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Answer the following medical question with one of the provided options: | Q:A 46-year-old woman comes to the physician for a routine health maintenance examination. She feels well. She has a history of seizures controlled with levetiracetam. She has needed glasses for the past 13 years. Her father died of pancreatic cancer. She is 175 cm (5 ft 9 in) tall and weighs 79 kg (174 lbs); BMI is 25.8 kg/m2. Vital signs are within normal limits. A photograph of the face is shown. This patient is most likely to be at increased risk for which of the following conditions?? {'A': 'Optic glioma', 'B': 'Squamous cell carcinoma', 'C': 'Gastric cancer', 'D': 'Coronary artery disease', 'E': 'Renal angiomyolipoma'}, | D: Coronary artery disease |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man presents to his physician with the complaint of bilateral lower back pain. The pain is 5/10, constant, aching, aggravated by bending forward and lying supine, and is alleviated by resting in a neutral position. The pain appeared 3 days ago after the patient overstrained at the gym. He does not report changes in sensation or limb weakness. The patient works as a business analyst. The patient’s weight is 88 kg (194 lb), and the height is 186 cm (6 ft 1 in). The vital signs are within normal limits. The neurological examination shows equally normal lower limb reflexes, and preserved muscle tone and power. The paravertebral palpation of the lumbar region increases the pain. Which of the following non-pharmacological interventions is the most appropriate in the presented case?? {'A': 'Bed rest for 3 days', 'B': 'Manual traction', 'C': 'Maintaining usual activity as tolerated', 'D': 'Therapeutic ultrasonography', 'E': 'Electromyographic biofeedback'}, | C: Maintaining usual activity as tolerated |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy comes to the physician with a 4-day history of sore throat and mild fever. He is on the varsity soccer team at his high school, but has been unable to go to practice for the last few days because he has been very tired and is easily exhausted. He has no history of serious illness and takes no medications. His mother has type 2 diabetes mellitus. He appears weak and lethargic. His temperature is 38.7°C (101.7°F), pulse is 84/min, and blood pressure is 116/78 mm Hg. Examination shows enlarged, erythematous, and exudative tonsils; posterior cervical lymphadenopathy is present. Abdominal examination shows no abnormalities. His hemoglobin concentration is 14.5 g/dL and leukocyte count is 11,200/mm3 with 48% lymphocytes. A heterophile antibody test is positive. In addition to supportive therapy, which of the following is the most appropriate next step in management?? {'A': 'Write a medical note that excuses from soccer events', 'B': 'Oral amoxicillin therapy', 'C': 'Oral corticosteroid therapy', 'D': 'Intravenous acyclovir therapy', 'E': 'Intravenous foscarnet therapy\n"'}, | A: Write a medical note that excuses from soccer events |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman presents to her primary care physician complaining of watery diarrhea for the last 3 weeks. She reports now having over 10 bowel movements per day. She denies abdominal pain or rash. A basic metabolic profile is notable for the following: Na: 127 mEq/L; K 2.1 mEq/L; Glucose 98 mg/dL. Following additional work-up, octreotide was started with significant improvement in symptoms and laboratory values. Which of the following is the most likely diagnosis?? {'A': 'VIPoma', 'B': 'Glucagonoma', 'C': 'Somatostatinoma', 'D': 'Insulinoma', 'E': 'Gastrinoma'}, | A: VIPoma |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl is brought to the physician by her mother because she has not attained menarche. She has no history of serious illness. She is at 50th percentile for height and weight. Examination shows no breast glandular tissue and no pubic hair development. The remainder of the examination shows no abnormalities. A urine pregnancy test is negative. An ultrasound of the pelvis shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'GnRH stimulation test', 'B': 'Reassurance', 'C': 'Progesterone challenge test', 'D': 'Serum FSH level', 'E': 'Serum testosterone level'}, | D: Serum FSH level |
Answer the following medical question with one of the provided options: | Q:A 52-year-old Caucasian male presents to your office with an 8 mm dark lesion on his back. The lesion, as seen below, has irregular borders and marked internal color variation. Upon excisional biopsy, the presence of which of the following would best estimate the risk of metastasis in this patient’s lesion:? {'A': 'Palisading nuclei', 'B': 'Keratin pearls', 'C': 'Vertical tumor growth', 'D': 'Cellular atypia', 'E': 'Increased production of melanosomes'}, | C: Vertical tumor growth |
Answer the following medical question with one of the provided options: | Q:A 5-year-old child is brought to a pediatric clinic by his mother for a rash that started a few days ago. The mother adds that her son has also had a fever and sore throat since last week. His immunizations are up to date. On examination, a rash is present over the trunk and upper extremities and feels like sandpaper to touch. An oropharyngeal examination is suggestive of exudative pharyngitis with a white coat over the tongue. The physician swabs the throat and uses the swab in a rapid antigen detection test kit. He also sends the sample for microbiological culture. The physician then recommends empiric antibiotic therapy and tells the mother that if the boy is left untreated, the likelihood of developing a complication later in life is very high. Which of the following best explains the mechanism underlying the development of the complication the physician is talking about?? {'A': 'Antigenic shift', 'B': 'Bacterial tissue invasion', 'C': 'Molecular mimicry', 'D': 'Toxin-mediated cellular damage', 'E': 'Genetic drift'}, | C: Molecular mimicry |
Answer the following medical question with one of the provided options: | Q:A 19-year-old man with unknown medical history is found down on a subway platform and is brought to the hospital by ambulance. He experiences two episodes of emesis en route. In the emergency department, he appears confused and is complaining of abdominal pain. His temperature is 37.0° C (98.6° F), pulse is 94/min, blood pressure is 110/80 mmHg, respirations are 24/min, oxygen saturation is 99% on room air. His mucus membranes are dry and he is taking rapid, deep breathes. Laboratory work is presented below: Serum: Na+: 130 mEq/L K+: 4.3 mEq/L Cl-: 102 mEq/L HCO3-: 12 mEq/L BUN: 15 mg/dL Glucose: 362 mg/dL Creatinine: 1.2 mg/dL Urine ketones: Positive The patient is given a bolus of isotonic saline and started on intravenous insulin drip. Which of the following is the most appropriate next step in management?? {'A': 'Subcutaneous insulin glargine', 'B': 'Intravenous isotonic saline', 'C': 'Intravenous sodium bicarbonate', 'D': 'Intravenous potassium chloride', 'E': 'Intravenous 5% dextrose and 1/2 isotonic saline'}, | D: Intravenous potassium chloride |
Answer the following medical question with one of the provided options: | Q:A physiologist is studying various mediators that modulate coronary circulation. He is particularly looking at mediators that are activated via the clotting cascade, primarily activated factor XII. He finds that when the clotting cascade starts, it leads to the activation of factor XII, which in turn activates the enzyme kallikrein. This enzyme activates high and low-molecular-weight precursors of certain mediators, which work by contracting the visceral smooth muscle while relaxing the vascular smooth muscle. They are primarily associated with hypersensitivity and can cause an increase in capillary permeability, pain, and mobilize leukocytes. Which of the following is the precursor protein for the mediators the physiologist is studying?? {'A': 'L-Arginine', 'B': 'Arachidonic acid', 'C': 'Hydroxytryptophan', 'D': 'Kininogen', 'E': 'Prothrombin'}, | D: Kininogen |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man presents with gradually increasing shortness of breath. For the last 2 years, he has had a productive cough on most days. Past medical history is significant for hypertension and a recent admission to the hospital for pneumonia. He uses a triamcinolone inhaler and uses an albuterol inhaler as a rescue inhaler. He also takes lisinopril and a multivitamin daily. He has smoked a pack a day for the last 32 years and has no intention to quit now. Today, his blood pressure is 142/97 mm Hg, heart rate is 97/min, respiratory rate is 22/min, and temperature is 37.4°C (99.3°F). On physical exam, he has tachypnea and has some difficulty finishing his sentences. His heart has a regular rate and rhythm. Auscultation of his lungs reveals wheezing and rhonchi that improves after a deep cough. Fremitus is absent. Pulmonary function tests show FEV1/FVC of 55% with no change in FEV1 after albuterol treatment. Which of the following is the most likely pathology associated with this patients disease?? {'A': 'Permanent bronchial dilation', 'B': 'Chronic granulomatous inflammation with bilateral hilar lymphadenopathy', 'C': 'Airway hypersensitivity', 'D': 'Inflamed bronchus with hypertrophy and hyperplasia of mucous glands', 'E': 'Consolidation and red hepatization'}, | D: Inflamed bronchus with hypertrophy and hyperplasia of mucous glands |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is brought to the physician for presurgical evaluation before undergoing splenectomy. One year ago, he was diagnosed with hereditary spherocytosis and has received 6 blood transfusions for severe anemia since then. His only medication is a folate supplement. Immunizations are up-to-date. His temperature is 36.7°C (98°F), pulse is 115/min, respirations are 24/min, and blood pressure is 110/60 mm Hg. Examination shows conjunctival pallor and jaundice. The spleen tip is palpated 5 cm below the left costal margin. Which of the following is the most appropriate recommendation to prevent future morbidity and mortality in this patient?? {'A': 'Subcutaneous injection of deferoxamine', 'B': 'Vaccination against hepatitis B virus', 'C': 'Daily penicillin prophylaxis', 'D': 'Daily warfarin prophylaxis', 'E': 'Administration of hydroxyurea'}, | C: Daily penicillin prophylaxis |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents with a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. His 2 maternal uncles died after having had similar complaints. Lab investigations reveal an undetectable level of all serum immunoglobulins. Which of the following is the most likely diagnosis of this patient?? {'A': 'Common variable immunodeficiency', 'B': 'Hereditary angioedema', 'C': 'Chediak-Higashi syndrome', 'D': 'Bruton agammaglobulinemia', 'E': 'DiGeorge syndrome'}, | D: Bruton agammaglobulinemia |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man is brought to the emergency department for evaluation of abdominal pain. The pain started four days ago and is now a diffuse crampy pain with an intensity of 6/10. The patient has nausea and has vomited twice today. His last bowel movement was three days ago. He has a history of hypertension and recurrent constipation. Five years ago, he underwent emergency laparotomy for a perforated duodenal ulcer. His father died of colorectal cancer at the age of 65 years. The patient has been smoking one pack of cigarettes daily for the past 40 years. Current medications include lisinopril and lactulose. His temperature is 37.6°C (99.7°F), pulse is 89/min, and blood pressure is 120/80 mm Hg. Abdominal examination shows distention and mild tenderness to palpation. There is no guarding or rebound tenderness. The bowel sounds are high-pitched. Digital rectal examination shows no abnormalities. An x-ray of the abdomen is shown. In addition to fluid resuscitation, which of the following is the most appropriate next step in the management of this patient?? {'A': 'Ciprofloxacin and metronidazole', 'B': 'PEG placement and enteral feeding', 'C': 'Colonoscopy', 'D': 'Nasogastric tube placement and bowel rest', 'E': 'Surgical bowel decompression'}, | D: Nasogastric tube placement and bowel rest |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man comes to the emergency department because of a painful rash for 2 days. The rash initially appeared on his left lower abdomen and has spread to the rest of the abdomen and left upper thigh over the last 24 hours. Pain is exacerbated with movement. He initially thought the skin rash was an allergic reaction to a new laundry detergent, but it did not respond to over-the-counter antihistamines. Six weeks ago, the patient was diagnosed with Hodgkin's lymphoma and was started on doxorubicin, bleomycin, vinblastine, and dacarbazine. He is sexually active with one female partner and uses condoms for contraception. His temperature is 37.9°C (100.2°F), pulse is 80/min, and blood pressure is 117/72 mm Hg. Examination shows two markedly enlarged cervical lymph nodes. A photograph of the rash is shown. Which of the following is the most appropriate next step in management?? {'A': 'Outpatient treatment with oral penicillin V', 'B': 'Inpatient treatment with oral ivermectin', 'C': 'Outpatient treatment with topical permethrin', 'D': 'Inpatient treatment with intravenous acyclovir', 'E': 'Inpatient treatment with intravenous ceftriaxone\n"'}, | D: Inpatient treatment with intravenous acyclovir |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man with seizure disorder is brought to the emergency department by his girlfriend after falling while climbing a building. The girlfriend reports that he was started on a new medication for treatment of depressed mood, low energy, and difficulty sleeping 2 weeks ago by his physician. She says that he has had unstable emotions for several months. Over the past 3 days, he has not slept and has spent all his time “training to climb Everest.” He has never climbed before this period. He also spent all of his savings buying mountain climbing gear. Physical examination shows ecchymoses over his right upper extremity, pressured speech, and easy distractibility. He is alert but not oriented to place. Which of the following drugs is the most likely cause of this patient's current behavior?? {'A': 'Lithium', 'B': 'Quetiapine', 'C': 'Bupropion', 'D': 'Venlafaxine', 'E': 'Selegiline'}, | D: Venlafaxine |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy is brought to the emergency department 20 minutes after collapsing while playing basketball. There is no personal or family history of serious illness. On arrival, there is no palpable pulse and no respiratory effort is seen. He is declared dead. The family agrees to an autopsy. Which of the following is most likely to be found in this patient?? {'A': 'Defect in the atrial septum', 'B': 'Postductal narrowing of the aorta', 'C': 'Atheromatous plaque rupture', 'D': 'Interventricular septal hypertrophy', 'E': 'Pericardial fluid collection'}, | D: Interventricular septal hypertrophy |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the physician because of worsening lower back pain for 6 weeks. He reports that the pain is most intense with movement and that it sometimes occurs at night. Over the past 3 months, he has noticed a weakened urinary stream. He has not seen any blood in his urine. His only daily medication is ibuprofen. Examination shows no spinal deformities. Palpation of the lumbar spinal process elicits tenderness. Muscle strength is normal. Which of the following is the most likely cause of this patient’s back pain?? {'A': 'Malignancy', 'B': 'Lumbar spinal stenosis', 'C': 'Osteoporosis', 'D': 'Disc herniation', 'E': 'Lumbar strain'}, | A: Malignancy |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman presents to her primary care physician for a wellness checkup. The patient states that she currently feels well and has no complaints. She has failed multiple times at attempting to quit smoking and has a 40 pack-year smoking history. She drinks 4 alcoholic beverages every night. The patient is currently taking a multivitamin and vitamin D supplements. She has also attempted to eat more salmon given that she has heard of its health benefits. Physical exam is notable for back stiffness on mobility testing. The patient states that she frequently has back pain when sitting. Laboratory values are obtained as seen below. Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 12.2 mg/dL PTH: 75 pg/mL (normal 10 - 65 pg/mL) Urine: Color: Yellow pH: 7.0 Blood: 1+ Protein: Negative Nitrite: Positive Bacteria: Positive Ca2+: Low Benzodiazepines: Positive Which of the following is the best explanation for this patient’s electrolyte abnormalities?? {'A': 'Familial hypocalciuric hypercalcemia', 'B': 'Hyperparathyroidism', 'C': 'Hypervitaminosis D', 'D': 'Multiple myeloma', 'E': 'Renal cell carcinoma'}, | A: Familial hypocalciuric hypercalcemia |
Answer the following medical question with one of the provided options: | Q:A previously healthy 73-year-old man comes to the physician at his wife's insistence because of a skin lesion on his back. He lives with his wife and works for a high-profile law firm where he represents several major clients. Physical examination shows a 7-mm, brownish-black papule with irregular borders. When the doctor starts to mention possible diagnoses, the patient interrupts her and says that he does not want to know the diagnosis and that she should just do whatever she thinks is right. A biopsy of the skin lesion is performed and histological examination shows clusters of infiltrative melanocytes. Upon repeat questioning, the patient reaffirms his wish to not know the diagnosis. Which of the following is the most appropriate response from the physician?? {'A': '"""I have a moral obligation as a physician to inform you about the diagnosis."""', 'B': '"""I would like to do further testing to investigate how far this cancer has spread."""', 'C': '"""I don\'t have to tell you, but I will have to tell your wife so we can plan your therapy."""', 'D': '"""I\'ll have to consult with the ethics committee to determine further steps."""', 'E': '"""I would like to know more about why you don\'t want to hear your test results."""'}, | E: """I would like to know more about why you don't want to hear your test results.""" |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man comes to the physician for a follow-up examination. He feels well. He has hyperlipidemia and type 2 diabetes mellitus. He takes medium-dose simvastatin and metformin. Four months ago, fasting serum studies showed a LDL-cholesterol of 136 mg/dL and his medications were adjusted. Vital signs are within normal limits. On physical examination, there is generalized weakness of the proximal muscles. Deep tendon reflexes are 2+ bilaterally. Fasting serum studies show: Total cholesterol 154 mg/dL HDL-cholesterol 35 mg/dL LDL-cholesterol 63 mg/dL Triglycerides 138 mg/dL Glucose 98 mg/dL Creatinine 1.1 mg/dL Creatine kinase 260 mg/dL Which of the following is the most appropriate next step in management of this patient's hyperlipidemia?"? {'A': 'Discontinue simvastatin, start pravastatin in 3 weeks', 'B': 'Continue simvastatin, add niacin', 'C': 'Discontinue simvastatin, start fenofibrate now', 'D': 'Increase the dose of simvastatin', 'E': 'Discontinue simvastatin, start niacin in 3 weeks'}, | A: Discontinue simvastatin, start pravastatin in 3 weeks |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl presents with four days of malaise, painful joints, nodular swelling over her elbows, low-grade fever, and a rash on her chest and left shoulder. Two weeks ago, she complained of a sore throat that gradually improved but was not worked up. She was seen for a follow-up approximately one week later. At this visit her cardiac exam was notable for a late diastolic murmur heard best at the apex in the left lateral decubitus position with no radiation. Which of the following is the best step in the management of this patient?? {'A': 'Penicillin therapy', 'B': 'NSAIDS for symptomatic relief', 'C': 'Aortic valve replacement', 'D': 'Mitral valve repair', 'E': 'Reassurance that this is a benign murmur and send home'}, | A: Penicillin therapy |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to the pediatrician by her parents who are concerned that she is not developing normally. They say she does not talk and avoids eye contact. She prefers to sit and play with blocks by herself rather than engaging with other children. They also note that she will occasionally have violent outbursts in inappropriate situations. She is otherwise healthy. In the office, the patient sits quietly in the corner of the room stacking and unstacking blocks. Examination of the patient shows a well-developed female with no physical abnormalities. Which of the following is the most likely diagnosis in this patient?? {'A': 'Autism spectrum disorder', 'B': 'Cri-du-chat syndrome', 'C': 'Fragile X syndrome', 'D': 'Oppositional defiant disorder', 'E': 'Rett syndrome'}, | A: Autism spectrum disorder |
Answer the following medical question with one of the provided options: | Q:An 82-year-old man—a retired physics professor—presents with progressive difficulty walking. He has bilateral knee osteoarthritis and has used a walker for the past several years. For the past 6 months, he has experienced problems walking and maintaining balance and has been wheelchair-bound. He has fallen several times, hitting his head a few times but never losing consciousness. He complains of occasional difficulty remembering names and phone numbers, but his memory is otherwise fine. He also complains of occasional incontinence. Physical examination reveals a slow wide-based gait with small steps and intermittent hesitation. He scores 22 out of 30 on the Mini-Mental State Examination (MMSE). A brain MRI demonstrates dilated ventricles with high periventricular fluid-attenuated inversion recovery (FLAIR) signal. A large-volume lumbar puncture improves his gait. Which of the following is the most likely risk factor for the development of this condition?? {'A': 'Alzheimer’s disease', 'B': 'Diabetes mellitus', 'C': 'Epilepsy', 'D': 'Hypertension', 'E': 'Subarachnoid hemorrhage'}, | E: Subarachnoid hemorrhage |
Answer the following medical question with one of the provided options: | Q:A 44-year-old man presents to his primary care physician for muscle pain and weakness. He says that his muscle pain mainly affects his legs. He also experiences difficulty with chewing gum and has poor finger dexterity. Medical history is significant for infertility and cataracts. On physical exam, the patient's face is long and narrow with a high arched palate and mild frontal balding. There is bilateral ptosis and temporalis muscle and sternocleidomastoid muscle wasting. Creatine kinase level is mildly elevated. Which of the following is most likely to be found on genetic testing?? {'A': 'DMPK gene CTG expansion', 'B': 'DYSF gene missense mutation', 'C': 'Dystrophin gene nonsense mutation', 'D': 'Dystrophin gene non-frameshift mutation', 'E': 'No genetic abnormality'}, | A: DMPK gene CTG expansion |
Answer the following medical question with one of the provided options: | Q:A 10-year-old boy is brought to the pediatric clinic because of a sore throat of 1-week duration. He also has a cough and fever. He has pain when swallowing and sometimes water regurgitates from his nose when drinking. He was diagnosed with acute tonsillitis by his primary care physician 1 month ago, for which he received a week-long course of amoxicillin. His immunization status is unknown as he recently moved to the US from Asia. On examination, he is alert and oriented to time, place, and person. On inspection of his oral cavity, an edematous tongue with a grey-white membrane on the soft palate and tonsils is noted. The neck is diffusely swollen with bilateral tender cervical lymphadenopathy. Which of the following is the cause of this patient’s condition and could have been prevented through vaccinations in childhood?? {'A': 'Streptococcus pyogenes', 'B': 'Corynebacterium diphtheriae', 'C': 'Haemophilus influenzae b', 'D': 'Agranulocytosis', 'E': 'Epstein Barr virus'}, | B: Corynebacterium diphtheriae |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman comes to the emergency room with chest pain. She describes the pain as a squeezing sensation in her chest with radiation to the left shoulder. The episode began about 15 minutes ago when she was sitting reading a book. She has had this pain before, typically in the evenings, though prior episodes usually resolved after a couple of minutes. Her pulse is 112/min, blood pressure is 121/87 mmHg, and respiratory rate is 21/min. An ECG shows ST-segment elevations in the inferior leads. Serum troponins are negative on two successive blood draws and the ECG shows no abnormalities 30 minutes later. Which of the following is the best long-term treatment for this patient's symptoms?? {'A': 'Clopidogrel', 'B': 'Diltiazem', 'C': 'Aspirin', 'D': 'Enalapril', 'E': 'Metoprolol'}, | B: Diltiazem |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man is brought to the emergency department because of progressive weakness of his lower extremities and urinary incontinence for the past 2 weeks. Over the past 2 months, he has had increasing back pain. His temperature is 37.1°C (98.8°F), pulse is 88/min, and blood pressure is 106/60 mm Hg. Examination shows an ataxic gait. Muscle strength is decreased in bilateral lower extremities. Sensation to pain, temperature, and position sense is absent in the buttocks, perineum, and lower extremities. Ankle clonus is present. Digital rectal examination is unremarkable. An x-ray of the spine shows multiple sclerotic lesions in the thoracic and lumbar vertebrae. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Left testicular mass', 'B': 'Irregular, asymmetric mole', 'C': 'Enlarged left thyroid lobe', 'D': 'Bence Jones protein in the urine', 'E': 'Elevated prostate-specific antigen'}, | E: Elevated prostate-specific antigen |
Answer the following medical question with one of the provided options: | Q:A 51-year-old African American man with a history of poorly controlled hypertension presents to the emergency room with blurry vision and dyspnea. He reports rapid-onset blurred vision and difficulty breathing 4 hours prior to presentation. He takes lisinopril, hydrochlorothiazide, and spironolactone but has a history of poor medication compliance. He has a 50 pack-year smoking history and drinks 4-6 shots of vodka per day. His temperature is 99.2°F (37.3°C), blood pressure is 195/115 mmHg, pulse is 85/min, and respirations are 20/min. On exam, he is ill-appearing and pale. He is intermittently responsive and oriented to person but not place or time. Fundoscopic examination reveals swelling of the optic disc with blurred margins. A biopsy of this patient’s kidney would most likely reveal which of the following?? {'A': 'Anuclear arteriolar thickening', 'B': 'Calcific deposits in the arterial media without luminal narrowing', 'C': 'Concentrically thickened arteriolar tunica media with abundant nuclei', 'D': 'Endothelial proliferation and luminal narrowing with a chronic inflammatory infiltrate', 'E': 'Fibrous atheromatous plaques in the arteriolar intima'}, | C: Concentrically thickened arteriolar tunica media with abundant nuclei |
Answer the following medical question with one of the provided options: | Q:A pharmaceutical company is studying the effect of a novel compound that they have discovered to treat osteoporosis. They perform a randomized controlled clinical trial to study if this compound has an effect on the incidence of hip fractures among osteoporotic patients. They find that there is no statistical difference between the experimental and control groups so they do not pursue the compound further. Two years later, a second team tests the same compound and finds that the compound is effective, and follow up studies confirm that the compound has a statistically significant effect on fracture risk. Which of the following most likely describes what occurred in the first study?? {'A': 'Design bias', 'B': 'Selection bias', 'C': 'Type I error', 'D': 'Type II error', 'E': 'Type III error'}, | D: Type II error |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman comes to the physician because of constipation, loss of appetite, and increased urinary frequency for the past 8 weeks. She has a history of hypertension and underwent mastectomy for breast cancer 9 months ago. Her sister has hyperthyroidism and her mother died of complications from breast cancer at the age of 52 years. She does not smoke or drink alcohol. Current medications include chlorthalidone. Her temperature is 36.2°C (97.2°F), pulse is 102/min, and blood pressure is 142/88 mm Hg. Physical examination shows dry mucous membranes. Abdominal examination shows mild, diffuse abdominal tenderness to palpation with decreased bowel sounds. Her serum creatinine concentration is 1.2 mg/dL and serum calcium concentration is 12 mg/dL. Serum parathyroid hormone levels are decreased. Which of the following is the most appropriate long-term pharmacotherapy?? {'A': 'Magnesium oxide', 'B': 'Denosumab', 'C': 'Furosemide', 'D': 'Zoledronic acid', 'E': 'Prednisone\n"'}, | D: Zoledronic acid |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man is brought to the emergency department because of a 2-day history of fever, chills, and headache. He frequently has headaches, for which he takes aspirin, but says that this headache is more intense. His wife claims that he has also not been responding right away to her. He has a 20-year history of hypertension and poorly controlled type 2 diabetes mellitus. His current medications include metformin and lisinopril. He has received all recommended childhood vaccines. His temperature is 39°C (102.2F°), pulse is 100/min, and blood pressure is 150/80 mm Hg. He is lethargic but oriented to person, place, and time. Examination shows severe neck rigidity with limited active and passive range of motion. Blood cultures are obtained and a lumbar puncture is performed. Which of the following is the most likely causal organism?? {'A': 'Streptococcus agalactiae', 'B': 'Staphylococcus aureus', 'C': 'Neisseria meningitidis', 'D': 'Streptococcus pneumoniae', 'E': 'Escherichia coli'}, | D: Streptococcus pneumoniae |
Answer the following medical question with one of the provided options: | Q:A 34-year-old female comes to the ED complaining of epigastric pain and intractable nausea and vomiting for the last 24 hours. Her vitals are as follows: Temperature 38.1 C, HR 97 beats/minute, BP 90/63 mm Hg, RR 12 breaths/minute. Arterial blood gas and labs are drawn. Which of the following sets of lab values is consistent with her presentation?? {'A': 'pH 7.39, PaCO2 37 , serum chloride 102 mEq/L, serum bicarbonate 27 mEq/L', 'B': 'pH 7.36, PaCO2 75 , serum chloride 119 mEq/L, serum bicarbonate 42 mEq/L', 'C': 'pH 7.46, PaCO2 26 , serum chloride 102 mEq/L, serum bicarbonate 16 mEq/L', 'D': 'pH 7.51, PaCO2 50 , serum chloride 81 mEq/L, serum bicarbonate 38 mEq/L', 'E': 'pH 7.31, PaCO2 30 , serum chloride 92 mEq/L, serum bicarbonate 15 mEq/L'}, | D: pH 7.51, PaCO2 50 , serum chloride 81 mEq/L, serum bicarbonate 38 mEq/L |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man comes to the physician because of worsening shortness of breath and nocturnal cough for the past 2 weeks. On two occasions, his cough was bloody. He had a heart condition as a child that was treated with antibiotics. He emigrated to the US from Kazakhstan 15 years ago. Pulmonary examination shows crackles at both lung bases. Cardiac examination is shown. Which of the following is the most likely diagnosis?? {'A': 'Aortic valve regurgitation', 'B': 'Mitral valve prolapse', 'C': 'Mitral valve stenosis', 'D': 'Mitral valve regurgitation', 'E': 'Tricuspid valve stenosis\n"'}, | C: Mitral valve stenosis |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the emergency department because of a 12-hour history of a severe headache. She does not smoke or use illicit drugs. Her blood pressure at admission is 180/125 mm Hg. Physical examination shows a bruit in the epigastric region. Fundoscopy shows bilateral optic disc swelling. Which of the following investigations is most likely to confirm the diagnosis?? {'A': 'Urinary catecholamine metabolites', 'B': 'Echocardiography', 'C': 'Serum 17-hydroxyprogesterone level', 'D': 'Oral sodium loading test', 'E': 'CT angiography'}, | E: CT angiography |
Answer the following medical question with one of the provided options: | Q:A grant reviewer at the National Institutes of Health is determining which of two studies investigating the effects of gastric bypass surgery on fasting blood sugar to fund. Study A is spearheaded by a world renowned surgeon, is a multi-center study planning to enroll 50 patients at each of 5 different sites, and is single-blinded. Study B plans to enroll 300 patients from a single site and will be double-blinded by virtue of a sham surgery for the control group. The studies both plan to use a t-test, and they both report identical expected treatment effect sizes and variance. If the reviewer were interested only in which trial has the higher power, which proposal should he fund?? {'A': 'Study A, because it has a superior surgeon', 'B': 'Study A, because it is a multi-center trial', 'C': 'Study B, because it has a larger sample size', 'D': 'Study B, because it is double blinded', 'E': 'Both studies have the same power'}, | C: Study B, because it has a larger sample size |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman presents to the physician because of facial flushing and weakness for 3 months, abdominal discomfort and bloating for 6 months, and profuse watery diarrhea for 1 year. She reports that her diarrhea was episodic initially, but it has been continuous for the past 3 months. The frequency ranges from 10 to 12 bowel movements per day, and the diarrhea persists even if she is fasting. She describes the stools as odorless, watery in consistency, and tea-colored, without blood or mucus. She has not been diagnosed with any specific medical conditions, and there is no history of substance use. Her temperature is 36.9°C (98.4°F), heart rate is 88/min, respiratory rate is 18/min, and blood pressure is 110/74 mm Hg. Her physical exam shows decreased skin turgor, and the abdominal exam does not reveal any significant abnormality. Laboratory studies show: Serum glucose 216 mg/dL (12.0 mmol/L) Serum sodium 142 mEq/L (142 mmol/L) Serum potassium 3.1 mEq/L (3.1 mmol/L) Serum chloride 100 mEq/L (100 mmol/L) Serum calcium 11.1 mg/dL (2.77 mmol/L) Her 24-hour stool volume is 4 liters. Which of the following tests is most likely to yield an accurate diagnosis?? {'A': 'Urinary 5-hydroxyindoleacetic acid excretion', 'B': 'Plasma gastrin level', 'C': 'Plasma vasoactive intestinal peptide', 'D': 'Plasma glucagon level', 'E': 'Plasma somatostatin level'}, | C: Plasma vasoactive intestinal peptide |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the physician by his parents because of a 4-day history of arthralgias, abdominal pain, and lesions on his arms and legs. Ten days ago, he had an upper respiratory tract infection. A photograph of one of his legs is shown. Further evaluation is most likely to show which of the following?? {'A': 'Genital ulcers', 'B': 'Hematuria', 'C': 'Tick bite', 'D': 'Conjunctivitis', 'E': 'Thrombocytopenia'}, | B: Hematuria |
Answer the following medical question with one of the provided options: | Q:A previously healthy 61-year-old man comes to the physician because of a 3-month history of intermittent fever, easy fatiguability, and a 4.4-kg (9.7-lb) weight loss. Physical examination shows conjunctival pallor. The spleen is palpated 5 cm below the left costal margin. Laboratory studies show a leukocyte count of 75,300/mm3 with increased basophils, a platelet count of 455,000/mm3, and a decreased leukocyte alkaline phosphatase score. A peripheral blood smear shows increased numbers of promyelocytes, myelocytes, and metamyelocytes. Which of the following is the most likely diagnosis?? {'A': 'Leukemoid reaction', 'B': 'Chronic lymphocytic leukemia', 'C': 'Essential thrombocythemia', 'D': 'Chronic myeloid leukemia', 'E': 'Acute promyelocytic leukemia'}, | D: Chronic myeloid leukemia |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman presents to the emergency department with progressive nausea and vomiting. She reports that approximately one day prior to presentation she experienced abdominal discomfort that subsequently worsened to severe nausea, vomiting, and two episodes of watery diarrhea. She recently noticed that her vision has become blurry along with mild alterations in color perception. Medical history is significant for congestive heart failure with a low ejection fraction. She cannot recall which medications she is currently taking but believes she is taking them as prescribed. Which of the following is a characteristic of the likely offending drug that led to this patient’s clinical presentation?? {'A': 'High potency', 'B': 'Low potency', 'C': 'Ratio of toxic dose to effective dose much greater than 1', 'D': 'Ratio of toxic dose to effective dose close to 1', 'E': 'Low bioavailability'}, | D: Ratio of toxic dose to effective dose close to 1 |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man who lives in a beach house in Florida visits his twin brother who lives in the Rocky Mountains. They are out hiking and the visitor struggles to keep up with his brother. Which of the following adaptations is most likely present in the mountain-dwelling brother relative to his twin?? {'A': 'Decreased mean corpuscular hemoglobin concentration', 'B': 'Decreased red blood cell 2,3-diphosphoglycerate', 'C': 'Decreased oxygen binding ability of hemoglobin', 'D': 'Decreased pulmonary vascular resistance', 'E': 'Decreased renal erythropoietin production'}, | C: Decreased oxygen binding ability of hemoglobin |
Answer the following medical question with one of the provided options: | Q:A 25-year-old G1P0000 presents to her obstetrician’s office for a routine prenatal visit at 32 weeks gestation. At this visit, she feels well and has no complaints. Her pregnancy has been uncomplicated, aside from her Rh negative status, for which she received Rhogam at 28 weeks gestation. The patient has a past medical history of mild intermittent asthma and migraine headaches. She currently uses her albuterol inhaler once a week and takes a prenatal vitamin. Her temperature is 98.6°F (37.0°C), pulse is 70/min, blood pressure is 117/68 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and abdominal exam reveals a gravid uterus with fundal height at 30 centimeters. Bedside ultrasound reveals that the fetus is in transverse lie. The patient states that she prefers to have a vaginal delivery. Which of the following is the best next step in management?? {'A': 'Expectant management', 'B': 'Weekly ultrasound', 'C': 'External cephalic version', 'D': 'Internal cephalic version', 'E': 'Caesarean section at 38 weeks'}, | A: Expectant management |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man with a past medical history significant for hypertension, type 2 diabetes, and chronic obstructive pulmonary disease presents with complaints of nausea and abdominal pain for the past month. The pain is located in the epigastric region and is described as “burning” in quality, often following food intake. The patient denies any changes in bowel movements, fever, or significant weight loss. Medications include metformin, lisinopril, hydrochlorothiazide, albuterol inhaler, and fluconazole for a recent fungal infection. Physical examination was unremarkable except for a mildly distended abdomen that is diffusely tender to palpation and decreased sensation at lower extremities bilaterally. A medication was started for the symptoms. Two days later, the patient reports heart palpitations. An EKG is shown below. Which of the following is the medication most likely prescribed?? {'A': 'Aspirin', 'B': 'Erythromycin', 'C': 'Metformin', 'D': 'Omeprazole', 'E': 'Ranitidine'}, | B: Erythromycin |
Answer the following medical question with one of the provided options: | Q:An investigator is studying the affinity of hemoglobin for oxygen in different clinical settings. An illustration of an oxygen-hemoglobin dissociation curve is shown. Curve A shows the test results of one of the research participants and curve B shows a normal oxygen-hemoglobin dissociation curve. Which of the following is most likely present in this research participant?? {'A': 'Temperature of 39.1°C (102.4°F)', 'B': 'Sickled red blood cells', 'C': 'Neutrophilia', 'D': 'Serum pH of 7.1', 'E': 'Polycythemia'}, | E: Polycythemia |
Answer the following medical question with one of the provided options: | Q:A 24-year-old obese woman presents with a severe right-sided frontotemporal headache that started 2 days ago. There is no improvement with over-the-counter pain medications. Yesterday, the pain was so intense that she stayed in bed all day in a dark, quiet room instead of going to work. This morning she decided to come in after an episode of vomiting. She says she has experienced 5–6 similar types of headaches each lasting 12–24 hours over the last 6 months but never this severe. She denies any seizures, visual disturbances, meningismus, sick contacts or focal neurologic deficits. Her past medical history is significant for moderate persistent asthma, which is managed with ipratropium bromide and an albuterol inhaler. She is currently sexually active with 2 men, uses condoms consistently, and regularly takes estrogen-containing oral contraceptive pills (OCPs). Her vital signs include: blood pressure 122/84 mm Hg, pulse 86/min, respiratory rate 19/min, and blood oxygen saturation (SpO2) 98% on room air. Physical examination, including a complete neurologic exam, is unremarkable. A magnetic resonance image (MRI) of the brain appears normal. Which of the following is the best prophylactic treatment for this patient’s most likely condition?? {'A': 'Sumatriptan', 'B': 'Methysergide', 'C': 'Gabapentin', 'D': 'Amitriptyline', 'E': 'Ibuprofen'}, | D: Amitriptyline |
Answer the following medical question with one of the provided options: | Q:In a community of 5,000 people, 40 people from 40 different households develop an infection with a new strain of influenza virus with an incubation period of 7 days. The total number of people in these households is 150. Ten days later, 90 new cases of the same disease are reported from these same households. Twenty-five more cases are reported from these households after a month. The total number of cases reported after a month from this community is 1,024. What is the secondary attack rate for this infection?? {'A': '(115/150) × 100', 'B': '(115/1024) × 100', 'C': '(90/110) × 100', 'D': '(90/150) × 100', 'E': '(90/5000) × 100'}, | C: (90/110) × 100 |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman is brought to the emergency department by campus police for bizarre behavior. She was arrested while trying to break into her university's supercomputer center and was found crying and claiming she needs access to the high-powered processors immediately. Her boyfriend arrived at the hospital and reports that, over the past week, she has been staying up all night working on ‘various projects’. A review of her electronic medical record reveals that she was seen at student health 1 week ago for low energy and depressed mood, for which treatment was started. In the emergency department, she continues to appear agitated, pacing around the room and scolding staff for stopping her from her important work. Her speech is pressured, but she exhibits no evidence of visual or auditory hallucinations. The physical exam is otherwise unremarkable. Which of the following medications most likely precipitated this patient’s event?? {'A': 'Alprazolam', 'B': 'Haloperidol', 'C': 'Lithium', 'D': 'Sertraline', 'E': 'Valproate'}, | D: Sertraline |
Answer the following medical question with one of the provided options: | Q:You would like to conduct a study investigating potential risk factors that predispose patients to develop cirrhosis. Using a registry of admitted patients over the last 10 years at your local hospital, you isolate all patients who have been diagnosed with cirrhosis. Subsequently, you contact this group of patients, asking them to complete a survey assessing their prior exposure to alcohol use, intravenous drug abuse, blood transfusions, personal history of cancer, and other medical comorbidities. An identical survey is given to an equal number of patients in the registry who do not carry a prior diagnosis of cirrhosis. Which of the following best describes the type of study you are attempting to conduct?? {'A': 'Cohort study', 'B': 'Meta-analysis', 'C': 'Case-control study', 'D': 'Cross-sectional study', 'E': 'Randomized controlled trial'}, | C: Case-control study |
Answer the following medical question with one of the provided options: | Q:An 18-year-old female presents to general medical clinic with the report of a rape on her college campus. The patient was visiting a local fraternity, and after having a few drinks, awakened to find another student having intercourse with her. Aside from the risk of unintended pregnancy and sexually transmitted infections, this patient is also at higher risk of developing which of the following?? {'A': 'Attention Deficit Hyperactivity Disorder', 'B': 'Bipolar Disorder', 'C': 'Suicidality', 'D': 'Schizoaffective Disorder', 'E': 'Schizophrenia'}, | C: Suicidality |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man complains of ascending weakness, palpitations, and abdominal pain. He has a history of hypertension, type II diabetes mellitus, diabetic retinopathy, and end-stage renal disease requiring dialysis. He denies any recent infection. Physical examination is notable for decreased motor strength in both his upper and lower extremities, intact cranial nerves, as well as decreased bowel sounds. On further questioning, the patient shares that he has been depressed, as he feels he may not be able to see his grandchildren grow due to his complicated medical course. This caused him to miss two of his dialysis appointments. Which of the following will mostly likely be found on electrocardiography?? {'A': "Progressive PR prolongation, followed by a 'drop' in QRS", 'B': 'S wave in lead I, Q wave in lead III, and inverted T wave in lead III', 'C': 'ST-segment elevation in leads II, III, and aVF', 'D': 'Peaked T-waves and shortened QT interval', 'E': 'Diffuse PR segment depression and ST-segment deviations'}, | D: Peaked T-waves and shortened QT interval |
Answer the following medical question with one of the provided options: | Q:After learning in a lecture that cesarean section rates vary from < 0.5% to over 30% across countries, a medical student wants to investigate if national cesarean section rates correlate with national maternal mortality rates worldwide. For his investigation, the student obtains population data from an international registry that contains tabulated cesarean section rates and maternal mortality rates from the last 10 years for a total of 119 countries. Which of the following best describes this study design?? {'A': 'Case series', 'B': 'Meta-analysis', 'C': 'Retrospective cohort study', 'D': 'Ecological study', 'E': 'Prospective cohort study\n"'}, | D: Ecological study |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman presents to the fertility clinic with her husband for infertility workup. The patient reports that they have been having unprotected intercourse for 14 months without any successful pregnancy. She is G1P1, with 1 child from a previous marriage. Her menstrual cycle is regular and without pain. Physical and pelvic examinations are unremarkable. The husband denies erectile dysfunction, decrease in libido, or other concerns. A physical examination of the husband demonstrates tall long extremities and bilateral hard nodules behind the areola. What abnormality would you most likely find in the husband?? {'A': 'Decreased luteinizing hormone (LH) levels', 'B': 'Defective fibrillin', 'C': 'Elevated aromatase levels', 'D': 'Elevated homocysteine levels', 'E': 'Elevated testosterone levels'}, | C: Elevated aromatase levels |
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-day history of episodic retrosternal pain, shortness of breath, and palpitations. The episodes occur when he climbs stairs or tries to walk briskly on his treadmill. The symptoms resolve when he stops walking. The previous evening he felt dizzy and weak during such an episode. He also reports that he had a cold 2 weeks ago. He was diagnosed with type 2 diabetes mellitus four years ago but is otherwise healthy. His only medication is glyburide. He appears well. His pulse is 62/min and is weak, respirations are 20/min, and blood pressure is 134/90 mmHg. Cardiovascular examination shows a late systolic ejection murmur that is best heard in the second right intercostal space. The lungs are clear to auscultation. Which of the following mechanisms is the most likely cause of this patient's current condition?? {'A': 'Increased left ventricular oxygen demand', 'B': 'Lymphocytic infiltration of the myocardium', 'C': 'Critical transmural hypoperfusion of the myocardium', 'D': 'Catecholamine-induced transient regional systolic dysfunction', 'E': 'Increased release of endogenous insulin'}, | A: Increased left ventricular oxygen demand |
Answer the following medical question with one of the provided options: | Q:A 62-year-old male is rushed to the emergency department (ED) for what he believes is his second myocardial infarction (MI). His medical history is significant for severe chronic obstructive pulmonary disease (COPD) and a prior MI at the age of 58. After receiving aspirin, morphine, and face mask oxygen in the field, the patient arrives to the ED tachycardic (105 bpm), diaphoretic, and normotensive (126/86). A 12 lead electrocardiogram shows ST-elevation in I, aVL, and V5-V6. The attending physician suspects a lateral wall infarction. Which of following beta-blockers should be given to this patient and why?? {'A': 'Propranolol, because it is a non-selective ß-blocker', 'B': 'Metoprolol, because it is a selective ß1 > ß2 blocker', 'C': 'Atenolol, because it is a selective ß2 > ß1 blocker', 'D': 'Labetalol, because it is a selective ß1 > ß2 blocker', 'E': 'Nadolol, because it is a selective ß1 > ß2 blocker'}, | B: Metoprolol, because it is a selective ß1 > ß2 blocker |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman presents to a primary care clinic for a physical evaluation. She works as a software engineer, travels frequently, is married with 2 kids, and drinks alcohol occasionally. She does not exercise regularly. She currently does not take any medications except for occasional ibuprofen or acetaminophen. She is currently undergoing menopause. Her initial vital signs reveal that her blood pressure is 140/95 mmHg and heart rate is 75/min. She weighs 65 kg (143 lb) and is 160 cm (63 in) tall. Her physical exam is unremarkable. A repeat measurement of her blood pressure is the same as before. Among various laboratory tests for hypertension evaluation, the physician requests fasting glucose and hemoglobin A1c levels. Which of the following is the greatest risk factor for type 2 diabetes mellitus?? {'A': 'Age', 'B': 'Body mass index', 'C': 'Hypertension', 'D': 'Menopause', 'E': 'Occupation'}, | B: Body mass index |
Answer the following medical question with one of the provided options: | Q:A 8-month-old boy is brought to the emergency department by his mother and father due to decreasing activity and excessive sleepiness. The patient was born at full-term in the hospital with no complications. The patient's parents appear incredibly worried as their son has had no medical issues in the past. They show you videos of the child happily playing with his parents the day before. The patient’s mother states that the patient hit his head while crawling this morning and since then has been difficult to arouse. His mother is worried because she thinks he had a fever earlier in the day and he was clutching his head and neck in pain. Physical examination shows a barely arousable boy with a large, full anterior fontanelle. The boy grimaces on palpation of his chest, and a radiograph show posterior rib fractures. Retinal examination shows bilateral retinal hemorrhages. Which of the following is the most likely cause for this patient’s presentation?? {'A': 'Child abuse', 'B': 'Unintentional head injury', 'C': 'Vitamin K deficiency', 'D': 'Osteogenesis imperfecta', 'E': 'Bacterial meningitis'}, | A: Child abuse |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the physician because of a 2-month history of generalized itching and worsening fatigue. There is no personal or family history of serious illness. She takes eye drops for dry eyes. She occasionally takes acetaminophen for recurrent headaches. She drinks one alcoholic beverage daily. Vital signs are within normal limits. Examination shows jaundice and a nontender abdomen. The liver is palpated 3 cm below the right costal margin and the spleen is palpated 2 cm below the left costal margin. Laboratory studies show: Hemoglobin 15.3 g/dL Leukocyte count 8,400/mm3 Prothrombin time 13 seconds Serum Bilirubin Total 3.5 mg/dL Direct 2.4 mg/dL Alkaline phosphatase 396 U/L Aspartate aminotransferase (AST, GOT) 79 U/L Alanine aminotransferase (ALT, GPT) 73 U/L A liver biopsy specimen shows inflammation and destruction of small- and medium-sized intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) shows multiple small stones within the gallbladder and a normal appearance of extrahepatic bile ducts. Which of the following is the most appropriate next step in management?"? {'A': 'Extracorporeal shock wave lithotripsy', 'B': 'Dual-energy x-ray absorptiometry', 'C': 'Administer N-acetylcysteine', 'D': 'Serum electrophoresis', 'E': 'Chest x-ray'}, | B: Dual-energy x-ray absorptiometry |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man presents to the physician with difficulty breathing for the last 2 months. He denies any cough, fever, or chest pain. His past medical history is significant for hypertension for which he takes chlorothiazide. He has worked in the construction industry, applying insulation to roofs for over 20 years. He denies smoking, drinking, and illicit drug use. His pulse rate is 74/min, respiratory rate is 14/min, blood pressure is 130/76 mm Hg, and temperature is 36.8°C (98.2°F). Physical examination reveals some end-inspiratory crackles at the lung bases. No other examination findings are significant. The lung inflation curve is obtained for the patient and is shown in the image. Which of the following most likely accounts for this patient’s symptoms?? {'A': 'Normal aging', 'B': 'Alpha-1 antitrypsin deficiency', 'C': 'Asthma', 'D': 'Idiopathic pulmonary hypertension', 'E': 'Pulmonary fibrosis'}, | E: Pulmonary fibrosis |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy presents to an urgent care clinic complaining of a runny nose that has lasted for a few weeks. He also reports sneezing attacks that last up to an hour, nasal obstruction, and generalized itching. He has similar episodes each year during the springtime that prevent him from going out with his friends or trying out for sports. His younger brother has a history of asthma. Which of the following diseases has a similar pathophysiology?? {'A': 'Allergic contact dermatitis', 'B': 'Atopic dermatitis', 'C': 'Irritant contact dermatitis', 'D': 'Systemic lupus erythematosus', 'E': 'Dermatitis herpetiformis'}, | B: Atopic dermatitis |
Answer the following medical question with one of the provided options: | Q:A 26-year-old G2P1 undergoes labor induction at 40 weeks gestation. The estimated fetal weight was 3890 g. The pregnancy was complicated by gestational diabetes treated with insulin. The vital signs were as follows: blood pressure 125/80 mm Hg, heart rate 91/min, respiratory rate 21/min, and temperature 36.8℃ (98.2℉). The blood workup yields the following results: Fasting glucose 92 mg/dL HbA1c 7.8% Erythrocyte count 3.3 million/mm3 Hb 11.6 mg/dL Ht 46% Thrombocyte count 240,000/mm3 Serum creatinine 0.71 mg/dL ALT 12 IU/L AST 9 IU/L Which of the following should be administered during labor?? {'A': '5% dextrose', 'B': 'Intravenous regular insulin', 'C': '25% magnesium sulphate', 'D': 'Erythrocyte mass', 'E': 'Subcutaneous insulin'}, | A: 5% dextrose |
Answer the following medical question with one of the provided options: | Q:A 33-year-old man is brought to the emergency department by his partner for 24 hours of fever, severe headache, and neck stiffness. His companion also comments that he has been vomiting several times in the past 8 hours and looks confused. His personal medical history is unremarkable. Upon examination, his blood pressure is 125/82 mm Hg, heart rate 110/mine, and temperature is 38.9 C (102F). There is no rash or any other skin lesions, his lung sounds are clear and symmetrical. There is nuchal rigidity, jolt accentuation of a headache, and photophobia. A lumbar puncture is taken, and cerebrospinal fluid is sent for analysis and a Gram stain (shown in the picture). The patient is put on empirical antimicrobial therapy with ceftriaxone and vancomycin. According to the clinical manifestations and Gram stain, which of the following should be considered in the management of this case?? {'A': 'Addition of ampicillin', 'B': 'Prophylaxis with rifampin for close contacts', 'C': 'Switch to meropenem', 'D': 'Initiation of amphotericin', 'E': 'Initiation rifampin, isoniazid, pyrazinamide, and ethambutol'}, | B: Prophylaxis with rifampin for close contacts |
Answer the following medical question with one of the provided options: | Q:A 43-year-old male presents to a clinic for routine follow-up. He was diagnosed with hepatitis B several months ago. He does not have any complaints about his health, except for poor appetite. The general physical examination is normal. The laboratory investigation reveals mildly elevated aminotransferases. Which of the following findings indicate that the patient has developed a chronic form of his viral infection?? {'A': 'HbsAg -, Anti-HbsAg -, Anti-HbcAg IgM +, Anti-HbcAg IgG -, HbeAg -, Anti-HbeAg +', 'B': 'HbsAg +, Anti-HbsAg -, Anti-HbcAg IgM +, Anti-HbcAg IgG -, HbeAg +, Anti-HbeAg -', 'C': 'HbsAg +, Anti-HbsAg -, Anti-HbcAg IgM -, Anti-HbcAg IgG +, HbeAg +, Anti-HbeAg -', 'D': 'HbsAg -, Anti-HbsAg +, Anti-HbcAg IgM -, Anti-HbcAg IgG -, HbeAg -, Anti-HbeAg -', 'E': 'HbsAg -, Anti-HbsAg +, Anti-HbcAg IgM -, Anti-HbcAg IgG +, HbeAg -, Anti-HbeAg +'}, | C: HbsAg +, Anti-HbsAg -, Anti-HbcAg IgM -, Anti-HbcAg IgG +, HbeAg +, Anti-HbeAg - |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician with involuntary lip smacking and hand and leg movements for the past two weeks. The movements are causing him difficulty walking and functioning at work. He has bipolar disorder treated with fluphenazine. Three months ago, he was hospitalized because of a manic episode, and his dosage was adjusted. Since then, he has not experienced a depressed mood, increased energy, irritability, or a change in his eating or sleeping patterns. He does not have suicidal or homicidal ideation. His temperature is 37.2°C (99°F), pulse is 75/min, and blood pressure is 126/78 mmHg. Examination shows repetitive lip smacking and dance-like hand and leg movements. His speech is not pressured, and his affect is appropriate. He is switched from fluphenazine to risperidone and his symptoms improve. Which of the following mechanisms explains this patient's improvement?? {'A': 'Weaker acetylcholine antagonism', 'B': 'Weaker histamine antagonism', 'C': 'Weaker acetylcholine agonism', 'D': 'Weaker dopamine antagonism', 'E': 'Weaker histamine agonism'}, | D: Weaker dopamine antagonism |
Answer the following medical question with one of the provided options: | Q:A 37-year-old-woman presents to the emergency room with complaints of fever and abdominal pain. Her blood pressure is 130/74 mmHg, pulse is 98/min, temperature is 101.5°F (38.6°C), and respirations are 23/min. The patient reports that she had a laparoscopic cholecystectomy 4 days ago but has otherwise been healthy. She is visiting her family from Nebraska and just arrived this morning from a 12-hour drive. Physical examination revealed erythema and white discharge from abdominal incisions and tenderness upon palpations at the right upper quadrant. What is the most probable cause of the patient’s fever?? {'A': 'Pulmonary atelectasis', 'B': 'Pulmonary embolism', 'C': 'Residual gallstones', 'D': 'Urinary tract infection', 'E': 'Wound infection'}, | E: Wound infection |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl comes to the physician because she is worried about gaining weight. She reports that at least twice a week, she eats excessive amounts of food but feels ashamed about losing control soon after. She is very active in her high school's tennis team and goes running daily to lose weight. She has a history of cutting her forearms with the metal tab from a soda can. Her last menstrual period was 3 weeks ago. She is 165 cm (5 ft 5 in) tall and weighs 57 kg (125 lb); BMI is 21 kg/m2. Physical examination shows enlarged, firm parotid glands bilaterally. There are erosions of the enamel on the lingual surfaces of the teeth. Which of the following is the most likely diagnosis?? {'A': 'Obsessive-compulsive disorder', 'B': 'Borderline personality disorder', 'C': 'Bulimia nervosa', 'D': 'Anorexia nervosa', 'E': 'Body dysmorphic disorder'}, | C: Bulimia nervosa |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman presents to the emergency department with a chief complaint of severe pain in her face. She states that over the past week she has experienced episodic and intense pain in her face that comes on suddenly and resolves on its own. She states she feels the pain over her cheek and near her eye. The pain is so severe it causes her eyes to tear up, and she is very self conscious about the episodes. She fears going out in public as a result and sometimes feels her symptoms come on when she thinks about an episode occurring while in public. While she is waiting in the emergency room her symptoms resolve. The patient has a past medical history of diabetes, constipation, irritable bowel syndrome, and anxiety. She is well known to the emergency department for coming in with chief complaints that often do not have an organic etiology. Her temperature is 99.5°F (37.5°C), blood pressure is 177/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiopulmonary and abdominal exams are within normal limits. Neurological exam reveals cranial nerves II-XII are grossly intact. The patient's pupils are equal and reactive to light. Pain is not elicited with palpation of the patient's face. Which of the following is the best initial step in management?? {'A': 'Alprazolam', 'B': 'Carbamazepine', 'C': 'High flow oxygen', 'D': 'Ibuprofen', 'E': 'Regular outpatient follow up'}, | B: Carbamazepine |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man with type 2 diabetes mellitus presents to his family physician for a follow-up appointment. He is currently using a 3-drug regimen consisting of metformin, sitagliptin, and glipizide. Despite this therapeutic regimen, his most recent hemoglobin A1c level is 8.1%. Which of the following is the next best step for this patient?? {'A': 'Discontinue glipizide; initiate insulin glargine 10 units at bedtime', 'B': 'Discontinue metformin; initiate basal-bolus insulin', 'C': 'Discontinue metformin; initiate insulin aspart at mealtimes', 'D': 'Discontinue sitagliptin; initiate basal-bolus insulin', 'E': 'Discontinue metformin; initiate insulin glargine 10 units at bedtime'}, | A: Discontinue glipizide; initiate insulin glargine 10 units at bedtime |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman has been trying to conceive with her 37-year-old husband for the past 4 years. After repeated visits to a fertility clinic, she finally gets pregnant. Although she missed most of her antenatal visits, her pregnancy was uneventful. A baby girl is born at the 38th week of gestation with some abnormalities. She has a flat face with upward-slanting eyes and a short neck. The tongue seems to be protruding from a small mouth. She has poor muscle tone and excessive joint laxity. The pediatrician orders an analysis of the infant’s chromosomes, also known as a karyotype (see image). The infant is most likely to suffer from which of the following conditions in the future?? {'A': 'Acute lymphoblastic leukemia', 'B': 'Chronic myelogenous leukemia', 'C': 'Immotile cilia syndrome', 'D': 'Macroorchidism', 'E': 'Red blood cell sickling'}, | A: Acute lymphoblastic leukemia |
Answer the following medical question with one of the provided options: | Q:A 64-year-old gentleman with hypertension is started on a new diuretic medication by his primary care physician because of poor blood pressure control on his previous regimen. Before starting, he is warned by his physician that the new medication may have side effects including hypokalemia and metabolic alkalosis. Furthermore it may cause alterations in his metabolites such as hyperglycemia, hyperlipidemia, hyperuricemia, and hypercalcemia. What is the mechanism of the class of diuretic most likely being recommended by the physician?? {'A': 'Osmotic diuresis', 'B': 'NKCC inhibitor in loop of Henle', 'C': 'NCC inhibitor in distal tubule', 'D': 'ENaC inhibitor in collecting duct', 'E': 'Aldosterone receptor inhibitor'}, | C: NCC inhibitor in distal tubule |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man presents to the outpatient department complaining of a rash similar to the ones in the image. The skin lesions have been present for about 2 weeks. It is present in the buttocks and both inferior limbs. There is no association of skin lesions with exposure to sunlight or medication use. The patient also reports joint pain affecting the distal and proximal joints in both the upper and lower limbs. The joint pain has been present for about a week and seems to improve with Tylenol use. The patient is a retired armed force personnel with an extensive tour of overseas duty. He received blood transfusion following a career-ending injury about 30 years ago. He denies alcohol and tobacco use. He is currently in a monogamous relationship with his wife for 40 years. His past medical history is significant for hypertension controlled on Enalapril. Physical examination shows mild pallor, multiple palpable purpuric lesions with occasional ulcerations bilaterally in the upper and lower limbs. Pulse rate is 88/min and blood pressure is 128/82 mm Hg. Laboratory test findings are: HIV I and II antibodies negative Rheumatoid factor positive Hepatitis C antigen positive Hepatitis B surface antigen positive Hepatitis B antibody positive Anti-neutrophil antibody positive Hematocrit 38% Which of the following mechanisms is most likely responsible for his clinical presentation?? {'A': 'Cyto-proliferative effect of HCV on hepatocytes', 'B': 'Excessive uroporphyrinogen caused by HCV induced decarboxylase deficiency', 'C': 'Defective hepatic removal of IgA caused by chronic HCV', 'D': 'Monoclonal expansion of IgM caused by benign neoplasia', 'E': 'Virus-induced clonal expansion of autoreactive B lymphocytes'}, | E: Virus-induced clonal expansion of autoreactive B lymphocytes |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man is brought to the emergency department because of fever, progressive weakness, and cough for the past five days. He experienced a similar episode 2 months ago, for which he was hospitalized for 10 days while visiting his son in Russia. He states that he has never fully recovered from that episode. He felt much better after being treated with antibiotics, but he still coughs often during meals. He sometimes also coughs up undigested food after eating. For the last 5 days, his coughing has become more frequent and productive of yellowish-green sputum. He takes hydrochlorothiazide for hypertension and pantoprazole for the retrosternal discomfort that he often experiences while eating. He has smoked half a pack of cigarettes daily for the last 30 years and drinks one shot of vodka every day. The patient appears thin. His temperature is 40.1°C (104.2°F), pulse is 118/min, respirations are 22/min, and blood pressure is 125/90 mm Hg. Auscultation of the lungs shows right basal crackles. There is dullness on percussion at the right lung base. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 15.4 g/dL Leukocyte count 17,000/mm3 Platelet count 350,000/mm3 Na+ 139 mEq/L K+ 4.6 mEq/L Cl- 102 mEq/L HCO3- 25 mEq/L Urea Nitrogen 16 mg/dL Creatinine 1.3 mg/dL An x-ray of the chest shows a right lower lobe infiltrate. Which of the following is the most likely explanation for this patient's symptoms?"? {'A': 'Weak tone of the lower esophageal sphincter', 'B': 'Formation of a tissue cavity containing necrotic debris', 'C': 'Uncoordinated contractions of the esophagus', 'D': 'Unrestricted growth of pneumocytes with invasion of the surrounding tissue', 'E': 'Outpouching of the hypopharynx\n"'}, | E: Outpouching of the hypopharynx " |
Answer the following medical question with one of the provided options: | Q:Benzodiazepines are clinically useful because of their inhibitory effects on the central nervous system. Which of the following correctly pairs the site of action of benzodiazepines with the molecular mechanism by which a they exerts their effects?? {'A': 'GABA-A receptors; blocking action of GABA', 'B': 'GABA-B receptors; activating potassium channels', 'C': 'GABA-B receptors; activating a G-protein coupled receptor', 'D': 'GABA-A receptors; increasing the duration of activation of a chloride ion channel', 'E': 'GABA-A receptors; increasing the frequency of activation of a chloride ion channel'}, | E: GABA-A receptors; increasing the frequency of activation of a chloride ion channel |
Answer the following medical question with one of the provided options: | Q:A 57-year-old male with diabetes mellitus type II presents for a routine check-up. His blood glucose levels have been inconsistently controlled with medications and diet since his diagnosis 3 years ago. At this current visit, urinalysis demonstrates albumin levels of 250 mg/day. All prior urinalyses have shown albumin levels below 20 mg/day. At this point in the progression of the patient’s disease, which of the following is the most likely finding seen on kidney biopsy?? {'A': 'Normal kidney biopsy, no pathological finding is evident at this time', 'B': 'Glomerular hypertrophy with slight glomerular basement membrane thickening', 'C': 'Glomerular basement membrane thickening and mesangial expansion', 'D': 'Kimmelstiel-Wilson nodules and tubulointerstitial fibrosis', 'E': 'Significant global glomerulosclerosis'}, | C: Glomerular basement membrane thickening and mesangial expansion |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man comes to the physician for evaluation of fatigue, facial rash, hair loss, and tingling of his hands and feet. He has followed a vegetarian diet for the past 3 years and has eaten 8 raw egg whites daily for the past year in preparation for a bodybuilding competition. Physical examination shows conjunctival injections and a scaly, erythematous rash around the eyes and mouth. Laboratory studies show decreased activity of propionyl-coenzyme A carboxylase in peripheral blood lymphocytes. Which of the following substances is most likely to be decreased in this patient?? {'A': 'Cystathionine', 'B': 'Ribulose-5-phosphate', 'C': 'Adenine', 'D': 'Lactate', 'E': 'Oxaloacetate'}, | E: Oxaloacetate |
Answer the following medical question with one of the provided options: | Q:A full-term and healthy infant girl presents to the office for a newborn visit. The baby was born at 40 weeks to a 35-year-old G2P1 mother via cesarean section for breech presentation. She had an unremarkable delivery and hospital course, but family history is significant for a sister with developmental dysplasia of the hip (DDH). A physical exam is normal. During a discussion with the mother about the possibility of screening imaging for DDH she becomes very anxious and would like something done as soon as possible. What would be the imaging of choice in this scenario?? {'A': 'Hip MRI at 6 weeks of age', 'B': 'Hip ultrasound at 6 weeks of age', 'C': 'Hip ultrasound within the next week', 'D': 'Hip radiograph at 6 weeks of age', 'E': 'Hip radiograph at 5 months of age'}, | B: Hip ultrasound at 6 weeks of age |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man comes to the emergency department for evaluation of burning with urination and purulent urethral discharge for the past 3 days. He is sexually active with multiple female partners. Several months ago he was diagnosed with urethritis caused by gram-negative diplococci and received antibiotic treatment with complete resolution of his symptoms. A Gram stain of the patient's urethral discharge shows gram-negative intracellular diplococci. Which of the following properties of the infecting organism most contributed to the pathogenesis of this patient's recurrent infection?? {'A': 'Expression of beta-lactamase genes', 'B': 'Synthesis of capsular polysaccharides', 'C': 'Absence of immunogenic proteins', 'D': 'Production of enzymes that hydrolyze urea', 'E': 'Variation of expressed pilus proteins'}, | E: Variation of expressed pilus proteins |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman comes to the emergency department because of a 5-hour history of diffuse, severe abdominal pain, nausea, and vomiting. She reports that there is no blood or bile in the vomitus. Two weeks ago, she started having mild aching epigastric pain, which improved with eating. Since then, she has gained 1.4 kg (3 lb). She has a 2-year history of osteoarthritis of both knees, for which she takes ibuprofen. She drinks 1–2 glasses of wine daily. She is lying supine with her knees drawn up and avoids any movement. Her temperature is 38.5°C (101.3°F), pulse is 112/min, respirations are 20/min, and blood pressure is 115/70 mm Hg. Physical examination shows abdominal tenderness and guarding; bowel sounds are decreased. An x-ray of the chest is shown. Which of the following is the most likely cause of this patient's current symptoms?? {'A': 'Perforated peptic ulcer', 'B': 'Acute pancreatitis', 'C': 'Acute mesenteric ischemia', 'D': 'Gastroesophageal reflux disease', 'E': 'Cholecystolithiasis\n"'}, | A: Perforated peptic ulcer |
Answer the following medical question with one of the provided options: | Q:A 52-year-old-woman presents to an urgent care clinic with right upper quadrant pain for the past few hours. She admits to having similar episodes of pain in the past but milder than today. Past medical history is insignificant. She took an antacid, but it did not help. Her temperature is 37°C (98.6°F ), respirations are 16/min, pulse is 78/min, and blood pressure is 122/98 mm Hg. Physical examination is normal, and she says that her pain has subsided. The urgent care provider suspects she has cholecystitis, so she undergoes a limited abdominal ultrasound to confirm it. However, no evidence of cholecystitis is seen with ultrasound, but adenomyomatosis of the gallbladder is incidentally noted. The patient has no clinical features suspicious for malignancy. What is the next best step in the management of this patient?? {'A': 'Cholecystectomy', 'B': 'Barium swallow study', 'C': 'Endoscopic retrograde cholangiopancreatography', 'D': 'Magnetic resonance cholangiopancreatography', 'E': 'No further treatment required'}, | E: No further treatment required |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to your office with a chief complaint of constipation and many other perturbing minor medical concerns. He reports tiring easily, which he attributes to old age and years of persistent pain in his back and ribs. A complete blood count shows low hemoglobin and elevated serum creatinine. A peripheral blood smear shows stacks of red blood cells among other findings, and serum electropheresis reveals an abnormal concentration of protein resulting in a spike. Which of the following additional findings would you expect to see in this patient?? {'A': 'Early satiety and splenomegaly', 'B': 'Smudge cells on peripheral smear', 'C': 'An elevated PSA and a nodular prostate', 'D': 'Bence-Jones proteins in the urine', 'E': 'No additional findings - normal aging explains symptoms'}, | D: Bence-Jones proteins in the urine |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl presents with episodes of sharp pain in her left upper limb. She says her symptoms gradually onset a few months ago and have progressively worsened. She describes her pain as severe and feeling like “someone stabbing me in my arm and then the pain moves down to my hand”. She says the pain is worse after physical activity and improves with rest. She also says she has some vision problems in her left eye. The patient is afebrile, and her vital signs are within normal limits. On physical examination, there are no visible deformities in the shoulders or upper extremities. Palpation of her left upper limb reveals tenderness mainly near her neck. Mild left-sided ptosis is present. There is anisocoria of her left pupil which measures 1 mm smaller than the right. The right upper limb is normal. A plain radiograph and an MRI are ordered (shown in the image). Which of the following focal neurologic deficits would most likely be seen on the left hand of this patient?? {'A': 'Numbness over her left thumb', 'B': 'Crutch palsy', 'C': 'Numbness over her left index finger', 'D': 'Numbness over her left little finger', 'E': 'Numbness over the thenar area of her left hand'}, | D: Numbness over her left little finger |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents with worsening joint pain and stiffness. Past medical history is significant for rheumatoid arthritis, diagnosed 3 months ago and managed with celecoxib and methotrexate, and occasional gastric reflux, managed with omeprazole. His vitals are a pulse of 80/min, a respiratory rate of 16/min, and blood pressure of 122/80 mm Hg. On physical examination, the left wrist is swollen, stiff, and warm to touch, and the right wrist is red and warm. There is limited active and passive range of motion at the proximal interphalangeal and metacarpophalangeal joints of both hands. The remainder of the examination is unremarkable. A plain radiograph of the hands shows progressive degeneration of multiple joints. Another drug, etanercept, is added to help control progressive arthritis. Which of the following diagnostic tests should be ordered before starting this new medication in this patient?? {'A': 'Tuberculosis screening', 'B': 'Antinuclear antibody (ANA) level', 'C': 'Endoscopy', 'D': 'Bleeding time', 'E': 'Malignancy screening'}, | A: Tuberculosis screening |
Answer the following medical question with one of the provided options: | Q:A 78-year-old male comes to the physician’s office for a routine check-up. He complains of increased lower extremity swelling, inability to climb the one flight of stairs in his home, and waking up in the middle of the night 2-3 times gasping for breath. He has had to increase the number of pillows on which he sleeps at night. These symptoms started 9 months ago and have been progressing. The doctor starts him on a medication regimen, one of which changes his Starling curve from A to B as shown in the Figure. Which of the following medications is most consistent with this mechanism of action?? {'A': 'Metoprolol', 'B': 'Furosemide', 'C': 'Hydrochlorothiazide', 'D': 'Aspirin', 'E': 'Digoxin'}, | E: Digoxin |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman comes to the physician because of lower back pain that began suddenly 2 weeks ago after getting up from her chair. She has hypertension, chronic bilateral knee pain, and a history of breast cancer 15 years ago that was treated with lumpectomy. Her mother has rheumatoid arthritis. Medications include hydrochlorothiazide and acetaminophen. She appears well. Her vital signs are within normal limits. Physical examination shows tenderness to palpation of the lower spine. Both knees are enlarged and swollen. Neurologic examination shows sensorineural hearing impairment of the left ear. Her gamma-glutamyl transferase (GGT) is 30 U/L (N: 0–30 U/L), alkaline phosphatase (ALP) is 310 U/L, and serum calcium is 10.2 mg/dL. A spinal x-ray shows a fracture in the L4 vertebra. Which of the following is the most likely diagnosis?? {'A': 'Type 1 osteopetrosis', 'B': 'Primary biliary cholangitis', 'C': 'Rheumatoid arthritis', 'D': 'Paget disease of bone', 'E': 'Bone metastases'}, | D: Paget disease of bone |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought in to his pediatrician by his mother because of several days of fever, irritability, and ear pain. His mother says that she was particularly concerned about his complaints of difficulty hearing and dizziness. Physical exam reveals a bulging tympanic membrane. As the pediatrician does the examination, she explains to the medical student accompanying her that the lining of the infected area is derived from the endodermal component of a certain embryological structure. The mesodermal component at the same level is most likely responsible for the development of which of the following structures?? {'A': 'Cricothyroid muscle', 'B': 'Mylohyoid muscle', 'C': 'Stylohyoid muscle', 'D': 'Stylopharyngeus muscle', 'E': 'Thyroarytenoid muscle'}, | B: Mylohyoid muscle |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman comes to the physician because of right-sided blurry vision and eye pain for 4 days. She has a 6-day history of low-grade fever, headache, and malaise. One year ago, she was diagnosed with Crohn disease. Her only medication is prednisone. Her temperature is 38°C (100.4°F), pulse is 84/min, and blood pressure is 112/75 mm Hg. The right eyelid is erythematous and tender; there are multiple vesicles over the right forehead and the tip of the nose. Visual acuity is 20/20 in the left eye and 20/80 in the right eye. Extraocular movements are normal. The right eye shows conjunctival injection and reduced corneal sensitivity. Fluorescein staining shows a corneal lesion with a tree-like pattern. Which of the following is the most likely diagnosis?? {'A': 'Pseudomonas keratitis', 'B': 'Anterior uveitis', 'C': 'Herpes zoster keratitis', 'D': 'Angle-closure glaucoma', 'E': 'Herpes simplex keratitis'}, | C: Herpes zoster keratitis |
Answer the following medical question with one of the provided options: | Q:A pathologist examines a tissue specimen in which cells are grouped together in acini with visible ducts between them. He finds a patch of pale cells with a rich blood supply among the highly basophilic and granular cells. A representative micrograph is shown in the image. Which statement is correct about these cells?? {'A': 'These cells should be separated from the basophils by a dense capsule.', 'B': 'These cells are often found to be damaged in acute pancreatitis with a subsequent increase in serum amylase levels.', 'C': 'Some of these cells undergo transformation and begin to secrete insulin to compensate for the loss of pancreatic beta cells.', 'D': 'There are several different types of cells within the patch that cannot be differentiated by light microscopy.', 'E': 'Some of these cells are capable of producing leptin, a hormone which regulates satiety.'}, | D: There are several different types of cells within the patch that cannot be differentiated by light microscopy. |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman presents to the emergency department with prominent hypotension and tachycardia. On examination, she has a low central venous pressure and high cardiac output. Her temperature is 38.9°C (102.0°F). The physician suspects a bacterial infection with a gram-negative bacterium. Samples are sent to the lab. Meanwhile, high volumes of fluids were given, but the blood pressure did not improve. She was started on noradrenaline. At the biochemical level, a major reaction was induced as part of this patient’s presentation. Of the following vitamins, which one is related to the coenzyme that participates in this induced biochemical reaction?? {'A': 'Vitamin B1 (thiamine)', 'B': 'Vitamin B2 (riboflavin)', 'C': 'Vitamin B3 (niacin)', 'D': 'Vitamin B5 (pantothenic acid)', 'E': 'Vitamin B6 (pyridoxal phosphate)'}, | C: Vitamin B3 (niacin) |
Answer the following medical question with one of the provided options: | Q:A public health researcher is invited to participate in a government meeting on immunization policies. Other participants in the meeting include physicians, pediatricians, representatives of vaccine manufacturers, persons from the health ministry, etc. For a specific viral disease, there are 2 vaccines - one is a live attenuated vaccine (LAV) and the other is a subunit vaccine. Manufacturers of both the vaccines promote their own vaccines in the meeting. Non-medical people in the meeting ask the public health researcher to compare the 2 types of vaccines objectively. The public health researcher clearly explains the pros and cons of the 2 types of vaccines. Which of the following statements is most likely to have been made by the public health researcher in his presentation?? {'A': 'LAV has a less potential for immunization errors as compared to a subunit vaccine', 'B': 'LAV cannot cause symptomatic infection in a immunocompetent person and, therefore, is as safe as a subunit vaccine', 'C': 'LAV is equally safe as a subunit vaccine for administration to a pregnant woman', 'D': 'LAV requires stricter requirements for cold chain maintenance as compared to a subunit vaccine', 'E': 'LAV produces poorer immunological memory than a subunit vaccine as the later contains only specific immunogenic antigens'}, | D: LAV requires stricter requirements for cold chain maintenance as compared to a subunit vaccine |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to his primary care physician for a decline in his hearing that he noticed over the past week. The patient has a past medical history of hypertension and diabetes mellitus and was recently diagnosed with bladder cancer which is currently appropriately being treated. The patient is a hunter and often goes shooting in his spare time. His recent sick contacts include his grandson who is being treated with amoxicillin for ear pain. Physical exam is notable for decreased hearing bilaterally. The Weber test does not localize to either ear, and the Rinne test demonstrates air conduction is louder than bone conduction. Which of the following is the most likely etiology for this patient's hearing loss?? {'A': 'Medication regimen', 'B': 'Otitis externa', 'C': 'Otitis media', 'D': 'Otosclerosis', 'E': 'Presbycusis'}, | A: Medication regimen |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man is rushed to the emergency department by ambulance after being found on the floor gasping for air with severe shortness of breath by his partner. Past medical history is significant for congestive heart failure, hypertension, and hyperlipidemia. He normally takes chlorthalidone, atorvastatin, metoprolol, and valsartan, but he recently lost his job and insurance and has not been able to afford his medication in 2 months. Upon arrival at the hospital, his blood pressure is 85/50 mm Hg, heart rate is 110/min, respiratory rate is 24/min, oxygen saturation 90% on 100% oxygen, and temperature is 37.7°C (99.9°F). On physical exam, he appears obese and can only answer questions in short gasps as he struggles to breathe. His heart rate is tachycardic with a mildly irregular rhythm and auscultation of his lungs reveal crackles in the lower lobes, bilaterally. Which of the following physiologic changes is currently seen in this patient?? {'A': '↓ Plasma renin and angiotensin II activity, ↑ blood pressure, normal renal perfusion pressure, ↑ serum pH', 'B': '↑ Plasma renin and angiotensin II activity, ↑ blood pressure, normal renal perfusion pressure, ↓ serum pH', 'C': 'Normal plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusion pressure, ↓ serum pH', 'D': '↑ Plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusion pressure, ↑ serum pH', 'E': '↑ Plasma renin and angiotensin II activity, ↑ blood pressure,↓ renal perfusion pressure, ↑ serum pH'}, | D: ↑ Plasma renin and angiotensin II activity, ↓ blood pressure, ↓ renal perfusion pressure, ↑ serum pH |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man presents to the emergency room following a stab wound to the back. He was in a bar when he got into an argument with another man who proceeded to stab him slightly right of the midline of his back. He is otherwise healthy and does not take any medications. He has one previous admission to the hospital for a stab wound to the leg from another bar fight 2 years ago. His temperature is 99°F (37.2°C), blood pressure is 115/80 mmHg, pulse is 100/min, and pulse oximetry is 99% on room air. Cardiopulmonary and abdominal exams are unremarkable; however, he has an abnormal neurologic exam. If this wound entered his spinal cord but did not cross the midline, which of the following would most likely be seen in this patient?? {'A': 'Ipsilateral loss of pain and temperature sensation below the lesion', 'B': 'Contralateral loss of tactile, vibration, and proprioception below the lesion', 'C': 'Contralateral spasticity below the level of the lesion', 'D': 'Ipsilateral flaccid paralysis at the level of the lesion', 'E': 'Contralateral loss of sensation at the level of the lesion'}, | D: Ipsilateral flaccid paralysis at the level of the lesion |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man presents to the emergency department with 1-month of progressive dyspnea, decreased exercise tolerance, and inability to sleep flat on his back. He says that he been getting increasingly short of breath over the past few years; however, he attributed these changes to getting older. He started becoming very concerned when he was unable to climb the stairs to his apartment about 3 weeks ago. Since then, he has been experiencing shortness of breath even during activities of daily living. His past medical history is significant for heroin and cocaine use as well as periods of homelessness. Physical exam reveals a gallop that occurs just after the end of systole. Which of the following could lead to the same pathology that is seen in this patient?? {'A': 'Amyloid production', 'B': 'Myosin mutation', 'C': 'Radiation therapy', 'D': 'Turner syndrome', 'E': 'Vitamin B1 deficiency'}, | E: Vitamin B1 deficiency |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman presents to her gynecologist as part of her follow-up for her abnormal pap test a year ago. She has a normal menstrual cycle and has never been pregnant. She does not take oral contraceptive pills, as she is sexually inactive. She denies the use of any illicit drugs. Conventional cytology from her cervix uteri is done, which reveals pathological findings suggestive of a low-grade squamous intraepithelial lesion as shown in the photograph below. The same test last year revealed normal histological findings. What is the most likely process leading to these pathological findings in this patient’s pap smear?? {'A': 'Hyperplasia', 'B': 'Hypertrophy', 'C': 'Atrophy', 'D': 'Dysplasia', 'E': 'Anaplasia'}, | D: Dysplasia |
Answer the following medical question with one of the provided options: | Q:A 42-year-old man presents with unremitting diarrhea that has lasted for 2 weeks. He describes his bowel movements as watery, non-bloody, foul-smelling, and greasy. He also has cramping abdominal pain associated with the diarrhea. He says that his symptoms started right after he returned from a father-son camping trip to the mountains. His son has similar symptoms. His vital signs include: pulse 78/min, respiratory rate 15/min, temperature 37.2°C (99.0°F), and blood pressure 120/70 mm Hg. A stool sample is obtained and microscopic analysis is significant for the findings shown in the image below. Which of the following pathogens is most likely responsible for this patient’s condition?? {'A': 'Bacillus cereus', 'B': 'Campylobacter jejuni', 'C': 'Clostridium difficile', 'D': 'Giardia lamblia', 'E': 'Yersinia enterocolitica'}, | D: Giardia lamblia |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman presents to the emergency department with swelling of her face and abdominal pain. She states she was outside doing yard work when her symptoms began. The patient has a past medical history of recently diagnosed diabetes and hypertension. Her current medications include lisinopril, metformin, and glipizide. Her temperature is 99.5°F (37.5°C), blood pressure is 149/95 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, the patient's cardiac and pulmonary exam are within normal limits. Dermatologic exam reveals edema of her hands, lips, and eyelids. There is mild laryngeal edema; however, the patient is speaking clearly and maintaining her airway. Which of the following is appropriate long-term management of this patient?? {'A': 'Fresh frozen plasma', 'B': 'Ecallantide', 'C': 'Danazol', 'D': 'Discontinue metformin', 'E': 'Prednisone'}, | C: Danazol |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man comes to the physician because of a 5-month history of watery diarrhea and episodic crampy abdominal pain. He has no fever, nausea, or vomiting. Over the past 6 months, he has had a 1.8-kg (4-lb) weight loss, despite experiencing no decrease in appetite. His wife has noticed that sometimes his face and neck become red after meals or when he is in distress. A year ago, he was diagnosed with asthma. He has hypertension. Current medications include an albuterol inhaler and enalapril. He drinks one beer daily. His temperature is 36.7°C (98°F), pulse is 85/min, and blood pressure is 130/85 mm Hg. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the left sternal border and fourth intercostal space. The abdomen is soft, and there is mild tenderness to palpation with no guarding or rebound. The remainder of the physical examination shows no abnormalities. A complete blood count is within the reference range. Without treatment, this patient is at greatest risk for which of the following conditions?? {'A': 'Asphyxia', 'B': 'Achlorhydria', 'C': 'Megaloblastic anemia', 'D': 'Dementia', 'E': 'Intestinal fistula'}, | D: Dementia |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the emergency department by his parents because of crushing chest pain, nausea, and vomiting for the past 2 hours. The pain is constant and radiates to his left shoulder. Over the past year, he has been admitted to the hospital twice for deep vein thrombosis. He has a history of learning disability and has been held back three grades. The patient is at the 99th percentile for length and the 45th percentile for weight. His pulse is 110/min, respirations are 21/min, and blood pressure is 128/84 mm Hg. His fingers are long and slender, and his arm span exceeds his body height. Electrocardiography shows ST-segment elevation in leads V1 and V2. His serum troponin I concentration is 2.0 ng/mL (N ≤ 0.04). Coronary angiography shows 90% occlusion of the proximal left anterior descending artery. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Bilateral gynecomastia', 'B': 'Downward lens subluxation', 'C': 'Macroorchidism', 'D': 'Saccular cerebral aneurysms', 'E': 'Ascending aortic aneurysm'}, | B: Downward lens subluxation |
Answer the following medical question with one of the provided options: | Q:A 7-year-old Caucasian male presents with a temperature of 38°C. During the physical exam, the patient complains of pain when his femur is palpated. The patient's parents state that the fever started a few days after they noticed a honey-colored crusting on the left upper lip of the child's face. Culture of the bacteria reveals a catalase-positive, gram-positive cocci. Which of the following bacteria is most likely to be found in a biopsy of the child's left femur?? {'A': 'Staphylococcus aureus', 'B': 'Staphylococcus saprophyticus', 'C': 'Streptococcus pyogenes', 'D': 'Clostridium perfingens', 'E': 'Escherichia coli'}, | A: Staphylococcus aureus |
Answer the following medical question with one of the provided options: | Q:A 46-year-old woman complains of chronic cough for the past 3 weeks. She was recently diagnosed with hypertension and placed on an angiotensin receptor blocker therapy (ARBs). Chest X-ray shows large nodular densities bilaterally. Bronchial biopsy showed granulomatous inflammation of the pulmonary artery. Lab investigations showed a positive cANCA with a serum creatinine of 3.6 mg/dL. Urine analysis shows RBC casts and hematuria. Which is the most likely cause of this presentation?? {'A': 'Microscopic polyangitis', 'B': 'Churg-Strauss syndrome', 'C': 'Polyarteritis nodosa', 'D': 'Hypertensive medication', 'E': 'Granulomatosis with polyangiitis'}, | E: Granulomatosis with polyangiitis |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician because of recurrent episodes of palpitations, chest pain, shortness of breath, sweating, and dizziness over the past 4 months. These episodes are accompanied by intense fear of “losing control” over himself. Most of the episodes have occurred at work in situations when it would have been unacceptable to leave, such as during team meetings. The last episode occurred at home right before this visit, after he noticed that he was running late. He has been otherwise healthy. He occasionally drinks a beer or a glass of wine. Vital signs are within normal limits. Cardiopulmonary examination shows no abnormalities. Thyroid function studies and an ECG show no abnormalities. Given his symptoms, this patient is at greatest risk of developing which of the following?? {'A': 'Preoccupation with an observed flaw in physical appearance', 'B': 'Abnormally elevated mood and flight of ideas', 'C': 'Depressed mood and feeling of guilt', 'D': 'Fear of spiders and heights', 'E': 'Disorganized speech and delusions'}, | C: Depressed mood and feeling of guilt |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman presents with shortness of breath and left-sided chest pain for a week. She says that her breathlessness is getting worse, and the chest pain is especially severe when she takes a deep breath. The patient denies any similar symptoms in the past. Her past medical history is insignificant except for occasional heartburn. She currently does not take any medication. She is a nonsmoker and drinks alcohol occasionally. She denies the use of any illicit drugs including marijuana. Vital signs are: blood pressure 122/78 mm Hg, pulse 67/min, respiratory rate 20/min, temperature 37.2°C (99.0°F). Her physical examination is remarkable for diminished chest expansion on the left side, absence of breath sounds at the left lung base, and dullness to percussion and decreased tactile fremitus on the left. A plain radiograph of the chest reveals a large left-sided pleural effusion occupying almost two-thirds of the left lung field. Thoracentesis is performed, and 2 L of fluid is drained from the thorax under ultrasound guidance. Which of the following patient positions and points of entry is the safest for performing a thoracentesis in this patient?? {'A': 'With the patient in the sitting position, below the tip of the scapula midway between the spine and the posterior axillary line on the superior margin of the eighth rib', 'B': 'With the patient in the sitting position, just above the fifth rib in the anterior axillary line', 'C': 'With the patient in the sitting position, at the midclavicular line on the second intercostal space', 'D': 'With the patient in the supine position, just above the fifth rib in the midaxillary line', 'E': 'With the patient in the supine position, in the fifth intercostal space right below the nipple'}, | A: With the patient in the sitting position, below the tip of the scapula midway between the spine and the posterior axillary line on the superior margin of the eighth rib |
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