instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options: | Q:An 80-year-old woman is brought to the physician by her 2 daughters for worsening memory loss. They report that their mother is increasingly forgetful about recent conversations and events. She is unable to remember her appointments and commitments she has made. 3 years ago, the patient was moved into an elder care facility because she was often getting lost on her way home and forgetting to take her medications. The patient reports that she is very socially active at her new home and has long conversations with the other residents about her adventures as an air hostess during her youth. Which of the following cerebral pathologies is most likely present in this patient?? {'A': 'Demyelination', 'B': 'Intracytoplasmic vacuoles', 'C': 'Lacunar infarcts', 'D': 'Lewy bodies', 'E': 'Neurofibrillary tangles'}, | E: Neurofibrillary tangles |
Answer the following medical question with one of the provided options: | Q:An experimental new drug (SD27C) is being studied. This novel drug delivers insulin via the intranasal route. Consent is obtained from participants who are diabetic and are taking insulin as their current treatment regimen to participate in a clinical trial. 500 patients consent and are divided into 2 groups, and a double-blind clinical trial was conducted. One group received the new formulation (SD27C), while the second group received regular insulin via subcutaneous injection. The results showed that the treatment outcomes in both groups are the same. SD27C is currently under investigation in which phase of the clinical trial?? {'A': 'Phase IV', 'B': 'Phase III', 'C': 'Post-market surveillance', 'D': 'Phase II', 'E': 'Phase I'}, | B: Phase III |
Answer the following medical question with one of the provided options: | Q:A 65-year-old woman presents with progressive gait difficulty, neck pain, and bladder incontinence. She also complains of urinary urgency. Past medical history is significant for uncontrolled diabetes mellitus with a previous hemoglobin A1c of 10.8%. Physical examination reveals slightly increased muscle tone in all limbs with brisk tendon reflexes. Sensory examination reveals a decrease of all sensations in a stocking and glove distribution. Her gait is significantly impaired. She walks slowly with small steps and has difficulty turning while walking. She scores 23 out of 30 on a mini-mental state examination (MMSE). A brain MRI reveals dilated ventricles with a callosal angle of 60 degrees and mild cortical atrophy. What is the most appropriate next step in the management of this patient?? {'A': 'Acetazolamide', 'B': 'Donepezil', 'C': 'Large-volume lumbar tap', 'D': 'Levodopa', 'E': 'Ventriculoperitoneal shunt'}, | C: Large-volume lumbar tap |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman presents to the emergency department because of increasingly severe right upper abdominal pain, fever, and non-bloody vomiting for the last 5 hours. The pain is dull, intermittent, and radiates to her right shoulder. During the past 3 months, she has had recurring abdominal discomfort after meals. The patient underwent an appendectomy more than 30 years ago. She has hypertension, diabetes mellitus type 2, and chronic back pain. She takes bisoprolol, metformin, and ibuprofen daily. She is 171 cm (5 ft 6 in) tall and weighs 99 kg (218 lb). Her BMI is 35.2 kg/m2. She appears uncomfortable and is clutching her abdomen. Her temperature is 38.5°C (101.3°F), pulse is 108/min, and blood pressure is 150/82 mm Hg. Abdominal examination shows right upper quadrant abdominal tenderness and guarding. Upon deep palpation of the right upper quadrant, the patient pauses during inspiration. Laboratory studies show the following: Blood Hemoglobin 13.1 g/dL Leukocyte count 10,900/mm3 Platelet count 236,000/mm3 Mean corpuscular volume 89/µm3 Serum Urea nitrogen 28 mg/dL Glucose 89 mg/dL Creatinine 0.7 mg/dL Bilirubin Total 1.6 mg/dL Direct 1.1 mg/dL Alkaline phosphatase 79 U/L Alanine aminotransferase (ALT, GPT) 28 U/L Aspartate aminotransferase (AST, GOT) 32 U/L An X-ray of the abdomen shows no abnormalities. Further evaluation of the patient is most likely to reveal which of the following?? {'A': 'Elevated carbohydrate-deficient transferrin', 'B': 'Frequent, high-pitched bowel sounds on auscultation', 'C': 'History of multiple past pregnancies', 'D': 'History of recent travel to Indonesia', 'E': 'History of recurrent sexually transmitted infections'}, | C: History of multiple past pregnancies |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man is running a marathon (42.2 km) on a hot summer day and collapses about halfway through the run. Emergency personnel are called and find him having a seizure. As the seizure subsides, the runner exhibits confusion, dry lips and decreased skin turgor. On the way to the emergency department, he denies taking medication or having a history of seizures. He reports that he drank water, but he admits that it was probably not enough. Which of the following would be the next best step in the management of this patient?? {'A': 'Indapamide', 'B': 'Relcovaptan', 'C': '3% NaCl', 'D': '0.9% NaCl', 'E': 'Furosemide'}, | C: 3% NaCl |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman comes to the physician for a 2-month history of chest pain and heartburn after meals. The patient reports that the pain is worse at night and especially when lying down. She has a history of Raynaud's disease treated with nifedipine. There is no family history of serious illness. She emigrated to the US from Nigeria 5 years ago. She does not smoke or drink alcohol. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Thickening and hardening of the skin is seen on the hands and face. There are several firm, white nodules on the elbows and fingertips. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Anti-RNA polymerase III antibodies', 'B': 'Anti-U1 RNP antibodies', 'C': 'Anticentromere antibodies', 'D': 'Anti-Scl-70 antibodies', 'E': 'Anti-dsDNA antibodies'}, | C: Anticentromere antibodies |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man is evaluated in the clinic for several episodes of diarrhea during the past 2 months. He denies having fever or abdominal pain and states that his diarrhea has been getting worse despite the use of over-the-counter loperamide and bismuth compounds. Upon further questioning, he recalls having multiple episodes of a burning sensation in his neck and upper chest, associated with redness and flushing of his face, which lasted for a few seconds. Because of his hypertension and dyslipidemia, the man is taking amlodipine and following a low-calorie diet. Physical examination shows that the blood pressure is 129/89 mm Hg, the pulse rate is 78/min, the respiratory rate is 14/min, and the temperature is 36.6°C (98.0°F). His abdomen is lax with no tenderness or rigidity, and rectal examination shows no blood in the rectal vault. Cardiac auscultation reveals a 3/6 holosystolic murmur in the tricuspid area, which increases in intensity with inspiration. Altered metabolism of which of the following amino acids is most likely the explanation for this patient’s presentation?? {'A': 'Phenylalanine', 'B': 'Tryptophan', 'C': 'Homocysteine', 'D': 'Arginine', 'E': 'Glycine'}, | B: Tryptophan |
Answer the following medical question with one of the provided options: | Q:A 15-month-old girl is brought to the emergency department shortly after a 2-minute episode of rhythmic eye blinking and uncontrolled shaking of all limbs. She was unresponsive during the episode. For the past few days, the girl has had a fever and mild nasal congestion. Her immunizations are up-to-date. Her temperature is 39.2°C (102.6°F), pulse is 110/min, respirations are 28/min, and blood pressure is 88/45 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 100%. She is sleepy but opens her eyes when her name is called. Examination shows moist mucous membranes. Neurologic examination shows no abnormalities. The neck is supple with normal range of motion. An oral dose of acetaminophen is administered. On re-evaluation, the girl is alert and playing with toys in the examination room. Which of the following is the most appropriate next step in management?? {'A': 'Perform an EEG', 'B': 'Perform a CT scan of the head', 'C': 'Observe the patient for 24 hours', 'D': 'Discharge the patient', 'E': 'Administer lorazepam'}, | D: Discharge the patient |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents with involuntary jerks seen in his upper extremities. The patient’s mother says that “his eyes move in different directions every now and then”. Last winter, the patient had chickenpox but otherwise has always been healthy. His vital signs are a blood pressure of 100/90 mm Hg, temperature of 36.8°C (98.2°F), and respiratory rate of 17/min. On physical examination, the patient’s eyes move chaotically in all directions. Laboratory tests are unremarkable, except for a random urinary vanillylmandelic acid (VMA) level of 18 mg/g creatinine (reference range for children aged 2–4 years: < 13 mg/g creatinine). An abdominal ultrasound shows a 2 cm x 3 cm x 5 cm mass in the left adrenal gland. A biopsy of the mass reveals neuroblasts arranged in a rosette pattern. Which of the following oncogenes is most commonly associated with this condition?? {'A': 'MYCN', 'B': 'KRAS', 'C': 'ALK', 'D': 'JAK2', 'E': 'RET'}, | A: MYCN |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man undergoes surgical intervention due to a right upper quadrant stab wound. His gallbladder was found to be lacerated and is removed. It is sent for histological evaluation. The pathologist examines the slide shown in the exhibit and identifies several structures numbered the image. Which of the following statements is correct?? {'A': 'The function of the cells in area 1 is to secrete bile', 'B': 'The cells in area 3 are inactivated by cholecystokinin', 'C': 'The cells in area 2 belong to muscularis propria', 'D': 'This section is taken from the site which does not adjoin liver', 'E': 'Normally, there should be goblet cells among the cells in area 1'}, | D: This section is taken from the site which does not adjoin liver |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man presents to the emergency department for a fever and abdominal pain. The patient states that his pain has been worsening over the past week in the setting of a fever. He has a past medical history of IV drug abuse and multiple admissions for septic shock. His temperature is 102°F (38.9°C), blood pressure is 94/54 mmHg, pulse is 133/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for a murmur over the left upper sternal border. Abdominal exam reveals left upper quadrant tenderness. Laboratory values are ordered as seen below. Hemoglobin: 15 g/dL Hematocrit: 44% Leukocyte count: 16,700/mm^3 Platelet count: 299,000/mm^3 Which of the following is the most likely diagnosis?? {'A': 'Appendicitis', 'B': 'Diverticulitis', 'C': 'Hepatic abscess', 'D': 'Mesenteric ischemia', 'E': 'Splenic abscess'}, | E: Splenic abscess |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man is brought to the emergency department from a senior-care facility after he was found with a decreased level of consciousness and fever. His personal history is relevant for colorectal cancer that was managed with surgical excision of the tumor. Upon admission, he is found to have a blood pressure of 130/80 mm Hg, a pulse of 102/min, a respiratory rate of 20/min, and a body temperature 38.8°C (101.8°F). There is no rash on physical examination; he is found to have neck rigidity, confusion, and photophobia. There are no focal neurological deficits. A head CT is normal without mass or hydrocephalus. A lumbar puncture was performed and cerebrospinal fluid (CSF) is sent to analysis while ceftriaxone and vancomycin are started. Which of the following additional antimicrobials should be added in the management of this patient?? {'A': 'Ampicillin', 'B': 'Amphotericin', 'C': 'Clindamycin', 'D': 'Trimethoprim-sulfamethoxazole (TMP-SMX)', 'E': 'Meropenem'}, | A: Ampicillin |
Answer the following medical question with one of the provided options: | Q:A 13-year-old boy re-presents to his pediatrician with a new onset rash that began a few days after his initial visit. He initially presented with complaints of sore throat but was found to have a negative strep test. His mother demanded that he be placed on antibiotics, but this was refused by his pediatrician. The boy's father, a neurologist, therefore, started him on penicillin. Shortly after starting the drug, the boy developed a fever and a rash. The patient is admitted and his symptoms worsen. His skin begins to slough off, and the rash covers over 30% of his body. His oropharynx and corneal membranes are also affected. You examine him at the bedside and note a positive Nikolsky's sign. What is the most likely diagnosis?? {'A': 'Erythema Multiforme', 'B': 'Stevens-Johnson Syndrome', 'C': 'Toxic Epidermal Necrolysis', 'D': 'Rocky Mounted Spotted Fever', 'E': 'Pemphigus Vulgaris'}, | C: Toxic Epidermal Necrolysis |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl who recently immigrated to the United States from Bolivia presents to her primary care physician with a chief complaint of inattentiveness in school. The patient's teacher describes her as occasionally "day-dreaming" for periods of time during which the patient does not respond or participate in school activities. Nothing has helped the patient change her behavior, including parent-teacher conferences or punishment. The patient has no other complaints herself. The only other concern that the patient's mother has is that upon awakening she notices that sometimes the patient's arm will jerk back and forth. The patient states she is not doing this intentionally. The patient has an unknown past medical history and is currently not on any medications. On physical exam you note a young, healthy girl whose neurological exam is within normal limits. Which of the following is the best initial treatment?? {'A': 'Carbamazepine', 'B': 'Ethosuximide', 'C': 'Valproic acid', 'D': 'Lamotrigine', 'E': 'Cognitive behavioral therapy'}, | C: Valproic acid |
Answer the following medical question with one of the provided options: | Q:A 29-year-old man is brought to the emergency room 6 hours after the onset of severe epigastric pain and vomiting. His heart rate is 110/min and blood pressure is 98/72 mm Hg. He is diagnosed with acute pancreatitis, and fluid resuscitation with normal saline is initiated. Which of the following is the most likely immediate effect of fluid resuscitation in this patient?? {'A': 'Increase in cardiac afterload', 'B': 'Increase in volume of distribution', 'C': 'Increase in myocardial oxygen demand', 'D': 'Increase in plasma oncotic pressure', 'E': 'Increase in glomerular filtration fraction\n"'}, | C: Increase in myocardial oxygen demand |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman presents with abdominal pain and discomfort for the past 3 days. She was diagnosed with irritable bowel syndrome (IBS) a couple of years ago, managed until recently with imipramine, psyllium, and loperamide. 5 days ago, because she had developed alternating diarrhea and constipation, bloating, and abdominal pain on her medication, she was started on alosetron. Her current temperature is 39.0°C (102.2°F), the heart rate is 115/min, the blood pressure is 90/60 mm Hg and the respiratory rate is 22/min. Abdominal examination shows diffuse tenderness to palpation with guarding but no rebound. Bowel sounds are hypoactive on auscultation. A fecal occult blood test is positive and laboratory tests show her white cell count to be 15,800/µL. Arterial blood gas (ABG) analysis reveals a metabolic acidosis Which of the following is the most likely diagnosis in this patient?? {'A': 'Pseudomembranous colitis', 'B': 'Crohn’s disease', 'C': 'Perforated duodenal ulcer', 'D': 'Appendicitis', 'E': 'Ischemic colitis'}, | E: Ischemic colitis |
Answer the following medical question with one of the provided options: | Q:A 34-year-old patient with a history of anxiety, chronic constipation, chronic headaches, and chronic hypertension presents to the emergency room with severe right flank pain radiating to his scrotum. A urinalysis with stone analysis is performed and the results are shown in figure A. Prior to discharge, it is noted that the patients BP is still 170/110 mmHg. Furthermore, his calcium and PTH levels were both found to be increased. Which of the following representative histology slides of thyroid tissue represents a potential complication of the patients condition?? {'A': 'Anaplastic thyroid cancer', 'B': 'Medullary thyroid cancer', 'C': 'Papillary thyroid cancer', 'D': 'Lymphoma', 'E': 'Follicular thyroid cancer'}, | B: Medullary thyroid cancer |
Answer the following medical question with one of the provided options: | Q:A 10-year-old boy presents with a painful rash for 1 day. He says that the reddish, purple rash started on his forearm but has now spread to his abdomen. He says there is a burning pain in the area where the rash is located. He also says he has had a stuffy nose for several days. Past medical history is significant for asthma and epilepsy, medically managed. Current medications are a daily chewable multivitamin, albuterol, budesonide, and lamotrigine. On physical examination, there is a red-purple maculopapular rash present on upper extremities and torso. There are some blisters present over the rash, as shown in the image, which is also present in the oral mucosa. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Budesonide', 'B': 'Infection', 'C': 'Lamotrigine', 'D': 'Multivitamin', 'E': 'Albuterol'}, | C: Lamotrigine |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man presents to the endocrinologist with complaints of increased shoe size and headaches in the morning. These symptoms have developed gradually over the past year but have become especially concerning because he can no longer wear his normal-sized boots. He denies any other symptoms, including visual changes. He was recently started on lisinopril by his primary care physician for high blood pressure. His vital signs are within normal limits and stable. On exam, the endocrinologist notes the findings shown in Figures A and B. These facial features are especially striking when contrasted with his drivers license from 10 years prior, when his jaw was much less prominent. The endocrinologist sends a screening blood test to work-up the likely diagnosis. Which of the following organs or glands produces the molecule being tested in this screening?? {'A': 'Anterior pituitary gland', 'B': 'Liver', 'C': 'Posterior pituitary gland', 'D': 'Pancreas', 'E': 'Kidney'}, | B: Liver |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man is brought to the emergency department because of dull lower abdominal pain for 3 hours. He has not urinated for 24 hours and has not passed stool for over 3 days. He was diagnosed with herpes zoster 4 weeks ago and continues to have pain even after his rash resolved. He has hypertension, benign prostatic hyperplasia, and coronary artery disease. Physical examination shows a tender, palpable suprapubic mass. Bowel sounds are hypoactive. Abdominal ultrasound shows a large anechoic mass in the pelvis. Which of the following drugs most likely accounts for this patient's current symptoms?? {'A': 'Simvastatin', 'B': 'Pregabalin', 'C': 'Amlodipine', 'D': 'Valproate', 'E': 'Desipramine'}, | E: Desipramine |
Answer the following medical question with one of the provided options: | Q:A 12-year-old girl presents to the pediatric dermatologist with an expanding, but otherwise asymptomatic erythematous patch on her right shoulder, which she first noticed 3 days ago. The girl states the rash started as a small red bump but has gradually progressed to its current size. No similar lesions were observed elsewhere by her or her mother. She has felt ill and her mother has detected intermittent low-grade fevers. During the skin examination, a target-like erythematous patch, approximately 7 cm in diameter, was noted on the left shoulder (as shown in the image). Another notable finding was axillary lymphadenopathy. On further questioning it was revealed that the patient went camping with her grandfather approximately 11 days ago; however, she does not recall any insect bites or exposure to animals. The family has a pet cat living in their household. Based on the history and physical examination results, what is the most likely diagnosis?? {'A': 'Tinea corporis', 'B': 'Lyme disease', 'C': 'Granuloma anulare', 'D': 'Pityriasis rosea', 'E': 'Hansen’s disease'}, | B: Lyme disease |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man with a 35-pack-year history of smoking is found to be lethargic three days being admitted with a femur fracture following a motor vehicle accident. His recovery has been progressing well thus far, though pain continued to be present. On exam, the patient minimally responsive with pinpoint pupils. Vital signs are blood pressure of 115/65 mmHg, HR 80/min, respiratory rate 6/min, and oxygen saturation of 87% on room air. Arterial blood gas (ABG) shows a pH of 7.24 (Normal: 7.35-7.45), PaCO2 of 60mm Hg (normal 35-45mm Hg), a HCO3 of 23 mEq/L (normal 21-28 mEq/L) and a Pa02 of 60 mmHg (normal 80-100 mmHg). Which of the following is the most appropriate therapy at this time?? {'A': 'Repeat catheterization', 'B': 'Glucocorticoids', 'C': 'Heparin', 'D': 'Naloxone', 'E': 'Emergent cardiac surgery'}, | D: Naloxone |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman comes to the physician for the evaluation of infertility. She has been unable to conceive for the past 2 years. Menses occur at 45 to 80-day intervals. She is 168 cm (5 ft 6 in) tall and weighs 77 kg (170 lb); BMI is 27.4 kg/m2. Physical examination shows facial acne and pigmented hair on the upper lip. Serum studies show elevated levels of testosterone and an LH:FSH ratio of 4:1. Treatment with the appropriate drug for this patient's infertility is begun. Which of the following is the primary mechanism of action of this drug?? {'A': 'Activation of pituitary dopamine receptors', 'B': 'Inhibition of endometrial progesterone receptors', 'C': 'Activation of ovarian luteinizing hormone receptors', 'D': 'Activation of granulosa cell aromatase', 'E': 'Inhibition of hypothalamic estrogen receptors'}, | E: Inhibition of hypothalamic estrogen receptors |
Answer the following medical question with one of the provided options: | Q:A six-year-old male presents to the pediatrician for a well child visit. The patient’s parents report that they are struggling to manage his temper tantrums, which happen as frequently as several times per day. They usually occur in the morning before school and during mealtimes, when his parents try to limit how much he eats. The patient often returns for second or third helpings at meals and snacks throughout the day. The patient’s parents have begun limiting the patient’s food intake because he has been gaining weight. They also report that the patient recently began first grade but still struggles with counting objects and naming letters consistently. The patient sat without support at 11 months of age and walked at 17 months of age. He is in the 99th percentile for weight and 5th percentile for height. On physical exam, he has almond-shaped eyes and a downturned mouth. He has poor muscle tone. Which of the following additional findings would most likely be seen in this patient?? {'A': 'Ataxia', 'B': 'Hemihyperplasia', 'C': 'Hypogonadism', 'D': 'Macroorchidism', 'E': 'Webbed neck'}, | C: Hypogonadism |
Answer the following medical question with one of the provided options: | Q:A 72-year-old and his caregiver present for a follow-up after a transthoracic needle biopsy of one of the large lesions in his chest was reported as non-small cell carcinoma of the lung. Previously, a chest CT revealed numerous nodules in the lungs bilaterally. The chest CT was ordered after the patient experienced a persistent cough with hemoptysis and a history of multiple episodes of pneumonia over the past year. The patient has a history of dementia and is a poor historian. The caregiver states that the patient has no history of smoking and that he was a lawyer before he retired, 10 years ago. The caregiver can only provide a limited medical history, but states that the patient sees another doctor “to monitor his prostate”. Which of the following is true regarding the pathogenesis of the nodules seen in this patient?? {'A': "Aspergillus infection leading to a formation of a 'fungus ball'", 'B': 'Malignant transformation of neuroendocrine cells', 'C': 'Infection of the lung parenchyma with a gram-negative bacteria grown on charcoal yeast agar', 'D': 'Proliferation of cells that contain glands that produce mucin', 'E': 'Tumors seeded via the pulmonary arteries'}, | E: Tumors seeded via the pulmonary arteries |
Answer the following medical question with one of the provided options: | Q:A 21-year-old African American female presents to her primary care physician reporting a history of excess hair growth. She has to shave her face and chest on a regular basis. She is sexually active and uses condoms for protection. Her last period was two months ago and she reports having 5-6 menstrual periods per year at irregular intervals. She has no past medical history and takes no medications. She drinks socially and does not smoke. Her family history is notable for heart disease in her father and endometrial cancer in her mother. Her temperature is 98.6°F (37°C), blood pressure is 125/85 mmHg, pulse is 95/min, and respirations are 16/min. The physician considers starting the patient on a medication that is also indicated in the treatment of histoplasmosis. This medication primary acts by inhibiting which of the following proteins?? {'A': 'Squalene epoxidase', 'B': 'Desmolase', 'C': 'Aromatase', 'D': '5-alpha-reductase', 'E': '1,3-beta-glucan synthase'}, | B: Desmolase |
Answer the following medical question with one of the provided options: | Q:A previously healthy 18-year-old woman comes to the emergency department for evaluation of intractable vomiting and uterine cramping. Her last menstrual period was 7 weeks ago. Serum β-human chorionic gonadotropin concentration is 170,000 mIU/mL. A transvaginal ultrasound shows a complex intrauterine mass with numerous anechoic spaces and multiple ovarian cysts. The patient undergoes dilation and curettage, which shows hydropic villi with diffuse, circumferential trophoblastic proliferation. Karyotype analysis of the specimen is most likely to show which of the following?? {'A': '46,XX of maternal origin only', 'B': '69,XXY of paternal origin only', 'C': '46,XX of paternal origin only', 'D': '46,XY of both maternal and paternal origin', 'E': '69,XYY of both maternal and paternal origin'}, | C: 46,XX of paternal origin only |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to the emergency department for sudden pain in his foot. The patient states that when he woke up, he experienced severe pain in his right great toe. The patient’s wife immediately brought him to the emergency department. The patient has a past medical history of diabetes mellitus, obesity, and hypertension and is currently taking insulin, metformin, lisinopril, and ibuprofen. The patient is a current smoker and smokes 2 packs per day. He also drinks 3 glasses of whiskey every night. The patient is started on IV fluids and corticosteroids. His blood pressure, taken at the end of this visit, is 175/95 mmHg. As the patient’s symptoms improve, he asks how he can avoid having these symptoms again in the future. Which of the following is the best initial intervention in preventing a future episode of this patient’s condition?? {'A': 'Allopurinol', 'B': 'Hydrochlorothiazide', 'C': 'Lifestyle measures', 'D': 'Niacin', 'E': 'Probenecid'}, | C: Lifestyle measures |
Answer the following medical question with one of the provided options: | Q:A 14-year-old girl is brought to the physician for a follow-up examination. She has had frequent falls over the past two years. During the past six months, the patient has been unable to walk or stand without assistance and she now uses a wheelchair. Her mother was diagnosed with a vestibular schwannoma at age 52. Her vital signs are within normal limits. Her speech is slow and unclear. Neurological examination shows nystagmus in both eyes. Her gait is wide-based with irregular and uneven steps. Her proprioception and vibration sense are absent. Muscle strength is decreased especially in the lower extremities. Deep tendon reflexes are 1+ bilaterally. The remainder of the examination shows kyphoscoliosis and foot inversion with hammer toes. This patient is most likely to die from which of the following complications?? {'A': 'Posterior fossa tumors', 'B': 'Renal cell carcinoma', 'C': 'Heart failure', 'D': 'Leukemia', 'E': 'Aspiration pneumonia'}, | C: Heart failure |
Answer the following medical question with one of the provided options: | Q:A drug discovery team is conducting research to observe the characteristics of a novel drug under different experimental conditions. The drug is converted into the inactive metabolites by an action of an enzyme E. After multiple experiments, the team concludes that as compared to physiologic pH, the affinity of the enzyme E for the drug decreases markedly in acidic pH. Co-administration of an antioxidant A increases the value of Michaelis-Menten constant (Km) for the enzyme reaction, while co-administration of a drug B decreases the value of Km. Assume the metabolism of the novel drug follows Michaelis-Menten kinetics at the therapeutic dose, and that the effects of different factors on the metabolism of the drug are first-order linear. For which of the following conditions will the metabolism of the drug be the slowest?? {'A': 'Physiologic pH, co-administration of antioxidant A, no administration of drug B', 'B': 'Acidic pH, co-administration of antioxidant A, no administration of drug B', 'C': 'Acidic pH, co-administration of antioxidant A and of drug B', 'D': 'Acidic pH, co-administration of drug B, no administration of antioxidant A', 'E': 'Acidic pH, without administration of antioxidant A or drug B'}, | B: Acidic pH, co-administration of antioxidant A, no administration of drug B |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman is brought to the emergency department 30 minutes after the onset of severe dyspnea. On arrival, she is unresponsive. Her pulse is 160/min, respirations are 32/min, and blood pressure is 60/30 mm Hg. CT angiography of the chest shows extensive pulmonary embolism in both lungs. She is given a drug that inhibits both thrombin and factor Xa. Which of the following medications was most likely administered?? {'A': 'Ticagrelor', 'B': 'Apixaban', 'C': 'Unfractioned heparin', 'D': 'Fondaparinux', 'E': 'Tenecteplase\n"'}, | C: Unfractioned heparin |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man is brought to the emergency department because of confusion, weight loss, and anuria. He has chronic kidney disease, hypertension, and type 2 diabetes mellitus. He was diagnosed with acute lymphoblastic leukemia at the age of 8 years and was treated with an allogeneic stem cell transplantation. He is HIV-positive and has active hepatitis C virus infection. He drinks around 8 cans of beer every week. His current medications include tenofovir, emtricitabine, atazanavir, daclatasvir, sofosbuvir, insulin, amlodipine, and enalapril. He appears lethargic. His temperature is 36°C (96.8°F), pulse is 130/min, respirations are 26/min, and blood pressure is 145/90 mm Hg. Examination shows severe edema in his legs and generalized muscular weakness. Auscultation of the lung shows crepitant rales. Laboratory studies show positive HCV antibody and positive HCV RNA. His HIV viral load is undetectable and his CD4+ T-lymphocyte count is 589/μL. Six months ago, his CD4+ T-lymphocyte count was 618/μL. An ECG of the heart shows arrhythmia with frequent premature ventricular contractions. Arterial blood gas analysis on room air shows: pH 7.23 PCO2 31 mm Hg HCO3- 13 mEq/L Base excess -12 mEq/L The patient states he would like to donate organs or tissues in the case of his death. Which of the following is an absolute contraindication for organ donation in this patient?"? {'A': 'HIV infection', 'B': 'Childhood leukemia', 'C': 'Acute kidney injury', 'D': 'Alcoholism', 'E': 'No absolute contraindications'}, | E: No absolute contraindications |
Answer the following medical question with one of the provided options: | Q:A 27-year-old G1P0 presents to her obstetrician for her normal 30-week obstetric appointment. She reports that she feels well and has no complaints. Her past medical history is notable for intermittent asthma. Her only medications are prenatal vitamins. She has gained 10 pounds, more than expected given her current stage of pregnancy. Abdominal ultrasound reveals the presence of twins with separate amniotic sacs that share a common chorion and placenta. During which time interval following fertilization did the morula divide into two in this mother?? {'A': 'Days 1-3', 'B': 'Days 4-8', 'C': 'Days 9-12', 'D': 'Days 13-15', 'E': 'Day 16+'}, | B: Days 4-8 |
Answer the following medical question with one of the provided options: | Q:A 2-month-old girl is brought to the physician by her father for a routine well-child examination. She is given a vaccine that contains polyribosylribitol phosphate conjugated to a toxoid carrier. The vaccine is most likely to provide immunity against which of the following pathogens?? {'A': 'Streptococcus pneumoniae', 'B': 'Corynebacterium diphtheriae', 'C': 'Neisseria meningitidis', 'D': 'Haemophilus influenzae', 'E': 'Bordetella pertussis'}, | D: Haemophilus influenzae |
Answer the following medical question with one of the provided options: | Q:A research group designed a study to investigate the epidemiology of syphilis in the United States. The investigators examined per capita income and rates of syphilis in New York City, Los Angeles, Chicago, and Houston. Data on city-wide syphilis rates was provided by each city's health agency. The investigators ultimately found that the number of new cases of syphilis was higher in low-income neighborhoods. This study is best described as which of the following?? {'A': 'Prospective cohort study', 'B': 'Case-control study', 'C': 'Ecological study', 'D': 'Case series', 'E': 'Double-blind clinical trial'}, | C: Ecological study |
Answer the following medical question with one of the provided options: | Q:A 7-year-old girl is brought to her pediatrician complaining of painful urination over the last 5 days. She describes it as a burning and itching when she uses the bathroom and has never had a feeling like this before. She was born at 39 weeks gestation via spontaneous vaginal delivery. She is up to date on all vaccines and is meeting all developmental milestones. Detailed history reveals that the parents have observed significant behavior changes in their daughter over the last 6 months such as social withdrawal and increased fearfulness. They have not identified a cause for these sudden behavioral changes. The pediatrician performs a complete physical examination. Upon genital examination, the girl becomes very nervous and begins to cry. After an examination of the vagina, the physician is concerned about a sexually transmitted disease. She orders testing and connects the family to child protective services for further investigation and counseling. Which of the following findings on physical examination of the vaginal region justifies the pediatrician’s suspicion?? {'A': 'Erythematous and greasy yellowish scaling', 'B': 'Crusty weepy lesions accompanied by erythema and severe itching', 'C': 'Well-demarcated erythematous plaques with silvery-white scaling and mild pruritus', 'D': 'Linear pruritic rash with papules and vesicles', 'E': 'Yellow mucopurulent discharge'}, | E: Yellow mucopurulent discharge |
Answer the following medical question with one of the provided options: | Q:A 9-month-old girl is brought in by her father for a scheduled check-up with her pediatrician. He states that over the past 4-5 months she has had multiple ear infections. She was also hospitalized for an upper respiratory infection 2 months ago. Since then she has been well. She has started to pull herself up to walk. Additionally, the patient’s medical history is significant for eczema and allergic rhinitis. The father denies any family history of immunodeficiencies. There are no notable findings on physical exam. Labs are remarkable for low IgG levels with normal IgA, IgE, and IgM levels. Which of the following is the most likely etiology for the patient’s presentation?? {'A': 'Adenosine deaminase deficiency', 'B': 'Defect in Bruton tyrosine kinase', 'C': 'Delayed onset of normal immunoglobulins', 'D': 'Failure of B-cell differentiation', 'E': 'Impaired T cell signaling'}, | C: Delayed onset of normal immunoglobulins |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman is admitted to the inpatient psychiatry unit after her boyfriend reported she was “acting funny and refusing to talk.” The patient’s boyfriend states that he came home from work and found the patient sitting up in bed staring at the wall. When he said her name or waved his hand in front of her, she did not respond. When he tried to move her, she would remain in whatever position she was placed. The patient’s temperature is 99°F (37.2°C), blood pressure is 122/79 mmHg, pulse is 68/min, and respirations are 12/min with an oxygen saturation of 98% O2 on room air. During the physical exam, the patient is lying on the bed with her left arm raised and pointing at the ceiling. She resists any attempt to change her position. The patient remains mute and ignores any external stimuli. The patient’s medical history is significant for depression. She was recently switched from phenelzine to fluoxetine. Which of the following is the best initial therapy?? {'A': 'Benztropine', 'B': 'Cyproheptadine', 'C': 'Electroconvulsive therapy', 'D': 'Haloperidol', 'E': 'Lorazepam'}, | E: Lorazepam |
Answer the following medical question with one of the provided options: | Q:An 8-year-old girl is brought to the emergency room for a 6-hour history of fever, sore throat, and difficulty swallowing. Physical examination shows pooling of oral secretions and inspiratory stridor. Lateral x-ray of the neck shows thickening of the epiglottis and aryepiglottic folds. Throat culture with chocolate agar shows small, gram-negative coccobacilli. The patient's brother is started on the recommended antibiotic for chemoprophylaxis. Which of the following is the primary mechanism of action of this drug?? {'A': 'Inhibition of DNA-dependent RNA-polymerase', 'B': 'Inhibition of the 50S ribosomal subunit', 'C': 'Inhibition of prokaryotic topoisomerase II', 'D': 'Inhibition of the 30S ribosomal subunit', 'E': 'Inhibition of peptidoglycan crosslinking'}, | A: Inhibition of DNA-dependent RNA-polymerase |
Answer the following medical question with one of the provided options: | Q:A group of medical students is studying bacteria and their pathogenesis. They have identified that a substantial number of bacteria cause human disease by producing exotoxins. Exotoxins are typically proteins, but they have different mechanisms of action and act at different sites. The following is a list of exotoxins together with mechanisms of action. Which of the following pairs is correctly matched?? {'A': 'Diphtheria toxin - cleaves synaptobrevin, blocking vesicle formation and the release of acetylcholine', 'B': 'Tetanospasmin - binds 60S ribosome subunit and inhibits protein synthesis', 'C': 'Cholera toxin - ADP-ribosylates Gs, keeping adenylate cyclase active and ↑ [cAMP]', 'D': 'Botulinum toxin - cleaves synaptobrevin, blocking vesicle formation and the release of the inhibitory neurotransmitters GABA and glycine', 'E': 'Anthrax toxin - ADP-ribosylates elongation factor - 2 (EF-2) and inhibits protein synthesis'}, | C: Cholera toxin - ADP-ribosylates Gs, keeping adenylate cyclase active and ↑ [cAMP] |
Answer the following medical question with one of the provided options: | Q:A previously healthy 52-year-old woman comes to the physician because of a 3-month history of chest pain on exertion. She takes no medications. Cardiopulmonary examination shows no abnormalities. Cardiac stress ECG shows inducible ST-segment depressions in the precordial leads that coincide with the patient's report of chest pain and resolve upon cessation of exercise. Pharmacotherapy with verapamil is initiated. This drug is most likely to have which of the following sets of effects? $$$ End-diastolic volume (EDV) %%% Blood pressure (BP) %%% Contractility %%% Heart rate (HR) $$$? {'A': '↓ ↓ ↓ ↑', 'B': 'No change no change no change no change', 'C': '↓ ↓ ↓ no change', 'D': '↓ ↓ no change ↑', 'E': '↑ ↓ ↓ ↓'}, | E: ↑ ↓ ↓ ↓ |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the physician by his parents who are concerned about his bizarre behavior. Over the past three months, he has become withdrawn from his friends and less interested in his classes and extracurricular activities. On several occasions, he has torn apart rooms in their home looking for “bugs” and states that the President is spying on him because aliens have told the government that he is a threat. Although he has always been quite clean in the past, his father notes that the patient’s room is now malodorous with clothes and dishes strewn about haphazardly. He also says that sometimes he can hear the devil speaking to him from inside his head. He has no medical problems, does not drink alcohol or use any drugs. Physical examination of the boy reveals no abnormalities. On mental status examination, the boy is oriented to person, place and time. He avoids eye contact and replies mostly with monosyllabic responses. He appears distracted, and confirms that he is hearing whispering voices in his head. What is the most appropriate diagnosis for this patient?? {'A': 'Brief psychotic disorder', 'B': 'Schizoid personality type', 'C': 'Schizoaffective disorder', 'D': 'Schizophreniform disorder', 'E': 'Schizophrenia'}, | D: Schizophreniform disorder |
Answer the following medical question with one of the provided options: | Q:A 59-year-old female presents to the emergency department after a fall. She reports severe pain in her right hip and an inability to move her right leg. Her past medical history is notable for osteoporosis, rheumatoid arthritis, and has never undergone surgery before. The patient was adopted, and her family history is unknown. She has never smoked and drinks alcohol socially. Her temperature is 98.8°F (37.1°C), blood pressure is 150/90 mmHg, pulse is 110/min, and respirations are 22/min. Her right leg is shortened, abducted, and externally rotated. A radiograph demonstrates a displaced femoral neck fracture. She is admitted and eventually brought to the operating room to undergo right hip arthroplasty. While undergoing induction anesthesia with inhaled sevoflurane, she develops severe muscle contractions. Her temperature is 103.4°F (39.7°C). A medication with which of the following mechanisms of action is indicated in the acute management of this patient’s condition?? {'A': 'Ryanodine receptor antagonist', 'B': 'GABA agonist', 'C': 'Serotonin 1B/1D agonist', 'D': 'NMDA receptor antagonist', 'E': 'Acetylcholine receptor agonist'}, | A: Ryanodine receptor antagonist |
Answer the following medical question with one of the provided options: | Q:Recently, clarithromycin was found to have an increased risk of cardiac death in a Danish study. This study analyzed patients who were previously treated with clarithromycin or another antibiotic, and then they were followed over time to ascertain if cardiac death resulted. What type of study design does this represent?? {'A': 'Randomized controlled trial', 'B': 'Cohort study', 'C': 'Cross-sectional study', 'D': 'Case control study', 'E': 'Non-inferiority trial'}, | B: Cohort study |
Answer the following medical question with one of the provided options: | Q:A 21-year-old male college student is brought to the emergency department by the campus police after he was found yelling at a bookshelf in the library. His roommate does not know of any prior episodes similar to this. His vital signs are within normal limits. The patient appears unkempt. On mental status examination, he talks very fast with occasional abrupt interruptions. He is agitated. He is disoriented to time and repeatedly tells the physician, “I hear the sun telling me that I was chosen to save the universe.” Urine toxicology screen is negative. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Haloperidol', 'B': 'Alprazolam', 'C': 'Dexmedetomidine', 'D': 'Valproic acid', 'E': 'Ziprasidone'}, | E: Ziprasidone |
Answer the following medical question with one of the provided options: | Q:A 62-year-old female presents to her primary care physician complaining of bloody stool. She reports several episodes of bloody stools over the past two months as well as a feeling of a mass near her anus. She has one to two non-painful bowel movements per day. She has a history of alcohol abuse and hypertension. Anoscopy reveals engorged vessels. Which of the following vessels most likely drains blood from the affected region?? {'A': 'Superior rectal vein', 'B': 'Inferior rectal vein', 'C': 'Internal pudendal vein', 'D': 'Middle rectal vein', 'E': 'Left colic vein'}, | A: Superior rectal vein |
Answer the following medical question with one of the provided options: | Q:Three weeks after delivering a healthy boy, a 28-year-old woman, gravida 1, para 1, comes to the physician for a postpartum check-up. Labor and delivery were uncomplicated. Two days after delivery she was diagnosed with postpartum endometritis and received intravenous clindamycin plus gentamicin for 2 days. She had painful swelling of the breasts at the beginning of lactation, but frequent breastfeeding and warm compresses prior to breastfeeding improved her symptoms. Physical examination shows no abnormalities. The patient asks about a reliable contraceptive method. Which of the following is the most appropriate recommendation?? {'A': 'Spermicide', 'B': 'Basal body temperature method', 'C': 'Progestin-only contraceptive pills', 'D': 'Combined oral contraceptives', 'E': 'No contraception needed while lactating'}, | C: Progestin-only contraceptive pills |
Answer the following medical question with one of the provided options: | Q:An 83-year-old man is being seen in the hospital for confusion. The patient was admitted 4 days ago for pneumonia. He has been improving on ceftriaxone and azithromycin. Then 2 nights ago he had an episode of confusion. He was unsure where he was and attempted to leave. He was calmed down by nurses with redirection. He had a chest radiograph that was stable from admission, a normal EKG, and a normal urinalysis. This morning he was alert and oriented. Then this evening he became confused and agitated again. The patient has a history of benign prostatic hyperplasia, severe dementia, and osteoarthritis. He takes tamsulosin in addition to the newly started antibiotics. Upon physical examination, the patient is alert but orientated only to name. He tries to get up, falls back onto the bed, and grabs his right knee. He states, “I need to get to work. My boss is waiting, but my knee hurts.” He tries to walk again, threatens the nurse who stops him, and throws a plate at the wall. In addition to reorientation, which of the following is the next best step in management?? {'A': 'Haloperidol', 'B': 'Lorazepam', 'C': 'Morphine', 'D': 'Physical restraints', 'E': 'Rivastigmine'}, | A: Haloperidol |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman presents to her physician with foot tingling, numbness, and pain. She describes her pain as constant and burning and gives it 5 out of 10 on the visual analog pain scale. She also recalls several falls due to the numbness in her feet. She was diagnosed with diabetes mellitus and diabetic retinopathy 5 years ago. Since then, she takes metformin 1000 mg twice daily and had no follow-up visits to adjust her therapy. Her weight is 110 kg (242.5 lb), and her height is 176 cm (5 ft. 7 in). The vital signs are as follows: blood pressure is 150/90 mm Hg, heart rate is 72/min, respiratory rate is 12/min, and the temperature is 36.6°C (97.9°F). The patient has increased adiposity in the abdominal region with stretch marks. The respiratory examination is within normal limits. The cardiovascular exam is significant for a bilateral carotid bruit. The neurological examination shows bilateral decreased ankle reflex, symmetrically decreased touch sensation and absent vibration sensation in both feet up to the ankle. The gait is mildly ataxic. The Romberg test is positive with a tendency to fall to both sides, and significant worsening on eye closure. Which of the following medications should be used to manage the patient’s pain?? {'A': 'Diclofenac', 'B': 'Morphine', 'C': 'Tramadol', 'D': 'Topiramate', 'E': 'Nortriptyline'}, | E: Nortriptyline |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the pediatrician in the month of January with a one-week history of a cough and somnolence. He developed a fever and cough and stated that his legs hurt ‘really bad’ 3–4 days prior to his symptoms. He has asthma but no other significant past medical history. He takes albuterol and his mom administered acetaminophen because he was feeling ‘hot’. The blood pressure is 92/66 mm Hg, the heart rate is 118/min, the respiratory rate is 40/min, and the temperature is 39.2°C (102.6°F). On physical examination, the visualization of the pharynx shows mild erythema without purulence. Auscultation of the lungs reveals crackles over the right lung base. The rapid strep test is negative. A chest X-ray shows homogenous opacity in the lower lobe of the right lung. Which of the following best describes the vaccine that could have prevented the boy from acquiring this infection?? {'A': 'Live attenuated vaccine', 'B': 'Inactivated vaccine', 'C': 'Subunit vaccine', 'D': 'Conjugate vaccine', 'E': 'Toxoid vaccine'}, | B: Inactivated vaccine |
Answer the following medical question with one of the provided options: | Q:A 3-month-old African American infant presents to the hospital with 2 days of fever, "coke"-colored urine, and jaundice. The pregnancy was uneventful except the infant was found to have hyperbilirubinemia that was treated with phototherapy. The mother explains that she breastfeeds her child and recently was treated herself for a UTI with trimethoprim-sulfamethoxazole (TMP-SMX). Which of the following diseases is similarly inherited as the disease experienced by the child?? {'A': 'Marfan syndrome', 'B': 'Sickle cell anemia', 'C': 'Hemophilia A', 'D': 'Beta thalassemia', 'E': 'Rett syndrome'}, | C: Hemophilia A |
Answer the following medical question with one of the provided options: | Q:An 83-year-old male presents with dyspnea, orthopnea, and a chest radiograph demonstrating pulmonary edema. A diagnosis of congestive heart failure is considered. The following clinical measurements are obtained: 100 bpm heart rate, 0.2 mL O2/mL systemic blood arterial oxygen content, 0.1 mL O2/mL pulmonary arterial oxygen content, and 400 mL O2/min oxygen consumption. Using the above information, which of the following values represents this patient's cardiac stroke volume?? {'A': '30 mL/beat', 'B': '40 mL/beat', 'C': '50 mL/beat', 'D': '60 mL/beat', 'E': '70 mL/beat'}, | B: 40 mL/beat |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents with an excruciatingly painful tongue lesion. He says the lesion was preceded by an intermittent headache for the past month that localized unilaterally to the left temple and occasionally radiates to the right eye. The tongue lesion onset acutely and has been present for a few days. The pain is constant. His past medical history is relevant for hypertension and recurrent migraines. Current medications include captopril. On physical examination, multiple knot-like swellings are seen on the left temple. Findings from an inspection of the oral cavity are shown in the exhibit (see image). Laboratory findings are significant for the following: Hemoglobin 12.9 g/dL Hematocrit 40.7% Leukocyte count 5500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Mean corpuscular volume 88.2 μm3 Platelet count 190,000/mm3 Erythrocyte sedimentation rate 45 mm/h Which of the following is the next best step in the management of this patient?? {'A': 'Temporal artery biopsy', 'B': 'CT', 'C': 'Lysis therapy', 'D': 'High-dose systemic corticosteroids', 'E': 'Paracetamol'}, | D: High-dose systemic corticosteroids |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to his primary care physician for a wellness checkup. The patient states he has been doing well and currently has no concerns. The patient's daughter states that she feels he is abnormally fatigued and has complained of light-headedness whenever he gardens. He also admits that he fainted once. The patient has a past medical history of type II diabetes, hypertension, and constipation. He recently had a "throat cold" that he recovered from with rest and fluids. His temperature is 98.9°F (37.2°C), blood pressure is 167/98 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 99% on room air. Physical exam reveals a systolic murmur heard best along the right upper sternal border. An ECG is performed and demonstrates no signs of ST elevation. Cardiac troponins are negative. Which of the following is the most likely diagnosis?? {'A': 'Autoimmune valve destruction', 'B': 'Bicuspid valve', 'C': 'Calcification of valve leaflets', 'D': 'Incompetent valve', 'E': 'Outflow tract obstruction'}, | C: Calcification of valve leaflets |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman presents to the office complaining of leg ulcers for the past 6 months. She has a chronic history of severe rheumatoid arthritis controlled with methotrexate. She does not drink alcohol or smoke cigarettes. Her vitals are normal. Her lungs are clear to auscultation. The abdomen is soft and non-tender with a palpable spleen tip on inspiration. Skin examination shows scattered ulcers on the legs in various stages of healing. Additionally, metacarpophalangeal and proximal interphalangeal joints are tender. Varicose veins are not observed. Laboratory results are as follows: Hemoglobin 10.5 g/dL MCV 74 fl Platelets 226,000/mm3 White blood cells 2500 /mm3 Neutrophils 20% Alanine 36/UL Aminotransaminase aspartate 39/UL Aminotransaminase creatinine 1.0 mg/dL HIV test is negative. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Venous stasis and valve insufficiency', 'B': 'Felty syndrome', 'C': 'Drug toxicity', 'D': 'Vitamin deficiency', 'E': 'Caplan syndrome'}, | B: Felty syndrome |
Answer the following medical question with one of the provided options: | Q:A previously healthy 10-day-old infant is brought to the emergency department by his mother because of episodes of weakness and spasms for the past 12 hours. His mother states that he has also had difficulty feeding and a weak suck. He has not had fever, cough, diarrhea, or vomiting. He was born at 39 weeks' gestation via uncomplicated vaginal delivery at home. Pregnancy was uncomplicated. The mother refused antenatal vaccines out of concern they would cause side effects. She is worried his symptoms may be from some raw honey his older sister maybe inadvertently fed him 5 days ago. He appears irritable. His temperature is 37.1°C (98.8°F). Examination shows generalized muscle stiffness and twitches. His fontanelles are soft and flat. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?? {'A': 'Clostridium botulinum', 'B': 'Clostridium tetani', 'C': 'Neisseria meningitidis', 'D': 'Listeria monocytogenes', 'E': 'Escherichia coli\n"'}, | B: Clostridium tetani |
Answer the following medical question with one of the provided options: | Q:A 4-year-old girl is brought to the clinic by her parents, who are concerned about an abdominal swelling that they noticed 2 days ago. The family immigrated from Bangladesh to the United States recently. The mother mentions that the girl has never been as active as other children of the same age but has no medical conditions either. Her appetite has declined, and she vomited a few times last week. On physical examination, slight prominence of frontal bosses at the forehead is noticeable with malar prominence and massive splenomegaly. Slight beading at the end of her ribs is evident. She has a dusky complexion, sclerae are anicteric, and oral mucosa is pale. Laboratory results are pending. Which of the following is the most likely explanation for the findings seen in this patient?? {'A': 'Glycogen storage disease', 'B': 'Graves disease', 'C': 'Renal failure', 'D': 'Extramedullary hematopoiesis due to thalassemia', 'E': 'Lymphoma'}, | D: Extramedullary hematopoiesis due to thalassemia |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy presents to his pediatrician with a 5-day history of abdominal pain and bloody stool. He denies having a fever and says that he has not experienced any other symptoms associated with the abdominal pain. He has no past medical history and does not take any medications or supplements. His family history is significant for a grandfather who developed Alzheimer disease at age 80 and a cousin who died at age 21 from colon cancer. Physical exam is unremarkable. Based on clinical suspicion a colonoscopy is obtained showing hundreds of small polyps in the colon. A mutation of a gene on which of the following chromosomes is most likely responsible for this patient's symptoms?? {'A': '5', 'B': '7', 'C': '17', 'D': '19', 'E': 'X'}, | A: 5 |
Answer the following medical question with one of the provided options: | Q:A 31-year-old man comes to the physician because of pain, tingling, and numbness in his right hand that started 3 months ago. It is worse at night and frequently wakes him up. The symptoms can be relieved by shaking his hands but soon recur. He reports weakness of his right hand, especially when grasping objects. He has type 2 diabetes mellitus. His current medications are metformin and sitagliptin. Four months ago he went on a camping trip. He has been working as a hardscaper for 8 years. His temperature is 37.5°C (99.5°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Examination shows reproduction of his symptoms when his right hand is held above his head for 2 minutes. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 7,600/mm3 Hemoglobin A1C 6.3% Erythrocyte sedimentation rate 13 mm/h Which of the following is most likely to confirm the diagnosis?"? {'A': 'ELISA for B. burgdorferi antibodies', 'B': 'CT scan of cervical spine', 'C': 'Nerve conduction studies', 'D': 'MRI of the head', 'E': 'Arterial Doppler ultrasonography\n"'}, | C: Nerve conduction studies |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man comes to the physician because of fatigue and decreased urinary frequency for 6 months. His pulse is 86/min and blood pressure is 150/90 mm Hg. Examination shows 1+ edema on bilateral ankles. His serum creatinine is 2 mg/dL and blood urea nitrogen is 28 mg/dL. Urinalysis shows proteinuria. A photomicrograph of a biopsy specimen from the patient's kidney is shown. Which of the following is the most likely explanation for the patient’s biopsy findings?? {'A': 'HIV infection', 'B': 'Amyloidosis', 'C': 'Chronic hyperglycemia', 'D': 'Recurrent kidney infections', 'E': 'Systemic lupus erythematosus'}, | C: Chronic hyperglycemia |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman comes to the physician for a routine health maintenance examination. She has no personal or family history of serious illness. She smoked one pack of cigarettes daily for 5 years during her 20s. Her pulse is 70/min, and blood pressure is 120/78 mm Hg. Serum lipid studies and glucose concentration are within the reference ranges. Which of the following health maintenance recommendations is most appropriate at this time?? {'A': 'Perform DEXA scan', 'B': 'Perform colonoscopy', 'C': 'Perform 24-hour ECG', 'D': 'Perform BRCA gene test', 'E': 'Perform abdominal ultrasound'}, | B: Perform colonoscopy |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the emergency department when he discovered a large volume of blood in his stool. He states that he was going to the bathroom when he saw a large amount of bright red blood in the toilet bowl. He was surprised because he did not feel pain and felt it was a normal bowel movement. The patient has a past medical history of diabetes, obesity, hypertension, anxiety, fibromyalgia, diabetic nephropathy, and schizotypal personality disorder. His current medications include atorvastatin, lisinopril, metformin, insulin, clonazepam, gabapentin, sodium docusate, polyethylene glycol, fiber supplements, and ibuprofen. His temperature is 99.5°F (37.5°C), blood pressure is 132/84 mmHg, pulse is 80/min, respirations are 11/min, and oxygen saturation is 96% on room air. On physical exam, the patient's cardiac exam reveals a normal rate and rhythm, and his pulmonary exam is clear to auscultation bilaterally. Abdominal exam is notable for an obese abdomen without tenderness to palpation. Which of the following is an appropriate treatment for this patient's condition?? {'A': 'Cautery of an arteriovenous malformation', 'B': 'IV fluids and NPO', 'C': 'NPO, ciprofloxacin, and metronidazole', 'D': 'Surgical excision of poorly differentiated tissue', 'E': 'Surgical resection of a blood vessel'}, | B: IV fluids and NPO |
Answer the following medical question with one of the provided options: | Q:A popular news outlet recently published an article that discussed the size of low-density lipoprotein (LDL) cholesterol particles: type A and type B. Type B is thought to be more harmful to arterial walls. A group of researchers wants to determine whether patients who have an elevated level of type B LDL cholesterol are more likely to develop cardiovascular events. A study is designed with 3418 adult participants. Initial levels of type B LDL are obtained and participants are separated into normal and elevated levels of type B LDL. Socio-demographics including age, gender, education level, and smoking status are also recorded. The primary outcome is incidence of cardiovascular events over 10 years. Secondary outcomes include all-cause death, death by cardiovascular events, stroke, and hospitalizations. For this study, which of the following analyses would be the most appropriate measure to determine the association between type B LDL and cardiovascular events?? {'A': 'Analysis of covariance', 'B': 'Fisher’s exact test', 'C': 'Likelihood ratios', 'D': 'Odds ratio', 'E': 'Relative risk'}, | E: Relative risk |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man comes to the emergency department for the evaluation of recurrent bloody diarrhea for 4 weeks. During this time, he has also had intermittent abdominal pain. His symptoms have worsened over the past 2 days and he has also had fever and several episodes of nonbloody vomiting. He was diagnosed with ulcerative colitis three years ago but has had difficulty complying with his drug regimen. His temperature is 38.8°C (100.9°F), pulse is 112/min and regular, and blood pressure is 90/50 mm Hg. Abdominal examination shows a distended abdomen with no guarding or rebound; bowel sounds are hypoactive. Hemoglobin concentration is 10.1 g/dL, leukocyte count is 15,000/mm3, and erythrocyte sedimentation rate is 50 mm/h. Fluid resuscitation is initiated. In addition to complete bowel rest, which of the following is the most appropriate next step in the management of this patient?? {'A': 'Topical sulfasalazine and oral prednisolone', 'B': 'Abdominal x-ray', 'C': 'IV metronidazole and rectal vancomycin', 'D': 'Double-contrast barium enema', 'E': 'Colonoscopy\n"'}, | B: Abdominal x-ray |
Answer the following medical question with one of the provided options: | Q:A 19-year-old woman, gravida 1, para 0, at 21 weeks’ gestation comes to the physician for a follow-up prenatal visit. At her previous appointment, her serum α-fetoprotein concentration was elevated. She had smoked 1 pack of cigarettes daily for 3 years but quit at 6 weeks' gestation. Examination shows a uterus consistent in size with a 21-week gestation. Ultrasonography shows fetal viscera suspended freely into the amniotic cavity. Which of the following is the most likely diagnosis?? {'A': 'Diaphragmatic hernia', 'B': 'Umbilical hernia', 'C': 'Vesicourachal diverticulum', 'D': 'Gastroschisis', 'E': 'Omphalocele'}, | D: Gastroschisis |
Answer the following medical question with one of the provided options: | Q:A mother brings her 10 month-old boy to the pediatrician for a check-up. His birth was without complications and his development to-date has been progressing normally. He currently crawls, pulls himself up to standing, says 'mama' and 'dada' nonspecifically, and responds when called by his name. However, his mother is concerned, as she has noted over the past several weeks that he has periods where he stops breathing when he gets frightened or upset. These episodes last for 20-30 seconds and are accompanied by his lips and face become bluish. His breathing has always resumed normally within 45 seconds after the start of the episode, and he acts normally afterwards. One instance resulted in the child passing out for a 5-10 seconds before a spontaneous recovery. Which of the following is the most appropriate management of this patient's condition?? {'A': 'Education and reassurance of the mother', 'B': 'Echocardiogram', 'C': 'Electroencephalogram', 'D': 'Basic metabolic panel', 'E': 'Lung spirometry'}, | A: Education and reassurance of the mother |
Answer the following medical question with one of the provided options: | Q: An outbreak of diphtheria has occurred for the third time in a decade in a small village in South Africa. Diphtheria is endemic to the area with many healthy villagers colonized with different bacterial strains. Vaccine distribution in this area is difficult due to treacherous terrain. A team of doctors is sent to the region to conduct a health campaign. Toxigenic strains of C. diphtheria are isolated from symptomatic patients. Which of the following best explains the initial emergence of a pathogenic strain causing such outbreaks?? {'A': 'Presence of naked DNA in the environment', 'B': 'Infection with a lytic phage', 'C': 'Lysogenic conversion', 'D': 'Suppression of lysogenic cycle', 'E': 'Conjugation between the toxigenic and non-toxigenic strains of C. diphtheriae'}, | C: Lysogenic conversion |
Answer the following medical question with one of the provided options: | Q:A 39-year-old man presents to the emergency department for severe abdominal pain. His pain is located in the epigastric region of his abdomen, which he describes as sharp and persistent. His symptoms began approximately 2 days prior to presentation, and he has tried acetaminophen and ibuprofen, which did not improve his symptoms. He feels nauseated and has had 2 episodes of non-bloody, non-bilious emesis. He has a medical history of hypertension and hyperlipidemia for which he is on chlorthalidone and simvastatin. He has smoked 1 pack of cigarettes per day for the last 20 years and drinks 1 pint of vodka per day. On physical exam, there is tenderness to palpation of the upper abdomen, and the patient is noted to have tender hepatomegaly. Serum studies demonstrate: Amylase: 350 U/L (25-125 U/L) Lipase: 150 U/L (12-53 U/L) AST: 305 U/L (8-20 U/L) ALT: 152 U/L (8-20 U/L) He is admitted to the hospital and started on intravenous fluids and morphine. Approximately 18 hours after admission the patient reports to feeling anxious, tremulous, and having trouble falling asleep. His blood pressure is 165/105 mmHg and pulse is 140/min. On exam, the patient appears restless and diaphoretic. Which of the following will most likely improve this patient's symptoms?? {'A': 'Chlordiazepoxide', 'B': 'Haloperidol', 'C': 'Lorazepam', 'D': 'Risperidone', 'E': 'Thiamine'}, | C: Lorazepam |
Answer the following medical question with one of the provided options: | Q:A 41-year-old African American man presents to his primary care physician a few months after being found to have a blood pressure of 152/95 mmHg. The patient denies any current symptoms, having any past medical history, or prior hospitalizations. He does not take any medications but takes one multivitamin daily. His blood pressures on three separate occasions have been 151/93 mmHg, 150/90 mmHg, and 155/97 mmHg. In today’s visit, his blood pressure is 149/91 mmHg despite exercise and dietary modifications. Physical examination is unremarkable. After extensive work-up he is started on appropriate monotherapy for his hypertension. Which of the following laboratory abnormalities may be found on follow-up testing?? {'A': 'Hypercalcemia', 'B': 'Hyperkalemia', 'C': 'Hypermagnesemia', 'D': 'Hypolipidemia', 'E': 'Hypouricemia'}, | A: Hypercalcemia |
Answer the following medical question with one of the provided options: | Q:An 11-year-old boy presents to the emergency department with heavy drooling. The patient was being watched by his babysitter when she found him in this manner. His temperature is 99.1°F (37.3°C), blood pressure is 107/58 mmHg, pulse is 119/min, respirations are 14/min, and oxygen saturation is 98% on room air. Physical exam is notable for a young boy in acute distress who is drooling. The boy states he is in pain and can’t swallow. The patient’s tongue seems abnormally enlarged and erythematous. Which of the following is the most likely diagnosis?? {'A': 'Aspirin overdose', 'B': 'Caustic ingestion', 'C': 'Diphenhydramine ingestion', 'D': 'Insecticide exposure', 'E': 'Iron overdose'}, | B: Caustic ingestion |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man is brought to the emergency department because of shortness of breath and confusion. His pulse is 98/min, and blood pressure is 109/73 mm Hg. He is oriented to person but not time or place. A graph of his breathing pattern and oxygen saturation is shown. Which of the following additional findings is most likely present in this patient?? {'A': 'Ventricular gallop', 'B': 'Rib fracture', 'C': 'Miotic pupils', 'D': 'Barrel chest', 'E': 'Fruity breath odor'}, | A: Ventricular gallop |
Answer the following medical question with one of the provided options: | Q:A patient in the neonatal intensive care unit develops severe cyanosis. Cardiac exam reveals a single loud S2 with a right ventricular heave. Echocardiography reveals an aorta lying anterior and right of the pulmonary artery. Which of the following processes failed during fetal development?? {'A': 'Fusion of the membranous ventricular septum', 'B': 'Aorticopulmonary septum to spiral', 'C': 'Ectopic ductal tissue tightening', 'D': 'Reentry of viscera from yolk sac', 'E': 'Fusion of septum primum and septum secondum'}, | B: Aorticopulmonary septum to spiral |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought to the emergency department late at night by his worried mother. She says he has not been feeling well since this morning after breakfast. He skipped both lunch and dinner. He complains of abdominal pain as he points towards his lower abdomen but says that the pain initially started at the center of his belly. His mother adds that he vomited once on the way to the hospital. His past medical history is noncontributory and his vaccinations are up to date. His temperature is 38.1°C (100.6°F), pulse is 98/min, respirations are 20/min, and blood pressure is 110/75 mm Hg. Physical examination reveals right lower quadrant tenderness. The patient is prepared for laparoscopic abdominal surgery. Which of the following structures is most likely to aid the surgeons in finding the source of this patient's pain and fever?? {'A': 'Teniae coli', 'B': "McBurney's point", 'C': 'Transumbilical plane', 'D': 'Linea Semilunaris', 'E': 'Arcuate line'}, | A: Teniae coli |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman is followed in the nephrology clinic for longstanding chronic kidney disease (CKD) secondary to uncontrolled hypertension. Her glomerular filtration rate (GFR) continues to decline, and she is approaching initiation of hemodialysis. Plans are made to obtain vascular access at the appropriate time, and the patient undergoes the requisite screening to be enrolled as an end stage renal disease (ESRD) patient. Among patients on chronic hemodialysis, which of the following is the most common cause of death?? {'A': 'Stroke', 'B': 'Hyperkalemia', 'C': 'Infection', 'D': 'Cardiovascular disease', 'E': 'Cancer'}, | D: Cardiovascular disease |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman is brought to her primary care physician by her sister who is concerned about a deterioration in the patient’s general status. The patient was diagnosed with HIV 7 years ago. She says that her last T cell count was "good enough", so she has been been skipping every other dose of her antiretroviral medications and trimethoprim-sulfamethoxazole. Her sister has had to drive her home from work several times this month because she has become disoriented and confused about her surroundings. Motor strength is 4/5 on the right and 3/5 on the left. She is able to walk unassisted, but her gait appears mildly uncoordinated. There is diplopia when the right eye is covered. Her CD4 count is 75 cells/µL. MRI shows numerous asymmetric, hyperintense, non-enhancing lesions bilaterally without mass effect. Brain biopsy shows demyelination and atypical astrocytes. Which of the following is most likely responsible for this patient's current condition?? {'A': 'Autoimmune demyelination', 'B': 'HIV associated neurocognitive disorder (HAND)', 'C': 'John Cunningham virus (JC virus)', 'D': 'Primary CNS lymphoma (PCNSL)', 'E': 'Toxoplasma gondii'}, | C: John Cunningham virus (JC virus) |
Answer the following medical question with one of the provided options: | Q:A 30-year-old forest landscape specialist is brought to the emergency department with hematemesis and confusion. One week ago, she was diagnosed with influenza when she had fevers, severe headaches, myalgias, hip and shoulder pain, and a maculopapular rash. After a day of relative remission, she developed abdominal pain, vomiting, and diarrhea. A single episode of hematemesis occurred prior to admission. Two weeks ago she visited rainforests and caves in western Africa where she had direct contact with animals, including apes. She has no history of serious illnesses or use of medications. She is restless and her temperature is 38.0°C (100.4°F); pulse, 95/min; respirations, 20/min; and supine and upright blood pressure, 130/70 mm Hg and 100/65 mm Hg, respectively. Conjunctival suffusion is seen. Ecchymoses are observed on the lower extremities. She is bleeding from one of her intravenous lines. The peripheral blood smear is negative for organisms. The laboratory studies show the following: Hemoglobin 10 g/dL Leukocyte count 1,000/mm3 Segmented neutrophils 65% Lymphocytes 20% Platelet count 50,000/mm3 Partial thromboplastin time (activated) 60 seconds Prothrombin time 25 seconds Fibrin split products positive Serum Alanine aminotransferase (ALT) 85 U/L Aspartate aminotransferase (AST) 120 U/L γ-Glutamyltransferase (GGT) 83 U/L (N = 5–50 U/L) Creatinine 2 mg/dL Which of the following is the most likely causal pathogen?? {'A': 'Ebola virus', 'B': 'Babesia microti', 'C': 'Plasmodium falciparum', 'D': 'Yersinia pestis', 'E': 'Zika virus'}, | A: Ebola virus |
Answer the following medical question with one of the provided options: | Q:A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?? {'A': 'Administration of clozapine', 'B': 'Administration of lithium', 'C': 'Cognitive-behavioral therapy', 'D': 'Interpersonal therapy', 'E': 'Motivational interviewing'}, | C: Cognitive-behavioral therapy |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the physician by his parents for the evaluation of an episode of loss of consciousness while he was playing soccer earlier that morning. He was unconscious for about 15 seconds and did not shake, bite his tongue, or lose bowel or bladder control. He has been healthy except for 1 episode of simple febrile seizure. His father died suddenly at the age of 34 of an unknown heart condition. The patient does not take any medications. He is alert and oriented. His temperature is 37°C (98.6°F), pulse is 95/min and regular, and blood pressure is 90/60 mm Hg. Physical examination shows no abnormalities. Laboratory studies are within normal limits. An ECG shows sinus rhythm and a QT interval corrected for heart rate (QTc) of 470 milliseconds. Which of the following is the most appropriate next step in treatment?? {'A': 'Propranolol', 'B': 'Implantable cardioverter defibrillator', 'C': 'Procainamide', 'D': 'Magnesium sulfate', 'E': 'Amiodarone'}, | A: Propranolol |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy is brought to the emergency department by his mother because of painful swelling in his right knee that started after he collided with another player during a soccer game. He has no history of serious illness except for an episode of prolonged bleeding following a tooth extraction a few months ago. Physical examination shows marked tenderness and swelling of the right knee joint. There are multiple bruises on the lower extremities in various stages of healing. Laboratory studies show a platelet count of 235,000/mm3, partial thromboplastin time of 78 seconds, prothrombin time of 14 seconds, and bleeding time of 4 minutes. The plasma concentration of which of the following is most likely to be decreased in this patient?? {'A': 'Protein C', 'B': 'Plasmin', 'C': 'Thrombin', 'D': 'Von Willebrand factor', 'E': 'Factor VII'}, | C: Thrombin |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman presents with dysphagia. She says the dysphagia is worse for solids than liquids and is progressive. She also complains of associated weakness, fatigue, and dyspnea. The patient denies any recent history of weight loss. Laboratory findings are significant for a hemoglobin of 8.7 g/dL. A peripheral blood smear shows evidence of microcytic hypochromic anemia. Which of the following is the most likely cause of her dysphagia?? {'A': 'Lower esophageal ring', 'B': 'Failure of the relaxation of lower esophageal sphincter', 'C': 'Upper esophageal web', 'D': 'Lower esophageal spasm', 'E': 'Esophageal carcinoma'}, | C: Upper esophageal web |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl is brought to the physician because of a 1-month history of fever, headaches, and profound fatigue. Her temperature is 38.2°C (100.8°F). Examination shows splenomegaly. Laboratory studies show: Leukocyte count 13,000/mm3 (15% atypical lymphocytes) Serum Alanine aminotransferase (ALT) 60 U/L Aspartate aminotransferase (AST) 40 U/L Heterophile antibody assay negative EBV viral capsid antigen (VCA) antibodies negative HIV antibody negative In an immunocompromised host, the causal organism of this patient's symptoms would most likely cause which of the following conditions?"? {'A': 'Multiple cerebral abscesses with surrounding edema', 'B': 'Diffuse pulmonary infiltrates with pneumatoceles', 'C': 'Purplish skin nodules on the distal extremities', 'D': 'Non-scrapable white patches on the lateral tongue', 'E': 'Linear ulcers near the lower esophageal sphincter'}, | E: Linear ulcers near the lower esophageal sphincter |
Answer the following medical question with one of the provided options: | Q:A 33-year-old African American woman presents to her primary care physician for a wellness checkup. She states that she has lost 20 pounds over the past 2 months yet has experienced an increased appetite during this period. She endorses hyperhidrosis and increased urinary volume and frequency. Physical exam is notable for an anxious woman and a regular and tachycardic pulse. Laboratory values are ordered as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L Ca2+: 12.2 mg/dL The patient's urine calcium level is elevated. Which of the following is the most likely diagnosis?? {'A': 'Familial hypercalcemic hypocalciuria', 'B': 'Hyperparathyroidism', 'C': 'Hyperthyroidism', 'D': 'Malignancy', 'E': 'Sarcoidosis'}, | C: Hyperthyroidism |
Answer the following medical question with one of the provided options: | Q:A 57-year-old woman comes to the emergency department because of dizziness, nausea, and vomiting for 4 days. Her temperature is 37.3°C (99.1°F), pulse is 100/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Arterial blood gas analysis on room air shows: pH 7.58 PCO2 43 mm Hg PO2 96 mm Hg HCO3- 32 mEq/L The most appropriate next step in diagnosis is measurement of which of the following?"? {'A': 'Urine albumin to creatinine ratio', 'B': 'Serum osmolal gap', 'C': 'Urine chloride', 'D': 'Urine anion gap', 'E': 'Serum anion gap'}, | C: Urine chloride |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician because of low-grade fever and progressive painful lumps in his right groin for 6 days. The lumps have been discharging purulent fluid since the evening of the previous day. He had a shallow, painless lesion on his penis 3 weeks ago, but was too embarrassed to seek medical attention; it has resolved in the meantime. There is no personal or family history of serious illness. He has smoked one pack of cigarettes daily for 12 years. He is sexually active with multiple male partners and uses condoms inconsistently. His temperature is 38.0°C (100.4°F). Examination of his groin shows multiple masses discharging pus. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal organism?? {'A': 'Haemophilus ducreyi', 'B': 'Yersinia pestis', 'C': 'Herpes simplex virus 2', 'D': 'Klebsiella granulomatis', 'E': 'Chlamydia trachomatis'}, | E: Chlamydia trachomatis |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman comes to the physician for the evaluation of persistent headaches for the last 2 months. The symptoms started insidiously. Menses had previously occurred at regular 28-day intervals with moderate flow. Her last menstrual period was 12 weeks ago. She is sexually active with her husband but reports decreased interest in sexual intercourse over the past few months. The patient does not smoke or drink alcohol. She is 168 cm (5 ft 6 in) tall and weighs 68 kg (150 lb); BMI is 24 kg/m2. She appears uncomfortable. Vital signs are within normal limits. A urine pregnancy test is negative. A pelvic ultrasound shows atrophic endometrium. A cranial MRI with contrast shows a 2-cm intrasellar mass. A hormone assay is performed and is positive. Which of the following is the most appropriate next step in the management?? {'A': 'Cabergoline therapy', 'B': 'Radiotherapy', 'C': 'Observation and outpatient follow-up', 'D': 'Biopsy of intrasellar mass', 'E': 'Temozolomide therapy\n"'}, | A: Cabergoline therapy |
Answer the following medical question with one of the provided options: | Q:A 69-year-old man presents to his primary care physician after 2 episodes of dizziness while watching television. On further questioning, he admits to progressive fatigue and shortness of breath on exertion for the past few weeks. His medical history is significant for hypertension for the past 25 years and congestive heart failure for the past 2 years, for which he is on multiple medications. His blood pressure is 100/50 mm Hg, the heart rate is 50/min, and the temperature is 36.6°C (97.8°F). The physical examination is within normal limits. A 12-lead ECG is obtained and the results are shown in the picture. Which of the following is the best initial step for the management of this patient?? {'A': 'Observation and repeat ECG if symptoms recur', 'B': 'Temporary cardiac pacing', 'C': 'External defibrillation', 'D': "Check the patient's medication profile", 'E': 'Glucagon'}, | D: Check the patient's medication profile |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the physician because of increasingly frequent episodes of double vision for 2 days. She was seen in the emergency department for an episode of imbalance and decreased sensation in her right arm 3 months ago. Examination shows impaired adduction of the right eye with left lateral gaze but normal convergence of both eyes. Deep tendon reflexes are 4+ in all extremities. The Romberg test is positive. An MRI of the brain shows hyperintense oval plaques in the periventricular region and a plaque in the midbrain on T2-weighted images. Microscopic examination of material from the midbrain plaque would most likely show which of the following?? {'A': 'Eosinophilic intracytoplasmic inclusion bodies', 'B': 'Loss of axons and atrophy of oligodendrocytes', 'C': 'Lymphocytic infiltration of the endoneurium', 'D': 'Extracellular deposits of amyloid peptides', 'E': 'Demyelination with partial preservation of axons\n"'}, | E: Demyelination with partial preservation of axons " |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman is brought to the emergency department by police after being found naked outside a government building. She is accompanied by her husband who reports that she has been having “crazy” ideas. The patient’s speech is pressured and she switches topics quickly from how she is going to be president one day to how she is going to learn 20 languages fluently by the end of the year. Upon further questioning, it is revealed that she has struggled with at least 2 depressive episodes in the past year. Her medical history is significant for hypertension, hyperlipidemia, gout, and chronic migraines. She was recently diagnosed with a urinary tract infection and given nitrofurantoin. She has also been taking indomethacin for an acute gout flare. Her other medications include atorvastatin, allopurinol, metoprolol, and acetazolamide. She is prescribed lithium and instructed to follow-up with a primary care physician. At a follow-up appointment, she complains of nausea, vomiting, and increased urinary frequency. On examination, she has a coarse tremor and diffuse hyperreflexia. Which of the following medications is most likely is responsible for the patient’s current presentation?? {'A': 'Acetazolamide', 'B': 'Atorvastatin', 'C': 'Indomethacin', 'D': 'Metoprolol', 'E': 'Nitrofurantoin'}, | C: Indomethacin |
Answer the following medical question with one of the provided options: | Q:A 58-year-old Caucasian woman visits her primary care physician for an annual check-up. She has a history of type 2 diabetes mellitus and stage 3A chronic kidney disease. Her estimated glomerular filtration rate has not changed since her last visit. Today, her parathyroid levels are moderately elevated. She lives at home with her husband and 2 children and works as a bank clerk. Her vitals are normal, and her physical examination is unremarkable. Which of the following explains this new finding?? {'A': 'Phosphate retention', 'B': 'Hyperuricemia', 'C': 'Acidemia', 'D': 'Hypercalcemia', 'E': 'Uremia'}, | A: Phosphate retention |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman presents with a severe headache and neck pain for the past 60 minutes. She says the headache was severe and onset suddenly like a ‘thunderclap’. She reports associated nausea, vomiting, neck pain, and stiffness. She denies any recent head trauma, loss of consciousness, visual disturbances, or focal neurologic deficits. Her past medical history is significant for hypertension, managed with hydrochlorothiazide. She denies any history of smoking, alcohol use, or recreational drug use. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 165/95 mm Hg, pulse 92/min, and respiratory rate 15/min. On physical examination, there is mild nuchal rigidity noted with limited flexion at the neck. An ophthalmic examination of the retina shows mild papilledema. A noncontrast computed tomography (CT) scan of the head is performed and shown in the exhibit (see image). Which of the following is the next best step in the management of this patient?? {'A': 'Mannitol', 'B': 'Lumbar puncture', 'C': 'Nitroprusside', 'D': 'Dexamethasone', 'E': 'Labetalol'}, | E: Labetalol |
Answer the following medical question with one of the provided options: | Q:A 26-year-old primigravida presents to her physician’s office at 35 weeks gestation with new onset lower leg edema. The course of her pregnancy was uneventful up to the time of presentation and she has been compliant with the recommended prenatal care. She reports a 4 pack-year history of smoking prior to her pregnancy. She also used oral contraceptives for birth control before considering the pregnancy. Prior to pregnancy, she weighed 52 kg (114.6 lb). She gained 11 kg (24.3 lb) during the pregnancy thus far, and 2 kg (4.4 lb) during the last 2 weeks. Her height is 169 cm (5 ft 7 in). She has a family history of hypertension in her mother (diagnosed at 46 years of age) and aunt (diagnosed at 51 years of age). The blood pressure is 145/90 mm Hg, the heart rate is 91/min, the respiratory rate is 15/min, and the temperature is 36.6℃ (97.9℉). The blood pressure is unchanged 15 minutes and 4 hours after the initial measurement. The fetal heart rate is 144/min. The examination is remarkable for 2+ pitting lower leg edema. The neurologic examination shows no focality. A urine dipstick test shows 2+ proteinuria. Which of the following factors is a risk factor for her condition?? {'A': 'Smoking prior to pregnancy', 'B': 'Oral contraceptives intake', 'C': 'Primigravida', 'D': 'BMI < 18.5 kg/m2 prior to pregnancy', 'E': 'Family history of hypertension'}, | C: Primigravida |
Answer the following medical question with one of the provided options: | Q:A 46-year-old African American woman presents to her primary care doctor complaining of muscle aches and weakness. She reports a 3 month history of gradually worsening upper and lower extremity pain. She is having trouble keeping up with her children and feels tired for most of the day. A review of systems reveals mild constipation. Her past medical history is notable for hypertension, diabetes, rheumatoid arthritis, and obesity. She takes lisinopril, metformin, and methotrexate. Her family history is notable for chronic lymphocytic leukemia in her mother and prostate cancer in her father. Her temperature is 99°F (37.2°C), blood pressure is 145/95 mmHg, pulse is 80/min, and respirations are 17/min. On exam, she appears well and in no acute distress. Muscle strength is 4/5 in her upper and lower extremities bilaterally. Patellar and brachioradialis reflexes are 2+ bilaterally. A serum analysis in this patient would most likely reveal which of the following?? {'A': 'Decreased PTH, decreased phosphate, and increased calcium', 'B': 'Decreased PTH, increased phosphate, and decreased calcium', 'C': 'Increased PTH, decreased phosphate, and increased calcium', 'D': 'Increased PTH, increased phosphate, and decreased calcium', 'E': 'Increased PTH, increased phosphate, and increased calcium'}, | C: Increased PTH, decreased phosphate, and increased calcium |
Answer the following medical question with one of the provided options: | Q:A 14-year-old girl presents to her pediatrician with complaints of repeated jerking of her neck for the past 2 years. Initially, her parents considered it a sign of discomfort in her neck, but later they noticed that the jerking was more frequent when she was under emotional stress or when she was fatigued. The patient says she can voluntarily control the jerking in some social situations, but when she is under stress, she feels the urge to jerk her neck and she feels better after that. The parents also report that during the past year, there have even been a few weeks when the frequency of the neck jerking had decreased drastically, only to increase again afterwards. On physical examination, she is a physically healthy female with normal vital signs. Her neurologic examination is normal. The pediatrician also notes that when he makes certain movements, the patient partially imitates these movements. The parents are very much concerned about her abnormal movements and insist on a complete diagnostic work-up. After a detailed history, physical examination, and laboratory investigations, the pediatrician confirms the diagnosis of Tourette syndrome. The presence of which of the following findings is most likely to confirm the pediatrician’s diagnosis?? {'A': 'History of repeated bouts of unprovoked obscene speech over the past year', 'B': 'Rigidity and bradykinesia', 'C': 'Low serum ceruloplasmin level', 'D': 'Decreased caudate volumes in magnetic resonance imaging (MRI) of the brain', 'E': 'Increased activity in frontal subcortical regions in positron-emission tomography (PET) study'}, | A: History of repeated bouts of unprovoked obscene speech over the past year |
Answer the following medical question with one of the provided options: | Q:The division chief of general internal medicine at an academic medical center is interested in reducing 30-day readmissions for diabetic ketoacidosis (DKA) in elderly patients. Her research team decided to follow 587 patients over the age of 65 who have recently been admitted to the hospital for DKA for a 30-day period. At the end of 30 days, she identified 100 patients who were readmitted to the hospital and examined risk factors associated with readmission. The main results of her study are summarized in the table below. RR (95% CI) P-value Episodes of DKA in the past 3 years < 0.001 None Reference 1–2 1.23 (1.04–1.36) 3–4 1.48 (1.38–1.59) 5+ 2.20 (1.83–2.51) Which of the following aspects of the results would support a causal relationship between a history of DKA and 30-day readmission risk for DKA?"? {'A': 'Low p-value', 'B': 'Confidence intervals that do not cross 1.0', 'C': 'Case-control study design', 'D': 'High odds ratio', 'E': 'Dose-response relationship'}, | E: Dose-response relationship |
Answer the following medical question with one of the provided options: | Q:A 74-year-old man is brought from a nursing home to the emergency room for progressive confusion. The patient has a history of stroke 3 years ago, which rendered him wheelchair-bound. He was recently started on clozapine for schizothymia disorder. Vital signs reveal a temperature of 38.7°C (101.66°F), a blood pressure of 100/72 mm Hg, and a pulse of 105/minute. On physical examination, he is disoriented to place and time. Initial lab work-up results are shown: Serum glucose: 945 mg/dL Serum sodium: 120 mEq/L Serum urea: 58 mg/dL Serum creatinine: 2.2 mg/dL Serum osmolality: 338 mOsm/kg Serum beta-hydroxybutyrate: negative Urinalysis reveals: numerous white blood cells and trace ketones Which of the following manifestations is more likely to be present in this patient?? {'A': 'Fruity odor of the breath', 'B': 'Abdominal pain', 'C': 'Seizures', 'D': 'Nausea or vomiting', 'E': 'Rapid deep breathing'}, | C: Seizures |
Answer the following medical question with one of the provided options: | Q:A 54-year-old male presents to the emergency department with nasal congestion and sore throat. He also endorses ten days of fatigue, rhinorrhea and cough, which he reports are getting worse. For the last four days, he has also had facial pain and thicker nasal drainage. The patient’s past medical history includes obesity, type II diabetes mellitus, and mild intermittent asthma. His home medications include metformin and an albuterol inhaler as needed. The patient has a 40 pack-year smoking history and drinks 6-12 beers per week. His temperature is 102.8°F (39.3°C), blood pressure is 145/96 mmHg, pulse is 105/min, and respirations are 16/min. On physical exam, he has poor dentition. Purulent mucus is draining from his nares, and his oropharynx is erythematous. His maxillary sinuses are tender to palpation. Which one of the following is the most common risk factor for this condition?? {'A': 'Asthma', 'B': 'Diabetes mellitus', 'C': 'Poor dentition', 'D': 'Tobacco use', 'E': 'Viral infection'}, | E: Viral infection |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to the emergency department with severe respiratory distress. He was diagnosed with metastatic pancreatic cancer 6 months ago and underwent 2 rounds of chemotherapy. He says that he has had a cough and flu-like symptoms for the past week. During the interview, he is having progressive difficulty answering questions and suddenly becomes obtunded with decreased motor reflexes. His temperature is 38.8°C (102.0°F), blood pressure is 90/60 mm Hg, pulse is 94/min, and respirations are 22/min. Pulse oximetry is 82% on room air. The patient’s medical record contains an advanced directive stating that he would like all interventions except for cardiopulmonary resuscitation. Which of the following is the most appropriate next step in management?? {'A': 'Observe and monitor vital signs for improvement.', 'B': 'Administer intravenous fluids.', 'C': 'Intubate and administer intravenous antibiotics.', 'D': 'Administer intravenous antibiotics and draw blood for testing.', 'E': 'Intubate only.'}, | C: Intubate and administer intravenous antibiotics. |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman presents to clinic complaining of pelvic pain and heavy menstrual bleeding for the past 2 years. The patient reports that her last menstrual period was 1 week ago and she soaked through 1 tampon every 1-2 hours during that time. She does not take any medications and denies alcohol and cigarette use. She is currently trying to have a child with her husband. She works as a school teacher and exercises regularly. Her temperature is 97.0°F (36.1°C), blood pressure is 122/80 mmHg, pulse is 93/min, respirations are 16/min, and oxygen saturation is 99% on room air. Physical examination reveals an enlarged, irregularly-shaped uterus palpable at the level of the umbilicus. Laboratory studies are ordered as seen below. Hemoglobin: 9.0 g/dL Hematocrit: 29% MCV: 70 fL Leukocyte count: 4,500/mm^3 with normal differential Platelet count: 188,000/mm^3 Urine: hCG: Negative Blood: Negative Leukocytes: Negative Bacteria: Negative Which of the following is the most effective treatment for this patient?? {'A': 'Folate', 'B': 'Hysterectomy', 'C': 'Iron', 'D': 'Myomectomy', 'E': 'Oral contraceptive pills'}, | D: Myomectomy |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. His car was rear-ended by a drunk driver while he was stopped at a traffic light. At the scene, he was noted to have multiple small lacerations over his upper extremities from broken glass. He has otherwise been healthy, does not smoke, and drinks 5 beers per night. He notes that he recently started trying out a vegan diet and moved to an apartment located in a historic neighborhood that was built in the 1870s. Physical exam reveals several small lacerations on his arms bilaterally but is otherwise unremarkable. A complete blood workup is sent and some of the notable findings are shown below: Hemoglobin: 12.1 g/dL (normal: 13.5-17.5 g/dL) Platelet count: 261,000/mm^3 (normal: 150,000-400,000/mm^3) Mean corpuscular volume: 74 µm^3 (normal: 80-100 µm^3) Further testing using serum hemoglobin electrophoresis reveals: Hemoglobin A1 92% (normal 95-98%) Hemoglobin A2: 6% (normal: 1.5-3.1%) Which of the following cell morphologies would most likely be seen on blood smear in this patient?? {'A': 'All cells appear normal', 'B': 'Codocytes', 'C': 'Megaloblasts', 'D': 'Sideroblasts', 'E': 'Schistocytes'}, | B: Codocytes |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman comes to the physician because of a 3-month history of worsening fatigue. She has difficulty concentrating at work despite sleeping well most nights. Three years ago, she was diagnosed with Crohn disease. She has about 7 non-bloody, mildly painful bowel movements daily. Her current medications include 5-aminosalicylic acid and topical budesonide. She does not smoke or drink alcohol. She appears pale. Her temperature is 37.9°C (100.2°F), pulse is 92/min, and blood pressure is 110/65 mmHg. The abdomen is diffusely tender to palpation, with no guarding. Laboratory results show: Hemoglobin 10.5 g/dL Mean corpuscular volume 83 μm3 Reticulocytes 0.2 % Platelets 189,000/mm3 Serum Iron 21 μg/dL Total iron binding capacity 176 μg/dL (N=240–450) A blood smear shows anisocytosis. Which of the following is the most appropriate next step in treatment?"? {'A': 'Oral prednisone therapy', 'B': 'Subcutaneous erythropoietin injection', 'C': 'Red blood cell transfusion', 'D': 'Intravenous metronidazole therapy', 'E': 'Oral vitamin B12 supplementation'}, | A: Oral prednisone therapy |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.