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Answer the following medical question with one of the provided options: | Q:A 32-year-old African American man presents to the office for a routine examination. He has no complaints at this time. Records show that his systolic blood pressure was in the 130–138 range and diastolic blood pressure in the 88–95 range despite counseling on lifestyle modification. He admits that he was not compliant with this advice. He takes no medications and works at home as a web designer. He does not drink alcohol but smokes marijuana on a weekly basis. Temperature is 37°C (98.6°F), blood pressure is 138/90 mm Hg, pulse is 76/min, and respirations are 12/min. BMI is 29.8 kg/m2. Physical examination is normal except for truncal obesity, with a waist circumference of 44 inches. Fasting laboratory results are as follows: Blood glucose 117 mg/dL Total cholesterol 210 mg/dL LDL cholesterol 120 mg/dL HDL cholesterol 38 mg/dL Triglycerides 240 mg/dL Which of the following mechanisms contribute to this patient’s condition?? {'A': 'Granulomatous inflammation in medium-sized vessels', 'B': 'Autoimmune destruction of pancreatic beta cells', 'C': 'Insulin receptor resistance', 'D': 'LDL receptor gene mutation', 'E': 'Excessive cortisol secretion and activity'}, | C: Insulin receptor resistance |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man is brought by his wife with a complaint of an ongoing progressive history of memory problems for 6 months. He is an accountant by profession. He has difficulty remembering things and events, which has affected his job. He began using a diary to aid with remembering his agenda. His wife also says that he has wet his pants multiple times in the past 2 months and he avoids going out. He has been smoking 1 pack of cigarettes daily for the past 20 years. His past medical history is unremarkable. The vital signs include: blood pressure of 134/76 mm Hg, a pulse of 70 per minute, and a temperature of 37.0°C (98.6°F). His mini-mental state examination (MMSE) result is 22/30. His extraocular movements are normal. The muscle tone and strength are normal in all 4 limbs. The sensory examination is unremarkable. He has an absent Romberg’s sign. He walks slowly, taking small steps, with feet wide apart as if his feet are stuck to the floor. The CT scan of the head is shown in the image. What is the most likely diagnosis of the patient?? {'A': 'Early-onset Alzheimer’s disease', 'B': 'Frontotemporal dementia', 'C': 'Normal-pressure hydrocephalus', 'D': 'Parkinson’s disease', 'E': 'Progressive supranuclear palsy'}, | C: Normal-pressure hydrocephalus |
Answer the following medical question with one of the provided options: | Q:A 69-year-old man presents with granulomatosis with polyangiitis diagnosed about 8 months ago. He was treated appropriately and states that his symptoms are well controlled. He is presenting today for a general follow up visit. His temperature is 99.0°F (37.2°C), blood pressure is 184/104 mmHg, pulse is 88/min, respirations are 12/min, and oxygen saturation is 98% on room air. His physical examination is notable for the findings in Figures A and B. Which of the following would be found in this patient on serum laboratory studies?? {'A': 'Hyperkalemia and metabolic acidosis', 'B': 'Hyperkalemia and metabolic alkalosis', 'C': 'Hypokalemia and metabolic acidosis', 'D': 'Hypokalemia and metabolic alkalosis', 'E': 'Hypokalemia and normal acid-base status'}, | D: Hypokalemia and metabolic alkalosis |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the emergency department because of left-sided chest pain and difficulty breathing for the past 30 minutes. His pulse is 88/min. He is pale and anxious. Serum studies show increased cardiac enzymes. An ECG shows ST-elevations in leads I, aVL, and V5-V6. A percutaneous coronary intervention is performed. In order to localize the site of the lesion, the catheter must pass through which of the following structures?? {'A': 'Left coronary artery → left circumflex artery', 'B': 'Right coronary artery → right marginal artery', 'C': 'Left coronary artery → posterior descending artery', 'D': 'Right coronary artery → posterior descending artery', 'E': 'Left coronary artery → left anterior descending artery'}, | A: Left coronary artery → left circumflex artery |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman, gravida 1, para 0, at 20 weeks' gestation comes to the physician for genetic counseling. Her brother and maternal uncle both have anemia that worsens after taking certain medications. Based on the pedigree shown, what is the probability that her son will be affected by the disease?? {'A': '25%', 'B': '0%', 'C': '100%', 'D': '12.5%', 'E': '50%\n"'}, | A: 25% |
Answer the following medical question with one of the provided options: | Q:A 75-year-old woman with late-onset autoimmune diabetes mellitus, rheumatoid arthritis, coronary artery disease, and idiopathic pulmonary fibrosis presents to the ship medic with altered mental status. While on her current cruise to the Caribbean islands, she experienced nausea, vomiting, and diarrhea. She takes aspirin, simvastatin, low-dose prednisone, glargine, and aspart. She is allergic to amoxicillin and shellfish. She works as a greeter at a warehouse and smokes 5 packs/day. Her temperature is 100.5°F (38.1°C), blood pressure is 90/55 mmHg, pulse is 130/min, and respirations are 30/min. Her pupils are equal and reactive to light bilaterally. Her lungs are clear to auscultation bilaterally, but her breath has a fruity odor. She has an early systolic murmur best appreciated at the left upper sternal border. She has reproducible peri-umbilical tenderness. Which of the following will most likely be present in this patient?? {'A': 'Respiratory acidosis and contraction metabolic alkalosis', 'B': 'Respiratory alkalosis and non-contraction metabolic alkalosis', 'C': 'Respiratory alkalosis and anion-gap metabolic acidosis', 'D': 'Respiratory alkalosis and non anion-gap metabolic acidosis', 'E': 'Respiratory acidosis and anion-gap metabolic acidosis'}, | C: Respiratory alkalosis and anion-gap metabolic acidosis |
Answer the following medical question with one of the provided options: | Q:A 31-year-old man is referred to a neurologist due to his gradually increasing eccentric behavior and involuntary movements, especially the movements of his arms and hands. He also has difficulty with his short-term memory. Past medical history is otherwise noncontributory. His father had similar symptoms before he died but those symptoms started at the age of 33. His blood pressure is 125/92 mm Hg, pulse is 90/min, respiratory rate 12/min, and temperature is 36.6°C (97.9°F). Physical exam reveals involuntary writhing movements of hands, slow eye movements, and sporadic rigidity. The physician explains that this is an inherited disorder where the symptoms occur progressively at an earlier age than the parent and often with increased severity in the future generations. Which of the following is the most likely diagnosis of this patient?? {'A': "Huntington's disease", 'B': 'Friedreich ataxia', 'C': 'Myotonic dystrophy', 'D': "Wilson's disease", 'E': 'Neurofibromatosis'}, | A: Huntington's disease |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician for evaluation prior to parathyroidectomy. A Tc99m-sestamibi scan shows two spots of increased uptake in the superior mediastinum. These spots represent structures that are most likely derived from which of the following embryological precursors?? {'A': '4th branchial pouch', 'B': '3rd branchial pouch', 'C': '2nd branchial arch', 'D': '4th branchial arch', 'E': '3rd branchial arch'}, | B: 3rd branchial pouch |
Answer the following medical question with one of the provided options: | Q:A 45-year-old obese man presents to his primary care provider for an annual physical. The patient states that he has noticed increased sleepiness during the day at work over the past 6 months in addition to difficulty concentrating and worsening memory. He denies recent weight loss, and is not sure if he snores because he sleeps by himself. His past medical history is significant for hypertension and type II diabetes. Vital signs are T 98.6 F, HR 75 bpm, BP 140/90 mm Hg, RR 18/min. Physical exam reveals a 350 pound man. Jugular venous distension is difficult to evaluate due to excess tissue in the neck. There is no peripheral edema. Lung exam is normal. Routine CBC shows WBC count of 5000 cells/ml, platelet count of 350,000/mcL, hemoglobin of 18 gm/dL, and hematocrit of 54%. What is the most likely cause of his abnormal lab results?? {'A': 'Cor pulmonale', 'B': 'Malignancy', 'C': 'Diuretic overuse', 'D': 'JAK2 mutation', 'E': 'Sleep apnea'}, | E: Sleep apnea |
Answer the following medical question with one of the provided options: | Q:A new assay for Lyme disease has been developed. While the assay has been tested extensively in Maine, a group of inventors are planning to test it in Southern California. In comparison to the assay's performance in Maine, testing the assay in Southern California would affect the performance of the assay in which of the following ways?? {'A': 'Decrease negative likelihood ratio of the Lyme disease assay', 'B': 'Lower likelihood that a patient without Lyme disease truly has a negative test', 'C': 'Greater likelihood that an individual with a positive test will truly have Lyme disease', 'D': 'Decreased positive likelihood ratio of the Lyme disease assay', 'E': 'Greater likelihood that an individual with a negative test will truly not have Lyme disease\n"'}, | E: Greater likelihood that an individual with a negative test will truly not have Lyme disease " |
Answer the following medical question with one of the provided options: | Q:A 68-year-old male is brought to the emergency department by his wife. An hour earlier, he dropped to the floor and began to violently shake his extremities. He urinated on the carpet and seemed confused for several minutes after. He is now feeling better. He has never experienced an episode like this before, nor does he think anyone in his family has. He and his wife are concerned that he has unintentionally lost 22.6 kg (50 lb) in the past 6 months. He has also been experiencing chest pain and has coughed up blood on a few occasions. He has a 50-pack-year smoking history and quit 2 years ago. His temperature is 36.8°C (98.2°F), heart rate is 98/min, respiratory rate is 15/min, blood pressure is 100/75 mm Hg, and he is O2 saturation is 100% on room air. The physical exam, including a full neurologic and cardiac assessment, demonstrates no abnormal findings. Edema, ascites, and skin tenting are notably absent. A brain MRI does not indicate areas of infarction or metastatic lesions. ECG is normal. Urine toxicology screen is negative. EEG is pending. Laboratory findings are shown below: BUN 15 mg/dL N: 7 to 20 mg/dL pCO2 40 mm Hg N: 35-45 mm Hg Creatinine 0.8 mg/dL N: 0.8 to 1.4 mg/dL Glucose 95 mg/dL N: 64 to 128 mg/dL Serum chloride 103 mmol/L N: 101 to 111 mmol/L Serum potassium 3.9 mEq/L N: 3.7 to 5.2 mEq/L Serum sodium 115 mEq/L N: 136 to 144 mEq/L Total calcium 2.3 mmol/L N: 2-2.6 mmol/L Magnesium 1.7 mEq/L N: 1.5-2 mEq/L Phosphate 0.9 mmol/L N: 0.8-1.5 mmol/L Hemoglobin 14 g/dL N: 13-17 g/dL (men), 12-15 g/dL (women) Glycosylated hemoglobin 5.5% N: 4%-6% Total cholesterol 4 mmol/L N: 3-5.5 mmol/L Bicarbonate (HCO3) 19 mmol/L N: 18-22 mmol/L What is indicated first?? {'A': 'Phenytoin', 'B': 'Valproic acid', 'C': 'Diazepam', 'D': 'Hypertonic saline', 'E': 'Chemotherapy'}, | D: Hypertonic saline |
Answer the following medical question with one of the provided options: | Q:One day after undergoing an open colectomy, a 65-year-old man with colon cancer experiences shivers. The procedure was originally scheduled to be done laparoscopically, but it was converted because of persistent bleeding. Besides the conversion, the operation was uneventful. Five years ago, he underwent renal transplantation because of cystic disease and has been taking prednisolone since then. He has a history of allergy to sulfonamides. He appears acutely ill. His temperature is 39.2°C (102.5°F), pulse is 120/min, respirations are 23/min, and blood pressure is 90/62 mm Hg. Abdominal examination shows a midline incision extending from the xiphisternum to the pubic symphysis. There is a 5-cm (2-in) area of purplish discoloration near the margin of the incision in the lower abdomen. Palpation of the abdomen produces severe pain and crackling sounds are heard. Laboratory studies show: Hemoglobin 12.5 g/dL Leukocyte count 18,600/mm3 Platelet count 228,000/mm3 Erythrocyte sedimentation rate 120 mm/h Serum Na+ 134 mEq/L K+ 3.5 mEq/L Cl- 98 mEq/L HCO3- 22 mEq/L Glucose 200 mg/dL Urea nitrogen 60 mg/dL Creatinine 3.2 mg/dL Creatine kinase 750 U/L Which of the following is the most appropriate next step in management?"? {'A': 'X-ray of the abdomen and pelvis', 'B': 'Vacuum-assisted wound closure device', 'C': 'Surgical debridement', 'D': 'CT scan of abdomen', 'E': 'Intravenous clindamycin therapy'}, | C: Surgical debridement |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the physician by his mother because of fever and left ear pain for the past 3 days. He has also been frequently rubbing his left ear since he woke up in the morning. He has a history of atopic dermatitis, and his mother is concerned that his symptoms may be caused by him itching at night. She says that he has not been having many flare-ups lately; the latest flare-up subsided in time for his second birthday party, which he celebrated at a swimming pool 1 week ago. Six months ago, he had an episode of urticaria following antibiotic treatment for pharyngitis. He takes no medications. His temperature is 38.5°C (101.3°F), pulse is 110/min, respirations are 25/min, and blood pressure is 90/50 mm Hg. Otoscopy shows an opaque, bulging tympanic membrane. Which of the following is the most appropriate next step in management?? {'A': 'Topical hydrocortisone and gentamicin eardrops', 'B': 'Oral azithromycin', 'C': 'Tympanostomy tube placement', 'D': 'Otic ofloxacin therapy', 'E': 'Tympanocentesis'}, | B: Oral azithromycin |
Answer the following medical question with one of the provided options: | Q:A 75-year-old Caucasian man presents to the emergency department with abdominal pain. The patient states he was at home eating dinner when he began to experience severe abdominal pain. The patient has a past medical history of diabetes, hypertension, and atherosclerosis. He lives at home alone, smokes cigarettes, and drinks 1 to 2 alcoholic drinks per day. The patient is given IV morphine and an ultrasound is obtained demonstrating a dilated abdominal aorta. The patient states that his father died of a similar finding and is concerned about his prognosis. Which of the following is the greatest risk factor for this patient's presentation?? {'A': 'Atherosclerosis', 'B': 'Caucasian race', 'C': 'Cigarette smoking', 'D': 'Family history', 'E': 'Male gender and age'}, | C: Cigarette smoking |
Answer the following medical question with one of the provided options: | Q:A 74-year-old gentleman presents to his family practitioner with the complaint of an inability to open his left eye since this morning. He also complains of intermittent pain and numbness in his left arm that has been present for the last few days. He denies ocular pain, difficulty swallowing, fatigability, or diplopia. His symptoms remain constant without fluctuation. He has a history of diabetes mellitus type 2, hypertension, and hypercholesterolemia. Further history reveals that he has lost 5.4 kg (12 lb) of weight in the past 4 months. He is a chronic smoker with a 72 pack-year smoking history. His blood pressure is 142/76 mm Hg, the heart rate is 76/min, the respiratory rate is 12/min, the temperature is 36.8°C (98.4°F), and BMI is the 18.2 kg/m2. The patient is awake, alert, and oriented to person, place, and time. He has partial drooping of the left eyelid while the right eyelid appears normal. The left pupil is 1 mm and the right pupil is 3 mm in diameter. Extraocular muscle movements are normal. What additional clinical feature would most likely be present in this patient?? {'A': 'Facial asymmetry', 'B': 'Ipsilateral loss of touch sensations on the face', 'C': 'Loss of hemifacial sweating', 'D': 'Tongue deviation to the left side', 'E': 'Urinary retention'}, | C: Loss of hemifacial sweating |
Answer the following medical question with one of the provided options: | Q:A 65-year-old female patient with a past medical history of diabetes mellitus and an allergy to penicillin develops an infected abscess positive for MRSA on the third day of her hospital stay. She is started on an IV infusion of vancomycin at a dose of 1000 mg every 12 hours. Vancomycin is eliminated by first-order kinetics and has a half life of 6 hours. The volume of distribution of vancomycin is 0.5 L/kg. Assuming no loading dose is given, how long will it take for the drug to reach 94% of its plasma steady state concentration?? {'A': '6 hours', 'B': '12 hours', 'C': '18 hours', 'D': '24 hours', 'E': '30 hours'}, | D: 24 hours |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to his primary care physician with concerns about poor sleep quality. The patient states that he often has trouble falling asleep and that it is negatively affecting his studies. He is nervous that he is going to fail out of graduate school. He states that he recently performed poorly at a lab meeting where he had to present his research. This has been a recurrent issue for the patient any time he has had to present in front of groups. Additionally, the patient is concerned that his girlfriend is going to leave him and feels the relationship is failing. The patient has a past medical history of irritable bowel syndrome for which he takes fiber supplements. His temperature is 98.9°F (37.2°C), blood pressure is 117/68 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is within normal limits. Which of the following is the best initial step in management?? {'A': 'Alprazolam during presentations', 'B': 'Cognitive behavioral therapy', 'C': 'Duloxetine', 'D': 'Fluoxetine', 'E': 'Propranolol during presentations'}, | B: Cognitive behavioral therapy |
Answer the following medical question with one of the provided options: | Q:A 56-year-old woman presents to the emergency department with a 1-hour history of persistent nasal bleeding. The bleeding started spontaneously. The patient experienced a similar episode last year. Currently, she has hypertension and takes hydrochlorothiazide and losartan. She is anxious. Her blood pressure is 175/88 mm Hg. During the examination, the patient holds a blood-stained gauze against her right nostril. Upon removal of the gauze, blood slowly drips down from her right nostril. Examination of the left nostril reveals no abnormalities. Squeezing the nostrils for 20 minutes fails to control bleeding. Which of the following interventions is the most appropriate next step in the management of this patient?? {'A': 'Anterior nasal packing with topical antibiotics', 'B': 'Intravenous infusion of nitroglycerin', 'C': 'Nasal oxymetazoline', 'D': 'Oral captopril', 'E': 'Silver nitrate cauterization of the bleeding vessel'}, | C: Nasal oxymetazoline |
Answer the following medical question with one of the provided options: | Q:A professional musician visits his physician after a morning concert. He complains of painless swelling in his right cheek when he plays his tuba. Physical examination of the patient reveals slight facial asymmetry due to minor swelling on the right side of the face. The skin over the swelling is smooth without any secondary changes. Palpation reveals a soft and non-tender swelling. The oral opening is normal without any trismus. Further examination reveals swelling of the left buccal mucosa extending from the first to the third molar. Bedside ultrasound shows small areas of high echogenicity consistent with pneumoparotid. Which nerve is associated with motor function to prevent air from entering the affected duct in this patient?? {'A': 'V2 – Maxillary nerve', 'B': 'V3 – Mandibular nerve', 'C': 'CN VII – Zygomatic branch', 'D': 'CN VII – Buccal branch', 'E': 'CN VII – Marginal mandibular branch'}, | D: CN VII – Buccal branch |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the emergency department for evaluation of progressively worsening edema and decreased urine output over the past few days. He has a history of chronic sinus infections and was hospitalized last year for a suspected pneumonia with hemoptysis. Physical exam shows bilateral pitting edema of the lower extremities. Serum studies show a creatinine of 3.4 mg/dL and blood urea nitrogen of 35 mg/dL. Urine dipstick shows 3+ blood. A kidney biopsy is performed and light microscopy shows crescent-shaped glomeruli. Immunofluorescent microscopy of the tissue sample is most likely to show which of the following findings?? {'A': 'Subendothelial deposits', 'B': 'Intramembranous deposits', 'C': 'Mesangial deposits', 'D': 'Subepithelial deposits', 'E': 'No deposits'}, | E: No deposits |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man alcoholic presents to the emergency department with persistent vomiting. He was found vomiting forcefully next to an empty bottle of vodka. His medical history is significant for Lyme disease, currently being treated with doxycycline. After a prolonged episode of retching, the patient begins choking and coughing forcefully in between bouts of chest pain in the ER. At this point, the patient is unable to communicate. The patient appears toxic. His temperature is 37°C (98.6°F), respiratory rate is 15/min, pulse is 107/min, and blood pressure is 90/68 mm Hg. A quick physical exam reveals fullness at the base of the neck and a crunching, rasping sound on auscultation of the chest. The attending physician orders an upright chest X-ray, showing free mediastinal air. What is the most likely diagnosis?? {'A': 'Esophageal candidiasis', 'B': "Dieulafoy's lesion", 'C': 'Pill esophagitis', 'D': 'Boerhaave syndrome', 'E': 'Mallory Weiss tear'}, | D: Boerhaave syndrome |
Answer the following medical question with one of the provided options: | Q:An 85-year-old woman presents to her physician with complaints of significant weakness and weight loss. She recently has been diagnosed with stage IV breast cancer for which she currently is receiving treatment. She mentions that, despite taking a diet rich in protein and calories, she continues to lose weight. On physical examination, her vital signs are stable, but muscle wasting is clearly evident in her upper limbs, lower limbs, and face. The physician explains to her that her advanced cancer is the most important cause for the weight loss and muscle wasting. This cachexia is mediated by the proteolysis-inducing factor released from cancer cells. Which of the following effects is produced by this factor?? {'A': 'Activation of hormone-sensitive lipase in adipose tissue', 'B': 'Increased release of tumor necrosis factor (TNF) from macrophages', 'C': 'Stimulation of apoptosis', 'D': 'Activation of NF-κB', 'E': 'Suppression of the appetite center in the hypothalamus'}, | D: Activation of NF-κB |
Answer the following medical question with one of the provided options: | Q:A 74-year-old man is brought to the emergency department because of lower abdominal pain for 3 hours. The pain is sharp, constant, and does not radiate. He has not urinated for 24 hours and he has not passed stool for over 3 days. He was diagnosed with herpes zoster 3 weeks ago and has been taking amitriptyline for post-herpetic neuralgia for 1 week. Last year he was diagnosed with nephrolithiasis and was treated with lithotripsy. He has a history of hypertension, benign prostatic hyperplasia, and coronary artery disease. His other medications include amlodipine, metoprolol, tamsulosin, aspirin, and simvastatin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 102/min, and blood pressure is 140/90 mm Hg. Abdominal examination shows a palpable lower midline abdominal mass that is tender to palpation. Bowel sounds are hypoactive. The remainder of the examination shows no abnormalities. A pelvic ultrasound shows an anechoic mass in the lower abdomen. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'CT scan of the abdomen and pelvis', 'B': 'Observation and NSAIDs administration', 'C': 'Transurethral catheterization', 'D': 'Finasteride administration', 'E': 'IV pyelography'}, | C: Transurethral catheterization |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents with a large wound on his right lower leg that has been present for 6 months as shown in the picture. He has had chronically swollen legs for over 10 years. His mother and brother had similar problems with their legs. He had a documented deep vein thrombosis (DVT) in the affected leg 5 years earlier, but has no other past medical history. He has a blood pressure of 126/84 and heart rate of 62/min. Which of the following is the most likely diagnosis?? {'A': 'Arterial ulcer', 'B': 'Marjolin ulcer', 'C': 'Chronic venous insufficiency', 'D': 'Lymphedema', 'E': 'Kaposi sarcoma'}, | C: Chronic venous insufficiency |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl is brought into the clinic for a second opinion by her mother. She was recently diagnosed with alopecia areata after having presented to her family doctor with a 2-month history of noticeable bald patches. The mother was concerned because the treatment involved topical steroids. The patient is noted to have started high school earlier this year and has an attention-deficit/ hyperactivity disorder that is treated with methylphenidate. The patient is afebrile and her vital signs are within normal limits. Physical examination reveals a moderately distressed young female playing with her hair. She has very short nails on both hands and patches of hair loss on the scalp. Which of the following is the most appropriate initial management for this patient’s condition?? {'A': 'Behavioral therapy', 'B': 'Selective serotonin reuptake inhibitors', 'C': 'Antipsychotics', 'D': 'Lithium', 'E': 'Psychodynamic therapy'}, | A: Behavioral therapy |
Answer the following medical question with one of the provided options: | Q:Seven hours after undergoing left hip arthroplasty for chronic hip pain, a 67-year-old woman reports a prickling sensation in her left anteromedial thigh and lower leg. Neurologic examination shows left leg strength 3/5 on hip flexion and 2/5 on knee extension. Patellar reflex is decreased on the left. Sensation to pinprick and light touch are decreased on the anteromedial left thigh as well as medial lower leg. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Sural nerve injury', 'B': 'Femoral nerve injury', 'C': 'Fibular nerve injury', 'D': 'S1 radiculopathy', 'E': 'L5 radiculopathy\n"'}, | B: Femoral nerve injury |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man comes to the physician because of a 3-month history of worsening exertional dyspnea and a persistent dry cough. For 37 years he has worked in a naval shipyard. He has smoked 1 pack of cigarettes daily for the past 40 years. Pulmonary examination shows fine bibasilar end-expiratory crackles. An x-ray of the chest shows diffuse bilateral infiltrates predominantly in the lower lobes and pleural reticulonodular opacities. A CT scan of the chest shows pleural plaques and subpleural linear opacities. The patient is most likely to develop which of the following conditions?? {'A': 'Bronchogenic carcinoma', 'B': 'Aspergilloma', 'C': 'Mycobacterial Infection', 'D': 'Malignant mesothelioma', 'E': 'Spontaneous pneumothorax'}, | A: Bronchogenic carcinoma |
Answer the following medical question with one of the provided options: | Q:A previously healthy 28-year-old woman comes to the physician because of lower abdominal pain and purulent vaginal discharge for the past 5 days. Menses occur at irregular 20 to 40-day intervals and last 4 to 8 days. She is sexually active with a new partner that she met 2 months ago and they use condoms inconsistently. She had a normal pap smear 5 months ago. She drinks 2 beers every other day. Her temperature is 39°C (102.2°F), pulse is 85/min, and blood pressure is 108/75 mm Hg. Examination shows lower abdominal tenderness and bilateral inguinal lymphadenopathy. Pelvic examination is notable for uterine and adnexal tenderness as well as small amounts of bloody cervical discharge. A spot urine pregnancy test is negative. Laboratory studies show a leukocyte count of 14,500/mm3 and an erythrocyte sedimentation rate of 90 mm/h. Nucleic acid amplification confirms the suspected diagnosis. The patient is started on ceftriaxone and doxycycline. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the abdomen', 'B': 'Tzanck smear', 'C': 'Colposcopy', 'D': 'Pap smear', 'E': 'HIV test'}, | E: HIV test |
Answer the following medical question with one of the provided options: | Q:Scientists are developing a new non-steroidal anti-inflammatory drug for osteoarthritis. Their hope is that the new drug will have a higher potency but the same efficacy as ibuprofen in the hope of minimizing gastrointestinal side effects. If ibuprofen is curve C in the figure provided, which of the following would be the curve for the new drug based on the scientists’ specifications? The desired therapeutic effect in patients is represented by the dashed line Y.? {'A': 'Curve A', 'B': 'Curve B', 'C': 'Curve C', 'D': 'Curve D', 'E': 'Curve E'}, | A: Curve A |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man presents to the emergency department with shortness of breath. He reports that 6 months ago he was able to walk several miles without stopping. Yesterday, he became short of breath walking from his bed to the bathroom. He also endorses worsening abdominal distension and leg swelling, which he reports is new from several months ago. The patient has a past medical history of hypertension and hyperlipidemia. On physical exam, the patient has moderate abdominal distension and pitting edema to the knee. Crackles are present at the bilateral bases. Laboratory testing reveals the following: Hemoglobin: 13.4 g/dL Mean corpuscular volume (MCV): 102 um^3 Leukocyte count: 11,200 /mm^3 with normal differential Platelet count: 256,000/mm^3 Serum: Na+: 137 mEq/L Cl-: 100 mEq/L K+: 4.2 mEq/L HCO3-: 25 mEq/L BUN: 18 mg/dL Glucose: 126 mg/dL Creatinine: 0.9 mg/dL Alkaline phosphatase: 88 U/L Aspartate aminotransferase (AST): 212 U/L Alanine aminotransferase (ALT): 104 U/L Which of the following is the best next step in management?? {'A': 'Alcohol cessation', 'B': 'Antiviral therapy', 'C': 'Hormone replacement', 'D': 'Immunosuppressive therapy', 'E': 'Vitamin repletion'}, | A: Alcohol cessation |
Answer the following medical question with one of the provided options: | Q:A 28-year-old patient comes to the physician’s office with complaints of headaches and difficulty seeing out of the corner of her eye. She gave birth to her son 1 year ago. Further visual testing reveals the patient has bitemporal hemianopsia. The patient undergoes brain MRI which shows an anterior pituitary mass, likely adenoma. The patient has her blood tested to see if the adenoma is secreting extra hormone. The patient is found to have a slight excess of a hormone that uptakes a basophilic stain. Which of the following is most likely to be the hormone detected in her blood?? {'A': 'Prolactin', 'B': 'Oxytocin', 'C': 'Growth hormone', 'D': 'Antidiuretic hormone', 'E': 'Thyroid stimulating hormone'}, | E: Thyroid stimulating hormone |
Answer the following medical question with one of the provided options: | Q:Several weeks following a kidney transplantation, a 50-year-old Caucasian female presents for evaluation of the transplanted organ. Biopsy shows inflammation involving the endothelial cells of the kidney vasculature and the presence of mononuclear cells in the interstitium. Which cells are most likely responsible for this presentation?? {'A': 'Donor T-cells', 'B': 'Recipient T-cells', 'C': 'Preformed recipient antibodies', 'D': 'Donor antibodies', 'E': 'Deposition of antibody immune complexes'}, | B: Recipient T-cells |
Answer the following medical question with one of the provided options: | Q:A 64-year-old woman comes to the physician for her routine health maintenance examination. She feels well. She had cervical cancer and received radiotherapy 8 years ago. Her vital signs are within normal limits. On percussion, the spleen size is 15 cm. Otherwise, the physical examination shows no abnormalities. The laboratory test results are as follows: Hemoglobin 10 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 65,000/mm3 Platelet count 500,000/mm3 Two images of the peripheral blood smear are shown on the image. Which of the following is the most appropriate next step in management?? {'A': 'Allogeneic stem cell transplantation', 'B': 'Dasatinib', 'C': 'Phlebotomy', 'D': 'Rituximab', 'E': 'Watchful waiting'}, | B: Dasatinib |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the emergency department after being stabbed with a knife during an altercation. Physical examination shows a 4-cm stab wound on the right lateral border of the T1 spinous process. An MRI of the spinal cord shows damage to the area of the right lateral corticospinal tract at the level of T1. Further evaluation will most likely show which of the following findings?? {'A': 'Absence of left-sided proprioception below T1', 'B': 'Absence of right-sided temperature sensation below T1', 'C': 'Presence of left-sided Babinski sign', 'D': 'Absence of left-sided fine touch sensation below T1', 'E': 'Absence of right-sided motor function below T1'}, | E: Absence of right-sided motor function below T1 |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man with type 1 diabetes mellitus is brought to the emergency department because of weakness, abdominal pain, nausea, and one episode of vomiting for 1 day. He has not taken his insulin for 3 days. His pulse is 125/min and respirations are 29/min. Examination shows dry mucous membranes. His breath has a fruity odor. Which of the following sets of laboratory values is most likely on evaluation of urine obtained before treatment? $$$ pH %%% HCO3- %%% NH4+ %%% K+ $$$? {'A': '↓ ↓ ↑ ↑', 'B': '↓ normal ↓ ↓', 'C': '↓ ↑ normal ↑', 'D': '↑ ↑ normal ↑', 'E': '↓ ↓ ↑ ↓'}, | A: ↓ ↓ ↑ ↑ |
Answer the following medical question with one of the provided options: | Q:A group of researchers is looking to study the effect of body weight on blood pressure in the elderly. Previous work measuring body weight and blood pressure at 2-time points in a large group of healthy individuals revealed that a 10% increase in body weight was accompanied by a 7 mm Hg increase in blood pressure. If the researchers want to determine if there is a linear relationship between body weight and blood pressure in a subgroup of elderly individuals in this study, which of the following statistical methods would best be employed to answer this question?? {'A': 'One-way analysis of variance (ANOVA)', 'B': 'Two-way analysis of variance (ANOVA)', 'C': 'Pearson’s correlation', 'D': 'Spearman’s correlation', 'E': 'Wilcoxon signed-rank test'}, | C: Pearson’s correlation |
Answer the following medical question with one of the provided options: | Q:A 80-year-old man is brought to the emergency department with complaints that he "can’t control his left leg”. His symptoms started a few hours ago. He was outside taking a walk with his wife when suddenly his leg shot out and kicked her. His past medical history is notable for diabetes, hypertension, and a myocardial infarction 5 years ago. He smokes 1-2 cigarettes/day. He does not use alcohol or illicit drugs. On exam, the patient has intermittent wide, flinging movements that affect his proximal left arm. Which of the following parts of his brain is most likely damaged?? {'A': 'Left internal capsule', 'B': 'Right internal capsule', 'C': 'Left subthalamic nucleus', 'D': 'Right subthalamic nucleus', 'E': 'Ventral posterior thalamic nucleus'}, | D: Right subthalamic nucleus |
Answer the following medical question with one of the provided options: | Q:A 23-year-old college student presents with his parents for a follow-up appointment. He was recently diagnosed with schizophrenia and was started on risperidone approx. 2 months ago. He reports a significant improvement since the start of treatment. His parents report that their son’s symptoms of delusions, hallucinations, and paranoid behavior have been ameliorated. On physical examination, the patient seems uncomfortable. He frequently fidgets and repeatedly crosses and uncrosses his legs. When asked if something is troubling him, he gets up and starts pacing. He says, “It’s always like this. I cannot sit still. It is frustrating.” What is the most likely diagnosis?? {'A': 'Ataxia', 'B': 'Akathisia', 'C': 'Generalized anxiety disorder', 'D': 'Restless legs syndrome', 'E': 'Tardive dyskinesia'}, | B: Akathisia |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman with type 2 diabetes mellitus is admitted for evaluation of recurrent episodes of nausea, tremors, and excessive sweating. She works as a nurse and reports self-measured blood glucose levels below 50 mg/dL on several occasions. Her family history is positive for borderline personality disorder. The only medication listed in her history is metformin. Which of the following is the most appropriate next step in management?? {'A': 'Report the patient to her employer', 'B': 'Ask the patient if she is taking any medications other than metformin', 'C': "Search the patient's belongings for insulin", 'D': 'Measure glycated hemoglobin concentration', 'E': 'Measure serum C-peptide concentration'}, | B: Ask the patient if she is taking any medications other than metformin |
Answer the following medical question with one of the provided options: | Q:A 25-year old Caucasian female presents with symptoms of Graves' disease. Her doctor prescribes medications and sends the patient home. After two months of therapy, the patient returns upset that her exophthalmos has not gone away. Which of the following drugs should the physician have prescribed to treat the exophthalmos?? {'A': 'Propanolol', 'B': 'Metropolol', 'C': 'PTU', 'D': 'Corticosteroids', 'E': 'No treatment as this will resolve naturally'}, | D: Corticosteroids |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman is brought to the emergency department because of intermittent sharp right upper quadrant abdominal pain and nausea for the past 10 hours. She vomited three times. There is no associated fever, chills, diarrhea, or urinary symptoms. She has two children who both attend high school. She appears uncomfortable. She is 165 cm (5 ft 5 in) tall and weighs 86 kg (190 lb); BMI is 32 kg/m2. Her temperature is 37°C (98.6°F), pulse is 100/min, and blood pressure is 140/90 mm Hg. She has mild scleral icterus. The abdomen is soft and nondistended, with tenderness to palpation of the right upper quadrant without guarding or rebound. Bowel sounds are normal. Laboratory studies show: Hemoglobin count 14 g/dL Leukocyte count 9,000 mm3 Platelet count 160,000 mm3 Serum Alkaline phosphatase 238 U/L Aspartate aminotransferase 60 U/L Bilirubin Total 2.8 mg/dL Direct 2.1 mg/dL Which of the following is the most appropriate next step in diagnosis?"? {'A': 'CT scan of the abdomen', 'B': 'Transabdominal ultrasonography', 'C': 'Endoscopic retrograde cholangiopancreatography', 'D': 'HIDA scan of the biliary tract', 'E': 'Upper gastrointestinal series'}, | B: Transabdominal ultrasonography |
Answer the following medical question with one of the provided options: | Q:A 12-month-old girl is brought to her pediatrician for a checkup and vaccines. The patient’s mother wants to send her to daycare but is worried about exposure to unvaccinated children and other potential sources of infection. The toddler was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines. She does not walk yet but stands in place and can say a few words. The toddler drinks formula and eats a mixture of soft vegetables and pureed meals. She has no current medications. On physical exam, the vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/50 mm Hg, pulse 130/min, and respiratory rate 28/min. The patient is alert and responsive. The remainder of the exam is unremarkable. Which of the following is most appropriate for this patient at this visit?? {'A': 'Referral for speech pathology', 'B': 'MMR vaccine', 'C': 'Rotavirus vaccine', 'D': 'Meningococcal vaccine', 'E': 'Gross motor workup and evaluation'}, | B: MMR vaccine |
Answer the following medical question with one of the provided options: | Q:A 72-year-old patient is referred to an ophthalmologist because he has noticed some mild discomfort in his eyes though his vision remains unchanged. He cannot recall when this feeling started. His past medical history is significant for diabetes mellitus and two myocardial infarctions that have led to significant cardiac dysfunction. Specifically, he has dyspnea and peripheral edema and occasionally decompensates into more severe pulmonary edema requiring hospitalization. Testing reveals increased intra-ocular pressure so the ophthalmologist prescribes several medications. The medication for this disorder that is most likely to be contraindicated in this patient has which of the following characteristics?? {'A': 'It alters bicarbonate metabolism', 'B': 'It decreases intracellular cyclic AMP levels', 'C': 'It increases intracellular calcium levels', 'D': 'It increases adenylyl cyclase activity', 'E': 'It is produced by cyclooxygenase'}, | B: It decreases intracellular cyclic AMP levels |
Answer the following medical question with one of the provided options: | Q:A baby is born after the 32nd gestational week by cesarean delivery. The mother suffered from gestational diabetes; however, she had no other pregnancy-related diseases and was otherwise healthy. The baby has a blood pressure of 100/58 mm Hg, heart rate of 104/min, and oxygen saturation of 88%. The child has tachypnea, subcostal and intercostal retractions, nasal flaring, and cyanosis. The cyanosis is responding well to initial administration of oxygen. The nasogastric tube was positioned without problems. Which of the following is the most likely diagnosis?? {'A': 'Neonatal respiratory distress syndrome (NRDS)', 'B': 'Sepsis', 'C': 'Tracheoesophageal fistula', 'D': 'Pneumonia', 'E': 'Congenital heart anomaly with right-to-left shunt'}, | A: Neonatal respiratory distress syndrome (NRDS) |
Answer the following medical question with one of the provided options: | Q:Eight days after sigmoid resection for acute diverticulitis, a 61-year-old man has left-sided flank pain. He has been on bowel rest since admission. Other than multiple admissions for alcohol withdrawal, he has no history of serious illness. Current medications include intravenous cefepime and morphine. His temperature is 36.9°C (98.4°F), pulse is 89/min, and blood pressure is 118/75 mm Hg. Abdominal exam shows a well-healing incision with minimal serous drainage. Examination of the skin shows scattered spider angiomas, a large hematoma on the left flank, and numerous bruises over the abdomen and extremities. He complains of pain when his left hip is extended. Laboratory studies show: Hemoglobin 8.4 g/dL Mean corpuscular volume 102 μm3 Leukocyte count 8,200/mm3 Platelet count 170,000/mm3 Serum Bleeding time 4 minutes Prothrombin time 26 seconds Partial thromboplastin time (activated) 39 seconds Which of the following is the most likely underlying cause of this patient's current symptoms?"? {'A': 'Resistance of Factor V inactivation', 'B': 'Impaired activation of factor VII', 'C': 'Administration of heparin', 'D': 'Decreased synthesis of thrombopoietin', 'E': 'Deficiency of folic acid'}, | B: Impaired activation of factor VII |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 14-year-old girl is brought to the emergency room by her father because of excessive thirst, excessive urination, and weight loss. Her symptoms started acutely 5 days ago. Vital signs reveal a temperature of 36.6°C (97.8°F), blood pressure of 100/65 mm Hg, and pulse of 105/min. Physical examination shows a thin girl with dry mucous membranes but normal skin turgor. Laboratory results are shown: Random blood sugar 410 mg/dL C-peptide undetectable Serum beta-hydroxybutyrate negative Which of the following is the best initial therapy for this patient?? {'A': 'Metformin', 'B': 'Glimepiride', 'C': 'Intravenous fluids, insulin infusion, and correction of electrolytes', 'D': 'Basal-bolus insulin', 'E': 'Pramlintide'}, | D: Basal-bolus insulin |
Answer the following medical question with one of the provided options: | Q:An 8-year old boy is brought to the emergency department because he has been lethargic and has had several episodes of nausea and vomiting for the past day. He has also had increased thirst over the past two months. He has lost 5.4 kg (11.9 lbs) during this time. He is otherwise healthy and has no history of serious illness. His temperature is 37.5 °C (99.5 °F), blood pressure is 95/68 mm Hg, pulse is 110/min, and respirations are 30/min. He is somnolent and slightly confused. His mucous membranes are dry. Laboratory studies show: Hemoglobin 16.2 g/dL Leukocyte count 9,500/mm3 Platelet count 380,000/mm3 Serum Na+ 130 mEq/L K+ 5.5 mEq/L Cl- 99 mEq/L HCO3- 16 mEq/L Creatinine 1.2 mg/dL Glucose 570 mg/dL Ketones positive Blood gases, arterial pH 7.25 pCO2 21 mm Hg Which of the following is the most appropriate next step in management?"? {'A': 'Intravenous hydration with 0.9% normal saline and insulin', 'B': 'Intravenous hydration with 5% dextrose solution and 0.45% normal saline', 'C': 'Intravenous hydration with 0.45% normal saline and insulin', 'D': 'Intravenous hydration with 0.9% normal saline and potassium chloride', 'E': 'Intravenous sodium bicarbonate\n"'}, | A: Intravenous hydration with 0.9% normal saline and insulin |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman presents with a history of repeated episodes of discoloration of the fingers over the last 3 years. She mentions that the episodes are usually triggered by exposure to cold, which leads to a sequential white, blue, and red discoloration of her fingers, followed by resolution of the symptoms. During an episode, she experiences pain and numbness in the affected fingers. The episodes are usually of short duration and do not interfere with her life, so she did not seek medical advice till now. Which of the following additional clinical features in this patient would most likely support the most likely diagnosis?? {'A': 'Calcinosis on the dorsal surface of the forearm', 'B': 'Generalized pruritus', 'C': 'Photosensitive skin rash', 'D': 'Telangiectasia over face', 'E': 'Bilateral symmetrical involvement of the extremities'}, | E: Bilateral symmetrical involvement of the extremities |
Answer the following medical question with one of the provided options: | Q:A 4-month-old boy is brought to the physician by his parents for a well-child examination. He has cystic fibrosis diagnosed by newborn screening. His parents report frequent feedings and large-volume and greasy stools. His 4-year-old brother has autism. Current medications include bronchodilators, pancreatic enzyme supplements, and fat-soluble vitamins. He is at the 18th percentile for height and 15th percentile for weight. Scattered wheezes are heard throughout both lung fields. Examination shows a distended and tympanic abdomen with no tenderness or guarding. Which of the following is a contraindication for administering one or more routine vaccinations in this patient at this time?? {'A': 'Fever of 38.2°C (100.7°F) following previous vaccinations', 'B': 'History of cystic fibrosis', 'C': 'Allergy to egg protein', 'D': 'History of febrile seizures', 'E': 'History of intussusception'}, | E: History of intussusception |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman comes to the physician because of blisters on her forearm that appeared 3 days ago. She also reports pain in her left cheek when eating and pain during sexual intercourse for the past week. She has not been sick for the past 6 months. She has started hiking in the woods on the weekends with her son a couple months ago but has been careful to avoid poison ivy. She has a history of hypertension and osteoarthritis. She recently started taking captopril and stopped taking meloxicam 2 weeks ago. She has a family history of pernicious anemia and Graves' disease. The patient's vital signs are within normal limits. Examination reveals multiple, flaccid blisters on the volar surface of the forearm and ulcers on the buccal, gingival, and vulvar mucosa. The epidermis on the forearm separates when the skin is lightly stroked. The total body surface area involvement of the blisters is estimated to be 10%. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Lichen planus', 'B': 'Toxic epidermal necrolysis', 'C': 'Dermatitis herpetiformis', 'D': 'Bullous pemphigoid', 'E': 'Pemphigus vulgaris'}, | E: Pemphigus vulgaris |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man presents to his primary care physician for pain in his left ankle. The patient states that he was at karate practice when he suddenly felt severe pain in his ankle forcing him to stop. The patient has a past medical history notable for type I diabetes and is currently being treated for an episode of acute bacterial sinusitis with moxifloxacin. The patient recently had to have his insulin dose increased secondary to poorly controlled blood glucose levels. Otherwise, the patient takes ibuprofen for headaches and loratadine for seasonal allergies. Physical exam reveals a young healthy man in no acute distress. Pain is elicited over the Achilles tendon with dorsiflexion of the left foot. Pain is also elicited with plantar flexion of the left foot against resistance. Which of the following is the best next step in management?? {'A': 'Change antibiotics and refrain from athletic activities', 'B': 'Ibuprofen and rest', 'C': 'Orthopedic ankle brace', 'D': 'Refrain from athletic activities for 1 to 2 weeks', 'E': 'Rehabilitation exercises and activity as tolerated'}, | A: Change antibiotics and refrain from athletic activities |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the replication of a virus in denucleated embryonic fibroblasts. After the fibroblasts are infected with the virus, viral proteins are directly translated from the virion's genetic material using fibroblast ribosomes. The resultant large polypeptides are then cleaved into smaller peptides by viral proteases to generate mature viral proteins. Finally, the virion's genetic material is replicated using a protein translated from the virion's genetic material. Which of the following is the most likely virus being evaluated in this study?? {'A': 'Human immunodeficiency virus', 'B': 'Parvovirus', 'C': 'Molluscum contagiosum virus', 'D': 'Measles virus', 'E': 'Coxsackievirus'}, | E: Coxsackievirus |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man with a past medical history of HIV is hospitalized with a disseminated zoster infection and treated with IV acyclovir. His course of illness worsens on the 4th day after admission and his creatinine level increases to 4.2 mg/dL. Urinalysis shows birefringent needle-shaped crystals. What could have prevented this deterioration in the patient's renal function?? {'A': 'Initial administration of glucocorticoids', 'B': 'Monitoring of drug levels', 'C': 'Obtaining a thorough history of patient allergies', 'D': 'Adequate initial hydration', 'E': 'Initial administration of allopurinol'}, | D: Adequate initial hydration |
Answer the following medical question with one of the provided options: | Q:A 81-year-old man presents to his primary care physician with a 4-month history of shortness of breath. He says that he has slowly lost the ability to do things due to fatigue and now gets winded after walking around the house. He also says that his cough has been getting worse and seems to be producing more sputum. He has gained about 5 pounds over the last 6 months. His past medical history is significant for hypertension and diabetes. He has a 40 pack-year smoking history and drinks about 3 drinks per week. Physical exam reveals a cyanotic appearing man with 1+ edema in his legs bilaterally. He also has wheezing on lung auscultation with a prolonged expiratory phase. Which of the following would most likely be seen on a chest radiograph in this patient?? {'A': 'Calcified pleural plaques surrounding the diaphragm', 'B': 'Cardiomegaly and increased bronchial markings', 'C': 'Hyperinflated lungs and loss of lung markings', 'D': 'Perihilar mass with unilateral hilar enlargement', 'E': 'Subpleural cystic enlargement'}, | B: Cardiomegaly and increased bronchial markings |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care physician because he feels like his vision has been changing over the last 6 months. In particular, he feels that he cannot see as well out of his right eye as previously. His past medical history is significant for myocardial infarction as well as Lyme disease. On presentation, he is found to have a droopy right eyelid as well as persistent constriction of his right pupil. Additionally, the skin on his right half of his face is found to be cracked and dry. Which of the following is most likely associated with this patient's symptoms?? {'A': 'Drug use', 'B': 'Facial nerve damage', 'C': 'Oculomotor nerve damage', 'D': 'Pancoast tumor', 'E': 'Syphilis'}, | D: Pancoast tumor |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the emergency department after he fell on the playground in kindergarten and was unable to get up. His right leg was found to be bent abnormally at the femur, and he was splinted on site by first responders. His past medical history is significant for multiple prior fractures in his left humerus and femur. Otherwise, he has been hitting normal developmental milestones and appears to be excelling in kindergarten. Physical exam also reveals the finding shown in figure A. Which of the following is the most likely cause of this patient's multiple fractures?? {'A': 'Abnormal collagen production', 'B': 'Decreased collagen hydroxylation', 'C': 'Increased adenylyl cyclase activity', 'D': 'Mutation in neurofibromin', 'E': 'Non-accidental trauma'}, | C: Increased adenylyl cyclase activity |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman is brought to the emergency department after she started convulsing in the office. She has no previous history of seizures and recovers by the time she arrives at the emergency department. She says that over the last 2 days she has also experienced insomnia, abdominal pain, and dark urine. Her past medical history is significant for asthma; however, she says that she has not experienced any of these symptoms previously. She smokes 1 pack of cigarettes per day, drinks a glass of wine with dinner every night, and is currently taking oral contraceptive pills (OCPs). On presentation, her temperature is 99°F (37.2°C), blood pressure is 140/98 mmHg, pulse is 112/min, and respirations are 11/min. Which of the following enzymes is most likely to be defective in this patient?? {'A': 'Aminolevulinate dehydratase', 'B': 'Aminolevulinate synthase', 'C': 'Ferrochelatase', 'D': 'Porphobilinogen deaminase', 'E': 'Uroporphyrinogen decarboxylase'}, | D: Porphobilinogen deaminase |
Answer the following medical question with one of the provided options: | Q:A 3-year-old is brought to the pediatrician by his mother because she is concerned about recent changes to his behavior. She states that he has seemed to regress in his motor development and has been having occasional brief episodes of uncontrollable shaking. During the subsequent work up, a muscle biopsy is obtained which demonstrates red ragged fibers and a presumptive diagnosis of a genetic disease made. The mother asks if her other son will be affected. What should be the physician's response?? {'A': 'There is a 100% he will be affected, but the severity may be different', 'B': 'There is a 25% chance he will be affected', 'C': 'He will be unaffected', 'D': 'There is a 100% he will be affected, and the severity will be the same', 'E': 'There is a 50% chance he will be affected'}, | A: There is a 100% he will be affected, but the severity may be different |
Answer the following medical question with one of the provided options: | Q:A group of researchers studying the relationship between major depressive disorder and unprovoked seizures identified 36 patients via chart review who had been rehospitalized for unprovoked seizures following discharge from an inpatient psychiatric unit and 105 patients recently discharged from the same unit who did not experience unprovoked seizures. The results of the study show: Unprovoked seizure No seizure Major depressive disorder 20 35 No major depressive disorder 16 70 Based on this information, which of the following is the most appropriate measure of association between history of major depressive disorder (MDD) and unprovoked seizures?"? {'A': '0.36', 'B': '1.95', 'C': '0.19', 'D': '2.5', 'E': '0.17'}, | D: 2.5 |
Answer the following medical question with one of the provided options: | Q:A 56-year-old man of Nepalese origin presents to a clinic complaining of skin rashes that have been troubling him for years. On examination, there are numerous poorly demarcated skin lesions present on all parts of the body. There is also evidence of significant facial thickening, eyebrow loss, and symmetrical sensory neuropathy in a ‘glove and stocking’ distribution. An examination of the hands reveals bilateral weakness. A skin biopsy is taken from one of the lesions, and the culture is positive for acid-fast bacilli. Which of the following pharmacological therapies is involved in the treatment of this condition?? {'A': 'Dapsone', 'B': 'Flucloxacillin', 'C': 'Isoniazid', 'D': 'Ketoconazole', 'E': 'Prednisone'}, | A: Dapsone |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl comes to the physician because of episodic lower abdominal pain for 5 months. The pain starts to occur a few hours before her menses and lasts for 2–3 days. Ibuprofen helped reduce the pain in the first months but has no effect now. She has missed a couple of days at school because of severe pain. Menarche was at the age of 14 years, and menses occur at regular 29-day intervals. She is sexually active with one male partner and uses condoms inconsistently. Her temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 110/70 mm Hg. Physical and pelvic examination show no abnormalities. A urine pregnancy test is negative. Which of the following is the most appropriate next step in management?? {'A': 'Diagnostic laparoscopy', 'B': 'Ceftriaxone and doxycycline therapy', 'C': 'Pelvic ultrasonography', 'D': 'Oral contraceptive pill', 'E': 'Urinalysis'}, | D: Oral contraceptive pill |
Answer the following medical question with one of the provided options: | Q:A medical examiner was called to investigate the death of a 75-year-old type 1 diabetic Caucasian male who was a retired physician. His caretaker discovered his body in the bedroom with an empty syringe and a small bottle of lispro lying on the nightstand. She explains that his wife of 50 years passed away six months ago and that he had no children or family. He had become extremely depressed and did not want to live anymore. Which of the following would be most consistent with his blood chemistry if a blood sample were taken?? {'A': 'Glucose: 25 mg/dL, high insulin and high C-peptide levels', 'B': 'Glucose: 25 mg/dL, high insulin and normal C-peptide levels', 'C': 'Glucose: 25 mg/dL, high insulin and absent C-peptide levels', 'D': 'Glucose: 95 mg/dL, low insulin and low C-peptide levels', 'E': 'Glucose: 95 mg/dL, high insulin and C-peptide levels'}, | C: Glucose: 25 mg/dL, high insulin and absent C-peptide levels |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman makes a follow-up appointment with her primary care physician for evaluation of her diabetes medications. Specifically, she complains that she has been experiencing flushing, nausea, and palpitations after drinking a glass of wine with dinner after she started the latest regimen for her diabetes. She was warned that this was a side-effect of one of her medications but she did not understand the severity of the reaction. Given this experience, she asks to be placed on an alternative regimen that does not involve the medication that caused this reaction. Her physician therefore replaces the medication with another one that interacts with the same target though at a different binding site. Which of the following is a side-effect of the new medication?? {'A': 'Hepatotoxicity', 'B': 'Lactic acidosis', 'C': 'Pancreatitis', 'D': 'Urinary tract infection', 'E': 'Weight gain'}, | E: Weight gain |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to the physician by her mother two days after the sudden onset of a rash. The mother says that the rash developed an hour after she bathed the child in lukewarm water. Two weeks ago, the patient was diagnosed with a skin infection and was treated with penicillin V. She has been otherwise healthy but has missed several well-child examinations. She lives with her single mother, who recently lost her job and is now dependent on social assistance. The patient's mother has major depressive disorder and her maternal aunt has systemic lupus erythematosus. The girl's temperature is 36.8°C (98.2°F), pulse is 112/min, and blood pressure is 108/62 mm Hg. She has poor eye contact. Physical examination shows sharply delineated erythema on the lower extremities up to the umbilicus with sparing of the knees and flexor surfaces. Further evaluation is most likely to reveal which of the following?? {'A': 'Multiple injuries in different stages of healing', 'B': 'Dermatographism', 'C': "Positive Nikolsky's sign", 'D': 'Malar rash with sparing of the nasolabial folds', 'E': 'Ulcers of the oral mucosa\n"'}, | A: Multiple injuries in different stages of healing |
Answer the following medical question with one of the provided options: | Q:An 2-year-old girl with a history of SS-hemoglobin is brought to her pediatrician by her mother, who noted an abdominal mass. On exam, the girl's spleen is palpably enlarged, and her palms and conjunctiva are noted to be extremely pale. Serum haptoglobin levels are normal. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Decreased red blood cell production', 'B': 'Extravascular hemolysis', 'C': 'Intravascular hemolysis', 'D': 'Complement-mediated hemolysis', 'E': 'Hemolytic uremic syndrome'}, | B: Extravascular hemolysis |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman comes to the physician because of a delayed menstrual period. She has had regular menses since menarche at age 11. Her last menstrual period was 7 weeks ago. She is sexually active with two male partners. A urine pregnancy test is positive. An ultrasound of the pelvis shows a viable intrauterine pregnancy with an estimated gestational age of 6 weeks and 5 days. She does not wish to continue with the pregnancy. After carefully weighing the options with her physician, she is prescribed two medications, one of which is mifepristone. Which of the following is this drug's primary mechanism of action?? {'A': 'Inhibition of dihydrofolate reductase', 'B': 'Blockage of progesterone receptor', 'C': 'Activation of prostaglandin E1 receptors', 'D': 'Antagonist at gonadotropin-releasing hormone receptors', 'E': 'Agonist at oxytocin receptors'}, | B: Blockage of progesterone receptor |
Answer the following medical question with one of the provided options: | Q:A 97-year-old man visits the urology clinic 5 days after experiencing urinary retention at an emergency department visit. The patient has a history of hypertension, type II diabetes mellitus, stroke, dyslipidemia, a past myocardial infarction, and severe osteoarthritis in his right hip. He is not compliant with his medications and his multiple comorbidities are poorly managed. In the hospital, the patient’s urinary retention was treated with Foley catheterization. At clinic, the patient’s serum-specific prostate-specific antigen (PSA) is 6.0 ng/mL (normal is < 4 ng/mL). Digital rectal examination (DRE) demonstrates a nontender prostate with several rock hard nodules. The patient's Foley is removed and he is able to urinate on his own. Which is the most appropriate next step in management?? {'A': 'CT abdomen and pelvis', 'B': 'Cystourethroscopy', 'C': 'Transrectal prostate biopsy', 'D': 'Reassurance', 'E': 'Repeat PSA test'}, | D: Reassurance |
Answer the following medical question with one of the provided options: | Q:A 66-year-old woman presents to the emergency department with lower extremity pain. She reports that she has had worsening pain in her left calf over the past year while walking. The pain improves with rest, but the patient notes that she now has to stop walking more frequently than in the past to relieve the pain. The patient’s past medical history is otherwise notable for hypertension and coronary artery disease. Her home medications include hydrochlorothiazide and lisinopril. Her family history is significant for diabetes mellitus in her father. On physical exam, her left lower extremity is slightly cool to the touch with palpable distal pulses. The skin of the left lower extremity appears smooth and shiny below the mid-calf. Laboratory testing is performed and reveals the following: Serum: High-density lipoprotein (HDL): 60 mg/dL Low-density lipoprotein (LDL): 96 mg/dL Triglycerides: 140 mg/dL This patient should be started on which of the following medication regimens?? {'A': 'Aspirin only', 'B': 'Aspirin and atorvastatin', 'C': 'Aspirin and cilostazol', 'D': 'Atorvastatin only', 'E': 'Atorvastatin and cilostazol'}, | B: Aspirin and atorvastatin |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man comes to the emergency department for evaluation of right-sided facial weakness that he noticed after waking up. One month ago, he also experienced right-sided neck pain and headache that began after returning from a hunting trip to New Hampshire the week before. He took ibuprofen to relieve symptoms, which subsided a week later. He has a 5-year history of hypertension controlled with drug therapy. He has smoked one pack of cigarettes daily for 35 years and he drinks two beers daily. His vital signs are within the normal range. Physical examination shows right-sided drooping of the upper and lower half of the face. The patient has difficulties smiling and he is unable to close his right eye. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Western blot', 'B': 'Polymerase chain reaction of the facial skin', 'C': 'Cerebrospinal fluid analysis', 'D': 'Enzyme‑linked immunosorbent assay', 'E': 'Noncontrast CT'}, | D: Enzyme‑linked immunosorbent assay |
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 10-day history of intermittent fevers and painful swelling of the right ankle. He has not had trauma to the ankle. He has a history of sickle cell disease and had an episode of dactylitis of his left index finger 3 years ago. Current medications include hydroxyurea and acetaminophen as needed for the ankle pain. His temperature is 38°C (100.4°F), blood pressure is 125/68 mm Hg, pulse is 105/min, and respirations are 14/min. Examination shows a tender, swollen, and erythematous right ankle with point tenderness over the medial malleolus. X-ray of the right ankle demonstrates marked periosteal thickening and elevation, as well as a central sclerotic lesion with a lucent rim over the right lateral malleolus. A bone biopsy culture confirms the diagnosis. Which of the following is the most likely causal organism?? {'A': 'Streptococcus pneumoniae', 'B': 'Escherichia coli', 'C': 'Streptococcus pyogenes', 'D': 'Salmonella enterica', 'E': 'Pseudomonas aeruginosa'}, | D: Salmonella enterica |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman presents to the emergency department with moderate right wrist pain after falling on her outstretched hand. She has numbness in the 3 medial digits. The patient has no known previous medical conditions. Her family history is not pertinent, and she currently takes no medications. Physical examination shows her blood pressure is 134/82 mm Hg, the respirations are 14/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). When asked to make a fist, the patient is able to flex only the lateral 2 digits. Tapping the anterior portion of her wrist elicits tingling in the medial 3 digits. The patient is taken to get an X-ray. Which of the following is the most likely diagnosis for this patient’s injury?? {'A': 'Scaphoid fracture', 'B': 'Lunate dislocation', 'C': 'Fracture of distal radius', 'D': 'Palmar aponeurosis tear', 'E': 'Interosseous ligament rupture'}, | B: Lunate dislocation |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman visits the clinic expressing a desire to become pregnant. She was seen for depressed mood and disinterest in her usual leisure activities a few months ago. She also had decreased sleep and appetite and was not able to concentrate at work. She was started on fluoxetine and has been compliant for the last 6 months despite experiencing some of the side effects. She now feels significantly better and would like to stop the medication because she plans to become pregnant and thinks it is unnecessary now. Which of the following statements is correct regarding this patient’s current antidepressant therapy?? {'A': 'It can cause anorgasmia.', 'B': 'It has the shortest half-life of any drugs in the same class.', 'C': 'It is unsafe to take during pregnancy.', 'D': 'It decreases levels of concurrent neuroleptics.', 'E': 'Most side effects persist throughout therapy.'}, | A: It can cause anorgasmia. |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to his primary care provider because of fatigue and loss of appetite. He is also concerned that his legs are swollen below the knee. He has had type 2 diabetes for 35 years, for which he takes metformin and glyburide. Today his temperature is 36.5°C (97.7°F), the blood pressure is 165/82 mm Hg, and the pulse is 88/min. Presence of which of the following would make diabetic kidney disease less likely in this patient?? {'A': 'Nephrotic range proteinuria', 'B': 'Diabetic retinopathy', 'C': 'Cellular casts in urinalysis', 'D': 'Gradual reduction of glomerular filtration rate (GFR)', 'E': 'Normal-to-large kidneys on ultrasound'}, | C: Cellular casts in urinalysis |
Answer the following medical question with one of the provided options: | Q:A 33-year-old woman presents to the clinic complaining of yellowish discoloration of her skin and eyes, mild fever, and body aches. She has had this problem for 6 months, but it has become worse over the past few weeks. She also complains of repeated bouts of bloody diarrhea and abdominal pain. The past medical history is noncontributory. She takes no medication. Both of her parents are alive with no significant disease. She works as a dental hygienist and drinks wine occasionally on weekends. Today, the vital signs include blood pressure 110/60 mm Hg, pulse rate 90/min, respiratory rate 19/min, and temperature 36.6°C (97.8°F). On physical examination, she appears uncomfortable. The skin and sclera are jaundiced. The heart has a regular rate and rhythm, and the lungs are clear to auscultation bilaterally. The abdomen is soft with mild hepatosplenomegaly. There is no tenderness or rebound tenderness. The digital rectal examination reveals blood and mucus in the rectal vault. Laboratory studies show: Serum sodium 140 mEq/L Serum potassium 3.8 mEq/L Alanine aminotransferase (ALT) 250 U/L Aspartate aminotransferase (AST) 170 U/L Alkaline phosphatase (ALP) 120 U/L Which of the following antibodies would you expect to find in this patient?? {'A': 'Anti-mitochondrial antibody', 'B': 'Anti-endomysial IgA', 'C': 'Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)', 'D': 'Anti-cyclic citrullinated peptide (anti-CCP)', 'E': 'Anti-double stranded DNA (anti-dsDNA)'}, | C: Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) |
Answer the following medical question with one of the provided options: | Q:An 11-year-old male presents to the pediatrician with his mother for evaluation of difficulty walking. His mother reports that the patient was walking normally until about a year ago, when he started to complain of weakness in his legs. He seems to be less steady on his feet than before, and he has fallen twice at home. Prior to a year ago, the patient had no difficulty walking and was active on his school’s soccer team. He has no other past medical history. The patient is an only child, and his mother denies any family history of neurological disease. On physical examination, the patient has mildly slurred speech. He has a wide-based gait with symmetric weakness and decreased sensation in his lower extremities. The patient also has the physical exam findings seen in Figures A and B. Which of the following is the most likely etiology of this patient’s presentation?? {'A': 'Genetic mutation on chromosome 11q22', 'B': 'Infection with gram-negative rods', 'C': 'Trinucleotide (CGG) repeat expansion on chromosome X', 'D': 'Trinucleotide (CTG) repeat expansion on chromosome 19', 'E': 'Trinucleotide (GAA) repeat expansion on chromosome 9'}, | E: Trinucleotide (GAA) repeat expansion on chromosome 9 |
Answer the following medical question with one of the provided options: | Q:A 4-month-old girl is brought to the physician by her mother because of a 4-day history of vomiting, poor feeding, and more frequent napping. She appears lethargic. Her vital signs are within normal limits. Physical examination shows a bulging, tense anterior fontanelle. Fundoscopic exam shows bilateral retinal hemorrhage. A complete blood count shows a leukocyte count of 8,000/mm3. An x-ray of the chest shows healing fractures of the 4th and 5th left ribs. Which of the following is the most likely cause of the patient's condition?? {'A': 'Malnutrition', 'B': 'Shearing head injury', 'C': 'Inherited connective tissue disorder', 'D': 'Bleeding from the germinal matrix', 'E': 'Epidural hematoma'}, | B: Shearing head injury |
Answer the following medical question with one of the provided options: | Q:A 27-year-old G1P0 at 12 weeks estimated gestational age presents for prenatal care. The patient says she has occasional nausea and vomiting and a few episodes of palpitations and diarrhea this last week. Physical examination is unremarkable, except for a heart rate of 145/min. Basic thyroid function tests are shown in the table below. Which of the following additional laboratory tests would be most useful is assessing this patient’s condition? Thyroid-stimulating hormone (TSH) 0.28 mIU/L (0.3–4.5 mIU/L) Total T4 12 µg/dL (5.4–11.5 µg/dL)? {'A': 'Total triiodothyronine (T3) levels', 'B': 'Free thyroxine (T4) levels', 'C': 'Thyroxine-binding globulin (TBG) levels', 'D': 'Thyroid peroxidase (TPO) antibodies', 'E': 'Thyrotropin receptor antibodies (TRAb)'}, | B: Free thyroxine (T4) levels |
Answer the following medical question with one of the provided options: | Q:A 1-year-old girl is brought to the physician for follow-up examination 1 week after admission to the hospital for bacterial pneumonia. She has had multiple episodes of purulent otitis media and infectious diarrhea since the age of 6 months. She underwent treatment for oral thrush 1 month ago. There is no family history of serious illness. Her height and weight are both below the 10th percentile. Physical examination shows no visible tonsils and slightly decreased breath sounds in the left lower lobe. Laboratory studies show increased deoxyadenosine concentration in both the serum and urine. An x-ray of the chest shows an absent thymic shadow. Which of the following additional findings is most likely in this patient?? {'A': 'Decreased circulating parathyroid hormone', 'B': 'Increased circulating IgE', 'C': 'Decreased circulating T cells', 'D': 'Decreased circulating platelets', 'E': 'Increased circulating neutrophils'}, | C: Decreased circulating T cells |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man presents to his primary care doctor for a 2 month follow-up appointment. He had recently separated from his male partner of 10 years and has been struggling to maintain his weight and the rigors of work in a new start-up company. At his initial visit, he was prescribed escitalopram. 2 weeks later, the patient was instructed to continue taking the medication despite feeling more depressed. After expressing increased desire to carry out suicidal thoughts, he was hospitalized for a brief course. During this visit, he reports that he is feeling much better, but he has an elective inguinal hernia repair scheduled for the end of the week. "The surgeon said to not take anything before the surgery. Besides, I'm feeling better and don't feel like taking escitalopram everyday." What is the most appropriate response?? {'A': 'Continue escitalopram on day of surgery and continue afterwards for 4 more months', 'B': 'Continue escitalopram until surgery and discontinue afterwards', 'C': 'Discontinue escitalopram', 'D': 'Hold escitalopram the day before surgery and continue afterwards for 4 more months', 'E': 'Hold escitalopram the day of surgery and continue afterwards for 4 more months'}, | A: Continue escitalopram on day of surgery and continue afterwards for 4 more months |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man comes to the physician because of difficulty walking for the past year. He reports that his gait has become slower and that initiating steps has become more challenging. During the past 6 months, his family has noticed that he is starting to forget important family meetings and holidays. On a number of occasions, he has not been able to get to the bathroom in time in order to urinate. He has hypertension treated with hydrochlorothiazide. His father died of Parkinson's disease at the age of 63 years. The patient had smoked one pack of cigarettes daily for 40 years, but quit 10 years ago. His vital signs are within normal limits. On mental status examination, he is confused and has short-term memory deficits. He has a wide-based, shuffling gait. Muscle strength is normal. Deep tendon reflexes are 2+ bilaterally. An MRI of the head is shown. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Normal changes associated with aging', 'B': 'Increased cerebrospinal fluid production', 'C': 'Decreased cerebrospinal fluid absorption', 'D': 'Obstructed passage of cerebrospinal fluid', 'E': 'Degeneration of cholinergic neurons in the temporal lobe'}, | C: Decreased cerebrospinal fluid absorption |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman presents with right leg pain and swelling of 5 days’ duration. She has a history of hypertension for 15 years and had a recent hospitalization for pneumonia. She had been recuperating at home but on beginning to mobilize and walk, the right leg became painful and swollen. Her temperature is 37.1°C (98.7°F), the blood pressure is 130/80 mm Hg, and the pulse is 75/min. On physical examination, the right calf is 4 cm greater in circumference than the left when measured 10 cm below the tibial tuberosity. Dilated superficial veins are present on the right foot and the right leg is slightly redder than the left. There is some tenderness on palpation in the popliteal fossa behind the knee. Which of the following is the best initial step in the management of this patient’s condition?? {'A': 'Wells’ clinical probability tool', 'B': 'Computerized tomography (CT) with contrast', 'C': 'International randomized ratio (INR)', 'D': 'Thrombophilia screen', 'E': 'Activated partial thromboplastin time (aPTT)'}, | A: Wells’ clinical probability tool |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man with Hodgkin lymphoma is admitted to the hospital with lower back pain and no urine output over the last 12 hours. Physical examination shows inguinal lymphadenopathy. There is no suprapubic fullness or tenderness. Serum creatinine is elevated compared to 1 week prior. A contrast-enhanced CT scan of the abdomen shows retroperitoneal fibrosis, bilateral hydronephrosis, and a collapsed bladder. Which of the following is the next appropriate step in management of this patient?? {'A': 'Place a urethral catheter', 'B': 'Perform ureteral stenting', 'C': 'Initiate oxybutynin therapy', 'D': 'Place a suprapubic catheter', 'E': 'Initiate tamsulosin therapy'}, | B: Perform ureteral stenting |
Answer the following medical question with one of the provided options: | Q:A 30-year-old African-American woman comes to the physician for a routine checkup. She feels well. She has a history of type 2 diabetes mellitus that is well-controlled with metformin. Her mother died of a progressive lung disease at the age of 50 years. The patient is sexually active with her husband, and they use condoms consistently. She has smoked one pack of cigarettes daily for the past 10 years. She drinks one to two glasses of wine per day. She does not use illicit drugs. Vital signs are within normal limits. Examination, including ophthalmologic evaluation, shows no abnormalities. Laboratory studies, including serum creatinine and calcium concentrations, are within normal limits. An ECG shows no abnormalities. A tuberculin skin test is negative. A chest x-ray is shown. Which of the following is the most appropriate next step in management?? {'A': 'ANCA testing', 'B': 'Lung biopsy', 'C': 'Oral methotrexate therapy', 'D': 'Monitoring', 'E': 'Oral isoniazid monotherapy'}, | D: Monitoring |
Answer the following medical question with one of the provided options: | Q:A research scientist attempts to understand the influence of carbon dioxide content in blood on its oxygen binding. The scientist adds carbon dioxide to dog blood and measures the uptake of oxygen in the blood versus oxygen pressure in the peripheral tissue. He notes in one dog that with the addition of carbon dioxide with a pressure of 90 mmHg, the oxygen pressure in the peripheral tissue rose from 26 to 33 mmHg. How can this phenomenon be explained?? {'A': 'Binding of O2 to hemoglobin in lungs drives release of CO2 from hemoglobin', 'B': 'The sum of the partial pressures of CO2 and O2 cannot exceed a known threshold in blood', 'C': 'High partial pressure of CO2 in tissues facilitates O2 unloading in peripheral tissues', 'D': 'High partial pressure of CO2 in tissues decreases peripheral blood volume', 'E': 'High partial pressure of CO2 in tissues causes alkalemia, which is necessary for O2 unloading'}, | C: High partial pressure of CO2 in tissues facilitates O2 unloading in peripheral tissues |
Answer the following medical question with one of the provided options: | Q:A young man about to leave for his freshman year of college visits his physician in order to ensure that his immunizations are up-to-date. Because he is living in a college dormitory, his physician gives him a vaccine that prevents meningococcal disease. What type of vaccine did this patient likely receive?? {'A': 'Live, attenuated', 'B': 'Killed, inactivated', 'C': 'Toxoid', 'D': 'Conjugated polysaccharide', 'E': 'Killed, attenuated'}, | D: Conjugated polysaccharide |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman comes to the military physician because of a 2-day history of fever, joint pain, dry cough, chest pain, and a painful red rash on her lower legs. Two weeks ago, she returned from military training in Southern California. She appears ill. Her temperature is 39°C (102.1°F). Physical examination shows diffuse inspiratory crackles over all lung fields and multiple tender erythematous nodules over the anterior aspect of both legs. A biopsy specimen of this patient's lungs is most likely to show which of the following?? {'A': 'Spherules filled with endospores', 'B': 'Broad-based budding yeast', 'C': 'Oval, budding yeast with pseudohyphae', 'D': 'Septate hyphae with acute-angle branching', 'E': 'Round yeast surrounded by budding yeast cells'}, | A: Spherules filled with endospores |
Answer the following medical question with one of the provided options: | Q:a 34-year-old G2P2 woman presents to her obstetrician because of new onset discharge from her breast. She first noticed it in her bra a few days ago, but now she notes that at times she's soaking through to her blouse, which is mortifying. She was also concerned about being pregnant because she has not gotten her period in 3 months. In the office ß-HCG is negative. The patient's nipple discharge is guaiac negative. Which of the following therapies is most appropriate?? {'A': 'Tamoxifine', 'B': 'Leuprolide', 'C': 'Haloperidol', 'D': 'Cabergoline', 'E': 'Carbidopa-levodopa'}, | D: Cabergoline |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman returns to the outpatient oncology clinic to follow up on her recently diagnosed breast cancer. A few months ago, she noticed a lump during a breast self-exam that was shown to be breast cancer. A lumpectomy revealed invasive ductal carcinoma that was estrogen- and progesterone receptor-positive with nodal metastases. She is following up to discuss treatment options. She had her last menstrual period 10 years ago and has not had any spotting since that time. Her mother had breast cancer and she remembered her taking chemotherapy and had a poor quality of life, thus she asks not to be treated similarly. Which of the following is the mechanism of action of the best treatment option for this patient?? {'A': 'Antagonist for estrogen receptors in the breast', 'B': 'Cell cycle arrest', 'C': 'Antagonist for estrogen receptors in the hypothalamus', 'D': 'Inhibit peripheral conversion of androgens to estrogen', 'E': 'Estrogen receptors downregulation in the breast'}, | D: Inhibit peripheral conversion of androgens to estrogen |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl comes to the emergency department because of numbness around her mouth and uncontrolled twitching of the mouth for the past 30 minutes. Her symptoms began while she was at a concert. Her temperature is 37°C (98.6°F), pulse is 69/min, and respirations are 28/min. When the blood pressure cuff is inflated, painful contractions of the hand muscles occur. Arterial blood gas shows a pH of 7.53, pO2 of 100 mm Hg, and a pCO2 of 29 mm Hg. Which of the following additional findings is most likely in this patient?? {'A': 'Decreased cerebral blood flow', 'B': 'Increased peripheral oxygen unloading from hemoglobin', 'C': 'Decreased total serum calcium concentration', 'D': 'Increased serum potassium concentration', 'E': 'Increased serum phosphate concentration'}, | A: Decreased cerebral blood flow |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman is brought to the emergency department after being found unresponsive in her bedroom in a nursing home facility. Her past medical history is relevant for hypertension, diagnosed 5 years ago, for which she has been prescribed a calcium channel blocker and a thiazide diuretic. Upon admission, she is found with a blood pressure of 200/116 mm Hg, a heart rate of 70/min, a respiratory rate of 15 /min, and a temperature of 36.5°C (97.7°F). Her cardiopulmonary auscultation is unremarkable, except for the identification of a 4th heart sound. Neurological examination reveals the patient is stuporous, with eye-opening response reacting only to pain, no verbal response, and flexion withdrawal to pain. Both pupils are symmetric, with the sluggish pupillary response to light. A noncontrast CT of the head is performed and is shown in the image. Which of the following is the most likely etiology of this patient’s condition?? {'A': 'Charcot-Bouchard aneurysm rupture', 'B': 'Arteriovenous malformation rupture', 'C': 'Dural arteriovenous fistula', 'D': 'Venous sinus thrombosis', 'E': 'Hemorrhagic transformation'}, | A: Charcot-Bouchard aneurysm rupture |
Answer the following medical question with one of the provided options: | Q:An 11-year-old boy presents to his pediatrician with muscle cramps and fatigue that have progressively worsened over the past year. His mom says that he has always had occasional symptoms including abdominal pain, muscle weakness, and mild paresthesias; however, since starting middle school these symptoms have started interfering with his daily activities. In addition, the boy complains that he has been needing to use the restroom a lot, which is annoying since he has to ask for permission to leave class every time. Labs are obtained showing hypokalemia, hypochloremia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. The most likely cause of this patient's symptoms involves a protein that binds which of the following drugs?? {'A': 'Amiloride', 'B': 'Furosemide', 'C': 'Hydrochlorothiazide', 'D': 'Mannitol', 'E': 'Spironolactone'}, | C: Hydrochlorothiazide |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man with a 55-pack-year smoking history, diabetes type II, and hyperlipidemia presents to his primary care clinic for an annual exam. He has no complaints. He reports that his blood glucose has been under tight control and that he has not smoked a cigarette for the past 5 months. His temperature is 97.5°F (36.4°C), blood pressure is 182/112 mmHg, pulse is 85/min, respirations are 15/min, and oxygen saturation is 95% on room air. Physical examination is notable for bruits bilaterally just lateral of midline near his umbilicus. The patient is started on anti-hypertensive medications including a beta-blocker, a thiazide diuretic, and a calcium channel blocker. He returns 1 month later with no change in his blood pressure. Which of the following is the best next step in management?? {'A': 'CT abdomen/pelvis', 'B': 'Increase dose of current blood pressure medications', 'C': 'Lisinopril', 'D': 'Renal ultrasound with Doppler', 'E': 'Surgical revascularization'}, | D: Renal ultrasound with Doppler |
Answer the following medical question with one of the provided options: | Q:A 7-year-old girl presents to a new pediatrician with fever, shortness of breath, and productive cough. She had similar symptoms a few weeks ago. The girl was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. A further review of her history reveals seizures, upper respiratory infections, and cellulitis. On physical examination, the patient is pale with white-blonde hair and pale blue eyes. Which of the following would you expect to see on a peripheral blood smear for this patient?? {'A': 'Predominance of band leukocytes', 'B': 'Stippled eosinophils', 'C': 'Downey cells', 'D': 'Polymorphonuclear leukocytes containing giant inclusion bodies', 'E': 'Significant basophil predominance'}, | D: Polymorphonuclear leukocytes containing giant inclusion bodies |
Answer the following medical question with one of the provided options: | Q:A 16-year-old female presents to her pediatrician's office requesting to be started on an oral contraceptive pill. She has no significant past medical history and is not currently taking any medications. The physician is a devout member of the Roman Catholic church and is strongly opposed to the use of any type of artificial contraception. Which of the following is the most appropriate response to this patient's request?? {'A': 'The physician is obligated to prescribe the oral contraceptives regardless of his personal beliefs', 'B': 'Refuse to prescribe the oral contraceptive', 'C': 'Suggest that the patient remain abstinent or, if necessary, use an alternative means of birth control', 'D': 'Explain that he will refer the patient to one of his partners who can fulfill this request', 'E': 'Tell the patient that he is unable to prescribe this medication without parental consent'}, | D: Explain that he will refer the patient to one of his partners who can fulfill this request |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy presents to the emergency department with an intractable nosebleed. Pinching of the nose has failed to stop the bleed. The patient is otherwise healthy and has no history of trauma or hereditary bleeding disorders. His temperature is 98.9°F (37.2°C), blood pressure is 120/64 mmHg, pulse is 85/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for multiple clots in the nares which, when dislodged, are followed by bleeding. Which of the following location is the most likely etiology of this patient's symptoms?? {'A': 'Carotid artery', 'B': 'Ethmoidal artery', 'C': 'Kiesselbach plexus', 'D': 'Septal hematoma', 'E': 'Sphenopalatine artery'}, | C: Kiesselbach plexus |
Answer the following medical question with one of the provided options: | Q:A 27-year-old male arrives in the emergency department with a stab wound over the precordial chest wall. The patient is in distress and is cold, sweaty, and pale. Initial physical examination is significant for muffled heart sounds, distended neck veins, and a 3 cm stab wound near the left sternal border. Breath sounds are present bilaterally without evidence of tracheal deviation. Which of the following additional findings would be expected on further evaluation?? {'A': "Decrease in the patient's heart rate by 15 beats per minute with inspiration", 'B': 'Elevated blood pressure to 170/110', 'C': 'Steadily decreasing heart rate to 60 beats per minute', 'D': '15 mmHg decrease in systolic blood pressure with inspiration', 'E': 'Decrease in central venous pressure by 5 mmHg with inspiration'}, | D: 15 mmHg decrease in systolic blood pressure with inspiration |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman comes to the physician because of a 3-day history of worsening shortness of breath, nonproductive cough, and sharp substernal chest pain. The chest pain worsens on inspiration and on lying down. The patient was diagnosed with breast cancer 2 months ago and was treated with mastectomy followed by adjuvant radiation therapy. She has hypertension and hyperlipidemia. Current medications include tamoxifen, valsartan, and pitavastatin. She has smoked a pack of cigarettes daily for 15 years but quit after being diagnosed with breast cancer. Her pulse is 95/min, respirations are 20/min, and blood pressure is 110/60 mm Hg. Cardiac examination shows a scratching sound best heard at the left lower sternal border. An ECG shows sinus tachycardia and ST segment elevations in leads I, II, avF, and V1–6. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Dystrophic calcification of the mitral valve', 'B': 'Embolic occlusion of a pulmonary artery', 'C': 'Neutrophilic infiltration of the pericardium', 'D': 'Subendothelial fibrosis of coronary arteries', 'E': 'Fibrotic thickening of the pericardium'}, | C: Neutrophilic infiltration of the pericardium |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man is brought into the clinic by his wife. She reports that her husband has been feeling down since he lost a big project at work 2 months ago. The patient says he feels unmotivated to work or do things around the house. He also says he is not eating or sleeping as usual and spends most of his day pacing about his room. He feels guilty for losing such a project this late in his career and feels overwhelming fear about the future of his company and his family’s well-being. During the interview, he appears to be in mild distress and is wringing his hands. The patient is prescribed citalopram and buspirone. Which of the following side effects is most commonly seen with buspirone?? {'A': 'Lightheadedness', 'B': 'Dry mouth', 'C': 'Respiratory depression', 'D': 'Anterograde amnesia', 'E': 'Sleepwalking'}, | A: Lightheadedness |
Answer the following medical question with one of the provided options: | Q:A 35-year-old African-American female presents to the emergency room complaining of chest pain. She also complains of recent onset arthritis and increased photosensitivity. Physical examination reveals bilateral facial rash. Which of the following is most likely to be observed in this patient?? {'A': 'Pain improves with inspiration', 'B': 'Pain relieved by sitting up and leaning forward', 'C': 'High-pitched diastolic murmur', 'D': 'Fixed and split S2', 'E': 'Mid-systolic click'}, | B: Pain relieved by sitting up and leaning forward |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman presents to her primary care doctor with her son who reports that his mother is not acting like herself. She has gotten lost while driving several times in the past 2 months and appears to be talking to herself frequently. Of note, the patient’s husband died from a stroke 4 months ago. The patient reports feeling sad and guilty for causing so much trouble for her son. Her appetite has decreased since her husband died. On examination, she is oriented to person, place, and time. She is inattentive, and her speech is disorganized. She shakes her hand throughout the exam without realizing it. Her gait is slow and appears unstable. This patient’s condition would most likely benefit from which of the following medications?? {'A': 'Bromocriptine', 'B': 'Levodopa', 'C': 'Reserpine', 'D': 'Rivastigmine', 'E': 'Selegiline'}, | D: Rivastigmine |
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