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Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency department after a dog bite. The patient was intoxicated and pulled the dog’s tail while it was eating. The dog belongs to his friend and is back at his friend’s house currently. Physical exam is notable for a dog bite on the patient’s right arm. The wound is irrigated and explored with no retained bodies found. A tetanus vaccination is administered. Which of the following is appropriate management of this patient?? {'A': 'Administer amoxicillin-clavulanic acid', 'B': 'Administer the rabies vaccine and rabies immunoglobulin', 'C': 'Administer trimethoprim-sulfamethoxazole', 'D': 'Close the wound with sutures and discharge the patient', 'E': 'Discharge the patient with outpatient follow up'}, | A: Administer amoxicillin-clavulanic acid |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman, accompanied by her parents, presents after a one-week history of abnormal behavior, delusions, and unusual aggression. She denies fever, seizures or illicit drug use. Family history is negative for psychiatric illnesses. She was started on risperidone and sent home with her parents. Three days later, she is brought to the emergency department with fever and confusion. She is not verbally responsive. At the hospital, her temperature is 39.8°C (103.6°F), the blood pressure is 100/60 mm Hg, the pulse rate is 102/min, and the respiratory rate is 16/min. She is extremely diaphoretic and appears stiff. She has spontaneous eye-opening but she is not verbally responsive and she is not following commands. Laboratory studies show: Sodium 142 mmol/L Potassium 5.0 mmol/L Creatinine 1.8 mg/dl Calcium 10.4 mg/dl Creatine kinase 9800 U/L White blood cells 14,500/mm3 Hemoglobin 12.9 g/dl Platelets 175,000/mm3 Urinalysis shows protein 1+, hemoglobin 3+ with occasional leukocytes and no red blood casts. What is the best first step in the management of this condition?? {'A': 'Dantrolene', 'B': 'Intravenous hydration', 'C': 'Paracetamol', 'D': 'Stop risperidone', 'E': 'Switch risperidone to clozapine'}, | D: Stop risperidone |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman comes to the physician because of a 1-month history of double vision, difficulty climbing stairs, and weakness when trying to brush her hair. She reports that these symptoms are worse after she exercises and disappear after she rests for a few hours. Physical examination shows drooping of her right upper eyelid that worsens when the patient is asked to gaze at the ceiling for 2 minutes. There is diminished motor strength in the upper extremities. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Myasthenia gravis', 'B': 'Polymyositis', 'C': 'Amyotrophic lateral sclerosis', 'D': 'Guillain-Barré syndrome', 'E': 'Multiple sclerosis'}, | A: Myasthenia gravis |
Answer the following medical question with one of the provided options: | Q:A 6-year-old male who recently immigrated to the United States from Asia is admitted to the hospital with dyspnea. Physical exam reveals a gray pseudomembrane in the patient's oropharynx along with lymphadenopathy. The patient develops myocarditis and expires on hospital day 5. Which of the following would have prevented this patient's presentation and decline?? {'A': 'Increased CD4+ T cell count', 'B': 'Secretory IgA against viral proteins', 'C': 'Increased IgM preventing bacterial invasion', 'D': 'Circulating IgG against AB exotoxin', 'E': 'Improved IgE release from mast cells'}, | D: Circulating IgG against AB exotoxin |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy who recently emigrated from Pakistan presents with fever, muscle pain, and weakness of the trunk, abdomen, and legs. The patient’s mother says that he has not been vaccinated. Physical examination reveals fasciculation and flaccid paralysis of the lower limbs. A CSF analysis reveals lymphocytosis with normal glucose and protein levels. A throat swab reveals an RNA virus. Which of the following would most likely be destroyed by the virus in this patient?? {'A': 'Basal ganglia', 'B': 'Posterior horn cells of the spinal cord', 'C': 'Myelin sheath of neurons', 'D': 'Muscle cells', 'E': 'Anterior horn of the spinal cord'}, | E: Anterior horn of the spinal cord |
Answer the following medical question with one of the provided options: | Q:A researcher is studying the properties of an enzyme that adds phosphate groups to glucose. She discovers that the enzyme is present in most body tissues and is located in the cytoplasm of the cells expressing the enzyme. She decides to mix this enzyme under subphysiologic conditions with varying levels of glucose in order to determine the kinetic properties of the enzyme. Specifically, she adds increasing levels of glucose at a saturating concentration of phosphate and sees that the rate at which glucose becomes phosphorylated gets faster at higher levels of glucose. She observes that this rate approaches a maximum speed and calls this speed Y. She then determines the concentration of glucose that is needed to make the enzyme function at half the speed Y and calls this concentration X. Which of the following is most likely true about the properties of this enzyme?? {'A': 'High X and high Y', 'B': 'High X and low Y', 'C': 'Low X and high Y', 'D': 'Low X and infinite Y', 'E': 'Low X and low Y'}, | E: Low X and low Y |
Answer the following medical question with one of the provided options: | Q:A 31-year-old G2P2 female at 40 weeks gestation presents to the hospital following a rush of water that came from her vagina. She is 4 cm dilated and 80% effaced. Fetal heart tracing shows a pulse of 155/min with variable decelerations. About 12 hours after presentation, she gives birth to a 6 lb 15 oz baby boy with APGAR scores of 8 and 9 at 1 and 5 minutes, respectively. Which of the following structures is responsible for inhibition of female internal genitalia?? {'A': 'Spermatogonia', 'B': 'Allantois', 'C': 'Syncytiotrophoblast', 'D': 'Sertoli cells', 'E': 'Leydig cells'}, | D: Sertoli cells |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman presents to the emergency department complaining of palpitations, dry cough, and shortness of breath for 1 week. She immigrated to the United States from Korea at the age of 20. She says that her heart is racing and she has never felt these symptoms before. Her cough is dry and is associated with shortness of breath that occurs with minimal exertion. Her past medical history is otherwise unremarkable. She has no allergies and is not currently taking any medications. She is a nonsmoker and an occasional drinker. She denies illicit drug use. Her blood pressure is 100/65 mm Hg, pulse is 76/min, respiratory rate is 23/min, and temperature is 36.8°C (98.2°F). Her physical examination is significant for bibasilar lung crackles and a non-radiating, low-pitched, mid-diastolic rumbling murmur best heard at the apical region. In addition, she has jugular vein distention and bilateral pitting edema in her lower extremities. Which of the following best describes the infectious agent that led to this patient’s condition?? {'A': 'A bacterium that induces partial lysis of red cells with hydrogen peroxide', 'B': 'A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin', 'C': 'A bacterium that induces heme degradation of the red cells of a blood agar plate', 'D': 'A bacterium that does not lyse red cells', 'E': 'A bacterium that requires an anaerobic environment to grow properly'}, | B: A bacterium that induces complete lysis of the red cells of a blood agar plate with an oxygen-sensitive cytotoxin |
Answer the following medical question with one of the provided options: | Q:A male neonate is being examined by a pediatrician. His mother informs the doctor that she had a mild fever with rash, muscle pain, and swollen and tender lymph nodes during the second month of gestation. The boy was born at 39 weeks gestation via spontaneous vaginal delivery with no prenatal care. On physical examination, the neonate has normal vital signs. Retinal examination reveals the findings shown in the image. Which of the following congenital heart defects is most likely to be present in this neonate?? {'A': 'Atrial septal defect', 'B': 'Ventricular septal defect', 'C': 'Tetralogy of Fallot', 'D': 'Patent ductus arteriosus', 'E': 'Double outlet right ventricle'}, | D: Patent ductus arteriosus |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the emergency department by his parents. He is lethargic and confused and has a severe headache, vomiting, and a high-grade fever since earlier that day. His mother reports that the child was doing well until 2 days ago when he developed a fever and green nasal discharge. The patient has a history of neonatal sepsis, meningococcemia at 18 months of age, and pneumococcal pneumonia at 2 and 3 years of age. His scheduled vaccinations are up to date. His blood pressure is 70/50 mm Hg, heart rate is 120/min, respiratory rate is 22/min, and temperature is 39.3°C (102.4°F). On examination, the child is lethargic and his skin is pale, with several petechiae over his buttocks. There is a purulent nasal discharge from both nostrils. The lungs are clear to auscultation bilaterally. Heart sounds are normal. There is marked neck rigidity. Cerebrospinal fluid analysis shows the following results: Opening pressure 100 mm H2O Appearance cloudy Protein 500 mg/dL (5 g/L) White blood cells 2500/μL (polymorphonuclear predominance) Protein 450 mg/dL (4.5 g/L) Glucose 31 mg/dL (1.7 mmol/L) Culture positive for N. meningitidis Which of the following immunological processes is most likely to be impaired in this child?? {'A': 'Production of IL-2 by Th1 cells', 'B': 'Activation of TCRs by MHC-II', 'C': 'Formation of C5-9 complex', 'D': 'Cleavage of C2 component of complement into C2a and C2b', 'E': 'Oxidative burst in macrophages'}, | C: Formation of C5-9 complex |
Answer the following medical question with one of the provided options: | Q:A 66-year-old woman with chronic obstructive pulmonary disease is brought to the emergency department because of fever, body aches, malaise, and a dry cough. She has smoked one pack of cigarettes daily for 30 years but quit smoking 1 year ago. She lives with her daughter and her granddaughter, who attends daycare. Her temperature is 38.1°C (101°F). Physical examination shows bilateral conjunctivitis, rhinorrhea, and erythematous tonsils without exudates. Further testing confirms infection with an enveloped orthomyxovirus. Administration of a drug with which of the following mechanisms of action is most appropriate?? {'A': 'Inhibition of nucleoside reverse transcriptase', 'B': 'Inhibition of DNA polymerase', 'C': 'Inhibition of proton translocation', 'D': 'Inhibition of neuraminidase', 'E': 'Inhibition of protease'}, | D: Inhibition of neuraminidase |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman undergoes hemithyroidectomy for treatment of localized, well-differentiated papillary thyroid carcinoma. The lesion is removed with clear margins. However, during the surgery, a structure lying directly adjacent to the superior thyroid artery at the upper pole of the thyroid lobe is damaged. This patient is most likely to experience which of the following symptoms?? {'A': 'Voice pitch limitation', 'B': 'Ineffective cough', 'C': 'Weakness of shoulder shrug', 'D': 'Difficulty swallowing', 'E': 'Shortness of breath'}, | A: Voice pitch limitation |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency room with persistent fever, nausea, and vomiting for the past 3 days. While waiting to be seen, he quickly becomes disoriented and agitated. Upon examination, he has visible signs of difficulty breathing with copious oral secretions and generalized muscle twitching. The patient’s temperature is 104°F (40°C), blood pressure is 90/64 mmHg, pulse is 88/min, and respirations are 18/min with an oxygen saturation of 90% on room air. When the nurse tries to place a nasal cannula, the patient becomes fearful and combative. The patient is sedated and placed on mechanical ventilation. Which of the following is a risk factor for the patient’s most likely diagnosis?? {'A': 'Contaminated beef', 'B': 'Epiglottic cyst', 'C': 'Influenza vaccination', 'D': 'Mosquito bite', 'E': 'Spelunking'}, | E: Spelunking |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Arteriography', 'B': 'CT angiogram', 'C': 'Intubation', 'D': 'Observation and blood pressure monitoring', 'E': 'Surgical exploration'}, | B: CT angiogram |
Answer the following medical question with one of the provided options: | Q:A 13-year-old girl presents to a medical office for the evaluation of a lump on the front of her neck. The patient denies pain, but states that the mass bothers her because “it moves when I swallow”. The physical examination reveals a midline neck mass that is above the hyoid bone but below the level of the mandible. The mass is minimally mobile and feels fluctuant without erythema. The patient is afebrile and all vital signs are stable. A complete blood count and thyroid function tests are performed and are within normal limits. What is the most likely cause of this patient’s presentation?? {'A': 'Persistent thyroid tissue at the tongue base', 'B': 'Deletion of the 22q11 gene', 'C': 'Thyroid hyperplasia due to iodine deficiency', 'D': 'Cyst formation in a persistent thyroglossal duct', 'E': 'Lymph node enlargement'}, | D: Cyst formation in a persistent thyroglossal duct |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman with a history of Crohn disease presents for a follow-up appointment. She says that lately, she has started to notice difficulty walking. She says that some of her friends have joked that she appears to be walking as if she was drunk. Past medical history is significant for Crohn disease diagnosed 2 years ago, managed with natalizumab for the past year because her intestinal symptoms have become severe and unresponsive to other therapies. On physical examination, there is gait and limb ataxia present. Strength is 4/5 in the right upper limb. A T1/T2 MRI of the brain is ordered and is shown. Which of the following is the most likely diagnosis?? {'A': 'Sporadic Creutzfeldt-Jakob disease (sCJD)', 'B': 'Variant Creutzfeldt-Jakob disease (vCJD)', 'C': 'Subacute sclerosing panencephalitis (SSPE)', 'D': 'Progressive multifocal encephalopathy (PML)', 'E': 'West Nile encephalitis'}, | D: Progressive multifocal encephalopathy (PML) |
Answer the following medical question with one of the provided options: | Q:A 23-year-old G1 at 10 weeks gestation based on her last menstrual period is brought to the emergency department by her husband due to sudden vaginal bleeding. She says that she has mild lower abdominal cramps and is feeling dizzy and weak. Her blood pressure is 100/60 mm Hg, the pulse is 100/min, and the respiration rate is 15/min. She says that she has had light spotting over the last 3 days, but today the bleeding increased markedly and she also noticed the passage of clots. She says that she has changed three pads since the morning. She has also noticed that the nausea she was experiencing over the past few days has subsided. The physician examines her and notes that the cervical os is open and blood is pooling in the vagina. Products of conception can be visualized in the os. The patient is prepared for a suction curettage. Which of the following is the most likely cause for the pregnancy loss?? {'A': 'Sexually transmitted disease (STD)', 'B': 'Rh immunization', 'C': 'Antiphospholipid syndrome', 'D': 'Chromosomal abnormalities', 'E': 'Trauma'}, | D: Chromosomal abnormalities |
Answer the following medical question with one of the provided options: | Q:An 8-month-old boy is brought to a medical office by his mother. The mother states that the boy has been very fussy and has not been feeding recently. The mother thinks the baby has been gaining weight despite not feeding well. The boy was delivered vaginally at 39 weeks gestation without complications. On physical examination, the boy is noted to be crying in his mother’s arms. There is no evidence of cyanosis, and the cardiac examination is within normal limits. The crying intensifies when the abdomen is palpated. The abdomen is distended with tympany in the left lower quadrant. You suspect a condition caused by the failure of specialized cells to migrate. What is the most likely diagnosis?? {'A': 'Meckel diverticulum', 'B': 'DiGeorge syndrome', 'C': 'Pyloric stenosis', 'D': 'Duodenal atresia', 'E': 'Hirschsprung disease'}, | E: Hirschsprung disease |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man seeks evaluation at a medical office due to leg pain while walking. He says the pain starts in his buttocks and extends to his thighs and down to his calves. Previously, the pain resolved with rest, but the pain now persists in his feet, even during rest. His past medical history is significant for diabetes mellitus, hypertension, and cigarette smoking. The vital signs are within normal limits. The physical examination shows an atrophied leg with bilateral loss of hair. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Decreased permeability of endothelium', 'B': 'Narrowing and calcification of vessels', 'C': 'Peripheral emboli formation', 'D': 'Thrombus formation', 'E': 'Weakening of vessel wall'}, | B: Narrowing and calcification of vessels |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man presents to the emergency department with chest pain radiating to his left jaw and arm. He states that he had experienced similar symptoms when playing basketball. The medical history is significant for diabetes mellitus, hypertension, and GERD, for which he takes metformin, hydrochlorothiazide, and pantoprazole, respectively. The blood pressure is 150/90 mm Hg, the pulse is 100/min, and the respirations are 15/min. The ECG reveals ST elevation in leads V3-V6. He is hospitalized for an acute MI and started on treatment. The next day he complains of dizziness and blurred vision. Repeat vital signs were as follows: blood pressure 90/60 mm Hg, pulse 72/min, and respirations 12/min. The laboratory results were as follows: 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 120 mg/dL Which of the following drugs is responsible for this patient’s lab abnormalities?? {'A': 'Digoxin', 'B': 'Pantoprazole', 'C': 'Lisinopril', 'D': 'Atorvastatin', 'E': 'Nitroglycerin'}, | C: Lisinopril |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman is brought to the hospital by her boyfriend. She has had three days of fever and headache followed by one day of worsening confusion and hallucinations. She also becomes agitated when offered water. Her temperature is 101°F (38.3°C). Two months prior to presentation, the couple was camping and encountered bats in their cabin. In addition to an injection shortly after exposure, what would have been the most effective treatment for this patient?? {'A': 'A toxoid vaccine within ten days of exposure', 'B': 'A killed vaccine within ten days of exposure', 'C': 'Oseltamivir within one week of exposure', 'D': 'Venom antiserum within hours of exposure', 'E': 'Doxycycline for one month after exposure'}, | B: A killed vaccine within ten days of exposure |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man comes to the physician for an examination prior to a scheduled cholecystectomy. He has hypertension treated with hydrochlorothiazide. His mother had chronic granulomatous disease of the lung. He works in a glass manufacturing plant. He has smoked two packs of cigarettes daily for 38 years. His vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies are within the reference range. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?? {'A': 'Perform arterial blood gas analysis', 'B': 'Perform CT-guided biopsy', 'C': 'Perform diffusion capacity of the lung for carbon monoxide', 'D': 'Measure angiotensin-converting enzyme', 'E': 'Request previous chest x-ray'}, | E: Request previous chest x-ray |
Answer the following medical question with one of the provided options: | Q:You are examining a 3-day-old newborn who was delivered vaginally without any complications. The newborn presents with vomiting, hyperventilation, lethargy, and seizures. Blood work demonstrates hyperammonemia, elevated glutamine levels, and decreased blood urea nitrogen. A CT scan demonstrates cerebral edema. Defects in which of the following enzymes would result in a clinical presentation similar to this infant?? {'A': 'Phenylalanine hydroxylase', 'B': 'Branched-chain ketoacid dehydrogenase', 'C': 'Homogentisate oxidase', 'D': 'Cystathionine synthase', 'E': 'Carbamoyl phosphate synthetase I'}, | E: Carbamoyl phosphate synthetase I |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man with HIV comes to the physician because of skin lesions over his face and neck for 2 weeks. They are not itchy or painful. He does not have fever or a sore throat. He was treated for candidal esophagitis 3 months ago. He is sexually active with his wife, who knows of his condition, and uses condoms consistently. He is currently receiving triple antiretroviral therapy with lamivudine, abacavir, and efavirenz. He is 175 cm (5 ft 9 in) tall and weighs 58 kg (128 lb); BMI is 18.8 kg/m2. Examination shows multiple skin colored papules over his face and neck with a dimpled center. Cervical lymphadenopathy is present. The remainder of the examination is unremarkable. His hemoglobin concentration is 12.1 g/dL, leukocyte count is 4,900/mm3, and platelet count is 143,000/mm3; serum studies and urinalysis show no abnormalities. CD4+ T-lymphocyte count is 312/mm3 (normal ≥ 500). Which of the following is the most likely cause of this patient's findings?? {'A': 'A herpesvirus', 'B': 'Bartonella', 'C': 'Papillomavirus', 'D': 'Poxvirus', 'E': 'Coccidioides\n"'}, | D: Poxvirus |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of fatigue and worsening abdominal pain for 4 weeks. He also reports excessive night sweats and a 5.4-kg (12-lb) weight loss during this time. He has a neck swelling for 4 days. Physical examination shows a nontender, enlarged, and fixed supraclavicular lymph node. There is splenomegaly. A CT scan of the thorax and abdomen shows massively enlarged axillary, mediastinal, and cervical lymph nodes. Analysis of an excised cervical lymph node shows lymphocytes with a high proliferative index that stain positive for CD20. Which of the following is the most likely diagnosis?? {'A': 'Adult T-cell lymphoma', 'B': 'Burkitt lymphoma', 'C': 'Follicular lymphoma', 'D': 'Diffuse large B-cell lymphoma', 'E': 'Hodgkin lymphoma'}, | D: Diffuse large B-cell lymphoma |
Answer the following medical question with one of the provided options: | Q:A 26-year-old G1P0 woman at 32-weeks gestation presents for follow-up ultrasound. She was diagnosed with gestational diabetes during her second trimester, but admits to poor glucose control and non-adherence to insulin therapy. Fetal ultrasound reveals an asymmetric, enlarged interventricular septum, left ventricular outflow tract obstruction, and significantly reduced ejection fraction. Which of the following is the most appropriate step in management after delivery?? {'A': 'Emergent open fetal surgery', 'B': 'Cardiac magnetic resonance imaging', 'C': 'Cardiac catheterization', 'D': 'Chest radiograph', 'E': 'Medical management'}, | E: Medical management |
Answer the following medical question with one of the provided options: | Q:A recent study attempted to analyze whether increased "patient satisfaction" driven healthcare resulted in increased hospitalization. In this hospital, several of the wards adopted new aspects of "patient satisfaction" driven healthcare, whereas the remainder of the hospital continued to use existing protocols. Baseline population characteristics and demographics were collected at the start of the study. At the end of the following year, hospital use was assessed and compared between the two groups. Which of the following best describes this type of study?? {'A': 'Retrospective cohort', 'B': 'Prospective cohort', 'C': 'Retrospective case-control', 'D': 'Prospective case-control', 'E': 'Cross-sectional study'}, | B: Prospective cohort |
Answer the following medical question with one of the provided options: | Q:A new screening test utilizing a telemedicine approach to diagnosing diabetic retinopathy has been implemented in a diabetes clinic. An ophthalmologist’s exam was also performed on all patients as the gold standard for diagnosis. In a pilot study of 500 patients, the screening test detected the presence of diabetic retinopathy in 250 patients. Ophthalmologist exam confirmed a diagnosis of diabetic retinopathy in 200 patients who tested positive in the screening test, as well as 10 patients who tested negative in the screening test. What is the sensitivity, specificity, positive predictive value, and negative predictive value of the screening test?? {'A': 'Sensitivity = 83%, Specificity = 95%, PPV = 80%, NPV = 96%', 'B': 'Sensitivity = 83%, Specificity = 95%, PPV = 96%, NPV = 80%', 'C': 'Sensitivity = 95%, Specificity = 83%, PPV = 96%, NPV = 80%', 'D': 'Sensitivity = 80%, Specificity = 95%, PPV = 96%, NPV = 83%', 'E': 'Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96%'}, | E: Sensitivity = 95%, Specificity = 83%, PPV = 80%, NPV = 96% |
Answer the following medical question with one of the provided options: | Q:A healthy 22-year-old male participates in a research study you are leading to compare the properties of skeletal and cardiac muscle. You conduct a 3-phased experiment with the participant. In the first phase, you get him to lift up a 2.3 kg (5 lb) weight off a table with his left hand. In the second phase, you get him to do 20 burpees, taking his heart rate to 150/min. In the third phase, you electrically stimulate his gastrocnemius with a frequency of 50 Hz. You are interested in the tension and electrical activity of specific muscles as follows: Biceps in phase 1, cardiac muscle in phase 2, and gastrocnemius in phase 3. What would you expect to be happening in the phases and the respective muscles of interest?? {'A': 'Recruitment of small motor units at the start of experiments 1 and 2', 'B': 'Increase of tension in experiments 2 and 3, with the same underlying mechanism', 'C': 'Recruitment of large motor units followed by small motor units in experiment 1', 'D': 'Fused tetanic contraction at the end of all three experiments', 'E': 'Increase of tension in all phases'}, | E: Increase of tension in all phases |
Answer the following medical question with one of the provided options: | Q:A 20-year-old male comes into your office two days after falling during a pick up basketball game. The patient states that the lateral aspect of his knee collided with another player's knee. On exam, the patient's right knee appears the same size as his left knee without any swelling or effusion. The patient has intact sensation and strength in both lower extremities. The patient's right knee has no laxity upon varus stress test, but is more lax upon valgus stress test when compared to his left knee. Lachman's test and posterior drawer test both have firm endpoints without laxity. Which of the following structures has this patient injured?? {'A': 'Posterior cruciate ligament', 'B': 'Anterior cruciate ligament', 'C': 'Medial collateral ligament', 'D': 'Lateral collateral ligament', 'E': 'Medial meniscus'}, | C: Medial collateral ligament |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the physician because of swelling around his eyes for 4 days. The swelling is most severe in the morning and milder by bedtime. Ten days ago, he had a sore throat that resolved spontaneously. His temperature is 37°C (98.6°F), pulse is 103/min, and blood pressure is 88/52 mm Hg. Examination shows 3+ pitting edema of the lower extremities and periorbital edema. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 15.3 g/dL Leukocyte count 10,500/mm3 Platelet count 480,000/mm3 Serum Urea nitrogen 36 mg/dL Glucose 67 mg/dL Creatinine 0.8 mg/dL Albumin 2.6 mg/dL Urine Blood negative Glucose negative Protein 4+ RBC none WBC 0–1/hpf Fatty casts numerous Protein/creatinine ratio 6.8 (N ≤0.2) Serum complement concentrations are within the reference ranges. Which of the following is the most appropriate next step in management?"? {'A': 'Enalapril therapy', 'B': 'Furosemide therapy', 'C': 'Anti-streptolysin O levels', 'D': 'Prednisone therapy', 'E': 'Cyclosporine therapy'}, | D: Prednisone therapy |
Answer the following medical question with one of the provided options: | Q:An 18-year-old man comes to the clinic with his mom for “pins and needles” of both of his arms. He denies any past medical history besides a recent anterior cruciate ligament (ACL) tear that was repaired 1 week ago. The patient reports that the paresthesias are mostly located along the posterior forearms, left more than the right. What physical examination finding would you expect from this patient?? {'A': 'Loss of arm abduction', 'B': 'Loss of finger abducton', 'C': 'Loss of forearm flexion and supination', 'D': 'Loss of thumb opposition', 'E': 'Loss of wrist extension'}, | E: Loss of wrist extension |
Answer the following medical question with one of the provided options: | Q:A 9-year-old girl is resuscitated after the administration of an erroneous dose of intravenous phenytoin for recurrent seizures. This incident is reported to the authorities. A thorough investigation reveals various causative factors leading to the event. One important finding is a verbal misunderstanding of the dose of phenytoin between the ordering senior resident and the receiving first-year resident during the handover of the patient. To minimize the risk of this particular error in the future, the most appropriate management is to implement which of the following?? {'A': 'Closed-loop communication', 'B': 'Near miss', 'C': 'Root cause analysis', 'D': 'Sentinel event', 'E': 'Two patient identifiers'}, | A: Closed-loop communication |
Answer the following medical question with one of the provided options: | Q:You are the team physician for an NBA basketball team. On the morning of an important playoff game, an EKG of a star player, Mr. P, shows findings suspicious for hypertrophic cardiomyopathy (HCM). Mr. P is an otherwise healthy, fit, professional athlete. The playoff game that night is the most important of Mr. P's career. When you inform the coach that you are thinking of restricting Mr. P's participation, he threatens to fire you. Later that day you receive a phone call from the owner of the team threatening a lawsuit should you restrict Mr. P's ability to play. Mr. P states that he will be playing in the game "if it's the last thing I do." Which of the following is the most appropriate next step?? {'A': 'Consult with a psychiatrist to have Mr. P committed', 'B': 'Call the police and have Mr. P arrested', 'C': 'Allow Mr. P to play against medical advice', 'D': 'Educate Mr. P about the risks of HCM', 'E': 'Schedule a repeat EKG for the following morning'}, | D: Educate Mr. P about the risks of HCM |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman presents to the emergency department complaining of generalized malaise, weakness, headache, nausea, vomiting, and diarrhea; she last felt well roughly two days ago. She is otherwise healthy, and takes no medications. Her vital signs are: T 38.0, HR 96 beats per minute, BP 110/73, and O2 sat 96% on room air. Examination reveals a somewhat ill-appearing woman; she is drowsy but arousable and has no focal neurological deficits. Initial laboratory studies are notable for hematocrit 26%, platelets of 80,000/mL, and serum creatinine of 1.5 mg/dL. Which of the following is the most appropriate treatment at this time?? {'A': 'High-dose glucocorticoids', 'B': 'Cyclophosphamide and rituximab', 'C': 'Vancomycin and cefepime', 'D': 'Plasma exchange therapy', 'E': 'Urgent laparoscopic splenectomy'}, | D: Plasma exchange therapy |
Answer the following medical question with one of the provided options: | Q:A 5-week-old infant born at 36 weeks' gestation is brought to the physician for a well-child examination. Her mother reports that she previously breastfed her for 15 minutes every 2 hours but now feeds her for 40 minutes every 4 hours. The infant has six wet diapers and two stools daily. She currently weighs 3500 g (7.7 lb) and is 52 cm (20.4 in) in length. Vital signs are with normal limits. Cardiopulmonary examination shows a grade 4/6 continuous murmur heard best at the left infraclavicular area. After confirming the diagnosis via echocardiography, which of the following is the most appropriate next step in management of this patient?? {'A': 'Prostaglandin E1 infusion', 'B': 'Indomethacin infusion', 'C': 'Surgical ligation', 'D': 'Reassurance and follow-up', 'E': 'Percutaneous surgery'}, | B: Indomethacin infusion |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman comes to the physician because of a 1-day history of right flank pain and bloody urine. Over the past 2 weeks, she has also developed progressive lower extremity swelling and a 3-kg (7-lb) weight gain. She has a history of chronic hepatitis B infection, which was diagnosed 10 years ago. She frequently flies from California to New York for business. She appears fatigued. Her pulse is 98/min, respirations are 18/min, and blood pressure is 135/75 mm Hg. Examination shows periorbital edema, a distended abdomen, and 2+ edema of the lower extremities. The lungs are clear to auscultation. A CT scan of the abdomen shows a nodular liver with ascites, a large right kidney with abundant collateral vessels, and a filling defect in the right renal vein. Urinalysis shows 4+ protein, positive glucose, and fatty casts. Which of the following is the most likely underlying cause of this patient's renal vein findings?? {'A': 'Acquired factor VIII deficiency', 'B': 'Loss of antithrombin III', 'C': 'Impaired estrogen degradation', 'D': 'Antiphospholipid antibodies', 'E': 'Paraneoplastic erythropoietin production'}, | B: Loss of antithrombin III |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man comes to the physician for a follow-up evaluation of chronic, retrosternal chest pain. The pain is worse at night and after heavy meals. He has taken oral pantoprazole for several months without any relief of his symptoms. Esophagogastroduodenoscopy shows ulcerations in the distal esophagus and a proximally dislocated Z-line. A biopsy of the distal esophagus shows columnar epithelium with goblet cells. Which of the following microscopic findings underlie the same pathomechanism as the cellular changes seen in this patient?? {'A': 'Pseudostratified columnar epithelium in the bronchi', 'B': 'Squamous epithelium in the bladder', 'C': 'Paneth cells in the duodenum', 'D': 'Branching muscularis mucosa in the jejunum', 'E': 'Disorganized squamous epithelium in the endocervix'}, | B: Squamous epithelium in the bladder |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman comes to the physician because of a 6-month history of weight loss, bloating, and diarrhea. She does not smoke or drink alcohol. Her vital signs are within normal limits. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows bilateral white spots on the temporal half of the conjunctiva, dry skin, and a hard neck mass in the anterior midline that does not move with swallowing. Urinalysis after a D-xylose meal shows an increase in renal D-xylose excretion. Which of the following is most likely to have prevented this patient's weight loss?? {'A': 'Gluten-free diet', 'B': 'Pancreatic enzyme replacement', 'C': 'Tetracycline therapy', 'D': 'Mesalamine therapy', 'E': 'Lactose-free diet'}, | B: Pancreatic enzyme replacement |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man presents for a routine checkup. Past medical history is remarkable for stage 1 systemic hypertension and hepatitis A infection diagnosed 10 years ago. He takes aspirin, rosuvastatin, enalapril daily, and a magnesium supplement every once in a while. He is planning to visit Ecuador for a week-long vacation and is concerned about malaria prophylaxis before his travel. The physician advised taking 1 primaquine pill every day while he is there and for 7 consecutive days after leaving Ecuador. On the third day of his trip, the patient develops an acute onset headache, dizziness, shortness of breath, and fingertips and toes turning blue. His blood pressure is 135/80 mm Hg, heart rate is 94/min, respiratory rate is 22/min, temperature is 36.9℃ (98.4℉), and blood oxygen saturation is 97% in room air. While drawing blood for his laboratory workup, the nurse notes that his blood has a chocolate brown color. Which of the following statements best describes the etiology of this patient’s most likely condition?? {'A': 'The patient’s condition is due to consumption of water polluted with nitrates.', 'B': 'This condition resulted from primaquine overdose.', 'C': 'The patient had pre-existing liver damage caused by viral hepatitis.', 'D': 'The condition developed because of his concomitant use of primaquine and magnesium supplement.', 'E': 'It is a type B adverse drug reaction.'}, | E: It is a type B adverse drug reaction. |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman, gravida 2, para 1, at 32 weeks' gestation comes to the emergency department for sudden leakage of clear vaginal fluid. Her pregnancy has been uncomplicated. Her first child was born at term by vaginal delivery. She has no history of serious illness. She does not drink alcohol or smoke cigarettes. Current medications include vitamin supplements. Her temperature is 37.2°C (98.9°F), pulse is 70/min, respirations are 18/min, and blood pressure is 128/82 mm Hg. Speculum examination demonstrates clear fluid in the cervical canal. The fetal heart rate is reactive at 160/min with no decelerations. Tocometry shows uterine contractions. Nitrazine testing is positive. She is started on indomethacin. Which of the following is the most appropriate next step in management?? {'A': 'Administer betamethasone, ampicillin, and proceed with cesarean section', 'B': 'Administer ampicillin and perform amnioinfusion', 'C': 'Administer ampicillin and test amniotic fluid for fetal lung maturity', 'D': 'Administer betamethasone and ampicillin', 'E': 'Administer betamethasone, ampicillin, and proceed with induction of labor'}, | D: Administer betamethasone and ampicillin |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl is brought to the emergency department by her friends who say that she took a whole bottle of her mom’s medication. They do not know which medication it was she ingested. The patient is slipping in and out of consciousness and is unable to offer any history. Her temperature is 39.6°C (103.2°F), the heart rate is 135/min, the blood pressure is 178/98 mm Hg, and the respiratory rate is 16/min. On physical examination, there is significant muscle rigidity without tremor or clonus. Which of the following is the best course of treatment for this patient?? {'A': 'Naloxone', 'B': 'Dantrolene', 'C': 'Fenoldopam', 'D': 'Cyproheptadine', 'E': 'Flumazenil'}, | B: Dantrolene |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman is brought to the emergency department because of fever, productive cough, and dyspnea for 3 days. She has had upper back pain for 3 months, which is worse after activity. She takes ibuprofen for pain relief. She has no history of smoking. The temperature is 39.5°C (103.1°F), the blood pressure is 100/70 mm Hg, the pulse is 95/min, and the respirations are 22/min. Lung auscultation shows rales in the left lower lobe area. Painful lymph nodes (1 × 1 cm) are palpated in the left axillary and cervical regions. There is point tenderness along several thoracic vertebrae. Laboratory studies are pending. A skull X-ray and lung window thoracic computed tomography scan are shown. Which of the following disorders most likely played a role in this patient’s acute condition?? {'A': 'Metastatic breast cancer', 'B': 'Multiple myeloma', 'C': 'Non-small cell lung cancer', 'D': 'Paget’s disease', 'E': 'Primary hyperparathyroidism'}, | B: Multiple myeloma |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman presents to the emergency department with a 2-day history of severe blistering. She says that she woke up 2 days ago with a number of painful blisters in her mouth and has since been continuing to develop blisters of her cutaneous skin all over her body and the mucosa of her mouth. She has no past medical history and has never experienced these symptoms before. Physical exam reveals a diffuse vesicular rash with painful, flaccid blisters that separate easily with gentle rubbing. The function of which of the following proteins is most likely disrupted in this patient?? {'A': 'Cadherin', 'B': 'Collagen', 'C': 'Integrin', 'D': 'Keratin', 'E': 'T-cell receptor'}, | A: Cadherin |
Answer the following medical question with one of the provided options: | Q:A 3-week-old boy is brought to the emergency department by his parents because of a 3-day history of progressive lethargy and difficulty feeding. He was born at term and did not have difficulty feeding previously. His temperature is 39.4°C (103°F), pulse is 220/min, respirations are 45/min, and blood pressure is 50/30 mm Hg. Pulse oximetry on 100% oxygen shows an oxygen saturation of 97%. Examination shows dry mucous membranes, delayed capillary refill time, and cool skin with poor turgor. Despite multiple attempts by the nursing staff, they are unable to establish peripheral intravenous access. Which of the following is the most appropriate next step in management?? {'A': 'Rapid sequence intubation', 'B': 'Intramuscular epinephrine', 'C': 'Internal jugular vein cannulation', 'D': 'Intraosseous cannulation', 'E': 'Ultrasound-guided antecubital vein cannulation'}, | D: Intraosseous cannulation |
Answer the following medical question with one of the provided options: | Q:A previously healthy 10-year-old boy is brought to the emergency room by his mother 5 hours after the onset of abdominal pain and nausea. Over the past 2 weeks, he has also had progressive abdominal pain and a 4-kg (8.8-lb) weight loss. The mother reports that her son has been drinking more water than usual during this period. Last week he wet his bed three times despite being completely toilet-trained since 3 years of age. His temperature is 37.8°C (100°F), pulse is 128/min, respirations are 35/min, and blood pressure is 95/55 mm Hg. He appears lethargic. Physical examination shows deep and labored breathing and dry mucous membranes. The abdomen is soft, and there is diffuse tenderness to palpation with no guarding or rebound. Serum laboratory studies show: Na+ 133 mEq/L K+ 5.9 mEq/L Cl- 95 mEq/L HCO3- 13 mEq/L Urea nitrogen 25 mg/dL Creatinine 1.0 mg/dL Urine dipstick is positive for ketones and glucose. Further evaluation is most likely to reveal which of the following?"? {'A': 'Decreased total body potassium', 'B': 'Increased total body sodium', 'C': 'Increased arterial pCO2', 'D': 'Hypervolemia', 'E': 'Serum glucose concentration > 600 mg/dL'}, | A: Decreased total body potassium |
Answer the following medical question with one of the provided options: | Q:A 70-year-old Caucasian male visits your office regularly for treatment of New York Heart association class IV congestive heart failure. Which of the following medications would you add to this man's drug regimen in order to improve his overall survival?? {'A': 'Spironolactone', 'B': 'Amiloride', 'C': 'Hydrochlorothiazide', 'D': 'Furosemide', 'E': 'Acetazolamide'}, | A: Spironolactone |
Answer the following medical question with one of the provided options: | Q:Several hours after vaginal delivery, a male newborn delivered at full-term develops tachycardia and tachypnea. His blood pressure is within normal limits. Pulse oximetry on room air shows an oxygen saturation of 79% in the right hand and 61% in the left foot. Physical examination shows bluish discoloration of the face and trunk, supraclavicular and intercostal retractions, and a machine-like murmur over the precordium. Bedside echocardiography shows pulmonary and systemic circulation are in parallel rather than in series. What is the most appropriate pharmacotherapy for this patient?? {'A': 'Sildenafil', 'B': 'Alprostadil', 'C': 'Metoprolol', 'D': 'Indomethacin', 'E': 'Dopamine'}, | B: Alprostadil |
Answer the following medical question with one of the provided options: | Q:A 5-year-old male visits his pediatrician for a check-up. His height corresponds to the 99th percentile for his age, and pubic hair is present upon physical examination. Serum renin and potassium levels are high, as is 17-hydroxyprogesterone. Which of the following is likely deficient in this patient?? {'A': '17a-hydroxylase', 'B': '11ß-hydroxylase', 'C': '21-hydroxylase', 'D': 'Aromatase', 'E': '5a-reductase'}, | C: 21-hydroxylase |
Answer the following medical question with one of the provided options: | Q:A 41-year-old African American woman presents with her husband to her primary care doctor for evaluation of depression and anxiety. She reports a 2-week history of rapid onset sadness with no clear inciting factor. She is accompanied by her husband who notes that she has had at least three similar episodes that have occurred over the past two years. He also notes that she has been “more emotional” lately and seems confused throughout the day. She has had to leave her job as a librarian at her child’s elementary school. Her past medical history is notable for two diagnostic laparoscopies for recurrent episodes of abdominal pain of unknown etiology. Her family history is notable for psychosis in her mother and maternal grandfather. Her temperature is 99°F (37.2°C), blood pressure is 125/75 mmHg, pulse is 75/min, and respirations are 17/min. On exam, she is disheveled and appears confused and disoriented. Her attention span is limited and she exhibits emotional lability. This patient’s condition is most likely due to a defect in an enzyme that metabolizes which of the following compounds?? {'A': 'Aminolevulinic acid', 'B': 'Coproporphyrinogen III', 'C': 'Hydroxymethylbilane', 'D': 'Porphobilinogen', 'E': 'Protoporphyrin IX'}, | D: Porphobilinogen |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman presents to her primary care physician for a general wellness appointment. The patient has no complaints currently and just wants to be sure that she is in good health. The patient has a past medical history of asthma, hypertension, and anxiety. Her current medications include albuterol, fluticasone, hydrochlorothiazide, lisinopril, and fexofenadine. Her temperature is 99.5°F (37.5°C), blood pressure is 165/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 98% on room air. On exam, you note a healthy young woman with a lean habitus. Cardiac exam reveals a S1 and S2 heart sound with a normal rate. Pulmonary exam is clear to auscultation bilaterally with good air movement. Abdominal exam reveals a bruit, normoactive bowel sounds, and an audible borborygmus. Neurological exam reveals cranial nerves II-XII as grossly intact with normal strength and reflexes in the upper and lower extremities. Which of the following is the best next step in management?? {'A': 'Raise lisinopril dose', 'B': 'Add furosemide', 'C': 'Ultrasound with doppler', 'D': 'CT of the abdomen', 'E': 'No additional management needed'}, | C: Ultrasound with doppler |
Answer the following medical question with one of the provided options: | Q:A 46-year-old man comes to the emergency department because of a 10-day history of right upper quadrant abdominal pain. He has also been feeling tired and nauseous for the past 6 weeks. On examination, scleral icterus is present. Abdominal examination shows tenderness to palpation in the right upper quadrant. The liver edge is palpated 2 cm below the right costal margin. Laboratory studies show: Aspartate aminotransferase 1780 U/L Alanine aminotransferase 2520 U/L Hepatitis A IgM antibody Negative Hepatitis B surface antigen Negative Hepatitis B surface antibody Negative Hepatitis B core IgM antibody Positive Hepatitis C antibody Positive Hepatitis C RNA Negative Which of the following is the best course of action for this patient?"? {'A': 'Ribavirin and interferon', 'B': 'Supportive therapy', 'C': 'Tenofovir', 'D': 'Emergency liver transplantation', 'E': 'Pegylated interferon-alpha'}, | B: Supportive therapy |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy who recently emigrated from Nigeria is brought to the emergency department because of a 2-day history of lower leg weakness, swallowing difficulty, and drooling of saliva. He has not yet received any childhood vaccinations. Two days after admission, the patient develops shortness of breath. Pulse oximetry shows an oxygen saturation of 64%. Despite resuscitative efforts, the patient dies of respiratory failure. At autopsy, examination of the spinal cord shows destruction of the anterior horn cells. Neurological examination of this patient would have most likely shown which of the following findings?? {'A': 'Positive Babinski sign', 'B': 'Hyporeflexia', 'C': 'Sensory loss', 'D': 'Myoclonus', 'E': 'Pronator drift'}, | B: Hyporeflexia |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman is brought to the urgent care clinic by her husband. She complains of numbness around her lips and a tingling sensation in her hands and feet. She underwent near-total thyroidectomy for an enlarged thyroid gland a month ago. Vital signs include: blood pressure is 130/70 mm Hg, pulse is 72/min, respiratory rate is 16/min, and temperature is 37.0°C (98.6°F). A surgical incision scar is present in the anterior aspect of the neck. The attending physician inflates the blood pressure cuff above 150 mm Hg and observes the patient a couple of minutes while measuring her blood pressure. The patient develops sudden stiffness and tingling in her hand. Blood test results are as follows: Hemoglobin (Hb%) 10.2 g/dL White blood cell count 7000/mm3 Platelet count 160,000/mm3 Calcium, serum (Ca2+) 6.0 mg/dL Albumin 4 g/dL Alanine aminotransferase (ALT), serum 15 U/L Aspartate aminotransferase (AST), serum 8 U/L Serum creatinine 0.5 mg/dL Urea 27 mg/dL Sodium 137 mEq/L Potassium 4.5 mEq/L Magnesium 2.5 mEq/L Urinalysis shows no white or red blood cells and leukocyte esterase is negative. Which of the following is the next best step in the management of this patient?? {'A': 'CT scan abdomen with pancreatic protocol', 'B': 'Thyroid function tests', 'C': 'Serum vitamin D level', 'D': '24-hour urinary calcium', 'E': 'Serum parathyroid hormone (PTH) level'}, | E: Serum parathyroid hormone (PTH) level |
Answer the following medical question with one of the provided options: | Q:A woman with coronary artery disease is starting to go for a walk. As she begins, her heart rate accelerates from a resting pulse of 60 bpm until it reaches a rate of 120 bpm, at which point she begins to feel a tightening in her chest. She stops walking to rest and the tightening resolves. This has been happening to her consistently for the last 6 months. Which of the following is a true statement?? {'A': 'Increasing the heart rate increases the amount of time spent during each cardiac cycle', 'B': 'Increasing the heart rate decreases the relative amount of time spent during diastole', 'C': 'Perfusion of the myocardium takes place primarily during systole', 'D': 'Perfusion of the myocardium takes place equally throughout the cardiac cycle', 'E': "This patient's chest pain is indicative of transmural ischemia"}, | B: Increasing the heart rate decreases the relative amount of time spent during diastole |
Answer the following medical question with one of the provided options: | Q:A 22-year-old female presents to her physician for evaluation of a vaginal discharge, itching, and irritation. She recently started a new relationship with her boyfriend, who is her only sexual partner. He does not report any genitourinary symptoms. She takes oral contraceptives and does not use barrier contraception. The medical history is unremarkable. The vital signs are within normal limits. A gynecologic examination reveals a thin, yellow, frothy vaginal discharge with a musty, unpleasant odor and numerous punctate red maculae on the ectocervix. The remainder of the exam is normal. Which of the following organisms will most likely be revealed on wet mount microscopy?? {'A': 'Budding yeasts cells and/or pseudohyphae', 'B': 'Epithelial cells covered by numerous bacterial cells', 'C': 'Motile round or oval-shaped microorganisms', 'D': 'Numerous rod-shaped bacteria', 'E': 'Chains of cocci'}, | C: Motile round or oval-shaped microorganisms |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman with hypertension and hyperlipidemia comes to the physician because of generalized reddening of her skin and itching for the past 2 weeks. Her symptoms occur every evening before bedtime and last for about 30 minutes. Three months ago, atorvastatin was stopped after she experienced progressively worsening neck and back pain. Statin therapy was reinitiated at lower doses 3 weeks ago but had to be stopped again after her musculoskeletal symptoms recurred. Her menses occur irregularly at 2–3 month intervals and last for 3–4 days. She has smoked one pack of cigarettes daily for the past 30 years. Her current medications include lisinopril and niacin. Her brother died of colonic adenocarcinoma, and her father died of small cell lung cancer. She is 169 cm (5 ft 6 in) tall and weighs 83 kg (183 lb); BMI is 29 kg/m2. Her vital signs are within normal limits. Physical examination shows no abnormalities. Serum lipid studies show: Total cholesterol 247 mg/dL HDL-cholesterol 39 mg/dL LDL-cholesterol 172 mg/dL Triglycerides 152 mg/dL Which of the following is the most appropriate next step in management?"? {'A': 'Administer ibuprofen', 'B': 'Measure urine hydroxyindoleacetic acid levels', 'C': 'Measure urine metanephrine levels', 'D': 'Switch lisinopril to hydrochlorothiazide', 'E': 'Switch niacin to fenofibrate'}, | A: Administer ibuprofen |
Answer the following medical question with one of the provided options: | Q:Five days after undergoing right knee arthroplasty for osteoarthritis, a 68-year-old man has severe pain in this right knee preventing him from participating in physical therapy. On the third postoperative day when the dressing was changed, the surgical wound appeared to be intact, slightly swollen, and had a clear secretion. He has a history of diabetes, hyperlipidemia, and hypertension. Current medications include metformin, enalapril, and simvastatin. His temperature is 37.3°C (99.1°F), pulse is 94/min, and blood pressure is 130/88 mm Hg. His right knee is swollen, erythematous, and tender to palpation. There is pain on movement of the joint. The medial parapatellar skin incision appears superficially opened in its proximal and distal part with yellow-green discharge. There is blackening of the skin on both sides of the incision. Which of the following is the next best step in the management of this patient?? {'A': 'Surgical debridement', 'B': 'Nafcillin therapy', 'C': 'Removal of prostheses', 'D': 'Vacuum dressing', 'E': 'Antiseptic dressing\n"'}, | A: Surgical debridement |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman comes to the physician in February because of a 1-day history of fever, chills, headache, and dry cough. She also reports malaise and generalized muscle aches. She works as a teacher at a local high school, where there was recently an outbreak of influenza. She has a history of intermittent asthma, for which she takes albuterol as needed. She declined the influenza vaccine offered in the fall because her sister told her that a friend developed a flulike illness after receiving the vaccine. She is worried about possibly becoming ill and cannot afford to miss work. Her temperature is 37.9°C (100.3°F), heart rate is 58/min, and her respirations are 12/min. Physical examination is unremarkable. Her hemoglobin concentration is 14.5 g/dL, leukocyte count is 9,400/mm3, and platelet count is 280,000/mm3. In addition to analgesia, which of the following is the most appropriate next step in management?? {'A': 'Supportive therapy only', 'B': 'Amantadine', 'C': 'Inactivated influenza vaccine', 'D': 'Oseltamivir', 'E': 'Live attenuated influenza vaccine'}, | D: Oseltamivir |
Answer the following medical question with one of the provided options: | Q:Red-green color blindness, an X-linked recessive disorder, has an incidence of 1/200 in males in a certain population. What is the probability of a phenotypically normal male and female having a child with red-green color blindness?? {'A': '1/200', 'B': '199/200', 'C': '1/100', 'D': '1/400', 'E': '99/100'}, | D: 1/400 |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man is transferred to the intensive care unit from the emergency department for acute respiratory failure. He was rushed to the hospital after developing progressive respiratory distress over the last 24 hours. His medical history is significant for long-standing severe persistent asthma, hypertension, and several bouts of community and hospital-acquired pneumonia. His medications include amlodipine, lisinopril, inhaled fluticasone, salmeterol, and oral prednisone. He is a lifelong non-smoker and drinks alcohol occasionally on the weekends. He works as a sales executive and went to Hawaii a month ago. In the emergency department, he was started on broad-spectrum antibiotics and bronchodilators. His respiratory failure progressively worsens, and on day 2 of admission, he requires mechanical ventilator support. Chest X-ray shows multiple nodules bilaterally in the lower lobes. Flexible bronchoscopy is performed and the bronchoalveolar lavage sample from the medial segment of the right lower lobe shows neutrophils, and the fungal preparation shows Aspergillus fumigatus. A video-assisted thoracoscopy is performed and biopsy from the right lower lobe is taken which shows plugging of the terminal bronchioles with mucus, inflammatory cells, and fungal vascular invasion. Which of the following is the most likely mechanism responsible for the biopsy findings?? {'A': 'Defects in the immune response', 'B': 'The production of a superantigen by Aspergillus fumigatus', 'C': 'Aspergillus fumigatus suppresses the production of IgA', 'D': 'Aspergillus fumigatus suppresses the production of IgM', 'E': 'Suppression of the innate immune system by Aspergillus fumigatus'}, | A: Defects in the immune response |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man comes to the physician because of a 4-month history of epigastric pain, nausea, and weakness. He has smoked one pack of cigarettes daily for 50 years and drinks one alcoholic beverage daily. He appears emaciated. He is 175 cm (5 ft 9 in) tall and weighs 47 kg (103 lb); BMI is 15 kg/m2. He is diagnosed with gastric cancer. Which of the following cytokines is the most likely direct cause of this patient’s examination findings?? {'A': 'TGF-β', 'B': 'IL-6', 'C': 'IL-2', 'D': 'IFN-α', 'E': 'TNF-β'}, | B: IL-6 |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman comes to the physician because of a 1-week history of fatigue, dark urine, and a feeling of heaviness in her legs. Two weeks ago, she returned from a vacation to Brazil, where she spent most of her days exploring the city of Rio de Janeiro on foot. She also gained 3 kg (7 lb) during her vacation. She has systemic lupus erythematosus. Her only medication is hydroxychloroquine. Her temperature is 37.5°C (99.5°F), pulse is 78/min, and blood pressure is 162/98 mm Hg. Physical examination shows 2+ pretibial edema bilaterally. Urinalysis shows: Blood 3+ Protein 1+ RBC 6–8/hpf with dysmorphic features RBC casts numerous WBC 8/hpf WBC casts rare Bacteria negative Which of the following is the most likely cause of this patient's leg findings?"? {'A': 'Venous insufficiency', 'B': 'Lymphatic obstruction', 'C': 'Increased capillary permeability', 'D': 'Renal protein loss', 'E': 'Salt retention'}, | E: Salt retention |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman with advanced bladder cancer comes to the physician for a follow-up examination. She is currently undergoing chemotherapy with an agent that forms cross-links between DNA strands. Serum studies show a creatinine concentration of 2.1 mg/dL and a blood urea nitrogen concentration of 30 mg/dL. Urine dipstick of a clean-catch midstream specimen shows 2+ protein and 1+ glucose. Prior to initiation of chemotherapy, her laboratory values were within the reference range. In addition to hydration, administration of which of the following would most likely have prevented this patient's current condition?? {'A': 'Mesna', 'B': 'Aprepitant', 'C': 'Amifostine', 'D': 'Rasburicase', 'E': 'Leucovorin'}, | C: Amifostine |
Answer the following medical question with one of the provided options: | Q:A 57-year-old post-menopausal woman comes to the physician because of intermittent, bloody post-coital vaginal discharge for the past month. She does not have pain with intercourse. Eleven years ago, she had LSIL on a routine Pap smear and testing for high-risk HPV strains was positive. Colposcopy showed CIN 1. She has not returned for follow-up Pap smears since then. She is sexually active with her husband only, and they do not use condoms. She has smoked half a pack of cigarettes per day for the past 25 years and does not drink alcohol. On speculum exam, a 1.4 cm, erythematous exophytic mass with ulceration is noted on the posterior wall of the upper third of the vagina. Which of the following is the most probable histopathology of this mass?? {'A': 'Squamous cell carcinoma', 'B': 'Basal cell carcinoma', 'C': 'Melanoma', 'D': 'Sarcoma botryoides', 'E': 'Adenocarcinoma'}, | A: Squamous cell carcinoma |
Answer the following medical question with one of the provided options: | Q:Three days after starting a new drug for malaria prophylaxis, a 19-year-old college student comes to the physician because of dark-colored urine and fatigue. He has not had any fever, dysuria, or abdominal pain. He has no history of serious illness. Physical examination shows scleral icterus. Laboratory studies show a hemoglobin of 9.7 g/dL and serum lactate dehydrogenase of 234 U/L. Peripheral blood smear shows poikilocytes with bite-shaped irregularities. Which of the following drugs has the patient most likely been taking?? {'A': 'Pyrimethamine', 'B': 'Primaquine', 'C': 'Dapsone', 'D': 'Ivermectin', 'E': 'Doxycycline'}, | B: Primaquine |
Answer the following medical question with one of the provided options: | Q:You are reviewing raw data from a research study performed at your medical center examining the effectiveness of a novel AIDS screening examination. The study enrolled 250 patients with confirmed AIDS, and 240 of these patients demonstrated a positive screening examination. The control arm of the study enrolled 250 patients who do not have AIDS, and only 5 of these patients tested positive on the novel screening examination. What is the NPV of this novel test?? {'A': '245 / (245 + 10)', 'B': '245 / (245 + 5)', 'C': '240 / (240 + 5)', 'D': '240 / (240 + 15)', 'E': '240 / (240 + 10)'}, | A: 245 / (245 + 10) |
Answer the following medical question with one of the provided options: | Q:A P1G0 diabetic woman is at risk of delivering at 30 weeks gestation. Her obstetrician counsels her that there is a risk the baby could have significant pulmonary distress after it is born. However, she states she will administer a drug to the mother to help prevent this from occurring. By what action will this drug prevent respiratory distress in the premature infant?? {'A': 'Suppressing the neonatal immune system', 'B': 'Increasing the secretory product of type II alveolar cells', 'C': 'Preventing infection of immature lungs', 'D': 'Reducing the secretory product of type II alveolar cells', 'E': 'Promoting increased surface tension of alveoli'}, | B: Increasing the secretory product of type II alveolar cells |
Answer the following medical question with one of the provided options: | Q:A case-control study is conducted to investigate the association between the use of phenytoin during pregnancy in women with epilepsy and the risk for congenital malformations. The odds ratio of congenital malformations in newborns born to women who were undergoing treatment with phenytoin is 1.74 (P = 0.02) compared to newborns of women who were not treated with phenytoin. Which of the following 95% confidence intervals is most likely reported for this association?? {'A': '1.75 to 2.48', 'B': '0.56 to 1.88', 'C': '0.36 to 0.94', 'D': '1.34 to 2.36', 'E': '0.83 to 2.19'}, | D: 1.34 to 2.36 |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy presents with altered mental status and difficulty breathing for the past couple of hours. The patient’s father, a mechanic, says the boy accidentally ingested an unknown amount of radiator fluid. The patient’s vital signs are: temperature 37.1°C (98.8.F), pulse 116/min, blood pressure 98/78 mm Hg, and respiratory rate 42/min. On physical examination, cardiopulmonary auscultation reveals deep, rapid respirations with no wheezing, rhonchi, or crepitations. An ABG reveals the blood pH to be 7.2 with an anion gap of 16 mEq/L. Urinalysis reveals the presence of oxalate crystals. Which of the following is the most appropriate antidote for the poison that this patient has ingested?? {'A': 'Flumazenil', 'B': 'Succimer', 'C': 'Methylene blue', 'D': 'Fomepizole', 'E': 'Dimercaprol'}, | D: Fomepizole |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man with HIV comes to the physician because of multiple lesions on his chest and lower extremities. The lesions have progressively increased in size and are not painful or pruritic. Current medications include abacavir, dolutegravir, and lamivudine. A photograph of the lesions is shown. His CD4+ T-lymphocyte count is 450/mm3 (normal ≥ 500/mm3). A skin biopsy shows multiple spindle-shaped cells and lymphocytic infiltrate. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Ganciclovir', 'B': 'Nitazoxanide', 'C': 'Alpha-interferon', 'D': 'Amphotericin B', 'E': 'Doxycycline'}, | C: Alpha-interferon |
Answer the following medical question with one of the provided options: | Q:An 18-year-old man presents to the office, complaining of an itchy patch on his torso that appeared one week ago. The patient is on the college wrestling team and is concerned he will not be able to compete if it gets infected. He has no significant medical history, and his vital signs are within normal limits. On examination, there is an erythematous, scaly plaque with central clearing at approximately the level of rib 6 on the left side of his torso. What diagnostic test would be most appropriate at this time?? {'A': 'Sabouraud agar', 'B': 'Eaton agar', 'C': 'Thayer-Martin agar', 'D': 'KOH preparation', 'E': 'Wood’s lamp examination'}, | D: KOH preparation |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man with no significant medical history begins to have memory loss and personality changes. Rapidly, over the next few months his symptoms increase in severity. He experiences a rapid mental deterioration associated with sudden, jerking movements, particularly in response to being startled. He has gait disturbances as well. Eventually, he lapses into a coma and dies approximately ten months after the onset of symptoms. Which of the following would most likely be seen on autopsy of the brain in this patient?? {'A': 'A', 'B': 'B', 'C': 'C', 'D': 'D', 'E': 'E'}, | C: C |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman with type 1 diabetes mellitus is brought to the emergency department by her husband because of a 2-day history of profound fatigue and generalized weakness. One week ago, she increased her basal insulin dose because of inadequate control of her glucose concentrations. Neurologic examination shows hyporeflexia. An ECG shows T-wave flattening and diffuse ST-segment depression. Which of the following changes are most likely to occur in this patient's kidneys?? {'A': 'Increased activity of H+/K+ antiporter in α-intercalated cells', 'B': 'Decreased activity of epithelial Na+ channels in principal cells', 'C': 'Decreased activity of Na+/K+/2Cl- cotransporter in the loop of Henle', 'D': 'Decreased activity of Na+/H+ antiporter in the proximal convoluted tubule', 'E': 'Increased activity of luminal K+ channels in principal cells'}, | A: Increased activity of H+/K+ antiporter in α-intercalated cells |
Answer the following medical question with one of the provided options: | Q:A newborn male is evaluated in the hospital nursery 24 hours after birth for cyanosis. The patient was born at 38 weeks gestation to a 36-year-old gravida 3 via cesarean section for fetal distress. The patient’s mother received inconsistent prenatal care, and the delivery was uncomplicated. The patient’s Apgar evaluation was notable for acrocyanosis at both 1 and 5 minutes of life. The patient’s mother denies any family history of congenital heart disease. The patient’s father has a past medical history of hypertension, and one of the patient’s older siblings was recently diagnosed with autism spectrum disorder. The patient’s birth weight was 3180 g (7 lb 0 oz). In the hospital nursery, his temperature is 99.3°F (37.4°C), blood pressure is 66/37 mmHg, pulse is 179/min, and respirations are 42/min. On physical exam, the patient is in moderate distress. He has low-set ears, orbital hypertelorism, and a cleft palate. The patient is centrally cyanotic. A chest CT shows thymic hypoplasia. Echocardiography demonstrates a single vessel emanating from both the right and left ventricle. This patient should be urgently evaluated for which of the following acute complications?? {'A': 'Cerebral edema', 'B': 'Hypoglycemia', 'C': 'Neuromuscular irritability', 'D': 'Rhabdomyolysis', 'E': 'Shortening of the QT interval'}, | C: Neuromuscular irritability |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman comes to the physician because of intermittent episodes of sharp chest pain and palpitations. She appears nervous. Her pulse is 115/min and irregularly irregular, and blood pressure is 139/86 mmHg. Examination shows a fine tremor on both hands and digital swelling; the extremities are warm. There is retraction of the right upper eyelid. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Amiodarone', 'B': 'Propylthiouracil', 'C': 'Warfarin', 'D': 'Methimazole', 'E': 'Propranolol'}, | E: Propranolol |
Answer the following medical question with one of the provided options: | Q:A 23-year-old female is found by her roommate in her dormitory. The patient has a history of Type 1 Diabetes Mellitus and was binge drinking the night prior with friends at a local bar. The patient is brought to the emergency department, where vital signs are as follow: T 97.3 F, HR 119 bpm, BP 110/68 mmHg, RR 24, SpO2 100% on RA. On physical exam, the patient is clammy to touch, mucous membranes are tacky, and she is generally drowsy and disoriented. Finger stick glucose is 342 mg/dL; additional lab work reveals: Na: 146 K: 5.6 Cl: 99 HCO3: 12 BUN: 18 Cr: 0.74. Arterial Blood Gas reveals: pH 7.26, PCO2 21, PO2 102. Which of the following statements is correct regarding this patient's electrolyte and acid/base status?? {'A': 'The patient has a primary respiratory alkalosis with a compensatory metabolic acidosis', 'B': 'The patient has a metabolic acidosis with hyperkalemia from increased total body potassium', 'C': 'The patient has an anion gap metabolic acidosis as well as a respiratory acidosis', 'D': 'The patient has an anion gap metabolic acidosis with decreased total body potassium', 'E': 'The patient has a non-anion gap metabolic acidosis with decreased total body sodium'}, | D: The patient has an anion gap metabolic acidosis with decreased total body potassium |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man is admitted to the hospital because of a 1-day history of epigastric pain and vomiting. He has had similar episodes of epigastric pain in the past. He drinks 8 oz of vodka daily. Five days after admission, the patient develops aspiration pneumonia and sepsis. Despite appropriate therapy, the patient dies. At autopsy, the pancreas appears gray, enlarged, and nodular. Microscopic examination of the pancreas shows localized deposits of calcium. This finding is most similar to an adaptive change that can occur in which of the following conditions?? {'A': 'Primary hyperparathyroidism', 'B': 'Chronic kidney disease', 'C': 'Sarcoidosis', 'D': 'Congenital CMV infection', 'E': 'Multiple myeloma\n"'}, | D: Congenital CMV infection |
Answer the following medical question with one of the provided options: | Q:A 37-year-old patient is being evaluated for involuntary movements, difficulty swallowing food, and personality change. He has entered a clinical trial that is studying the interaction of certain neuromediators in patients with similar (CAG) n trinucleotide repeat disorders. The laboratory results of 1 of the candidates for the clinical trial are presented below: Acetylcholine ↓ Dopamine ↑ Gamma-aminobutyric acid (GABA) ↓ Norepinephrine unchanged Serotonin unchanged Which trinucleotide disorder most likely represents the diagnosis of this patient?? {'A': 'Myotonic dystrophy', 'B': "Friedreich's ataxia", 'C': 'Fragile X syndrome', 'D': "Huntington's disease", 'E': 'Spinobulbar muscular atrophy'}, | D: Huntington's disease |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man with hypertension comes to the physician for a routine health maintenance examination. Current medications include atenolol, lisinopril, and atorvastatin. His pulse is 86/min, respirations are 18/min, and blood pressure is 145/95 mm Hg. Cardiac examination is shown. Which of the following is the most likely cause of this physical examination finding?? {'A': 'Decreased compliance of the left ventricle', 'B': 'Myxomatous degeneration of the mitral valve', 'C': 'Inflammation of the pericardium', 'D': 'Dilation of the aortic root', 'E': 'Thickening of the mitral valve leaflets'}, | A: Decreased compliance of the left ventricle |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man presents to the hospital with chief complaints of unintentional weight loss, anorexia, fever, and sweating. The patient has pleuritic chest pain, progressive dyspnea, and dry cough. There is no history of orthopnea or paroxysmal nocturnal dyspnea. On examination, the patient is afebrile and pericardial friction rub is noted. ECG shows diffuse ST-segment elevation in V1-V4 along with T wave inversion. Chest X-ray and CT scan show anterior and inferior pericardial eggshell calcification. Echocardiography reveals thickened pericardium and signs of diastolic right ventricular collapse. Pericardial fluid is sent for Ziehl-Neelsen staining to detect acid-fast bacilli. Mycobacterium tuberculosis is detected by PCR. What is the most likely mechanism associated with the patient’s condition?? {'A': 'Metastatic calcifications', 'B': 'Dystrophic calcification', 'C': 'Primary amyloidosis', 'D': 'Secondary amyloidosis', 'E': 'Age-related amyloidosis'}, | B: Dystrophic calcification |
Answer the following medical question with one of the provided options: | Q:A 7-month-old infant with Tetralogy of Fallot is brought to the emergency department by her parents because of a 1-day history of fever, cough, and difficulty breathing. She was born at 29 weeks of gestation. Her routine immunizations are up-to-date. She is currently in the 4th percentile for length and 2nd percentile for weight. She appears ill. Her temperature is 39.1°C (102.3°F). Physical examination shows diffuse wheezing, subcostal retractions, and bluish discoloration of the fingertips. Administration of which of the following would most likely have prevented this patient's current condition?? {'A': 'Ribavirin', 'B': 'Oseltamivir', 'C': 'Ganciclovir', 'D': 'Ceftriaxone', 'E': 'Palivizumab'}, | E: Palivizumab |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman has been receiving amoxicillin for acute sinusitis for 12 days. She develops a macular rash on her neck, back, and torso. The amoxicillin is therefore changed to cephalexin for an additional week. The rash resolves, but she returns complaining of fatigue, flank pain, and fever that has persisted despite the resolution of the sinusitis. She has a history of essential hypertension, hyperlipidemia, and gastric reflux. She has been on a stable regimen of lisinopril, simvastatin, and omeprazole. Today, her vital signs reveal: temperature 37.9°C (100.2°F), blood pressure 145/90 mm Hg, regular pulse 75/min, and respirations 16/min. The physical examination is unremarkable. Serum urea and creatinine are elevated. Urinalysis shows leukocyturia, but urine bacterial culture is negative. A urine cytospin stained with Hansel’s solution reveals 3% binucleated cells with eosinophilic, granular cytoplasm. Which of the following is the most likely diagnosis?? {'A': 'Acute interstitial nephritis', 'B': 'Acute glomerulonephritis', 'C': 'Acute tubular necrosis', 'D': 'Acute vascular injury', 'E': 'IgA nephropathy'}, | A: Acute interstitial nephritis |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man with a history of stage IIIa lung adenocarcinoma that has been treated with wedge resection and chemotherapy presents to the primary care clinic. He is largely asymptomatic, but he demonstrates a persistent microcytic anemia despite iron supplementation. Colonoscopy performed 3 years earlier was unremarkable. His past medical history is significant for diabetes mellitus type II, hypertension, acute lymphoblastic leukemia as a child, and hypercholesterolemia. He currently smokes 1 pack of cigarettes per day, drinks a glass of pinot grigio per day, and currently denies any illicit drug use. His vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 126/74 mm Hg; heart rate, 87/min; and respiratory rate, 17/min. On physical examination, his pulses are bounding, complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 91% on room air, with a new oxygen requirement of 2 L by nasal cannula. Which of the following lab values would suggest anemia of chronic disease as the underlying etiology?? {'A': 'Decreased serum iron and transferrin, increased ferritin, normal serum transferrin receptor', 'B': 'Decreased serum iron, increased transferrin, decreased ferritin, increased serum transferrin receptor', 'C': 'Increased serum iron and transferrin, increased ferritin, normal serum transferrin receptor', 'D': 'Decreased serum iron and transferrin, decreased ferritin, normal serum transferrin receptor', 'E': 'Increased serum iron and transferrin, decreased ferritin, normal serum transferrin receptor'}, | A: Decreased serum iron and transferrin, increased ferritin, normal serum transferrin receptor |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman presents to her physician with a painless breast mass on her left breast for the past 4 months. She mentions that she noticed the swelling suddenly one day and thought it would resolve by itself. Instead, it has been slowly increasing in size. On physical examination of the breasts, the physician notes a single non-tender, hard, and fixed nodule over left breast. An ultrasonogram of the breast shows a solid mass, and a fine-needle aspiration biopsy confirms the mass to be lobular carcinoma of the breast. When the patient asks about her prognosis, the physician says that the prognosis can be best determined after both grading and staging of the tumor. Based on the current diagnostic information, the physician says that they can only grade, but no stage, the neoplasm. Which of the following facts about the neoplasm is currently available to the physician?? {'A': 'The tumor cells exhibit marked nuclear atypia.', 'B': 'The tumor invades the pectoralis major.', 'C': 'The tumor has metastasized to the axillary lymph nodes.', 'D': 'The tumor has not metastasized to the contralateral superior mediastinal lymph nodes.', 'E': 'The tumor has spread via blood-borne metastasis.'}, | A: The tumor cells exhibit marked nuclear atypia. |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman has fallen from the second story level of her home while hanging laundry. She was brought to the emergency department immediately and presented with severe abdominal pain. The patient is anxious, and her hands and feet feel very cold to the touch. There is no evidence of bone fractures, superficial skin wounds, or a foreign body penetration. Her blood pressure is 102/67 mm Hg, respirations are 19/min, pulse is 87/min, and temperature is 36.7°C (98.0°F). Her abdominal exam reveals rigidity and severe tenderness. A Foley catheter and nasogastric tube are inserted. The central venous pressure (CVP) is 5 cm H2O. The medical history is significant for hypertension. Which of the following is best indicated for the evaluation of this patient?? {'A': 'X-Ray', 'B': 'Ultrasound', 'C': 'Peritoneal lavage', 'D': 'CT scan', 'E': 'Diagnostic laparotomy'}, | B: Ultrasound |
Answer the following medical question with one of the provided options: | Q:A 74-year-old female is brought to the emergency department because of a 2-week history of increasing weakness and chills. She also notes difficulty breathing for the last three days. Eight weeks ago, she underwent left hemicolectomy for adenocarcinoma of the colon. She subsequently developed a severe urinary tract infection, was treated in the intensive care unit for four days, and was discharged from the hospital three weeks ago. She has type 2 diabetes mellitus, osteoporosis with lumbar pain, hypertension, and atrial fibrillation. She has smoked one pack of cigarettes daily for 50 years. She does not drink alcohol and has never used illicit drugs. Current medications include warfarin, metformin, lisinopril, and aspirin. She appears lethargic and has a large conjunctival hemorrhage in her left eye. Her temperature is 39.3°C (102.7°F), pulse is 112/min, respirations are 25/min, and blood pressure is 126/79 mm Hg. Cardiac auscultation reveals a new holosystolic murmur over the apex. Abdominal examination shows mild, diffuse tenderness throughout the upper quadrants and a well-healed 12-cm paramedian scar. There are multiple tender nodules on the palmar surface of her fingertips. Funduscopic examination shows retinal hemorrhages with pale centers. An ECG shows atrial fibrillation and right bundle branch block. Which of the following is the most likely underlying etiology of this patient's condition?? {'A': 'Pulmonary metastases', 'B': 'Streptococcus sanguinis infection', 'C': 'Cardiobacterium hominis infection', 'D': 'Aspergillus fumigatus infection', 'E': 'Enterococcus faecalis infection'}, | E: Enterococcus faecalis infection |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman presents to her physician with a persistent cough. She has been unable to control her cough and also is finding it increasingly difficult to breathe. The cough has been persistent for about 2 months now, but 2 weeks ago she started noticing streaks of blood in the sputum regularly after coughing. Over the course of 4 months, she has also observed an unusual loss of 10 kg (22 lb) in her weight. She has an unchanged appetite and remains fairly active, which makes her suspicious as to the cause of her weight loss. Another troublesome concern for her is that on a couple occasions over the past few weeks, she has observed herself drenched in sweat when she wakes up in the morning. Other than having a 35 pack-year smoking history, her medical history is insignificant. She is sent for a chest X-ray which shows a central nodule of about 13 mm located in the hilar region. Which of the following would be the next best step in the management of this patient?? {'A': 'Chemotherapy', 'B': 'Mediastinoscopy', 'C': 'Radiotherapy', 'D': 'Surgical removal', 'E': 'Repeat surveillance after 6 months'}, | B: Mediastinoscopy |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the emergency department by his parents after they found him to be lethargic and febrile. His current symptoms started 1 week ago and initially consisted of a sore throat and a runny nose. He subsequently developed a fever and productive cough that has become worse over time. Notably, this patient has previously presented with pneumonia and gastroenteritis 8 times since he was born. On presentation, the patient's temperature is 103°F (39.4°C), blood pressure is 90/50 mmHg, pulse is 152/min, and respirations are 38/min. Based on clinical suspicion, an antibody panel is obtained and the results show low levels of IgG and IgA relative to the level of IgM. The expression of which of the following genes is most likely abnormal in this patient?? {'A': 'CD40L', 'B': 'STAT3', 'C': 'LYST', 'D': 'CD18', 'E': 'NADPH oxidase'}, | A: CD40L |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man comes to the emergency department because of a 2-month history of severe muscle cramps and back pain. He says that he is homeless and has not visited a physician in the past 20 years. He is 183 cm (6 ft 0 in) tall and weighs 62 kg (137 lb); BMI is 18.5 kg/m2. His blood pressure is 154/88 mm Hg. Physical examination shows pallor, multiple cutaneous excoriations, and decreased sensation over the lower extremities. Serum studies show: Calcium 7.2 mg/dL Phosphorus 5.1 mg/dL Glucose 221 mg/dL Creatinine 4.5 mg/dL An x-ray of the spine shows alternating sclerotic and radiolucent bands in the lumbar and thoracic vertebral bodies. Which of the following is the most likely explanation for these findings?"? {'A': 'Tertiary hyperparathyroidism', 'B': 'Secondary hyperparathyroidism', 'C': 'Primary hypoparathyroidism', 'D': 'Pseudohypoparathyroidism', 'E': 'Multiple myeloma'}, | B: Secondary hyperparathyroidism |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman presents to her primary care physician for knee pain. The patient states it started yesterday and has been steadily worsening. She recently joined a volleyball team to try to get into shape as she was informed that weight loss would be beneficial for her at her last physical exam. She states that she has been repetitively pivoting and twisting on her knee while playing volleyball. The patient has a past medical history of polycystic ovarian syndrome and is currently taking oral contraceptive pills. Her temperature is 98.5°F (36.9°C), blood pressure is 137/88 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam reveals an obese woman with facial hair. Physical exam is notable for tenderness that is mediated with palpation over the medial aspect of the tibia just inferior to the patella. Her BMI is 37 kg/m^2. The rest of the exam of the lower extremity is not remarkable. Which of the following is the most likely diagnosis?? {'A': 'Medial collateral ligament tear', 'B': 'Medial meniscus tear', 'C': 'Osteoarthritis', 'D': 'Patellofemoral syndrome', 'E': 'Pes anserine bursitis'}, | E: Pes anserine bursitis |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman comes to the physician because of a 6-week history of fatigue and low-grade fever. She has no history of serious illness except for a bicuspid aortic valve, diagnosed 10 years ago. She does not use illicit drugs. Her temperature is 37.7°C (99.9°F). Physical examination shows petechiae under the fingernails and multiple tender, red nodules on the fingers. A new grade 2/6 diastolic murmur is heard at the right second intercostal space. Which of the following is the most likely causal organism?? {'A': 'Enterococcus faecalis', 'B': 'Staphylococcus epidermidis', 'C': 'Streptococcus pyogenes', 'D': 'Streptococcus sanguinis', 'E': 'Streptococcus pneumoniae'}, | D: Streptococcus sanguinis |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is rushed to the emergency department after a motor vehicle accident. The patient states that he feels weakness and numbness in both of his legs. He also reports pain in his lower back. His airway, breathing, and circulation is intact, and he is conversational. Neurologic exam is significant for bilateral lower extremity flaccid paralysis and impaired pain and temperature sensation up to T10-T11 with normal vibration sense. A computerized tomography scan of the spine is performed which shows a vertebral burst fracture of the vertebral body at the level of T11. Which of the following findings is most likely present in this patient?? {'A': 'Impaired proprioception sense', 'B': 'Preserved fine touch', 'C': 'Preserved crude touch', 'D': 'Hyperreflexia at the level of the lesion', 'E': 'Normal bladder function'}, | B: Preserved fine touch |
Answer the following medical question with one of the provided options: | Q:A 58-year-old obese woman presents with painless postmenopausal bleeding for the past 5 days. A recent endometrial biopsy confirmed endometrial cancer, and the patient is scheduled for total abdominal hysterectomy and bilateral salpingo-oophorectomy. Past medical history is significant for stress incontinence and diabetes mellitus type 2. Menarche was at age 11 and menopause was at age 55. The patient has 4 healthy children from uncomplicated pregnancies, who were all formula fed. Current medications are topical estrogen and metformin. Family history is significant for breast cancer in her grandmother at age 80. Which of the following aspects of this patient’s history is associated with a decreased risk of breast cancer?? {'A': 'Early menarche', 'B': 'Obesity', 'C': 'Formula feeding', 'D': 'Endometrial cancer', 'E': 'Multiple pregnancies'}, | E: Multiple pregnancies |
Answer the following medical question with one of the provided options: | Q:A middle-aged homeless man is found lying unresponsive on the streets by the police and is rushed to the emergency department. His vital signs include: blood pressure 110/80 mm Hg, pulse rate 100/min, and respirations 10/min and shallow. On physical examination, his extremities are cold and clammy. Pupils are constricted and non-reactive. His blood glucose is 55 mg/dL. IV access is established immediately with the administration of dextrose and naloxone. In half an hour, the patient is fully conscious, alert and responsive. He denies any medical illnesses, hospitalizations, or surgeries in the past. Physical examination reveals injection track marks along both arms. He admits to the use of cocaine and heroin. He smokes cigarettes and consumes alcohol. His vital signs are now stable. A urine sample is sent for toxicology screening. Which of the following was the most likely cause of this patient’s respiratory depression?? {'A': 'Hallucinogen toxicity', 'B': 'Cocaine abuse', 'C': 'Hypoglycemia', 'D': 'Alcohol intoxication', 'E': 'Opioid intoxication'}, | E: Opioid intoxication |
Answer the following medical question with one of the provided options: | Q:A 47-year-old female with a history of hypertension presents to your outpatient clinic for numbness, tingling in her right hand that has been slowly worsening over the last several months. She has tried using a splint but receives minimal relief. She is an analyst for a large consulting firm and spends most of her workday in front of a computer. Upon examination, you noticed that the patient has a prominent jaw and her hands appear disproportionately large. Her temperature is 99 deg F (37.2 deg C), blood pressure is 154/72 mmHg, pulse is 87/min, respirations are 12/min. A fasting basic metabolic panel shows: Na: 138 mEq/L, K: 4.1 mEq/L, Cl: 103 mEq/L, CO2: 24 mEq/L, BUN: 12 mg/dL, Cr: 0.8 mg/dL, Glucose: 163 mg/dL. Which of the following tests would be most helpful in identifying the underlying diagnosis?? {'A': 'Measurement of serum morning cortisol levels and dexamethasone suppression test', 'B': 'Measurement of insulin-like growth factor 1 alone and growth hormone levels after oral glucose', 'C': 'Measurement of thyroid stimulating hormone', 'D': 'Measurement of serum growth hormone alone', 'E': 'Measurement of insulin-like growth factor 1 levels alone'}, | B: Measurement of insulin-like growth factor 1 alone and growth hormone levels after oral glucose |
Answer the following medical question with one of the provided options: | Q:A 17-year-old woman is rushed into the emergency department by her father who found her collapsed in her bedroom 15 minutes before the ambulance's arrival. There was an empty bottle of clomipramine in her bedroom which her mother takes for her depression. Vital signs include the following: respiratory rate 8/min, pulse 130/min, and blood pressure 100/60 mm Hg. On physical examination, the patient is unresponsive to vocal and tactile stimuli. Oral mucosa and tongue are dry, and the bladder is palpable. A bedside electrocardiogram (ECG) shows widening of the QRS complexes. Which of the following would be the best course of treatment in this patient?? {'A': 'Sodium bicarbonate', 'B': 'Lidocaine', 'C': 'Induced vomiting', 'D': 'Norepinephrine', 'E': 'Diazepam'}, | A: Sodium bicarbonate |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to the physician by her 30-year-old mother, who reports that her daughter has been passing multiple foul-smelling, bulky stools with flatulence every day for the last 6 months. The girl was born in Guatemala, and soon after her birth, her parents moved to the United States so that they could access better healthcare. During pregnancy, the mother had little prenatal care, but labor and delivery were uneventful. However, the newborn had significant abdominal distention immediately at birth that increased when she ate or yawned. She failed to pass stool in the first 24 hours of life and had greenish-black vomitus. The parents report similar symptoms in other family members. After diagnosis, the girl underwent a procedure that alleviated her symptoms; however, there was no remission. Her abdominal X-ray (see the first image) and barium contrast enema (second image) from when she was born is shown. Her blood pressure is 100/68 mm Hg, heart rate is 96/min, respiratory rate is 19/min, and temperature is 36.7°C (98.0°F). The girl is in the 10th percentile for height and weight. On physical exam, she has periumbilical and midepigastric tenderness to palpation without rebound tenderness or guarding. There is a slight genu varum deformity and bony tenderness noted in her legs. She has foul-smelling flatulation 2–3 times during the visit. Her rectosphincteric reflex is intact. She has decreased fecal elastase and a negative D-xylose test. Which of the following is the most appropriate long-term treatment for her condition?? {'A': 'Enzyme-replacement therapy', 'B': 'Broad-spectrum antibiotics', 'C': 'Rectal suction biopsy and surgical correction (Hirschsprung)', 'D': 'Duodenal atresia repair', 'E': 'Cholecalciferol'}, | A: Enzyme-replacement therapy |
Answer the following medical question with one of the provided options: | Q:A 60-year-old, multiparous, woman comes to the physician because of urinary leakage for the past 4 months. She involuntarily loses a small amount of urine after experiencing a sudden, painful sensation in the bladder. She wakes up at night several times to urinate, and she sometimes cannot make it to the bathroom in time. She has diabetes mellitus type 2 controlled with insulin and a history of pelvic organ prolapse, for which she underwent surgical treatment 5 years ago. Menopause was 11 years ago. She drinks 4-5 cups of coffee daily. Pelvic examination shows no abnormalities, and a Q-tip test is negative. Ultrasound of the bladder shows a normal postvoid residual urine. Which of the following is the underlying cause of this patient's urinary incontinence?? {'A': 'Recurrent pelvic organ prolapse', 'B': 'Decreased pelvic floor muscle tone', 'C': 'Increased detrusor muscle activity', 'D': 'Increased urine bladder volumes', 'E': 'Decreased estrogen levels'}, | C: Increased detrusor muscle activity |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman with type 1 diabetes mellitus comes to the emergency department for evaluation of a 1-month history of fever, fatigue, loss of appetite, and a 3.6-kg (8-lb) weight loss. She has also had a cough for the last 2 months. She reports recent loss of pubic hair. The patient immigrated from the Philippines 7 weeks ago. Her mother has systemic lupus erythematosus. She has never smoked and does not drink alcohol. Her only medication is insulin, but she sometimes misses doses. She is 165 cm (5 ft 5 in) tall and weighs 49 kg (108 lb); BMI is 18 kg/m2. She appears lethargic. Her temperature is 38.9°C (102°F), pulse is 58/min, and blood pressure is 90/60 mm Hg. Examination shows decreased sensation to touch and vibration over both feet. The remainder of the examination shows no abnormalities. Serum studies show: Na+ 122 mEq/L Cl- 100 mEq/L K+ 5.8 mEq/L Glucose 172 mg/dL Albumin 2.8 g/dL Cortisol 2.5 μg/dL ACTH 531.2 pg/mL (N=5–27 pg/mL) CT scan of the abdomen with contrast shows bilateral adrenal enlargement. Which of the following is the most likely underlying mechanism of this patient's symptoms?"? {'A': 'Adrenal infarction', 'B': 'Adrenal hemorrhage', 'C': 'Pituitary tumor', 'D': 'Infection with acid-fast bacilli', 'E': 'Autoimmune adrenalitis'}, | D: Infection with acid-fast bacilli |
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