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Answer the following medical question with one of the provided options: | Q:A 53-year-old man is brought to the emergency department following an episode of loss of consciousness 1 hour ago. He had just finished micturating, when he fell down. His wife heard the noise and found him unconscious on the floor. He regained consciousness after 30 seconds and was able to talk normally with his wife immediately. There was no urinary incontinence. On arrival, he is alert and oriented. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Serum concentrations of glucose, creatinine, and electrolytes are within the reference range. An electrocardiogram shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Cardiovascular syncope', 'B': 'Situational syncope', 'C': 'Emotional syncope', 'D': 'Neurocardiogenic syncope', 'E': 'Arrhythmogenic syncope'}, | B: Situational syncope |
Answer the following medical question with one of the provided options: | Q:A 3000-g (6.6-lb) female newborn is delivered at term to a 23-year-old primigravid woman. The mother has had no prenatal care. Immunization records are not available. Cardiac examination shows a continuous heart murmur. There are several bluish macules on the skin that do not blanch with pressure. Slit lamp examination shows cloudy lenses in both eyes. The newborn does not pass his auditory screening tests. Which of the following is the most likely diagnosis?? {'A': 'Congenital parvovirus infection', 'B': 'Congenital toxoplasmosis', 'C': 'Congenital rubella infection', 'D': 'Congenital cytomegalovirus infection', 'E': 'Congenital syphilis'}, | C: Congenital rubella infection |
Answer the following medical question with one of the provided options: | Q:A group of investigators conducted a randomized controlled trial to compare the effectiveness of rivaroxaban to warfarin for ischemic stroke prevention in patients with atrial fibrillation. A total of 14,000 participants were enrolled and one half was assigned to each of the cohorts. The patients were followed prospectively for 3 years. At the conclusion of the trial, the incidence of ischemic stroke in participants taking rivaroxaban was 1.7% compared to 2.2% in participants taking warfarin. The hazard ratio is calculated as 0.79 and the 95% confidence interval is reported as 0.64 to 0.97. If the study was conducted with a total of 7,000 participants, which of the following changes would most be expected?? {'A': 'Increased risk of selection bias', 'B': 'Decreased hazard ratio', 'C': 'Increased confidence interval range', 'D': 'Decreased type I error rate', 'E': 'Increased risk of confounding bias'}, | C: Increased confidence interval range |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman comes to the physician for the evaluation of a left breast mass that she noticed 4 weeks ago. It has rapidly increased in size during this period. Vital signs are within normal limits. Examination shows large dense breasts; a 6-cm, nontender, multinodular mass is palpated in the upper outer quadrant of the left breast. There are no changes in the skin or nipple. There is no palpable cervical or axillary adenopathy. Mammography shows a smooth polylobulated mass. An image of a biopsy specimen is shown. Which of the following is the most likely diagnosis?? {'A': 'Comedocarcinoma', 'B': 'Invasive ductal carcinoma', 'C': 'Fibroadenoma', 'D': 'Phyllodes tumor', 'E': 'Invasive lobular carcinoma'}, | D: Phyllodes tumor |
Answer the following medical question with one of the provided options: | Q:An investigator is studying obesity in mice. Over the course of 2 weeks, mice in the experimental group receive a daily injection with a synthetic analog of an endogenous hormone. Compared to the control group, the hormone-injected mice eat more and gain significantly more weight. Which of the following is the most likely explanation for the observed weight gain in the experimental group?? {'A': 'Cholecystokinin stimulation of the nucleus tractus solitarius', 'B': 'Somatostatin inhibition of the anterior pituitary', 'C': 'Leptin stimulation of the ventromedial hypothalamus', 'D': 'Ghrelin stimulation of the lateral hypothalamus', 'E': 'Glucagon stimulation of hepatocytes'}, | D: Ghrelin stimulation of the lateral hypothalamus |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man presents to the emergency department because of pain and swelling in his left leg over the past few hours. He traveled from Sydney to Los Angeles 2 days ago. He has had type 2 diabetes mellitus for 10 years and takes metformin for it. He has smoked a pack of cigarettes daily for 25 years. His temperature is 36.9°C (98.4°F), the blood pressure is 140/90 mm Hg, and the pulse is 90/min. On examination, the left calf is 5 cm greater in circumference than the right. The left leg appears more erythematous than the right with dilated superficial veins. Venous duplex ultrasound shows non-compressibility. Which of the following best represents the mechanism of this patient’s illness?? {'A': 'Impaired arterial blood flow', 'B': 'Impaired venous blood flow', 'C': 'Impaired lymphatic blood flow', 'D': 'Subcutaneous soft-tissue infection that may extend to the deep fascia', 'E': 'Infection of the dermis and subcutaneous tissues'}, | B: Impaired venous blood flow |
Answer the following medical question with one of the provided options: | Q:A man returns home late at night to find his 15-year-old son and 40-year-old wife unconscious in the family room. He immediately summons emergency services. In the field, pulse oximetry shows oxygen saturation at 100% for both patients. 100% yet they both appear cyanotic. Both patients are provided with 2L of oxygen by way of nasal cannula on the way to the hospital. An arterial blood gas is performed on the teenager and reveals pH of 7.35, PaCO2 of 31.8 mm Hg, PaO2 of 150 mm Hg, HCO3- of 20 mEq/L, SaO2 of 80%, and a COHb of 18%. What is the most likely cause of his condition?? {'A': 'Anemic hypoxia', 'B': 'Diffusion-limited hypoxia', 'C': 'Methemoglobinemia', 'D': 'Carbon monoxide poisoning', 'E': 'Ischemic hypoxia'}, | D: Carbon monoxide poisoning |
Answer the following medical question with one of the provided options: | Q:A 28-year-old research assistant is brought to the emergency department for severe chemical burns 30 minutes after accidentally spilling hydrochloric acid on himself. The burns cover both hands and forearms. His temperature is 37°C (98.6°F), pulse is 112/min, respirations are 20/min, and blood pressure is 108/82 mm Hg. Initial stabilization and resuscitation is begun, including respiratory support, fluid resuscitation, and cardiovascular stabilization. The burned skin is irrigated with saline water to remove the chemical agent. Which of the following is the most appropriate method to verify adequate fluid infusion in this patient?? {'A': 'Heart rate', 'B': 'The Parkland formula', 'C': 'Blood pressure', 'D': 'Pulmonary capillary wedge pressure', 'E': 'Urinary output\n"'}, | E: Urinary output " |
Answer the following medical question with one of the provided options: | Q:A 61-year-old female with congestive heart failure and type 2 diabetes is brought to the emergency room by her husband because of an altered mental status. He states he normally helps her be compliant with her medications, but he had been away for several days. On physical exam, her temperature is 37.2 C, BP 85/55, and HR 130. Serum glucose is 500 mg/dL. Which of the following is the first step in the management of this patient?? {'A': 'IV ½ NS', 'B': 'IV NS', 'C': 'IV D5W', 'D': 'Subcutaneous insulin injection', 'E': 'IV insulin'}, | B: IV NS |
Answer the following medical question with one of the provided options: | Q:A 27-year-old G2P2002 is recovering in the hospital on postpartum day 3 after a low transverse C-section. During morning rounds, she reports a “pus-like” discharge and shaking chills overnight. She also endorses increased uterine cramping compared to the day before, but her postpartum course has otherwise been uneventful with a well-healing incision and normal vaginal bleeding. The patient’s prenatal care was complicated by HIV with a recent viral load of 400 copies/mL, type I diabetes well controlled on insulin, and a history of herpes simplex virus encephalitis in her first child. She did not have any genital lesions during the most recent pregnancy. Four days ago, she presented to the obstetric triage unit after spontaneous rupture of membranes and onset of labor. She made slow cervical change and reached full dilation after 16 hours, but there was limited fetal descent. Cephalopelvic disproportion was felt to be the reason for arrest of descent, so prophylactic ampillicin was administered and C-section was performed. A vaginal hand was required to dislodge the fetus’s head from the pelvis, and a healthy baby boy was delivered. On postpartum day 3, her temperature is 101.5°F (38.6°C), blood pressure is 119/82 mmHg, pulse is 100/min, and respirations are 14/min. Her incision looks clean and dry, there is mild suprapubic tenderness, and a foul yellow discharge tinged with blood is seen on her pad. Which of the following is the most significant risk factor for this patient’s presentation?? {'A': 'HIV positive status', 'B': 'Prolonged rupture of membranes', 'C': 'C-section after onset of labor', 'D': 'History of herpes simplex virus in previous pregnancy', 'E': 'Maternal diabetes'}, | C: C-section after onset of labor |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man comes to the physician because of fatigue and shortness of breath with moderate exertion for the past 2 months. Over the past 10 days, he has had low-grade fevers and night sweats. He has no history of serious illness except for a bicuspid aortic valve diagnosed 5 years ago. He has smoked one pack of cigarettes daily for 10 years and drinks 3–5 beers on social occasions. He does not use illicit drugs. The patient takes no medications. He appears weak. His temperature is 37.7°C (99.9°F), pulse is 70/min, and blood pressure is 128/64 mm Hg. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the right sternal border and second intercostal space. There are several hemorrhages underneath his fingernails on both hands and multiple tender, red nodules on his fingers. Which of the following is the most likely causal organism?? {'A': 'Staphylococcus epidermidis', 'B': 'Streptococcus sanguinis', 'C': 'Streptococcus pneumoniae', 'D': 'Streptococcus pyogenes', 'E': 'Candida albicans'}, | B: Streptococcus sanguinis |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man presents to the emergency department after a motor vehicle collision. He was the front seat and unrestrained driver in a head on collision. His temperature is 99.2°F (37.3°C), blood pressure is 90/65 mmHg, pulse is 152/min, respirations are 16/min, and oxygen saturation is 100% on room air. Physical exam is notable for a young man who opens his eyes spontaneously and is looking around. He answers questions with inappropriate responses but discernible words. He withdraws from pain but does not have purposeful movement. Which of the following is this patient’s Glasgow coma scale?? {'A': '7', 'B': '9', 'C': '11', 'D': '13', 'E': '15'}, | C: 11 |
Answer the following medical question with one of the provided options: | Q:A 34-year-old Caucasian female presents at the ER with fever and sharp pain in her chest upon coughing and inhalation. Three weeks earlier she presented to her rheumatologist with a butterfly rash, joint pain and fatigue and was given a diagnosis of systemic lupus erythematosus. A friction rub is present upon physical exam. Which of the following do you most suspect in this patient?? {'A': 'Pulmonary hypertension', 'B': 'Interstitial lung disease', 'C': 'Acute myocardial infarction', 'D': 'Pericarditis', 'E': 'Pericardial tamponade'}, | D: Pericarditis |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man with a history of alcoholism undergoes an upper endoscopy, which reveals a superficial mucosal tear in the distal esophagus. Laboratory results show a metabolic alkalosis. What is the most likely mechanism of the acid/base disturbance in this patient?? {'A': 'B12 deficiency', 'B': 'Anemia', 'C': 'Vomiting', 'D': 'Hypokalemia', 'E': 'Hepatic cirrhosis'}, | C: Vomiting |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man comes to the physician because of flank pain, rash, and blood-tinged urine for 1 day. Two months ago, he was started on hydrochlorothiazide for hypertension. He takes acetaminophen for back pain. Examination shows a generalized, diffuse maculopapular rash. Serum studies show a creatinine concentration of 3.0 mg/dL. Renal ultrasonography shows no abnormalities. Which of the following findings is most likely to be observed in this patient?? {'A': 'Urinary crystals on Brightfield microscopy', 'B': 'Dermal IgA deposition on skin biopsy', 'C': 'Crescent-shape extracapillary cell proliferation', 'D': 'Mesangial IgA deposits on renal biopsy', 'E': 'Urinary eosinophils'}, | E: Urinary eosinophils |
Answer the following medical question with one of the provided options: | Q:Nucleic acid amplification testing (NAAT) of first-void urine confirms infection with Chlamydia trachomatis. Treatment with the appropriate pharmacotherapy is started. Which of the following health maintenance recommendations is most appropriate at this time?? {'A': 'Avoid sun exposure', 'B': 'Avoid drinking alcohol', 'C': 'Avoid sexual activity for the next month', 'D': 'Take medication with food', 'E': 'Schedule an ophthalmology consultation\n"'}, | A: Avoid sun exposure |
Answer the following medical question with one of the provided options: | Q:A 14-year-old boy presents as a new patient to your practice. While conducting your physical exam, you observe the findings depicted in Figures A and B. Which of the following additional findings would most likely be found in this patient?? {'A': 'The presence of ash-leaf spots', 'B': 'A family history of seizures and mental retardation', 'C': 'Facial angiofibromas', 'D': 'Iris hamartomas', 'E': 'A white tuft of scalp hair since birth'}, | D: Iris hamartomas |
Answer the following medical question with one of the provided options: | Q:An investigator who studies virology obtains a biopsy from the ulcer base of an active genital herpes lesion for viral culture. The cultured virions, along with herpes simplex virions of a different phenotype, are cointroduced into a human epithelial cell in vitro. The progeny viruses are found to have phenotypes that are distinct from the parent strains. Sequencing of these progeny viruses shows that most genomes have material from both parent strains. These findings are best explained by which of the following terms?? {'A': 'Complementation', 'B': 'Recombination', 'C': 'Phenotypic mixing', 'D': 'Reassortment', 'E': 'Transduction'}, | B: Recombination |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man is rushed to the emergency room with constant, severe right lower abdominal pain that started 7 hours ago in the periumbilical region and later shifted to the right lower quadrant with a gradual increase in intensity. The patient’s blood pressure is 110/80 mm Hg, the heart rate is 76/min, the respiratory rate is 17/min, and the temperature is 37.5℃ (99.5℉). The physical examination shows tenderness, muscle guarding, and rebound over the right lower quadrant of the abdomen. Abdominal sonography shows a dilated appendix with a periappendiceal fluid collection. He is diagnosed with acute appendicitis and undergoes a laparoscopic appendectomy. The histopathologic examination of the removed appendix is shown in the image. Which of the following substances is responsible for attracting the marked cells to the inflamed tissue?? {'A': 'IL-7', 'B': 'IL-8', 'C': 'CCL-11', 'D': 'CXCL-9', 'E': 'IL-10'}, | B: IL-8 |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents to his primary care physician for a pre-operative evaluation. He is scheduled for cataract surgery in 3 weeks. His past medical history is notable for diabetes, hypertension, and severe osteoarthritis of the right knee. His medications include metformin, hydrochlorothiazide, lisinopril, and aspirin. His surgeon ordered blood work 1 month ago, which showed a hemoglobin of 14.2 g/dL, INR of 1.2, and an hemoglobin A1c of 6.9%. His vital signs at the time of the visit show BP: 130/70 mmHg, Pulse: 80, RR: 12, and T: 37.2 C. He has no current complaints and is eager for his surgery. Which of the following is the most appropriate course of action for this patient at this time?? {'A': 'Medically clear the patient for surgery', 'B': "Repeat the patient's CBC and coagulation studies", 'C': 'Perform an EKG', 'D': 'Schedule the patient for a stress test and ask him to delay surgery for at least 6 months', 'E': 'Tell the patient he will have to delay his surgery for at least 1 year'}, | A: Medically clear the patient for surgery |
Answer the following medical question with one of the provided options: | Q:A 19-year-old African female refugee has been granted asylum in Stockholm, Sweden and has been living there for the past month. She arrived in Sweden with her 2-month-old infant, whom she exclusively breast feeds. Which of the following deficiencies is the infant most likely to develop?? {'A': 'Vitamin A', 'B': 'Vitamin B1', 'C': 'Vitamin D', 'D': 'Vitamin E', 'E': 'Vitamin C'}, | C: Vitamin D |
Answer the following medical question with one of the provided options: | Q:A 10-year-old girl is brought to the emergency department by her mother 30 minutes after having had a seizure. When her mother woke her up that morning, the girl's entire body stiffened and she started shaking vigorously for several minutes. Her mother also reports that over the past few months, her daughter has had multiple episodes of being unresponsive for less than a minute, during which her eyelids were fluttering. The girl did not recall these episodes afterwards. Upon arrival, she appears drowsy. Neurologic examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy to prevent recurrence of this patient's symptoms?? {'A': 'Phenytoin', 'B': 'Lorazepam', 'C': 'Ethosuximide', 'D': 'Topiramate', 'E': 'Valproate'}, | E: Valproate |
Answer the following medical question with one of the provided options: | Q:A 48-year-old female complains of tingling sensation in her fingertips as well as the skin around her mouth which woke her up from sleep. She is in the postoperative floor as she just underwent a complete thyroidectomy for papillary thyroid cancer. Her temperature is 37° C (98.6° F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/88 mm Hg. While recording the blood pressure, spasm of the muscles of the hand and forearm is seen. What is the next best step in the management of this patient?? {'A': 'No treatment is necessary, this is expected following surgery', 'B': 'Propylthiouracil', 'C': 'Magnesium replacement', 'D': 'Albumin infusion', 'E': 'Calcium replacement'}, | E: Calcium replacement |
Answer the following medical question with one of the provided options: | Q:A 23-year old man is brought to the emergency department by his brother after trying to jump out of a moving car. He says that the Federal Bureau of Investigation has been following him for the last 7 months. He recently quit his job at a local consulting firm to work on his mission to rid the world from evil. He does not smoke, drink alcoholic beverages, or use illicit drugs. He takes no medications. His temperature is 36.7°C (98.1°F), pulse is 90/min, respirations are 20/min, and blood pressure is 120/86 mm Hg. On mental status examination, his response to the first question lasted 5 minutes without interruption. He switched topics a number of times and his speech was pressured. He spoke excessively about his plan to “bring absolute justice to the world”. He has a labile affect. There is no evidence of suicidal ideation. A toxicology screen is negative. He is admitted to the hospital for his symptoms and starts therapy. One week later, he develops difficulty walking and a tremor that improves with activity. Which of the following is the most likely cause of this patient's latest symptoms?? {'A': 'Dopamine antagonist', 'B': 'Acetylcholine antagonist', 'C': 'Serotonin–norepinephrine reuptake inhibitor', 'D': 'Histamine antagonist', 'E': 'Selective serotonin reuptake inhibitor'}, | A: Dopamine antagonist |
Answer the following medical question with one of the provided options: | Q:A 10-year-old boy is referred to a pediatric neurologist by his pediatrician for lower extremity weakness. The boy is healthy with no past medical history, but his parents began to notice that he was having difficulty at football practice the previous day. Over the course of the past 24 hours, the boy has become increasingly clumsy and has been “tripping over himself.” On further questioning, the boy had a viral illness the previous week and was out of school for 2 days. Today, the patient’s temperature is 99.3°F (37.4°C), blood pressure is 108/72 mmHg, pulse is 88/min, respirations are 12/min. On motor exam, the patient has 5/5 strength in hip flexion, 5/5 strength in knee extension and flexion, 3/5 strength in foot dorsiflexion, and 5/5 strength in foot plantarflexion. The findings are the same bilaterally. On gait exam, the patient exhibits foot drop in both feet. Which of the following areas would the patient most likely have diminished sensation?? {'A': 'Anteromedial thigh', 'B': 'First dorsal webspace of foot', 'C': 'Lateral foot', 'D': 'Lateral plantar foot', 'E': 'Medial plantar foot'}, | B: First dorsal webspace of foot |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman comes to the physician because of a 1-day history of swelling and pain in the left leg. Two days ago, she returned from a business trip on a long-distance flight. She has alcohol use disorder. Physical examination shows a tender, swollen, and warm left calf. Serum studies show an increased homocysteine concentration and a methylmalonic acid concentration within the reference range. Further evaluation of this patient is most likely to show which of the following serum findings?? {'A': 'Increased pyridoxine concentration', 'B': 'Increased fibrinogen concentration', 'C': 'Decreased cobalamin concentration', 'D': 'Decreased protein C concentration', 'E': 'Decreased folate concentration'}, | E: Decreased folate concentration |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the emergency department because of increasing abdominal pain for 2 days. The pain is diffuse and constant, and she describes it as 7 out of 10 in intensity. She has also had numbness in her lower extremities for 12 hours. She has type 1 diabetes mellitus, migraine with aura, and essential tremor. She appears uncomfortable. She is oriented to place and person only. Her temperature is 37°C (98.6°F), pulse is 123/min, and blood pressure is 140/70 mm Hg. Examination shows a distended abdomen with no tenderness to palpation. Bowel sounds are decreased. Muscle strength and sensation is decreased in the lower extremities. There is a tremor of the right upper extremity. Urinalysis shows elevated levels of aminolevulinic acid and porphobilinogen. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Primidone', 'B': 'Amitriptyline', 'C': 'Flunarizine', 'D': 'Metoclopramide', 'E': 'Sumatriptan'}, | A: Primidone |
Answer the following medical question with one of the provided options: | Q:One week after undergoing sigmoidectomy with end colostomy for complicated diverticulitis, a 67-year-old man has upper abdominal pain. During the surgery, he was transfused two units of packed red blood cells. His postoperative course was uncomplicated. Two days ago, he developed fever. He is currently receiving parenteral nutrition through a central venous catheter. He has type 2 diabetes mellitus, hypertension, and hypercholesterolemia. He is oriented to person, but not to place and time. Prior to admission, his medications included metformin, valsartan, aspirin, and atorvastatin. His temperature is 38.9°C (102.0°F), pulse is 120/min, and blood pressure is 100/60 mmHg. Examination shows jaundice of the conjunctivae. Abdominal examination shows tenderness to palpation in the right upper quadrant. There is no rebound tenderness or guarding; bowel sounds are hypoactive. Laboratory studies show: Leukocytes 13,500 /mm3 Segmented neutrophils 75 % Serum Aspartate aminotransferase 140 IU/L Alanine aminotransferase 85 IU/L Alkaline phosphatase 150 IU/L Bilirubin Total 2.1 mg/dL Direct 1.3 mg/dL Amylase 20 IU/L Which of the following is the most likely diagnosis in this patient?"? {'A': 'Acalculous cholecystitis', 'B': 'Small bowel obstruction', 'C': 'Anastomotic insufficiency', 'D': 'Acute pancreatitis', 'E': 'Hemolytic transfusion reaction'}, | A: Acalculous cholecystitis |
Answer the following medical question with one of the provided options: | Q:An 82-year-old comes to the physician for a routine checkup. He feels well. He has a history of hypertension, peripheral vascular disease, carotid stenosis, and mild dementia. His father had Parkinson's disease and died of a stroke at the age of 74 years. He has smoked one-half pack of cigarettes daily for 30 years but quit at the age of 50 years. He drinks alcohol in moderation. Current medications include aspirin and lisinopril. He appears healthy. His temperature is 36.9°C (98.4°F), pulse is 73/min, respirations are 12/min, and blood pressure is 142/92 mmHg. Examination shows decreased pedal pulses bilaterally. Ankle jerk and patellar reflexes are absent bilaterally. Sensation to light touch, pinprick, and proprioception is intact bilaterally. Muscle strength is 5/5 bilaterally. He describes the town he grew up in with detail but only recalls one of three words after 5 minutes. Which of the following is the most appropriate next step in management for these findings?? {'A': 'No further workup required', 'B': 'Carbidopa-levodopa', 'C': 'CT scan of the head', 'D': 'Prescribe thiamine supplementation', 'E': 'Lumbar puncture'}, | A: No further workup required |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman with a history of intravenous drug use is brought to the emergency department because of a 1-day history of fatigue, yellow eyes, confusion, and blood in her stools. She appears ill. Her temperature is 38.1°C (100.6°F). Physical examination shows pain in the right upper quadrant, diffuse jaundice with scleral icterus, and bright red blood in the rectal vault. Further evaluation demonstrates virions in her blood, some of which have a partially double-stranded DNA genome while others have a single-stranded RNA genome. They are found to share an identical lipoprotein envelope. This patient is most likely infected with which of the following pathogens?? {'A': 'Calicivirus', 'B': 'Filovirus', 'C': 'Hepevirus', 'D': 'Herpesvirus', 'E': 'Deltavirus'}, | E: Deltavirus |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman comes to the physician because of a 2-week history of fatigue and excessive thirst. During this period, she has not been able to sleep through the night because of the frequent urge to urinate. She also urinates more than usual during the day. She drinks 4–5 liters of water and 1–2 beers daily. She has autosomal dominant polycystic kidney disease, hypertension treated with lisinopril, and bipolar disorder. Therapy with valproic acid was begun after a manic episode 3 months ago. Vital signs are within normal limits. Irregular flank masses are palpated bilaterally. The remainder of the examination shows no abnormalities. Laboratory studies show: Serum Na+ 152 mEq/L K+ 4.1 mEq/L Cl− 100 mEq/L HCO3− 25 mEq/L Creatinine 1.8 mg/dL Osmolality 312 mOsmol/kg Glucose 98 mg/dL Urine osmolality 190 mOsmol/kg The urine osmolality does not change after 3 hours despite no fluid intake or after administration of desmopressin. Which of the following is the most appropriate next step in management?"? {'A': 'Further water restriction', 'B': 'Amiloride therapy', 'C': 'Begin infusion of 3% saline', 'D': 'Hydrochlorothiazide therapy', 'E': 'Desmopressin therapy'}, | D: Hydrochlorothiazide therapy |
Answer the following medical question with one of the provided options: | Q:A 54-year-old G2P2 presents to her gynecologist's office with complaints of frequent hot flashes, malaise, insomnia, and mild mood swings for 2 weeks. She has also noticed some pain with intercourse and vaginal dryness during this time. She is otherwise healthy besides hyperlipidemia, controlled on atorvastatin. She has no other past medical history, but underwent hysterectomy for postpartum hemorrhage. She is desiring of a medication to control her symptoms. Which of the following is the most appropriate short-term medical therapy in this patient for symptomatic relief?? {'A': 'Hormonal replacement therapy with estrogen alone', 'B': 'Hormonal replacement therapy with combined estrogen/progesterone', 'C': 'Hormonal replacement therapy with progesterone alone', 'D': 'Paroxetine', 'E': 'Gabapentin'}, | A: Hormonal replacement therapy with estrogen alone |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man is brought to the physician by his wife because she is worried about his unusual behavior. Two weeks ago, he was promoted and is now convinced that he will soon take over the firm. He has been working overtime at the office and spends most of his nights at parties. Whenever he comes home, he asks his wife to have sex with him and rarely sleeps more than 3 hours. He has a history of a similar episode and several periods of depression over the past 2 years. He currently takes no medications. He appears impatient, repeatedly jumps up from his seat, and says, “I have more important things to do.” There is no evidence of suicidal ideation. Urine toxicology screening is negative. Long-term treatment with lithium is started. Which of the following parameters should be regularly assessed in this patient while he is undergoing treatment?? {'A': 'Serum thyroid-stimulating hormone', 'B': 'Serum aminotransferases', 'C': 'Complete blood count with differential', 'D': 'Serum glucose', 'E': 'Urine culture'}, | A: Serum thyroid-stimulating hormone |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man presents to the emergency department for evaluation of intermittent chest pain over the past 6 months. His history reveals that he has had moderate exertional dyspnea and 2 episodes of syncope while working at his factory job. These episodes of syncope were witnessed by others and lasted roughly 30 seconds. The patient states that he did not have any seizure activity. His vital signs include: blood pressure 121/89 mm Hg, heart rate 89/min, temperature 37.0°C (98.6°F), and respiratory rate 16/min. Physical examination reveals a crescendo-decrescendo systolic murmur in the right second intercostal area. An electrocardiogram is performed, which shows left ventricular hypertrophy. Which of the following is the best next step for this patient?? {'A': 'Cardiac chamber catheterization', 'B': 'Chest radiograph', 'C': 'Computed tomography (CT) chest scan without contrast', 'D': 'Transesophageal echocardiography', 'E': 'Transthoracic echocardiography'}, | E: Transthoracic echocardiography |
Answer the following medical question with one of the provided options: | Q:A 42-year-old male presents to the emergency department due to severe headaches and palpitations. He has had previous episodes of sweating and headache, but this episode was particularly disabling. Upon presentation, he appears pale and diaphoretic. His temperature is 99.3°F (37.4°C), blood pressure is 162/118 mmHg, pulse is 87/min, and respirations are 20/min. Based on clinical suspicion, an abdominal CT scan is obtained, which shows a retroperitoneal mass. This patient's increased heart rate is most likely due to a change in activity of which of the following channels?? {'A': 'Hyperpolarization-activated, nucleotide-gated channels', 'B': 'L-type calcium channels', 'C': 'T-type calcium channels', 'D': 'Voltage-gated sodium channels', 'E': 'Voltage-gated potassium channels'}, | A: Hyperpolarization-activated, nucleotide-gated channels |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman presents to the labor and delivery floor in active labor at 40 weeks gestation. She has a prolonged course but ultimately vaginally delivers an 11 pound boy. On post operative day 2, she is noted to have uterine tenderness and decreased bowel sounds. She states she has been urinating more frequently as well. Her temperature is 102°F (38.9°C), blood pressure is 118/78 mmHg, pulse is 111/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a non-distended abdomen and a tender uterus. Pulmonary exam reveals minor bibasilar crackles. Initial laboratory studies and a urinalysis are pending. Which of the following is the most likely diagnosis?? {'A': 'Atelectasis', 'B': 'Chorioamnionitis', 'C': 'Deep vein thrombosis', 'D': 'Endometritis', 'E': 'Urinary tract infection'}, | D: Endometritis |
Answer the following medical question with one of the provided options: | Q:A 52-year-old farmer presents to his physician with a puncture wound on his left shin. He got this wound accidentally when he felt unwell and went out to his garden "to catch some air". He reports he had been treated for tetanus 35 years ago and has received the Tdap vaccine several times since then, but he does not remember when he last received the vaccine. His vital signs are as follows: the blood pressure is 110/80 mm Hg, heart rate is 91/min, respiratory rate is 19/min, and temperature is 37.8°C (100.0°F). On physical examination, he is mildly dyspneic and pale. Lung auscultation reveals diminished vesicular breath sounds in the lower lobes bilaterally with a few inspiratory crackles heard over the left lower lobe. There is a puncture wound 1 cm in diameter that is contaminated with soil in the middle third of the patient’s shin. You order blood tests and an X-ray, and now you are arranging his wound treatment. How should tetanus post-exposure prevention be performed in this case?? {'A': 'The patient should only be administered human tetanus immunoglobulin, because he is acutely ill and febrile, which are contraindications for tetanus toxoid-containing vaccine administration.', 'B': 'The patient does not need tetanus post-exposure prevention, because he has a past medical history of tetanus.', 'C': 'The patient does not need tetanus post-exposure prevention, because he received the Tdap vaccine several times in the past.', 'D': 'The patient should receive both tetanus toxoid-containing vaccine and human tetanus immunoglobulin.', 'E': 'The patient should be administered only the Tdap vaccine, because it is a minor wound with a small area of possible toxin absorption.'}, | D: The patient should receive both tetanus toxoid-containing vaccine and human tetanus immunoglobulin. |
Answer the following medical question with one of the provided options: | Q:A 74-year-old woman is brought to the physician by her husband because of difficulty sleeping for several years. She says that she has been gradually sleeping less each night over the past 2 years. It takes her 20–25 minutes to fall asleep each night and she wakes up earlier in the morning than she used to. On average, she sleeps 5–6 hours each night. She says that she has also been waking up several times per night and needs about 20 minutes before she is able to fall back to sleep. She feels mildly tired in the afternoon but does not take any naps. Her husband reports that she does not snore. The patient drinks two cups of coffee each morning, but she does not smoke or drink alcohol. She takes a 45 minute walk with her husband and their dog every other day. She is 160 cm (5 ft 3 in) tall and weighs 55 kg (121 lb); BMI is 21 kg/m2. Vital signs are within normal limits. On mental status examination, she appears cooperative with a mildly anxious mood and a full range of affect. Which of the following is the most appropriate next step in management?? {'A': 'Sleep restriction', 'B': 'Flurazepam', 'C': 'Reassurance', 'D': 'Bilevel positive airway pressure (BiPAP)', 'E': 'Paradoxical intention'}, | C: Reassurance |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man comes to the emergency department because of pain in his left groin for the past hour. The pain began soon after he returned from a walk. He describes it as 8 out of 10 in intensity and vomited once on the way to the hospital. He has had a swelling of the left groin for the past 2 months. He has chronic obstructive pulmonary disease and hypertension. Current medications include amlodipine, albuterol inhaler, and a salmeterol-fluticasone inhaler. He appears uncomfortable. His temperature is 37.4°C (99.3°F), pulse is 101/min, and blood pressure is 126/84 mm Hg. Examination shows a tender bulge on the left side above the inguinal ligament that extends into the left scrotum; lying down or applying external force does not reduce the swelling. Coughing does not make the swelling bulge further. There is no erythema. The abdomen is distended. Bowel sounds are hyperactive. Scattered rhonchi are heard throughout both lung fields. Which of the following is the most appropriate next step in management?? {'A': 'Surgical drainage', 'B': 'Antibiotic therapy', 'C': 'Open surgical repair', 'D': 'Surgical exploration of the testicle', 'E': 'Laparoscopic surgical repair'}, | C: Open surgical repair |
Answer the following medical question with one of the provided options: | Q:Certain glucose transporters that are expressed predominantly on skeletal muscle cells and adipocytes are unique compared to those transporters found on other cell types within the body. Without directly affecting glucose transport in other cell types, which of the following would be most likely to selectively increase glucose uptake in skeletal muscle cells and adipocytes?? {'A': 'Increased levels of circulating insulin', 'B': 'Decreased levels of circulating insulin', 'C': 'Increased plasma glucose concentration', 'D': 'Decreased plasma glucose concentration', 'E': 'It is physiologically impossible to selectively increase glucose uptake in specific cells'}, | A: Increased levels of circulating insulin |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy presents to your office with facial swelling and dark urine. He has no other complaints other than a sore throat 3 weeks ago that resolved after 6 days. He is otherwise healthy, lives at home with his mother and 2 cats, has no recent history of travel ,and no sick contacts. On physical examination his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 80/min, respirations are 19/min, and pulse oximetry is 99% on room air. Cardiopulmonary and abdominal examinations are unremarkable. There is mild periorbital and pedal edema. Urinalysis shows 12-15 RBC/hpf, 2-5 WBC/hpf, and 30 mg/dL protein. Which additional finding would you expect to see on urinalysis?? {'A': 'WBC casts', 'B': 'Granular casts', 'C': 'Hyaline', 'D': 'RBC casts', 'E': 'Fatty casts'}, | D: RBC casts |
Answer the following medical question with one of the provided options: | Q:A 65-year-old male with a history of CHF presents to the emergency room with shortness of breath, lower leg edema, and fatigue. He is diagnosed with acute decompensated congestive heart failure, was admitted to the CCU, and treated with a medication that targets beta-1 adrenergic receptors preferentially over beta-2 adrenergic receptors. The prescribing physician explained that this medication would only be used temporarily as its efficacy decreases within one week due to receptor downregulation. Which of the following was prescribed?? {'A': 'Epinephrine', 'B': 'Milrinone', 'C': 'Isoproterenol', 'D': 'Norepinephrine', 'E': 'Dobutamine'}, | E: Dobutamine |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to his primary care physician for his first appointment. He recently was released from prison. The patient wants a checkup before he goes out and finds a job. He states that lately he has felt very fatigued and has had a cough. He has lost roughly 15 pounds over the past 3 weeks. He attributes this to intravenous drug use in prison. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 100/min, respirations are 18/min, and oxygen saturation is 98% on room air. The patient is started on appropriate treatment. Which of the following is the most likely indication to discontinue this patient's treatment?? {'A': 'Elevated liver enzymes', 'B': 'Hyperuricemia', 'C': 'Optic neuritis', 'D': 'Peripheral neuropathy', 'E': 'Red body excretions'}, | A: Elevated liver enzymes |
Answer the following medical question with one of the provided options: | Q:A 60-year-old male presents for a routine health check-up. The patient complains of reduced exercise tolerance for the past 2 years. Also, in the past year, he has noticed chest pain after climbing the stairs in his home. He has no significant past medical history or current medications. The patient reports a 45-pack-year smoking history. The vital signs include temperature 37.0°C (98.6°F), blood pressure 160/100 mm Hg, pulse 72/min, respiratory rate 15/min, and oxygen saturation 99% on room air. His body mass index (BMI) is 34 kg/m2. Physical examination is unremarkable. Laboratory studies show: Serum total cholesterol 265 mg/dL HDL 22 mg/dL LDL 130 mg/dL Triglycerides 175 mg/dL HDL: high-density lipoprotein; LDL: low-density lipoprotein Which of the following vascular pathologies is most likely present in this patient?? {'A': 'Medial calcific sclerosis', 'B': 'Lymphedema', 'C': 'Deep venous thrombosis', 'D': 'Hyperplastic arteriosclerosis', 'E': 'Atherosclerosis'}, | E: Atherosclerosis |
Answer the following medical question with one of the provided options: | Q:An 88-year-old woman with no significant medical history is brought to the emergency room by her daughter after a fall, where the woman lightly hit her head against a wall. The patient is lucid and complains of a mild headache. The daughter indicates that her mother did not lose consciousness after the fall. On exam, there are no focal neurological deficits, but you decide to perform a CT scan to be sure there is no intracranial bleeding. The CT scan are within normal limits and head MRI is preformed (shown). Which of the following conditions has the most similar risk factor to this patient's condition?? {'A': "Prinzmetal's angina", 'B': 'Thoracic aortic aneurysm', 'C': 'Abdominal aortic aneurysm', 'D': "Raynaud's phenomenon", 'E': 'Pulmonary embolism'}, | B: Thoracic aortic aneurysm |
Answer the following medical question with one of the provided options: | Q:While explaining the effects of hypokalemia and hyperkalemia on the cardiac rhythm, a cardiologist explains that the electrophysiology of cardiac tissue is unique. He mentions that potassium ions play an important role in the electrophysiology of the heart, and the resting membrane potential of the cardiac myocytes is close to the equilibrium potential of K+ ions. This is because of the high resting potassium conductance of the ventricular myocytes, which is regulated by specific potassium channels. These are open at rest and are closed when there is depolarization. Which of the following potassium channels is the cardiologist talking about?? {'A': 'Inward rectifier IK1 potassium channels', 'B': 'Inward rectifier IKACh potassium channels', 'C': 'Fast delayed rectifier IKr potassium channels', 'D': 'Slow delayed rectifier IKs potassium channels', 'E': 'Transient outward current Ito potassium channels'}, | A: Inward rectifier IK1 potassium channels |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man presents to his dermatologist with white scaly papules and plaques on his extensor arms, elbows, knees, and shins. Scaly and flaky eruptions are also present on his ears, eyebrows, and scalp. He describes the lesions as being itchy and irritating. When the scales are scraped away, pinpoint bleeding is noted. His vital signs are unremarkable, and physical examination is otherwise within normal limits. Which of the following is the best initial test for this patient’s condition?? {'A': 'Skin biopsy', 'B': 'Serum autoantibodies', 'C': 'Plain film X-rays of the hands and feet', 'D': 'No tests are necessary', 'E': 'Wood’s lamp'}, | D: No tests are necessary |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man presents with a mass on the central part of his neck. He reports it has been growing steadily for the past 2 weeks, and he has also been experiencing fatigue and recurrent fevers. No significant past medical history. The patient denies any smoking history, or alcohol or recreational drug use. He denies any recent travel in the previous 6 months. On physical examination, there are multiple enlarged submandibular and cervical lymph nodes that are firm, mobile, and non-tender. A biopsy of one of the lymph nodes is performed and shows predominantly lymphocytes and histiocytes present in a pattern ‘resembling popcorn’. A flow cytometry analysis demonstrates cells that are CD19 and CD20 positive and CD15 and CD30 negative. Which of the following is the most likely diagnosis in this patient?? {'A': 'Lymphocyte rich classical Hodgkin lymphoma', 'B': 'Nodular lymphocyte-predominant Hodgkin lymphoma', 'C': 'Nodular sclerosis classical Hodgkin lymphoma', 'D': 'Mixed cellularity classical Hodgkin lymphoma', 'E': 'Lymphocyte depleted Hodgkin lymphoma'}, | B: Nodular lymphocyte-predominant Hodgkin lymphoma |
Answer the following medical question with one of the provided options: | Q:A 3550-g (7-lb 13-oz) male newborn is delivered at 37 weeks' gestation to a 28-year-old woman. Apgar scores are 9 and 10 at 1 and 5 minutes, respectively. His vital signs are within normal limits. Physical examination shows no abnormalities. Routine neonatal screening tests show mildly elevated TSH concentrations. Ultrasonography of the neck shows a complete absence of both lobes of the thyroid gland. This patient's normal physical examination findings, despite the total absence of a thyroid gland, is best explained by which of the following mechanisms?? {'A': 'Transplacental transmission of thyroxine', 'B': 'Presence of lingual thyroid tissue', 'C': 'Molecular mimicry of hCG subunit', 'D': 'Production of TSH-receptor antibodies', 'E': 'Degradation of thyroid-binding globulin'}, | A: Transplacental transmission of thyroxine |
Answer the following medical question with one of the provided options: | Q:A 2-month-old boy is brought to the physician by his mother because of poor weight gain and irritability since delivery. He is at the 10th percentile for height and below the 5th percentile for weight. Physical examination shows conjunctival pallor. Laboratory studies show: Hemoglobin 11.2 g/dL Mean corpuscular hemoglobin 24.2 pg/cell Mean corpuscular volume 108 μm3 Serum Ammonia 26 μmol/L (N=11–35 μmol/L) A peripheral blood smear shows macrocytosis of erythrocytes and hypersegmented neutrophils. Supplementation with folate and cobalamin is begun. Two months later, his hemoglobin concentration is 11.1 g/dL and mean corpuscular volume is 107 μm3. The patient's condition is most likely caused by failure of which of the following enzymatic reactions?"? {'A': 'Ornithine and carbamoylphosphate to citrulline', 'B': 'Glucose-6-phosphate to 6-phosphogluconate', 'C': 'Hypoxanthine to inosine monophosphate', 'D': 'Phosphoenolpyruvate to pyruvate', 'E': "Orotate to uridine 5'-monophosphate"}, | E: Orotate to uridine 5'-monophosphate |
Answer the following medical question with one of the provided options: | Q:A previously healthy 40-year-old woman comes to the physician because of a 3-day history of fever, headaches, and fatigue. She also reports a persistent tingling sensation in her right hand and numbness in her right arm that started this morning. Physical examination shows pallor, mild scleral icterus, and petechiae on her forearms and legs. On mental status examination, she appears confused and is only oriented to person. Laboratory studies show: Hemoglobin 11.1 mg/dL Platelet count 39,500/mm3 Bleeding time 9 minutes Prothrombin time 14 seconds Partial thromboplastin time 35 seconds Serum Creatinine 1.7 mg/dL Total bilirubin 2.1 mg/dL A peripheral blood smear shows fragmented erythrocytes. Which of the following is the most likely underlying cause of this patient's condition?"? {'A': 'Antibodies against ADAMTS13', 'B': 'Antibodies against GpIIb/IIIa', 'C': 'Absence of platelet GpIIb/IIIa receptors', 'D': 'Mutation of the PIGA gene', 'E': 'Antibodies against double-stranded DNA'}, | A: Antibodies against ADAMTS13 |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman comes to the office with a 2-week history of rectal bleeding that occurs every day with her bowel movements. She denies any pain during defecation. Apart from this, she does not have any other complaints. Her past medical history is insignificant except for 5 normal vaginal deliveries. Her vitals are a heart rate of 72/min, a respiratory rate of 15/min, a temperature of 36.7°C (98.1°F), and a blood pressure of 115/85 mm Hg. On rectovaginal examination, there is a palpable, non-tender, prolapsed mass that can be pushed back by the examiner's finger into the anal sphincter. What is the most likely diagnosis?? {'A': 'Anal fissure', 'B': 'Anorectal fistula', 'C': 'Rectal ulcer', 'D': 'Proctitis', 'E': 'Hemorrhoids'}, | E: Hemorrhoids |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man comes to the physician’s office with jaundice. Liver ultrasound reveals a shrunken liver and biopsy reveals cirrhosis. Hepatitis serologies are below: Anti-HAV: negative HBsAg: negative HBsAb: positive HBeAg: negative Anti-HBe: negative Anti-HBc: negative Anti-HCV: positive The hepatitis C viral load is 1,000,000 copies/mL. The patient is started on an antiviral regimen including sofosbuvir. What is the mechanism of action of this drug?? {'A': 'Inhibits synthesis of DNA-dependent DNA polymerase', 'B': 'Inhibits hepatitis C protease', 'C': 'Inhibits reverse transcriptase', 'D': 'Inhibits integrase', 'E': 'Inhibits RNA-dependent RNA polymerase'}, | E: Inhibits RNA-dependent RNA polymerase |
Answer the following medical question with one of the provided options: | Q:A 55-year-old Chinese man presents to the office with a complaint of progressive unilateral nasal obstruction for 10 months. Though he was able to tolerate his symptoms at the beginning, he can’t breathe properly through the obstructed nostril anymore. Also, a bloody nasal discharge has started recently through the occluded nostril. He also complains of double vision during the past 2 months but did not pay attention to it until now. Past medical history is insignificant except for occasional sore throats. His vitals include: blood pressure of 120/88 mm Hg, respiratory rate of 14/min, pulse of 88/min, temperature 37.0°C (98.6°F). Blood analysis shows: Hemoglobin 15 g/dL Hematocrit 46% Leukocyte count 15000/mm3 Neutrophils 72% Lymphocytes 25% Monocytes 3% Mean corpuscular volume 95 fL Platelet count 350,000/mm3 Which of the following viral etiology is most likely associated with the development of this patient’s condition?? {'A': 'Human papillomavirus', 'B': 'HIV', 'C': 'Epstein-Barr virus', 'D': 'Hepatitis B virus', 'E': 'Human T lymphotropic virus type I'}, | C: Epstein-Barr virus |
Answer the following medical question with one of the provided options: | Q:A 78-year-old man is brought in to the emergency department by ambulance after his wife noticed that he began slurring his speech and had developed facial asymmetry during dinner approximately 30 minutes ago. His past medical history is remarkable for hypertension and diabetes. His temperature is 99.1°F (37.3°C), blood pressure is 154/99 mmHg, pulse is 89/min, respirations are 12/min, and oxygen saturation is 98% on room air. Neurologic exam reveals right upper and lower extremity weakness and an asymmetric smile. Which of the following is the next best step in management?? {'A': 'Alteplase', 'B': 'Aspirin', 'C': 'CT head', 'D': 'CTA head', 'E': 'MRI brain'}, | C: CT head |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy is brought to the physician for recurrent 3–4 minutes episodes of facial grimacing and staring over the past month. He is nonresponsive during these episodes and does not remember them afterward. He recalls a muddy taste in his mouth before the onset of symptoms. One week ago, his brother witnessed an episode where he woke up, stared, and made hand gestures. After the incident, he felt lethargic and confused. Examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Absence seizures', 'B': 'Myoclonic seizure', 'C': 'Simple partial seizures', 'D': 'Breath-holding spell', 'E': 'Complex partial seizure'}, | E: Complex partial seizure |
Answer the following medical question with one of the provided options: | Q:A group of scientists is studying the mechanism by which the human papillomavirus (HPV) vaccine confers immunity. They observe that during the inoculation of test subjects, mammals with certain viral proteins result in the organism’s antigen-presenting cells (APCs) absorbing the antigen and presenting it on major histocompatibility complex (MHC) class 1 molecules. Which of the following is the correct term for the process that the scientists are observing in this inoculation?? {'A': 'Endogenous antigen presentation', 'B': 'Cross-presentation', 'C': 'Priming of CD4+ T cells', 'D': 'Adhesion', 'E': 'Ubiquitination'}, | B: Cross-presentation |
Answer the following medical question with one of the provided options: | Q:A 21-year-old woman presents with the complaints of nausea, vomiting, and diarrhea for 5 days. She adds that she has fever and abdominal cramping as well. She had recently attended a large family picnic and describes eating many varieties of cold noodle salads. Her past medical history is insignificant. Her temperature is 37.5°C (99.6°F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 92/68 mm Hg. Physical examination is non-contributory. Given the clinical information provided and most likely diagnosis, which of the following would be the next best step in the management of this patient?? {'A': 'IV antibiotic therapy to prevent disseminated disease', 'B': 'Replacement of fluids and electrolytes', 'C': 'Empiric therapy assuming multi-drug resistance', 'D': 'Short course of oral antibiotics to prevent asymptomatic carrier state', 'E': 'Prolonged oral antibiotics'}, | B: Replacement of fluids and electrolytes |
Answer the following medical question with one of the provided options: | Q:An investigator is studying biomolecular mechanisms in human cells. A radioactive isotope that is unable to cross into organelles is introduced into a sample of cells. The cells are then fragmented via centrifugation and the isotope-containing components are isolated. Which of the following reactions is most likely to be present in this cell component?? {'A': 'Glucose-6-phosphate to glucose', 'B': 'Fatty acyl-CoA to acetyl-CoA', 'C': 'Carbamoyl phosphate to citrulline', 'D': 'Glucose-6-phosphate to 6-phosphogluconolactone', 'E': 'Isocitrate to α-ketoglutarate'}, | D: Glucose-6-phosphate to 6-phosphogluconolactone |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man comes to the physician for his annual health maintenance examination. The patient has no particular health concerns. He has a history of bilateral cryptorchidism treated with orchidopexy at 8 months of age. This patient is at increased risk for which of the following?? {'A': 'Teratocarcinoma', 'B': 'Sertoli cell tumor', 'C': 'Leydig cell tumor', 'D': 'Yolk sac tumor', 'E': 'Testicular lymphoma\n"'}, | A: Teratocarcinoma |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the emergency department because of a 2-day history of dark urine, increasing abdominal pain, and a tingling sensation in her arms and legs. She has a history of epilepsy. Her current medication is phenytoin. She is nauseated and confused. Following the administration of hemin and glucose, her symptoms improve. The beneficial effect of this treatment is most likely due to inhibition of which of the following enzymes?? {'A': 'Aminolevulinate dehydratase', 'B': 'Aminolevulinate acid synthase', 'C': 'Ferrochelatase', 'D': 'Porphobilinogen deaminase', 'E': 'Uroporphyrinogen decarboxylase'}, | B: Aminolevulinate acid synthase |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the emergency department by his parents because of fever and recurrent episodes of jerky movements of his extremities for the past 6 hours. Pregnancy and delivery were uncomplicated, and development was normal until the age of 1 year. The parents report that he has had gradual loss of speech, vision, and motor skills over the past year. During this time, he has been admitted to the hospital three times because of myoclonic seizures. Physical examination shows hypertonicity of the upper and lower extremities. Fundoscopic examination shows pallor of the optic disc bilaterally. An MRI of the brain shows brain atrophy and hyperintensity of the periventricular and subcortical areas. Two days after admission, the patient dies. Histopathologic examination of the brain shows aggregation of globoid cells and loss of glial cells. The patient’s condition was most likely caused by a deficiency of which of the following enzymes?? {'A': 'Sphingomyelinase', 'B': 'Arylsulfatase A', 'C': 'β-Glucocerebrosidase', 'D': 'β-Hexosaminidase A', 'E': 'β-Galactocerebrosidase'}, | E: β-Galactocerebrosidase |
Answer the following medical question with one of the provided options: | Q:An obese, 66-year-old woman comes to the physician for a routine health maintenance examination. She feels well but is unhappy about being overweight. She reports that she feels out of breath when walking for more than one block and while climbing stairs. She has tried to lose weight for several years without success. She goes for a walk 3 times a week but she has difficulty following a low-calorie diet. During the past 12 months, she has had two urinary tract infections that were treated with fosfomycin. She has type 2 diabetes mellitus and osteoarthritis. Her only current medication is metformin. She has never smoked. She is 160 cm (5 ft 3 in) tall and weighs 100 kg (220 lb); BMI is 39.1 kg/m2. Vital signs are within normal limits. Physical examination shows cracking in both knees on passive movement. The remainder of the examination shows no abnormalities. Serum studies show an HbA1c of 9.5%, and a fasting serum glucose concentration of 158 mg/dL. An ECG shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Topiramate', 'B': 'Exenatide', 'C': 'Pioglitazone', 'D': 'Acarbose', 'E': 'Phentermine'}, | B: Exenatide |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man comes to the physician for a follow-up examination. One month ago, therapy with lisinopril was initiated for treatment of hypertension. His blood pressure is 136/86 mm Hg. Urinalysis shows a creatinine clearance of 92 mL/min. The patient's serum creatinine concentration is most likely closest to which of the following values?? {'A': '1.4 mg/dL', 'B': '2.3 mg/dL', 'C': '2.0 mg/dL', 'D': '1.1 mg/dL', 'E': '1.7 mg/dL'}, | D: 1.1 mg/dL |
Answer the following medical question with one of the provided options: | Q:A 21-year-old woman presents to the emergency department with complaints of intermittent bouts of lower abdominal and pelvic pain over the last week. The pain is primarily localized to the right side and is non-radiating. The patient is not sexually active at this time and is not currently under any medication. At the hospital, her vitals are normal. A pelvic examination reveals a tender palpable mass on the right adnexal structure. A pelvic CT scan reveals a 7-cm solid adnexal mass that was surgically removed with the ovary. Histological evaluation indicates sheets of uniform cells resembling a 'fried egg', consistent with dysgerminoma. Which of the following tumor markers is most likely elevated with this type of tumor?? {'A': 'Lactate dehydrogenase (LDH)', 'B': 'Beta-human chorionic gonadotropin (beta-hCG)', 'C': 'Alpha-fetoprotein (AFP)', 'D': 'Inhibin A', 'E': 'Cancer antigen 125 (CA-125)'}, | A: Lactate dehydrogenase (LDH) |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman, gravida 2, para 1, comes to the physician for her initial prenatal visit at 18 weeks’ gestation. She is a recent immigrant from Thailand. Her history is significant for anemia since childhood that has not required any treatment. Her mother and husband have anemia, as well. She has no history of serious illness and takes no medications. Her vital signs are within normal limits. Fundal height measures at 22 weeks. Ultrasound shows polyhydramnios and pleural and peritoneal effusion in the fetus with fetal subcutaneous edema. Which of the following is the most likely clinical course for this fetus?? {'A': 'Asymptomatic anemia', 'B': 'Carrier state', 'C': 'Intrauterine fetal demise', 'D': 'Neonatal death', 'E': 'Normal development with regular blood transfusion'}, | C: Intrauterine fetal demise |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman comes to the physician because of increasing blurring of vision in both eyes. She says that the blurring has made it difficult to read, although she has noticed that she can read a little better if she holds the book below or above eye level. She also requires a bright light to look at objects. She reports that her symptoms began 8 years ago and have gradually gotten worse over time. She has hypertension and type 2 diabetes mellitus. Current medications include glyburide and lisinopril. When looking at an Amsler grid, she says that the lines in the center appear wavy and bent. An image of her retina, as viewed through fundoscopy is shown. Which of the following is the most likely diagnosis?? {'A': 'Central serous retinopathy', 'B': 'Hypertensive retinopathy', 'C': 'Diabetic retinopathy', 'D': 'Cystoid macular edema', 'E': 'Age-related macular degeneration\n"'}, | E: Age-related macular degeneration " |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman presents with esophageal varices, alcoholic cirrhosis, hepatic encephalopathy, portal hypertension, and recent onset confusion. The patient’s husband does not recall her past medical history but knows her current medications and states that she is quite disciplined about taking them. Current medications are spironolactone, labetalol, lactulose, and furosemide. Her temperature is 38.3°C (100.9°F), heart rate is 115/min, blood pressure is 105/62 mm Hg, respiratory rate is 12/min, and oxygen saturation is 96% on room air. On physical examination, the patient is disoriented, lethargic, and poorly responsive to commands. A cardiac examination is unremarkable. Lungs are clear to auscultation. The abdomen is distended, tense, and mildly tender. Mild asterixis is present. Neurologic examination is normal. The digital rectal examination reveals guaiac negative stool. Laboratory findings are significant for the following: Basic metabolic panel Unremarkable Platelet count 95,500/µL Leukocyte count 14,790/µL Hematocrit 33% (baseline is 30%) Which of the following would most likely be of diagnostic value in this patient?? {'A': 'Noncontrast CT of the head', 'B': 'Therapeutic trial of lactulose', 'C': 'Esophagogastroduodenoscopy', 'D': 'Abdominal paracentesis', 'E': 'Serum ammonia level'}, | D: Abdominal paracentesis |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman is brought to the emergency department 8 hours after the sudden onset of shortness of breath and pleuritic chest pain. She has cystic fibrosis and, during the past year, has had 4 respiratory exacerbations that have required hospitalization. Current medications include an inhaled bronchodilator, an inhaled corticosteroid, inhaled N-acetylcysteine, and azithromycin. The patient appears chronically ill. Her temperature is 37.9°C (100.2°F), pulse is 96/min, respirations are 22/min and labored, and blood pressure is 106/64 mm Hg. Pulse oximetry on 2 L/min of oxygen via nasal cannula shows an oxygen saturation of 96%. Examination shows an increased anteroposterior chest diameter. There is digital clubbing. Chest excursions and tactile fremitus are decreased on the right side. On auscultation of the chest, breath sounds are significantly diminished over the right lung field and diffuse wheezing is heard over the left lung field. Which of the following is the most likely underlying cause of this patient's current symptoms?? {'A': 'Bronchial hyperresponsiveness', 'B': 'Inflammation of costal cartilage', 'C': 'Infection with gram-negative coccobacilli', 'D': 'Apical subpleural cyst', 'E': 'Increased pulmonary capillary permeability'}, | D: Apical subpleural cyst |
Answer the following medical question with one of the provided options: | Q:A 61-year-old diabetic woman is brought to the emergency department with the complaint of multiple bouts of abdominal pain in the last 24 hours. She says that the pain is dull aching in nature, radiates to the back, and worsens with meals. She also complains of nausea and occasional vomiting. She has been hospitalized repeatedly in the past with similar complaints. Her temperature is 37° C (98.6° F), respiratory rate is 16/min, pulse is 77/min, and blood pressure is 120/89 mm Hg. On physical exam, dark hyperpigmentation of the axillary skin is noted. Her blood test report from last month is given below: Glycated hemoglobin (HbA1c): 9.1% Triglyceride: 675 mg/dL LDL-Cholesterol: 102 mg/dL HDL-Cholesterol: 35 mg/dL Total Cholesterol: 250 mg/dL Serum Creatinine: 1.2 mg/dL BUN: 12 mg/dL Alkaline phosphatase: 100 U/L Alanine aminotransferase: 36 U/L Aspartate aminotransferase: 28 U/L What is the most likely diagnosis in this case?? {'A': 'Cholecystitis', 'B': 'Choledocholithiasis', 'C': 'Pancreatitis', 'D': 'Duodenal peptic ulcer', 'E': 'Gallbladder cancer'}, | C: Pancreatitis |
Answer the following medical question with one of the provided options: | Q:An 82-year-old woman is admitted to the hospital because of wet gangrene on her right leg. Two days after admission, she becomes increasingly confused and tachypneic. She is intubated and ventilatory support is initiated. Her temperature is 39.6°C (102.5°F), pulse is 127/min, and blood pressure is 83/47 mm Hg. The ventilator is set at a FiO2 of 100% and a respiratory rate of 20/min. An arterial blood gas checked 30 minutes after intubation shows a PCO2 of 41 mm Hg and a PO2 of 55 mm Hg. Despite appropriate care, the patient dies from respiratory failure. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Hyperinflation of the lungs', 'B': 'Emboli in the pulmonary vasculature', 'C': 'Nodular thickening of the interlobular septa', 'D': 'Abscess in the lung parenchyma', 'E': 'Fluid in the alveolar space'}, | E: Fluid in the alveolar space |
Answer the following medical question with one of the provided options: | Q:A 57-year-old florist presents to his family physician with nodular lesions on his right hand and forearm. He explains that he got pricked by a rose thorn on his right "pointer finger" where the first lesions appeared, and the other lesions then began to appear in an ascending manner. The physician prescribed a medication and warned him of gynecomastia as a side effect if taken for long periods of time. Which of the following is the mechanism of action of the medication?? {'A': 'Inhibits ergosterol synthesis', 'B': 'Binds to ergosterol, forming destructive pores in cell membrane', 'C': 'Inhibits squalene epoxidase', 'D': 'Inhibits formation of beta glucan', 'E': 'Disrupts microtubule function'}, | A: Inhibits ergosterol synthesis |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman presents to the physician’s office with vaginal bleeding. The bleeding started as a spotting and has increased and has become persistent over the last month. The patient is G3P1 with a history of polycystic ovary syndrome and type 2 diabetes mellitus. She completed menopause 4 years ago. She took cyclic estrogen-progesterone replacement therapy for 1 year at the beginning of menopause. Her weight is 89 kg (196 lb), height 157 cm (5 ft 2 in). Her vital signs are as follows: blood pressure 135/70 mm Hg, heart rate 78/min, respiratory rate 12/min, and temperature 36.7℃ (98.1℉). Physical examination is unremarkable. Transvaginal ultrasound reveals an endometrium of 6 mm thickness. Speculum examination shows a cervix without focal lesions with bloody discharge from the non-dilated external os. On pelvic examination, the uterus is slightly enlarged, movable, and non-tender. Adnexa is non-palpable. What is the next appropriate step in the management of this patient?? {'A': 'Hysteroscopy with dilation and curettage', 'B': 'Medroxyprogesterone acetate therapy', 'C': 'Endometrial biopsy', 'D': 'Saline infusion sonography', 'E': 'Hysteroscopy with targeted biopsy'}, | C: Endometrial biopsy |
Answer the following medical question with one of the provided options: | Q:A student is reviewing the various effects that can be plotted on a dose-response curve. He has observed that certain drugs can work as an agonist and an antagonist at a particular site. He has plotted a particular graph (as shown below) and is checking for other responses that can be measured on the same graph. He learned that drug B is less potent than drug A. Drug B also reduces the potency of drug A when combined in the same solution; however, if additional drug A is added to the solution, the maximal efficacy (Emax) of drug A increases. He wishes to plot another curve for drug C. He learns that drug C works on the same molecules as drugs A and B, but drug C reduces the maximal efficacy (Emax) of drug A significantly when combined with drug A. Which of the following best describes drug C?? {'A': 'Competitive antagonist', 'B': 'Non-competitive antagonist', 'C': 'Inverse agonist', 'D': 'Full agonist', 'E': 'Reversible antagonist'}, | B: Non-competitive antagonist |
Answer the following medical question with one of the provided options: | Q:You are seeing a patient in clinic who recently started treatment for active tuberculosis. The patient is currently being treated with rifampin, isoniazid, pyrazinamide, and ethambutol. The patient is not used to taking medicines and is very concerned about side effects. Specifically regarding the carbohydrate polymerization inhibiting medication, which of the following is a known side effect?? {'A': 'Cutaneous flushing', 'B': 'Elevated liver enzymes', 'C': 'Paresthesias of the hands and feet', 'D': 'Vision loss', 'E': 'Arthralgias'}, | D: Vision loss |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man visits his primary care physician for a routine health maintenance examination. During the examination, he expresses concerns about not wanting to become a father. He has been sexually active and monogamous with his wife for the past 5 years, and they inconsistently use condoms for contraception. He tells the physician that he would like to undergo vasectomy. His wife is also a patient under the care of the physician and during her last appointment, she expressed concerns over being prescribed any drugs that could affect her fertility because she would like to conceive soon. Which of the following is the most appropriate action by the physician regarding this patient's wish to undergo vasectomy?? {'A': 'Insist that the patient returns with his wife to discuss the risks and benefits of the procedure together', 'B': "Explain the procedure's benefits, alternatives, and potential complications", 'C': 'Refer the patient to a psychotherapist to discuss his reluctance to have children', 'D': "Call the patient's wife to obtain her consent for the procedure", 'E': 'Discourage the patient from undergoing the procedure because his wife wants children'}, | B: Explain the procedure's benefits, alternatives, and potential complications |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man is brought to the emergency department by his wife 20 minutes after she witnessed him vigorously shaking for about 1 minute. During this episode, he urinated on himself. He feels drowsy and has nausea. He has a history of chronic alcoholism; he has been drinking 15 beers daily for the past 3 days. Before this time, he drank 8 beers daily. His last drink was 2 hours ago. He appears lethargic. His vital signs are within normal limits. Physical and neurologic examinations show no other abnormalities. On mental status examination, he is confused and not oriented to time. Laboratory studies show: Hematocrit 44.0% Leukocyte count 12,000/mm3 Platelet count 320,000/mm3 Serum Na+ 112 mEq/L Cl- 75 mEq/L K+ 3.8 mEq/L HCO3- 13 mEq/L Urea nitrogen 6 mEq/L Creatinine 0.6 mg/dL Albumin 2.1 g/dL Glucose 80 mg/dL Urgent treatment for this patient's current condition puts him at increased risk for which of the following adverse events?"? {'A': 'Cerebral edema', 'B': 'Cardiac arrhythmia', 'C': 'Hyperglycemia', 'D': 'Osmotic myelinolysis', 'E': 'Wernicke encephalopathy'}, | D: Osmotic myelinolysis |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man presents early in the morning to the emergency department with a burning sensation in his chest. He describes a crushing feeling below the sternum and reports some neck pain on the left side. Furthermore, he complains of difficulty breathing. Late last night, he had come home and had eaten a family size lasagna by himself while watching TV. His past medical history is significant for type 2 diabetes and poorly controlled hypertension. The patient admits he often neglects to take his medications and has not been following his advised diet. His current medications are aspirin, metformin, and captopril. Examination reveals a distressed, overweight male sweating profusely. Which of the following is most likely to be found on auscultation?? {'A': 'Diminished breath sounds', 'B': 'Ejection systolic murmur', 'C': 'Expiratory wheezes', 'D': 'Fixed splitting of the second heart sound', 'E': 'Fourth heart sound'}, | E: Fourth heart sound |
Answer the following medical question with one of the provided options: | Q:A 76-year-old man is brought to the emergency room because of one episode of hemoptysis. His pulse is 110/min. Physical examination shows pallor; there is blood in the oral cavity. Examination of the nasal cavity with a nasal speculum shows active bleeding from the posterior nasal cavity. Tamponade with a balloon catheter is attempted without success. The most appropriate next step in the management is ligation of a branch of a vessel of which of the following arteries?? {'A': 'Ophthalmic artery', 'B': 'Anterior cerebral artery', 'C': 'Facial artery', 'D': 'Occipital artery', 'E': 'Maxillary artery'}, | E: Maxillary artery |
Answer the following medical question with one of the provided options: | Q:A researcher is studying how arachidonic acid metabolites mediate the inflammatory response in rats. She has developed multiple enzyme inhibitors that specifically target individual proteins in the arachidonic acid pathway. She injects these inhibitors in rats who have been exposed to common bacterial pathogens and analyzes their downstream effects. In one of her experiments, she injects a leukotriene B4 inhibitor into a rat and observes an abnormal cell response. Which of the following interleukins would most closely restore the function of one of the missing products?? {'A': 'Interleukin 1', 'B': 'Interleukin 2', 'C': 'Interleukin 4', 'D': 'Interleukin 5', 'E': 'Interleukin 8'}, | E: Interleukin 8 |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man comes to the physician because of recurrent episodes of chest pain, shortness of breath, palpitations, and a sensation of choking. The symptoms usually resolve with deep breathing exercises after about 5 minutes. He now avoids going to his graduate school classes because he is worried about having another episode. Physical examination is unremarkable. Treatment with lorazepam is initiated. The concurrent intake of which of the following drugs should be avoided in this patient?? {'A': 'Diphenhydramine', 'B': 'Phenelzine', 'C': 'Naloxone', 'D': 'Fluoxetine', 'E': 'Ondansetron'}, | A: Diphenhydramine |
Answer the following medical question with one of the provided options: | Q:A 17-year-old girl with a BMI of 14.5 kg/m2 is admitted to the hospital for the treatment of anorexia nervosa. The patient is administered intravenous fluids and is supplied with 1,600 calories daily with an increase of 200 calories each day. On day 5 of treatment, the patient manifests symptoms of weakness and confusion, and dark brown urine. Which of the following clinical conditions is the most likely cause of the patient's symptoms?? {'A': 'Hypercalcemia', 'B': 'Hyperkalemia', 'C': 'Hypermagnesemia', 'D': 'Hypophosphatemia', 'E': 'Thiamine deficiency'}, | D: Hypophosphatemia |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman is brought to the emergency department after being involved in a rear-end collision, in which she was the restrained driver of the back car. On arrival, she is alert and active. She reports pain in both knees and severe pain over the right groin. Temperature is 37°C (98.6°F), pulse is 116/min, respirations are 19/min, and blood pressure is 132/79 mm Hg. Physical examination shows tenderness over both knee caps. The right groin is tender to palpation. The right leg is slightly shortened, flexed, adducted, and internally rotated. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Femoral neck fracture', 'B': 'Anterior hip dislocation', 'C': 'Femoral shaft fracture', 'D': 'Posterior hip dislocation', 'E': 'Pelvic fracture\n"'}, | D: Posterior hip dislocation |
Answer the following medical question with one of the provided options: | Q:An investigator is studying human genetics and cell division. A molecule is used to inhibit the exchange of genetic material between homologous chromosomes. Which of the following phases of the cell cycle does the molecule target?? {'A': 'Telophase I', 'B': 'Metaphase II', 'C': 'Prophase II', 'D': 'Prophase I', 'E': 'Anaphase I'}, | D: Prophase I |
Answer the following medical question with one of the provided options: | Q:An investigator is studying neuronal regeneration. For microscopic visualization of the neuron, an aniline stain is applied. After staining, only the soma and dendrites of the neurons are visualized, not the axon. Presence of which of the following cellular elements best explains this staining pattern?? {'A': 'Microtubule', 'B': 'Nucleus', 'C': 'Lysosome', 'D': 'Golgi apparatus', 'E': 'Rough endoplasmic reticulum'}, | E: Rough endoplasmic reticulum |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman presents to a surgeon with a painless, slowly growing ulcer in the periauricular region for the last 2 months. On physical examination, there is an irregular-shaped ulcer, 2 cm x 1 cm in its dimensions, with irregular margins and crusting over the surface. The woman is a fair-skinned individual who loves to go sunbathing. There is no family history of malignancy. After a complete physical examination, the surgeon performs a biopsy of the lesion under local anesthesia and sends the tissue for histopathological examination. The pathologist confirms the diagnosis of squamous cell carcinoma of the skin. When she asks about the cause, the surgeon explains that there are many possible causes, but it is likely that she has developed squamous cell carcinoma on her face due to repeated exposure to ultraviolet rays from the sun, especially ultraviolet B (UVB) rays. If the surgeon’s opinion is correct, which of the following mechanisms is most likely involved in the pathogenesis of the condition?? {'A': 'Intrastrand cross-linking of thymidine residues in DNA', 'B': 'Gain-of-function mutations of TP53', 'C': 'Upregulation of expression of cyclin D2', 'D': 'Activation of transcription factor NF-κB', 'E': 'DNA damage caused by the formation of reactive oxygen species'}, | A: Intrastrand cross-linking of thymidine residues in DNA |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to the physician with profuse watery diarrhea along with fever and crampy abdominal pain. He has been taking an antibiotic course of cefixime for about a week to treat a respiratory tract infection. At the doctor’s office, his pulse is 112/min, the blood pressure is 100/66 mm Hg, the respirations are 22/min, and the temperature is 38.9°C (102.0°F). His oral mucosa appears dry and his abdomen is soft with vague diffuse tenderness. A digital rectal examination is normal. Laboratory studies show: Hemoglobin 11.1 g/dL Hematocrit 33% Total leucocyte count 16,000/mm3 Serum lactate 0.9 mmol/L Serum creatinine 1.1 mg/dL What is most likely to confirm the diagnosis?? {'A': 'Identification of C. difficile toxin in stool', 'B': 'Stool culture', 'C': 'Colonoscopy', 'D': 'Abdominal X-ray', 'E': 'CT scan of the abdomen'}, | A: Identification of C. difficile toxin in stool |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man presents to the emergency department with fever and easy bruising for 3 days. He has had fatigue for 2 weeks. He has no past medical history, and takes no medications. Excessive bleeding from intravenous lines was reported by the nurse. He does not smoke or drink alcohol. The temperature is 38.2°C (102.6°F), pulse is 105/min, respiration rate is 18/min, and blood pressure is 110/70 mm Hg. On physical examination, he has multiple purpura on the lower extremities and several ecchymoses on the lower back and buttocks. Petechiae are noticed on the soft palate. Cervical painless lymphadenopathy is detected on both sides. The examination of the lungs, heart, and abdomen shows no other abnormalities. The laboratory test results are as follows: Hemoglobin 8 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 18,000/mm3 Platelet count 10,000/mm3 Partial thromboplastin time (activated) 60 seconds Prothrombin time 25 seconds (INR: 2.2) Fibrin split products Positive Lactate dehydrogenase, serum 1,000 U/L A Giemsa-stained peripheral blood smear is shown by the image. Intravenous fluids, blood products, and antibiotics are given to the patient. Based on the most likely diagnosis, which of the following is the best therapy for this patient at this time?? {'A': 'All-trans retinoic acid (ATRA)', 'B': 'Citarubin plus daunorubicin', 'C': 'Hematopoietic cell transplantation', 'D': 'Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)', 'E': 'Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD)'}, | A: All-trans retinoic acid (ATRA) |
Answer the following medical question with one of the provided options: | Q:A 2-month-old is brought to the physician for a well-child examination. She was born at 39 weeks gestation via spontaneous vaginal delivery and is exclusively breastfed. She weighed 3,400 g (7 lb 8 oz) at birth. At the physician's office, she appears well. Her pulse is 136/min, the respirations are 41/min, and the blood pressure is 82/45 mm Hg. She weighs 5,200 g (11 lb 8 oz) and measures 57.5 cm (22.6 in) in length. The remainder of the physical examination is normal. Which of the following developmental milestones has this patient most likely met?? {'A': 'Absence of asymmetric tonic neck reflex', 'B': 'Monosyllabic babble', 'C': 'Reaches for objects', 'D': 'Smiles in response to face', 'E': 'Stares at own hand'}, | D: Smiles in response to face |
Answer the following medical question with one of the provided options: | Q:A 40-year-old female comes in with several months of unintentional weight loss, epigastric pain, and a sensation of abdominal pressure. She has diabetes well-controlled on metformin but no other prior medical history. She has not previously had any surgeries. On physical exam, her doctor notices brown velvety areas of pigmentation on her neck. Her doctor also notices an enlarged, left supraclavicular node. Endoscopic findings show a stomach wall that appears to be grossly thickened. Which of the following findings would most likely be seen on biopsy?? {'A': 'Cells with central mucin pool', 'B': 'Keratin pearls', 'C': 'Psammoma bodies', 'D': "Peyer's patches", 'E': 'Noncaseating granulomas'}, | A: Cells with central mucin pool |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy is brought to the emergency room by ambulance, accompanied by his kindergarten teacher. Emergency department staff attempt to call his parents, but they cannot be reached. The boy’s medical history is unknown. According to his teacher, the boy was eating in the cafeteria with friends when he suddenly complained of itching and developed a widespread rash. Physical exam is notable for diffuse hives and tongue edema. His pulse is 100/min and blood pressure is 90/60 mmHg. The boy appears frightened and tells you that he does not want any treatment until his parents arrive. Which of the following is the next best step in the management of this patient?? {'A': 'Continue calling the patient’s parents and do not intubate until verbal consent is obtained over the phone', 'B': 'Immediately administer epinephrine and sedate and intubate the patient', 'C': 'Obtain written consent to intubate from the patient’s teacher', 'D': 'Obtain written consent to intubate from the patient', 'E': "Wait for the patient's parents to arrive, calm the patient, and provide written consent before intubating"}, | B: Immediately administer epinephrine and sedate and intubate the patient |
Answer the following medical question with one of the provided options: | Q:A 12-month-old boy is brought to the physician for a well-child examination. He was born at 38 weeks' gestation and was 48 cm (19 in) in length and weighed 3061 g (6 lb 12 oz); he is currently 60 cm (24 in) in length and weighs 7,910 g (17 lb 7 oz). He can walk with one hand held and can throw a small ball. He can pick up an object between his thumb and index finger. He can wave 'bye-bye'. He can say 'mama', 'dada' and 'uh-oh'. He cries if left to play with a stranger alone. Physical examination shows no abnormalities. Which of the following is most likely delayed in this child?? {'A': 'Language skills', 'B': 'Gross motor skills', 'C': 'Growth', 'D': 'Fine motor skills', 'E': 'Social skills'}, | C: Growth |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman presents to the emergency department with right lower quadrant abdominal pain and vaginal spotting. She denies diarrhea, constipation, or blood in the stool. The medical history is unremarkable. She does not use tobacco or drink alcohol. She is sexually active with her husband and uses an IUD for contraception. The temperature is 37.2 °C (99.0°F), the blood pressure is 110/70 mm Hg, the pulse is 80/min, and the respiratory rate is 12/min. The physical examination reveals localized tenderness in the right adnexa, but no masses are palpated. The LMP was 8 weeks ago. Which of the following is most likely associated with this patient’s diagnosis?? {'A': 'Physical examination reveals rebound tenderness and tenderness at McBurney’s point', 'B': 'Positive urinary beta-HCG and no intrauterine mass', 'C': 'Abdominal x-ray shows free air under the diaphragm', 'D': 'Barium enema shows true diverticuli in the colon', 'E': 'Positive urinary beta-HCG and some products of conception in the uterus'}, | B: Positive urinary beta-HCG and no intrauterine mass |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man with a past medical history of diabetes, hypertension, and hyperlipidemia was brought into the emergency department by his wife after she observed him go without sleep for several days and recently open and max out several credit cards. She also reports that he has quit his bartending job and has been excessively talkative and easily annoyed for the last several weeks. The patient has no previous psychiatric history. Routine medical examination, investigations, and toxicology rule out a medical cause or substance abuse. Lab results are consistent with chronically impaired renal function. What is the single best treatment for this patient?? {'A': 'Valproic acid', 'B': 'Lithium', 'C': 'Gabapentin', 'D': 'Pregabalin', 'E': 'Lamotrigine'}, | A: Valproic acid |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the physician for the evaluation of a 1-month history of dull lower abdominal pain, decreased appetite, and a 5-kg (11-lb) weight loss. Physical examination shows no abnormalities. Pelvic ultrasonography shows bilateral ovarian enlargement and free fluid in the rectouterine pouch. Biopsy specimens from the ovaries show multiple, round, mucin-filled cells with flat, peripheral nuclei. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Decreased TSH levels', 'B': 'Increased testosterone levels', 'C': 'Dark blue peritoneal spots', 'D': 'Gastric wall thickening', 'E': 'Elevated β-hCG levels'}, | D: Gastric wall thickening |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man presents to the clinic with complaints of right wrist pain for 2 days. On examination, redness and swelling were noted on the dorsal aspect of his right wrist. He had pain with extreme range of motion of the wrist. His history includes 2 hip replacements, 2 previous episodes of gout in both first metatarsophalangeal joints, and hypertension. Two days later, the swelling had increased in the dorsal aspect of his right wrist and hand. Wrist flexion was limited to 80% with severe pain. The pain was present on palpation of the scaphoid bone. Due to the suspicion of fracture, the patient was referred to his general practitioner for radiographs. These findings were consistent with gouty arthritis. What is the most likely cytokine involved in this process?? {'A': 'IL-1', 'B': 'IL-10', 'C': 'INFγ', 'D': 'IL-4', 'E': 'IL-5'}, | A: IL-1 |
Answer the following medical question with one of the provided options: | Q:A group of investigators have conducted a randomized clinical trial to evaluate the efficacy of adding a novel adenosine A1 receptor agonist to the standard anti-epileptic treatment in reducing the frequency of focal seizures. It was found that patients taking the combination regimen (n = 200) had a lower seizure frequency compared to patients taking the standard treatment alone (n = 200; p < 0.01). However, several participants taking the novel drug reported severe drowsiness. The investigators administered a survey to both the combination treatment group and standard treatment group to evaluate whether the drowsiness interfered with daily functioning using a yes or no questionnaire. Results are shown: Interference with daily functioning Yes (number of patients) No (number of patients) Combination treatment group 115 85 Standard treatment group 78 122 Which of the following statistical methods would be most appropriate for assessing the statistical significance of these results?"? {'A': 'Multiple linear regression', 'B': 'Chi-square test', 'C': 'Unpaired t-test', 'D': 'Paired t-test', 'E': 'Analysis of variance'}, | B: Chi-square test |
Answer the following medical question with one of the provided options: | Q:A 39-year-old male presents to your office with nodular skin lesions that progress from his right hand to right shoulder. The patient reports that the initial lesion, currently necrotic and ulcerative, developed from an injury he received while weeding his shrubs a couple weeks earlier. The patient denies symptoms of respiratory or meningeal disease. Which of the following most likely characterizes the pattern of this patient’s skin lesions:? {'A': 'Contact dermatitis', 'B': 'Hematogenous dissemination', 'C': 'Dermatophyte colonization', 'D': 'Ascending lymphangitis', 'E': 'Arthropod bite'}, | D: Ascending lymphangitis |
Answer the following medical question with one of the provided options: | Q:A 17-year-old Latin American woman with no significant past medical history or family history presents to her pediatrician with concerns about several long-standing skin lesions. She notes that she has had a light-colored rash on her chest and abdomen that has been present for the last 2 years. The blood pressure is 111/81 mm Hg, pulse is 82/min, respiratory rate is 16/min, and temperature is 37.3°C (99.1°F). Physical examination reveals numerous hypopigmented macules over her chest and abdomen. No lesions are seen on her palms or soles. When questioned, she states that these lesions do not tan like the rest of her skin when exposed to the sun. The remainder of her review of systems is negative. What is the most likely cause of these lesions?? {'A': 'Malassezia yeast', 'B': 'Cutaneous T cell lymphoma', 'C': 'Post-viral immunologic reaction', 'D': 'TYR gene dysfunction in melanocytes', 'E': 'Treponema pallidum infection'}, | A: Malassezia yeast |
Answer the following medical question with one of the provided options: | Q:A 45-year-old male presents to the emergency room complaining of severe diarrhea. He recently returned from a business trip to Bangladesh. Since returning, he has experienced several loose bloody stools per day that are accompanied by abdominal cramping and occasional nausea and vomiting. His temperature is 101.7°F (38.7°C), blood pressure is 100/60 mmHg, pulse is 120/min, and respirations are 20/min. On examination, he demonstrates mild tenderness to palpation throughout his abdomen, delayed capillary refill, and dry mucus membranes. Results from a stool sample and subsequent stool culture are pending. What is the mechanism of action of the toxin elaborated by the pathogen responsible for this patient’s current condition?? {'A': 'ADP-ribosylation of elongation factor 2', 'B': 'Phospholipid degradation', 'C': 'Stimulation of guanylyl cyclase', 'D': 'ADP-ribosylation of a G protein', 'E': 'Inhibition of 60S ribosomal subunit'}, | E: Inhibition of 60S ribosomal subunit |
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