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Answer the following medical question with one of the provided options: | Q:A 32-year-old female with Crohn's disease diagnosed in her early 20s comes to your office for a follow-up appointment. She is complaining of headaches and fatigue. Which of the following arterial blood findings might you expect?? {'A': 'Normal Pa02, normal 02 saturation (Sa02), normal 02 content (Ca02)', 'B': 'Low Pa02, low 02 saturation (Sa02), low 02 content (Ca02)', 'C': 'Low Pa02, normal 02 saturation (Sa02), normal 02 content (Ca02)', 'D': 'Normal Pa02, normal 02 saturation (Sa02), low 02 content (Ca02)', 'E': 'High Pa02, normal 02 saturation (Sa02), normal 02 content (Ca02)'}, | D: Normal Pa02, normal 02 saturation (Sa02), low 02 content (Ca02) |
Answer the following medical question with one of the provided options: | Q:Four days into hospitalization for severe pneumonia, a 76-year-old woman suddenly becomes unresponsive. She has no history of heart disease. She is on clarithromycin and ceftriaxone. Her carotid pulse is not detected. A single-lead ECG strip is shown. Previous ECG shows QT prolongation. Laboratory studies show: Serum Na+ 145 mEq/L K+ 6.1 mEq/L Ca2+ 10.5 mEq/L Mg2+ 1.8 mEq/L Thyroid-stimulating hormone 0.1 μU/mL Cardiopulmonary resuscitation has been initiated. Which of the following is the most likely underlying cause of this patient’s recent condition?? {'A': 'Hypercalcemia', 'B': 'Thyrotoxicosis', 'C': 'Hyperkalemia', 'D': 'Clarithromycin', 'E': 'Septic shock'}, | D: Clarithromycin |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the physician for a routine health maintenance examination. She is doing well. She is 168 cm (5 ft 6 in) tall and weighs 75 kg (165 lb); BMI is 27 kg/m2. Her BMI had previously been stable at 24 kg/m2. The patient states that she has had decreased appetite over the past month. The patient's change in appetite is most likely mediated by which of the following?? {'A': 'Increased hepatic somatomedin C secretion', 'B': 'Decreased hypothalamic neuropeptide Y', 'C': 'Potentiation of cholecystokinin', 'D': 'Increased fatty acid oxidation', 'E': 'Inhibition of proopiomelanocortin neurons'}, | B: Decreased hypothalamic neuropeptide Y |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man is brought to the emergency department after experiencing a seizure. According to his girlfriend, he has had fatigue for the last 3 days and became confused this morning, after which he started having uncontrollable convulsions throughout his entire body. He was unconscious throughout the episode, which lasted about 4 minutes. He has not visited a physician for over 10 years. He has smoked one pack of cigarettes daily for 12 years. His girlfriend admits they occasionally use heroin together with their friends. His temperature is 38.8°C (101.8°F), pulse is 93/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. The lungs are clear to auscultation and examination shows normal heart sounds and no carotid or femoral bruits. He appears emaciated and somnolent. There are multiple track marks on both his arms. He is unable to cooperate for a neurological exam. Laboratory studies show a leukocyte count of 3,000/mm3, a hematocrit of 34%, a platelet count of 354,000/mm3, and an erythrocyte sedimentation rate of 27 mm/h. His CD4+ T-lymphocyte count is 84/mm3 (normal ≥ 500). A CT scan of the head is shown. Which of the following is the most appropriate next step considering this patient's CT scan findings?? {'A': 'Pyrimethamine, sulfadiazine, and leucovorin', 'B': 'Trimethoprim-sulfamethoxazole', 'C': 'CT-guided stereotactic aspiration', 'D': 'Albendazole', 'E': 'Glucocorticoids'}, | A: Pyrimethamine, sulfadiazine, and leucovorin |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman presents with fatigue and flu-like symptoms. She says her symptoms started 5 days ago with a low-grade fever and myalgia, which have not improved. For the past 4 days, she has also had chills, sore throat, and rhinorrhea. She works as a kindergarten teacher and says several children in her class have had similar symptoms. Her past medical history is significant for depression managed with escitalopram, and dysmenorrhea. A review of systems is significant for general fatigue for the past 5 months. Her vital signs include: temperature 38.5°C (101.3°F), pulse 99/min, blood pressure 115/75 mm Hg, and respiratory rate 22/min. Physical examination reveals pallor of the mucous membranes. Initial laboratory findings are significant for the following: Hematocrit 24.5% Hemoglobin 11.0 g/dL Platelet Count 215,000/mm3 Mean corpuscular volume (MCV) 82 fL Red cell distribution width (RDW) 10.5% Which of the following is the best next diagnostic test in this patient?? {'A': 'Reticulocyte count', 'B': 'Serum folate level', 'C': 'Serum ferritin level', 'D': 'Serum iron level', 'E': 'Hemoglobin electrophoresis'}, | A: Reticulocyte count |
Answer the following medical question with one of the provided options: | Q:An investigator is studying collagen synthesis in human fibroblast cells. Using a fluorescent tag, α-collagen chains are identified and then monitored as they travel through the rough endoplasmic reticulum, the Golgi apparatus, and eventually into the extracellular space. Which of the following steps in collagen synthesis occurs extracellularly?? {'A': 'Glycosylation of pro-α chains', 'B': 'Hydroxylation of proline and lysine', 'C': 'Cleavage of procollagen C- and N-terminals', 'D': 'Triple-helix formation', 'E': 'Translation of pro-α chains'}, | C: Cleavage of procollagen C- and N-terminals |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy is brought in by his mother due to complaints of a headache with diminished vision of his temporal field. It has been previously recorded that the patient has poor growth velocity. On imaging, a cystic calcified mass is noted above the sella turcica. From which of the following is this mass most likely derived?? {'A': 'Oral ectoderm', 'B': 'Cholesterol', 'C': 'Neuroectoderm', 'D': 'Neurohypophysis', 'E': 'Paraxial mesoderm'}, | A: Oral ectoderm |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to the physician because of a 10-month history of crampy left lower extremity pain that is exacerbated by walking and relieved by rest. The pain is especially severe when he walks on an incline. He has a 20-year history of type 2 diabetes mellitus, for which he takes metformin. He has smoked 1 pack of cigarettes daily for 40 years. His blood pressure is 140/92 mm Hg. Physical examination shows dry and hairless skin over the left foot. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Osteophytic compression of the lumbar spinal canal', 'B': 'Thrombosing vasculitis of the popliteal artery', 'C': 'Intimal plaque in the posterior tibial artery', 'D': 'Fibrin clot in the left popliteal vein', 'E': 'Systemic hyperplastic arteriolosclerosis'}, | C: Intimal plaque in the posterior tibial artery |
Answer the following medical question with one of the provided options: | Q:A 65-year-old African-American man comes to the physician for a follow-up examination after presenting with elevated blood pressure readings during his last visit. He has no history of major medical illness and takes no medications. He is 180 cm (5 ft 9 in) tall and weighs 68 kg (150 lb); BMI is 22 kg/m2. His pulse is 80/min and blood pressure is 155/90 mm Hg. Laboratory studies show no abnormalities. Which of the following is the most appropriate initial pharmacotherapy for this patient?? {'A': 'Valsartan', 'B': 'Metoprolol', 'C': 'Chlorthalidone', 'D': 'Aliskiren', 'E': 'Captopril'}, | C: Chlorthalidone |
Answer the following medical question with one of the provided options: | Q:A 7-month-old boy is brought in to his pediatrician’s office due to concern for recurrent infections. The parents state that over the last 3-4 months, the boy has had multiple viral respiratory infections, along with a fungal pneumonia requiring hospitalization. Currently he is without complaints; however, the parents are concerned that he continues to have loose stools and is falling off of his growth curve. Newborn screening is not recorded in the patient’s chart. On exam, the patient’s temperature is 98.4°F (36.9°C), blood pressure is 108/68 mmHg, pulse is 90/min, and respirations are 12/min. The patient is engaging appropriately and is able to grasp, sit, and is beginning to crawl. However, the patient is at the 20th percentile for length and weight, when he was previously at the 50th percentile at 3 months of age. Further screening suggests that the patient has an autosomal recessive immunodeficiency associated with absent T-cells. Which of the following is also associated with this disease?? {'A': 'Accumulation of deoxyadenosine', 'B': 'Dysfunctional cell chemotaxis', 'C': 'Mutation in ATM DNA repair gene', 'D': 'Negative nitroblue-tetrazolium test', 'E': 'Nonfunctional common gamma chain'}, | A: Accumulation of deoxyadenosine |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman with a history of palpitations is being evaluated by a surgeon for epigastric pain. It is discovered that she has an epigastric hernia that needs repair. During her preoperative evaluation, she is ordered to receive lab testing, an electrocardiogram (ECG), and a chest X-ray. These screening studies are unremarkable except for her chest X-ray, which shows a 2 cm isolated pulmonary nodule in the middle lobe of the right lung. The nodule has poorly defined margins, and it shows a dense, irregular pattern of calcification. The patient is immediately referred to a pulmonologist for evaluation of the lesion. The patient denies any recent illnesses and states that she has not traveled outside of the country since she was a child. She has had no sick contacts or respiratory symptoms, and she does not currently take any medications. She does, however, admit to a 20-pack-year history of smoking. Which of the following is the most appropriate next step in evaluating this patient’s diagnosis with regard to the pulmonary nodule?? {'A': 'Obtain a contrast-enhanced CT scan of the chest', 'B': 'Send sputum for cytology', 'C': 'Order a positron emission tomography scan of the chest', 'D': 'Perform a flexible bronchoscopy with biopsy', 'E': 'Try to obtain previous chest radiographs for comparison'}, | E: Try to obtain previous chest radiographs for comparison |
Answer the following medical question with one of the provided options: | Q:You are currently employed as a clinical researcher working on clinical trials of a new drug to be used for the treatment of Parkinson's disease. Currently, you have already determined the safe clinical dose of the drug in a healthy patient. You are in the phase of drug development where the drug is studied in patients with the target disease to determine its efficacy. Which of the following phases is this new drug currently in?? {'A': 'Phase 1', 'B': 'Phase 2', 'C': 'Phase 3', 'D': 'Phase 4', 'E': 'Phase 0'}, | B: Phase 2 |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man is presented to the emergency department by paramedics after being involved in a serious 3-car collision on an interstate highway while he was driving his motorcycle. On physical examination, he is responsive only to painful stimuli and his pupils are not reactive to light. His upper extremities are involuntarily flexed with hands clenched into fists. The vital signs include temperature 36.1°C (97.0°F), blood pressure 80/60 mm Hg, and pulse 102/min. A non-contrast computed tomography (CT) scan of the head shows a massive intracerebral hemorrhage with a midline shift. Arterial blood gas (ABG) analysis shows partial pressure of carbon dioxide in arterial blood (PaCO2) of 68 mm Hg, and the patient is put on mechanical ventilation. His condition continues to decline while in the emergency department and it is suspected that this patient is brain dead. Which of the following results can be used to confirm brain death and legally remove this patient from the ventilator?? {'A': 'Electrocardiogram', 'B': 'More than a 30% decrease in pulse oximetry', 'C': 'Lumbar puncture and CSF culture', 'D': 'Electromyography with nerve conduction studies', 'E': 'CT scan'}, | E: CT scan |
Answer the following medical question with one of the provided options: | Q:A 45-year-old male presents to his primary care provider with an abnormal gait. He was hospitalized one week prior for acute cholecystitis and underwent a laparoscopic cholecystectomy. He received post-operative antibiotics via intramuscular injection. He recovered well and he was discharged on post-operative day #3. However, since he started walking after the operation, he noticed a limp that has not improved. On exam, his left hip drops every time he raises his left foot to take a step. In which of the following locations did this patient likely receive the intramuscular injection?? {'A': 'Anteromedial thigh', 'B': 'Superomedial quadrant of the buttock', 'C': 'Superolateral quadrant of the buttock', 'D': 'Inferomedial quadrant of the buttock', 'E': 'Inferolateral quadrant of the buttock'}, | B: Superomedial quadrant of the buttock |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman in the intensive care unit has had persistent oozing from the margins of wounds for 2 hours that is not controlled by pressure bandages. She was admitted to the hospital 13 hours ago following a high-speed motor vehicle collision. Initial focused assessment with sonography for trauma was negative. An x-ray survey showed opacification of the right lung field and fractures of multiple ribs, the tibia, fibula, calcaneus, right acetabulum, and bilateral pubic rami. Laboratory studies showed a hemoglobin concentration of 14.8 g/dL, leukocyte count of 10,300/mm3, platelet count of 175,000/mm3, and blood glucose concentration of 77 mg/dL. Infusion of 0.9% saline was begun. Multiple lacerations on the forehead and extremities were sutured, and fractures were stabilized. Repeat laboratory studies now show a hemoglobin concentration of 12.4 g/dL, platelet count of 102,000/mm3, prothrombin time of 26 seconds (INR=1.8), and activated partial thromboplastin time of 63 seconds. Which of the following is the next best step in management?? {'A': 'Transfuse packed RBC, fresh frozen plasma, and platelet concentrate in a 1:1:1 ratio', 'B': 'Transfuse whole blood and administer vitamin K', 'C': 'Transfuse fresh frozen plasma and platelet concentrate in a 1:1 ratio', 'D': 'Transfuse packed RBC', 'E': 'Transfuse packed RBC and fresh frozen plasma in a 1:1 ratio'}, | A: Transfuse packed RBC, fresh frozen plasma, and platelet concentrate in a 1:1:1 ratio |
Answer the following medical question with one of the provided options: | Q:A 13-month-old boy with sickle cell anemia is brought to the emergency department because of continuous crying and severe left-hand swelling. His condition started 2 hours earlier without any preceding trauma. The child was given diclofenac syrup at home with no relief. The temperature is 37°C (98.6°F), blood pressure is 100/60 mm Hg, and pulse is 100/min. The physical examination reveals swelling and tenderness to palpation of the left hand. The hemoglobin level is 10.4 g/dL. Which of the following is the best initial step in management of this patient condition?? {'A': 'Intravenous morphine', 'B': 'Intravenous meperidine', 'C': 'Joint aspiration', 'D': 'Incentive spirometry', 'E': 'Magnetic resonance imaging (MRI) of the affected joint'}, | A: Intravenous morphine |
Answer the following medical question with one of the provided options: | Q:A 31-year-old male comedian presents to your mental health clinic for a psychotherapy appointment. He is undergoing psychodynamic psychotherapy for depressive symptoms. During the therapy session, you discuss his job as a successful comedian and identify ways that he channels his emotions about his abusive childhood into comedy routines. Though he enjoys his job overall and idolizes some of his coworkers, he complains about most of them being “totally incompetent.” When you attempt to shift the discussion back to his childhood, he avoids eye contact and he tells you he “doesn’t want to talk about it anymore.” Which of the following is an immature defense mechanism exhibited by this patient?? {'A': 'Denial', 'B': 'Humor', 'C': 'Reaction formation', 'D': 'Splitting', 'E': 'Suppression'}, | D: Splitting |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the physiological response during congestive heart failure exacerbations in patients with systolic heart failure. A hormone released by ventricular cardiomyocytes in response to increased wall stress is isolated from a patient's blood sample. The intracellular mechanism by which this hormone acts is most similar to the effect of which of the following substances?? {'A': 'Nitric oxide', 'B': 'Human chorionic gonadotropin', 'C': 'Aldosterone', 'D': 'Angiotensin II', 'E': 'Platelet-derived growth factor'}, | A: Nitric oxide |
Answer the following medical question with one of the provided options: | Q:An asymptomatic 15-year-old high school wrestler with no family history of renal disease is completing his preseason physical exam. He submits a urine sample for a dipstick examination, which tests positive for protein. What is the next appropriate step in management?? {'A': 'Repeat dipstick on a separate occasion', 'B': 'Urine culture', 'C': 'Renal ultrasound', 'D': '24 hour urine collection', 'E': 'Spot urine-protein-to-creatinine ratio'}, | A: Repeat dipstick on a separate occasion |
Answer the following medical question with one of the provided options: | Q:A 44-year-old man is brought to the emergency department by his daughter for a 1-week history of right leg weakness, unsteady gait, and multiple falls. During the past 6 months, he has become more forgetful and has sometimes lost his way along familiar routes. He has been having difficulties operating simple kitchen appliances such as the dishwasher and the coffee maker. He has recently become increasingly paranoid, agitated, and restless. He has HIV, hypertension, and type 2 diabetes mellitus. His last visit to a physician was more than 2 years ago, and he has been noncompliant with his medications. His temperature is 37.2 °C (99.0 °F), blood pressure is 152/68 mm Hg, pulse is 98/min, and respirations are 14/min. He is somnolent and slightly confused. He is oriented to person, but not place or time. There is mild lymphadenopathy in the cervical, axillary, and inguinal areas. Neurological examination shows right lower extremity weakness with normal tone and no other focal deficits. Laboratory studies show: Hemoglobin 9.2 g/dL Leukocyte count 3600/mm3 Platelet count 140,000/mm3 CD4+ count 56/μL HIV viral load > 100,000 copies/mL Serum Cryptococcal antigen negative Toxoplasma gondii IgG positive An MRI of the brain shows disseminated, nonenhancing white matter lesions with no mass effect. Which of the following is the most likely diagnosis?"? {'A': 'Vascular dementia', 'B': 'Neurocysticercosis', 'C': 'Progressive multifocal leukoencephalopathy', 'D': 'Primary CNS lymphoma', 'E': 'Cerebral toxoplasmosis'}, | C: Progressive multifocal leukoencephalopathy |
Answer the following medical question with one of the provided options: | Q:A 70 year-old man comes to the emergency department for sudden loss of vision in the right eye over the last 24 hours. He has noticed progressive bilateral loss of central vision over the last year. He has had difficulty reading his newspaper and watching his television. He has smoked 1 pack daily for 50 years. Ophthalmologic examination shows visual acuity of 20/60 in the left eye and 20/200 in the right eye. The pupils are equal and reactive to light. Tonometry reveals an intraocular pressure of 18 mm Hg in the right eye and 20 mm Hg in the left eye. Anterior segment exam is unremarkable. Slit-lamp examination shows subretinal fluid and small hemorrhage with grayish-green discoloration in the macular area in the right eye, and multiple drusen in the left eye with retinal pigment epithelial changes. Which of the following is the most appropriate initial treatment for the patient's illness?? {'A': 'Etanercept', 'B': 'Thermal laser photocoagulation', 'C': 'Ranibizumab', 'D': 'Macular translocation surgery', 'E': 'Photodynamic therapy'}, | C: Ranibizumab |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to the emergency department with confusion. The patient is generally healthy, but his wife noticed him becoming progressively more confused as the day went on. The patient is not currently taking any medications and has no recent falls or trauma. His temperature is 102°F (38.9°C), blood pressure is 126/64 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a confused man who cannot participate in a neurological exam secondary to his confusion. No symptoms are elicited with flexion of the neck and jolt accentuation of headache is negative. Initial laboratory values are unremarkable and the patient's chest radiograph and urinalysis are within normal limits. An initial CT scan of the head is unremarkable. Which of the following is the best next step in management?? {'A': 'Acyclovir', 'B': 'CT angiogram of the head and neck', 'C': 'MRI of the head', 'D': 'PCR of the cerebrospinal fluid', 'E': 'Vancomycin, ceftriaxone, ampicillin, and dexamethasone'}, | A: Acyclovir |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man presents to his primary care physician for ear pain. The patient states he has had ear pain for the past several days that seems to be worsening. The patient lives in a retirement home and previously worked as a banker. The patient currently is active, swims every day, and drinks 3 to 4 glasses of whiskey at night. There have been multiple cases of the common cold at his retirement community. The patient has a past medical history of myocardial infarction, Alzheimer dementia, diabetes, hypertension, vascular claudication, and anxiety. His current medications include insulin, metformin, aspirin, metoprolol, lisinopril, and buspirone. His temperature is 99.5°F (37.5°C), blood pressure is 167/108 mmHg, pulse is 102/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is within normal limits. HEENT exam is notable for tenderness over the left mastoid process. Abdominal and musculoskeletal exam are within normal limits. Which of the following is the best management for this patient's condition?? {'A': 'Acetic acid drops', 'B': 'Amoxicillin', 'C': 'Amoxicillin/clavulanic acid', 'D': 'Ciprofloxacin', 'E': 'Observation'}, | D: Ciprofloxacin |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman with endometriosis comes to the physician because of bilateral flank pain and decreased urine output for 1-week. She has not had any fevers, chills, or dysuria. Physical examination shows several surgical scars on her abdomen. Laboratory studies show a serum creatinine concentration of 3.5 mg/dL. A CT scan of the abdomen shows numerous intra-abdominal adhesions, as well as dilatation of the renal pelvis and proximal ureters bilaterally. An increase in which of following is the most likely underlying mechanism of this patient's renal dysfunction?? {'A': 'Hydrostatic pressure in the tubules', 'B': 'Osmotic pressure in the glomeruli', 'C': 'Hydrostatic pressure in the efferent arteriole', 'D': 'Osmotic pressure in the afferent arteriole', 'E': 'Osmotic pressure in the tubules'}, | A: Hydrostatic pressure in the tubules |
Answer the following medical question with one of the provided options: | Q:A 43-year-old male visits the emergency room around 4 weeks after getting bitten by a bat during a cave diving trip. After cleansing the wound with water, the patient reports that he felt well enough not to seek medical attention immediately following his trip. He does endorse feeling feverish in the past week but a new onset of photophobia and irritability led him to seek help today. What would the post-mortem pathology report show if the patient succumbs to this infection?? {'A': 'Psammoma bodies', 'B': 'Pick bodies', 'C': 'Heinz bodies', 'D': 'Negri bodies', 'E': 'Howell-Jolly bodies'}, | D: Negri bodies |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman is brought to the emergency department by her husband who found her lying unconscious at home. He says that the patient has been complaining of progressively worsening weakness and confusion for the past week. Her past medical history is significant for hypertension, systemic lupus erythematosus, and trigeminal neuralgia. Her medications include metoprolol, valsartan, prednisone, and carbamazepine. On admission, blood pressure is 130/70 mm Hg, pulse rate is 100 /min, respiratory rate is 17/min, and temperature is 36.5°C (97.7ºF). She regained consciousness while on the way to the hospital but is still drowsy and disoriented. Physical examination is normal. Finger-stick glucose level is 110 mg/dl. Other laboratory studies show: Na+ 120 mEq/L (136—145 mEq/L) K+ 3.5 mEq/L (3.5—5.0 mEq/L) CI- 107 mEq/L (95—105 mEq/L) Creatinine 0.8 mg/dL (0.6—1.2 mg/dL) Serum osmolality 250 mOsm/kg (275—295 mOsm/kg) Urine Na+ 70 mEq/L Urine osmolality 105 mOsm/kg She is admitted to the hospital for further management. Which of the following is the next best step in the management of this patient’s condition?? {'A': 'Fluid restriction', 'B': 'Rapid resuscitation with hypertonic saline', 'C': 'Desmopressin', 'D': 'Lithium', 'E': 'Tolvaptan'}, | A: Fluid restriction |
Answer the following medical question with one of the provided options: | Q:A 22-year-old primigravid woman at 12 weeks' gestation comes to the physician because of several hours of abdominal cramping and passing of large vaginal blood clots. Her temperature is 36.8°C (98.3°F), pulse is 75/min, and blood pressure is 110/65 mmHg. The uterus is consistent in size with a 12-week gestation. Speculum exam shows an open cervical os and blood clots within the vaginal vault. Transvaginal ultrasound shows an empty gestational sac. The patient is worried about undergoing invasive procedures. Which of the following is the most appropriate next step in management?? {'A': 'Dilation and curettage', 'B': 'Expectant management', 'C': 'Methotrexate therapy', 'D': 'Serial beta-hCG measurement', 'E': 'Oxytocin therapy'}, | B: Expectant management |
Answer the following medical question with one of the provided options: | Q:A surgeon is interested in studying how different surgical techniques impact the healing of tendon injuries. In particular, he will compare 3 different types of suture repairs biomechanically in order to determine the maximum load before failure of the tendon 2 weeks after repair. He collects data on maximum load for 90 different repaired tendons from an animal model. Thirty tendons were repaired using each of the different suture techniques. Which of the following statistical measures is most appropriate for analyzing the results of this study?? {'A': 'ANOVA', 'B': 'Chi-squared', 'C': 'Pearson r coefficient', 'D': 'Student t-test', 'E': 'Wilcoxon rank sum'}, | A: ANOVA |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the physician because of a 2-month history of generalized fatigue. On examination, he appears pale. He also has multiple pinpoint, red, nonblanching spots on his extremities. His spleen is significantly enlarged. Laboratory studies show a hemoglobin concentration of 8.3 g/dL, a leukocyte count of 81,000/mm3, and a platelet count of 35,600/mm3. A peripheral blood smear shows immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions. Which of the following is the most likely diagnosis?? {'A': 'Myelodysplastic syndrome', 'B': 'Acute lymphoblastic leukemia', 'C': 'Acute myelogenous leukemia', 'D': 'Chronic myelogenous leukemia', 'E': 'Hairy cell leukemia'}, | C: Acute myelogenous leukemia |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the effect that mutations in different parts of the respiratory tract have on susceptibility to infection. A mutation in the gene encoding for the CD21 protein is induced in a sample of cells obtained from the nasopharyngeal epithelium. This mutation is most likely to prevent infection with which of the following viruses?? {'A': 'Rhinovirus', 'B': 'Epstein-Barr virus', 'C': 'Human immunodeficiency virus', 'D': 'Cytomegalovirus', 'E': 'Parvovirus'}, | B: Epstein-Barr virus |
Answer the following medical question with one of the provided options: | Q:A 33-year-old woman presents to her primary care physician for gradually worsening pain in both wrists that began several months ago. The pain originally did not bother her, but it has recently begun to affect her daily functioning. She states that the early morning stiffness in her hands is severe and has made it difficult to tend to her rose garden. She occasionally takes ibuprofen for the pain, but she says this does not really help. Her medical history is significant for diabetes mellitus and major depressive disorder. She is currently taking insulin, sertraline, and a daily multivitamin. The vital signs include: blood pressure 126/84 mm Hg, heart rate 82/min, and temperature 37.0°C (98.6°F). On physical exam, her wrists and metacarpophalangeal joints are swollen, tender, erythematous, and warm to the touch. There are no nodules or vasculitic lesions. Which of the following antibodies would be most specific to this patient’s condition?? {'A': 'Anti-Ro', 'B': 'Rheumatoid factor', 'C': 'Anti-Scl-70', 'D': 'c-ANCA', 'E': 'Anti-cyclic citrullinated peptide'}, | E: Anti-cyclic citrullinated peptide |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man comes to the physician for a follow-up evaluation for chronic lower back pain. He has back stiffness that lasts all morning and slowly improves throughout the day. He has tried multiple over-the-counter medications, including ibuprofen, without any improvement in his symptoms. Physical examination shows tenderness over the iliac crest bilaterally and limited range of motion of the lumbar spine with forward flexion. The results of HLA-B27 testing are positive. An x-ray of the lumbar spine shows fusion of the lumbar vertebrae and sacroiliac joints. The physician plans to prescribe a new medication but first orders a tuberculin skin test to assess for the risk of latent tuberculosis reactivation. Inhibition of which of the following is the most likely primary mechanism of action of this drug?? {'A': 'Inosine monophosphate dehydrogenase', 'B': 'TNF-α', 'C': 'NF-κB', 'D': 'Calcineurin', 'E': 'mTOR kinase'}, | B: TNF-α |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man is brought to the emergency department by his wife because of bizarre and agitated behavior for the last 6 weeks. He thinks that the NSA is spying on him and controlling his mind. His wife reports that the patient has become withdrawn and at times depressed for the past 3 months. He lost his job because he stopped going to work 4 weeks ago. Since then, he has been working on an invention that will block people from being able to control his mind. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?? {'A': 'Delusional disorder', 'B': 'Schizophreniform disorder', 'C': 'Schizophrenia', 'D': 'Brief psychotic disorder', 'E': 'Schizotypal personality disorder'}, | B: Schizophreniform disorder |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents to his primary care provider because of shortness of breath, cough, and wheezing. He reports that in high school, he occasionally had shortness of breath and would wheeze after running. His symptoms have progressively worsened over the past 6 months and are now occurring daily. He also finds himself being woken up from sleep by his wheeze approximately 3 times a week. His medical history is unremarkable. He denies tobacco use or excessive alcohol consumption. His temperature is 37.1°C (98.8°F), blood pressure is 121/82 mm Hg, and heart rate is 82/min. Physical examination is remarkable for expiratory wheezing bilaterally. Spirometry shows an FEV1 of 73% of predicted, which improves by 19% with albuterol. In addition to a short-acting beta-agonist as needed, which of the following is the most appropriate therapy for this patient?? {'A': 'A low-dose inhaled corticosteroid alone', 'B': 'A long-acting beta-agonist alone', 'C': 'A low-dose inhaled corticosteroid and a long-acting beta-agonist', 'D': 'A medium-dose inhaled corticosteroid and a long-acting beta-agonist', 'E': 'A high-dose inhaled corticosteroid and a long-acting beta-agonist'}, | C: A low-dose inhaled corticosteroid and a long-acting beta-agonist |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman comes to the physician because of a dry cough and worsening shortness of breath with exertion for the past 6 months. She used to go running three times each week but had to stop because of decreased exercise tolerance and pain in the bilateral ankles. Two months ago, she was in Nigeria for several weeks to visit her family. She is allergic to cats and pollen. She has smoked one pack of cigarettes daily for the past 17 years. Her vital signs are within normal limits. Examination shows multiple 1.5- to 2-cm, nontender lymph nodes in the axillae. A few crackles are heard on auscultation of the chest. Her serum calcium concentration is 11.7 mg/dL. An x-ray of the chest shows enlarged hilar lymph nodes bilaterally and reticular opacities in both lungs. Which of the following is the most likely cause of these findings?? {'A': 'Necrotizing inflammation', 'B': 'Granulomatous inflammation', 'C': 'Neoplastic transformation', 'D': 'Viral infection', 'E': 'Air trapping'}, | B: Granulomatous inflammation |
Answer the following medical question with one of the provided options: | Q:A 78-year-old male presents to the emergency department after passing out. His wife reports that she and the patient were walking their dog when he suddenly lost consciousness. On physical exam, he has a loud crescendo-decrescendo systolic murmur and is subsequently diagnosed with severe aortic stenosis. The patient undergoes open aortic valve replacement and has an uncomplicated postoperative course. His sternal wound drain is pulled for low output on post-operative day three. On post-operative day five, the patient complains of pain during deep inspiration and retrosternal chest pain. His temperature is 101.7°F (38.7°C), blood pressure is 125/81 mmHg, pulse is 104/min, and respirations are 18/min. On physical exam, the patient is tender to palpation around his sternal wound, and there is erythema around the incision without dehiscence. His chest radiograph shows a widened mediastinum with a small pleural effusion on the left. CT angiography shows stranding in the subcutaneous tissue and a fluid collection below the sternum. Which of the following is the best next step in management?? {'A': 'Placement of a left-sided chest tube', 'B': 'Surgical repair of esophageal perforation', 'C': 'Surgical repair of aortic injury', 'D': 'Intravenous antibiotics and observation', 'E': 'Intravenous antibiotics and debridement of surgical wound'}, | E: Intravenous antibiotics and debridement of surgical wound |
Answer the following medical question with one of the provided options: | Q:A 66-year-old G3P3 presents with an 8-year-history of back pain, perineal discomfort, difficulty urinating, recurrent malaise, and low-grade fevers. These symptoms have recurred regularly for the past 5–6 years. She also says that there are times when she experiences a feeling of having a foreign body in her vagina. With the onset of symptoms, she was evaluated by a physician who prescribed her medications after a thorough examination and recommended a vaginal pessary, but she was non-compliant. She had 3 vaginal deliveries She has been menopausal since 51 years of age. She does not have a history of malignancies or cardiovascular disease. She has type 2 diabetes mellitus that is controlled with diet and metformin. Her vital signs include: blood pressure 110/60 mm Hg, heart rate 91/min, respiratory rate 13/min, and temperature 37.4℃ (99.3℉). On physical examination, there is bilateral costovertebral angle tenderness. The urinary bladder is non-palpable. The gynecologic examination reveals descent of the cervix to the level of the introitus. A Valsalva maneuver elicits uterine procidentia. Which pathology is most likely to be revealed by imaging in this patient?? {'A': 'Renal tumor', 'B': 'Hydronephrosis', 'C': 'Urinary bladder polyp', 'D': 'Renal calculi', 'E': 'Renal cyst'}, | B: Hydronephrosis |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to the emergency department for the evaluation of diarrhea and vomiting for the last 2 days. During this period, he has had about 12 watery, non-bloody bowel movements and has vomited three times. He came back from a trip to India 3 days ago, where he and his family were visiting relatives. He has not been able to eat anything since the symptoms started. The patient has not urinated since yesterday. He appears pale. His temperature is 38°C (100.4°F), pulse is 106/min, and blood pressure is 96/60 mm Hg. Examination shows dry mucous membranes. The abdomen is soft with no organomegaly. Bowel sounds are hyperactive. Laboratory studies show: Hemoglobin 13 g/dL Serum Na+ 148 mEq/L Cl- 103 mEq/L K+ 3.7 mEq/L HCO3- 19 mEq/L Urea nitrogen 80 mg/dL Glucose 90 mg/dL Creatinine 2 mg/dL Intravenous fluid resuscitation is begun. Which of the following is the most likely cause of this patient's abnormal renal laboratory findings?"? {'A': 'Decreased renal perfusion', 'B': 'Renal artery stenosis', 'C': 'IgA complex deposition', 'D': 'Glomerulonephritis', 'E': 'Urinary tract obstruction'}, | A: Decreased renal perfusion |
Answer the following medical question with one of the provided options: | Q:A previously healthy 25-year-old man comes to the physician because of a 4-day history of fever, joint and body pain, diffuse headache, and pain behind the eyes. This morning he noticed that his gums bled when he brushed his teeth. He returned from a backpacking trip to the Philippines 4 days ago. His temperature is 39.4°C (103.0°F). Physical examination shows a diffuse maculopapular rash. His leukocyte count is 3,200/mm3 and platelet count is 89,000/mm3. Further evaluation shows increased serum levels of a flavivirus. Which of the following is the most likely causal pathogen?? {'A': 'Chikungunya virus', 'B': 'Ebola virus', 'C': 'Hanta virus', 'D': 'Lassa virus', 'E': 'Dengue virus'}, | E: Dengue virus |
Answer the following medical question with one of the provided options: | Q:You are reviewing the protocol for a retrospective case-control study investigating risk factors for mesothelioma among retired factory workers. 100 cases of mesothelioma and 100 age and sex matched controls are to be recruited and interviewed about their exposure to industrial grade fiberglass by blinded interviewers. The investigators' primary hypothesis is that cases of mesothelioma will be more likely to have been exposed to industrial grade fiberglass. The design of this study is most concerning for which type of bias?? {'A': 'Interviewer bias', 'B': 'Recall bias', 'C': 'Observer bias', 'D': 'Lead-time bias', 'E': 'This study design is free of potential bias'}, | B: Recall bias |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man presents to his primary care provider complaining of abdominal pain. The patient reports a dull pain that has been present for 4 weeks now. The patient states that the pain is located to his right upper quadrant and does not change with eating. The patient denies any alcohol or illicit substance use, stating that he is meticulous about eating healthy since he is a professional bodybuilder. The patient reports no history of malignancy. On exam, the patient's temperature is 98.2°F (36.8°C), blood pressure is 130/86 mmHg, pulse is 60/min, and respirations are 12/min. The patient has an athletic build, and his exam is unremarkable for any palpable mass or abdominal tenderness. On further questioning, the patient does endorse a 5-year history of using anabolic steroids for bodybuilding. Imaging demonstrates an enhancing liver nodule. Which of the following is the most likely histopathologic finding of this patient’s disease?? {'A': 'Columnar cells with acinar structures', 'B': 'Hemorrhagic nests with atypical endothelial cells', 'C': 'Hypervascular lesion lined by normal endothelial cells', 'D': 'Multifocal tumor with multiple layers of hepatocytes with hemorrhage and necrosis', 'E': 'Sheets of normal hepatocytes without portal tracts or central veins'}, | E: Sheets of normal hepatocytes without portal tracts or central veins |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man comes to the physician because of a 3-month history of worsening shortness of breath and cough productive of frothy, whitish sputum. One year ago, he had a similar episode lasting 6 months. He has smoked a pack of cigarettes daily for 25 years. Physical examination shows bluish discoloration of the tongue and lips. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Increased pulmonary capillary wedge pressure', 'B': 'Normal FEV1', 'C': 'Increased FEV1/FVC ratio', 'D': 'Increased serum hematocrit', 'E': 'Increased diffusing capacity for carbon monoxide'}, | D: Increased serum hematocrit |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman presents to the emergency department after she was found agitated and screaming for help in the middle of the street. She says she also has dizziness and tingling in the lips and hands. Her past medical history is relevant for general anxiety disorder, managed medically with paroxetine. At admission, her pulse is 125/min, respiratory rate is 25/min, and body temperature is 36.5°C (97.7°C). Physical examination is unremarkable. An arterial blood gas sample is taken. Which of the following results would you most likely expect to see in this patient?? {'A': 'pH: increased, HCO3- : decreased, Pco2: decreased', 'B': 'pH: decreased, HCO3- : decreased, Pco2: decreased', 'C': 'pH: decreased, HCO3- : increased, Pco2: increased', 'D': 'pH: increased, HCO3- : increased, Pco2: increased', 'E': 'pH: normal, HCO3- : increased, Pco2: increased'}, | A: pH: increased, HCO3- : decreased, Pco2: decreased |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman presents to a medical office with complaints of fatigue, weight loss, and low-grade fever for 1 week. She noticed bleeding spots on her feet this morning. The past medical history is significant for a recent dental appointment. She is a non-smoker and does not drink alcohol. She does not currently take any medications. On examination, the vital signs include temperature 37.8°C (100.0°F), blood pressure 138/90 mm Hg, respirations 21/min, and pulse 87/min. Cardiac auscultation reveals a pansystolic murmur in the mitral area with radiation to the right axilla. Laboratory studies show hemoglobin levels of 17.2 g/dL, erythrocyte sedimentation rate (ESR) of 25 mm/h, and a white blood cell (WBC) count of 12,000 cells/mm3. An echocardiogram (ECG) reveals valvular vegetations on the mitral valve with mild regurgitation. Blood samples are sent for bacterial culture. Empiric antibiotic therapy is initiated with ceftriaxone and vancomycin. The blood cultures most likely will yield the growth of which of the following organisms?? {'A': 'Staphylococcus aureus', 'B': 'Actinomyces israelii', 'C': 'Streptococcus viridans', 'D': 'Group B Streptococcus', 'E': 'Coxiella burnetii'}, | C: Streptococcus viridans |
Answer the following medical question with one of the provided options: | Q:A 38-year-old G2P2 presents to her gynecologist to discuss the results of her diagnostic tests. She has no current complaints or concurrent diseases. She underwent a tubal ligation after her last pregnancy. Her last Pap smear showed a high-grade squamous intraepithelial lesion and a reflex HPV test was positive. Colposcopic examination reveals areas of thin acetowhite epithelium with diffuse borders and fine punctation. The biopsy obtained from the suspicious areas shows CIN 1. Which of the following is an appropriate next step in the management of this patient?? {'A': 'Cryoablation', 'B': 'Loop electrosurgical excision procedure', 'C': 'Cold-knife conization', 'D': 'Test for type 16 and 18 HPV', 'E': 'Repeat cytology and HPV co-testing in 6 months'}, | B: Loop electrosurgical excision procedure |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man comes to the physician for a follow-up examination after having been diagnosed with stage II adenocarcinoma of the left lower lung lobe without evidence of distant metastases 1 week ago following an evaluation for a chronic cough. He has hypertension and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 40 years. His current medications include metformin, sitagliptin, and enalapril. He is 177 cm (5 ft 10 in) tall and weighs 65 kg (143 lb); BMI is 20.7 kg/m2. He appears lethargic. Vital signs are within normal limits. Pulse oximetry shows an oxygen saturation of 98%. Examination shows inspiratory wheezing at the left lung base. The remainder of the examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, creatinine, glucose, and liver enzymes are within the reference range. Spirometry shows an FEV1 of 1.6 L. The diffusing lung capacity for carbon monoxide (DLCO) is 66% of predicted. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Schedule lobectomy', 'B': 'Radiation therapy', 'C': 'Schedule a wedge resection', 'D': 'Administer cisplatin and etoposide', 'E': 'Administer cisplatin and vinorelbine'}, | A: Schedule lobectomy |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 23-year-old man comes to the physician because of a 3-day history of mild persistent bleeding from the site of a tooth extraction. He has no prior history of medical procedures or surgeries and no history of easy bruising. He appears well. Vital signs are within normal limits. Laboratory studies show: Hemoglobin 12.4 g/dL Platelets 200,000/mm3 Serum Prothrombin time 25 seconds Partial thromboplastin time (activated) 35 seconds Deficiency of which of the following coagulation factors is the most likely cause of this patient’s condition?"? {'A': 'Factor VII', 'B': 'Factor V', 'C': 'Factor II', 'D': 'Factor XIII', 'E': 'Factor X'}, | A: Factor VII |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man presents to his primary care clinic for a regular checkup. He reports feeling depressed since his wife left him 6 months prior and is unable to recall why she left him. He denies any sleep disturbance, change in his eating habits, guilt, or suicidal ideation. His past medical history is notable for hypertension, gout, and a myocardial infarction five years ago. He takes lisinopril, aspirin, metoprolol, and allopurinol. He has a 50 pack-year smoking history and was previously a heroin addict but has not used in over 20 years. He drinks at least 6 beers per day. His temperature is 98.6°F (37°C), blood pressure is 155/95 mmHg, pulse is 100/min, and respirations are 18/min. He appears somewhat disheveled, inattentive, and smells of alcohol. During his prior visits, he has been well-groomed and attentive. When asked what year it is and who the president is, he confidently replies “1999” and “Jimmy Carter.” He says his son’s name is “Peter” when it is actually “Jake.” This patient likely has a lesion in which of the following brain regions?? {'A': 'Anterior pillars of the fornix', 'B': 'Arcuate fasciculus', 'C': 'Dorsal hippocampus', 'D': 'Parahippocampal gyrus', 'E': 'Posterior pillars of the fornix'}, | A: Anterior pillars of the fornix |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man comes to the physician's office due to a 3-week history of fatigue and a rash, along with the recent development of joint pain that has moved from his knee to his elbows. The patient reports going camping last month but denies having been bitten by a tick. His past medical history is significant for asthma treated with an albuterol inhaler. His pulse is 54/min and blood pressure is 110/72. Physical examination reveals multiple circular red rings with central clearings on the right arm and chest. There is a normal range of motion in all joints and 5/5 strength bilaterally in the upper and lower extremities. Without proper treatment, the patient is at highest risk for which of the following complications?? {'A': 'Cranial nerve palsy', 'B': 'Glomerular damage', 'C': 'Heart valve stenosis', 'D': 'Bone marrow failure', 'E': 'Liver capsule inflammation'}, | A: Cranial nerve palsy |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man presents to the emergency department with severe chest pain and uneasiness. He says that symptoms onset acutely half an hour ago while he was watching television. He describes the pain as being 8/10 in intensity, sharp in character, localized to the center of the chest and retrosternal, and radiating to the back and shoulders. The patient denies any associated change in the pain with breathing or body position. He says he has associated nausea but denies any vomiting. He denies any recent history of fever, chills, or chronic cough. His past medical history is significant for hypertension, hyperlipidemia, and diabetes mellitus for which he takes lisinopril, hydrochlorothiazide, simvastatin, and metformin. He reports a 30-pack-year smoking history and has 1–2 alcoholic drinks during the weekend. Family history is significant for hypertension, hyperlipidemia, and an ST elevation myocardial infarction in his father and paternal uncle. His blood pressure is 220/110 mm Hg in the right arm and 180/100 mm Hg in the left arm. On physical examination, the patient is diaphoretic. Cardiac exam reveals a grade 2/6 diastolic decrescendo murmur loudest over the left sternal border. Remainder of the physical examination is normal. The chest radiograph shows a widened mediastinum. The electrocardiogram (ECG) reveals non-specific ST segment and T wave changes. Intravenous morphine and beta-blockers are started. Which of the following is the most likely diagnosis in this patient?? {'A': 'Aortic dissection', 'B': 'Pulmonary embolism', 'C': 'Acute myocardial infarction', 'D': 'Myocarditis', 'E': 'Aortic regurgitation'}, | A: Aortic dissection |
Answer the following medical question with one of the provided options: | Q:A study on cholesterol levels is performed. There are 1000 participants. It is determined that in this population, the mean LDL is 200 mg/dL with a standard deviation of 50 mg/dL. If the population has a normal distribution, how many people have a cholesterol less than 300 mg/dL?? {'A': '680', 'B': '840', 'C': '950', 'D': '975', 'E': '997'}, | D: 975 |
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 for evaluation of recurrent infections and easy bruising. He has been hospitalized 3 times for severe skin and respiratory infections, which responded to treatment with antibiotics. Examination shows sparse silvery hair. The skin is hypopigmented and there are diffuse petechiae. Laboratory studies show a hemoglobin concentration of 8 g/dL, leukocyte count of 3000/mm3, and platelet count of 45,000/mm3. A peripheral blood smear shows giant cytoplasmic granules in granulocytes and platelets. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Defective CD40 ligand', 'B': 'Defective tyrosine kinase gene', 'C': 'WAS gene mutation', 'D': 'Defective NADPH oxidase', 'E': 'Defective lysosomal trafficking regulator gene'}, | E: Defective lysosomal trafficking regulator gene |
Answer the following medical question with one of the provided options: | Q:To protect against a potentially deadly infection, a 19-year-old female receives a vaccine containing capsular polysaccharide. This vaccine will stimulate her immune system to produce antibodies against which organism?? {'A': 'Measles', 'B': 'Smallpox', 'C': 'Neisseria meningitidis', 'D': 'Corynebacterium diphtheriae', 'E': 'Clostridium tetani'}, | C: Neisseria meningitidis |
Answer the following medical question with one of the provided options: | Q:A 6-year-old African American boy presents with fever, jaundice, normochromic normocytic anemia and generalized bone pain. He has a history of similar recurrent bone pain in the past which was partially relieved by analgesics. His vital signs include: blood pressure 120/70 mm Hg, pulse 105/min, respiratory rate 40/min, temperature 37.7℃ (99.9℉), and oxygen saturation 98% in room air. On physical examination, the patient is in severe distress due to pain. He is pale, icteric and dehydrated. His abdomen is full, tense and some degree of guarding is present. Musculoskeletal examination reveals diffuse tenderness of the legs and arms. A complete blood count reveals the following: Hb 6.5g/dL Hct 18% MCV 82.3 fL Platelet 465,000/µL WBC 9800/µL Reticulocyte 7% Total bilirubin 84 g/dL A peripheral blood smear shows target cells, elongated cells, and erythrocytes with nuclear remnants. Results from Hb electrophoresis are shown in the exhibit (see image). Which of the following is the most likely cause of this patient’s condition?? {'A': 'Sickle cell trait', 'B': 'Sickle cell disease', 'C': 'Von-Gierke’s disease', 'D': 'G6PD deficiency', 'E': 'HbC'}, | B: Sickle cell disease |
Answer the following medical question with one of the provided options: | Q:A 69-year-old woman is admitted to the hospital with substernal, crushing chest pain. She is emergently moved to the cardiac catheterization lab where she undergoes cardiac angiography. Angiography reveals that the diameter of her left anterior descending artery (LAD) is 50% of normal. If her blood pressure, LAD length, and blood viscosity have not changed, which of the following represents the most likely change in LAD flow from baseline?? {'A': 'Increased by 6.25%', 'B': 'Increased by 25%', 'C': 'Decreased by 93.75%', 'D': 'Decreased by 87.5%', 'E': 'Decreased by 25%'}, | C: Decreased by 93.75% |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man comes to the physician because of generalized fatigue and malaise for 2 months. He has been unable to engage in his daily activities. Three months ago, he was treated for a urinary tract infection with trimethoprim-sulfamethoxazole. He has hypertension, asthma, and chronic lower back pain. Current medications include hydrochlorothiazide, an albuterol inhaler, naproxen, and an aspirin-caffeine combination. Vital signs are within normal limits. Examination shows conjunctival pallor. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.1 g/dL Leukocyte count 8,900/mm3 Erythrocyte sedimentation rate 13 mm/h Serum Na+ 136 mEq/L K+ 4.8 mEq/L Cl- 102 mEq/L Urea nitrogen 41 mg/dL Glucose 70 mg/dL Creatinine 2.4 mg/dL Calcium 9.8 mg/dL Urine Protein 1+ Blood 1+ RBCs none WBCs 8–9/hpf Bacteria none Urine cultures are negative. Ultrasound shows shrunken kidneys with irregular contours and papillary calcifications. Which of the following is the most likely underlying mechanism of this patient's renal failure?"? {'A': 'Inhibition of prostacyclin production', 'B': 'Excess amount of light chain production', 'C': 'Precipitation of drugs within the renal tubules', 'D': 'MUC1 gene mutation', 'E': 'Hypersensitivity reaction'}, | A: Inhibition of prostacyclin production |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman presents to the clinic with a 3-month history of shortness of breath that worsens on exertion. She also complains of chronic cough that has lasted for 10 years. Her symptoms are worsened even with light activities like climbing up a flight of stairs. She denies any weight loss, lightheadedness, or fever. Her medical history is significant for hypertension, for which she takes amlodipine daily. She has a 70-pack-year history of cigarette smoking and drinks 3–4 alcoholic beverages per week. Her blood pressure today is 128/84 mm Hg. A chest X-ray shows flattening of the diaphragm bilaterally. Physical examination is notable for coarse wheezing bilaterally. Which of the following is likely to be seen with pulmonary function testing?? {'A': 'Increased FEV1: FVC and decreased total lung capacity', 'B': 'Decreased FEV1: FVC and increased total lung capacity', 'C': 'Increased FEV1: FVC and normal total lung capacity', 'D': 'Decreased FEV1: FVC and decreased total lung capacity', 'E': 'Normal FEV1: FVC and decreased total lung capacity'}, | B: Decreased FEV1: FVC and increased total lung capacity |
Answer the following medical question with one of the provided options: | Q:A 54-year-old male presents to clinic complaining that he is not sleeping well because he has to get up from bed to urinate multiple times throughout the night. He says that he strains to void, has terminal dribbling, and has urinary urgency. Past medical history is significant for orthostatic hypotension. On digital rectal exam, you note symmetric firm enlargement of the prostate. Free Prostate-Specific-Antigen (PSA) level is 4.6 ng/mL. Before you finish your physical exam, the patient asks if there is anything you can do for his male-pattern baldness. What is the mechanism of action of the drug that would pharmacologically treat this patient’s urinary issues and his male-pattern baldness?? {'A': 'Phosphodiesterase-5 inhibition', 'B': 'Alpha-1 blockade', 'C': 'Squalene epoxidase inhibition', 'D': '5-alpha reductase inhibition', 'E': '17,20-desmolase inhibition'}, | D: 5-alpha reductase inhibition |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man presents to the emergency department after an episode of syncope while walking outside with his wife. His wife states that he suddenly appeared pale and collapsed to the ground. She says he remained unconscious for 1 minute. He says noticed a fluttering in his chest and excessive sweating before the episode. He has type 2 diabetes mellitus, essential hypertension, and chronic stable angina. He has not started any new medications in the past few months. Vital signs reveal: temperature 37.0°C (98.6°F), blood pressure 135/72 mm Hg, and pulse 72/min. Physical examination is unremarkable. ECG shows an old bifascicular block. Echocardiogram and 24-hour Holter monitoring are normal. Which of the following is the best next step in the evaluation of this patient’s condition?? {'A': 'Electroencephalography (EEG)', 'B': 'Tilt-table test', 'C': 'Continuous loop recorder', 'D': 'Valsalva maneuver', 'E': 'Cardiac enzymes'}, | C: Continuous loop recorder |
Answer the following medical question with one of the provided options: | Q:Two days after undergoing emergency cardiac catherization for myocardial infarction, a 68-year-old woman has pain in her toes. During the intervention, she was found to have an occluded left anterior descending artery and 3 stents were placed. She has hypertension, hypercholesterolemia, and coronary artery disease. Prior to admission, her medications were metoprolol, enalapril, atorvastatin, and aspirin. Her temperature is 37.3°C (99.1°F), pulse is 93/min, and blood pressure is 115/78 mm Hg. Examination shows discoloration of the toes of both feet. A photograph of the right foot is shown. The lesions are cool and tender to palpation. The rest of the skin on the feet is warm; femoral and pedal pulses are palpable bilaterally. This patient is at increased risk for which of the following conditions?? {'A': 'Acute kidney injury', 'B': 'Lipodermatosclerosis', 'C': 'Basophilia', 'D': 'Permanent flexion contracture', 'E': 'Migratory thrombophlebitis'}, | A: Acute kidney injury |
Answer the following medical question with one of the provided options: | Q:A novel PET radiotracer is being evaluated for its ability to aid in the diagnosis of Alzheimer’s disease (AD). The study decides to use a sample size of 1,000 patients, and half of the patients enrolled have AD. In the group of patients with AD, 400 are found positive on the novel type of PET imaging examination. In the control group, 50 are found positive. What is the PPV of this novel exam?? {'A': '400 / (400+100)', 'B': '450 / (450 + 50)', 'C': '400 / (400+50)', 'D': '400 / (400 + 150)', 'E': '450 / (450 + 100)'}, | C: 400 / (400+50) |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl is brought in by her mother due to rapid weight loss over the past month. The patient says she has been having episodes of diarrhea, which she attributes to laxatives she takes regularly to keep her weight down. She also says she has not had her period yet. The patient’s mother adds that the patient has been underperforming at school and acting very strangely at home. Her current BMI is 16.8 kg/m2. On physical examination, the skin on her limbs and around her neck is inflamed and erythematous. Her tongue is bright red and smooth. She states that over the last 2 weeks, she has been eating nothing but small portions of fruit. She is diagnosed with a vitamin deficiency. Which of the following statements is true about the vitamin most likely deficient in this patient?? {'A': 'It is derived from tyrosine', 'B': 'Synthesis requires vitamin B1 and B6', 'C': 'It is used to treat hypertension', 'D': 'Synthesis requires vitamin B2 and B6', 'E': 'It increases the GI absorption of iron'}, | D: Synthesis requires vitamin B2 and B6 |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man is admitted to the burn unit after he was brought to the emergency room following an accidental fire in his house. His past medical history is unknown due to his current clinical condition. Currently, his blood pressure is 75/40 mmHg, pulse rate is 140/min, and respiratory rate is 17/min. The patient is subsequently intubated and started on aggressive fluid resuscitation. A Swan-Ganz catheter is inserted to clarify his volume status. Which of the following hemodynamic parameters would you expect to see in this patient?? {'A': 'Cardiac output: ↓, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔', 'B': 'Cardiac output: ↑, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↔', 'C': 'Cardiac output: ↓, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↓', 'D': 'Cardiac output: ↑, systemic vascular resistance: ↓, pulmonary artery wedge pressure: ↔', 'E': 'Cardiac output: ↔, systemic vascular resistance: ↔, pulmonary artery wedge pressure: ↔'}, | C: Cardiac output: ↓, systemic vascular resistance: ↑, pulmonary artery wedge pressure: ↓ |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman volunteers for a study on respiratory physiology. Pressure probes A and B are placed as follows: Probe A: between the parietal and visceral pleura Probe B: within the cavity of an alveoli The probes provide a pressure reading relative to atmospheric pressure. To obtain a baseline reading, she is asked to sit comfortably and breathe normally. Which of the following sets of values will most likely be seen at the end of inspiration?? {'A': 'Probe A: 0 mm Hg; Probe B: -1 mm Hg', 'B': 'Probe A: -4 mm Hg; Probe B: 0 mm Hg', 'C': 'Probe A: -4 mm Hg; Probe B: -1 mm Hg', 'D': 'Probe A: -6 mm Hg; Probe B: 0 mm Hg', 'E': 'Probe A: -6 mm Hg; Probe B: -1 mm Hg'}, | D: Probe A: -6 mm Hg; Probe B: 0 mm Hg |
Answer the following medical question with one of the provided options: | Q:A 16-year-old man presents to the emergency department with a 2-hour history of sudden-onset abdominal pain. He was playing football when his symptoms started. The patient’s past medical history is notable only for asthma. Social history is notable for unprotected sex with 4 women in the past month. His temperature is 99.3°F (37.4°C), blood pressure is 120/88 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is noted for a non-tender abdomen. Testicular exam reveals a right testicle which is elevated with a horizontal lie and the scrotum is neither swollen nor discolored. Which of the following is the most likely diagnosis?? {'A': 'Appendicitis', 'B': 'Epididymitis', 'C': 'Seminoma', 'D': 'Testicular torsion', 'E': 'Traumatic urethral injury'}, | D: Testicular torsion |
Answer the following medical question with one of the provided options: | Q:Please refer to the summary above to answer this question Which of the following is the most appropriate next step in management?" "Patient Information Age: 23 years Gender: F, self-identified Ethnicity: unspecified Site of Care: office History Reason for Visit/Chief Concern: “I can't run anymore because my knee hurts.” History of Present Illness: 2-day history of right knee pain pain is localized “somewhere under the kneecap” pain is achy; rated 5/10; increases to 8/10 with prolonged sitting reports an occasional “popping” sound and sensation when she rises from a seated position no history of trauma to the knee Past Medical History: right clavicular fracture 2 years ago, treated with a shoulder sling Medications: multivitamin Allergies: no known drug allergies Psychosocial History: does not smoke drinks up to three glasses of wine weekly Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 37°C (98.6°F) 65/min 15/min 108/62 mm Hg – 173 cm (5 ft 8 in) 54 kg (119 lb) 18 kg/m2 Appearance: no acute distress Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs, rubs, or gallops Abdominal: thin; no tenderness, guarding, masses, bruits, or hepatosplenomegaly Extremities: no joint erythema, edema, or warmth; dorsalis pedis, radial, and femoral pulses intact Musculoskeletal: diffuse tenderness to palpation over the right anterior knee, worse with full extension of the knee; no associated effusion or erythema; full, symmetric strength of quadriceps, hip abductors, and hip external rotators; crepitus with knee range of motion; antalgic gait Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits"? {'A': 'Pain control and rest', 'B': 'Physical therapy', 'C': 'Arthroscopy of the knee', 'D': 'Synovial fluid analysis', 'E': 'Intraarticular steroid injection'}, | A: Pain control and rest |
Answer the following medical question with one of the provided options: | Q:A 12-month-old boy is brought to the physician by his parents for a 4-week history of fever, malaise, cough, and difficulty breathing. He has had recurrent episodes of gastroenteritis since birth. Cardiopulmonary examination shows subcostal retractions and crackles bilaterally. There is enlargement of the cervical, axillary, and inguinal lymph nodes. An x-ray of the chest shows bilateral consolidations. A sputum culture shows colonies of Burkholderia cepacia. A blood sample is obtained and after the addition of nitroblue tetrazolium to the sample, neutrophils remain colorless. A defect in which of the following is the most likely cause of this patient's condition?? {'A': 'B cell maturation', 'B': 'Microtubule polymerization', 'C': 'T cell CD40 ligand', 'D': 'Actin filament assembly', 'E': 'NADPH oxidase complex'}, | E: NADPH oxidase complex |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the pediatrician by his mother who is concerned about progressive leg weakness. His mother reports that the patient used to play outside with their neighbors for hours, but for the past few months she has seen him sitting on the sidewalk after 15 minutes because he’s too tired. The patient says his legs are “sleepy.” The patient’s mother has also had to remove the carpets from the house because the patient kept tripping over the edges. The mother reports that the patient is shy but cooperates well with his siblings and other children. He can say his first and last name and just started counting. His mother states he learned to fully walk by 15 months of age. He was hospitalized for bronchiolitis at 12 months of age, which resolved with supportive care. He had an uncomplicated orchiopexy surgery for undescended testes at 7 months of age. He has no other chronic medical conditions and takes no medications. He is up to date on his vaccinations including a flu vaccine 2 weeks ago. The patient’s mother has systemic lupus erythematous and his paternal uncle has dermatomyositis. On physical examination, bilateral calves are large in circumference compared to the thighs. Strength is 3/5 in bilateral quadriceps and 4/5 in bilateral calves. Sensation is intact. Achilles tendon reflexes are 1+ bilaterally. The patient can hop on one leg, but gets tired after 10 jumps. He has a slight waddling gait. Which of the following is the most appropriate test to confirm the diagnosis?? {'A': 'Acetylcholine receptor antibody level', 'B': 'Creatine kinase level', 'C': 'Genetic testing', 'D': 'Muscle biopsy', 'E': 'Nerve conduction study'}, | C: Genetic testing |
Answer the following medical question with one of the provided options: | Q:A 22-year-old female is brought to the emergency department by her friends. She was supposed to attend her first job interview in a few hours when she started having palpitations. Her past medical history is insignificant, and she currently takes no medications. Her vitals show the following: pulse rate is 90/min, respiratory rate is 28/min, and blood pressure is 136/86 mm Hg. Her ECG is normal. What will be the patient’s approximate alveolar carbon dioxide pressure (PACO2) given her normal respiratory rate is 14/min and PACO2 is 36 mm Hg? Ignore dead space and assume carbon dioxide production is constant.? {'A': '18 mm Hg', 'B': '27 mm Hg', 'C': '36 mm Hg', 'D': '44 mm Hg', 'E': '72 mm Hg'}, | A: 18 mm Hg |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man with hypertension comes to the physician because of fatigue and difficulty initiating urination. He wakes up several times a night to urinate. He does not take any medications. His blood pressure is 166/82 mm Hg. Digital rectal examination shows a firm, non-tender, and uniformly enlarged prostate. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Finasteride', 'B': 'Phenoxybenzamine', 'C': 'Tamsulosin', 'D': 'Terazosin', 'E': 'α-Methyldopa'}, | D: Terazosin |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman comes to the physician because of numbness of her legs and toes for 3 months. She has also had fatigue and occasional shortness of breath for the past 5 months. She is a painter. Examination shows pale conjunctivae. Sensation to vibration and position is absent over the lower extremities. She has a broad-based gait. The patient sways when she stands with her feet together and closes her eyes. Which of the following laboratory findings is most likely to be seen in this patient?? {'A': 'Poliovirus RNA in cerebrospinal fluid', 'B': 'Basophilic stippling on peripheral smear', 'C': 'Oligoclonal bands in cerebrospinal fluid', 'D': 'Positive rapid plasma reagin test', 'E': 'Elevated methylmalonic acid levels\n"'}, | E: Elevated methylmalonic acid levels " |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman makes an appointment with her family physician for a routine check-up after being away due to travel for 1 year. She recently had a screening Pap smear, which was negative for malignancy. Her past medical history is significant for a Pap smear 2 years ago that reported a low-grade squamous intraepithelial lesion (LSIL). A subsequent colposcopy diagnosed low-grade cervical intraepithelial neoplasia (CIN2). The patient is surprised by the differences in her diagnostic tests. You explain to her the basis for the difference and reassure her. With this in mind, which of the following HPV serotypes is most likely to be present in the patient?? {'A': 'HPV 18', 'B': 'HPV 6', 'C': 'HPV 31', 'D': 'HPV 16', 'E': 'HPV 33'}, | B: HPV 6 |
Answer the following medical question with one of the provided options: | Q:A 19-year-old collegiate football player sustains an injury to his left knee during a game. He was running with the ball when he dodged a defensive player and fell, twisting his left knee. He felt a “pop” as he fell. When he attempts to bear weight on his left knee, it feels unstable, and "gives way." He needs assistance to walk off the field. The pain is localized diffusely over the knee and is non-radiating. His past medical history is notable for asthma. He uses an albuterol inhaler as needed. He does not smoke or drink alcohol. On exam, he has a notable suprapatellar effusion. Range of motion is limited in the extremes of flexion. When the proximal tibia is pulled anteriorly while the knee is flexed and the patient is supine, there is 1.5 centimeter of anterior translation. The contralateral knee translates 0.5 centimeters with a similar force. The injured structure in this patient originates on which of the following bony landmarks?? {'A': 'Lateral aspect of the lateral femoral condyle', 'B': 'Lateral aspect of the medial femoral condyle', 'C': 'Medial aspect of the medial femoral condyle', 'D': 'Posteromedial aspect of the lateral femoral condyle', 'E': 'Tibial tubercle'}, | D: Posteromedial aspect of the lateral femoral condyle |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman is brought to the emergency department by her husband due to difficulty speaking and confusion for 1 hour. She was gardening when she suddenly developed these symptoms. She is not able to respond to the questions despite multiple repetitions. She also appears unsteady with her gait and is able to walk with support. The past medical history includes type 2 diabetes mellitus, dyslipidemia, and osteoarthritis. The medicine list includes aspirin, atorvastatin, metformin, and chondroitin sulfate. The vital signs include: blood pressure 174/88 mm Hg, heart rate 154/min and irregular, respiratory rate 12/min, and oxygen saturation 96% on room air. She is awake, but not following commands. The pupils are equal bilaterally and reactive to light. There is mild facial droop on the right side. The forehead wrinkles are preserved. When the soles of her feet are stimulated with a blunt instrument, the right-sided big toe goes upward, while the left-sided big toe goes downward. The ECG shows variable R-R intervals and absent of P waves. What is the next step in the management of this patient?? {'A': 'Amiodarone', 'B': 'Aspirin', 'C': 'CT scan of the head', 'D': 'Echocardiography', 'E': 'MRI of the head'}, | C: CT scan of the head |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to the physician with a complaint of recurrent chest pain for the last 2 weeks. He mentions that the pain is not present at rest, but when he walks for some distance, he feels pain like a pressure over the retrosternal region. The pain disappears within a few minutes of stopping the physical activity. He is an otherwise healthy man with no known medical disorder. He does not smoke or have any known dependence. There is no family history of ischemic heart disease or vascular disorder. On physical examination, his vital signs, including blood pressure, are normal. The diagnosis of coronary artery disease due to atherosclerosis is made. Which of the following is known to be an infection associated with this patient’s condition?? {'A': 'Chlamydophila pneumoniae', 'B': 'Coxiella burnetii', 'C': 'Legionella pneumophilia', 'D': 'Mycoplasma pneumoniae', 'E': 'Rickettsia rickettsii'}, | A: Chlamydophila pneumoniae |
Answer the following medical question with one of the provided options: | Q:An investigator is studying cellular repair mechanisms in various tissues. One of the samples being reviewed is from the anterior horn of the spinal cord of a patient who was involved in a snowboard accident. Pathologic examination of the biopsy specimen shows dispersion of the Nissl bodies, swelling of the neuronal body, and a displacement of the nucleus to the periphery in numerous cells. Which of the following is the most likely explanation for the observed findings?? {'A': 'Neurodegenerative changes', 'B': 'Wallerian degeneration', 'C': 'Central chromatolysis', 'D': 'Reactive astrogliosis', 'E': 'Neuronal aging'}, | C: Central chromatolysis |
Answer the following medical question with one of the provided options: | Q:Fertilization begins when sperm binds to the corona radiata of the egg. Once the sperm enters the cytoplasm, a cortical reaction occurs which prevents other sperm from entering the oocyte. The oocyte then undergoes an important reaction. What is the next reaction that is necessary for fertilization to continue?? {'A': 'Release of a polar body', 'B': 'Degeneration of the sperm tail', 'C': 'Acrosome reaction', 'D': 'The second meiotic division', 'E': 'Formation of the spindle apparatus'}, | D: The second meiotic division |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to his primary care provider with bloody urine. He first noticed the blood 1 week ago. He otherwise feels healthy. His past medical history is significant for type 2 diabetes mellitus for 18 years, for which he takes insulin injections. He has smoked 30–40 cigarettes per day for the past 29 years and drinks alcohol socially. Today his vital signs include: temperature 36.6°C (97.8°F), blood pressure 135/82 mm Hg, and heart rate 105/min. There are no findings on physical examination. Urinalysis shows 15–20 red cells/high power field. Which of the following is the next best test to evaluate this patient’s condition?? {'A': 'Urine cytology', 'B': 'Contrast-enhanced CT', 'C': 'Prostate-specific antigen', 'D': 'Biopsy', 'E': 'Urinary markers'}, | B: Contrast-enhanced CT |
Answer the following medical question with one of the provided options: | Q:A previously healthy 19-year-old woman comes to the physician because of vaginal discharge for 3 days. She describes the discharge as yellow and mucopurulent with a foul odor. She has also noticed vaginal bleeding after sexual activity. She has not had any itching or irritation. Her last menstrual period was 2 weeks ago. She is sexually active with one male partner, and they use condoms inconsistently. A rapid urine hCG test is negative. Her temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 108/62 mm Hg. Pelvic examination shows a friable cervix. Speculum examination is unremarkable. A wet mount shows no abnormalities. Which of the following is the most appropriate diagnostic test?? {'A': 'Tzanck smear', 'B': 'Gram stain of cervical swab', 'C': 'Colposcopy', 'D': 'Pap smear', 'E': 'Nucleic acid amplification test\n"'}, | E: Nucleic acid amplification test " |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man with no past medical history presents to his primary care physician with complaints of fatigue. He states that his life has been hectic lately and that everything seems to be falling apart. He is scared that he will lose his job, that his wife will leave him, and that his children will not be able to afford to go to college. His worries are severe enough that they have began to interfere with his daily activities. His wife is also present and states that he has a very secure job and that they are well off financially. She says that he has always worried about something since she met him years ago. What medication would benefit this patient long term?? {'A': 'Escitalopram', 'B': 'Diazepam', 'C': 'Risperidone', 'D': 'Lithium', 'E': 'No treatment recommended'}, | A: Escitalopram |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man comes to the physician because of blurry vision and fatigue for 2 months. During this period, he has also had occasional bleeding from his gums after brushing his teeth. One month ago, he was diagnosed with deep vein thrombosis after returning from an overseas business meeting. His pulse is 118/min, respirations are 19/min, and blood pressure is 149/91 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Examination shows bluish discoloration of the lips. The tip of the spleen is palpable 1 cm below the left costal margin. Sensory examination of the hands shows paresthesia. Hemoglobin concentration is 18 g/dL, hematocrit is 65%, leukocytes are 15,000/μL, and platelets are 470,000/μL. His serum erythropoietin concentration is decreased. Activation of which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Cytokine receptor', 'B': 'Transcription factor', 'C': 'Antiapoptotic molecule', 'D': 'Nonreceptor tyrosine kinase', 'E': 'Serine/threonine kinase'}, | D: Nonreceptor tyrosine kinase |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman is brought to the emergency department by emergency medical services. She was found trying to hang herself in her kitchen. The patient has a past medical history of drug abuse, alcoholism, anxiety, mania, irritable bowel syndrome, and hypertension. Her current medications include naltrexone, sodium docusate, and clonazepam as needed. Her temperature is 99.5°F (37.5°C), blood pressure is 100/65 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note a teary young woman. There are multiple bilateral superficial cuts along her wrists. The patient's cardiac and pulmonary exams are within normal limits. Neurological exam reveals a patient who is alert and oriented. The patient claims that you cannot send her home because if you do she will kill herself. Laboratory values are ordered and return as below. Hemoglobin: 15 g/dL Hematocrit: 40% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelet count: 197,500/mm^3 Serum: Na+: 139 mEq/L Cl-: 102 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 90 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL AST: 12 U/L ALT: 10 U/L The patient is transferred to the crisis intervention unit. Which of the following is the best next step in management?? {'A': 'Haloperidol', 'B': 'Lamotrigine', 'C': 'Fluoxetine', 'D': 'Escitalopram', 'E': 'Diazepam'}, | B: Lamotrigine |
Answer the following medical question with one of the provided options: | Q:A 6-year-old girl is brought to the physician because of a 4-day history of irritation and redness in both eyes. Her symptoms initially started in the left eye and progressed to involve both eyes within 24 hours. She presents with profuse tearing and reports that her eyes are sticky and difficult to open in the morning. She was diagnosed with asthma 2 years ago and has been admitted to the hospital for acute exacerbations 3 times since then. Current medications include inhaled beclomethasone, inhaled albuterol, and montelukast. Her temperature is 38.2 °C (100.8°F). Physical examination reveals a tender left preauricular lymph node. There is chemosis and diffuse erythema of the bulbar conjunctiva bilaterally. Slit lamp examination reveals a follicular reaction in both palpebral conjunctivae and diffuse, fine epithelial keratitis of both corneas. Corneal sensation is normal. Which of the following is the most appropriate next step in management?? {'A': 'Supportive therapy', 'B': 'Oral cetirizine', 'C': 'Topical prednisolone acetate', 'D': 'Topical natamycin', 'E': 'Topical erythromycin'}, | A: Supportive therapy |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman comes to the physician because of a 4-month history of a painless lump on her neck. Examination shows a hard nodule on the left side of her neck. A fine-needle aspiration biopsy shows well-differentiated cuboidal cells arranged spherically around colloid. She undergoes thyroidectomy. Histopathological examination of the surgical specimen shows invasion of the thyroid capsule and blood vessels. Which of the following cellular events is most likely involved in the pathogenesis of this patient's condition?? {'A': 'TSH receptor gene mutation', 'B': 'Activation mutation in the BRAF gene', 'C': 'p53 tumor suppressor gene inactivation', 'D': 'Mutation in the RET proto-oncogene', 'E': 'PAX8-PPAR gamma gene rearrangement'}, | E: PAX8-PPAR gamma gene rearrangement |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man sustains an intracranial injury to a nerve that also passes through the parotid gland. Which of the following is a possible consequence of this injury?? {'A': 'Loss of taste from posterior 1/3 of tongue', 'B': 'Loss of general sensation in anterior 2/3 of tongue', 'C': 'Paralysis of lateral rectus muscle', 'D': 'Changes in hearing', 'E': "Horner's syndrome"}, | D: Changes in hearing |
Answer the following medical question with one of the provided options: | Q:A 10-month-old boy is admitted to the pediatric intensive care ward because of progressive dyspnea and fever. For the past 2 weeks, he was unsuccessfully treated for an upper respiratory tract infection with ampicillin. He has a history of neonatal sepsis, frequent respiratory tract infections since the age of 3 months, and recurrent otitis media. He was born full-term vaginally to a consanguineous couple from an uncomplicated pregnancy. He received routine immunizations until 6 months of age. The patient’s vital signs are as follows: blood pressure is 70/40 mm Hg, heart rate is 138/min, respiratory rate is 39/min, and temperature is 39.5℃ (103.1 ℉). Physical examination reveals cyanosis, nasal flare, intercostal retractions, and bilaterally decreased breath sounds with crackles heard over the lower lobes on auscultation. The chest X-ray confirms bilateral lower lobe pneumonia. The blood count shows the following findings: Erythrocytes 4.1 x 106/mm3 Hgb 13 g/dL Total leukocyte count 41,100/mm3 Neutrophils 74% Lymphocytes 14% Eosinophils 2% Monocytes 10% Basophils 0% Platelet count 210,000/mm3 The patient is diagnosed with bilateral community-acquired lower lobe pneumonia and prescribed antibiotics. An immunological workup is performed to assess the patient’s immunity: Measurement Result Normal range Antibodies Total serum IgG 22.0 mg/dL 231–1,411 mg/dL Serum IgA 59.3 mg/dL 0–83 mg/dL Serum IgM 111.9 mg/dL 0–145 mg/dL Lymphocyte flow cytometry CD3+ cells 2.2% 60–85% CD19+ cells 95.1% 8–20% CD16/CD56+ cells 0.1% 3–30% Which of the following procedures is the option of choice for the further management of this patient?? {'A': 'Periodical prophylactic antibiotic administration', 'B': 'Periodical intravenous immune globulin administration', 'C': 'Thymectomy', 'D': 'Bone marrow transplantation', 'E': 'Chemotherapy'}, | D: Bone marrow transplantation |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man arrives to the clinic complaining of progressive weakness. He explains that for 3 months he has had difficulty climbing the stairs, which has now progressed to difficulty getting out of a chair. He denies diplopia, dysphagia, dyspnea, muscle aches, or joint pains. He denies weight loss, weight gain, change in appetite, or heat or cold intolerance. He reports intermittent low-grade fevers. He has a medical history significant for hypertension and hyperlipidemia. He has taken simvastatin and losartan daily for the past 6 years. His temperature is 99.0°F (37.2°C), blood pressure is 135/82 mmHg, and pulse is 76/min. Cardiopulmonary examination is normal. The abdomen is soft, non-tender, non-distended, and without hepatosplenomegaly. Muscle strength is 3/5 in the hip flexors and 4/5 in the deltoids, biceps, triceps, patellar, and Achilles tendon reflexes are 2+ and symmetric. Sensation to pain, light touch, and vibration are intact. Gait is cautious, but grossly normal. There is mild muscle tenderness of his thighs and upper extremities. There is no joint swelling or erythema and no skin rashes. A complete metabolic panel is within normal limits. Additional lab work is obtained as shown below: Serum: Na+: 141 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 23 mEq/L Urea nitrogen: 18 mg/dL Glucose: 128 mg/dL Creatinine: 1.0 mg/dL Alkaline phosphatase: 69 U/L Aspartate aminotransferase (AST): 302 U/L Alanine aminotransferase (ALT): 210 U/L TSH: 6.9 uU/mL Thyroxine (T4): 5.8 ug/dL Creatine kinase: 4300 U/L C-reactive protein: 11.9 mg/L Erythrocyte sedimentation rate: 37 mm/h Which of the following is the most accurate diagnostic test?? {'A': 'Autoantibodies', 'B': 'Electromyography', 'C': 'Fine needle aspiration', 'D': 'Muscle biopsy', 'E': 'Statin cessation'}, | D: Muscle biopsy |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man presents with an episode of rectal bleeding. He is concerned because his mother died of colorectal cancer at 50 years of age. He has no further information about his family history. Physical examination and digital rectal examination are normal. He undergoes a colonoscopy and is found to have innumerable adenomas in the left side of the colon ranging in size from 4–15 mm. Which of the following is the most likely underlying mechanism of this patient illness?? {'A': 'Mutation in DNA mismatch repair genes', 'B': 'Alterations in STK11 gene', 'C': 'Mutations of the APC gene', 'D': 'Inactivation of RB1 gene', 'E': 'Inactivation of BRCA1 and BRCA2 genes'}, | C: Mutations of the APC gene |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents to his physician with a history of excessive thirst and excessive urination over the last 3 weeks. He mentions that he has to wake up multiple times at night to urinate. A detailed history reveals that he has a known case of bipolar mood disorder and has been taking lithium carbonate for 5 years. His urinary specific gravity is 1.003, and his urinary osmolality is 150 mOsm/kg H2O. Which of the following Darrow-Yannet diagrams best describes the status of volumes and osmolality of this man’s body fluids?? {'A': 'Image 1', 'B': 'Image 2', 'C': 'Image 3', 'D': 'Image 4', 'E': 'IMage 5'}, | B: Image 2 |
Answer the following medical question with one of the provided options: | Q:An 8-year-old African American girl is brought to the clinic by her mother for her regular blood exchange. They come in every 2–3 months for the procedure. The child is in good health with no symptoms. Her last trip to the emergency department was 6 months ago due to bone pain. She was treated with morphine and oxygen and a blood transfusion. She takes hydroxyurea and a multivitamin with iron every day. She has an uncle that also has to get blood exchanges. Today, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 37.0°C (98.6°F). She calmly waits for the machine to be set up and catheters inserted into both of her arms. She watches a movie as her blood is slowly replaced with 6 L of red blood cells. Based on this history, which of the following mechanisms most likely explains this patient’s condition?? {'A': 'Amino acid deletion', 'B': 'Amino acid substitution', 'C': 'Enzyme deficiency', 'D': 'Trinucleotide repeat', 'E': 'Nonsense mutation'}, | B: Amino acid substitution |
Answer the following medical question with one of the provided options: | Q:A 75-year-old woman presents to the emergency department because of a brief loss of consciousness, slurred speech, and facial numbness. Family members report that she complained about feeling chest pain and shortness of breath while on her morning walk. Medical history is noncontributory. Physical examination shows decreased pupil reactivity to light and hemiplegic gait. Her pulse is 120/min, respirations are 26/min, temperature is 36.7°C (98.0°F), and blood pressure is 160/80 mm Hg. On heart auscultation, S1 is loud, widely split, and there is a diastolic murmur. Transthoracic echocardiography in a 4-chamber apical view revealed a large oval-shaped and sessile left atrial mass. Which of the following is the most likely complication of this patient's condition?? {'A': 'Atrial fibrillation', 'B': 'Atrioventricular block', 'C': 'Congestive heart failure', 'D': 'Mitral valve obstruction', 'E': 'Pericarditis'}, | D: Mitral valve obstruction |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man presents to the office with complaints of fatigue and difficulty breathing for the past few weeks. He also complains of early morning stiffness of his metatarsophalangeal and metacarpophalangeal joints on both sides that lasts for 2 hours. He feels better only after a warm water tub bath every day in the morning. He denies noticing any kind of rash on his body. He has been working in the shipbuilding industry for 20 years. He loves skin tanning and hunting in summer. He smokes 2 packs of cigarettes every day and has been doing so for the past 15 years. His pulmonary function test shows reduced forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio with a reduction of both FEV1 and FEV1 and decreased diffusing capacity of the lungs for carbon monoxide (DLCO). His chest X-ray shows multiple nodules with calcification. Which of the following antibodies will most likely be present in this patient that is very specific to the condition he has?? {'A': 'Anti-CCP', 'B': 'Anti-Scl 70', 'C': 'Anti-Ro', 'D': 'Anti-ds-DNA', 'E': 'Anti-Jo1'}, | A: Anti-CCP |
Answer the following medical question with one of the provided options: | Q:A 29-year-old man presents to clinic with a complaint of fatigue that has developed over the past 6 months. Upon questioning, he endorses abdominal pain, non-bloody diarrhea, and decreased appetite over the past year. He denies recent travel outside of the country or eating uncooked meats. On exam, his temperature is 99.0°F (37.2°C), blood pressure is 126/78 mmHg, pulse is 93/min, and respirations are 12/min. Notably, the abdominal exam is unremarkable aside from some tenderness to palpation near the umbilicus. His colonoscopy demonstrates perianal inflammation with a normal rectum, and biopsies of suspicious lesions in the transverse colon reveal transmural inflammation. Which one of the following is most strongly associated with the patient’s condition?? {'A': 'Colorectal cancer', 'B': 'Endocarditis', 'C': 'Hemolytic anemia', 'D': 'Kidney stones', 'E': 'Positive serum transglutaminase antibodies'}, | D: Kidney stones |
Answer the following medical question with one of the provided options: | Q:A 37-year-old male presents to your clinic with shortness of breath and lower extremity edema. He was born in Southeast Asia and emigrated to America ten years prior. Examination demonstrates 2+ pitting edema to the level of his knees, ascites, and bibasilar crackles, as well as an opening snap followed by a mid-to-late diastolic murmur. The patient undergoes a right heart catheterization that demonstrates a pulmonary capillary wedge pressure (PCWP) of 24 mmHg. The patient is most likely to have which of the following?? {'A': 'Increased pulmonary vascular compliance', 'B': 'Decreased pulmonary artery systolic pressure (PASP)', 'C': 'Increased left ventricular end diastolic pressure (LVEDP)', 'D': 'Normal or decreased left ventricular end diastolic pressure (LVEDP)', 'E': 'Decreased transmitral gradient'}, | D: Normal or decreased left ventricular end diastolic pressure (LVEDP) |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the physician for a follow-up examination after he was diagnosed with mantle cell lymphoma. The physician recommends a chemotherapeutic regimen containing bortezomib. Which of the following best describes the effect of this drug?? {'A': 'Stabilization of tubulin polymers', 'B': 'Accumulation of ubiquitinated proteins', 'C': 'Crosslinking of purine bases', 'D': 'Preventing the relaxation of DNA supercoils', 'E': 'Inhibition of tyrosine kinase receptors'}, | B: Accumulation of ubiquitinated proteins |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents for his yearly wellness visit. He says he has been feeling well and has no complaints. No significant past medical history or current medications. The patient reports a 35-pack-year smoking history but says he quit 5 years ago. His family history is significant for lung cancer in his father who died at age 67. His vital signs include: temperature 36.8°C (98.2°F), pulse 95/min, respiratory rate 16/min, blood pressure 100/75 mm Hg. Physical examination is unremarkable. Laboratory findings are significant for the following: Serum potassium 3.9 mEq/L Serum sodium 140 mEq/L Serum chloride 103 mEq/L Serum calcium 2.5 mmol/L BUN 15 mg/dL Creatinine 0.8 mg/dL Glucose 95 mg/dL Magnesium 1.7 mEq/L Phosphate 1.1 mmol/L Hemoglobin 14 g/dL Bicarbonate (HCO3-) 25 mEq/L Bilirubin, total 0.9 mg/dL Bilirubin, indirect 0.4 mg/dL AST 10 U/L ALT 19 U/L Alkaline phosphatase 40 U/L Albumin 3.6 g/dL Which of the following preventative screening tests is recommended for this patient at this time?? {'A': 'Chest X-ray', 'B': 'Abdominal ultrasound', 'C': 'ECG', 'D': 'Low-dose CT scan (LDCT) of the chest', 'E': 'No screening indicated'}, | D: Low-dose CT scan (LDCT) of the chest |
Answer the following medical question with one of the provided options: | Q:A 49-year-old woman presents to her physician with a fever accompanied by chills and burning micturition since the past 5 days. She is an otherwise healthy woman with no significant past medical history and has an active sexual life. On physical examination, her temperature is 39.4°C (103.0°F), pulse rate is 90/min, blood pressure is 122/80 mm Hg, and respiratory rate is 14/min. Examination of the abdomen and genitourinary region do not reveal any specific positive findings. The physician orders a urinalysis of fresh unspun urine for this patient which shows 25 WBCs/mL of urine. The physician prescribes an empirical antibiotic and other medications for symptom relief. He also orders a bacteriological culture of her urine. After 48 hours of treatment, the woman returns to the physician to report that her symptoms have not improved. The bacteriological culture report indicates the growth of gram-negative bacilli which are lactose-negative and indole-negative, which produce a substance that hydrolyzes urea to produce ammonia. Which of the following bacteria is the most likely cause of infection in the woman?? {'A': 'Citrobacter freundii', 'B': 'Escherichia coli', 'C': 'Enterobacter cloacae', 'D': 'Klebsiella pneumoniae', 'E': 'Proteus mirabilis'}, | E: Proteus mirabilis |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care physician with progressively worsening hearing loss. He states that his trouble with hearing began approximately 7-8 years ago. He is able to hear when someone is speaking to him; however, he has difficulty with understanding what is being said, especially when there is background noise. In addition to his current symptoms, he reports a steady ringing in both ears, and at times experiences dizziness. Medical history is significant for three prior episodes of acute otitis media. Family history is notable for his father being diagnosed with cholesteatoma. His temperature is 98.6°F (37°C), blood pressure is 138/88 mmHg, pulse is 14/min, and respirations are 13/min. On physical exam, when a tuning fork is placed in the middle of the patient's forehead, sound is appreciated equally on both ears. When a tuning fork is placed by the external auditory canal and subsequently on the mastoid process, air conduction is greater than bone conduction. Which of the following is most likely the cause of this patient's symptoms?? {'A': 'Accumulation of desquamated keratin debri', 'B': 'Eustachian tube obstruction secondary to nasopharyngeal inflammatory edema', 'C': 'Stapedial abnormal bone growth', 'D': 'Cochlear hair cell degeneration', 'E': 'Endolymphatic hydrops'}, | D: Cochlear hair cell degeneration |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the molecular structure of various proteinogenic L-amino acids. The structure of one of the amino acids being studied is shown. The derivative of this amino acid is most likely to cause which of the following effects in the human body?? {'A': 'Ketotic acidosis', 'B': 'Skin pigmentation', 'C': 'Pupillary dilation', 'D': 'Peripheral vasodilation', 'E': 'Respiratory depression'}, | D: Peripheral vasodilation |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man presents to his primary care physician with a 4-week history of back pain. He says that the pain does not appear to be associated with activity and is somewhat relieved by taking an NSAID. Furthermore, he says that he has had increasing difficulty trying to urinate. His past medical history is significant for kidney stones and a 30-pack-year smoking history. Radiographs reveal osteoblastic lesions in the spine. Which of the following drugs would most likely be effective in treating this patient's disease?? {'A': 'Continuous leuprolide', 'B': 'Imatinib', 'C': 'Pulsatile leuprolide', 'D': 'Rituximab', 'E': 'Tamsulosin'}, | A: Continuous leuprolide |
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