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Answer the following medical question with one of the provided options:
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Q:A 31-year-old African American woman with a history of Addison's disease presents with widespread, symmetric hypopigmented patches and macules overlying her face and shoulders. After a thorough interview and using a Wood’s lamp to exclude fungal etiology, vitiligo is suspected. Complete blood count shows leukocytes 6,300, Hct 48.3%, Hgb 16.2 g/dL, mean corpuscular volume (MCV) 90 fL, and platelets 292. Which of the statements below about this patient’s suspected disease is correct?? {'A': 'The course usually is slowly progressive with spontaneous repigmentation in 15% of patients.', 'B': 'The disease is relapsing and remitting with complete interval repigmentation.', 'C': 'Keloid formation is associated with regions of depigmentation.', 'D': 'Vitiligo is self-limited and will resolve in 8-14 weeks.', 'E': 'Topical corticosteroids are inappropriate for patients with limited disease.'},
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A: The course usually is slowly progressive with spontaneous repigmentation in 15% of patients.
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman comes to the physician for a follow-up examination after a Pap smear showed atypical squamous cells. A colposcopy-directed biopsy of the cervix shows evidence of squamous cell carcinoma. The malignant cells from this lesion are most likely to drain into which of the following group of lymph nodes?? {'A': 'Internal iliac', 'B': 'Right supraclavicular', 'C': 'Inferior mesenteric', 'D': 'Superficial inguinal', 'E': 'Left supraclavicular'},
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A: Internal iliac
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old G2P1001 presents to her obstetrician’s office complaining of dyspareunia. She endorses ongoing vaginal dryness resulting in uncomfortable intercourse over the last month. In addition, she has noticed a gritty sensation in her eyes as well as difficulty tasting food and halitosis. She denies pain with urination and defecation. Her medications include a daily multivitamin, folic acid, and over-the-counter eye drops. The patient’s temperature is 98.6°F (37.0°C), pulse is 70/min, blood pressure is 121/80 mmHg, and respirations are 13/min. Physical exam is notable for a well-appearing female with fullness in the bilateral cheeks and reduced salivary pool. For which of the following is the patient’s fetus at increased risk?? {'A': 'Macrosomia', 'B': 'Neonatal hypoglycemia', 'C': 'Heart block', 'D': 'Pulmonary hypertension', 'E': 'Meconium aspiration'},
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C: Heart block
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Answer the following medical question with one of the provided options:
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Q:A healthy mother gives birth to a child at 40 weeks of gestation. On examination, the child has ambiguous genitalia. A karyotype analysis reveals the presence of a Y chromosome. Additional workup reveals the presence of testes and a normal level of serum luteinizing hormone (LH) and testosterone. Which of the following is the most likely cause of this patient’s condition?? {'A': 'Androgen receptor deficiency', 'B': 'Failed migration of neurons producing gonadotropin releasing hormone (GnRH)', 'C': 'Presence of two X chromosomes', 'D': '5-alpha reductase deficiency', 'E': 'Aromatase deficiency'},
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D: 5-alpha reductase deficiency
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man who was recently placed on TMP-SMX for a urinary tract infection presents to urgent care with a new rash. The vital signs include: blood pressure 121/80 mm Hg, pulse 91/min, respiratory rate 18/min, and temperature 36.7°C (98.2°F). Physical examination reveals a desquamative skin covering both of his lower extremities. A basic chemistry panel reveal sodium 139 mmol/L, potassium 3.8 mmol/L, chloride 110 mmol/L, carbon dioxide 47, blood urea nitrogen 23 mg/dL, creatinine 0.9 mg/dL, and glucose 103 mg/dL. Which of the following is the most likely diagnosis?? {'A': 'Dermatitis herpetiformis', 'B': 'Steven-Johnson syndrome (SJS)', 'C': 'Seborrheic dermatitis', 'D': 'Atopic dermatitis', 'E': 'Toxic epidermal necrolysis (TEN)'},
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E: Toxic epidermal necrolysis (TEN)
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man with a history of type I diabetes presents to the emergency room in respiratory distress. His respirations are labored and deep, and his breath odor is notably fruity. Which of the following laboratory results would you most expect to find in this patient?? {'A': 'Increased serum HCO3-', 'B': 'Decreased serum H+', 'C': 'Decreased urine H+', 'D': 'Increased urine HCO3-', 'E': 'Increased urine H2PO4-'},
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E: Increased urine H2PO4-
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old boy presents to the ED with a one day history of severe right eye pain accompanied by nausea, vomiting, and headache. He is afebrile and he appears to be alert despite being irritable. Three days ago an ophthalmologist prescribed eye drops for his right eye but his parents do not know the name of the medication. On exam, his right eye is hard to palpation and moderately dilated. His left eye is unremarkable. What is the mechanism of action of the medication that most likely provoked this acute presentation?? {'A': 'Muscarinic antagonist inhibiting pupillary sphincter muscle contraction', 'B': 'Iris neovascularization', 'C': 'M3 agonist causing ciliary muscle contraction', 'D': 'Agonist of prostaglandin F receptor increasing aqueous fluid production', 'E': 'Alpha-adrenergic agonist increasing aqueous fluid production'},
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A: Muscarinic antagonist inhibiting pupillary sphincter muscle contraction
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman presents to the clinic complaining of a 9-month history of weight loss, fatigue, and a general sense of malaise. She additionally complains of an unusual sensation in her chest upon rapidly rising from a supine to a standing position. Current vitals include a temperature of 36.8°C (98.2°F), pulse of 72/min, blood pressure of 118/63 mm Hg, and a respiratory rate of 15/min. Her BMI is 21 kg/m2. Auscultation demonstrates an early-mid diastole low-pitched sound at the apex of the heart. A chest X-ray reveals a poorly demarcated abnormality in the heart and requires CT imaging for further analysis. What would most likely be seen on CT imaging?? {'A': 'Tumor within the right atria', 'B': 'Fistula between the right and left atria', 'C': 'Normal cardiac imaging', 'D': 'Tumor within the left atria', 'E': 'Connection between the pulmonary artery and aorta'},
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D: Tumor within the left atria
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man presents to the physician with fever and malaise for 4 days. He has headaches and joint pain. A pruritic rash appeared on the trunk yesterday. He had blood in his ejaculate twice. His hearing has become partially impaired. There is no history of serious illnesses or the use of medications. Ten days ago, he traveled to Brazil where he spent most of the time outdoors in the evenings. He did not use any control measures for mosquito bites. His temperature is 38.2℃ (100.8℉); the pulse is 88/min; the respiratory rate is 13/min, and the blood pressure is 125/60 mm Hg. Conjunctival suffusion is noted. A maculopapular rash is present over the trunk and proximal extremities without the involvement of the palms or soles. Several joints of the hands are tender to palpation. The abdomen is soft with no organomegaly. A peripheral blood smear shows no pathogenic organisms. Which of the following is the most likely diagnosis?? {'A': 'Chagas disease', 'B': 'Malaria', 'C': 'Rocky Mountain spotted fever', 'D': 'Whipple’s disease', 'E': 'Zika virus disease'},
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E: Zika virus disease
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old Japanese female presents with flu-like symptoms and weak pulses in her upper extremities. An angiogram reveals granulomatous inflammation of the aortic arch. Which of the following disease processes is most similar to this patient's disease?? {'A': 'Temporal arteritis', 'B': 'Polyarteritis nodosa', 'C': 'Kawasaki disease', 'D': "Buerger's disease", 'E': 'Infectious vasculitis'},
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A: Temporal arteritis
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Answer the following medical question with one of the provided options:
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Q:A 3-month-old girl is brought to the emergency department in respiratory distress after her parents noticed that she was having difficulty breathing. They say that she developed a fever 2 days ago and subsequently developed increasing respiratory difficulty, lethargy, and productive cough. On presentation, her temperature is 103°F (39.5°C), blood pressure is 84/58 mmHg, pulse is 141/min, and respirations are 48/min. Physical exam reveals subcostal retractions and consolidation in the right lower lung field. She is also found to have coarse facial features and restricted joint movement. Serum laboratory tests reveal abnormally elevated levels of lysosomal enzymes circulating in the blood. The enzyme that is most likely defective in this patient has which of the following substrates?? {'A': 'Ceremide', 'B': 'Dermatan sulfate', 'C': 'Galactocerebroside', 'D': 'Mannose', 'E': 'Sphingomyelin'},
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D: Mannose
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician because of a 4-month history of intermittent lower abdominal cramps associated with diarrhea, bloating, and mild nausea. During this period, she has had a 5-kg (11-lb) weight loss. She feels like she cannot fully empty her bowels. She has no history of serious illness. She has a high-fiber diet. Her father is of Ashkenazi Jewish descent. She appears well. Her temperature is 36.9°C (98.5°F), pulse is 90/min, and blood pressure is 130/90 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Abdominal examination shows mild tenderness to palpation in the right lower quadrant without guarding or rebound. Bowel sounds are normal. Test of the stool for occult blood is negative. Her hemoglobin concentration is 10.5 g/dL, leukocyte count is 12,000 mm3, platelet count is 480,000 mm3, and erythrocyte sedimentation rate is 129 mm/h. A barium enema shows ulceration and narrowing of the right colon. Which of the following is the most likely diagnosis?? {'A': 'Ulcerative colitis', 'B': 'Celiac disease', 'C': 'Intestinal carcinoid tumor', 'D': 'Crohn disease', 'E': 'Diverticulitis\n"'},
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D: Crohn disease
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man with dilated cardiomyopathy is admitted to the cardiac care unit (CCU) because of congestive heart failure exacerbation. A medical student wants to determine the flow velocity across the aortic valve. She estimates the cross-sectional area of the valve is 5 cm2and the volumetric flow rate is 55 cm3/s. Which of the following best represents this patient's flow velocity across the aortic valve?? {'A': '0.009 m/s', 'B': '0.0009 m/s', 'C': '2.75 m/s', 'D': '0.11 m/s', 'E': '0.09 m/s'},
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D: 0.11 m/s
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman, gravida 2, para 1, at 10 weeks' gestation comes to the emergency department for vaginal bleeding, cramping lower abdominal pain, and dizziness. She also has had fevers, chills, and foul-smelling vaginal discharge for the past 2 days. She is sexually active with one male partner, and they use condoms inconsistently. Pregnancy and delivery of her first child were uncomplicated. She appears acutely ill. Her temperature is 38.9°C (102°F), pulse is 120/min, respirations are 22/min, and blood pressure is 88/50 mm Hg. Abdominal examination shows moderate tenderness to palpation over the lower quadrants. Pelvic examination shows a tender cervix that is dilated with clots and a solid bloody mass within the cervical canal. Her serum β-human chorionic gonadotropin concentration is 15,000 mIU/mL. Pelvic ultrasound shows an intrauterine gestational sac with absent fetal heart tones. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous clindamycin and gentamicin followed by oral misoprostol', 'B': 'Oral clindamycin followed by outpatient follow-up in 2 weeks', 'C': 'Intravenous clindamycin and gentamicin followed by suction and curettage', 'D': 'Intravenous clindamycin and gentamycin followed by close observation', 'E': 'Oral clindamycin followed by suction curettage'},
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C: Intravenous clindamycin and gentamicin followed by suction and curettage
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl presents to the family doctor with fever, headache, sore throat, dry cough, myalgias, and weakness. Her symptoms began acutely 2 days ago. On presentation, her blood pressure is 110/80 mm Hg, heart rate is 86/min, respiratory rate is 18/min, and temperature is 39.0°C (102.2°F). Physical examination reveals conjunctival injection and posterior pharyngeal wall erythema. Rapid diagnostic testing of a throat swab for influenza A+B shows positive results. Which of the following statements is true regarding the process of B cell clonal selection and the formation of specific IgG antibodies against influenza virus antigens in this patient?? {'A': 'The first event that occurs after B lymphocyte activation is V(D)J recombination.', 'B': 'During antibody class switching, variable region of antibody heavy chain changes, and the constant one stays the same.', 'C': 'Deletions are the most common form of mutations that occur during somatic hypermutation in this patient’s B cells.', 'D': 'V(D)J recombination results in the formation of a B cell clone, which produces specific antibodies against influenza virus antigens.', 'E': 'After somatic hypermutation, only a small amount of B cells antigen receptors have increased affinity for the antigen.'},
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E: After somatic hypermutation, only a small amount of B cells antigen receptors have increased affinity for the antigen.
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old man comes to the physician because of a whistling sound during respiration for the past 3 weeks. He reports that the whistling is becoming louder, and is especially loud when he exercises. He says the noise is frustrating for him. Six months ago, the patient underwent outpatient treatment for an uncomplicated nasal fracture after being hit in the nose by a high-velocity stray baseball. Since the accident, the patient has been taking aspirin for pain. He has a history of asymptomatic nasal polyps. His temperature is 37°C (98.6°F), pulse is 70/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Which of the following would have prevented the whistling during respiration?? {'A': 'Nasal septal hematoma drainage', 'B': 'Nasal polyp removal', 'C': 'Antibiotic therapy', 'D': 'Rhinoplasty', 'E': 'Septoplasty'},
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A: Nasal septal hematoma drainage
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old boy with behavioral changes is brought in by his concerned parents. The patient’s parents say that he has been acting very odd and having difficulty academically for the past 4 months. The patient says that he has been worried and distracted because he is certain the government is secretly recording him although he cannot provide a reason why. He mentions that he does feel depressed sometimes and no longer gets joy out of playing the guitar and his other previous activities. He has no significant past medical history. The patient denies any history of smoking, alcohol consumption, or recreational drug use. He is afebrile, and his vital signs are within normal limits. Physical examination is unremarkable. On mental status examination, the patient is slightly disheveled and unkempt. He has a disorganized monotonous speech pattern. He expresses tangential thinking and has a flat affect. During the exam, it is clear that he suffers from auditory hallucinations. Which of the following is the most likely diagnosis in this patient?? {'A': 'Brief psychotic disorder', 'B': 'Schizophreniform disorder', 'C': 'Schizophrenia', 'D': 'Schizoaffective disorder', 'E': 'Schizotypal personality disorder'},
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B: Schizophreniform disorder
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Answer the following medical question with one of the provided options:
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Q:A 1-month-old boy is brought to the emergency department by his parents for recent episodes of non-bilious projectile vomiting and refusal to eat. The boy had no problem with passing meconium or eating at birth; he only started having these episodes at 3 weeks old. Further history reveals that the patient is a first born male and that the boy’s mother was treated with erythromycin for an infection late in the third trimester. Physical exam reveals a palpable mass in the epigastrum. Which of the following mechanisms is likely responsible for this patient’s disorder?? {'A': 'Defect of lumen recanalization', 'B': 'Hypertrophy of smooth muscle', 'C': 'Intestinal vascular accident', 'D': 'Neural crest cell migration failure', 'E': 'Pancreatic fusion abnormality'},
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B: Hypertrophy of smooth muscle
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents with difficulty breathing and blurred vision in the left eye. No significant past medical history or current medications. He has had more than 6 sexual partners (both men and women) and did not use any form of protection during sexual intercourse. No significant family history. Upon physical examination, the patient has crackles in all lobes bilaterally. Ophthalmologic exam reveals a single white lesion in the left eye with an irregular, feathery border, as well as evidence of retinal edema and necrosis. A rapid HIV test is positive. What is the mechanism of action of the drug that can be given to treat the ocular symptoms in this patient?? {'A': 'Blocks CCR5 receptor preventing viral entry', 'B': 'Guanosine analog that preferably inhibits viral DNA polymerase', 'C': 'A neuraminidase inhibitor preventing release of viral progeny', 'D': 'Prevents viral uncoating', 'E': 'Inhibits A-site tRNA binding during translation'},
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B: Guanosine analog that preferably inhibits viral DNA polymerase
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy is brought to the emergency department by ambulance due to difficulty breathing. On presentation he is found to be straining to breathe. Physical exam reveals bilateral prolonged expiratory wheezing, difficulty speaking, and belly breathing. Radiographs also reveal hyperinflation of the lungs. He is given oxygen as well as albuterol, which begins to reverse the flow limitation in the airway segments of this patient. The airway segment that is most susceptible to this type of flow limitation has which of the following characteristics?? {'A': 'Contains c-shaped hyaline cartilage rings', 'B': 'Contains mucous producing goblet cells', 'C': 'Distal most extent of smooth muscle', 'D': 'Lined by only simple cuboidal cells', 'E': 'Lined by type I and type II pneumocytes'},
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C: Distal most extent of smooth muscle
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man comes to the physician because of a 3-month history of fatigue, polyuria, and blurry vision. His BMI is 33 kg/m2 and his blood pressure is 147/95 mm Hg. Laboratory studies show a serum glucose concentration of 192 mg/dL and hemoglobin A1c concentration of 7.2%. Urinalysis shows 1+ glucose, 1+ protein, and no ketones. Which of the following is the most appropriate pharmacotherapy to prevent cardiovascular disease in this patient?? {'A': 'Lisinopril therapy', 'B': 'Sleeve gastrectomy', 'C': 'Aspirin therapy', 'D': 'Insulin therapy', 'E': 'Gemfibrozil therapy'},
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A: Lisinopril therapy
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Answer the following medical question with one of the provided options:
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Q:Background and Methods: Aldosterone is important in the pathophysiology of heart failure. In a double-blind study, we enrolled 1,663 patients who had NYHA class III or IV heart failure, a left ventricular ejection fraction of no more than 35%, and who were being treated with an angiotensin-converting-enzyme inhibitor, a loop diuretic, and in most cases digoxin. A total of 822 patients were randomly assigned to receive 25 mg of spironolactone daily and 841 to receive placebo. The primary endpoint was death from all causes. Results: The trial was discontinued early, after a mean follow-up period of 24 months, because an interim analysis determined that spironolactone was efficacious. There were 386 deaths in the placebo group (46%) and 284 in the spironolactone group (35%; relative risk of death, 0.70; 95% confidence interval, 0.60 to 0.82; P<0.001). This 30% reduction in the risk of death among patients in the spironolactone group was attributed to a lower risk of both death from progressive heart failure and sudden death from cardiac causes. The frequency of hospitalization for worsening heart failure was 35% lower in the spironolactone group than in the placebo group (relative risk of hospitalization, 0.65; 95% confidence interval, 0.54 to 0.77; P<0.001). In addition, patients who received spironolactone had a significant improvement in the symptoms of heart failure, as assessed on the basis of the New York Heart Association functional class (P<0.001). Gynecomastia or breast pain was reported in 10% of men who were treated with spironolactone, as compared with 1 percent of men in the placebo group (P<0.001). The incidence of serious hyperkalemia was minimal in both groups of patients. To which of the following patients are the results of this clinical trial applicable?? {'A': 'An 82-year-old female with NYHA class II heart failure with an LVEF of 22%, taking lisinopril, furosemide, and digoxin', 'B': 'A 65-year-old male with newly diagnosed NYHA class IV heart failure and a LVEF of 21%, about to begin medical therapy', 'C': 'A 56-year-old male with NYHA class III heart failure with an LVEF of 32%, current taking lisinopril, furosemide, and digoxin', 'D': 'An 86-year-old female recently found to have an LVEF of 34%, currently taking furosemide and carvedilol', 'E': 'A 78-year-old male with NYHA class II heart failure and LVEF 36%'},
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C: A 56-year-old male with NYHA class III heart failure with an LVEF of 32%, current taking lisinopril, furosemide, and digoxin
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents for an annual checkup. He has no complaints at the moment of presentation. He was diagnosed with diabetes mellitus a year ago and takes metformin 1000 mg per day. The patient also has a history of postinfectious myocarditis that occurred 15 years ago with no apparent residual heart failure. His family history is unremarkable. He has a 15-pack-year history of smoking, but he currently does not smoke. He is a retired weightlifting athlete who at the present works as a coach and continues to work out. His BMI is 29 kg/m2. The blood pressure is 120/85 mm Hg, heart rate is 85/min, respiratory rate is 14/min, and temperature is 36.6℃ (97.9℉). Physical examination is only remarkable for an increased adiposity. The ECG is significant for increased R amplitude in leads I, II, and V3-6 and an incomplete left bundle branch block. Which of the following is most likely included in the treatment regimen of this patient?? {'A': 'No management is required since the patient is asymptomatic', 'B': 'Diltiazem', 'C': 'Amlodipine', 'D': 'Furosemide', 'E': 'Fosinopril'},
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E: Fosinopril
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old male presents to the emergency department after falling from his scooter. The patient reports that he fell sideways off the scooter as he rounded a curve in the road, and he describes dull, aching pain along his left side where he hit the ground. The patient’s parents report that he has never had any serious injury but that he has always seemed to bruise easily, especially after he started playing youth soccer this fall. His parents deny that he has ever had nosebleeds or bleeding from the gums, and they have never seen blood in his stool or urine. His mother notes that her brother has had similar problems. On physical exam, the patient has extensive bruising of the lateral left thigh and tenderness to palpation. Laboratory tests are performed and reveal the following: Hemoglobin: 14 g/dL Hematocrit: 41% Mean corpuscular volume: 89 µm3 Reticulocyte count: 0.8% Leukocyte count: 4,700/mm3 Prothrombin time (PT): 13 seconds Partial thromboplastin time (PTT): 56 seconds Bleeding time (BT): 4 minutes Which of the following is the most likely underlying pathophysiology of this patient's presentation?? {'A': 'Factor VIII deficiency', 'B': 'Factor IX deficiency', 'C': 'Factor VIII antigen deficiency', 'D': 'GP1b deficiency', 'E': 'Anti-platelet antibodies'},
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A: Factor VIII deficiency
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man comes to the physician because of fever, malaise, cough, and shortness of breath for 2 months. He has had a 4-kg (9-lb) weight loss during the same period. He works at a flour mill and does not smoke cigarettes. His temperature is 38.1°C (100.6°F) and pulse oximetry shows 95% on room air. Diffuse fine crackles are heard over both lung fields. A chest x-ray shows patchy reticulonodular infiltrates in the mid and apical lung fields bilaterally. A photomicrograph of a lung biopsy specimen is shown. Which of the following cytokines have the greatest involvement in the pathogenesis of the lesion indicated by the arrow?? {'A': 'Tumor necrosis factor alpha and interleukin-4', 'B': 'Interferon gamma and interleukin-2', 'C': 'Interferon alpha and interleukin-1', 'D': 'Interleukin-4 and interleukin-10', 'E': 'Transforming growth factor beta and interleukin-12'},
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B: Interferon gamma and interleukin-2
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Answer the following medical question with one of the provided options:
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Q:A group of investigators is examining the effect of the drug orlistat as an adjunct therapy to lifestyle modification on weight loss in obese volunteers. 800 obese participants were randomized to receive orlistat in addition to counseling on lifestyle modification and 800 obese participants were randomized to receive counseling on lifestyle modification alone. At the conclusion of the study, the investigators found that patients who underwent combined therapy lost a mean of 8.2 kg (18.1 lb), whereas patients counseled on lifestyle modification alone lost a mean of 4.3 kg (9.5 lb) (p < 0.001). The investigators also observed that of the 120 participants who did not complete the study, 97 participants were in the lifestyle modification group and 23 participants were in the combination group. Based on this information, the investigators should be most concerned about which of the following?? {'A': 'Error in randomization', 'B': 'Lead-time bias', 'C': 'Attrition bias', 'D': 'Nonresponse bias', 'E': 'Confounding bias'},
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C: Attrition bias
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Answer the following medical question with one of the provided options:
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Q:A 14-year-old girl is brought to the physician because of a 1-week history of malaise and chest pain. Three weeks ago, she had a sore throat that resolved without treatment. Her temperature is 38.7°C (101.7°F). Examination shows several subcutaneous nodules on her elbows and wrist bilaterally and a new-onset early systolic murmur best heard at the apex in the left lateral position. An endomysial biopsy is most likely to show which of the following?? {'A': 'Coagulative necrosis with neutrophilic infiltrate', 'B': 'Fibrinoid necrosis with histiocytic infiltrate', 'C': 'Deposits of misfolded protein aggregates', 'D': 'Myocardial infiltration with eosinophilic proteins', 'E': 'Fibrosis with myofibrillar disarray'},
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B: Fibrinoid necrosis with histiocytic infiltrate
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Answer the following medical question with one of the provided options:
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Q:A study of a new antihypertensive drug that affects glomerular filtration rate is being conducted. Infusion of drug X causes constriction of the efferent arteriole. After infusion of the drug, the following glomerular values are obtained from an experimental subject: hydrostatic pressure of the glomerular capillary (PGC) of 48 mm Hg, oncotic pressure of the glomerular capillary (πGC) of 23 mm Hg, hydrostatic pressure of Bowman’s space (PBS) of 10 mm Hg, and oncotic pressure of Bowman’s space (πBS) of 0 mm Hg. Which of the following best measures net filtration pressure in this participant?? {'A': '15 mm Hg', 'B': '35 mm Hg', 'C': '61 mm Hg', 'D': '0 mm Hg', 'E': '81 mm Hg'},
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A: 15 mm Hg
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman comes to the physician because of worsening mental status over the past month. Her husband reports that she was initially experiencing lapses in memory but has recently started having difficulties performing activities of daily living. She appears withdrawn and avoids eye contact. Examination shows diffuse involuntary muscle jerking that can be provoked by loud noises. A cerebrospinal fluid analysis shows elevated concentration of 14-3-3 protein. Four months later, the patient dies. Pathologic examination of the brain on autopsy is most likely to show which of the following findings?? {'A': 'Degeneration of the substantia nigra pars compacta', 'B': 'Marked atrophy of caudate and putamen', 'C': 'Focal inflammatory demyelination and gliosis', 'D': 'Deposits of amyloid beta peptides', 'E': 'Spongiform vacuolation of the cortex'},
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E: Spongiform vacuolation of the cortex
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man comes to the physician because of fatigue and nausea for 1 week. Over the past six months, he has had to get up twice every night to urinate. Occasionally, he has had discomfort during urination. He has arterial hypertension. His father died of renal cell carcinoma. Current medications include ramipril. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 124/78 mm Hg. The abdomen is soft and nontender. Cardiac and pulmonary examinations show no abnormalities. Rectal examination shows a symmetrically enlarged and smooth prostate. Serum studies show: Hemoglobin 14.9 g/dL Leukocyte count 7500/mm3 Platelet count 215,000/mm3 Serum Na+ 136 mEq/L Cl- 101 mEq/L K+ 4.9 mEq/L HCO3- 23 mEq/L Glucose 95 mg/dL Urea nitrogen 25 mg/dL Creatinine 1.9 mg/dL PSA 2.1 ng/mL (normal <4 ng/mL) Urine Blood negative Protein 1+ Glucose negative RBC casts negative Which of the following is the most appropriate next step in management?"? {'A': 'Four-glass test', 'B': 'CT scan of the abdomen and pelvis', 'C': 'Transrectal ultrasonography', 'D': 'Renal ultrasonography', 'E': 'Ureteral stenting'},
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D: Renal ultrasonography
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man comes to the physician because of right-sided painless scrotal swelling that he noticed yesterday while taking a shower. He is currently sexually active with two female partners and uses condoms inconsistently. He immigrated to the US from Argentina 2 years ago. His immunization records are unavailable. He has smoked one pack of cigarettes daily for the last 5 years. He is 170 cm (5 ft 7 in) tall and weighs 70 kg (154 lb); BMI is 24.2 kg/m2. He appears healthy and well nourished. His temperature is 37°C (98.6°F), pulse is 72/min, and blood pressure is 125/75 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft with dull lower abdominal discomfort. Testicular examination shows a solid mass in the right testis that is firm and nontender. A light held behind the scrotum does not shine through. The mass is not reduced when the patient is in a supine position. The remainder of the physical examination shows no abnormalities. Which of the following is the most likely diagnosis in this patient?? {'A': 'Orchitis', 'B': 'Hydrocele testis', 'C': 'Scrotal hernia', 'D': 'Testicular torsion', 'E': 'Testicular tumor'},
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E: Testicular tumor
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Answer the following medical question with one of the provided options:
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Q:Two days after undergoing an emergency laparotomy following a motor vehicle collision, a 37-year-old man has increased thirst. Examination shows dry mucous membranes and decreased skin turgor. A review of his chart shows his urine output to be in excess of his fluid intake. Laboratory studies show a serum sodium concentration of 151 mEq/L and urine osmolality of 110 mOsmol/kg H2O. One hour after the administration of desmopressin, the serum sodium concentration is 146 mEq/L and urine osmolality is 400 mOsmol/kg H2O. One week later, his laboratory values are within normal limits. This patient's condition was most likely caused by damage to which of the following structures?? {'A': 'Posterior pituitary', 'B': 'Adrenal cortex', 'C': 'Proximal renal tubule', 'D': 'Collecting duct', 'E': 'Supraoptic nucleus'},
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A: Posterior pituitary
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Q:A 10-year-old girl is brought to the emergency department because of lower abdominal pain for the past 12 hours. The pain has progressively worsened and was accompanied by occasional episodes of diarrhea. She has vomited twice. Her mother has Crohn disease. Her temperature is 38.1°C (100.6°F), pulse is 95/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. The abdomen is soft, and there is mild tenderness to palpation in the right lower quadrant without rebound or guarding. Bowel sounds are normal. Her hemoglobin concentration is 13.0 g/dL, leukocyte count is 12,800/mm3, and platelet count is 345,000/mm3. Urine dipstick is negative for nitrites and leukocyte esterase. Urinalysis shows 3 WBC/hpf and no RBCs. Which of the following is the most appropriate next step in management?? {'A': 'Ultrasound of the abdomen', 'B': 'Colonoscopy', 'C': 'CT scan of the abdomen', 'D': 'X-ray of the abdomen', 'E': 'MRI of the abdomen'},
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A: Ultrasound of the abdomen
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Q:A 57-year-old man comes to the emergency department with fatigue and palpitations for several weeks. An ECG shows atrial fibrillation. Echocardiography shows thrombus formation in the left atrium. Which of the following organs is most likely to continue to function in the case of an embolic event?? {'A': 'Spleen', 'B': 'Brain', 'C': 'Kidney', 'D': 'Liver', 'E': 'Colon'},
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D: Liver
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Q:A 28-year-old female patient with a history of schizophrenia, type 2 diabetes mellitus, and hypothyroidism comes to clinic stating she would like to be put back on a medication. She recently stopped taking her haloperidol as it made it hard for her to "sit still." She requests to be put on olanzapine as a friend from a support group said it was helpful. Why should this medication be avoided in this patient?? {'A': 'The patient is at a high risk for torsades de pointes', 'B': 'There is a high risk for retinopathy', 'C': 'The patient has type 2 diabetes', 'D': 'The patient may develop galactorrhea', 'E': 'Tardive dyskinesia will likely result from the prolonged use of olanzapine'},
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C: The patient has type 2 diabetes
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Q:A 16-year-old girl presents to her physician with itching, soreness, and irritation in the vulvar region. She reports that these episodes have occurred 6–7 times a year since the age of 5. She used to treat these symptoms with topical ketoconazole cream, but this time it failed to help. She also has had several episodes of oral candidiasis in the past. She is not sexually active and does not take any medication. Her vital signs are as follows: the blood pressure is 115/80 mm Hg, the heart rate is 78/min, the respiratory rate is 15/min, and the temperature is 35.5°C (97.7°F). Examination shows vulvovaginal erythema with cottage cheese-like plaques and an intact hymen. Wet mount microscopy is positive for yeast. Along with a swab culture, the physician orders a dihydrorhodamine test and myelin peroxidase staining for a suspected primary immunodeficiency. The dihydrorhodamine test is positive, and the myeloperoxidase staining reveals diminished staining. Which of the following best describes this patient’s condition?? {'A': 'The patient’s phagocytes are unable to generate an oxidative burst to kill intracellular bacteria.', 'B': 'The patient is likely to have another immune impairment besides the one for which she was tested.', 'C': 'The patient should receive prophylactic courses of wide spectrum antibiotics to prevent infections.', 'D': 'The patient’s phagocytes can only perform extracellular killing.', 'E': 'The patient is susceptible to all mycotic infections.'},
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B: The patient is likely to have another immune impairment besides the one for which she was tested.
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Q:A 46-year-old man comes to the physician with chronic abdominal pain. He has a 3-year history of severe peptic ulcer disease and esophagitis. Two months ago, he took omeprazole, clarithromycin, and amoxicillin for 14 days. His medical history is otherwise unremarkable. Currently, he takes omeprazole 60 mg/day. He is a 10 pack-year smoker and consumes alcohol regularly. Vital signs are within normal limits. Mild epigastric tenderness is noted on deep palpation of the epigastrium. Laboratory studies show: Serum Calcium 9.5 mg/dL Phosphorus 4 mg/dL An upper endoscopy shows several large ulcers in the antrum and 2nd and 3rd parts of the duodenum. The rapid urease test is negative. Fasting gastrin levels are elevated. PET-CT with Ga-Dotatate shows a single mass in the wall of the duodenum. No other mass is detected. Pituitary MRI shows no abnormality. Which of the following is the most appropriate next step in management?? {'A': 'Adjuvant therapy with octreotide', 'B': 'Biological therapy with interferon-alpha', 'C': 'Quadruple therapy for Helicobacter pylori', 'D': 'Smoking cessation', 'E': 'Surgical resection'},
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E: Surgical resection
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Q:A 16-day-old male newborn is brought to the emergency department because of fever and poor feeding for 2 days. He became very fussy the previous evening and cried for most of the night. He was born at 36 weeks' gestation and weighed 2430 g (5 lb 3 oz). The pregnancy and delivery were uncomplicated. The mother does not recall any sick contacts at home. He currently weighs 2776 g (6 lb 2 oz). He appears irritable. His temperature is 38.6°C (101.5°F), pulse is 180/min, and blood pressure is 82/51 mm Hg. Examination shows scleral icterus. He becomes more agitated when picked up. There is full range of motion of his neck and extremities. The anterior fontanelle feels soft and flat. Neurologic examination shows no abnormalities. Blood cultures are drawn and fluid resuscitation is initiated. A urinalysis obtained by catheterization shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?? {'A': 'MRI of the head', 'B': 'Reassurance', 'C': 'Urine culture', 'D': 'CT scan of the head', 'E': 'Lumbar puncture'},
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E: Lumbar puncture
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Q:A 24-year-old man comes to the emergency department because of left shoulder pain hours after suffering a fall from a height of approximately 10 feet while rock climbing about 5 hours ago. He initially thought the pain would resolve with rest but it became more severe over the last 2 hours. Last year while rock climbing he fell onto his right shoulder and “needed a sling to fix it”. He has psoriasis. His only medication is topical clobetasol. His pulse is 95/min, respiratory rate is 16/minute, and blood pressure is 114/70 mm Hg. Examination shows full passive and active range of motion at the left shoulder. There is no tenderness to palpation at the acromioclavicular joint. There are silvery plaques over both knees and elbows. Abdominal exam shows 7/10 left upper quadrant tenderness with voluntary guarding. A complete blood count and serum concentrations of electrolytes are within the reference range. Which of the following is the most appropriate next step in management?? {'A': 'Serial vital signs for at least nine hours', 'B': 'CT scan of the abdomen', 'C': 'Abdominal ultrasound', 'D': 'Radiographs of the left shoulder', 'E': 'MRI of the left shoulder'},
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B: CT scan of the abdomen
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Q:A 3-year-old boy is brought to the emergency department because of persistent fever and cough. Three days ago, he was diagnosed with pneumonia and acute otitis media. He was started on ampicillin-sulbactam and clarithromycin, but his symptoms did not improve. The mother reports that her son has been hospitalized 3 times due to pneumonia. He was first diagnosed with pneumonia at the age of 10 months. She also reports several episodes of bilateral otitis media and recurrent respiratory tract infections. His immunizations are up-to-date. He is at the 50th percentile for height and 20th percentile for weight. He appears fatigued. His temperature is 38°C (100.4°F). Pneumatic otoscopy shows purulent otorrhea bilaterally. Pulmonary examination shows decreased breath sounds over both lung fields. The palatine tonsils and adenoids are hypoplastic. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Defective NADPH oxidase', 'B': 'Defective IL-2R gamma chain', 'C': 'Defect in the ATM gene', 'D': 'WAS gene mutation', 'E': 'Tyrosine kinase gene mutation'},
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E: Tyrosine kinase gene mutation
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Q:A 70-year-old woman is brought to her physician by her daughter who reports that the patient has been increasingly confused and forgetful over the past year. The daughter reports that the patient has difficulty finding words, remembering names, and maintaining a conversation. She has gotten lost twice while driving. Her past medical history is known for obesity, diabetes, and atrial fibrillation. She takes metformin, glyburide, and warfarin. She drinks socially and has a 30 pack-year smoking history. Her family history is notable for Parkinson’s disease in her father and stroke in her mother. A head CT demonstrates sulcal widening and narrowing of the gyri. The physician decides to start the patient on a medication known to inhibit a cell surface glutamate receptor. Which of the following is a downstream effect of this medication?? {'A': 'Decreased intracellular calcium', 'B': 'Increased intracellular calcium', 'C': 'Increased intracellular sodium', 'D': 'Increased intracellular acetylcholine', 'E': 'Decreased intracellular acetylcholine'},
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A: Decreased intracellular calcium
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Q:A 67-year-old farmer presents to the emergency department with a chief complaint of unusual behavior. His wife states that since this morning he has experienced dryness and flushing of his skin while working outside. As the day went on, the patient found it exceedingly difficult to urinate and had to create significant abdominal pressure for a weak stream of urine to be produced. Currently, the patient seems confused and responds incoherently. The patient has a past medical history of Parkinson's disease, alcohol abuse, irritable bowel syndrome, anxiety, diabetes mellitus, hypertension, constipation and a suicide attempt when he was 23 years old. He is currently taking lisinopril, hydrochlorothiazie, metformin, insulin, benztropine, levodopa/carbidopa, and vitamin C. The only other notable symptoms this patient has experienced are recent severe seasonal allergies. On physical exam you note dry, flushed skin, and a confused gentleman. His temperature is 99.5°F (37.5°C), pulse is 112/min, blood pressure is 130/90 mmHg, respirations are 18/min, and oxygen saturation is 96% on room air. Lab values are ordered. Which of the following is the most likely cause of this patient's presentation?? {'A': 'Medication', 'B': 'Insecticide exposure', 'C': 'Alcohol', 'D': 'Infection', 'E': 'Heat stroke'},
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A: Medication
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Q:A 65-year-old man is brought to the emergency department by his wife because of progressive lethargy and confusion during the past 2 days. His wife reports that he has been complaining of nausea and increased urination for the past 5 days. He also developed a cough 1 week ago. He has a history of a cerebrovascular accident 3 years ago and was diagnosed with hypertension 10 years ago. Current medications include lisinopril and aspirin. His temperature is 38.5°C (101.3°F), pulse is 114/min, respirations are 15/min, and blood pressure is 108/75 mm Hg. He is somnolent and oriented only to person. Examination shows dry mucous membranes and decreased skin turgor. Crackles are heard at the left lung base. The remainder of the physical examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Chest x-ray', 'B': 'Serum calcium measurement', 'C': 'Broad-spectrum antibiotics', 'D': 'Blood glucose measurement', 'E': 'Arterial blood gas analysis'},
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D: Blood glucose measurement
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Q:A 59-year-old man comes to the emergency department because of progressively worsening chest pain and nausea that started while visiting a local bar 30 minutes ago. The pain radiates to the epigastric area. He has a 10-year history of untreated hypertension. He has smoked 1 pack of cigarettes daily for 35 years. The patient is diaphoretic and in marked distress. His pulse is 94/min, respirations are 28/min, and blood pressure is 161/92 mm Hg. Pulse oximetry on 2 L/min of oxygen via nasal cannula shows an oxygen saturation of 97%. Cardiac examination shows a regular heartbeat and a systolic ejection murmur heard best over the upper right sternal border. The lungs are clear to auscultation bilaterally. Pedal pulses are intact. An ECG shows inverted T waves in leads I, avL, and V5-6. Urine toxicology screening is positive for cocaine. Which of the following drugs is contraindicated in the management of this patient's condition?? {'A': 'Propranolol', 'B': 'Diazepam', 'C': 'Prasugrel', 'D': 'Diltiazem', 'E': 'Aspirin\n"'},
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A: Propranolol
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Q:A 25-year-old female presents with recent muscle weakness, fatigue, and constipation. Physical examination reveals a bradycardic patient with cool, dry skin. Which of the following lab values would be most likely to be present with this patient's presentation?? {'A': 'Elevated serum calcitonin', 'B': 'Elevated serum CK', 'C': 'Low serum TSH', 'D': 'Activating TSH-receptor immunoglobulins', 'E': 'Hypocalcemia'},
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B: Elevated serum CK
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Q:A 26-year-old gravida 2 para 1 presents to her physician at 12 weeks gestation. She has no complaints. Her previous pregnancy 5 years ago had an uncomplicated course with vaginal delivery of a healthy boy at 39 + 1 weeks gestation. Her weight is 75 kg (165 lb) and the height is 168 cm (5 ft 6 in). On presentation, the blood pressure is 110/70 mm Hg, the heart rate is 83/min, the respiratory rate is 14/min, and the temperature is 36.6℃ (97.9℉). The physical examination is within normal limits. The gynecologic examination demonstrates a fetal heart rate of 180/min. The uterus cannot be palpated and the ultrasound exam is benign. Blood testing showed the following: RBC count 3.9 million/mm3 Leukocyte count 11,100/mm3 Hb 11.6 g/dL Hct 32% MCV 87 fl Reticulocyte count 0.4% The patient’s blood type is A neg. Which testing is indicated in this patient?? {'A': 'Measurement of serum iron', 'B': 'Direct Coombs test', 'C': 'White blood cell differential', 'D': 'Indirect Coombs test', 'E': 'Measurement of serum vitamin B12'},
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D: Indirect Coombs test
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Q:A 34-year-old man presents to his primary care physician with frequent urination. He was recently hospitalized following a severe motorcycle accident in which he suffered multiple injuries to his head and extremities. He reports that he has been constantly thirsty and has been urinating four to five times per night since being discharged from the hospital one week prior to presentation. His past medical history is notable for type II diabetes mellitus, which is well controlled on metformin. He has a 10 pack-year smoking history and drinks 3-4 alcoholic beverages per day. His temperature is 98.8°F (37.1°C), blood pressure is 110/70 mmHg, pulse is 95/min, and respirations are 18/min. Physical examination reveals delayed capillary refill and decreased skin turgor. Notable laboratory results are shown below: Serum: Na+: 148 mEq/L Cl-: 101 mEq/L K+: 3.7 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 110 mg/dL Hemoglobin A1c: 5.7% This patient’s condition is most likely caused by defective production in which of the following locations?? {'A': 'Supraoptic nucleus of the hypothalamus', 'B': 'Lateral nucleus of the hypothalamus', 'C': 'Posterior pituitary', 'D': 'Anterior pituitary', 'E': 'Posterior nucleus of the hypothalamus'},
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A: Supraoptic nucleus of the hypothalamus
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Q:An 88-year-old man presents to his primary care physician due to insomnia. The patient’s wife states that she often sees him sitting awake at night, seemed visibly irritated. This has persisted for years but worsened recently when the patient attended a funeral for one of his friends in the military. The patient states that he has trouble sleeping and finds that any slight sound causes him to feel very alarmed. Recently, the patient has been having what he describes as strong memories of events that occurred with his fellow soldiers while at war. At times he awakes in a cold sweat and has not been able to get quality sleep in weeks. The patient has a past medical history of anxiety, obesity, and type II diabetes mellitus. His current medications include insulin, metformin, lisinopril, sodium docusate, and fish oil. Which of the following is the best initial medical therapy for this patient?? {'A': 'Bupropion', 'B': 'Buspirone', 'C': 'Clonazepam', 'D': 'Escitalopram', 'E': 'Trazodone'},
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D: Escitalopram
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Q:A 66-year-old man presents to the office complaining of abdominal pain. He reports that the pain is mid-epigastric and “gnawing.” It worsens after meals but improves “somewhat” with antacids. The patient’s medical history is significant for hypertension, hyperlipidemia, and gout. He takes aspirin, lisinopril, atorvastatin, and allopurinol. He uses ibuprofen during acute gout attacks and takes over the counter multivitamins. He also started drinking ginkgo tea once a week after his wife saw a news story on its potential benefits. The patient has a glass of whiskey after work 2 nights a week but denies tobacco or illicit drug use. An upper endoscopy is performed that reveals a gastric ulcer. A urease breath test is positive for Heliobacter pylori. The patient is prescribed bismuth subsalicylate, omeprazole, metronidazole, and tetracycline for 2 weeks. At follow-up, the patient continues to complain of abdominal pain. He has taken all his medications as prescribed along with 10-12 tablets of antacids a day. He denies hematemesis, hematochezia, or melena. Biopsy from the previous upper endoscopy was negative for malignancy. A repeat urease breath test is positive. Which of the following is the most likely cause for the patient’s poor treatment response?? {'A': 'Alcohol use', 'B': 'Allopurinol', 'C': 'Antacid use', 'D': 'Ginkgo tea', 'E': 'Ibuprofen'},
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C: Antacid use
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Q:A 17-year-old boy is brought to the emergency department by his brother after losing consciousness 1 hour ago. The brother reports that the patient was skateboarding outside when he fell on the ground and started to have generalized contractions. There was also some blood coming from his mouth. The contractions stopped after about 1 minute, but he remained unconscious for a few minutes afterward. He has never had a similar episode before. There is no personal or family history of serious illness. He does not smoke or drink alcohol. He does not use illicit drugs. He takes no medications. On arrival, he is confused and oriented only to person and place. He cannot recall what happened and reports diffuse muscle ache, headache, and fatigue. He appears pale. His temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 130/80 mm Hg. There is a small wound on the left side of the tongue. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference ranges. Toxicology screening is negative. An ECG shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Lorazepam therapy', 'B': 'Reassurance and follow-up', 'C': 'Lumbar puncture', 'D': 'CT scan of the head', 'E': 'Electroencephalography\n"'},
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D: CT scan of the head
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Q:A 59-year-old man comes to the physician because of urinary frequency and perineal pain for the past 3 days. During this time, he has also had pain with defecation. He is sexually active with his wife only. His temperature is 39.1°C (102.3°F). His penis and scrotum appear normal. Digital rectal examination shows a swollen, exquisitely tender prostate. His leukocyte count is 13,400/mm3. A urine culture obtained prior to initiating treatment is most likely to show which of the following?? {'A': 'Gram-negative, lactose-fermenting rods in pink colonies', 'B': 'Gram-negative, oxidase-positive rods in green colonies', 'C': 'Gram-negative, encapsulated rods in mucoid colonies', 'D': 'Weakly staining, obligate intracellular bacilli', 'E': 'Gram-negative, aerobic, intracellular diplococci'},
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A: Gram-negative, lactose-fermenting rods in pink colonies
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Q:A 32-year-old woman is brought to the emergency department for the evaluation of burn injuries that she sustained after stumbling into a bonfire 1 hour ago. The patient has severe pain in her left leg and torso, and minimal pain in her right arm. She does not smoke cigarettes. She takes no medications. She is tearful and in moderate distress. Her temperature is 37.2°C (99.0°F), pulse is 88/min, respirations are 19/min, and blood pressure is 118/65 mm Hg. Her pulse oximetry is 98% on room air. Cardiopulmonary examination shows no abnormalities. There are two tender, blanchable erythemas without blisters over a 5 x 6 -cm area of the left abdomen and a 3 x 2-cm area of the left anterior thigh. There is also an area of white, leathery skin and tissue necrosis encircling the right upper extremity just proximal to the elbow, which is dry and nontender. An ECG shows normal sinus rhythm with no ST or T wave changes. She is started on intravenous fluids. Which of the following is the most appropriate next step in management?? {'A': 'Serial arterial blood gas analysis', 'B': 'Soft-tissue ultrasound', 'C': 'Intravenous ampicillin therapy', 'D': 'Monitoring of peripheral pulses and capillary filling', 'E': 'X-ray of the chest'},
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D: Monitoring of peripheral pulses and capillary filling
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Q:An 8-year-old boy is brought to the emergency department after falling from a trampoline and landing on his left arm. On presentation, he is found to be holding his left arm against his chest and says that his arm is extremely painful just above the elbow. Radiographs are obtained showing the finding in figure A. The boy's arm is reduced and placed into a splint pending surgical fixation. If this patient's fracture is associated with a nerve injury, which of the following actions would he most likely be unable to perform in the emergency department?? {'A': 'Elbow flexion', 'B': 'Finger crossing', 'C': 'Finger extension', 'D': 'Shoulder abduction', 'E': 'Thumb flexion'},
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E: Thumb flexion
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Q:A 30-year-old woman came to her OBGYN for an infertility consultation. The patient reports having intercourse with her husband at least 3 times per week with increasing frequency during the periods. The lab reports of her husband revealed an adequate sperm count. After the work-ups was complete, her OBGYN prescribed a medication similar to GnRH to be administered in a pulsatile manner. Which drug is prescribed to the patient?? {'A': 'Danazol', 'B': 'Leuprolide', 'C': 'Anastrazole', 'D': 'Clomiphene', 'E': 'Mestranol'},
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B: Leuprolide
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Q:A 51-year-old man presents to his primary care provider for recurrent epigastric pain. He reports a 3-month history of gnawing epigastric and chest pain that is worse after meals and after lying down. His past medical history is notable for obesity, hypertension, and hyperlipidemia. He takes lisinopril and rosuvastatin. He has a 30 pack-year smoking history and drinks 4-5 beers per day. On exam, he is well-appearing and in no acute distress. He has no epigastric tenderness. He is prescribed an appropriate medication for his symptoms and is told to follow up in 2 weeks. He returns 2 weeks later with improvement in his symptoms, and a decision is made to continue the medication. However, he returns to clinic 3 months later complaining of decreased libido and enlarged breast tissue. Which of the following medications was this patient most likely taking?? {'A': 'Cimetidine', 'B': 'Famotidine', 'C': 'Lansoprazole', 'D': 'Nizatidine', 'E': 'Calcium carbonate'},
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A: Cimetidine
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Q:A 22-year-old Caucasian G1 presents to her physician at 29 weeks gestation for a checkup. The medical history is unremarkable and the current pregnancy has been uncomplicated. Her weight is 81 kg (178.6 lb) and the height is 169 cm (5 ft 6 in). She has gained 13 kg (28.6 lb) during the pregnancy. She has no abnormalities on physical examination. Which of the following screening tests should be obtained ?? {'A': 'Fasting glucose level', 'B': 'Non-fasting oral glucose tolerance test with 50 g of glucose', 'C': 'Fasting oral glucose test with 50 g of glucose', 'D': 'Non-fasting oral glucose load test with 75 g of glucose', 'E': 'Measurement of HbA1c'},
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B: Non-fasting oral glucose tolerance test with 50 g of glucose
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Q:A 45-year-old man is brought to the emergency department 30 minutes after falling off a staircase and hitting his head on the handrail. He was unconscious for 10 minutes and vomited twice. On arrival, he is drowsy. Examination shows a fixed, dilated left pupil and right-sided flaccid paralysis. A CT scan of the head shows a skull fracture in the region of the pterion and a biconvex hyperdensity overlying the left frontotemporal lobe. This patient's condition is most likely caused by damage to a vessel that enters the skull through which of the following foramina?? {'A': 'Foramen lacerum', 'B': 'Jugular foramen', 'C': 'Foramen rotundum', 'D': 'Foramen magnum', 'E': 'Foramen spinosum'},
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E: Foramen spinosum
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Q:A 5-day-old male newborn is brought to the physician by his mother for the evaluation of progressive yellowing of his skin for 2 days. The mother reports that the yellowing started on the face and on the forehead before affecting the trunk and the limbs. She states that she breastfeeds every 2–3 hours and that the newborn feeds well. He has not vomited and there have been no changes in his bowel habits or urination. The patient was born at 38 weeks' gestation via vaginal delivery and has been healthy. His newborn screening was normal. His vital signs are within normal limits. Physical examination shows scleral icterus and widespread jaundice. The remainder of the examination shows no abnormalities. Serum studies show: Bilirubin Total 8 mg/dL Direct 0.5 mg/dL AST 16 U/L ALT 16 U/L Which of the following is the most appropriate next step in management?"? {'A': 'Phototherapy', 'B': 'Exchange transfusion', 'C': 'Abdominal sonography', 'D': 'Intravenous immunoglobulin', 'E': 'Reassurance'},
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E: Reassurance
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Q:A previously healthy 32-year-old man is brought to the emergency department by his girlfriend after having a seizure. Earlier that day, he also experienced a nosebleed that took 30 minutes to stop when applying pressure. He has had no sick contacts or history of epilepsy or other seizure disorder. He does not take any medications. His temperature is 39.1 °C (102.4 °F), pulse is 106/min, respirations are 26/min, and blood pressure is 128/70 mm Hg. He is confused and disoriented. Examination shows pallor and scattered petechiae over the trunk and arms. The neck is supple, and neurological examination is otherwise within normal limits. Laboratory studies show: Hemoglobin 9 g/dL Leukocyte count 8,200/mm3 Platelet count 34,000/mm3 Prothrombin time 13 seconds Partial thromboplastin time 30 seconds Fibrin split products negative Serum Creatinine 2.9 mg/dL Bilirubin Total 3.2 mg/dL Direct 0.4 mg/dL Lactate dehydrogenase 559 U/L A peripheral blood smear shows numerous schistocytes. Which of the following is the most appropriate next step in management?"? {'A': 'Transfusion of packed red blood cells', 'B': 'Plasma exchange therapy', 'C': 'Fresh frozen plasma transfusion', 'D': 'Platelet transfusion', 'E': 'Intravenous tranexamic acid\n"'},
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B: Plasma exchange therapy
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Q:A 4-year-old girl is brought to the physician because of a nonpruritic, painless rash that has been on her face for 5 days. She was born at term and has been healthy throughout childhood. Her 62-year-old maternal grandmother has bullous pemphigoid. Her development is adequate for her age and immunizations are up-to-date. She appears healthy and well-nourished. Her temperature is 37.0°C (98.6°F) pulse is 90/min, and respiratory rate is 18/min. Examination shows a crusted rash on the right side of the patient's face. An image of the patient's lower face is shown. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Oral acyclovir therapy', 'B': 'Oral cephalexin therapy', 'C': 'Oral clindamycin therapy', 'D': 'Topical miconazole therapy', 'E': 'Topical mupirocin therapy'},
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E: Topical mupirocin therapy
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Q:A 24-year-old female medical student presents to the emergency department after she develops sudden difficulty breathing and vague chest pain while preparing for exams. The chest pain is non-pleuritic without radiation. She denies any recent travel. She denies any hemoptysis, nausea, vomiting, or leg pain. She only takes oral contraceptives; she denies smoking or alcohol use. Her vitals reveal a heart rate of 120 beats per minute, blood pressure of 100/80 mm Hg, and respiratory rate of 30 per minute. She is afebrile. Otherwise, her physical exam is unremarkable. A CT scan of her chest with IV contrast reveals filling defects along her left pulmonary artery. Which of the following is the most likely mechanism of this finding?? {'A': 'Venous stasis', 'B': 'Endothelial injury', 'C': 'Dehydration', 'D': 'Hypercoagulability', 'E': 'Anxiety'},
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D: Hypercoagulability
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Q:A 1-year-old immigrant girl has not received any recommended vaccines since birth. She attends daycare and remains healthy despite her daily association with several other children for the past 3 months at a home day-care facility. Which of the following phenomena explains why she has not contracted any vaccine-preventable diseases such as measles, diphtheria, or pertussis?? {'A': 'Genetic drift', 'B': 'Genetic shift', 'C': 'Tolerance', 'D': 'Immune evasion', 'E': 'Herd immunity'},
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E: Herd immunity
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Q:A 37-year-old woman presents to her physician with a decreased interest in her daily activities. She says that she has noticed a decreased motivation to participate in her daily routine. She says she feels sad and depressed on most days of the week. She reports her symptoms have been there for about two months but have been more severe for the past 3 weeks. She also says she is unable to sleep well at night and feels tired most of the day, which is affecting her job performance. The patient reports a 10-pack-year smoking history which has increased in frequency lately and she would like to quit. Lately, she has observed an inability to reach orgasm during intercourse and has also lost all interest in sex. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Venlafaxine', 'B': 'Mirtazapine', 'C': 'Bupropion', 'D': 'Fluoxetine', 'E': 'Trazodone'},
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C: Bupropion
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Q:Two 19-year-old men are referred by their professor and mentor to a psychiatrist for substance abuse management. The two friends have both used different stimulants for 3 years—Drug A and Drug B, respectively. Both use these substances cyclically. Use of Drug A usually lasts for about 12 hours. The cycle for Drug B lasts several days. A month ago, both men visited the emergency room (ER) due to acute intoxication. Clinical features in the emergency department included hypotension, bradycardia, sweating, chills, mydriasis, nausea, and psychomotor agitation. After a urine drug screen, the psychiatrist identifies both the drugs and informs the professor that although both Drug A and Drug B are stimulants, their mechanisms of action are different. Drug A is an alkaloid that is naturally present in the leaves of the coca plant, while it is possible to make Drug B from over-the-counter nasal decongestant products. Which of the following options best describes the mechanism of action of both drugs?? {'A': 'Drug A transiently increases the extracellular concentration of dopamine in the reward circuit, while Drug B does not.', 'B': 'Drug A predominantly acts by inhibiting the reuptake of monoamine neurotransmitters (dopamine, serotonin, and norepinephrine) at the synapse, while Drug B does not.', 'C': 'Drug A predominantly acts by increasing the release of monoamine neurotransmitters (dopamine, serotonin, and norepinephrine) into the synapse, while Drug B does not.', 'D': 'Drug A increases serotonin activity, while Drug B does not.', 'E': 'Drug A increases norepinephrine activity, while Drug B does not.'},
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B: Drug A predominantly acts by inhibiting the reuptake of monoamine neurotransmitters (dopamine, serotonin, and norepinephrine) at the synapse, while Drug B does not.
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Q:A 45-year-old woman presents to the clinic for a routine examination. She has a chronic history of systemic lupus erythematosus, diagnosed at age 27. Medications include hydroxychloroquine and low-dose prednisone. She has had no recent flare-ups and is compliant with her medication. Anticardiolipin and anti-beta-2 glycoprotein-1 antibodies are negative, and she has had no history of thrombi or emboli. Physical examination is normal except for mild bilateral tenderness and swelling of the knees. Creatinine and GFR are normal. Which of the following is the next best step in management to monitor disease activity?? {'A': 'Urinalysis and renal biopsy', 'B': 'Anti-dsDNA antibody levels', 'C': 'Anti-Smith antibody levels', 'D': 'Reduce dosage and taper off hydroxychloroquine', 'E': 'Arthrocentesis and synovial fluid analysis'},
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B: Anti-dsDNA antibody levels
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Q:A 10-year-old boy is brought to a pediatrician by his mother for evaluation of fever, malaise, and rash with severe itching all over his body for the past 5 days. His immunization history is unavailable. His vital signs include: pulse 110/min, temperature 37.8°C (100.0°F), and respiratory rate 26/min. On examination of the skin, diffuse peeling vesicular lesions involving the arms and chest are observed. The pediatrician diagnosis the boy with chickenpox and reassures the mother. A few days later the boy returns to the clinic for a follow-up with his mother. The skin lesions have healed and there are scars. The formation of these scars is best described by which of the following statements?? {'A': 'The scars represent complete resolution of acute inflammation.', 'B': 'It is a part of the healing process of acute inflammation.', 'C': 'The scars are permanent and remain for life in all cases.', 'D': 'Neutrophils, plasma cells, and macrophages are the predominant cells in these lesions.', 'E': 'The lesions now have progressed on to chronic inflammation.'},
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B: It is a part of the healing process of acute inflammation.
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Q:A 15-year-old girl is brought to her pediatrician's office complaining of frequent diarrhea, fatigue, and inability to gain weight. Her vital signs are within normal limits, and her BMI is 17. She describes her stools as pale, malodorous, and bulky. She often has abdominal bloating. Her symptoms are most prominent after breakfast when she typically consumes cereal. After several weeks of careful evaluation and symptomatic treatment, the pediatrician recommends an esophagogastroduodenoscopy. A diagnostic biopsy shows blunting of intestinal villi and flat mucosa with multiple intraepithelial lymphocytes. Which of the following is the patient likely deficient in?? {'A': 'IgA', 'B': 'IgM', 'C': 'IgG', 'D': 'IgE', 'E': 'IgD'},
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A: IgA
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Q:A 23-year-old man is brought to the emergency department by a coworker for an injury sustained at work. He works in construction and accidentally shot himself in the chest with a nail gun. Physical examination shows a bleeding wound in the left hemithorax at the level of the 4th intercostal space at the midclavicular line. Which of the following structures is most likely injured in this patient?? {'A': 'Right atrium of the heart', 'B': 'Superior vena cava', 'C': 'Inferior vena cava', 'D': 'Left atrium of the heart', 'E': 'Left upper lobe of the lung'},
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E: Left upper lobe of the lung
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman presents to her primary care physician due to amenorrhea. The patient states that historically she has her period once every three months but recently has not had it at all. Otherwise, she has no other complaints. The patient recently started college and is a varsity athlete for the track team. She works part time in a coffee shop and is doing well in school. The patient is not sexually active and does not drink alcohol, use illicit drugs, or smoke. She has no significant past medical history and occasionally takes ibuprofen for headaches. Her temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 50/min, respirations are 10/min, and oxygen saturation is 98% on room air. On physical exam, you note a young, lean, muscular woman in no acute distress. Which of the following is the most likely long-term outcome in this patient?? {'A': 'Endometrial cancer', 'B': 'Infertility', 'C': 'Osteoarthritis', 'D': 'Osteoporosis', 'E': 'Anorexia nervosa'},
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D: Osteoporosis
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Q:A 40-year-old man who was previously antisocial, low energy at work, and not keen to attend office parties was arrested and brought to the emergency department after he showed up to the office Christmas party out of control. He was noted to be very energetic and irritable. He spent the entire evening hijacking conversations and sharing his plans for the company that will save it from inevitable ruin. What other finding are you most likely to find in this patient’s current condition?? {'A': 'Irresponsibility', 'B': 'Hypersomnia after days of not sleeping', 'C': 'Patient completing numerous outstanding projects', 'D': 'Rapid but interruptible speech pattern', 'E': 'Patient is unlikely to have a major depressive episode'},
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A: Irresponsibility
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Q:A 70-year-old man is at his dermatologist’s office for the treatment of a severely pruritic erythroderma with scaling on his buttocks that has been slowly progressing over the past two weeks. The patient works as a truck driver and has a history of hypertension treated with enalapril. The patient reports having tried an over-the-counter cream on the rash without improvement. The vital signs are within normal range. On physical exam, he has multiple confluent and well-demarcated pink patches on his buttocks and legs with some scaling and enlarged inguinal lymph nodes. The dermatologist orders a skin biopsy that reveals Pautrier microabscesses. What is the most likely diagnosis?? {'A': 'Psoriasis', 'B': 'Linchen planus', 'C': 'Atopic dermatitis', 'D': 'Mycosis fungoides', 'E': 'Kaposi sarcoma'},
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D: Mycosis fungoides
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Q:A 31-year-old G6P6 woman with a history of fibroids gives birth to twins via vaginal delivery. Her pregnancy was uneventful, and she reported having good prenatal care. Both placentas are delivered immediately after the birth. The patient continues to bleed significantly over the next 20 minutes. Her temperature is 97.0°F (36.1°C), blood pressure is 124/84 mmHg, pulse is 95/min, respirations are 16/min, and oxygen saturation is 98% on room air. Continued vaginal bleeding is noted. Which of the following is the most appropriate initial step in management?? {'A': 'Bimanual massage', 'B': 'Blood product transfusion', 'C': 'Hysterectomy', 'D': 'Oxytocin', 'E': 'Uterine artery embolization'},
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A: Bimanual massage
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Q:A 13-year-old boy is brought to the pediatrician by his parents who are concerned about his short stature. He also has had recurrent episodes of diarrhea. Past medical history is significant for iron deficiency anemia diagnosed 6 months ago. Physical examination is unremarkable except that he is in the 9th percentile for height. Serum anti-tissue transglutaminase (anti-tTG) antibodies are positive. An upper endoscopy along with small bowel luminal biopsy is performed. Which of the following histopathologic changes would most likely be present in the mucosa of the duodenal biopsy in this patient?? {'A': 'Neutrophilic infiltration', 'B': 'Blunting of the intestinal villi', 'C': 'Granulomas extending through the layers of the intestinal wall', 'D': 'Crypt aplasia', 'E': 'Cuboidal appearance of basal epithelial cells'},
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B: Blunting of the intestinal villi
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Q:An 11-year-old girl is brought into the clinic by her parents, who are distraught over her behavior. They state that over the past several months she has started to act oddly, combing the hair of her toy dolls for hours without stopping and repetitively counting her steps in the house. She is often brought to tears when confronted about these behaviors. The patient has no past medical history. When questioned about family history, the mother states she has needed close medical follow-up in the past, but declines to elaborate. The patient's vital signs are all within normal limits. On physical exam the patient is a well nourished 11-year-old girl in no acute distress. She has occasional motor tics, but the remainder of the exam is benign. What is the diagnosis in this patient?? {'A': 'Autism spectrum disorder (ASD)', 'B': 'Generalized anxiety disorder (GAD)', 'C': 'Obsessive compulsive disorder (OCD)', 'D': "Tourette's syndrome", 'E': 'Major depressive disorder (MDD)'},
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C: Obsessive compulsive disorder (OCD)
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Q:A 46-year-old man accountant is admitted to the emergency department with complaints of retrosternal crushing pain that radiates to his left arm and jaw. The medical history is significant for hyperlipidemia and arterial hypertension, for which he is prescribed a statin and ACE inhibitor, respectively. An ECG is obtained and shows an ST-segment elevation in leads avF and V2-V4. The blood pressure is 100/50 mm Hg, the pulse is 120/min, and the respiratory rate is 20/min. His BMI is 33 kg/m2 and he has a 20-year history of smoking cigarettes. Troponin I is elevated. The patient undergoes percutaneous coronary intervention immediately after admission. Angioplasty and stenting were successfully performed. On follow-up the next day, the ECG shows decreased left ventricular function and local hypokinesia. The patient is re-evaluated 14 days later. The echocardiography reveals a normal ejection fraction and no hypokinesis. Which of the phenomena below explains the patient’s clinical course?? {'A': 'Coronary steal syndrome', 'B': 'Reperfusion injury', 'C': 'Myocardial hibernation', 'D': 'Myocardial stunning', 'E': 'Coronary collateral circulation'},
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D: Myocardial stunning
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Q:A 27-year-old woman, primigravida, gave birth to a boy 3 months ago and now presents the newborn to your clinic for evaluation. She did not receive prenatal care. She reports that she was taking a medication for her mood swings, but cannot remember the medication’s name. The baby was born cyanotic, with a congenital malformation of the heart that is characterized by apical displacement of the septa and posterior tricuspid valve leaflets. A chest radiograph is shown in the image. Which of the following medications was the mother most likely taking?? {'A': 'Buspirone', 'B': 'Clozapine', 'C': 'Losartan', 'D': 'Lithium', 'E': 'Enalapril'},
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D: Lithium
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying gene expression in a mouse model. She inactivates the assembly of small nuclear ribonucleoproteins (snRNPs) in motor nerve cells. Which of the following processes is most likely to be affected as a result?? {'A': 'Folding of proteins', 'B': 'Aminoacylation of tRNA', 'C': 'Activity of 3′ to 5′ proofreading', 'D': 'Unwinding of DNA strands', 'E': 'Removal of introns'},
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E: Removal of introns
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman comes to the physician for evaluation of a mass in the left breast that she first noticed 2 weeks ago. During this period, the mass has not increased in size and the patient has had no pain. Three months ago, she hit her left chest against the closet door, which was painful for a day. Menses occurs at regular 28-day intervals and last for 5 days with moderate flow. Her last menstrual period was 3 weeks ago. Physical examination shows dense breasts and a 2.5-cm well-defined, rubbery, mobile mass that is nontender in the upper outer quadrant of the left breast. There is no axillary adenopathy. Which of the following is the most likely diagnosis?? {'A': 'Phyllodes tumor', 'B': 'Fibrocystic changes of the breast', 'C': 'Fibroadenoma', 'D': 'Lobular carcinoma', 'E': 'Fat necrosis'},
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C: Fibroadenoma
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Answer the following medical question with one of the provided options:
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Q:A 70 year-old man comes to the physician for difficulty swallowing for 6 months. During this time, he has occasionally coughed up undigested food. He did not have weight loss or fever. Four weeks ago, he had an episode of sore throat, that resolved spontaneously. He has smoked one pack of cigarettes daily for 5 years. He has gastroesophageal reflux disease and osteoporosis. Current medications include alendronate and omeprazole. His temperature is 37.0°C (98.6°F), pulse is 84/min, and blood pressure is 130/90 mmHg. On examination, he has foul-smelling breath and a fluctuant mass on the right neck. Which of the following is most likely involved in the pathogenesis of this patient's symptoms?? {'A': 'Deep neck space infection', 'B': 'Degeneration of neurons in the esophageal wall', 'C': 'Cellular dysplasia', 'D': 'Abnormal esophageal motor function', 'E': 'Adverse effect of medication\n"'},
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D: Abnormal esophageal motor function
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Answer the following medical question with one of the provided options:
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Q:A bacterial isolate obtained from a hospitalized patient is found to be resistant to amikacin. The isolated bacteria most likely has which of the following characteristics?? {'A': 'D-Ala to D-Lac mutation', 'B': 'DNA topoisomerase II mutation', 'C': 'Low-affinity penicillin binding protein', 'D': 'Increased drug influx capacity', 'E': 'Enhanced ability to transfer acetyl groups'},
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E: Enhanced ability to transfer acetyl groups
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Q:A 10-year-old boy is brought to the pediatrician by his parents with complaints of short stature with small hands and skin hypopigmentation. A detailed development history reveals that he was born by normal vaginal delivery at full term and his neonatal period was uneventful. Until he was 6 months of age, he was breast-fed and then solid foods were started. At the age of 3 years, his parents noted that he had difficulty in sucking and swallowing. They also noted a weak cry. His motor milestones were delayed. His intelligence quotient (IQ) is 65. His temperature is 37.0ºC (98.6°F), pulse is 88/min, and respirations are 20/min. He has a short stature and falls in the obese category according to his body mass index. His neurologic examination shows the presence of hypotonia. Panoramic radiographic examination shows anterior teeth crowding and the presence of residual roots in some teeth. Which of the following is the most likely cause of this condition?? {'A': 'Maternal inheritance', 'B': 'Paternal inheritance', 'C': 'Both paternal inheritance and maternal inheritance', 'D': 'Infectious in origin', 'E': 'Nutritional and metabolic in origin'},
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B: Paternal inheritance
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman is brought to the physician for worsening depressive mood and irritability. Her mood changes began several months ago. Her husband has also noticed shaky movements of her limbs and trunk for the past year. The patient has no suicidal ideation. She has no history of serious illness and takes no medications. Her father died by suicide at the age of 45 years. Her temperature is 37°C (98.6°F), pulse is 76/min, and blood pressure is 128/72 mm Hg. She speaks slowly and quietly and only looks at the floor. She registers 3/3 words but can recall only one word 5 minutes later. Examination shows irregular movements of the arms and legs at rest. Extraocular eye movements are normal. Muscle strength is 5/5 throughout, and deep tendon reflexes are 2+ bilaterally. Further evaluation is most likely to show which of the following?? {'A': 'Mitral vegetations on echocardiogram', 'B': 'Positive Babinski sign on physical examination', 'C': 'Oligoclonal bands on lumbar puncture', 'D': 'Poor performance on an IQ test', 'E': 'Caudate nucleus atrophy on MRI'},
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E: Caudate nucleus atrophy on MRI
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his primary care physician for a regular check-up. The patient was born in Germany in 1960 in with shortened limbs, underdeveloped digits, absent external ears, and a cleft palate. He is currently in a wheelchair. His past medical history is also notable for hypertension and allergies. He takes lisinopril daily and loratadine as needed. His mother had a complicated past medical history and took multiple medications during her pregnancy. His temperature is 98.6°F (37°C), blood pressure is 120/80 mmHg, pulse is 90/min, and respirations are 20/min. The drug that most likely caused this patient's condition is also indicated for which of the following?? {'A': 'Acne vulgaris', 'B': 'Deep venous thrombosis', 'C': 'Multiple myeloma', 'D': 'Bipolar disease', 'E': 'Recurrent miscarriage'},
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C: Multiple myeloma
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman presents to her gynecologist because of chronic pelvic pain that she has been experiencing for the last 6 months. Specifically, she says that she has severe pain during menstruation that is localized primarily to her lower abdomen and pelvis. In addition, she has been having pain while defecating and during intercourse. She has no past surgical history and her past medical history is significant for asthma. She uses protection while having intercourse with her long time boyfriend and has never been pregnant. Physical exam reveals adnexal tenderness and the presence of an adnexal mass. Laparoscopic examination is conducted showing several cysts filled with dark brown fluid on her ovaries and powder burn marks along her peritoneal surfaces. Which of the following markers would most likely be elevated in this patient?? {'A': 'Alpha-fetoprotein', 'B': 'Beta-hCG', 'C': 'Bombesin', 'D': 'CA-125', 'E': 'CA-19-9'},
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D: CA-125
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man presented to the emergency department complaining of left-sided weakness for the past 5 hours. Past medical history is significant for a previous ischemic stroke involving the right posterior cerebral artery and left-sided homonymous hemianopia. He also has a history of type-II diabetes mellitus and hypertension. He takes an 81 mg aspirin, amlodipine, atorvastatin, and a vitamin supplement with calcium and vitamin D. A brain MRI reveals a small atrophic area of the left occipital lobe and a new acute infarct involving the territory of the right middle cerebral artery. Electrocardiogram (ECG) shows normal sinus rhythm. An echocardiogram reveals mild left ventricular hypertrophy with an ejection fraction of 55%. Doppler ultrasound of the carotid arteries reveals no significant narrowing. What is the next step in the management to prevent future risks of stroke?? {'A': 'Add dipyridamole', 'B': 'Add warfarin', 'C': 'Increase aspirin to 325 mg', 'D': 'Administer tPA', 'E': 'Stop aspirin and start warfarin'},
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A: Add dipyridamole
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old primigravid woman comes to the physician for a prenatal visit at 37-weeks' gestation because of worsening back pain for 3 weeks. The pain is worse with extended periods of walking, standing, and sitting. She has not had any changes in bowel movements or urination. Her mother has rheumatoid arthritis. Examination of the back shows bilateral pain along the sacroiliac joint area as a posterior force is applied through the femurs while the knees are flexed. She has difficulty actively raising either leg while the knee is extended. Motor and sensory function are normal bilaterally. Deep tendon reflexes are 2+. Babinski sign is absent. Pelvic examination shows a uterus consistent in size with a 37-weeks' gestation. There is no tenderness during abdominal palpation. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Spinal cord compression', 'B': 'Vertebral bone compression fracture', 'C': 'Placental abruption', 'D': 'Relaxation of the pelvic girdle ligaments', 'E': 'Rheumatoid arthritis'},
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D: Relaxation of the pelvic girdle ligaments
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Q:An investigator studying immune response administers a 0.5 mL intradermal injection of an autoclaved microorganism to a study volunteer. Four weeks later, there is a 12-mm, indurated, hypopigmented patch over the site of injection. Which of the following is the most likely explanation for the observed skin finding?? {'A': 'Increased lipid uptake by macrophages', 'B': 'Increased antibody production by B cells', 'C': 'Increased activity of neutrophils', 'D': 'Increased activity of CD4+ Th1 cells', 'E': 'Increased release of transforming growth factor beta'},
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D: Increased activity of CD4+ Th1 cells
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Q:A 37-year-old woman comes to the physician because of oligomenorrhea and intermittent vaginal spotting for 5 months. Menses previously occurred at regular 28-day intervals and lasted for 5 days with normal flow. She has also noted increased hair growth on her chin. She is not sexually active. She takes no medications. Physical examination shows temporal hair recession and nodulocystic acne on her cheeks and forehead. There is coarse hair on the chin and the upper lip. Pelvic examination shows clitoral enlargement and a right adnexal mass. Laboratory studies show increased serum testosterone concentration; serum concentrations of androstenedione and dehydroepiandrosterone are within the reference ranges. Ultrasonography of the pelvis shows a 10-cm right ovarian tumor. Which of the following is the most likely diagnosis?? {'A': 'Ovarian thecoma', 'B': 'Dermoid cyst', 'C': 'Ovarian dysgerminoma', 'D': 'Serous cystadenoma', 'E': 'Sertoli-Leydig cell tumor'},
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E: Sertoli-Leydig cell tumor
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl presents to the emergency department with a fever and a change in her behavior. She presented with similar symptoms 6 weeks ago and was treated for an Escherchia coli infection. She also was treated for a urinary tract infection 10 weeks ago. Her mother says that last night her daughter felt ill and her condition has been worsening. Her daughter experienced a severe headache and had a stiff neck. This morning she was minimally responsive, vomited several times, and produced a small amount of dark cloudy urine. The patient was born at 39 weeks and met all her developmental milestones. She is currently up to date on her vaccinations. Her temperature is 99.5°F (37.5°C), blood pressure is 60/35 mmHg, pulse is 190/min, respirations are 33/min, and oxygen saturation is 98% on room air. The patient is started on intravenous fluids, vasopressors, and broad-spectrum antibiotics. Which of the following is the best underlying explanation for this patient's presentation?? {'A': 'Gastroenteritis', 'B': 'Intentional contamination', 'C': 'Meningitis', 'D': 'Sepsis', 'E': 'Urinary tract infection'},
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B: Intentional contamination
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman comes to your office with a variety of complaints. As part of her evaluation, she undergoes laboratory testing which reveals the presence of anti-centromere antibodies. All of the following symptoms and signs would be expected to be present EXCEPT:? {'A': 'Pallor, cyanosis, and erythema of the hands', 'B': 'Calcium deposits on digits', 'C': 'Blanching vascular abnormalities', 'D': 'Hypercoagulable state', 'E': 'Heartburn and regurgitation'},
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D: Hypercoagulable state
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman comes to the physician for a 6-month history of worsening bronchial asthma control. Before this issue began, she only used her salbutamol inhaler once a day. Now, she has to use it multiple times daily and also reports frequent nighttime awakening. Seven months ago, she moved to an apartment that is damp and has mold on some of the walls. The physician injects 0.1 mL of Candida albicans extract on the mid-volar surface of the right arm intradermally. After 48 hours there is a palpable induration of 17 mm. This reaction is most likely a result of release of which of the following substances?? {'A': 'Tryptase', 'B': 'Interleukin-10', 'C': 'Lysozyme', 'D': 'Interferon-γ', 'E': 'Superoxide anion\n"'},
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D: Interferon-γ
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old, G1P0 woman at 35 weeks of gestation comes to the emergency room for a severe headache. She reports that she was washing the dishes 2 hours ago when a dull headache came on and progressively worsened. She also reports 2 episodes of intermittent blurred vision over the past hour that has since cleared. Nothing similar has ever happened before. She denies any precipitating events, trauma, mental status changes, abdominal pain, lightheadedness, fever, ulcers, or urinary changes. Her temperature is 98.9°F (37.1°C), blood pressure is 160/110 mmHg, pulse is 98/min, respirations are 12/min, and oxygen saturation is 98%. A physical examination demonstrates a rash on her face that she attributes to a recent change in cosmetics. A urine test demonstrates the presence of protein. What is the most likely explanation for this patient’s symptoms?? {'A': 'Abnormal placental spiral arteries', 'B': 'Neoplasm of meningeal tissue', 'C': 'Premature separation of the placenta from the uterine wall', 'D': 'Production of pathogenic autoantibodies and tissue injury', 'E': 'Rupture of an aneurysm'},
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A: Abnormal placental spiral arteries
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man is brought to the emergency department 25 minutes after being involved in a high-speed motor vehicle collision in which he was a restrained passenger. On arrival, he has shortness of breath and is in severe pain. His pulse is 130/min, respirations are 35/min, and blood pressure is 90/40 mm Hg. Examination shows superficial abrasions and diffuse crepitus at the left shoulder level. Cardiac examination shows tachycardia with no murmurs, rubs, or gallops. The upper part of the left chest wall moves inward during inspiration. Breath sounds are absent on the left. He is intubated and mechanically ventilated. Two large bore intravenous catheters are placed and infusion of 0.9% saline is begun. Which of the following is the most likely cause of his symptoms?? {'A': 'Diaphragmatic rupture', 'B': 'Phrenic nerve paralysis', 'C': 'Cardiac tamponade', 'D': 'Sternal fracture', 'E': 'Flail chest'},
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E: Flail chest
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Answer the following medical question with one of the provided options:
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Q:A 66-year-old man presents to the emergency room with blurred vision, lightheadedness, and chest pain that started 30 minutes ago. The patient is awake and alert. His history is significant for uncontrolled hypertension, coronary artery disease, and he previously underwent percutaneous coronary intervention. He is afebrile. The heart rate is 102/min, the blood pressure is 240/135 mm Hg, and the O2 saturation is 100% on room air. An ECG is performed and shows no acute changes. A rapid intravenous infusion of a drug that increases peripheral venous capacitance is started. This drug has an onset of action that is less than 1 minute with rapid serum clearance than necessitates a continuous infusion. What is the most severe side effect of this medication?? {'A': 'Cyanide poisoning', 'B': 'Lupus-like syndrome', 'C': 'Status asthmaticus', 'D': 'Intractable headache', 'E': 'Increased intraocular pressure'},
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A: Cyanide poisoning
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old man is brought to the emergency department because of a 5-hour history of worsening chest pain and dyspnea. Six days ago, he fell in the shower and since then has had mild pain in his left chest. He appears pale and anxious. His temperature is 36.5°C (97.7°F), pulse is 108/min, respirations are 30/min, and blood pressure is 115/58 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Examination shows decreased breath sounds and dullness to percussion over the left lung base. There is a 3-cm (1.2-in) hematoma over the left lower chest. An x-ray of the chest shows fractures of the left 8th and 9th rib, increased opacity of the left lung, and mild tracheal deviation to the right. Which of the following is the most appropriate next step in management?? {'A': 'Admission to the ICU and observation', 'B': 'Needle thoracentesis in the eighth intercostal space at the posterior axillary line', 'C': 'Emergency thoracotomy', 'D': 'Pericardiocentesis', 'E': 'Chest tube insertion in the fifth intercostal space at the midaxillary line\n"'},
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E: Chest tube insertion in the fifth intercostal space at the midaxillary line "
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman comes to the physician because of growths around her anus that developed over the past 4 weeks. They are not painful and she does not have blood in her stool. She is sexually active with two male partners and uses condoms inconsistently. She appears healthy. Vital signs are within normal limits. Examination shows nontender, irregular, hyperkeratotic sessile lesions in the perianal area around 4–7 mm in diameter. There is no lymphadenopathy. The application of a dilute solution of acetic acid turns the lesions white. Which of the following is the most likely cause of the lesions?? {'A': 'Poxvirus', 'B': 'Treponema pallidum', 'C': 'Malignant transformation', 'D': 'Benign fibroepithelial growth', 'E': 'Human papilloma virus'},
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E: Human papilloma virus
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman comes to the physician because of intermittent episodes of cramping lower abdominal pain and bloating over the past 3 months. These episodes are often associated with non-bloody, watery, frothy stools, and excessive flatulence. The cramping does not subside after defecation. She reports that her symptoms typically begin an hour or two after eating ice cream, cheese, or pudding. She is otherwise healthy. Her only medication is an iron supplement and an oral contraceptive pill. The patient's height is 158 cm (5 ft 2 in) and her weight is 59 kg (130 lb); her BMI is 23.6 kg/m2. Abdominal examination is normal. Which of the following is the most appropriate next step in management?? {'A': 'Fecal fat test', 'B': 'D-xylose absorption test', 'C': 'Jejunal biopsy', 'D': 'Hydrogen breath test', 'E': 'Serum IgE levels'},
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D: Hydrogen breath test
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old woman presents with 5-day history of progressively worsening shortness of breath and bilateral pleuritic chest pain. She also has been having associated fatigue, low grade fever, and night sweats. Her temperature is 38.1°C (100.6°F), pulse is 106/min, respiratory rate is 26/min, and blood pressure is 136/88 mm Hg. On physical examination, she is diaphoretic and in mild respiratory distress. Cardiac auscultation reveals a faint 2/6 systolic murmur best heard over the lower left sternal border. Her neck veins are distended, and abdominal examination shows significant hepatomegaly. Echocardiography is performed and results are shown below. Which of the following is the most likely underlying cause of this patient’s clinical presentation?? {'A': 'Fat embolism', 'B': 'Infective endocarditis', 'C': 'Myocardial infarction', 'D': 'Rheumatic fever', 'E': 'Small cell lung cancer'},
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B: Infective endocarditis
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old female presents to her primary care provider complaining of shaking of her hands. She reports that her hands shake when she is pouring her coffee in the morning and when she is buttoning her shirt. She has noticed that her tremor improves with the several beers she has every night with dinner. She has a past medical history of hypertension, atrial fibrillation, moderate persistent asthma, acute intermittent porphyria, and urinary retention. Her home medications include hydrochlorothiazide, warfarin, bethanechol, low-dose inhaled fluticasone, and an albuterol inhaler as needed. On physical exam, she has an irregularly irregular heart rhythm without S3/S4. She has mild wheezing on pulmonary exam. She has no tremor when her hands are in her lap. A low-amplitude tremor is present during finger-to-nose testing. Her neurological exam is otherwise unremarkable. Which of the following is a contraindication to the first-line treatment of this condition?? {'A': 'Acute intermittent porphyria', 'B': 'Asthma', 'C': 'Heavy alcohol use', 'D': 'Urinary retention', 'E': 'Warfarin use'},
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B: Asthma
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman, gravida 1, para 0, at 16 weeks' gestation comes to the physician for a routine prenatal visit. She feels well. She has no history of serious illness. She has smoked one pack of cigarettes daily for 10 years but quit when she learned she was pregnant. She does not drink alcohol or use illicit drugs. Her mother has type 1 diabetes mellitus, and her father has asthma. Current medications include a prenatal multivitamin. She appears well. Her vital signs are within normal limits. Physical examination shows no abnormalities. Serum studies show: Alpha-fetoprotein decreased Unconjugated estriol decreased Human chorionic gonadotropin increased Inhibin A increased During counseling regarding the potential for fetal abnormalities, the patient says that she would like a definitive diagnosis as quickly as possible. Which of the following is the most appropriate next step in management?"? {'A': 'Reassurance', 'B': 'Cell-free fetal DNA testing', 'C': 'Amniocentesis', 'D': 'Chorionic villus sampling', 'E': 'Pelvic ultrasound'},
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C: Amniocentesis
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