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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents to his family physician admitting to using heroin. He says he started using about 6-months ago when his back pain medication ran out. At first, he says he would borrow his wife’s Percocet but, eventually, that ran out and he had to find a different source. Since then, he has been having more and more issues related to his heroin use, and it has started to affect his work and home life. He is concerned that, if he continues like this, he might end up in real trouble. He denies sharing needles and is sincerely interested in quitting. He recalls trying to quit last month but recounts how horrible the withdrawal symptoms were. Because of this and the strong cravings, he relapsed shortly after his initial attempt. Methadone maintenance therapy is prescribed. Which of the following would most likely be the most important benefit of this new treatment plan in this patient?? {'A': 'Improved interpersonal relationships', 'B': 'Euphoria without the side effects', 'C': 'Decreased incidence of hepatitis A', 'D': 'Depot dosing allowing for better compliance', 'E': 'Decreases methadone dependence'},
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A: Improved interpersonal relationships
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Answer the following medical question with one of the provided options:
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Q:A 53-year-old man presents to an urgent care center with severe fever that began during the day along with muscle and joint pains. He states that he felt fine the day before but then developed a fever to 103°F (39.4°C) and had to leave work after which he developed a headache and body pains. The patient states that he was recently in South Asia for a business trip and was otherwise feeling well since returning 2 weeks ago. On exam, the patient’s temperature is 103.3°F (39.6°C), blood pressure is 110/84 mmHg, pulse is 94/min, and respirations are 14/min. On physical exam, the patient appears flushed and has a rash that blanches when touched. On laboratory workup, the pathogen was identified as an enveloped virus with an icosahedral capsid and had positive-sense, single-stranded linear RNA. Which of the following is the most likely cause of this patient's presentation?? {'A': 'Coronavirus', 'B': 'Dengue virus', 'C': 'Marburg virus', 'D': 'Norovirus', 'E': 'Saint Louis encephalitis virus'},
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B: Dengue virus
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Answer the following medical question with one of the provided options:
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Q:A 64-hour-old baby girl is being evaluated for discharge. She was born by forceps-assisted vaginal delivery at 39 weeks gestation. The mother has no chronic medical conditions and attended all her prenatal visits. The mother’s blood type is A+. On day 1, the patient was noted to have a scalp laceration. Breastfeeding was difficult at first but quickly improved upon nurse assistance. The patient has had adequate wet diapers since birth. Upon physical examination, the resident notes the infant has scleral icterus and jaundiced skin. The scalp laceration noted on day 1 is intact without fluctuance or surrounding erythema. When the infant is slightly lifted from the bed and released, she spread out her arms, pulls them in, and exhibits a strong cry. Labs are drawn as shown below: Blood type: AB- Total bilirubin 8.7 mg/dL Direct bilirubin 0.5 mg/dL Six hours later, repeat total bilirubin is 8.3 mg/dL. Which of the following is the next best step in the management of the baby’s condition?? {'A': 'Coombs test', 'B': 'Exchange transfusion', 'C': 'Switch to baby formula', 'D': 'Observation', 'E': 'Phototherapy'},
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D: Observation
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Answer the following medical question with one of the provided options:
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Q:An autopsy of a 75-year-old man reveals obliterating endarteritis of the vasa vasorum of the aorta. Which of the following investigations will most likely be positive in this patient?? {'A': 'Perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA)', 'B': 'Increased double-stranded (ds) DNA titer', 'C': 'Increased ketonuria', 'D': 'Increased serum creatinine', 'E': 'Rapid plasma reagin (RPR)'},
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E: Rapid plasma reagin (RPR)
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old woman comes to the physician for a routine examination prior to starting a new job as a nurse. Over the past year, the patient has had mild shortness of breath and a cough productive of white sputum, particularly in the morning. She immigrated to the United States from South Africa with her parents 40 years ago. She received all appropriate immunizations during childhood, including the oral polio and BCG vaccine. She has smoked two packs of cigarettes daily for 30 years and drinks one glass of wine occasionally. Her only medication is a multivitamin. Her temperature is 36.5°C (97.7°F), pulse is 74/min, and blood pressure is 124/60 mm Hg. Bilateral wheezing is heard throughout both lung fields. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Which of the following is the most appropriate next step to evaluate for tuberculosis in this patient?? {'A': 'Tuberculin skin test', 'B': 'Sputum culture', 'C': 'X-ray of the chest', 'D': 'PCR of the sputum', 'E': 'Interferon-gamma release assay'},
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E: Interferon-gamma release assay
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old G1P0000 presents for her first obstetric visit and is found to be at approximately 8 weeks gestation. She has no complaints aside from increased fatigue and occasional nausea. The patient is a recent immigrant from Africa and is currently working as a babysitter for several neighborhood children. One of them recently had the flu, and another is home sick with chickenpox. The patient has no immunization records and does not recall if she has had any vaccinations. She is sexually active with only her husband, has never had a sexually transmitted disease, and denies intravenous drug use. Her husband has no past medical history. Exam at this visit is unremarkable. Her temperature is 98.7°F (37.1°C), blood pressure is 122/76 mmHg, pulse is 66/min, and respirations are 12/min. Which of the following immunizations should this patient receive at this time?? {'A': 'Intranasal flu vaccine', 'B': 'Tetanus/Diphtheria/Pertussis vaccine', 'C': 'Hepatitis B vaccine', 'D': 'Varicella vaccine', 'E': 'Intramuscular flu vaccine'},
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E: Intramuscular flu vaccine
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Answer the following medical question with one of the provided options:
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Q:A 54-year-old man is brought to the emergency department by his wife because of progressive nausea, vomiting, and right-sided flank pain for 2 days. The pain is colicky and radiates to the groin. He has a history of gout and type 2 diabetes mellitus. Current medications are metformin and allopurinol. He recently began taking large amounts of a multivitamin supplement after he read on the internet that it may help to prevent gout attacks. Physical examination shows right-sided costovertebral angle tenderness. Oral examination shows dental erosions. A CT scan of the abdomen shows an 8-mm stone in the right proximal ureter. Microscopic examination of a urine sample shows bipyramidal, envelope-shaped crystals. An increased serum concentration of which of the following is the most likely cause of this patient’s symptoms?? {'A': 'Vitamin A', 'B': 'Vitamin B3', 'C': 'Vitamin E', 'D': 'Vitamin C', 'E': 'Uric acid'},
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D: Vitamin C
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old man comes to the physician because of decreased hearing in his right ear for the past 4 months. During this period, he has also had multiple episodes of dizziness and a constant ringing noise in his right ear. Over the past 5 weeks, he has also noticed scant amounts of right-sided ear discharge. He has a history of multiple ear infections since childhood that were treated with antibiotics. Vital signs are within normal limits. Otoscopic examination shows a white pearly mass behind the right tympanic membrane. Placing a 512 Hz tuning fork in the center of the forehead shows lateralization to the right ear. Which of the following is the most appropriate therapy for this patient's symptoms?? {'A': 'Topical ciprofloxacin', 'B': 'Radiation therapy', 'C': 'Systemic corticosteroids', 'D': 'Fitting for hearing aids', 'E': 'Surgical excision'},
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E: Surgical excision
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Answer the following medical question with one of the provided options:
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Q:A 73-year-old woman presents to the emergency department with diffuse abdominal pain, nausea, and vomiting. Her daughter who accompanies her says she was in her usual state of health until two days ago when she started to complain of abdominal pain and was unable to tolerate oral intake. She has hypertension, congestive heart failure, atrial fibrillation, and osteoarthritis. She underwent an exploratory laparotomy for an ovarian mass a year ago where a mucinous cystadenoma was excised. Her medications include aspirin, nifedipine, lisinopril, metoprolol, warfarin, and Tylenol as needed for pain. She does not drink alcohol or smoke cigarettes. She appears ill and disoriented. Her temperature is 37.9°C (100.3°F), blood pressure is 102/60 mm Hg, pulse is 110/min and irregular, and respirations are 16/min. Examination shows diffuse tenderness to palpation of the abdomen. The abdomen is tympanitic on percussion. Bowel sounds are hyperactive. The lungs are clear to auscultation bilaterally. There is a soft crescendo-decrescendo murmur best auscultated in the right second intercostal space. Laboratory studies show: Hemoglobin 10.2 g/dL Leukocyte count 14,000/mm3 Platelet count 130,000/mm3 Prothrombin time 38 seconds INR 3.2 Serum Na+ 132 mEq/dL K+ 3.6 mEq/dL Cl- 102 mEq/dL HCO3- 19 mEq/dL Urea nitrogen 36 mg/dl Creatinine 2.3 mg/dL Lactate 2.8 mEq/dL (N= 0.5-2.2 mEq/dL) An x-ray of the abdomen shows multiple centrally located dilated loops of gas filled bowel. There is no free air under the diaphragm. A nasogastric tube is inserted and IV fluids and empiric antibiotic therapy are started. Emergent exploratory laparotomy is planned. Which of the following is the next best step in management?"? {'A': 'Administer unfractionated heparin', 'B': 'Administer protamine sulfate', 'C': 'Administer fresh frozen plasma and Vitamin K', 'D': 'Administer platelet concentrate', 'E': 'Administer recombinant activated factor VII'},
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C: Administer fresh frozen plasma and Vitamin K
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Answer the following medical question with one of the provided options:
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Q:You are asked to examine a 1-year-old child brought to the emergency department by his sister. The sister reports that the child has been acting strangely since that morning after "getting in trouble" for crying. The child appears lethargic and confused and is noted to have a cigarette burn on his forearm. Emergency head CT reveals a subdural hematoma. Which of the following additional findings is most likely?? {'A': 'Posterior rib fracture', 'B': 'Bilateral retinal hemorrhages', 'C': 'Skull fracture', 'D': 'Burns to buttocks', 'E': 'Epidural hematoma'},
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B: Bilateral retinal hemorrhages
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Answer the following medical question with one of the provided options:
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Q:Paramedics respond to a call regarding an 18-year-old male with severe sudden-onset heart palpitations. The patient reports symptoms of chest pain, fatigue, and dizziness. Upon examination, his heart rate is 175/min and regular. His blood pressure is 110/75 mm Hg. Gentle massage below the level of the left mandible elicits an immediate improvement in the patient, as his heart rate returns to 70/min. What was the mechanism of action of this maneuver?? {'A': 'Increasing the refractory period in ventricular myocytes', 'B': 'Increasing sympathetic tone in systemic arteries', 'C': 'Decreasing the length of phase 4 of the SA node myocytes', 'D': 'Slowing conduction in the AV node', 'E': 'Decreasing the firing rate of carotid baroreceptors'},
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D: Slowing conduction in the AV node
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old female visits her primary care physician with 2+ pitting edema in her legs. She takes no medications and does not use alcohol, tobacco, or illicit drugs. 4.5 grams of protein are collected during 24-hour urine excretion. A kidney biopsy is obtained. Examination with light microscopy shows diffuse thickening of the glomerular basement membrane. Electron microscopy shows subepithelial spike and dome deposits. Which of the following is the most likely diagnosis:? {'A': 'Minimal change disease', 'B': 'Postinfectious glomerulonephritis', 'C': 'Focal segmental glomerulosclerosis', 'D': 'Rapidly progressive glomerulonephritis', 'E': 'Membranous nephropathy'},
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E: Membranous nephropathy
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman, gravida 1, para 0, at 10 weeks' gestation comes to the physician for her initial prenatal visit. She has no history of serious illness, but reports that she is allergic to penicillin. Vital signs are within normal limits. The lungs are clear to auscultation, and cardiac examination shows no abnormalities. Transvaginal ultrasonography shows an intrauterine pregnancy with no abnormalities. The fetal heart rate is 174/min. Routine prenatal laboratory tests are drawn. Rapid plasma reagin (RPR) test is 1:128 and fluorescent treponemal antibody absorption test (FTA-ABS) is positive. Which of the following is the most appropriate next step in management?? {'A': 'Administer therapeutic dose of intramuscular penicillin G', 'B': 'Administer intravenous ceftriaxone', 'C': 'Administer penicillin desensitization dose', 'D': 'Administer oral azithromycin', 'E': 'Perform oral penicillin challenge test'},
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C: Administer penicillin desensitization dose
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old man is brought to the emergency room by police after being found passed out on the sidewalk. He is intermittently alert and smells strongly of alcohol. He is unable to provide a history, but an electronic medical record search reveals that the patient has a history of alcohol abuse and was seen in the emergency room twice in the past year for alcohol intoxication. Further review of the medical record reveals that he works as a day laborer on a farm. His temperature is 98.8°F (37.1°C), blood pressure is 122/78 mmHg, pulse is 102/min, and respirations are 14/min. On examination, he is somnolent but arousable. He has vomitus on his shirt. He is given intravenous fluids and provided with supportive care. He vomits twice more and is discharged 6 hours later. However, 6 days after discharge, he presents to the emergency room again complaining of shortness of breath and fever. His temperature is 102°F (38.9°C), blood pressure is 100/58 mmHg, pulse is 116/min, and respirations are 24/min. The patient is actively coughing up foul-smelling purulent sputum. Which of the following is the most likely cause of this patient’s current symptoms?? {'A': 'Bacteroides melaninogenicus', 'B': 'Coxiella burnetii', 'C': 'Francisella tularensis', 'D': 'Legionella pneumonphila', 'E': 'Mycoplasma pneumoniae'},
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A: Bacteroides melaninogenicus
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman who resides in an area endemic for chloroquine-resistant P. falciparum malaria presents to the physician with fatigue, malaise, and episodes of fever with chills over the last 5 days. She mentions that she has episodes of shivering and chills on alternate days that last for approximately 2 hours, followed by high-grade fevers; then she has profuse sweating and her body temperature returns to normal. She also mentions that she is currently in her 7th week of pregnancy. The physical examination reveals the presence of mild splenomegaly. A peripheral blood smear confirms the diagnosis of P. falciparum infection. Which of the following is the most appropriate anti-malarial treatment for the woman?? {'A': 'Mefloquine only', 'B': 'Chloroquine phosphate plus primaquine', 'C': 'Quinine sulfate plus clindamycin', 'D': 'Quinine sulfate plus doxycycline', 'E': 'Quinine sulfate plus sulfadoxine-pyrimethamine'},
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C: Quinine sulfate plus clindamycin
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy presents to your office for a routine well-child visit. Upon physical examination, he is found to have a harsh-sounding, holosystolic murmur that is best appreciated at the left sternal border. The murmur becomes louder when you ask him to make fists with his hands. Which of the following is the most likely explanation for these findings?? {'A': 'Aortic stenosis', 'B': 'Tricuspid atresia', 'C': 'Pulmonary hypertension', 'D': 'Ventricular septal defect', 'E': 'Left ventricular hypertrophy'},
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D: Ventricular septal defect
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old woman, gravida 5, para 5, comes to the physician for the evaluation of decreased sexual desire for approximately 6 months. She has been sexually active with her husband but reports that she has no desire in having sexual intercourse anymore. She states that she feels guilty and is worried about losing her husband if this problem goes on for a longer period of time. She also reports that they have had several fights recently due to financial problems. She has problems going to sleep and wakes up often, and is tired throughout the day. One year ago, the patient underwent hysterectomy with bilateral salpingo-oophorectomy due to uterine prolapse. Her last menstrual period was 2 years ago. She does not smoke. She drinks 3–4 glasses of wine daily. Vital signs are within normal limits. Physical examination shows no abnormalities except for an enlarged liver. Which of the following most likely explains this patient's loss of libido?? {'A': 'Chronic alcohol intake', 'B': 'Major depressive disorder', 'C': 'Decreased testosterone', 'D': 'Elevated prolactin', 'E': 'Stress'},
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C: Decreased testosterone
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old previously healthy woman presents to the emergency room with right leg pain and difficulty breathing. She recently returned from a trip to Alaska and noticed her leg started to swell when she got home. Her medications include a multivitamin and oral contraceptives. She is diagnosed with a deep venous thrombosis complicated by a pulmonary embolism and started on anticoagulation. She remains stable and is discharged on the third hospital day with long-term anticoagulation. During the 2 month follow-up visit, the patient’s lab results are as follows: Hemoglobin: 14 g/dL Hematocrit: 44% Leukocyte count: 5,000/mm^3 with normal differential Platelet count: 300,000/mm^3 Prothrombin time: 23 seconds Partial thromboplastin time (activated): 20 seconds Bleeding time: 4 minutes Which of the following factors is initially activated in the target pathway for her long-term treatment?? {'A': 'II', 'B': 'V', 'C': 'VII', 'D': 'IX', 'E': 'X'},
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C: VII
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents to the emergency department after fainting at his investment banking office. He states that he has experienced intermittent headaches since high school, but has never fainted. He reports eating multiple small meals regularly throughout the day. He further notes that multiple family members have frequently complained about headaches. Physical exam reveals a well-nourished, well-built, afebrile man with BP 170/80, HR 55, RR 10. Chemistries reveal Na 147, K 3, Cl 110, HCO3 30, BUN 25, Cr 1.1, glucose 120. A biopsy of the tissue most likely at issue in this patient will reveal the most abnormal cellular amounts of which of the following?? {'A': 'rough endoplasmic reticulum', 'B': 'lysosome', 'C': 'peroxisome', 'D': 'smooth endoplasmic reticulum', 'E': 'beta-adrenergic receptor'},
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D: smooth endoplasmic reticulum
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Answer the following medical question with one of the provided options:
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Q:A 43-year-old man presents to the emergency department with nausea and vomiting. He says symptoms onset 4 hours ago and is progressively worsening. He denies any hematemesis. Past medical history is significant for a recent negative screening colonoscopy that was performed due to a family history of colon cancer. His vital signs are significant for a temperature of 39.5°C (103.1°F). Physical examination is unremarkable. A contrast CT of the abdomen reveals a colonic perforation. Laboratory findings are significant for an elevated WBC count with a predominant left shift, a decreased platelet count, increased PT and PTT, slightly decreased hemoglobin/hematocrit, and prolonged bleeding time. Which of the following is most closely related to this patient’s prolonged bleeding time?? {'A': 'GpIIb/IIIa', 'B': 'Vitamin K', 'C': 'Fibrinogen', 'D': 'COX-1 and COX-2', 'E': 'Giant platelets'},
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C: Fibrinogen
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Answer the following medical question with one of the provided options:
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Q:A group of investigators is evaluating the diagnostic properties of a new blood test that uses two serum biomarkers, dityrosine and Nε-carboxymethyl-lysine, for the clinical diagnosis of autism spectrum disorder (ASD) in children. The test is considered positive only if both markers are found in the serum. 50 children who have been diagnosed with ASD based on established clinical criteria and 50 children without the disorder undergo testing. The results show: Diagnosis of ASD No diagnosis of ASD Test positive 45 15 Test negative 5 35 Which of the following is the specificity of this new test?"? {'A': '30%', 'B': '10%', 'C': '88%', 'D': '70%', 'E': '90%'},
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D: 70%
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man is brought to the local emergency room in severe respiratory distress. The patient is an industrial chemist and was working in his lab with a new partner when a massive chemical spill occurred releasing fumes into their workspace. The patient and his lab partner attempted to clean up the spill before they realized it was too large for them to handle. They were not wearing protective equipment at the time, except for a pair of goggles. The fumes caused them both to begin coughing; however, this patient has a history significant for asthma. His condition worsened, which prompted lab management to call for an ambulance. On arrival at the emergency room, the patient’s respiratory rate is 42/min and oxygen saturation is 96% on room air. He is unable to speak on account of his coughing. He is clearly using accessory muscles with inspiration. A pulmonary exam reveals bilateral wheezes. He is given multiple nebulizer treatments of albuterol and is started on intravenous (IV) methylprednisolone. After 2 successive nebulizer treatments, the arterial blood gas test result shows pH 7.36, partial pressure of carbon dioxide (PCO2) 41 mm Hg, and partial pressure of oxygen (PO2) 79 mm Hg. He is now able to speak and the respiratory rate is 32/min. Which of the following is the best next step in this patient’s management?? {'A': 'Administer IV epinephrine', 'B': 'Administer IV prednisone in addition to IV methylprednisolone', 'C': 'Continue to administer albuterol', 'D': 'Switch from nebulized albuterol to nebulized ipratropium', 'E': 'Intubate the patient and begin mechanical ventilation'},
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C: Continue to administer albuterol
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Answer the following medical question with one of the provided options:
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Q:Blood cultures are sent to the laboratory. Antibiotic treatment is started. Blood cultures confirm an infection with methicillin-susceptible Staphylococcus epidermidis. Which of the following is the most appropriate next step in management?? {'A': 'Oral penicillin V + gentamicin for 4 weeks', 'B': 'Intravenous ampicillin + rifampin + ceftriaxone for 2 weeks', 'C': 'Oral gentamicin + ceftriaxone for 4 weeks', 'D': 'Oral amoxicillin for 6 weeks', 'E': 'Intravenous nafcillin + rifampin for 6 weeks + gentamicin for 2 weeks'},
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E: Intravenous nafcillin + rifampin for 6 weeks + gentamicin for 2 weeks
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Answer the following medical question with one of the provided options:
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Q:A 6-week-old child is brought to his pediatrician for a physical exam and hepatitis B booster. The boy was born at 39 weeks gestation via spontaneous vaginal delivery to a 19-year-old G-1-P-1. He was previously up to date on all vaccines and is mildly delayed in some developmental milestones. His mother is especially concerned with colic, as the boy cries endlessly at night. During the conversation, the infant's mother breaks down and starts crying and complaining about how tired she is and how she has no support from her family. She admits to repeatedly striking the infant in an effort to stop his crying. On physical exam, the infant’s vitals are normal. The child appears cranky and begins to cry during the exam. The infant's backside is swollen, red, and tender to touch. Which of the following is the best response to this situation?? {'A': 'Confront the mother directly', 'B': 'Contact child protective services', 'C': 'Recommend treating the colic with a few drops of whiskey', 'D': 'Encourage the mother to take a class on parenting', 'E': 'Contact the hospital ethics committee'},
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B: Contact child protective services
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old girl presents to the emergency room with her 8-month-old daughter for evaluation of “turning blue when she cries.” The baby is found to have an atrial septal defect that is causing a left to right shunt, resulting in cyanosis and pulmonary hypertension. Surgical intervention is indicated; however, the mother wants to go to another hospital for a second opinion. Which of the following is the most appropriate next course of action?? {'A': "Consult the mother's parents because she is a minor.", 'B': 'Contact child protective services.', 'C': 'Perform the surgery.', 'D': 'Allow the mother to take the patient for a second opinion.', 'E': 'Obtain a court order to perform the surgery.'},
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D: Allow the mother to take the patient for a second opinion.
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man presents to the outpatient clinic with a swollen and painful toe. The pain intensity increased further after he went to a party last night. Which of the following is the drug of choice for the treatment of this patient's condition?? {'A': 'Aspirin', 'B': 'Probenecid', 'C': 'Rasburicase', 'D': 'Indomethacin', 'E': 'Allopurinol'},
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D: Indomethacin
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman, gravida 2, para 1, at 40 weeks' gestation is admitted to the hospital in active labor. Pregnancy has been complicated by iron deficiency anemia, which was treated with iron supplements. Her first pregnancy and vaginal delivery were uncomplicated. There is no personal or family history of serious illness. Her pulse is 90/min, respirations are 15/min, and blood pressure is 130/80 mm Hg. The abdomen is nontender and contractions are felt. Ultrasonography shows that the fetal long axis is at a right angle compared to the long axis of the maternal uterus. The fetal heart rate is 140/min and is reactive with no decelerations. Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Administration of oxytocin and normal vaginal birth', 'B': 'Vacuum-assisted delivery', 'C': 'Lateral positioning of the mother', 'D': 'Cesarean section', 'E': 'External cephalic version'},
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D: Cesarean section
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Answer the following medical question with one of the provided options:
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Q:A scientist is studying the process by which innate immune cells are able to respond to damage and pathogen infiltration. Specifically, she examines patients with an immunodeficiency where they are unable to respond to local infections. She notices that these patients do not produce pustulant fluid and do not have recruitment of immune cells in the first several hours of inflammation. Examining neutrophils within these patients reveals that they are able to slow their movement in a flow chamber by loosely attaching to purified vessel tissues. Subsequently, she shows that the neutrophils attach tightly to these vessel walls and move across the walls to the other side. Finally, when different levels of pathogenic proteins are placed on two sides of a purified vessel wall, the neutrophils from this patient do not exhibit a preference between the two sides. The step of neutrophil recruitment that is most likely defective in this patient involves which of the following mediators?? {'A': 'C5a', 'B': 'Integrins', 'C': 'ICAM proteins', 'D': 'Nitric oxide', 'E': 'Selectins'},
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A: C5a
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Answer the following medical question with one of the provided options:
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Q:A 1-month-old boy is brought to the physician because of a 5-day history of generalized fatigue and multiple episodes of vomiting which is most pronounced after formula feeding. His vomiting progressed from 2–3 episodes on the first day to 6–8 episodes at present. The vomitus is whitish in color. The mother reports that he has been very hungry after each episode of vomiting. The patient was born at 38 weeks' gestation and weighed 3100 g (6 lb 13 oz); he currently weighs 3500 g (7 lb 11 oz). He appears irritable. His temperature is 37.1°C (98.8°F), pulse is 130/min, respirations are 43/min, and blood pressure is 74/36 mm Hg. Examination shows dry mucous membranes. The abdomen is soft and not distended. There is a round mass palpable in the epigastric region. The liver is palpated 1 cm below the right costal margin. Laboratory studies show: Hemoglobin 15.3 g/dL Leukocyte count 6300/mm3 Platelet count 230,000/mm3 Serum Na+ 133 mEq/L K+ 3.4 mEq/L Cl- 92 mEq/L Glucose 77 mg/dL Creatinine 1.0 mg/dL A urinalysis shows a decreased pH. Which of the following is the most appropriate next step in the management of this patient?"? {'A': 'Administer IV 0.9% NaCl and replace electrolytes', 'B': 'Perform emergency pyloromyotomy', 'C': 'Perform upper GI endoscopy', 'D': 'Obtain CT scan of the abdomen with contrast', 'E': 'Measure serum cortisol levels'},
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A: Administer IV 0.9% NaCl and replace electrolytes
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Answer the following medical question with one of the provided options:
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Q:In order to study the association between coffee drinking and the subsequent development of lung cancer, a group of researchers decides to carry out a multicentric case-control study with a large number of participants–800 with a diagnosis of lung cancer, and 800 as age-adjusted controls. According to the results outlined in table 1 (below), 80% of those with lung cancer were regular coffee drinkers, resulting in an odds ratio of 23. Lung cancer present Lung cancer absent Coffee drinking 640 120 No coffee drinking 160 680 Table: Contingency table of coffee drinking in relation to the presence of lung cancer The researchers concluded from this that regular consumption of coffee is strongly linked to the development of lung cancer. Which of the following systematic errors did they not take into account?? {'A': 'Observer bias', 'B': 'Selection bias', 'C': 'Confounding bias', 'D': 'Attrition bias', 'E': 'Information bias'},
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C: Confounding bias
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Answer the following medical question with one of the provided options:
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Q:A 48-hour-old newborn presents in respiratory distress. He is gasping for breath in the neonatal intensive care unit (NICU) and has had a fever for the past 2 days with a temperature ranging between 37.2°C (99.0°F) and 38.6°C (101.5°F). He also has not been feeding well and seems to be lethargic. The patient was delivered normally at 36 weeks of gestation. His mother had a premature rupture of membranes, which occurred with her last pregnancy, as well. No history of infection during pregnancy. On physical examination, a bulging anterior fontanelle is noticed, along with tensing of the extensor muscles. A lumbar puncture is performed, and CSF analysis is pending. Which of the following would be the best course of treatment in this patient?? {'A': 'Ampicillin and gentamicin', 'B': 'Ampicillin and cefotaxime', 'C': 'Ampicillin and acyclovir', 'D': 'Ampicillin and ticarcillin', 'E': 'Ampicillin and sulbactam'},
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A: Ampicillin and gentamicin
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Answer the following medical question with one of the provided options:
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Q:A 8-year-old boy is brought to the clinic by his father for an annual well-check. His dad reports that he has been “difficult to handle” as he would not listen and follow instructions at home. “Telling him to sit still and do something is just so hard,” the father says. His teacher also reports difficulties in the classroom where the child would talk out of turn and interrupt the class intermittently by doing something else. His grades have been suffering as a result. Otherwise, the patient has been healthy and up to date on his immunizations. What is the best course of management for this patient?? {'A': 'Family therapy', 'B': 'Haloperidol', 'C': 'Methylphenidate', 'D': 'Psychodynamic therapy', 'E': 'Reassurance'},
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C: Methylphenidate
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Q:A previously healthy 30-year-old woman comes to the physician because of a 3-month history of progressive shortness of breath and nonproductive cough. She also complains of constipation and fatigue during the same time period. She has not traveled recently or been exposed to any sick contacts. Physical examination shows injected conjunctivae and tender, erythematous nodules on both shins. The lungs are clear to auscultation. An x-ray of the chest is shown. Which of the following additional findings is most likely in this patient?? {'A': 'Positive interferon-gamma release assay', 'B': 'Low serum angiotensin-converting enzyme levels', 'C': 'Elevated serum parathyroid hormone levels', 'D': 'Low serum CD4+ T-cell count', 'E': 'Positive anti-dsDNA antibody testing'},
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D: Low serum CD4+ T-cell count
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Q:A 29-year-old female reports having a positive home pregnancy test result 9 weeks ago. She presents today with vaginal bleeding and complains of recent onset abdominal pain. Ultrasound of the patient’s uterus is included as Image A. Subsequent histologic analysis (Image B) reveals regions of both normal as well as enlarged trophoblastic villi. Which of the following is the most likely karyotype associated with this pregnancy?? {'A': '46 XX, both of maternal origin', 'B': '46 XY, both of paternal origin', 'C': '69 XXY', 'D': '47 XXY', 'E': '45 XO'},
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C: 69 XXY
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Q:A mother brings her infant for a regular well-child check-up with the pediatrician. During the routine developmental examination, the physician notes that the child is looking at him with his head lifted upwards when he is about to pick up the child from the table. At what age is it common to begin to observe this finding in a child, assuming that the child is developmentally normal?? {'A': '4 months', 'B': '2 months', 'C': '6 months', 'D': '9 months', 'E': '12 months'},
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B: 2 months
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Q:A 55-year-old man comes to the physician because of a 2-month history of headaches, facial numbness, recurrent epistaxis, and a 5-kg (11-lb) weight loss. He recently immigrated from Hong Kong. Examination shows right-sided cervical lymphadenopathy. Endoscopy shows an exophytic nasopharyngeal mass. Histologic examination of a biopsy specimen of the mass shows sheets of undifferentiated cells with nuclear pleomorphism and abundant mitotic figures. The patient most likely acquired the causal pathogen of his nasopharyngeal mass via which of the following routes of transmission?? {'A': 'Sexual contact', 'B': 'Tick bite', 'C': 'Transfer of saliva', 'D': 'Fecal-oral', 'E': 'Mother to baby'},
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C: Transfer of saliva
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Q:An 8-year-old boy is brought to the physician by his parents for blurry vision for the past 2 months. He is at the 97th percentile for height and 25th percentile for weight. Physical examination shows joint hypermobility, a high-arched palate, and abnormally long, slender fingers and toes. Slit lamp examination shows superotemporal lens subluxation bilaterally. This patient's findings are most likely caused by a defect in which of the following structural proteins?? {'A': 'Laminin', 'B': 'Type III collagen', 'C': 'Fibrillin', 'D': 'Type I collagen', 'E': 'Keratin'},
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C: Fibrillin
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Q:A 70-year-old man presents to a medical office with painful micturition for 2 weeks. He denies any other symptoms. The past medical history is unremarkable. He has been a smoker most of his life, smoking approx. 1 pack of cigarettes every day. The physical examination is benign. A urinalysis shows an abundance of red blood cells. A cystoscopy is performed, which reveals a slightly erythematous area measuring 1.5 x 1 cm on the bladder mucosa. A biopsy is obtained and microscopic evaluation shows cells with an increased nuclear: cytoplasmic ratio and marked hyperchromatism involving the full thickness of the epithelium, but above the basement membrane. Which of the following best describes the biopsy findings?? {'A': 'Reactive atypia', 'B': 'Microinvasion', 'C': 'Urothelial metaplasia', 'D': 'Urothelial carcinoma-in-situ', 'E': 'Urothelial hyperplasia'},
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D: Urothelial carcinoma-in-situ
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Q:A 13-year-old girl is brought to the physician by her father because of a 1-month history of pain in her right knee. She is a competitive volleyball player and has missed several games recently due to pain. Examination shows swelling distal to the right knee joint on the anterior surface of the proximal tibia; there is no overlying warmth or deformity. Extension of the right knee against resistance is painful. Which of the following structures is attached to the affected anterior tibial area?? {'A': 'Anterior cruciate ligament', 'B': 'Patellar ligament', 'C': 'Quadriceps tendon', 'D': 'Iliotibial band', 'E': 'Pes anserinus tendon'},
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B: Patellar ligament
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Q:A 51-year-old woman presents the following significant and unintentional weight loss. She denies any personal history of blood clots in her past, but she says that her mother has also had to be treated for pulmonary embolism in the recent past. She also mentions that she had been struggling with her weight, so she was initially content with losing the weight, but her daughter convinced her to come to the office to be checked out. Her past medical history is significant for preeclampsia, hypertension, polycystic ovarian syndrome, and hypercholesterolemia. She currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and she currently denies any illicit drug use, although she has a remote past of injection drug use with heroin. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 111/min and irregular, and respiratory rate 17/min. On physical examination, her pulses are bounding and complexion is pale, but breath sounds remain clear. Oxygen saturation was initially 91% on room air and electrocardiogram (ECG) showed atrial fibrillation. Upon further discussion with the patient, her physician discovers that she is having some cognitive difficulty. Her leukocyte count is elevated to 128,000/mm3, and she has elevated lactate dehydrogenase (LDH), uric acid, and B-12 levels. A BCR-ABL translocation is present, as evidenced by the Philadelphia chromosome. What is the most likely diagnosis for this patient?? {'A': 'Acute lymphocytic leukemia', 'B': 'Acute myelogenous leukemia', 'C': 'Chronic lymphocytic leukemia', 'D': 'Chronic myelogenous leukemia', 'E': 'Hairy cell leukemia'},
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D: Chronic myelogenous leukemia
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Q:A 75-year-old man presents to the physician with a complaint of persistent back pain. The patient states that the pain has been constant and occurs throughout the day. He says that he has also been experiencing greater fatigue when carrying out his daily activities. On review of systems, the patient notes that he lost more than 10 pounds in the past month despite maintaining his usual diet and exercising less often due to his fatigue. Physical exam is notable for a systolic murmur at the right sternal border, mild crackles at the bases of both lungs, and tenderness to palpation of his lumbar spine. Laboratory values are below: Serum: Na+: 141 mEq/L Cl-: 101 mEq/L K+: 4.2 mEq/L HCO3-: 23 mEq/L BUN: 20 mg/dL Glucose: 101 mg/dL Creatinine: 1.6 mg/dL Ca2+: 12.8 mg/dL A peripheral blood smear is ordered for the patient’s work-up. Which of the following would be the most likely finding on peripheral blood smear?? {'A': 'Atypical lymphocytes', 'B': 'Echinocytes', 'C': 'Rouleaux formation', 'D': 'Schistocytes', 'E': 'Target cells'},
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C: Rouleaux formation
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Q:An 8-year-old girl is brought into your clinic with a 5 day history of decreased oral intake, body aches and lymphadenopathy. She has no significant medical history. Upon further questioning you find that the patient frequently plays outside, where she enjoys chasing the neighborhood cats and dogs. She has had no recent sick contacts or travel to foreign countries. The patients vital signs are: temperature 100.4F, HR 80, BP 105/75 and RR 15. Physical exam is significant for a 1-cm erythematous and tender lymph node in the right posterior cervical area (Figure 1). There is a nearly healed scratch in the right occipital region. What is the most likely diagnosis for this patient?? {'A': 'Acute lymphoblastic leukemia (ALL)', 'B': 'Extrapulmonary tuberculosis', 'C': 'Toxoplasmosis gandii infection', 'D': 'Bartonella henselae infection', 'E': 'Staphlococcal aureus adenitis'},
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D: Bartonella henselae infection
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Q:A 28-year-old G2P1 female with a history of hypertension presents to the emergency room at 33 weeks with headache and blurry vision. On exam, her vitals include BP 186/102 mmHg, HR 102 beats per minute, RR 15 breaths per minute, and T 98.9 degrees Fahrenheit. She undergoes an immediate Caesarian section, and although she is noted to have large-volume blood loss during the procedure, the remainder of her hospital course is without complications. Four weeks later, the patient returns to her physician and notes that she has had blurry vision and has not been able to lactate. A prolactin level is found to be 10 ng/mL (normal: 100 ng/mL). Which of the following is the most appropriate next step?? {'A': 'Galactogram', 'B': 'Observation of maternal-child interactions', 'C': 'Brain MRI', 'D': 'Head CT', 'E': 'Breast ultrasound'},
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C: Brain MRI
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Q:A female child presents to her pediatrician for a well child visit. Her mother reports that she is eating well at home and sleeping well throughout the night. She can jump and walk up and down stairs with both feet on each step. In the doctor’s office, the patient builds a six-cube tower and imitates a circle. She seems to have a vocabulary of over 50 words that she uses in two-word sentences. Her mother reports that the patient enjoys playing near other children and sometimes argues over toys with her older brother. On physical exam, she appears well developed and well nourished, and she is following along her growth curves. The child is assessed as developmentally normal. Which of the following is an additional milestone associated with this child’s age?? {'A': 'Balances on one foot', 'B': 'Cuts with scissors', 'C': 'Follows two-step commands', 'D': 'Points to one body part', 'E': 'Turns pages in book'},
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C: Follows two-step commands
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Q:A 51-year-old woman comes to the emergency department because of a 1-day history of severe pain in her left knee. To lose weight, she recently started jogging for 30 minutes a few times per week. She has type 2 diabetes mellitus and hypertension treated with metformin and chlorothiazide. Her sister has rheumatoid arthritis. She is sexually active with two partners and uses condoms inconsistently. On examination, her temperature is 38.5°C (101.3°F), pulse is 88/min, and blood pressure is 138/87 mm Hg. The left knee is swollen and tender to palpation with a significantly impaired range of motion. A 1.5-cm, painless ulcer is seen on the plantar surface of the left foot. Which of the following is most likely to help establish the diagnosis?? {'A': 'Perform MRI of the knee', 'B': 'Perform arthrocentesis', 'C': 'Measure HLA-B27', 'D': 'Measure rheumatoid factor', 'E': 'Perform ultrasonography of the knee'},
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B: Perform arthrocentesis
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Q:A 25-year-old man comes to the physician with intermittent bloody diarrhea over the past 2 months. He has occasional abdominal pain. His symptoms have not improved over this time. He has no history of a serious illness and takes no medications. His blood pressure is 110/70 mm Hg, pulse is 75/min, respirations are 14/min, and temperature is 37.8°C (100.0°F). Deep palpation of the abdomen shows mild tenderness in the right lower quadrant. Colonoscopy shows diffuse erythema with a sandpaper pattern involving the rectosigmoid and descending colon, with normal mucosa of the rest of the colon. Biopsy shows involvement of the mucosal and submucosal layers with distortion of crypt architecture and crypt abscess formation. This patient is most likely to develop which of the following hepatobiliary diseases?? {'A': 'Cholangiocarcinoma', 'B': 'Cholelithiasis', 'C': 'Hepatocellular carcinoma', 'D': 'Primary biliary cirrhosis', 'E': 'Primary sclerosing cholangitis'},
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E: Primary sclerosing cholangitis
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Q:A 48-year-old woman presents to her primary care physician with the complaints of persistent fatigue, dizziness, and weight loss for the past 3 months. She has hypothyroidism for 15 years and takes thyroxine replacement. Her blood pressure is 90/60 mm Hg in a supine position and 65/40 mm Hg while sitting, temperature is 36.8°C (98.2°F) and pulse is 75/min. On physical examination, there is a mild increase in thyroid size, with a rubbery consistency. Her skin shows diffuse hyperpigmentation, more pronounced in the oral mucosa and palmar creases. The morning serum cortisol test is found to be 3 µg/dL. Which of the following is the best next step in this case?? {'A': 'Serum adrenocorticotropic hormone (ACTH)', 'B': 'Plasma aldosterone', 'C': 'Adrenocorticotropic hormone (ACTH) stimulation test', 'D': 'Adrenal imaging', 'E': '21-hydroxylase antibodies'},
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C: Adrenocorticotropic hormone (ACTH) stimulation test
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Q:A 17-year-old girl comes to your outpatient clinic. She is sexually active with multiple partners and requests a prescription for oral contraceptive pills. A urine pregnancy test in your office is negative. Which of the following is the most appropriate next step?? {'A': "Contact the patient's parents to obtain consent", 'B': 'Recommend sexually-transmitted infection screening and provide the requested prescription', 'C': 'Refer the patient for counseling and recommend sexually-transmitted infection screening', 'D': 'Perform urine drug screen', 'E': 'Advise against oral contraceptive medications and recommend condom use instead'},
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B: Recommend sexually-transmitted infection screening and provide the requested prescription
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Q:A newborn infant presents with severe weakness. He was born to a G1P1 mother at 40 weeks gestation with the pregnancy attended by a midwife. The mother's past medical history is unremarkable. She took a prenatal vitamin and folic acid throughout the pregnancy. Since birth, the child has had trouble breastfeeding despite proper counseling. He also has had poor muscle tone and a weak cry. His temperature is 99.5°F (37.5°C), blood pressure is 57/38 mmHg, pulse is 150/min, respirations are 37/min, and oxygen saturation is 96% on room air. Physical exam reveals poor muscle tone. The patient's sucking reflex is weak, and an enlarged tongue is noted. An ultrasound is performed, and is notable for hypertrophy of the myocardium. Which of the following is the most likely diagnosis?? {'A': 'Acid maltase deficiency', 'B': 'Clostridium botulinum infection', 'C': 'Clostridium tetani infection', 'D': 'Familial hypertrophic cardiomyopathy', 'E': 'Spinal muscular atrophy type I disease'},
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A: Acid maltase deficiency
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Q:A 2-week-old infant is brought to the emergency room because of 4 episodes of bilious vomiting and inconsolable crying for the past 3 hours. Abdominal examination shows no abnormalities. An upper GI contrast series shows the duodenojejunal junction to the right of the vertebral midline; an air-filled cecum is noted in the right upper quadrant. Which of the following is the most likely cause of this patient's condition?? {'A': 'Failure of duodenal recanalization', 'B': 'Incomplete intestinal rotation', 'C': 'Arrested rotation of ventral pancreatic bud', 'D': 'Hypertrophy and hyperplasia of the pyloric sphincter', 'E': 'Resorption of a small bowel segment'},
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B: Incomplete intestinal rotation
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Q:A 43-year-old male is admitted to the hospital for a left leg cellulitis. He is being treated with clindamycin and is recovering nicely. On the second day of his admission, a nurse incorrectly administers 100 mg of metoprolol which was intended for another patient with the same last name. The error is not discovered until the next day, at which time it is clear that the patient has suffered no ill effects of the medication and is not aware that an error has occurred. What is the proper course of action of the attending physician?? {'A': 'Immediately disclose the error to the patient', 'B': 'Notify hospital administration but do not notify the patient as no ill effects occurred', 'C': 'Do not disclose the error to the patient as no ill effects occurred', 'D': 'Tell the nurse who administered the drug to notify the patient an error has occurred', 'E': "Make a note in the patient's chart an error has occurred but do not disclose the error to the patient"},
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A: Immediately disclose the error to the patient
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Q:A 42-year-old woman presents to her primary care physician with 2 weeks of abdominal pain. She says that the pain is squeezing in character and gets worse after she eats food. The pain is particularly bad after she eats dairy products so she has begun to avoid ice cream and cheese. Furthermore, she has noticed that she has been experiencing episodes of nausea associated with abdominal pain in the last 4 days. Physical exam reveals tenderness to palpation and rebound tenderness in the right upper quadrant of the abdomen. The molecule that is most likely responsible for the increased pain this patient experiences after eating fatty foods is most likely secreted by which of the following cells?? {'A': 'D cells', 'B': 'G cells', 'C': 'I cells', 'D': 'P/D1 cells', 'E': 'S cells'},
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C: I cells
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Q:A 65-year-old woman comes to clinic complaining of pain with chewing solid foods. She reports that she has been feeling unwell lately, with pains in her shoulders and hips, and she has lost five pounds in the past few months. Her vital signs are T 39C, RR 18 breaths/min, HR 95 bpm, BP 120/65 mmHg. When you ask her to stand from her chair to get on the exam table she moves stiffly but displays preserved proximal muscle strength. Another potential symptom or sign of this disease could be:? {'A': 'Violaceous rash across the eyelids', 'B': 'Blindness', 'C': 'Easily sunburned on face and hands', 'D': 'Hemoptysis', 'E': 'Thickened, tight skin on the fingers'},
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B: Blindness
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Q:An 1800-g (4.0-lb) male newborn is delivered to a 26-year-old woman, gravida 2, para 1, at 33 weeks' gestation. The Apgar scores are 7 at 1 minute and 8 at 5 minutes. The pregnancy was complicated by iron deficiency anemia. The mother has no other history of serious illness. She has smoked one-half pack of cigarettes daily for the past 10 years. She does not drink alcohol. She has never used illicit drugs. Pregnancy and delivery of her first child were complicated by placenta previa. The mother has received all appropriate immunizations. It is most appropriate for the physician to recommend which of the following to the mother regarding her son's immunizations?? {'A': 'Give first dose of hepatitis B vaccine at 3 months of chronological age', 'B': 'Give first dose of influenza vaccine at 2 months of chronological age', 'C': 'Give first dose of varicella vaccine at 2 months of chronological age', 'D': 'Give first dose of Haemophilus influenza type b vaccine at 3 months of chronological age', 'E': 'Give first dose of diphtheria and tetanus toxoids, acellular pertussis (DTaP) vaccine at 2 months of chronological age'},
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E: Give first dose of diphtheria and tetanus toxoids, acellular pertussis (DTaP) vaccine at 2 months of chronological age
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Q:One day after undergoing a right hemicolectomy for colon cancer, a 55-year-old woman has back pain and numbness and difficulty moving her legs. Her initial postoperative course was uncomplicated. Current medications include prophylactic subcutaneous heparin. Her temperature is 37.2°C (98.9°F), pulse is 100/min, respirations are 18/min, and blood pressure is 130/90 mm Hg. Examination shows a well-positioned epidural catheter site without redness or swelling. There is weakness of the lower extremities. Deep tendon reflexes are absent in both lower extremities. Perineal sensation to pinprick is decreased. Her hemoglobin concentration is 11.2 g/dL, leukocyte count is 6,000/m3, and platelet count is 215,000/mm3. Her erythrocyte sedimentation rate is 19 mm/h. A T2-weighted MRI of the spine shows a 15-cm, hyperintense, epidural space-occupying lesion compressing the spinal cord at the level of L2–L5 vertebrae. Which of the following is the most appropriate next step in treatment?? {'A': 'Observation', 'B': 'Perform surgical decompression', 'C': 'Perform CT-guided aspiration', 'D': 'Obtain lumbar puncture', 'E': 'Obtain blood cultures\n"'},
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B: Perform surgical decompression
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Q:A 10-month-old boy is brought to the physician by his mother because of a 2-day history of rhinorrhea, nasal congestion, and cough. He has been feeding normally and has not had vomiting or diarrhea. The infant was born at term via uncomplicated spontaneous vaginal delivery. Immunizations are up-to-date. Eight months ago, he was treated for a urinary tract infection. Four months ago, he had an uncomplicated upper respiratory infection. He is alert and well-appearing. His temperature is 38.4°C (101.1°F), pulse is 110/min, respirations are 32/min, and blood pressure is 90/56 mm Hg. Examination shows erythematous nasal mucosa. Scattered expiratory wheezing is heard throughout both lung fields. The remainder of the examination shows no abnormalities. An x-ray of the chest is shown. After administration of an antipyretic, which of the following is the most appropriate next step in management?? {'A': 'Provide reassurance', 'B': 'Begin oral antibiotic therapy', 'C': 'Perform PPD skin testing', 'D': 'Obtain a thoracic CT scan', 'E': 'Measure T cell count'},
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A: Provide reassurance
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Q:A 73-year-old man presents to his primary care physician with chest pain. He noticed the pain after walking several blocks, and the pain is relieved by sitting. On exam, he has a BP 155/89 mmHg, HR 79 bpm, and T 98.9 F. The physician refers the patient to a cardiologist and offers prescriptions for carvedilol and nitroglycerin. Which of the following describes the mechanism or effects of each of these medications, respectively?? {'A': 'Increased cAMP; Increased cAMP', 'B': 'Increased contractility; Decreased endothelial nitrous oxide', 'C': 'Decreased cAMP; Increased cGMP', 'D': 'Decreased cGMP; Increased venous resistance', 'E': 'Increased heart rate; Decreased arterial resistance'},
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C: Decreased cAMP; Increased cGMP
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Answer the following medical question with one of the provided options:
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Q:An 84-year-old man comes to the emergency department because of lower back pain and lower extremity weakness for 3 weeks. Over the past week, he has also found it increasingly difficult to urinate. He has a history of prostate cancer, for which he underwent radical prostatectomy 8 years ago. His prostate-specific antigen (PSA) level was undetectable until a routine follow-up visit last year, when it began to increase from 0.8 ng/mL to its present value of 64.3 ng/mL (N < 4). An MRI of the spine shows infiltrative vertebral lesions with a collapse of the L5 vertebral body, resulting in cord compression at L4–L5. The patient receives one dose of intravenous dexamethasone and subsequently undergoes external beam radiation. Which of the following cellular changes is most likely to occur as a result of this treatment?? {'A': 'Formation of pyrimidine dimers', 'B': 'Disruption of microtubule assembly', 'C': 'Intercalation of neighbouring DNA base pairs', 'D': 'Generation of hydroxyl radicals', 'E': 'Formation of DNA crosslinks'},
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D: Generation of hydroxyl radicals
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Q:A 33-year-old man presents to the emergency department with severe anxiety. He has had multiple episodes in the past treated with low dose lorazepam. The patient states that he feels as if he is going to die and that he cannot breathe. His past medical history is notable for depression and anxiety. His temperature is 98.1°F (36.7°C), blood pressure is 122/83 mmHg, pulse is 153/min, respirations are 13/min, and oxygen saturation is 98% on room air. The patient is given a low dose of lorazepam and reports a complete resolution of his symptoms. An ECG is performed and demonstrates prolongation of the P-R interval with a widened QRS complex. There is a P wave preceding every QRS complex, no dropped QRS complexes, and the P-R interval does not change. His initial lab values are unremarkable. Which of the following is the best management of this patient?? {'A': 'Cardiac catheterization', 'B': 'Electrophysiological studies', 'C': 'No further management needed', 'D': 'Sodium bicarbonate', 'E': 'Transcutaneous pacing'},
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B: Electrophysiological studies
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Q:A 74-year-old male presents to his primary care physician complaining of left lower back pain. He reports a four-month history of worsening left flank pain. More recently, he has started to notice that his urine appears brown. His past medical history is notable for gout, hypertension, hyperlipidemia, and myocardial infarction status-post stent placement. He has a 45 pack-year smoking history and drinks 2-3 alcoholic beverages per day. His temperature is 100.9°F (38.3°C), blood pressure is 145/80 mmHg, pulse is 105/min, and respirations are 20/min. Physical examination is notable for left costovertebral angle tenderness. A CT of this patient’s abdomen is shown in figure A. This lesion most likely arose from which of the following cells?? {'A': 'Proximal tubule cells', 'B': 'Distal convoluted tubule cells', 'C': 'Mesangial cells', 'D': 'Perirenal adipocytes', 'E': 'Collecting duct epithelial cells'},
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A: Proximal tubule cells
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old man is brought to the emergency department by his wife for high blood pressure readings at home. He is asymptomatic. He has a history of hypertension and hyperlipidemia for which he takes atenolol and atorvastatin, however, his wife reports that he recently ran out of atenolol and has not been able to refill it due to lack of health insurance. His temperature is 36.8°C (98.2°F), the pulse 65/min, the respiratory rate 22/min, and the blood pressure 201/139 mm Hg. He has no papilledema on fundoscopic examination. A CT scan shows no evidence of intracranial hemorrhage or ischemia. Of the following, what is the next best step?? {'A': 'Start or restart low-dose medication to reduce blood pressure gradually over the next 24–48 hours', 'B': 'Start or restart low-dose medication to reduce blood pressure aggressively over the next 24–48 hours', 'C': 'Start high-dose medication to bring his blood pressure to under 140/90 within 24 hours', 'D': 'Admit him to the ICU and start intravenous medication to reduce blood pressure by 10% in the first hour', 'E': 'Admit him to the ICU and start intravenous medication to reduce blood pressure by 25% in the first 4 hours'},
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A: Start or restart low-dose medication to reduce blood pressure gradually over the next 24–48 hours
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Q:A 45-year-old woman is in a high-speed motor vehicle accident and suffers multiple injuries to her extremities and abdomen. In the field, she was bleeding profusely bleeding and, upon arrival to the emergency department, she is lethargic and unable to speak. Her blood pressure on presentation is 70/40 mmHg. The trauma surgery team recommends emergency exploratory laparotomy. While the patient is in the trauma bay, her husband calls and says that the patient is a Jehovah's witness and that her religion does not permit her to receive a blood transfusion. No advanced directives are available. Which of the following is an appropriate next step?? {'A': 'Provide transfusions as needed', 'B': 'Ask husband to bring identification to the trauma bay', 'C': "Withhold transfusion based on husband's request", 'D': 'Obtain an ethics consult', 'E': 'Obtain a court order for transfusion'},
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A: Provide transfusions as needed
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Q:A 21-year-old woman presents to her primary care physician for evaluation of malaise, joint pains, and rash. She has developed joint pain in her hands over the last month, and has noted a rash over her face that gets worse with sun exposure. She is taking no medication at the present time. On further physical examination, an erythematous rash with a small amount of underlying edema is seen on her face. Her complete blood count is remarkable due to a lymphocytopenia. What are other disorders known to cause lymphocytopenia? I 22q.11.2 deletion syndrome II Bruton tyrosine kinase (BTK) defect III Diphyllobothrium latum infection IV Whole body radiation V Glanzmann-Riniker syndrome? {'A': 'I, II, III', 'B': 'I, III, V', 'C': 'III, IV', 'D': 'I, II, IV, V', 'E': 'III, V'},
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D: I, II, IV, V
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician for a follow-up examination. She has a history of Crohn disease, for which she takes methotrexate. She and her husband would like to start trying to have a child. Because of the teratogenicity of methotrexate, the physician switches the patient from methotrexate to a purine analog drug that inhibits lymphocyte proliferation by blocking nucleotide synthesis. Toxicity of the newly prescribed purine analog would most likely increase if the patient was also being treated with which of the following medications?? {'A': 'Febuxostat', 'B': 'Pemetrexed', 'C': 'Rasburicase', 'D': 'Hydroxyurea', 'E': 'Cyclosporine'},
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A: Febuxostat
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Q:Antituberculosis treatment is started. Two months later, the patient comes to the physician for a follow-up examination. The patient feels well. She reports that she has had tingling and bilateral numbness of her feet for the past 6 days. Her vital signs are within normal limits. Her lips are dry, scaly, and slightly swollen. Neurologic examination shows decreased sensation to pinprick and light touch over her feet, ankles, and the distal portion of her calves. Laboratory studies show: Leukocyte count 7400 /mm3 RBC count 2.9 million/mm3 Hemoglobin 10.8 g/dL Hematocrit 30.1% Mean corpuscular volume 78 fL Mean corpuscular hemoglobin 24.2 pg/cell Platelet count 320,000/mm3 Serum Glucose 98 mg/dL Alanine aminotransferase (ALT) 44 U/L Aspartate aminotransferase (AST) 52 U/L Administration of which of the following is most likely to have prevented this patient's neurological symptoms?"? {'A': 'Vitamin B12', 'B': 'Vitamin E', 'C': 'Pyridoxine', 'D': 'Iron', 'E': 'Interferon beta\n"'},
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C: Pyridoxine
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Answer the following medical question with one of the provided options:
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Q:Before starting a new job at a law firm, a 33-year-old woman speaks to a representative about the health insurance plan offered by the firm. The representative explains that treatment is provided by primary health care physicians who focus on preventive care. Patients require a referral by the primary care physician for specialist care inside the network; treatment by health care providers outside the network is only covered in the case of an emergency. When the prospective employee asks how prices are negotiated between the health insurance company and the health care providers, the physician explains that the health care providers get a fixed payment for each patient enrolled over a specific period of time, regardless of whether or not services are provided. This arrangement best describes which of the following health care payment models?? {'A': 'Per diem payment', 'B': 'Bundled payment', 'C': 'Fee-for-service', 'D': 'Discounted fee-for-service', 'E': 'Capitation'},
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E: Capitation
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Q:A 73-year-old man with a 50-year history of type 2 diabetes and stage 3 chronic kidney disease presents to his primary care doctor for a scheduled follow-up and routine labs. He states that he has had no real change in his health except that he feels like he has had bouts of lightheadedness and almost passing out, which resolve with sitting down. The patient does not have a history of syncope or arrhythmia. On his labs, he is found to have a hemoglobin of 11.0 g/dL. His estimated glomerular filtration rate is determined to be 45 ml/min/1.73m^2. Testing of his stool is negative for blood. Additionally, a peripheral blood smear demonstrates normochromic cells. As a result, the patient is started on erythropoietin. Which of the following likely describes the anemia?? {'A': 'Macrocytic anemia with megaloblasts', 'B': 'Macrocytic anemia without megaloblasts', 'C': 'Microcytic anemia', 'D': 'Normocytic anemia with decreased reticulocyte count', 'E': 'Normocytic anemia with increased reticulocyte count'},
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D: Normocytic anemia with decreased reticulocyte count
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man presents to the physician with severe lower back pain and fatigue for 3 months. The pain increases with activity. He has no history of a serious illness. He takes ibuprofen for pain relief. He does not smoke. The blood pressure is 105/65 mm Hg, the pulse is 86/min, the respirations are 16/min, and the temperature is 36.7℃ (98.1℉). The conjunctivae are pale. Palpation over the 1st lumbar vertebra shows tenderness. The heart, lung, and abdominal examination shows no abnormalities. No lymphadenopathy is palpated. The results of the laboratory studies show: Laboratory test Hemoglobin 9 g/dL Mean corpuscular volume 90 μm3 Leukocyte count 5,500/mm3 with a normal differential Platelet count 350,000/mm3 Serum Calcium 11.5 mg/dL Albumin 3.8 g/dL Urea nitrogen 54 mg/dL Creatinine 2.5 mg/dL Lumbosacral computed tomography (CT) scan shows a low-density lesion in the 1st lumbar vertebra and several similar lesions in the pelvic bones. Which of the following is the most likely diagnosis?? {'A': 'Metastatic prostatic cancer', 'B': 'Multiple myeloma', 'C': 'Secondary hyperparathyroidism', 'D': 'Small-cell lung carcinoma', 'E': 'Waldenstrom’s macroglobulinemia'},
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B: Multiple myeloma
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Q:A 28-year-old man visits his physician complaining of hematochezia over the last several days. He also has tenesmus and bowel urgency without any abdominal pain. He has had several milder episodes over the past several years that resolved on their own. He has no history of a serious illness and takes no medications. His blood pressure is 129/85 mm Hg; temperature, 37.4°C (99.3°F); and pulse, 75/min. On physical exam, his abdominal examination shows mild tenderness on deep palpation of the left lower quadrant. Digital rectal examination reveals anal tenderness and fresh blood. Stool examination is negative for pathogenic bacteria and an ova and parasite test is negative. Erythrocyte sedimentation rate is 28 mm/h. Colonoscopy shows diffuse erythema involving the rectum and extending to the distal sigmoid. The mucosa also shows a decreased vascular pattern with fine granularity. The remaining colon and distal ileum are normal. Biopsy of the inflamed mucosa of the sigmoid colon shows distorted crypt architecture. The most appropriate next step is to administer which of the following?? {'A': 'Azathioprine', 'B': 'Ciprofloxacin', 'C': 'Mesalamine', 'D': 'Metronidazole', 'E': 'Total parenteral nutrition'},
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C: Mesalamine
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Q:A 4-year-old girl is brought to the physician for a well-child examination. She has been healthy apart from an episode of bronchiolitis as an infant. Her 6-year-old sister recently underwent surgery for ventricular septal defect closure. She is at the 60th percentile for height and weight. Her mother is concerned about the possibility of the patient having a cardiovascular anomaly. Which of the following is most likely to indicate a benign heart murmur in this child?? {'A': 'A grade 3/6 systolic ejection murmur heard along the left lower sternal border that increases on valsalva', 'B': 'A grade 4/6 midsystolic murmur at the right upper sternal border that increases on rapid squatting', 'C': 'A grade 2/6 continuous murmur heard at the right supraclavicular region', 'D': 'A grade 4/6 holosytolic murmur heard along the left lower sternal border that increases on hand grip', 'E': 'A grade 3/6 holosytolic murmur at the apex that increases on hand grip'},
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C: A grade 2/6 continuous murmur heard at the right supraclavicular region
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Q:A mother with HIV has given birth to a healthy boy 2 days ago. She takes her antiretroviral medication regularly and is compliant with the therapy. Before being discharged, her doctor explains that she cannot breastfeed the child since there is a risk of infection through breastfeeding and stresses that the child can benefit from formula feeding. The physician stresses the importance of not overheating the formula since Vitamin C may be inactivated by overheating. Which process could be impaired if the mother boiled the formula longer than needed?? {'A': 'Heme synthesis', 'B': 'Purine synthesis', 'C': 'Collagen synthesis', 'D': 'Protein catabolism', 'E': 'Fatty acid metabolism'},
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C: Collagen synthesis
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Q:A healthy 33-year-old gravida 1, para 0, at 15 weeks' gestation comes to the genetic counselor for a follow-up visit. Her uncle had recurrent pulmonary infections, chronic diarrhea, and infertility, and died at the age of 28 years. She does not smoke or drink alcohol. The results of an amniotic karyotype analysis show a deletion of Phe508 on chromosome 7. This patient's fetus is at greatest risk for developing which of the following complications?? {'A': 'Duodenal atresia', 'B': 'Congenital megacolon', 'C': 'Cardiac defects', 'D': 'Meconium ileus', 'E': 'Neural tube defects'},
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D: Meconium ileus
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Q:Four days after being admitted to the intensive care unit for acute substernal chest pain and dyspnea, an 80-year-old man is evaluated for hypotension. Coronary angiography on admission showed an occlusion in the left anterior descending artery, and a drug-eluting stent was placed successfully. The patient has a history of hypertension and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, metoprolol, lisinopril, and atorvastatin. His temperature is 37.2 °C (99 °F), pulse is 112/min, respirations are 21/min, and blood pressure is 72/50 mm Hg. Cardiac examination shows a normal S1 and S2 and a new harsh, holosystolic murmur heard best at the left sternal border. There is jugular venous distention and a right parasternal heave. The lungs are clear to auscultation. Pitting edema extends up to the knees bilaterally. An ECG shows Q waves in the inferior leads. Which of the following is the most likely cause of this patient’s hypotension?? {'A': 'Ascending aortic dissection rupture', 'B': 'Post-infarction fibrinous pericarditis', 'C': 'Left ventricular free wall rupture', 'D': 'Left ventricular aneurysm rupture', 'E': 'Interventricular septum rupture'},
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E: Interventricular septum rupture
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Q:A 68-year-old right hand-dominant man presents to the emergency room complaining of severe right arm pain after falling down a flight of stairs. He landed on his shoulder and developed immediate severe upper arm pain. Physical examination reveals a 2-cm laceration in the patient’s anterior right upper arm. Bone is visible through the laceration. An arm radiograph demonstrates a displaced comminuted fracture of the surgical neck of the humerus. Irrigation and debridement is performed immediately and the patient is scheduled to undergo definitive operative management of his fracture. In the operating room on the following day, the operation is more complicated than expected and the surgeon accidentally nicks a neurovascular structure piercing the coracobrachialis muscle. This patient would most likely develop a defect in which of the following?? {'A': 'Elbow extension', 'B': 'Forearm pronation', 'C': 'Lateral forearm skin sensation', 'D': 'Medial arm skin sensation', 'E': 'Wrist extension'},
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C: Lateral forearm skin sensation
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Answer the following medical question with one of the provided options:
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Q:A first-year medical student is conducting a summer project with his medical school's pediatrics department using adolescent IQ data from a database of 1,252 patients. He observes that the mean IQ of the dataset is 100. The standard deviation was calculated to be 10. Assuming that the values are normally distributed, approximately 87% of the measurements will fall in between which of the following limits?? {'A': '70–130', 'B': '65–135', 'C': '85–115', 'D': '80–120', 'E': '95–105\n"'},
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C: 85–115
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Q:The the mean, median, and mode weight of 37 newborns in a hospital nursery is 7 lbs 2 oz. In fact, there are 7 infants in the nursery that weigh exactly 7 lbs 2 oz. The standard deviation of the weights is 2 oz. The weights follow a normal distribution. A newborn delivered at 10 lbs 2 oz is added to the data set. What is most likely to happen to the mean, median, and mode with the addition of this new data point?? {'A': 'The mean will increase; the median will increase; the mode will increase', 'B': 'The mean will stay the same; the median will increase; the mode will increase', 'C': 'The mean will stay the same; the median will increase; the mode will stay the same', 'D': 'The mean will increase; the median will stay the same; the mode will stay the same', 'E': 'The mean will increase; the median will increase; the mode will stay the same'},
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D: The mean will increase; the median will stay the same; the mode will stay the same
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Answer the following medical question with one of the provided options:
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Q:A 10-month-old boy is brought to the emergency department by his parents because he has a high fever and severe cough. His fever started 2 days ago and his parents are concerned as he is now listless and fatigued. He had a similar presentation 5 months ago and was diagnosed with pneumonia caused by Staphyloccocus aureus. He has been experiencing intermittent diarrhea and skin abscesses since birth. The child had an uneventful birth and the child is otherwise developmentally normal. Analysis of this patient's sputum reveals acute angle branching fungi and a throat swab reveals a white plaque with germ tube forming yeast. Which of the following is most likely to be abnormal in this patient?? {'A': 'Autoimmune regulator function', 'B': 'LFA-1 integrin binding', 'C': 'Lysosomal trafficking', 'D': 'NADPH oxidase activity', 'E': 'Thymus development'},
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D: NADPH oxidase activity
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Q:A 46-year-old woman comes to the physician for a routine health examination. She was last seen by a physician 3 years ago. She has been healthy aside from occasional mild flank pain. Her only medication is a multivitamin. Her blood pressure is 154/90 mm Hg. Physical examination shows no abnormalities. Serum studies show: Sodium 141 mEq/L Potassium 3.7 mEq/L Calcium 11.3 mg/dL Phosphorus 2.3 mg/dL Urea nitrogen 15 mg/dL Creatinine 0.9 mg/dL Albumin 3.6 g/dL Subsequent serum studies show a repeat calcium of 11.2 mg/dL, parathyroid hormone concentration of 890 pg/mL, and 25-hydroxyvitamin D of 48 ng/mL (N = 25–80). Her 24-hour urine calcium excretion is elevated. An abdominal ultrasound shows several small calculi in bilateral kidneys. Further testing shows normal bone mineral density. Which of the following is the most appropriate next step in management?"? {'A': 'Refer to surgery for parathyroidectomy', 'B': 'Begin cinacalcet therapy', 'C': 'Order serum protein electrophoresis', 'D': 'Begin hydrochlorothiazide therapy', 'E': 'Perform percutaneous nephrolithotomy'},
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A: Refer to surgery for parathyroidectomy
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Q:A 12-year-old boy is brought in by his mother to the emergency department. He has had abdominal pain, fever, nausea, vomiting, and loss of appetite since yesterday. At first, the mother believed it was just a "stomach flu," but she is growing concerned about his progressive decline. Vitals include: T 102.3 F, HR 110 bpm, BP 120/89 mmHg, RR 16, O2 Sat 100%. Abdominal exam is notable for pain over the right lower quadrant. What is the next best step in management in addition to IV hydration and analgesia?? {'A': 'Abdominal CT scan with IV and PO contrast', 'B': 'Abdominal CT scan with IV contrast', 'C': 'Upright and supine abdominal radiographs', 'D': 'Right lower quadrant ultrasound', 'E': 'Abdominal MRI with gadolinium contrast'},
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D: Right lower quadrant ultrasound
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man with a long history of mild persistent asthma on daily fluticasone therapy has been using his albuterol inhaler every day for the past month and presents requesting a refill. He denies any recent upper respiratory infections, but he says he has felt much more short of breath throughout this time frame. He works as a landscaper, and he informs you that he has been taking longer to complete some of his daily activities on the job. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical exam reveals mild bilateral wheezes and normal heart sounds. What changes should be made to his current regimen?? {'A': 'Add ciclesonide to current regimen', 'B': 'Add salmeterol to current regimen', 'C': 'Discontinue fluticasone and instead use salmeterol', 'D': 'Add cromolyn to current regimen', 'E': 'Discontinue fluticasone and add ipratropium to current regimen'},
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B: Add salmeterol to current regimen
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Q:A 3500-g (7 lb 11 oz) healthy female newborn is delivered at 38 weeks' gestation. Chorionic villus sampling (CVS) in the first trimester showed a trisomy of chromosome 21 but the pregnancy was otherwise uncomplicated. Physical examination of the newborn is normal. Chromosomal analysis at birth shows a 46, XX karyotype. Which of the following is the most likely explanation for the prenatal chromosomal abnormality?? {'A': 'Maternal disomy', 'B': 'Phenotypic pleiotropy', 'C': 'Incomplete penetrance', 'D': 'Variable expressivity', 'E': 'Placental mosaicism'},
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E: Placental mosaicism
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Answer the following medical question with one of the provided options:
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Q:An 11-year-old girl presents with a 1-day history of frothy brown urine. She has no significant medical history and takes no medications. She reports that several of her classmates have been sick, and she notes that she had a very sore throat with a fever approx. 2 weeks ago. Her blood pressure is 146/94 mm Hg, heart rate is 74/min, and respiratory rate is 14/min. Laboratory analysis reveals elevated serum creatinine, hematuria with RBC casts, and elevated urine protein without frank proteinuria. Physical examination reveals a healthy-looking girl with no abdominal or costovertebral angle tenderness. Which of the following is the most likely diagnosis?? {'A': 'Alport syndrome', 'B': 'Minimal change disease', 'C': 'Membranoproliferative glomerulonephritis', 'D': 'Poststreptococcal glomerulonephritis', 'E': 'Henoch-Schönlein purpura'},
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D: Poststreptococcal glomerulonephritis
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Q:A 16-year-old male adolescent presents to his pediatrician with increasing fatigue and breathlessness with exercise. His parents inform the doctor that they have recently migrated from a developing country, where he was diagnosed as having a large ventricular septal defect (VSD). However, due to their poor economic condition and scarce medical facilities, surgical repair was not performed in that country. The pediatrician explains to the parents that patients with large VSDs are at increased risk for several complications, including Eisenmenger syndrome. If the patient has developed this complication, he is not a good candidate for surgical closure of the defect. Which of the following clinical signs, if present on physical examination, would suggest the presence of this complication?? {'A': 'A loud first heart sound', 'B': 'A mid-diastolic low-pitched rumble at the apex', 'C': 'Right ventricular heave', 'D': 'Prominence of the left precordium', 'E': 'Lateral displacement of the apical impulse'},
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C: Right ventricular heave
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Q:A 59-year-old man presents to the emergency department with right-sided weakness and an inability to speak for the past 2 hours. His wife says he was gardening in his backyard when he suddenly lost balance and fell down. The patient has a past medical history of hypertension, diabetes mellitus, and coronary artery disease. Two years ago, he was admitted to the coronary intensive care unit with an anterolateral myocardial infarction. He has not been compliant with his medications since he was discharged. On physical examination, his blood pressure is 110/70 mm Hg, pulse is 110/min and irregular, temperature is 36.6°C (97.8°F), and respiratory rate is 18/min. Strength is 2/5 in both his right upper and right lower extremities. His right calf is edematous with visible varicose veins. Which of the following is the best method to detect the source of this patient’s stroke?? {'A': 'Duplex ultrasound of his right leg', 'B': 'Carotid duplex', 'C': 'Head CT without contrast', 'D': 'ECG', 'E': 'V/Q scan of his lungs'},
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D: ECG
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Q:A 3-year-old boy is brought to the emergency department because of worsening pain and swelling in both of his hands for 1 week. He appears distressed. His temperature is 38.5°C (101.4°F). Examination shows erythema, swelling, warmth, and tenderness on the dorsum of his hands. His hemoglobin concentration is 9.1 g/dL. A peripheral blood smear is shown. The drug indicated to prevent recurrence of this patient's symptoms is also used to treat which of the following conditions?? {'A': 'Primary syphilis', 'B': 'Chronic kidney disease', 'C': 'Megaloblastic anemia', 'D': 'Iron intoxication', 'E': 'Polycythemia vera'},
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E: Polycythemia vera
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old primigravid woman at 14 weeks' gestation comes to the physician for her first prenatal visit. She reports some nausea and fatigue. She takes lithium for bipolar disorder and completed a course of clindamycin for bacterial vaginosis 12 weeks ago. She works as a teacher at a local school. She smoked a pack of cigarettes daily for 12 years but stopped after finding out that she was pregnant. She does not drink alcohol. Her temperature is 37°C (98.6°F), pulse is 80/min, and blood pressure is 125/80 mm Hg. Pelvic examination shows a uterus consistent in size with a 14-week gestation. There is mild lower extremity edema bilaterally. Urinalysis is within normal limits. The patient's child is at increased risk for developing which of the following complications?? {'A': 'Ototoxicity and hearing loss', 'B': 'Atrialized right ventricle', 'C': 'Fetal hydantoin syndrome', 'D': 'Bone damage', 'E': 'Chorioretinitis\n"'},
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B: Atrialized right ventricle
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Q:A 65-year-old woman with COPD comes to the emergency department with 2-day history of worsening shortness of breath and cough. She often has a mild productive cough, but she noticed that her sputum is more yellow than usual. She has not had any recent fevers, chills, sore throat, or a runny nose. Her only medication is a salmeterol inhaler that she uses twice daily. Her temperature is 36.7°C (98°F), pulse is 104/min, blood pressure is 134/73 mm Hg, respiratory rate is 22/min, and oxygen saturation is 85%. She appears uncomfortable and shows labored breathing. Lung auscultation reveals coarse bibasilar inspiratory crackles. A plain film of the chest shows mild hyperinflation and flattening of the diaphragm but no consolidation. She is started on supplemental oxygen via nasal cannula. Which of the following is the most appropriate initial pharmacotherapy?? {'A': 'Roflumilast and prednisone', 'B': 'Albuterol and montelukast', 'C': 'Prednisone and salmeterol', 'D': 'Albuterol and theophylline', 'E': 'Prednisone and albuterol'},
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E: Prednisone and albuterol
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman comes to the emergency department because of weakness and fatigue for 2 days. She has also noticed that her urine is darker than usual. For the past week, she has had a persistent non-productive cough and low-grade fever. She has seasonal allergies. She drinks one to two glasses of wine on social occasions and does not smoke. Her temperature is 37.9°C (100.2°F), pulse is 88/min, respirations are 18/min, and blood pressure is 110/76 mm Hg. She has conjunctival pallor and scleral icterus. Cardiopulmonary examination shows bibasilar crackles. The remainder of the physical examination shows no abnormalities. Laboratory studies show: Leukocyte count 8,000/mm3 Hemoglobin 7.1 g/dL Hematocrit 21% Platelet count 110,000/mm3 MCV 94 μm3 Serum Total bilirubin 4.3 mg/dL Direct 1.1 mg/dL Indirect 3.2 mg/dL AST 15 U/L ALT 17 U/L LDH 1,251 U/L Haptoglobin 5.8 mg/dL (N = 41–165) An x-ray of the chest shows bilateral patchy infiltrates. A peripheral blood smear shows spherocytes. Which of the following is most likely to confirm the diagnosis?"? {'A': 'Osmotic fragility test', 'B': 'Direct Coombs test', 'C': 'ADAMTS13 activity and inhibitor profile', 'D': 'Hemoglobin electrophoresis', 'E': 'Flow cytometry'},
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B: Direct Coombs test
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Answer the following medical question with one of the provided options:
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Q:A 46-year-old woman comes to the physician for a follow-up examination. She had a blood pressure recording of 148/94 mm Hg on her previous visit one week ago. Her home blood pressure log shows readings of 151/97 and 146/92 mm Hg in the past week. She has no history of serious illness and takes no medications. She is 160 cm (5 ft 3 in) tall and weighs 52 kg (115 lb); BMI is 20 kg/m2. Her pulse is 88/min and blood pressure is 150/96 mm Hg. Cardiopulmonary examination is unremarkable. Abdominal examination shows no abnormalities. The extremities are well perfused with strong peripheral pulses. Serum concentrations of electrolytes, creatinine, lipids, TSH, and fasting glucose are within the reference range. A urinalysis is within normal limits. Which of the following is the most appropriate next step in management?? {'A': 'Electrocardiogram', 'B': 'Plasma renin activity', 'C': 'Polysomnography', 'D': 'Echocardiography', 'E': 'Renal ultrasonography'},
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A: Electrocardiogram
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Q:A sample is taken of an ulcer in the inguinal region of a 29-year-old Malaysian male who has had unprotected sex in the past few months. Intracytoplasmic inclusions are seen in the Giemsa staining in Image A. On which of the following can the organism in the staining be grown?? {'A': 'Bordet-Gengou agar', 'B': 'Löwenstein-Jensen agar', 'C': 'Charcoal yeast extract agar with cysteine and iron', 'D': "Eaton's agar", 'E': 'Yolk sac of a chick embryo'},
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E: Yolk sac of a chick embryo
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man who recently emigrated from Colombia comes to the physician because of a 3-month history of shortness of breath and fatigue. Physical examination shows jugular venous distention and an additional late diastolic heart sound. Crackles are heard at the lung bases bilaterally. Cardiac catheterization is performed and left ventricular pressures are obtained. The left ventricular pressure-volume relationship compared to that of a healthy patient is shown. Which of the following is the most likely cause of this patient's heart failure?? {'A': 'Chagas heart disease', 'B': 'Viral myocarditis', 'C': 'Cardiac sarcoidosis', 'D': 'Alcohol use disorder', 'E': 'Thiamine deficiency'},
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C: Cardiac sarcoidosis
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old female college basketball player presents in Sports Clinic after she felt a "pop" in her knee after coming down with a rebound. To examine the patient, you have her lie down on the table with her knees flexed 90 degrees. With your hand around her knee you are able to draw the tibia toward you from underneath the femur. The torn structure implicated by this physical exam maneuver has which of the following attachments?? {'A': 'The posterior intercondylar area of tibia and the posteromedial aspect of the lateral femur', 'B': 'The anterior intercondylar area of tibia and the posteromedial aspect of the lateral femur', 'C': 'The patella and tibial tuberosity', 'D': 'The lateral epicondyle of the femur and the head of fibula', 'E': 'The medial condyle of the femur and the medial condyle of the tibia'},
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B: The anterior intercondylar area of tibia and the posteromedial aspect of the lateral femur
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Q:A 42-year-old man is brought to the emergency department after having a seizure. His wife states that the patient has been struggling with alcohol abuse and has recently decided to "quit once and for all". Physical exam is notable for a malnourished patient responsive to verbal stimuli. He has moderate extremity weakness, occasional palpitations, and brisk deep tendon reflexes (DTRs). EKG demonstrates normal sinus rhythm and a prolonged QT interval. What nutritional deficiency most likely contributed to these findings?? {'A': 'Potassium', 'B': 'Calcium', 'C': 'Folate', 'D': 'Magnesium', 'E': 'Vitamin D'},
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D: Magnesium
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Q:A 22-year-old man presents to his physician with a chronic cough which he has had for the last five years. He mentions that his cough is usually productive; however, sometimes it is dry. His past medical records show seven episodes of sinusitis over the last two years and two episodes of community acquired pneumonia. He is a non-smoker and there is no history of long-term exposure to passive smoking or other airway irritants. There is no family history of an allergic disorder. On physical examination, his vital signs are stable. General examination shows mild clubbing of his fingers and examination of his nasal turbinates reveals nasal polyps. Auscultation of his chest reveals crackles and scattered wheezing bilaterally. A high-resolution computed tomography (HRCT) of the chest shows dilated, “tram track” bronchi, predominantly involving upper lung fields. Which of the following is the next best step in the diagnostic evaluation of the patient?? {'A': 'Sputum culture for acid-fast bacilli', 'B': 'Serum quantitative immunoglobulin levels', 'C': 'Measurement of sweat chloride levels', 'D': 'Skin testing for Aspergillus reactivity', 'E': 'Testing for swallowing function'},
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C: Measurement of sweat chloride levels
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old male with a past medical history of obesity, diabetes, hypertension, and hyperlipidemia presents with an acute onset of nausea, vomiting, diaphoresis, and crushing substernal chest pain. Vital signs are temperature 37° C, HR 110, BP 149/87, and RR of 22 with an oxygen saturation of 99% on room air. Physical exam reveals a fourth heart sound (S4), and labs are remarkable for an elevated troponin. EKG is shown below. The pathogenesis of the condition resulting in this patient’s presentation involves:? {'A': 'Genetic inheritance of a mutation in ß-myosin or troponin expressed in cardiac myocytes', 'B': 'A fully obstructive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque', 'C': 'A partially occlusive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque', 'D': 'Destruction of the vasa vasorum caused by vasculitic phenomena', 'E': 'A stable atheromatous lesion without overlying thrombus'},
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B: A fully obstructive thrombus at the site of a ruptured, ulcerated atherosclerotic plaque
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Q:A 60-year-old man is brought to the emergency room because of fever and increasing confusion for the past 2 days. He has paranoid schizophrenia and hypertension. His current medications are chlorpromazine and amlodipine. He appears ill. He is not oriented to time, place, or person. His temperature is 40°C (104°F), pulse is 130/min, respirations are 29/min and blood pressure is 155/100 mm Hg. Examination shows diaphoresis. Muscle tone is increased bilaterally. Deep tendon reflexes are 1+ bilaterally. Neurologic examination shows psychomotor agitation. His speech is incoherent. Lungs are clear to auscultation. His neck is supple. The abdomen is soft and nontender. Serum laboratory analysis shows a leukocyte count of 11,300/mm3 and serum creatine kinase concentration of 833 U/L. Which of the following is the most appropriate initial pharmacotherapy?? {'A': 'Dantrolene', 'B': 'Clozapine', 'C': 'Cyproheptadine', 'D': 'Physostigmine', 'E': 'Propranolol'},
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A: Dantrolene
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man comes to the emergency department because of decreased vision and black spots in front of his left eye for the past 24 hours. He states that it feels as if 'a curtain is hanging over his eye.' He sees flashes of light intermittently. He has no pain or diplopia. He underwent cataract surgery on the left eye 2 weeks ago. He has hypertension and type 2 diabetes mellitus. His sister has open-angle glaucoma. Current medications include metformin, linagliptin, ramipril, and hydrochlorothiazide. Vital signs are within normal limits. Examination shows a visual acuity in the right eye of 20/25 and the ability to count fingers at 3 feet in the left eye. The pupils are equal and reactive. The corneal reflex is present. The anterior chamber shows no abnormalities. The confrontation test is normal on the right side and shows nasal and inferior defects on the left side. Cardiopulmonary examination shows no abnormalities. The patient is awaiting dilation for fundus examination. Which of the following is the most likely diagnosis?? {'A': 'Degenerative retinoschisis', 'B': 'Retinal detachment', 'C': 'Acute angle-closure glaucoma', 'D': 'Endophthalmitis', 'E': 'Hemorrhagic choroidal detachment'},
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B: Retinal detachment
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old woman presents to her physician with the complaint of ringing in her right ear. She says it started about 3 months ago with associated progressive difficulty in hearing on the same side. Past medical history is significant for a hysterectomy 5 years ago due to dysfunctional uterine bleeding. She is currently not taking any medications. She is a non-smoker and drinks socially. On otoscopic examination, a red-blue pulsatile mass is observed behind the right tympanic membrane. A noncontrast CT scan of the head shows significant bone destruction resulting in a larger jugular foramen highly suggestive of a tumor derived from neural crest cells. Which of the cranial nerves are most likely to be involved in this type of lesion?? {'A': 'Cranial nerves VII & VIII', 'B': 'Cranial nerves IX, X', 'C': 'Cranial nerves III, IV, VI', 'D': 'Cranial nerves I, II, V', 'E': 'Cranial nerves X, XI, XII'},
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B: Cranial nerves IX, X
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Answer the following medical question with one of the provided options:
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Q:A 3-year-old boy presents to a geneticist for generalized developmental delay. Upon presentation he is found to have a distinctive facial structure with prominent epicanthal folds and macroglossia. Further physical examination reveals a simian crease on his palms bilaterally. Based on these findings, the physician strongly suspects Down syndrome and obtains a karyotype. Surprisingly the karyotype shows 46 chromosomes with two normal appearing alleles of chromosome 21. Further examination with fluorescent probes reveals a third copy of chromosome 21 genes that have been incorporated into another chromosome. What is the name of this mechanism of Down syndrome inheritance?? {'A': 'Nondisjunction', 'B': 'Mosaicism', 'C': 'Robertsonian translocation', 'D': 'Imprinting', 'E': 'Anticipation'},
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C: Robertsonian translocation
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old infant male is brought to the emergency department with a 1-hour history of vomiting and convulsions. He was born at home and had sporadic prenatal care though his parents say that he appeared healthy at birth. He initially fed well; however, his parents have noticed that he has been feeding poorly and is very irritable since they moved on to baby foods. They have also noticed mild yellowing of his skin but assumed it would go away over time. On presentation, he is found to be very sleepy, and physical exam reveals an enlarged liver and spleen. The rest of the physical exam is normal. Which of the following enzymes is most likely functioning abnormally in this patient?? {'A': 'Aldolase B', 'B': 'Fructokinase', 'C': 'Gal-1-phosphate uridyl transferase', 'D': 'Galactokinase deficiency', 'E': 'Lactase'},
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A: Aldolase B
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