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Answer the following medical question with one of the provided options: | Q:A 45-year-old gentleman with a history of poorly controlled diabetes mellitus is referred to a nephrologist for evaluation of the possibility of early stage kidney failure. Upon evaluation, the nephrologist decides to assess the patient's renal plasma flow by performing a laboratory test. Which of the following substances would be the best for estimating this value?? {'A': 'Creatinine', 'B': 'Inulin', 'C': 'Glucose', 'D': 'Para-aminohippurate (PAH)', 'E': 'Urea'}, | D: Para-aminohippurate (PAH) |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman comes to the physician because of a 2-week history of malaise, nausea, and a 3-kg (6.6-lb) weight loss. She has been drinking 8–9 alcoholic beverages daily for the past 20 years. Her temperature is 37.8°C (100°F) and pulse is 105/min. Examination shows jaundice and hepatosplenomegaly. A photomicrograph of a section of a biopsy specimen of the liver is shown. Which of the following mechanisms best explains the findings shown?? {'A': 'Excessive interstitial TGF-β activity', 'B': 'Decreased clearance of N-acetyl-p-benzoquinone imine', 'C': 'Intracellular accumulation of lactate', 'D': 'Increased glycerol 3-phosphate formation', 'E': 'Estrogen-mediated glandular hyperplasia'}, | D: Increased glycerol 3-phosphate formation |
Answer the following medical question with one of the provided options: | Q:A 48-year-old female with a history of hypertension, type II diabetes mellitus, hypothyroidism, and asthma undergoes a scheduled total abdominal hysterectomy for symptomatic fibroids. She is given a dose of preoperative prophylactic antibiotics. Her urinary catheter is removed on post-operative day one. She is on low-molecular-weight heparin for deep vein thrombosis prophylaxis. On post-operative day four, the patient complains of abdominal pain. She denies cough, nausea, vomiting, or dysuria, but has had 3-4 loose stools over her hospitalization. Her temperature is 101.0°F (38.3°C), blood pressure is 97/59 mmHg, pulse is 106/min, and respirations are 16/min. The surgical wound has new erythema with dusky patches and abundant cloudy discharge. The patient reports new decreased sensation around her wound site. Her lungs are clear to auscultation and abdomen is soft with hypoactive bowel sounds. She has no costovertebral angle tenderness. Urinalysis is within normal limits and urine culture grows >100,000 CFU/mL of Escherichia coli. Which of the following is the best next step in management?? {'A': 'Discontinue low-molecular-weight heparin', 'B': 'Oral levofloxacin for 3 days', 'C': 'Oral vancomycin for 10-14 days', 'D': 'Vancomycin/piperacillin-tazobactam/clindamycin and observation', 'E': 'Vancomycin/piperacillin-tazobactam/clindamycin and debridement of the surgical wound'}, | E: Vancomycin/piperacillin-tazobactam/clindamycin and debridement of the surgical wound |
Answer the following medical question with one of the provided options: | Q:A 1-month-old boy is brought to the emergency department 25 minutes after having a seizure. His mother reports that he has become lethargic and does not cry as vigorously anymore. Examination shows muscular hypotonia and hepatomegaly. Arterial blood gas on room air shows metabolic acidosis. Serum studies show elevated levels of methylmalonic acid. A deficiency of which of the following types of enzymes is the most likely cause of this patient's condition?? {'A': 'Phosphorylase', 'B': 'Phosphatase', 'C': 'Carboxylase', 'D': 'Hydroxylase', 'E': 'Mutase'}, | E: Mutase |
Answer the following medical question with one of the provided options: | Q:A 22-year-old patient presents to the rural medicine clinic for a physical examination. She has a past medical history of major depressive disorder. The patient has a history of smoking 1 pack of cigarettes daily for 5 years. She states that she is not currently sexually active, but had sexual intercourse in the past. Her paternal grandfather died of a heart attack at the age of 60. She takes citalopram by mouth once every morning. The blood pressure is 110/70 mm Hg, the heart rate is 76/min, and the respiratory rate is 12/min. Her physical examination reveals a well-nourished, alert, and oriented female. While auscultating the heart, a 2/6 holosystolic murmur at the left upper sternal border is present. Which of the following would be the most appropriate next step for this patient?? {'A': 'Pap smear', 'B': 'Pap smear and HPV testing', 'C': 'Colposcopy and biopsy', 'D': 'Education on breast self-examinations', 'E': 'Screening for hyperlipidemia'}, | A: Pap smear |
Answer the following medical question with one of the provided options: | Q:A 66-year-old homeless HIV-positive male presents with numbness in his hands and feet. The patient says that his symptoms started gradually a couple weeks ago and have slowly worsened. He describes numbness initially in just his fingertips and toes but it has now spread to involve his entire hands and feet. Past medical history is significant for HIV diagnosed many years ago, for which the patient has never sought treatment. The patient also has a long history of various illnesses, especially chronic diarrhea, but he is unable to remember any details. He currently takes no medications. The patient has been homeless for years, and he denies any alcohol or drug use. Review of systems is significant for a sore tongue. His temperature is 37°C (98.6°F), blood pressure is 100/65 mm Hg, pulse is 102/min, respiratory rate is 25/min, and oxygen saturation is 97% on room air. On physical exam, the patient is alert and oriented, his body habitus is cachectic, and his BMI is 17 kg/m2. His tongue appears erythematous and smooth with loss of papillae, but no lesions or evidence of infection is noted. Cardiac exam is normal apart from tachycardia. Lungs are clear to auscultation. His abdomen is soft and nontender with no hepatosplenomegaly. There is decreased 2-point discrimination in the hands and feet bilaterally. Strength in the hands and feet is 4/5 bilaterally. Reflexes are absent in the ankles. Gait is slightly wide-based and ataxic, and there is a positive Romberg sign. Which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Elevated levels of methylmalonic acid (MMA)', 'B': 'Poorly controlled, undiagnosed diabetes', 'C': 'Autoimmune reaction', 'D': 'Disseminated bacterial infection', 'E': 'Deposition of an insoluble protein'}, | A: Elevated levels of methylmalonic acid (MMA) |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman presents to the emergency department in a frantic state and demands immediate treatment for an allergic reaction, which started soon after she had lunch (approximately 1 hour ago). She had her usual meal consisting of homemade salad and lemonade. She was recently started on niacin because she could not tolerate statins. The only other medication she takes is captopril for hypertension. She has no respiratory difficulty and denies rhinorrhea, epiphora, and diarrhea. She is complaining of a stinging sensation on her face. She has no history of allergies and no family history of allergies. The vital signs include: pulse 90/min, respirations 16/min, blood pressure 120/80 mm Hg, and oxygen saturation, 98% on room air. On physical examination, the face and trunk have a flushed appearance. The rest of the physical examination is unremarkable. The attending physician reassures her that she is not in any immediate danger, and in fact, her symptoms subsided over the next hour. She is advised to take aspirin 30 minutes before her other medications and sent home. Which of the following is the etiology of her symptoms?? {'A': 'Anxiety', 'B': 'Drug overdose', 'C': 'A mild allergic reaction', 'D': 'Prostaglandin release', 'E': 'Serotonin'}, | D: Prostaglandin release |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man comes to the physician for 2 months of intermittent low-grade fever, malaise, and joint pain. He has a history of recurrent dental abscesses requiring drainage but has otherwise been healthy. His temperature is 38.3°C (100.9°F) and pulse is 112/min. Physical examination shows a new holosystolic murmur in the left midclavicular line that radiates to the axilla. There are linear reddish-brown lesions underneath the nail beds and tender violaceous nodules on the bilateral thenar eminences. Two sets of blood cultures grow Streptococcus mutans. A transthoracic echocardiogram shows moderate regurgitation of the mitral valve. Which of the following mechanisms is most likely directly involved in the pathogenesis of this patient's valvular condition?? {'A': 'Antibody cross-reaction', 'B': 'Sterile platelet thrombi deposition', 'C': 'Leaflet calcification and fibrosis', 'D': 'Coagulative necrosis', 'E': 'Fibrin clot formation'}, | E: Fibrin clot formation |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the physician by his mother because of painless lesions on his face that he has had since shortly after birth. They recently moved to the USA from Indonesia where they had limited access to healthcare. A photograph of the lesions is shown. Which of the following is the most likely diagnosis?? {'A': 'Infantile hemangioma', 'B': 'Verruca vulgaris', 'C': 'Neurofibromas', 'D': 'Spider angioma', 'E': 'Molluscum contagiosum'}, | A: Infantile hemangioma |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man is diagnosed with multi-drug resistant tuberculosis after a recent trip to Eastern Europe. After drug susceptibility testing is completed, he is given a regimen of antibiotics as treatment. He returns two weeks later complaining of decreased visual acuity and color-blindness. Which drug of the following is the mechanism of action of the drug that is most likely to cause this side effect?? {'A': 'Inhibition of mycolic acid synthesis', 'B': 'Inhibition of arabinogalactan synthesis', 'C': 'Binding to ergosterol and formation of a transmembrane channel', 'D': 'Inhibition of RNA synthesis', 'E': 'Inhibition of RNA translation'}, | B: Inhibition of arabinogalactan synthesis |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the physician because of intermittent abdominal cramps and recurrent episodes of foul-smelling greasy diarrhea for 3 months. He has a history of recurrent upper respiratory infection. The abdomen is diffusely tender to palpation and resonant to percussion. A photomicrograph of a stool sample is shown. This patient is at increased risk for which of the following?? {'A': 'Hypersensitivity reaction to transfusion', 'B': 'Gastric adenocarcinoma', 'C': 'Progressive peripheral neuropathy', 'D': 'Cutaneous granulomas', 'E': 'Disseminated tuberculosis'}, | A: Hypersensitivity reaction to transfusion |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man comes to the emergency department for 2 days of severe headaches. The pain is most intense on his left forehead and eye. He had similar symptoms last summer. He has been taking indomethacin every 6 hours for the last 24 hours but has not had any relief. He has smoked 1 pack of cigarettes daily for the past 5 years. He works as an accountant and describes his work as very stressful. Physical examination shows drooping of the left eyelid, tearing of the left eye, and rhinorrhea. The left pupil is 2 mm and the right pupil is 4 mm. There is localized tenderness along the right supraspinatus muscle. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Giant cell arteritis', 'B': 'Medication overuse headache', 'C': 'Cluster headache', 'D': 'Trigeminal neuralgia', 'E': 'Tension headache'}, | C: Cluster headache |
Answer the following medical question with one of the provided options: | Q:A research group wants to assess the relationship between childhood diet and cardiovascular disease in adulthood. A prospective cohort study of 500 children between 10 to 15 years of age is conducted in which the participants' diets are recorded for 1 year and then the patients are assessed 20 years later for the presence of cardiovascular disease. A statistically significant association is found between childhood consumption of vegetables and decreased risk of hyperlipidemia and exercise tolerance. When these findings are submitted to a scientific journal, a peer reviewer comments that the researchers did not discuss the study's validity. Which of the following additional analyses would most likely address the concerns about this study's design?? {'A': 'Blinding', 'B': 'Crossover', 'C': 'Matching', 'D': 'Stratification', 'E': 'Randomization'}, | D: Stratification |
Answer the following medical question with one of the provided options: | Q:A 40-year-old male with Down syndrome is brought to your clinic by his mother. She reports that over the past few months he has started having difficulty managing his daily routine at his assisted-living facility and no longer seems like himself. She says that last week he wandered away from the facility and was brought back by police. Additionally, he has stopped taking his regular antiepileptic medication, and she is concerned that he might have a seizure. TSH is checked and is normal. Which of the following is most likely to be responsible for this man's current presentation?? {'A': 'Expansion of trinucleotide repeats', 'B': 'Abnormal protein metabolism', 'C': 'Hormone deficiency', 'D': 'Premature degradation of a protein', 'E': 'Nutritional deficiency'}, | B: Abnormal protein metabolism |
Answer the following medical question with one of the provided options: | Q:A 14-year-old Caucasian male patient found to have low serum copper, high urine copper, and low serum ceruloplasmin is placed on penicillamine for management of his genetic disorder. Which of the following is LEAST consistent with this patient's clinical picture?? {'A': 'Kinky, easily breakable hair', 'B': 'Cirrhosis', 'C': 'Hemiballismus', 'D': 'Corneal deposits', 'E': 'Parkinson-like symptoms'}, | A: Kinky, easily breakable hair |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man is brought to the emergency department 30 minutes after having a seizure. His wife reports that the patient has been having recurrent headaches and has become increasingly irritable over the past 3 months. Physical examination shows a spastic paresis of the right lower extremity. The Babinski sign is present on the right side. An MRI of the brain is shown. Which of the following is the most likely diagnosis?? {'A': 'Pituitary adenoma', 'B': 'Metastatic brain tumor', 'C': 'Ependymoma', 'D': 'Oligodendroglioma', 'E': 'Meningioma'}, | E: Meningioma |
Answer the following medical question with one of the provided options: | Q:A high-throughput screen to identify new sympathomimetic compounds was developed such that a transgenic line of cells was created that contained the alpha-1 (red), alpha-2 (yellow), beta-1 (green) and beta-2 (blue) receptors. When each of the receptors was activated a different fluorescent protein was expressed and new compounds with different properties could be identified by the fluorescence that they induced. Compound 7583 selectively induced the expression of the blue fluorescent protein. Which of the following known sympathomimetic medications if administered would similarly result in expression of only the blue fluorescent protein?? {'A': 'Albuterol', 'B': 'Midrodrine', 'C': 'Epinephrine', 'D': 'Isoproterenol', 'E': 'Fenoldopam'}, | A: Albuterol |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man is brought by his daughter to the clinic. She lives a town away but visits often. She reports that on recent visits, his mood has been volatile, ranging from aggressive at some moments to depressed at others. She has noticed some new jerky movements which she has never seen before and has been quite forgetful. She is concerned that he might be abusing alcohol and drugs. What changes would you expect in the brain of this patient?? {'A': 'Increased norepinephrine at the locus ceruleus', 'B': 'Increased acetylcholine at the caudate', 'C': 'Decreased seratonin at the raphe nucleus', 'D': 'Decreased GABA at the caudate', 'E': 'Decreased dopamine at the ventral tegmentum and substantia nigra pars compacta'}, | D: Decreased GABA at the caudate |
Answer the following medical question with one of the provided options: | Q:A male newborn is delivered at term to a 30-year-old woman. Pregnancy and delivery were uncomplicated. At birth, the umbilical cord is noted to be large. When the newborn cries, straw-colored fluid leaks from the umbilicus. The external genitalia appear normal. Which of the following is the most likely cause of this newborn's symptoms?? {'A': 'Abnormal fusion of the urethral folds', 'B': 'Failed closure of the vitelline duct', 'C': 'Failed obliteration of an allantoic remnant', 'D': 'Infection of the umbilical cord stump', 'E': 'Malformation of the medial umbilical ligament'}, | C: Failed obliteration of an allantoic remnant |
Answer the following medical question with one of the provided options: | Q:A medical student is performing research on the properties of viruses in order to determine the transmission patterns of various organisms. He accidentally drops a rack of tubes and spills various virus samples on the benchtop. Upon seeing this, the laboratory technician wipes down the workbench with alcohol in order to clean up the spill. Which of the following organisms would most likely still be alive after this cleaning?? {'A': 'Adenovirus and coronavirus', 'B': 'Adenovirus and herpesvirus', 'C': 'Adenovirus and rhinovirus', 'D': 'Coronavirus and herpesvirus', 'E': 'Coronavirus and rhinovirus'}, | C: Adenovirus and rhinovirus |
Answer the following medical question with one of the provided options: | Q:An 3-year-old boy is brought in to his pediatrician by his mother after she noticed that the child was starting to turn yellow. She has not noticed any behavioral changes. On exam, the boy is icteric but is behaving normally. His temperature is 98.8°F (37.1°C), blood pressure is 108/78 mmHg, pulse is 78/min, and respirations are 14/min. His labs are drawn, and he is found to have an unconjugated hyperbilirubinemia with a serum bilirubin of 15 mg/dL. The mother is counseled that this boy’s condition may require phenobarbital as a treatment to reduce his bilirubin levels. Which of the following is the most likely defect in this child?? {'A': 'Absent UDP-glucuronosyltransferase activity', 'B': 'Defective liver excretion of bilirubin due to ABCC2 mutation', 'C': 'Defective liver excretion of bilirubin due to SLCO1B1 and SLCO1B3 mutations', 'D': 'Impaired bilirubin uptake', 'E': 'Reduced UDP-glucuronosyltransferase activity'}, | E: Reduced UDP-glucuronosyltransferase activity |
Answer the following medical question with one of the provided options: | Q:A 20-year-old woman presents to the emergency department after developing a widespread rash when she was playing in the park. She states she feels somewhat light-headed. She is otherwise healthy and has no significant past medical history. Her temperature is 97.0°F (36.1°C), blood pressure is 84/54 mmHg, pulse is 130/min, respirations are 22/min, and oxygen saturation is 95% on room air. Physical exam is notable for bilateral wheezing and a diffuse urticarial rash. Which of the following is the next best step in management?? {'A': 'Albuterol', 'B': 'Continuous monitoring', 'C': 'Diphenhydramine', 'D': 'Epinephrine', 'E': 'Normal saline'}, | D: Epinephrine |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman with rheumatoid arthritis comes to the physician because of a 3-month history of worsening fatigue and dyspnea. She has felt short-of-breath when walking up the stairs to her apartment. Menopause occurred 5 years ago. Her medications are methotrexate and folic acid supplementation. Physical examination shows conjunctival pallor, tenderness of bilateral wrists and knees, and ulnar deviation of the fingers. Her hematocrit is 27%, mean corpuscular volume is 84 μm3, and serum ferritin is 375 ng/mL. Which of the following has most likely contributed to the patient's current symptoms?? {'A': 'Increased activity of ferroportin-1 in enterocytes', 'B': 'Increased release of iron from macrophages', 'C': 'Increased release of hepcidin by hepatocytes', 'D': 'Increased production of reticulocytes in bone marrow', 'E': 'Increased concentration of transferrin in serum'}, | C: Increased release of hepcidin by hepatocytes |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents with complaints of weakness and swollen gums for the past 3 weeks. He also says he cut his finger while cooking, and the bleeding took more than 10 minutes to stop. He has a family history of diabetes mellitus type 2 and prostate cancer. Current medications are multivitamin. His blood pressure is 122/67 mm Hg, the respiratory rate is 13/min, and the temperature is 36.7°C (98.0°F). On physical examination, the patient seems pale and lethargic. On cardiac exam, a pulmonary valve flow murmur is heard. There is significant hepatosplenomegaly present, and several oral mucosal petechiae in the oral cavity are noted. Gum hypertrophy is also present. A peripheral blood smear reveals myeloperoxidase-positive cells and Auer Rods. A bone marrow biopsy shows > 30% of blast cells. Which of the following chromosomal abnormalities is associated with this patient’s most likely diagnosis?? {'A': 'JAK2 mutation', 'B': 't(9;22)', 'C': 't(15;17)', 'D': 't(11;14)', 'E': 't(8;14)'}, | C: t(15;17) |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 16-year-old girl comes to the physician because she has not had a menstrual period. Examination shows normal breast development. There is coarse pubic and axillary hair. Pelvic examination shows a blind vaginal pouch. Ultrasonography shows normal ovaries and an atretic uterus. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Deficiency of 5-alpha reductase', 'B': 'End-organ insensitivity to androgens', 'C': 'Monosomy of sex chromosomes', 'D': 'Agenesis of the paramesonephric duct', 'E': 'Deficiency of 17-alpha-hydroxylase'}, | D: Agenesis of the paramesonephric duct |
Answer the following medical question with one of the provided options: | Q:A 75-year-old woman is being treated for atrial fibrillation. She presents to the clinic with complaints of nausea, vomiting, photophobia, and yellow-green vision with yellow halos around the lights. She has a heart rate of 64/min, blood pressure is 118/76 mm Hg, and respiratory rate is 15/min. Physical examination reveals regular heart sounds with clear lung sounds bilaterally. Liver function tests are normal. Toxicity of which of the following anti-arrhythmic drugs would best fit this clinical picture?? {'A': 'Digoxin', 'B': 'Amiodarone', 'C': 'Propafenone', 'D': 'Sotalol', 'E': 'Atenolol'}, | A: Digoxin |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man is rushed to the emergency department after being involved in a motor vehicle accident. He has lacerations on his right arm and some minor abrasions on his face and lower limbs. The resident on call quickly manages the patient with proper care of his open wounds in the emergency department. The patient is admitted to the surgery unit for the daily care of his wounds. His lacerations begin to heal with proper dressing and occasional debridement. Which of the following best describes the healing process in this patient?? {'A': 'Abundant lymphocytes accumulate during the healing process, forming a granuloma.', 'B': 'The formation of granulation tissue is not affected by factors such as blood sugar and decreased circulation of blood.', 'C': 'Healing by secondary intention will occur along with the deposition of large amount of granulation tissue.', 'D': 'Healing involves abscess formation, which should be drained.', 'E': 'Healing by primary intention will occur without granulation tissue formation.'}, | C: Healing by secondary intention will occur along with the deposition of large amount of granulation tissue. |
Answer the following medical question with one of the provided options: | Q:Hormone balance is essential for maintaining a normal pregnancy. Early on, elevated progesterone levels are needed to maintain pregnancy and progesterone is produced in excess by the corpus luteum. In the normal menstrual cycle the corpus luteum involutes, but this process is impeded during pregnancy because of the presence of which hormone?? {'A': 'Cortisol', 'B': 'Human chorionic gonadotropin', 'C': 'Estrogen', 'D': 'Progesterone', 'E': 'Inhibin A'}, | B: Human chorionic gonadotropin |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the emergency department because of worsening shortness of breath and a productive cough for 3 days. He sustained trauma to the right hemithorax during a fight 3 weeks ago. He had significant pain and mild shortness of breath following the incident but did not seek medical care. He does not smoke or drink alcohol. He is a construction worker. His temperature is 38.4°C (101.1°F), pulse is 95/min, respirations are 18/min, and blood pressure is 120/75 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Pulmonary examination shows decreased breath sounds over the right lower lung fields. CT scan of the chest shows fractures of the right 7th and 8th ribs, right pleural splitting and thickening, and a dense fluid collection in the pleural space. Which of the following is the most likely diagnosis?? {'A': 'Viral pleurisy', 'B': 'Lung abscess', 'C': 'Chylothorax', 'D': 'Pleural empyema', 'E': 'Mesothelioma'}, | D: Pleural empyema |
Answer the following medical question with one of the provided options: | Q:A cross-sectional oral health survey was designed to assess both functional and psychosocial effects of dental disease on the elderly population of Buda, Texas (US). Printed surveys that consisted of 50 open-ended questions on dental disease history and dental hygiene were mailed to the selected members of a target population. However, the response rate was not satisfactory, as a large percentage of the selected study participants either did not return the survey or failed to answer all of the questions posed. The researchers opted for 2 strategies: prompt those who did not respond with a second letter that guaranteed complete confidentiality and broaden the pool of selected participants. Depending on the final response rate and the researchers’ statistical skills, the bias in the final publication will be more pronounced if...?? {'A': '....the proportion of nonrespondents from the targeted sample is decreased.', 'B': '...the specific weighting-class adjustments are used on the final data.', 'C': '...the difference between the observed and nonrespondent answers is increased.', 'D': '...the auxiliary population variables are introduced by means of a calibration method.', 'E': '...the imputation techniques for data correction are employed.'}, | C: ...the difference between the observed and nonrespondent answers is increased. |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy is brought to the physician for a follow-up examination. He has a 6-year history of type 1 diabetes mellitus and his only medication is insulin. Seven months ago, he was treated for an episode of diabetic ketoacidosis. He has previously been compliant with his diet and insulin regimen. He wants to join the high school soccer team. Vital signs are within normal limits. His hemoglobin A1C is 6.3%. Which of the following is the most appropriate recommendation at this time?? {'A': 'Advise against physical activity', 'B': 'Lower insulin dosage on days of exercise', 'C': 'Switch from insulin to metformin', 'D': 'Increase insulin dosage on days of exercise', 'E': 'Limit activity to 20 minutes per day'}, | B: Lower insulin dosage on days of exercise |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman comes to the physician because of headaches for 1 month. She describes them as 7 out of 10 in intensity. She has no nausea. Two years ago, she was treated for invasive lobular carcinoma of the left breast. She underwent a left mastectomy and multiple cycles of chemotherapy. She has been in good health since this treatment. Her temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 118/72 mm Hg. There is a well-healed scar on the left side of the chest. There is no lymphadenopathy. The abdomen is soft and nontender; there is no organomegaly. Neurologic examination shows no focal findings. An MRI of the brain shows a 4-cm temporal hyperintense mass near the surface of the brain. Which of the following is the most appropriate next step in management?? {'A': 'Whole brain radiation therapy', 'B': 'Surgical resection', 'C': 'Chemotherapy', 'D': 'Antibiotic therapy', 'E': 'Palliative care'}, | B: Surgical resection |
Answer the following medical question with one of the provided options: | Q:A 44-year-old man presents to his primary care physician due to a shock-like pain in his left leg. He describes the pain as sharp and lasting a few minutes at a time. He has noticed being "clumsy" when walking in a dark room. Approximately 2 weeks ago, he was helping his daughter move and this required him to lift heavy boxes. He denies any trauma to the back or lower back pain. Medical history is significant for hypertension, hyperlipidemia, and type 2 diabetes mellitus. He is currently sexually active and is in a monogamous relationship with his wife. Approximately 15 years ago, he noted a painless genital lesion. On physical exam, there is a miotic pupil that does not constrict with light but constricts with convergence and accommodation. Strength, reflex, and sensory exam of the lower extremity is unremarkable. The patient has a positive Romberg test. Which of the following is most likely the cause of this patient's symptoms?? {'A': 'Acute ischemic cerebellar stroke', 'B': 'Diabetic peripheral neuropathy', 'C': 'Lumbar disc herniation', 'D': 'Lumbar spinal stenosis', 'E': 'Sexually transmitted infection'}, | E: Sexually transmitted infection |
Answer the following medical question with one of the provided options: | Q:The VALIANT trial compared the effect of captopril and valsartan on mortality in patients with myocardial infarction complicated by heart failure. Subjects were randomly assigned to treatment with either captopril or valsartan and subsequently followed for 2 years. The primary endpoint was death from any cause. The study concluded that valsartan was as effective as captopril in patients who are at high risk for cardiac events after an MI. Which of the following describes this type of study?? {'A': 'Randomized controlled trial', 'B': 'Cohort study', 'C': 'Cross-sectional study', 'D': 'Case-control study', 'E': 'Crossover study'}, | A: Randomized controlled trial |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman comes to the physician because of a 3-month history of mild right upper abdominal pain. She has not had any fevers, chills, or weight loss. There is no personal or family history of serious illness. Medications include transdermal estrogen, which she recently started taking for symptoms related to menopause. Abdominal examination shows no abnormalities. Ultrasonography of the liver shows a well-demarcated, homogeneous, hyperechoic mass surrounded by normal liver tissue. A biopsy of the lesion would put this patient at greatest risk for which of the following complications?? {'A': 'Intraperitoneal hemorrhage', 'B': 'Biliary peritonitis', 'C': 'Bacteremia', 'D': 'Metastatic spread', 'E': 'Anaphylactic shock'}, | A: Intraperitoneal hemorrhage |
Answer the following medical question with one of the provided options: | Q:A 33-year-old Honduran woman presents to your clinic with shortness of breath. She reports that her symptoms have progressed over the past several months and are now impacting her quality of life because she cannot complete her usual exercise routine. She recalls "normal" childhood illnesses, including sore throats and fevers, but never required hospitalization. Vital signs are temperature 37 degrees Celsius, blood pressure 110/70 mm Hg, heart rate 109/min, respiratory rate 22/min, and oxygen saturation 98% on room air. Physical exam reveals a holosystolic, high-pitched, blowing murmur at the cardiac apex. One would expect that this murmur would also:? {'A': 'Radiate to the neck', 'B': 'Increase with squatting or handgrip', 'C': 'Increase with inspiration', 'D': 'Also have a mid-systolic click loudest at S2', 'E': 'Have a characteristic machine-like sound'}, | B: Increase with squatting or handgrip |
Answer the following medical question with one of the provided options: | Q:A 73-year-old man dies 4 months after being diagnosed with advanced adenocarcinoma of the colon. Examination of the heart at autopsy shows vegetations lining the mitral valve margins. The vegetations are loosely attached and can be easily scraped off. Microscopic examination shows the vegetations to be composed of interwoven fibrin strands with mononuclear cells. The mitral valve endothelium is intact. Which of the following is the most likely underlying cause of these autopsy findings?? {'A': 'Procoagulant release', 'B': 'Dystrophic calcifications', 'C': 'Antibody cross-reactivity', 'D': 'Bacterial colonization', 'E': 'Metastatic infiltration'}, | A: Procoagulant release |
Answer the following medical question with one of the provided options: | Q:A 22-year-old primigravid woman comes to the physician for her first prenatal visit at 10 weeks' gestation. She has no history of serious illness. She has been using cocaine for the past two years. Without cessation of cocaine use, which of the following complications is most likely to occur?? {'A': 'Premature delivery', 'B': 'Obstructed labor', 'C': 'Congenital heart defect', 'D': 'Neural tube defects', 'E': 'Polyhydramnios'}, | A: Premature delivery |
Answer the following medical question with one of the provided options: | Q:An 18-year-old man comes to the physician because of severe left shoulder pain after a basketball match. During the game, the patient sustained an injury to the posterior part of his outstretched arm after being blocked by a defender. Examination shows no gross deformity of the left shoulder. Palpation of the shoulder elicits mild tenderness. Internal rotation of the arm against resistance shows weakness. These findings are most specific for injury to which of the following muscles?? {'A': 'Supraspinatus', 'B': 'Deltoid', 'C': 'Subscapularis', 'D': 'Infraspinatus', 'E': 'Teres minor'}, | C: Subscapularis |
Answer the following medical question with one of the provided options: | Q:A six-month-old male presents to the pediatrician for a well-child visit. His mother reports that the patient has just started eating solids and sleeps well throughout the night. She notes that she often puts the patient to sleep on his stomach because he seems to breathe more easily in that position. The patient’s mother has noticed that the patient’s breathing becomes more “strained” when lying on his back. She cannot remember when this problem began, but she believes it has gotten worse in recent weeks. The patient was born at 40 weeks gestation and has no other past medical history. The patient’s temperature is 98.0°F (36.7°C), blood pressure is 75/55 mmHg, pulse is 115/min, and respirations are 24/min. His oxygen saturation is 98% on room air. On physical exam, the patient appears comfortable and has inspiratory stridor that improves while leaning forward. His lungs are otherwise clear to auscultation bilaterally. Which of the following is the most likely cause of this patient’s respiratory symptoms?? {'A': 'Epiglottitis', 'B': 'Foreign body aspiration', 'C': 'Laryngomalacia', 'D': 'Laryngotracheitis', 'E': 'Vascular ring'}, | C: Laryngomalacia |
Answer the following medical question with one of the provided options: | Q:A 36-year-old woman comes to the physician because of blurred vision and difficulty keeping her eyes open. She also has occasional difficulty chewing, especially when eating meat or other foods that require prolonged chewing. The symptoms are worse at the end of the day. Physical examination shows bilateral drooping of the eyelids, which becomes more pronounced when she is asked to look upwards for 30 seconds. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Inhibition of calcium release from the sarcoplasmic reticulum', 'B': 'Interrupted transmission of T-tubule depolarization', 'C': 'Sustained blockade of actin myosin-binding sites', 'D': 'Decreased generation of end plate potential', 'E': 'Impaired flow of calcium ions between gap junctions'}, | D: Decreased generation of end plate potential |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man presents to the emergency room for a generalized tonic-clonic seizure. After stabilizing the patient, a full radiologic evaluation reveals multiple contrast-enhancing lesions in the brain, lungs, and liver. According to his wife, he lost several pounds in the last few months. The medical history is relevant for cryptorchidism, with abdominal testes that were surgically transferred to the scrotum just before he turned 1-year old. His lab investigation reveals: α-fetoprotein: 9 ng/mL (normal values < 10 ng/mL) Human chorionic gonadotropin: 1,895 IU/L (normal values < 0.5 IU/L) Which of the following microscopic features best describes the lesions seen in this patient's imaging study?? {'A': 'Glomerulus-like structure with a mesoderm core, a central capillary, and lined with germ cells', 'B': 'Germ cells with well-defined borders, central nuclei, prominent nucleoli, and clear cytoplasm', 'C': 'Cells with hyaline-like globules', 'D': 'Mixture of primitive neuroectoderm, loose mesenchyme, and primitive glandular structures', 'E': 'Intimate association of syncytiotrophoblast and cytotrophoblast cells'}, | E: Intimate association of syncytiotrophoblast and cytotrophoblast cells |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman with type 2 diabetes mellitus comes to the physician because of a 1-year history of progressively worsening paresthesias in her upper limbs. She has accidentally burned her fingers on hot dishes several times. She was involved in a motor vehicle collision 3 years ago. Neurologic examination shows absent temperature sensation with normal fine touch sensation over the upper extremities and chest. Without treatment, this patient is at increased risk of developing which of the following?? {'A': 'Exaggerated biceps reflex', 'B': 'Decreased Mini-Mental State Examination score', 'C': 'Absent anal wink reflex', 'D': 'Drooping of the eyelid', 'E': 'Absent knee-jerk reflex'}, | D: Drooping of the eyelid |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation is admitted to the hospital 30 minutes after spontaneous rupture of membranes. Her pregnancy has been complicated by gestational diabetes treated with insulin. Her first child was delivered vaginally. Her immunizations are up-to-date. She delivers the child via cesarean section without complications after failure to progress for 16 hours. Fourteen hours after birth, she reports having body aches and feeling warm. She has to change her perineal pad every 2–3 hours. She has abdominal cramping, especially when breastfeeding. She has voided her bladder four times since the birth. She appears uncomfortable. Her temperature is 37.9°C (100.2°F), pulse is 85/min, respirations are 18/min, and blood pressure is 115/60 mm Hg. The abdomen is soft, distended, and nontender. There is a healing transverse suprapubic incision without erythema or discharge. A firm, nontender uterine fundus is palpated at the level of the umbilicus. There is bright red blood on the perineal pad. The breasts are engorged and tender, without redness or palpable masses. Which of the following is the most appropriate next step in management?? {'A': 'Dilation and curettage', 'B': 'Pelvic ultrasound', 'C': 'Hysterectomy', 'D': 'Administration of intravenous clindamycin and gentamycin', 'E': 'Observation\n"'}, | E: Observation " |
Answer the following medical question with one of the provided options: | Q:A 45-year-old chronic smoker presents to the physician with a complaint of worsening left shoulder pain for several months which has become acutely worse the past 2 weeks and now radiates down his left arm. Physical examination reveals a palpable 2 x 1.5 cm supraclavicular lymph node along with decreased grip strength in his left hand. Examination of the face reveals partial ptosis of the left eyelid and miosis of the left eye. Laboratory testing shows the following values: Sodium (Na+) 135 mEq/L Potassium (K+) 3.6 mEq/L Chloride (Cl-) 100 mEq/L BUN 12 mg/dL Creatinine (Cr) 0.6 mg/dL Magnesium (Mg2+) 1.5 mg/dL Phosphate 3 mg/dL Calcium (Ca2+) 8.5 mg/dL An X-ray of the chest reveals a soft tissue mass at the apex of the left lung with possible involvement of the first rib. What is the most likely diagnosis?? {'A': 'Pulmonary hamartoma', 'B': 'Mesothelioma', 'C': 'Pancoast tumor', 'D': 'Subclavian aneurysm', 'E': 'Osteophyte'}, | C: Pancoast tumor |
Answer the following medical question with one of the provided options: | Q:A 24-year-old 70 kilogram African-American man with epilepsy refractory to valproic acid, phenytoin, and levetiracetam undergoes magnetic resonance imaging of his brain under monitored anesthetic care. He wakes up screaming in pain due to an electrocardiogram lead having caused a significant thermal burn circumferentially around his left leg. He is admitted to the medical intensive care unit for continuous electroencephalogram monitoring while on a midazolam infusion for seizure suppression and supportive care for his burn. Overnight, the nurse continues to increase the patient's midazolam infusion rate, but she also notices that his left toes are cold to touch with significant edema. His temperature is 100°F (37.8°C), blood pressure is 110/75 mmHg, pulse is 80/min, respirations are 10/min and oxygen saturation is 95% on 2 liters nasal cannula. No dorsalis pedis or posterior tibial pulses are detected on the left lower extremity. A delta pressure of 25 mmHg is obtained in the left leg. What is the best next step in management?? {'A': 'Amputation', 'B': 'Escharotomy', 'C': 'Fasciotomy', 'D': 'Intravenous fluid infusion based on Parkland formula', 'E': 'Transfer to burn center'}, | B: Escharotomy |
Answer the following medical question with one of the provided options: | Q:A 60-year-old African American woman presents to her ophthalmologist with blurry vision. She reports a 2-month history of decreased vision primarily affecting her right eye. Her past medical history is notable for type 1 diabetes and hypertension. She takes insulin and enalapril. She has a 40-pack-year smoking history and drinks a glass of wine at dinner each night. Her family history is notable for glaucoma in her mother and severe diabetes complicated by nephropathy and retinopathy in her father. Her temperature is 99°F (37.2°C), blood pressure is 134/82 mmHg, pulse is 88/min, and respirations are 18/min. On exam, she is well-appearing and in no acute distress. The physician asks the patient to look forward and shines a penlight first in one eye, then the other, alternating quickly to observe the pupillary response to the light. When the light is shined in the right eye, both pupils partially constrict. When the light is shined in the left eye, both pupils constrict further. When the light is moved back to the right eye, both eyes dilate slightly to a partially constricted state. Where is the most likely site of this patient’s lesion?? {'A': 'Ciliary ganglion', 'B': 'Lateral geniculate nucleus', 'C': 'Lens', 'D': 'Oculomotor nerve', 'E': 'Optic nerve'}, | E: Optic nerve |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man with a history of diabetes mellitus presents for a primary care visit. His diabetes is well controlled on metformin, with fasting glucose concentrations between 110–150 mg/dl. His blood pressure on multiple office visits are between 115-130/75-85 mmHg. Today his temperature is 98°F (36.7 °C), blood pressure is 125/80 mmHg, pulse is 86/min, and respirations are 15/min. Labs are obtained with the following results: Hemoglobin A1c: 6.7% Glucose: 120 mg/dl Cholesterol (plasma): 190 mg/dL Urine albumin: 60mg/24hr Which of the following treatments is effective in slowing the progression of the most likely cause of this patient's abnormal albumin result?? {'A': 'No effective treatments', 'B': 'Enalapril', 'C': 'Metformin', 'D': 'Simvastatin', 'E': 'Aspirin'}, | B: Enalapril |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman with a missed menstrual cycle has a positive pregnancy test. The estimated gestational age is 4 weeks. The patient questions the pregnancy test results and mentions that a urinary pregnancy test she took 3 weeks ago was negative. What is the explanation for the patient’s first negative pregnancy test result?? {'A': 'The embryonic liver has not yet developed to produce human chorionic gonadotropin at that term.', 'B': 'The syncytiotrophoblast had not yet developed to produce human chorionic gonadotropin at that term.', 'C': 'Pregnancy test becomes positive during organogenesis so should be expected positive no earlier than at week 4.', 'D': 'Human chorionic gonadotropin starts to be produced by the uterus only after the embryonic implantation which has not yet occurred.', 'E': 'Human chorionic gonadotropin can only be found in the urine after its placental production is started.'}, | B: The syncytiotrophoblast had not yet developed to produce human chorionic gonadotropin at that term. |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man is brought to the emergency department by ambulance after he fainted in the supermarket. He recently had 2 days of gastroenteritis, but did not come to the hospital for treatment. He also recently arrived in Denver for a vacation, but normally lives in Florida. His past medical history is significant for morbid obesity and heavy alcohol use. Arterial blood gas and serum chemistry results are shown below: Sodium: 138 mEq/L Chloride: 121 mEq/L Bicarbonate: 8 mEq/L pH: 7.25 PaCO2: 20 mmHg Which of the following etiologies is most likely responsible for this patient's findings?? {'A': 'Altitude sickness', 'B': 'Diarrhea', 'C': 'Ethanol consumption', 'D': 'Hypoventilation', 'E': 'Vomiting'}, | B: Diarrhea |
Answer the following medical question with one of the provided options: | Q:A 15-year-old boy is brought to the emergency department by his mother because of a 5-hour history of right lower quadrant pain, vomiting, and abdominal distention. Examination shows a palpable mass in the right lower quadrant of the abdomen. An x-ray of the abdomen shows a dilated ascending colon with an air-fluid level in the small intestine. A test is performed in which electrodes are placed on the nasal epithelium and the nose is perfused with several different solutions. When a chloride-free solution is administered, hyperpolarization across the nasal epithelium is absent. Which of the following is the most common cause of mortality in patients with the condition described here?? {'A': 'Liver cirrhosis', 'B': 'Pulmonary embolism', 'C': 'Diabetes mellitus', 'D': 'Pulmonary infection', 'E': 'Nephrolithiasis'}, | D: Pulmonary infection |
Answer the following medical question with one of the provided options: | Q:An 8-year-old boy is brought by his mother to his pediatrician because his urine is tea-colored and his face has appeared puffy for the past 2 days. He suffered a fever and sore throat several weeks ago that was treated with ibuprofen. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, his heart rate is 100/min, the respiratory rate is 22/min, the blood pressure is 130/80 mm Hg, and the temperature is 36.8°C (98.2°F). On physical exam the boy has mild periorbital swelling. A urine dipstick reveals 1+ proteinuria and urinalysis reveals 10–15 red cells/high power field and dysmorphic red cells. The pediatrician is concerned with the child’s hypertension, facial edema, and abnormal urine analysis results. Which of the following best represents the mechanism of this patient’s condition?? {'A': 'Diffuse mesangial IgA deposition', 'B': 'Immune complex deposition', 'C': 'Complement-dependent antibody reaction', 'D': 'Complement-independent reaction', 'E': 'Podocyte injury'}, | B: Immune complex deposition |
Answer the following medical question with one of the provided options: | Q:A 39-year-old man presents to his primary care physician with new onset lower extremity edema, fatigue, and hematuria. His symptoms began approximately 2 weeks prior to presentation and have progressively worsened. Medical history is significant for opioid-use disorder with heroin treated with methadone. He is in a monogamous relationship with a female partner of 4 years and does not use condoms. He denies cigarette smoking, alcohol use, and last used heroin approximately 1 month ago. His temperature is 99°F (37.2°C), blood pressure is 152/98 mmHg, pulse is 83/min, and respirations are 17/min. On physical exam, there is conjunctival pallor, scleral icterus, a 14 cm liver span, acrocyanosis, and lower extremity 2+ pitting edema. Urinalysis demonstrates proteinuria and dysmorphic red blood cells. Laboratory testing reveals a mildly decreased C3 and decreased C4 serum concentration. Which of the following will most likely be present on renal biopsy in this patient?? {'A': 'Apple-green birefringence on Congo red stain', 'B': 'Diffuse mesangial cell proliferation with capillary wall thickening', 'C': 'Enlarged and hypercellular glomeruli', 'D': 'Glomerular basement membrane thinning and splitting', 'E': 'Normal appearing glomerulus'}, | B: Diffuse mesangial cell proliferation with capillary wall thickening |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy presents after suffering a tonic-clonic seizure. He says it had a duration of 2 minutes and a postictal period of 10 minutes. Patient denies any similar episodes in the past. Past medical history is unremarkable. Family history is significant for his mother and older brother who died of colorectal cancer at ages 40 and 20, respectively. On physical examination, the patient is drowsy but arousable and responsive to commands. Both pupils are symmetrical and responsive to light. An MRI of the brain reveals an infratentorial hypointense cerebellar mass with a small cystic area. Which of the following is the most likely diagnosis in this patient?? {'A': 'Peutz-Jeghers syndrome', 'B': 'Lynch syndrome', 'C': 'Gardner syndrome', 'D': 'Turcot syndrome', 'E': 'Cowden syndrome'}, | D: Turcot syndrome |
Answer the following medical question with one of the provided options: | Q:A 2-day-old boy fails to pass meconium for the first 48 hours of life. He was born at term to a healthy 19-year-old woman after an uncomplicated pregnancy. At birth, his weight was 3.9 kg (8.6 lb); at the time of presentation, he weighs 3.8 kg (8.4 lb). His vital signs are as follows: blood pressure 70/50 mm Hg, heart rate 130/min, respiratory rate 33/min, and temperature 37.0℃ (98.6℉). On physical examination, he is fussy and appears mildly dehydrated. Bowel sounds are active on auscultation. His abdomen is mildly distended and no masses can be identified on palpation. The patient’s anus is patent. An upper gastrointestinal study with oral contrast demonstrates normal anatomy. A lower gastrointestinal series with barium enema reveals a large amount of retained barium contrast within a dilated sigmoid colon and a normal appearing rectum. The barium solution retention persisted beyond 24 hours after administration. Which of the following best describes the cause of the patient’s symptoms?? {'A': 'Failure of neural crest cells to migrate caudally to intestinal wall during embryogenesis', 'B': 'Disruption of apoptosis of intestinal cells', 'C': 'Hypertrophy of the muscular layer of the lower sigmoid colon', 'D': 'Propelling of a polyp distally by peristalsis', 'E': 'Decreased blood supply to developing intestine in the embryonic period'}, | A: Failure of neural crest cells to migrate caudally to intestinal wall during embryogenesis |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman with a past medical history of obesity and longstanding GERD presents to the emergency room with chest pain. She describes the pain as central with a sensation of something being stuck in her chest, and this is the third episode in the last month. The prior two incidents occurred at the gym while she was drinking a sport drink and resolved after resting for 3-4 minutes. This episode started after she received news that her father had just had a heart attack at age 69 and has lasted for 15 minutes. The patient also notes several months of intermittent difficulty swallowing but denies palpitations, diaphoresis, or shortness of breath. The patient has a family history of scleroderma in her mother. In the emergency room, her temperature is 98.4°F (36.8°C), blood pressure is 143/82 mmHg, pulse is 89/min, and respirations are 16/min. The patient appears mildly uncomfortable but exam is otherwise unremarkable. Which of the following is the most appropriate confirmatory test for this patient’s condition?? {'A': 'Endoscopy', 'B': 'Esophageal manometry', 'C': 'Barium swallow', 'D': 'EKG', 'E': 'Troponin I'}, | B: Esophageal manometry |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man comes to the physician because of several episodes of crushing substernal chest pain on exertion over the past 6 weeks. The pain occurs when he goes for his morning run and disappears if he slows down to a walk. The patient is concerned because two of his uncles died of myocardial infarction in their early 50s. Physical examination shows yellow plaques on both the palms. An ECG shows no abnormalities. Serum lipid studies show: Total cholesterol 650 mg/dL HDL cholesterol 30 mg/dL VLDL cholesterol 185 mg/dL Triglycerides 800 mg/dL Chylomicron remnants elevated Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Hepatic overproduction of VLDL', 'B': 'Defective apolipoprotein B-100', 'C': 'Decreased apolipoprotein B-48', 'D': 'Decreased apolipoprotein C-II', 'E': 'Defective apolipoprotein E\n"'}, | E: Defective apolipoprotein E " |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman comes to the physician because of a 2-month history of vaginal bleeding after intercourse. Menarche occurred at the age of 13 years and menses occur at regular 28-day intervals. Gynecologic examination shows an irregular lesion at the cervical os. Histological evaluation of a cervical biopsy specimen obtained on colposcopy confirms a diagnosis of in-situ cervical cancer. This cancer is most likely derived from which of the following types of cells?? {'A': 'Simple columnar epithelium with tubular glands', 'B': 'Ciliated simple columnar epithelium', 'C': 'Non-keratinized stratified squamous epithelium', 'D': 'Simple cuboidal epithelium', 'E': 'Keratinized stratified squamous epithelium'}, | C: Non-keratinized stratified squamous epithelium |
Answer the following medical question with one of the provided options: | Q:A 55-year-old college professor with a long-standing history of neuropathic pain presents to a medical clinic with weight loss and early morning awakening for the past several months. She feels as if she has no energy to go about her work. She complains that she is not as focused at work or home as she used to be and finds both her life and work unfulfilling. She has had these symptoms for the past 2 months. She was started on antidepressants in the past, but the antidepressants did not provide any significant improvement. She eventually improved and has been in remission for almost 1 year now. She would really like a simple treatment option to address both her neuropathic pain and her depression, and she is started on a tricyclic antidepressant. What safety advice is most important for this patient’s treatment plan?? {'A': 'The medication can cause serotonin syndrome.', 'B': 'The medication can cause agranulocytosis.', 'C': 'The medication can lower the seizure threshold.', 'D': 'The medication has a very short half-life.', 'E': 'This medication is rarely lethal at high doses.'}, | A: The medication can cause serotonin syndrome. |
Answer the following medical question with one of the provided options: | Q:A 8-month-old girl is brought to the emergency department because of fever, vomiting, and diarrhea for 3 days. Her parents report at least 10 watery stools daily. She has had three upper respiratory tract infections since she started daycare 2 months ago, but has otherwise been developing normally. Her mother has a history of celiac disease. The patient is at the 57th percentile for height and the 65th percentile for weight. Her immunizations are incomplete. Her temperature is 38.5°C (101.3°F), pulse is 145/min, and blood pressure is 92/54 mm Hg. Examination shows dry mucous membranes and decreased skin turgor. Bowel sounds are hyperactive. A complete blood count and serum concentrations of glucose, urea nitrogen, and creatinine are within the reference range; there is hypokalemia. In addition to intravenous fluid resuscitation, which of the following is the most appropriate next step in management?? {'A': 'Sonography of the abdomen', 'B': 'Administration of antidiarrheal medication', 'C': 'Blood cultures', 'D': 'Examination of the stool for ova and parasites', 'E': 'Enzyme immunoassay of stool'}, | E: Enzyme immunoassay of stool |
Answer the following medical question with one of the provided options: | Q:A 5-year-old girl is brought to her pediatrician for vaccinations and a physical. She is a generally healthy child with no thumb on her right hand and a shortened and deformed left thumb. She was born at 39 weeks gestation via spontaneous vaginal delivery and is up to date on all vaccines and meeting all developmental milestones. On physical examination her vital signs are stable. On auscultation of the heart, the pediatrician notes a wide fixed split in the second heart sound (S2) and a medium-pitched systolic ejection murmur at the left sternal border. The murmur is not harsh in quality and is not accompanied by a thrill. Her echocardiogram confirms the diagnosis of acyanotic congenital heart defect with left-to-right shunt. Which of the following genetic syndromes is most consistent d with this girl’s congenital defects?? {'A': 'Alagille syndrome', 'B': 'DiGeorge syndrome', 'C': 'Holt-Oram syndrome', 'D': 'Marfan syndrome', 'E': 'Williams-Beuren syndrome'}, | C: Holt-Oram syndrome |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman presents to the emergency department with pain and frequent urination. She states she has felt uncomfortable with frequent small-volume urinary voids for the past 3 days, which have progressively worsened. The patient has no past medical history. She currently smokes 1 pack of cigarettes per day and engages in unprotected sex with 2 male partners. Her temperature is 103°F (39.4°C), blood pressure is 127/68 mmHg, pulse is 97/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiac, pulmonary, and abdominal exams are within normal limits. There is tenderness upon palpation of the left costovertebral angle and the left flank. Urine is collected and a pregnancy test is negative. Which of the following is the best next step in management?? {'A': 'Abscess drainage and IV antibiotics', 'B': 'Analgesics, encourage oral fluid intake, and discharge', 'C': 'Ceftriaxone and hospital admission', 'D': 'Levofloxacin and outpatient followup', 'E': 'Nitrofurantoin'}, | D: Levofloxacin and outpatient followup |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman presents to the occupational health clinic for a new employee health screening. She has limited medical records prior to her immigration to the United States several years ago. She denies any current illness or significant medical history. Purified protein derivative (PPD) is injected on the inside of her left forearm for tuberculosis (TB) screening. Approximately 36 hours later, the patient comes back to the occupational health clinic and has an indurated lesion with bordering erythema measuring 15 mm in diameter at the site of PPD injection. Of the following options, which is the mechanism of her reaction?? {'A': 'Type I–anaphylactic hypersensitivity reaction', 'B': 'Type II–cytotoxic hypersensitivity reaction', 'C': 'Type III–immune complex-mediated hypersensitivity reaction', 'D': 'Type IV–cell-mediated (delayed) hypersensitivity reaction', 'E': 'Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions'}, | D: Type IV–cell-mediated (delayed) hypersensitivity reaction |
Answer the following medical question with one of the provided options: | Q:A 32-year-old HIV positive female known to be non-adherent to her treatment regimen, presents to the hospital with the complaint of new-onset headaches. Her vital signs are only significant for a low-grade fever. Neurological examination reveals right-sided upper motor neuron signs, as well as a inattention and difficulty with concentration. The patient currently does not have a primary medical provider. A CT of the patients head is shown in the image below. What is the next best step in management for this patient?? {'A': 'Perform a biopsy of the lesion', 'B': 'Perform an analysis for 14-3-3 protein levels', 'C': 'Begin treatment with pyrimethamine-sulfadiazine', 'D': 'Begin treatment with albendazole and corticosteroids', 'E': 'Begin treatment with acyclovir'}, | C: Begin treatment with pyrimethamine-sulfadiazine |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman, gravida 1, para 1, comes to the physician because of difficulty conceiving for one year. She is sexually active with her husband 4–5 times a week. Pregnancy and delivery of her first child 3 years ago were uncomplicated. She returned to work as an event coordinator 12 months ago and has found the transition stressful. Menses previously occurred at 30-day intervals and lasted for 3–4 days with moderate flow. Her last menstrual period was three months ago. She has occasional vaginal dryness. The patient runs 5 to 10 miles every day. Her BMI is 19.0 kg/m2. Her pulse is 73/min and blood pressure is 125/70 mm Hg. Abdominal examination shows no abnormalities. Pelvic examination shows dry vaginal mucosa. A serum pregnancy test is negative. Serum studies show: Prolactin 18 μg/L Thyroid-stimulating hormone 2.5 mU/L Follicle-stimulating hormone 3.6 U/L Luteinizing hormone 2.3 U/L Ultrasound of the pelvis shows no abnormalities. In addition to dietary and exercise counseling, which of the following is the most appropriate next step in management?"? {'A': 'Offer clomiphene citrate therapy', 'B': 'Offer in vitro fertilization', 'C': 'Offer pulsatile gonadotropin-releasing hormone therapy', 'D': 'Offer human chorionic gonadotropin therapy', 'E': 'Obtain MRI of the pituitary gland'}, | C: Offer pulsatile gonadotropin-releasing hormone therapy |
Answer the following medical question with one of the provided options: | Q:A neonate is noted to have very light skin, light blue eyes, and sparse blonde-white hair. The family states that the baby is much lighter in appearance than anyone else in the family. Both parents are Fitzpatrick skin type III with dark brown hair. On further exam, the baby's temperature is 98.4°F (36.9°C), blood pressure is 110/70 mmHg, pulse is 88/min, and respirations are 14/min. The patient is oxygenating well at SpO2 of 97% on room air with no respiratory distress. All reflexes are appropriate, and the APGAR score is 10. A referral is placed with Ophthalmology for a comprehensive eye exam. The condition is believed to be due to an enzyme deficiency, and a hair bulb assay is performed. Which of the following substrates should be incubated with the specimen in order to determine the activity of the enzyme in question for this disease?? {'A': 'Dihydroxyphenylalanine', 'B': 'Dopamine', 'C': 'Homogentisic Acid', 'D': 'Pyridoxine', 'E': 'Tetrahydrobiopterin'}, | A: Dihydroxyphenylalanine |
Answer the following medical question with one of the provided options: | Q:A 2-year-old girl is brought to the emergency room by her parents for seizure-like activity earlier today. Her mother describes that she was napping when both of her arms began to twitch and she started foaming at the mouth. She was unresponsive during this time and the episode lasted a total of 30 seconds. The mother denies any fever, pain, recent trauma, changes in feeding, or gastrointestinal changes in her daughter. She states her daughter has recently been lethargic and is currently receiving antibiotics for an ear infection. The patient was born vaginally at home via a midwife without any complications. A physical examination is unremarkable. Results of her laboratory studies are shown below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 7,600/mm^3 with normal differential Platelet count: 170,000/mm^3 Serum: Na+: 136 mEq/L Cl-: 101 mEq/L K+: 3.9 mEq/L HCO3-: 20 mEq/L BUN: 25 mg/dL Glucose: 34 mmol/L Creatinine: 0.8 mg/dL Thyroid-stimulating hormone: 3.2 µU/mL Ca2+: 9.3 mg/dL AST: 183 U/L ALT: 220 U/L What is the most likely explanation for this patient’s symptoms?? {'A': 'Accumulation of sphingomyelin', 'B': 'Defieincy of myophosphorylase', 'C': 'Infection with Streptococcus pneumoniae', 'D': 'Medium-chain acyl-CoA dehydrogenase deficiency', 'E': 'Primary carnitine deficiency'}, | D: Medium-chain acyl-CoA dehydrogenase deficiency |
Answer the following medical question with one of the provided options: | Q:A first-year medical student is analyzing data in a nationwide cancer registry. She identified a group of patients who had recently undergone surgery for epithelial ovarian cancer and achieved a complete clinical response to chemotherapy. Some of these patients had been scheduled to receive annual abdominal CTs while other patients had not been scheduled for such routine imaging surveillance. The medical student then identified a subgroup of patients who have developed recurrent metastatic disease despite their previous complete clinical response to chemotherapy and surgery. She compared patients who were diagnosed with metastatic cancer during routine follow-up imaging with patients who were diagnosed with metastatic cancer based on clinical symptoms at routine follow-up history and physical exams. She found that the average survival of patients who underwent routine imaging was four months longer than the survival of their peers who were diagnosed based on history and physical exam. Which of the following is a reason why these results should be interpreted with caution?? {'A': 'Observer bias', 'B': 'Lead-time bias', 'C': 'Confounding bias', 'D': 'Length-time bias', 'E': 'Surveillance bias'}, | B: Lead-time bias |
Answer the following medical question with one of the provided options: | Q:A 43-year-old man is brought to the physician for a follow-up examination. He has a history of epilepsy that has been treated with a stable dose of phenytoin for 15 years. He was recently seen by another physician who added a drug to his medications, but he cannot recall the name. Shortly after, he started noticing occasional double vision. Physical examination shows slight vertical nystagmus and gait ataxia. Which of the following drugs was most likely added to this patient's medication regimen?? {'A': 'Modafinil', 'B': 'Nafcillin', 'C': 'Cimetidine', 'D': "St. John's wort", 'E': 'Rifampin'}, | C: Cimetidine |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents to his psychiatrist for continuing cognitive behavioral therapy for bipolar disorder. At this session, he reveals that he has had fantasies of killing his boss because he feels he is not treated fairly at work. He says that he has been stalking his boss and has made detailed plans for how to kill him in about a week. He then asks his psychiatrist not to reveal this information and says that he shared it only because he knew these therapy sessions would remain confidential. Which of the following actions should the psychiatrist take in this scenario?? {'A': "Ask for the patient's permission to share this information and share only if granted", 'B': "Contact the police to warn them about this threat against the patient's wishes", 'C': 'Refer the patient to the ethics board of the hospital that meets in 1 week', 'D': 'Respect patient confidentiality and do not write down this information', 'E': 'Write the information in the note but do not contact the police'}, | B: Contact the police to warn them about this threat against the patient's wishes |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman is admitted to the hospital with headache, photophobia, vomiting without nausea, and fever, which have evolved over the last 12 hours. She was diagnosed with systemic lupus erythematosus at 30 years of age and is on immunosuppressive therapy, which includes oral methylprednisolone. She has received vaccinations—meningococcal and pneumococcal vaccination, as well as BCG. Her vital signs are as follows: blood pressure 125/70 mm Hg, heart rate 82/min, respiratory rate 15/min, and temperature 38.7°C (101.7°F). On examination, her GCS score is 15. Pulmonary, cardiac, and abdominal examinations are within normal limits. A neurologic examination does not reveal focal symptoms. Moderate neck stiffness and a positive Brudzinski’s sign are noted. Which of the following would you expect to note in a CSF sample?? {'A': 'Lymphocytic pleocytosis', 'B': 'Formation of a spiderweb clot in the collected CSF', 'C': 'Haemophilus influenzae growth is the CSF culture', 'D': 'Decrease in CSF protein level', 'E': 'Listeria monocytogenes growth in the CSF culture'}, | E: Listeria monocytogenes growth in the CSF culture |
Answer the following medical question with one of the provided options: | Q:A 45-year-old female presents to the emergency room as a trauma after a motor vehicle accident. The patient was a restrained passenger who collided with a drunk driver traveling approximately 45 mph. Upon impact, the passenger was able to extricate herself from the crushed car and was sitting on the ground at the scene of the accident. Her vitals are all stable. On physical exam, she is alert and oriented, speaking in complete sentences with a GCS of 15. She has a cervical spine collar in place and endorses exquisite cervical spine tenderness on palpation. Aside from her superficial abrasions on her right lower extremity, the rest of her examination including FAST exam is normal. Rapid hemoglobin testing is within normal limits. What is the next best step in management of this trauma patient?? {'A': 'CT cervical spine', 'B': 'Remove the patient’s cervical collar immediately', 'C': 'Discharge home and start physical therapy', 'D': 'Consult neurosurgery immediately', 'E': 'Initiate rapid sequence intubation.'}, | A: CT cervical spine |
Answer the following medical question with one of the provided options: | Q:A 41-year-old man presents to the emergency department with several days of hand tremor, vomiting, and persistent diarrhea. His wife, who accompanies him, notes that he seems very “out of it.” He was in his usual state of health last week and is now having difficulties at work. He has tried several over-the-counter medications without success. His past medical history is significant for bipolar disorder and both type 1 and type 2 diabetes. He takes lithium, metformin, and a multivitamin every day. At the hospital, his heart rate is 90/min, respiratory rate is 17/min, blood pressure is 130/85 mm Hg, and temperature is 37.0°C (98.6°F). The man appears uncomfortable. His cardiac and respiratory exams are normal and his bowel sounds are hyperactive. His lithium level is 1.8 mEq/L (therapeutic range, 0.6–1.2 mEq/L). Which of the following may have contributed to this patient’s elevated lithium level?? {'A': 'Decreased salt intake', 'B': 'Weight loss', 'C': 'Large amounts of caffeine intake', 'D': 'Addition of fluoxetine to lithium therapy', 'E': 'Addition of lurasidone to lithium therapy'}, | A: Decreased salt intake |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents for a routine checkup. He says he has arthralgia in his hands and wrists. No significant past medical history. The patient takes no current medications. Family history is significant for his grandfather who died of liver cirrhosis from an unknown disease. He denies any alcohol use or alcoholism in the family. The patient is afebrile and vital signs are within normal limits. On physical examination, there is bronze hyperpigmentation of the skin and significant hepatomegaly is noted. The remainder of the exam is unremarkable. Which of the following is true about this patient’s most likely diagnosis?? {'A': 'The associated dilated cardiomyopathy is irreversible', 'B': 'The arthropathy is due to iron deposition in the joints.', 'C': 'A hypersensitivity reaction to blood transfusions causes the iron to accumulate', 'D': 'Increased ferritin activity results in excess iron accumulation', 'E': 'A triad of cirrhosis, diabetes mellitus, and skin pigmentation is characteristic'}, | E: A triad of cirrhosis, diabetes mellitus, and skin pigmentation is characteristic |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man comes to the physician because of a 2-month history of upper abdominal pain that occurs immediately after eating. The pain is sharp, localized to the epigastrium, and does not radiate. He reports that he has been eating less frequently to avoid the pain and has had a 4-kg (8.8-lb) weight loss during this time. He has smoked a pack of cigarettes daily for 20 years and drinks 3 beers daily. His vital signs are within normal limits. He is 165 cm (5 ft 5 in) tall and weighs 76.6 kg (169 lb); BMI is 28 kg/m2. Physical examination shows mild upper abdominal tenderness with no guarding or rebound. Bowel sounds are normal. Laboratory studies are within the reference range. This patient is at greatest risk for which of the following conditions?? {'A': 'Malignant transformation', 'B': 'Biliary tract infection', 'C': 'Pyloric scarring', 'D': 'Gastrointestinal hemorrhage', 'E': 'Subhepatic abscess formation'}, | D: Gastrointestinal hemorrhage |
Answer the following medical question with one of the provided options: | Q:A 47-year-old female with a history of poorly controlled type I diabetes mellitus and end-stage renal disease undergoes an allogeneic renal transplant. Her immediate post-operative period is unremarkable and she is discharged from the hospital on post-operative day 4. Her past medical history is also notable for major depressive disorder, obesity, and gout. She takes sertraline, allopurinol, and insulin. She does not smoke or drink alcohol. To decrease the risk of transplant rejection, her nephrologist adds a medication known to serve as a precursor to 6-mercaptopurine. Following initiation of this medication, which of the following toxicities should this patient be monitored for?? {'A': 'Hyperlipidemia', 'B': 'Osteoporosis', 'C': 'Hirsutism', 'D': 'Cytokine storm', 'E': 'Pancytopenia'}, | E: Pancytopenia |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the physician because of coughing and difficulty breathing that started shortly after his mother found him in the living room playing with his older brother's toys. He appears anxious. Respirations are 33/min and pulse oximetry on room air shows an oxygen saturation of 88%. Physical examination shows nasal flaring and intercostal retractions. Auscultation of the lungs shows a high-pitched inspiratory wheeze and absent breath sounds on the right side. There is no improvement in his oxygen saturation after applying a non-rebreather mask with 100% FiO2. Which of the following terms best describes the most likely underlying mechanism of the right lung's impaired ventilation?? {'A': 'Alveolar hyperventilation', 'B': 'Alveolar dead space', 'C': 'Diffusion limitation', 'D': 'Alveolar hypoventilation', 'E': 'Right-to-left shunt'}, | E: Right-to-left shunt |
Answer the following medical question with one of the provided options: | Q:A 26-year-old man undergoing surgical correction of his deviated septum experiences excessive bleeding on the operating room table. Preoperative prothrombin time and platelet count were normal. The patient’s past medical history is significant for frequent blue blemishes on his skin along with easy bruising since he was a child. He indicated that he has some sort of genetic blood disorder running in his family but could not recall any details. Which of the following is the most appropriate treatment for this patient’s most likely condition?? {'A': 'Desmopressin and tranexamic acid', 'B': 'Cryoprecipitate', 'C': 'Fresh frozen plasma', 'D': 'Recombinant factor IX', 'E': 'Red blood cell transfusion'}, | A: Desmopressin and tranexamic acid |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the physician for a routine examination. She has no history of serious medical illness. She appears well. Physical examination shows several hundred pigmented lesions on the back and upper extremities. A photograph of the lesions is shown. The remainder of the examination shows no abnormalities. This patient is at increased risk of developing a tumor with which of the following findings?? {'A': 'Atypical keratinocytes forming keratin pearls', 'B': 'S100-positive epithelioid cells with fine granules', 'C': 'Spindle endothelial cells forming slit-like spaces', 'D': 'Mucin-filled cells with peripheral nuclei', 'E': 'Pale, round cells with palisading nuclei'}, | B: S100-positive epithelioid cells with fine granules |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man comes to the physician because of progressive shortness of breath, exercise intolerance, and cough for the past 6 months. He is no longer able to climb a full flight of stairs without resting and uses 3 pillows to sleep at night. He has a history of using cocaine in his 30s but has not used any illicit drugs for the past 20 years. His pulse is 99/min, respiratory rate is 21/min, and blood pressure is 95/60 mm Hg. Crackles are heard in both lower lung fields. An x-ray of the chest shows an enlarged cardiac silhouette with bilateral fluffy infiltrates and thickening of the interlobar fissures. Which of the following findings is most likely in this patient?? {'A': 'Decreased pulmonary vascular resistance', 'B': 'Decreased lung compliance', 'C': 'Decreased forced expiratory volume', 'D': 'Increased carbon dioxide production', 'E': 'Increased residual volume\n"'}, | B: Decreased lung compliance |
Answer the following medical question with one of the provided options: | Q:A 15-year-old teenager presents for a sports physical. His blood pressure is 110/70 mm Hg, temperature is 36.5°C (97.7°F), and heart rate is 100/min. On cardiac auscultation, an early diastolic heart sound is heard over the cardiac apex while the patient is in the left lateral decubitus position. A transthoracic echocardiogram is performed which shows an ejection fraction of 60% without any other abnormalities. Which of the following is the end-systolic volume in this patient if his cardiac output is 6 L/min?? {'A': '50 mL', 'B': '60 mL', 'C': '100 mL', 'D': '40 mL', 'E': '120 mL'}, | D: 40 mL |
Answer the following medical question with one of the provided options: | Q:A 41-year-old woman presents to her primary care provider reporting abdominal pain. She reports a three-hour history of right upper quadrant sharp pain that started an hour after her last meal. She denies nausea, vomiting, or changes in her bowel habits. She notes a history of multiple similar episodes of pain over the past two years. Her past medical history is notable for type II diabetes mellitus, major depressive disorder, and obesity. She takes glyburide and sertraline. Her temperature is 98.6°F (37°C), blood pressure is 140/85 mmHg, pulse is 98/min, and respirations are 18/min. On examination, she is tender to palpation in her right upper quadrant. She has no rebound or guarding. Murphy’s sign is negative. No jaundice is noted. The hormone responsible for this patient’s pain has which of the following functions?? {'A': 'Increase growth hormone secretion before meals', 'B': 'Increase pancreatic bicarbonate secretion', 'C': 'Promote gallbladder relaxation', 'D': 'Promote migrating motor complexes', 'E': 'Promote relaxation of the sphincter of Oddi'}, | E: Promote relaxation of the sphincter of Oddi |
Answer the following medical question with one of the provided options: | Q:A 1-year-old boy brought in by his mother presents to his physician for a routine checkup. On examination, the child is happy and playful and meets normal cognitive development markers. However, the child’s arms and legs are not meeting development goals, while his head and torso are. The mother states that the boy gets this from his father. Which of the following is the mutation associated with this presentation?? {'A': 'FBN1 gene mutation', 'B': 'Underactivation of FGFR3', 'C': 'GAA repeat', 'D': 'Deletion of DMD', 'E': 'Overactivation of FGFR3'}, | E: Overactivation of FGFR3 |
Answer the following medical question with one of the provided options: | Q:A 33-year-old man is being evaluated for malaise and fatigability. He says that he hasn’t been able to perform at work, can’t exercise like before, and is constantly tired. He also says that his clothes have ‘become larger’ in the past few months. Past medical history is significant for gastroesophageal reflux disease, which is under control with lifestyle changes. His blood pressure is 110/70 mm Hg, the temperature is 37.0°C (98.6°F), the respiratory rate is 17/min, and the pulse is 82/min. On physical examination, an enlarged, painless, mobile, cervical lymph node is palpable. A complete blood count is performed. Hemoglobin 9.0 g/dL Hematocrit 37.7% Leukocyte count 5,500/mm3 Neutrophils 65% Lymphocytes 30% Monocytes 5% Mean corpuscular volume 82.2 μm3 Platelet count 190,000 mm3 Erythrocyte sedimentation rate 35 mm/h C-reactive protein 8 mg/dL A biopsy of the lymph node is performed which reveals both multinucleated and bilobed cells. The patient is started on a regimen of drugs for his condition. Echocardiography is performed before treatment is started and shows normal ejection fraction, ventricle function, and wall motion. After 2 rounds of chemotherapy, another echocardiography is performed by protocol, but this time all heart chambers are enlarged, and the patient is suffering from severe exertion dyspnea. Which of the drugs below is most likely responsible for these side effects?? {'A': 'Adriamycin', 'B': 'Bleomycin', 'C': 'Vinblastine', 'D': 'Dacarbazine', 'E': 'Rituximab'}, | A: Adriamycin |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to the emergency department with severe substernal pain at rest, which radiates to his left arm and jaw. He reports that he has had similar but milder pain several times in the past during strenuous exercise. He had heart transplantation due to dilatory cardiomyopathy 5 years ago with an acute rejection reaction that was successfully treated with corticosteroids. He had been taking 1 mg tacrolimus twice a day for 3.5 years but then discontinued it and had no regular follow-ups. The man does not have a family history of premature coronary artery disease. His blood pressure is 110/60 mm Hg, heart rate is 97/min, respiratory rate is 22/min, and temperature is 37.3°C (99.1°F). On physical examination, the patient is alert, responsive, and agitated. Cardiac auscultation reveals a fourth heart sound (S4) and an irregularly irregular heart rhythm. His ECG shows ST elevation in leads I, II, V5, and V6, and ST depression in leads III and aVF. His complete blood count and lipidogram are within normal limits. The patient’s cardiac troponin I and T levels are elevated. A coronary angiogram reveals diffuse concentric narrowing of all branches of the left coronary artery. What is the most likely causative mechanism of this patient’s cardiac ischemia?? {'A': 'Vasospasm of distal coronary arteries branches', 'B': 'Left ventricular hypertrophy', 'C': 'Obliterative arteriopathy', 'D': 'Increased oxygen demand due to tachycardia', 'E': 'Granulomatous vasculitis of coronary arteries'}, | C: Obliterative arteriopathy |
Answer the following medical question with one of the provided options: | Q:A 24-hour-old neonate girl is brought to the clinic by her mother because of a blue-spotted skin rash. Her mother says she is from a rural area. She did not receive any prenatal care including vaccinations and prenatal counseling. The neonate does not react to sounds or movements, and on physical examination, a continuous murmur is heard over the left upper sternal border on auscultation. Which of the following cardiac findings is most likely in this patient?? {'A': 'Coarctation of the aorta', 'B': 'Mitral valve prolapse', 'C': 'Patent ductus arteriosus', 'D': 'Tetralogy of Fallot', 'E': 'Ventricular septal defect'}, | C: Patent ductus arteriosus |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man comes to the physician because his wife has noticed that his left eye looks smaller than his right. He has had worsening left shoulder and arm pain for 3 months. He has smoked two packs of cigarettes daily for 35 years. Examination shows left-sided ptosis. The pupils are unequal but reactive to light; when measured in dim light, the left pupil is 3 mm and the right pupil is 5 mm. Which of the following is the most likely cause of this patient's ophthalmologic symptoms?? {'A': 'Thrombosis of the cavernous sinus', 'B': 'Aneurysm of the posterior cerebral artery', 'C': 'Dissection of the carotid artery', 'D': 'Compression of the stellate ganglion', 'E': 'Infiltration of the cervical plexus'}, | D: Compression of the stellate ganglion |
Answer the following medical question with one of the provided options: | Q:A 22-year-old male presents to the emergency department after a motor vehicle accident. The patient is conscious and communicating with hospital personnel. He is in pain and covered in bruises and scrapes. The patient was the driver in a head-on motor vehicle collision. The patient's temperature is 99.5°F (37.5°C), pulse is 112/min, blood pressure is 120/70 mmHg, respirations are 18/min, and oxygen saturation is 99% on room air. A full trauma assessment is being performed and is notable for 0/5 strength in the right upper extremity for extension of the wrist. The patient is started on IV fluids and morphine, and radiography is ordered. The patient has bilateral breath sounds, a normal S1 and S2, and no signs of JVD. His blood pressure 30 minutes later is 122/70 mmHg. Which of the following fractures is most likely in this patient?? {'A': 'Humeral neck', 'B': 'Midshaft humerus', 'C': 'Supracondylar', 'D': 'Ulnar', 'E': 'Radial'}, | B: Midshaft humerus |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man comes to the physician because of a 3-month history of diffuse muscle pain, malaise, pain in both knees, recurrent episodes of abdominal and chest pain. He has also had a 5-kg (11-lb) weight loss over the past 4 months. Four years ago, he was diagnosed with chronic hepatitis B infection and was started on tenofovir. There are several ulcerations around the ankle and calves bilaterally. Perinuclear anti-neutrophil cytoplasmic antibodies are negative. Urinalysis shows proteinuria and hematuria. Muscle biopsy shows a transmural inflammation of the arterial wall with leukocytic infiltration and fibrinoid necrosis. Which of the following is the most likely diagnosis?? {'A': 'Giant cell arteritis', 'B': 'Polyarteritis nodosa', 'C': 'Granulomatosis with polyangiitis', 'D': 'Thromboangiitis obliterans', 'E': 'Microscopic polyangiitis'}, | B: Polyarteritis nodosa |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman presents to a physician with complaints of fever, cough, and cold for the last 2 days. She does not have any other symptoms and she has no significant medical history. She has recently started using combined oral contraceptive pills (OCPs) for birth control. On physical examination, the temperature is 38.3°C (101.0°F), the pulse is 98/min, the blood pressure is 122/80 mm Hg, and the respiratory rate is 14/min. The nasal mucosa and pharynx are inflamed, but there is no purulent discharge. Auscultation of the chest does not reveal any abnormalities. She mentions that she has been a heavy smoker for the last 5 years, smoking about 15–20 cigarettes per day. The physician suggests she should discontinue using combined OCPs and choose an alternative contraception method. Which of the following best explains the rationale behind the physician's suggestion?? {'A': 'Smoking inhibits CYP1A2, therefore there is an increased risk of estrogen-related side effects of OCPs', 'B': 'Smoking induces CYP3A4, therefore OCPs would be ineffective', 'C': 'Smoking induces CYP1A2, therefore OCPs would be ineffective', 'D': 'Smoking inhibits CYP3A4, therefore there is an increased risk of progestin-related side effects of OCPs', 'E': 'Smoking is likely to increase the risk of developing deep vein thrombosis and pulmonary embolism in women taking OCPs'}, | E: Smoking is likely to increase the risk of developing deep vein thrombosis and pulmonary embolism in women taking OCPs |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man is brought to the emergency department shortly after sustaining injuries in a building fire. On arrival, he appears agitated and has shortness of breath. Examination shows multiple second-degree burns over the chest and abdomen and third-degree burns over the upper extremities. Treatment with intravenous fluids and analgesics is begun. Two days later, the patient is confused. His temperature is 36°C (96.8°F), pulse is 125/min, and blood pressure is 100/58 mm Hg. Examination shows violaceous discoloration and edema of the burn wounds. His leukocyte count is 16,000/mm3. Blood cultures grow gram-negative, oxidase-positive, non-lactose fermenting rods. The causal organism actively secretes a virulence factor that acts primarily via which of the following mechanisms?? {'A': 'Inhibition of phagocytosis', 'B': 'Overwhelming release of cytokines', 'C': 'Increase in fluid secretion', 'D': 'Inhibition of protein synthesis', 'E': 'Inhibition of neurotransmitter release\n"'}, | D: Inhibition of protein synthesis |
Answer the following medical question with one of the provided options: | Q:A 32-day-old boy is brought to the emergency department because he is found to be febrile and listless. He was born at home to a G1P1 mother without complications, and his mother has no past medical history. On presentation he is found to be febrile with a bulging tympanic membrane on otoscopic examination. Furthermore, he is found to have an abscess around his rectum that discharges a serosanguinous fluid. Finally, the remnants of the umbilical cord are found to be attached and necrotic. Which of the following processes is most likely abnormal in this patient?? {'A': 'Actin remodeling', 'B': 'Antibody class switching', 'C': 'Microtubule organization', 'D': 'Neutrophil migration', 'E': 'Reactive oxygen species production'}, | D: Neutrophil migration |
Answer the following medical question with one of the provided options: | Q:A 37-year-old woman, G1P0, visits her gynecologist’s office for a routine prenatal checkup. During her quadruple screening test, her alpha-fetoprotein levels were increased while the β-hCG and pregnancy-associated plasma protein were decreased. There is also evidence of increased nuchal translucency on the scanning of the male fetus. A confirmatory test indicates signs of a genetic syndrome. The woman is counseled that her child will most likely have a severe intellectual disability. Physical features of this condition include polydactyly, cleft palate, micrognathia and clenched fists. This genetic condition also affects the formation of the brain and can lead to stillbirth. Most babies do not survive beyond the first year of life. Which of the following is responsible for this type of genetic syndrome?? {'A': 'In utero infections', 'B': 'Error in metabolism', 'C': 'Genomic imprinting', 'D': 'Nondisjunction of chromosomes', 'E': 'Autosomal dominant genes'}, | D: Nondisjunction of chromosomes |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy comes to the emergency department because of painful urination and urethral discharge for 3 days. He has multiple sexual partners and only occasionally uses condoms. His vital signs are within normal limits. The result of nucleic acid amplification testing for Neisseria gonorrhoeae is positive. The patient requests that his parents not be informed of the diagnosis. Which of the following initial actions by the physician is most appropriate?? {'A': 'Order urinary PCR testing in two weeks', 'B': 'Perform urethral swab culture for antibiotic sensitivities', 'C': 'Request parental consent prior to prescribing antibiotics', 'D': "Discuss results with patient's primary care physician", 'E': 'Administer intramuscular and oral antibiotics'}, | E: Administer intramuscular and oral antibiotics |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man comes to the emergency department because of fever and productive cough for the past 4 days. During this period, he has had shortness of breath and chest pain that is worse on inspiration. He also reports fatigue and nausea. He has refractory schizophrenia and recurrent asthma attacks. He used to attend college but was expelled after threatening to harm one of his professors 2 months ago. His temperature is 38.5°C (101.3°F), pulse is 90/min, respirations are 20/min, and blood pressure is 120/80 mm Hg. Crackles and bronchial breath sounds are heard on auscultation of the left lung. Laboratory studies show: Hemoglobin 13.5 g/dL Leukocyte count 1,100/mm3 Segmented neutrophils 5% Eosinophils 0% Lymphocytes 93% Monocytes 2% Platelet count 260,000/mm3 Which of the following medications is this patient most likely taking?"? {'A': 'Clozapine', 'B': 'Olanzapine', 'C': 'Haloperidol', 'D': 'Risperidone', 'E': 'Chlorpromazine'}, | A: Clozapine |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman comes to the clinic for blisters on both hands. The patient has a past medical history of asthma, eczema, and a car accident 2 years ago where she sustained a concussion. She also reports frequent transient episodes of blurred vision that clear with artificial tears. When asked about her blisters, the patient claims she was baking yesterday and forgot to take the pan out with oven gloves. Physical examination demonstrates weeping blisters bilaterally concentrated along the palmar surfaces of both hands and decreased pinprick sensation along the arms bilaterally. What is the most likely explanation of this patient’s symptoms?? {'A': 'Brain contusion', 'B': 'Multiple sclerosis', 'C': 'Sjogren syndrome', 'D': 'Syringomyelia at the cervico-thoracic region', 'E': 'Syringomyelia at the lumbar region'}, | D: Syringomyelia at the cervico-thoracic region |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man presents with heartburn for the past couple of weeks. He says he feels a burning sensation in his chest, at times reaching his throat, usually worse after eating spicy foods. He is overweight and actively trying to lose weight. He also has tried other lifestyle modifications for the past couple of months, but symptoms have not improved. He denies any history of cough, difficulty swallowing, hematemesis, or melena. The patient says he often drinks a can of beer in the evening after work and does not smoke. His blood pressure is 124/82 mm Hg, pulse is 72/min and regular, and respiratory rate is 14/min. Abdominal tenderness is absent. Which of the following is the next best step in the management of this patient?? {'A': 'Start omeprazole.', 'B': 'Start sucralfate.', 'C': 'Start famotidine.', 'D': 'Start oral antacids.', 'E': 'H. pylori screening'}, | A: Start omeprazole. |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man is brought to his primary care physician by his wife because she is concerned that he has become more confused over the past month. Specifically, he has been having difficulty finding words and recently started forgetting the names of their friends. She became particularly worried when he got lost in their neighborhood during a morning walk. Finally, he has had several episodes of incontinence and has tripped over objects because he "does not lift his feet off the ground" while walking. He has a history of hypertension and diabetes but has otherwise been healthy. His family history is significant for many family members with early onset dementia. Which of the following treatments would most likely be effective for this patient?? {'A': 'Better control of diabetes and hypertension', 'B': 'Galantamine', 'C': 'Placement of shunt', 'D': 'Selegiline', 'E': 'Tetrabenazine'}, | C: Placement of shunt |
Answer the following medical question with one of the provided options: | Q:A 65-year-old veteran with a history of hypertension, diabetes, and end-stage renal disease presents with nausea, vomiting, and abdominal pain. The patient was found to have a small bowel obstruction on CT imaging. He is managed conservatively with a nasogastric tube placed for decompression. After several days in the hospital, the patient’s symptoms are gradually improving. Today, he complains of left leg swelling. On physical exam, the patient has a swollen left lower extremity with calf tenderness on forced dorsiflexion of the ankle. An ultrasound confirms a deep vein thrombus. An unfractionated heparin drip is started. What should be monitored to adjust heparin dosing?? {'A': 'Prothrombin time', 'B': 'Activated partial thromboplastin time', 'C': 'Internationalized Normal Ratio (INR)', 'D': 'Creatinine level', 'E': 'Liver transaminase levels'}, | B: Activated partial thromboplastin time |
Answer the following medical question with one of the provided options: | Q:A 30-year-old gravida 2 para 2 presents to a medical clinic to discuss contraception options. She had a normal vaginal delivery of a healthy baby boy with no complications 2 weeks ago. She is currently doing well and is breastfeeding exclusively. She would like to initiate a contraceptive method other than an intrauterine device, which she tried a few years ago, but the intrauterine device made her uncomfortable. The medical history includes migraine headaches without aura, abnormal liver function with mild fibrosis, and epilepsy as a teenager. She sees multiple specialists due to her complicated history, but is stable and takes no medications. There is a history of breast cancer on the maternal side. On physical examination, the temperature is 36.5°C (97.7°F), the blood pressure is 150/95 mm Hg, the pulse is 89/min, and the respiratory rate is 16/min. After discussing the various contraceptive methods available, the patient decides to try combination oral contraceptive pills. Which of the following is an absolute contraindication to start the patient on combination oral contraceptive pills?? {'A': 'Breastfeeding', 'B': 'History of epilepsy', 'C': 'Elevated blood pressure', 'D': 'Mild liver fibrosis', 'E': 'Migraine headaches'}, | A: Breastfeeding |
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