instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options:
|
Q:A 15-year-old Caucasian male is brought to his pediatrician by his parents, who note the development of a tremor in their child. Urine and serum analysis reveal elevated levels of copper. Which of the following clinical manifestations would the physician most expect to see in this patient?? {'A': 'Diabetes mellitus', 'B': 'Kaiser-Fleischer rings', 'C': 'Panacinar emphysema', 'D': 'Increased serum ceruloplasmin', 'E': 'Hepatocytes that stain with Prussian blue'},
|
B: Kaiser-Fleischer rings
|
Answer the following medical question with one of the provided options:
|
Q:A 61-year-old man is brought to the emergency department by his son after collapsing to the ground while at home. His son immediately performed cardiopulmonary resuscitation and later the patient underwent successful defibrillation after being evaluated by the emergency medical technician. The patient has a medical history of hypertension, hyperlipidemia, and type II diabetes mellitus. He has smoked one-half pack of cigarettes for approximately 30 years. The patient was admitted to the cardiac intensive care unit, and after a few days developed acute onset right upper extremity weakness. His temperature is 99°F (37.2°C), blood pressure is 145/91 mmHg, pulse is 102/min and irregularly irregular, and respirations are 16/min. On physical examination, the patient is alert and orientated to person, place, and time. His language is fluent and he is able to name, repeat, and read. His strength is 5/5 throughout except in the right hand, wrist, and arm, which is 2/5. Based on this patient's clinical presentation, the affected neuronal fibers decussate at which level of the central nervous system?? {'A': 'Primary motor cortex', 'B': 'Thalamus', 'C': 'Pons', 'D': 'Caudal medulla', 'E': 'Spinal cord'},
|
D: Caudal medulla
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old woman comes to the emergency department 1 hour after her husband saw her faint shortly after getting out of bed from a nap. She regained consciousness within 30 seconds and was fully alert and oriented. She has had 2 similar episodes in the last 5 years, once while standing in line at the grocery store and once when getting out of bed in the morning. 24-hour Holter monitoring and echocardiography were unremarkable at her last hospitalization 1 year ago. She has hypertension, depression, and asthma. Current medications include verapamil, nortriptyline, and an albuterol inhaler as needed. Her temperature is 37°C (98.4°F), pulse is 74/min and regular, respirations are 14/min, blood pressure is 114/72 mm Hg when supine and 95/60 mm Hg while standing. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. A complete blood count and serum concentrations of electrolytes, urea nitrogen, creatinine, and glucose are within the reference range. Bedside cardiac monitoring shows rare premature ventricular contractions and T-wave inversions in lead III. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Adrenal insufficiency', 'B': 'Autonomic dysfunction', 'C': 'Structural cardiac abnormality', 'D': 'Hemorrhagic blood loss', 'E': 'Cardiac arrhythmia'},
|
B: Autonomic dysfunction
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old executive travels frequently around the world. He often has difficulty falling asleep at night when he returns home. You suspect a circadian rhythm disorder is responsible for his pathology. Which of the following regulates the circadian rhythm?? {'A': 'Anterior hypothalamus', 'B': 'Posterior hypothalamus', 'C': 'Ventromedial area of hypothalamus', 'D': 'Supraoptic area of hypothalamus', 'E': 'Suprachiasmatic nucleus of hypothalamus'},
|
E: Suprachiasmatic nucleus of hypothalamus
|
Answer the following medical question with one of the provided options:
|
Q:A 16-year-old male presents to his pediatrician concerned that he is not maturing like his friends. He has a history of cleft palate status-post multiple surgeries and asthma treated with budesonide and albuterol. He is a good student and is very active on his school’s gymnastics team. His mother is also concerned that her son does not understand good personal hygiene. She reports that he always forgets to put on deodorant. When asked about this, he says he does not notice any body odor on himself or others. His temperature is 99.2°F (37.3°C), blood pressure is 105/70 mmHg, pulse is 70/min, and respirations are 18/min. His height and weight are in the 20th and 25th percentiles, respectively. On physical examination, his penis and testicles show no evidence of enlargement. He has no pubic or axillary hair. Which of the following sets of hormone levels is most likely to be found in this patient?? {'A': 'Decreased testosterone, decreased FSH, decreased LH, decreased GnRH', 'B': 'Increased testosterone, decreased FSH, decreased LH, decreased GnRH', 'C': 'Decreased testosterone, increased FSH, increased LH, increased GnRH', 'D': 'Decreased testosterone, decreased FSH, decreased LH, increased GnRH', 'E': 'Normal testosterone, normal FSH, normal LH, normal GnRH'},
|
A: Decreased testosterone, decreased FSH, decreased LH, decreased GnRH
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old primigravid woman at 10 weeks' gestation comes to the physician for a prenatal visit. Pregnancy was confirmed by an ultrasound 3 weeks earlier after the patient presented with severe nausea and vomiting. The nausea and vomiting have subsided without medication. She has no vaginal bleeding or discharge. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 10-week gestation. Transvaginal ultrasonography shows a gestational sac with a mean diameter of 23 mm and an embryo 6 mm in length with absent cardiac activity. Which of the following is the most appropriate next step in management?? {'A': 'Serial β-HCG measurements', 'B': 'Misoprostol therapy', 'C': 'Cervical cerclage', 'D': 'Thrombophilia work-up', 'E': 'Methotrexate therapy'},
|
B: Misoprostol therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 67-year-old man is brought to the emergency department when he was found obtunded at the homeless shelter. The patient is currently not responsive and smells of alcohol. The patient has a past medical history of alcohol use, IV drug use, and hepatitis C. His temperature is 99°F (37.2°C), blood pressure is 95/65 mmHg, pulse is 95/min, respirations are 13/min, and oxygen saturation is 95% on room air. The patient is started on IV fluids, and his pulse decreases to 70/min. On physical exam, the patient has an abdominal exam notable for distension and a positive fluid wave. The patient displays mild yellow discoloration of his skin. The patient has notable poor dentition and poor hygiene overall. A systolic murmur is heard along the left sternal border on cardiac exam. Pulmonary exam is notable for mild bibasilar crackles. Laboratory values are ordered, and return as below: Hemoglobin: 10 g/dL Hematocrit: 32% Leukocyte count: 7,500 cells/mm^3 with normal differential Platelet count: 227,000/mm^3 Serum: Na+: 125 mEq/L Cl-: 100 mEq/L K+: 5.0 mEq/L HCO3-: 24 mEq/L BUN: 51 mg/dL Glucose: 89 mg/dL Creatinine: 2.2 mg/dL Ca2+: 10.0 mg/dL AST: 22 U/L ALT: 19 U/L Urine: Color: Amber Nitrites: Negative Sodium: 12 mmol/24 hours Red blood cells: 0/hpf Over the next 24 hours, the patient produces very little urine. Which of the following best explains this patient’s renal findings?? {'A': 'Congestive heart failure', 'B': 'Dehydration', 'C': 'Liver failure', 'D': 'Nephrotoxic agent', 'E': 'Postrenal azotemia'},
|
C: Liver failure
|
Answer the following medical question with one of the provided options:
|
Q:Two days after spontaneous delivery, a 23-year-old woman has progressively worsening, throbbing pain in the back of her head. The pain radiates to the neck and shoulder area. The patient is nauseous and had one episode of clear emesis. She wants to be in a dark and quiet room. The patient's symptoms are exacerbated when she gets up to go to the bathroom and mildly improve with bed rest. The pregnancy was uncomplicated and she attended all prenatal health visits. She underwent epidural analgesia for delivery with adequate pain relief. Her postpartum course was free of obstetric complications. Her vital signs are within normal limits. She is alert and oriented. On examination, neck stiffness is present. Neurological examination shows no other abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Head CT angiography', 'B': 'Send coagulation panel', 'C': 'Cerebrospinal fluid analysis', 'D': 'Continued bed rest', 'E': 'Epidural blood injection'},
|
E: Epidural blood injection
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old man presents to the emergency department with persistent cough. The patient states that for the past week he has been coughing. He also states that he has seen blood in his sputum and experienced shortness of breath. On review of systems, the patient endorses fever and chills as well as joint pain. His temperature is 102°F (38.9°C), blood pressure is 159/98 mmHg, pulse is 80/min, respirations are 14/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 107,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 101 mEq/L K+: 4.2 mEq/L HCO3-: 24 mEq/L BUN: 32 mg/dL Glucose: 99 mg/dL Creatinine: 1.9 mg/dL Ca2+: 10.0 mg/dL AST: 11 U/L ALT: 10 U/L Urine: Color: Amber, cloudy Red blood cells: Positive Protein: Positive Which of the following is the best next step in management?? {'A': 'Steroids', 'B': 'Azithromycin', 'C': 'Type IV collagen antibody levels', 'D': 'p-ANCA levels', 'E': 'Renal biopsy'},
|
C: Type IV collagen antibody levels
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 5-year-old boy is brought to the emergency department because of fever, irritability, malaise, and left knee pain for 4 days. Four days ago, he fell off his bike and scraped his elbow. His temperature is 39.1°C (102.4°F). The patient walks with a limp. Examination shows swelling and point tenderness over the medial aspect of the left knee. An MRI of the left knee shows edema of the bone marrow and destruction of the medial metaphysis of the tibia. Which of the following is the most likely causal organism?? {'A': 'Staphylococcus epidermidis', 'B': 'Brucella melitensis', 'C': 'Staphylococcus aureus', 'D': 'Pseudomonas aeruginosa', 'E': 'Pasteurella multocida'},
|
C: Staphylococcus aureus
|
Answer the following medical question with one of the provided options:
|
Q:A 64-year-old woman presents to her primary care physician complaining of difficulty maintaining her balance while walking. Her husband comes along to the appointment with her, because he feels that she has not been acting herself at home lately. After further questioning him, it is noted that she has recently been voiding urine unintentionally at inappropriate times. If there is suspicion for an intracranial process, what would most likely be seen on MRI and what is the treatment?? {'A': 'Constricted ventricles; ventricular shunt', 'B': 'Constricted ventricles; surgical resection', 'C': 'Dilated ventricles; ventricular shunt', 'D': 'Dilated ventricles; surgical resection', 'E': 'Constricted ventricles; watch and wait'},
|
C: Dilated ventricles; ventricular shunt
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old man with type 2 diabetes mellitus comes to the physician for a routine health maintenance. He feels well. His blood pressure is 155/60 mm Hg. Physical exam shows no abnormalities. Laboratory studies show a glucose concentration of 150 mg/dL and a hemoglobin A1c concentration of 9%. Treatment with lisinopril is initiated. Which of the following findings would be expected two days after initiating lisinopril therapy? $$$ Glomerular filtration rate %%% Renal plasma flow %%% Filtration fraction $$$? {'A': '↑ no change ↑', 'B': '↓ no change ↓', 'C': '↓ ↓ no change', 'D': '↓ ↑ ↓', 'E': '↓ ↓ ↑'},
|
D: ↓ ↑ ↓
|
Answer the following medical question with one of the provided options:
|
Q:A 3629-g (8-lb) newborn is examined shortly after spontaneous vaginal delivery. She was delivered at 40 weeks' gestation and pregnancy was uncomplicated. Her mother is concerned because she is not moving her left arm as much as her right arm. Physical examination shows her left arm to be adducted and internally rotated, with the forearm extended and pronated, and the wrist flexed. The Moro reflex is present on the right side but absent on the left side. Which of the following brachial plexus structures is most likely injured in this infant?? {'A': 'Upper trunk', 'B': 'Long thoracic nerve', 'C': 'Lower trunk', 'D': 'Axillary nerve', 'E': 'Posterior cord'},
|
A: Upper trunk
|
Answer the following medical question with one of the provided options:
|
Q:A 45-year-old woman presents to the office complaining of bilateral joint pain and stiffness in her hand joints for the past 3 months. She reports increasing difficulty holding a coffee cup or pen due to stiffness, especially in the morning. Over-the-counter ibuprofen partially relieves her symptoms. Past medical history is significant for dysthymia and gastroesophageal reflux disease. Vital signs are normal except for a low-grade fever. On examination, there is mild swelling and tenderness in the proximal interphalangeal and metacarpophalangeal joints and wrists. Nontender and non-pruritic nodules near the elbows are noted. Chest and abdominal examination are normal. X-rays of the hands reveal soft tissue swelling, joint space narrowing, and bony erosions. Her hematocrit is 32%, and her erythrocyte sedimentation rate is 40 mm/hr. This patient is at greatest risk for which of the following?? {'A': 'Disease progression to distal interphalangeal joints', 'B': 'Osteoporosis', 'C': 'Sacroiliac joint inflammation', 'D': 'Obstructive pulmonary disease', 'E': 'Osteitis deformans'},
|
B: Osteoporosis
|
Answer the following medical question with one of the provided options:
|
Q:A 40-year-old woman comes to the physician for a preoperative examination before undergoing a planned elective cholecystectomy. She has a history of myasthenia gravis, for which she takes oral pyridostigmine. She has had occasional episodes of muscle weakness, blurred vision, and slurred speech recently. Physical examination shows mild ptosis bilaterally. The pupils are normal in size and reactive bilaterally. Muscle strength is 3/5 at the hips and shoulders. Sensory examination shows no abnormalities. After the administration of 10 mg of edrophonium, her ptosis resolves, and her proximal muscle strength improves to 5/5. This patient is most likely to benefit from which of the following interventions?? {'A': 'Administer timed doses of edrophonium', 'B': 'Increase the dose of pyridostigmine', 'C': 'Discontinue treatment with pyridostigmine', 'D': 'Initiate treatment with intravenous atropine', 'E': 'Add glycopyrrolate as needed'},
|
B: Increase the dose of pyridostigmine
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old woman presents to the emergency department with abdominal pain. She states that she was eating dinner when she suddenly felt abdominal pain and nausea. The pain did not improve after 30 minutes, so her husband brought her in. The patient has a past medical history of diabetes that is well-treated with exercise and metformin. Her temperature is 101°F (38.3°C), blood pressure is 147/98 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam reveals right upper quadrant tenderness and guaiac negative stools. Which of the following is optimal management for this patient's condition?? {'A': 'NPO, IV fluids, analgesics, antibiotics', 'B': 'NPO, IV fluids, analgesics, antibiotics, emergent cholecystectomy', 'C': 'NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 24 hours', 'D': 'NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 48 hours', 'E': 'NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 72 hours'},
|
E: NPO, IV fluids, analgesics, antibiotics, cholescystecomy within 72 hours
|
Answer the following medical question with one of the provided options:
|
Q:An otherwise healthy 56-year-old man comes to the physician for a 2-year history of recurrent upper abdominal pain and fullness that worsens after meals. Urea breath test is positive. An endoscopy shows diffuse mucosal atrophy and patchy erythema, but no ulcer. A biopsy from which of the following areas is most likely to yield an accurate diagnosis?? {'A': 'Gastric fundus', 'B': 'Distal esophagus', 'C': 'Gastric antrum', 'D': 'Duodenal bulb', 'E': 'Gastric pylorus'},
|
C: Gastric antrum
|
Answer the following medical question with one of the provided options:
|
Q:To study the flow of blood in the systemic circulation, partially occlusive stents are placed in the pulmonary trunk of a physiological system while the pressure in the right atrium is monitored. A graph where the right atrial pressure is a function of venous return is plotted. Assuming all circulatory nerve reflexes are absent in the system, at what point on the diagram shown below will the arterial pressure be closest to the venous pressure?? {'A': 'Point I', 'B': 'Point II', 'C': 'Point III', 'D': 'Point IV', 'E': 'Point V'},
|
C: Point III
|
Answer the following medical question with one of the provided options:
|
Q:A 63-year-old man presents to the emergency room with severe upper abdominal pain. His symptoms started 2 days prior to presentation and have progressed rapidly. He has been seen in the emergency room 3 times in the past year for acute alcohol intoxication. His past medical history is notable for multiple deep venous thromboses, hypertension, diabetes mellitus, gout, and a transient ischemic attack one year prior. He takes warfarin, lisinopril, metformin, glyburide, and allopurinol. His temperature is 100.0°F (37.8°C), blood pressure is 100/55 mmHg, pulse is 130/min, and respirations are 26/min. On exam, he is in acute distress but is able to answer questions appropriately. Hepatomegaly, splenomegaly, and scleral icterus are noted. There is a positive fluid wave. Laboratory analysis reveals an INR of 1.3. An abdominal ultrasound is ordered, and the patient is started on the appropriate management. However, before the ultrasound can begin, he rapidly loses consciousness and becomes unresponsive. He expires despite appropriate management. An autopsy the following day determines the cause of death to be a massive cerebrovascular accident. A liver biopsy demonstrates darkly erythematous congested areas in the centrilobular regions. This patient’s presenting symptoms are most likely caused by obstructive blood flow in which of the following vessels?? {'A': 'Common hepatic artery', 'B': 'Hepatic vein', 'C': 'Inferior vena cava', 'D': 'Portal vein', 'E': 'Splenic vein'},
|
B: Hepatic vein
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old African American male presents to his family physician for “spots” on his foot. Yesterday, he noticed brown spots on his foot that have a whitish rim around them. The skin lesions are not painful, but he got particularly concerned when he found similar lesions on his penis that appear wet. He recalls having pain with urination for the last 4 weeks, but he did not seek medical attention until now. He also has joint pain in his right knee which started this week. He is sexually active with a new partner and uses condoms inconsistently. His physician prescribes a topical glucocorticoid to treat his lesions. Which of the following risk factors is most commonly implicated in the development of this condition?? {'A': 'Race', 'B': 'HLA B27 allele', 'C': 'Co-infection with HIV', 'D': 'Diagnosis with psoriasis', 'E': 'Increased CRP serum levels'},
|
B: HLA B27 allele
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old pregnant female presents for a prenatal check-up at 20 weeks gestation, which includes routine screening ultrasound. Fetal ultrasound demonstrates bilateral multicystic dysplastic kidneys. Her pregnancy has been complicated by persistent oligohydramnios. The child requires significant pulmonary support upon delivery. Which of the following clinical findings is most likely present in this child as a result of these abnormalities?? {'A': 'Urachal fistula', 'B': 'Esophageal atresia', 'C': 'Spina bifida occulta', 'D': 'Clubbed feet', 'E': 'Macrosomia'},
|
D: Clubbed feet
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old boy is brought to the hospital for evaluation, he is accompanied by agents from child protective services after he was rescued from a home where he was being neglected. He was found locked in a closet and says that he was fed only once every 2 days for the past month. On presentation, he is found to be extremely emaciated with protruding ribs and prominent joints. He is provided with an appropriate rehydration and nourishment therapy. Despite his prolonged nutritional deprivation, the patient demonstrates appropriate cognitive function for his age. The transporter responsible for preventing cognitive decline in this malnourished patient has which of the following characteristics?? {'A': 'Facilitates insulin release', 'B': 'Has high affinity for glucose', 'C': 'Responsive to insulin', 'D': 'Has high affinity for fructose', 'E': 'Transports glucose against its concentration gradient'},
|
B: Has high affinity for glucose
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old woman comes to the physician because of vaginal discharge for 4 days. Her last menstrual period was 3 weeks ago. Twelve months ago, she was diagnosed with trichomoniasis, for which she and her partner were treated with a course of an antimicrobial. She is sexually active with one male partner, and they use condoms inconsistently. Her only medication is a combined oral contraceptive that she has been taking for the past 4 years. A Gram stain of her vaginal fluid is shown. Which of the following is the most likely causal organism?? {'A': 'Neisseria gonorrhoeae', 'B': 'Gardnerella vaginalis', 'C': 'Haemophilus ducreyi', 'D': 'Klebsiella granulomatis', 'E': 'Treponema pallidum'},
|
A: Neisseria gonorrhoeae
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old woman presents to the physician for a routine physical examination. She has type 2 diabetes that she treats with metformin. Her pulse is 85/min, respiratory rate is 15/min, blood pressure is 162/96 mm Hg, and temperature is 37.0°C (98.6°F). Treatment with a first-line drug is initiated. Which of the following is the most likely effect of this medication? 24-hour urine sodium Aldosterone Angiotensin II Peripheral vascular resistance Renin A Increased Decreased Decreased Decreased Increased B Increased Decreased Decreased Decreased Decreased C Increased Increased Increased Increased Increased D Decreased Increased Increased Decreased Increased E Increased Decreased Increased Decreased Increased? {'A': 'A', 'B': 'B', 'C': 'C', 'D': 'D', 'E': 'E'},
|
A: A
|
Answer the following medical question with one of the provided options:
|
Q:A 59-year-old man comes to the physician because of a 6-month history of numbness and burning sensation in his feet that is worse at rest. He has not been seen by a physician in several years. He is 178 cm (5 ft 10 in) tall and weighs 118 kg (260 lb); BMI is 37.3 kg/m2. Physical examination shows decreased sensation to pinprick, light touch, and vibration over the soles of both feet. Ankle jerk is 1+ bilaterally. His hemoglobin A1C concentration is 10.2%. Which of the following pathophysiological processes is most likely to be involved in this patient's condition?? {'A': 'Accumulation of islet amyloid polypeptide', 'B': 'Complement-mediated destruction of insulin receptors', 'C': 'Increased production of adiponectin by adipocytes', 'D': 'Expression of human leukocyte antigen subtype DR4', 'E': 'Lymphocytic infiltration of islet cells'},
|
A: Accumulation of islet amyloid polypeptide
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old woman who works as a chef is brought to the hospital for evaluation of burns sustained in a kitchen accident. Physical examination reveals 3rd-degree burns over the anterior surface of the right thigh and the lower limbs, which involve approx. 11% of the total body surface area (TBSA). The skin in the burned areas is thick and painless to touch, and the dorsalis pedis pulses are palpable but weak. Which of the following is the most appropriate next step in management?? {'A': 'Early excision and full-thickness skin grafting', 'B': 'Early excision and split-thickness skin grafting', 'C': 'Delayed excision and skin grafting', 'D': 'Topical antibiotic application of mafenide acetate', 'E': 'Fluid resuscitation with Ringer’s lactate solution per the Parkland formula'},
|
B: Early excision and split-thickness skin grafting
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old boy with a past medical history significant only for prior head lice infection presents to the clinic after being sent by the school nurse for a repeat lice infection. The boy endorses an itchy scalp, but a review of systems is otherwise negative. After confirming the child’s diagnosis and sending him home with appropriate treatment, the school nurse contacts the clinic asking for recommendations on how to prevent future infection. Which of the following would be the best option to decrease the likelihood of lice reinfestation?? {'A': 'Observation with close monitoring', 'B': 'Encourage family to move out of their home', 'C': 'Treatment of household members with topical ivermectin', 'D': 'Treatment with oral albendazole', 'E': 'Treatment with topical clindamycin'},
|
C: Treatment of household members with topical ivermectin
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old woman at 6 weeks gestation seeks evaluation at a local walk-in clinic because she has noticed a clear, sticky discharge from her right nipple for the past 1 week. The discharge leaves a pink stain on her bra. She does not have pain in her breasts and denies changes in skin color or nipple shape. The past medical history is significant for a major depressive disorder, for which she takes fluoxetine. The family history is negative for breast, endometrial, and ovarian cancers. The physical examination is unremarkable. There are no palpable masses or tenderness on breast exam and no skin discoloration or ulcers. The breasts are symmetric. The nipple discharge on the right side is a pink secretion that is sticky. There are no secretions on the left. The axillary lymph nodes are normal. Which of the following is the most likely diagnosis?? {'A': 'Mastitis', 'B': 'Drug-induced', 'C': 'Papilloma', 'D': 'Breast cancer', 'E': 'Lactation'},
|
C: Papilloma
|
Answer the following medical question with one of the provided options:
|
Q:A 56-year-old woman, gravida 3, para 3, comes to the physician because her left breast has become larger, hot, and itchy over the past 2 months. The patient felt a small lump in her left breast 1 year ago but did not seek medical attention at that time. She has hypertension and hyperlipidemia. Menarche was at the age of 11 years and menopause at the age of 46 years. Her mother died of breast cancer at the age of 45 years. The patient does not smoke or drink alcohol. Current medications include labetalol, simvastatin, and daily low-dose aspirin. She is 170 cm (5 ft 7 in) tall and weighs 78 kg (172 lb); BMI is 27 kg/m2. Her temperature is 37.7°C (99.9°F), pulse is 78/min, and blood pressure is 138/88 mm Hg. Examination shows large dense breasts. There is widespread erythema and edematous skin plaques over a breast mass in the left breast. The left breast is tender to touch and left-sided axillary lymphadenopathy is noted. Which of the following is the most likely diagnosis?? {'A': "Paget's disease of the breast", 'B': 'Mastitis', 'C': 'Breast fibroadenoma', 'D': 'Breast abscess', 'E': 'Inflammatory breast cancer'},
|
E: Inflammatory breast cancer
|
Answer the following medical question with one of the provided options:
|
Q:A 22-year-old man is brought to the emergency department 25 minutes after an episode of violent jerky movements of his arms and legs. He has no recollection of the episode. The episode lasted for 3–4 minutes. His girlfriend reports that he has not been sleeping well over the past month. He is only oriented to place and person. His temperature is 37°C (98.6°F), pulse is 99/min, respirations are 18/min, and blood pressure is 110/80 mm Hg. Neurologic examination shows no focal findings. A complete blood count as well as serum concentrations of glucose, electrolytes, and calcium are within the reference range. Urine toxicology screening is negative. An MRI of the brain shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Lorazepam', 'B': 'Lumbar puncture', 'C': 'Tilt table test', 'D': 'Electroencephalography', 'E': 'Lamotrigine'},
|
D: Electroencephalography
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man is admitted to the ER for a severe persistent abdominal pain of 6 hours duration with nausea, vomiting, and steatorrhea. His medical history is relevant for multiple similar episodes of abdominal pain, hypertension, a recent fasting plasma glucose test of 150 mg/dL, and an HbA1c of 7.8%. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination is positive for epigastric tenderness. A computed tomography of the abdomen of the patient is shown in the picture. Which of the following laboratory results is most specific for this patient's condition?? {'A': 'Elevated amylase, elevated lipase', 'B': 'Low serum trypsin, low stool elastase', 'C': 'Elevated ALT, elevated gamma-glutamyl transpeptidase', 'D': 'High serum trypsin, high stool elastase', 'E': 'Elevated alkaline phosphatase, elevated total bilirubin'},
|
B: Low serum trypsin, low stool elastase
|
Answer the following medical question with one of the provided options:
|
Q:An investigator is studying the effect of chromatin structure on gene regulation. The investigator isolates a class of proteins that compact DNA by serving as spools upon which DNA winds around. These proteins are most likely rich in which of the following compounds?? {'A': 'Phosphate', 'B': 'Proline and alanine', 'C': 'Heparan sulfate', 'D': 'Lysine and arginine', 'E': 'Disulfide-bonded cysteine'},
|
D: Lysine and arginine
|
Answer the following medical question with one of the provided options:
|
Q:A 73-year-old man comes to the physician because of a 2-month history of intermittent blood in his stool. He has had no pain with defecation. Physical examination shows a 2-cm mass located above the dentate line. Further evaluation of the mass confirms adenocarcinoma. Which of the following describes the most likely route of hematogenous spread of the malignancy?? {'A': 'Superior rectal vein → inferior mesenteric vein → hepatic portal vein', 'B': 'Inferior rectal vein → inferior mesenteric vein → splenic vein', 'C': 'Inferior rectal vein → internal pudendal vein → internal iliac vein', 'D': 'Superior rectal vein → superior mesenteric vein → hepatic portal vein', 'E': 'Inferior rectal vein → internal pudendal vein → external iliac vein'},
|
A: Superior rectal vein → inferior mesenteric vein → hepatic portal vein
|
Answer the following medical question with one of the provided options:
|
Q:A 12-year-old boy and his mother are brought to the emergency department after a motor vehicle accident. The boy was an unrestrained passenger in a head-on collision and was ejected from the front seat. The patient's mother was the driver and she is currently being resuscitated. Neither the child nor the mother are conscious; however, it is documented that the family are all Jehovah's witnesses and would not want a transfusion in an acute situation. The husband/father arrives to the trauma bay and confirms this wish that everyone in the family would not want a transfusion in accordance with their beliefs. The father is confirmed as the official healthcare proxy. Which of the following is the best next step in management?? {'A': 'Consult the hospital ethics committee', 'B': 'Do not transfuse the boy and transfuse the mother', 'C': 'Do not transfuse the boy or the mother', 'D': 'Do not transfuse the mother and transfuse the boy', 'E': 'Transfuse the boy and mother'},
|
D: Do not transfuse the mother and transfuse the boy
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old woman comes to the physician because of increasing heartburn for the last few months. During this period, she has taken ranitidine several times a day without relief and has lost 10 kg (22 lbs). She has retrosternal pressure and burning with every meal. She has had heartburn for several years and took ranitidine as needed. She has hypertension. She has smoked one pack of cigarettes daily for the last 40 years and drinks one glass of wine occasionally. Other current medications include amlodipine and hydrochlorothiazide. She appears pale. Her height is 163 cm (5 ft 4 in), her weight is 75 kg (165 lbs), BMI is 27.5 kg/m2. Her temperature is 37.2°C (98.96°F), pulse is 78/min, and blood pressure is 135/80 mm Hg. Cardiovascular examination shows no abnormalities. Abdominal examination shows mild tenderness to palpation in the epigastric region. Bowel sounds are normal. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 10.2 g/dL Mean corpuscular volume 78 μm Mean corpuscular hemoglobin 23 pg/cell Leukocyte count 9,500/mm3 Platelet count 330,000/mm3 Serum Na+ 137 mEq/L K+ 3.8 mEq/L Cl- 100 mEq/L HCO3- 25 mEq/L Creatinine 1.2 mg/dL Lactate dehydrogenase 260 U/L Alanine aminotransferase 18 U/L Aspartate aminotransferase 15 U/L Lipase (N < 280 U/L) 40 U/L Troponin I (N < 0.1 ng/mL) 0.029 ng/mL An ECG shows normal sinus rhythm without ST-T changes. Which of the following is the most appropriate next step in the management of this patient?"? {'A': '24-hour esophageal pH monitoring', 'B': 'Trial of proton-pump inhibitor', 'C': 'Esophageal manometry', 'D': 'Barium swallow', 'E': 'Esophagogastroduodenoscopy'},
|
E: Esophagogastroduodenoscopy
|
Answer the following medical question with one of the provided options:
|
Q:A 66-year-old man is brought to the emergency department 20 minutes after being involved in a high-speed motor vehicle collision in which he was the unrestrained passenger. His wife confirms that he has hypertension, atrial fibrillation, and chronic lower back pain. Current medications include metoprolol, warfarin, hydrochlorothiazide, and oxycodone. On arrival, he is lethargic and confused. His pulse is 112/min, respirations are 10/min, and blood pressure is 172/78 mm Hg. The eyes open spontaneously. The pupils are equal and sluggish. He moves his extremities in response to commands. There is a 3-cm scalp laceration. There are multiple bruises over the right upper extremity. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. Neurologic examination shows no focal findings. Two large-bore peripheral intravenous catheters are inserted. A 0.9% saline infusion is begun. A focused assessment with sonography in trauma is negative. Plain CT of the brain shows a 5-mm right subdural hematoma with no mass effect. Fresh frozen plasma is administered. Which of the following is most likely to reduce this patient's cerebral blood flow?? {'A': 'Hyperventilation', 'B': 'Decompressive craniectomy', 'C': 'Lumbar puncture', 'D': 'Intravenous hypertonic saline', 'E': 'Intravenous mannitol'},
|
A: Hyperventilation
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old woman comes to her primary care physician hoping she is pregnant. She reports that she had been taking oral contraceptive pills, but she stopped when she began trying to get pregnant about 7 months ago. Since then she has not had her period. She took a few home pregnancy tests that were negative, but she feels they could be wrong. She says she has gained 4 lbs in the past month, and her breasts feel full. Today, she expressed milk from her nipples. She complains of fatigue, which she attributes to stress at work, and headaches, to which she says “my sister told me she had headaches when she was pregnant.” She denies spotting or vaginal discharge. Her last menstrual period was at age 22, prior to starting oral contraceptive pills. Her medical and surgical history are non-significant. She has no history of sexually transmitted infections. She reports she and her husband are having intercourse 3-4 times a week. Her family history is significant for breast cancer in her mother and an aunt who died of ovarian cancer at 55. On physical examination, no breast masses are appreciated, but compression of the nipples produces whitish discharge bilaterally. A bimanual pelvic examination is normal. A urine pregnancy test is negative. Which of the following is the best initial step in management for this patient?? {'A': 'Mammogram', 'B': 'Magnetic resonance imaging of the head', 'C': 'Pelvic ultrasound', 'D': 'Serum follicle-stimulating hormone/luteinizing hormone ratio', 'E': 'Serum thyroid-stimulating hormone level'},
|
E: Serum thyroid-stimulating hormone level
|
Answer the following medical question with one of the provided options:
|
Q:A 72-year-old man comes to the physician for a routine physical examination. He does not take any medications. Physical examination shows no abnormalities. Laboratory studies show a calcium concentration of 8.5 mg/dL, a phosphorus concentration of 3.1 mg/dL, an elevated bone-specific alkaline phosphatase concentration, and a normal urine deoxypyridinoline concentration. Which of the following is the most likely explanation for this patient's laboratory abnormalities?? {'A': 'Increased parafollicular C-cell activity', 'B': 'Decreased osteoclast activity', 'C': 'Increased osteoblast activity', 'D': 'Decreased parathyroid chief cell activity', 'E': 'Increased chondroblast activity'},
|
C: Increased osteoblast activity
|
Answer the following medical question with one of the provided options:
|
Q:A 28-year-old woman who has never been pregnant presents to the physician for a follow-up examination. She has had 5 months of deep pain during sexual intercourse and pelvic pain that intensified prior to her menses. The pain has not subsided despite taking oral contraceptives. She denies any vaginal discharge or foul smell. She is in a monogamous relationship with her husband of 2 years. She has no history of any serious illnesses. Her vital signs are within normal limits. Physical examination shows tenderness on deep palpation of the hypogastrium. A speculum examination of the vagina and cervix shows no abnormalities or discharge. Serum studies show a beta hCG of 6 mIU/mL. A transabdominal ultrasound shows no abnormalities. Which of the following is most likely to establish a diagnosis?? {'A': 'Abdominopelvic computed tomography (CT) scan', 'B': 'Cancer antigen 125 (CA-125)', 'C': 'Laparoscopy', 'D': 'Dilation and curettage', 'E': 'Wet-mount test'},
|
C: Laparoscopy
|
Answer the following medical question with one of the provided options:
|
Q:A 62-year-old woman with metastatic breast cancer comes to the physician because of a 2-day history of fever, chills, and new gluteal lesions. The lesions began as painless red macules and evolved into painful ulcers overnight. She received her fourth course of palliative chemotherapy 2 weeks ago. Her temperature is 38.2°C (100.8°F). Laboratory studies show a leukocyte count of 2,000/mm3 (20% segmented neutrophils). A photograph of one of the skin lesions is shown. Which of the following virulence factors is most likely involved in the pathogenesis of this patient's skin finding?? {'A': 'Edema toxin', 'B': 'Heat-stable toxin', 'C': 'Toxic shock syndrome toxin-1', 'D': 'Exotoxin A', 'E': 'Endotoxin'},
|
D: Exotoxin A
|
Answer the following medical question with one of the provided options:
|
Q:A 61-year-old female presents to her primary care physician complaining of fatigue and feeling sad. She reports that ever since her husband passed away 3 months ago, she has noticed a decrease in her energy level and reports frequently awaking at 2 in the morning and cannot fall back asleep. She sometimes wakes up and hears her husband's voice, constantly thinks about how much she misses him, and has recently thought about ways to kill herself including driving through a red light. She used to be an active member of her neighborhood’s bridge club but has stopped playing. She has lost 15 pounds and rarely feels hungry. Which of the following is the most likely diagnosis in this patient?? {'A': 'Bipolar II disorder', 'B': 'Major depressive disorder', 'C': 'Acute grief', 'D': 'Persistent depressive disorder', 'E': 'Schizoaffective disorder'},
|
B: Major depressive disorder
|
Answer the following medical question with one of the provided options:
|
Q:A physician is describing a case to his residents where a kidney transplant was rapidly rejected by the recipient minutes after graft perfusion. The physician most likely describes all of the following manifestations EXCEPT?? {'A': 'Graft mottling', 'B': 'Graft cyanosis', 'C': 'Low urine output with evidence of blood', 'D': 'Histological evidence of arteriosclerosis', 'E': 'Histological evidence of vascular damage'},
|
D: Histological evidence of arteriosclerosis
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old man comes to the physician because of a 3-month history of intermittent flank pain and reddish discoloration of urine. His blood pressure is 150/92 mm Hg. His serum creatinine concentration is 1.4 mg/dL. An abdominal CT scan is shown. This patient's condition is most likely caused by a genetic defect in which of the following locations?? {'A': 'Short arm of chromosome 16', 'B': 'Short arm of chromosome 3', 'C': 'Long arm of chromosome 4', 'D': 'Long arm of chromosome 10', 'E': 'Short arm of chromosome 6'},
|
A: Short arm of chromosome 16
|
Answer the following medical question with one of the provided options:
|
Q:A 6-year-old boy is brought to the physician because of inability to concentrate and difficulties completing assignments at school. His mother says that he frequently interrupts others during conversations at home and that his teachers often reprimand him for talking excessively in school. He refuses to play with the other children and often has physical altercations with his classmates. He can jump up and down but he cannot hop on one foot. He eats without assistance but has difficulty using silverware. He cannot follow three-step directions. There is no family history of serious illness. Examination shows a small head, wide-spaced eyes, and short palpebral fissures. His upper lip is thin and flat. He has a sunken nasal bridge and a small jaw. There is a 3/6 pansystolic murmur heard along the left lower sternal border. Which of the following is the most likely cause of these findings?? {'A': 'Nondisjunction of chromosome 21', 'B': 'Deletion of long arm of chromosome 7', 'C': 'Prenatal alcohol exposure', 'D': 'FMR1 gene mutation', 'E': 'Maternal intake of phenytoin'},
|
C: Prenatal alcohol exposure
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old female is brought in by ambulance with altered mental status. She is in a comatose state, but is breathing spontaneously with deep and rapid respirations. Her vital signs are as follows: T 100.2F, BP 92/54 mmHg, HR 103 bpm, RR 28, and SpO2 97% on room air. Complete blood count reveals: WBC 12.7, hemoglobin 11.3, platelets 254. Basic metabolic panel reveals: sodium 137, potassium 4.2, chloride 100, bicarbonate 16, creatinine 1.78 An ABG is performed which showed pH 7.38, PaO2 94, PaCO2 26. Which of the following is the most likely cause of this patient’s presentation?? {'A': 'Undiagnosed type 1 diabetes mellitus', 'B': 'Severe sepsis', 'C': 'Medication overdose', 'D': 'Acute renal failure', 'E': 'Alcohol binging'},
|
C: Medication overdose
|
Answer the following medical question with one of the provided options:
|
Q:Researchers are studying the relationship between heart disease and alcohol consumption. They review the electronic medical records of 500 patients at a local hospital during the study period and identify the presence or absence of acute coronary syndrome (ACS) and the number of alcoholic drinks consumed on the day of presentation. The researchers determine the prevalence of ACS and of alcoholic drink consumption. They correlate the relationship between these two variables and find that patients who reported no alcohol consumption or 1 drink only that day had a lower risk of acute coronary syndrome than patients who reported 2 or more drinks. Which of the following is the most accurate description of this study type?? {'A': 'Randomized controlled trial', 'B': 'Case-control study', 'C': 'Cross-sectional study', 'D': 'Retrospective study', 'E': 'Prospective study'},
|
C: Cross-sectional study
|
Answer the following medical question with one of the provided options:
|
Q:A 69-year-old man is brought to the emergency department because of a 1-week history of recurring black stools. On questioning, he reports fatigue and loss of appetite over the last 3 months. Twenty years ago, he underwent a partial gastrectomy for peptic ulcer disease. The patient's father died of metastatic colon cancer at the age of 57 years. He is 163 cm (5 ft 4 in) tall and weighs 55 kg (121 lb); BMI is 20.8 kg/m2. He appears chronically ill. His temperature is 36.5°C (97.7°F), pulse is 105/min, and blood pressure is 115/70 mm Hg. The conjunctiva appear pale. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and nontender. There is a well-healed scar on the upper abdomen. His hemoglobin concentration is 10.5 g/dL and his mean corpuscular volume is 101 μm3. An upper endoscopy shows a large nodular mass on the anterior wall of the lesser curvature of the gastric stump. Biopsy samples are obtained, showing polypoid, glandular formation of irregular-shaped and fused gastric cells with intraluminal mucus, demonstrating an infiltrative growth. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Stool antigen test for H. pylori', 'B': 'Laparoscopy', 'C': 'Treatment with PPI, clarithromycin, and amoxicillin', 'D': 'Abdominopelvic CT scan', 'E': 'Vitamin B12 assessment'},
|
D: Abdominopelvic CT scan
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old woman comes to the physician because of a 4-month history of fatigue. She admits to binge eating several times per month, after which she usually induces vomiting for compensation. She exercises daily in an effort to lose weight. She is 168 cm (5 ft 6 in) tall and weighs 60 kg (132 lb); BMI is 21.3 kg/m2. Physical examination shows calluses on the knuckles and bilateral parotid gland enlargement. Oropharyngeal examination shows eroded dental enamel and decalcified teeth. Which of the following is the most appropriate pharmacotherapy for this patient's condition?? {'A': 'Orlistat', 'B': 'Mirtazapine', 'C': 'Buspirone', 'D': 'Venlafaxine', 'E': 'Fluoxetine'},
|
E: Fluoxetine
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old man comes to the physician with his wife for evaluation of infertility. They have been unable to conceive for 2 years. The man reports normal libido and erectile function. He has smoked one pack of cigarettes daily for 13 years. He does not take any medications. He has a history of right-sided cryptorchidism that was surgically corrected when he was 7 years of age. Physical examination shows no abnormalities. Analysis of his semen shows a low sperm count. Laboratory studies are most likely to show which of the following?? {'A': 'Increased placental ALP concentration', 'B': 'Increased prolactin concentration', 'C': 'Decreased inhibin B concentration', 'D': 'Decreased FSH concentration', 'E': 'Decreased testosterone concentration'},
|
C: Decreased inhibin B concentration
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old boy was brought to the emergency department because of palpitations and lightheadedness that began 16 hours ago. He admitted to binge drinking the night before. He was sedated and electrically cardioverted. An ECG that was recorded following cardioversion is shown. After regaining consciousness, he was admitted for observation. Serum concentration of creatinine and electrolytes were measured to be within the reference range. Twelve hours after cardioversion, the patient complains again of palpitations. He does not have lightheadedness or chest pain. His temperature is 37.1°C (98.8°F), pulse is 220/min, respirations are 20/min, and blood pressure is 112/84 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. A newly recorded ECG shows a shortened PR interval, and wide, monomorphic QRS complexes with a regular rhythm. Which of the following is the most appropriate next best step in management?? {'A': 'Administer magnesium sulfate', 'B': 'Administer verapamil', 'C': 'Administer atenolol', 'D': 'Administer procainamide', 'E': 'Administer adenosine'},
|
D: Administer procainamide
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old girl is brought to the emergency department after falling about from a chair and injuring her right leg. During the past 2 years, she has had two long bone fractures. She is at the 5th percentile for height and 20th percentile for weight. Her right lower leg is diffusely erythematous. The patient withdraws and yells when her lower leg is touched. A photograph of her face is shown. An x-ray of the right lower leg shows a transverse mid-tibial fracture with diffusely decreased bone density. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Type 3 collagen defect', 'B': 'Type 5 collagen defect', 'C': 'Type 1 collagen defect', 'D': 'Type 4 collagen defect', 'E': 'Type 2 collagen defect'},
|
C: Type 1 collagen defect
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old woman with type 1 diabetes mellitus suddenly develops tremors, cold sweats, and confusion while on a backpacking trip with friends. She is only oriented to person and is unable to follow commands. Her fingerstick blood glucose concentration is 28 mg/dL. Her friend administers an intramuscular injection with a substance that reverses her symptoms. Which of the following is the most likely mechanism of action of this drug?? {'A': 'Activation of glucokinase', 'B': 'Inhibition of glucose-6-phosphatase', 'C': 'Inhibition of α-glucosidase', 'D': 'Activation of adenylyl cyclase', 'E': 'Inhibition of glycogen phosphorylase\n"'},
|
D: Activation of adenylyl cyclase
|
Answer the following medical question with one of the provided options:
|
Q:A 52-year-old diabetic man presents with fever, headache, and excruciating pain in his right eye for the past 2 days. He says that he has been taking sitagliptin and metformin regularly. He endorses recently having a sore throat. On examination, vesicles are present in groups with an erythematous base on the upper eyelid, forehead, and nose on the right half of his face. The patient is prescribed an antiviral agent and sent home. Which of the following nerves is most likely involved?? {'A': 'Nasociliary nerve', 'B': 'Ophthalmic nerve', 'C': 'Supraorbital nerve', 'D': 'Supratrochlear nerve', 'E': 'Lacrimal nerve'},
|
B: Ophthalmic nerve
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old man presents to his primary care provider with recent swelling in his legs that has now spread to the lower part of his thighs. He sometimes has difficulty putting on his shoes and pants. He also noticed puffiness under his eyes over the last 3 weeks. A 24-hour urine collection confirms proteinuria of 5 g/day. Electron microscopy of a renal biopsy specimen reveals subepithelial deposits with a spike and dome pattern. Which of the following is associated with this patient’s condition?? {'A': 'HIV infection', 'B': 'High HbA1C', 'C': 'Hepatitis B infection', 'D': "Hodgkin's lymphoma", 'E': 'Monoclonal protein spike'},
|
C: Hepatitis B infection
|
Answer the following medical question with one of the provided options:
|
Q:A 24-year-old woman comes to the physician for an annual routine examination. Menses occur at regular 28-day intervals and last for 4 days with normal flow. Her last menstrual period was 3 weeks ago. She is sexually active with one male partner and they use condoms consistently. The patient is 160 cm (5 ft 3 in) tall and weighs 72 kg (150 lb); BMI is 28.1 kg/m2. She feels well. Pelvic examination shows a smooth, mobile right adnexal mass. A subsequent ultrasound of the pelvis shows a single, 2-cm large, round, hypoechoic mass with a thin, smooth wall in the right ovary. The mass has posterior wall enhancement, and there are no signs of blood flow or septae within the mass. Which of the following is the most appropriate next step in management?? {'A': 'Diagnostic laparoscopy', 'B': 'CA-125 level', 'C': 'CT scan of the pelvis', 'D': 'Oral contraceptive', 'E': 'Follow-up examination'},
|
E: Follow-up examination
|
Answer the following medical question with one of the provided options:
|
Q:A 21-year-old man presents with fever, headache, and clouded sensorium for the past 3 days. His fever is low-grade. He says his headache is mild-to-moderate in intensity and associated with nausea, vomiting, and photophobia. There is no history of a sore throat, pain on urination, abdominal pain, or loose motions. He smokes 1–2 cigarettes daily and drinks alcohol socially. Past medical history and family history are unremarkable. His vital signs include: blood pressure 120/80 mm Hg, pulse 106/min, temperature 37.3°C (99.2°F). On physical examination, he is confused, disoriented, and agitated. Extraocular movements are intact. The neck is supple on flexion. He is moving all his 4 limbs spontaneously. A noncontrast CT scan of the head is within normal limits. A lumbar puncture is performed, and cerebrospinal fluid results are still pending. The patient is started on empiric intravenous acyclovir. Which of the following clinical features favors encephalitis rather than meningitis?? {'A': 'Clouded sensorium', 'B': 'Fever', 'C': 'Headache', 'D': 'Nausea and vomiting', 'E': 'Photophobia'},
|
A: Clouded sensorium
|
Answer the following medical question with one of the provided options:
|
Q:A 68-year-old man comes to the physician because of a 3-month history of anorexia, weight loss, and cough productive of blood-tinged sputum with yellow granules. Four months ago he was treated for gingivitis. He has smoked 1 pack of cigarettes daily for 40 years. Examination shows crackles over the right upper lung field. An x-ray of the chest shows a solitary nodule and one cavitary lesion in the right upper lung field. A photomicrograph of a biopsy specimen from the nodule obtained via CT-guided biopsy is shown. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Penicillin G', 'B': 'Cisplatin and paclitaxel', 'C': 'Trimethoprim-sulfamethoxazole', 'D': 'Rifampin, isoniazid, pyrazinamide, and ethambutol', 'E': 'Itraconazole'},
|
A: Penicillin G
|
Answer the following medical question with one of the provided options:
|
Q:A 70-year-old man comes to the physician because of intermittent shortness of breath while going up stairs and walking his dog. It began about 1 month ago and seems to be getting worse. He has also developed a dry cough. He has not had any wheezing, fevers, chills, recent weight loss, or shortness of breath at rest. He has a history of Hodgkin lymphoma, for which he was treated with chemotherapy and radiation to the chest 7 years ago. He also has hypertension, for which he takes lisinopril. Ten years ago, he retired from work in the shipbuilding industry. He has smoked half a pack of cigarettes daily since the age of 21. Vital signs are within normal limits. On lung auscultation, there are mild bibasilar crackles. A plain x-ray of the chest shows bilateral ground-glass opacities at the lung bases and bilateral calcified pleural plaques. Which of the following is the greatest risk factor for this patient's current condition?? {'A': 'Occupational exposure', 'B': 'Smoking', 'C': 'Advanced age', 'D': 'Family history', 'E': 'Radiation therapy'},
|
A: Occupational exposure
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old obese woman presents with changes in her left breast. The patient states that, about a month ago, she noticed that she was able to feel a hard mass in the upper outer quadrant of her left breast, which has not gone away. In addition, her nipple and skin overlying the breast have started to look different. Past medical history is significant for the polycystic ovarian syndrome (PCOS) and hypertension, well-managed with lisinopril. The patient has never been pregnant. Menopause was at age 53. Family history is significant for breast cancer in her mother at age 55, and her father who died of lung cancer at age 52. A review of systems is significant for a 13.6 kg (30 lb) weight loss in the last 2 months despite no change in diet or activity. Vitals include: temperature 37.0°C (98.6°F), blood pressure 120/75 mm Hg, pulse 97/min, respiratory rate 16/min, and oxygen saturation 99% on room air. The physical exam is significant for a palpable, hard, fixed mass in the upper outer quadrant of the left breast, as well as nipple retraction and axillary lymphadenopathy. Mammography of the left breast reveals a spiculated mass in the upper outer quadrant. A biopsy confirms invasive ductal carcinoma. Molecular analysis reveals that the tumor cells are positive for a receptor that is associated with a poor prognosis. Which of the following are indicated as part of this patient’s treatment?? {'A': 'Goserelin', 'B': 'Tamoxifen', 'C': 'Trastuzumab', 'D': 'Anastrozole', 'E': 'Raloxifene'},
|
C: Trastuzumab
|
Answer the following medical question with one of the provided options:
|
Q:An 11-year-old boy is brought to the doctor by his father because his father is worried about the boy's performance in school and his lack of a social life. His father is also worried about the ongoing bullying his son is experiencing due to swearing outbursts the boy has exhibited for several years. During these outbursts, the boy contorts his face, blinks repeatedly, and grunts. His father is worried that the bullying will worsen and would like to see if there is a medication that can help his son. Which of the following medications is most likely to be beneficial?? {'A': 'Valproic acid', 'B': 'Risperidone', 'C': 'Lamotrigine', 'D': 'Clonazepam', 'E': 'Lithium'},
|
B: Risperidone
|
Answer the following medical question with one of the provided options:
|
Q:A 54-year-old woman presents to the emergency room after falling on her right side at a bar and breaking her clavicle and 2 ribs. Her husband reports that she has had a 6-month history of diarrhea and has lost 6.8 kg (15 lb) over the last year without dieting or exercising. She has a family history of type I diabetes. On physical exam, ecchymosis is noted over her entire right shoulder, extending to her sternum and over her broken ribs. She also has other bruises in various stages of healing. Her abdomen is diffusely tender, radiating to her back, and there is a palpable midepigastric mass. The woman has a positive Romberg test, but the rest of her examination is normal. She is admitted for further evaluation. Her labs and pancreas biopsy histology are as follows: Laboratory tests Serum chemistries Albumin 5.1 g/dL Amylase 124 U/L Lipase 146 U/L Blood glucose (fasting) 180 mg/dL Triglycerides 140 mg/dL Cholesterol, total 210 mg/dL HDL 25 mg/dL LDL 165 mg/dL Serum electrolytes Sodium 137 mEq/L Potassium 3.5 mEq/L Chloride 90 mEq/L International normalized ratio 2.5 Activated partial thromboplastin time 30 s Complete blood count Hemoglobin 12.5 g/dL Mean corpuscular volume 102 µm3 Platelets 150,000/mm3 Leukocytes 6000/mm3 Stool analysis Elastase low Occult blood absent Which of the following is the best way to manage her condition in the long term?? {'A': 'Thiamine and 50% dextrose', 'B': 'Gemcitabine alone', 'C': 'Pancreatic resection followed by 5-fluorouracil with leucovorin', 'D': 'Insulin aspart and glargine', 'E': 'Insulin aspart and glargine with pancreatic enzyme replacement therapy'},
|
E: Insulin aspart and glargine with pancreatic enzyme replacement therapy
|
Answer the following medical question with one of the provided options:
|
Q:A 34-year-old G2P1 female at 37 weeks of gestation presents to the clinic for complaints of right-hand numbness and pain for the past month. She reports that the pain is usually worse at night and that she would sometimes wake up in the middle of the night from the “pins and needles.” She denies fever, weakness, or weight changes but endorses paresthesia and pain. The patient also reports a fall on her right hand 2 weeks ago. A physical examination demonstrates mild sensory deficits at the first 3 digits of the right hand but no tenderness with palpation. Strength is intact throughout. Which of the following findings would further support the diagnosis of this patient’s condition?? {'A': 'Hairline fracture of the scaphoid bone on magnetic resonance imaging (MRI)', 'B': 'Loss of sensation at the thenar eminence', 'C': 'Small cross-sectional area of the median nerve on ultrasonography', 'D': 'Tingling when the right wrist is percussed', 'E': 'Tingling when the wrists are extended 90 degrees'},
|
D: Tingling when the right wrist is percussed
|
Answer the following medical question with one of the provided options:
|
Q:A 6-year-old boy presents to his pediatrician’s office for muscle weakness. The patient is accompanied by his mother who states that he has difficulty running and walking up the stairs. The mother has noticed mild weakness when the patient attempts to sit up from a supine position since he was 4-years-old. Medical history is significant for fractures involving the arms and legs secondary to falling. On physical exam, the child does not appear to be in distress and is conversational. He has a waddling gait along with lumbar lordosis and bilateral calf enlargement. The patient uses his hands to push himself into an upright position when arising from the floor. He has absent patellar and ankle-jerk reflexes. Which of the following is the best next step to confirm the diagnosis?? {'A': 'Electrocardiogram', 'B': 'Electromyogram', 'C': 'Genetic testing', 'D': 'Muscle biopsy', 'E': 'Serum creatine kinase level'},
|
C: Genetic testing
|
Answer the following medical question with one of the provided options:
|
Q:A 26-year-old male currently undergoing standard therapy for a recently diagnosed active tuberculosis infection develops sudden onset of fever and oliguria. Laboratory evaluations demonstrate high levels of eosinophils in both the blood and urine. Which of the following is most likely responsible for the patient’s symptoms:? {'A': 'Rifampin', 'B': 'Isoniazid', 'C': 'Pyrazinamide', 'D': 'Ethambutol', 'E': 'Return of active tuberculosis symptoms secondary to patient non-compliance with anti-TB regimen'},
|
A: Rifampin
|
Answer the following medical question with one of the provided options:
|
Q:A 3-year-old boy is brought to the physician for evaluation of a generalized, pruritic rash. The rash began during infancy and did not resolve despite initiating treatment with topical corticosteroids. Three months ago, he was treated for several asymptomatic soft tissue abscesses on his legs. He has been admitted to the hospital three times during the past two years for pneumonia. Physical examination shows a prominent forehead and a wide nasal bridge. Examination of the skin shows a diffuse eczematous rash and white plaques on the face, scalp, and shoulders. Laboratory studies show a leukocyte count of 6,000/mm3 with 25% eosinophils and a serum IgE concentration of 2,300 IU/mL (N = 0–380). Flow cytometry shows a deficiency of T helper 17 cells. The patient’s increased susceptibility to infection is most likely due to which of the following?? {'A': 'Impaired chemotaxis of neutrophils', 'B': 'Impaired DNA repair in lymphocytes', 'C': 'Impaired actin assembly in lymphocytes', 'D': 'Impaired Ig class-switching in lymphocytes', 'E': 'Impaired interferon-γ secretion by Th1 cells'},
|
A: Impaired chemotaxis of neutrophils
|
Answer the following medical question with one of the provided options:
|
Q:A 2-month-old boy is brought to the pediatrician for a routine check-up. His mother says he is feeding well and has no concerns. He is at the 85th percentile for height and 82nd percentile for weight. Immunizations are up-to-date. Results of serum hepatitis B surface IgG antibody testing are positive. Which of the following best explains this patient's hepatitis B virus status?? {'A': 'Window period', 'B': 'Chronic infection', 'C': 'Spontaneous recovery', 'D': 'Vaccination reaction', 'E': 'Passive immunity'},
|
E: Passive immunity
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man comes to the physician because of progressive pain in his right hip and lower back over the past 4 weeks. He describes the pain as dull and constant. It is worse with exertion and at night. Over the past 2 months, he has helped his son with renovating his home, which required heavy lifting and kneeling. His father died of prostate cancer. He drinks 2–3 beers daily. Vital signs are within normal limits. Examination shows localized tenderness over the right hip and groin area; range of motion is decreased. Hearing is mildly decreased on the right side. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 15 g/dL Serum Total protein 6.5 g/dL Bilirubin 0.8 mg/dL Alanine aminotransferase 20 U/L Alkaline phosphatase (ALP) 950 U/L γ-Glutamyltransferase (GGT) 40 U/L (N=5–50) Calcium 9 mg/dL Phosphate 4 mg/dL Parathyroid hormone 450 pg/mL An x-ray of the hip shows cortical thickening and prominent trabecular markings. Which of the following is the most likely underlying mechanism of this patient's symptoms?"? {'A': 'Proliferation of plasma cells in the bone marrow', 'B': 'Increased rate of bone remodeling', 'C': 'Decreased bone mass with microarchitectural disruption', 'D': 'Infarction of the bone and marrow', 'E': 'Osteoblastic destruction of the bone'},
|
B: Increased rate of bone remodeling
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old man comes to the physician because of low-grade fever, dry cough, and shortness of breath. His symptoms began 6 days ago while he was on vacation in Thailand where he went to an urgent care clinic and was started on cefuroxime. His temperature is 38.2°C (100.8°F). Physical examination shows decreased breath sounds at bilateral lung bases. An x-ray of the chest shows diffuse patchy infiltrates. Sputum analysis shows numerous neutrophils but no organisms. Giemsa stain shows epithelial cells with cytoplasmic inclusion bodies. This patient's condition did not improve after the initial treatment because of which of the following properties of the most likely causal pathogen?? {'A': 'Lack of peptidoglycan in cell wall', 'B': 'Enclosure by polysaccharide capsule', 'C': 'Formation of biofilms', 'D': 'Production of β-lactamase enzymes', 'E': 'Rapid alteration of drug binding sites'},
|
A: Lack of peptidoglycan in cell wall
|
Answer the following medical question with one of the provided options:
|
Q:Four days after undergoing a coronary artery bypass graft for coronary artery disease, a 60-year-old man complains of abdominal fullness and bloating. Since his surgery, he has not had a bowel movement and is unable to pass flatus. He has no nausea or vomiting. Prior to the operation, the patient had daily bowel movements without abnormalities. He has a history of bipolar disorder and hypertension. His current medications include aspirin, atorvastatin, chlorpromazine, amlodipine, and prophylactic subcutaneous heparin. His temperature is 39°C (102.2°F), pulse is 110/min, and blood pressure is 120/80 mm Hg. Cardiopulmonary examination shows no abnormalities. Abdominal examination shows a distended, tympanic abdomen with guarding and rebound tenderness; bowel sounds are hypoactive. Abdominal x-ray shows diffuse distention of the colon loops. A CT scan with contrast confirms the x-ray findings and shows a cecal dilation of 14 cm. Which of the following is the most appropriate next step in the management?? {'A': 'Nasogastric and rectal tube insertion', 'B': 'Colonoscopy', 'C': 'Intravenous neostigmine therapy', 'D': 'Laparotomy', 'E': 'Intravenous fluids and bowel rest\n"'},
|
D: Laparotomy
|
Answer the following medical question with one of the provided options:
|
Q:A 42-year-old woman presents with trouble focusing. She says that she has trouble focusing on simple tasks and her thoughts are very scattered. These difficulties have been present since she was a young student in elementary school. She says she had difficulty focusing both at school and at home. The patient is diagnosed with a psychiatric condition and is prescribed the medication that is recommended as the first-line treatment. Which of the following statements is true regarding this new medication?? {'A': '“Appetite suppression is a common side effect of this medication.”', 'B': '“Bupropion is less effective in adults with this disorder than this medication.”', 'C': '“Chronic use of this medication can lead to tardive dyskinesia.”', 'D': '“Hypotension is a common side effect of this medication.”', 'E': '“Sedation is a common side effect of this medication.”'},
|
A: “Appetite suppression is a common side effect of this medication.”
|
Answer the following medical question with one of the provided options:
|
Q:A 29-year-old woman presents to the fertility clinic due to an inability to conceive. She and her husband have been attempting to have children for over a year. She underwent menarche at 16 years of age and typically has menses every 29 days regularly. Her menstrual periods would last 6 days and are mildly painful. However, she reports that her last menstrual period was 3 months ago. Her medical history is non-contributory and she does not take any medications. Her temperature is 99°F (37.2°C), blood pressure is 125/76 mmHg, pulse is 78/min, and respirations are 15/min. Her body mass index is 26.3 kg/m^2. Physical examination is unremarkable. Urine hCG is negative, serum prolactin level is 75 ng/mL (normal < 20 ng/mL) and thyroid-stimulating hormone is 0.8 microU/mL. Which of the following is the best treatment option for this patient’s infertility?? {'A': 'Cabergoline', 'B': 'Clomiphene', 'C': 'Levothyroxine', 'D': 'Letrozole', 'E': 'Metformin'},
|
A: Cabergoline
|
Answer the following medical question with one of the provided options:
|
Q:A 47-year-old man with alcoholic cirrhosis comes to the physician for a follow-up examination. Examination of the skin shows erythema over the thenar and hypothenar eminences of both hands. He also has numerous blanching lesions over the trunk and upper extremities that have a central red vessel with thin extensions radiating outwards. Which of the following is the most likely underlying cause of these findings?? {'A': 'Increased circulating ammonia', 'B': 'Decreased circulating albumin', 'C': 'Decreased circulating thrombopoietin', 'D': 'Decreased circulating testosterone', 'E': 'Increased circulating estrogen'},
|
E: Increased circulating estrogen
|
Answer the following medical question with one of the provided options:
|
Q:An otherwise healthy 15-year-old boy comes to the physician for a routine health maintenance examination. He feels well and is doing well in school. He has no history of serious illness. Vital signs are within normal limits. The lungs are clear to auscultation. Cardiac auscultation shows no murmur, but a wide-split S2 that does not change with respiration. If left untreated, this patient is at increased risk for which of the following complications?? {'A': 'Sudden cardiac death', 'B': 'Cerebral aneurysm', 'C': 'Left ventricular hypertrophy', 'D': 'Paradoxical embolism', 'E': 'Infective endocarditis'},
|
D: Paradoxical embolism
|
Answer the following medical question with one of the provided options:
|
Q:A 33-year-old woman comes to the physician because of a 4-day history of fever and neck pain that radiates to the jaw and ears. She has also noticed swelling in the front part of her throat since the onset of the pain. She reports feeling anxious and sweating profusely over the past 2 days. She has no history of major illness and takes no medication. Her temperature is 38.1°C (100.6°F), pulse is 95/min, and blood pressure is 140/70 mm Hg. Examination shows moist palms and a bilateral fine resting tremor of the outstretched hands. Examination of the neck shows a thyroid gland that is tender, firm, and enlarged. Serum studies show: Hemoglobin 12.7 g/dL ESR 65 mm/h Serum Creatinine 0.7 mg/dL Thyroid-stimulating hormone 0.063 μU/mL Triiodothyronine (T3) 218 ng/dL Thyroxine (T4) 88 μg/dL 123I scan shows an enlarged thyroid gland with multiple areas of decreased uptake. Which of the following is the most likely diagnosis?"? {'A': 'Subacute thyroiditis', 'B': 'Thyroid lymphoma', 'C': 'Struma ovarii', 'D': 'Factitious hyperthyroidism', 'E': 'Toxic adenoma'},
|
A: Subacute thyroiditis
|
Answer the following medical question with one of the provided options:
|
Q:A 20-year-old female arrives at the urgent care clinic at her university’s health plan asking for an HIV test. She is an undergraduate at the university and just started having sexual intercourse with her new boyfriend. They use protection only occasionally so she wants to get tested to make sure everything is okay. She has never been tested for STDs before. She reports no symptoms and has not seen a physician regularly for any medical conditions in the past. Her family history is uncertain because she was adopted. Her HIV immunoassay and HIV-1/HIV-2 differentiation immunoassay both come back positive. She asks on the phone, “Doctor, tell it to me straight. Do I have AIDS?” Which of the following is the most accurate response?? {'A': 'We have to get a confirmatory PCR test to see if you have AIDS.', 'B': 'You do not have AIDS because you just started having sex recently.', 'C': 'You have AIDS but this disease is now a manageable condition.', 'D': "We need your partner's information to be sure of your diagnosis.", 'E': 'We need additional bloodwork to see if you have AIDS.'},
|
E: We need additional bloodwork to see if you have AIDS.
|
Answer the following medical question with one of the provided options:
|
Q:A 32-year-old woman visits the office with a complaint of recurrent abdominal pain for the past 2 months. She says the pain has been increasing every day and is located in the right upper quadrant. She has been using oral contraceptive pills for the past 2 years. She is a nonsmoker and does not drink alcohol. Her vital signs show a heart rate of 85/min, respiratory rate of 16/min, temperature of 37.6 °C (99.68 °F), and blood pressure of 120/80 mm Hg. Physical examination reveals right upper quadrant tenderness and hepatomegaly 3 cm below the right costal border. Her serology tests for viral hepatitis are as follows: HBsAg Negative Anti-HBs Negative IgM anti-HBc Negative Anti-HCV Negative A hepatic ultrasound shows hepatomegaly with diffusely increased echogenicity and a well-defined, predominantly hypoechoic mass in segment VI of the right lobe of the liver. What is the most likely diagnosis?? {'A': 'Cholangiocarcinoma', 'B': 'Focal nodular hyperplasia', 'C': 'Hepatocellular carcinoma', 'D': 'Metastatic disease', 'E': 'Hepatic adenoma'},
|
E: Hepatic adenoma
|
Answer the following medical question with one of the provided options:
|
Q:A previously healthy 67-year-old man comes to the physician because of a history of recurrent right lower abdominal pain for the past 2 years. A CT scan shows a 1.2-cm (0.47-in) mass located in the terminal ileum. He undergoes surgical removal of the mass. A photomicrograph of the resected specimen is shown. Cells from this tissue are most likely to stain positive for which of the following?? {'A': 'Desmin', 'B': 'Chromogranin A', 'C': 'Vimentin', 'D': 'Cytokeratin', 'E': 'Glial fibrillary acid protein'},
|
B: Chromogranin A
|
Answer the following medical question with one of the provided options:
|
Q:A 66-year-old woman presents to the emergency department with abdominal pain. Her symptoms began when she was eating dinner. She has a past medical history of obesity, constipation, intravenous drug use, and diabetes. The patient is instructed to be nil per os and is transferred to the surgical floor. Three days later she had a cholecystectomy and is recovering on the surgical floor. Her laboratory values are ordered as seen below. Hemoglobin: 11 g/dL Hematocrit: 33% Leukocyte count: 8,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.5 mg/dL Alkaline phosphatase: 533 U/L GGT: 50 U/L AST: 22 U/L ALT: 20 U/L The patient is currently asymptomatic and states that she feels well. Which of the following is associated with this patient's underlying condition?? {'A': 'Blastic and lytic skeletal lesions', 'B': 'Monoclonal plasma cell replication', 'C': 'Reemergence of a hepatitis infection', 'D': 'Repeat gastrointestinal tract obstruction', 'E': 'Qualitative bone defect'},
|
A: Blastic and lytic skeletal lesions
|
Answer the following medical question with one of the provided options:
|
Q:A 55-year-old obese woman is referred to the cardiology clinic for progressive dyspnea. She has had no recent travel or sick contacts. Besides a multivitamin, she has only tried online weight-loss medications for the past five years, including fenfluramine-phentermine. An echocardiogram reveals a dilated right ventricle with systolic pressure of 60 mmHg as well as both tricuspid and pulmonary regurgitation. A right heart catheterization shows a mean pulmonary artery pressure of 40 mmHg. What disease process is most analogous to this patient's presentation?? {'A': 'Subacute endocarditis', 'B': 'Carcinoid syndrome', 'C': 'Chronic thromboembolic disease', 'D': 'Left heart failure', 'E': 'Chronic obstructive pulmonary disease'},
|
B: Carcinoid syndrome
|
Answer the following medical question with one of the provided options:
|
Q:An 18-year-old man seeks an evaluation from a physician for painful right axillary swelling since 2 days ago. He has malaise. He has no history of serious illnesses and takes no medications. He has a pet kitten which was recently treated for fleas. The temperature is 38.5℃ (101.3℉), the pulse is 88/min, the respiration rate is 14/min, and the blood pressure is 120/80 mm Hg. There are 2 painless papules on the patient’s right forearm that appeared on the healing scratch marks left by his pet kitten a few days ago. Several lymph nodes in the right axilla are enlarged and tender. The overlying skin is erythematous. No other lymphadenopathy is detected in other areas. The rest of the examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy at this time?? {'A': 'Azithromycin', 'B': 'Doxycycline', 'C': 'Pyrimethamine', 'D': 'Streptomycin', 'E': 'No pharmacotherapy'},
|
E: No pharmacotherapy
|
Answer the following medical question with one of the provided options:
|
Q:A prospective cohort study was conducted to assess the relationship between LDL-C and the incidence of heart disease. The patients were selected at random. Results showed a 10-year relative risk (RR) of 2.30 for people with elevated LDL-C levels compared to individuals with normal LDL levels. The p value was 0.04. This study is most likely to have which of the following 95% confidence intervals?? {'A': '1.01-3.70', 'B': '1.00-3.60', 'C': '0.09-3.50', 'D': '0.08-3.40', 'E': '0.07-3.30'},
|
A: 1.01-3.70
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old man is brought to the emergency department by police officers because he was seen acting strangely in public. The patient was found talking nonsensically to the characters on cereal boxes in a grocery store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and alcohol withdrawal seizures. Vital signs are within normal limits. On physical examination, the patient is disheveled and oriented x1. Neurologic examination shows horizontal nystagmus and severe ataxia is also noted, that after interviewing the patient, he forgets the face of persons and the questions asked shortly after he walks out the door. He, however, remembers events from his distant past quite well. Which of the following is the most likely diagnosis in this patient?? {'A': 'Delirium', 'B': 'Delirium tremens', 'C': 'Korsakoff amnesia', 'D': 'Schizophrenia', 'E': 'Dementia'},
|
C: Korsakoff amnesia
|
Answer the following medical question with one of the provided options:
|
Q:A 76-year-old man presents for a follow-up appointment at his primary care provider’s office. The patient has severe osteoarthritis, which substantially limits his daily physical activity. Several imaging studies have confirmed severe articular degeneration and evidence of bone grinding on bone in his hip joints. The patient suffers from chronic pain and depression that have been resistant to medication. At the physician’s office, his blood pressure is 119/67 mm Hg, the respirations are 18/min, the pulse is 87/min, and the temperature is 36.7°C (98.0°F). On physical examination, the patient has a flat affect and appears anxious. He has significant pain and limited passive and active range of motion of his hip joints bilaterally. This patient would most likely benefit from which of the following procedures if there are no contraindications?? {'A': 'Hip osteotomy', 'B': 'Hip resurfacing', 'C': 'Total hip arthroplasty', 'D': 'Arthroscopic debridement', 'E': 'Autologous chondrocyte implantation'},
|
C: Total hip arthroplasty
|
Answer the following medical question with one of the provided options:
|
Q:A 7-year-old boy and the rest of his family visit a physician for a physical after migrating to the United States. His mother reports that her son is always fatigued and has no energy to play like the other kids in their remote village in Nigeria. He was born at 39 weeks via spontaneous vaginal delivery and is meeting all developmental milestones. He is behind on most of his vaccines, and they develop a plan to get him caught up. On examination, the boy presents with jaundice, mild hepatomegaly, and tachycardia. A CBC with manual differential reveals atypical appearing red blood cells. The physician takes time to review the lab work results with the mother, and he discusses her son’s diagnosis. It is expected that one molecule at the biochemical level should be high. Which of the following best describes this molecule and its significance in this patient?? {'A': 'Pathological; an intermediate of glycolysis', 'B': 'Physiological; an intermediate of gluconeogenesis', 'C': 'Pathological; an intermediate of the Krebs cycle', 'D': 'Physiological; an intermediate of the Krebs cycle', 'E': 'Physiological; found in the mitochondrial intermembrane space'},
|
A: Pathological; an intermediate of glycolysis
|
Answer the following medical question with one of the provided options:
|
Q:A 14-year-old male of eastern European descent presents to the free clinic at a university hospital for a respiratory infection, which his mother explains occurs quite frequently. The male is noted to be of short stature, have a gargoyle-like facies, clouded corneas, poor dentition, and is severely mentally retarded. A urinalysis revealed large amounts of heparan and dermatan sulfate. Which of the following is the most likely diagnosis?? {'A': "Hurler's syndrome", 'B': "Hunter's syndrome", 'C': 'Tay Sachs disease', 'D': "Gaucher's disease", 'E': "Fabry's disease"},
|
A: Hurler's syndrome
|
Answer the following medical question with one of the provided options:
|
Q:A 4-year-old girl is brought to the physician by her mother for a follow-up examination. She has a history of recurrent asthma attacks. The mother reports that her daughter has also had mild abdominal pain for the past 2 weeks. The patient's current medications include daily inhaled fluticasone and inhaled albuterol as needed. She appears well. Her temperature is 37°C (98.6°F), pulse is 100/min, and blood pressure is 130/85 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Abdominal examination shows a left-sided, nontender, smooth abdominal mass that does not cross the midline. The remainder of the examination shows no abnormalities. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Which of the following is the most likely diagnosis?? {'A': 'Polycystic kidney disease', 'B': 'Lymphoma', 'C': "Wilms' tumor", 'D': 'Neuroblastoma', 'E': 'Renal cell carcinoma'},
|
C: Wilms' tumor
|
Answer the following medical question with one of the provided options:
|
Q:A 58-year-old man with a history of hepatitis C infection presents to his physician because of unintentional weight loss and weakness. He has lost 6.8 kg (15 lb) within the last 6 months. Vital signs are within normal limits. Physical examination shows jaundice, splenomegaly, and caput medusae. A complete metabolic panel is ordered. Which of the following tests is the most likely to result in a diagnosis?? {'A': 'Alanine aminotransferase', 'B': 'Alkaline phosphatase', 'C': 'Aspartate aminotransferase', 'D': 'Blood urea nitrogen', 'E': 'Troponin'},
|
A: Alanine aminotransferase
|
Answer the following medical question with one of the provided options:
|
Q:An investigator studying fungal growth isolates organisms from an infant with diaper rash. The isolate is cultured and exposed to increasing concentrations of nystatin. Selected colonies continue to grow and replicate even at high concentrations of the drug. Which of the following is the most likely explanation for this finding?? {'A': 'Reduced ergosterol content in cell membrane', 'B': 'Inactivation of cytosine permease', 'C': 'Mutation of the β-glucan gene', 'D': 'Altered binding site of squalene epoxidase', 'E': 'Expression of dysfunctional cytochrome P-450 enzymes'},
|
A: Reduced ergosterol content in cell membrane
|
Answer the following medical question with one of the provided options:
|
Q:A rheumatologist is evaluating the long-term risk of venous thromboembolism in patients with newly diagnosed rheumatoid arthritis by comparing two retrospective cohort studies. In study A, the hazard ratio for venous thromboembolism was found to be 1.7 with a 95% confidence interval of 0.89–2.9. Study B identified a hazard ratio for venous thromboembolism of 1.6 with a 95% confidence interval of 1.1–2.5. Which of the following statements about the reported association in these studies is most accurate?? {'A': 'The results of study B are less likely to be accurate than the results of study A.', 'B': 'The HR of study B is less likely to be statistically significant than the HR of study A.', 'C': 'Study A likely had a larger sample size than study B.', 'D': 'The p-value of study A is likely larger than the p-value of study B.', 'E': 'The power of study B is likely smaller than the power of study A.'},
|
D: The p-value of study A is likely larger than the p-value of study B.
|
Answer the following medical question with one of the provided options:
|
Q:A 17-year-old girl is brought into the clinic by her mother who is concerned that she may be depressed. The mother states that her daughter feels unattractive and does not fit into any of the social groups at school. When talking to the patient, it is discovered that she mostly avoids the kids in school because of fear of rejection. She usually keeps to herself and says she hasn’t involved herself in any group activities since elementary school. The patient’s mother is worried that this kind of behavior might continue or worsen if it progresses into her college years. Which of the following is the most likely diagnosis in this patient?? {'A': 'Avoidant personality disorder', 'B': 'Schizoid personality disorder', 'C': 'Social phobia', 'D': 'Dependent personality disorder', 'E': 'Body dysmorphic disorder'},
|
A: Avoidant personality disorder
|
Answer the following medical question with one of the provided options:
|
Q:A 16-year-old female presents to her pediatrician complaining of 2 weeks of fever and 1 week of swollen lumps in her left armpit. Upon examination of the left upper extremity, her physician notes the presence of a single papule which the patient claimed appeared one week ago. The patient started her first job at a pet store 2.5 weeks ago. Which of the following is the vector of transmission of the causative agent?? {'A': 'Animal urine', 'B': 'Cats', 'C': 'Parrots', 'D': 'Armadillos', 'E': 'Rabbits'},
|
B: Cats
|
Answer the following medical question with one of the provided options:
|
Q:A 63-year-old woman presents to her primary care provider with her spouse for routine follow-up. She has a history of schizophrenia and is currently living at a nursing facility. Her symptoms first started 2 years ago, when she developed auditory hallucinations and her family noticed that her thoughts and speech became more tangential and disorganized. After being referred to a psychiatrist, the patient was started on medication. Currently she reports occasional auditory hallucinations, but her spouse states that her symptoms have improved dramatically with medication. On exam, her temperature is 98.4°F (36.9°C), blood pressure is 110/74 mmHg, pulse is 64/min, and respirations are 12/min. The patient has normal affect with well-formulated, non-pressured speech. She denies any audiovisual hallucinations. Notably, however, the patient has repetitive lip-smacking behavior and occasionally sweeps her tongue across her lips. The spouse is curious about how this developed. Which of the following is the most likely medication this patient was started on?? {'A': 'Clozapine', 'B': 'Haloperidol', 'C': 'Olanzapine', 'D': 'Quetiapine', 'E': 'Risperidone'},
|
B: Haloperidol
|
Answer the following medical question with one of the provided options:
|
Q:A 65-year-old G4P4 woman presents to her primary care physician complaining of a breast lump. She reports that she felt the lump while conducting a breast self-examination. Her past medical history is notable for endometrial cancer status post radical hysterectomy. She takes aspirin and fish oil. The patient drinks 3-4 alcoholic beverages per day and has a distant smoking history. Her temperature is 98.6°F (37°C), blood pressure is 130/75 mmHg, pulse is 90/min, and respirations are 18/min. A firm palpable mass in the upper outer quadrant of the right breast is noted on physical exam. Further workup reveals invasive ductal adenocarcinoma. She eventually undergoes radical resection and is started on a medication that is known to inhibit thymidylate synthetase. This patient is at increased risk for which of the following medication adverse effects?? {'A': 'Peripheral neuropathy', 'B': 'Pulmonary fibrosis', 'C': 'Dilated cardiomyopathy', 'D': 'Ototoxicity', 'E': 'Photosensitivity'},
|
E: Photosensitivity
|
Answer the following medical question with one of the provided options:
|
Q:A 59-year-old man is evaluated for progressive joint pain. There is swelling and tenderness over the first, second, and third metacarpophalangeal joints of both hands. His hand radiograph shows beak-like osteophytes on his 2nd and 3rd metacarpophalangeal joints, subchondral cysts, and osteopenia. He has had diabetes mellitus for 2 years which is not well controlled with medications. Lab studies show a transferrin saturation of 88% and serum ferritin of 1,200 ng/mL. This patient is at risk of which of the following complications?? {'A': 'Hypogonadism', 'B': 'Hepatic adenoma', 'C': 'Hypertrophic cardiomyopathy', 'D': 'Hepatic steatosis', 'E': 'Cryoglobulinemia'},
|
A: Hypogonadism
|
Answer the following medical question with one of the provided options:
|
Q:A 60-year-old woman is brought to the emergency department because of altered mental status for 2 hours. She and her husband were at the grocery store when she suddenly could not remember why she was there or how she got there. She has not had any head trauma. She has a history of depression and migraines. She does not smoke and drinks a glass of wine each night with dinner. She takes fluoxetine daily. She appears distressed and anxious. Her vital signs are within normal limits. She is fully alert and oriented to self and place but not to time. Every few minutes she asks how she got to the emergency department. She is able to follow commands and sustain attention. She recalls 3/3 objects immediately and recalls 0/3 objects at 5 minutes. The remainder of the neurological exam shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Transient global amnesia', 'B': 'Depersonalization/derealization disorder', 'C': 'Seizure', 'D': 'Dissociative amnesia', 'E': 'Migraine'},
|
A: Transient global amnesia
|
Answer the following medical question with one of the provided options:
|
Q:A team of biology graduate students are performing research on epigenetics and chromosome inactivation. The goal is to silence all the genes on a chromosome at once. The team chooses to develop a model based on a known human gene that can accomplish this task in vivo. Which of the genes listed below would be a suitable model for their research?? {'A': 'SRY', 'B': 'XIST', 'C': 'Hox', 'D': 'Hedgehog', 'E': 'NF1'},
|
B: XIST
|
Answer the following medical question with one of the provided options:
|
Q:A 36-year-old man presents to a physician with the complaint of a dry cough for the last 2 months. He denies any nasal discharge, sneezing, nose congestion, blood in sputum, breathlessness, fever, or weight loss. He started smoking 2 years back. His temperature is 37.3°C (99.2°F), the heart rate is 88/min, the blood pressure is 118/78 mm Hg, and the respiratory rate is 18/min. Auscultation of the lungs reveals localized rhonchi over the left infrascapular region. His chest radiogram reveals a single, round-shaped nodule with scalloped margins in the lower zone of the left lung. The nodule is surrounded by normally aerated lung tissue, and its size is approx. 9 mm (0.35 in) in diameter. The physician explains to him that he requires further diagnostic evaluation, as the nodule could be malignant. On the radiogram, which of the following features of the nodule is associated with the increased possibility of a malignant lesion?? {'A': 'Lack of calcification', 'B': 'Dense central nidus of calcification', 'C': 'Multiple punctate foci of calcification throughout the nodule', 'D': 'Bull’s eye calcification', 'E': 'Popcorn ball calcification'},
|
A: Lack of calcification
|
Answer the following medical question with one of the provided options:
|
Q:A 23-year-old man comes to the physician because of progressive pain, redness, and swelling of his left forearm. The symptoms began after he scratched his arm on a metal table 4 days ago. Examination of the left forearm shows a 2-cm, tender, erythematous, fluctuant lesion at the site of trauma. Incision and drainage of the lesion is performed and a small amount of thick, white liquid is expressed. Which of the following cytokines is involved in the recruitment of the primary cell type found in this liquid?? {'A': 'IL-11', 'B': 'IL-8', 'C': 'IL-2', 'D': 'IL-5', 'E': 'IL-14'},
|
B: IL-8
|
Answer the following medical question with one of the provided options:
|
Q:Your test subject is a stout 52-year-old gentleman participating in a study on digestion. After eating a platter of meat riblets and beef strips a test subjects digestive tract undergoes vast hormonal changes. Which of the following changes likely occurred in this patient as a result of the meal?? {'A': 'Increased gastrin release leading to a decrease in proton secretion', 'B': 'Decreased cholecystokinin release from the I cells of the duodenum', 'C': 'Increased release of secretin from S cells of the duodenum', 'D': 'Decreased Ach release from the vagus nerve', 'E': 'Increased release of ghrelin from P/D1 cells of the stomach'},
|
C: Increased release of secretin from S cells of the duodenum
|
Answer the following medical question with one of the provided options:
|
Q:A 27-year-old G1P0 woman at 25 weeks estimated gestational age presents with a blood pressure of 188/99 mm Hg during a routine prenatal visit. She has no symptoms, except for a mild headache. The patient's heart rate is 78/min. An injectable antihypertensive along with a beta-blocker is administered, and her blood pressure returns to normal within a couple of hours. She is sent home with advice to continue the beta-blocker. The patient returns after a couple of weeks with joint pain in both of her knees and fatigue. A blood test for anti-histone antibodies is positive. Which of the following is the mechanism of action of the intravenous antihypertensive medication most likely used in this patient?? {'A': 'Calcium channel antagonism', 'B': 'Potassium channel activation', 'C': 'Release endogenous nitrous oxide', 'D': 'Inhibition of phosphodiesterase enzyme', 'E': 'Interference with action of inositol trisphosphate (IP3) on intracellular calcium release'},
|
E: Interference with action of inositol trisphosphate (IP3) on intracellular calcium release
|
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.