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Answer the following medical question with one of the provided options: | Q:A 53-year-old woman comes to the physician because of progressive headache and fatigue for the past 2 months. One year ago, she was diagnosed with Cushing disease, which was ultimately treated with bilateral adrenalectomy. Current medications are hydrocortisone and fludrocortisone. Examination shows generalized hyperpigmentation of the skin and bitemporal visual field defects. Serum studies show an ACTH concentration of 1250 pg/mL (N = 20–100). Which of the following is the most appropriate next step in management?? {'A': 'Administer bromocriptine', 'B': 'Administer metyrapone', 'C': 'Perform radiotherapy of the pituitary', 'D': 'Reduce dosage of glucocorticoids', 'E': 'Resect small cell lung carcinoma'}, | C: Perform radiotherapy of the pituitary |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman presents to her family doctor worried that she might have a heart condition. For the past 7 months, she has been having short panic attacks where she feels short of breath, sweaty, and feels like her heart wants to jump out her chest. During these attacks, she feels like she ‘is going crazy’. She has now mapped out all of the places she has had an attack such as the subway, the crowded pharmacy near her house, and an elevator at her work that is especially slow and poorly lit. She actively avoids these areas to prevent an additional episode. She is afraid that during these attacks she may not be able to get the help she needs or escape if needed. No significant past medical history. The patient takes no current medications. Her grandfather died of a heart attack at the age of 70 and she is worried that it might run in the family. The patient is afebrile and vital signs are within normal limits. Laboratory results are unremarkable. Which of the following is the most likely diagnosis for this patient’s condition?? {'A': 'Panic disorder and agoraphobia', 'B': 'Panic disorder', 'C': 'Social anxiety disorder', 'D': 'Agoraphobia', 'E': 'Generalized anxiety disorder'}, | A: Panic disorder and agoraphobia |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman comes to the emergency department because of a mild headache, dizziness, fatigue, and nausea over the past several hours. She has no history of serious illness and takes no medications. She lives in a basement apartment and uses a wood stove for heating. Her temperature is 36°C (96.8°F) and pulse is 120/min. Arterial blood gas analysis shows a carboxyhemoglobin level of 11% (N = < 1.5). Which of the following mechanisms is the underlying cause of this patient's symptoms?? {'A': 'Inhibition of mitochondrial succinate dehydrogenase', 'B': 'Inhibition of mitochondrial ATP synthase', 'C': 'Increased oxygen binding capacity', 'D': 'Inhibition of mitochondrial cytochrome c oxidase', 'E': 'Increased mitochondrial membrane permeability'}, | D: Inhibition of mitochondrial cytochrome c oxidase |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman with a history of anorexia nervosa diagnosed 2 years ago presents for follow up. She says that, although she feels some improvement with cognitive-behavioral therapy (CBT), she is still struggling with her body image and fears gaining weight. She says that for the past 3 weeks she has noticed her ankles are uncomfortably swollen in the mornings. She also mentions that she still is having intermittent menstruation; her last menstrual cycle was 4 months ago. The patient denies any suicidal ideations. She has no other significant past medical history. She denies any history of smoking, alcohol consumption, or recreational drug use. The patient’s vital signs include: temperature 37.0°C (98.6°F), pulse 55/min, blood pressure 100/69 mm Hg, and respiratory rate 18/min. Her body mass index (BMI) is 17.1 kg/m2, improved from 16.9 kg/m2, 6 months ago. Her physical examination is significant for an irregular heart rhythm on cardiopulmonary auscultation. There is also significant 3+ pitting edema in the lower extremities bilaterally. An ECG reveals multiple isolated premature ventricular contractions (PVCs) with 1 10-sec episode of bigeminy. Which of the following aspects of this patient’s history and physical examination would be the strongest indication for inpatient hospitalization?? {'A': 'BMI of 17.1 kg/m2', 'B': 'Amenorrhea', 'C': 'Bigeminy', 'D': 'Pulse 55/min', 'E': 'Lower extremity edema'}, | E: Lower extremity edema |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man with a long-standing history of chronic obstructive pulmonary disease (COPD) presents to the clinic for progressive shortness of breath. The patient reports generalized fatigue, distress, and difficulty breathing that is exacerbated with exertion. Physical examination demonstrates clubbing of the fingers, and an echocardiogram shows right ventricular hypertrophy. The patient is placed on a medication for symptom control. One month later, the patient returns for follow up with some improvement in symptoms. Laboratory tests are drawn and shown below: Serum: Na+: 137 mEq/L Cl-: 101 mEq/L K+: 4.8 mEq/L HCO3-: 25 mEq/L BUN: 8.5 mg/dL Glucose: 117 mg/dL Creatinine: 1.4 mg/dL Thyroid-stimulating hormone: 1.8 µU/mL Ca2+: 9.6 mg/dL AST: 159 U/L ALT: 201 U/L What is the mechanism of action of the likely medication given?? {'A': 'Beta-2 agonist', 'B': 'Competitive inhibition of endothelin-1 receptors', 'C': 'Competitive inhibition of muscarinic receptors', 'D': 'Inhibition of phosphodiesterase-5', 'E': 'Prostacylin with direct vasodilatory effects'}, | B: Competitive inhibition of endothelin-1 receptors |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman, gravida 4, para 0, at 8 weeks' gestation comes to the physician for a prenatal visit. The previous pregnancies ended in spontaneous abortion between the 8th and 10th week of gestation. She feels well but is worried about having another miscarriage. She has no history of serious illness. Previous gynecologic evaluations showed no abnormalities. The patient takes a daily prenatal multivitamin. Her temperature is 36.5°C (97.7°F), pulse is 85/min, and blood pressure is 125/85 mm Hg. Examination shows a violaceous, reticular rash on the lower extremities. Hemoglobin 10.5 g/dL Leukocyte count 5,200/mm3 Platelet count 120,000/mm3 Prothrombin time 13 seconds Partial thromboplastin time 49 seconds Serum Na+ 140 mEq/L K+ 4.4 mEq/L Cl- 101 mEq/L Urea nitrogen 12 mg/dL Creatinine 1.1 mg/dL AST 20 U/L ALT 15 U/L Anti-beta 2 glycoprotein-1 antibody positive Which of the following is the most appropriate next step in management?"? {'A': 'Heparin bridged to warfarin', 'B': 'Glucocorticoids and plasmapharesis', 'C': 'Aspirin and enoxaparin', 'D': 'Enoxaparin', 'E': 'Warfarin'}, | C: Aspirin and enoxaparin |
Answer the following medical question with one of the provided options: | Q:A 32-year-old Caucasian woman presents to her primary care physician’s office with a chief complaint of excessive facial and arm hair. On further questioning, she reveals that in the past year, she has often gone more than 3 months without menstruating. On exam she is well-appearing; her temperature is 98.6°F (37°C), blood pressure is 120/80 mmHg, pulse is 60/min, and BMI is 30 kg/m^2. Labwork confirms the suspected diagnosis. What is the best initial treatment (Rx) for this disease AND what other comorbid conditions (CC) should be tested for at this time?? {'A': 'Rx: Combined oral contraceptives, CC: Infertility and insulin resistance', 'B': 'Rx: Weight loss, CC: Infertility and insulin resistance', 'C': 'Rx: Weight loss, CC: Infertility and lipid dysfunction', 'D': 'Rx: Combined oral contraceptives, CC: Insulin resistance and lipid dysfunction', 'E': 'Rx: Weight loss, CC: Insulin resistance and lipid dysfunction'}, | E: Rx: Weight loss, CC: Insulin resistance and lipid dysfunction |
Answer the following medical question with one of the provided options: | Q:A 29-year-old man is brought to the emergency department 20 minutes after sustaining a gunshot wound to the abdomen. On arrival, he is awake and oriented to person, place, and time. He appears agitated. His pulse is 102/min, respirations are 20/min, and blood pressure is 115/70 mm Hg. The pupils are equal and reactive to light. Abdominal examination shows an entrance wound in the right upper quadrant above the umbilicus. There is an exit wound on the right lower back next to the lumbar spine. Breath sounds are normal bilaterally. There is diffuse mild tenderness to palpation with no guarding or rebound. Cardiac examination shows no abnormalities. Intravenous fluid therapy is begun. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the abdomen', 'B': 'Close observation', 'C': 'Diagnostic laparoscopy', 'D': 'Immediate laparotomy', 'E': 'Diagnostic peritoneal lavage'}, | A: CT scan of the abdomen |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman presents with fatigue. She says that her symptoms have gradually onset after she recently had a total thyroidectomy due to Graves’ disease. Past medical history is otherwise unremarkable. The patient is afebrile, and her vital signs are within normal limits. Physical examination is unremarkable. Laboratory findings are significant for the following: Potassium 4.2 mEq/L Calcium 7.8 mg/dL Chloride 102 mEg/L Vitamin D3 8 ng/mL (ref range: 25–80 ng/mL) A deficiency of which of the following is the most likely cause of this patient’s symptoms?? {'A': '1-alpha-hydroxylase', 'B': 'Thyroid-stimulating hormone (TSH)', 'C': '25-hydroxycholecalciferol', 'D': 'Calcitonin', 'E': 'Parathyroid hormone (PTH)'}, | E: Parathyroid hormone (PTH) |
Answer the following medical question with one of the provided options: | Q:A 36-year-old female presents to her gynecologist for a check-up. She has had normal Pap smears as recommended every 3 years since she turned 30 years old. The physician conducts a pelvic examination that is without abnormality and obtains a cervical Pap smear. The results of the patient's Pap smear from the visit return as high grade squamous intraepithelial lesion (HGSIL). Which of the following is the best next step in the management of this patient?? {'A': 'Repeat Pap smear in 12 months', 'B': 'Repeat Pap smear in 3 years', 'C': 'Obtain HPV DNA test', 'D': 'Perform colposcopy', 'E': 'Radical hysterectomy'}, | D: Perform colposcopy |
Answer the following medical question with one of the provided options: | Q:An 88-year-old man is brought to his primary care physician by his son. The patient has been in excellent health his entire life, but in the last few years appears to have grown steadily confused. He frequently calls his son about things that they have already discussed, forgets where he has placed his keys, and recently the patient's son noticed several unpaid bills on the patient's desk at home. The patient is upset at being "dragged" into see the physician and claims that everything is fine--he is just "getting older". A complete neurologic exam is normal except for significant difficulty with recall tasks. In the course of the medical work-up, you obtain a CT scan and see the findings in figure A. What is the most likely cause of this patient's CT findings?? {'A': 'Blockage of the cerebral aqueduct', 'B': 'Cortical atrophy', 'C': 'Increased CSF production', 'D': 'Congenital malformation', 'E': 'Infection'}, | B: Cortical atrophy |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents to the family medicine clinic to be evaluated by her physician for weight gain. She reports feeling fatigued most of the day despite eating a healthy diet and exercising regularly. The patient smokes a half-pack of cigarettes daily and has done so for the last 23 years. She is employed as a phlebotomist by the Red Cross. She has a history of hyperlipidemia for which she takes atorvastatin. She is unaware of her vaccination history, and there is no documented record of her receiving any vaccinations. Her heart rate is 76/min, respiratory rate is 14/min, temperature is 37.3°C (99.1°F), body mass index (BMI) is 33 kg/m2, and blood pressure is 128/78 mm Hg. The patient appears alert and oriented. Lung and heart auscultation are without audible abnormalities. The physician orders a thyroid panel to determine if that patient has hypothyroidism. Which of the following recommendations may be appropriate for the patient at this time?? {'A': 'Hepatitis B vaccination', 'B': 'Low-dose chest CT', 'C': 'Hepatitis C vaccination', 'D': 'Mammogram', 'E': 'Shingles vaccination'}, | A: Hepatitis B vaccination |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man comes to the physician because of a 4-month history of progressive shortness of breath and chest pressure with exertion. Cardiac examination shows a crescendo-decrescendo systolic murmur that is heard best in the second right intercostal space. Radial pulses are decreased and delayed bilaterally. Transesophageal echocardiography shows hypertrophy of the left ventricle and a thick, calcified aortic valve. The area of the left ventricular outflow tract is 30.6 mm2. Using continuous-wave Doppler measurements, the left ventricular outflow tract velocity is 1.0 m/s, and the peak aortic valve velocity is 3.0 m/s. Which of the following values most closely represents the area of the stenotic aortic valve?? {'A': '16.0 mm2', 'B': '10.2 mm2', 'C': '23 mm2', 'D': '6.2 mm2', 'E': '2.0 mm2'}, | B: 10.2 mm2 |
Answer the following medical question with one of the provided options: | Q:A newborn male born prematurely at 33 weeks is noted to have mild dyspnea and difficulty with feeding. Examination reveals bounding peripheral radial pulses and a continuous 'machine-like' murmur. The patient is subsequently started on indomethacin. Which of the following is the embryologic origin of the structure most likely responsible for this patient's presentation?? {'A': '1st branchial cleft', 'B': '4th branchial arch', 'C': '4th branchial pouch', 'D': '6th aortic arch', 'E': '6th branchial pouch'}, | D: 6th aortic arch |
Answer the following medical question with one of the provided options: | Q:An 18-year-old female visits your obstetrics clinic for her first prenatal check up. It's her first month of pregnancy and other than morning sickness, she is feeling well. Upon inquiring about her past medical history, the patient admits that she used to be very fearful of weight gain and often used laxatives to lose weight. After getting therapy for this condition, she regained her normal body weight but continues to struggle with the disease occasionally. Given this history, how could her past condition affect the pregnancy?? {'A': 'Down syndrome in newborn', 'B': 'Postpartum depression for mother', 'C': 'Bradycardia in newborn', 'D': 'Anemia in newborn', 'E': 'Seizure for mother'}, | B: Postpartum depression for mother |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents to the pediatrician's office for a well child checkup. He does not speak during the visit and will not make eye contact. The father explains that the child has always been shy with strangers. However, the child speaks a lot at home and with friends. He can speak in 4 word sentences, tells stories, and parents understand 100% of what he says. He names colors and is starting to recognize letters. However, his pre-kindergarten teachers are concerned that even after 5 months in their class, he does not speak during school at all. The father notes that he is equally as shy in church, which he has been going to his entire life. Which of the following is most likely?? {'A': 'Autism spectrum disorder', 'B': 'Child abuse at school', 'C': 'Expressive speech delay', 'D': 'Normal development', 'E': 'Selective mutism'}, | E: Selective mutism |
Answer the following medical question with one of the provided options: | Q:A 61-year-old man with Alzheimer disease is brought to the emergency department 20 minutes after ingesting an unknown amount of his medications in a suicide attempt. He reports abdominal cramps, diarrhea, diaphoresis, and muscular weakness and spasms in his extremities. His temperature is 38.4°C (101.1°F), pulse is 51/min, respirations are 12/min and labored, and blood pressure is 88/56 mm Hg. Physical examination shows excessive salivation and tearing, and small pupils bilaterally. Treatment with atropine is initiated. Shortly after, most of his symptoms have resolved, but he continues to have muscular spasms. Administration of which of the following is the most appropriate next step in management of this patient?? {'A': 'Carbachol', 'B': 'Physostigmine', 'C': 'Pancuronium', 'D': 'Benztropine', 'E': 'Pralidoxime'}, | E: Pralidoxime |
Answer the following medical question with one of the provided options: | Q:A 46-year-old woman comes to the physician because of a 3-day history of diarrhea and abdominal pain. She returned from a trip to Egypt 4 weeks ago. Her vital signs are within normal limits. There is mild tenderness in the right lower quadrant. Stool studies show occult blood and unicellular organisms with engulfed erythrocytes. Which of the following is the most appropriate initial pharmacotherapy for this patient?? {'A': 'Doxycycline', 'B': 'Metronidazole', 'C': 'Albendazole', 'D': 'Paromomycin', 'E': 'Ciprofloxacin'}, | B: Metronidazole |
Answer the following medical question with one of the provided options: | Q:A 36-year-old woman is brought to the emergency department after being involved in a motor vehicle collision. She is alert, awake, and oriented. There is no family history of serious illness and her only medication is an oral contraceptive. Her temperature is 37.3°C (99°F), pulse is 100/min, respirations are 20/min, and blood pressure is 102/80 mm Hg. Physical examination shows ecchymoses over the trunk and abdomen. A FAST scan of the abdomen is negative. An x-ray of the chest shows no fractures. A contrast-enhanced CT scan of the chest and abdomen is performed that shows a 4-cm sharply defined liver mass with a hypoattenuated central scar. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance and observation', 'B': 'Biopsy of the mass', 'C': 'Discontinue the oral contraceptive', 'D': 'Percutaneous aspiration of the mass', 'E': 'Surgical resection of the mass'}, | A: Reassurance and observation |
Answer the following medical question with one of the provided options: | Q:Two hours after a 2280-g male newborn is born at 38 weeks' gestation to a 22-year-old primigravid woman, he has 2 episodes of vomiting and jitteriness. The mother has noticed that the baby is not feeding adequately. She received adequate prenatal care and admits to smoking one pack of cigarettes daily while pregnant. His temperature is 36.3°C (97.3°F), pulse is 171/min and respirations are 60/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination shows pale extremities. There is facial plethora. Capillary refill time is 3 seconds. Laboratory studies show: Hematocrit 70% Leukocyte count 7800/mm3 Platelet count 220,000/mm3 Serum Glucose 38 mg/dL Calcium 8.3 mg/dL Which of the following is the most likely cause of these findings?"? {'A': 'Transient tachypnea of the newborn', 'B': 'Intraventricular hemorrhage', 'C': 'Hyperinsulinism', 'D': 'Congenital heart disease', 'E': 'Intrauterine hypoxia\n"'}, | E: Intrauterine hypoxia " |
Answer the following medical question with one of the provided options: | Q:A 20-year-old man comes to the physician because of dark urine and decreased urine output for 2 days. He had a skin infection that required antibiotic treatment 3 weeks ago but stopped the antibiotics early because the infection had resolved. His blood pressure is 140/90 mm Hg. Physical examination shows periorbital edema bilaterally. A photomicrograph of a renal biopsy specimen is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Mutation in type IV collagen', 'B': 'Impaired glutathione regeneration', 'C': 'Mesangial IgA deposition', 'D': 'Decreased platelet count', 'E': 'Elevated Anti-DNase B titer'}, | E: Elevated Anti-DNase B titer |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy with a history of fetal alcohol syndrome is brought by his mother to the emergency room for malaise and lethargy. His mother reports that the family was on vacation in a cabin in the mountains for the past 10 days. Five days ago, the child developed a fever with a max temperature of 102.6°F (39.2°F). She also reports that he was given multiple medications to try to bring down his fever. Although his fever resolved two days ago, the child has become increasingly lethargic. He started having non-bilious, non-bloody emesis one day prior to presentation. His current temperature is 100°F (37.8°C), blood pressure is 95/55 mmHg, pulse is 110/min, and respirations are 22/min. On exam, the child is lethargic and minimally reactive. Mild hepatomegaly is noted. A biopsy of this patient’s liver would likely reveal which of the following?? {'A': 'Microvesicular steatosis', 'B': 'Macrovesicular steatosis', 'C': 'Hepatocyte necrosis with ballooning degeneration', 'D': 'Macronodular cirrhosis', 'E': 'Micronodular cirrhosis'}, | A: Microvesicular steatosis |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman presents to the ED with a diffuse, erythematous rash in the setting of nausea, vomiting, and fever for 2 days. Physical exam reveals a soaked tampon in her vagina. Blood cultures are negative. The likely cause of this patient's disease binds to which molecule on T cells?? {'A': 'CD3', 'B': 'Gamma chain of the IL-2 receptor', 'C': 'CD40 ligand', 'D': 'Variable beta portion of the T-cell receptor', 'E': 'Fas ligand'}, | D: Variable beta portion of the T-cell receptor |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman comes to the physician because of pain and swelling of her left foot. Three days ago, she cut her foot on an exposed rock at the beach. Her temperature is 37.7°C (100°F). Examination of the left foot shows edema around a fluctuant erythematous lesion on the lateral foot. Which of the following is most likely the primary mechanism for the development of edema in this patient?? {'A': 'Fluid production by bacteria', 'B': 'Increased capillary hydrostatic pressure', 'C': 'Decreased plasma oncotic pressure', 'D': 'Systemic cytokine release', 'E': 'Separation of endothelial junctions'}, | E: Separation of endothelial junctions |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman with a history of atrial arrhythmia arrives in the emergency department with complaints of tinnitus, headache, visual disturbances, and severe diarrhea. The patient is given oxygen by nasal cannula. ECG leads, pulse oximeter and an automated blood pressure cuff are applied. The patient suddenly faints. Her ECG indicates the presence of a multifocal ventricular tachycardia with continuous change in the QRS electrical axis. Which of the following drugs is most likely responsible for this patient's symptoms?? {'A': 'Digoxin', 'B': 'Quinidine', 'C': 'Lidocaine', 'D': 'Amiodarone', 'E': 'Verapamil'}, | B: Quinidine |
Answer the following medical question with one of the provided options: | Q:A 35-year-old soldier is rescued from a helicopter crash in the Arctic Circle and brought back to a treatment facility at a nearby military base. On arrival, the patient's wet clothes are removed. He appears pale and is not shivering. He is unresponsive to verbal and painful stimuli. His temperature is 27.4°C (81.3°F), pulse is 30/min and irregular, respirations are 7/min, and blood pressure is 83/52 mm Hg. Examination shows fixed, dilated pupils and diffuse rigidity. The fingers and toes are white in color and hard to the touch. An ECG shows atrial fibrillation. In addition to emergent intubation, which of the following is the most appropriate next step in management?? {'A': 'Intravenous administration of tissue plasminogen activator', 'B': 'Intravenous administration of diltiazem', 'C': 'Application of heating pads to the extremities', 'D': 'Intravenous administration of warmed normal saline', 'E': 'Emergent electrical cardioversion'}, | D: Intravenous administration of warmed normal saline |
Answer the following medical question with one of the provided options: | Q:A 44-year-old woman comes to the physician for the evaluation of right knee pain for 1 week. The pain began after the patient twisted her knee during basketball practice. At the time of the injury, she felt a popping sensation and her knee became swollen over the next few hours. The pain is exacerbated by walking up or down stairs and worsens throughout the day. She also reports occasional locking of the knee. She has been taking acetaminophen during the past week, but the pain is worse today. Her mother has rheumatoid arthritis. The patient is 155 cm (4 ft 11 in) tall and weighs 75 kg (165 lb); BMI is 33 kg/m2. Vital signs are within normal limits. Examination shows effusion of the right knee; range of motion is limited by pain. There is medial joint line tenderness. Knee extension with rotation results in an audible snap. Further evaluation is most likely to show which of the following?? {'A': 'Hyperintense line in the meniscus on MRI', 'B': 'Anterior tibial translation on examination', 'C': 'Trabecular loss in the proximal femur on x-ray', 'D': 'Erosions and synovial hyperplasia on MRI', 'E': 'Posterior tibial translation on examination'}, | A: Hyperintense line in the meniscus on MRI |
Answer the following medical question with one of the provided options: | Q:A 31-year-old man living in a remote tropical village presents with a swollen left leg and scrotum (see image). He says that his symptoms started more than 2 years ago with several small swollen areas near his groin and have gradually and progressively worsened. He has also noticed that over time, there has been a progressive coarsening and fissuring of the skin overlying the swollen areas. Blood samples drawn at night show worm-like organisms under microscopy. Which of the following arthropods is the vector for the organism most likely responsible for this patient’s condition?? {'A': 'Mosquito', 'B': 'Tick', 'C': 'Tsetse fly', 'D': 'Sandfly', 'E': 'Human louse'}, | A: Mosquito |
Answer the following medical question with one of the provided options: | Q:A 17-year-old female is found to have an inherited deficiency of alpha-galactosidase A. Skin biopsy shows accumulation of ceramide trihexose in the tissue. Which of the following abnormalities would be expected in this patient?? {'A': 'Cherry red spots on macula', 'B': 'Histiocytes with a wrinkled tissue paper appearance', 'C': 'Gargoyle-like facies', 'D': 'Corneal clouding', 'E': 'Angiokeratomas'}, | E: Angiokeratomas |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents to your office with 4 days of fever, sore throat, generalized aching, arthralgias, and tender nodules on both of her shins that arose in the last 48 hours. Her medical history is negative for disease and she does not take oral contraceptives or any other medication regularly. The physical examination reveals the vital signs that include body temperature 38.5°C (101.3°F), heart rate 85/min, blood pressure 120/65 mm Hg, tender and enlarged submandibular lymph nodes, and an erythematous, edematous, and swollen pharynx with enlarged tonsils and a patchy white exudate on the surface. She is not pregnant. Examination of the lower limbs reveals erythematous, tender, immobile nodules on both shins. You do not identify ulcers or similar lesions on other areas of her body. What is the most likely diagnosis in this patient?? {'A': 'Alpha-1 antitrypsin deficiency', 'B': 'Erythema induratum', 'C': 'Cutaneous polyarteritis nodosa', 'D': 'Henoch-Schönlein purpura', 'E': 'Erythema nodosum'}, | E: Erythema nodosum |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man is brought to the emergency department because of weakness of his left leg for the past 30 minutes. His pants are soaked with urine. He has hypertension and atrial fibrillation. His temperature is 37°C (98.6°F), pulse is 98/min, and blood pressure is 160/90 mm Hg. Examination shows equal pupils that are reactive to light. Muscle strength is 2/5 in the left lower extremity. Plantar reflex shows an extensor response on the left. Within one minute of the onset of this patient's symptoms, the cells in his right anteromedial cortical surface enlarge significantly. Which of the following is the most likely explanation of the described cellular change?? {'A': 'Rupture of lysosomes', 'B': 'Influx of extracellular calcium', 'C': 'Intracellular depletion of ATP', 'D': 'Release of pro-apoptotic proteins', 'E': 'Breakdown of the cell membrane'}, | C: Intracellular depletion of ATP |
Answer the following medical question with one of the provided options: | Q:A 23-year-old male presents to his primary care physician after an injury during a rugby game. The patient states that he was tackled and ever since then has had pain in his knee. The patient has tried NSAIDs and ice to no avail. The patient has no past medical history and is currently taking a multivitamin, fish oil, and a whey protein supplement. On physical exam you note a knee that is heavily bruised. It is painful for the patient to bear weight on the knee, and passive motion of the knee elicits some pain. There is laxity at the knee to varus stress. The patient is wondering when he can return to athletics. Which of the following is the most likely diagnosis?? {'A': 'Medial collateral ligament tear', 'B': 'Lateral collateral ligament tear', 'C': 'Anterior cruciate ligament tear', 'D': 'Posterior cruciate ligament tear', 'E': 'Meniscal tear'}, | B: Lateral collateral ligament tear |
Answer the following medical question with one of the provided options: | Q:An 80-year-old woman is brought to the emergency department due to the gradual worsening of confusion and lethargy for the past 5 days. Her son reports that she had recovered from a severe stomach bug with vomiting and diarrhea 3 days ago without seeing a physician or going to the hospital. The patient’s past medical history is notable for type 2 diabetes mellitus and hypertension. She takes hydrochlorothiazide, metformin, a children’s aspirin, and a multivitamin. The patient is not compliant with her medication regimen. Physical examination reveals dry oral mucous membranes and the patient appears extremely lethargic but arousable. She refuses to answer questions and has extreme difficulty following the conversation. Laboratory results are as follows: Sodium 126 mEq/L Potassium 3.9 mEq/L Chloride 94 mEq/L Bicarbonate 25 mEq/L Calcium 8.1 mg/dL Glucose 910 mg/dL Urine ketones Trace Which of the following may also be found in this patient?? {'A': 'Characteristic breath odor', 'B': 'Flapping hand tremor', 'C': 'Increased BUN/creatinine ratio', 'D': 'Diffuse abdominal pain', 'E': 'Rapid and deep respiration'}, | C: Increased BUN/creatinine ratio |
Answer the following medical question with one of the provided options: | Q:A 73-year-old man presents to the emergency department complaining of abdominal pain with nausea and vomiting, stating that he “can’t keep anything down”. He states that the pain has been gradually getting worse over the past 2 months, saying that, at first, it was present only an hour after he ate but now is constant. He also says that he has been constipated for the last 2 weeks, which has also been getting progressively worse. His last bowel movement was 4 days ago which was normal. He states that he cannot pass flatus. The patient’s past medical history is significant for hypertension and an episode of pneumonia last year. The patient is afebrile and his pulse is 105/min. On physical examination, the patient is uncomfortable. His lungs are clear to auscultation bilaterally. His abdomen is visibly distended and diffusely tender with tympany on percussion. A contrast CT scan of the abdomen shows dilated loops of small bowel with collapsed large bowel. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Incarcerated hernia', 'B': 'Mass effect from a tumor', 'C': "Crohn's disease", 'D': 'Adhesions', 'E': 'Diverticulitis'}, | B: Mass effect from a tumor |
Answer the following medical question with one of the provided options: | Q:A 20-year-old college student has elevated stress levels due to her rigorous academic schedule, social commitments, and family pressures. She complains of never having enough time for all her responsibilities. Which of the following hormones acts by intracellular receptors to exert the physiologic effects of her stress?? {'A': 'Cortisol', 'B': 'Glucagon', 'C': 'Growth hormone', 'D': 'Norepinephrine', 'E': 'Prolactin'}, | A: Cortisol |
Answer the following medical question with one of the provided options: | Q:A 61-year-old female is referred to an oncologist for evaluation of a breast lump that she noticed two weeks ago while doing a breast self-examination. Her past medical history is notable for essential hypertension and major depressive disorder for which she takes lisinopril and escitalopram, respectively. Her temperature is 98.6°F (37°C), blood pressure is 120/65 mmHg, pulse is 82/min, and respirations are 18/min. Biopsy of the lesion confirms a diagnosis of invasive ductal carcinoma with metastatic disease in the ipsilateral axillary lymph nodes. The physician starts the patient on a multi-drug chemotherapeutic regimen. The patient successfully undergoes mastectomy and axillary dissection and completes the chemotherapeutic regimen. However, several months after completion of the regimen, the patient presents to the emergency department with dyspnea, chest pain, and palpitations. A chest radiograph demonstrates an enlarged cardiac silhouette. This patient’s current symptoms could have been prevented by administration of which of the following medications?? {'A': 'Vincristine', 'B': 'Dexrazoxane', 'C': 'Aspirin', 'D': 'Rosuvastatin', 'E': 'Cyclophosphamide'}, | B: Dexrazoxane |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman presents with frequent headaches for the past few months. She says the pain starts randomly and is unrelated to any stimulus. She also says that has difficulty falling asleep and has had problems concentrating at work for several months. While she occasionally thinks about committing suicide, she denies any suicidal plans. Her appetite is diminished. No significant past medical history. No current medications. There is no family history of depression or psychiatric illness. The physical exam is unremarkable. The thyroid-stimulating hormone (TSH) level is 3.5 uU/mL. The patient is started on amitriptyline and asked to follow-up in 2 weeks. At her follow-up visit, the patient reports slight improvement in her mood and has no more headaches, but she complains of lightheadedness when she rises out of bed in the morning or stands up from her desk at work. Which of the following pharmacological effects of amitriptyline is most likely responsible for her lightheadedness?? {'A': 'Blockage of muscarinic receptors', 'B': 'Decreased reuptake of norepinephrine', 'C': 'Blockage of α1 adrenergic receptors', 'D': 'Decreased reuptake of serotonin', 'E': 'Blockage of H1 histamine receptors'}, | C: Blockage of α1 adrenergic receptors |
Answer the following medical question with one of the provided options: | Q:A new real time-PCR test for the hepatitis C virus is approved for medical use. The manufacturer sets the threshold number of DNA copies required to achieve a positive result such that the sensitivity is 98% and the specificity is 80%. The tested population has a hepatitis C prevalence of 0.7%. Which of the following changes in the prevalence, incidence, or threshold concentration will increase the positive predictive value of the test, if the other two values are held constant?? {'A': 'An increase in incidence', 'B': 'An increase in prevalence', 'C': 'A decrease in incidence', 'D': 'A decrease in prevalence', 'E': 'Lowering the threshold concentration required for a positive test.'}, | B: An increase in prevalence |
Answer the following medical question with one of the provided options: | Q:A 4080-g (9-lb) male newborn is delivered at term to a 32-year-old woman, gravida 2, para 1. Apgar scores are 8 and 9 at 1- and 5-minutes, respectively. Examination in the delivery room shows both feet pointing downwards and inwards. Both the forefeet are twisted medially in adduction, with the hindfeet elevated and the midfeet appearing concave. Both Achilles tendons are taut on palpation. There are skin creases on the medial side of both feet. The deformity persists despite attempts to passively straighten the foot. X-rays of both feet confirm the suspected diagnosis. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Foot abduction brace', 'B': 'Surgery', 'C': 'Reassurance', 'D': 'Repositioning and serial casting', 'E': 'Physiotherapy'}, | D: Repositioning and serial casting |
Answer the following medical question with one of the provided options: | Q:A 4390-g (9-lb 11-oz) male newborn is delivered at term to a 28-year-old primigravid woman. Pregnancy was complicated by gestational diabetes mellitus. Labor was prolonged by the impaction of the fetal shoulder and required hyperabduction of the left upper extremity. Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Vital signs are within normal limits. Examination in the delivery room shows a constricted left pupil. There is drooping of the left eyelid. Active movement of the left upper extremity is reduced. Further evaluation of this newborn is most likely to show which of the following?? {'A': 'Generalized hypotonia', 'B': 'Absent nasolabial fold', 'C': 'Absent unilateral grasp reflex', 'D': 'Lower back mass', 'E': 'Decreased movement of unilateral rib cage\n"'}, | C: Absent unilateral grasp reflex |
Answer the following medical question with one of the provided options: | Q:A 4-year-old girl presents to the emergency department after persistent vomiting and complaints that her abdomen hurts. Her parents came home to their daughter like this while she was at home being watched by the babysitter. The child is otherwise healthy. Family history is notable for depression, suicide, neuropathic pain, diabetes, hypertension, cancer, and angina. The child is now minimally responsive and confused. Her temperature is 100°F (37.8°C), blood pressure is 100/60 mmHg, pulse is 140/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for a confused girl who is vomiting bloody emesis into a basin. Laboratory studies are ordered as seen below. Serum: Na+: 140 mEq/L Cl-: 101 mEq/L K+: 3.9 mEq/L HCO3-: 11 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Radiography is notable for a few radiopaque objects in the stomach. Urine and serum toxicology are pending. Which of the following is the most likely intoxication?? {'A': 'Acetaminophen', 'B': 'Aspirin', 'C': 'Iron', 'D': 'Lead', 'E': 'Nortriptyline'}, | C: Iron |
Answer the following medical question with one of the provided options: | Q:A 70-year-old woman comes to the physician because of a 4-month history of fatigue, worsening swelling of her ankles, and a 5-kg (11-lb) weight gain. Neurologic examination shows diminished two-point discrimination in her fingers. Laboratory studies show a hemoglobin A1c concentration of 9.2% and a creatinine concentration of 1.3 mg/dL. Urine dipstick shows heavy proteinuria. A biopsy specimen of this patient's kidney is most likely to show which of the following?? {'A': 'Split glomerular basement membrane', 'B': 'Immune complex deposition', 'C': 'Interstitial inflammation', 'D': 'Wire looping of capillaries', 'E': 'Nodular glomerulosclerosis'}, | E: Nodular glomerulosclerosis |
Answer the following medical question with one of the provided options: | Q:An 11-year-old male with light purple eyes presents with gradual loss of bilateral visual acuity. Over the past several years, vision has worsened from 20/20 to 20/100 in both eyes. He also has mild nystagmus when focusing on objects such as when he is trying to do his homework. He is diagnosed with a disease affecting melanin production in the iris. If both of his parents are unaffected, which of the following represents the most likely probabilities that another male or female child from this family would be affected by this disorder?? {'A': 'Same as general population', 'B': 'Male: 25% Female: 25%', 'C': 'Male: 50% Female: 50%', 'D': 'Male: 50% Female: 0%', 'E': 'Male: 100% Female: 0%'}, | D: Male: 50% Female: 0% |
Answer the following medical question with one of the provided options: | Q:A 75-year-old man comes to his primary care physician because he has been having diarrhea and difficulty breathing. The diarrhea has been intermittent with frequent watery stools that occur along with abdominal cramps. Furthermore, the skin on his face and upper chest feels hot and changes color in episodes lasting from a few minutes to hours. Finally, the patient complains of loss of appetite and says that he has unexpectedly lost 20 pounds over the last two months. Based on clinical suspicion, magnetic resonance imaging is obtained showing a small mass in this patient's lungs. Which of the following is associated with the most likely cause of this patient's symptoms?? {'A': 'Contains psammoma bodies', 'B': 'It also arises in the GI tract', 'C': 'Has keratin pearls and intercellular bridges', 'D': 'Most common lung cancer in non-smokers and females', 'E': 'Stains positive for vimentin'}, | B: It also arises in the GI tract |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy is brought to the physician by his foster mother because of complaints from his teachers regarding poor performance at school for the past 8 months. He does not listen to their instructions, often talks during class, and rarely completes his school assignments. He does not sit in his seat in the classroom and often cuts in line at the cafeteria. His foster mother reports that he runs around a lot inside the house and refuses to help his sister with chores and errands. He frequently interrupts his foster mother's conversations with others and talks excessively. She has found him trying to climb on the roof on multiple occasions. He was placed in foster care because of neglect by his biological parents 3 years ago. Physical examination shows no abnormalities. Neurologic examination shows no focal findings. Mental status examination shows a neutral affect. Which of the following is the most likely diagnosis?? {'A': 'Age-appropriate behavior', 'B': 'Conduct disorder', 'C': 'Oppositional defiant disorder', 'D': 'Attention-deficit/hyperactivity disorder', 'E': 'Hearing impairment'}, | D: Attention-deficit/hyperactivity disorder |
Answer the following medical question with one of the provided options: | Q:A 30-year-old Caucasian male is brought to the emergency room for recurrent diarrhea. He has had multiple upper respiratory infections since birth and does not take any medications at home. It is determined that Giardia lamblia is responsible for the recurrent diarrhea. The physician performs a serum analysis and finds normal levels of mature B lymphocytes. What other finding on serum analysis predisposes the patient to recurrent diarrheal infections?? {'A': 'Deficiency in CD8+ T cells', 'B': 'Deficiency in neutrophils', 'C': 'Deficiency in IgA', 'D': 'Deficiency in NK cells', 'E': 'Deficiency in IgG'}, | C: Deficiency in IgA |
Answer the following medical question with one of the provided options: | Q:Paramedics are called to a 35-year-old man who had accidentally amputated his left index finger tip with a knife. He has no significant past medical history. His temperature is 37.2°C (99°F), pulse is 96/min, and blood pressure is 112/72 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. His left index finger is amputated distal to the distal interphalangeal joint at the level of the nail bed, and exposed bone is visible. There is profuse bleeding from the wound site. His ability to flex, extend, abduct, and adduct the joints is preserved and sensation is intact. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step prior to transporting this patient to the emergency department?? {'A': 'Wrap finger in gauze wet with iodine in a sealed plastic bag placed on ice', 'B': 'Preserve finger tip in cooled saline water', 'C': 'Preserve finger tip in warm saline water', 'D': 'Wrap finger tip in gauze damp with saline in a sealed plastic bag placed on ice water', 'E': 'Place finger tip on ice in a sealed plastic bag'}, | D: Wrap finger tip in gauze damp with saline in a sealed plastic bag placed on ice water |
Answer the following medical question with one of the provided options: | Q:A 22-year-old medical student presents to a community health center due to an episode of loss of consciousness 3 days ago. She also has a history of multiple episodes of dizziness in the last year. These episodes almost always occur when she is observing surgery in the operating room. She describes her dizziness as a feeling of lightheadedness, warmth, excessive sweating, and palpitations. She feels that she will fall down if she stood longer and usually sits on the floor or leaves the room until the feeling subsides. Three days ago, she collapsed while observing an open cholecystectomy but regained consciousness after a few seconds. Once she regained consciousness, she was pale and sweating excessively. Her medical history is significant for migraines, but she is not on prophylactic therapy. Her younger brother has cerebral palsy, and her uncle had a sudden death at the age of 25. Her blood pressure is 120/80 mm Hg when lying down and 118/80 mm Hg when in a standing position. The rest of the physical examination is within normal limits. What is the next best step in the management of this patient?? {'A': 'Echocardiogram', 'B': 'Electrocardiogram (ECG)', 'C': 'Electroencephalogram (EEG)', 'D': 'MRI of the brain', 'E': 'Psychiatric evaluation for anxiety'}, | B: Electrocardiogram (ECG) |
Answer the following medical question with one of the provided options: | Q:A 51-year-old Caucasian female presents to her primary care provider complaining of intermittent chest pain. She reports that over the past 6 months, she has developed burning chest pain that occurs whenever she exerts herself. The pain decreases when she rests. Her past medical history is notable for type II diabetes mellitus. Her family history is notable for multiple myocardial infarctions in her father and paternal grandmother. She currently takes aspirin and metformin. Her primary care provider starts her on a medication which is indicated given her medical history and current symptoms. However, 10 days later, she presents to the emergency room complaining of weakness and muscle pain. Her plasma creatine kinase level is 250,000 IU/L. This patient was most likely started on a medication that inhibits an enzyme that produces which of the following?? {'A': 'Farnesyl pyrophosphate', 'B': 'HMG-CoA', 'C': 'Lanosterol', 'D': 'Mevalonic acid', 'E': 'Squalene'}, | D: Mevalonic acid |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man presents to his primary care physician complaining of impotence. He reports that he has a healthy, long-term relationship with a woman whom he hopes to marry, but he is embarrassed that he is unable to have an erection. Which of the following is the next best step?? {'A': 'Obtain a sperm sample', 'B': 'Evaluate nocturnal tumescence', 'C': 'Duplex penile ultrasound', 'D': 'Prescribe sildenafil', 'E': 'Prescribe vardenafil'}, | B: Evaluate nocturnal tumescence |
Answer the following medical question with one of the provided options: | Q:A cohort study was done to assess the differential incidence of diabetes in patients consuming a typical western diet, versus those consuming a Mediterranean diet. A total of 600 subjects were included with 300 in each arm. Results are as follows: Diabetes development No-diabetes development Western diet 36 264 Mediterranean diet 9 291 What is the odds ratio of developing diabetes for a given subject consuming the western diet as compared to a subject who consumes the Mediterranean diet?? {'A': '1.0', 'B': '3.2', 'C': '4.4', 'D': '5.6', 'E': '6.7'}, | C: 4.4 |
Answer the following medical question with one of the provided options: | Q:Researchers are investigating the effects of an Amazonian plant extract as a novel therapy for certain types of tumors. When applied to tumor cells in culture, the extract causes widespread endoplasmic reticulum stress and subsequent cell death. Further experiments show that the extract acts on an important member of a protein complex that transduces proliferation signals. When this protein alone is exposed to the plant extract, its function is not recovered by the addition of chaperones. Which type of bond is the extract most likely targeting?? {'A': 'Hydrogen bonds', 'B': 'Ionic bonds', 'C': 'Hydrophobic interactions', 'D': 'Covalent bond between two sulfide groups', 'E': 'Covalent bonds between carboxyl and amino groups'}, | E: Covalent bonds between carboxyl and amino groups |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman accompanied by her husband presents to the emergency department after loss of consciousness 30 minutes ago. The husband reports that she was sitting in a chair at home and began having sustained rhythmic contractions of all 4 extremities for approximately 1 minute. During transport via ambulance she appeared confused but arousable. Her husband reports she has no medical conditions, but for the past 2 months she has occasionally complained of episodes of sweating, palpitations, and anxiety. Her brother has epilepsy and her mother has type 1 diabetes mellitus. Laboratory studies obtained in the emergency department demonstrate the following: Serum: Na+: 136 mEq/L K+: 3.8 mEq/L Cl-: 100 mEq/L HCO3-: 19 mEq/L BUN: 16 mg/dL Creatinine: 0.9 mg/dL Glucose: 54 mg/dL C-peptide: Low Which of the following is the most likely diagnosis?? {'A': 'Alpha cell tumor', 'B': 'Beta cell tumor', 'C': 'Diabetic ketoacidosis', 'D': 'Surreptitious insulin use', 'E': 'Surreptitious sulfonylurea use'}, | D: Surreptitious insulin use |
Answer the following medical question with one of the provided options: | Q:A healthy 36-year-old Caucasian man takes part in an experimental drug trial. The drug is designed to lower glomerular filtration rate (GFR) while simultaneously raising the filtration fraction. Which of the following effects on the glomerulus would you expect the drug to have?? {'A': 'Afferent arteriole constriction and efferent arteriole vasodilation', 'B': 'Afferent arteriole constriction and efferent arteriole constriction', 'C': 'Afferent arteriole dilation and efferent arteriole vasodilation', 'D': 'Afferent arteriole dilation and efferent arteriole constriction', 'E': "Increased oncotic pressure in Bowman's space"}, | B: Afferent arteriole constriction and efferent arteriole constriction |
Answer the following medical question with one of the provided options: | Q:A pathologist is investigating the cytology of cells that have been infected with a particularly virulent strain of the influenza virus. The physician suspects that the virus results in cell death after viral replication in order to expedite the spread of the virus. She recalls that there are three known biochemical mechanisms of initiating programmed cellular death: 1) transmembrane receptor-mediated interaction, 2) stimuli producing intracellular signals leading to mitochondrial-initiated events, and 3) release of cytoplasmic granules into a cell via a perforin molecule. Which of the following biochemical components plays a common role in all of these 3 processes?? {'A': 'FAS ligand', 'B': 'Caspase-3', 'C': 'Bax', 'D': 'Bcl-2', 'E': 'CD-95 protein'}, | B: Caspase-3 |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl is hospitalized because of increased fatigue and weight loss over the past 2 months. The patient has no personal or family history of a serious illness. She takes no medications, currently. Her blood pressure is 175/74 mm Hg on the left arm and 90/45 on the right. The radial pulse is 84/min but weaker on the right side. The femoral blood pressure and pulses show no abnormalities. Temperature is 38.1℃ (100.6℉). The muscles over the right upper arm are slightly atrophic. The remainder of the examination reveals no abnormalities. Laboratory studies show the following results: Hemoglobin 10.4 g/dL Leukocyte count 5,000/mm3 Erythrocyte sedimentation rate 58 mm/h Magnetic resonance arteriography reveals irregularity, stenosis, and poststenotic dilation involving the proximal right subclavian artery. Prednisone is initiated with improvement of her symptoms. Which of the following is the most appropriate next step in the patient management?? {'A': 'Carvedilol + hydrochlorothiazide', 'B': 'Cyclophosphamide', 'C': 'Plasmapheresis', 'D': 'Rituximab', 'E': 'Surgery'}, | A: Carvedilol + hydrochlorothiazide |
Answer the following medical question with one of the provided options: | Q:A neonate appears irritable and refuses to feed. The patient is febrile and physical examination reveals a bulge at the anterior fontanelle. A CSF culture yields Gram-negative bacilli that form a metallic green sheen on eosin methylene blue (EMB) agar. The virulence factor most important to the development of infection in this patient is:? {'A': 'Exotoxin A', 'B': 'LPS endotoxin', 'C': 'Fimbrial antigen', 'D': 'IgA protease', 'E': 'K capsule'}, | E: K capsule |
Answer the following medical question with one of the provided options: | Q:A 16-year-old female is brought to the primary care clinic by her mother. The mother is concerned about her daughter’s grades, which have been recently slipping. Per the mother, the patient usually earns a mix of As and Bs in her classes, but this past semester she has been getting Cs and a few Ds. Her mother is also frustrated because she feels like her daughter is acting out more and “hanging out with some no-good friends.” Upon questioning the patient with her mother in the room, the patient does not say much and makes no eye contact. The mother is asked to leave the room and the patient is questioned again about any stressors. After rapport is established, the patient breaks down and tearfully admits to trying various drugs in order to “fit in with her friends.” She says that she knows the drugs “are not good for me” but has been very stressed out about telling her friends she’s not interested. Detailed questioning reveals that the patient has been using alcohol, cocaine, and marijuana 2-3 times per week. The patient becomes agitated at the end of the interview and pleads for you to not tell her mother. She says that she knows they’re illegal but is very afraid of what her parents would say. What is the best action in response to the adolescent’s request?? {'A': 'Apologize and say that you must inform her mother because the use of these drugs is illegal', 'B': 'Apologize and say that you must inform legal authorities because the use of these drugs is illegal', 'C': 'Apologize and say that you must inform her mother because these drugs pose a danger to her health', 'D': 'Agree to the patient’s request and do not inform the patient’s mother', 'E': 'Reassure the patient that there is confidentiality in this situation but encourage her to tell her mother'}, | E: Reassure the patient that there is confidentiality in this situation but encourage her to tell her mother |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman comes to the physician because of a 2-week history of severe, retrosternal chest pain. She also has pain when swallowing solid food and medications. She has hypertension, type 2 diabetes mellitus, poorly-controlled asthma, and osteoporosis. She was recently admitted to the hospital for an acute asthma exacerbation that was treated with bronchodilators and a 7-day course of oral corticosteroids. Her current medications include aspirin, amlodipine, metformin, insulin, beclomethasone and albuterol inhalers, and alendronate. Vital signs are within normal limits. Examination of the oral pharynx appears normal. The lungs are clear to auscultation. An upper endoscopy shows a single punched-out ulcer with normal surrounding mucosa at the gastroesophageal junction. Biopsies of the ulcer are taken. Which of the following is the most appropriate next step in management?? {'A': 'Start ganciclovir', 'B': 'Discontinue alendronate', 'C': 'Start pantoprazole', 'D': 'Discontinue amlodipine', 'E': 'Start fluconazole'}, | B: Discontinue alendronate |
Answer the following medical question with one of the provided options: | Q:A 36-year-old woman is admitted to the hospital because of irritability, nausea, and diarrhea. She has a history of recreational oxycodone use and last took a dose 48 hours ago. Physical examination shows mydriasis, rhinorrhea, and piloerection. A drug is administered that provides an effect similar to oxycodone but does not cause euphoria. Which of the following best explains the difference in effect?? {'A': 'Lower bioavailability', 'B': 'Lower potency', 'C': 'Lower efficacy', 'D': 'Lower affinity', 'E': 'Lower tolerance'}, | C: Lower efficacy |
Answer the following medical question with one of the provided options: | Q:A 6-year-old girl is brought to a clinic with complaints of fever and sore throat for 2 days. This morning, she developed a rash on her face and neck which is progressing towards the trunk. The teachers in her school report that none of her classmates has similar symptoms. She has a normal birth history. On physical examination, the child looks healthy. The heart rate is 90/min, respiratory rate is 20/min, temperature is 39.0°C (102.2°F), and blood pressure is 90/50 mm Hg. An oropharyngeal examination reveals circumoral pallor with a red tongue, as shown in the photograph below. The chest and cardiac examinations are within normal limits. No hepatosplenomegaly is noted. What is the most likely diagnosis?? {'A': 'Scarlet fever', 'B': 'Erythema Infectiosum', 'C': 'Kawasaki disease', 'D': 'Roseola', 'E': 'Measles'}, | A: Scarlet fever |
Answer the following medical question with one of the provided options: | Q:A 4-day-old healthy male infant is born with normal internal and external male reproductive organs. Karyotype analysis reveals a 46XY genotype. Production of what substance by which cell type is responsible for the development of the normal male seminal vesicles, epididymides, ejaculatory ducts, and ductus deferens?? {'A': 'Testis-determining factor; Sertoli cells', 'B': 'Testis-determining factor; Leydig cells', 'C': 'Testosterone; Sertoli cells', 'D': 'Testosterone; Leydig cells', 'E': 'Mullerian inhibitory factor; Sertoli cells'}, | D: Testosterone; Leydig cells |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man presents to his primary care physician with 3 months of increasing fatigue. He says that he has been feeling short of breath while walking to his office from the parking lot and is no longer able to participate in recreational activities that he enjoys such as hiking. His wife also comments that he has been looking very pale even though they spend a lot of time outdoors. His past medical history is significant for acute kidney injury after losing blood during a car accident as well as alcoholic hepatitis. Physical exam reveals conjunctival pallor, and a peripheral blood smear is obtained with the finding demonstrate in figure A. Which of the following is associated with the most likely cause of this patient's symptoms?? {'A': 'Abnormal triglyceride handling', 'B': 'Increased production of platelet derived growth factor', 'C': 'Inhibition of metalloproteinase activity', 'D': 'Mutation in cytoskeletal proteins', 'E': 'Mutation in glycolysis pathway protein'}, | B: Increased production of platelet derived growth factor |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man is referred to the outpatient psychiatry clinic for depressed mood. He was diagnosed with pancreatic cancer recently. Since then, he has not been able to go to work. Over the past several weeks, he has had significant unintentional weight loss and several bouts of epigastric pain. He lost his father to cancer when he was 10 years old. After a complete history and physical examination, the patient is diagnosed with major depressive disorder, provisional. Which of the following statements regarding this patient’s psychiatric condition is true?? {'A': 'This patient must have anhedonia or depressed mood.', 'B': 'This patient may have a history of elated mood.', 'C': 'This patient has preserved social and occupational functioning.', 'D': 'This patient may have pressured speech.', 'E': 'This patient’s symptoms must have been present for at least 1 month.'}, | A: This patient must have anhedonia or depressed mood. |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man is admitted to the intensive care unit after open abdominal aortic aneurysm repair. The patient has received 4 units of packed red blood cells during the surgery. During the first 24 hours following the procedure, he has only passed 200 mL of urine. He has congestive heart failure and hypertension. Current medications include atenolol, enalapril, and spironolactone. He appears ill. His temperature is 37.1°C (98.8°F), pulse is 110/min, respirations are 18/min, and blood pressure is 110/78 mm Hg. Examination shows dry mucous membranes and flat neck veins. The remainder of the examination shows no abnormalities. Laboratory studies show a serum creatinine level of 2.0 mg/dL and a BUN of 48 mg/dL. His serum creatinine and BUN on admission were 1.2 mg/dL and 18 mg/dL, respectively. Further evaluation of this patient is most likely to reveal which of the following findings?? {'A': 'Decreased urine osmolarity', 'B': 'Leukocyte casts', 'C': 'Hematuria', 'D': 'Low urine sodium', 'E': 'Proteinuria'}, | D: Low urine sodium |
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 2 episodes of screaming in the night over the past week. The parents report that their son woke up suddenly screaming, crying, and aggressively kicking his legs around both times. The episodes lasted several minutes and were accompanied by sweating and fast breathing. The parents state that they were unable to stop the episodes and that their son simply went back to sleep when the episodes were over. The patient cannot recall any details of these incidents. He has a history of obstructive sleep apnea. He takes no medications. His vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Insomnia disorder', 'B': 'Restless legs syndrome', 'C': 'Sleep terror disorder', 'D': 'Nightmare disorder', 'E': 'Sleepwalking disorder'}, | C: Sleep terror disorder |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the pediatrician by his mother for fatigue. The patient reports that he was supposed to try out for winter track this year, but he had to quit because his “legs just give up.” He also reports increased difficulty breathing with exercise but denies chest pain or palpitations. He has no chronic medical conditions and takes no medications. He has had no surgeries in the past. The mother reports that he met all his pediatric milestones and is an “average” student. He is up-to-date on all childhood vaccinations, including a recent flu vaccine. On physical examination, there is mild lumbar lordosis. The patient’s thighs appear thin in diameter compared to his lower leg muscles, and he walks on his toes. An electrocardiogram shows 1st degree atrioventricular nodal block. Which of the following is the most likely cause of the patient’s condition?? {'A': 'Abnormal dystrophin', 'B': 'Absent dystrophin', 'C': 'Peripheral nerve demyelination', 'D': 'Sarcomere protein dysfunction', 'E': 'Trinucleotide repeats'}, | A: Abnormal dystrophin |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 1-month-old girl is brought to the physician because of a 1-day history of multiple episodes of bilious vomiting. She is diagnosed with intestinal malrotation and volvulus and undergoes emergency laparotomy. During surgery, a 3 x 3 cm cystic mass is excised from behind the umbilicus. Microscopic examination of the mass shows mature nonciliated columnar epithelium with some goblet cells lining the inner cyst wall. Dilation of which of the following structures is the most likely cause of this patient's mass?? {'A': 'Urachus', 'B': 'Umbilical ring', 'C': 'Vitelline duct', 'D': 'Ovarian follicle', 'E': 'Common bile duct'}, | C: Vitelline duct |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman comes to the emergency department because of right flank pain and vomiting for 5 hours. She has had fever and chills for the past 2 days. She attended a barbecue 3 days ago, where she ate egg salad. She underwent surgery for left ovarian torsion a year ago. Menses occur at regular 28-day intervals and last 5 days. She is sexually active with 2 male partners and uses condoms inconsistently. Her only medication is an oral contraceptive pill. She is 163 cm (5 ft 4 in) tall and weighs 72.5 kg (160 lb); BMI is 27.5 kg/m2. She appears uncomfortable. Her temperature is 38.9°C (102°F), pulse is 101/min, and blood pressure is 118/76 mm Hg. The lungs are clear to auscultation. The right lower quadrant and right flank show severe tenderness to palpation. Pelvic examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.8 g/dL Leukocyte count 14,200/mm3 Platelet count 230,000/mm3 Serum Na+ 136 mEq/L K+ 3.8 mEq/L Cl- 103 mEq/L Urea nitrogen 23 mg/dL Creatinine 1.2 mg/dL Urine Blood 1+ Protein 1+ Glucose negative Leukocyte esterase positive Nitrites negative RBC 6–8/hpf WBC 80–85/hpf Which of the following is the most likely diagnosis?"? {'A': 'Ovarian torsion', 'B': 'Gastroenteritis', 'C': 'Urethritis', 'D': 'Pelvic inflammatory disease', 'E': 'Pyelonephritis'}, | E: Pyelonephritis |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the pediatrician by his mother for a recurring cough and difficult breathing. He was tentatively diagnosed with asthma last year, and the mother was advised to administer albuterol nebulizers at home when symptoms occur. The boy has only required nebulizers once every 10 days. The mother says his cough is usually accompanied by a prominent wheeze and nebulizers have not been of much help. On examination, the child appears lethargic. His trachea is slightly deviated to the right, and auscultation of the chest reveals diminished breath sounds with a unilateral wheeze on the right. Which of the following pulmonary flow-volume loops best represents this patient’s most likely condition?? {'A': 'Chart A', 'B': 'Chart B', 'C': 'Chart C', 'D': 'Chart D', 'E': 'Chart E'}, | C: Chart C |
Answer the following medical question with one of the provided options: | Q:A 74-year-old African-American woman is brought to the emergency department by her home health aid. The patient was eating breakfast this morning when she suddenly was unable to lift her spoon with her right hand. She attempted to get up from the table, but her right leg felt weak. One hour later in the emergency department, her strength is 0/5 in the right upper and right lower extremities. Strength is normal in her left upper and lower extremities. Sensation is normal bilaterally. An emergency CT of the head does not show signs of hemorrhage. Subsequent brain MRI shows an infarct involving the internal capsule. Which of the following is true about her disease process?? {'A': 'The most important risk factors are hypertension and diabetes', 'B': 'The most common cause is embolism originating from the left atrium', 'C': 'It is caused by ischemia to watershed areas', 'D': 'IV thrombolysis cannot be used', 'E': 'The most important risk factors are ethnicity and sex'}, | A: The most important risk factors are hypertension and diabetes |
Answer the following medical question with one of the provided options: | Q:A 60-year-old male presents to your office for follow-up after an upper gastrointestinal (GI) endoscopy revealed the presence of esophageal varices. His medical history is significant for cirrhosis caused by heavy alcohol abuse for the past 20 years. He was instructed to follow-up with his primary care physician for management of his condition. Which of the following is the most appropriate next step for prevention of future variceal bleeding?? {'A': 'Careful observation', 'B': 'Octreotide', 'C': 'Nadolol', 'D': 'Isosorbide mononitrate', 'E': 'Transjugular intrahepatic portosystemic shunt'}, | C: Nadolol |
Answer the following medical question with one of the provided options: | Q:A 3-year-old boy is taken to the ER by his parents due to his elevated temperature. He has had a fever (>101.1 deg F) for a little over a week, and over that time, his parents noticed his eyes had gotten a little pink, and his palms and soles were red and swollen. His lips and tongue are also peeling. His parents note he has not taken any new medications, and they did not notice any runny nose, sore throat, cough, or changes in his bowel or bladder habits. In the ER, his vitals are as follows: temperature is 101.3 deg F (38.5 deg C), blood pressure is 90/60 mmHg, pulse is 125/min, and respirations are 20/min. His exam is notable for bilateral injected conjunctivae, right-sided cervical lymphadenopathy, erythematous and edematous palms and soles, and erythema multiforme-like rash over his trunk. Appropriate lab tests and imaging were performed. Which of the following is the most worrisome complication of this boy's disease process?? {'A': 'Digital gangrene', 'B': 'Coronary artery aneurysms', 'C': 'Glomerulonephritis', 'D': 'Endocardial valve damage', 'E': 'Toxic endodermal necrolysis'}, | B: Coronary artery aneurysms |
Answer the following medical question with one of the provided options: | Q:A 22-year-old woman seeks evaluation at a local walk-in clinic for severe lower abdominal pain, vaginal discharge, and painful intercourse for the last couple of weeks. Her last day of menstruation was 1 week ago, and since then the pain has worsened. She is an out-of-town college student engaged in an open relationship with a fellow classmate and another partner from her hometown. Additional concerns include painful micturition and a low-grade fever for the same duration. The physical examination reveals a heart rate of 120/min, respiratory rate of 24/min, and temperature of 38.6°C (101.5°F). The pelvic examination shows an erythematous cervix with a mucopurulent exudate. The cervix bleeds when manipulated with a swab and is extremely tender with movement. Based on the clinical findings, which of the following agents is the most likely cause of her condition?? {'A': 'Neisseria gonorrhoeae', 'B': 'Mycobacterium tuberculosis', 'C': 'Mycoplasma genitalium', 'D': 'Streptococcus agalactiae', 'E': 'Chlamydia trachomatis'}, | A: Neisseria gonorrhoeae |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man comes to the physician because of a rash on the thigh for 10 days. He reports that the rash has been enlarging and is intensely itchy. Two weeks ago, he adopted a stray dog from an animal shelter. Vital signs are within normal limits. A photograph of the examination findings is shown. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Psoriasis', 'B': 'Erythrasma', 'C': 'Pityriasis rosea', 'D': 'Dermatophyte infection', 'E': 'Tinea versicolor'}, | D: Dermatophyte infection |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man with hypertension comes to the physician for a routine follow-up evaluation. His blood pressure is 146/98 mm Hg. The physician wishes to prescribe lisinopril. The patient says that his blood pressure is high when he is “anxious” and requests alprazolam instead of lisinopril. Which of the following is the most appropriate initial response by the physician?? {'A': '“I would recommend fluoxetine because alprazolam can cause dependence.”', 'B': '“I would recommend consultation with a psychiatrist.”', 'C': '“Anxiety can cause temporary spikes in blood pressure, but it does not cause a long-term increase in blood pressure.”', 'D': '“What have you heard about the use of alprazolam to treat high blood pressure?”', 'E': '“Lisinopril is more effective to treat hypertension. If you do not control your high blood pressure, you may develop a stroke.”'}, | D: “What have you heard about the use of alprazolam to treat high blood pressure?” |
Answer the following medical question with one of the provided options: | Q:A 78-year-old right-handed male is brought in by ambulance after being found down in his home. After being aroused, the patient has difficulty answering questions and appears to be frustrated by his inability to communicate. He is able to speak his name and a few other words but his speech is not fluent. Subsequent neurologic exam finds that the patient is able to comprehend both one and two step instructions; however, he is unable to repeat phrases despite being able to understand them. He also has difficulty writing despite retaining fine motor control. CT reveals an acute stroke to his left hemisphere. Damage to which of the following sets of structures would be most likely to result in this pattern of deficits?? {'A': 'Inferior frontal gyrus', 'B': 'Superior temporal gyrus', 'C': 'Arcuate fasciculus', 'D': 'Watershed zone', 'E': 'Precentral gyrus'}, | A: Inferior frontal gyrus |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man presents to the emergency department for a 1-hour history of right arm weakness. He was having breakfast this morning when his right arm suddenly became weak, causing him to drop his coffee mug. He also noticed that he was slurring his speech and had some additional weakness in his right leg. He had no symptoms prior to the onset of the weakness and noted no other unusual phenomena. These symptoms lasted for about 30 minutes, but they resolved completely by the time he arrived at the emergency department. His medical history is notable for hypertension and hyperlipidemia, but he does not receive close follow-up from a primary care physician for these conditions. The patient currently is not taking any medications. His pulse is 75/min, the blood pressure is 160/95 mm Hg, and the respiratory rate is 14/min. Physical exam is remarkable for a high-pitched sound heard on auscultation of the neck, the remainder of the exam, including a complete neurological exam, is entirely unremarkable. CT angiography of the head and neck shows no active hemorrhage and 80% stenosis of the left internal carotid artery. Which of the following is the next best step in the long-term management of this patient?? {'A': 'Carotid endarterectomy', 'B': 'Administration of tissue plasminogen activator (tPA)', 'C': 'Brain MRI', 'D': 'Initiation of aspirin and atorvastatinInitiation of aspirin and atorvastatin', 'E': 'Initiation of lisinopril'}, | A: Carotid endarterectomy |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman is seen in the hospital for neutropenic fever. She was admitted 1 week ago for newly diagnosed acute myeloid leukemia. Due to her chemotherapy, she became pancytopenic. Last night, during a packed red blood cell transfusion, she became febrile to 102.6°F (39.3°C), her blood pressure was 92/55, pulse was 112/min, respirations were 16/min, and oxygen saturation was 94% on room air. The transfusion was stopped, intravenous fluids were started, and blood cultures were drawn. The patient also complained of chest pain and shortness of breath. A chest radiograph was obtained and was normal. This morning, she reports “dark urine” but denies dysuria or abnormal vaginal discharge. Her prophylactic antimicrobials started at the time of her chemotherapy include acyclovir, levofloxacin, and fluconazole. The patient’s temperature this morning is 98.7°F (37.1°C), blood pressure is 110/72 mmHg, pulse is 88/min, and respirations are 17/min with an oxygen saturation of 95% on room air. On physical examination, she has 1+ pitting peripheral edema of bilateral lower extremities to the mid-shin. Her jugular venous pressure is 6 cm. Her labs show neutropenia, normocytic anemia, thrombocytopenia, elevated lactose dehydrogenase, elevated total bilirubin, and decreased haptoglobin. Coagulation studies show an increase in bleeding time with normal D-dimer levels. Which of the following is the most likely cause of the patient’s symptoms?? {'A': 'ABO incompatibility', 'B': 'Disseminated intravascular coagulation', 'C': 'Severe urosepsis', 'D': 'Transfusion associated circulatory overload', 'E': 'Transfusion related acute lung injury'}, | A: ABO incompatibility |
Answer the following medical question with one of the provided options: | Q:A 3-year-old African-American boy presents with a rapid onset of severe abdominal pain. He has a palpably enlarged mass in the left upper quadrant of his abdomen. Complete blood count is notable for a hemoglobin of 7.2 g/dL. Serum haptoglobin level returns normal. Serum unconjugated bilirubin is elevated. The corrected reticulocyte count is elevated. Which of the following is the most likely explanation for the findings above?? {'A': 'Aplastic crisis', 'B': 'Acute chest syndrome', 'C': 'Renal infarction', 'D': 'Intravascular hemolysis', 'E': 'Extravascular hemolysis'}, | E: Extravascular hemolysis |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man comes to the physician because of a persistent cough for the past 2 weeks. During this time, he has also had occasional discomfort in his chest. Three weeks ago, he had a sore throat, headache, and a low-grade fever, which were treated with acetaminophen and rest. He has a history of hypertension and hyperlipidemia. His father died of myocardial infarction at the age of 57 years. He has smoked a pack of cigarettes daily for the past 40 years. Current medications include enalapril and atorvastatin. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 145/90 mm Hg. Physical examination shows no abnormalities. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?? {'A': 'Esophageal manometry', 'B': 'CT scan of the chest', 'C': 'Arteriography', 'D': 'Genetic testing', 'E': 'Endovascular repair'}, | B: CT scan of the chest |
Answer the following medical question with one of the provided options: | Q:A 31-year-old male with cirrhosis, dementia, and Parkinson-like symptoms is diagnosed with a hereditary metabolic disease resulting from the accumulation of a certain metal in various tissues. Impairment of which of the following elimination pathways is most likely responsible?? {'A': 'Secretion into bile', 'B': 'Loop of Henle secretion into lumen of kidney', 'C': 'Glomerular filtration', 'D': 'Bleeding', 'E': 'Duodenal secretion'}, | A: Secretion into bile |
Answer the following medical question with one of the provided options: | Q:An x-ray of the chest shows an extensive consolidation within the right lower lobe consistent with lobar pneumonia. Sputum and blood cultures are sent to the laboratory for analysis, and empiric antibiotic treatment with intravenous cefotaxime is begun. Which of the following is most likely to have prevented this patient's pneumonia?? {'A': 'Incentive spirometry', 'B': 'Rapid sequence induction', 'C': 'Prolonged bed rest', 'D': 'Perioperative antibiotic prophylaxis', 'E': 'Smoking cessation'}, | A: Incentive spirometry |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man with history of diabetes and hypertension suffers a cardiac arrest at home. The family calls 911, yet no one performs CPR. Five minutes after the arrest, EMS arrives to begin resuscitation. At this point, which region of the CNS is most likely to suffer ischemic damage?? {'A': 'Thalamus', 'B': 'Spinal cord', 'C': 'Pons', 'D': 'Medulla', 'E': 'Hippocampus'}, | E: Hippocampus |
Answer the following medical question with one of the provided options: | Q:A 77-year-old man with type 2 diabetes mellitus is admitted to the hospital because of chest pain and dyspnea. Serum troponin levels are elevated and an ECG shows ST-segment depressions in the lateral leads. Percutaneous coronary angiography is performed and occlusion of the distal left anterior descending coronary artery is identified. Pharmacotherapy with eptifibatide is initiated and a drug-eluting stent is placed in the left anterior descending coronary artery. The mechanism by which eptifibatide acts is similar to the underlying pathophysiology of which of the following conditions?? {'A': 'Von Willebrand disease', 'B': 'Vitamin K deficiency', 'C': 'Protein C deficiency', 'D': 'Thrombotic thrombocytopenic purpura', 'E': 'Glanzmann thrombasthenia'}, | E: Glanzmann thrombasthenia |
Answer the following medical question with one of the provided options: | Q:A 66-year-old man comes to the physician for a follow-up examination after a below-knee amputation of the right lower leg. Three weeks ago, he had an acute arterial embolism that could not be revascularized in time to save the leg. He now reports episodic hot, shooting, and tingling pain in the right lower leg that began shortly after the amputation. He has type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for the past 30 years. His current medications are metformin and prophylactic subcutaneous heparin. His temperature is 37.1°C (98.8°F), pulse is 78/min, and blood pressure is 135/88 mm Hg. Physical examination shows a slightly erythematous stump with clean sutures. The skin overlying the stump is warm and well-perfused. Muscle strength and sensation are normal throughout the remaining extremity and the left lower extremity. Which of the following is the most likely diagnosis?? {'A': 'Phantom limb pain', 'B': 'Foreign body reaction', 'C': 'Reinfarction', 'D': 'Diabetic neuropathy', 'E': 'Osteomyelitis'}, | A: Phantom limb pain |
Answer the following medical question with one of the provided options: | Q:Four days after undergoing liver transplantation, a 47-year-old man develops fever, chills, malaise, and confusion while in the intensive care unit. His temperature is 39.1°C (102.4°F). Blood cultures grow an organism. Microscopic examination of this organism after incubation at 25°C (77°F) for 3 hours is shown. Which of the following is the most likely causal organism of this patient's symptoms?? {'A': 'Aspergillus fumigatus', 'B': 'Candida albicans', 'C': 'Cryptococcus neoformans', 'D': 'Histoplasma capsulatum', 'E': 'Malassezia furfur'}, | B: Candida albicans |
Answer the following medical question with one of the provided options: | Q:An 18-year-old man presents to his primary care provider for a routine checkup. He feels well and has no complaints. He is the captain of his high school football team and will be attending college on a football scholarship the following year. His past medical history is unremarkable. He underwent a laparoscopic appendectomy at age 13. He takes no medications and has no allergies. His temperature is 99.1°F (37.3°C), blood pressure is 155/85 mmHg, pulse is 96/min, and respirations are 16/min. On examination, he has severe nodulocystic acne. He has gained 15 pounds and 1/2 inch in height since his last visit one year ago. Mild gynecomastia and testicular shrinkage are noted. This patient is at the greatest risk of developing which of the following?? {'A': 'Hepatic adenoma', 'B': 'Hepatocellular carcinoma', 'C': 'Renal cyst', 'D': 'Testicular enlargement', 'E': 'Type 1 diabetes mellitus'}, | A: Hepatic adenoma |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man with a 4-year history of Parkinson disease comes to the physician for evaluation of his medication. Since his last visit one year ago, he has had increased tremor and bradykinesia up to an hour before his next scheduled dose and sometimes feels like he does not respond to some doses at all. One week ago, he was entirely unable to move for about a minute when he wanted to exit an elevator. The physician prescribes a drug that increases the bioavailability of levodopa by preferentially preventing its peripheral methylation. This patient was most likely prescribed which of the following drugs by the physician?? {'A': 'Carbidopa', 'B': 'Entacapone', 'C': 'Ropinirole', 'D': 'Amantadine', 'E': 'Rasagiline'}, | B: Entacapone |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman has a follow-up visit with her psychiatrist. She was recently diagnosed with major depressive disorder and was started on citalopram 3 months ago. Her dosage was increased one time 6 weeks ago. She has come in to discuss her progress and notes that she feels “normal again” and “happier” and has not experienced her usual feelings of depression, crying spells, or insomnia. Her appetite has also improved and she is performing better at work, stating that she has more focus and motivation to complete her assignments. During the beginning of her treatment, she states that she had occasional headaches and diarrhea, but that she no longer has those side effects. Which of the following is the most appropriate next step in this patient’s management?? {'A': 'Lower the dose of citalopram', 'B': 'Maintain the current dose of citalopram for several months', 'C': 'Increase the dose of citalopram', 'D': 'Discontinue the citalopram', 'E': 'Discontinue the citalopram and switch to amitriptyline'}, | B: Maintain the current dose of citalopram for several months |
Answer the following medical question with one of the provided options: | Q:A 43-year-old construction worker presents to the emergency department two hours after sustaining a deep laceration to his left forearm by a piece of soiled and rusted sheet metal. His vital signs are stable, there is no active bleeding, his pain is well controlled, and a hand surgeon has been notified about damage to his forearm tendons. He does not recall receiving any vaccinations in the last 30 years and does not know if he was vaccinated as a child. What is the appropriate post-exposure prophylaxis?? {'A': 'IV metronidazole only', 'B': 'Anthrax vaccine', 'C': 'Tetanus vaccine booster only', 'D': 'Tetanus immunglobulin only', 'E': 'Tetanus vaccine + immunoglobulin'}, | E: Tetanus vaccine + immunoglobulin |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman presents with a feeling of pelvic pressure which worsens with prolonged standing, pain on sexual intercourse, and lower back pain. She reports no urinary or fecal incontinence. She is G3P3 with no history of any gynecological disease and is premenopausal. All pregnancies were without complication and resolved with full-term vaginal deliveries. The patient has sex with her husband who is her single sexual partner and uses oral contraceptives. Her vital signs are within normal limits and physical examination is unremarkable. A gynecological examination reveals bulging of the posterior vaginal wall in the lower portion of the vagina which increases in the upright position and Valsalva maneuver. The cervix is in its normal position. The uterus is not enlarged, ovaries are nonpalpable. Damage to which of the following structures might contribute to the patient’s condition?? {'A': 'Rectovaginal fascia', 'B': 'Cardinal ligaments', 'C': 'Round ligaments', 'D': 'Pubocervical fascia', 'E': 'Uterosacral ligaments'}, | A: Rectovaginal fascia |
Answer the following medical question with one of the provided options: | Q:A 64-year-old woman presents to the emergency department with a 1-hour history of shortness of breath and chest pain. She said that the symptoms came on suddenly and that the chest pain is worse when she tries to take a deep breath. Her past medical history is significant for a previous deep venous thrombosis for which she was taking a blood thinner. She also has diabetes, hypertension, hyperlipidemia, and partial seizures which are treated with metformin, lisinopril, atorvastatin, and carbamazepine and valproic acid, respectively. Which of these drugs is most likely responsible for causing this patient's blood thinner medications to fail?? {'A': 'Atorvastatin', 'B': 'Carbamazepine', 'C': 'Lisinopril', 'D': 'Metformin', 'E': 'Valproic acid'}, | B: Carbamazepine |
Answer the following medical question with one of the provided options: | Q:5 days after receiving chemotherapy for ovarian cancer, a 74-year-old woman comes to the physician for a follow-up examination. She feels well and has no complaints. Her leukocyte count is 3,500/mm3 (11% neutrophils and 89% lymphocytes). This patient's profound granulocytopenia is most likely to predispose her to infection with which of the following organisms?? {'A': 'Enterococcus faecalis', 'B': 'Gardnerella vaginalis', 'C': 'Giardia lamblia', 'D': 'Cytomegalovirus infection', 'E': 'Pneumocystis jirovecii'}, | A: Enterococcus faecalis |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man presents to your office because he noticed a "weird patch" on the floor of his mouth. He states that he noticed it a few months ago, but did not report it because it did not hurt. However, he is concerned because it has not regressed and seems to have changed in shape. On examination, you notice the patient has poor dentition and he admits to using chewing tobacco daily. The patch on the floor of his mouth is red with irregular borders. Which of the following would be an appropriate way to counsel this patient on his current condition?? {'A': 'This lesion is due to an infection.', 'B': 'This lesion is closely associated with chronic Hepatitis C infection.', 'C': 'This lesion necessitates biopsy.', 'D': 'This lesion carries no increased risk of cancer.', 'E': 'Tobacco use is not a risk factor.'}, | C: This lesion necessitates biopsy. |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman comes to the physician for evaluation of worsening fatigue for 1 week. She also has a 1-year history of hand pain and stiffness. Four months ago, she started a new medication for these symptoms. Medications used prior to that included ibuprofen, prednisone, and hydroxychloroquine. Examination shows a subcutaneous nodule on her left elbow and old joint destruction with Boutonniere deformity. Her hemoglobin concentration is 10.1 g/dL, leukocyte count is 3400/mm3, and platelet count is 101,000/mm3. Methylmalonic acid levels are normal. Which of the following could have prevented this patient's laboratory abnormalities?? {'A': 'Vitamin B6', 'B': 'Vitamin B12', 'C': 'Amifostine', 'D': '2-Mercaptoethanesulfonate', 'E': 'Leucovorin'}, | E: Leucovorin |
Answer the following medical question with one of the provided options: | Q:A 32-year-old previously healthy female presents to her primary care physician with double vision. She first noted the double vision yesterday and saw no improvement this morning. She does not think it is worsening. She has not had any changes in her normal routine though she recalls one episode of right arm weakness 2 months ago. She did not seek treatment and the weakness subsided after several days. She does not have a history of head trauma. She denies headache, fever, chills, nausea, vomiting, paresthesias, extremity pain, or weakness. On exam she has right adduction palsy on leftward gaze. She has no focal weakness. Which of the following additional physical exam findings is associated with the lesion responsible for her ocular findings?? {'A': 'Horizontal nystagmus in the left eye on leftward gaze', 'B': 'Ptosis on the right', 'C': 'Proptosis of the right eye', 'D': 'Left abduction palsy on leftward gaze', 'E': 'Afferent pupillary defect in the left eye'}, | A: Horizontal nystagmus in the left eye on leftward gaze |
Answer the following medical question with one of the provided options: | Q:A team of researchers is investigating different mechanisms of transmitting sensory information in the body. They are particularly interested in the different types of sensory receptors. From a sample of tissue, they isolate a receptor that is encased in deep skin layers and joints. The receptor adapts quickly and they discover its role is to sense vibration and pressure. Which of the following types of nerve fibers is most likely used by this receptor to transmit sensory information?? {'A': 'Small, unmyelinated fibers', 'B': 'Small, myelinated fibers', 'C': 'Large, unmyelinated fibers', 'D': 'Large, myelinated fibers', 'E': 'Dendritic endings'}, | D: Large, myelinated fibers |
Answer the following medical question with one of the provided options: | Q:A 28-year-old African American woman comes to the emergency department with intermittent and progressively worsening dizziness with near-fainting incidents for the last 3 weeks. She denies fever, weight loss, nausea, vomiting, or chest pain. Her medical history is significant for a chronic cough and intermittent skin rashes that spontaneously resolved after a few weeks. She does not smoke tobacco but drinks alcohol socially. The patient lives alone with no pets. Her temperature is 37°C (98.6°F), blood pressure is 122/80 mm Hg, pulse is 43/min, and respirations are 12/min. On physical examination, cervical lymphadenopathy is noted. No heart murmurs are heard. ECG shows sinus rhythm with 2:1 atrioventricular block and left bundle branch block. Chest X-ray shows prominent hilar lymphadenopathy. Which of the following is the most likely diagnosis?? {'A': 'Carotid artery stenosis', 'B': 'Cardiac myxoma', 'C': 'Non-Hodgkin’s lymphoma', 'D': 'Small cell lung cancer', 'E': 'Sarcoidosis'}, | E: Sarcoidosis |
Answer the following medical question with one of the provided options: | Q:A 36-year-old woman comes to the physician for evaluation of unintentional weight gain of 5.5 kg (12.2 lb) and irregular menstrual cycles over the past 2 months. She does not take any medications. Her blood pressure is 155/85 mm Hg. Physical examination shows central obesity, hyperpigmentation of the palmar creases, and violaceous scarring of the abdomen. Early morning serum cortisol levels are elevated and serum adrenocorticotropic hormone (ACTH) is within the reference range after a low-dose dexamethasone suppression test. A high-dose dexamethasone suppression test shows suppression of ACTH. Further evaluation is most likely to show which of the following findings?? {'A': 'Atrophy of the pituitary gland', 'B': 'Benign adenoma of the adrenal medulla', 'C': 'Nodular hypertrophy of the zona reticularis', 'D': 'Bilateral hyperplasia of the zona fasciculata', 'E': 'Unilateral carcinoma of the adrenal cortex'}, | D: Bilateral hyperplasia of the zona fasciculata |
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