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Answer the following medical question with one of the provided options: | Q:A 32-year-old woman is brought to the emergency department by her neighbors 30 minutes after they found her unconscious in her yard. Her neighbors report that she has been spending more time at home by herself because she recently lost her job. On arrival, she is unable to provide a history. She appears anxious. Her pulse is 76/min, respirations are 13/min, and blood pressure is 114/72 mm Hg. Examination shows significant weakness of the left upper and lower extremities. She is unable to plantarflex the ankle while supine. She is able to stand on her toes. Her gait is unsteady. Deep tendon reflexes are 3+ and symmetric. A CT scan of the head shows no abnormalities. An MRI of the brain and MR angiography show no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Conversion disorder', 'B': 'Malingering', 'C': 'Somatic symptom disorder', 'D': 'Acute stress disorder', 'E': 'Acute hemorrhagic stroke'}, | A: Conversion disorder |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought to the physician because of difficulty in walking for 5 months. His mother reports that he has trouble keeping his balance and walking without support. Over the past year, he has started to have difficulty seeing in the dark and his hearing has been impaired. Examination shows marked scaling of the skin on the face and feet and a shortened 4th toe. Muscle strength is 3/5 in the lower extremities and 4/5 in the upper extremities. Sensation to pinprick is symmetrically decreased over the legs. Fundoscopy shows peripheral pigment deposits and retinal atrophy. His serum phytanic acid concentration is markedly elevated. The patient's condition is most likely caused by a defect in which of the following cellular structures?? {'A': 'Peroxisomes', 'B': 'Mitochondria', 'C': 'Smooth endoplasmic reticulum', 'D': 'Myofilaments', 'E': 'Proteasomes'}, | A: Peroxisomes |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man presents with a rash, oral lesions, and vision problems for 5 days. He says the rash started as a burning feeling on his face and the upper part of his torso, but soon red spots appeared in that same distribution. The spots grew in size and spread to his upper extremities. The patient says the spots are painful but denies any associated pruritus. He says the painful oral lesions appeared about the same time as the rash. For the past 3 days, he also says he has been having double vision and dry, itchy eyes. He reports that he had a mild upper respiratory infection for a few days that preceded his current symptoms. The patient denies any chills, hematuria, abdominal or chest pain, or similar symptoms in the past. Past medical history is significant for a severe urinary tract infection diagnosed 3 weeks ago for which he has been taking trimethoprim-sulfamethoxazole. The vital signs include: temperature 38.3℃ (101.0℉), blood pressure 110/60 mm Hg, respiratory rate 20/min, and pulse 108/min. On physical examination, the patient has severe painful erosions of the oral mucosa. There are multiple fluid-filled vesicles and bullae averaging 3 mm in diameter with a surrounding erythematous ring that involve only the upper torso and extensor surfaces of upper extremities. Several of the lesions have ruptured, resulting in sloughing off of the epidermal layer. There is a prominent conjunctival injection present. Ophthalmic examination reveals mild bilateral corneal abrasions without any evidence of frank ulceration. Laboratory findings are significant for the following: White blood cell (WBC) count 8,500/mm3 Red blood cell (RBC) count 4.20 x 106/mm3 Hematocrit 41.5% Hemoglobin 14.0 g/dL Platelet count 215,000/mm3 C-reactive protein (CRP) 86 mg/L Urine and blood cultures are pending. Which of the following would confirm the most likely diagnosis in this patient? ? {'A': 'Gram stain and culture of skin sample', 'B': 'Biopsy and histopathologic analysis of skin lesions', 'C': 'Direct immunofluorescence analysis of perilesional skin biopsy', 'D': 'Urine collection (24-hour)', 'E': 'Flow cytometry'}, | B: Biopsy and histopathologic analysis of skin lesions |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the physician for the evaluation of fever, difficulty breathing, and coughing for the past week. In the past year, he has had four sinus infections, three upper respiratory tract infections, and an episode of severe bronchiolitis requiring hospitalization. Since birth, he has had multiple episodes of oral thrush treated with nystatin, as well as chronic diarrhea and failure to thrive. His temperature is 38.0°C (100.4°F), pulse is 130/min, respirations are 38/min, and blood pressure is 106/63 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Auscultation of the lungs show bilateral crackles and wheezing. Examination shows a prominent nasal bridge, hypoplastic wing of the nose, a shortened chin, and dysplastic ears. An x-ray of the chest shows hyperinflation of the lungs, interstitial infiltrates, and atelectasis. A nasopharyngeal aspirate test for respiratory syncytial virus (RSV) is positive. This patient most likely has a deficiency of which of the following?? {'A': 'B cells', 'B': 'T cells', 'C': 'Interleukin-12 receptor', 'D': 'B and T cells', 'E': 'Leukocyte adhesion\n"'}, | B: T cells |
Answer the following medical question with one of the provided options: | Q:A morbidly obese 43-year-old man presents for elective bariatric surgery after previously failing several non-surgical weight loss plans. After discussing the risks and benefits of several different procedures, a sleeve gastrectomy is performed. During the surgery, the surgeon begins by incising into the right half of the greater curvature of the stomach. Which of the following arteries most likely directly provides the blood supply to this region of the stomach?? {'A': 'Short gastric arteries', 'B': 'Splenic artery', 'C': 'Right gastric artery', 'D': 'Right gastroepiploic artery', 'E': 'Right gastroduodenal artery'}, | D: Right gastroepiploic artery |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought in by his parents for recurrent abdominal pain. The child has been taken out of class 5 times this past week for abdominal pain that resulted in him being sent home. The mother reports that her son's stools have remained unchanged during this time and are brown in color, without blood, and with normal consistency and scent. She also notes that while at home he seems to be his usual self and does not complain of any symptoms. Of note she presents to you that she has been preparing her son's lunches which consist of couscous, vegetables, fried rice, and chicken. The patient denies difficulty with producing stool and does not complain of any functional pain. The child's vitals and labs including BMP and CBC are unremarkable and within normal limits. An abdominal exam is performed and there is no tenderness upon palpation, and the abdomen is soft and non-distended. After a conversation with the child exploring his symptoms, which of the following is the next step in management for this child?? {'A': 'Increase oral hydration and fiber intake', 'B': 'Check the stool for fecal red blood cells and leukocytes', 'C': 'Perform a stool culture', 'D': 'Begin treatment with ciprofloxacin', 'E': 'Begin cognitive behavioral therapy'}, | E: Begin cognitive behavioral therapy |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman comes to the physician for the evaluation of a 4-month history of reddening of the nose and cheeks. She has no itching or pain. She first noticed the redness while on a recent holiday in Spain, where she stayed at the beach and did daily wine tastings. She has tried several brands of sunscreen, stopped going outside in the middle of the day, and has not drunk alcohol since her trip, but the facial redness persists. She has no history of serious illness. Her younger sister has acne vulgaris, and her mother has systemic lupus erythematosus. The patient reports that she has had a lot of stress lately due to relationship problems with her husband. She does not smoke. Her vital signs are within normal limits. Examination shows erythema of the nose, chin, and medial cheeks with scant papules and telangiectasias. There are no comedones or blisters. The remainder of the examination shows no abnormalities. In addition to behavioral modifications, which of the following is the most appropriate initial treatment?? {'A': 'Topical corticosteroids', 'B': 'Topical benzoyl peroxide', 'C': 'Oral isotretinoin', 'D': 'Oral hydroxychloroquine', 'E': 'Topical metronidazole'}, | E: Topical metronidazole |
Answer the following medical question with one of the provided options: | Q:A 25-year-old previously healthy woman presents to her PCP reporting cessation of menses for the past 6 months. Previously, her period occurred regularly, every 30 days. She also complains of decreased peripheral vision, most noticeably when she is driving her car. She denies any recent sexual activity and a pregnancy test is negative. Upon further work-up, what other physical findings may be discovered?? {'A': 'Pregnancy', 'B': 'Breast mass', 'C': 'Decreased bone density', 'D': 'Enlarged thyroid', 'E': 'Renal failure'}, | C: Decreased bone density |
Answer the following medical question with one of the provided options: | Q:A 13-year-old boy is brought to the physician because of bleeding from his lips earlier that day. He has a history of recurrent nosebleeds since childhood. His father has a similar history of recurrent nosebleeds. He is at the 60th percentile for height and weight. Examination shows multiple, small dilated capillaries over the lips, nose, and fingers. The remainder of the examination shows no abnormalities. Which of the following conditions is this patient at increased risk for?? {'A': 'Glaucoma', 'B': 'Acute leukemia', 'C': 'Renal cell carcinoma', 'D': 'High-output cardiac failure', 'E': 'Gastrointestinal polyps'}, | D: High-output cardiac failure |
Answer the following medical question with one of the provided options: | Q:A 22-year-old G1P1 has an uncomplicated vaginal delivery and delivers a newborn boy at 39 + 1 weeks. The APGAR scores are 8 and 9 at 1 and 5 minutes, respectively. Shortly after the delivery, the child is put on his mother’s chest for skin-to-skin and the mother is encouraged to initiate breastfeeding. Which of the following cels produces the hormone responsible for establishing lactation during this process?? {'A': 'Gonadotropes', 'B': 'Thyrotropes', 'C': 'Lactotropes', 'D': 'Corticotropes', 'E': 'Somatotropes'}, | C: Lactotropes |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents to the physician because of dizziness and palpitations for the past 12 hours and fever, malaise, headache, and myalgias for the past week. The patient traveled into the woods of Massachusetts 4 weeks ago. He has no known chronic medical conditions, and there is no history of substance use. His temperature is 38.3°C (100.9°F), pulse is 52/min, respirations are 16/min, and blood pressure is 126/84 mm Hg. His physical examination shows a single, 10-cm, round, erythematous lesion with a bull’s-eye pattern in the right popliteal fossa. His electrocardiogram shows Mobitz I second-degree atrioventricular (AV) block. The complete blood cell count and serum electrolyte levels are normal, but the erythrocyte sedimentation rate is 35 mm/hour. What is the most likely cause of the patient’s cardiac symptoms?? {'A': 'Mycoplasma infection', 'B': ' Spirochete infection', 'C': 'Systemic fungal infection', 'D': 'Viral infection transmitted by Aedes aegypti mosquito bite', 'E': 'Sexually transmitted bacterial infection'}, | B: Spirochete infection |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is presented to the clinic by his mother due to a peeling erythematous rash on his face, back, and buttocks which started this morning. Two days ago, the patient’s mother says his skin was extremely tender and within 24 hours progressed to desquamation. She also says that, for the past few weeks, he was very irritable and cried more than usual during diaper changes. The patient is up to date on his vaccinations and has been meeting all developmental milestones. No significant family history. On physical examination, the temperature is 38.4°C (101.1°F) and the pulse is 70/min. The epidermis separates from the dermis by gentle lateral stroking of the skin. Systemic antibiotics are prescribed, and adequate fluid replacement is provided. Which of the following microorganisms most likely caused this patient’s condition?? {'A': 'Neisseria meningitidis', 'B': 'Bacillus anthracis', 'C': 'Clostridium sp.', 'D': 'Streptococcus sp.', 'E': 'Staphylococcus aureus'}, | E: Staphylococcus aureus |
Answer the following medical question with one of the provided options: | Q:A 12-month-old boy presents for a routine checkup. The patient immigrated from the Philippines with his parents a few months ago. No prior immunization records are available. The patient’s mother claims that he had a series of shots at 6 months of age which gave him a severe allergic reaction with swelling of the tongue and the face. She also remembers that he had the same reaction when she introduced solid foods to his diet, including carrots, eggs, and bananas. Which of the following vaccinations are not recommended for this patient?? {'A': 'Measles, mumps, and rubella (MMR) vaccine', 'B': 'Intramuscular influenza vaccine', 'C': 'Varicella vaccine', 'D': 'Intranasal influenza vaccine', 'E': 'Hepatitis B vaccine'}, | B: Intramuscular influenza vaccine |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man is brought to the emergency department by a friend after he was found lying unconscious outside his front door. The friend reports that they were “pretty drunk” the previous night, and she had dropped her friend off at his home and driven off. When she came back in the morning, she found him passed out on the ground next to the doorstep. On arrival, he is conscious and cooperative. He reports feeling cold, with severe pain in his hands and face. He remembers having lost his gloves last night. His rectal temperature is 35.2°C (95.3°F), pulse is 86/min, respirations are 17/min, and blood pressure is 124/58 mm Hg. Examination shows decreased sensations over the distal fingers, which are cold to touch. The skin over the distal phalanges is cyanotic, hard, waxy, and tender, with surrounding edema. Laboratory studies are within the reference range. An x-ray of the chest and ECG show no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Debridement of the affected tissue', 'B': 'Intra-arterial administration of tissue plasminogen activator', 'C': 'Intravenous administration of warmed crystalloid', 'D': 'Intravenous administration of antibiotics', 'E': 'Immersion of affected extremities in warm water'}, | E: Immersion of affected extremities in warm water |
Answer the following medical question with one of the provided options: | Q:A 16-year-old woman presents to the emergency department for evaluation of acute vomiting and abdominal pain. Onset was roughly 3 hours ago while she was sleeping. She has no known past medical history. Her family history is positive for hypothyroidism and diabetes mellitus in her maternal grandmother. On examination, she is found to have fruity breath and poor skin turgor. She appears fatigued and her consciousness is slightly altered. Laboratory results show a blood glucose level of 691 mg/dL, sodium of 125 mg/dL, and elevated serum ketones. Of the following, which is the next best step in patient management?? {'A': 'Administer IV fluids and insulin', 'B': 'Discontinue metformin; initiate basal-bolus insulin', 'C': 'Discontinue metformin; initiate insulin aspart at mealtimes', 'D': 'Discontinue sitagliptin; initiate basal-bolus insulin', 'E': 'Discontinue metformin; initiate insulin glargine 10 units at bedtime'}, | A: Administer IV fluids and insulin |
Answer the following medical question with one of the provided options: | Q:A 4-year-old African-American girl is brought to the physician because of multiple episodes of bilateral leg pain for 4 months. The pain is crampy in nature, lasts up to an hour, and occurs primarily before her bedtime. Occasionally, she has woken up crying because of severe pain. The pain is reduced when her mother massages her legs. She has no pain while attending school or playing. Her mother has rheumatoid arthritis. The patient's temperature is 37°C (98.6°F), pulse is 90/min and blood pressure is 94/60 mm Hg. Physical examination shows no abnormalities. Her hemoglobin concentration is 12.1 g/dL, leukocyte count is 10,900/mm3 and platelet count is 230,000/mm3. Which of the following is the most appropriate next best step in management?? {'A': 'Antinuclear antibody', 'B': 'Pramipexole therapy', 'C': 'Nafcillin therapy', 'D': 'X-ray of the lower extremities', 'E': 'Reassurance'}, | E: Reassurance |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man makes an appointment with his primary care physician because he has been feeling tired and is no longer able to play on a recreational soccer team. He also says his coworkers have commented that he appears pale though he has not noticed any changes himself. He says that he has been generally healthy and that the only notable event that happened in the last year is that he went backpacking all over the world. Based on clinical suspicion, a series of blood tests are performed with partial results presented below: Hemoglobin: 9.8 g/dL Platelet count: 174,000/mm^3 Mean corpuscular volume: 72 µm^3 (normal: 80-100 µm^3) Iron: 22 µg/dL (normal: 50-170 µg/dL) Ferritin: 8 ng/mL (normal: 15-200 ng/mL) Lactate dehydrogenase: 57 U/L (normal: 45-90 U/L) Urine hemoglobin: absent Infection with which of the following types of organisms could lead to this pattern of findings?? {'A': 'Double-stranded virus', 'B': 'Nematode', 'C': 'Mosquito-born protozoa', 'D': 'Single-stranded virus', 'E': 'Tick-born protozoa'}, | B: Nematode |
Answer the following medical question with one of the provided options: | Q:A 53-year-old male presents to your office for a regularly scheduled check-up. The patient was diagnosed with type II diabetes mellitus two years ago. To date, diet, exercise, and metformin have failed to control his elevated blood glucose. Past medical history is also significant for hypertension. The patient does not smoke or use cigarettes. Laboratory values show a hemoglobin A1c (HbA1c) of 8.5%. You decide to add sitagliptin to the patient’s medication regimen. Which of the following is the direct mechanism of action of sitagliptin?? {'A': 'Inhibits degradation of endogenous incretins', 'B': 'Inhibits alpha-glucosidases at the intestinal brush border', 'C': 'Activates transcription of PPARs to increase peripheral sensitivity to insulin', 'D': 'Depolarizes potassium channels in pancreatic beta cells', 'E': 'Increases secretion of insulin in response to oral glucose loads and delays gastric emptying'}, | A: Inhibits degradation of endogenous incretins |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman presents with her husband because of left leg pain and swelling of 3 days’ duration. He has a history of type 2 diabetes mellitus and recent hospitalization for congestive heart failure exacerbation. On physical examination, the left calf is 4 cm greater in circumference than the right. Pitting edema is present on the left leg and there are superficial dilated veins. Venous duplex ultrasound shows an inability to fully compress the lumen of the profunda femoris vein. Which of the following is the most likely diagnosis?? {'A': 'Superficial venous thrombophlebitis', 'B': 'Erythema nodosum', 'C': 'Lymphangitis', 'D': 'Deep venous thrombosis', 'E': 'Ruptured popliteal cyst'}, | D: Deep venous thrombosis |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman presents to the emergency room complaining of chest pain. She reports a 4-hour history of dull substernal pain radiating to her jaw. Her history is notable for hypertension, diabetes mellitus, and alcohol abuse. She has a 30 pack-year smoking history and takes lisinopril and metformin but has an allergy to aspirin. Her temperature is 99.1°F (37.3°C), blood pressure is 150/90 mmHg, pulse is 120/min, and respirations are 22/min. Physical examination reveals a diaphoretic and distressed woman. An electrocardiogram reveals ST elevations in leads I, aVL, and V5-6. She is admitted with plans for immediate transport to the catheterization lab for stent placement. What is the mechanism of the next medication that should be given to this patient?? {'A': 'Thrombin inhibitor', 'B': 'Phosphodiesterase activator', 'C': 'Vitamin K epoxide reductase inhibitor', 'D': 'ADP receptor inhibitor', 'E': 'Cyclooxygenase activator'}, | D: ADP receptor inhibitor |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman presents with left lower limb swelling. She first noticed her left leg was swollen about 2 weeks ago. She denies any pain and initially thought the swelling would subside on its own. Past medical history is significant for hypertension and hyperlipidemia. She is a smoker with a 35 pack-year history and an occasional drinker. She takes chlorthalidone, lisinopril, atorvastatin and a multivitamin. On physical examination, her left leg appears larger than her right with 2+ pitting edema up to her knee. She also has a few distended superficial veins along the posterior aspect of her left leg. Lower extremities have 2+ pulses bilaterally. The ultrasound of her left lower thigh and leg shows an obstructing thrombosis of the distal portion of the femoral vein. Which of the following veins help to prevent this patient’s condition from happening?? {'A': 'Giacomini vein', 'B': 'Perforator veins', 'C': 'Accessory saphenous vein', 'D': 'Deep femoral vein', 'E': 'Fibular vein'}, | B: Perforator veins |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man comes to the physician because of headaches and blurry vision for the past 6 months. He also reports frequent episodes of vomiting over the last month. His father has died of renal cell carcinoma at the age of 37 years. Examination shows 20/40 vision bilaterally. Fundoscopic examination shows bilateral optic disc swelling and growth of capillary vessels in the temporal peripheral retina. An MRI of the brain shows an infratentorial mass. The patient undergoes surgical resection of the mass. A photomicrograph of the resected specimen is shown. Which of the following is the most likely diagnosis?? {'A': 'Medulloblastoma', 'B': 'Glioblastoma', 'C': 'Oligodendroglioma', 'D': 'Hemangioblastoma', 'E': 'Ependymoma'}, | D: Hemangioblastoma |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man presents to his psychiatrist for a follow-up visit. He was diagnosed with schizophrenia 6 months ago and has been taking fluphenazine. He says that his symptoms are well controlled by the medication, and he no longer has auditory hallucinations. The psychiatrist also notes that his delusions and other psychotic symptoms have improved significantly. However, the psychiatrist notices something while talking to the patient that prompts him to say, “I know the drug has effectively controlled your symptoms but I think you should discontinue it now otherwise this side effect is likely to be irreversible.” Which of the following did the psychiatrist most likely notice in this patient?? {'A': 'Resting tremors', 'B': 'Crossing and uncrossing legs constantly', 'C': 'Reduced spontaneous movements while walking ', 'D': 'Involuntary sustained twisting of neck', 'E': 'Choreoathetoid movements of face'}, | E: Choreoathetoid movements of face |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy and his 26-year-old babysitter are brought into the emergency department with severe injuries caused by a motor vehicle accident. The child is wheeled to the pediatric intensive care unit with a severe injury to his right arm, as well as other external and internal injuries. He is hemorrhaging and found to be hemodynamically unstable. He subsequently requires transfusion and surgery, and he is currently unconscious. The pediatric trauma surgeon evaluates the child’s arm and realizes it will need to be amputated at the elbow. Which of the following is the most appropriate course of action to take with regards to the amputation?? {'A': 'Amputate the child’s arm at the elbow joint', 'B': 'Wait for the child to gain consciousness to obtain his consent to amputate his arm', 'C': 'Wait for the child’s babysitter to recover from her injuries to obtain her consent to amputate the child’s arm', 'D': 'Find the child’s parents to obtain consent to amputate the child’s arm', 'E': 'Obtain an emergency court order from a judge to obtain consent to amputate the child’s arm'}, | A: Amputate the child’s arm at the elbow joint |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of difficulties achieving an erection for the past year. A medication is prescribed that inhibits cyclic GMP phosphodiesterase type 5. Which of the following is the most likely site of action of the prescribed drug?? {'A': 'Corpus cavernosum', 'B': 'Prostate smooth muscle', 'C': 'Corpus spongiosum', 'D': 'Pelvic splanchnic nerves', 'E': 'Pudendal nerve'}, | A: Corpus cavernosum |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman undergoes an abdominal hysterectomy. She develops pain and discharge at the incision site on the fourth postoperative day. The past medical history is significant for diabetes of 12 years duration, which is well-controlled on insulin. Pus from the incision site is sent for culture on MacConkey agar, which shows white-colorless colonies. On blood agar, the colonies were green. Biochemical tests reveal an oxidase-positive organism. Which of the following is the most likely pathogen?? {'A': 'Staphylococcus aureus', 'B': 'Staphylococcus epidermidis', 'C': 'Enterococcus faecalis', 'D': 'Streptococcus pyogenes', 'E': 'Pseudomonas aeruginosa'}, | E: Pseudomonas aeruginosa |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman comes to the emergency department because of difficulty walking for the past 4 hours. She first noticed her symptoms after getting up this morning and her foot dragging while walking. She feels tired. She has a history of chronic sinusitis. Six months ago, she was diagnosed with asthma. Current medications include an albuterol inhaler and inhaled corticosteroids. Her temperature is 38.9°C (102°F), pulse is 80/min, and her blood pressure is 140/90 mm Hg. Auscultation of her lungs shows diffuse wheezing over bilateral lung fields. Physical examination shows tender subcutaneous nodules on the extensor surfaces of the elbows. There are palpable, non-blanching erythematous lesions on both shins. Dorsiflexion of the right foot is impaired. Sensation to pinprick, light touch, and vibration is decreased over the ulnar aspect of the left forearm. Laboratory studies show: Hemoglobin 11.3 g/dL Leukocyte count 24,500 Segmented neutrophils 48% Eosinophils 29% Lymphocytes 19% Monocytes 4% Platelet count 290,000/mm3 Serum Urea nitrogen 32 mg/dL Creatinine 1.85 mg/dL Urine Blood 2+ Protein 3+ Which of the following is the most likely diagnosis in this patient?"? {'A': 'Granulomatosis with polyangiitis', 'B': 'Goodpasture syndrome', 'C': 'Henoch-Schönlein purpura', 'D': 'Excessive glucocorticoid use', 'E': 'Eosinophilic granulomatosis with polyangiitis\n"'}, | E: Eosinophilic granulomatosis with polyangiitis " |
Answer the following medical question with one of the provided options: | Q:A 21-year-old medical student is studying different types of necrosis and tissue injuries. In the pathology laboratory, he observes different dead tissues under the microscope and notices the changes that are occurring as a function of time. After serial observations, he deduced that coagulation necrosis is...?? {'A': 'The result of denaturation of glucose', 'B': 'The result of hydrolytic enzymes', 'C': 'Characterized by the preservation of cellular shape', 'D': 'Characteristic of brain ischemia', 'E': 'Commonly associated with acute pancreatic necrosis'}, | C: Characterized by the preservation of cellular shape |
Answer the following medical question with one of the provided options: | Q:A 35-year-old male presents to the emergency room with difficulty breathing. He is accompanied by his wife who reports that they were eating peanuts while lying in bed on their backs when he suddenly started coughing profusely. He has a significant cough and has some trouble breathing. His past medical history is notable for obesity, obstructive sleep apnea, seasonal allergies, and alcohol abuse. He uses a continuous positive airway pressure machine nightly. His medications include cetirizine and fish oil. He has a 10 pack-year smoking history. His temperature is 98.6°F (37°C), blood pressure is 125/30 mmHg, pulse is 110/min, and respirations are 23/min. Which of the following lung segments is most likely affected in this patient?? {'A': 'Inferior segment of left inferior lobe', 'B': 'Anterior segment of right superior lobe', 'C': 'Inferior segment of right inferior lobe', 'D': 'Superior segment of right inferior lobe', 'E': 'Posterior segment of right superior lobe'}, | D: Superior segment of right inferior lobe |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman, gravida 1, para 0, at 10 weeks gestation comes to the physician for her first prenatal visit. Today, she feels well. She has no history of serious illness. Her pulse is 75/min and blood pressure is 110/74 mm Hg. Examination shows no abnormalities. Ultrasonography shows a pregnancy consistent in size with a 10-week gestation. Serum studies in this patient are most likely to show which of the following sets of laboratory values? $$$ Thyroid-binding globulin %%% Free Triiodothyronine (T3) %%% Free Thyroxine (T4) %%% Total T3+T4 $$$? {'A': '↑ normal normal ↑', 'B': '↓ normal normal ↓', 'C': 'Normal normal normal normal', 'D': 'Normal ↑ ↑ ↑', 'E': '↓ ↓ normal ↓'}, | A: ↑ normal normal ↑ |
Answer the following medical question with one of the provided options: | Q:A 4-day-old boy is monitored in the well baby nursery. He was born to a G1P1 mother at 36 weeks gestation. The child is doing well, and the mother is recovering from vaginal delivery. On physical exam, there is an arousable infant who is crying vigorously and is mildly cyanotic. A red reflex is noted bilaterally on ophthalmologic exam. The infant's fontanelle is soft, and his sucking reflex is present. A positive Babinski sign is noted on physical exam bilaterally. A continuous murmur is auscultated on cardiac exam. Which of the following would most likely have prevented the abnormal finding in this infant?? {'A': 'Betamethasone', 'B': 'Delivery at 40 weeks gestation', 'C': 'Folic acid', 'D': 'Indomethacin', 'E': 'Prostaglandins'}, | D: Indomethacin |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl is brought to the physician for the evaluation of fatigue for the past 6 months. During this period, she has had a 5-kg (11-lbs) weight loss. She states that she has no friends. When she is not in school, she spends most of her time in bed. She has no history of serious illness. Her mother has major depressive disorder. She appears pale and thin. She is at 25th percentile for height, 10th percentile for weight, and 20th percentile for BMI; her BMI is 19.0. Her temperature is 37°C (98.6°F), pulse is 65/min, and blood pressure is 110/70 mm Hg. Examination shows dry skin, brittle nails, and calluses on the knuckles. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.3 g/dL Serum Na+ 133 mEq/L Cl- 90 mEq/L K+ 3.2 mEq/L HCO3- 30 mEq/L Ca+2 7.8 mg/dL Which of the following is the most likely diagnosis?"? {'A': 'Anemia', 'B': 'Milk-alkali syndrome', 'C': 'Anorexia nervosa', 'D': 'Major depressive disorder', 'E': 'Bulimia nervosa'}, | E: Bulimia nervosa |
Answer the following medical question with one of the provided options: | Q:A study is performed to determine the prevalence of a particular rare fungal pneumonia. A sample population of 100 subjects is monitored for 4 months. Every month, the entire population is screened and the number of new cases is recorded for the group. The data from the study are given in the table below: Time point New cases of fungal pneumonia t = 0 months 10 t = 1 months 4 t = 2 months 2 t = 3 months 5 t = 4 months 4 Which of the following is correct regarding the prevalence of this rare genetic condition in this sample population?? {'A': 'The prevalence at time point 2 months is 2%.', 'B': 'The prevalence at time point 3 months is 11%.', 'C': 'The prevalence at the conclusion of the study is 15%.', 'D': 'The prevalence and the incidence at time point 2 months are equal.', 'E': 'The prevalence at the conclusion of the study is 25%.'}, | E: The prevalence at the conclusion of the study is 25%. |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman comes to the physician because of a 3-year history of increasing weakness of her extremities and neck pain that is worse on coughing or sneezing. She first noticed weakness of her right upper extremity 3 years ago, which progressed to her right lower extremity 2 years ago, her left lower extremity 1 year ago, and her left upper extremity 6 months ago. She has had difficulty swallowing and speaking for the past 5 months. Vital signs are within normal limits. Examination shows an ataxic gait. Speech is dysarthritic. Muscular examination shows spasticity and muscle strength is decreased in all extremities. There is bilateral atrophy of the sternocleidomastoid and trapezius muscles. Deep tendon reflexes are 4+ bilaterally. Plantar response shows an extensor response bilaterally. Sensation is decreased below the C5 dermatome bilaterally. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Foramen magnum meningioma', 'B': 'Cerebellar astrocytoma', 'C': 'Amyotrophic lateral sclerosis', 'D': 'Multiple sclerosis', 'E': 'Cerebral glioblastoma multiforme\n"'}, | A: Foramen magnum meningioma |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to her pediatrician because of a nosebleed that will not stop. Her parents say that she started having a nosebleed about 1 hour prior to presentation. Since then they have not been able to stop the bleeding. Her past medical history is remarkable for asthma, and she has a cousin who has been diagnosed with hemophilia. Physical exam reveals diffuse petechiae and purpura. A panel of bleeding tests are obtained with the following results: Bleeding time: 11 minutes Prothrombin time: 14 seconds Partial thromboplastin time: 32 seconds Platelet count: 195,000/mm^3 Peripheral blood smear shows normal cell morphology. Which of the following characteristics is most likely true about this patient?? {'A': 'Decreased levels of von Willebrand factor', 'B': 'Mutation in glycoprotein Ib', 'C': 'Mutation in glycoprotein IIb/IIIa', 'D': 'Production of anti platelet antibodies', 'E': 'Production of antibodies against ADAMTS13'}, | C: Mutation in glycoprotein IIb/IIIa |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents to his primary care physician with a 2-month history of right upper and lower extremity weakness. He noticed the weakness when he started falling far more frequently while running errands. Since then, he has had increasing difficulty with walking and lifting objects. His past medical history is significant only for well-controlled hypertension, but he says that some members of his family have had musculoskeletal problems. His right upper extremity shows forearm atrophy and depressed reflexes while his right lower extremity is hypertonic with a positive Babinski sign. Which of the following is most likely associated with the cause of this patient's symptoms?? {'A': 'HLA-B8 haplotype', 'B': 'HLA-DR2 haplotype', 'C': 'Mutation in SOD1', 'D': 'Mutation in SMN1', 'E': 'Viral infection'}, | C: Mutation in SOD1 |
Answer the following medical question with one of the provided options: | Q:A 56-year-old African American presents to the emergency department due to abdominal pain, fatigue, and weight loss over the past 3 months. He has a long-standing history of chronic hepatitis B virus infection complicated by cirrhosis. On examination, he has jaundice, leg edema, and a palpable mass in the right upper abdominal quadrant. Abdominal ultrasound shows a 3-cm liver mass with poorly defined margins and coarse, irregular internal echoes. Lab results are shown: Aspartate aminotransferase (AST) 90 U/L Alanine aminotransferase (ALT) 50 U/L Total bilirubin 2 mg/dL Albumin 3 g/dL Alkaline phosphatase 100 U/L Alpha fetoprotein 600 micrograms/L Which of the following is a feature of this patient's condition?? {'A': 'Liver biopsy is required for diagnosis in a majority of patients', 'B': 'It arises from the bile duct epithelium', 'C': 'It arises from hepatocytes', 'D': 'Daughter cysts are usually present on abdominal ultrasound', 'E': 'Doppler blood flow shows venous pattern'}, | C: It arises from hepatocytes |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy presents to the office to establish care after recently being assigned to a shelter run by the local child protective services authority. The nurse who performed the vitals and intake says that, when offered an age-appropriate book to read while waiting for the physician, the patient said that he has never attended a school of any sort and is unable to read. He answers questions with short responses and avoids eye contact for most of the visit. His father suffers from alcoholism and physically abused the patient’s mother. Physical examination is negative for any abnormal findings, including signs of fracture or bruising. Which of the following types of abuse has the child most likely experienced?? {'A': 'Corrupting', 'B': 'Child neglect', 'C': 'No abuse', 'D': 'Active abuse', 'E': 'Passive abuse'}, | B: Child neglect |
Answer the following medical question with one of the provided options: | Q:Researchers are investigating oncogenes, specifically the KRAS gene that is associated with colon, lung, and pancreatic cancer. They have established that the gain-of-function mutation in this gene increases the chance of cancer development. They are also working to advance the research further to study tumor suppressor genes. Which of the genes below is considered a tumor suppressor gene?? {'A': 'JAK2', 'B': 'Her2/neu', 'C': 'Rb', 'D': 'BRAF', 'E': 'BCL-2'}, | C: Rb |
Answer the following medical question with one of the provided options: | Q:The success of a new treatment designed to deter people from smoking was evaluated by a team of researchers. However, the heaviest and most committed smokers in the study group were less interested in quitting and subsequently dropped out of the study. Nonetheless, the researchers continued with their research (disregarding those who dropped out), which resulted in a false conclusion that the treatment was more successful than the results would have shown under ideal study conditions. The smokers who were confirmed as quitters were actually the ones who were more interested in giving up smoking, which is why they remained in the study. Which of the following is the bias that invalidates the researchers’ conclusion in this example?? {'A': 'Ascertainment bias', 'B': 'Non-response bias', 'C': 'Exclusion bias', 'D': 'Detection bias', 'E': 'Attrition bias'}, | E: Attrition bias |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to the emergency department with complaint off dizziness and nausea for the past hour. He says that he can feel his heartbeat racing. He also reports of generalized weakness that began in the morning. He was diagnosed with end-stage renal disease 2 years ago and currently on dialysis, but he missed his last dialysis session. He has also been diabetic for the past 15 years and managed with insulin, and was also diagnosed with celiac disease 8 years ago. He does not smoke or drink alcohol. The family history is insignificant. The temperature is 36.7°C (98.0°F), blood pressure is 145/90 mm Hg, pulse is 87/min, and respiratory rate is 14/min. On physical examination, the patient looks fatigued and exhausted. The muscle strength in the lower limbs is 4/5 bilaterally. An ECG is ordered which shows peaked and narrow T waves and prolongation of PR interval. The lab test results are as follows: Serum Sodium 132 mEq/L Serum Potassium 8 mEq/L Serum Creatinine 5 mg/dL Blood urea nitrogen (BUN) 25 mg/dL What is the mechanism of action of the most likely initial treatment for the patient’s condition? ? {'A': 'Blocks Na+/K+ ATPase', 'B': 'Antagonizes the membrane action of hyperkalemia', 'C': 'Blocks B adrenergic receptors', 'D': 'Prevents platelet aggregation', 'E': 'Increase potassium loss from the gastrointestinal tract'}, | B: Antagonizes the membrane action of hyperkalemia |
Answer the following medical question with one of the provided options: | Q:A 38-year-old G1P0 woman presents to her obstetrician for a prenatal visit. She reports feeling well and has no acute concerns. She is currently at 28 weeks gestation previously confirmed by ultrasound. She takes her folate supplements daily. On physical exam, the uterus is soft and globular. The top of the uterine fundus is found around the level of the umbilicus. A fetal ultrasound demonstrates a reduced liver volume and subcutaneous fat with relative sparing of the head. Which of the following is most likely the cause of this patient's ultrasound findings?? {'A': 'Aneuploidy', 'B': 'Cigarette smoking', 'C': 'Fetal congenital heart disease', 'D': 'Fetal infection', 'E': 'Neural tube defect'}, | B: Cigarette smoking |
Answer the following medical question with one of the provided options: | Q:A 7-day-old female newborn is brought to the physician because of lethargy, vomiting, poor feeding, and diarrhea for 4 days. She was born at 39 weeks' gestation. Vital signs are within normal limits. Bilateral cataracts and icterus are present. Examination shows jaundice of the skin, and the liver is palpated 5-cm below the right costal margin. Muscle tone is decreased in all extremities. Serum glucose concentration is 40 mg/dL. Which of the following metabolites is most likely to be increased in this patient?? {'A': 'Sphingomyelin', 'B': 'Uric acid', 'C': 'Branched-chain amino acids', 'D': 'Galactose-1-phosphate', 'E': 'Limit dextrins'}, | D: Galactose-1-phosphate |
Answer the following medical question with one of the provided options: | Q:An 82-year-old man is brought to the emergency department after he was found down by his daughter. On presentation, he is alert and oriented with no obvious signs of trauma. He says that he felt lightheaded shortly before passing out and that he has been feeling extremely fatigued over the last few weeks. He has a known diagnosis of colorectal adenocarcinoma and had it surgically removed 2 months ago; however, recently he has been feeling increasingly short of breath. He has a 60-pack-year smoking history and drinks 2-3 beers a night. He worked as an insulation technician and shipyard laborer for 40 years prior to retiring at age 65. Radiographs reveal approximately a dozen new nodules scattered throughout his lungs bilaterally. Biopsy of these lesions would most likely reveal which of the following?? {'A': 'Flat cells with keratin pearls and intercellular bridges', 'B': 'Mucin-producing glands with squamous components', 'C': 'Pleomorphic giant cells', 'D': 'Psammoma bodies', 'E': 'Small dark blue cells that stain for chromogranin'}, | B: Mucin-producing glands with squamous components |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman comes to the physician because of lower back pain, night sweats, and a 5-kg (11-lb) weight loss during the past 4 weeks. She has rheumatoid arthritis treated with adalimumab. Her temperature is 38°C (100.4°F). Physical examination shows tenderness over the T10 and L1 spinous processes. Passive extension of the right hip causes pain in the right lower quadrant. The patient's symptoms are most likely caused by an organism with which of the following virulence factors?? {'A': 'Polysaccharide capsule that prevents phagocytosis', 'B': 'Surface glycolipids that prevent phagolysosome fusion', 'C': 'Polypeptides that inactivate elongation factor 2', 'D': 'Proteins that bind to the Fc region of immunoglobulin G', 'E': 'Protease that cleaves immunoglobulin A'}, | B: Surface glycolipids that prevent phagolysosome fusion |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman presents to her primary care physician for a wellness visit. She states she is generally healthy and currently has no complaints. She drinks 1 alcoholic beverage daily and is currently sexually active. Her last menstrual period was 1 week ago and it is regular. She smokes 1 pack of cigarettes per day and would like to quit. She describes her mood as being a bit down in the winter months but otherwise feels well. Her family history is notable for diabetes in all of her uncles and colon cancer in her mother and father at age 72 and 81, respectively. She has been trying to lose weight and requests help with this as well. Her diet consists of mostly packaged foods. His temperature is 98.0°F (36.7°C), blood pressure is 122/82 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Her BMI is 23 kg/m^2. Physical exam reveals a healthy woman with no abnormal findings. Which of the following is the most appropriate initial intervention for this patient?? {'A': 'Alcohol cessation', 'B': 'Bupropion', 'C': 'Colonoscopy', 'D': 'Varenicline and nicotine gum', 'E': 'Weight loss, exercise, and nutrition consultation'}, | D: Varenicline and nicotine gum |
Answer the following medical question with one of the provided options: | Q:A 55-year-old male presents to his primary care physician complaining of right hip pain for the past eight months. He also reports progressive loss of hearing over the same time period. Radiographic imaging reveals multiple areas of expanded bony cortices and coarsened trabeculae in his right hip and skull. Laboratory analysis reveals an isolated elevation in alkaline phosphatase with normal levels of serum calcium and phosphate. Which of the following histologic findings is most likely to be seen if one of the lesions were biopsied?? {'A': 'Immature woven bone with collagen fibers arranged irregularly', 'B': 'Mature lamellar bone with collagen fibers arranged in lamellae', 'C': 'Chondroblasts and chondrocytes forming a cartilaginous matrix', 'D': 'Large pleomorphic cells with numerous atypical mitotic figures and “lacey” osteoid formation', 'E': 'Sheets of monotonous round blue cells'}, | A: Immature woven bone with collagen fibers arranged irregularly |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the physician because she has not had a menstrual period for 3 months. Menarche occurred at the age of 12 years and menses occurred at regular 30-day intervals until they became irregular 1 year ago. She is 160 cm (5 ft 3 in) tall and weighs 85 kg (187 lb); BMI is 33.2 kg/m2. Physical exam shows nodules and pustules along the jaw line and dark hair growth around the umbilicus. Pelvic examination shows a normal-sized, retroverted uterus. A urine pregnancy test is negative. Without treatment, this patient is at greatest risk for which of the following?? {'A': 'Endometrioma', 'B': 'Cervical carcinoma', 'C': 'Choriocarcinoma', 'D': 'Mature cystic teratoma', 'E': 'Endometrial carcinoma'}, | E: Endometrial carcinoma |
Answer the following medical question with one of the provided options: | Q:A 33-year-old woman with Crohn’s disease colitis presents to her physician after 2 days of photophobia and blurred vision. She has had no similar episodes in the past. She has no abdominal pain or diarrhea and takes mesalazine, azathioprine, and prednisone as maintenance therapy. Her vital signs are within normal range. Examination of the eyes shows conjunctival injection. The physical examination is otherwise normal. Slit-lamp examination by an ophthalmologist shows evidence of inflammation in the anterior chamber. Which of the following is the most appropriate modification to this patient’s medication at this time?? {'A': 'Adding infliximab', 'B': 'Decreasing dose of azathioprine', 'C': 'Discontinuing sulfasalazine', 'D': 'Increasing dose of prednisone', 'E': 'No modification of therapy at this time'}, | D: Increasing dose of prednisone |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman with type 2 diabetes mellitus is admitted to the hospital because of a 2-day history of fever, breathlessness, and cough productive of large quantities of green sputum. She drinks 8 beers daily. Her temperature is 39°C (102.2°F), pulse is 110/min, respirations are 28/min, and blood pressure is 100/60 mm Hg. Blood and sputum cultures grow gram-negative, catalase-positive, capsulated bacilli. Which of the following components of the causal organism is the most likely cause of this patient's hypotension?? {'A': 'Lecithinase', 'B': 'Lipooligosaccharide', 'C': 'Poly-D-glutamate', 'D': 'Teichoic acid', 'E': 'Lipid A'}, | E: Lipid A |
Answer the following medical question with one of the provided options: | Q:A 6-month-old male presents for a routine visit to his pediatrician. Two months ago, the patient was seen for tachypnea and wheezing, and diagnosed with severe respiratory syncytial virus (RSV) bronchiolitis. After admission to the hospital and supportive care, the patient recovered and currently is not experiencing any trouble breathing. Regarding the possible of future reactive airway disease, which of the following statements is most accurate?? {'A': '“Your child’s risk of asthma is the same as the general population.”', 'B': '“There is no clear relationship between RSV and the development of asthma.”', 'C': '“Your child has a less than 5% chance of developing asthma”', 'D': '“Your child has a greater than 20% chance of developing asthma”', 'E': '“Your child’s risk of asthma is less than the general population.”'}, | D: “Your child has a greater than 20% chance of developing asthma” |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought to an outpatient clinic by his mother, who noticed that her son’s urine has been dark for the past 4 days. She initially attributed this to inadequate hydration, so she monitored her son’s fluid intake and encouraged him to drink more water. However, she noticed that the color of the urine kept getting darker until it began to resemble cola. The boy’s medical history is significant for a sore throat approx. 2 weeks ago, which resolved without medication or treatment. The boy has also been complaining of pain in his ankles, which he first noticed shortly after soccer practice 1 week ago. He has had no pain during urination or urethral discharge, however, and does not have any history of previous episodes of cola-colored urine or passage of blood in the urine. However, the boy has been experiencing intermittent episodes of abdominal pain for the past 3 days. The boy also has wheals on his torso, legs, and buttocks, which his mother attributes to seasonal allergies. Physical examination reveals an alert child who is not in obvious distress but who has a mild conjunctival pallor. Vital signs include: respiratory rate is 22/min, temperature is 36.7°C (98.0°F), and blood pressure is 130/90 mm Hg. Examination of the musculoskeletal system reveals multiple skin lesions (see image). Which of the following laboratory findings is most likely associated with this patient’s clinical presentation?? {'A': '24-hour urinary protein of more than 4 g', 'B': 'Low C-reactive protein level', 'C': 'Elevated level of serum IgA', 'D': 'Elevated IgM-IgG immune complex rheumatoid factor', 'E': 'Elevated levels of serum IgG and C3 protein'}, | C: Elevated level of serum IgA |
Answer the following medical question with one of the provided options: | Q:A 7-month-old boy is brought to the ED by his mother because of abdominal pain. Two weeks ago, she noticed he had a fever and looser stools, but both resolved after a few days. One week ago, he began to experience periodic episodes during which he would curl up into a ball, scream, and cry. The episodes lasted a few minutes, and were occasionally followed by vomiting. Between events, he was completely normal. She says the episodes have become more frequent over time, and this morning, she noticed blood in his diaper. In the ED, his vitals are within normal ranges, and his physical exam is normal. After confirming the diagnosis with an abdominal ultrasound, what is the next step in management?? {'A': 'Supportive care', 'B': 'Air contrast enema', 'C': 'Abdominal laparotomy', 'D': 'Abdominal CT scan', 'E': 'Broad-spectrum antibiotics'}, | B: Air contrast enema |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man visits a local clinic while volunteering abroad to rebuild homes after a natural disaster. He reports that he has been experiencing an intermittent rash on his feet for several weeks that is associated with occasional itching and burning. He states that he has been working in wet conditions in work boots and often does not get a chance to remove them until just before going to bed. On physical exam, there is diffuse erythema and maceration of the webspaces between his toes. He starts taking a medication. Two days later, he experiences severe nausea and vomiting after drinking alcohol. Which of the following is the mechanism of action of the drug most likely prescribed in this case?? {'A': 'Cell arrest at metaphase', 'B': 'Disruption of fungal cell membrane', 'C': 'Inhibition of cell wall synthesis', 'D': 'Inhibition of DNA synthesis', 'E': 'Inhibition of steroid synthesis'}, | A: Cell arrest at metaphase |
Answer the following medical question with one of the provided options: | Q:A 58-year-old male presents to his primary care doctor with the complaint of vision changes over the last several months. The patient's past medical history is notable for schizophrenia which has been well-controlled for the last 25 years on chlorpromazine. Which of the following is likely to be seen on ophthalmoscopy?? {'A': 'Retinitis pigmentosa', 'B': 'Macular degeneration', 'C': 'Glaucoma', 'D': 'Retinal hemorrhage', 'E': 'Corneal deposits'}, | E: Corneal deposits |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman presents with a ‘tingling’ feeling in the toes of both feet that started 5 days ago. She says that the feeling varies in intensity but has been there ever since she recovered from a stomach flu last week. Over the last 2 days, the tingling sensation has started to spread up her legs. She also reports feeling weak in the legs for the past 2 days. Her past medical history is unremarkable, and she currently takes no medications. Which of the following diagnostic tests would most likely be abnormal in this patient?? {'A': 'Noncontrast CT of the head', 'B': 'Transthoracic echocardiography', 'C': 'Serum hemoglobin concentration', 'D': 'Nerve conduction studies', 'E': 'Serum calcium concentration'}, | D: Nerve conduction studies |
Answer the following medical question with one of the provided options: | Q:А 60-уеаr-old Ніѕраnіс mаn рrеѕеntѕ to thе offісе for а rеgulаr hеаlth сhесkuр. Не hаѕ bееn wаіtіng for his hір rерlасеmеnt ѕurgеrу for osteoarthritis, whісh he was diagnosed for the past 5 уеаrѕ. Не admits to having taken high doses of painkillers for hip pain management, but now they don’t provide any pain relief. Ніѕ vіtаl ѕigns include: blood рrеѕѕurе 110/70 mm Нg, рulѕе 78/mіn, tеmреrаturе 36.7°C (98.1°F), and rеѕріrаtorу rаtе 10/mіn. Оn physical ехаmіnаtіon, thеrе іѕ а lіmіtеd rаngе of motіon of hіѕ rіght hір. The laboratory results are as follows: Hemoglobin 12 g/dL Red blood cell 5.1 million cells/µL Hematocrit 45% Total leukocyte count 6,500 cells/µL Neutrophils 71% Lymphocyte 14% Monocytes 4% Eosinophil 11% Basophils 0% Platelets 240,000 cells/µL Urinalysis shows: pH 6.2 Color light yellow RBC 7–8/ HPF WBC 10-12 /HPF Protein 1+ Cast none Glucose absent Crystal none Ketone absent Nitrite negative 24-hr urine protein excretion 0.9 g Urine for culture No growth noted after 48 hours of inoculation at 37.0°C (98.6°F) What is the most likely diagnosis?? {'A': 'Chronic pyelonephritis', 'B': 'Diffuse cortical necrosis', 'C': 'Acute tubular necrosis', 'D': 'Membranous nephropathy', 'E': 'Analgesic nephropathy'}, | E: Analgesic nephropathy |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman is hospitalized due to depression and suicidal ideation. She has a 5-year history of chaotic relationships that last only a few short weeks or months. Each relationship has left her feeling abandoned, empty, and extremely upset. During these periods, the patient confesses to shopping and making big purchases on impulse. She says she gets bored easily and moves on to the next adventure. The patient denies any changes in appetite, energy level, or concentration. On examination, multiple linear lacerations of varying phases of healing were noted on her forearms and trunk. Following consultation, she praises physicians to be ‘the best people on the planet’, but when the nurse came in to take her blood, she furiously stated that ‘all nurses are incompetent and cruel’. Which of the following is the most likely diagnosis?? {'A': 'Major depressive disorder (MDD)', 'B': 'Bipolar I disorder', 'C': 'Borderline personality disorder', 'D': 'Histrionic personality disorder', 'E': 'Factitious disorder'}, | C: Borderline personality disorder |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man is brought to the emergency department by his wife because she is concerned he is having another stroke. The patient says he woke up with right-sided facial weakness and drooping. Past medical history is significant for a recent case of shingles treated with acyclovir, and a stroke, diagnosed 10 years ago, from which he recovered with no residual functional deficits. On physical examination, there is weakness and drooping of the entire right side of the face. Sensation is intact. The remainder of the physical examination is unremarkable. Which of the following additional findings would also most likely be seen in this patient?? {'A': 'Decreased salivation', 'B': 'Partial hearing loss', 'C': 'Complete loss of taste to the tongue', 'D': 'Wrinkled forehead', 'E': 'Expressive aphasia'}, | A: Decreased salivation |
Answer the following medical question with one of the provided options: | Q:A 65-year-old male with diffuse large B cell lymphoma is treated with a chemotherapy regimen including 6-mercaptopurine. Administration of which of the following agents would increase this patient’s risk for mercaptopurine toxicity?? {'A': 'Leucovorin', 'B': 'Dexrazoxane', 'C': 'Mesna', 'D': 'Allopurinol', 'E': 'Amifostine'}, | D: Allopurinol |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of weight loss and increased urinary frequency for the past month. He has also noticed blood in the urine, usually towards the end of voiding. He emigrated to the U.S. from Kenya 5 years ago. He has smoked one pack of cigarettes daily for 35 years. Physical examination shows a palpable liver edge and splenomegaly. Laboratory studies show a hemoglobin concentration of 9.5 mg/dL and a urine dipstick is strongly positive for blood. A CT scan of the abdomen shows bladder wall thickening and fibrosis. A biopsy specimen of the bladder shows squamous cell carcinoma. Which of the following additional findings is most likely in this patient?? {'A': 'Calcified cysts in the liver', 'B': 'Dilation of right and left ventricles', 'C': 'Elevated mean pulmonary artery pressure', 'D': 'Atrophy of the retina with sclerosing keratitis', 'E': 'Peripheral nonpitting edema'}, | C: Elevated mean pulmonary artery pressure |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman is brought to the emergency department because of sudden loss of vision in her right eye that occurred 50 minutes ago. She does not have eye pain. She had several episodes of loss of vision in the past, but her vision improved following treatment with glucocorticoids. She has coronary artery disease, hypertension, type 2 diabetes mellitus, and multiple sclerosis. She underwent a left carotid endarterectomy 3 years ago. She had a myocardial infarction 5 years ago. Current medications include aspirin, metoprolol, lisinopril, atorvastatin, metformin, glipizide, and weekly intramuscular beta-interferon injections. Her temperature is 36.8°C (98.2°F), pulse is 80/min, and blood pressure is 155/88 mm Hg. Examination shows 20/50 vision in the left eye and no perception of light in the right eye. The direct pupillary reflex is brisk in the left eye and absent in the right eye. The indirect pupillary reflex is brisk in the right eye but absent in the left eye. Intraocular pressure is 18 mm Hg in the right eye and 16 mm Hg in the left eye. A white, 1-mm ring is seen around the circumference of the cornea in both eyes. Fundoscopic examination of the right eye shows a pale, white retina with a bright red area within the macula. The optic disc appears normal. Fundoscopic examination of the left eye shows a few soft and hard exudates in the superior and nasal retinal quadrants. The optic disc and macula appear normal. Which of the following is the most likely diagnosis?? {'A': 'Central serous retinopathy', 'B': 'Acute angle-closure glaucoma', 'C': 'Central retinal vein occlusion', 'D': 'Vitreous hemorrhage', 'E': 'Central retinal artery occlusion'}, | E: Central retinal artery occlusion |
Answer the following medical question with one of the provided options: | Q:A male child is presented at the pediatric clinic for a well-child visit by his mother who reports previously normal developmental milestones. The child was born at 40 weeks with no complications during pregnancy or birth. The mother notes that the child is able to sit momentarily propped up with his hand. The infant is able to sit without support. He is able to feed himself crackers and pureed food. He is constantly shaking his toy teddy bear but is able to stop when the mother says ‘no’. Which of the following indicate the most likely language milestone the child presents with?? {'A': 'Able to say his first and last name', 'B': 'Babbling', 'C': 'Cooing', 'D': 'Saying words such as apple and cat, though limited to around 4 different words', 'E': 'Two-word combinations'}, | B: Babbling |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy is brought to a child psychiatry office by his father, who is concerned about his grades and teachers’ comments that he has “problems focusing.” He has a B- average. The boy's teachers in math, social studies, and English say that he often appears to not be listening in class, instead talking to classmates, making jokes, and blurting out incorrect answers. He typically turns in his homework late or not at all. During other classes (band and science, which he enjoys), none of these behaviors are observed. At home, he enjoys playing chess and reads comic and fiction books for hours without pause. His father describes him as calm and organized at home. Formal testing reveals an intelligence quotient (IQ) of 102. Which of the following is the most likely explanation for this patient’s grades?? {'A': 'Absence seizures', 'B': 'Attention deficit hyperactivity disorder (ADHD)', 'C': 'Intellectual disability', 'D': 'Mood disorder', 'E': 'Reduced interest'}, | E: Reduced interest |
Answer the following medical question with one of the provided options: | Q:A 65-year-old male who is being treated for depression visits your emergency room complaining of being unable to urinate. In addition, the patient complains of tachycardia and dry mouth. He has no history of benign prostatic hyperplasia and reports of only being on one psychiatric medication. What type of psychiatric medication would cause such a side effect profile?? {'A': 'Monoamine oxidase inhibitor', 'B': 'Serotonin norepinephrine receptor inhibitor', 'C': 'Aminoketone', 'D': 'Selective serotonin reuptake inhibitor', 'E': 'Tricyclic antidepressant'}, | E: Tricyclic antidepressant |
Answer the following medical question with one of the provided options: | Q:A previously healthy 5-year-old boy is brought to the emergency department because of a 1-day history of high fever. His temperature prior to arrival was 40.0°C (104°F). There is no family history of serious illness. Development has been appropriate for his age. He is administered rectal acetaminophen. While in the waiting room, he becomes unresponsive and starts jerking his arms and legs back and forth. A fingerstick blood glucose concentration is 86 mg/dL. After 5 minutes, he continues having jerky movements and is unresponsive to verbal and painful stimuli. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous administration of valproate', 'B': 'Intravenous administration of lorazepam', 'C': 'Intravenous administration of phenobarbital', 'D': 'Obtain blood cultures', 'E': 'Intravenous administration of fosphenytoin'}, | B: Intravenous administration of lorazepam |
Answer the following medical question with one of the provided options: | Q:A 21-year-old man with a recent history of traumatic right femur fracture status post open reduction and internal fixation presents for follow-up. The patient says his pain is controlled with the oxycodone but he says he has been severely constipated the past 4 days. No other past medical history. Current medications are oxycodone and ibuprofen. The patient is afebrile and vital signs are within normal limits. On physical examination, surgical incision is healing well. Which of the following is correct regarding the likely role of opiates in this patient’s constipation?? {'A': 'Opiates cause rapid gastrointestinal transit', 'B': 'Opiates increase the production and secretion of pancreatic digestive enzymes', 'C': 'Opiates increase fluid absorption from the lumen leading to hard stools', 'D': 'Opiates decrease the sympathetic activity of the gut wall', 'E': 'Opiates activate the excitatory neural pathways in the gut'}, | C: Opiates increase fluid absorption from the lumen leading to hard stools |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man presents to an urgent care center with epigastric discomfort following meals and an occasional dry cough worse in the morning, both of which have increased in frequency over the past several months. He is otherwise healthy and has no additional complaints. Past medical history is significant for major depressive disease, anxiety, and hypothyroidism. Physical exam is unremarkable. Given the following options, what is the most appropriate next step in patient management?? {'A': 'Electrocardiogram', 'B': 'Lifestyle modifications', 'C': 'Begin Omeprazole therapy', 'D': 'EGD with esophageal biopsy', 'E': 'Fluoroscopic barium swallow'}, | B: Lifestyle modifications |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man comes to the physician because of a 3-month history of constipation and streaks of blood in his stool. He has had a 10-kg (22-lb) weight loss during this period. Colonoscopy shows an exophytic tumor in the sigmoid colon. A CT scan of the abdomen shows liver metastases and enlarged mesenteric and para-aortic lymph nodes. A diagnosis of stage IV colorectal cancer is made, and palliative chemotherapy is initiated. The chemotherapy regimen includes a monoclonal antibody that inhibits tumor growth by preventing ligand binding to a protein directly responsible for epithelial cell proliferation and organogenesis. Which of the following proteins is most likely inhibited by this drug?? {'A': 'ALK', 'B': 'EGFR', 'C': 'TNF-α', 'D': 'VEGF', 'E': 'CD52'}, | B: EGFR |
Answer the following medical question with one of the provided options: | Q:A 9-year-old girl is brought to the physician because her parents are concerned about their daughter's physical changes. She recently started wearing a bra and uses a facial scrub for oily skin. The parents have also noticed increasing body odor. The patient has a history of migraine headaches controlled with propranolol. She is at the 55th percentile for height and 60th percentile for weight. Examination shows separation of areola and breast contours; the nipple and areola form a secondary mound. Coarse dark axillary hair and sparse pubic hair are present. Which of the following is the most likely cause of these findings?? {'A': 'Tumor of the pineal gland', 'B': 'Hamartoma of the hypothalamus', 'C': 'Physiological development', 'D': 'Mosaic G-protein mutation', 'E': 'Functioning follicular ovarian cyst'}, | C: Physiological development |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman presents to her gynecologist to be evaluated for her inability to conceive. She is G1P0 who has a 28-day cycle and no menstrual abnormalities. Her single pregnancy terminated early with an elective abortion at the patient’s request. She had several sexual partners before meeting her husband 5 years ago. They have intercourse regularly without the use of contraception and have been tracking her ovulation cycle to try to become pregnant for at least 1 year. She reports a history of occasional malodorous vaginal discharge and mild lower abdominal pain after menses and sexual intercourse, but she notes no such symptoms recently. Her husband’s spermogram was normal. Her weight is 65 kg (143 lb) and the height is 160 cm (5 ft, 3 in). On examination, the patient’s vital signs are within normal limits. The physical examination is unremarkable. On pelvic examination, the adnexa are slightly tender to palpation bilaterally. Which of the following tests is the most reasonable to be performed next in this patient?? {'A': 'Post-coital testing of cervical mucus', 'B': 'Test for anti-Mullerian hormone', 'C': 'Exploratory laparoscopy', 'D': 'Hysterosalpingography', 'E': 'Pelvic MRI'}, | D: Hysterosalpingography |
Answer the following medical question with one of the provided options: | Q:A 10-day-old male infant is brought to the emergency room for abdominal distension for the past day. His mother reports that he has been refusing feeds for about 1 day and appears more lethargic than usual. While changing his diaper today, she noticed that the baby felt warm. He has about 1-2 wet diapers a day and has 1-2 seedy stools a day. The mother reports an uncomplicated vaginal delivery. His past medical history is significant for moderate respiratory distress following birth that has since resolved. His temperature is 101°F (38.3°C), blood pressure is 98/69 mmHg, pulse is 174/min, respirations are 47/min, and oxygen saturation is 99% on room air. A physical examination demonstrates a baby in moderate distress with abdominal distension. What is the best initial step in the management of this patient?? {'A': 'Cystoscopy', 'B': 'Radionuclide scan', 'C': 'Renal ultrasound', 'D': 'Urinary catheterization', 'E': 'Voiding cystourethrogram'}, | D: Urinary catheterization |
Answer the following medical question with one of the provided options: | Q:A 66-year-old male with a history of deep venous thrombosis is admitted to the hospital with shortness of breath and pleuritic chest pain. He is treated with an anticoagulant, but he develops significant hematochezia. His BP is now 105/60 and HR is 117; both were within normal limits on admission. The effects of the anticoagulant are virtually completely reversed with the administration of protamine. Which of the following was the anticoagulant most likely administered to this patient?? {'A': 'Warfarin', 'B': 'Enoxaparin', 'C': 'Heparin', 'D': 'Bivalirudin', 'E': 'Dabigatran'}, | C: Heparin |
Answer the following medical question with one of the provided options: | Q:A 4-day-old boy is brought to the physician because of somnolence, poor feeding, and vomiting after his first few breast feedings. He appears lethargic. His respiratory rate is 73/min. Serum ammonia is markedly increased. Genetic analysis shows deficiency in N-acetylglutamate synthase. The activity of which of the following enzymes is most likely directly affected by this genetic defect?? {'A': 'Carbamoyl phosphate synthetase I', 'B': 'Ornithine translocase', 'C': 'Argininosuccinate synthetase', 'D': 'Argininosuccinase', 'E': 'Arginase'}, | A: Carbamoyl phosphate synthetase I |
Answer the following medical question with one of the provided options: | Q:During the selection of subjects for a study on infantile vitamin deficiencies, a child is examined by the lead investigator. She is at the 75th percentile for head circumference and the 80th percentile for length and weight. She can lift her chest and shoulders up when in a prone position, but cannot roll over from a prone position. Her eyes follow objects past the midline. She coos and makes gurgling sounds. When the investigator strokes the sole of her foot, her big toe curls upward and there is fanning of her other toes. She makes a stepping motion when she is held upright and her feet are in contact with the examination table. Which of the following additional skills or behaviors would be expected in a healthy patient of this developmental age?? {'A': 'Reaches out for objects', 'B': 'Responds to calling of own name', 'C': 'Cries when separated from her mother', 'D': 'Rolls over from her back', 'E': 'Smiles at her mother'}, | E: Smiles at her mother |
Answer the following medical question with one of the provided options: | Q:Two viruses, X and Y, infect the same cell and begin to reproduce within the cell. As a result of the co-infection, some viruses are produced where the genome of Y is surrounded by the nucleocapsid of X and vice versa with the genome of X and nucleocapsid of Y. When the virus containing genome X surrounded by the nucleocapsid of Y infects another cell, what is the most likely outcome?? {'A': 'Virions containing genome X and nucleocapsid Y will be produced', 'B': 'Virions containing genome X and nucleocapsid X will be produced', 'C': 'Virions containing genome Y and nucleocapsid Y will be produced', 'D': 'Virions containing genome Y and nucleocapsid X will be produced', 'E': 'No virions will be produced'}, | B: Virions containing genome X and nucleocapsid X will be produced |
Answer the following medical question with one of the provided options: | Q:A 56-year-old Caucasian male presents to the clinic to establish care. He has never seen a physician and denies any known medical problems. Physical examination is notable for central obesity, but the patient has regular heart and lung sounds. He has a blood pressure of 157/95 mm Hg and heart rate of 92/min. He follows up 2 weeks later, and his blood pressure continues to be elevated. At this time, you diagnose him with essential hypertension and decide to initiate antihypertensive therapy. Per the Joint National Committee 8 guidelines for treatment of high blood pressure, of the following combinations of drugs, which can be considered for first-line treatment of high blood pressure in the Caucasian population?? {'A': 'ACE inhibitor, angiotensin receptor blocker (ARB), beta-blocker (BB), or thiazide', 'B': 'ACE inhibitor, ARB, CCB, or thiazide', 'C': 'ACE inhibitor, ARB, CCB or loop diuretic', 'D': 'ACE inhibitor, ARB, alpha-blocker, or loop diuretic', 'E': 'ACE inhibitor, ARB, alpha-blocker, or direct vasodilator'}, | B: ACE inhibitor, ARB, CCB, or thiazide |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman returns from a family trip to the Caribbean with three days of fever, watery diarrhea, and vomiting. She states that she tried to avoid uncooked food and unpeeled fruits on her vacation. Of note, her grandson had caught a cold from daycare prior to the trip, and she had been in close contact with the infant throughout the trip. She denies rhinorrhea or coughing. On exam, her temperature is 99.1°F (37.3°C), blood pressure is 110/68 mmHg, pulse is 113/min, and respirations are 12/min. Her stool culture is negative for bacteria. Which of the following describes the most likely cause?? {'A': 'Linear dsDNA virus', 'B': 'Linear dsRNA virus', 'C': 'ssDNA virus', 'D': '(+) ssRNA virus', 'E': '(-) ssRNA virus'}, | D: (+) ssRNA virus |
Answer the following medical question with one of the provided options: | Q:An 18-year-old high school student is brought to the emergency department after collapsing during her cheerleading practice session. She was brought to the hospital even though she regained consciousness within seconds. Her mother informs the doctor that she had a similar episode last month at a party, but they thought it was due to stress and exhaustion. Both incidents occurred in a loud and crowded environment. Her past medical history is insignificant. Her blood pressure is 120/80 mm Hg and the pulse is 77/min and regular. Physical examination findings are within normal limits. A set of tests are ordered along with a 12-lead ECG. The ECG tracing obtained is shown. What is the best treatment option for this patient?? {'A': 'Epinephrine', 'B': 'Erythromycin', 'C': 'Furosemide', 'D': 'Nadolol', 'E': 'Quinidine'}, | D: Nadolol |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man comes to the physician because of severe muscle aches and fatigue for 3 days. Last week he was diagnosed with atypical pneumonia and treated with clarithromycin. He has hyperlipidemia for which he takes lovastatin. Physical examination shows generalized tenderness of the proximal muscles in the upper and lower extremities. Serum studies show an elevated creatinine kinase concentration. This patient's current symptoms are most likely caused by inhibition of which of the following hepatic enzymes?? {'A': 'CYP2E1', 'B': 'CYP3A4', 'C': 'CYP2C9', 'D': 'CYP1A2', 'E': 'CYP2C19'}, | B: CYP3A4 |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman presents to the physician for a routine health maintenance examination. She has a history of dyslipidemia and chronic hypertension. Her medications include atorvastatin, hydrochlorothiazide, and lisinopril. She exercises every day and follows a healthy diet. She does not smoke. There is no family history of chronic disease. Her blood pressure is 130/80 mm Hg, which is confirmed on repeat measurement. Her BMI is 22 kg/m2. The physical examination shows no abnormal findings. The laboratory test results show: Serum Total cholesterol 193 mg/dL Low-density lipoprotein (LDL-C) 124 mg/dL High-density lipoprotein (HDL-C) 40 mg/dL Triglycerides 148 mg/dL The patient's 10-year risk of cardiovascular disease (CVD) is 4.6%. Which of the following is the most appropriate next step in pharmacotherapy?? {'A': 'Ezetimibe', 'B': 'Fenofibrate', 'C': 'Niacin', 'D': 'Fish oils', 'E': 'No additional pharmacotherapy at this time'}, | A: Ezetimibe |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman presents to her new doctor at 27 weeks' gestation with her second pregnancy. Her blood type is B- and the father of the child is B+. Her first child had an Apgar score of 7 at 1 minute and 9 at 5 minutes and has a B+ blood type. The fetus has a heart rate of 130/min and blood pressure of 100/58 mm Hg. There is a concern that the fetus may develop erythroblastosis fetalis (EF). Which of the following statements is true about erythroblastosis fetalis?? {'A': 'Can occur with an Rh-negative mother and Rh-positive father.', 'B': 'Rho(D) immune globulin should be administered during the first trimester.', 'C': 'The first child will always be affected, as well as all subsequent pregnancies.', 'D': 'The combination of an Rh-positive mother and an Rh-negative fetus will cause the condition.', 'E': 'In EF, IgM crosses the placenta and causes erythrocyte hemolysis in the fetus.'}, | A: Can occur with an Rh-negative mother and Rh-positive father. |
Answer the following medical question with one of the provided options: | Q:Five days after undergoing right hemicolectomy for colon cancer, a 62-year-old man has fever, abdominal pain, nausea, and urinary frequency. The surgery was uncomplicated. An indwelling urinary catheter was placed intraoperatively. His temperature is 39.4°C (102.9°F), pulse is 91/min, and blood pressure is 118/83 mm Hg. There is tenderness to palpation of the costovertebral angle. The urine collected in the catheter bag appears cloudy. Which of the following measures is most likely to have prevented this patient's current condition?? {'A': 'Urinary antiseptics', 'B': 'Early removal of catheter', 'C': 'Antimicrobial prophylaxis', 'D': 'Periurethral care', 'E': 'Daily catheter replacement'}, | B: Early removal of catheter |
Answer the following medical question with one of the provided options: | Q:A previously healthy 42-year-old man comes to the emergency room with constipation and diffuse, worsening abdominal pain for 2 days. He has no history of major medical illness. His father died in a car accident at the age of 32 years, and his mother has type 2 diabetes mellitus. A diagnosis of bowel obstruction is suspected and he is taken to the operating room for exploratory laparotomy. A partial resection of the colon is performed. The gross appearance of the patient's colonic tissue is shown. Microscopic examination shows tubular, tubulovillous, and villous adenomas. Assuming the patient's partner is not a carrier of the condition, which of the following is the likelihood that this patient’s children will develop this condition?? {'A': '100%', 'B': '25%', 'C': '75%', 'D': '50%', 'E': '0%'}, | D: 50% |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man is brought to the emergency department by his wife with a 2-hour history of diarrhea and vomiting. He says that he felt fine in the morning, but noticed that he was salivating, sweating, and feeling nauseated on the way home from his work as a landscaper. The diarrhea and vomiting then started about 10 minutes after he got home. His past medical history is significant for depression and drug abuse. His wife says that he has also been more confused lately and is afraid he may have ingested something unusual. Physical exam reveals miosis, rhinorrhea, wheezing, and tongue fasciculations. Which of the following treatments would most likely be effective for this patient?? {'A': 'Ammonium chloride', 'B': 'Atropine', 'C': 'Fomepizole', 'D': 'Naloxone', 'E': 'Sodium bicarbonate'}, | B: Atropine |
Answer the following medical question with one of the provided options: | Q:A 36-year-old female presents to clinic inquiring about the meaning of a previous negative test result from a new HIV screening test. The efficacy of this new screening test for HIV has been assessed by comparison against existing gold standard detection of HIV RNA via PCR. The study includes 1000 patients, with 850 HIV-negative patients (by PCR) receiving a negative test result, 30 HIV-negative patients receiving a positive test result, 100 HIV positive patients receiving a positive test result, and 20 HIV positive patients receiving a negative test result. Which of the following is most likely to increase the negative predictive value for this test?? {'A': 'Increased prevalence of HIV in the tested population', 'B': 'Decreased prevalence of HIV in the tested population', 'C': 'Increased number of false positive test results', 'D': 'Increased number of false negative test results', 'E': 'Decreased number of false positive test results'}, | B: Decreased prevalence of HIV in the tested population |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman is brought to the emergency room by her husband complaining, “I can’t see out of my right eye.” She was watching television last night when she covered her left eye due to an itch and discovered that she could not see. The patient denies any precipitating event, pain, swelling, flashes, floaters, or headaches. Her past medical history is significant for uncontrolled hypertension and angina. Her medications include hydrochlorothiazide, lisinopril, atorvastatin, and nitroglycerin as needed. Her physical examination is unremarkable. Fundus examination demonstrates generalized pallor and slight disc edema with no hemorrhages. What is the most likely explanation for this patient’s symptoms?? {'A': 'Acute increase in pressure of the eye', 'B': 'Detachment of the retina', 'C': 'Inflammation of the temporal artery', 'D': 'Occlusion of the ophthalmic artery by embolus', 'E': 'Optic neuritis'}, | D: Occlusion of the ophthalmic artery by embolus |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man is brought to the emergency department with shortness of breath and chest pain, 35 minutes after he was involved in a high-speed motor vehicle collision. He was the helmeted driver of a scooter hit by a truck. On arrival, he is alert and oriented with a Glasgow Coma Scale rating of 14. His temperature is 37.3°C (99.1°F), pulse is 103/min, respirations are 33/min and blood pressure is 132/88 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 94%. Examination shows multiple abrasions over his abdomen and extremities. There is a 2.5-cm (1-in) laceration on the left side of the chest. There are decreased breath sounds over the left base. Cardiac examination shows no abnormalities. The abdomen is soft and there is tenderness to palpation over the left upper quadrant. Bowel sounds are normal. His hemoglobin concentration is 13.6 g/dL, leukocyte count is 9,110/mm3, and platelet count is 190,000/mm3. A chest x-ray is shown. Which of the following is the most likely diagnosis?? {'A': 'Diaphragmatic rupture', 'B': 'Esophageal perforation', 'C': 'Diaphragmatic eventration', 'D': 'Pneumothorax', 'E': 'Phrenic nerve palsy\n"'}, | A: Diaphragmatic rupture |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man has been recently diagnosed with stage 3 squamous cell carcinoma of the oral cavity. After the necessary laboratory workup, concurrent chemoradiation therapy has been planned. Radiation therapy is planned to take place over 7 weeks and he will receive radiation doses daily, Monday–Friday, in 2.0 Gy fractions. For concurrent chemotherapy, he will receive intravenous cisplatin at a dosage of 50 mg/m2 weekly for 7 weeks. Which of the following best explains the mechanism of action of the antineoplastic drug that the patient will receive?? {'A': 'Inhibition of polymerization of tubulin', 'B': 'Inhibition of topoisomerase 2', 'C': 'Formation of interstrand DNA cross-links', 'D': 'Inhibition of topoisomerase 1', 'E': 'Free radical-mediated lipid peroxidation'}, | C: Formation of interstrand DNA cross-links |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman presents to her primary care provider with shortness of breath. She reports a 3-month history of difficulty breathing with exertion that has progressed to affect her at rest. She swims 45 minutes every day but has had trouble swimming recently due to her breathing difficulties. Her past medical history is notable for well-controlled mild intermittent asthma and generalized anxiety disorder. She has a 15 pack-year smoking history but quit 15 years ago. She does not drink alcohol. Her mother died at the age of 60 from heart failure and was a lifetime non-smoker. Her temperature is 99°F (37.2°C), blood pressure is 135/85 mmHg, pulse is 85/min, and respirations are 22/min. Her BMI is 23 kg/m^2. On exam, she has slightly increased work of breathing. Cardiac auscultation reveals a normal S1 and loud P2. An echocardiogram is performed demonstrating right ventricular hypertrophy. Her pulmonary artery pressure is 24 mmHg at rest and 40 mmHg with exercise. This patient’s condition is associated with a mutation in a gene that does which of the following?? {'A': 'Degrades proteases', 'B': 'Inhibits free radical formation', 'C': 'Inhibits smooth muscle proliferation', 'D': 'Internalizes low-density lipoprotein', 'E': 'Promotes intracellular chloride transport'}, | C: Inhibits smooth muscle proliferation |
Answer the following medical question with one of the provided options: | Q:A 20-year-old man presents to the family medicine clinic with left knee pain. He is the star running back for his college football team with a promising future in the sport. He states he injured his knee 2 days ago during the final game of the season while making a cutting move, where his foot was planted and rotated outward and his knee buckled inward. He admits to feeling a ‘pop’ and having immediate pain. He denies any locking, clicking, or giving way since the event. Physical examination reveals an antalgic gait with avoidance of active knee extension. His left knee demonstrates moderate, diffuse swelling and is very tender to palpation along the joint line. Which of the following structures is most likely damaged in this patient?? {'A': 'Anterior cruciate ligament', 'B': 'Lateral meniscus', 'C': 'Medial collateral ligament', 'D': 'Medial meniscus', 'E': 'Posterior cruciate ligament'}, | A: Anterior cruciate ligament |
Answer the following medical question with one of the provided options: | Q:A 9-year-old girl is brought to the pediatrician by her parents because of unremitting cough, fevers, night sweats, anorexia, and weight loss for 4 weeks. Her vaccinations are up to date. When asked about recent exposure to an ill person, the parents mention that she is frequently under the care of a middle-aged woman who recently immigrated from a small rural community in north India. Her temperature is 39.0°C (102.2°F), respiratory rate is 30/min, and heart rate is 120/min. Her weight is 2 standard deviations below normal for her age. Chest auscultation shows fine crackles in both lung fields. The patient is referred to a nearby children’s hospital where her clinical condition rapidly worsens over several weeks. A chest radiograph is shown. Microbiological evaluation of a bronchial aspirate reveals an organism with a cell wall that is impervious to Gram stain. Which of the following best describes the cell wall of the causative agent?? {'A': 'Low muramic acid content', 'B': 'High mycolic acid content', 'C': 'High ergosterol content', 'D': 'Absence of cellular wall', 'E': 'Teichoic acid-rich cellular wall'}, | B: High mycolic acid content |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man is brought to the emergency room with complaints of severe substernal chest pain for the last hour. The pain started suddenly, and the patient describes the pain as “going into the shoulder”. The patient took aspirin at home and has been given multiple doses of sublingual nitroglycerin, but the pain has not subsided. He has a blood pressure of 112/84 mm Hg, the pulse is 63/min, the respiratory rate is 18/min, and the temperature is 36.9°C (98.0°F). Cardiac auscultation reveals normal S1 and S2 sounds, however, an additional S4 sound is heard. The patient is sweating profusely, and the lungs are clear to auscultation. No jugular venous distension or pedal edema is observed. His initial ECG shows ST elevation in leads II, III, and aVF. Which of the following will likely have the most benefit in this patient?? {'A': 'Antiarrhythmics', 'B': 'Beta blockers', 'C': 'Clopidogrel', 'D': 'Thrombolytics', 'E': 'Percutaneous coronary intervention'}, | E: Percutaneous coronary intervention |
Answer the following medical question with one of the provided options: | Q:A 24-year-old female comes to the physician for evaluation of a delayed menstrual period and intermittent lower abdominal pain for 2 days. Menarche occurred at the age of 12 years, and menses have occurred at regular 28-day intervals. Her last menstrual period was 7 weeks ago. Two years ago, she was treated for chlamydia infection. Pelvic examination shows a soft, mildly enlarged uterus. Endometrial biopsy shows decidualization of the endometrium without chorionic villi. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Benign proliferation of myometrial smooth muscle', 'B': 'Ectopic endometrial tissue', 'C': 'Fertilized ovum outside the uterus', 'D': 'Endometrial infiltration by plasma cells', 'E': 'Empty ovum fertilized by two sperm'}, | C: Fertilized ovum outside the uterus |
Answer the following medical question with one of the provided options: | Q:A 10-year-old girl with previously diagnosed sickle cell anemia presents to the emergency room with a low-grade fever, malaise, petechiae on her arms, and a rash on her face. She regularly takes hydroxyurea and receives blood transfusions to treat her condition. Her blood tests show a hemoglobin of 4.0 g/dL, MCV of 87 fl, and 2% reticulocyte count. An attempted bone marrow biopsy was a dry, empty tap. What is the most likely diagnosis?? {'A': 'Aplastic crisis', 'B': 'Gastrointestinal bleeding', 'C': 'Anemia of chronic disease', 'D': 'Reaction to the blood transfusions', 'E': 'Sequestration crisis'}, | A: Aplastic crisis |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician because of progressive daytime sleepiness and exertional dyspnea for the past 6 months. Physical examination shows conjunctival pallor and several subcutaneous purple spots on his legs. His hemoglobin concentration is 8.5 g/dL, leukocyte count is 3,000/mm3, and platelet count is 16,000/mm3. Which of the following laboratory values is most likely to be increased in this patient?? {'A': 'Haptoglobin concentration', 'B': 'Transferrin concentration', 'C': 'Reticulocyte count', 'D': 'Erythropoietin concentration', 'E': 'Lactate dehydrogenase concentration'}, | D: Erythropoietin concentration |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man is referred to a physical therapist due to limitation of movement in the wrist and fingers of his left hand. He cannot hold objects or perform daily activities with his left hand. He broke his left arm at the humerus one month ago. The break was simple and treatment involved a cast for one month. Then he lost his health insurance and could not return for follow up. Only after removing the cast did he notice the movement issues in his left hand and wrist. His past medical history is otherwise insignificant, and vital signs are within normal limits. On examination, the patient’s left hand is pale and flexed in a claw-like position. It is firm and tender to palpation. Right radial pulse is 2+ and left radial pulse is 1+. The patient is unable to actively extend his fingers and wrist, and passive extension is difficult and painful. Which of the following is a proper treatment for the presented patient?? {'A': 'Surgical release', 'B': 'Needle fasciotomy', 'C': 'Corticosteroid injections', 'D': 'Collagenase injections', 'E': 'Botulinum toxin injections'}, | A: Surgical release |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is brought to the emergency department because of progressive left-sided scrotal pain for 4 hours. He describes the pain as throbbing in nature and 6 out of 10 in intensity. He has vomited once on the way to the hospital. He has had pain during urination for the past 4 days. He has been sexually active with 2 female partners over the past year and uses condoms inconsistently. His father was diagnosed with testicular cancer at the age of 51 years. He appears anxious. His temperature is 36.9°C (98.42°F), pulse is 94/min, and blood pressure is 124/78 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Examination shows a tender, swollen left testicle and an erythematous left hemiscrotum. Urine dipstick shows leukocyte esterase; urinalysis shows WBCs. Which of the following is the most appropriate next step in management?? {'A': 'Measurement of serum α-fetoprotein level', 'B': 'CT scan of the abdomen and pelvis', 'C': 'Surgical exploration', 'D': 'Scrotal ultrasonography', 'E': 'Measurement of serum mumps IgG titer'}, | D: Scrotal ultrasonography |
Answer the following medical question with one of the provided options: | Q:A 4-month-old boy is brought to the physician because of a lesion on his right thigh. Yesterday, he was administered all scheduled childhood immunizations. His vital signs are within normal limits. Physical examination shows a 2-cm sized ulcer with surrounding induration over the right anterolateral thigh. Which of the following is the most likely cause of his symptoms?? {'A': 'Dermal mast cell activation', 'B': 'Immune complex deposition', 'C': 'Intradermal acantholysis', 'D': 'Infective dermal inflammation', 'E': 'T lymphocyte mediated hypersensitivity'}, | B: Immune complex deposition |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy presents to a pediatric orthopedic surgeon for evaluation of spinal curvature. His primary care physician noticed during an annual checkup that the boy's shoulders were uneven, and radiograph revealed early onset scoliosis. His past medical history is significant for multiple fractures as well as short stature. Based on the early presentation of scoliosis and the unusual history of fractures, the surgeon orders further workup and discovers a genetic mutation in an extracellular protein. This protein exists in two different forms. The first is an insoluble dimer that is linked by disulfide bonds and links integrins to the extracellular matrix. The second is a soluble protein that assists with clotting. Based on these descriptions, which of the following proteins is most likely mutated in this patient?? {'A': 'Dermatan sulfate', 'B': 'Fibrillin', 'C': 'Fibronectin', 'D': 'Type 1 collagen', 'E': 'Type 3 collagen'}, | C: Fibronectin |
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