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Answer the following medical question with one of the provided options:
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Q:A 55-year-old black male otherwise healthy presents for a yearly physical. No significant past medical history. Current medications are a multivitamin and rosuvastatin 20 mg orally daily. Vitals are temperature 37°C (98.6°F), blood pressure 155/75 mm Hg, pulse 95/min, respirations 16/min, and oxygen saturation 99% on room air. On physical examination, the patient is alert and cooperative. The cardiac exam is significant for a high-pitched diastolic murmur loudest at the left sternal border. Peripheral pulses are bounding and prominent followed by a quick collapse on palpation. Lungs are clear to auscultation. The abdomen is soft and nontender. Chest X-ray is normal. ECG is significant for left axis deviation and broad bifid P-waves in lead II. Transthoracic echocardiography shows a bicuspid aortic valve, severe aortic regurgitation, left atrial enlargement and left ventricular dilatation and hypertrophy. Left ventricular ejection fraction is 45%. Which of the following is the best course of treatment for this patient?? {'A': 'Reassurance and recommend long-term follow-up with outpatient cardiology for clinical surveillance with regular echocardiography', 'B': 'Outpatient management on nifedipine 45 mg orally daily', 'C': 'Outpatient management on enalapril 10 mg orally twice daily', 'D': 'Administer dobutamine and nitroprusside', 'E': 'Admit to hospital for aortic valve replacement'},
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E: Admit to hospital for aortic valve replacement
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman presents to the outpatient infectious disease clinic. She has a known history of HIV, well-controlled on HAART for the past 8 years. She currently has no additional significant medical conditions. She feels well and a physical examination is within normal limits. She denies any current tobacco use, alcohol use, or illicit drug use, although she has a history of heroin use (injection). Her vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 126/74 mm Hg; heart rate, 87/min; and respiratory rate, 17/min. She has no complaints and is up to date on all of her vaccinations and preventative care. Which of the following malignancies can be seen and is often associated with AIDS?? {'A': 'Colonic adenocarcinoma', 'B': 'Kaposi’s sarcoma', 'C': 'Secondary osteosarcoma', 'D': 'Thymomas', 'E': 'Malignant melanoma'},
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B: Kaposi’s sarcoma
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy presents to the emergency department with severe right-lower-quadrant abdominal pain. Workup reveals acute appendicitis, and he subsequently undergoes laparoscopic appendectomy. The appendix is sent for histological examination. A pathologist reviews the slide shown in the image below. Which statement about the structures marked within the yellow circles is correct?? {'A': 'In children, appendicitis can frequently arise from certain changes in these structures.', 'B': 'The only part of the digestive system in which this structure can be found is the appendix.', 'C': 'Neutrophils are the major components of these structures.', 'D': 'These structures are not normally present within the appendix.', 'E': 'These structures belong to the primary lymphatic system.'},
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A: In children, appendicitis can frequently arise from certain changes in these structures.
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old female college student is brought to the university clinic by her roommates. They became worried because they noted long strands of hair all over the dormitory room floor. This has progressively worsened, with the midterms approaching. During discussions with the physician, the roommates also mention that she aggressively manipulates her scalp when she becomes upset or stressed. Physical examination reveals an otherwise well but anxious female with patches of missing and varying lengths of hair. A dermal biopsy is consistent with traumatic alopecia. What is the single most appropriate treatment for this patient?? {'A': 'Cognitive-behavior therapy or behavior modification', 'B': 'Clomipramine', 'C': 'Venlafaxine', 'D': 'Phenelzine', 'E': 'Electroconvulsive therapy'},
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A: Cognitive-behavior therapy or behavior modification
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old Hispanic man presents with complaints of recent heat intolerance and rapid heart rate. The patient has also experienced recent unintentional weight loss of 15 pounds. Physical exam reveals tachycardia and skin that is warm to the touch. A radioactive iodine uptake scan of the thyroid reveals several focal nodules of increased iodine uptake. Prior to this study, the physician had also ordered a serum analysis that will most likely show which of the following?? {'A': 'High TSH and low T4', 'B': 'Low TSH and high T4', 'C': 'High TSH and normal T4', 'D': 'High TSH and high T4', 'E': 'Low TSH and low T4'},
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B: Low TSH and high T4
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Answer the following medical question with one of the provided options:
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Q:A 74-year-old man is brought to the emergency department because of increasing abdominal pain and distention for 3 days. The pain is diffuse and colicky, and he describes it as 4 out of 10 in intensity. His last bowel movement was 5 days ago. He has not undergone any previous abdominal surgeries. He has hypertension, chronic lower back pain, coronary artery disease, and hypercholesterolemia. Prior to admission, his medications were enalapril, gabapentin, oxycodone, metoprolol, aspirin, and simvastatin. He appears uncomfortable. His temperature is 37.3°C (99.1°F), pulse is 93/min, and blood pressure is 118/76 mm Hg. Examination shows a distended and tympanitic abdomen; bowel sounds are reduced. There is mild tenderness to palpation in the lower abdomen with no guarding or rebound. Rectal examination shows an empty rectum. Laboratory studies show: Hemoglobin 13.1 g/dL Serum Na+ 134 mEq/L K+ 2.7 mEq/L Cl- 98 mEq/L Urea nitrogen 32 mg/dL Creatinine 1 mg/dL An x-ray of the abdomen shows a dilated cecum and right colon and preservation of the haustrae. A CT scan of the abdomen and pelvis with contrast shows a cecal diameter of 11 cm. The patient is kept NPO and intravenous fluids with electrolytes are administered. A nasogastric tube and rectal tube are inserted. Thirty-six hours later, he still has abdominal pain. Examination shows a distended and tympanitic abdomen. Serum concentrations of electrolytes are within the reference range. Which of the following is the most appropriate next step in management?"? {'A': 'Percutaneous cecostomy', 'B': 'Neostigmine therapy', 'C': 'Laparotomy', 'D': 'Metronidazole therapy', 'E': 'Colonoscopy'},
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B: Neostigmine therapy
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man comes to the physician because of a 2-day history of a rash across his trunk and extremities. For the past 3 months, he has had persistent pruritus in these areas. He started hiking in the woods with his grandson last week to try to lose weight. His grandson, who often spends the weekends with him, recently had impetigo. He has hypertension, hyperlipidemia, and osteoarthritis of his thumbs. Five months ago, he was treated for a gout attack of his left hallux. Current medications include captopril, hydrochlorothiazide, simvastatin, allopurinol, and ibuprofen. Vital signs are within normal limits. There are diffuse vesicles and tense blisters involving the chest, flexures of the arms, and shoulders. Rubbing the skin on his chest does not produce blisters. Oral examination shows no abnormalities. This patient's condition is most likely associated with which of the following findings?? {'A': 'Growth of Gram-positive bacteria on blood culture', 'B': 'Antibodies to tissue transglutaminase on serologic testing', 'C': 'Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies', 'D': 'Spongiotic dermatitis on skin biopsy', 'E': 'Subepidermal separation with full thickness epidermal necrosis on skin biopsy'},
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C: Linear deposits of IgG and C3 along the basement membrane on direct immunofluorescence studies
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man is undergoing chemotherapy treatment for a rapidly progressive newly-diagnosed acute myelogenous leukemia. On day 4 of his hospitalization, the patient is noted to be obtunded. Other than the chemotherapy, he is receiving lansoprazole, acetaminophen, and an infusion of D5–0.9% normal saline at 50 mL/h. On examination, the patient’s blood pressure is 94/50 mm Hg, heart rate is 52/min, and respiratory rate is 14/min. The patient appears weak but is in no acute distress. Chest auscultation reveals bibasilar crackles and scattered wheezing. His abdomen is soft, non-distended, and with a palpable liver and spleen. His ECG shows peaked T waves and widened QRS complexes. What is the best next step in the management of this patient?? {'A': 'Glucagon', 'B': 'Subcutaneous regular insulin', 'C': 'Polystyrene sulfonate', 'D': 'Calcium chloride', 'E': 'Atropine'},
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D: Calcium chloride
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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 is brought to the pediatrician’s office for a flu-like episode. His father tells the physician that his child has fallen ill several times over the past few months. He also has occasional bouts of night sweats and loss of appetite. He has lost 5 lbs (2.3 kg) in the last 6 months. At the pediatrician’s office, his temperature is 38.9°C (102°F), pulse is 105/min and respiration rate is 18/min. On physical examination, the pediatrician observes a flattened facial profile, prominent epicanthal folds, and a single palmar crease. There are petechiae on the arms and legs. Blood count shows pancytopenia. Bone marrow aspiration is diagnostic for ALL (acute lymphoblastic leukemia), but all cells also show a trisomy. Children with similar genetic anomalies are at an increased risk of developing which of the following neurological conditions as they grow older?? {'A': 'Lewy body dementia', 'B': 'Alzheimer’s disease', 'C': 'Amyotrophic lateral sclerosis', 'D': 'Pick’s disease', 'E': 'Parkinson’s dementia'},
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B: Alzheimer’s disease
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old man comes to the military base physician for evaluation of progressive discomfort in his right shoulder for the past 4 months. He joined the military 6 months ago and is part of a drill team. In anticipation of an upcoming competition, he has been practicing rifle drills and firing exercises 8 hours a day. Physical examination shows tenderness to palpation and a firm mass in the superior part of the right deltopectoral groove. Range of motion is limited by pain and stiffness. Which of the following is the most likely diagnosis?? {'A': 'Osteoid osteoma', 'B': 'Lipoma', 'C': 'Acromioclavicular joint separation', 'D': 'Myositis ossificans', 'E': 'Arteriovenous fistula'},
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D: Myositis ossificans
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Answer the following medical question with one of the provided options:
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Q:A 5-year-old girl is brought to the physician by her mother because of a 3-week history of a foul-smelling discharge from the left nostril. There was one episode of blood-tinged fluid draining from the nostril during this period. She has been mouth-breathing in her sleep for the past 4 days. She was born at term. Her 1-year-old brother was treated for viral gastroenteritis 3 weeks ago. She is at 60th percentile for height and at 70th percentile for weight. Her temperature is 37°C (98.6°F), pulse is 96/min, respirations are 23/min, and blood pressure is 96/54 mm Hg. Examination shows mucopurulent discharge in the left nasal cavity. Oral and otoscopic examination is unremarkable. Endoscopic examination of the nose confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Transnasal puncture and stenting', 'B': 'Foreign body extraction', 'C': 'Perform septoplasty', 'D': 'Adenoidectomy', 'E': 'Intranasal glucocorticoid therapy\n"'},
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B: Foreign body extraction
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 57-year-old man is brought to the emergency department because of a 3-day history of fever and headache. He also has nausea and vomited twice in the past 24 hours. His temperature is 39.1°C (102.4°F). He is lethargic but oriented to person, place, and time. Examination shows severe neck rigidity with limited active and passive range of motion. A lumbar puncture is performed; cerebrospinal fluid analysis shows a neutrophilic pleocytosis and a decreased glucose concentration. A Gram stain of the patient's cerebrospinal fluid is most likely to show which of the following?? {'A': 'Non-encapsulated, gram-negative cocci in pairs', 'B': 'Gram-positive cocci in clusters', 'C': 'Gram-negative bacilli', 'D': 'Encapsulated, gram-positive cocci in pairs', 'E': 'Gram-positive bacilli'},
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D: Encapsulated, gram-positive cocci in pairs
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old G2P0 presents to her physician to discuss the results of her 16-week obstetric screening tests. She has no complaints. Her previous pregnancy at 28 years of age was a spontaneous abortion in the first trimester. She has no history of gynecologic diseases. Her quadruple test shows the following findings: Alpha-fetoprotein Low Beta-hCG High Unconjugated estriol Low Inhibin A High Which of the following statements regarding the presented results is correct? ? {'A': 'Such results are associated with a 100% lethal fetal condition.', 'B': 'Maternal age is a significant risk factor for the condition of the patient, the increased risk of which is indicated by the results of the study.', 'C': 'Such results are a strong indicator of a monogenic disease.', 'D': 'The obtained results can be normal for women aged 35 and older.', 'E': 'The results show increased chances of aneuploidies associated with the sex chromosomes.'},
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B: Maternal age is a significant risk factor for the condition of the patient, the increased risk of which is indicated by the results of the study.
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man comes to the clinic complaining of yellow discoloration of his skin and eyes for the past week. He also complains about loss of appetite, nausea, malaise, and severe tiredness. He has no known past medical history and takes over-the-counter acetaminophen for headache. He has smoked a half pack of cigarettes every day for the last 15 years and drinks alcohol occasionally. He has been sexually active with a new partner for a month and uses condoms inconsistently. His father and mother live in China, and he visited them last year. Temperature is 37°C (98.7°F), blood pressure is 130/90 mm Hg, pulse is 90/min, respirations are 12/min, and BMI is 25 kg/m2. On physical examination, his sclera and skin are icteric. Cardiopulmonary examination is negative, no lymphadenopathy is noted, and his abdomen is tender in the right upper quadrant (RUQ). His liver is palpated 3 cm below the costal margin. On laboratory investigations: Laboratory test Complete blood count Hemoglobin 15 g/dL Leucocytes 13,000/mm3 Platelets 170,000/mm3 Basic metabolic panel Serum Na+ 133 mEq/L Serum K+ 3.6 mEq/L Serum Cl- 107 mEq/L Serum HCO3- 26 mEq/L BUN 12 mg/dL Liver function test Serum bilirubin 3.4 mg/dL Direct bilirubin 2.5 mg/dL AST 2,100 U/L ALT 2,435 U/L ALP 130 U/L What is the next best step to do in this patient?? {'A': 'USG of the abdomen', 'B': 'CT scan of the abdomen', 'C': 'Reassurance and counselling', 'D': 'HbsAg and Anti-IgM Hbc', 'E': 'ERCP'},
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D: HbsAg and Anti-IgM Hbc
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old woman presents with loss of sensation in her left arm and hand. A rapid evaluation is performed to rule out stroke. No other focal neurologic deficits are found except for a loss of fine touch sensation in a C6 dermatome pattern. Further evaluation reveals that the patient was recently sick with an upper respiratory infection. A biopsy is performed and shows destruction of the cell bodies of sensory nerves. Which of the following structures is most likely been damaged?? {'A': "Meissner's corpuscles", 'B': 'Dorsal root ganglion', 'C': 'Ventral root ganglion', 'D': 'Dorsal column', 'E': 'Lateral corticospinal tract'},
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B: Dorsal root ganglion
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Answer the following medical question with one of the provided options:
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Q:Lipidator is a nonionic surfactant that is used to disrupt the lipid membranes of cells. This disruption of the lipid membrane results in the release of all of its cytoplasmic contents. Which of the following viruses would not be disrupted if treated with this detergent?? {'A': 'Herpesvirus', 'B': 'Hepadnavirus', 'C': 'Flavivirus', 'D': 'Picornavirus', 'E': 'HIV'},
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D: Picornavirus
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old woman presents to her primary care physician with a 1-week history of facial drooping. Specifically, she has noticed that the left side of her face does not move when she tries to smile. Furthermore, she has been having difficulty closing her left eye. Her past medical history is significant for hypertension but she does not have any known prior neurological deficits. Imaging reveals a cranial mass that is compressing an adjacent nerve. Which tumor location would most likely be associated with this patient's symptoms?? {'A': 'Foramen ovale', 'B': 'Internal auditory meatus', 'C': 'Jugular foramen', 'D': 'Optic canal', 'E': 'Superior orbital fissure'},
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B: Internal auditory meatus
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman comes to the physician because of a 5-month history of insomnia. She frequently experiences leg discomfort when trying to fall asleep that is relieved temporarily by movement. Her husband tells her that she frequently flexes her ankles upward when she sleeps. She appears fatigued and anxious. Physical examination shows no abnormalities. Laboratory studies including a complete blood count and iron studies are within the reference range. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Ropinirole', 'B': 'Zolpidem', 'C': 'Nortriptyline', 'D': 'Atenolol', 'E': 'Sertraline'},
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A: Ropinirole
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man comes to the emergency department for progressively worsening abdominal pain. The pain began 2 weeks ago and is localized to the right upper quadrant. He feels sick and fatigued. He also reports breathlessness when climbing the stairs to his first-floor apartment. He is a retired painter. He has hypertension and type 2 diabetes mellitus. He is sexually active with one female partner and does not use condoms consistently. He began having sexual relations with his most recent partner 2 months ago. He smoked 1 pack of cigarettes daily for 40 years but quit 10 years ago. He does not drink alcohol. Current medications include insulin and enalapril. He is 181 cm (5 ft 11 in) tall and weighs 110 kg (264 lb); BMI is 33.5 kg/m2. His vital signs are within normal limits. Physical examination shows jaundice, a distended abdomen, and tender hepatomegaly. There is no jugular venous distention. A grade 2/6 systolic ejection murmur is heard along the right upper sternal border. Laboratory studies show: Hemoglobin 18.9 g/dL Aspartate aminotransferase 450 U/L Alanine aminotransferase 335 U/L Total bilirubin 2.1 mg/dL Which of the following is the most likely cause of his symptoms?"? {'A': 'Hepatotropic viral infection', 'B': 'Increased iron absorption', 'C': 'Hepatic vein obstruction', 'D': 'Thickened pericaridium', 'E': 'Hepatic steatosis'},
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C: Hepatic vein obstruction
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man is brought to the emergency department because of a 2-hour history of abdominal pain and severe vomiting after ingesting an unknown medication in a suicide attempt. On the way to the hospital, he had a generalized tonic-clonic seizure. He has chronic obstructive pulmonary disease, coronary artery disease, and chronic back pain. His pulse is 130/min, respirations are 16/min, and blood pressure is 110/60 mm Hg. Serum studies show a glucose concentration of 180 mg/dL and a potassium concentration of 2.8 mEq/L. An ECG shows ventricular tachycardia. This patient's current findings are most likely caused by an overdose of which of the following drugs?? {'A': 'Albuterol', 'B': 'Theophylline', 'C': 'Metoprolol', 'D': 'Amitriptyline', 'E': 'Acetaminophen\n"'},
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B: Theophylline
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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 presents to the clinic today complaining of weakness and fatigue. She is a vegetarian and often struggles to maintain an adequate intake of non-animal based protein. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use. Her past medical history is non-contributory. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 16/min. On physical examination, her pulses are bounding, the complexion is pale, the breath sounds are clear, and the heart sounds are normal. The spleen is mildly enlarged. Oxygen saturation was initially 81% on room air, with a new oxygen requirement of 8 L by face mask. She is at a healthy body mass index (BMI) of 22 kg/m2. The laboratory results indicate: mean corpuscular volume MCV: 71 fL, Hgb: 11.0, total iron-binding capacity (TIBC): 412 mcg/dL, transferrin saturation (TSAT): 11%. What is the most appropriate treatment for this patient?? {'A': 'Iron replacement for 4–6 months', 'B': 'Lifelong Vitamin B6 supplementation', 'C': 'Lifelong Vitamin B1 supplementation', 'D': 'Folic acid supplementation', 'E': 'Obtain a bone-marrow biopsy'},
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A: Iron replacement for 4–6 months
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Answer the following medical question with one of the provided options:
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Q:An autopsy was performed on a 2-year-old male child. The clinical report stated that the child's parents were first cousins, and that he had deteriorated physically and mentally over the past year, becoming deaf, unable to eat, and paralyzed. A brain biopsy demonstrated the accumulation of GM2-gangliosides in the neurons. Which of the following enzymes was missing from this child?? {'A': 'Sphingomyelinase', 'B': 'a-galactosidase A', 'C': 'ß-galactocerebrosidase', 'D': 'Hexosaminidase A', 'E': 'a-L-iduronidase'},
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D: Hexosaminidase A
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old woman comes to the physician for a follow-up examination 2 months after undergoing a total hip replacement surgery. She reports that she has persistent difficulty in walking since the surgery despite regular physiotherapy. Examination of her gait shows sagging of the left pelvis when her right leg is weight-bearing. Which of the following nerves is most likely to have been injured in this patient?? {'A': 'Left superior gluteal nerve', 'B': 'Right femoral nerve', 'C': 'Left inferior gluteal nerve', 'D': 'Left femoral nerve', 'E': 'Right superior gluteal nerve'},
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E: Right superior gluteal nerve
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man seeks evaluation at a clinic with a 2-week history of pain during urination and a yellow-white discharge from the urethra. He has a history of multiple sexual partners and inconsistent use of condoms. He admits to having similar symptoms in the past and being treated with antibiotics. On genital examination, solitary erythematous nodules are present on the penile shaft with a yellow-white urethral discharge. The urinalysis was leukocyte esterase-positive, but the urine culture report is pending. Gram staining of the urethral discharge showed kidney bean-shaped diplococci within neutrophils. Urethral swabs were collected for cultures. Which of the following best explains why this patient lacks immunity against the organism causing his recurrent infections?? {'A': 'Lipooligosaccharide', 'B': 'Protein pili', 'C': 'Exotoxin', 'D': 'Lack of vaccine', 'E': 'Complement deficiency'},
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B: Protein pili
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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 is diagnosed with schizophrenia after nine months of experiencing auditory hallucinations and persecutory delusions. Over the next year, she fails to experience symptom relief from separate and appropriately dosed trials of olanzapine, quetiapine, and risperidone. At this point, which of the following treatment options is most likely to be effective?? {'A': 'Aripiprazole', 'B': 'Haloperidol', 'C': 'Clozapine', 'D': 'Clonidine', 'E': 'Cognitive behavioral therapy'},
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C: Clozapine
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old woman comes to the physician because of an ulcer on her left ankle for 6 years. She has had multiple ulcers over her left lower extremity during this period that have subsided with wound care and dressing. She has type 2 diabetes mellitus and gastroesophageal reflux disease. Current medications include metformin, sitagliptin, and omeprazole. She appears anxious. She is 162 cm (5 ft 4 in) tall and weighs 89 kg (196 lb); BMI is 34 kg/m2. Vital signs are within normal limits. Examination shows a 7.5-cm (3-in) ulcer with elevated, indurated margins and a necrotic floor above the left medial malleolus. There are multiple dilated, tortuous veins along the left lower extremity. There is 2+ pretibial edema of the lower extremities bilaterally. The skin around the left ankle appears darker than the right and there are multiple excoriation marks. Cardiopulmonary examination shows no abnormalities. Which of the following is the most appropriate next step in management of this patient's current condition?? {'A': 'Digital subtraction angiography', 'B': 'CT scan of the left leg', 'C': 'Perthes test', 'D': 'Trendelenburg test', 'E': 'Punch biopsy\n"'},
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E: Punch biopsy "
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old woman presents to you with vision problems. Objects appear clear, but she just can't see as well as before. She says she first noticed this when she went to the movies with her grandkids, and she could not see the whole screen. She denies any complaints of redness, itchiness, or excessive tearing of her eyes. Current medications are captopril for her hypertension, acetaminophen for occasional headaches, and a daily multivitamin. Her vital signs are a blood pressure 130/80 mm Hg, pulse 80/min and regular, respiratory rate 14/min, and a temperature of 36.7°C (98.0°F). Eye examination reveals that her visual acuity is normal but the visual field is reduced with enlarged blind spots. Tonometry reveals mildly increased IOP. The patient is started on brimonidine. Which of the following statements best describes the therapeutic mechanism of action of this medication in this patient?? {'A': 'Brimonidine causes an increase in cAMP, leading to increased aqueous humor formation by the ciliary body.', 'B': 'Brimonidine causes immediate contraction of the ciliary body, leading to decreased uveoscleral outflow.', 'C': 'Brimonidine blocks the beta-receptors on the ciliary body to reduce aqueous humor production.', 'D': 'Peripheral vasoconstriction by brimonidine leads to better control of her hypertension.', 'E': 'Brimonidine causes release of prostaglandins that relax the ciliary muscle and increases uveoscleral outflow.'},
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E: Brimonidine causes release of prostaglandins that relax the ciliary muscle and increases uveoscleral outflow.
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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 presents to the office because she has noticed yellowish bumps and patches on her elbows and knees that seem to come and go. Recently she noticed the same yellow bumps on her eyelids. She is a new patient and reports that she is otherwise healthy but did not have insurance until recently so she has not been to the doctor in over 8 years. Past medical history is significant for occasional headaches that she treats with aspirin. She used to smoke a pack a day for the last 20 years but recently quit. Her father died of a heart attack at the age of 55 years and her mother had a stroke at 64 and lives in a nursing home. Her blood pressure is 135/87 mm Hg, the heart rate is 95/min, the respiratory rate is 12/min, and the temperature is 37.0°C (98.6°F). On physical exam, she has multiple tan-yellow, firm papules on her knees and elbows. The papules around her eyes are smaller and soft. You discuss the likely cause of the bumps and explain that you will need to order additional tests. What test should you perform?? {'A': 'Biopsy', 'B': 'PET scan', 'C': 'Celiac panel', 'D': 'Lipid panel', 'E': 'Erythrocyte sedimentation rate (ESR)'},
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D: Lipid panel
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 47-year-old woman comes to the emergency department because of a 2-week history of fatigue, abdominal distention, and vomiting. She drinks 6 beers daily. Physical examination shows pallor and scleral icterus. A fluid wave and shifting dullness are present on abdominal examination. The intravascular pressure in which of the following vessels is most likely to be increased?? {'A': 'Short gastric vein', 'B': 'Splenic artery', 'C': 'Inferior epigastric vein', 'D': 'Azygos vein', 'E': 'Gastroduodenal artery'},
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A: Short gastric vein
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Answer the following medical question with one of the provided options:
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Q:One month after undergoing surgical spinal fusion because of a traumatic spinal cord injury, a 68-year-old man comes to the physician because of lower abdominal pain. He last voided yesterday. Physical examination shows a suprapubic mass and decreased sensation below the umbilicus. Urodynamic studies show simultaneous contractions of the detrusor muscle and the internal urethral sphincter. Urinary catheterization drains 900 mL of urine from the bladder. Which of the following is the most appropriate pharmacotherapy for this patient’s urinary symptoms?? {'A': 'Neostigmine', 'B': 'Finasteride', 'C': 'Phenylephrine', 'D': 'Bethanechol', 'E': 'Prazosin'},
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E: Prazosin
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old African American male with sickle cell disease has been followed by a hematologist since infancy. Two years ago, he was started on hydroxyurea for frequent pain crises but has not achieved good control. The addition of a Gardos channel blocking agent is being considered. What is the mechanism of action of this class of medications?? {'A': 'Prevents RBC dehydration by inhibiting K+ efflux', 'B': 'Increases production of hemoglobin F', 'C': 'Prevents dehydration of RBCs by inhibiting Ca2+ efflux', 'D': 'Encourages alkalinization of the blood by facilitating H+/K+ antiporter activity', 'E': 'Increases water diffusion by increasing activity of aquaporin-1 receptors'},
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A: Prevents RBC dehydration by inhibiting K+ efflux
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 5-year-old boy is brought to the physician by his parents because of a 2-day history of poor balance and difficulty walking. He has fallen multiple times and is unable to walk up the stairs unassisted. He has also had difficulty tying his shoes and dressing himself. His family adheres to a vegetarian diet. He has not yet received any routine childhood vaccinations. His mother has a history of anxiety. He is at the 70th percentile for height and 30th percentile for weight. Vital signs are within normal limits. He is alert and oriented to person, place, and time. Physical examination shows a broad-based, staggering gait. He has difficulty touching his nose and cannot perform rapidly-alternating palm movements. Strength is 5/5 in the upper and lower extremities. Deep tendon reflexes are 1+ bilaterally. Skin examination shows several faint hyperpigmented macules on the chest. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Vitamin B1 deficiency', 'B': 'Varicella zoster infection', 'C': 'Accidental medication ingestion', 'D': 'Posterior fossa malignancy', 'E': 'Peripheral nerve demyelination'},
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B: Varicella zoster infection
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old female presents to her primary care physician with a 1-month history of facial and chest flushing, as well as intermittent diarrhea and occasional difficulty breathing. On physical exam, a new-onset systolic ejection murmur is auscultated and is loudest at the left second intercostal space. Subsequent echocardiography reveals leaflet thickening secondary to fibrous plaque deposition on both the pulmonic and tricuspid valves. Which of the following laboratory abnormalities would most likely in this patient?? {'A': 'Decreased serum chromogranin A', 'B': 'Elevated serum bicarbonate', 'C': 'Elevated urinary vanillylmandelic acid', 'D': 'Elevated serum potassium', 'E': 'Elevated urinary 5-hydroxyindoleacetic acid'},
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E: Elevated urinary 5-hydroxyindoleacetic acid
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old man is brought to the clinic by his son for the evaluation of unusual behavior. He is a shopkeeper by profession and sometimes behaves very rudely to the customers. Recently, he accused one of the customers of using black magic over his shop. He has been increasingly irritable, forgetting things, and having problems managing his finances over the past 8 months. He is also having difficulty finding words and recalling the names of objects during the conversation. There is no history of recent head trauma, fever, hallucinations, or abnormal limb movements. Past medical history is significant for a well-controlled type 2 diabetes mellitus. Family history is unremarkable. He does not smoke or use illicit drugs. Vital signs are stable with a blood pressure of 134/76 mm Hg, a heart rate of 88/min, and a temperature of 37.0°C (98.6°F). On physical examination, he has problems naming objects and planning tasks. Mini-mental state examination (MMSE) score is 26/30. Cranial nerve examination is normal. Muscle strength is normal in all 4 limbs with normal muscle tone and deep tendon reflexes. Sensory examination is also normal. What is the most likely diagnosis?? {'A': 'Alzheimer’s disease', 'B': 'Creutzfeldt–Jakob disease', 'C': 'Huntington’s disease', 'D': 'Lewy body dementia', 'E': 'Pick’s disease'},
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E: Pick’s disease
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old G0P0 African American woman presents to the physician with complaints of heavy menstrual bleeding as well as menstrual bleeding in between her periods. She also reports feeling fatigued and having bizarre cravings for ice and chalk. Despite heavy bleeding, she does not report any pain with menstruation. Physical examination is notable for an enlarged, asymmetrical, firm uterus with multiple palpable, non-tender masses. Biopsy confirms the diagnosis of a benign condition. Which of the following histological characteristics would most likely be seen on biopsy in this patient?? {'A': 'Clustered pleomorphic, hyperchromatic smooth muscle cells with extensive mitosis', 'B': 'Granulosa cells scattered around collections of eosinophilic fluid', 'C': 'Laminated, concentric spherules with dystrophic calcification', 'D': 'Presence of endometrial glands and stroma in the myometrium', 'E': 'Whorled pattern of smooth muscle bundles with well-defined borders'},
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E: Whorled pattern of smooth muscle bundles with well-defined borders
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Q:A young immigrant girl presents with low-grade fever, sore throat, painful swallowing, and difficulty in breathing. Her voice is unusually nasal and her swollen neck gives the impression of “bull's neck”. On examination, a large gray membrane is noticed on the oropharynx as shown in the picture. Removal of the membrane reveals a bleeding edematous mucosa. Culture on potassium tellurite medium reveals several black colonies. What is the mechanism of action of the bacterial toxin responsible for this condition?? {'A': 'Travels retrogradely on axons of peripheral motor neurons and blocks the release of inhibitory neurotransmitters', 'B': 'Spreads to peripheral cholinergic nerve terminals and blocks the release of acetylcholine ', 'C': 'Cytotoxic to cells', 'D': 'ADP ribosylates EF-2 and prevents protein synthesis (ADP = adenosine diphosphate; EF-2 = elongation factor-2)', 'E': 'Causes muscle cell necrosis'},
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D: ADP ribosylates EF-2 and prevents protein synthesis (ADP = adenosine diphosphate; EF-2 = elongation factor-2)
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man is brought to the emergency department by ambulance after he was found to be altered at home. Specifically, his wife says that he fell and was unable to get back up while walking to bed. When she approached him, she found that he was unable to move his left leg. His past medical history is significant for hypertension, atrial fibrillation, and diabetes. In addition, he has a 20-pack-year smoking history. On presentation, he is found to still have difficulty moving his left leg though motor function in his left arm is completely intact. The cause of this patient's symptoms most likely occurred in an artery supplying which of the following brain regions?? {'A': 'Cingulate gyrus', 'B': 'Globus pallidus', 'C': 'Lateral medulla', 'D': 'Lingual gyrus', 'E': 'Superior temporal gyrus'},
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A: Cingulate gyrus
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Q:A 9-year-old boy is brought to the emergency room by his mother for weakness, diaphoresis, and syncope. His mother says that he has never been diagnosed with any medical conditions but has been having “fainting spells” over the past month. Routine lab work reveals a glucose level of 25 mg/dL. The patient is promptly given glucagon and intravenous dextrose and admitted to the hospital for observation. The patient’s mother stays with him during his hospitalization. The patient is successfully watched overnight and his blood glucose levels normalize on his morning levels. The care team discusses a possible discharge during morning rounds. One hour later the nurse is called in for a repeat fainting episode. A c-peptide level is drawn and shown to be low. The patient appears ill, diaphoretic, and is barely arousable. Which of the following is the most likely diagnosis in this child?? {'A': 'Munchausen syndrome', 'B': 'Munchausen syndrome by proxy', 'C': 'Somatic symptom disorder', 'D': 'Conversion disorder', 'E': 'Insulinoma'},
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B: Munchausen syndrome by proxy
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Q:A 35-year-old woman comes to the physician because of progressive left flank pain and increased urinary frequency for the past two weeks. Her appetite is normal and she has not had any nausea or vomiting. She has a history of type 1 diabetes mellitus that is poorly controlled with insulin. She is sexually active with her boyfriend, and they use condoms inconsistently. Her temperature is 38° C (100.4° F), pulse is 90/min, and blood pressure is 120/80 mm Hg. The abdomen is soft and there is tenderness to palpation in the left lower quadrant; there is no guarding or rebound. There is tenderness to percussion along the left flank. She complains of pain when her left hip is passively extended. Her leukocyte count is 16,000/mm3 and urine pregnancy test is negative. Urinalysis shows 3+ glucose. An ultrasound of the abdomen shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Urinary tract infection', 'B': 'Ectopic pregnancy', 'C': 'Nephrolithiasis', 'D': 'Psoas muscle abscess', 'E': 'Uterine leiomyoma'},
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D: Psoas muscle abscess
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Q:A 27-year-old woman, gravida 3, para 2, delivers twins via an uncomplicated vaginal delivery. Both placentas are delivered shortly afterward. The patient received regular prenatal care and experienced no issues during her pregnancy. Over the next hour, she continues to experience vaginal bleeding, with an estimated blood loss of 1150 mL. Vital signs are within normal limits. Physical exam shows an enlarged, soft uterus. Which of the following is the most appropriate next step in management?? {'A': 'Methylergometrine', 'B': 'Hysterectomy', 'C': 'Curettage with suctioning', 'D': 'Tranexamic acid', 'E': 'Bimanual uterine massage'},
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E: Bimanual uterine massage
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Q:An otherwise healthy 78-year-old man is brought to the emergency department by his daughter because of a 1-day history of a diffuse headache and an inability to understand speech. There is no history of head trauma. He drinks one to two beers daily and occasionally more on weekends. His vital signs are within normal limits. Mental status examination shows fluent but meaningless speech and an inability to repeat sentences. A noncontrast CT scan of the head shows an acute hemorrhage in the left temporal lobe and several small old hemorrhages in bilateral occipital lobes. Which of the following is the most likely underlying cause of this patient's neurological symptoms?? {'A': 'Vascular lipohyalinosis', 'B': 'Ruptured vascular malformation', 'C': 'Hypertensive encephalopathy', 'D': 'Cardiac embolism', 'E': 'Amyloid angiopathy'},
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E: Amyloid angiopathy
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Q:A 40-year-old woman presents to her primary care physician complaining of a several-month history of episodic sweating and heart racing. Her husband noticed that she becomes pale during these episodes. She also has progressive episodic pounding headaches which are not relieved by paracetamol. Her family history is negative for hypertension, endocrinopathies, or tumors. Vital signs reveal a blood pressure of 220/120 mm Hg, temperature (normal) and pulse of 110/min. Fundus examination reveals hypertensive retinal changes. This patient condition is most likely due to neoplasm arising from which of the following?? {'A': 'Zona glomerulosa', 'B': 'Zona fasciculata', 'C': 'Zonta reticularis', 'D': 'Adrenal chromaffin cells', 'E': 'Extra-adrenal chromaffin cells'},
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D: Adrenal chromaffin cells
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Q:A 13-year-old boy is brought to the physician because of swelling around his eyes for the past 2 days. His mother also notes that his urine became gradually darker during this time. Three weeks ago, he was treated for bacterial tonsillitis. His temperature is 37.6°C (99.7°F), pulse is 79/min, and blood pressure is 158/87 mm Hg. Examination shows periorbital swelling. Laboratory studies show: Serum Urea nitrogen 9 mg/dL Creatinine 1.7 mg/dL Urine Protein 2+ RBC 12/hpf RBC casts numerous A renal biopsy would most likely show which of the following findings?"? {'A': '"""Spike-and-dome"" appearance of subepithelial deposits on electron microscopy"', 'B': 'Splitting and alternating thickening and thinning of the glomerular basement membrane on light microscopy', 'C': 'Mesangial IgA deposits on immunofluorescence', 'D': 'Effacement of podocyte foot processes on electron microscopy', 'E': 'Granular deposits of IgG, IgM, and C3 on immunofluorescence'},
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E: Granular deposits of IgG, IgM, and C3 on immunofluorescence
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Q:A 71 year-old female is brought to the emergency room by her husband. The husband reports that they were taking a walk together one hour ago, when his wife experienced sudden, right arm and leg weakness. He noticed that she had slurred speech, and that she was not able to tell him where she was. The patient underwent an emergent CT scan, which was unremarkable, and was treated with tissue plasminogen activator (tPA). Which of the following EKG findings increases a patient's risk for this acute presentation?? {'A': 'Supraventricular tachycardia', 'B': 'Atrial bigeminy', 'C': 'Normal sinus rhythm', 'D': 'Prolonged QT', 'E': 'Atrial fibrillation'},
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E: Atrial fibrillation
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Q:A 23-year-old man presents with increasing neck pain for several months that does not improve with nonsteroidal anti-inflammatory drugs. The patient says he has had neck pain ever since he was involved in a motor vehicle accident 10 months ago. For the last 2 weeks, he says he has also noticed weakness and numbness in his hands and has difficulty gripping objects. Physical examination reveals a thermal injury that he says he got while holding a hot cup of coffee a week ago when he could not feel the warmth of the coffee mug. Strength is 4/5 bilaterally during elbow flexion and extension and wrist extension. He also has exaggerated deep tendon reflexes bilaterally and decreased sensation symmetrically on the dorsal and ventral surface of both forearms and hands. Which of the following additional findings would you expect to find in this patient?? {'A': 'Fusion of cervical vertebrae', 'B': 'Hypoplasia of the cerebellar vermis', 'C': 'Bilateral carpal tunnel syndrome', 'D': 'A cavitation in the cervical spinal cord', 'E': 'Cervical spinal epidural abscess'},
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D: A cavitation in the cervical spinal cord
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Q:A 45-year-old man presents to the emergency department because of fever and scrotal pain for 2 days. Medical history includes diabetes mellitus and morbid obesity. His temperature is 40.0°C (104.0°F), the pulse is 130/min, the respirations are 35/min, and the blood pressure is 90/68 mm Hg. Physical examination shows a large area of ecchymosis, edema, and crepitus in his perineal area. Fournier gangrene is suspected. A right internal jugular central venous catheter is placed without complication under ultrasound guidance for vascular access in preparation for the administration of vasopressors. Which of the following is the most appropriate next step?? {'A': 'Begin infusion of norepinephrine to maintain systolic blood pressure over 90 mm Hg', 'B': 'Begin infusion of normal saline through a central line', 'C': 'Begin to use the line after documenting the return of dark, non-pulsatile blood from all ports', 'D': 'Confirm line placement by ultrasound', 'E': 'Obtain an immediate portable chest radiograph to evaluate line placement'},
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E: Obtain an immediate portable chest radiograph to evaluate line placement
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Q:A 32-year-old man of Asian descent presents with a skin rash after being started on prophylactic doses of trimethoprim/sulfamethoxazole 3 weeks earlier. He was diagnosed with acquired immunodeficiency syndrome (AIDS) 2 months ago which prompted the initiation of prophylactic antibiotics. The vital signs include: blood pressure 112/72 mm Hg, temperature 40.0°C (104.0°F), respiratory rate 22/min, and heart rate 95/min. He has 20% total body surface area (TBSA) skin slough with scattered vesicles and erosions throughout his face and extremities, as shown in the image. He does have erosions on his lips, but he does not have any other mucosal involvement. Which of the following is most consistent with this patient’s findings?? {'A': 'Erythema multiforme', 'B': 'Staphylococcal scalded skin syndrome', 'C': 'Stevens-Johnson syndrome', 'D': 'Drug rash with eosinophilia and systemic symptoms', 'E': 'Toxic shock syndrome'},
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C: Stevens-Johnson syndrome
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Q:A 43-year-old woman comes to the physician because of a 2-month history of chest pain. She describes the pain as intermittent and burning-like. She states that she has tried using proton pump inhibitors but has had no relief of her symptoms. She has had a 5-kg (11-lb) weight loss over the past 2 months. Her temperature is 36.7°C (98.1°F), pulse is 75/min, and blood pressure is 150/80 mm Hg. Examination shows tightness of the skin of the fingers; there are small nonhealing, nonpurulent ulcers over thickened skin on the fingertips. Fine inspiratory crackles are heard at both lung bases. There is mild tenderness to palpation of the epigastrium. Which of the following is most likely associated with her diagnosis?? {'A': 'c-ANCA', 'B': 'Anti-topoisomerase antibodies', 'C': 'Anti-mitochondrial antibodies', 'D': 'Anti-histone antibodies', 'E': 'Anti-Ro/SSA and anti-La/SSB antibodies'},
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B: Anti-topoisomerase antibodies
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the emergency department with general weakness and fatigue. He states that he has not felt well for several days and can't take care of himself anymore due to fatigue. The patient has a past medical history of IV drug abuse, alcohol abuse, and multiple minor traumas associated with intoxication. His temperature is 104°F (40°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 19/min, and oxygen saturation is 98% on room air. A murmur is heard on cardiac exam. The patient is treated appropriately and transferred to the inpatient floor and recovers over the next several days. The patient has been unable to eat solids, though he has been drinking large amounts of juice. On day 5 of his stay, the patient states he feels much better. He is no longer febrile. His only concern is profuse and watery diarrhea and severe abdominal pain which he has been experiencing since yesterday. The patient is started on IV fluids and given oral fluid replacement as well. Which of the following is associated with the most likely underlying diagnosis?? {'A': 'Anti-Saccharomyces cerevisiae antibody positivity (ASCA)', 'B': 'Ascitic fluid infection', 'C': 'Pseudomembranes of fibrin', 'D': 'Increased osmotic load', 'E': 'Schistocytes on peripheral smear'},
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C: Pseudomembranes of fibrin
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Q:A 9-year-old boy is brought to the physician for evaluation of a 3-day history of fever, sore throat, and itchy, red eyes. His symptoms began while he was away at summer camp. His immunizations are not up-to-date. He appears ill. His temperature is 39.1°C (102.3°F). Physical examination shows erythema and edema of the conjunctivae and posterior pharyngeal wall. There is bilateral, tender, preauricular lymphadenopathy. Further evaluation shows infection with a DNA virus. Which of the following is the most likely causal pathogen?? {'A': 'Adenovirus', 'B': 'Parvovirus', 'C': 'Picornavirus', 'D': 'Paramyxovirus', 'E': 'Human herpes virus 4'},
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A: Adenovirus
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Q:A 70-year-old man presents to the emergency department with severe substernal chest pain of one hour’s duration. The patient was taking a morning walk when the onset of pain led him to seek care. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6. The ST elevations found in leads V5-V6 are most indicative of pathology in which of the following areas of the heart?? {'A': 'Inferior wall, right coronary artery', 'B': 'Interventricular septum, left anterior descending coronary artery', 'C': 'Lateral wall of left ventricle, left circumflex coronary artery', 'D': 'Left atrium, left main coronary artery', 'E': 'Right ventricle, left main coronary artery'},
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C: Lateral wall of left ventricle, left circumflex coronary artery
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Q:A 68-year-old male visits his primary care physician after an episode of syncope during a tennis match. He reports exertional dyspnea with mild substernal chest pain. On physical exam a systolic crescendo-decrescendo murmur is heard best at the right 2nd intercostal space. This murmur was not heard at the patient's last appointment six months ago. Which of the following would most support a diagnosis of aortic stenosis?? {'A': 'Presence of S3', 'B': 'Murmur radiates to carotid arteries bilaterally', 'C': 'Murmur radiates to axilla', 'D': 'Asymmetric ventricular hypertrophy', 'E': 'Double pulsation of the carotid pulse'},
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B: Murmur radiates to carotid arteries bilaterally
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Q:A 37-year-old man presents to the physician. He has been overweight since childhood. He has not succeeded in losing weight despite following different diet and exercise programs over the past several years. He has had diabetes mellitus for 2 years and severe gastroesophageal reflux disease for 9 years. His medications include metformin, aspirin, and pantoprazole. His blood pressure is 142/94 mm Hg, pulse is 76/min, and respiratory rate is 14/min. His BMI is 36.5 kg/m2. Laboratory studies show: Hemoglobin A1C 6.6% Serum Fasting glucose 132 mg/dL Which of the following is the most appropriate surgical management?? {'A': 'Biliopancreatic diversion and duodenal switch (BPD-DS)', 'B': 'Laparoscopic adjustable gastric banding', 'C': 'Laparoscopic Roux-en-Y gastric bypass', 'D': 'Laparoscopic sleeve gastrectomy', 'E': 'No surgical management at this time'},
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C: Laparoscopic Roux-en-Y gastric bypass
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Q:An 8-year-old girl is brought to the emergency department because of a 2-day history of an intermittent, diffuse abdominal pain. She has also had a nonpruritic rash on her legs and swelling of her ankles for 1 week. Two weeks ago, she had a sore throat, which was treated with oral amoxicillin. Examination of the lower extremities shows non-blanching, raised erythematous papules. The ankle joints are swollen and warm, and their range of motion is limited by pain. Laboratory studies show a platelet count of 450,000/mm3. Test of the stool for occult blood is positive. Which of the following is the most likely diagnosis?? {'A': 'Immune thrombocytopenic purpura', 'B': 'Acute rheumatic fever', 'C': 'Juvenile idiopathic arthritis', 'D': 'Familial Mediterranean fever', 'E': 'Leukocytoclastic vasculitis'},
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E: Leukocytoclastic vasculitis
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old physician notices that her senior colleague has been arriving late for work for the past 2 weeks. The colleague recently lost his wife to cancer and has been taking care of his four young children. Following the death of his wife, the department chair offered him extended time off but he declined. There have been some recent changes noted in this colleague that have been discussed among the resident physicians, such as missed clinic appointments, two intra-operative errors, and the smell of alcohol on his breath on three different occasions. Which of the following is the most appropriate action by the physician regarding her colleague?? {'A': "Contact the colleague's friends and family", 'B': 'Confront the colleague in private', 'C': 'Inform the local Physician Health Program', 'D': "Inform the colleague's patients about the potential hazard", 'E': 'Alert the State Licensing Board'},
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C: Inform the local Physician Health Program
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Q:A 58-year-old man presents for a follow-up appointment. He recently was found to have a history of stage 2 chronic kidney disease secondary to benign prostatic hyperplasia leading to urinary tract obstruction. He has no other medical conditions. His father died at age 86 from a stroke, and his mother lives in an assisted living facility. He smokes a pack of cigarettes a day and occasionally drinks alcohol. His vital signs include: blood pressure 130/75 mm Hg, pulse 75/min, respiratory rate 17/min, and temperature 36.5°C (97.7°F). His physical examination is unremarkable. A 24-hour urine specimen reveals the following findings: Specific gravity 1,050 pH 5.6 Nitrites (-) Glucose (-) Proteins 250 mg/24hrs Which of the following should be prescribed to this patient to decrease his cardiovascular risk?? {'A': 'Ezetimibe', 'B': 'Enalapril', 'C': 'Carvedilol', 'D': 'Aspirin', 'E': 'Amlodipine'},
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B: Enalapril
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Q:A 25-year-old man comes to the physician because he and his wife have been unable to conceive despite regular unprotected sex for the past 15 months without using contraception. His wife has been tested and is fertile. The patient began puberty at the age of 14 years. He was treated for Chlamydia trachomatis 6 years ago. He is a professional cyclist and trains every day for 3–4 hours. He feels stressed because of an upcoming race. His blood pressure is 148/92 mm Hg. Physical examination of the husband shows a tall, athletic stature with uniform inflammatory papular eruptions of the face, back, and chest. Genital examination shows small testes. Which of the following is the most likely underlying cause of this patient's infertility?? {'A': 'Psychogenic erectile dysfunction', 'B': 'Kallmann syndrome', 'C': 'Anabolic steroid use', 'D': 'Scrotal hyperthermia', 'E': 'Klinefelter syndrome'},
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C: Anabolic steroid use
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Q:A 48-year-old male with a history of rhinitis presents to the emergency department with complaints of shortness of breath and wheezing over the past 2 days. He reports bilateral knee pain over the past month for which he recently began taking naproxen 1 week ago. Physical examination is significant for a nasal polyp and disappearance of bilateral radial pulses on deep inspiration. Which of the following is the most likely cause of this patient's physical examination findings?? {'A': 'Pulmonary hypertension', 'B': 'Interstitial lung fibrosis', 'C': 'Asthma', 'D': 'Pulmonary embolism', 'E': 'Cardiac tamponade'},
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C: Asthma
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old lifeguard develops squamous cell carcinoma of the skin on his forehead. Which of the following most likely preceded the development of this carcinoma?? {'A': 'Hamartomatous lesion of sebaceous glands', 'B': 'Dry, scaly, hyperkeratotic papule', 'C': 'A single, large pink patch', 'D': 'Dermatophyte infection', 'E': 'UVC exposure'},
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B: Dry, scaly, hyperkeratotic papule
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Q:A 29-year-old man is brought to the emergency department by his wife due to unusual behavior for the past week. She has noted several incidents when he spoke to her so fast that she could not understand what he was saying. She also says that one evening, he drove home naked after a night where he said he was ‘painting the town red’. She also says he has also been sleeping for about 2 hours a night and has barely had any sleep in the past 2 weeks. She says that he goes ‘to work’ in the morning every day, but she suspects that he has been doing other things. She denies any knowledge of similar symptoms in the past. On physical examination, the patient appears agitated and is pacing the exam room. He compliments the cleanliness of the floors, recommends the hospital change to the metric system, and asks if anyone else can hear ‘that ringing’. Laboratory results are unremarkable. The patient denies any suicidal or homicidal ideations. Which of the following is the most likely diagnosis in this patient?? {'A': 'Major depressive disorder', 'B': 'Brief psychotic disorder', 'C': 'Schizoaffective disorder', 'D': 'Bipolar disorder, type I', 'E': 'Bipolar disorder, type II'},
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D: Bipolar disorder, type I
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Q:A 65-year-old man presents with a small painless ulcer with a raised border on his right forearm which has persisted for the last 3 weeks. His past history is significant for 3 occurrences of basal cell carcinoma on different areas of the body during the last 4 years, which have all been surgically excised. The morphology of the present lesion is also highly suggestive of basal cell carcinoma. The patient says that, if the lesion is a basal cell carcinoma, he does not want to undergo biopsy and surgery if it can be avoided. The patient is prescribed a cream, which is FDA-approved for the treatment of small superficial basal cell carcinomas in low-risk areas. The cream contains a chemotherapeutic agent, which is an antimetabolite and an S-phase-specific anticancer drug. Which of the following best explains the mechanism of action of this cream?? {'A': 'Inhibition of ribonucleotide reductase', 'B': 'Inhibition of DNA repair', 'C': 'Inhibition of thymidylate synthase', 'D': 'Inhibition of dihydrofolate reductase', 'E': 'Inhibition of de novo purine nucleotide synthesis'},
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C: Inhibition of thymidylate synthase
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Q:A 29-year-old woman presents for a follow-up visit after an emergency appendectomy. The laparoscopic procedure went well with no complications. Physical examination reveals the surgical site is slightly tender but is healing appropriately. She is delighted that the operation went well and offers you a cake and VIP tickets to a musical concert. Which of the following is the most appropriate response?? {'A': '"Thank you, I will enjoy these gifts immensely."', 'B': '"No, I cannot accept these gifts, please take them with you as you leave."', 'C': '"May I pay you for them?"', 'D': '"Thank you, but I cannot accept the tickets you offered. Accepting such a generous gift is against our policy. However, I will gladly accept your cake and distribute it among the staff."', 'E': '"Can you get another ticket for my friend?"'},
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D: "Thank you, but I cannot accept the tickets you offered. Accepting such a generous gift is against our policy. However, I will gladly accept your cake and distribute it among the staff."
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man presents to the emergency department with increased fatigue and changes in his vision. The patient states that for the past month he has felt abnormally tired, and today he noticed his vision was blurry. The patient also endorses increased sweating at night and new onset headaches. He states that he currently feels dizzy. The patient has a past medical history of diabetes and hypertension. His current medications include insulin, metformin, and lisinopril. His temperature is 99.5°F (37.5°C), blood pressure is 157/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is within normal limits. HEENT exam reveals non-tender posterior and anterior chain lymphadenopathy. Abdominal exam reveals splenomegaly and hepatomegaly. There are large, non-tender palpable lymph nodes in the patient's inguinal region. Neurological exam is notable for decreased sensation in the patients hands and feet. He also complains of a numb/tingling pain in his extremities that has been persistent during this time. Dermatologic exam is notable for multiple bruises on his upper and lower extremities. Which of the following is most likely to be abnormal in this patient?? {'A': 'Calcium', 'B': 'IgA and IgG', 'C': 'IgM', 'D': 'Natural killer cells', 'E': 'T-cells'},
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C: IgM
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Q:A 42-year-old man presents to his primary care provider for a follow-up appointment after a new diagnosis of hypertension follow-up. The doctor mentions that a recent study where the effect of a healthy lifestyle education program on blood pressure was studied in 2 matched rural communities. One community received health education program and the other did not. What is the type of study most likely being described here?? {'A': 'Crossover study', 'B': 'Case-control trial', 'C': 'Explanatory study', 'D': 'Community trial', 'E': 'Cross-sectional study'},
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D: Community trial
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Q:A 50-year-old female radiologist who is interviewing for a night shift position states that she was fired from her past 3 previous positions because she had difficulty working with others. She states that she is perfect for this job however, as she likes to work on her own and be left alone. She emphasizes that she does not have any distractions or meaningful relationships, and therefore she is always punctual and never calls in sick. She is not an emotional individual. Which of the following personality disorders best fits this female?? {'A': 'Schizotypal', 'B': 'Schizoid', 'C': 'Antisocial', 'D': 'Borderline', 'E': 'Obsessive-compulsive disorder'},
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B: Schizoid
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Q:A 67-year-old female presents to her primary care physician complaining of headaches in her left temple and scalp area, neck stiffness, occasional blurred vision, and pain in her jaw when chewing. The appropriate medical therapy is initiated, and a subsequent biopsy of the temporal artery reveals arteritis. Five months later, the patient returns to her physician with a complaint of weakness, leading to difficulty climbing stairs, rising from a chair, and combing her hair. The patient states that this weakness has worsened gradually over the last 2 months. She reports that her headaches, jaw pain, and visual disturbances have resolved. Physical examination is significant for 4/5 strength for both hip flexion/extension as well as shoulder flexion/extension/abduction. Initial laboratory work-up reveals ESR and creatine kinase levels within normal limits. Which of the following is the most likely diagnosis in this patient's current presentation?? {'A': 'Mononeuritis multiplex', 'B': 'Polymyalgia rheumatica', 'C': 'Drug-induced myopathy', 'D': 'Polymyositis', 'E': 'Dermatomyositis'},
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C: Drug-induced myopathy
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Q:A 67-year-old man presents to the office complaining of abdominal pain. He was started on a trial of proton pump inhibitors 5 weeks ago but the pain has not improved. He describes the pain as dull, cramping, and worse during meals. Medical history is unremarkable. Physical examination is normal except for tenderness in the epigastric region. Endoscopy reveals an eroding gastric ulcer in the proximal part of the greater curvature of the stomach overlying a large pulsing artery. Which of the following arteries is most likely visible?? {'A': 'Common hepatic artery', 'B': 'Left gastric artery', 'C': 'Right gastro-omental artery', 'D': 'Left gastro-omental artery', 'E': 'Cystic artery'},
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D: Left gastro-omental artery
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Q:A mother brings her 2-year-old son to the pediatrician following an episode of abdominal pain and bloody stool. The child has otherwise been healthy and growing normally. On physical exam, the patient is irritable with guarding of the right lower quadrant of the abdomen. Based on clinical suspicion, pertechnetate scintigraphy demonstrates increased uptake in the right lower abdomen. Which of the following embryologic structures is associated with this patient’s condition?? {'A': 'Metanephric mesenchyme', 'B': 'Ductus arteriosus', 'C': 'Vitelline duct', 'D': 'Paramesonephric duct', 'E': 'Allantois'},
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C: Vitelline duct
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Q:A 59-year-old patient comes to the emergency department accompanied by his wife because of severe right leg pain and numbness. His condition suddenly started an hour ago. His wife says that he has a heart rhythm problem for which he takes a blood thinner, but he is not compliant with his medications. He has smoked 10–15 cigarettes daily for the past 15 years. His temperature is 36.9°C (98.42°F), blood pressure is 140/90 mm Hg, and pulse is 85/min and irregular. On physical examination, the patient is anxious and his right leg is cool and pale. Palpation of the popliteal fossa shows a weaker popliteal pulse on the right side compared to the left side. Which of the following is the best initial step in the management of this patient's condition?? {'A': 'Cilostazol', 'B': 'Decompressive laminectomy', 'C': 'Urgent assessment for amputation or revascularization', 'D': 'Oral acetaminophen and topical capsaicin', 'E': 'Arthroscopic synovectomy'},
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C: Urgent assessment for amputation or revascularization
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Q:A 12-year-old girl is brought to the pediatrician by her father who is concerned about the child’s ability to sit in a moving vehicle. She frequently develops nausea and dizziness when riding in a car for more than 10 minutes. The child has vomited twice over the past month while riding in the car. Her symptoms are significantly impairing her ability to make it to school on time without having to stop and get out of the car. The child does well in school and has several close friends. On examination, the child is well-appearing and appropriately interactive. Dix-Hallpike maneuver is negative. Her gait is normal. Strength and range of motion are full and symmetric bilaterally in the upper and lower extremities. The father would like to know if there is anything his daughter can take to be able to sit in a moving vehicle without feeling ill. A medication with which of the following mechanisms of action is indicated to manage this patient’s symptoms?? {'A': 'Alpha-2 adrenergic receptor agonist', 'B': 'Beta-1 adrenergic receptor agonist', 'C': 'Muscarinic acetylcholine receptor agonist', 'D': 'Muscarinic acetylcholine receptor antagonist', 'E': 'Nicotinic acetylcholine receptor agonist'},
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D: Muscarinic acetylcholine receptor antagonist
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Q:A 28-year-old female suffering from a urinary tract infection is given trimethoprim-sulfamethoxazole (TMP-SMX) by her physician. Several days later, she begins to experience itchiness and joint pain. Laboratory and histologic analysis reveals vasculitis and antibody complexes deposited near the basement membrane of the glomerulus. What other serological finding is expected with this presentation?? {'A': 'Decreased levels of IgE', 'B': 'Increased levels of IgE', 'C': 'Decreased neutrophil count', 'D': 'Increased serum levels of complement protein C3', 'E': 'Lowered serum levels of complement protein C3'},
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E: Lowered serum levels of complement protein C3
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Q:A 27-year-old woman presents to your office complaining of difficulty swallowing, and she describes that "there is something in the back of her throat". Furthermore, she also feels an "achy" chest pain that has been getting progressively worse over the last few weeks. She denies having any fever, shortness of breath, cough, abdominal pain, heartburn, nausea, or vomiting. The patient has a history of wrist fracture as a child, migraines, and a recent diagnosis of myasthenia gravis. Which of the following is the most likely diagnosis?? {'A': 'Benign tumor of the thymus', 'B': 'Superior vena cava syndrome', 'C': 'Anaplastic thyroid cancer', 'D': 'Mediastinitis', 'E': 'Thyroglossal duct cyst'},
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A: Benign tumor of the thymus
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Q:A 34-year-old woman comes to the physician for a follow-up appointment because of a blood pressure of 148/98 mm Hg at her last health maintenance examination four weeks ago. She feels well. She has a 20-year history of migraine with aura of moderate to severe intensity. For the past year, the headaches have been occurring 1–2 times per week. Her only medication is sumatriptan. She runs two to three times a week and does yoga once a week. She is sexually active with her husband and uses condoms inconsistently. Her father has type 2 diabetes mellitus and hypertension. Her temperature is 37.2°C (99.0°F), pulse is 76/min, respirations are 12/min, and blood pressure is 143/92 mm Hg. A repeat sitting blood pressure 20 minutes later is 145/94 mm Hg. Physical examination is unremarkable. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Hydrochlorothiazide', 'B': 'Lisinopril', 'C': 'Propranolol', 'D': 'Losartan', 'E': 'Prazosin'},
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C: Propranolol
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Q:A mother brings her 25-month-old son to the pediatrician’s office for a well child visit. She reports he had an ear infection 3 months ago for which he took a short course of antibiotics but has otherwise been well. He is now in daycare where he likes to play with the other children. She says he can stack multiple cubes and enjoys playing with objects. He goes outside frequently to play with a ball and is able to kick it. While talking to the mother, the patient and his sister draw on paper quietly side by side. His mother says he knows about 200 words and he frequently likes to use “I” sentences, like “I read” and “I drink”. His mother does complain that he throws more tantrums than he used to and she has found it harder to get him to follow instructions, although he appears to understand them. Which of the following milestones is delayed in this child?? {'A': 'Gross motor', 'B': 'Fine motor', 'C': 'Language', 'D': 'Social development', 'E': 'None'},
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E: None
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Q:A 68-year-old man is brought to the emergency department 25 minutes after he was found shaking violently on the bathroom floor. His wife reports that he has become increasingly confused over the past 2 days and that he has been sleeping more than usual. He was started on chemotherapy 4 months ago for chronic lymphocytic leukemia. He is confused and oriented to person only. Neurological examination shows right-sided ptosis and diffuse hyperreflexia. An MRI of the brain shows disseminated, nonenhancing white matter lesions with no mass effect. A polymerase chain reaction assay of the cerebrospinal fluid confirms infection with a virus that has double-stranded, circular DNA. An antineoplastic drug with which of the following mechanisms of action is most likely responsible for this patient's current condition?? {'A': 'Free radical formation', 'B': 'Tyrosine kinase inhibitor', 'C': 'Topoisomerase II inhibitor', 'D': 'Monoclonal antibody against EGFR', 'E': 'Monoclonal antibody against CD20+'},
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E: Monoclonal antibody against CD20+
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Q:A 29-year-old woman presents to her primary care provider complaining of lower back pain. She reports a 3 day history of extreme right lower back pain. She also reports mild dysuria. Her past medical history is notable for recurrent urinary tract infections leading to 3 emergency room visits over the past year. Her family history is notable for renal cell carcinoma in her paternal grandfather and diabetes in her father. Her temperature is 99.5°F (37.5°C), blood pressure is 125/75 mmHg, pulse is 82/min, and respirations are 18/min. On exam, she has mild right costovertebral angle tenderness. Radiography demonstrates a vague radiopaque structure in the right lower abdomen. Results of a urinalysis are shown below: Appearance: Hazy, yellow Protein: Negative Specific gravity: 1.029 WBC: 2+ Casts: None Bacteria: None pH: 8.9 Blood: Negative Bilirubin: Negative Urobilinogen: < 2.0 A urine culture is pending. Which of the following pathogens is most likely responsible for this patient’s condition?? {'A': 'Escherichia coli', 'B': 'Enterococcus', 'C': 'Citrobacter freundii', 'D': 'Proteus mirabilis', 'E': 'Staphylococcus epidermidis'},
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D: Proteus mirabilis
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Q:An 8-month-old boy is brought to the emergency room by his mother who notes that the child has not been passing stool regularly. Palpation and radiographic imaging of the umbilical region reveal the presence of fecal material in an abnormal out-pocketing of bowel. Which of the following is a common complication seen in this condition?? {'A': 'Enlarged rugal folds', 'B': 'Dysplasia', 'C': 'Ulceration', 'D': 'Megacolon', 'E': 'Paneth cell metaplasia'},
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C: Ulceration
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Q:A 69-year-old woman is brought to the clinic for difficulty breathing over the past 2 months. She denies any clear precipitating factor but reports that her breathing has become progressively labored and she feels like she can’t breathe. Her past medical history is significant for heart failure, diabetes mellitus, and hypertension. Her medications include lisinopril, metoprolol, and metformin. She is allergic to sulfa drugs and peanuts. A physical examination demonstrates bilateral rales at the lung bases, pitting edema of the lower extremities, and a laterally displaced point of maximal impulse (PMI). She is subsequently given a medication that will reduce her volume status by competitively binding to aldosterone receptors. What is the most likely drug prescribed to this patient?? {'A': 'Amiloride', 'B': 'Atorvastatin', 'C': 'Furosemide', 'D': 'Hydrochlorothiazide', 'E': 'Spironolactone'},
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E: Spironolactone
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Q:An 80-year-old woman presents with general malaise and low-grade fever. Physical examination reveals several retinal hemorrhages with pale centers, erythematous nodules on palms that are not painful, and splinter hemorrhages under her fingernails. Echocardiogram shows vegetations on the mitral valve. Blood culture indicates gram-positive bacteria which are catalase negative and able to grow in 40% bile; however, not in 6.5% NaCl. In addition to endocarditis, the doctor is concerned that the patient may also be suffering from which of the following medical conditions?? {'A': 'Subacute sclerosing panencephalitis', 'B': 'Sickle cell disease', 'C': 'Dental caries', 'D': 'HIV/AIDS', 'E': 'Colon cancer'},
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E: Colon cancer
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Q:A 63-year-old man presents to the physician with fever for 5 days. He has had increasing fatigue and dyspnea for the past 2 months. During this time, he has lost 3 kg (6.6 lb). He received outpatient treatment for pneumonia last month. He had urinary tract infection 2 weeks ago. He takes no other medications other than daily low dose aspirin and recent oral antibiotics. He does not smoke or drink alcohol. The vital signs include: temperature 38.5°C (101.3°F), pulse 93/min, respiration rate 18/min, and blood pressure 110/65 mm Hg. On physical examination, he has petechiae distally on the lower extremities and several purpura on the trunk and extremities. Several enlarged lymph nodes are detected in the axillary and cervical regions on both sides. The examination of the lungs, heart, and abdomen shows no abnormalities. The laboratory test results are as follows: Hemoglobin 10 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 18,000/mm3 Platelet count 40,000/mm3 A Giemsa-stained peripheral blood smear is shown by the image. Which of the following is the most likely diagnosis?? {'A': 'Acute myeloblastic leukemia', 'B': 'Burkitt lymphoma', 'C': 'Hairy cell leukemia', 'D': 'Hodgkin’s lymphoma', 'E': 'MALT lymphoma'},
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A: Acute myeloblastic leukemia
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Q:A 9-year-old girl is brought to her pediatrician by her mother for the evaluation of recent-onset seizures. She has had 2 episodes of generalized tonic-clonic seizures in the past 3 days. Each episode lasted for 1–2 minutes and aborted spontaneously. There is no history of fever, headache, altered behavior, diarrhea, vomiting, or previous seizure episodes. Past medical history is unremarkable. Physical examination reveals: blood pressure 102/64 mm Hg, heart rate 89/min, respiratory rate 16/min, and temperature 37.0°C (98.6°F). She looks anxious but oriented to time and space. Multiple flat hyperpigmented spots are present over her body, each more than 5 mm in diameter. Axillary freckling is present. Cranial nerves are intact. Muscle strength is normal in all 4 limbs with a normal sensory examination. Gait is normal. An eye examination is shown in the exhibit. What is the most likely diagnosis?? {'A': 'Neurofibromatosis type 2', 'B': 'Sturge-Weber disease', 'C': 'Tuberous sclerosis', 'D': 'Von Recklinghausen disease', 'E': 'Wilson disease'},
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D: Von Recklinghausen disease
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Q:A 7-year-old boy is brought to the emergency department by his parents. They state that he has had trouble walking the past day and this morning refuses to walk at all. The child has a past medical history of asthma, which is treated with albuterol. His temperature is 102°F (38.9°C), blood pressure is 77/48 mmHg, pulse is 150/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory tests are drawn and shown below. Hemoglobin: 10 g/dL Hematocrit: 36% Leukocyte count: 13,500/mm^3 with normal differential Platelet count: 197,000/mm^3 An MRI of the the thigh and knee is performed and demonstrates edema and cortical destruction of the distal femur. Which of the following is the most likely infectious agent in this patient?? {'A': 'Bacteroides species', 'B': 'Pseudomonas aeruginosa', 'C': 'Salmonella species', 'D': 'Staphylococcus aureus', 'E': 'Staphylococcus epidermidis'},
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D: Staphylococcus aureus
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Q:A 24-year-old man presents to his family practitioner for routine follow-up of asthma. He is currently on albuterol, corticosteroids, and salmeterol, all via inhalation. The patient is compliant with his medications, but he still complains of episodic shortness of breath and wheezing. The peak expiratory flow (PEF) has improved since the last visit, but it is still less than the ideal predicted values based on age, gender, and height. Montelukast is added to his treatment regimen. What is the mechanism of action of this drug?? {'A': 'Montelukast inhibits the release of inflammatory substances from mast cells.', 'B': 'Montelukast binds to IgE.', 'C': 'Montelukast activates adrenal receptors on the bronchial smooth muscles.', 'D': 'Montelukast blocks receptors of some arachidonic acid metabolites.', 'E': 'Montelukast inhibits lipoxygenase, thus decreasing the production of inflammatory leukotrienes.'},
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D: Montelukast blocks receptors of some arachidonic acid metabolites.
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Q:A 25-year-old medical student is doing an international health elective in the Amazon River basin studying tropical disease epidemiology. As part of his pre-trip preparation, he wants to be protected from malaria and is researching options for prophylaxis. Which of the following agents should be avoided for malarial prophylaxis in this patient?? {'A': 'Chloroquine', 'B': 'Mefloquine', 'C': 'Atovaquone-proguanil', 'D': 'Doxycycline', 'E': 'Quinine'},
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A: Chloroquine
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Q:A 32-year-old woman presents complaining of nightmares. She reports that these “nightmares” happen when she is asleep and also sometimes when she is awake, but she cannot come up with another description for them. The episodes have been happening for at least 3 weeks now. She states that when it happens she feels “outside of her body,” like she’s “watching myself.” She also reports some chronic fatigue. The patient denies headaches, vision changes, dizziness, or loss in sensation or motor function. She has no notable medical or surgical history. She takes a multivitamin every day. She smokes 1 pack of cigarettes a day but denies alcohol or illicit drug use. The patient appears slightly anxious but is in no acute distress. A physical and neurological exam is normal. She denies suicidal or homicidal ideation. Which of the following is the most likely diagnosis for the patient’s symptoms?? {'A': 'Brief psychotic disorder', 'B': 'Delusional disorder', 'C': 'Depersonalization disorder', 'D': 'Dissociative fugue disorder', 'E': 'Dissociative identity disorder'},
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C: Depersonalization disorder
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Q:A 38-year-old woman comes to the physician for a 6-week history of sleeping difficulties because she thinks that someone is watching her through security cameras. Her anxiety started 6 weeks ago when a security camera was installed outside her house by the police. Ever since, she has felt that she is being monitored by security cameras throughout the city. She avoids going outside whenever possible and refuses to take the subway. Whenever she needs to leave the house she wears large hats or hooded sweaters so that she cannot be recognized by the cameras. As soon as she arrives at her office or at home she feels safer. She was recently promoted to the team manager of a small advertising agency. She takes no medications. On mental status examination, she is alert, oriented, and shows normal range of affect. Urine toxicology screening is negative. The patient's symptoms are best described as which of the following?? {'A': 'Agoraphobia', 'B': 'Delusions', 'C': 'Derealization', 'D': 'Disorganized thoughts', 'E': 'Hallucinations'},
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B: Delusions
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Q:A 49-year-old man with alcohol use disorder is brought to the emergency department immediately after two episodes of coffee-ground emesis. His pulse is 116/min and blood pressure is 92/54 mm Hg. Physical examination shows a distended abdomen with shifting dullness. Skin examination shows jaundice, erythematous palms, and dilated veins in the anterior abdominal wall. After fluid resuscitation, he is given a drug that decreases portal venous pressure. The drug works by inhibiting the secretion of splanchnic vasodilatory hormones as well as blocking glucagon and insulin release. This drug is a synthetic analog of a substance normally produced in which of the following cells?? {'A': 'S cells', 'B': 'G cells', 'C': 'K cells', 'D': 'D cells', 'E': 'I cells\n"'},
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D: D cells
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Q:A 19-year-old college student is brought to the emergency department by his roommates after being found unconscious on their dorm room floor. His temperature is 102.0°F (38.9°C) and blood pressure is 85/64 mmHg. On physical examination, he has multiple rose-colored spots on the skin covering his abdomen and lower limbs. Lab tests reveal hyperkalemia and an arterial blood gas test that reads pH: 7.04, pCO2: 30.1 mmHg, pO2: 23.4 mmHg. What is the most likely diagnosis for this patient’s condition?? {'A': 'Addison disease', 'B': 'Dengue hemorrhagic fever', 'C': 'Diabetic ketoacidosis', 'D': 'Typhoid fever', 'E': 'Waterhouse-Friderichsen syndrome'},
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E: Waterhouse-Friderichsen syndrome
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Q:A 39-year-old man with a history of major depression is brought into the emergency department by his concerned daughter. She reports that he was recently let go from work because of his sudden and erratic behavior at work. He was noted to be making inappropriate sexual advances to his female co-workers which is very out of his character. He seemed to be full of energy, running on little to no sleep, trying to fix all the companies problems and at times arguing with some of the senior managers. During admission, he was uninterpretable as he boasted about how he was right and that the managers were fools for not listening to his great ideas. What treatment options are available for this patient?? {'A': 'Mood stabilizers, antipsychotics, benzodiazepines, ECT', 'B': 'Mood stabilizers, antipsychotics', 'C': 'Antipsychotics', 'D': 'Benzodiazepines', 'E': 'ECT'},
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A: Mood stabilizers, antipsychotics, benzodiazepines, ECT
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Q:A 24-year-old woman, gravida 2, para 1, at 33 weeks’ gestation, is admitted to the hospital for treatment of preterm labor. She has no history of serious illness and her only medication is a multivitamin. Her temperature is 37.2°C (99.0°F), pulse is 100/min, respirations are 20/min, and blood pressure is 100/75 mm Hg. Therapy with nifedipine and betamethasone is begun. The patient continues to have contractions; nifedipine is discontinued and treatment with high-dose terbutaline is initiated. Her contractions resolve. Three hours later, the patient reports fatigue and weakness. Neurologic examination shows proximal muscle weakness of the lower extremities. Deep tendon reflexes are 1+ bilaterally. Which of the following is most likely to confirm the diagnosis?? {'A': 'Serum electrolytes', 'B': 'Complete blood count', 'C': 'Serologic antibody testing', 'D': 'Amniotic fluid culture', 'E': 'Thyroid function tests'},
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A: Serum electrolytes
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Q:A 70-year-old male patient comes into your office because of leg pain. The patient states that his calves have been hurting more and more over the last two months. The pain isn't present at rest, but the pain develops as the patient starts walking and exerting himself. He states that stopping to rest is the only thing that relieves the pain. Of note, the patient's medical history is significant for 30-pack-years of smoking, hypertension, hyperlipidemia, and a previous myocardial infarction status-post angioplasty and stent. On exam, the patient's lower legs (below knee) have glossy skin with loss of hair. The dorsalis pedis pulses are barely palpable bilaterally. Which of the following is the best initial therapy for this patient?? {'A': 'Lifestyle modifications', 'B': 'Cilostazol', 'C': 'Clopidogrel', 'D': 'Angioplasty and stenting', 'E': 'Arterial bypass surgery'},
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A: Lifestyle modifications
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Q:A 23-year-old man comes to the physician because of a 1-week history of muscle ache, fatigue, and fever that occurs every 2 days. He recently returned from a trip to Myanmar. A peripheral blood smear shows erythrocytes with brick-red granules. The physician recommends a combination of two antimicrobial drugs after confirming normal glucose-6-phosphate dehydrogenase activity. Which of the following is the most appropriate rationale for dual therapy?? {'A': 'Prevention of infection relapse', 'B': 'Therapy against polymicrobial infections', 'C': 'Prevention of drug resistance', 'D': 'Decrease in renal drug secretion', 'E': 'Decrease in enzymatic drug deactivation'},
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A: Prevention of infection relapse
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Q:A 20-year-old woman is brought to the emergency department by her parents after finding her seizing in her room at home. She has no known medical condition and this is her first witnessed seizure. She is stabilized in the emergency department. A detailed history reveals that the patient has been progressively calorie restricting for the past few years. Based on her last known height and weight, her body mass index (BMI) is 16.5 kg/m2. Which of the following electrolyte abnormalities would be of the most concern when this patient is reintroduced to food?? {'A': 'Hypophosphatemia', 'B': 'Hypercalcemia', 'C': 'Hypermagnesemia', 'D': 'Hyponatremia', 'E': 'Hypokalemia'},
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A: Hypophosphatemia
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Q:A 27-year-old woman, gravida 3, para 1, at 22 weeks gestation visits her physician for a prenatal visit. She feels well. Her current pregnancy has been uncomplicated. She has attended many prenatal appointments and followed the physician's advice about screening for diseases, laboratory testing, diet, and exercise. The patient’s previous pregnancies were complicated by preterm labor at 24 weeks gestation in one pregnancy and spontanious abortion at 22 weeks in the other. She takes a multivitamin with folate every day. At the physician’s office, her temperature is 37.2°C (99.0°F), and blood pressure is 109/61 mm Hg. Pelvic examination shows a uterus consistent in size with a 20-week gestation. Fetal heart sounds are normal. An ultrasound shows a short cervix, measured at 20 mm. Which of the following is the most appropriate next step in management?? {'A': 'Cerclage', 'B': 'Cervical pessary', 'C': 'Intramuscular progesterone', 'D': 'Intravenous betamethasone', 'E': 'Vaginal progesterone'},
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A: Cerclage
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Q:A 23-year-old female presents to the emergency department complaining of a worsening headache. The patient reports that the headache started one month ago. It is constant and “all over” but gets worse when she is lying down or in the setting of bright lights. Review of systems is significant for low-grade fever, night sweats, cough, malaise, poor appetite, and unintentional weight loss of 12 pounds in the last two months. The patient is sexually active with multiple male partners and reports inconsistent condom use. She has a history of intravenous drug use, and has not been to a doctor in the last two years. The patient’s temperature is 100.4°F (38.0°C), blood pressure is 110/78 mmHg, pulse is 88/min, and respirations are 14/min with an oxygen saturation of 98% O2 on room air. On physical exam, pain is elicited upon passive flexion of the patient’s neck. A CT scan shows ventricular enlargement. A CD4+ count is 57 cells/µL blood. A lumbar puncture is performed with the following findings: Cerebrospinal fluid: Opening pressure: 210 mmH2O Glucose: 32 mg/dL Protein: 204 mg/dL India ink stain: Positive Leukocyte count and differential: Leukocyte count: 200/mm^3 Lymphocytes: 100% Red blood cell count: 2 What is the next best step in therapy?? {'A': 'Administer fluconazole', 'B': 'Administer amphotericin B and 5-flucytosine', 'C': 'Administer vancomycin and ceftriaxone', 'D': 'Administer acyclovir', 'E': 'Administer dexamethasone'},
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B: Administer amphotericin B and 5-flucytosine
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Q:A 67-year-old man is brought to the emergency department by his wife due to dizziness, trouble with walking, and progressively worsening headache. These symptoms began approximately two hours prior to arriving to the hospital and were associated with nausea and one episode of vomiting. Medical history is significant for hypertension, hypercholesterolemia, and type II diabetes mellitus, which is managed with lisinopril, atorvastatin, and metformin. His temperature is 99°F (37.2°C), blood pressure is 182/106 mmHg, pulse is 102/min, and respirations are 20/min. On physical examination, the patient has right-sided dysmetria on finger-to-nose testing and right-sided dysrhythmia on rapid finger tapping. This patient's abnormal physical exam findings is best explained by decreased neuronal input into which of the following nuclei?? {'A': 'Dentate and vestibular nuclei', 'B': 'Eboliform and fastigial nuclei', 'C': 'Dentate and interposed nuclei', 'D': 'Fastigial and globose nuclei', 'E': 'Vestibular and eboliform nuclei'},
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C: Dentate and interposed nuclei
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Q:A 52-year-old woman presents with fatigue and pain of the proximal interphalangeal and metacarpophalangeal joints for the past 6 months. She also has knee and wrist pain that has been present for the past 2 months, with morning stiffness that improves over the course of the day. Physical examination is significant for subcutaneous nodules. Laboratory tests are significant for the following: Hemoglobin 12.5 g/dL Red blood cell count 4.9 x 106/µL White blood cell count 5,000/mm3 Platelet count 180,000/mm3 Coombs' test Negative C-reactive peptide (CRP) Elevated Erythrocyte sedimentation rate (ESR) Negative Anti-cyclic citrullinated peptide antibody (anti-CCP antibody) Moderately positive Anti-nuclear antibody (ANA) Negative Rheumatoid factor (RF) Negative What is the most likely human leukocyte antigen (HLA) subtype associated with this disease?? {'A': 'HLA-DR4', 'B': 'HLA-DR2', 'C': 'HLA-DR5', 'D': 'HLA-DQ2', 'E': 'HLA-B27'},
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A: HLA-DR4
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Q:A 27-year-old woman presents to the emergency department for sudden, bilateral, painful loss of vision. She states that her symptoms started last night and have persisted until this morning. The patient has a past medical history of peripheral neuropathy which is currently treated with duloxetine and severe anxiety. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 100/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, the patient demonstrates 4/5 strength in her upper and lower extremities with decreased sensation in her fingers bilaterally. Towards the end of the exam, the patient embarrassingly admits to having an episode of urinary incontinence the previous night. An MRI is obtained and is within normal limits. Which of the following is the best next step in management and most likely finding for this patient?? {'A': 'A repeat MRI 3 days later demonstrating periventricular lesions', 'B': 'A high resolution CT demonstrating hyperdense lesions', 'C': 'A lumbar puncture demonstrating oligoclonal bands', 'D': 'Urine toxicology panel demonstrating cocaine use', 'E': 'A psychiatric evaluation revealing multiple acute life stressors'},
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C: A lumbar puncture demonstrating oligoclonal bands
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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 is fasting prior to a religious ceremony. Her only oral intake in the last 36 hours has been small amounts of water. The metabolic enzyme that is primarily responsible for maintaining normal blood glucose in this patient is located exclusively within the mitochondria. An increase in which of the following substances is most likely to increase the activity of this enzyme?? {'A': 'Adenosine monophosphate', 'B': 'Glucagon', 'C': 'Oxidized nicotinamide adenine dinucleotide', 'D': 'Citrate', 'E': 'Acetyl coenzyme A'},
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E: Acetyl coenzyme A
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the emergency department 3 hours after being bitten by his neighbor's dog. He was chasing the dog with a stick when it attacked him. He has fed the dog on multiple occasions and it has never bitten him before. His father saw the dog 2 hours after the incident and its behavior seemed normal. There is no personal or family history of serious illness in the family. The last vaccination the boy received was against varicella 2 years ago; he has never been immunized against rabies. He is not in acute distress. Vital signs are within normal limits. Examination shows a 2 cm (0.8 in) puncture wound on his left calf; there is minimal erythema around the wound. The remainder of the examination shows no abnormalities. A complete blood count is within the reference range. The wound is irrigated and washed with saline and chlorhexidine solution. Which of the following is the most appropriate next step in management?? {'A': 'Observe the dog for 10 days', 'B': 'Euthanize the dog and test for rabies', 'C': 'Administer rabies vaccine and immune globulin', 'D': 'Administer rabies immune globulin', 'E': 'Administer rabies vaccine\n"'},
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A: Observe the dog for 10 days
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