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Answer the following medical question with one of the provided options: | Q:A 29-year-old woman presents with skin lesions on her elbows and forearms. She notes that they first started appearing 2 months ago and have not improved. She describes the lesions as painless and rarely itchy. She denies any similar symptoms in the past, and has no other significant past medical history. Review of systems is significant for recent joint pain, conjunctivitis, and corneal dryness. The patient is afebrile and vital signs are within normal limits. Non-tender, raised, inflamed, white-silver maculopapular lesions are present. Which of the following are the most likely histopathologic findings in this patient's skin biopsy?? {'A': 'Intracellular edema with detachment at basal level', 'B': 'Subepidermal blister (detachment at suprabasal level)', 'C': 'Cytoplasmic vacuolation', 'D': 'Basal cell hyperplasia, proliferation of subepidermal vasculature, and keratinization', 'E': 'Nuclear atypia, cellular pleomorphism, and a disorganized structure of cells from basal to apical layers of the tissue'}, | D: Basal cell hyperplasia, proliferation of subepidermal vasculature, and keratinization |
Answer the following medical question with one of the provided options: | Q:Two days after delivery, a newborn develops a red, irritated eye with yellow discharge. She was born at 39 weeks' gestation to a 28-year-old woman, gravida 1, para 1. Pregnancy and delivery were uncomplicated. The mother had not seen her gynecologist since her first prenatal visit. The newborn's temperature is 37.2°C (99.0°F), pulse is 140/min, respirations are 42/min, and blood pressure is 73/53 mm Hg. Ophthalmic examination shows eyelid edema, conjunctival injection, and copious yellow mucopurulent discharge from the right eye. There is no corneal ulceration or evidence of keratitis. Funduscopic examination is normal. The diagnosis is confirmed and appropriate treatment is administered. Which of the following is most likely to have prevented this patient's condition?? {'A': 'Oral erythromycin administered to the infant', 'B': 'IV ceftriaxone administered to the infant', 'C': 'Topical erythromycin administered to the infant', 'D': 'Oral doxycycline administered to the mother', 'E': 'Oral amoxicillin administered to the mother'}, | C: Topical erythromycin administered to the infant |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy is brought to the emergency department after losing consciousness. He had no preceding chest pain or palpitations. His father has cataracts and had frontal balding in his twenties but has no history of cardiac disease. His paternal grandfather also had early-onset balding. His pulse is 43/min. Physical examination shows frontal hair loss, temporal muscle wasting, and testicular atrophy. Neurologic examination shows bilateral foot drop and weakness of the intrinsic hand muscles. An ECG shows bradycardia with third-degree atrioventricular block. The severity of this patient's symptoms compared to that of his father is most likely due to which of the following genetic properties?? {'A': 'Pleiotropy', 'B': 'Loss of heterozygosity', 'C': 'Codominance', 'D': 'Penetrance', 'E': 'Anticipation'}, | E: Anticipation |
Answer the following medical question with one of the provided options: | Q:A 32-year-old primigravida at 35 weeks gestation seeks evaluation at the emergency department for swelling and redness of the left calf, which started 2 hours ago. She reports that the pain has worsened since the onset. The patient denies a history of insect bites or trauma. She has never experienced something like this in the past. Her pregnancy has been uneventful so far. She does not use alcohol, tobacco, or any illicit drugs. She does not take any medications other than prenatal vitamins. Her temperature is 36.8℃ (98.2℉), the blood pressure is 105/60 mm Hg, the pulse is 110/min, and the respirations are 15/min. The left calf is edematous with the presence of erythema. The skin feels warm and pain is elicited with passive dorsiflexion of the foot. The femoral, popliteal, and pedal pulses are palpable bilaterally. An abdominal examination reveals a fundal height consistent with the gestational age. The lungs are clear to auscultation bilaterally. The patient is admitted to the hospital and appropriate treatment is initiated. Which of the following hormones is most likely implicated in the development of this patient’s condition?? {'A': 'Estriol', 'B': 'Progesterone', 'C': 'Human chorionic gonadotropin', 'D': 'Human placental lactogen', 'E': 'Prolactin'}, | A: Estriol |
Answer the following medical question with one of the provided options: | Q:A 26-year-old nurse at 8 weeks of gestation presents to the physician with low-grade fever and body ache for the past 2 days. She also complains of a fine pink and itchy rash that appeared 2 nights ago. The rash 1st appeared on her face and spread to her neck. Past medical history is noncontributory. She takes prenatal vitamins with folate every day. She has had many sick contacts while working in the hospital. Additionally, her daughter has had several colds over the last few months. On examination, the temperature is 38.3°C (100.9°F), she has a fine macular rash on her face and neck with focal macules on her chest. Palpation of the neck reveals lymphadenopathy in the posterior auricular nodes. What is the most appropriate next step in the management of this patient?? {'A': 'Administer anti-rubella antibodies', 'B': 'Admit the patient and place her in isolation', 'C': 'Administer rubella vaccine', 'D': 'Test for rubella antibodies in her blood', 'E': 'Termination of pregnancy'}, | D: Test for rubella antibodies in her blood |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man with a history of fatigue and exertional dyspnea presents to the urgent care clinic following an acute upper respiratory illness. On physical examination, his pulses are bounding, his complexion is very pale, and scleral icterus is apparent. The spleen is moderately enlarged. Oxygen saturation is 79% at rest, with a new oxygen requirement of 9 L by a non-rebreather mask. Laboratory analysis results show a hemoglobin level of 6.8 g/dL. Of the following options, which hypersensitivity reaction does this condition represent?? {'A': 'Type I–anaphylactic hypersensitivity reaction', 'B': 'Type II–cytotoxic hypersensitivity reaction', 'C': 'Type III–immune complex-mediated hypersensitivity reaction', 'D': 'Type IV–cell-mediated (delayed) hypersensitivity reaction', 'E': 'Type II and II–mixed cytotoxic and immune complex hypersensitivity reaction'}, | B: Type II–cytotoxic hypersensitivity reaction |
Answer the following medical question with one of the provided options: | Q:A 57-year-old HIV-positive male with a history of intravenous drug abuse presents to the emergency room complaining of arm swelling. He reports that he developed progressively worsening swelling and tenderness over the right antecubital fossa three days prior. He recently returned from a trip to Nicaragua. His past medical history is notable for an anaphylactoid reaction to vancomycin. His temperature is 101.4°F (38.6°C), blood pressure is 140/70 mmHg, pulse is 110/min, and respirations are 20/min. Physical examination reveals an erythematous, fluctuant, and tender mass overlying the right antecubital fossa. Multiple injection marks are noted across both upper extremities. He undergoes incision and drainage and is started on an antibiotic that targets the 50S ribosome. He is discharged with plans to follow up in one week. However, five days later he presents to the same emergency room complaining of abdominal cramps and watery diarrhea. Which of the following classes of pathogens is most likely responsible for this patient’s current symptoms?? {'A': 'Gram-negative curved bacillus', 'B': 'Gram-negative bacillus', 'C': 'Anaerobic flagellated protozoan', 'D': 'Gram-positive coccus', 'E': 'Gram-positive bacillus'}, | E: Gram-positive bacillus |
Answer the following medical question with one of the provided options: | Q:A 69-year-old male presents to the emergency department for slurred speech and an inability to use his right arm which occurred while he was eating dinner. The patient arrived at the emergency department within one hour. A CT scan was performed of the head and did not reveal any signs of hemorrhage. The patient is given thrombolytics and is then managed on the neurology floor. Three days later, the patient is recovering and is stable. He seems depressed but is doing well with his symptoms gradually improving as compared to his initial presentation. The patient complains of neck pain that has worsened slowly over the past few days for which he is being given ibuprofen. Laboratory values are ordered and return as indicated below: Serum: Na+: 130 mEq/L K+: 3.7 mEq/L Cl-: 100 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 7 mg/dL Glucose: 70 mg/dL Creatinine: 0.9 mg/dL Ca2+: 9.7 mg/dL Urine: Appearance: dark Glucose: negative WBC: 0/hpf Bacterial: none Na+: 320 mEq/L/24 hours His temperature is 99.5°F (37.5°C), pulse is 95/min, blood pressure is 129/70 mmHg, respirations are 10/min, and oxygen saturation is 98% on room air. Which of the following is the best next step in management?? {'A': 'Fluid restriction', 'B': 'Oral salt tablets', 'C': 'Demeclocycline', 'D': 'Conivaptan', 'E': 'Continue conservative management'}, | A: Fluid restriction |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man with a 2 year history of Alzheimer disease presents is brought in from his nursing facility with altered mental status and recurrent falls during the past few days. Current medications include donepezil and galantamine. His vital signs are as follows: temperature 36.0°C (96.8°F), blood pressure 90/60 mm Hg, heart rate 102/min, respiratory rate 22/min. Physical examination reveals several lacerations on his head and extremities. He is oriented only to the person. Urine and blood cultures are positive for E. coli. The patient is admitted and initial treatment with IV fluids, antibiotics, and subcutaneous prophylactic heparin. On the second day of hospitalization, diffuse bleeding from venipuncture sites and wounds is observed. His blood test results show thrombocytopenia, prolonged PT and PTT, and a positive D-dimer. Which of the following is the most appropriate next step in the management of this patient’s condition?? {'A': 'Immediately cease heparin therapy and prescribe an alternative anticoagulant', 'B': 'Start prednisone therapy', 'C': 'Cryoprecipitate, FFP and low dose SC heparin', 'D': 'Urgent plasma exchange', 'E': 'Splenectomy'}, | C: Cryoprecipitate, FFP and low dose SC heparin |
Answer the following medical question with one of the provided options: | Q:A 59-year-old woman is brought to the emergency department for the confusion. She was in her usual state of health until about 2 hours ago when she was found trying to cook a frozen pizza in her medicine cabinet. She also complained to her husband that she had a terrible headache. Her past medical history is notable for hypertension, which has been difficult to control on multiple medications. Her temperature is 37.1°C (98.8°F), the pulse is 75/min, and the blood pressure is 202/128 mm Hg. On physical exam, she is alert and oriented only to self. The physical exam is otherwise unremarkable and the neurologic exam shows no focal neurological deficits. Noncontrast CT head imaging is unremarkable; a T2-weighted image from the patient’s MRI brain scan is shown. Which of the following is the next best step in management for this patient?? {'A': 'IV lorazepam', 'B': 'IV nicardipine', 'C': 'IV phenytoin', 'D': 'IV tissue plasminogen activator (tPA)', 'E': 'IV vancomycin, ceftriaxone, and ampicillin'}, | B: IV nicardipine |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is brought to the emergency department by his father because he is having bizarre thoughts. The patient says that he is being haunted by aliens from outer space. The father is worried as his son has had these symptoms for the past 7 months and lately, it seems to be getting worse. He has become more self-obsessed and does not seem to have any interest in his favorite activities. He has no plans to harm himself or others but spends a lot of time and energy building ‘defenses’ in and around his room as he is absolutely sure that aliens will come to get him soon. His blood pressure is 121/79 mm Hg, pulse 86/min, respiratory rate 15/min, temperature 36.8°C (98.2°F). Which of the following is correct regarding the patient’s symptoms?? {'A': 'It would benefit from psychosurgery.', 'B': 'He has a fixed false belief.', 'C': 'It is a negative symptom.', 'D': 'It falls under the disorganized thinking domain.', 'E': 'It is amenable to cognitive behavioral therapy.'}, | B: He has a fixed false belief. |
Answer the following medical question with one of the provided options: | Q:A family doctor in a rural area is treating a patient for dyspepsia. The patient had chronic heartburn and abdominal pain for the last 2 months and peptic ulcer disease due to a suspected H. pylori infection. For reasons relating to affordability and accessibility, the doctor decides to perform a diagnostic test in the office that is less invasive and more convenient. Which of the following is the most likely test used?? {'A': 'Detection of the breakdown products of urea in biopsy', 'B': "Steiner's stain", 'C': 'Stool antigen test', 'D': 'Culture of organisms from gastric specimen', 'E': 'Serology (ELISA testing)'}, | E: Serology (ELISA testing) |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician with difficulty swallowing for several weeks. Examination of the oropharynx shows lesions on palate and tongue that can be easily scraped off. An image of the lesions is shown. Which of the following is a risk factor for this patient's findings?? {'A': 'Decline in CD4+ T-cells', 'B': 'Inhalation of salbutamol', 'C': 'Missed childhood vaccination', 'D': 'Chronic nicotine abuse', 'E': 'Epstein-Barr virus infection'}, | A: Decline in CD4+ T-cells |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy presents with difficult left eye-opening in the morning, eye discharge, and irritation. These symptoms developed gradually over the past week. He attends a primary school where recently an outbreak of tonsillitis took place. He had otitis media 2 weeks ago treated with ampicillin. At the presentation, the patient’s vital signs are within normal limits. Eye examination reveals bulbar conjunctival injection, mild eyelid edema, and a moderate mucopurulent discharge with crusts on the lower eyelid. There is no corneal or eyelid ulceration. No lymphadenopathy is noted. Which of the following investigations should be performed to establish a diagnosis before the treatment?? {'A': 'Bacterial culture of the discharge', 'B': 'No investigations are required in this case', 'C': 'Rapid viral test', 'D': 'Scrapings with Gram staining', 'E': 'Polymerase chain reaction'}, | B: No investigations are required in this case |
Answer the following medical question with one of the provided options: | Q:A 32 year-old African American man with a past medical history of sickle cell anemia presents to his primary care physician for a routine check-up. He has no complaints. His physician notes that he likely has an increased susceptibility to infections with certain organisms. Which of the following patient groups has a similar pattern of increased susceptibility?? {'A': 'C5-9 complement deficiency', 'B': 'T-cell deficiency', 'C': 'C3 complement deficiency', 'D': 'Hemophilia A', 'E': 'Hemophilia B'}, | C: C3 complement deficiency |
Answer the following medical question with one of the provided options: | Q:A 3175-g (7-lb) male newborn is delivered at 39 weeks' gestation to a 29-year-old primigravid woman following a spontaneous vaginal delivery. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Cardiac examination in the delivery room shows a continuous machine-like murmur. An echocardiogram shows a structure with blood flow between the pulmonary artery and the aorta. This structure is most likely a derivate of which of the following?? {'A': '4th aortic arch', 'B': '2nd aortic arch', 'C': '6th aortic arch', 'D': '1st aortic arch', 'E': '3rd aortic arch'}, | C: 6th aortic arch |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man with a past medical history of type I diabetes mellitus presents to the emergency department with altered mental status. The patient was noted as becoming more lethargic and confused over the past day, prompting his roommates to bring him in. His temperature is 99.0°F (37.2°C), blood pressure is 107/68 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Serum: Na+: 144 mEq/L Cl-: 100 mEq/L K+: 6.3 mEq/L HCO3-: 16 mEq/L BUN: 20 mg/dL Glucose: 599 mg/dL Creatinine: 1.4 mg/dL Ca2+: 10.2 mg/dL Which of the following is the appropriate endpoint of treatment for this patient?? {'A': 'Clinically asymptomatic', 'B': 'Normal anion gap', 'C': 'Normal glucose', 'D': 'Normal potassium', 'E': 'Vitals stable'}, | B: Normal anion gap |
Answer the following medical question with one of the provided options: | Q:The drug cilostazol is known for its ability to relax vascular smooth muscle and therefore cause vasodilation through its inhibition of phosphodiesterase 3. Given this mechanism of action, what other effect would be expected?? {'A': 'Increased left ventricular end-diastolic volume', 'B': 'Positive inotropy', 'C': 'Negative chronotropy', 'D': 'Angioedema', 'E': 'Antiarrhythmic action'}, | B: Positive inotropy |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman presents to her primary care provider with shortness of breath. She reports a 4-month history of progressively worsening difficulty breathing with associated occasional chest pain. She is a long-distance runner but has had trouble running recently due to her breathing difficulties. Her past medical history is notable for well-controlled hypertension for which she takes hydrochlorothiazide. She had a tibial osteosarcoma lesion with pulmonary metastases as a child and successfully underwent chemotherapy and surgical resection. She has a 10 pack-year smoking history but quit 15 years ago. She drinks a glass of wine 3 times per week. Her temperature is 98.6°F (37°C), blood pressure is 140/85 mmHg, pulse is 82/min, and respirations are 18/min. On exam, she has increased work of breathing with a normal S1 and loud P2. An echocardiogram in this patient would most likely reveal which of the following?? {'A': 'Biventricular dilatation with a decreased ejection fraction', 'B': 'Left atrial dilatation with mitral valve stenosis', 'C': 'Left ventricular dilatation with an incompetent aortic valve', 'D': 'Left ventricular hypertrophy with a bicuspid aortic valve', 'E': 'Right ventricular hypertrophy with a dilated pulmonary artery'}, | E: Right ventricular hypertrophy with a dilated pulmonary artery |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man presents to the physician with nausea, vomiting, constipation, and abdominal pain for the past 24 hours. He has also developed difficulty in swallowing and blurring of vision. He also complains of significant dryness of his mouth and throat. When asked about his diet, he reports that he has been saving money by eating dented and old canned goods. On physical examination, his vital signs are stable. His neurologic examination reveals bilateral fixed dilated pupils, weakness of extraocular muscles, and weak gag reflex, while sensations and gait are normal. Laboratory evaluation of his stool isolates a toxin produced by gram-positive, anaerobic, spore-forming bacilli. Which of the following mechanisms best explains the action of the toxin?? {'A': 'Blockade of voltage-gated fast sodium channels in motor neurons', 'B': 'Blockade of release of acetylcholine at neuromuscular junctions', 'C': 'Inactivation of acetylcholinesterase at neuromuscular junctions', 'D': 'Competitive antagonism of acetylcholine at postsynaptic receptors', 'E': 'Prolonged depolarization of NM receptors'}, | B: Blockade of release of acetylcholine at neuromuscular junctions |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman comes to the physician because of involuntary rhythmic shaking of both hands for several months. More recently, she also noticed involuntary head nodding movements. The shaking seems to improve after having one or two glasses of wine. Her father had similar symptoms starting at the age of 60. Neurologic examination shows a symmetric hand tremor that worsens with voluntary movement of the respective extremity. The most appropriate pharmacotherapy for this patient's symptoms is also recommended for the treatment of which of the following conditions?? {'A': 'Motion sickness', 'B': 'Restless legs syndrome', 'C': 'Sleepwalking', 'D': 'Hyperthyroidism', 'E': 'Malignant hyperthermia'}, | D: Hyperthyroidism |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman is brought to the emergency department 4 hours after the sudden onset of shortness of breath and dizziness. Her blood pressure is 88/56 mm Hg. Examination shows crackles at both lung bases and an S3 gallop. The extremities are cold to the touch. Serum studies show a urea nitrogen concentration of 15 mg/dL, a creatinine concentration of 1.0 mg/dL, and a lactic acid concentration of 6.4 mmol/L (N < 2). Arterial blood gas analysis on room air shows: pH 7.27 pCO2 36 mm Hg HCO3- 15 mEq/L An ECG shows ST-segment elevation in the precordial leads. Which of the following is the most likely explanation for this patient's laboratory changes?"? {'A': 'Catecholamine stimulation of glycolysis', 'B': 'Decreased reabsorption of HCO3-', 'C': 'Increased activity of HMG-CoA lyase', 'D': 'Defective mitochondrial oxygen utilization', 'E': 'Accumulation of NADH'}, | E: Accumulation of NADH |
Answer the following medical question with one of the provided options: | Q:A previously healthy 24-year-old woman comes to the physician because of fever, headache, myalgia, photophobia, and a nonproductive cough for 2 days. Three weeks ago, she received a parrot as a birthday present. Her temperature is 38.5°C (101.3°F). Pulmonary examination shows crackles at both lung bases. Her leukocyte count is 8,000/mm3. An x-ray of the chest shows diffuse patchy infiltrates that are most prominent in the lower lobes. Which of the following is the most likely causal organism?? {'A': 'Chlamydophila psittaci', 'B': 'Cryptococcus neoformans', 'C': 'Leptospira interrogans', 'D': 'Babesia microti', 'E': 'Francisella tularensis'}, | A: Chlamydophila psittaci |
Answer the following medical question with one of the provided options: | Q:A 71-year-old woman presents to the emergency department with a headache for the past 30 minutes. She says that this is the worst headache of her life and that it came on suddenly after she hit her head. She says that she has also been experiencing visual problems with double vision when she looks to the left or the right. Visual examination reveals that her right eye cannot move right past the midline and her left eye cannot move left past the midline. Which of the following is most likely responsible for this patient's visual defects?? {'A': 'Bilateral uncal herniation', 'B': 'Central herniation', 'C': 'Subfalcine herniation', 'D': 'Tonsillar herniation', 'E': 'Unilateral uncal herniation'}, | B: Central herniation |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man comes to the physician because of intermittent throbbing headaches over the past year. The headaches are worse when he wakes up and are not accompanied by other symptoms. The patient also reports trouble concentrating on daily tasks at work. His wife has been complaining lately about his snoring during sleep, which he attributes to his chronic sinusitis. He has a history of hypertension and an allergy to dust mites. He has smoked a pack of cigarettes daily for 14 years. His pulse is 72/min and blood pressure is 150/95 mm Hg. He is 178 cm (5 ft 10 in) tall and weighs 120 kg (265 lb); BMI is 37.9 kg/m2. Neurological and cutaneous examination shows no abnormalities. Which of the following is the most likely cause of this patient's hypertension?? {'A': 'Low circulating free thyroxine levels', 'B': 'Nocturnal upper airway obstruction', 'C': 'Hypophyseal neoplasm', 'D': 'Hypersecretion of aldosterone', 'E': 'Low synaptic serotonin levels'}, | B: Nocturnal upper airway obstruction |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man presents to the emergency department for abdominal pain. The patient states the pain started this morning and has been worsening steadily. He decided to come to the emergency department when he began vomiting. The patient has a past medical history of obesity, diabetes, alcohol abuse, and hypertension. His current medications include captopril, insulin, metformin, sodium docusate, and ibuprofen. His temperature is 104.0°F (40°C), blood pressure is 160/97 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Abdominal exam reveals left lower quadrant tenderness. Cardiac exam reveals a crescendo systolic murmur heard best by the right upper sternal border. Lab values are ordered and return as below. Hemoglobin: 15 g/dL Hematocrit: 42% Leukocyte count: 19,500 cells/mm^3 with normal differential Platelet count: 226,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 101 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Glucose: 144 mg/dL Creatinine: 1.2 mg/dL Ca2+: 9.8 mg/dL Which of the following is the most accurate test for this patient's condition?? {'A': 'Amylase and lipase levels', 'B': 'Barium enema', 'C': 'Colonoscopy', 'D': 'CT scan', 'E': 'Sigmoidoscopy'}, | D: CT scan |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man is brought to the emergency department by his brother because of a 3-hour history of lethargy and confusion. The brother says that 2 days ago, the patient ate several large-capped mushrooms he had foraged in the woods. After eating the mushrooms, he developed severe, bloody diarrhea that has since resolved. His pulse is 140/min, respirations are 26/min, and blood pressure is 98/62 mm Hg. Examination shows dry mucous membranes and tenderness to deep palpation in the right upper quadrant. Serum studies show a serum AST concentration of 2335 U/L and ALT concentration of 2294 U/L. Inhibition of which of the following processes is the most likely cause of this patient's condition?? {'A': 'Messenger RNA synthesis', 'B': 'ATP production', 'C': 'Microtubule polymerization', 'D': 'Parasympathetic activation', 'E': 'Cell depolarization'}, | A: Messenger RNA synthesis |
Answer the following medical question with one of the provided options: | Q:A 76-year-old man is brought to the hospital after having a stroke. Head CT is done in the emergency department and shows intracranial hemorrhage. Upon arrival to the ED he is verbally non-responsive and withdraws only to pain. He does not open his eyes. He is transferred to the medical ICU for further management and intubated for airway protection. During his second day in the ICU, his blood pressure is measured as 91/54 mmHg and pulse is 120/min. He is given fluids and antibiotics, but he progresses to renal failure and his mental status deteriorates. The physicians in the ICU ask the patient’s family what his wishes are for end-of-life care. His wife tells the team that she is durable power of attorney for the patient and provides appropriate documentation. She mentions that he did not have a living will, but she believes that he would want care withdrawn in this situation, and therefore asks the team to withdraw care at this point. The patient’s daughter vehemently disagrees and believes it is in the best interest of her father, the patient, to continue all care. Based on this information, what is the best course of action for the physician team?? {'A': 'Listen to the patient’s wife’s wishes and withdraw care', 'B': 'Listen to the patient’s daughter’s wishes and continue all care', 'C': 'Compromise between the wife and daughter and withdraw the fluids and antibiotics but keep the patient intubated', 'D': 'Consult the hospital ethics committee and continue all care until a decision is reached', 'E': 'Call other family members and consult them for their opinions'}, | A: Listen to the patient’s wife’s wishes and withdraw care |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman walks into the clinic for an annual check-up appointment with her family physician. When asked about any changes in her life, she states that she lost her job about 6 months ago. Since then, she has lived with her boyfriend who is also unemployed. She frequently uses laxatives and takes some over the counter medications to help her sleep. Her blood pressure is 129/87 mm Hg, respirations are 12/min, pulse is 58/min, and temperature is 36.7°C (98.1°F). Her physical exam is mostly benign. Her pupils appear mildly constricted and she appears drowsy and subdued. The physician suspects that the physical findings in this patient are caused by a substance she is likely abusing. Which of the following is the substance?? {'A': 'Ketamine', 'B': 'Cocaine', 'C': 'Codeine', 'D': 'Alprazolam', 'E': 'Clonazepam'}, | C: Codeine |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the clinic with a complaint of a severely itchy and painful rash on her hands and legs for a day. On further questioning, she revealed that she loves nature and goes on trekking to the woods frequently. She just returned from a similar trip, 2 days ago. On physical examination, a prominent rash along with multiple blisters is noted on the ventral aspect of her right forearm. A photograph of the rash is shown. Which of the following is the most likely reaction that the patient is experiencing?? {'A': 'Type IV hypersensitivity reaction', 'B': 'Type III hypersensitivity reaction', 'C': 'Bullous pemphigoid', 'D': 'Type I hypersensitivity reaction', 'E': 'Type II hypersensitivity reaction'}, | A: Type IV hypersensitivity reaction |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy presents to his primary care physician with hip pain that started this morning. The patient claims the pain is severe and is stopping him from skateboarding. The patient recently recovered from a upper respiratory infection that he caught from his siblings but has otherwise been healthy. The patient has a past medical history of obesity. His temperature is 98.1°F (36.7°C), blood pressure is 100/55 mmHg, pulse is 90/min, respirations are 22/min, and oxygen saturation is 98% on room air. On physical exam, you note an obese boy in no acute distress. Cardiopulmonary exam is within normal limits. Inspection of the hip reveals no abnormalities or swelling. The hip exhibits a normal range of motion and physical exam only elicits minor pain. The patient's gait appears normal and pain is elicited when the patient jumps or runs. Which of the following is the best next step in management for this patient's most likely diagnosis?? {'A': 'Radiography', 'B': 'CT scan', 'C': 'MRI', 'D': 'Aspiration and broad spectrum antibiotics', 'E': 'Ibuprofen and rest'}, | E: Ibuprofen and rest |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the incidence of sickle cell trait in African American infants. To identify the trait, polymerase chain reaction testing is performed on venous blood samples obtained from the infants. Which of the following is required for this laboratory technique?? {'A': 'RNA-dependent DNA polymerase', 'B': 'Ligation of Okazaki fragments', 'C': "Initial sequence of the 3' end of a DNA strand", 'D': 'Complete genome DNA sequence', 'E': 'Single-stranded binding proteins'}, | C: Initial sequence of the 3' end of a DNA strand |
Answer the following medical question with one of the provided options: | Q:A previously healthy 20-year-old woman comes to the physician because of recurrent abdominal cramps, bloating, and diarrhea for 4 months. She describes her stools as greasy, foul-smelling, and difficult to flush. During this time she has had a 6-kg (13.2-lb) weight loss. She has no personal or family history of serious illness. Physical examination shows pallor and cheilitis. Laboratory studies show a hemoglobin concentration of 11 g/dL. Serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Test of the stool for occult blood is negative and stool microscopy reveals no pathogens and no leukocytes. Analysis of a 24-hour stool sample shows 12 g of fat. The patient is asked to consume 25 g of d-xylose. Five hours later, its concentration is measured in urine at 2 g (N = > 4 g/5 h). The test is repeated after a two-week course of rifaximin, but the urinary concentration of d-xylose remains the same. Which of the following is the most likely diagnosis?? {'A': 'Lactose intolerance', 'B': 'Exocrine pancreatic insufficiency', 'C': 'Tropheryma whipplei infection', 'D': 'Bacterial overgrowth in the small intestine', 'E': 'Hypersensitivity to gliadin\n"'}, | E: Hypersensitivity to gliadin " |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency room complaining of shortness of breath and productive cough for a few days. He says that his sputum is mostly yellow with tiny red specks. He denies fever, chills, recent weight loss, or joint pain. He has no history of recent travel or sick contacts. His medical history is unremarkable. He smokes a pack of cigarettes daily. He has had 3 sexual partners in the past year. His temperature is 37°C (98.6°F), blood pressure is 110/70 mm Hg, pulse is 98/min, and respirations are 20/min. On physical examination, the patient is in mild respiratory distress. Cardiopulmonary auscultation reveals diffuse bilateral rales. An HIV test is negative. His laboratory results are as follow: Complete blood count Hemoglobin 12 gm/dL Serum chemistry Sodium 143 mEq/L Potassium 4.1 mEq/L Chloride 98 mEq/L Bicarbonate 22 mEq/L Blood urea nitrogen 26 mg/dL Creatinine 2.3 mg/dL Glucose 86 mg/dL Urine dipstick Protein trace Blood positive Leukocytes negative Nitrates negative Which of the following is the most likely cause of his current condition?? {'A': 'Pneumocystis pneumonia', 'B': 'Pulmonary embolism', 'C': 'Heart failure', 'D': 'Basement membrane antibodies', 'E': 'Ruptured alveolar bleb'}, | D: Basement membrane antibodies |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the clearance of respiratory particles in healthy non-smokers. An aerosol containing radio-labeled particles that are small enough to reach the alveoli is administered to the subjects via a non-rebreather mask. A gamma scanner is then used to evaluate the rate of particle clearance from the lungs. The primary mechanism of particle clearance most likely involves which of the following cell types?? {'A': 'Goblet cells', 'B': 'Club cells', 'C': 'Type I pneumocytes', 'D': 'Macrophages', 'E': 'Neutrophils'}, | D: Macrophages |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman, gravida 4, para 3, at 34 weeks' gestation comes to the physician for a prenatal visit. She feels well. She does not note any contractions or fluid from her vagina. Her third child was delivered spontaneously at 35 weeks' gestation; pregnancy and delivery of her other two children were uncomplicated. Vital signs are normal. The abdomen is nontender and no contractions are felt. Pelvic examination shows a uterus consistent in size with a 34-weeks' gestation. Ultrasonography shows the fetus in a breech presentation. The fetal heart rate is 148/min. Which of the following is the most appropriate next step in management?? {'A': 'Internal cephalic version', 'B': 'Cesarean section', 'C': 'External cephalic version', 'D': 'Observation', 'E': 'Intravenous penicillin'}, | D: Observation |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman gives birth to a male child at 30 weeks of gestation. Pregnancy was complicated by polyhydramnios diagnosed on ultrasonography at 26 weeks of gestation. The baby is born vaginally weighing 1.2 kg (2.64 lb). Because he does not cry immediately after birth, endotracheal intubation is attempted to secure the airway. However, the vocal cords cannot be visualized because there is only a single opening corresponding to the esophagus. He is transferred to the NICU under bag and mask ventilation, where intubation is attempted once again by passing the endotracheal tube in the visualized opening, after which his oxygen saturation begins to improve. His temperature is 37.0ºC (98.6°F), pulse is 120/min, and respiratory rate is 42/min. On physical examination, no abnormalities are noted. Chest radiography is suggestive of respiratory distress syndrome. Which of the following most likely failed to develop in this patient?? {'A': 'First branchial arch', 'B': 'Second branchial arch', 'C': 'Third branchial arch', 'D': 'Fourth and sixth branchial arches', 'E': 'Mesonephric duct'}, | D: Fourth and sixth branchial arches |
Answer the following medical question with one of the provided options: | Q:An 19-year-old woman presents to her primary care physician because she has been feeling increasingly lethargic over the last 6 months. Specifically, she says that she feels tired easily and has been cold even though she is wearing lots of layers. Her medical history is significant for seasonal allergies but is otherwise unremarkable. When prompted, she also says that she has a hard time swallowing food though she has no difficulty drinking liquids. Physical exam reveals a midline mass in her neck. Which of the following structures would most likely be seen if this patient's mass was biopsied?? {'A': 'Blood vessels', 'B': 'Follicles with colloid', 'C': 'Hollow epithelial duct', 'D': 'Lymphatic ducts', 'E': 'Neutrophilic invasion'}, | B: Follicles with colloid |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man arrives at the emergency department 30 minutes after developing rapid onset right-sided weakness and decreased sensation on the right side of his body. The patient’s wife also reports that he has had difficulty forming sentences. His wife adds that these symptoms were at their maximum within a few minutes of the incident and began to resolve almost instantaneously. The patient says he had a related episode of painless visual loss in his left eye that resolved after about 10–20 minutes about 3 months ago. His past medical history includes diabetes mellitus type 2 and essential hypertension. The patient reports a 50 pack-year smoking history. His blood pressure is 140/60 mm Hg, and his temperature is 36.5°C (97.7°F). Neurological examination is significant for a subtle weakness of the right hand. A noncontrast CT scan of the head is unremarkable, and a carotid Doppler ultrasound shows 10% stenosis of the right internal carotid artery and 50% stenosis of the left internal carotid artery. Which of the following is the expected change in resistance to blood flow through the stenotic artery most likely responsible for this patient’s current symptoms?? {'A': 'It will double', 'B': 'It will be 4 times greater', 'C': 'It will be 8 times greater', 'D': 'It will be 16 times greater', 'E': 'No change'}, | D: It will be 16 times greater |
Answer the following medical question with one of the provided options: | Q:A 39-year-old African American woman is admitted to the hospital following a seizure with a severe post-ictal headache. She was diagnosed with breast cancer 1 year ago when she presented with a hard, rock-like, immobile mass with irregular borders accompanied by changes in the breast skin, including erythema and dimpling. She had ipsilateral mobile axillary lymphadenopathy at that time. A biopsy confirmed the diagnosis of stage 2B invasive breast cancer. Her mother died at 42 years of age due to the same type of breast cancer. A CT scan done during this admission reveals multiple metastatic lesions in the brain and liver, along with the involvement of supra- and infra-clavicular lymph nodes. Which of the following molecular profile most likely characterizes this patient?? {'A': 'Progesterone receptor (PR) positive', 'B': 'ER, PR, HER2 negative', 'C': 'Estrogen receptor (ER) positive', 'D': 'PR, ER, HER2 positive', 'E': 'HER2 positive'}, | B: ER, PR, HER2 negative |
Answer the following medical question with one of the provided options: | Q:A 13-year-old boy is brought to the physician because of a 1-month history of progressive difficulty breathing through his nose and a 2-week history of recurrent severe nosebleeds. When he holds the right nostril shut, he is unable to breathe nasally and his sense of smell is reduced. He has a 6-year history of asthma, which is well controlled with inhaled albuterol. Vital signs are within normal limits. Nasal inspection shows a pink, lobulated mass filling the left nasal cavity. The septum is deviated to the right side. The mass bleeds on touch. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?? {'A': 'Coagulation tests', 'B': 'Sweat chloride test', 'C': 'Punch biopsy of the mass', 'D': 'Genetic analysis of dynein genes', 'E': 'CT scan of head with contrast'}, | E: CT scan of head with contrast |
Answer the following medical question with one of the provided options: | Q:A 20-year-old man comes to the emergency room because of palpitations and mild dyspnea for the last 2 hours. He has had similar episodes in the past that resolved within 20 minutes, but they have been worsening since he started training for his first marathon 1 month ago. Ten years ago, he was treated for streptococcal pharyngitis with a 10-day course of penicillin. His maternal uncle passed away unexpectedly from a heart condition at age 40. He is 180 cm (5 ft 11 in) tall and weighs 85 kg (187 lb); BMI is 26.2 kg/m2. His temperature is 36.5°C (97.7°F), pulse is 70/min, respirations are 18/min, and blood pressure is 132/60 mm Hg. On examination, there is a decrescendo early diastolic murmur heard best along the left sternal border. His head slightly bobs about every second. The remainder of the examination shows no abnormalities. Which of the following is most likely to be present?? {'A': 'Asymmetric septal hypertrophy', 'B': 'Antistreptolysin O antibodies', 'C': 'Myxomatous degeneration', 'D': 'Bicuspid aortic valve', 'E': 'Valve vegetation'}, | D: Bicuspid aortic valve |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man comes to the physician for a routine health maintenance examination. He feels well. He goes for a 30-minute walk three times a week and does not experience any shortness of breath or chest or leg pain on exertion. He has not had any weakness, numbness, or vision disturbance. He has diabetes that is well controlled with insulin injections. He had smoked one pack of cigarettes every day for 40 years but quit 5 years ago. He appears healthy and well nourished. His temperature is 36.3°C (97.3°F), pulse is 75/min, and blood pressure is 136/78 mm Hg. Physical examination shows normal heart sounds. There are systolic bruits over the neck bilaterally. Physical and neurologic examinations show no other abnormalities. Fasting serum studies show: Total cholesterol 210 mg/dL HDL cholesterol 28 mg/dL LDL cholesterol 154 mg/dL Triglycerides 140 mg/dL Glucose 102 mg/dL Duplex ultrasonography of the carotid arteries shows a 85% stenosis on the left and a 55% stenosis on the right side. Which of the following is the most appropriate next step in management?"? {'A': 'Aspirin therapy only', 'B': 'Left carotid endarterectomy', 'C': 'Reassurance', 'D': 'Carotid artery stenting', 'E': 'Bilateral carotid endarterectomy'}, | B: Left carotid endarterectomy |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman is brought to the emergency department after being resuscitated in the field. Her husband is with her and recalls seeing pills beside her when he was in the bathroom. He reveals she has a past medical history of depression and was recently given a prescription for smoking cessation. On physical exam, you notice a right-sided scalp hematoma and a deep laceration to her tongue. She has a poor EEG waveform indicating limited to no cerebral blood flow and failed both her apnea test and reflexes. She is found to be in a persistent vegetative state, and the health care team starts to initiate the end of life discussion. The husband states that the patient had no advance directives other than to have told her husband she did not want to be kept alive with machines. The parents want all heroic measures to be taken. Which of the following is the most accurate statement with regards to this situation?? {'A': 'The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.', 'B': 'The patient’s parents may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.', 'C': 'The patient’s adult daughter may be appointed as her health care surrogate and may make end-of-life decisions on her behalf.', 'D': 'The physician may be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.', 'E': 'An ethics committee must be appointed as the patient’s health care surrogate and may make end-of-life decisions on her behalf.'}, | A: The patient’s husband may be appointed as her health care surrogate and may make end-of-life decisions on her behalf. |
Answer the following medical question with one of the provided options: | Q:An 8-year-old girl is brought to the emergency department because of a 2-day history of low-grade fever, itchy rash, and generalized joint pain. The rash initially started in the antecubital and popliteal fossae and then spread to her trunk and distal extremities. One week ago, she was diagnosed with acute sinusitis and was started on amoxicillin. She has no history of adverse drug reactions and immunizations are up-to-date. Her temperature is 37.5°C (99.5°F), pulse is 90/min, and blood pressure is 110/70 mm Hg. Physical examination shows periorbital edema and multiple erythematous, annular plaques of variable sizes over her entire body. One of the lesions in the right popliteal fossa has an area of central clearing and the patient's mother reports that it has been present for over 24 hours. Urinalysis is normal. Which of the following is the most likely diagnosis?? {'A': 'Serum sickness-like reaction', 'B': 'Stevens-Johnson syndrome', 'C': 'Pemphigus vulgaris', 'D': 'Drug reaction with eosinophilia and systemic symptoms', 'E': 'IgA vasculitis'}, | A: Serum sickness-like reaction |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy presents to the clinic with his mother, who notes that the way in which he plays has changed and that he has been limping, favoring his left leg. When asked, the patient states that his left knee hurts. He is afebrile and vital signs are stable. The patient is well nourished and meeting all developmental milestones. On physical examination, the knee has a full range of motion; however, passive motion elicits pain in the left hip. An X-ray is performed and reveals a flattened left femoral head. Which of the following is the most likely diagnosis?? {'A': 'Septic arthritis', 'B': 'Rickets', 'C': 'Legg-Calvé-Perthes disease (LCPD)', 'D': 'Slipped capital femoral epiphysis', 'E': 'Juvenile idiopathic arthritis (JIA)'}, | C: Legg-Calvé-Perthes disease (LCPD) |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents to the clinic for a chronic cough over the past 4 months. The patient reports a productive yellow/green cough that is worse at night. He denies any significant precipitating event prior to his symptoms. He denies fever, chest pain, palpitations, weight changes, or abdominal pain, but endorses some difficulty breathing that waxes and wanes. He denies alcohol usage but endorses a 35 pack-year smoking history. A physical examination demonstrates mild wheezes, bibasilar crackles, and mild clubbing of his fingertips. A pulmonary function test is subsequently ordered, and partial results are shown below: Tidal volume: 500 mL Residual volume: 1700 mL Expiratory reserve volume: 1500 mL Inspiratory reserve volume: 3000 mL What is the functional residual capacity of this patient?? {'A': '2000 mL', 'B': '2200 mL', 'C': '3200 mL', 'D': '3500 mL', 'E': '4500 mL'}, | C: 3200 mL |
Answer the following medical question with one of the provided options: | Q:A 17-year-old man presents to his primary care physician concerned about excessive sleepiness that has persisted his entire life. He notes that he has been having difficulty with his job as a waiter because he often falls asleep suddenly during the day. He also experiences a sensation of dreaming as he goes to sleep even though he still feels awake. He sleeps about 10 hours per day and still feels tired throughout the day. The patient has even reported driving into a tree once as he fell asleep while driving. The patient often stays up late at night working on the computer. Physical exam demonstrates an obese young man who appears tired. His oropharynx demonstrates high palatal ridges and good dental hygiene. Which of the following is the best next step in management?? {'A': 'Continuous positive airway pressure at night', 'B': 'Begin inhibitor of dopamine reuptake', 'C': 'Recommend scheduling regular naps and more time for sleep at night', 'D': 'Recommend to abstain from activities at night that expose the patient to blue light', 'E': 'Start a selective serotonin reuptake inhibitor'}, | B: Begin inhibitor of dopamine reuptake |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman presents to her primary care physician for a new patient appointment. She states that she feels well and has no current complaints. The patient recently started seeing a specialist for treatment for another medical condition but otherwise has had no medical problems. The patient lives alone and drinks 2 alcoholic beverages every night. She has had 3 sexual partners in her lifetime, uses oral contraceptive pills for contraception, and has never been pregnant. Physical exam reveals a pleasant, obese woman with normal S1 and S2 on cardiac exam. Musculoskeletal exam reveals swelling of the MCP and PIP joints of the hands as well as ulnar deviation of the fingers. Laboratory tests are ordered and results are below: Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL AST: 95 U/L ALT: 68 U/L Which of the following best explains this patient's abnormal laboratory values?? {'A': 'Alcohol', 'B': 'Bacterial infection', 'C': 'Medication', 'D': 'Obesity', 'E': 'Viral infection'}, | C: Medication |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman is brought to the emergency department by her husband because of a 1-hour history of severe groin pain, nausea, and vomiting. She has had a groin swelling that worsens with standing, coughing, and straining for the past 3 months. Her pulse is 120/min. Examination shows pallor; there is swelling, erythema, and tenderness to palpation of the right groin that is centered below the inguinal ligament. The most likely cause of this patient's condition is entrapment of an organ between which of the following structures?? {'A': 'Linea alba and conjoint tendon', 'B': 'Inferior epigastric artery and rectus sheath', 'C': 'Conjoint tendon and inguinal ligament', 'D': 'Medial and median umbilical ligaments', 'E': 'Lacunar ligament and femoral vein'}, | E: Lacunar ligament and femoral vein |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman presents to her dermatologist with complaints of discoloration of the skin on her hands and wrists. She says her symptoms started about 6-months ago. Around this time, she recalls moving into her new house with her husband and children. She had to quit her job to relocate and says she is having difficulty maintaining a clean and happy household. She admits to being stressed most of the time. She was previously in good health. No significant past medical history. The patient is afebrile and vital signs are within normal limits. Physical examination reveals patchy red, scaly skin on both hands. Upon further questioning, the patient admits to having to continuously wash her hands because she has this irrational idea that her hands are dirty. She tries her best to ignore these thoughts but eventually succumbs to wash her hands over and over to ease the anxiety. Which of the following statements is correct concerning this patient’s most likely condition?? {'A': 'Symptoms are ego-dystonic', 'B': 'Patients generally lack insight', 'C': 'The condition is readily treatable', 'D': 'The condition is associated with early onset dementia', 'E': 'The condition rarely affects daily functioning'}, | A: Symptoms are ego-dystonic |
Answer the following medical question with one of the provided options: | Q:A 2800-g (6-lb 3-oz) male newborn is born at 39 weeks’ gestation to a 22-year-old woman, gravida 2, para 2, after an uncomplicated labor and delivery. The mother did not receive prenatal care. She traveled to Brazil to visit relatives during the first trimester of her pregnancy. She has bipolar disorder treated with lithium. The newborn is at the 50th percentile for height, 25th percentile for weight, and 2nd percentile for head circumference. Neurologic examination shows spasticity of the upper and lower extremities. The wrists are fixed in flexion bilaterally. Deep tendon reflexes are 4+ and symmetric. Ophthalmoscopic examination shows focal pigmentary retinal mottling. Testing for otoacoustic emissions is negative. Which of the following measures during the mother’s pregnancy is most likely to have prevented this newborn's condition?? {'A': 'Avoid consumption of undercooked meat', 'B': 'Use of mosquito repellant', 'C': 'Administration of antibiotic therapy', 'D': 'Daily intake of prenatal vitamins', 'E': 'Discontinuation of mood stabilizer'}, | B: Use of mosquito repellant |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 47-year-old woman comes to the physician for the evaluation of a 4-month history of worsening fatigue and constipation. She has also noticed that her cheeks appear fuller and her voice has become hoarse. Her temperature is 36.3°C (97.3°F) and pulse is 59/min. Examination of the neck shows a painless, mildly enlarged thyroid gland. Her skin is dry and cool and her nails appear brittle. Serum studies show antibodies against thyroid peroxidase. A biopsy of the thyroid gland is most likely to show which of the following?? {'A': 'Large, irregular nuclei, nuclear grooves, and Psammoma bodies', 'B': 'Tall follicular cells, scalloped colloid, and vascular congestion', 'C': 'Spindle cells, pleomorphic giant cells, and mitotic figures', 'D': 'Multinucleated giant cells, macrophages, and degenerated follicular cells', 'E': 'Lymphocytic infiltration, Hürthle cells, and germinal centers'}, | E: Lymphocytic infiltration, Hürthle cells, and germinal centers |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman presents with abdominal pain and blood in her urine. Since the acute onset of symptoms 3 days ago, there has been no improvement. She describes the pain as moderate, sharp and burning in character, non-radiating, and localized to the suprapubic region. She also has noted some mild urinary frequency and urgency for the past 5 days, which has been getting progressively worse. She denies any flank pain, fever, chills, night sweats, dysuria, or pain on urination. The patient has a history of an abdominal leiomyosarcoma, which was diagnosed 6 months ago. The course of her disease is complicated by hepatic metastases, for which she recently started receiving a new therapy. The patient reports a 15-pack-year smoking history, but no alcohol or recreational drug use. Her temperature is 37.0℃ (98.6℉), pulse is 84/min, respiratory rate is 18/min, and blood pressure is 110/75 mm Hg. On physical examination, there is some mild suprapubic tenderness to palpation. The remainder of the exam is unremarkable. Laboratory findings include a mild leukopenia of 3,000/mm3. A urine dipstick reveals 3+ blood. Which of the following best describes the medication that could have prevented this patient’s symptoms?? {'A': 'Serine protease inhibitor that reduces the action of plasmin', 'B': 'Agent that binds to an intracellular receptor and results in the transactivation of genes that promote gluconeogenesis and has anti-inflammatory effects', 'C': 'A thiol given concurrently with an antineoplastic agent to help reduce inflammation of the transitional epithelium of the bladder', 'D': 'Monoclonal antibody that inhibits bcr-abl tyrosine kinase, blocking cell proliferation and inducing apoptosis', 'E': 'Antifolate that inhibits dihydrofolate reductase, inhibiting purine production necessary for cell synthesis and division'}, | C: A thiol given concurrently with an antineoplastic agent to help reduce inflammation of the transitional epithelium of the bladder |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the physician by his parents because of a 6-week history of increased tiredness, irritability, and worsening leg pain. His parents report that he has been reluctant to walk recently because of the pain in his legs. Examination shows conjunctival pallor and diffuse petechiae. There are palpable, nontender posterior cervical and axillary lymph nodes. His hemoglobin concentration is 8.9 g/dL, leukocyte count is 45,750/mm3, and platelet count is 25,000/mm3. A bone marrow aspiration shows numerous immature cells that stain positive for CD10, CD19, and terminal deoxynucleotidyl transferase (TdT). Which of the following translocations is associated with a favorable prognosis for this patient's condition?? {'A': 't(12;21)', 'B': 't(15;17)', 'C': 't(8;14)', 'D': 't(14;18)', 'E': 't(9;22)'}, | A: t(12;21) |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man comes to the physician because of fever, night sweats, malaise, dyspnea, and a productive cough with bloody sputum for 4 days. He was diagnosed with HIV infection 15 years ago and has not been compliant with his medication regimen. Physical examination shows diminished breath sounds over the left lung fields. An x-ray of the chest shows an ill-defined lesion in the upper lobe of the left lung. A CT-guided biopsy of the lesion is performed; a photomicrograph of the biopsy specimen stained with mucicarmine is shown. Which of the following is the most likely causal organism?? {'A': 'Cocciodioides immitis', 'B': 'Candida albicans', 'C': 'Histoplasma capsulatum', 'D': 'Blastomyces dermatitidis', 'E': 'Cryptococcus neoformans'}, | E: Cryptococcus neoformans |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man presents with a history of a frequent unpleasant crawling sensation in both of his legs accompanied by an urge to move his legs for the last 6 months. He continuously moves his legs to provide him with partial relief from the unpleasant feelings in his legs. The symptoms are especially severe during the night or while lying down in bed after returning from work. These symptoms occur 3–5 days per week. He also complains of significant daytime fatigue and sleep disturbances on most days of the week. He is advised to take a polysomnography test, which reveals periodic limb movements (PLMs) during his sleep. Which of the following conditions is most associated with secondary restless legs syndrome?? {'A': 'Iron deficiency anemia', 'B': 'Pulmonary tuberculosis', 'C': 'Zinc deficiency', 'D': 'Vitamin B3 deficiency', 'E': 'Liver failure'}, | A: Iron deficiency anemia |
Answer the following medical question with one of the provided options: | Q:A 4-year-old girl is brought to the physician because of worsening jaundice that started 8 days ago. She has had similar episodes in the past. Her father underwent a splenectomy during adolescence. Physical examination shows mild splenomegaly. Laboratory studies show: Hemoglobin 10.1 g/dL WBC count 7200/mm3 Mean corpuscular volume 81 μm3 Mean corpuscular hemoglobin concentration 41% Hb/cell Platelet count 250,000/mm3 Red cell distribution width 16% (N=13%–15%) Reticulocytes 11% Erythrocyte sedimentation rate 10 mm/h Serum Na+ 139 mEq/L K+ 4.2 mEq/L Cl- 100 mEq/L Urea nitrogen 16 mg/dL A peripheral blood smear shows red blood cells that appear round, smaller, and without central pallor. Which of the following is the most sensitive test for confirming this patient's condition?"? {'A': 'Osmotic fragility test', 'B': 'Coombs test', 'C': 'Eosin-5-maleimide binding test', 'D': 'Hemoglobin electrophoresis', 'E': 'Serum ferritin level\n"'}, | C: Eosin-5-maleimide binding test |
Answer the following medical question with one of the provided options: | Q:A 72-year-old obese man presents as a new patient to his primary care physician because he has been feeling tired and short of breath after recently moving to Denver. He is a former 50 pack-year smoker and has previously had deep venous thrombosis. Furthermore, he previously had a lobe of the lung removed due to lung cancer. Finally, he has a family history of a progressive restrictive lung disease. Laboratory values are obtained as follows: Oxygen tension in inspired air = 130 mmHg Alveolar carbon dioxide tension = 48 mmHg Arterial oxygen tension = 58 mmHg Respiratory exchange ratio = 0.80 Respiratory rate = 20/min Tidal volume = 500 mL Which of the following mechanisms is consistent with these values?? {'A': 'High altitude', 'B': 'Hypoventilation', 'C': 'Pulmonary fibrosis', 'D': 'Shunt physiology', 'E': 'V/Q mismatch'}, | A: High altitude |
Answer the following medical question with one of the provided options: | Q:A 27-year old gentleman presents to the primary care physician with the chief complaint of "feeling down" for the last 6 weeks. He describes trouble falling asleep at night, decreased appetite, and recent feelings of intense guilt regarding the state of his personal relationships. He says that everything "feels slower" than it used to. He endorses having a similar four-week period of feeling this way last year. He denies thoughts of self-harm or harm of others. He also denies racing thoughts or delusions of grandeur. Which of the following would be an INAPPROPRIATE first line treatment for him?? {'A': 'Psychotherapy', 'B': 'Citalopram', 'C': 'Paroxetine', 'D': 'Electroconvulsive therapy', 'E': 'Sertraline'}, | D: Electroconvulsive therapy |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency department after being hit by a car while riding his bike. The patient was brought in with his airway intact, vitals stable, and with a C-collar on. Physical exam is notable for bruising over the patient’s head and a confused man with a Glasgow coma scale of 11. It is noticed that the patient has a very irregular pattern of breathing. Repeat vitals demonstrate his temperature is 97.5°F (36.4°C), blood pressure is 172/102 mmHg, pulse is 55/min, respirations are 22/min and irregular, and oxygen saturation is 94% on room air. Which of the following interventions are most likely to improve this patient's vital signs?? {'A': 'Head elevation, norepinephrine, mannitol, hyperventilation', 'B': 'Head elevation, sedation, hypertonic saline, hypoventilation', 'C': 'Head elevation, sedation, mannitol, hyperventilation', 'D': 'Lower head, sedation, hypertonic saline, hyperventilation', 'E': 'Lower head, sedation, hypertonic saline, hypoventilation'}, | C: Head elevation, sedation, mannitol, hyperventilation |
Answer the following medical question with one of the provided options: | Q:A 27-year-old G0P0 female presents to her OB/GYN for a preconception visit to seek advice before becoming pregnant. A detailed history reveals no prior medical or surgical history, and she appears to be in good health currently. Her vaccination history is up-to-date. She denies tobacco or recreational drug use and admits to drinking 2 glasses of wine per week. She states that she is looking to start trying to become pregnant within the next month, hopefully by the end of January. Which of the following is NOT recommended as a next step for this patient's preconception care?? {'A': 'Begin 400 mcg folic acid supplementation', 'B': 'Recommend inactivated influenza vaccination', 'C': 'Obtain rubella titer', 'D': 'Administer measles, mumps, rubella (MMR) vaccination', 'E': 'Obtain varicella zoster titer'}, | D: Administer measles, mumps, rubella (MMR) vaccination |
Answer the following medical question with one of the provided options: | Q:A 22-year-old female college student presents to the emergency department due to severe pain in her stomach after an evening of heavy drinking with her friends. The pain is located in the upper half of the abdomen, is severe in intensity, and has an acute onset. She claims to have consumed a dozen alcoholic drinks. Her past medical history is unremarkable. She has recently completed an extremely low-calorie diet which resulted in her losing 10 kg (22 lb) of body weight. Her pulse is 130/min, respirations are 26/min, and blood pressure is 130/86 mm Hg. Examination reveals a visibly distressed young female with periumbilical tenderness. Her BMI is 23 kg/m2. Laboratory tests show: Arterial blood gas analysis pH 7.54 Po2 100 mm Hg Pco2 23 mm Hg HCO3- 22 mEq/L Serum Sodium 140 mEq/L Potassium 3.9 mEq/L Chloride 100 mEq/L Which of the following most likely caused her elevated pH?? {'A': 'Alcohol induced respiratory depression', 'B': 'Anxiety induced hyperventilation', 'C': 'Pain induced hypoventilation', 'D': 'Renal failure induced electrolyte imbalance', 'E': 'Weight loss induced electrolyte imbalance'}, | B: Anxiety induced hyperventilation |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy presents with shortness of breath after prolonged exposure to cold air during a recent hike with his friends. Past medical history is significant for asthma, untreated because he doesn't like using medications. The patient says he is a non-smoker and occasionally drinks alcohol. On physical examination, his temperature is 37.0°C (98.6°F), pulse rate is 120/min, blood pressure is 114/76 mm Hg, and respiratory rate is 32/min. Auscultation of the chest reveals bilateral wheezing. Nebulized ipratropium bromide results in significant clinical improvement. Which of the following second messenger systems is affected by this drug?? {'A': 'Cyclic adenosine monophosphate (cAMP) system', 'B': 'Cyclic guanosine monophosphate (cGMP) system', 'C': 'Arachidonic acid system', 'D': 'Phosphoinositol system', 'E': 'Tyrosine kinase system'}, | D: Phosphoinositol system |
Answer the following medical question with one of the provided options: | Q:A multicentric, ambidirectional cohort study (i.e. a study that combines elements of both prospective and retrospective cohort studies) was designed in order to evaluate the relationship between nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) and exposure to patients in intensive-care units of several tertiary hospital centers. The sample included 1,000 physicians who worked in the hospital environment and who willingly underwent swabbing of their nasal vestibule and nasopharynx for active surveillance. Data of their working location was obtained from hospital administrative services. Of those who worked in the intensive care unit, 350 were colonized with MRSA, while 250 were not. Whereas in those that worked in other hospital wards, 100 were colonized with MRSA, and 300 were not. What is the relative risk of MRSA colonization in relation to working in the intensive-care unit?? {'A': '0.18', 'B': '0.43', 'C': '1.66', 'D': '2.33', 'E': '3.22'}, | D: 2.33 |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to the emergency department with abdominal distension. The patient states he has had gradually worsening abdominal distension with undulating pain, nausea, and vomiting for the past several months. The patient does not see a physician typically and has no known past medical history. He works as a farmer and interacts with livestock and also breeds dogs. His temperature is 98.7°F (37.1°C), blood pressure is 159/90 mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is notable for mild abdominal distension and discomfort to palpation of the upper abdominal quadrants. Laboratory values are ordered and are notable for a mild eosinophilia. A CT scan of the abdomen demonstrates multiple small eggshell calcifications within the right lobe of the liver. Which of the following is the most likely etiology of this patients symptoms?? {'A': 'Echinococcus granulosus', 'B': 'Enterobius vermicularis', 'C': 'Necator americanus', 'D': 'Taenia saginata', 'E': 'Taenia solium'}, | A: Echinococcus granulosus |
Answer the following medical question with one of the provided options: | Q:A 49-year-old man presents to his physician complaining of weakness and fatigue. On exam, you note significant peripheral edema. Transthoracic echocardiogram is performed and reveals a preserved ejection fraction with impaired diastolic relaxation. A representative still image is shown in Image A. Which of the following is likely the cause of this patient's symptoms?? {'A': 'Previous treatment with doxorubicin', 'B': 'Hemochromatosis', 'C': 'Heavy, long-term alcohol consumption', 'D': 'History of myocardial infarction', 'E': 'History of a recent viral infection'}, | B: Hemochromatosis |
Answer the following medical question with one of the provided options: | Q:A 65-year-old male prisoner goes on a hunger strike to protest the conditions of his detainment. After 5 days without food, he suffers a seizure for which he is taken into a medical facility. On physical examination, he looks pale and diaphoretic. His blood glucose level is 50 mg/dL. In order to keep a constant supply of energy to his brain, which of the following molecules is his liver releasing into the bloodstream?? {'A': 'ß-hydroxybutyric acid', 'B': 'Fatty acids', 'C': 'Glucose-1-phosphate', 'D': 'Glucose-6-phosphate', 'E': 'Glycogen'}, | A: ß-hydroxybutyric acid |
Answer the following medical question with one of the provided options: | Q:A 67-year-old patient comes to the physician because of a 4-month history of weight loss, chest pain, dry cough, and shortness of breath on exertion. He worked as a shipbuilder for 45 years and is now retired. Since the death of his wife 2 years ago, he has lived with his daughter. He has never smoked. His temperature is 38.1°C (100.6°F), pulse is 85/min, and blood pressure is 134/82 mm Hg. Fine, end-inspiratory rales are heard at the left lung base; breath sounds are absent at the right lung base. A CT scan of the chest shows pleural thickening and a right hemothorax. Thoracocentesis confirms the diagnosis of mesothelioma. The patient and his family are informed about the poor prognosis of this condition and that the mean survival time is 1 year. The patient states that he wishes to receive radiation. He would also like to receive home hospice care but is unsure whether his health insurance would cover the costs. The patient's son, who has been assigned power of attorney, does not agree with this decision. The patient does not have a living will but states that if his heart stops beating, he wants to receive cardiopulmonary resuscitation. Which of the following disqualifies the patient from receiving hospice care?? {'A': 'Lack of living will', 'B': 'Wish for cardiopulmonary resuscitation', 'C': 'Uncertain coverage by health insurance', 'D': "The son's objection", 'E': 'His life expectancy\n"'}, | E: His life expectancy " |
Answer the following medical question with one of the provided options: | Q:An 8-month-old boy is brought to his pediatrician by his parents with a 12-hour history of fever and coughing. He has also been experiencing intermittent diarrhea and skin abscesses since birth. Otherwise, he has been meeting developmental milestones as expected. Analysis of this patient's sputum reveals acute angle branching fungi, and culture shows gram-positive cocci in clusters. A flow cytometry reduction test was obtained that confirmed the diagnosis. Which of the following processes is most likely defective in this patient?? {'A': 'Actin polymerization', 'B': 'Leukocyte migration', 'C': 'Maturation of B-cells', 'D': 'Transforming oxygen into superoxide radicals', 'E': 'Transforming superoxide radicals into hydrogen peroxide'}, | D: Transforming oxygen into superoxide radicals |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man with a genetic disorder presents for genetic counseling because he is concerned about the risk that any children he has will have the same disease as himself. Specifically, since childhood he has had difficulty breathing requiring bronchodilators, inhaled corticosteroids, and chest physiotherapy. He has also had diarrhea and malabsorption requiring enzyme replacement therapy. If his wife comes from a population where 1 in 10,000 people are affected by this same disorder, which of the following best represents the likelihood a child would be affected as well?? {'A': '0.01%', 'B': '0.5%', 'C': '1%', 'D': '2%', 'E': '50%'}, | C: 1% |
Answer the following medical question with one of the provided options: | Q:A medical research study is evaluating an investigational novel drug (medication 1) as compared with standard therapy (medication 2) in patients presenting to the emergency department with myocardial infarction (MI). The study enrolled a total of 3,000 subjects, 1,500 in each study arm. Follow-up was conducted at 45 days post-MI. The following are the results of the trial: Endpoints Medication 1 Medication 2 P-Value Primary: death from cardiac causes 134 210 0.03 Secondary: hyperkalemia 57 70 0.4 What is the relative risk of death from a cardiac cause? (Round to the nearest whole number.)? {'A': '36%', 'B': '42%', 'C': '57%', 'D': '64%', 'E': '72%'}, | D: 64% |
Answer the following medical question with one of the provided options: | Q:A 36-year-old male with fluctuating levels of consciousness is brought to the emergency department by ambulance due to a fire in his home. He currently opens his eyes to voice, localizes painful stimuli, responds when asked questions, but is disoriented and cannot obey commands. The patient’s temperature is 99°F (37.2°C), blood pressure is 86/52 mmHg, pulse is 88/min, and respirations are 14/min with an oxygen saturation of 97% O2 on room air. Physical exam shows evidence of soot around the patient’s nose and mouth, but no burns, airway obstruction, nor accessory muscle use. A blood lactate is 14 mmol/L. The patient is started on intravenous fluids. What is the next best step in management?? {'A': 'Methylene blue', 'B': 'Hyperbaric oxygen', 'C': 'Intravenous epinephrine', 'D': 'Sodium thiosulfate and sodium nitrite', 'E': '100% oxygen, hydroxycobalamin, and sodium thiosulfate'}, | E: 100% oxygen, hydroxycobalamin, and sodium thiosulfate |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man presents to the emergency department because of pain in his left thigh and left calf for the past 3 months. The pain occurs at rest, increases with walking, and is mildly improved by hanging the foot off the bed. He has had hypertension for 25 years and type 2 diabetes mellitus for 30 years. He has smoked 30–40 cigarettes per day for the past 45 years. On examination, femoral, popliteal, and dorsalis pedis pulses are faint on both sides. The patient’s foot is shown in the image. Resting ankle-brachial index (ABI) is found to be 0.30. Antiplatelet therapy and aggressive risk factors modifications are initiated. Which of the following is the best next step for this patient?? {'A': 'Systemic anticoagulation with heparin', 'B': 'Cilostazol', 'C': 'Urgent assessment for revascularization', 'D': 'Exercise therapy', 'E': 'Amputation'}, | C: Urgent assessment for revascularization |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the emergency department because of difficulty breathing and sharp chest pain. The chest pain increases in intensity with lying down, and it radiates to the scapular ridge. Approximately 3 weeks ago, he had an anterior ST-elevation myocardial infarction, which was treated with intravenous alteplase. He was discharged home in a stable condition. Current vital signs include a temperature of 38.1 (100.5°F), blood pressure of 131/91 mm Hg, and pulse of 99/min. On examination, heart sounds are distant and a scratching sound is heard on the left sternal border. ECG reveals widespread concave ST elevations in the precordial leads and PR depressions in leads V2-V6. Which of the following is the most likely cause of this patient condition?? {'A': 'Myocarditis', 'B': 'Ventricular aneurysm', 'C': 'Recurrent infarction', 'D': 'Aortic dissection', 'E': 'Dressler’s syndrome'}, | E: Dressler’s syndrome |
Answer the following medical question with one of the provided options: | Q:A 2-year-old girl is brought to the emergency department after swallowing a button battery that was lying on the table 1 hour ago. She has no shortness of breath or chest discomfort. Her pulse is 112/min and respirations are 30/min. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. An x-ray of the chest shows the battery lodged in the esophagus at the level of T2. Which of the following is the most appropriate next step in management?? {'A': 'Administer syrup of ipecac', 'B': 'Removal of the battery with magnet and nasogastric tube', 'C': 'Reassurance and observation', 'D': 'Administer chelation therapy', 'E': 'Endoscopic removal of the battery'}, | E: Endoscopic removal of the battery |
Answer the following medical question with one of the provided options: | Q:A 4-week-old male presents with his parents to the pediatrician for a well-child visit. The patient’s mother reports that the patient was eating well until about one week ago, when he began vomiting after breastfeeding. His mother has tried increasing the frequency of feeds and decreasing the amount of each feed, but the vomiting seems to be getting worse. The patient now vomits after every feed. His mother states the vomitus looks like breastmilk. The patient’s mother is exclusively breastfeeding and would prefer not to switch to formula but worries that the patient is not getting the nutrition he needs. Two weeks ago, the patient was in the 75th percentile for weight and 70th for height. He is now in the 60th percentile for weight and 68th percentile for height. On physical exam, the patient has dry mucous membranes. His abdomen is soft and non-distended. Which of the following is the best next step in management?? {'A': 'Abdominal ultrasound', 'B': 'Abdominal radiograph', 'C': 'Supplement breastfeeding with formula', 'D': "Trial of cow's milk-free diet", 'E': 'Trial of empiric proton pump inhibitor'}, | A: Abdominal ultrasound |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man being treated for benign prostatic hyperplasia (BPH) is admitted to the emergency department for 1 week of dysuria, nocturia, urge incontinence, and difficulty initiating micturition. His medical history is relevant for hypertension, active tobacco use, chronic obstructive pulmonary disease, and BPH with multiple urinary tract infections. Upon admission, he is found with a heart rate of 130/min, respiratory rate of 19/min, body temperature of 39.0°C (102.2°F), and blood pressure of 80/50 mm Hg. Additional findings during the physical examination include decreased breath sounds, wheezes, crackles at the lung bases, and intense right flank pain. A complete blood count shows leukocytosis and neutrophilia with a left shift. A sample for arterial blood gas analysis (ABG) was taken, which is shown below. Laboratory test Serum Na+ 140 mEq/L Serum Cl- 102 mEq/L Serum K+ 4.8 mEq/L Serum creatinine (SCr) 2.3 mg/dL Arterial blood gas pH 7.12 Po2 82 mm Hg Pco2 60 mm Hg SO2% 92% HCO3- 12.0 mEq/L Which of the following best explains the patient’s condition?? {'A': 'Metabolic acidosis complicated by respiratory acidosis', 'B': 'Metabolic acidosis complicated by respiratory alkalosis', 'C': 'Respiratory alkalosis complicated by metabolic acidosis', 'D': 'Respiratory acidosis complicated by metabolic alkalosis', 'E': 'Non-anion gap metabolic acidosis'}, | A: Metabolic acidosis complicated by respiratory acidosis |
Answer the following medical question with one of the provided options: | Q:A 22-year-old male varsity athlete visits the on-campus health services for shortness of breath, fatigue, and lower limb edema with onset 1 week after mild upper respiratory tract infection. Upon physical examination, his blood pressure is 100/68 mm Hg, heart rate is 120/min, respiratory rate is 23/min, and temperature is 36.4°C (97.5°F). He is referred to the nearest hospital, where his systolic pressure drops below 90 mm Hg with an S3 gallop, and he needs inotropic support in the critical care unit. A chest radiograph shows an enlarged heart, clear lungs, and effacement of the right costodiaphragmatic angle. A subsequent esophageal echocardiogram reveals severe dilation of all heart cavities, an ejection fraction of 23%, and mitral regurgitation. His family and personal history are unremarkable; therefore, an endomyocardial biopsy (EMB) is ordered. Which of the following microscopic findings would you expect in this specimen?? {'A': 'Infiltration with lymphocytes', 'B': 'Infiltration with eosinophils', 'C': 'Infiltration with giant cells', 'D': 'Infiltration with neutrophils', 'E': 'Infiltration with granulomas'}, | A: Infiltration with lymphocytes |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the outpatient clinic today. He has New York Heart Association class III heart failure. His current medications include captopril 20 mg, furosemide 40 mg, potassium chloride 10 mg twice daily, rosuvastatin 20 mg, and aspirin 81 mg. He reports that he generally feels well and has not had any recent worsening of his symptoms. His blood pressure is 132/85 mm Hg and heart rate is 84/min. Physical examination is unremarkable except for trace pitting edema of the bilateral lower extremities. What other medication should be added to his heart failure regimen?? {'A': 'Losartan', 'B': 'Metoprolol tartrate', 'C': 'Metoprolol succinate ', 'D': 'Isosorbide dinitrate/hydralazine ', 'E': 'Digoxin '}, | C: Metoprolol succinate |
Answer the following medical question with one of the provided options: | Q:A 40-year-old, gravida 2, nulliparous woman, at 14 weeks' gestation comes to the physician because of a 6-hour history of light vaginal bleeding and lower abdominal discomfort. Eight months ago she had a spontaneous abortion at 10 weeks' gestation. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Abdominal examination shows no tenderness or masses; bowel sounds are normal. On pelvic examination, there is old blood in the vaginal vault and at the closed cervical os. The uterus is larger than expected for the length of gestation and there are bilateral adnexal masses. Serum β-hCG concentration is 120,000 mIU/ml. Which of the following is the most appropriate next step in management?? {'A': 'Transvaginal ultrasound', 'B': 'Chorionic villus sampling', 'C': 'Thyroid function tests', 'D': 'Fetal blood sampling', 'E': 'Fetal Doppler ultrasound'}, | A: Transvaginal ultrasound |
Answer the following medical question with one of the provided options: | Q:A 34-year-old business executive presents to her primary care provider because of difficulty falling asleep on her trips. She makes 4–5 business trips from California to China every month. Her typical direct Los Angeles to Hong Kong flight leaves Los Angeles at 12:30 a.m. and reaches Hong Kong at 7:00 p.m. (local time) the next day. She complains of difficulty falling asleep at night and feeling sleepy the next morning. On arriving back in Los Angeles 2–3 days later, she feels extremely weak, has muscle soreness, and abdominal distension, all of which self-resolve in a few days. She is otherwise healthy and does not take any medications. Physical examination is unremarkable. After discussing general sleep hygiene recommendations, which of the following is the best next step for this patient’s condition?? {'A': 'Polysomnography', 'B': 'Escitalopram', 'C': 'Temazepam', 'D': 'Zolpidem', 'E': 'Melatonin'}, | E: Melatonin |
Answer the following medical question with one of the provided options: | Q:A 5-week-old infant boy presents to the pediatrician with intermittent vomiting for the last 2 weeks. The mother reports that the vomiting is non-bilious and immediately follows feeding. After vomiting, the baby is hungry and wants to feed again. The frequency of vomiting has been increasing progressively over 2 weeks. The vital signs are within normal limits. The examination of the abdomen reveals the presence of a firm mass of approx. 2 cm in length, above and to the right of the umbilicus. The mass is movable, olive-shaped, and hard on palpation. Which of the following is the most likely surgical treatment for this infant’s condition?? {'A': 'Surgical ligation of the fistula and primary end-to-end anastomosis of the esophagus', 'B': 'Pyloromyotomy', 'C': 'Duodenoduodenostomy', 'D': 'Diverticulectomy', 'E': 'Endorectal pull-through procedure'}, | B: Pyloromyotomy |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman with bipolar disorder visits her gynecologist because she believes she is pregnant. A urine pregnancy test is performed which confirms she is pregnant. She has mild bipolar disorder for which she takes lithium and admits that she has been taking it ‘on and off’ for 2 years now but has never had any symptoms or episodes of relapse. She says that she had not made contact with her psychiatrist for the past several months because she ‘couldn’t find any time.’ Which of the following is the next best step in the management of this patient?? {'A': 'Continue lithium administration through pregnancy', 'B': 'Taper lithium and administer valproate', 'C': 'Continue lithium administration through pregnancy and add lamotrigine', 'D': 'Taper lithium and administer carbamazepine', 'E': 'Taper lithium and provide a prescription for clonazepam as needed'}, | E: Taper lithium and provide a prescription for clonazepam as needed |
Answer the following medical question with one of the provided options: | Q:A 4-year-old male is brought by his mother to the emergency room with dyspnea and fever. His mother reports a two-day history of progressive shortness of breath, malaise, and a fever with a maximum temperature of 101.6°F (38.7°C). The child has visited the emergency room three times over the past two years for pneumonia and otitis media. His family history is notable for sarcoidosis in his mother, diabetes in his father, and an early childhood death in his maternal uncle. His temperature is 101.2°F (38.4°C), blood pressure is 110/90 mmHg, pulse is 110/min, and respirations are 24/min. Physical examination reveals scant lymphoid tissue. A serological analysis reveals decreased levels of IgA, IgG, and IgM. This patient most likely has a defect in a protein that is active in which of the following cellular stages?? {'A': 'Pro-B-cell', 'B': 'Pre-B-cell', 'C': 'Immature B-cell', 'D': 'Mature B-cell', 'E': 'Plasma cell'}, | B: Pre-B-cell |
Answer the following medical question with one of the provided options: | Q:A 4-month-old boy is brought to the physician for a well-child examination. He was born at 36 weeks' gestation. The mother has had no prenatal care. His 6-year-old sister has a history of osteosarcoma. He is exclusively breast fed. He is at the 60th percentile for height and weight. Vital signs are within normal limits. Examination shows inward deviation of the right eye. Indirect ophthalmoscopy shows a white reflex in the right eye and a red reflex in the left eye. Which of the following is the most appropriate next step in management?? {'A': 'Screen for galactosemia', 'B': 'Visual training exercises', 'C': 'CT scan of the eye', 'D': 'Fundus examination', 'E': 'Serum rubella titers'}, | D: Fundus examination |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman with a history of Crohn’s disease presents with a 3-week history of weight gain. The patient also presents with a 1-month history of abdominal pain, cramping, and bloody diarrhea consistent with worsening of her inflammatory bowel disease. Past medical history is significant for Crohn’s disease diagnosed 2 years ago for which she currently takes an oral medication daily and intermittently receives intravenous medication she cannot recall the name of. Her temperature is 37.0°C (98.6°F), blood pressure is 120/90 mm Hg, pulse is 68/min, respiratory rate is 14/min, and oxygen saturation is 99% on room air. Physical examination reveals significant truncal weight gain. The patient has excessive facial hair in addition to purplish striae on her abdomen. Which of the following laboratory findings would most likely be found in this patient?? {'A': 'Hyperkalemia', 'B': 'Normal random blood glucose levels', 'C': 'Metabolic acidosis', 'D': 'Hypoglycemia', 'E': 'Hypokalemia'}, | E: Hypokalemia |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man comes to the physician because of a 2-week history of cough and decreased urination. The cough was initially nonproductive, but in the last few days he has coughed up small amounts of blood-tinged sputum with clots. He has not had any fevers, chills, or weight loss. He has smoked one pack of cigarettes daily for 5 years. Pulse is 115/min and blood pressure is 125/66 mm Hg. Physical examination shows dried blood around the lips. Serum studies show a creatinine of 2.9 mg/dL. Results of a serum antineutrophil cytoplasm antibody test are negative. A biopsy specimen of the kidney is most likely to show which of the following light microscopy findings?? {'A': 'Neutrophilic infiltration of the capillaries', 'B': 'Expansion of the mesangial matrix', 'C': 'Thinning of the basement membrane', 'D': 'Fibrin crescents in Bowman space', 'E': 'Enlarged and hypercellular glomeruli'}, | D: Fibrin crescents in Bowman space |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man is brought to the emergency department after a motorcycle accident 30 minutes ago. He was found at the scene of the accident with a major injury to the anterior chest by a metallic object that was not removed during transport to the hospital. The medical history could not be obtained. His blood pressure is 80/50 mm Hg, pulse is 130/min, and respiratory rate is 40/min. Evaluation upon arrival to the emergency department reveals a sharp metal object penetrating through the anterior chest to the right of the sternum at the 4th intercostal space. The patient is taken to the operating room immediately, where it is shown the heart has sustained a major injury. Which of the following arteries supplies the part of the heart most likely injured in this patient?? {'A': 'Right marginal artery', 'B': 'Left circumflex coronary artery', 'C': 'Left anterior descending artery', 'D': 'Posterior descending artery', 'E': 'Left coronary artery'}, | A: Right marginal artery |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician because of a 2 month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory or visual hallucinations. Vital signs are normal. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and flat affect with slowed thinking and speech. The physician prescribes sertraline. Three weeks later, the patient comes to the physician again with only minor improvements in his symptoms. Which of the following is the most appropriate next step in management?? {'A': 'Provide electroconvulsive therapy', 'B': 'Change medication to duloxetine', 'C': 'Augment with phenelzine and continue sertraline', 'D': 'Augment with aripiprazole and continue sertraline', 'E': 'Continue sertraline for 3 more weeks\n"'}, | E: Continue sertraline for 3 more weeks " |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man presents with severe chest pain for a week. His pain increases with breathing and is localized to the right. He has tried over-the-counter medications at home, but they did not help. The patient has a 20-pack-year smoking history and currently smokes 2 pack of cigarettes daily, and he drinks 3 to 4 cans of beer daily before dinner. His temperature is 39.1°C (102.3°F), blood pressure is 127/85 mm Hg, pulse is 109/min, and respirations are 20/min. Respiratory examination shows dullness to percussion from the 7th rib inferiorly at the right midaxillary line, decreased vocal tactile fremitus, and diminished breath sounds in the same area. Chest radiograph is shown in the image. The patient is prepared for thoracocentesis. Which of the following locations would be the most appropriate for insertion of a chest tube?? {'A': 'Above the superior border of the 7th rib in the midclavicular line', 'B': 'Above the superior border of the 5th rib in the midclavicular line', 'C': 'Below the inferior border of the 5th rib in the midaxillary line', 'D': 'Above the superior border of the 8th rib in the midaxillary line', 'E': 'Below the inferior border of the 7th rib in the midaxillary line'}, | D: Above the superior border of the 8th rib in the midaxillary line |
Answer the following medical question with one of the provided options: | Q:A previously healthy 13-year-old girl is brought to the physician by her mother because of a change in behavior. The mother reports that over the past 6 months, her daughter has had frequent mood swings. Sometimes, she is irritable for several days and loses her temper easily. In between these episodes, she behaves “normal,” spends time with her friends, and participates in gymnastics training twice a week. The mother has also noticed that her daughter needs more time than usual to get ready for school. Sometimes, she puts on excessive make-up. One month ago, her teacher had informed the parents that their daughter had skipped school and was seen at the local mall with one of her classmates instead. The patient reports that she often feels tired, especially when she has to wake up early for school. On the weekends, she sleeps until 1 pm. Menses have occurred at 15- to 45-day intervals since menarche at the age of 12 years; they are not associated with abdominal discomfort or functional impairment. Physical examination shows no abnormalities. Which of the following is the most likely explanation for the patient's behavior?? {'A': 'Borderline personality disorder', 'B': 'Normal behavior', 'C': 'Major depressive disorder', 'D': 'Premenstrual syndrome', 'E': 'Bipolar disorder'}, | B: Normal behavior |
Answer the following medical question with one of the provided options: | Q:A 44-year-old woman with recurrent urinary tract infections is brought to the emergency department by ambulance after sudden onset of severe headache 30 minutes ago. She has a history of occasional, mild headaches in the morning. There is no other history of serious illness. Both her father and her paternal grandmother died of chronic kidney disease. Her temperature is 37.2°C (99.1°F) and blood pressure is 145/90 mm Hg. Physical examination shows neck stiffness. When her hip is flexed, she is unable to fully extend her knee because of pain. Lumbar puncture performed 12 hours after headache onset yields 10 mL of yellow-colored fluid with no leukocytes. Which of the following is the most likely predisposing factor for this patient's current condition?? {'A': 'Arterial atherosclerosis', 'B': 'Bacterial infection', 'C': 'Hypercoagulable state', 'D': 'Cerebral atrophy', 'E': 'Saccular aneurysm\n"'}, | E: Saccular aneurysm " |
Answer the following medical question with one of the provided options: | Q:A 56-year-old man presents to the family medicine office since he has been having difficulty keeping his blood pressure under control for the past month. He has a significant medical history of hypertension, coronary artery disease, and diabetes mellitus. He has a prescription for losartan, atenolol, and metformin. The blood pressure is 178/100 mm Hg, the heart rate is 92/min, and the respiratory rate is 16/min. The physical examination is positive for a grade II holosystolic murmur at the left sternal border. He also has diminished sensation in his toes. Which of the following statements is the most effective means of communication between the doctor and the patient?? {'A': '“Have you been taking your medications as prescribed?”', 'B': '“Why are you not taking your medication?”', 'C': '“What is causing your blood pressure to be elevated?”', 'D': '“You are taking your medications as prescribed, aren’t you?”', 'E': '“Would you like us to consider trying a different medication for your blood pressure?”'}, | C: “What is causing your blood pressure to be elevated?” |
Answer the following medical question with one of the provided options: | Q:Twenty minutes after delivery by lower segment cesarean section at 38 weeks' gestation, a 4630-g (10-lb 3-oz) male newborn has respiratory distress. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Pregnancy was complicated by gestational diabetes mellitus. His temperature is 36.9°C (98.4°F), pulse is 155/min and respirations are 72/min. Pulse oximetry on room air shows an oxygen saturation of 88%. Grunting and moderate intercostal and subcostal retractions are present. Diffuse crackles are heard on auscultation of the chest. An x-ray of the chest shows increased lung volume and fluid within the interlobar fissures. Which of the following is the most appropriate next step in management?? {'A': 'Supportive care', 'B': 'Broad-spectrum antibiotic therapy', 'C': 'Continuous positive airway pressure', 'D': 'Surfactant therapy', 'E': 'Nitric oxide therapy'}, | A: Supportive care |
Answer the following medical question with one of the provided options: | Q:A 27-year-old gravida 2, para 1 presents to her physician at 21 weeks gestation with decreased sensitivity, tingling, and pain in her right hand that is worse at night and is partially relieved by shaking her hand. She developed these symptoms gradually over the past month. She does not report any trauma to her extremities, neck, or spine. The physical examination shows a normal range of motion of the neck, spine, and extremities. On neurologic examination, the patient has 2+ biceps and triceps reflexes. She has decreased pressure and temperature sensitivity over the palmar surface of the 1st, 2nd, and 3rd fingers. Wrist flexion and tapping the skin over the flexor retinaculum trigger exacerbation of the symptoms. Which of the following statements about the patient’s condition is correct?? {'A': 'This is a fairly uncommon condition in pregnant women.', 'B': 'Pre-pregnancy obesity increases risk of developing this condition during pregnancy.', 'C': 'Corticosteroid injections are contraindicated in pregnant women for management of this condition.', 'D': 'If this condition has occurred in the second or third trimester of pregnancy, it is unlikely to resolve after the completion of pregnancy.', 'E': 'Immobilization (for example, splinting) should improve the reported outcome in this patient.'}, | E: Immobilization (for example, splinting) should improve the reported outcome in this patient. |
Answer the following medical question with one of the provided options: | Q:A 15-year-old female is brought to the emergency room with high fever and confusion. She complains of chills and myalgias, and physical examination reveals a petechial rash. Petechial biopsy reveals a Gram-negative diplococcus. The patient is at greatest risk for which of the following?? {'A': 'Bilateral adrenal destruction', 'B': 'Pelvic inflammatory disease', 'C': 'Septic arthritis', 'D': 'Osteomyelitis', 'E': 'Acute endocarditis'}, | A: Bilateral adrenal destruction |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man with a history of diabetes, hypertension, hyperlipidemia, and obesity is transferred from the cardiac catheterization lab to the cardiac critical care unit after sustaining a massive myocardial infarction. He received a bare metal stent and has now stabilized. However, shortly after being transferred, he reports palpitations. EKG reveals ventricular tachycardia. Your attending wishes to start an anti-arrhythmic drug with a high selectivity for ischemic cardiac myocytes. You call the nurse and ask her to begin intravenous:? {'A': 'Quinidine', 'B': 'Lidocaine', 'C': 'Dofetilide', 'D': 'Procainamide', 'E': 'Flecainide'}, | B: Lidocaine |
Answer the following medical question with one of the provided options: | Q:A 13-year-old girl is brought to the physician by her father because of a worsening pruritic rash for 2 days. Five weeks ago, she was diagnosed with juvenile myoclonic epilepsy and treatment with lamotrigine was begun. Her immunizations are up-to-date. Her temperature is 38.8°C (101.8°F). Physical examination shows facial edema and a partially confluent morbilliform rash over the face, trunk, and extremities. There is swelling of the cervical and inguinal lymph nodes and hepatomegaly. Further evaluation is most likely to show which of the following?? {'A': 'Fragmented red blood cells', 'B': 'Increased absolute eosinophil count', 'C': 'Positive heterophile antibody test', 'D': 'Anti-measles IgM antibodies', 'E': 'Elevated antistreptolysin-O titer'}, | B: Increased absolute eosinophil count |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to his physician for behavioral problems in school. The patient’s parents have noted that he often will “shake his hands” abnormally at times and does so on his own without provocation. This has persisted for the past year. Additionally, the child has made loud grunting sounds in school that disturb the other students and the teacher. The patient has a past medical history of asthma and atopic dermatitis, and his current medications include ibuprofen, albuterol, and topical corticosteroids during flares. On physical exam, you note an active young child who is playing with toys in the office. You observe the grunting sounds he makes at this office visit. The child seems mistrustful, does not reply to your questions, and does not look you in the eyes. Which of the following is most likely also found in this patient?? {'A': 'Auditory hallucinations', 'B': 'Cough that occurs only at night', 'C': 'Excessive hand washing', 'D': 'Mental retardation', 'E': 'Poor communication skills'}, | C: Excessive hand washing |
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