a 3-year history of benign prostatic hyperplasia. His symptoms of urinary hesitancy and terminal dribbling of urine are well controlled with tamsulosin and finasteride. He also had a percutaneous coronary angioplasty done 2 years ago following a diagnosis of unstable angina. His medication list also includes aspirin, atorvastatin, losartan, and nitroglycerin. His vital signs are within normal limits. He has never had a serum prostate-specific antigen (PSA) test or prostate ultrasonography. Which of the following is the most appropriate screening test for prostate cancer in this patient?? {'A': 'Prostate ultrasonography every year', 'B': 'Prostate ultrasonography every 5 years', 'C': 'Serum PSA every year', 'D': 'Serum PSA every 2-4 years', 'E': 'No screening test is recommended'}, | E: No screening test is recommended |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman presents to the clinic complaining of difficulty swallowing that started 1 month ago. The patient also reports a weight loss of 10 lbs during this time, without a change in her appetite. She denies fatigue, cough, hoarseness, pain, or hemoptysis. The patient has a history of childhood lymphoma, which was treated with radiation. She takes no medications. She has smoked 1 pack of cigarettes per day since she was 25 years old. Her physical exam is notable for a palpable nodule on the right side of the thyroid. An ultrasound is performed, which confirms a 1.2 cm hyperechoic nodule in the right lobe. Thyroid function labs are drawn and shown below: Serum TSH: 0.2 mU/L Serum thyroxine (T4): 187 nmol/L Serum triiodothyronine (T3): 3.3 nmol/L Which of the following is the next best step in management?? {'A': 'Fine needle aspiration', 'B': 'Levothyroxine', 'C': 'Partial thyroidectomy', 'D': 'Radioactive iodine', 'E': 'Thyroid scintigraphy'}, | E: Thyroid scintigraphy |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the physician by his parents for the evaluation of an unusual cough, a raspy voice, and noisy breathing for the last 2 days. During this time, the symptoms have always occurred in the late evening. The parents also report that prior to the onset of these symptoms, their son had a low-grade fever and a runny nose for 2 days. He attends daycare. His immunizations are up-to-date. His temperature is 37.8°C (100°F) and respirations are 33/min. Physical examination shows supraclavicular retractions. There is a high-pitched breath sound on inspiration. Which of the following is the most likely location of the abnormality?? {'A': 'Bronchioles', 'B': 'Epiglottis', 'C': 'Supraglottic larynx', 'D': 'Subglottic larynx', 'E': 'Bronchi\n"'}, | D: Subglottic larynx |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy from Eritrea is admitted to the hospital for lethargy and increased work of breathing. He has had recurrent episodes of fever, shortness of breath, and fatigue in the past 3 years. His pulse is 132/min and blood pressure is 90/66 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 82%. Auscultation of the chest shows coarse crackles in both lungs and a diastolic murmur at the cardiac apex. Despite appropriate lifesaving measures, he dies. A photomicrograph of a section of myocardium obtained at autopsy is shown. Which of the following is the most likely underlying cause of this patient's cardiac disease?? {'A': 'Amastigote infiltration', 'B': 'Beta-myosin heavy chain defect', 'C': 'Non-caseating granulomatous inflammation', 'D': 'Type II hypersensitivity reaction', 'E': 'Exotoxin-mediated myonecrosis'}, | D: Type II hypersensitivity reaction |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman presents to her primary care physician with symptoms of heat intolerance, unintentional weight loss, feelings of anxiety, and excessive energy that hinder her from falling asleep at night. On physical exam, the patient is found to have mildly protuberant eyes bilaterally as well as discoloration and swelling of her shins. Which of the following lab results would most likely be present in this patient?? {'A': 'Decreased anti-TSH antibodies', 'B': 'Decreased free T4', 'C': 'Decreased serum TSH', 'D': 'Increased anti-mitochondrial antibodies', 'E': 'Increased serum TSH'}, | C: Decreased serum TSH |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man presents with acute-onset right flank pain. He says that his symptoms began suddenly 6 hours ago and have not improved. He describes the pain as severe, colicky, and ‘coming in waves’. It is localized to the right flank and radiates to the groin. He says he has associated nausea. He denies any fever, chills, dysuria, or hematuria. His past medical history is significant for asymptomatic nephrolithiasis, diagnosed 9 months ago on an upright abdominal radiograph, which has not yet been treated. The patient’s vital signs include: temperature 37.0°C (98.6°F), blood pressure 145/90 mm Hg, pulse 119/min, and respiratory rate 21/min. On physical examination, the patient is constantly moving and writhing with pain. There is severe right costovertebral angle tenderness. The remainder of the physical examination is unremarkable. A urine dipstick shows 2+ blood. A noncontrast CT of the abdomen and pelvis reveals a 4-mm-diameter radiopaque stone at the right ureteropelvic junction. Several nonobstructing small-diameter stones are noted in the left kidney. Mild hydronephrosis of the right kidney is noted. Intravenous fluids are started and ondansetron is administered. Which of the following is the next best step in the management of this patient?? {'A': 'Emergency percutaneous nephrostomy', 'B': 'Hydrocodone and indomethacin', 'C': '24-hour urine chemistry', 'D': 'Lithotripsy', 'E': 'Potassium citrate'}, | B: Hydrocodone and indomethacin |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is brought to the emergency department by ambulance 1 hour after a motor vehicle accident. He did not require any circulatory resuscitation at the scene, but he was intubated because he was unresponsive. He has no history of serious illnesses. He is on mechanical ventilation with no sedation. His blood pressure is 121/62 mm Hg, the pulse is 68/min, and the temperature is 36.5°C (97.7°F). His Glasgow coma scale (GCS) is 3. Early laboratory studies show no abnormalities. A search of the state donor registry shows that he has registered as an organ donor. Which of the following is the most appropriate next step in evaluation?? {'A': 'Apnea test', 'B': 'Brain MRI', 'C': 'Cerebral angiography', 'D': 'Electroencephalography', 'E': 'Evaluation of brainstem reflexes'}, | E: Evaluation of brainstem reflexes |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman with a medical history significant for chronic kidney disease stage 4, hypertension, and type 2 diabetes mellitus, presents to the office for a scheduled visit. During her last visit, the physician started discussing with her the possibility of starting her on dialysis for her chronic kidney disease. The patient has no complaints about her health and enjoys spending time with her family. At presentation, she is afebrile; the blood pressure is 139/89 mm Hg and the heart rate is 80/min. On physical examination, her pulses are bounding, the complexion is pale, she has a grade ⅙ holosystolic murmur, breath sounds remain clear, and 2+ pedal edema to the knee. The measurement of which of the following laboratory values is most appropriate to screen for renal osteodystrophy in this patient?? {'A': 'Erythrocyte sedimentation rate', 'B': 'Serum C-reactive protein level', 'C': 'Serum intact parathyroid hormone level', 'D': 'Serum thyroid-stimulating hormone level', 'E': 'Serum vitamin B-12 level'}, | C: Serum intact parathyroid hormone level |
Answer the following medical question with one of the provided options: | Q:A 44-year-old woman presents to her physician’s office for weakness. She reports having some difficulty placing books on a high shelf and getting up from a seated position. She denies muscle pain or any new rashes. She has noticed a tremor that is worse with action and has been having trouble falling asleep and staying asleep. She has lost approximately 10 pounds unintentionally over the course of 2 months. Medical history is significant for type I diabetes mellitus managed with an insulin pump. Family history is notable for systemic lupus erythematosus in her mother and panic disorder in the father. Her temperature is 98.6°F (37 °C), blood pressure is 140/85 mmHg, pulse is 102/min, and respirations are 17/min. On physical exam, she is mildly diaphoretic and restless, she has notable lid retraction, and her hair is thin. She has 4/5 strength in the proximal upper and lower extremities. Biceps and patellar tendon reflexes are 3+. Which of the following laboratory findings are most likely present in this patient?? {'A': 'Anti-Mi-2 antibody positivity', 'B': 'Anti-nuclear antibody positivity', 'C': 'Decreased thyroid-stimulating hormone', 'D': 'Increased erythrocyte sedimentation rate', 'E': 'Normal laboratory results'}, | C: Decreased thyroid-stimulating hormone |
Answer the following medical question with one of the provided options: | Q:A 23-year-old college senior visits the university health clinic after vomiting large amounts of blood. He has been vomiting for the past 36 hours after celebrating his team’s win at the national hockey championship with his varsity friends while consuming copious amounts of alcohol. His personal medical history is unremarkable. His blood pressure is 129/89 mm Hg while supine and 100/70 mm Hg while standing. His pulse is 98/min, strong and regular, with an oxygen saturation of 98%. His body temperature is 36.5°C (97.7°F), while the rest of the physical exam is normal. Which of the following is associated with this patient’s condition?? {'A': 'Portal hypertension', 'B': 'Esophageal perforation', 'C': 'Esophageal metaplasia', 'D': 'Output of the esophageal mucosa', 'E': 'Esophageal tear'}, | E: Esophageal tear |
Answer the following medical question with one of the provided options: | Q:A 29-year-old G1P0 at 23 weeks of gestation presents to the ED for left flank pain migrating to the groin. The pain is sharp, causing her to have nausea and vomiting. She also endorses urinary frequency, but denies vaginal discharge. There have been no complications in her pregnancy thus far. Her abdominal exam is remarkable for left lower quadrant tenderness to palpation with pain radiating to the left groin, but no guarding. She also has tenderness to palpation of the left flank. Blood is visible on inspection of the perineal area. Urinalysis: Urine Color: Yellow pH: 7.1 Specific gravity: 1.010 Blood: 3+ Bilirubin: Negative Glucose: Negative Ketones: Negative Protein: Negative Nitrite: Negative Leukocyte esterase: Negative Red blood cells: 291 cells/ul White blood cells: 75 cells/ul Which of the following is the next best step in management?? {'A': 'Renal radiograph', 'B': 'Intravenous pyelogram', 'C': 'Renal ultrasound', 'D': 'Noncontrast CT scan of abdomen and pelvis', 'E': 'Exploratory laparoscopy'}, | C: Renal ultrasound |
Answer the following medical question with one of the provided options: | Q:A 26-year-old female presents to her primary care physician concerned that she has contracted a sexually transmitted disease. She states that she is having severe pain whenever she urinates and seems to be urinating more frequently than normal. She reports that her symptoms started after she began having unprotected sexual intercourse with 1 partner earlier this week. The physician obtains a urinalysis which demonstrates the following, SG: 1.010, Leukocyte esterase: Positive, Nitrites: Positive, Protein: Trace, pH: 5.0, RBC: Negative. A urease test is performed which is negative. This patient has most likely been infected with which of the following organisms?? {'A': 'Proteus mirabilis', 'B': 'Klebsiella pneumoniae', 'C': 'Escherichia coli', 'D': 'Staphylococcus saprophyticus', 'E': 'Enterobacter cloacae'}, | C: Escherichia coli |
Answer the following medical question with one of the provided options: | Q:A 57-year-old woman comes to the emergency department because of severe pain around her right eye, blurred vision in the same eye, and a headache for the past 4 hours. She is nauseous but has not vomited. She can see colored bright circles when she looks at a light source. She is currently being treated for a urinary tract infection with trimethoprim-sulfamethoxazole. She appears uncomfortable. Vital signs are within normal limits. Examination shows visual acuity of 20/20 in the left eye and counting fingers at 5 feet in the right eye. The right eye shows conjunctival injection and edema of the cornea. The right pupil is dilated and fixed. Intravenous analgesia and antiemetics are administered. Which of the following is the most appropriate next step in management?? {'A': 'Perform ultrasound biomicroscopy', 'B': 'Administer topical atropine', 'C': 'Perform gonioscopy', 'D': 'Perform fundoscopy', 'E': 'Administer topical steroids'}, | C: Perform gonioscopy |
Answer the following medical question with one of the provided options: | Q:A 48-year-old Caucasian woman presents to her physician for an initial visit. She has no chronic diseases. The past medical history is significant for myomectomy performed 10 years ago for a large uterine fibroid. She had 2 uncomplicated pregnancies and 2 spontaneous vaginal deliveries. Currently, she only takes oral contraceptives. She is a former smoker with a 3-pack-year history. Her last Pap test performed 2 years ago was negative. She had a normal blood glucose measurement 3 years ago. The family history is remarkable for systolic hypertension in her mother and older brother. The blood pressure is 110/80 mm Hg, heart rate is 76/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient is afebrile. The BMI is 32 kg/m2. Her physical examination is unremarkable. Which of the following preventative tests is indicated for this patient at this time?? {'A': 'Abdominal ultrasound', 'B': 'Chest CT', 'C': 'Pap smear', 'D': 'Fasting blood glucose', 'E': 'Colonoscopy'}, | D: Fasting blood glucose |
Answer the following medical question with one of the provided options: | Q:An investigator is studying a strain of bacteria that retains a blue color after crystal violet dye and acetone are applied. The bacteria are inoculated in a petri dish containing hypotonic saline. After the addition of an antibiotic, the bacteria swell and rupture. This antibiotic most likely belongs to which of the following classes?? {'A': 'Macrolide', 'B': 'Cephalosporin', 'C': 'Fluoroquinolone', 'D': 'Sulfonamide', 'E': 'Tetracycline'}, | B: Cephalosporin |
Answer the following medical question with one of the provided options: | Q:Immediately following prolonged delivery of the placenta at 40 weeks gestation, a 32-year-old multiparous woman develops vaginal bleeding. Other than mild asthma, the patient’s pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. Previous pregnancies were uncomplicated. She has no history of a serious illness. She is currently on intravenous infusion of oxytocin. Her temperature is 37.2°C (99.0°F), blood pressure is 108/60 mm Hg, pulse is 88/min, and respirations are 17/min. Uterine palpation reveals a soft enlarged fundus that extends above the umbilicus. Based on the assessment of the birth canal and placenta, which of the following options is the most appropriate initial step in patient management?? {'A': 'Discontinuing oxytocin', 'B': 'Intramuscular carboprost', 'C': 'Intravenous methylergonovine', 'D': 'Manual exploration of the uterus', 'E': 'Uterine fundal massage'}, | E: Uterine fundal massage |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl is brought to the physician because she has not had a menstrual period. There is no personal or family history of serious illness. Examination shows normal breast development. Pubic hair is coarse and extends to the inner surface of the thighs. Pelvic examination shows a blind vaginal pouch. Ultrasonography shows ovaries, but no uterus. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': '17-alpha-hydroxylase enzyme deficiency', 'B': 'Müllerian duct agenesis', 'C': 'Androgen insensitivity', 'D': 'Pure gonadal dysgenesis', 'E': 'Failure of Müllerian duct recanalization\n"'}, | B: Müllerian duct agenesis |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the emergency department because of abdominal pain, a runny nose, and chills for 6 hours. He has also had diarrhea and difficulty sleeping. He appears irritable. His temperature is 37.1°C (98.8°F), pulse is 110/min, and blood pressure is 140/90 mm Hg. Examination shows cool, damp skin with piloerection. The pupils are 7 mm in diameter and equal in size. Cardiopulmonary examination shows no abnormalities. The abdomen is tender to palpation. Bowel sounds are hyperactive. Deep tendon reflexes are 3+ bilaterally. Withdrawal from which of the following substances is the most likely cause of this patient's symptoms?? {'A': 'Gamma-hydroxybutyric acid', 'B': 'Barbiturates', 'C': 'Cannabis', 'D': 'Phencyclidine', 'E': 'Heroin'}, | E: Heroin |
Answer the following medical question with one of the provided options: | Q:A 34-year-old G3P2 undergoes colposcopy at 15 weeks gestation due to high-grade intraepithelial lesion detected on a Pap smear. She has no history of the gynecologic disease and had normal Pap smear results prior to the current pregnancy. The pelvic examination does not reveal any cervical lesions. Colposcopy shows a non-deformed cervix with a well-visualized transformation zone. Application of acetic acid reveals an area of acetowhite epithelium 2 cm in the largest diameter located at 6 o’clock with sharp irregular borders. A punch biopsy shows irregularly shaped tongues of pleomorphic squamous epithelium cells invading the stroma to a depth of 2 mm. Which of the following describes the proper management strategy for this patient?? {'A': 'Perform a diagnostic conization', 'B': 'Terminate the pregnancy and perform a radical hysterectomy', 'C': 'Observe until 34 weeks of pregnancy', 'D': 'Perform radical trachelectomy', 'E': 'Schedule a diagnostic lymphadenectomy'}, | A: Perform a diagnostic conization |
Answer the following medical question with one of the provided options: | Q:A 24-year-old G1P0 presents to her obstetrician at 26 weeks’ gestation complaining of worsening headaches and blurry vision. Her past medical history is notable for hypertension and diabetes mellitus. Her temperature is 98.6°F (37°C), blood pressure is 160/95 mmHg, pulse is 100/min, and respirations are 18/min. On physical exam, she is tender to palpation in her abdomen and has mild edema in her extremities. A urine dipstick demonstrates 3+ protein. The patient is immediately started on IV magnesium sulfate, diazepam, and a medication that affects both a- and ß-adrenergic receptors. Which of the following medications is most consistent with this mechanism of action?? {'A': 'Labetalol', 'B': 'Propranolol', 'C': 'Metoprolol', 'D': 'Esmolol', 'E': 'Pindolol'}, | A: Labetalol |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman complains of intermittent fever and joint pain. She says that these symptoms have been present for the past month. Before that, she had no signs or symptoms and was completely healthy. She has also lost her appetite and some weight. A complete blood count (CBC) showed severe pancytopenia. What is the next best step in evaluating this patient?? {'A': 'Bone marrow examination', 'B': 'Treatment with antibiotics', 'C': 'Repeated CBCs for several weeks and reassess', 'D': 'Treatment with corticosteroids', 'E': 'Treatment for acute leukemia'}, | A: Bone marrow examination |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy presents to the emergency department with puffy eyes. The patient’s parents noticed that his eyes were very puffy this morning thus prompting his presentation. They state their son has always been very healthy and other than a rash acquired from wrestling treated with a topical antibiotic has been very healthy. His temperature is 98.3°F (36.8°C), blood pressure is 125/85 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 99% on room air. Physical exam is notable for periorbital edema but is otherwise unremarkable. Urinalysis is notable for red blood cells and an amber urine sample. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Autoimmune type IV collagen destruction', 'B': 'Deposition of circulating immune complexes', 'C': 'IgA-mediated vasculitis', 'D': 'IgE-mediated degranulation', 'E': 'Increased glomerular permeability to protein only'}, | B: Deposition of circulating immune complexes |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman, gravida 1, para 0, at 38 weeks' gestation comes to the emergency department for sudden leakage of clear fluid from her vagina. Her pregnancy has been uncomplicated. She has largely been compliant with her prenatal care but missed some appointments. She has a history of chronic hypertension. She drinks a glass of wine once per week. Current medications include labetalol, iron, and vitamin supplements. Her temperature is 37.9°C (100.2°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Examination shows a soft and nontender abdomen on palpation. Speculum examination demonstrates clear fluid in the cervical canal. The fetal heart rate is reactive at 170/min with no decelerations. Tocometry shows no contractions. The vaginal fluid demonstrates a ferning pattern when placed onto a glass slide. Which of the following is the most likely cause of this patient's condition?? {'A': 'Ascending infection', 'B': 'Sexual intercourse during third trimester', 'C': 'β-blocker use', 'D': 'Alcohol use', 'E': 'Oligohydramnios'}, | A: Ascending infection |
Answer the following medical question with one of the provided options: | Q:A previously healthy 44-year-old man comes to his physician because of frequent urination and increased thirst for several weeks. Physical examination shows darkened skin and a firm mass in the right upper quadrant. His blood glucose is 220 mg/dL. A photomicrograph of a specimen obtained on liver biopsy is shown. Which of the following best describes the pathogenesis of the disease process in this patient?? {'A': 'Upregulation of erythropoietin production', 'B': 'Absence of β-globin synthesis', 'C': 'Absence of a serine protease inhibitor', 'D': 'Defective transferrin receptor binding', 'E': 'Defective serum copper transportation'}, | D: Defective transferrin receptor binding |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman comes to the clinic for an annual well-check. Her past medical history includes diabetes and hypertension, which are well-controlled with metformin and losartan, respectively. The patient reports a healthy diet consisting of mainly vegetables and lean meat. She denies smoking or alcohol use. She enjoys taking walks with her husband and sunbathing. Physical examination is unremarkable expect for a rough, scaly, sand paper-like plaque on her left dorsal hand with no tenderness or pain. What is the most likely diagnosis?? {'A': 'Actinic keratosis', 'B': 'Psoriasis', 'C': 'Rosacea', 'D': 'Seborrheic keratosis', 'E': 'Sunburn'}, | A: Actinic keratosis |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to the physician for a routine health maintenance examination. He feels well. His most recent examination 2 years ago included purified protein derivative (PPD) skin testing and showed no abnormalities. He is a retired physician and recently came back from rural China where he completed a voluntary service at a local healthcare center. A PPD skin test is performed. Three days later, an induration of 12 mm is noted. An x-ray of the chest shows no abnormalities. He is started on a drug that inhibits the synthesis of mycolic acid. This patient is at greatest risk of developing which of the following adverse effects?? {'A': 'Optic neuropathy', 'B': 'Liver injury', 'C': 'Hyperuricemia', 'D': 'Cytochrome P-450 induction', 'E': 'Nephrotoxicity'}, | B: Liver injury |
Answer the following medical question with one of the provided options: | Q:A 21-year-old gravida 1 presents to her physician’s office for an antepartum visit at 11 weeks gestation. She has complaints of malaise, occasional nausea, and changes in food preferences. Her vital signs include: blood pressure 100/70 mm Hg, heart rate 90/min, respiratory rate 14/min, and temperature 36.8℃ (98.2℉). Examination reveals a systolic ejection murmur along the left sternal border. There are no changes in skin color, nails, or hair growth. No neck enlargement is noted. Blood analysis shows the following: Erythrocyte count 3.5 million/mm3 Hb 11.9 g/dL HCT 35% Reticulocyte count 0.2% MCV 85 fL Platelet count 21,0000/mm3 Leukocyte count 7800/mm3 Serum iron 17 µmol/L Ferritin 120 µg/L What is the most likely cause of the changes in the patient’s blood count?? {'A': 'Decreased iron transport across the intestinal wall', 'B': 'Increase in plasma volume', 'C': 'Failure of synthesis of a D-aminolevulinic acid', 'D': 'Insufficient iron intake', 'E': 'Failure of purine and thymidylate synthesis'}, | B: Increase in plasma volume |
Answer the following medical question with one of the provided options: | Q:The study is performed in an attempt to determine whether there is an association between maternal exposure to 2nd-hand smoke and low birth weight. A total of 1,000 women who have given birth to at least 1 child are placed into 1 of 2 groups according to the birth weight of their 1st child. Each group includes 500 women whose 1st child either weighed < 2,500 g (5.5 lb) or > 2,500 g (5.5 lb). In the 1st group, 250 subjects admitted to living with or being in close proximity to a smoker. In the 2nd group, 50 subjects admitted to living with or being in close proximity to a smoker. Which of the following is the strongest measure of association that can be calculated from this study?? {'A': 'Odds ratio', 'B': 'Relative risk', 'C': 'Rate ratio', 'D': 'Absolute risk', 'E': 'Risk difference'}, | A: Odds ratio |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman is brought to the emergency department following a motor vehicle accident. She is awake but slow to respond. Her breath smells of alcohol. The emergency medical technician reports that her blood pressure has been dropping despite intravenous fluids. Ultrasound reveals a hypoechoic rim around the spleen, suspicious for a splenic laceration. The patient is brought into the operating room for abdominal exploration and a splenic embolization is performed. Since arriving to the hospital, the patient has received 8 units of packed red blood cells and 2 units of fresh frozen plasma. She is stabilized and admitted for observation. The next morning on rounds, the patient complains of numbness and tingling of her mouth and cramping of her hands. Her temperature is 99°F (37.2°C), blood pressure is 110/69 mmHg, and pulse is 93/min. On physical examination, her abdomen is mildly tender without distention. The surgical wound is clean, dry, and intact. Jugular venous pressure is normal. Periodic spasms of the muscles of her bilateral upper and lower extremities can be seen and tapping of the facial nerve elicits twitching of he facial muscles. Which of the following is most likely to improve the patient’s symptoms?? {'A': 'Calcium gluconate', 'B': 'Dextrose', 'C': 'Lorazepam', 'D': 'Thiamine', 'E': 'Sodium bicarbonate'}, | A: Calcium gluconate |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the ED complaining of worsening abdominal pain over the last few hours. He also reports nausea, but denies fever, vomiting, or changes in the appearance of his bowel movements. His medical history is significant for type 2 diabetes mellitus, hypertension, coronary artery disease, stroke, atrial fibrillation, and peptic ulcer disease. Due to his recurrent bleeding peptic ulcers, he does not take warfarin. His surgical history is significant for an appendectomy as a child. His medications include metformin, lisinopril, metoprolol, and omeprazole. He has a 50-pack-year history of smoking. His temperature is 37.6 C (99.7 F), blood pressure is 146/80 mm Hg, pulse is 115/min, and respiratory rate is 20/min. On physical exam, he is in acute distress due to the pain. Pulmonary auscultation reveals scattered wheezes and decreased air entry. His heart rate is irregularly irregular, with no murmurs, rubs or gallops. Abdominal exam is significant for decreased bowel sounds and diffuse tenderness. Initial laboratory evaluation is as follows: Na 138 mEq/L, Cl 101 mEq/L, HCO3 12 mEq/L, BUN 21 mg/dL, Cr 0.9 mg/dL, glucose 190 mg/dL, amylase 240 U/L (normal < 65 U/L). What is the most likely diagnosis in this patient?? {'A': 'Peptic ulcer perforation', 'B': 'Acute cholecystitis', 'C': 'Acute mesenteric ischemia', 'D': 'Diabetic ketoacidosis', 'E': 'Acute pancreatitis'}, | C: Acute mesenteric ischemia |
Answer the following medical question with one of the provided options: | Q:A 72-year-old multiparous woman comes to the physician for the evaluation of episodes of involuntary urine leakage for the past 6 months. She loses small amounts of urine without warning after laughing or sneezing. She also sometimes forgets the names of her grandchildren and friends. She is retired and lives at an assisted-living facility. She has insulin-dependent diabetes mellitus type 2. Her mother received a ventriculoperitoneal shunt around her age. She walks without any problems. Sensation to pinprick and light touch is normal. Which of the following is the primary underlying etiology for this patient's urinary incontinence?? {'A': 'Detrusor-sphincter dyssynergia', 'B': 'Urethral hypermobility', 'C': 'Decreased cerebrospinal fluid absorption', 'D': 'Impaired detrusor contractility', 'E': 'Loss of sphincter control'}, | B: Urethral hypermobility |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman presents to the office complaining of fatigue and unintentional weight loss. On examination, there is a palpable firm lymph node in the cervical area. Biopsy of the lymph node reveals Hodgkin’s lymphoma. The patient agrees to start the standard chemotherapy regimen. A few months later, after the completion of 3 successful courses, the patient presents with a dry cough and progressively worsening shortness of breath. Her temperature is 37°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 72/min, and the respirations are 16/min. Pulse oximetry shows an O2 saturation of 94% on room air. On spirometry, the patient's FEV1/FVC ratio is normal. Chest CT reveals bilateral diffuse cystic airspaces in middle and lower lung fields. Which of the following is the most likely cause of this patient’s current symptoms?? {'A': 'Drug-induced interstitial lung disease', 'B': 'Metastatic spread to the lungs', 'C': 'Development of chronic obstructive pulmonary disease', 'D': 'Transfusion-related acute lung injury', 'E': 'Development of bacterial pneumonia due to immunocompromised state'}, | A: Drug-induced interstitial lung disease |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman comes to the emergency department after coughing up 2 cups of bright red blood. A CT angiogram of the chest shows active extravasation from the right bronchial artery. A coil embolization is planned to stop the bleeding. During this procedure, a catheter is first inserted into the right femoral artery. Which of the following represents the correct subsequent order of the catheter route?? {'A': 'Thoracic aorta, brachiocephalic trunk, right subclavian artery, right internal thoracic artery, right bronchial artery', 'B': 'Thoracic aorta, right subclavian artery, right internal thoracic artery, right bronchial artery', 'C': 'Thoracic aorta, right posterior intercostal artery, right bronchial artery', 'D': 'Thoracic aorta, right superior epigastric artery, right bronchial artery', 'E': 'Thoracic aorta, left ventricle, left atrium, pulmonary artery, right bronchial artery'}, | C: Thoracic aorta, right posterior intercostal artery, right bronchial artery |
Answer the following medical question with one of the provided options: | Q:A 53-year-old farmer presents to the clinic for evaluation of a pigmented lesion on his arm. He states that he first noticed the lesion last year, but he believes that it has been slowly growing in size. He otherwise does not have any complaints and is generally healthy. Which of the following findings on physical exam would suggest a malignant diagnosis?? {'A': 'Different pigmentation throughout the lesion', 'B': 'Flat lesion with symmetric hyperpigmentation', 'C': 'Hyperpigmented lesion with smooth borders', 'D': 'Symmetrical ovoid lesion', 'E': 'Tenderness to palpation'}, | A: Different pigmentation throughout the lesion |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man comes to the physician because of fatigue and a 5-kg (11-lb) weight loss over the past 6 months despite a good appetite. He takes no medications. He does not smoke or use illicit drugs. Physical examination shows hepatosplenomegaly and diffuse, nontender lymphadenopathy. Laboratory studies show a hemoglobin concentration of 11 g/dL and a leukocyte count of 16,000/mm3. A direct antiglobulin (Coombs) test is positive. A photomicrograph of a peripheral blood smear is shown. Which of the following is the most likely diagnosis?? {'A': 'Chronic myelogenous leukemia', 'B': 'Acute myelogenous leukemia', 'C': 'Follicular lymphoma', 'D': 'Chronic lymphocytic leukemia', 'E': 'Hemophagocytic lymphohistiocytosis'}, | D: Chronic lymphocytic leukemia |
Answer the following medical question with one of the provided options: | Q:A 15-year-old adolescent presents to his pediatrician with progressive easy fatigability and exercises intolerance over the last several months. The patient was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. There is no history of palpitation, dyspnea, or lower limb edema. On physical examination his vital signs are stable. On chest auscultation, a wide fixed split in the second heart sound is detected. A medium-pitched systolic ejection murmur is present which is best heard at the left middle and upper sternal border. A short mid-diastolic rumble is also audible over the lower left sternal border, which is best heard with the bell of the stethoscope. Which of the following findings is most likely to be present on this patient’s echocardiogram?? {'A': 'Decreased right ventricular end-diastolic dimension', 'B': 'Anterior movement of ventricular septum during systole', 'C': 'Goose-neck deformity of left ventricular outflow tract', 'D': 'Increased left ventricular shortening fraction', 'E': 'Displacement of tricuspid valve leaflets inferiorly into right ventricle'}, | B: Anterior movement of ventricular septum during systole |
Answer the following medical question with one of the provided options: | Q:A one-week-old boy is brought to the emergency department by his mother, who recently immigrated to the United States and does not have health insurance. He was born at home, and has not received any medical care since birth. The mother states the boy has become irritable and has been feeding poorly. In the last day, she said he seems "stiff" and is having apparent muscle spasms. On your exam, you note the findings in figure A. Which of the following interventions might have prevented this disease?? {'A': 'Conjugated polysaccharide vaccine given to infant at birth', 'B': 'Toxoid vaccine given to mother pre-natally', 'C': 'Vitamin injection given to newborn at birth', 'D': 'Improved maternal nutrition', 'E': 'Genetic counseling'}, | B: Toxoid vaccine given to mother pre-natally |
Answer the following medical question with one of the provided options: | Q:Given the mRNA sequence shown below, if translation were to start at the first base, what would the tRNA anticodon be for the last amino acid translated in the chain? 5'----GCACCGGCCUGACUAUAA---3'? {'A': "3' GCG 5'", 'B': "3' CGC 5'", 'C': "3' GAU 5'", 'D': "5' CGG 3'", 'E': "3' CGG 5'"}, | E: 3' CGG 5' |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy is brought to a new pediatrician to establish care. He presents with a history of extensive eczema, recurrent respiratory, skin, and gastrointestinal infections, and significant thrombocytopenia. 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. Given this classic grouping of clinical symptoms in a patient of this age, which of the following represents the most likely underlying medical condition?? {'A': 'Wiskott-Aldrich syndrome', 'B': 'Ataxia-telangiectasia', 'C': 'Severe combined immunodeficiency syndrome', 'D': 'Chediak-Higashi syndrome', 'E': 'Hyper-IgE disease'}, | A: Wiskott-Aldrich syndrome |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to the physician by his mother for evaluation of diffuse bone pain in his right leg. His family immigrated to the United States 6 months ago from northern Canada. He is below the 5th percentile for height and at the 10th percentile for weight. Physical examination shows tenderness to palpation of the right distal femur. There is hepatosplenomegaly. An x-ray of right femur shows generalized trabecular thinning and several osteolytic bone lesions. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 7,600/mm3 Platelets 71,000/mm3 A bone marrow aspirate shows mononuclear cells filled with lipid that appear like wrinkled silk. Deficiency of which of the following enzymes is the most likely cause of this patient's symptoms?"? {'A': 'Sphingomyelinase', 'B': 'α-Galactosidase A', 'C': 'Arylsulfatase A', 'D': 'Galactocerebrosidase', 'E': 'Glucocerebrosidase'}, | E: Glucocerebrosidase |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of intermittent palpitations that occur when he is stressed, exercising, or when he drinks alcohol. Physical examination shows an irregularly irregular pulse. An ECG shows irregular QRS complexes without any discrete P waves. Pharmacotherapy with carvedilol is initiated for his condition. Compared to treatment with propranolol, which of the following adverse effects is most likely?? {'A': 'Hyperkalemia', 'B': 'Hypotension', 'C': 'Bradycardia', 'D': 'Hyperglycemia', 'E': 'Bronchospasm'}, | B: Hypotension |
Answer the following medical question with one of the provided options: | Q:When hepatitis D was injected into an immunocompromised mouse, there was no detectable hepatitis D RNA in the blood at any time point during the next several months. When co-injected with hepatitis B, hepatitis D RNA was was detected in the blood. Which of the following best describes this phenomenon?? {'A': 'Recombination', 'B': 'Reassortment', 'C': 'Complementation', 'D': 'Phenotypic mixing', 'E': 'Transduction'}, | C: Complementation |
Answer the following medical question with one of the provided options: | Q:A 33-year-old woman comes to the physician because of a 4-day history of fever, anterior neck pain, and throat swelling. She has no history of serious illness. Her temperature is 38.1°C (100.6°F) and pulse is 109/min. Physical examination shows diaphoresis and a fine tremor of the outstretched hands. The thyroid gland is enlarged, firm, and tender to palpation. Serum thyroid stimulating hormone level is 0.06 μU/mL and erythrocyte sedimentation rate is 65 mm/h. 123I scan shows an enlarged thyroid gland with diffusely decreased uptake. Histologic examination of a thyroid biopsy specimen is most likely to show which of the following findings?? {'A': 'Follicular epithelial cell hyperplasia', 'B': 'Undifferentiated giant cells with areas of necrosis and hemorrhage', 'C': 'Concentric intracellular lamellar calcifications', 'D': 'Lymphocytic infiltration with germinal follicle formation', 'E': 'Noncaseating granulomas with multinucleated giant cells'}, | E: Noncaseating granulomas with multinucleated giant cells |
Answer the following medical question with one of the provided options: | Q: A 43-year-old woman was admitted to the hospital for anticoagulation following a pulmonary embolism. She was found to have a deep venous thrombosis on further workup after a long plane ride coming back from visiting China. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min, and respiratory rate 23/min. On physical examination, her pulses are bounding and complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 81% on room air, with a new oxygen requirement of 8 L by face mask. On day 6 of combined heparin and warfarin anticoagulation, her platelet count decreases from 182,000/mcL to 63,000/mcL. Her international normalized ratio (INR) is not yet therapeutic. What is the next best step in therapy?? {'A': 'Continue heparin and warfarin until INR is therapeutic for 24 hours', 'B': 'Discontinue heparin; continue warfarin', 'C': 'Continue heparin; discontinue warfarin', 'D': 'Discontinue heparin and warfarin', 'E': 'Continue heparin and warfarin, and administer vitamin K'}, | D: Discontinue heparin and warfarin |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman is brought to the emergency department by ambulance after she was found down by her daughter. She lives alone in her apartment so it is unclear when she began to develop symptoms. Her medical history is significant for cardiac arrhythmias, diabetes, pericarditis, and a stroke 2 years ago. On presentation her temperature is 98.1°F (36.7°C), blood pressure is 88/51 mmHg, pulse is 137/min, and respirations are 18/min. On physical exam her skin is cold and clammy. If special tests were obtained, they would reveal dramatically decreased pulmonary capillary wedge pressure, increased systemic vascular resistance, and mildly decreased cardiac output. Which of the following treatments would most directly target the cause of this patient's low blood pressure?? {'A': 'Antibiotic administration', 'B': 'Intravenous fluids', 'C': 'Intravenous ionotropes', 'D': 'Relieve obstruction', 'E': 'Vasopressors'}, | B: Intravenous fluids |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman presents to her gynecologist for evaluation of amenorrhea and occasional dull right-sided lower abdominal pain that radiates to the rectum. She had menarche at 11 years of age and had regular 28-day cycles by 13 years of age. She developed menstrual cycle irregularity approximately 2 years ago and has not had a menses for 6 months. She is not sexually active. She does not take any medications. Her weight is 94 kg (207.2 lb) and her height is 166 cm (5.4 ft). Her vital signs are within normal limits. The physical examination shows a normal hair growth pattern. No hair loss or acne are noted. There is black discoloration of the skin in the axillae and posterior neck. Palpation of the abdomen reveals slight tenderness in the right lower quadrant, but no masses are appreciated. The gynecologic examination reveals no abnormalities. The hymen is intact. The rectal examination reveals a non-tender, mobile, right-sided adnexal mass. Which of the following management plans would be best for this patient?? {'A': 'No imaging is indicated for this patient because the diagnosis can be made on the basis of the clinical examination', 'B': 'A transvaginal ultrasound would provide a better resolution of the suspected pathology, but a transabdominal ultrasound can still be used to assess this patient', 'C': 'Increased anterior abdominal wall adiposity does not pose any problems with a full urinary bladder, so a transabdominal ultrasound will provide the same sensitivity as a transvaginal ultrasound', 'D': 'Transabdominal ultrasound would be better for this patient because it can detect small pelvic masses better than a transvaginal ultrasound', 'E': 'Pelvic MRI is warranted in this case because transvaginal ultrasound cannot be performed and transabdominal ultrasound is unlikely to provide any diagnostic information'}, | B: A transvaginal ultrasound would provide a better resolution of the suspected pathology, but a transabdominal ultrasound can still be used to assess this patient |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man comes to the physician for a follow-up examination. He was diagnosed with HIV infection 2 weeks ago. His CD4+ T-lymphocyte count is 162/mm3 (N ≥ 500). An interferon-gamma release assay is negative. Prophylactic treatment against which of the following pathogens is most appropriate at this time?? {'A': 'Aspergillus fumigatus', 'B': 'Mycobacterium tuberculosis', 'C': 'Pneumocystis jirovecii', 'D': 'Toxoplasma gondii', 'E': 'Cytomegalovirus'}, | C: Pneumocystis jirovecii |
Answer the following medical question with one of the provided options: | Q:A 58-year-old department store manager comes to his doctor’s office complaining that he had recently been waking up in the middle of the night with abdominal pain. This has happened several nights a week in the past month. He has also been experiencing occasional discomfort in the afternoon. The patient's appetite has suffered as a result of the pain he was experiencing. His clothes hang on him loosely. The patient does not take any prescription or over the counter medications. The remainder of the patient’s history and physical exam is completely normal. The doctor refers the patient to a gastroenterologist for a stomach acid test and an upper gastrointestinal endoscopy which revealed that this patient is a heavy acid producer and has a gastric peptic ulcer. This ulcer is most likely found in which part of the stomach?? {'A': 'In the pyloric channel within 3 cm of the pylorus', 'B': 'Along the lesser curve at the incisura angularis', 'C': 'Proximal gastroesophageal ulcer near the gastroesophageal junction', 'D': 'In the body', 'E': 'Multiple sites throughout the stomach'}, | A: In the pyloric channel within 3 cm of the pylorus |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 49-year-old man presents to his primary care physician for follow-up for a high HbA1C. 3 months ago, his HbA1c was 8.9% on routine screening. Today, after lifestyle modifications, it is 8.1% and his serum glucose is 270 mg/dL. Which of the following is the best initial therapy for this patient's condition?? {'A': 'Metformin', 'B': 'Metformin added to basal insulin', 'C': 'Metformin added to an insulin secretagogue', 'D': 'Metformin added to a glucagon-like peptide 1 (GLP-1) agonist', 'E': 'Metformin added to a dipeptidyl peptidase-4 (DPP-4) inhibitor'}, | A: Metformin |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to the physician by his parents because of right-sided shoulder pain for 1 day. He has not had chills or sweating. Over the past year, he was treated twice in the emergency department for painful swelling of his hands and feet. He emigrated with his family from Kenya 2 years ago. His temperature is 37.4°C (99.3°F), pulse is 96/min, and blood pressure is 123/82 mm Hg. Physical examination shows no tenderness, erythema, or joint swelling of the shoulder. Laboratory studies show: Hemoglobin 7 g/dL Mean corpuscular volume 88 μm Reticulocyte count 9% Leukocyte count 12,000/mm3 A peripheral blood smear is most likely to show which of the following abnormalities?"? {'A': 'Ring-shaped inclusions in erythrocytes', 'B': 'Teardrop-shaped erythrocytes', 'C': 'Nuclear remnants in erythrocytes', 'D': 'Fragmentation of erythrocytes', 'E': 'Erythrocytes with no central pallor'}, | C: Nuclear remnants in erythrocytes |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man with a history of coronary artery disease and hyperlipidemia presents to his internist for a follow-up visit 3 weeks after visiting an urgent care center for symptoms of cough, fever, and difficulty breathing. He had been prescribed erythromycin in addition to his usual regimen of rosuvastatin and aspirin. With which potential side effect or interaction should the internist be most concerned?? {'A': 'Gastric bleeding due to decreased aspirin metabolism in the presence of erythromycin', 'B': 'Unstable angina due to decreased rosuvastatin metabolism in the presence of erythromycin', 'C': 'Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin', 'D': 'Metabolic acidosis due to decreased aspirin metabolism in the presence of erythromycin', 'E': 'Tinnitus due to decreased aspirin metabolism in the presence of erythromycin'}, | C: Myalgia due to decreased rosuvastatin metabolism in the presence of erythromycin |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl is brought into her pediatrician's office by her mother because the mother thinks her daughter has attention issues. The mother explains that her daughter started high school four months ago and had lackluster grades in a recent progress report despite having earned consistent top marks in middle school. The mother complains that her daughter never talks to her at home anymore. The patient yells at her mother in the exam room, and the mother is escorted out of the room. The patient scoffs that her mother is so overbeaing, ruining her good days with criticism. She begins to chew gum and states that she hates hanging out with the girls on the cheerleading squad. She denies experiencing physical abuse from anyone or having a sexual partner. She has seen kids smoke marijuana underneath the football field bleachers, but does not go near them and denies smoking cigarettes. She denies any intention to harm herself or others, thinks her grades went down because her teachers are not as good as her middle school teachers, and states she thinks she learns best by watching explanations through online videos. What is the most likely diagnosis?? {'A': 'Oppositional defiant disorder', 'B': 'Normal behavior', 'C': 'Conduct disorder', 'D': 'Attention deficit hyperactivity disorder', 'E': 'Antisocial personality disorder'}, | B: Normal behavior |
Answer the following medical question with one of the provided options: | Q:A 47-year-old alcoholic man presents to the office for a 72-hour history of intense right hemithorax pain. He also complains of fever, chills, and sweating that started 10 days ago, as well as persistent coughing with abundant malodorous sputum. Chest radiography shows a round consolidation with hydro-aerial levels in the middle third of the right hemithorax. Sputum samples for a direct exam, culture, and bradykinin (BK) are sent. What is the correct diagnosis?? {'A': 'Bronchiectasis', 'B': 'Bronchopulmonary sequestration', 'C': 'Lung abscess', 'D': 'Tuberculosis', 'E': 'Lung cancer'}, | C: Lung abscess |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to the clinic by his parents for an annual wellness examination. He is a relatively healthy boy who was born at term via vaginal delivery. He is meeting his developmental milestones and growth curves and is up-to-date on his immunizations. The father complains that he is picky with his food and would rather eat pizza. The patient denies any trouble at school, fevers, pain, or other concerns. A physical examination demonstrates a healthy boy with a grade 3 midsystolic ejection murmur at the second intercostal space that does not disappear when he sits up. What is the most likely explanation for this patient’s findings?? {'A': 'Defect of the septum secundum', 'B': 'Failure of the septum primum to fuse with the endocardial cushions', 'C': 'Inflammation of the visceral and parietal pericardium', 'D': 'Physiologic conditions outside the heart', 'E': 'Prolonged patency of the ductus arteriosus'}, | A: Defect of the septum secundum |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman presents to the emergency department with palpitations for the last hour. This is her 3rd emergency department visit in the last 8 weeks due to the same complaint. She denies fever, shortness of breath, nasal discharge, bowel changes, weight loss, and heat intolerance. She has asthma that is poorly controlled despite regular inhaler use. She drinks a cup of coffee each morning, and she is physically active and jogs for at least 30 minutes daily. She is in a monogamous relationship with her boyfriend and regularly uses barrier contraceptives. Her last menses was 1 week ago. Physical examination reveals: blood pressure 104/70 mm Hg, pulse 194 /min that is regular, and respiratory rate 18/min. Her ECG is shown in the image. A gentle massage over the carotid artery for 5–10 seconds did not terminate her palpitations. What is the most appropriate next step in the management of this patient?? {'A': 'Adenosine', 'B': 'Amiodarone', 'C': 'Digoxin', 'D': 'Propranolol', 'E': 'Verapamil'}, | E: Verapamil |
Answer the following medical question with one of the provided options: | Q:One day after a 4700-g (10-lb 6-oz) male newborn is delivered to a 28-year-old primigravid woman, he has bluish discoloration of his lips and fingernails. Oxygen saturation on room air is 81%. Examination shows central cyanosis. A continuous machine-like murmur is heard over the left upper sternal border. A single S2 heart sound is present. Supplemental oxygen does not improve cyanosis. Echocardiography shows the pulmonary artery arising from the posterior left ventricle and aorta arising from the right ventricle with active blood flow between the right and left ventricles. Further evaluation of the mother is most likely to show which of the following?? {'A': 'Prenatal lithium intake', 'B': 'Elevated serum TSH', 'C': 'Prenatal phenytoin intake', 'D': 'Positive rapid plasma reagin test', 'E': 'Elevated fasting blood glucose'}, | E: Elevated fasting blood glucose |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy with a history of severe, persistent asthma presents to the emergency department with severe shortness of breath and cough. He states that he was outside playing basketball with his friends, forgot to take his inhaler, and began to have severe difficulty breathing. On exam, he is in clear respiratory distress with decreased air movement throughout all lung fields. He is immediately treated with beta-agonists which markedly improve his symptoms. Prior to treatment, which of the following was most likely observed in this patient?? {'A': 'Inspiratory stridor', 'B': 'Increased breath sounds', 'C': 'Friction rub', 'D': "Kussmaul's sign", 'E': 'Pulsus paradoxus'}, | E: Pulsus paradoxus |
Answer the following medical question with one of the provided options: | Q:A 3670-g (8 lb 1 oz) male newborn is delivered to a 26-year-old primigravid woman. She received adequate prenatal care and labor was uncomplicated. She has chronic hepatitis B infection and gastroesophageal reflux disease. Her only medication is ranitidine. She admits to smoking cannabis and one half-pack of cigarettes daily. She drinks two beers on the weekend. The mother is apprehensive about taking care of her baby and requests for some information regarding breastfeeding. Which of the following is a contraindication to breastfeeding?? {'A': 'Ranitidine use', 'B': 'Hepatitis B infection', 'C': 'Seropositive for cytomegalovirus', 'D': 'Cannabis use', 'E': 'Smoking\n"'}, | D: Cannabis use |
Answer the following medical question with one of the provided options: | Q:A 35-year-old male is picked up by paramedics presenting with respiratory depression, pupillary constriction, and seizures. Within a few minutes, the male dies. On autopsy, fresh tracks marks are seen on both arms. Administration of which of the following medications would have been appropriate for this patient?? {'A': 'Methadone', 'B': 'Naloxone', 'C': 'Diazepam', 'D': 'Flumazenil', 'E': 'Buproprion'}, | B: Naloxone |
Answer the following medical question with one of the provided options: | Q:A 3900-g (8.6-lb) newborn is delivered at 38 week' gestation to a 27-year-old woman, gravida 3, para 2, via spontaneous vaginal delivery. Immediately after delivery, he spontaneously cries, grimaces, and moves all four extremities. Over the next five minutes, he becomes cyanotic, dyspneic, and tachypneic. Mask ventilation with 100% oxygen is begun, but ten minutes after delivery the baby continues to appear cyanotic. His temperature is 37.2°C (99.0°F), pulse is 155/min, respirations are 65/min, and blood pressure is 90/60 mm Hg. Pulse oximetry on 100% oxygen mask ventilation shows an oxygen saturation of 83%. Breath sounds are normal on the right and absent on the left. Heart sounds are best heard in the right midclavicular line. The abdomen appears concave. An x-ray of the chest is shown below. Which of the following is the most appropriate initial step in the management of this patient?? {'A': 'Extracorporeal life support', 'B': 'Surfactant administration', 'C': 'Surgical repair', 'D': 'Chest tube placement', 'E': 'Intubation and mechanical ventilation\n"'}, | E: Intubation and mechanical ventilation " |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is being seen by student health for a sports physical. He denies any recent injuries. He reports that he is doing well in his classes. He fractured his left collar bone 3 years ago, which required open reduction and internal fixation. He has not had any other surgeries. He takes no medications. His father and his paternal grandfather have hypertension. When asked about his mother, the patient tears up and he quickly begins talkig about how excited he is for baseball tryouts. He has a chance this year to be in the starting lineup if, “I just stay focused.” From previous records, the patient’s mother died of ovarian cancer 6 months ago. Which of the following defense mechanisms is the patient exhibiting?? {'A': 'Denial', 'B': 'Displacement', 'C': 'Rationalization', 'D': 'Repression', 'E': 'Suppression'}, | E: Suppression |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the emergency department by his parents with complaints of severe muscle cramping and abdominal pain. They live in Virginia. The parents state that about 2 hours before, the child was playing in their outdoor shed when he suddenly ran inside crying, saying he was bitten by a bug. One hour following the bite, the child developed the symptoms of cramping and pain. He has no known medical history and takes no medications. His blood pressure is 132/86 mm Hg, the heart rate is 116/min, and the respiratory rate is 20/min. Vital signs reveal tachycardia and hypertension. On exam, there is a 1 cm area of erythema to the dorsum of his right hand without any further dermatologic findings. Palpation of his abdomen reveals firm rigidity but no discernable rebound tenderness. What arthropod is most likely responsible for his symptoms?? {'A': 'Brown recluse', 'B': 'Black widow', 'C': 'Bark scorpion', 'D': 'Cryptopid centipede', 'E': 'Tick'}, | B: Black widow |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man presents to his primary care provider complaining of bilateral calf cramping with walking for the past 7 months. His pain goes away when he stops walking; however, his condition affects his work as a mail carrier. His medical history is remarkable for type 2 diabetes mellitus, hyperlipidemia, and 25-pack-year smoking history. His ankle-brachial index (ABI) is found to be 0.70. The patient is diagnosed with mild to moderate peripheral artery disease. A supervised exercise program for 3 months, aspirin, and cilostazol are started. Which of the following is the best next step if the patient has no improvement?? {'A': 'Heparin', 'B': 'Pentoxifylline', 'C': 'Revascularization', 'D': 'Amputation', 'E': 'Surgical decompression'}, | C: Revascularization |
Answer the following medical question with one of the provided options: | Q:A 66-year-old female with hypertension and a recent history of acute ST-elevation myocardial infarction (STEMI) 6 days previous, treated with percutaneous transluminal angioplasty (PTA), presents with sudden onset chest pain, shortness of breath, diaphoresis, and syncope. Vitals are temperature 37°C (98.6°F), blood pressure 80/50 mm Hg, pulse 125/min, respirations 12/min, and oxygen saturation 92% on room air. On physical examination, the patient is pale and unresponsive. Cardiac exam reveals tachycardia and a pronounced holosystolic murmur loudest at the apex and radiates to the back. Lungs are clear to auscultation. Chest X-ray shows cardiomegaly with clear lung fields. ECG is significant for ST elevations in the precordial leads (V2-V4) and low-voltage QRS complexes. Emergency transthoracic echocardiography shows a left ventricular wall motion abnormality along with a significant pericardial effusion. The patient is intubated, and aggressive fluid resuscitation is initiated. What is the next best step in management?? {'A': 'Intra-aortic balloon counterpulsation', 'B': 'Administer dobutamine 70 mcg/min IV', 'C': 'Emergency pericardiocentesis', 'D': 'Immediate transfer to the operating room', 'E': 'Immediate cardiac catheterization'}, | D: Immediate transfer to the operating room |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the physician because of a 5-week history of pain in his left thigh. The mother reports that her son fell from a ladder while playing with friends about a month and a half ago. He had a runny nose 3 weeks ago. He has no history of serious illness. He has reached all developmental milestones for his age. His immunizations are up-to-date. His 7-year-old brother has asthma. He is at 60th percentile for height and 65th percentile for weight. He appears healthy. His temperature is 37.1°C (98.8°F), pulse is 88/min, respirations are 17/min, and blood pressure is 110/70 mm Hg. Examination shows a mild left-sided antalgic gait. The left groin is tender to palpation; abduction and internal rotation are limited by pain. The remainder of the physical examination shows no abnormalities. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 8,800/mm3, and platelet count is 230,000/mm3. An x-ray of the pelvis shows a left femoral epiphysis that is smaller than the right with widening of the medial joint space on the left. The femoral head shows little discernible damage. Which of the following is the most appropriate next step in management?? {'A': 'Femoral osteotomy', 'B': 'Oral hydroxyurea', 'C': 'Casting and bracing', 'D': 'Femoral head pinning', 'E': 'Limited weight bearing and physical therapy'}, | E: Limited weight bearing and physical therapy |
Answer the following medical question with one of the provided options: | Q:A 69-year-old man presents for a general follow up appointment. He states that he is doing well and wants to be sure he is healthy. The patient’s past medical history is significant for type II diabetes mellitus, peripheral vascular disease, and hypertension. His current medications include metformin, glyburide, lisinopril, metoprolol and hydrochlorothiazide. His blood pressure is 130/90 mmHg and pulse is 80/min. A fasting lipid panel was performed last week demonstrating an LDL of 85 mg/dL and triglycerides of 160 mg/dL. The patient states that he has not experienced any symptoms since his last visit. The patient’s blood glucose at this visit is 100 mg/dL. Which of the following is recommended in this patient?? {'A': 'Increase lisinopril dose', 'B': 'Increase HCTZ dose', 'C': 'Increase metformin dose', 'D': 'Begin statin therapy', 'E': 'Discontinue metoprolol and start propranolol'}, | D: Begin statin therapy |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency department with loss of consciousness. The patient was brought in 20 minutes ago by the supervisor at a homeless shelter who found him passed out next to a bottle of acetaminophen. The patient has a past medical history of HIV, hepatitis C, IV drug abuse, alcohol abuse, suicide attempt, and constipation. He takes methadone daily but is notably non-compliant with his anti-retroviral therapy. His temperature is 104°F (40°C), blood pressure is 85/40 mmHg, pulse is 180/min, respirations are 18/min, and oxygen saturation is 90% on room air. The patient is started on IV fluids, N-acetylcysteine, and 100% oxygen. Blood cultures are obtained, and lab work is sent off. The patient is then started on broad spectrum antibiotics and given norepinephrine. Repeat vitals demonstrate hypotension and tachycardia. Serum toxicology returns and is positive for alcohol. The patient is transferred to the medicine floor and managed further. Two days later, the patient's vitals have improved. Repeat lab values are ordered and return as follows: Hemoglobin: 11 g/dL Hematocrit: 30% Leukocyte count: 6,500 cells/mm^3 with normal differential Platelet count: 245,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 100 mEq/L K+: 4.1 mEq/L HCO3-: 22 mEq/L BUN: 30 mg/dL Glucose: 145 mg/dL Creatinine: 1.4 mg/dL Ca2+: 9.6 mg/dL AST: 1,440 U/L ALT: 1,350 U/L Which of the following is the best explanation for this patient’s laboratory abnormalities?? {'A': 'Alcohol abuse', 'B': 'Antibiotic use', 'C': 'Chronic viral infection', 'D': 'Previous hypotension', 'E': 'Toxic liver metabolite'}, | D: Previous hypotension |
Answer the following medical question with one of the provided options: | Q:A father brings his 1-year-old son into the pediatrician's office for a routine appointment. He states that his son is well but mentions that he has noticed an intermittent bulge on the right side of his son's groin whenever he cries or strains for bowel movement. Physical exam is unremarkable. The physician suspects a condition that may be caused by incomplete obliteration of the processus vaginalis. Which condition is caused by the same defective process?? {'A': 'Femoral hernia', 'B': 'Hydrocele', 'C': 'Varicocele', 'D': 'Diaphragmatic hernia', 'E': 'Testicular torsion'}, | B: Hydrocele |
Answer the following medical question with one of the provided options: | Q:A 42-year-old man comes to the physician because of a 3-week history of rash that began on his right ankle and gradually progressed up his calf. The rash is itchy and mildly painful. He has type 2 diabetes mellitus and hypertension. He does not smoke or drink alcohol. His current medications include metformin, glipizide, and enalapril. He returned from a trip to Nigeria around 5 weeks ago. He works on a fishing trawler. His temperature is 37°C (98.6°F), pulse is 65/min, and blood pressure is 150/86 mm Hg. Other than the rash on his calf, the examination shows no abnormalities. A picture of the rash is shown. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Contact dermatitis', 'B': 'Cutaneous larva migrans', 'C': 'Tinea', 'D': 'Superficial thrombophlebitis', 'E': "Swimmer's itch"}, | B: Cutaneous larva migrans |
Answer the following medical question with one of the provided options: | Q:A 64-year-old woman comes to the emergency room because of a sudden weakness in her right arm and leg. She has atrial fibrillation, tinea unguium, gastroesophageal reflux disease, hypertension, and hypercholesterolemia. Current medications include warfarin, enalapril, simvastatin, lansoprazole, hydrochlorothiazide, griseofulvin, and ginkgo biloba. Two weeks ago, she had an appointment with her podiatrist. Physical examination shows sagging of her right lower face and decreased muscle strength in her right upper and lower extremity. Babinski sign is positive on the right. Her prothrombin time is 14 seconds (INR = 1.5). Which of the following drugs is the most likely underlying cause of this patient's current condition?? {'A': 'Ginkgo biloba', 'B': 'Simvastatin', 'C': 'Enalapril', 'D': 'Lansoprazole', 'E': 'Griseofulvin'}, | E: Griseofulvin |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man is accompanied by his wife to the primary care clinic for hand tremors. He states that he first noticed the tremor of his left hand 1 year ago. Since then, the tremor has been worsening and now he can hardly relax when trying to read. His wife says that she is also worried about his memory. She had to take over the finances several weeks ago after learning that he had forgotten to pay the bills for the past few months. The patient’s medical history is significant for hypertension. He takes aspirin and amlodipine. His mother had schizophrenia. The patient drinks 1-2 beers a night and is a former cigar smoker. On physical examination, he speaks softly and has reduced facial expressions. He has a resting tremor that is worse on the left, and he resists manipulation of his bilateral upper extremities. Which of the following is the most likely diagnosis?? {'A': 'Essential tremor', 'B': 'Dementia with Lewy bodies', 'C': 'Parkinson disease', 'D': 'Progressive supranuclear palsy', 'E': 'Tardive dyskinesia'}, | C: Parkinson disease |
Answer the following medical question with one of the provided options: | Q:A 69-year-old woman comes to the physician because of a 3-week history of headache and worsening vision. Ophthalmologic examination shows a visual acuity of 20/120 in the right eye and 20/80 in the left eye. Physical examination shows no other abnormalities. Laboratory studies show a hemoglobin of 14.2 g/dL and total serum calcium of 9.9 mg/dL. A photomicrograph of a peripheral blood smear is shown. Serum electrophoresis shows increased concentration of a pentameric immunoglobulin. Which of the following is the most likely diagnosis?? {'A': 'Multiple myeloma', 'B': 'Hyper IgM syndrome', 'C': 'Essential thrombocythemia', 'D': 'Waldenstrom macroglobulinemia', 'E': 'Giant cell arteritis'}, | D: Waldenstrom macroglobulinemia |
Answer the following medical question with one of the provided options: | Q:A 55-year-old male bodybuilder presents to the emergency department with weakness of his right arm. The patient states he has experienced these symptoms for a few weeks; however, today his hand felt so weak he dropped his cup of tea. The patient has a past medical history of diabetes. He drinks 2-7 alcoholic drinks per day and has smoked 2 packs of cigarettes per day since he was 25. The patient admits to using anabolic steroids. He has lost 17 pounds since he last came to the emergency department 1 month ago. His temperature is 99.5°F (37.5°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals decreased sensation in the right arm and 2/5 strength in the right arm and 5/5 strength in in the left arm. The patient states that he is experiencing a dull aching and burning pain in his right arm during the exam. Which of the following is the most likely diagnosis?? {'A': 'Apical lung tumor', 'B': 'Brachial plexopathy', 'C': 'Cerebral infarction', 'D': 'Scalenus anticus syndrome', 'E': 'Subclavian steal syndrome'}, | A: Apical lung tumor |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman comes to the emergency department because of abdominal pain, fever, nausea, and vomiting for 12 hours. Her abdominal pain was initially dull and diffuse but has progressed to a sharp pain on the lower right side. Two years ago she had to undergo right salpingo-oophorectomy after an ectopic pregnancy. Her temperature is 38.7°C (101.7°F). Physical examination shows severe right lower quadrant tenderness with rebound tenderness; bowel sounds are decreased. Laboratory studies show leukocytosis with left shift. An abdominal CT scan shows a distended, edematous appendix. The patient is taken to the operating room for an appendectomy. During the surgery, the adhesions from the patient's previous surgery make it difficult for the resident physician to identify the appendix. Her attending mentions that she should use a certain structure for guidance to locate the appendix. The attending is most likely referring to which of the following structures?? {'A': 'Deep inguinal ring', 'B': 'Teniae coli', 'C': 'Ileocolic artery', 'D': 'Right ureter', 'E': 'Epiploic appendages'}, | B: Teniae coli |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man presents to the emergency department after a car accident. He was the front seat restrained driver in a head-on collision. He has no significant past medical history. The patient’s vitals are stabilized and he is ultimately discharged with his injuries appropriately treated. At the patient’s follow up primary care appointment, he complains of being unable to lift his left foot. He otherwise states that he feels well and is not in pain. His vitals are within normal limits. Physical exam is notable for 1/5 strength upon dorsiflexion of the patient’s left foot, and 5/5 plantarflexion of the same foot. Which of the following initial injuries most likely occurred in this patient?? {'A': 'Calcaneal fracture', 'B': 'Distal femur fracture', 'C': 'Fibular neck fracture', 'D': 'Lisfranc fracture', 'E': 'Tibial plateau fracture'}, | C: Fibular neck fracture |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man with no significant past medical history is brought in by ambulance after a witnessed seizure at home. On physical exam, temperature is 102.3 deg F (39.1 deg C), blood pressure is 90/62 mmHg, pulse is 118/min, and respirations are 25/min. He is unable to touch his chin to his chest and spontaneously flexes his hips with passive neck flexion. Appropriate empiric treatment is begun. CT head is unremarkable, and a lumbar puncture sample is obtained. Gram stain of the cerebrospinal fluid (CSF) reveals gram-positive diplococci. Which of the following would you expect to see on CSF studies?? {'A': 'Elevated opening pressure, elevated protein, elevated glucose', 'B': 'Elevated opening pressure, elevated protein, normal glucose', 'C': 'Elevated opening pressure, elevated protein, low glucose', 'D': 'Normal opening pressure, elevated protein, normal glucose', 'E': 'Normal opening pressure, normal protein, normal glucose'}, | C: Elevated opening pressure, elevated protein, low glucose |
Answer the following medical question with one of the provided options: | Q:A 25-year-old G1P0 woman at 33 weeks gestation presents to the obstetrician for an episode of postcoital spotting. The patient’s pregnancy is complicated by diet-controlled gestational diabetes. She has no other medical conditions. She takes prenatal vitamins. She denies tobacco, alcohol, or recreational drug use. She is currently sexually active with her boyfriend of 1 year, but prior to her current relationship, she states she had multiple male partners. On physical examination, no vaginal bleeding is appreciated. The cervix is closed, and there is no leakage of fluid or contractions. Fetal movement is normal. Fundal height is 33 cm. Fetal pulse is 138/min. The patient’s temperature is 37.0 °C (98.6°F), blood pressure is 112/75 mm Hg, and pulse is 76/min. A urine dipstick is negative for glucose and protein. Chlamydia trachomatis nucleic acid amplification testing is positive. Which of the following is the mechanism behind the first-line treatment for this patient’s condition?? {'A': 'Disrupts peptidoglycan cross-linking', 'B': 'Inhibits DNA gyrase', 'C': 'Inhibits the 30S ribosome subunit', 'D': 'Inhibits the 50S ribosome subunit', 'E': 'Inhibits transpeptidase and cell wall synthesis'}, | D: Inhibits the 50S ribosome subunit |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman comes to the physician because of a 2-day history of severe burning pain with urination, and urinary frequency. She has no history of serious illness. The patient and her husband are currently trying to conceive a child. Her only medication is a prenatal multivitamin. Her temperature is 36.5°C (97.7°F), pulse is 75/min, and blood pressure is 125/78 mm Hg. Examination shows mild tenderness to palpation over the suprapubic region. There is no costovertebral angle tenderness. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.8 g/dL Leukocyte count 8,200/mm3 Platelet count 230,000/mm3 Urine pH 7 WBC 52/hpf RBC 17/hpf Protein negative Nitrites positive Leukocyte esterase positive A urine pregnancy test is negative. Which of the following is the most appropriate next step in management?"? {'A': 'Oral ciprofloxacin', 'B': 'Reassurance and follow-up in 2 weeks', 'C': 'Urinary catheterization', 'D': 'Oral fosfomycin', 'E': 'Urine culture\n"'}, | D: Oral fosfomycin |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man comes to the physician because of a 2-day history of blood in his urine, lower abdominal pain, and a burning sensation while micturating. Five months ago, he was diagnosed with high-grade non-Hodgkin lymphoma and a deep vein thrombosis of his right popliteal vein. His medications include polychemotherapy every 3 weeks and a daily subcutaneous dose of low molecular weight heparin. The last cycle of chemotherapy was 2 weeks ago. His temperature is 37°C (98.6°F), pulse is 94/min, and blood pressure is 110/76 mm Hg. Examination shows bilateral axillary and inguinal lymphadenopathy, hepatosplenomegaly, and mild suprapubic tenderness. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocytes 4,300/mm3 Platelet count 145,000/mm3 Partial thromboplastin time 55 seconds Prothrombin time 11 seconds (INR=1) Urine RBCs 50–55/hpf RBC casts negative WBCs 7/hpf Epithelial cells 5/hpf Bacteria occasional Administration of which of the following is most likely to have prevented this patient's current condition?"? {'A': 'Protamine sulfate', 'B': 'Mercaptoethane sulfonate', 'C': 'Palifermin', 'D': 'Ciprofloxacin', 'E': 'Dexrazoxane'}, | B: Mercaptoethane sulfonate |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman is upset with her neighbor for playing music too loudly late at night. Rather than confront her neighbor directly, the woman makes a habit of parking her car in a manner that makes it difficult for her neighbor to park in his spot. Which of the following defense mechanisms is this woman demonstrating?? {'A': 'Sublimation', 'B': 'Regression', 'C': 'Acting out', 'D': 'Displacement', 'E': 'Passive aggression'}, | E: Passive aggression |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man presents with feelings of sadness and low mood on most days of the week for the past month. He reports an inability to concentrate and also finds it hard to develop an interest in his daily activities. He goes on to tell his physician that he struggles to get sleep at night, and, in the morning, he doesn’t have the energy to get out of bed. He says he feels like a loser since he hasn’t accomplished all that he had set out to do and feels guilty for being unable to provide for his family. He says he doesn’t have the will to live anymore but denies any plans to commit suicide. Past medical history is significant for erectile dysfunction which was diagnosed about a year ago. Which of the following medications should be avoided in the treatment of this patient’s depression?? {'A': 'Vortioxetine', 'B': 'Fluoxetine', 'C': 'Bupropion', 'D': 'Mirtazapine', 'E': 'Vilazodone'}, | B: Fluoxetine |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman residing at an iodine-deficient endemic area presents to the physician with a painless and gradually progressive anterior neck mass. She has occasional dysphagia, but has no history of prior head and neck irradiation. The examination shows a mass that moves with deglutition, suggesting a thyroid mass. An ultrasound of the neck reveals a 3 cm x 3 cm (1.2 in x 1.2 in) mass in the right thyroid lobe with punctate microcalcifications, hypoechogenicity, irregular margins, and enhanced vascularity. There is no cervical lymphadenopathy. Her serum TSH is 3.3 mU/L, serum T3 is 2.2 nmol/L, and serum T4 is 111 nmol/L. An FNAC of the nodule shows abundant follicular cells suspicious of follicular neoplasm. A right lobectomy with isthmectomy is performed. Which of the following histopathological finding is diagnostic?? {'A': 'Presence of Psammoma bodies', 'B': 'Well-differentiated follicular cells without vascular invasion', 'C': 'Follicular cells that lack nuclear atypia, with capsular and vascular invasion', 'D': 'Hyperplastic parafollicular C cells', 'E': 'Highly undifferentiated malignant cells with areas of necrosis and inflammation'}, | C: Follicular cells that lack nuclear atypia, with capsular and vascular invasion |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl is brought to the physician because she has not yet had her first menstrual period. She reports that she frequently experiences cramping and pain in her legs during school sports. The patient is at the 20th percentile for height and 50th percentile for weight. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 155/90 mm Hg. Examination shows a high-arched palate with maloccluded teeth and a low posterior hairline. The patient has a broad chest with widely spaced nipples. Pelvic examination shows normal external female genitalia. There is scant pubic hair. Without appropriate treatment, this patient is at the greatest risk of developing which of the following complications?? {'A': 'Obsessive-compulsive disorder', 'B': 'Pathologic fractures', 'C': 'Pulmonary stenosis', 'D': 'Severe acne', 'E': 'Ectopia lentis'}, | B: Pathologic fractures |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man presents to the urgent clinic complaining of pain in his right foot. He reported that the pain is intense that he had to remove his shoe and sock, and rates the pain level as 6 out of 10. He does not report trauma or recent infection. The past medical history includes hypertension. The medications include hydrochlorothiazide, enalapril, and a daily multivitamin. The family history is noncontributory. He consumes alcohol in moderation. His diet mostly consists of red meat and white rice. The blood pressure is 137/85 mm Hg, heart rate is 74/min, respiratory rate is 12/min, and the temperature is 36.9°C (98.4°F). The physical examination demonstrates swelling, redness, and tenderness to palpation in the first metatarsophalangeal joint of his right foot. There are no skin lesions. The rest of the patient’s examination is normal. An arthrocentesis procedure is scheduled. Which of the following is the most likely pharmacological treatment for the presented patient?? {'A': 'Probenecid alone', 'B': 'Oral methylprednisolone and meloxicam', 'C': 'Allopurinol alone', 'D': 'Colchicine and celecoxib', 'E': 'Diclofenac alone'}, | E: Diclofenac alone |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man presents to the emergency department for a persistent fever. The patient states he has felt unwell for the past week and has felt subjectively febrile. The patient has a past medical history of a suicide attempt and alcohol abuse. He is not currently taking any medications. The patient admits to using heroin and cocaine and drinking 5-8 alcoholic drinks per day. His temperature is 103°F (39.4°C), blood pressure is 92/59 mmHg, pulse is 110/min, respirations are 20/min, and oxygen saturation is 96% on room air. Cardiopulmonary exam is notable for a systolic murmur heard best along the left sternal border. Dermatologic exam reveals scarring in the antecubital fossa. Which of the following is the next best step in management?? {'A': 'Blood cultures', 'B': 'Chest radiograph', 'C': 'CT scan', 'D': 'Ultrasound', 'E': 'Vancomycin and gentamicin'}, | A: Blood cultures |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man comes to the physician for evaluation of fever and a nonproductive cough for the past 2 weeks. During this period, he has also had fatigue, myalgia, and difficulty breathing. Five weeks ago, he underwent an aortic prosthetic valve replacement due to high-grade aortic stenosis. The patient has a history of hypertension, asthma, and type 2 diabetes mellitus. A colonoscopy 2 years ago was normal. The patient has smoked one pack of cigarettes daily for the past 40 years. He has never used illicit drugs. Current medications include aspirin, warfarin, lisinopril, metformin, inhaled albuterol, and a multivitamin. The patient appears lethargic. Temperature is 38.6°C (101.5°F), pulse is 105/min, and blood pressure is 140/60 mm Hg. Rales are heard on auscultation of the lungs. A grade 2/6, diastolic blowing murmur is heard over the left sternal border and radiates to the right sternal border. A photograph of his right index finger is shown. Laboratory studies show a leukocyte count of 13,800/mm3 and an erythrocyte sedimentation rate of 48 mm/h. Which of the following is the most likely causal organism?? {'A': 'Streptococcus gallolyticus', 'B': 'Staphylococcus epidermidis', 'C': 'Enterococcus faecalis', 'D': 'Viridans streptococci', 'E': 'Streptococcus pyogenes'}, | B: Staphylococcus epidermidis |
Answer the following medical question with one of the provided options: | Q:A 42-year-old man presents to his primary care provider complaining of insomnia. He describes 3 months of frequent nighttime awakenings and nightmares. Per chart review, he is a combat veteran and was on a military tour in Afghanistan 4 months ago when a car bomb exploded, injuring him and killing his friend; however, when the physician asks about this, the patient states that he “does not talk about that” and changes the subject. He reports anxiety, irritability and feeling detached from his friends and family, which he believes is harming his relationships. Physical exam reveals an overweight, anxious appearing man with normal vital signs and an exaggerated startle response. Which of the following medications might have helped prevent this patient’s current disorder?? {'A': 'Buspirone', 'B': 'Prazosin', 'C': 'Propanolol', 'D': 'Sertraline', 'E': 'Zolpidem'}, | C: Propanolol |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man presents with fatigue and weight loss for the past 4 months. He feels tired all the time. He also no longer feels interested in his work. He says he has lost weight and says, "I just don’t want to eat." No significant past medical history. No current medications. Physical examination is unremarkable. The patient is started on sertraline. He returns for follow-up after 2 weeks and says that he has been compliant with his medications. He says that he is now getting a full night’s sleep with no early morning awakenings. Despite regaining his appetite, he hasn’t regained any lost weight, and he still feels fatigued. He believes that the medication is not working well and asks to be started on something else. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Replace sertraline with fluoxetine', 'B': 'Discontinue sertraline', 'C': 'Continue sertraline', 'D': 'Add fluoxetine to sertraline', 'E': 'Add amitriptyline to sertraline'}, | C: Continue sertraline |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man presents to the physician with fever, cough, weakness, night sweats, and poor appetite for the past 6 months. Medical records suggest that he has lost 7.5 kg (16.5 lb) of weight during this period. There is no history of breathlessness, nasal discharge, nasal obstruction, palpitations, chest pain, or symptoms related to digestion. He was released from prison 9 months ago after serving a 2-year sentence. His temperature is 38.1°C (100.6°F), pulse is 84/min, respirations are 16/min, and blood pressure is 122/80 mm Hg. Physical examination shows hepatomegaly and generalized lymphadenopathy, and auscultation of the chest reveals diffuse crackles throughout the lung fields bilaterally. On direct ophthalmoscopy, three discrete, yellow-colored, 0.5 mm to 1.0 mm lesions with indistinct borders are seen in the posterior pole. A chest X-ray is shown in the image. Tuberculin skin test with purified protein derivative is negative. What is the most likely diagnosis?? {'A': 'Sarcoidosis', 'B': 'Chronic histoplasmosis', 'C': 'Langerhans cell histiocytosis', 'D': 'Tuberculosis', 'E': 'Bronchoalveolar carcinoma'}, | D: Tuberculosis |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man seeks evaluation from his physician with concerns about his blood pressure. He was recently told at a local health fair that he has high blood pressure. He has not seen a physician since leaving college because he never felt the need for medical attention. Although he feels fine, he is concerned because his father had hypertension and died due to a heart attack at 61 years of age. He does not smoke cigarettes but drinks alcohol occasionally. The blood pressure is 150/90 mm Hg today. The physical examination is unremarkable. Labs are ordered and he is asked to monitor his blood pressure at home before the follow-up visit. Two weeks later, the blood pressure is 140/90 mm Hg. The blood pressure measurements at home ranged from 130/90 to 155/95 mm Hg. An electrocardiogram (ECG) is normal. Lab tests show the following: Serum glucose (fasting) 88 mg/dL Serum electrolytes: Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dL Blood urea nitrogen 10 mg/dL Cholesterol, total 250 mEq/L HDL-cholesterol 35 mEq/L LDL-cholesterol 186 mg/dL Triglycerides 250 mg/dL Urinalysis: Glucose negative Ketones negative Leucocytes negative Nitrite negative RBC negative Casts negative Regular exercise and a 'heart healthy diet' are advised. He is started on lisinopril for hypertension. Which of the following medications should be added to this patient?? {'A': 'Atorvastatin', 'B': 'Niacin', 'C': 'Gemfibrozil', 'D': 'Orlistat', 'E': 'Cholestyramine'}, | A: Atorvastatin |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman comes to the physician for a routine examination. She has one sexual partner, with whom she had unprotected sexual intercourse 3 days ago. She does not desire a pregnancy and is interested in a reliable and long-term contraceptive method. She has read in detail about the reliability, adverse-effects, health risks, and effective duration of intrauterine devices (IUD) as a birth control method. She requests the physician to prescribe and place an IUD for her. The physician feels that providing contraception would be a violation of her religious beliefs. Which of the following responses by the physician is most appropriate?? {'A': '“Prescribing any means of contraception is against my religious beliefs, but as a doctor, I am obliged to place the IUD for you.”', 'B': '“I need to discuss this with my pastor before I decide whether to insert an IUD, as this is against my religious beliefs.”', 'C': '“I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.”', 'D': '“I understand your concerns, but I cannot place the IUD for you due to my religious beliefs. I recommend you use condoms instead.', 'E': '“First, I would like to perform an STD panel since you are sexually active.”'}, | C: “I can understand your need for the IUD, but I cannot place it for you due to my religious beliefs. I would be happy to refer you to a colleague who could do it.” |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman was found lying down and unresponsive by her parents 2 hours ago. She has no significant medical history. Two years ago, the woman discovered that her husband of 8 years was having an extramarital affair; this revelation subsequently resulted in a drawn-out divorce. After the separation, she moved back in with her parents, who note that she stays in her room, sleeps a lot, and rarely eats. A physical exam shows obtundation. Her temperature is 37.1ºC (98.7ºF), pulse is 110/min, respirations are 24/min, and blood pressure is 126/78 mm Hg. The patient’s admission labs are as follows: TSH 3.2 µU/mL Morning cortisol 8 µg/dL Prolactin 15 ng/mL FSH 7 mIU/mL LH 6 mIU/mL Glucose 22 mg/dL C-peptide not detected Beta-hydroxybutyrate ≤ 2.7 mmol/L Which of the following is most true of the cell type that is likely involved in the production of the molecule causing this patient’s symptoms?? {'A': 'Contains M3 receptors that stimulate Gq in response to parasympathetic innervation', 'B': 'Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar', 'C': 'Located in the periphery of islets of Langerhans', 'D': 'Located in zona fasciculata of the adrenal cortex', 'E': 'Gram-negative enteric bacillus; urease-positive, oxidase-positive, can be identified by silver stain'}, | B: Gram-negative enteric bacillus; catalase-positive, oxidase-negative, turns pink on MacConkey agar |
Answer the following medical question with one of the provided options: | Q:A 46-year-old female is brought to the emergency department by her husband 1 hour after the onset of chest palpitations. Her symptoms began suddenly while she was drinking coffee and have persisted since then. She has not had shortness of breath, chest pain, dizziness, or loss of consciousness. She has experienced these palpitations before, but they typically resolve spontaneously within a few minutes. She has no history of serious illness and takes no medications. Her temperature is 36.8°C (98.2°F), pulse is 155/min, respirations are 18/min, and blood pressure is 130/82 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Physical examination shows no abnormalities other than tachycardia. An ECG is shown. Repeated, forceful exhalation against a closed glottis while supine fails to relieve her symptoms. Which of the following is the most appropriate next step in management?? {'A': 'Administer adenosine intravenously', 'B': 'Administer verapamil intravenously', 'C': 'Electrical cardioversion', 'D': 'Administer digoxin intravenously', 'E': 'Administer diltiazem intravenously'}, | A: Administer adenosine intravenously |
Answer the following medical question with one of the provided options: | Q:A 15-year-old boy is brought to the office by his mother with complaints of facial puffiness and smoky urine. The mother noticed puffiness on her son’s face a week ago, and it has been progressively worsening since then. She also states that her son had a sore throat 3 weeks ago. The patient does not have fever/chills, changes in urinary frequency, or abdominal discomfort. On physical examination, facial edema is noted. The vital signs include: blood pressure 145/85 mm Hg, pulse 96/min, temperature 36.7°C (98.1°F), and respiratory rate 20/min. A complete blood count report shows: Hemoglobin 10.1 g/dL RBC 4.9 million cells/µL Hematocrit 46% Total leukocyte count 6,800 cells/µL Neutrophils 70% Lymphocytes 26% Monocytes 3% Eosinophil 1% Basophils 0% Platelets 210,000 cells/µL ESR 18 mm (1st hour) Urinalysis shows: pH 6.4 Color dark brown RBC plenty WBC 3–4/HPF Protein absent Cast RBC and granular casts Glucose absent Crystal none Ketone absent Nitrite absent Which of the following laboratory findings can be expected in this patient?? {'A': 'Normal erythrocyte sedimentation rate', 'B': 'Decreased serum creatinine', 'C': 'Positive streptozyme test', 'D': 'Increased C3 level', 'E': 'Negative antistreptolysin O (ASO) titer'}, | C: Positive streptozyme test |
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