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:A 10-year-old girl with a rash is brought to the clinic by her mother. The patient’s mother says that the onset of the rash occurred 2 days ago. The rash was itchy, red, and initially localized to the cheeks with circumoral pallor, and it gradually spread to the arms and trunk. The patient’s mother also says her daughter had been reporting a high fever of 39.4°C (102.9°F), headaches, myalgia, and flu-like symptoms about a week ago, which resolved in 2 days with acetaminophen. The patient has no significant past medical history. Her vital signs include: temperature 37.0°C (98.6°F), pulse 90/min, blood pressure 125/85 mm Hg, respiratory rate 20/min. Physical examination shows a symmetric erythematous maculopapular rash on both cheeks with circumoral pallor, which extends to the patient’s trunk, arms, and buttocks. The remainder of the exam is unremarkable. Laboratory findings are significant for a leukocyte count of 7,100/mm3 and platelet count of 325,000/mm3. Which of the following is the next best step in the management of this patient?? {'A': 'Administer intravenous immunoglobulin (IVIG)', 'B': 'Transfuse with whole blood', 'C': 'Discharge home, saying that the patient may immediately return to school', 'D': 'Discharge home, saying that the patient may return to school after the disappearance of the rash', 'E': 'Discharge home with instructions for strict isolation from pregnant women until disappearance of the rash'},
|
C: Discharge home, saying that the patient may immediately return to school
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old male presents to the emergency department after an episode of bloody vomiting. He is a chronic alcoholic with a history of cirrhosis, and this is the third time he is presenting with this complaint. His first two episodes of hematemesis required endoscopic management of bleeding esophageal varices. His hemoglobin on admission laboratory evaluation was 11.2 g/dL. The patient is stabilized, and upper endoscopy is performed with successful banding of bleeding varices. Follow-up lab-work shows hemoglobin levels of 10.9 g/dL and 11.1 g/dL on days 1 and 2 after admission. Which of the following is the best next step in the management of this patient?? {'A': 'Monitor stability and discharge with continuation of endoscopic surveillance at regular 3 month intervals', 'B': 'Discuss with the patient the option of a transjugular intrahepatic portosystemic stent (TIPS)', 'C': 'Balloon tamponade of bleeding varices', 'D': 'Begin long-term octreotide and a 4-week course of prophylactic antibiotics', 'E': 'Give 2 units packed RBCs'},
|
B: Discuss with the patient the option of a transjugular intrahepatic portosystemic stent (TIPS)
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old man is brought into the emergency department after he was hit by a car. The patient was intoxicated and walked into oncoming traffic. He is currently unconscious and has a Glasgow coma scale score of 3. The patient has been admitted multiple times for alcohol intoxication and pancreatitis. The patient is resuscitated with fluid and blood products. An initial trauma survey reveals minor scrapes and abrasions and pelvic instability. The patient’s pelvis is placed in a binder. After further resuscitation the patient becomes responsive and states he is in pain. He is given medications and further resuscitation ensues. One hour later, the patient complains of numbness surrounding his mouth and in his extremities. Which of the following is the most likely explanation of this patient’s current symptoms?? {'A': 'Hypokalemia', 'B': 'Late-onset edema surrounding the spinal cord', 'C': 'Medication complication', 'D': 'Transfusion complication', 'E': 'Trauma to the spinal cord'},
|
D: Transfusion complication
|
Answer the following medical question with one of the provided options:
|
Q:A 57-year-old woman is admitted to the intensive care unit for management of shock. Her pulse is feeble and blood pressure is 86/45 mm Hg. The patient undergoes pulmonary artery catheterization which shows an elevated pulmonary capillary wedge pressure and increased systemic vascular resistance. Which of the following additional findings is most likely in this patient?? {'A': 'Cold skin due to loss of intravascular fluid volume', 'B': 'Bradycardia due to neurologic dysfunction', 'C': 'Bronchospasm due to excessive histamine release', 'D': 'Mottled skin due to release of endotoxins', 'E': 'Confusion due to decreased stroke volume'},
|
E: Confusion due to decreased stroke volume
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old Caucasian man presents to the emergency room with chest pain. Coronary angiography reveals significant stenosis of the left anterior descending (LAD) artery. Which of the following represents a plausible clinical predictor of myocardial necrosis in this patient?? {'A': 'Cholesterol crystal presence', 'B': 'Rate of plaque formation', 'C': 'Calcium content', 'D': 'Presence of cytokines', 'E': 'Amount of foam cells'},
|
B: Rate of plaque formation
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old woman comes to the physician because of a 1-month history of intermittent abdominal pain, flatulence, and watery diarrhea. The episodes typically occur 2–3 hours after meals, particularly following ingestion of ice cream, cheese, and pizza. She is administered 50 g of lactose orally. Which of the following changes is most likely to be observed in this patient?? {'A': 'Decreased urinary D-xylose concentration', 'B': 'Increased serum glucose concentration', 'C': 'Increased stool osmotic gap', 'D': 'Decreased fecal fat content', 'E': 'Decreased breath hydrogen content'},
|
C: Increased stool osmotic gap
|
Answer the following medical question with one of the provided options:
|
Q:A 70-year-old male with a 10-year history of COPD visits his pulmonologist for a checkup. Physical examination reveals cyanosis, digital clubbing, and bilateral lung wheezes are heard upon auscultation. The patient has a cough productive of thick yellow sputum. Which of the following findings is most likely present in this patient?? {'A': 'Decreased arterial carbon dioxide content', 'B': 'Increased pulmonary arterial resistance', 'C': 'Increased pH of the arterial blood', 'D': 'Increased cerebral vascular resistance', 'E': 'Increased right ventricle compliance'},
|
B: Increased pulmonary arterial resistance
|
Answer the following medical question with one of the provided options:
|
Q:Background and Methods: Aldosterone is important in the pathophysiology of heart failure. In a double-blind study, we enrolled 1,663 patients who had severe heart failure, a left ventricular ejection fraction of no more than 35 percent, and were being treated with an angiotensin-converting-enzyme inhibitor, a loop diuretic, and in most cases digoxin. A total of 822 patients were randomly assigned to receive 25 mg of spironolactone daily and 841 to receive placebo. The primary endpoint was death from all causes. Results: The trial was discontinued early, after a mean follow-up period of 24 months, because an interim analysis determined that spironolactone was efficacious. There were 386 deaths in the placebo group (46%) and 284 in the spironolactone group (35%; relative risk of death, 0.70; 95% confidence interval, 0.60 to 0.82; p<0.001). This 30 percent reduction in the risk of death among patients in the spironolactone group was attributed to a lower risk of both death from progressive heart failure and sudden death from cardiac causes. The frequency of hospitalization for worsening heart failure was 35% lower in the spironolactone group than in the placebo group (relative risk of hospitalization, 0.65; 95% confidence interval, 0.54 to 0.77; p<0.001). In addition, patients who received spironolactone had a significant improvement in the symptoms of heart failure, as assessed on the basis of the New York Heart Association functional class (p<0.001). Gynecomastia was reported in 10% of men who were treated with spironolactone, as compared with 1% of men in the placebo group (p<0.001). The incidence of serious hyperkalemia was minimal in both groups of patients. Which of the following statements represents the most accurate interpretation of the results from the aforementioned clinical trial?? {'A': 'Spironolactone, in addition to standard therapy, substantially reduces the risk of morbidity and death in patients with severe heart failure', 'B': 'The addition of spironolactone significant improved symptoms of heart failure, but not overall mortality', 'C': 'Spironolactone did not improve all-cause morbidity and mortality in patients with severe heart failure', 'D': 'The incidence of both gynecomastia and hyperkalemia was elevated in patients treated with spironolactone', 'E': 'Given the large sample size of this clinical trial, the results are likelily generalizable to all patient with heart failure'},
|
A: Spironolactone, in addition to standard therapy, substantially reduces the risk of morbidity and death in patients with severe heart failure
|
Answer the following medical question with one of the provided options:
|
Q:During an experiment, an investigator attempts to determine the rates of apoptosis in various tissue samples. Injecting cytotoxic T cells into the cell culture of one of the samples causes the tissue cells to undergo apoptosis. Apoptosis is most likely due to secretion of which of the following substances in this case?? {'A': 'Cytochrome C', 'B': 'Bcl-2', 'C': 'TNF-α', 'D': 'Granzyme B', 'E': 'Caspases'},
|
D: Granzyme B
|
Answer the following medical question with one of the provided options:
|
Q:Which of the following situations calls for treatment with alprazolam?? {'A': 'A 28-year-old female that gets irritated or worried about everyday things out of proportion to the actual source of worry', 'B': 'A 35-year-old male that gets tachycardic, tachypnic, and diaphoretic every time he rides a plane', 'C': 'A 42-year-old female with extreme mood changes ranging from mania to severe depression', 'D': 'A 19-year-old male that saw his sibling murdered, and has had flashbacks and hypervigilance for more than one month', 'E': 'A 65-year-old male with narrow angle glaucoma that complains of excessive worry, rumination, and uneasiness about future uncertainties'},
|
B: A 35-year-old male that gets tachycardic, tachypnic, and diaphoretic every time he rides a plane
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old woman is brought to the clinic at her husband's insistence for sleep disturbances. Most nights of the week she repeatedly gets out of bed to pace around their apartment before returning to bed. The woman says that while she's lying in bed, she becomes overwhelmed by a "creepy-crawly" feeling in her legs that she can only relieve by getting out of bed. Past medical history is noncontributory and physical exam is unremarkable. Which of the following laboratory studies is most likely abnormal in this patient?? {'A': 'Complete blood count', 'B': 'Hemoglobin A1c', 'C': 'Liver function tests', 'D': 'Lumbar puncture', 'E': 'Nerve conduction studies'},
|
A: Complete blood count
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old woman presents with ongoing heartburn despite being on treatment for the last few months. She describes a burning sensation in her chest even after small meals. She has stopped eating fatty and spicy foods as they aggravate her heartburn significantly. She has also stopped drinking alcohol but is unable to quit smoking. Her attempts to lose weight have failed. Three months ago, she was started on omeprazole and ranitidine, but she still is having symptoms. She had previously used oral antacids but had to stop because of intolerable constipation. Past medical history is significant for a mild cough for the past several years. Her vital signs are pulse 90/min, blood pressure 120/67 mm Hg, respiratory rate 14/min, and temperature of 36.7°C (98.0°F). Her current BMI is 26 kg/m2. Her teeth are yellow-stained, but the physical examination is otherwise unremarkable. What is the next best step in her management?? {'A': 'Prescribe a nicotine patch.', 'B': 'Abdominal radiographs', 'C': 'Start metoclopramide.', 'D': 'Endoscopic evaluation', 'E': 'Refer for bariatric surgery.'},
|
C: Start metoclopramide.
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old girl presents to the emergency department with a severe headache. The patient has had headaches in the past, but she describes this as the worst headache of her life. Her symptoms started yesterday and have been getting progressively worse. The patient states that the pain is mostly on one side of her head. There has been a recent outbreak of measles at the patient’s school, and the patient’s mother has been trying to give her daughter medicine to prevent her from getting sick, but the mother fears that her daughter may have caught the measles. On physical exam, you note an obese young girl who is clutching her head with the light in the room turned off. Her neurological exam is within normal limits. Fundoscopic exam reveals mild bilateral papilledema. A MRI of the head is obtained and reveals cerebral edema. A lumbar puncture reveals an increased opening pressure with a normal glucose level. Which of the following is the most likely diagnosis?? {'A': 'Viral meningitis', 'B': 'Bacterial meningitis', 'C': 'Subarachnoid hemorrhage', 'D': 'Migraine headache', 'E': 'Fat-soluble vitamin overuse'},
|
E: Fat-soluble vitamin overuse
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 1-year-old boy is brought to the emergency department because of irritability and fever for 2 days. His symptoms began shortly after returning from a family trip to Canada. He was born at term. His immunizations are up-to-date. His 6-year-old brother is healthy and there is no family history of serious illness. The boy appears weak and lethargic. He is at the 50th percentile for height and 75th percentile for weight. His temperature is 39.2°C (102.5°F), pulse is 110/min, respirations are 28/min, and blood pressure is 92/55 mm Hg. Physical examination shows several purple spots over the trunk and extremities that are 1 mm in diameter. Capillary refill time is 4 seconds. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 12 g/dL, leukocyte count is 19,000/mm3, and platelet count is 225,000/mm3. A lumbar puncture is done; cerebrospinal fluid (CSF) analysis shows abundant segmented neutrophils, decreased glucose concentration, and an increased protein concentration. Which of the following is the most appropriate next step in management?? {'A': 'Ampicillin therapy for the patient and ciprofloxacin prophylaxis for close contacts', 'B': 'Cefotaxime and vancomycin therapy for the patient and doxycycline prophylaxis for close contacts', 'C': 'Vancomycin therapy for the patient and rifampin prophylaxis for close contacts', 'D': 'Ceftriaxone and vancomycin therapy for the patient and rifampin prophylaxis for close contacts', 'E': 'Cefotaxime and vancomycin therapy for the patient and no prophylaxis for close contacts\n"'},
|
D: Ceftriaxone and vancomycin therapy for the patient and rifampin prophylaxis for close contacts
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old woman is brought to the emergency room at a nearby hospital after being involved in a roadside accident in which she sustained severe chest trauma. Enroute to the hospital, morphine is administered for pain control. Upon arrival, the patient rapidly develops respiratory failure and requires intubation and mechanical ventilation. She is administered pancuronium in preparation for intubation but suddenly develops severe bronchospasm and wheezing. Her blood pressure also quickly falls from 120/80 mm Hg to 100/60 mm Hg. Which of the following best explains the most likely etiology of this complication?? {'A': 'Autonomic stimulation', 'B': 'Drug interaction', 'C': 'Histamine release', 'D': 'Skeletal muscle paralysis', 'E': 'Underlying neuromuscular disease'},
|
C: Histamine release
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is studying intracellular processes in muscle tissue after denervation. A biopsy specimen is obtained from the biceps femoris muscle of an 82-year-old woman who sustained sciatic nerve injury. Investigation of the tissue specimen shows shrunken cells with dense eosinophilic cytoplasm, nuclear shrinkage, and plasma membrane blebbing. Which of the following best explains the muscle biopsy findings?? {'A': 'Release of mitochondrial cytochrome c', 'B': 'Degradation of Bcl-2-associated X protein', 'C': 'Denaturation of cytoplasmic proteins', 'D': 'Deactivation of caspases', 'E': 'Inhibition of Fas/FasL interaction'},
|
A: Release of mitochondrial cytochrome c
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old girl is brought to the physician by her mother because of lower abdominal pain for the past 5 days. The pain is constant and she describes it as 7 out of 10 in intensity. Over the past 7 months, she has had multiple similar episodes of abdominal pain, each lasting for 4–5 days. She has not yet attained menarche. Examination shows suprapubic tenderness to palpation. Pubic hair and breast development are Tanner stage 4. Examination of the external genitalia shows no abnormalities. Pelvic examination shows bulging, bluish vaginal tissue. Rectal examination shows an anterior tender mass. Which of the following is the most effective intervention for this patient's condition?? {'A': 'Administer oral contraceptives pills', 'B': 'Perform vaginal dilation', 'C': 'Administer ibuprofen', 'D': 'Perform hymenotomy', 'E': 'Administer gonadotropin-releasing hormone agonist therapy\n"'},
|
D: Perform hymenotomy
|
Answer the following medical question with one of the provided options:
|
Q:A 46-year-old woman comes to the physician for a cognitive evaluation. She is an office manager. She has had increasing difficulties with multitasking and reports that her job performance has declined over the past 1 year. On mental status examination, short-term memory is impaired and long-term memory is intact. Laboratory studies, including thyroid-stimulating hormone and vitamin B12, are within the reference range. An MRI of the brain shows generalized atrophy, most pronounced in the bilateral medial temporal lobes and hippocampi. If this patient's condition has a genetic etiology, which of the following alterations is most likely to be found on genetic testing?? {'A': 'Noncoding hexanucleotide repeats', 'B': 'Deletion of chromosome 21q', 'C': 'Mutation in presenilin 1', 'D': 'Expansion of CAG trinucleotide repeat', 'E': 'Presence of ApoE ε4 allele'},
|
C: Mutation in presenilin 1
|
Answer the following medical question with one of the provided options:
|
Q:An investigator, studying learning in primates, gives an experimental chimpanzee a series of puzzles to solve. The chimpanzee solves the puzzle when he is able to place a set of wooden blocks sequentially inside the next biggest block. When a puzzle is solved successfully, a 30-second audio clip of a pop song plays. 15 seconds after that, a tangerine drops into the chimpanzee's room. After 2 days of this regimen, the chimpanzee undergoes functional magnetic resonance imaging (fMRI) of his brain while hearing the audio clip, which shows markedly elevated neurotransmission in the ventral tegmental area and substantia nigra. Which of the following best explains the finding on fMRI?? {'A': 'Positive reinforcement', 'B': 'Negative reinforcement', 'C': 'Displacement', 'D': 'Classical conditioning', 'E': 'Extinction'},
|
D: Classical conditioning
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old male adolescent presents to the pediatrician with his parents complaining that he is shorter than his peers. His past medical history does not suggest any specific recurrent or chronic disease. There is no history of weight gain, weight loss, constipation, dry skin, headache. Both his parents are of normal height. On physical examination, he is a well-fed, well-developed male and his vital signs are within normal range. His physical examination is completely normal. His sexual development corresponds to Tanner stage 2. Analysis of his growth charts suggests that his height and weight at birth were within normal range. After the age of six months, his height and weight curves drifted further from average and approached the 5th percentile. An X-ray of the patient’s left hand reveals delayed bone age. Which of the following is the most likely cause of short stature in the boy?? {'A': 'Constitutional growth delay', 'B': 'Familial short stature', 'C': 'Congenital adrenal hyperplasia', 'D': 'Growth hormone deficiency', 'E': 'Hypothyroidism'},
|
A: Constitutional growth delay
|
Answer the following medical question with one of the provided options:
|
Q:A 53-year-old female visits her physician with watery diarrhea and episodic flushing. The patient reports that she is often short of breath, and a pulmonary exam reveals bilateral wheezing. A CT scan shows a mass in the terminal ileum. 24-hour urine collection shows abnormally elevated 5-hydroxyindoleacetic acid (HIAA) levels. Ultrasound demonstrates a tricuspid valve with signs of fibrosis with a normal mitral valve. A metastatic disease to which organ is most commonly associated with the patient's syndrome?? {'A': 'Lung', 'B': 'Kidney', 'C': 'Brain', 'D': 'Liver', 'E': 'Pancreas'},
|
D: Liver
|
Answer the following medical question with one of the provided options:
|
Q:A patient weighing 70 kg (154 lb) requires intravenous antibiotics for a calcified abscess. The desired target plasma concentration of the antibiotic is 4.5 mg/L. The patient is estimated to have a volume of distribution of 30 L and a clearance rate of 60 mL/min. How many milligrams of the drug should be administered for the initial dose to reach the desired target plasma concentration?? {'A': '135 mg', 'B': '270 mg', 'C': '35 mg', 'D': '200 mg', 'E': '70 mg'},
|
A: 135 mg
|
Answer the following medical question with one of the provided options:
|
Q:An 82-year-old man with alcohol use disorder is brought to the emergency department from his assisted living facility because of fever and cough for 1 week. The cough is productive of thick, mucoid, blood-tinged sputum. His temperature is 38.5°C (101.3°F) and respirations are 20/min. Physical examination shows coarse inspiratory crackles over the right lung field. Sputum cultures grow gram-negative, encapsulated bacilli that are resistant to amoxicillin, ceftriaxone, and aztreonam. Which of the following infection control measures is most appropriate for preventing transmission of this organism to other patients in the hospital?? {'A': 'Require all staff and visitors to wear droplet masks', 'B': 'Transfer patient to a positive pressure room', 'C': 'Require autoclave sterilization of all medical instruments', 'D': 'Isolate patient to a single-occupancy room', 'E': 'Transfer patient to a negative pressure room'},
|
D: Isolate patient to a single-occupancy room
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old boy presents to the Emergency Department with wheezing and shortness of breath after playing with the new family pet. Which of the following immunological factors is most involved in generating the antibodies necessary for mast cell Fc-receptor cross-linking and degranulation?? {'A': 'IL-2', 'B': 'IL-4', 'C': 'IL-5', 'D': 'IL-10', 'E': 'IL-13'},
|
B: IL-4
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old man is brought to his psychiatrist by his wife. The patient’s wife says his last visit was 3 years ago for an episode of depression. At that time, he was prescribed fluoxetine, which he did not take because he believed that his symptoms would subside on their own. A few months later, his wife says that he suddenly came out of his feelings of ‘depression’ and began to be more excitable and show pressured speech. She observed that he slept very little but had a heightened interest in sexual activity. This lasted for a few weeks, and he went back to his depressed state. He has continued to experience feelings of sadness and shows a lack of concentration at work. She often finds him crying, and he also expresses feelings of guilt for all the wrongs he allegedly did to her and to the family. There was a week where he had a brief time of excitability and was considering donating all their savings to a local charity. She is highly perturbed by his behavior and often finds it hard to predict what his mood will be like next. The patient denies any suicidal or homicidal ideations. A urine toxicology screen is negative. All laboratory tests, including thyroid hormone levels, are normal. Which of the following is the most appropriate diagnosis in this patient?? {'A': 'Major depressive disorder', 'B': 'Dysthymia', 'C': 'Cyclothymia', 'D': 'Bipolar disorder, type I', 'E': 'Schizoaffective disorder'},
|
C: Cyclothymia
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 56-year-old woman comes to the family physician for a 1-month history of sleep disturbance and sadness. The symptoms have been occurring since her husband died in a car accident. Before eventually falling asleep, she stays awake for multiple hours and has crying spells. Several times she has been woken up by the sound of her husband calling her name. She has lost 3 kg (6.6 lb) over the past month. She has 3 children with whom she still keeps regular contact and regularly attends church services with her friends. She expresses feeling a great feeling of loss over the death of her husband. She has no suicidal ideation. She is alert and oriented. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?? {'A': 'Schizoaffective disorder', 'B': 'Normal bereavement', 'C': 'Acute stress disorder', 'D': 'Major depressive disorder', 'E': 'Adjustment disorder with depressed mood'},
|
B: Normal bereavement
|
Answer the following medical question with one of the provided options:
|
Q:A 75-year-old man comes to the physician because of a 2-month history of intermittent bright red blood in his stool, progressive fatigue, and a 5-kg (11-lb) weight loss. He appears thin and fatigued. Physical examination shows conjunctival pallor. Hemoglobin concentration is 7.5 g/dL and MCV is 77 μm3. Results of fecal occult blood testing are positive. A colonoscopy shows a large, friable mass in the anal canal proximal to the pectinate line. Primary metastasis to which of the following lymph nodes is most likely in this patient?? {'A': 'Inferior mesenteric', 'B': 'Internal iliac', 'C': 'External iliac', 'D': 'Para-aortic', 'E': 'Deep inguinal'},
|
B: Internal iliac
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman presents with weight gain and marks on her abdomen (as seen in the image below). She does not have any significant past medical history. She is a nonsmoker and denies any alcohol use. Her blood pressure is 160/110 mm Hg and pulse is 77/min. A T1/T2 MRI of the head shows evidence of a pituitary adenoma, and she undergoes surgical resection of the tumor. Which of the following therapies is indicated in this patient to ensure normal functioning of her hypothalamic-pituitary-adrenal (HPA) axis?? {'A': 'Bilateral adrenalectomy', 'B': 'Fludrocortisone', 'C': 'Hydrocortisone', 'D': 'Mometasone', 'E': 'Methotrexate'},
|
C: Hydrocortisone
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old man presents with a sudden-onset severe headache and vomiting for the past 2 hours. Past medical history is significant for poorly controlled hypertension, managed with multiple medications. His blood pressure is 188/87 mm Hg and pulse is 110/min. A non-contrast CT of the head is unremarkable and cerebrospinal fluid analysis is within normal limits, except for an RBC count of 5.58 x 106/mm3. Labetalol IV is administered. Which of the following medications should also be added to this patient’s management?? {'A': 'Nifedipine', 'B': 'Verapamil', 'C': 'Furosemide', 'D': 'Nimodipine', 'E': 'Ecosprin'},
|
D: Nimodipine
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old patient comes to the physician with complaints of dysuria and white urethral discharge. He is sexually active with 4 partners and does not use condoms. The physician is concerned for a sexually transmitted infection and decides to analyze the nucleic acid sequences present in the discharge to aid in diagnosis via DNA amplification. Which of the following is responsible for the creation of the nucleic acid copies during the elongation phase of the technique most likely used in this case?? {'A': 'DNA primers', 'B': 'Nucleotide sequence of the target gene', 'C': 'Amino acid sequence of the target gene', 'D': 'Heat-sensitive DNA polymerase', 'E': 'Heat-resistant DNA polymerase'},
|
E: Heat-resistant DNA polymerase
|
Answer the following medical question with one of the provided options:
|
Q:A 61-year-old man is brought to the emergency department by his wife because of increasing confusion over the past 12 hours. His wife reports that he has a history of type 1 diabetes mellitus. His temperature is 38.8°C (101.8°F). He is confused and oriented only to person. Examination shows left periorbital swelling that is tender to palpation, mucopurulent rhinorrhea, and a black necrotic spot over the nose. There is discharge of the left eye with associated proptosis. A photomicrograph of a specimen obtained on biopsy of the left maxillary sinus is shown. Which of the following is the most likely causal organism?? {'A': 'Pseudomonas aeruginosa', 'B': 'Rhizopus microsporus', 'C': 'Aspergillus fumigatus', 'D': 'Blastomyces dermatitidis', 'E': 'Pneumocystis jirovecii'},
|
B: Rhizopus microsporus
|
Answer the following medical question with one of the provided options:
|
Q:A 57-year-old woman comes to the physician because of a 6-month history of tinnitus and progressive hearing loss in the left ear. She has type 2 diabetes mellitus and Raynaud syndrome. Her current medications include metformin, nifedipine, and a multivitamin. She appears well. Vital signs are within normal limits. Physical examination shows no abnormalities. A vibrating tuning fork is placed on the left mastoid process. Immediately after the patient does not hear a tone, the tuning fork is held over the left ear and she reports hearing the tuning fork again. The same test is repeated on the right side and shows the same pattern. The vibration tuning fork is then placed on the middle of the forehead and the patient hears the sound louder in the right ear. Which of the following is the most likely diagnosis?? {'A': 'Meningioma', 'B': 'Presbycusis', 'C': 'Acoustic neuroma', 'D': 'Cerumen impaction', 'E': 'Ménière disease\n"'},
|
C: Acoustic neuroma
|
Answer the following medical question with one of the provided options:
|
Q:A 4-week-old boy is brought to the emergency department with a 2-day history of projectile vomiting after feeding. His parents state that he is their firstborn child and that he was born healthy. He developed normally for several weeks but started to eat less 1 week ago. Physical exam reveals a small, round mass in the right upper quadrant of the abdomen close to the midline. The infant throws up in the emergency department, and the vomitus is observed to be watery with no traces of bile. Which of the following is associated with the most likely cause of this patient's symptoms?? {'A': 'Chloride transport defect', 'B': 'Failure of neural crest migration', 'C': 'Nitric oxide synthase deficiency', 'D': 'Recanalization defect', 'E': 'Vascular accident'},
|
C: Nitric oxide synthase deficiency
|
Answer the following medical question with one of the provided options:
|
Q:A 49-year-old woman is brought in to the emergency department by ambulance after developing crushing chest pain and palpitations. Past medical history is significant for hypertension, hyperlipidemia, and obesity. She takes chlorthalidone, lisinopril, atorvastatin, metformin, and an oral contraceptive every day. She works as a lawyer and her job is stressful. She drinks wine with dinner every night and smokes 10 cigarettes a day. Emergency personnel stabilized her and administered oxygen while on the way to the hospital. Upon arrival, the vital signs include: blood pressure 120/80 mm Hg, heart rate 120/min, respiratory rate 22/min, and temperature 37.7°C (99.9°F). On physical exam, she is an obese woman in acute distress. She is diaphoretic and has difficulty catching her breath. A bedside electrocardiogram (ECG) is performed which reveals ST-segment elevation in leads II, III, and aVF. Which of the following is the most probable diagnosis?? {'A': 'Inferior wall myocardial infarction ', 'B': 'Lateral wall myocardial infarction', 'C': 'Posterior wall myocardial infarction', 'D': 'Anteroseptal myocardial infarction', 'E': 'Right ventricular myocardial infarction'},
|
A: Inferior wall myocardial infarction
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old woman presents for an evaluation for snoring. According to her husband, her snoring has increased over the last year, and he can’t tolerate it anymore. He has also noticed that she wakes up at night regularly for a few seconds but then falls back asleep. During the day, the patient says she is sleepy most of the time and complains of headaches and poor concentration. Past medical history is significant for hypertension and hyperlipidemia. Her temperature is 36.6°C (97.9°F), blood pressure is 156/98 mm Hg, pulse is 90/min and respirations are 20/min. Her body mass index (BMI) is 38 kg/m2. A polysomnographic study is ordered, and the result is shown below. While counseling the patient about her condition and available treatment options, she is asked if she wants to try a new therapy in which a device stimulates one of her cranial nerves. Which of the following muscles would most likely be stimulated by this method?? {'A': 'Genioglossus muscle', 'B': 'Digastric muscle', 'C': 'Hyoglossus muscle', 'D': 'Palatoglossus muscle', 'E': 'Intercostal muscles'},
|
A: Genioglossus muscle
|
Answer the following medical question with one of the provided options:
|
Q:A 4-week-old male infant is brought to the physician because of a 1-week history of refusing to finish all his bottle feeds and becoming irritable shortly after feeding. He has also spit up sour-smelling milk after most feeds. Pregnancy and delivery were uncomplicated, with the exception of a positive vaginal swab for group B streptococci 6 weeks ago, for which the mother received one dose of intravenous penicillin. The baby is at the 70th percentile for length and 50th percentile for weight. His temperature is 36.6°C (98°F), pulse is 180/min, respirations are 30/min, and blood pressure is 85/55 mm Hg. He appears lethargic. Examination shows sunken fontanelles and a strong rooting reflex. The abdomen is soft with a 1.5-cm (0.6-inch) nontender epigastric mass. Examination of the genitals shows a normally pigmented scrotum, retractile testicles that can be pulled into the scrotum, a normal-appearing penis, and a patent anus. Which of the following interventions would have been most likely to decrease the patient's risk of developing his condition?? {'A': 'Feeding of soy milk formula', 'B': 'Breastfeeding only', 'C': 'Avoiding penicillin administration to the mother', 'D': 'Treating the infant with glucocorticoids', 'E': 'Performing cesarean section\n"'},
|
B: Breastfeeding only
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old woman status-post liver transplant presents to her transplant surgeon because she has noticed increased urination over the last 3 weeks. Six months ago she received a liver transplant because of fulminant liver failure after viral hepatitis. Since then, she has noticed that she has been drinking more water and urinating more. Her husband has also noticed that she has been eating a lot more. She says that she never had these symptoms prior to her transplant and has been taking her medications on time. After confirmatory tests, she is started on a medication that binds to an ATP-gated potassium channel. The drug that increases the risk of the complication experienced by this patient most likely has which of the following mechanisms of action?? {'A': 'Binding to cyclophilin D to inhibit calcineurin', 'B': 'Binding to FKBP-12 to inhibit calcineurin', 'C': 'Inosine monophosphate dehydrogenase inhibitor', 'D': 'Conversion into 6-mecaptopurine', 'E': 'Targeting the a-chain of the IL-2 receptor'},
|
B: Binding to FKBP-12 to inhibit calcineurin
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old woman with a history of recent gastric bypass surgery presents for a follow-up visit. 8 months ago, she underwent gastric bypass surgery because she was struggling with maintaining her BMI below 42 kg/m². She previously weighed 120 kg (265 lb), and now she weighs 74.8 kg (165 lb). She says that she has low energy and is easily fatigued. These symptoms have become progressively worse over the past month. She is struggling to get through the day and sometimes has to nap before she can continue with her work. She has also recently noticed that she gets cramps in her legs, especially after a long day. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Her hemoglobin is 9.5 mg/dL with an MCV of 75 fl. Her peripheral smear is shown in the exhibit. Which of the following supplements would most likely improve this patient’s symptoms?? {'A': 'Calcium', 'B': 'Pyridoxine', 'C': 'Retinoids', 'D': 'Methylcobalamin', 'E': 'Iron'},
|
E: Iron
|
Answer the following medical question with one of the provided options:
|
Q:A 19-year-old woman comes to the physician for a routine health maintenance examination. She appears well. Her vital signs are within normal limits. Cardiac auscultation shows a mid-systolic click and a grade 3/6, late-systolic, crescendo murmur that is best heard at the cardiac apex in the left lateral recumbent position. After the patient stands up suddenly, the click is heard during early systole and the intensity of the murmur increases. Which of the following is the most likely underlying cause of this patient's examination findings?? {'A': 'Myosin heavy chain defect', 'B': 'Dermatan sulfate deposition', 'C': 'Congenital valvular fusion', 'D': 'Congenital interventricular communication', 'E': 'Dystrophic valvular calcification\n"'},
|
B: Dermatan sulfate deposition
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old woman with ovarian cancer comes to the physician with a 5-day history of fever, chills, and dyspnea. She has a right subclavian chemoport in which she last received chemotherapy 2 weeks ago. Her temperature is 39.5°C (103.1°F), blood pressure is 110/80 mm Hg, and pulse is 115/min. Cardiopulmonary examination shows jugular venous distention and a new, soft holosystolic murmur heard best in the left parasternal region. Crackles are heard at both lung bases. Echocardiography shows a vegetation on the tricuspid valve. Peripheral blood cultures taken from this patient is most likely to show which of the following findings?? {'A': 'Gram-positive, catalase-negative, α-hemolytic, optochin-resistant cocci in chains', 'B': 'Gram-positive, catalase-positive, coagulase-negative, novobiocin-resistant cocci in clusters', 'C': 'Gram-positive, catalase-positive, coagulase-positive cocci in clusters', 'D': 'Gram-positive, catalase-negative, nonhemolytic, salt-sensitive cocci in chains', 'E': 'Gram-positive, catalase-negative, β-hemolytic, bacitracin-resistant cocci in chains'},
|
C: Gram-positive, catalase-positive, coagulase-positive cocci in clusters
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman at 28 weeks gestation seeks evaluation at her obstetrician’s office with complaints of a severe headache, blurred vision, and vomiting for the past 2 days. Her pregnancy has been otherwise uneventful. The past medical history is unremarkable. The blood pressure is 195/150 mm Hg and the pulse is 88/min. On examination, moderate pitting edema is present in her ankles. The urinalysis is normal except for 3+ proteinuria. The obstetrician orders a complete blood count (CBC), liver function tests (LFTs), creatinine, and a coagulation profile. The obstetrician transfers her to the hospital by ambulance for expectant management. Which of the following medications would be most helpful for this patient?? {'A': 'Hydrochlorothiazide', 'B': 'Lisinopril', 'C': 'Metoprolol', 'D': 'Olmesartan', 'E': 'Nifedipine'},
|
E: Nifedipine
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old G0P0000 presents to her gynecologist with complaints of irregular menstruation. She has had only two periods in the last year. She also endorses feeling flushed without provocation and experiencing occasional dyspareunia with post-coital spotting. In addition, she has also had more frequent headaches than usual. The patient has a past medical history of Hashimoto’s thyroiditis and takes levothyroxine daily. Her mother has type I diabetes mellitus. At this visit, the patient’s temperature is 98.5°F (36.9°C), pulse is 70/min, blood pressure is 118/76 mmHg, and respirations are 13/min. Cardiopulmonary and abdominal exams are unremarkable. The patient has Tanner V breasts and pubic hair. Pelvic exam reveals a normal cervix, anteverted uterus without tenderness, and no adnexal masses. The following laboratory studies are performed: Serum: Thyroid stimulating hormone (TSH): 28 µIU/mL (9-30 µIU/mL) Cycle day 3 follicle stimulating hormone (FSH): 49 mIU/mL (4.7-21.5 mIU/mL) Cycle day 3 estradiol: 8 pg/mL (27-123 pg/mL) Prolactin: 14 ng/mL (4-23 ng/mL) Testosterone: 42 ng/dL (15-70 ng/dL) Which of the following is the best next step in management?? {'A': 'Vaginal estradiol gel', 'B': 'Increase levothyroxine dose', 'C': 'Estradiol patch with oral medroxyprogesterone', 'D': 'Brain MRI', 'E': 'Combined oral contraceptive'},
|
C: Estradiol patch with oral medroxyprogesterone
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old man comes to the clinic complaining of yellow skin and eyes, loss of appetite, and severe nausea over the last month or so. He drinks 2–3 beers everyday and about 5–6 on the weekend. He does not take any over-the-counter medications. He has smoked one pack of cigarettes every day for the last 20 years but does not use illicit drugs. Additionally, he reports no history of vomiting, abdominal pain, altered bowel habits, or unintentional weight loss. His temperature is 37°C (98.6°F), blood pressure is 135/85 mm Hg, pulse is 78/ min, respiratory rate is 14/ min, and BMI is 19 kg/m2. On physical examination his skin and sclera are icteric, and his abdomen is tender with a mildly enlarged liver. On laboratory investigations: Complete blood count Hemoglobin 11 g/dL MCV 105 µm3 White blood cell 14,000/mm3 Platelets 110,000/mm3 Which of the following liver function analyses is expected in this patient?? {'A': 'Alanine aminotransferase (ALT): 38/ Aspartate aminotransferase (AST): 30 / AST/ALT: 0.79', 'B': 'Alanine aminotransferase (ALT): 1,500 / Aspartate aminotransferase (AST): 1,089 / AST/ALT: 0.73', 'C': 'Alanine aminotransferase (ALT): 120 / Aspartate aminotransferase (AST): 256 / AST/ALT: 2.1', 'D': 'Alanine aminotransferase (ALT): 83 / Aspartate aminotransferase (AST): 72 / AST/ALT: 0.87', 'E': 'Alanine aminotransferase (ALT): 2,521 / Aspartate aminotransferase (AST): 2,222 / AST/ALT: 0.88'},
|
C: Alanine aminotransferase (ALT): 120 / Aspartate aminotransferase (AST): 256 / AST/ALT: 2.1
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old man comes to the physician because of 2 episodes of bleeding from the rectum over the past month. The patient’s father died of colon cancer at the age of 42. The patient has no history of any serious illness and takes no medications. He does not smoke. His vital signs are within normal limits. Physical examination shows a small hard mass over the right mandible that is nontender and fixed to the underlying bone. A similarly hard and painless 5 × 5 mass is palpated over the rectus abdominis muscle. On examination of the rectum, a polypoid mass is palpated at fingertip. Proctosigmoidoscopy shows numerous polyps. Which of the following best explains these findings?? {'A': 'Familial polyposis of the colon', 'B': 'Gardner’s syndrome', 'C': 'Lynch’s syndrome', 'D': 'Peutz-Jeghers syndrome', 'E': 'Turcot’s syndrome'},
|
B: Gardner’s syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old man is brought to the emergency department after falling 16 feet from a ladder. He has severe pain in both his legs and his right arm. He appears pale and diaphoretic. His temperature is 37.5°C (99.5°F), pulse is 120/min and weak, respirations are 26/min, and blood pressure is 80/50 mm Hg. He opens his eyes and withdraws in response to painful stimuli and makes incomprehensible sounds. The abdomen is soft and nontender. All extremities are cold, with 1+ pulses distally. Arterial blood gas analysis on room air shows: pH 7.29 PCO2 33 mm Hg PO2 65 mm Hg HCO3- 15 mEq/L A CT scan shows displaced fractures of the pelvic ring, as well as fractures of both tibiae, the right distal radius, and right proximal humerus. The patient undergoes emergent open reduction and is admitted to the intensive care unit. Which of the following best indicates inadequate fluid resuscitation?"? {'A': 'High pulse pressure', 'B': 'Urine output of 25 mL in 3 hours', 'C': 'Glasgow coma score of 8', 'D': 'Capillary refill time of 3 seconds', 'E': 'Base deficit of 1 mmol/L\n"'},
|
B: Urine output of 25 mL in 3 hours
|
Answer the following medical question with one of the provided options:
|
Q:A 2-year-old boy is brought to the pediatrician for recurrent nosebleeds. The boy was adopted two months ago and the parents have no record of his medical or family history. They report that the child has had frequent prolonged nosebleeds several times per week. Despite them applying pressure on the distal aspect of the nares and keeping his head elevated, the bleeding generally continues for hours. On exam, the boy appears pale and lethargic. A blood sample is obtained but the child bleeds through multiple pieces of gauze. No agglutination is observed when ristocetin is added to the patient’s blood. The addition of normal plasma to the sample still does not lead to agglutination. This patient has a condition that is most consistent with which of the following modes of transmission?? {'A': 'Autosomal dominant', 'B': 'Autosomal recessive', 'C': 'Mitochondrial', 'D': 'X-linked dominant', 'E': 'X-linked recessive'},
|
B: Autosomal recessive
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man comes to the physician with his son for a follow-up examination. The son reports that his father's mental status has declined since the previous visit when he was diagnosed with Alzheimer dementia. The patient often begins tasks and forgets what he was doing. He has increased trouble remembering events that occurred the day before and sometimes forgets names of common household objects. He has hypertension and hyperlipidemia. His current medications include lisinopril, hydrochlorothiazide, atorvastatin, and donepezil. He is confused and oriented only to person. He is unable to count serial sevens backward from 100. He is able to register 3 items but unable to recall them 5 minutes later. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Risperidone', 'B': 'Ginkgo biloba', 'C': 'Citalopram', 'D': 'Memantine', 'E': 'Vitamin E'},
|
D: Memantine
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old female presents to her gynecologist complaining of vaginal discomfort. She reports that over the past two weeks, she has developed dyspareunia and feels as if there is a mass on the external aspect of her vagina. She is sexually active in a monogamous relationship. On physical examination, there is a 2 cm unilateral erythematous swelling on the right side of the posterolateral labia minora. Which of the following embryologic precursors gives rise to the affected tissue in this patient?? {'A': 'Paramesonephric duct', 'B': 'Genital tubercle', 'C': 'Urogenital sinus', 'D': 'Urogenital fold', 'E': 'Labioscrotal swelling'},
|
C: Urogenital sinus
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old woman comes to the emergency department complaining of severe headache and anxiety, diaphoresis, and palpitations for the last 30 minutes. She has had several similar episodes over the past few weeks. She has no significant past medical history and has a 10 pack-year smoking history. She takes no illicit drugs. Her blood pressure on arrival is 181/80 mmHg and her pulse is 134/min. If this patient was given metoprolol, how would her blood pressure respond?? {'A': 'Hypotension due to beta-adrenergic receptor blockade', 'B': 'Hypotension due to alpha-1-adrenergic receptor blockade', 'C': 'Hypertension due to alpha-1-adrenergic receptor blockade', 'D': 'Hypertension due to alpha-1-adrenergic receptor stimulation', 'E': 'Hypertension due to alpha- and beta-adrenergic receptor blockade'},
|
D: Hypertension due to alpha-1-adrenergic receptor stimulation
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old woman comes to the physician with a 2-week history of new pruritic plaques on the scalp and extensor surfaces of the elbows and knees. Ten years ago, she was diagnosed with psoriasis. Her only medication is topical calcipotriene. Physical examination shows well-demarcated, symmetrical, erythematous plaques with silvery scale. There is pitting of the nails on all fingers. Therapy with a high-potency topical medication that inhibits NF-κB and phospholipase A2 is begun. Long-term use of this agent is most likely to result in which of the following?? {'A': 'Dysplastic nevi', 'B': 'Nonblanchable pinpoint macules', 'C': 'Decreased sebum production', 'D': 'Dermal collagen loss', 'E': 'Hair growth on upper lip'},
|
D: Dermal collagen loss
|
Answer the following medical question with one of the provided options:
|
Q:A 25-year-old woman is brought to a psychiatrist’s office by her husband who states that he is worried about her recent behavior, as it has become more violent. The patient’s husband states that his family drove across the country to visit them and that his wife ‘threatened his parents with a knife’ at dinner last night. Police had to be called to calm her down. He states that she has been acting ‘really crazy’ for the last 9 months, and the initial behavior that caused him alarm was her admission that his deceased sister was talking to her through a decorative piece of ceramic art in the living room. Initially, he thought she was joking, but soon realized her complaints of ‘hearing ghosts’ talking to her throughout the house were persisting and ‘getting worse’. There was also a 4-week period where she experienced insomnia and an unintentional weight loss of 12 pounds. She seemed sad throughout these episodes, and, according to her husband, was complaining of feeling ‘worthless’. Her general hygiene has also suffered from her recent lack of motivation and she insists that the ‘ghosts’ are asking her to kill as many people as she can so they won’t be alone in the house. Her husband is extremely concerned that she may harm herself or someone else. He states that she currently does not take any medications or illicit drugs as far as he knows. She does not smoke or drink alcohol. The patient herself does not make eye contact or want to speak to the psychiatrist, allowing her husband to speak on her behalf. Which of the following is the most likely diagnosis in this patient?? {'A': 'Schizoaffective disorder', 'B': 'Brief psychotic disorder', 'C': 'Schizophreniform disorder', 'D': 'Schizophrenia', 'E': 'Delusional disorder'},
|
A: Schizoaffective disorder
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old previously healthy man presents to the clinic complaining of bloody diarrhea and abdominal pain. Sexual history reveals that he has sex with men and women and uses protection most of the time. He is febrile with all other vital signs within normal limits. Physical exam demonstrates tenderness to palpation of the right upper quadrant. Subsequent ultrasound shows a uniform cyst in the liver. In addition to draining the potential abscess and sending it for culture, appropriate medical therapy would involve which of the following?? {'A': 'Amphotericin', 'B': 'Nifurtimox', 'C': 'Supportive therapy', 'D': 'Sulfadiazine and pyrimethamine', 'E': 'Metronidazole and iodoquinol'},
|
E: Metronidazole and iodoquinol
|
Answer the following medical question with one of the provided options:
|
Q:An 81-year-old man is brought to the physician by his daughter after being found wandering on the street. His daughter says that over the past several months he has been more aggressive towards friends and family. She also reports several episodes in which he claimed to see two strangers in her apartment. He sometimes stares blankly for several minutes and does not react when addressed. He has hypertension, hyperlipidemia, and was diagnosed with Parkinson disease 10 months ago. His current medications include carbidopa-levodopa, hydrochlorothiazide, and atorvastatin. His temperature is 37°C (98.6°F), pulse is 99/min, and blood pressure is 150/85 mm Hg. He is confused and oriented to person and place but not to time. There is a resting tremor in his right upper extremities. There is muscle rigidity in the upper and lower extremities. He is able to walk without assistance but has a slow gait with short steps. Mental status examination shows short-term memory deficits. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Lewy body deposition', 'B': 'Vascular infarcts', 'C': 'Frontotemporal lobe atrophy', 'D': 'Thiamine deficiency', 'E': 'Impaired CSF absorption'},
|
A: Lewy body deposition
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old woman comes to the physician because of fever, chills, headache, and nausea over the past 3 days. Nine months ago, she returned from a vacation in Indonesia where she had experienced similar symptoms and episodic fever. She was treated with chloroquine and recovered uneventfully. Her temperature is 39.1°C (102.4°F), pulse is 97/min, and blood pressure is 123/85 mm Hg. Physical examination shows scleral icterus. The abdomen is soft; bowel sounds are active. Neurologic examination is unremarkable. Her hemoglobin concentration is 10 g/dL. A photomicrograph of a peripheral blood smear is shown. Which of the following is the most likely cause of the recurrence of symptoms in this patient?? {'A': 'Decline in circulating antibodies', 'B': 'Reinfection by Anopheles mosquito', 'C': 'Natural drug resistance', 'D': 'Reactivation of dormant liver stage', 'E': 'Dissemination within macrophages'},
|
D: Reactivation of dormant liver stage
|
Answer the following medical question with one of the provided options:
|
Q:A 6-month-old child is brought to the pediatrician by his parents for difficulty feeding and poor motor function. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones until 2 months ago. He started having trouble latching onto his bottle. He has also become extremely lethargic. Examination reveals diminished muscle tone in all four limbs, areflexia, and hepatosplenomegaly. A ophthalmoscopic exam reveals macular cherry red spots. Which of the following is most likely deficient in this child?? {'A': 'ß-Glucosidase', 'B': 'Hexosaminidase A', 'C': 'Arylsulfatase A', 'D': 'Ceramidase', 'E': 'Sphingomyelinase'},
|
E: Sphingomyelinase
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old G1P0 woman, at 12 weeks estimated gestational age, presents for her first prenatal visit. Past medical history reveals the patient has type O+ blood and that her husband has type A+ blood. The patient is worried about the risk of her baby having hemolytic disease. Which of the following is correct regarding fetomaternal incompatibility in this patient?? {'A': 'It cannot affect first borns', 'B': 'It is more severe than RhO (D) alloimmunization', 'C': 'Prenatal detection is very important because fetomaternal incompatibility is associated with severe fetal anemia', 'D': 'A direct Coombs test is strongly positive', 'E': 'It is a rare cause of newborn hemolytic disease'},
|
E: It is a rare cause of newborn hemolytic disease
|
Answer the following medical question with one of the provided options:
|
Q:An 80-year-old male is found dead at home and brought in for an autopsy. The patient's heart shows a diminished ventricular chamber volume and the interventricular septum appears sigmoid shaped. The left atrium appears enlarged as well. A few calcifications are seen on the undamaged aortic valves. Microscopic examination reveals increased connective tissue in the myocardium and brown perinuclear cytoplasmic granules in numerous myocardial cells as shown in the exhibit. Which of the following most likely explains this patient's cardiac findings?? {'A': 'Chronic hemolytic anemia', 'B': 'Dilated cardiomyopathy', 'C': 'Expected age related changes', 'D': 'Hypertrophic cardiomyopathy', 'E': 'Uncontrolled hypertension'},
|
C: Expected age related changes
|
Answer the following medical question with one of the provided options:
|
Q:A 39-year-old man comes to the physician because of a 4-month history of fatigue. During this period, he has also had a 7.7-kg (17-lb) weight loss, despite having a normal appetite. He is sexually active with 3 female partners and uses condoms inconsistently. An HIV screening test and confirmatory test are both positive. CD4+ T-lymphocyte count is 570/mm3 (N ≥ 500) and the viral load is 104 copies/mL. Treatment with lamivudine, zidovudine, and indinavir is begun. The patient is most likely to experience which of the following adverse effects?? {'A': 'Hyperpigmentation of palms and soles', 'B': 'Hepatotoxicity', 'C': 'Urolithiasis', 'D': 'Pancreatitis', 'E': 'Stevens-Johnson syndrome'},
|
C: Urolithiasis
|
Answer the following medical question with one of the provided options:
|
Q:A 49-year-old obese woman presents with a chronic non-healing ulcer on the right medial malleolus. Past medical history is significant for type 2 diabetes mellitus, diagnosed 10 years ago, poorly managed with metformin. Review of systems is significant for a recurrent white vaginal discharge. The patient is afebrile, and her vital signs are within normal limits. Her BMI is 31 kg/m2. On physical examination, there is a 2 cm by 2 cm nontender, erythematous shallow ulcer present over the right medial malleolus. Sensation is decreased symmetrically in the lower extremities below the level of the midcalf. Which of the following histopathological findings would most likely be seen in the peripheral nerves in this patient?? {'A': 'Wallerian degeneration', 'B': 'Reduced axonal fiber diameter and fiber density', 'C': 'Acute perivascular inflammation', 'D': 'Lymphocytic infiltration of the endoneurium', 'E': 'Accumulation of beta-pleated sheets of amyloid protein'},
|
B: Reduced axonal fiber diameter and fiber density
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old woman is brought to the emergency department by her daughter because of left-sided weakness for 1 hour. She does not have headache or blurring of vision. She has hypertension, hypercholesterolemia, type 2 diabetes, and coronary artery disease. She has smoked one half-pack of cigarettes daily for 45 years. Her medications include atorvastatin, amlodipine, metformin, and aspirin. Her temperature is 37°C (98.6°F), pulse is 92/min, and blood pressure is 168/90 mm Hg. Examination shows a left facial droop. Muscle strength is decreased on the left side. Deep tendon reflexes are 3+ on the left. Sensation to pinprick, light touch, and vibration as well as two-point discrimination are normal. Which of the following is the most likely cause of these findings?? {'A': 'Atherosclerosis of the internal carotid artery', 'B': 'Rupture of an intracranial aneurysm', 'C': 'Lipohyalinosis of lenticulostriate arteries', 'D': 'Dissection of the vertebral artery', 'E': 'Embolism from the left atrium'},
|
C: Lipohyalinosis of lenticulostriate arteries
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old male is brought to the emergency room following a violent assault in which he was stabbed in the chest. The knife penetrated both the left lung and the left ventricle. Where did the knife most likely enter his chest?? {'A': 'Left seventh intercostal space in the midaxillary line', 'B': 'Left seventh intercostal space in the midclavicular line', 'C': 'Left fifth intercostal space just lateral to the sternum', 'D': 'Left fifth intercostal space in the midaxillary line', 'E': 'Left fifth intercostal space in the midclavicular line'},
|
E: Left fifth intercostal space in the midclavicular line
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old man is brought to the emergency department for severe tearing lower back pain for 12 hours. The pain radiates to the flank and he describes it as 8 out of 10 in intensity. He has nausea and has vomited several times. He has no fever, diarrhea, or urinary symptoms. When he stands up suddenly, he becomes light-headed and has to steady himself for approximately 1 to 2 minutes before he is able to walk. He has hypertension and hyperlipidemia. Two years ago, he had a myocardial infarction and underwent coronary artery bypass grafting of his right coronary artery. He has smoked one and a half packs of cigarettes daily for 40 years and drinks 1 to 2 beers daily. His current medications include chlorthalidone, atorvastatin, lisinopril, and aspirin. He appears acutely ill. His temperature is 37.2°C (98.9°F), pulse is 130/min and regular, respirations are 35/min, and blood pressure is 80/55 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 85%. Examination shows a pulsatile mass in the abdomen. Intravenous fluids and high-flow oxygen are started. Thirty minutes later, the patient dies. Which of the following was the strongest predisposing factor for the condition leading to this patient's death?? {'A': 'Advanced age', 'B': 'Hyperlipidemia', 'C': 'Male sex', 'D': 'Hypertension', 'E': 'Smoking'},
|
E: Smoking
|
Answer the following medical question with one of the provided options:
|
Q:A 48-year-old African American male presents to his primary care provider complaining of facial swelling. He reports a three-day history of worsening swelling primarily around his eyes. The patient’s medical history is notable for sickle cell disease and poorly controlled hypertension. The patient currently takes enalapril, hydrochlorothiazide, and amlodipine but has a history of medication non-adherence. He has a 15 pack-year smoking history. His temperature is 99.1°F (37.3°C), blood pressure is 155/100 mmHg, pulse is 90/min, and respirations are 20/min. Physical examination is notable for periorbital swelling and 1+ bilateral lower extremity edema. Multiple serum and urine labs are ordered. A kidney biopsy in this patient would most likely yield which of the following sets of findings on light and electron microscopy?? {'A': 'Wire looping capillaries and subendothelial immune complex deposition', 'B': 'Hypercellular glomeruli with neutrophils and subepithelial immune complex deposition', 'C': 'Increased mesangial cellularity and mesangial immune complex deposition', 'D': 'Diffusely thickened capillaries and subepithelial immune complex deposition', 'E': 'Segmental sclerosis and negative immunofluorescence and foot process effacement'},
|
E: Segmental sclerosis and negative immunofluorescence and foot process effacement
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old man comes to the physician because of a 9-month history of sleep disturbances, restlessness, and difficulty acquiring erections. He has difficulty falling asleep and wakes up at least 3 times per night. He worries about paying his bills, failing law school, and disappointing his parents. He can no longer concentrate in class and failed the last exam. He feels on edge most days and avoids socializing with his classmates. He worries that he has an underlying medical condition that is causing his symptoms. Previous diagnostic evaluations were unremarkable. There is no personal or family history of serious illness. He is sexually active with his girlfriend. He has a history of drinking alcohol excessively during his early 20s, but he has not consumed alcohol for the past 3 years. He appears anxious. Vital signs are within normal limits. On mental status examination, he is oriented to person, place, and time. Physical examination shows no abnormalities. In addition to psychotherapy, treatment with which of the following drugs is most appropriate in this patient?? {'A': 'Buspirone', 'B': 'Doxepin', 'C': 'Propranolol', 'D': 'Lorazepam', 'E': 'Valerian\n"'},
|
A: Buspirone
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old woman presents for a checkup. She is 20 weeks pregnant and has been admitted to the hospital multiple times during her pregnancy for seizures. She has a known seizure disorder but discontinued her valproic acid when she became pregnant. The patient's past medical history is otherwise unremarkable. She does not smoke, drink alcohol, or use any drugs. She generally prefers not to take medications and sees a shaman for her care typically. Given her recent hospitalization, the patient agrees to start carbamazepine. Which of the following is the most appropriate treatment for this patient at this time?? {'A': 'Folate', 'B': 'Iron', 'C': 'Magnesium', 'D': 'Vitamin B12', 'E': 'Vitamin D'},
|
A: Folate
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 4-year-old boy is brought to the physician because of blisters and redness on his neck and chest for 2 days. He has also had a fever. He is lethargic and has not eaten well since the rash appeared. He has not had coughing, wheezing, or dysuria. He is an only child and there is no family history of serious illness. His immunizations are up-to-date. His temperature is 38.9°C (102°F), pulse is 90/min, and blood pressure is 80/40 mm Hg. Examination shows flaccid blisters over his neck and trunk that rupture easily. Areas of erythematous moist skin are also noted. Twirling an eraser over the trunk results in a blister. Oropharyngeal examination is normal. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 22,000/mm3 Segmented neutrophils 77% Eosinophils 3% Lymphocytes 18% Monocytes 2% Erythrocyte sedimentation rate 60 mm/h Urinalysis is normal. Which of the following is the most likely diagnosis?"? {'A': 'Staphylococcal scalded skin syndrome', 'B': 'Pemphigus vulgaris', 'C': 'Scarlet fever', 'D': 'Bullous pemphigoid', 'E': 'Toxic epidermal necrolysis'},
|
A: Staphylococcal scalded skin syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old woman comes to the emergency department because of a 3-day history of malaise, dysuria, blurred vision, and a painful, itchy rash. The rash began on her chest and face and spread to her limbs, palms, and soles. One week ago, she was diagnosed with trigeminal neuralgia and started on a new medicine. She appears ill. Her temperature is 38°C (100.4°F) and pulse is 110/min. Physical examination shows conjunctival injection and ulceration on the tongue and palate. There is no lymphadenopathy. Examination of the skin shows confluent annular, erythematous macules, bullae, and desquamation of the palms and soles. The epidermis separates when the skin is lightly stroked. Which of the following is the most likely diagnosis?? {'A': 'Bullous pemphigoid', 'B': 'Stevens-Johnson syndrome', 'C': 'Pemphigus vulgaris', 'D': 'Drug-induced lupus erythematosus', 'E': 'DRESS syndrome'},
|
B: Stevens-Johnson syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old woman presents to her primary care physician for knee pain. The pain started yesterday and has not improved since then. The patient is generally in good health. She attends college and plays soccer for her school's team. Three days ago, she was slide tackled during a game and her leg was struck from the outside. She fell to the ground and sat out for the rest of the game. It was not until yesterday that she noticed swelling in her knee. She also feels as if her knee is unstable and does not feel confident bearing weight on her leg during athletic activities. Her past medical history is notable for asthma, which is currently treated with an albuterol inhaler. On physical exam, you note bruising over her leg, knee, and lateral thigh, and edema of her knee. Passive range of motion of the knee is notable only for minor clicking and catching of the joint. The patient's gait appears normal, though the patient states that her injured knee does not feel stable. Further physical exam is performed and imaging is ordered. Which of the following is the most likely diagnosis?? {'A': 'Anterior cruciate ligament tear', 'B': 'Posterior cruciate ligament tear', 'C': 'Medial collateral ligament tear', 'D': 'Medial meniscal tear', 'E': 'Iliotibial band syndrome'},
|
D: Medial meniscal tear
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man presents to the emergency department with abdominal pain that started 1 hour ago. The patient has a past medical history of diabetes and hypertension as well as a 40 pack-year smoking history. His blood pressure is 107/58 mmHg, pulse is 130/min, respirations are 23/min, and oxygen saturation is 98% on room air. An abdominal ultrasound demonstrates focal dilation of the aorta with peri-aortic fluid. Which of the following is the best next step in management?? {'A': 'Administer labetalol', 'B': 'Counsel the patient in smoking cessation', 'C': 'Emergent surgical intervention', 'D': 'Serial annual abdominal ultrasounds', 'E': 'Urgent surgery within the next day'},
|
C: Emergent surgical intervention
|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old boy comes to the physician because of severe muscle cramps and pain for 3 months. He first noticed these symptoms while attending tryouts for the high school football team. Since then, he becomes easily fatigued and has severe muscle pain and swelling after 10 minutes of playing. However, after a brief period of rest, the symptoms improve, and he is able to return to the game. Two days ago, he had an episode of reddish-brown urine after playing football. There is no family history of serious illness. He appears healthy. Vital signs are within normal limits. Physical and neurological examinations show no abnormalities. Serum creatine kinase concentration is 333 U/L. Urinalysis shows: Blood 2+ Protein negative Glucose negative RBC negative WBC 1–2/hpf Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Thyroid hormone deficiency', 'B': 'Dystrophin gene mutation', 'C': 'Myophosphorylase deficiency', 'D': 'Acid maltase deficiency', 'E': 'CTG repeat in the DMPK gene'},
|
C: Myophosphorylase deficiency
|
Answer the following medical question with one of the provided options:
|
Q:A 82-year-old man who is currently being managed by the internal medicine service agrees to be examined by medical students as part of their training in physical examination. He is visited by a small group of medical students under the instruction of a preceptor and allows the students to make observations. They find that he has bibasilar crackles that are most prominent during inspiration as well as some wheezing. Furthermore, he coughs up some sputum during the exam, and this sputum is found to have a rust color. He does not report any pain and no skin findings are seen. Which of the following is most closely associated with the cause of this patient's physical exam findings?? {'A': 'Left heart failure', 'B': 'Long bone fractures', 'C': 'Protein C/S deficiency', 'D': 'Smoking', 'E': 'Tall, thin males'},
|
A: Left heart failure
|
Answer the following medical question with one of the provided options:
|
Q:A 2500-g (5.5-lb) male newborn is delivered at 35 weeks' gestation to a 25-year-old woman, gravida 2, para 1. The pregnancy was complicated by oligohydramnios. Pulse oximetry on room air shows an oxygen saturation of 78%. Examination in the delivery room shows that the newborn's skin appears blue with weak cry and irregular breathing and gasping. The nose is flat with bilateral epicanthal folds. The ears are low-set with broad auricles. The lower jaw is abnormally displaced backwards. The right lower limb appears shorter than the left lower limb with displaced right great toe. Breath sounds are decreased bilaterally. Renal ultrasound shows bilateral dilatation of the renal pelvis and ureters. Which of the following is most likely to confirm the underlying cause of this patient's condition?? {'A': 'Voiding cystourethrogram', 'B': 'Echocardiography', 'C': 'Karyotyping', 'D': 'Blood cultures', 'E': 'X-ray of the chest\n"'},
|
A: Voiding cystourethrogram
|
Answer the following medical question with one of the provided options:
|
Q:A 5-year-old girl presents to the physician with increased muscle cramping in her lower extremities after walking extended distances. The young girl is in the 10th percentile for height. Her past medical history is notable only for a cystic hygroma detected shortly after birth. Which of the following findings is most likely in this patient?? {'A': 'Decreased blood pressure in the upper and lower extremities', 'B': 'Barr bodies on buccal smear', 'C': 'Endocardial cushion defect', 'D': 'Inferior erosion of the ribs', 'E': 'Apparent hypertrophy of the calves'},
|
D: Inferior erosion of the ribs
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old African American man comes to the doctor's office for an annual checkup. He feels healthy and his only concern is an occasional headache after work. Past medical history is significant for an appendectomy 10 years ago and a fractured arm playing football in high school. His mother has type 2 diabetes mellitus, while his father and grandfather both have hypertension. He does not drink alcohol, smoke cigarettes, or use drugs. His vital signs include: pulse 78/min and regular, respiratory rate 16/min, and temperature 36.8°C (98.2°F). Physical examination reveals an overweight African American man 167 cm (5 ft 6 in) tall and weighing 80 kg (176 lb) with a protuberant belly. BMI is 28.7 kg/m2. The remainder of the examination is unremarkable. During his last 2 visits, his blood pressure readings have been 140/86 mm Hg and 136/82 mm Hg. Today his blood pressure is 136/86 mm Hg and his laboratory tests show: Serum Glucose (fasting) 90.0 mg/dL Serum Electrolytes: Sodium 142.0 mEq/L Potassium 3.9 mEq/L Chloride 101.0 mEq/L Serum Creatinine 0.8 mg/dL Blood urea nitrogen 9.0 mg/dL Urinalysis: Glucose Negative Ketones Negative Leukocytes Negative Nitrite Negative RBCs Negative Casts Negative Which of the following is the next best step in the management of this patient?? {'A': 'Start him on lisinopril.', 'B': 'Start him on hydrochlorothiazide.', 'C': 'Order a glycosylated hemoglobin test (HbA1c).', 'D': 'Start him on hydrochlorothiazide and lisinopril together.', 'E': 'Recommend weight loss, more exercise, and a salt-restricted diet.'},
|
E: Recommend weight loss, more exercise, and a salt-restricted diet.
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old girl is brought to the physician with a 3-month history of progressive intermittent pain and swelling involving both knees, right ankle, and right wrist. The patient has been undergoing treatment with acetaminophen and ice packs, both of which relieved her symptoms. The affected joints feel "stuck” and are difficult to move immediately upon waking up in the morning. However, the patient can move her joints freely after a few minutes. She also complains of occasional mild eye pain that resolves spontaneously. Five months ago, she was diagnosed with an upper respiratory tract infection that resolved without treatment. Vital signs are within normal limits. Physical examination shows swollen and erythematous joints, which are tender to touch. Slit-lamp examination shows an anterior chamber flare with signs of iris inflammation bilaterally. Laboratory studies show: Blood parameters Hemoglobin 12.6 g/dL Leukocyte count 8,000/mm3 Segmented neutrophils 76% Eosinophils 1% Lymphocytes 20% Monocytes 3% Platelet count 360,000/mm3 Erythrocyte sedimentation rate 36 mm/hr Serum parameters Antinuclear antibodies 1:320 Rheumatoid factor negative Which of the following is the most likely diagnosis?? {'A': 'Acute lymphocytic leukemia', 'B': 'Enthesitis-related arthritis', 'C': 'Oligoarticular juvenile idiopathic arthritis', 'D': 'Postinfectious arthritis', 'E': 'Seronegative polyarticular juvenile idiopathic arthritis'},
|
C: Oligoarticular juvenile idiopathic arthritis
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman with a past history of type 1 diabetes presents to your office with a 2-week history of vaginal itching and soreness accompanied by a white, clumpy vaginal discharge which she says resembles cheese curds. Her last HbA1c from a month ago was 7.8%, and her last cervical cytology from 10 months ago was reported as normal. She has a blood pressure of 118/76 mmHg, respiratory rate of 14/min, and heart rate of 74/min. Pelvic examination reveals multiple small erythematous lesions in the inguinal and perineal area, vulvar erythema, and excoriations. Inspection demonstrates a normal cervix and a white, adherent, thick, non-malodorous vaginal discharge. Which of the following is most likely to be present in a saline wet mount from the vaginal discharge of this patient?? {'A': 'Motile flagellates', 'B': 'Clue cells on saline smear', 'C': 'Hyphae', 'D': 'Multinucleated giant cells', 'E': 'Gram-negative diplococci'},
|
C: Hyphae
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman comes to the physician for the evaluation of bleeding from her gums for 2 weeks. These episodes occur spontaneously and are self-limiting. She has also had purplish skin lesions over her legs for 2 months. Last week, she had one episode of hematuria and watery diarrhea, both of which resolved without treatment. She has mild asthma. Her brother has hemophilia. Her only medication is a fenoterol inhaler. She appears healthy. Her temperature is 37.1°C (99.3°F), pulse is 88/min, respirations are 14/min, and blood pressure is 122/74 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender; there is no organomegaly. Oropharyngeal examination shows gingival bleeding. There are petechiae over the neck and the right upper extremity and purpuric spots over both lower extremities. Laboratory studies show: Hemoglobin 13.3 mg/dL Mean corpuscular volume 94 μm3 Leukocyte count 8,800/mm3 Platelet count 18,000/mm3 Bleeding time 9 minutes Prothrombin time 14 seconds (INR=0.9) Partial thromboplastin time 35 seconds Serum Glucose 88 mg/dL Creatinine 0.9 mg/dL Which of the following is the most likely underlying mechanism of this patient's symptoms?"? {'A': 'Deficient Von Willebrand factor', 'B': 'Shiga-like toxin', 'C': 'Consumptive coagulopathy', 'D': 'IgG antibodies against platelets', 'E': 'Decrease in ADAMTS13 activity'},
|
D: IgG antibodies against platelets
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old boy is brought to the physician by his mother because of left-sided neck swelling that has slowly progressed over the past 4 weeks. He has no history of serious illness. Temperature is 38°C (100.4°F). Physical examination shows a non-tender, mobile mass in the left submandibular region with overlying erythema. A biopsy of the mass shows caseating granulomas. Pharmacotherapy with azithromycin and ethambutol is initiated. This patient is most likely to experience which of the following adverse effects related to ethambutol use?? {'A': 'Orange urine', 'B': 'Acute kidney injury', 'C': 'Color blindness', 'D': 'Methemoglobinemia', 'E': 'Peripheral neuropathy'},
|
C: Color blindness
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old boy is brought to the pediatrician by his parents with complaints of extra teeth in his lower and upper jaws. He was born by cesarean section at full term and his birth weight was 3.6 kg (7.9 lb). Until 6 months of age, he was breastfed and after that, solid foods were started. He did not cry immediately after birth, for which he was admitted to the intensive care unit where he also developed jaundice. There is a family history of intellectual disability. His motor milestones were delayed. His intelligence quotient (IQ) is 56. His temperature is 37.0ºC (98.6ºF), pulse is 88/min, and respiratory rate is 20/min. On physical examination, he has behavior disorders with autistic features, elongated face with large forehead, and prominent chin. His intraoral examination shows the presence of multiple teeth with crowding in both the upper and lower jaws, along with high arch palate and macroglossia. Genital examination reveals enlarged testicles. Panoramic radiographic examination shows teeth crowding in the maxillary and mandibular dental arches and congenital absence of some teeth. Which of the following is the most likely trinucleotide repeat that explains these findings?? {'A': 'CGG', 'B': 'CAG', 'C': 'GAA', 'D': 'CTG', 'E': 'GCC'},
|
A: CGG
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman visits her physician with complaints of inability to become pregnant despite frequent unprotected sexual intercourse with her husband for over a year. She breastfed her only child until about 13 months ago, when the couple decided to have a second child. Over the past year, the patient has had only 4 episodes of menstrual bleeding. She reports occasional milk discharge from both breasts. Her only medication currently is daily pantoprazole, which she takes for dyspepsia. Her BMI is 29 kg/m2. Physical examination and vitals are normal. Pelvic examination indicates no abnormalities. The patient’s breast examination reveals full breasts and a few drops of milk can be expressed from both nipples. Estradiol, serum follicle-stimulating hormone (FSH), testosterone, and thyroid-stimulating hormone (TSH) levels are within the normal range. Which of the following best explains these findings?? {'A': 'Pantoprazole', 'B': 'Primary ovarian insufficiency', 'C': 'Prolactinoma', 'D': 'Sheehan’s syndrome', 'E': 'Normal findings'},
|
C: Prolactinoma
|
Answer the following medical question with one of the provided options:
|
Q:A 53-year-old man is admitted to the intensive care unit from the emergency department with severe pancreatitis. Overnight, he starts to develop severe hypoxemia, and he is evaluated by a rapid response team. On exam the patient is breathing very quickly and has rales and decreased breath sounds bilaterally. He is placed on 50% FiO2, and an arterial blood gas is collected with the following results: pH: 7.43 pCO2: 32 mmHg pO2: 78 mmHg The oxygen status of the patient continues to deteriorate, and he is placed on ventilator support. Which of the following would most likely be seen in this patient?? {'A': 'Decreased lecithin to sphingomyelin ratio', 'B': 'Diffuse lipid droplets and globules', 'C': 'Hemosiderin-laden alveolar macrophages', 'D': 'Intra-alveolar hyaline membrane formation', 'E': 'Large clot in pulmonary artery'},
|
D: Intra-alveolar hyaline membrane formation
|
Answer the following medical question with one of the provided options:
|
Q:Several weeks after starting a new medication for rheumatoid arthritis, a 44-year-old woman comes to the physician because of painful ulcers in her mouth. Oral examination shows inflammation and swelling of the tongue and oropharynx and ulcers on the buccal mucosa bilaterally. Skin examination shows soft tissue swelling over her proximal interphalangeal joints and subcutaneous nodules over her elbows. Serum studies show an alanine aminotransferase level of 220 U/L, aspartate aminotransferase level of 214 U/L, and creatinine level of 1.7 mg/dL. Which of the following is the most likely primary mechanism of action of the drug she is taking?? {'A': 'Inhibition of thymidylate synthase', 'B': 'Inhibition of dihydrofolate reductase', 'C': 'Inhibition of inosine monophosphate dehydrogenase', 'D': 'Inhibition of cyclooxygenase', 'E': 'Inhibition of NF-κB'},
|
B: Inhibition of dihydrofolate reductase
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old man comes to the physician for a routine health maintenance examination. His wife has noticed that his left eye looks smaller than his right eye. He has had left shoulder and arm pain for 3 months. He has hypertension and coronary artery disease. Current medications include enalapril, metoprolol, aspirin, and atorvastatin. His medical history is significant for gonorrhea, for which he was treated in his 30's. He has smoked two packs of cigarettes daily for 35 years. He does not drink alcohol. His temperature is 37°C (98.6°F), pulse is 71/min, and blood pressure is 126/84 mm Hg. The pupils are unequal; when measured in dim light, the left pupil is 3 mm and the right pupil is 5 mm. There is drooping of the left eyelid. The remainder of the examination shows no abnormalities. Application of apraclonidine drops in both eyes results in a left pupil size of 5 mm and a right pupil size of 4 mm. Which of the following is the most appropriate next step in management?? {'A': 'Applanation tonometry', 'B': 'Erythrocyte sedimentation rate', 'C': 'Rapid plasma reagin', 'D': 'CT scan of the chest', 'E': 'Anti-acetylcholine receptor antibodies'},
|
D: CT scan of the chest
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old man is brought to the emergency department after his girlfriend found him twitching and jerking in the yard while gardening. Shortly after he became obtunded, emergency medical services reported 1 episode of emesis during transport. His blood pressure is 85/50 mmHg, pulse is 55/min, and respirations are irregular. Physical examination demonstrates marks on his left forearm, pinpoint pupils, diaphoresis, and fasciculations of his left calf. Following initial stabilization and respiratory support, what is the best next step?? {'A': 'Atropine', 'B': 'Atropine and pralidoxime', 'C': 'Lamotrigine', 'D': 'Naloxone', 'E': 'Naltrexone'},
|
B: Atropine and pralidoxime
|
Answer the following medical question with one of the provided options:
|
Q:A 73-year-old female presents to you for an office visit with complaints of getting lost. The patient states that over the last several years, the patient has started getting lost in places that she is familiar with, like in her neighborhood while driving to her church. She has also has difficulty remembering to pay her bills. She denies any other complaints. Her vitals are normal, and her physical exam does not reveal any focal neurological deficits. Her mini-mental status exam is scored 19/30. Work up for secondary causes of cognitive decline is negative. Which of the following should be included in the patient's medication regimen to slow the progression of disease?? {'A': 'Ropinirole', 'B': 'Memantine', 'C': 'Bromocriptine', 'D': 'Pramipexole', 'E': 'Pergolide'},
|
B: Memantine
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old man comes to the physician because of a 10-month history of progressive shortness of breath and a cough productive of a small amount of white phlegm. Bilateral end-expiratory wheezing is heard on auscultation of the chest. Pulmonary function tests show total lung capacity that is 108% of predicted, an FEV1 that is 56% of predicted, and an FEV1:FVC ratio of 62%. Which of the following interventions is most likely to slow the decline in FEV1 in this patient?? {'A': 'Smoking cessation', 'B': 'Breathing exercises', 'C': 'Salmeterol therapy', 'D': 'Fluticasone therapy', 'E': 'Alpha-1 antitrypsin therapy'},
|
A: Smoking cessation
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman survives a plane crash in the Arctic region of Alaska. She is unable to recover any food from the crash site but is able to melt snow into drinking water using a kettle and a lighter. A rescue helicopter finally finds her after 12 days, and she is flown to a hospital. At this time, which of the following substances is mostly responsible for supplying her brain with energy?? {'A': 'Acetoacetate', 'B': 'Amino acids', 'C': 'Cholesterol', 'D': 'Free fatty acids', 'E': 'Glucose'},
|
A: Acetoacetate
|
Answer the following medical question with one of the provided options:
|
Q:A 31-year-old woman presents to the emergency department with a 2-week history of dry cough and shortness of breath on exertion. She says that she has also been feeling joint pain that has been increasing over time and is worst in the mornings. Finally, she has noticed painful swellings that have been appearing on her body over the last month. Her past medical history is significant for childhood asthma that does not require any current medications. She drinks socially and has smoked 2 packs per day since she was 16 years old. Physical exam reveals erythematous nodular lesions on her trunk and upper extremities. Serum protein electrophoresis shows polyclonal gammopathy. Which of the following would most likely also be seen in this patient?? {'A': 'Acid-fast rods', 'B': 'Antibodies to small nuclear ribonucleoproteins', 'C': 'Golden-brown fusiform rods', 'D': 'Macrophages with black phagocytosed particles', 'E': 'Noncaseating granulomas'},
|
E: Noncaseating granulomas
|
Answer the following medical question with one of the provided options:
|
Q:A 59-year-old man comes to the emergency department because of progressive abdominal swelling and shortness of breath for 1 week. He drinks 12 to 13 alcoholic beverages daily. He appears emaciated. Examination shows pallor, jaundice, hepatomegaly, gynecomastia, and a protuberant abdomen with a fluid wave and shifting dullness. Periodic monitoring of which of the following markers is most appropriate for this patient?? {'A': 'S-100 protein', 'B': 'Alpha-fetoprotein', 'C': 'Carcinoembryonic antigen', 'D': 'Cancer antigen 19-9', 'E': 'Beta-human chorionic gonadotropin'},
|
B: Alpha-fetoprotein
|
Answer the following medical question with one of the provided options:
|
Q:An 7-month-old boy is brought to the pediatrician by his parents due to progressively worsening weakness for the last three months. The parents also describe the boy as having an exaggerated response when startled as well as diminishing response to visual stimuli. At birth, the boy was healthy and remained as such for the first few months of life. The mother says pregnancy was unremarkable, and the boy was born at 39 weeks with no complications during delivery. He is up to date on his vaccinations. The boy's grandparents immigrated from an eastern European country. Physical examination reveals hyperreflexia. Abdominal examination reveals no abnormalities. On fundoscopy, the following is seen. Which of the following is most likely deficient in this patient?? {'A': 'α-Galactosidase', 'B': 'ß-Glucosidase', 'C': 'Hexosaminidase A', 'D': 'Hexosaminidase B', 'E': 'Arylsulfatase A'},
|
C: Hexosaminidase A
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old man presents to the clinic for a regular health checkup. He is hypertensive and was diagnosed with congestive heart failure last year. He has hyperlipidemia but does not take any medication for it. Although he takes his antihypertensive medications regularly, his blood pressure recordings at home tend to range between 150/98 and 160/90 mm Hg. Today, his blood pressure is 147/96 mm Hg. The doctor decides to add indapamide to his medication list and asks the patient to follow up within 2 weeks. The patient is compliant with the medication. He comes back to the physician in just one week complaining of muscle cramping and weakness. Which of the following is the most likely cause of his symptoms?? {'A': 'Hypocalcemia', 'B': 'Hypoglycemia', 'C': 'Hyperlipidemia', 'D': 'Hyperuricemia', 'E': 'Hypokalemia'},
|
E: Hypokalemia
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old female presents to her PCP at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient denies thoughts of suicide. Pregnancy test is negative. Which of the following is the best initial treatment?? {'A': 'Valproate', 'B': 'Valproate and venlafaxine', 'C': 'Valproate and olanzapine', 'D': 'Haloperidol', 'E': 'Electroconvulsive therapy'},
|
C: Valproate and olanzapine
|
Answer the following medical question with one of the provided options:
|
Q:A 10-day-old newborn is undergoing surgery for the removal of a branchial cleft cyst. Histopathology of the cyst shows squamous cells with lymphoid infiltrate and keratinaceous cellular debris embedded in adipose tissue with a high concentration of mitochondria. Which of the following substances is most likely to be found within these mitochondria?? {'A': 'Thermogenin', 'B': 'Leptin', 'C': 'Kinesin', 'D': 'Ubiquitin', 'E': 'Clathrin'},
|
A: Thermogenin
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old physician is cleaning his pool when he splashes the hydrochloric acid in his left eye. He feels immediate pain and burning. His eye starts to tear profusely, and he can barely open it. His medical history is significant for psoriasis. He is farsighted and has glasses for reading and computer work. He uses topical calcipotriene and topical triamcinolone as needed. His only surgery was a tonsillectomy as a child. He is married and has one son who is healthy. His mother has Graves disease. He drinks a glass of wine with dinner but denies tobacco or recreational drug use. Which of the following is the best initial step in management?? {'A': 'Apply topical bacitracin', 'B': 'Call the patient’s ophthalmologist', 'C': 'Go to the emergency department immediately', 'D': 'Irrigate with alkali solution', 'E': 'Irrigate with tap water'},
|
E: Irrigate with tap water
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 31-year-old woman comes to the emergency department because of sudden, severe epigastric pain and vomiting for the past 4 hours. She reports that the pain radiates to the back and began when she was having dinner and drinks at a local brewpub. Her temperature is 37.9°C (100.2°F), pulse is 98/min, respirations are 19/min, and blood pressure is 110/60 mm Hg. Abdominal examination shows epigastric tenderness and guarding but no rebound. Bowel sounds are decreased. Laboratory studies show: Hematocrit 43% Leukocyte count 9000/mm3 Serum Na+ 140 mEq/L K+ 4.5 mEq/L Ca2+ 9.0 mg/dL Lipase 170 U/L (N = < 50 U/L) Amylase 152 U/L Alanine aminotransferase (ALT, GPT) 140 U/L Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?"? {'A': 'Contrast-enhanced abdominal CT scan', 'B': 'Right upper quadrant abdominal ultrasound', 'C': 'Plain x-ray of the abdomen', 'D': 'Measure serum triglycerides', 'E': 'Blood alcohol level assay'},
|
B: Right upper quadrant abdominal ultrasound
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old man with a history of hyperlipidemia presents to the emergency department complaining of left sided chest pain. He says the pain began 3 hours ago while he was cooking dinner in his kitchen. The pain radiates to his left arm and stomach. He also complains of feeling anxious and heart palpitations. Temperature is 98.7°F (37.1°C), blood pressure is 130/80 mmHg, pulse is 101/min, and respirations are 22/min. Inspection demonstrates a diffuse diaphoresis, and cardiac auscultation reveals an S4 gallop. Cardiac catheterization reveals occlusion of the left anterior descending artery, and a vascular stent is placed. The patient is discharged on aspirin, atorvastatin, and an antiplatelet medication. Which of the following is the mechanism of action of the most likely prescribed antiplatelet medication?? {'A': 'Antithrombin III activation', 'B': 'Direct factor Xa inhibition', 'C': 'GPIIb/IIIa inhibition', 'D': 'Irreversible ADP receptor antagonism', 'E': 'Reversible ADP receptor antagonism'},
|
D: Irreversible ADP receptor antagonism
|
Answer the following medical question with one of the provided options:
|
Q:A 43-year-old Caucasian female with a long history of uncontrolled migraines presents to general medical clinic with painless hematuria. She is quite concerned because she has never had symptoms like this before. Vital signs are stable, and her physical examination is benign. She denies any groin pain, flank pain, or costovertebral angle tenderness. She denies any recent urinary tract infections or dysuria. Urinary analysis confirms hematuria and a serum creatinine returns at 3.0. A renal biopsy reveals papillary necrosis and a tubulointerstitial infiltrate. What is the most likely diagnosis?? {'A': 'Analgesic nephropathy', 'B': 'Kidney stone', 'C': 'Bladder cancer', 'D': 'Kidney cancer', 'E': 'Sickle cell disease'},
|
A: Analgesic nephropathy
|
Answer the following medical question with one of the provided options:
|
Q:A 38-year-old man comes to the physician because of a 2-week history of abdominal pain and an itchy rash on his buttocks. He also has fever, nausea, and diarrhea with mucoid stools. One week ago, the patient returned from Indonesia, where he went for vacation. Physical examination shows erythematous, serpiginous lesions located in the perianal region and the posterior thighs. His leukocyte count is 9,000/mm3 with 25% eosinophils. Further evaluation is most likely to show which of the following findings?? {'A': 'Rhabditiform larvae on stool microscopy', 'B': 'Oocysts on acid-fast stool stain', 'C': 'Giardia lamblia antibodies on stool immunoassay', 'D': 'Branching septate hyphae on KOH preparation', 'E': 'Entamoaeba histolytica antibodies on stool immunoassay'},
|
A: Rhabditiform larvae on stool microscopy
|
Answer the following medical question with one of the provided options:
|
Q:A 35-year-old woman comes to the physician because of headaches, irregular menses, and nipple discharge for the past 4 months. Breast examination shows milky white discharge from both nipples. Her thyroid function tests and morning cortisol concentrations are within the reference ranges. A urine pregnancy test is negative. An MRI of the brain is shown. Which of the following sets of changes is most likely in this patient? $$$ Serum estrogen %%% Serum progesterone %%% Dopamine synthesis $$$? {'A': '↔ ↔ ↔', 'B': '↑ ↔ ↔', 'C': '↓ ↓ ↓', 'D': '↓ ↓ ↑', 'E': '↑ ↑ ↔'},
|
D: ↓ ↓ ↑
|
Answer the following medical question with one of the provided options:
|
Q:A 30-year-old woman visits her local walk-in clinic and reports more than one week of progressive shortness of breath, dyspnea on effort, fatigue, lightheadedness, and lower limb edema. She claims she has been healthy all year round except for last week when she had a low-grade fever, malaise, and myalgias. Upon examination, her blood pressure is 94/58 mm Hg, heart rate is 125/min, respiratory rate is 26/min, and body temperature is 36.4°C (97.5°F). Her other symptoms include fine rattles in the base of both lungs, a laterally displaced pulse of maximum intensity, and regular, rhythmic heart sounds with an S3 gallop. She is referred to the nearest hospital for stabilization and further support. Which of the following best explains this patient’s condition?? {'A': 'Disruption of the dystrophin-glycoprotein complex', 'B': 'Cardiomyocyte hypertrophy', 'C': 'Fibrofatty replacement of the myocardium', 'D': 'IgA antiendomysial antibodies', 'E': 'Eosinophilic infiltration'},
|
A: Disruption of the dystrophin-glycoprotein complex
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.