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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman is brought to the physician for the evaluation of fatigue for the past 6 months. During this period, she has had recurrent episodes of constipation and diarrhea. She also reports frequent nausea and palpitations. She works as a nurse at a local hospital. She has tried cognitive behavioral therapy, but her symptoms have not improved. Her mother has hypothyroidism. The patient is 170 cm (5 ft 7 in) tall and weighs 62 kg (137 lb); BMI is 21.5 kg/m2. She appears pale. Vital signs are within normal limits. Examination shows calluses on the knuckles and bilateral parotid gland enlargement. Oropharyngeal examination shows eroded dental enamel and decalcified teeth. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Administration of fluoxetine', 'B': 'Administration of mirtazapine', 'C': 'Administration of olanzapine', 'D': 'Administration of venlafaxine', 'E': 'Administration of topiramate\n"'},
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A: Administration of fluoxetine
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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 comes to the physician because of intermittent pain and numbness in her right hand for 6 weeks. She has a pins-and-needles sensation that worsens at night and is relieved when she shakes her hand. She also has episodic left knee pain throughout the day. She has a history of hypertension controlled with lisinopril. She takes over-the-counter medications for constipation. Her BMI is 35 kg/m2. Her mother has a history of rheumatoid arthritis. She looks fatigued. Her pulse is 57/min and blood pressure is 120/75 mm Hg. On physical examination, there is normal range of motion in the wrists and digits. Sensation is decreased to light touch in the thumb and index finger. There is no thenar muscle atrophy. Deep tendon reflexes are 1+ and there is mild edema in the legs. Which of the following treatments is most likely to benefit the patient?? {'A': 'L-thyroxine', 'B': 'Methotrexate', 'C': 'Ibuprofen', 'D': 'Surgical decompression', 'E': 'Oral prednisone'},
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A: L-thyroxine
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old female presents to the emergency room complaining of severe abdominal pain. She reports acute onset of diffuse abdominal pain twelve hours prior to presentation. She has vomited twice and has not had a bowel movement in that time. She is in the fetal position because it relieves the pain. Her past medical history is notable for asthma; however, she was adopted as a baby and her family history is unknown. Her temperature is 99.7°F (37.6°C), blood pressure is 130/85 mmHg, pulse is 110/min, and respirations are 22/min. Physical examination reveals abdominal distension and tenderness to palpation. A sausage-shaped abdominal mass is palpated in the right upper quadrant. Mucocutaneous blue-gray macules are evident on the child’s buccal mucosa. A mutation in which of the following genes is associated with this patient’s condition?? {'A': 'C-KIT', 'B': 'NF1', 'C': 'TP53', 'D': 'APC', 'E': 'STK11'},
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E: STK11
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman presents to her OB/GYN with complaints of missing her last 3 periods as well as intermittent spontaneous milky-white nipple discharge bilaterally for the past 3 months. Vital signs are stable and within normal limits. Neurologic examination is without abnormality, including normal visual fields. Serology and MRI of the brain are ordered, with results pending. Which of the following sets of laboratory results would be expected in this patient?? {'A': 'Decreased prolactin, decreased FSH, decreased LH', 'B': 'Decreased prolactin, increased FSH, increased LH', 'C': 'Increased prolactin, decreased FSH, increased LH', 'D': 'Increased prolactin, decreased FSH, decreased LH', 'E': 'Increased prolactin, increased FSH, increased LH'},
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D: Increased prolactin, decreased FSH, decreased LH
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old primigravid woman at 24 weeks' gestation comes to the physician for a prenatal visit. She feels well. She has no personal history of serious illness. Medications include iron supplements and a multivitamin. Her temperature is 37.2°C (99°F) and blood pressure is 108/60 mm Hg. Pelvic examination shows a uterus consistent in size with a 24-week gestation. A 1-hour 50-g glucose challenge shows a glucose concentration of 155 mg/dL (N < 135 mg/dL). A 100-g oral glucose tolerance test shows glucose concentrations of 205 mg/dL (N < 180 mg/dL) and 154 mg/dL (N <140 mg/dL) at 1 and 3 hours, respectively. She refuses treatment with insulin. Which of the following complications is her infant at greatest risk of developing at birth?? {'A': 'Hypocalcemia', 'B': 'Omphalocele', 'C': 'Intrauterine growth restriction', 'D': 'Hypermagnesemia', 'E': 'Hyperglycemia'},
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A: Hypocalcemia
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man walks into an urgent care clinic complaining of a headache and dizziness. Earlier today he was in his normal state of health when symptoms started and lasted about 20 minutes. He did not lose consciousness or actually vomit. He also mentions that he was sweating a lot at that time. He has had similar dizzy spells on three separate occasions. His past medical history is significant for a total thyroidectomy 10 years ago for carcinoma. He takes levothyroxine and a multivitamin every day. Several family members seem to suffer from similar spells. At the clinic, his blood pressure is 140/90 mm Hg, his heart rate is 120/min, his respiratory rate is 18/min, and his temperature is 36.6 °C (98.0 °F). On physical exam, he appears quite anxious and uncomfortable. His heart rate is tachycardic with normal rhythm and his lungs are clear to auscultation bilaterally. Small nodules are observed on his buccal mucosa and tongue. The patient is referred to an endocrinologist for further assessment and CT. On CT exam, a mass is observed involving the medulla of his right adrenal gland. Which of the following additional symptoms is associated with this patients condition?? {'A': 'Bronchospasm', 'B': 'Decreased cardiac contractility', 'C': 'Pale skin', 'D': 'Bradycardia', 'E': 'Pupillary constriction'},
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C: Pale skin
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old male with past history of hypertension, hyperlipidemia, and a 30 pack/year smoking history presents to his primary care physician for his annual physical. Because of his age and past smoking history, he is sent for screening abdominal ultrasound. He is found to have a 4 cm infrarenal abdominal aortic aneurysm. Surgical repair of his aneurysm is indicated if which of the following are present?? {'A': 'Abdominal, back, or groin pain', 'B': 'Smoking history', 'C': 'Diameter >3 cm', 'D': 'Growth of < 0.5 cm in one year', 'E': "Marfan's syndrome"},
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A: Abdominal, back, or groin pain
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Answer the following medical question with one of the provided options:
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Q:Twelve hours after undergoing a femoral artery embolectomy, an 84-year-old man is found unconscious on the floor by his hospital bed. He had received a patient-controlled analgesia pump after surgery. He underwent 2 coronary bypass surgeries, 2 and 6 years ago. He has coronary artery disease, hypertension, hypercholesterolemia, gastroesophageal reflux, and type 2 diabetes mellitus. His current medications include metoprolol, atorvastatin, lisinopril, sublingual nitrate, and insulin. He appears pale. His temperature is 36.1°C (97°F), pulse is 120/min, respirations are 24/min, and blood pressure 88/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 85%. The patient does not respond to commands and withdraws his extremities to pain. The pupils are constricted bilaterally. Examination shows cold, clammy skin and jugular venous distention. There is ecchymosis on the right temple and maxilla. There is a surgical incision over the right thigh that shows no erythema or discharge. Crackles are heard at both lung bases. A new grade 2/6 systolic murmur is heard at the apex. He is intubated and mechanically ventilated. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Transudate within the pericardial layers', 'B': 'A new left bundle branch block on an ECG', 'C': 'Pulsatile abdominal mass at the level of the umbilicus', 'D': 'Positive procalcitonin and interleukin-6 levels', 'E': 'Improved mental status after naloxone administration\n"'},
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B: A new left bundle branch block on an ECG
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Answer the following medical question with one of the provided options:
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Q:An 8-year-old boy is brought to the physician because of a 2-month history of headaches. He is at the 25th percentile for weight and 80th percentile for height. His vital signs are within normal limits. Physical examination shows no abnormalities. CT scan of the head shows a small suprasellar cystic mass compressing the infundibular stalk. Serum concentration of which of the following hormones is most likely to be increased in this patient?? {'A': 'Luteinizing hormone', 'B': 'Somatotropin', 'C': 'Prolactin', 'D': 'Adrenocorticotropic hormone', 'E': 'Vasopressin'},
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C: Prolactin
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old woman comes to the physician because of recurrent episodes of severe pain over her neck, back, and shoulders for the past year. The pain worsens with exercise and lack of sleep. Use of over-the-counter analgesics have not resolved her symptoms. She also has stiffness of the shoulders and knees and tingling in her upper extremities that is worse in the morning. She takes escitalopram for generalized anxiety disorder. She also has tension headaches several times a month. Her maternal uncle has ankylosing spondylitis. Examination shows marked tenderness over the posterior neck, bilateral mid trapezius, and medial aspect of the left knee. Muscle strength is normal. Laboratory studies, including a complete blood count, erythrocyte sedimentation rate, and thyroid-stimulating hormone are within the reference ranges. X-rays of her cervical and lumbar spine show no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Polymyalgia rheumatica', 'B': 'Fibromyalgia', 'C': 'Axial spondyloarthritis', 'D': 'Polymyositis', 'E': 'Major depressive disorder'},
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B: Fibromyalgia
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Answer the following medical question with one of the provided options:
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Q:A cross-sectional study of 650 patients with confirmed bronchogenic carcinoma was conducted in patients of all age groups in order to establish a baseline picture for further mortality comparisons. All patients were investigated using thoracic ultrasound and computed tomography of the chest. Also, data about the size of the mass, invasion of lymph nodes and chest wall, pleural effusion, and eventual paralysis of the diaphragm were noted. The bias that can arise in this case, and that may hamper further conclusions on the aggressiveness and mortality of bronchogenic carcinoma, may be explained as a tendency to which of the following aspects?? {'A': 'Find more cases of the disease in older cohorts', 'B': 'Observe only the late stages of a disease with more severe manifestations', 'C': 'Detect only asymptomatic cases of the disease', 'D': 'Uncover more indolent cases of the disease preferentially', 'E': 'Identify more instances of fatal disease'},
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D: Uncover more indolent cases of the disease preferentially
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Answer the following medical question with one of the provided options:
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Q:A randomized, controlled trial was undertaken by a team of clinical researchers to evaluate a new drug for the treatment of cluster headaches. This type of headache (that mostly affects men) is characterized by excruciating pain on 1 side of the head. After careful randomization and controlling for all of the known confounders, a total of 200 patients with cluster headaches were divided into 2 groups. The first group of study participants received 40 mg of the new drug, X, in the form of a powder mixed with water. The second group received 80 mg of verapamil (a calcium channel blocker that is commonly prescribed for cluster headaches) in the form of a labeled pill. Participants from both groups were mixed together in rooms designated for drug research purposes and could communicate freely. After the study period has finished without any loss to follow-up or skipped treatments, the outcome (pain alleviation) was assessed by trained researchers that were blinded to treatment assignment. Study results have shown that the new drug is more efficacious than current gold standard by both clinically and statistically significant margin. Therefore, the investigators concluded that this drug should be introduced for the treatment of cluster headaches. However, their conclusions are likely to be criticized on the grounds of which of the following?? {'A': 'Observer bias', 'B': 'Response bias', 'C': 'Convenience sampling bias', 'D': 'Attrition bias', 'E': 'Intention to treat bias'},
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B: Response bias
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 15-year-old girl is brought to the physician by her parents for lethargy, increased thirst, and urinary frequency for 10 days. She is 173 cm (5 ft 8 in) tall and weighs 54 kg (120 lb); BMI is 18 kg/m2. Physical examination shows no abnormalities. Her serum glucose concentration is 224 mg/dL. A urine dipstick is positive for ketone bodies. Which of the following is most likely involved in the pathogenesis of this patient's condition?? {'A': 'Expression of human leukocyte antigen subtype A3', 'B': 'B-cell production of antimitochondrial antibodies', 'C': 'Complement-mediated destruction of insulin receptors', 'D': 'T-cell infiltration of pancreatic islets', 'E': 'Pancreatic islet amyloid polypeptide deposition'},
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D: T-cell infiltration of pancreatic islets
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Answer the following medical question with one of the provided options:
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Q:Last night you admitted a 72-year-old woman with severe COPD in respiratory distress. She is currently intubated and sedated and her family is at bedside. At the completion of morning rounds, the patient's adult son asks that you and the team take a minute to pray with him for his mother. What is the most appropriate response?? {'A': '"I\'m sorry, but this is a public hospital, so we cannot allow any group prayers."', 'B': '"I understand what you are experiencing and am happy to take a minute."', 'C': '"I also believe in the power of prayer, so I will pray with you and insist that the rest of team joins us."', 'D': '"While I cannot offer you my prayers, I will work very hard to take care of your mother."', 'E': '"I don\'t feel comfortable praying for patients, but I will happily refer you to pastoral care."'},
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B: "I understand what you are experiencing and am happy to take a minute."
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 32-year-old man comes to the physician because of a 2-month history of fatigue and daytime sleepiness. He works as an accountant and cannot concentrate at work anymore. He also has depressed mood and no longer takes pleasure in activities he used to enjoy, such as playing tennis with his friends. He has decreased appetite and has had a 4-kg (8.8-lb) weight loss of over the past 2 months. He does not have suicidal ideation. He is diagnosed with major depressive disorder and treatment with paroxetine is begun. The patient is at greatest risk for which of the following adverse effects?? {'A': 'Urinary retention', 'B': 'Increased suicidality', 'C': 'Decreased libido', 'D': 'Postural hypotension', 'E': 'Priapism'},
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C: Decreased libido
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old woman is brought to the emergency department with a puncture wound on the right side of her chest. She was walking to her apartment when she was assaulted. As she resisted to give up her purse, the assailant stabbed her in the chest with a knife and ran away. She is in severe respiratory distress. Her heart rate is 140/min, respiratory rate is 28/min, and blood pressure is 145/65 mm Hg. The pulse oximetry shows an oxygen saturation of 84%. An oval puncture wound is seen on the right lateral aspect of her chest and she is stuporous. The heart sounds are normal and no jugular venous distension is seen. Distant breath sounds are present on the right. Which of the following changes during inspiration explains her breathing difficulty?? {'A': 'Diminished inspiratory force due to pain', 'B': 'Decreased intrapleural pressure', 'C': 'Equal intrapleural and atmospheric pressures', 'D': 'Paralysis of the diaphragm', 'E': 'Increased elastic force of the chest wall pulling it inwards'},
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C: Equal intrapleural and atmospheric pressures
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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 electively underwent an open cholecystectomy for his cholelithiasis. The procedure was performed under general anesthesia with inhaled anesthetic agents after induction with an intravenous agent. The surgeon operated quickly, and the procedure was uncomplicated. As the surgery ended, the anesthesia resident stopped the anesthesia and noticed the oxygen saturation gradually decreasing to 84%. He quickly administers 100% oxygen and the hypoxia improves. Which of the following most likely accounts for the decreased oxygen saturation seen after the anesthesia was stopped in this patient?? {'A': 'Pneumothorax', 'B': 'Cardiotoxicity', 'C': 'Second gas effect', 'D': 'Laryngospasm', 'E': 'Diffusion hypoxia'},
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E: Diffusion hypoxia
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman presents to clinic for routine checkup. She has no complaints with the exception of occasional "shortness of breath." Her physical examination is unremarkable with the exception of a "snap"-like sound after S2, followed by a rumbling murmur. You notice that this murmur is heard best at the cardiac apex. A history of which of the following are you most likely to elicit upon further questioning of this patient?? {'A': 'Family history of aortic valve replacement at a young age', 'B': 'Hyperflexibility, vision problems, and pneumothorax', 'C': 'Systolic click auscultated on physical exam 10 years prior', 'D': 'Repeated episodes of streptococcal pharyngitis as a child', 'E': 'Cutaneous flushing, diarrhea, and bronchospasm'},
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D: Repeated episodes of streptococcal pharyngitis as a child
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man comes to the emergency department because of shortness of breath and palpitations for 3 hours. He has had similar episodes intermittently for 4 months. His pulse is 140/min and blood pressure is 90/60 mm Hg. An ECG shows irregular narrow-complex tachycardia with no discernable P waves. Emergent electrical cardioversion is performed and the patient reverts to normal sinus rhythm. Pharmacotherapy with sotalol is begun. Which of the following is the most likely physiologic effect of this drug?? {'A': 'Decreased AV nodal conduction', 'B': 'Increased ventricular repolarization rate', 'C': 'Decreased Purkinje fiber conduction', 'D': 'Increased myocyte inotropy', 'E': 'Increased K+ efflux from myocytes'},
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A: Decreased AV nodal conduction
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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 your Louisiana gulf coast community hospital with 48 hours of profuse watery diarrhea and 24 hours of vomiting and chills. The patient has a past medical history significant for hypertension and hypercholesterolemia. The patient denies sick contacts or any interaction with animals for the last month. Two days ago the patient attended a family crawfish boil where oysters, boiled crabs, and crawfish were consumed. Stool occult blood was negative. What is the most likely etiology of the patient's symptoms?? {'A': 'Campylobacter jejuni', 'B': 'Listeria monocytogenes', 'C': 'Vibrio vulnificus', 'D': 'Brucella melitensis', 'E': 'Shigella dysenteriae'},
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C: Vibrio vulnificus
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old presents with right-sided hemiparesis, right-sided sensory loss, leftward eye deviation, and slurred speech. A head CT is performed which is significant for a hyperdense lesion affecting the putamen. The patient has a history of hypertension treated with hydrochlorothiazide, but is non-adherent. Which of the following is most likely associated with the cause of this patient’s neurological deficits?? {'A': 'Thrombotic development over ruptured atherosclerotic plaque', 'B': 'Vessel lipohyalinosis and microaneurysm formation', 'C': 'Amyloid deposition in small cortical vessels', 'D': 'Predisposed vessel rupture secondary to cortical atrophy', 'E': 'Saccular aneurysm rupture into the subarachnoid space'},
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B: Vessel lipohyalinosis and microaneurysm formation
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man is brought to the Emergency Department after 2 days of shortness breath, orthopnea, and lower limb edema. His past medical history is significant for hypertension and a myocardial infarction 3 years ago that required a coronary arterial bypass graft. He has not been able to take prescribed medicine in several months due to recent unemployment and issues with insurance. On admission, his blood pressure is 155/92 mmHg, heart rate is 102/min, respiratory rate is 24/min, and temperature is 36.4°C (97.5°F). On physical examination there are fine rales in both lungs, regular and rhythmic cardiac sounds with an S3 gallop and a grade II/VI holosystolic murmur. Initial laboratory tests are shown below: Na+ 140 mEq/L K+ 4.2 mEq/L Cl- 105 mEq/L BUN 20 mg/dL Creatinine 0.8 mg/dL The patient is stabilized and admitted to the hospital. The next day his blood pressure is 110/60 mmHg, heart rate is 110/min, respiratory rate is 18/min, and temperature is 36.4°C (97.5°F). This morning's laboratory tests are shown below: Na+ 135 mEq/L K+ 3.2 mEq/L Cl- 102 mEq/L BUN 45 mg/dL Creatinine 1.7 mg/dL Which of the following best explains the changes seen in this patient?? {'A': 'Diuretic therapy', 'B': 'Cholesterol emboli', 'C': 'Chronic renal failure', 'D': 'Glomerular basement membrane damage', 'E': 'Urinary tract obstruction'},
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A: Diuretic therapy
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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 presents to discuss the results of her Pap smear. Her previous Pap smear 1 year ago showed atypical squamous cells of undetermined significance. This year the Pap smear was negative. She had a single pregnancy with a cesarean delivery. Currently, she and her partner do not use contraception because they are planning another pregnancy. She does not have any concurrent diseases and her family history is unremarkable. The patient is concerned about her previous Pap smear finding. She heard from her friend about a vaccine which can protect her against cervical cancer. She has never had such a vaccine and would like to be vaccinated. Which of the following answers regarding the vaccination in this patient is correct?? {'A': 'The patient can receive the vaccine after the pregnancy test is negative.', 'B': 'The patient should receive this vaccination as soon as possible.', 'C': 'This vaccination does not produce proper immunity in people who had at least 1 abnormal cytology report, so is unreasonable in this patient.', 'D': 'The patient should undergo HPV DNA testing; vaccination is indicated if the DNA testing is negative.', 'E': 'HPV vaccination is not recommended for women older than 26 years of age.'},
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E: HPV vaccination is not recommended for women older than 26 years of age.
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl is brought to the emergency room by her parents with severe shortness of breath, cough, and wheezing after playing with her friends in the garden. She has a history of bronchial asthma. Her vital signs are as follows: respiratory rate 39/min, pulse 121/min, blood pressure 129/67 mm Hg, and temperature 37.2°C (99°F). On physical exam, she looks confused and has bilateral diffuse wheezes on chest auscultation. Which of the following is the most appropriate drug to rapidly reverse her respiratory distress?? {'A': 'Inhaled cromolyn', 'B': 'Intravenous propranolol', 'C': 'Inhaled beclomethasone', 'D': 'Inhaled albuterol', 'E': 'Oral montelukast'},
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D: Inhaled albuterol
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old woman presents to the emergency department due to new-onset symptoms of asthma. She reports that the asthmatic attacks started a week ago. The past medical history includes gastroesophageal reflux disease and hepatitis B. On physical examination, the patient has bilateral foot drop as well as numbness and tingling sensation in all extremities. A complete blood count is relevant for eosinophilia of 9.1 × 108/L. Which of the markers below could explain all of the patient’s current symptoms?? {'A': 'ESR', 'B': 'p-ANCA', 'C': 'HLA B-27', 'D': 'Anti-Ro/SSA', 'E': 'Anti-histone antibodies'},
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B: p-ANCA
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the physician for a follow-up examination. Three weeks ago, he was hospitalized and treated for spontaneous bacterial peritonitis. He has alcoholic liver cirrhosis and hypothyroidism. His current medications include spironolactone, lactulose, levothyroxine, trimethoprim-sulfamethoxazole, and furosemide. He appears ill. His temperature is 36.8°C (98.2°F), pulse is 77/min, and blood pressure is 106/68 mm Hg. He is oriented to place and person only. Examination shows scleral icterus and jaundice. There is 3+ pedal edema and reddening of the palms bilaterally. Breast tissue appears enlarged, and several telangiectasias are visible over the chest and back. Abdominal examination shows dilated tortuous veins. On percussion of the abdomen, the fluid-air level shifts when the patient moves from lying supine to right lateral decubitus. Breath sounds are decreased over both lung bases. Cardiac examination shows no abnormalities. Bilateral tremor is seen when the wrists are extended. Genital examination shows reduced testicular volume of both testes. Digital rectal examination and proctoscopy show hemorrhoids. Which of the following potential complications of this patient's condition is the best indication for the placement of a transjugular intrahepatic portosystemic shunt (TIPS)?? {'A': 'Hepatic veno-occlusive disease', 'B': 'Recurrent variceal hemorrhage', 'C': 'Portal hypertensive gastropathy', 'D': 'Hepatic encephalopathy', 'E': 'Hepatic hydrothorax'},
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B: Recurrent variceal hemorrhage
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Answer the following medical question with one of the provided options:
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Q:Three days after delivery of a male newborn, a 36-year-old gravida 1, para 1 woman has fever and pain in her left leg. Pregnancy was complicated by premature rupture of membranes; the child was delivered at 35 weeks' gestation by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. The patient has smoked half a pack of cigarettes daily for 5 years and continued to smoke during her pregnancy. Her temperature is 38.9°C (102°F), pulse is 110/min, and blood pressure is 110/80 mm Hg. Examination shows an edematous, erythematous, and warm left leg. Passive dorsiflexion of the left foot elicits pain in the calf. The peripheral pulses are palpated bilaterally. The uterus is nontender and palpated at the umbilicus. Ultrasonography of the left leg shows an incompressible left popliteal vein. Which of the following is the most appropriate initial step in management?? {'A': 'Low molecular weight heparin', 'B': 'Embolectomy', 'C': 'Urokinase', 'D': 'Warfarin', 'E': 'Graduated compression stockings'},
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A: Low molecular weight heparin
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Answer the following medical question with one of the provided options:
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Q:Three hours later, the patient is reassessed. Her right arm is put in an elevated position and physical examination of the extremity is performed. The examination reveals reduced capillary return and peripheral pallor. Pulse oximetry of her right index finger on room air shows an oxygen saturation of 84%. Which of the following is the most appropriate next step in management?? {'A': 'Perform fasciotomy', 'B': 'Perform right upper extremity amputation', 'C': 'Obtain split-thickness skin graft', 'D': 'Decrease rate of IV fluids', 'E': 'Perform escharotomy'},
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E: Perform escharotomy
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man comes to the emergency department because of sudden, worsening pain in his right calf and foot that started 30 minutes ago. He also has a tingling sensation and weakness in his right leg. He has had no similar episodes, recent trauma, or claudication. He has type 2 diabetes mellitus and was diagnosed with hypertension 20 years ago. His sister has systemic sclerosis. He works as an office administrator and sits at his desk most of the day. He has smoked one and a half packs of cigarettes daily for 30 years. Current medications include metformin and lisinopril. His pulse is 110/min, respirations are 16/min, and blood pressure is 140/90 mm Hg. His right leg is pale and cool to touch. Muscle strength in his right leg is mildly reduced. Pedal pulses are absent on the right. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Arterial vasospasm', 'B': 'Popliteal artery aneurysm', 'C': 'Atherosclerotic narrowing of the artery', 'D': 'Arterial embolism', 'E': 'Atheroembolism'},
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D: Arterial embolism
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman comes to the physician because of a 3-day history of lower abdominal pain and dysuria. She has a history of recurring urinary tract infections that have resolved with antibiotic treatment. She is sexually active with one male partner and they do not use condoms. She had mild pain during her last sexual intercourse one week ago. Her temperature is 38.2°C (100.8°F), pulse is 86/min, and blood pressure is 110/70 mm Hg. Physical examination shows lower abdominal tenderness and bilateral inguinal lymphadenopathy. There is a small amount of purulent vaginal discharge. Bimanual examination shows uterine and cervical motion tenderness. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 13,500/mm3 Segmented neutrophils 75% Eosinophils 1% Lymphocytes 22% Monocytes 2% Platelet count 328,000/mm3 Erythrocyte sedimentation rate 82 mm/h Urine RBC 1–2/hpf WBC 0–1/hpf Nitrite negative Bacteria occasional Urine pregnancy test negative Which of the following is the most appropriate pharmacotherapy?"? {'A': 'Oral metronidazole', 'B': 'Intramuscular leuprolide', 'C': 'Oral levofloxacin and azithromycin', 'D': 'Oral trimethoprim-sulfamethoxazole', 'E': 'Intramuscular ceftriaxone and oral doxycycline'},
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E: Intramuscular ceftriaxone and oral doxycycline
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman presents to a walk-in clinic for evaluation of some bumps around her eyes. The bumps are not itchy or painful. They have been getting larger since appearing last year. She has no other complaints. She has not sought out medical attention for the last 20 years due to lack of insurance coverage. Her medical history reveals no problems and she takes no medications. Her periods are regular. A review of systems reveals no other concerns. She does not drink, smoke, or use illicit drugs. Her vital signs show a heart rate of 86/min, respirations of 14/min, and blood pressure of 124/76 mm Hg. On examination, the rash is a series of small papules and plaques around her eyes. The rest of the examination is unremarkable. Which of the following initial blood tests are most appropriate at this time?? {'A': 'Fasting blood glucose alone', 'B': 'Fasting blood glucose and lipid profile', 'C': 'Fasting lipid profile alone', 'D': 'Thyroid stimulating hormone alone', 'E': 'Fasting blood glucose, lipid profile, and thyroid stimulating hormone'},
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C: Fasting lipid profile alone
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man comes to the physician because of a 2-day history of severe perianal pain and bright red blood in his stool. Examination shows a bulging, red nodule at the rim of the anal opening. Which of the following arteries is the most likely source of blood to the mass found during examination?? {'A': 'Deep circumflex iliac', 'B': 'Internal pudendal', 'C': 'Median sacral', 'D': 'Inferior gluteal', 'E': 'Superior rectal'},
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B: Internal pudendal
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old man attends an appointment with a fertility specialist together with his wife. The couple has been attempting to conceive for over 2 years but without success. She has recently undergone a comprehensive gynecological exam and all the results were normal. He states that he has no prior medical history to report. He says that he does have a low libido compared to other men of his age. On physical examination, he is observed to be of a lean build with a height of 6ft 3 inches with slight evidence of gynecomastia. His testes are small and underdeveloped. His lab tests show an elevation of LH and FSH, along with azoospermia. Which of the following is the most likely cause of this man’s infertility?? {'A': 'Absence of chloride channel', 'B': 'Primary ciliary dyskinesia', 'C': 'Androgen insensitivity', 'D': 'Absent GnRH production', 'E': 'Presence of Barr body'},
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E: Presence of Barr body
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Q:A 62-year-old woman is hospitalized after a recent viral illness complicated by congestive heart failure. She has a past medical history of obesity and hypertension controlled on lisinopril but was otherwise healthy until she developed fatigue and edema after a recent viral illness. In the hospital, she is started on furosemide to manage her fluid status. On day 5 of her admission, the patient’s temperature is 100.0°F (37.8°C), blood pressure is 136/88 mmHg, pulse is 90/min, and respirations are 14/min. The patient continues to have normal heart sounds, but with crackles bilaterally on lung auscultation. Edema is 3+ up to the bilateral knees. On labs, her leukocyte count is now 13,000/mm^3, up from 9,000/mm^3 the day before. Differential shows that this includes 1,000 eosinophils/mm^3. Creatinine is 1.7 mg/dL from 1.0 mg/dL the day before. Which of the following is most likely expected on urinary analysis?? {'A': 'Bacteria > 100 CFU/mL', 'B': 'Crystals', 'C': 'Leukocyte esterase positive', 'D': 'Nitrites positive', 'E': 'Red blood cell casts'},
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C: Leukocyte esterase positive
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old right-handed man presents with complaints of difficulty writing for the past 6 months. He denies right-hand weakness, numbness, pain, and trauma. He can do most normal activities with his right hand, but whenever he holds a pen and starts to write, he experiences painful muscle spasms in his hand and arm. He is an account clerk by profession, and this problem causes him so much distress that he has started writing with his left hand. He is physically active. Sleep and appetite are normal. Past medical history is unremarkable. Physical examination is completely within normal limits with normal muscle tone, strength, and deep tendon reflexes. When he is asked to hold a pen and write, his hand becomes twisted with abnormal posturing while attempting to write. What is the next step in the management of this patient?? {'A': 'Botulinum injection', 'B': 'Electroencephalogram', 'C': 'Refer to the psychiatry clinic', 'D': 'Selective serotonin reuptake inhibitor', 'E': 'Wrist splint'},
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A: Botulinum injection
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Q:A 37-year-old G1P0 at 15 weeks gestation presents for an amniocentesis after a routine triple screen demonstrated a mildly elevated serum AFP. A chromosomal analysis revealed the absence of a second sex chromosome. Which of the following features will the infant most likely have?? {'A': 'Mental retardation', 'B': 'Macroglossia', 'C': 'Micrognathia', 'D': 'Cystic kidneys', 'E': 'Streak ovaries'},
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E: Streak ovaries
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy is brought to his primary care physician for evaluation of visual loss and is found to have lens subluxation. In addition, he is found to have mild scoliosis that is currently being monitored. Physical exam reveals a tall and thin boy with long extremities. Notably, his fingers and toes are extended and his thumb and little finger can easily encircle his wrist. On this visit, the boy asks his physician about a friend who has a very similar physical appearance because his friend was recently diagnosed with a pheochromocytoma. He is worried that he will also get a tumor but is reassured that he is not at increased risk for any endocrine tumors. Which of the following genetic principles most likely explains why this patient and his friend have a similar physical appearance and yet only one is at increased risk of tumors?? {'A': 'Anticipation', 'B': 'Incomplete penetrance', 'C': 'Locus heterogeneity', 'D': 'Pleiotropy', 'E': 'Variable expression'},
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C: Locus heterogeneity
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Q:A 19-year-old woman comes to the physician because of increased sweating for the past 6 months. She experiences severe sweating that is triggered by stressful situations and speaking in public. She is failing one of her university classes because of her avoidance of public speaking. She has not had any fevers, chills, weight loss, or night sweats. Her temperature is 36.6°C (98°F). Physical examination shows moist skin in the axillae and on the palms, soles, and face. Which of the following drugs is most likely to be effective for this patient's condition?? {'A': 'Pilocarpine', 'B': 'Oxytocin', 'C': 'Physostigmine', 'D': 'Phenylephrine', 'E': 'Glycopyrrolate'},
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E: Glycopyrrolate
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Q:A 73-year-old man is admitted to the hospital for jaundice and weight loss. He is an immigrant from the Dominican Republic and speaks little English. A CT scan is performed showing a large mass at the head of the pancreas. When you enter the room to discuss these results with the patient, his daughter and son ask to speak with you outside of the patient's room. They express their desire to keep these results from their father, who is "happy" and would prefer not to know his poor prognosis. What is the appropriate response in this situation?? {'A': "Explore the reasoning behind the children's reluctance to have their father know his prognosis", 'B': 'Tell the children that you are obligated to tell the father his prognosis', 'C': "Respect the children's wishes to hold prognosis information from their father", 'D': 'Deliver the information in English so that you have not withheld information but the patient will not understand', 'E': 'Bring the situation to the hospital ethics panel'},
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A: Explore the reasoning behind the children's reluctance to have their father know his prognosis
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Q:A 55-year-old man is seen in the hospital for new onset shortness of breath. The patient was hospitalized 5 days ago after initially presenting with chest pain. He was found to have an ST-elevation myocardial infarction. He underwent percutaneous coronary intervention with stent placement with resolution of his chest pain. He states that he was doing well until yesterday when he developed dyspnea while walking around the hall and occasionally when getting out of bed to use the bathroom. His shortness of breath has since progressed, and he is now having trouble breathing even at rest. His medical history is also significant for type II diabetes mellitus and hypercholesterolemia. He takes aspirin, clopidogrel, metformin, and atorvastatin. His temperature is 97°F (36.1°C), blood pressure is 133/62, pulse is 90/min, respirations are 20/min, and oxygen saturation is 88% on room air. On physical examination, there is a holosystolic murmur that radiates to the axilla and an S3 heart sound. Coarse crackles are heard bilaterally. An electrocardiogram, a chest radiograph, and cardiac enzyme levels are pending. Which of the following is the most likely diagnosis?? {'A': 'Dressler syndrome', 'B': 'Free wall rupture', 'C': 'Interventricular septum rupture', 'D': 'Papillary muscle rupture', 'E': 'Thickened mitral valve leaflets'},
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D: Papillary muscle rupture
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Q:A mother brings her 2-year-old son to your office after she noticed a “sore on the back of his throat.” She states that her son had a fever and was complaining of throat pain 2 days ago. The child has also been fussy and eating poorly. On examination, the child has met all appropriate developmental milestones and appears well-nourished. He has submandibular and anterior cervical lymphadenopathy. On oral examination, less than 10 lesions are visible on bilateral tonsillar pillars and soft palate with surrounding erythema. After 4 days, the lesions disappear without treatment. Which of the following is the most likely causative agent?? {'A': 'Type 2 sensitivity reaction', 'B': 'Herpes simplex virus type 1', 'C': 'Coxsackievirus A', 'D': 'Varicella-zoster', 'E': 'Staphylococcus aureus'},
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C: Coxsackievirus A
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Q:You are called to the bedside of a 75-year-old woman, who is post-op day 4 from a right total hip replacement. The patient appears agitated; she is trying to pull out her IV, and for the past 4 hours she has been accusing the nursing staff of trying to poison her. Her family notes that this behavior is completely different from her baseline; she has not shown any signs of memory loss or behavioral changes at home prior to the surgery. You note that she still has an indwelling catheter. She continues on an opioid-based pain regimen. All of the following are potential contributors to the patient’s presentation EXCEPT:? {'A': 'Infection', 'B': 'Polypharmacy', 'C': 'Amyloid accumulation', 'D': 'Volume depletion', 'E': 'Electrolyte abnormalities'},
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C: Amyloid accumulation
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Q:A 53-year-old man presents to the emergency department with a complaint of chest pain for 5 hours. The chest pain is continuous and squeezing in nature, not relieved by aspirin, and not related to the position of respiration. The blood pressure was 102/64 mm Hg, and the heart rate was 73/min. On physical examination, heart sounds are normal on auscultation. His ECG shows sinus rhythm with ST-segment elevation in leads II and III, aVF, and reciprocal segment depression in precordial leads V1–V6. Tissue plasminogen activator therapy is administered to the patient intravenously within 1 hour of arrival at the hospital. After 6 hours of therapy, the patient’s clinical condition starts to deteriorate. An ECG now shows ventricular fibrillation. The patient dies, despite all the efforts made in the intensive care unit. What is the most likely pathological finding to be expected in his heart muscles on autopsy?? {'A': 'Caseous necrosis', 'B': 'Coagulative necrosis', 'C': 'Fat necrosis', 'D': 'Liquefactive necrosis', 'E': 'Fibrinoid necrosis'},
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B: Coagulative necrosis
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Q:A 44-year-old man presents to the clinic with recurrent epigastric pain following meals for a month. He adds that the pain radiates up his neck and throat. Over the counter antacids have not helped. On further questioning, he endorses foul breath upon waking in the morning and worsening of pain when lying down. He denies any recent weight loss. His temperature is 37°C (98.6°F), respirations are 15/min, pulse is 70/min, and blood pressure is 100/84 mm Hg. A physical examination is performed which is within normal limits except for mild tenderness on deep palpation of the epigastrium. An ECG performed in the clinic shows no abnormalities. What is the next best step in the management of this patient?? {'A': 'Endoscopy', 'B': 'Barium swallow', 'C': 'Lansoprazole', 'D': 'Liquid antacid', 'E': 'Ranitidine'},
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C: Lansoprazole
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Q:A 37-year-old woman, gravida 3, para 2, at 35 weeks' gestation is brought to the emergency department for the evaluation of lower abdominal and back pain and vaginal bleeding that started one hour ago. She has had no prenatal care. Her first two pregnancies were uncomplicated and her children were delivered vaginally. The patient smoked one pack of cigarettes daily for 20 years; she reduced to half a pack every 2 days during her pregnancies. Her pulse is 80/min, respirations are 16/min, and blood pressure is 130/80 mm Hg. The uterus is tender, and regular hypertonic contractions are felt every 2 minutes. There is dark blood on the vulva, the introitus, and on the medial aspect of both thighs bilaterally. The fetus is in a cephalic presentation. The fetal heart rate is 158/min and reactive with no decelerations. Which of the following is the most appropriate next step in management?? {'A': 'Transvaginal ultrasonography', 'B': 'Vaginal delivery', 'C': 'Elective cesarean delivery', 'D': 'Administration of betamethasone', 'E': 'Administration of terbutaline'},
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B: Vaginal delivery
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Q:A 28-year-old woman presents with right lower quadrant abdominal pain, fatigue, and low-volume diarrhea of intermittent frequency for the past 4 months. She also reports weight loss and believes it to be due to a decreased appetite. She has noticed herself being more "forgetful" and she denies seeing any blood in her stool, changes in diet, infection, or recent travel history. Her temperature is 99.5°F (37.5°C), blood pressure is 112/72 mmHg, pulse is 89/min, and respirations are 17/min. Physical examination is unremarkable. Laboratory testing is shown below: Hemoglobin: 10.8 g/dL Hematocrit: 32% Platelet count: 380,000/mm^3 Mean corpuscular volume: 118 µm^3 Reticulocyte count: 0.27% Leukocyte count: 9,900 cells/mm^3 with normal differential Erythrocyte sedimentation rate: 65 mm/h A colonoscopy is performed and demonstrates focal ulcerations with polypoid mucosal changes adjacent to normal appearing mucosa. A biopsy is obtained and shows ulcerations and acute and chronic inflammatory changes. Involvement of which of the following sites most likely explains this patient's clinical presentation?? {'A': 'Colon', 'B': 'Gastric antrum', 'C': 'Gastric fundus', 'D': 'Ileum', 'E': 'Jejunum'},
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D: Ileum
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Q:A 43-year-old man with a history of untreated HIV presents with fever, shortness of breath, and a nonproductive cough for the past week. Past medical history is significant for HIV diagnosed 10 years ago and never treated. His most recent CD4+ T cell count was 105/µL. Physical examination reveals bilateral crepitus over all lobes. No lymphadenopathy is present. A chest radiograph reveals bilateral infiltrates. Which of the following is the best treatment for this patient?? {'A': 'Highly active antiretroviral therapy (HAART)', 'B': 'Trimethoprim-sulfamethoxazole', 'C': 'Ganciclovir', 'D': 'Azithromycin', 'E': 'Amphotericin B'},
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B: Trimethoprim-sulfamethoxazole
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Q:A 1-week-old male newborn is brought to the physician for a follow-up examination after the results of newborn screening showed an increased serum concentration of phenylalanine. Genetic analysis confirms a diagnosis of phenylketonuria. The physician counsels the patient's family on the recommended dietary restrictions, including avoidance of artificial sweeteners that contain aspartame. Aspartame is a molecule composed of aspartate and phenylalanine and its digestion can lead to hyperphenylalaninemia in patients with phenylketonuria. Which of the following enzymes is primarily responsible for the breakdown of aspartame?? {'A': 'Pepsin', 'B': 'Dipeptidase', 'C': 'Chymotrypsin', 'D': 'Trypsin', 'E': 'Carboxypeptidase A'},
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B: Dipeptidase
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Q:An American doctor is on an outreach trip to visit local communities in Ethiopia. In one clinic, he found many cases of children ages 2–5 years who have significantly low weight and height for their age. These children also had pale sclerae, distended abdomens, dermatoses, and marked edema in the lower extremities. Malnutrition in these patients is investigated and classified as (kwashiorkor) protein malnutrition. Appropriate nutrition supplementation was ordered and shipped in for the affected families. Which of the following amino acids must be included for these patients?? {'A': 'Alanine', 'B': 'Tyrosine', 'C': 'Arginine', 'D': 'Glutamine', 'E': 'Methionine'},
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E: Methionine
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Q:Under what physiologic state is the endogenous human analog of nesiritide produced?? {'A': 'Increased external stress', 'B': 'Increased ventricular stretch', 'C': 'Increased intracranial pressure', 'D': 'Increased circulatory volume presenting to the kidneys', 'E': 'Decreased circulatory volume presenting to the kidneys'},
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B: Increased ventricular stretch
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Q:A 9-year-old boy is brought to the physician for a well-child examination. His mother says his teachers report him being easily distracted, lagging behind his classmates in most of the subjects, and frequently falling asleep during class. She says that her son has complained of leg pain on multiple occasions. He is at the 45th percentile for height and 35th percentile for weight. Vital signs are within normal limits. Examination shows ptosis and a high-arched palate. Muscle strength is decreased in the face and hands. Muscle strength of the quadriceps and hamstrings is normal. Sensation is intact. Percussion of the thenar eminence causes the thumb to abduct and then relax slowly. Which of the following is the most likely diagnosis?? {'A': 'Spinal muscular atrophy', 'B': 'McArdle disease', 'C': 'Myotonic dystrophy', 'D': 'Juvenile dermatomyositis', 'E': 'Duchenne muscular dystrophy\n"'},
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C: Myotonic dystrophy
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Q:A 56-year old man is brought in by ambulance to the emergency department and presents with altered consciousness, confabulation, and widespread rash. He is recognized as a homeless man that lives in the area with a past medical history is significant for traumatic brain injury 4 years ago and chronic gastritis. He also has a long history of alcohol abuse. His vital signs are as follows: blood pressure 140/85 mm Hg, heart rate 101/min, respiratory rate 15/min, and temperature 36.1°C (97.0°F). His weight is 56 kg (123.5 lb) and height is 178 cm (5.8 ft). The patient is lethargic and his speech is incoherent. Examination reveals gingival bleeding, scattered corkscrew body hair, bruises over the forearms and abdomen, multiple petechiae, and perifollicular, hyperkeratotic papules over his extremities. His lung and heart sounds are normal. Abdominal palpation reveals tenderness over the epigastric area and hepatomegaly. Neurologic examination demonstrates symmetrically diminished reflexes in the lower extremities. Impairment of which of the following processes is the most likely cause of this patient’s hyperkeratotic rash?? {'A': 'Hydroxylation of proline residues', 'B': 'Carboxylation of clotting factors', 'C': 'Decarboxylation of histidine', 'D': 'Deamination of guanine', 'E': 'Ethanol oxidation to acetaldehyde'},
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A: Hydroxylation of proline residues
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Q:An 8-year-old girl is brought to the emergency department by her parents because she complained of very fast heartbeats. The patient has previously been healthy without any childhood illnesses and has not needed to visit a physician in the past 2 years. On examination, the heart rate is 198/min. Further examination by the physician reveals a grade III holosystolic murmur over the anterior chest wall. ECG is immediately performed after her heart rate is reduced, and shows a short P-R interval with a slow upstroke of the QRS complex. Which of the following is the most likely diagnosis in this patient?? {'A': 'Pulmonic stenosis', 'B': 'Tricuspid atresia', 'C': 'Ebstein anomaly', 'D': 'Tetralogy of Fallot', 'E': 'Atrial septal defect'},
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C: Ebstein anomaly
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Q:A 78-year-old man with advanced lung cancer with metastases to the brain is brought to the physician by his daughter, with whom he lives. The daughter reports that her father's condition has been slowly deteriorating over the past 2 months. His seizures have been poorly controlled despite maximal medical therapy. He has had progressive loss of mobility, a decrease in executive function, and worsening pain. The patient has Medicaid insurance. Current medications include high-dose corticosteroids and immediate-release opioid analgesics. The need for increased assistance has been distressing to the family, and they are concerned about the patient's overall comfort. The daughter asks the physician about her father's eligibility for hospice care. Which of the following responses from the physician about this model of care is most appropriate?? {'A': '"""Hospice care is likely to hasten your father\'s death."""', 'B': '"""Your father would have to be moved from home to a center that specializes in hospice care."""', 'C': '"""Your father cannot enter hospice care if there is a definitive cure for his disease."""', 'D': '"""Your father is only eligible if his life expectancy is less than 6 months."""', 'E': '"""Your father\'s current medication regimen is incompatible with hospice care because of the risk of respiratory depression."""'},
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D: """Your father is only eligible if his life expectancy is less than 6 months."""
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Q:A 26-year-old G1P0 mother is in the delivery room in labor. Her unborn fetus is known to have a patent urachus. Which of the following abnormalities would you expect to observe in the infant?? {'A': 'Myelomeningocele', 'B': 'Gastroschisis', 'C': 'Omphalocele', 'D': 'Meconium discharge from umbilicus', 'E': 'Urine discharge from umbilicus'},
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E: Urine discharge from umbilicus
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman is being treated by her oncologist for metastatic breast cancer. The patient had noticed severe weight loss and a fixed breast mass over the past 8 months but refused to see a physician until her husband brought her in. Surgery is scheduled, and the patient is given an initial dose of radiation therapy to destroy malignant cells. Which of the following therapies was administered to this patient?? {'A': 'Adjuvant therapy', 'B': 'Consolidation therapy', 'C': 'Induction therapy', 'D': 'Maintenance therapy', 'E': 'Salvage therapy'},
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C: Induction therapy
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to the emergency department with chief complaints of abdominal pain, distension, and bloody diarrhea for a day. Abdominal pain was episodic in nature and limited to the left lower quadrant. It was also associated with nausea and vomiting. He also has a history of postprandial abdominal pain for several months. He had an acute myocardial infarction which was treated with thrombolytics 3 months ago. He is a chronic smoker and has been diagnosed with diabetes mellitus for 10 years. On physical examination, the patient is ill-looking with a blood pressure of 90/60 mm Hg, pulse 100/min, respiratory rate of 22/min, temperature of 38.0°C (100.5°F) with oxygen saturation of 98% in room air. The abdomen is tender on palpation and distended. Rectal examination demonstrates bright red color stool. Leukocyte count is 14,000/mm3. Other biochemical tests were within normal ranges. Abdominal X-ray did not detect pneumoperitoneum or air-fluid level. The recent use of antibiotics was denied by the patient and stool culture was negative for C. difficile. Contrast-enhanced CT scan revealed segmental colitis involving the distal transverse colon. What is the most likely cause of the patient’s symptoms?? {'A': 'Hypokalemia', 'B': 'Aneurysm', 'C': 'Clostridium difficile infection', 'D': 'Embolism', 'E': 'Atherosclerosis'},
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E: Atherosclerosis
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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 comes to the physician for routine physical examination. His blood pressure is 158/96 mm Hg. Physical examination shows no abnormalities. Serum studies show a potassium concentration of 3.1 mEq/L. His plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is 47 (N < 10). A saline infusion test fails to suppress aldosterone secretion. A CT scan of the abdomen shows bilateral adrenal gland abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Bilateral adrenalectomy', 'B': 'Eplerenone therapy', 'C': 'Amiloride therapy', 'D': 'Unilateral adrenalectomy', 'E': 'Propranolol therapy'},
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B: Eplerenone therapy
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Answer the following medical question with one of the provided options:
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Q:In a routine medical examination, an otherwise healthy 12-year-old by is noted to have tall stature with a wide arm span and slight scoliosis. Chest auscultation reveals a heart murmur. Transthoracic echocardiography shows an enlarged aortic root and aortic valve insufficiency. Mutations in mutations in fibrillin-1 gene are positive. Plasma homocysteine levels are not elevated. This patient is at high risk for which of the following complications?? {'A': 'Arterial and visceral rupture', 'B': 'Aortic aneurysm', 'C': 'Thrombotic events', 'D': 'Infertility', 'E': 'Pheochromocytoma'},
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B: Aortic aneurysm
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Answer the following medical question with one of the provided options:
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Q:A 5-day-old boy is brought to the emergency department by his mother because of a 2-day history of difficulty feeding and multiple episodes of his lips turning blue. He was born at home via spontaneous vaginal delivery and Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. Physical examination shows grunting and moderate intercostal and subcostal retractions. Echocardiography shows a single vessel exiting from the heart. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Failure of neural crest cell migration', 'B': 'Insufficient growth of endocardial cushions', 'C': 'Abnormal placement of the infundibular septum', 'D': 'Absent fusion of septum primum and septum secundum', 'E': 'Abnormal cardiac looping'},
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A: Failure of neural crest cell migration
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Q:A 58-year-old woman presents to her primary care doctor with her husband. The patient's husband reports that his wife has been acting "funny" ever since she was in a motor vehicle accident 2 months ago. She's been very rude to him, their children, and her friends, often saying inappropriate things. She is not interested in her previous hobbies and will not watch her favorite television shows or play cards. Which of the following regions is suspicious for injury?? {'A': "Broca's area", 'B': 'Occipital lobe', 'C': 'Temporal lobe', 'D': 'Motor cortex', 'E': 'Frontal lobe'},
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E: Frontal lobe
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman presents to a psychiatrist to discuss a recent event in her life. At a social function 2 days back, she met a man who introduced himself as having worked with her at another private company 3 years ago. However, she did not recognize him. She also says that she does not remember working at any such company at any time during her life. However, the patient’s husband says that she had indeed worked at that company for three months and had quit due to her boss’s abusive behavior towards her. The man who met her at the function had actually been her colleague at that job. The woman asks the doctor, “How is it possible? I am really not able to recall any memories of having worked at any such company. What’s going on here?”. Her husband adds that after she quit the job, her mood frequently has been low. The patient denies any crying episodes, suicidal ideas, not enjoying recreational activities or feelings of worthlessness. Her appetite and sleep patterns are normal. She is otherwise a healthy woman with no significant medical history and lives a normal social and occupational life. The patient reports no history of smoking, alcohol, or substance use. On physical examination, she is alert and well-oriented to time, place and person. During memory testing, she correctly remembers the date of her marriage that took place 5 years back and the food she ate over the last 2 days. Which of the following is the most likely diagnosis in this patient?? {'A': 'Pseudodementia', 'B': 'Dissociative amnesia', 'C': 'Dissociative identity disorder', 'D': 'Dissociative fugue', 'E': 'Transient global amnesia'},
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B: Dissociative amnesia
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Answer the following medical question with one of the provided options:
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Q:A 12-year-old boy is brought by his parents to the physician for a fever for the past 2 days. His temperature is 101.3°F (38.5°C). His medical history is significant for sickle cell disease and recurrent infections. A year ago, he underwent spleen scintigraphy with technetium-99m that revealed functional hyposplenism. Which of the following findings would be found in a peripheral blood smear from this patient?? {'A': 'Acanthocytes', 'B': 'Basophilic stippling', 'C': 'Heinz bodies', 'D': 'Howell-Jolly bodies', 'E': 'Schistocytes'},
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D: Howell-Jolly bodies
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old woman presents to the emergency department multiple times over the past 3 months feeling like her chest is about to explode. She has been screened on several occasions for acute coronary syndrome, but each time, her cardiac enzymes have all been within normal limits. She comes into the emergency room diaphoretic, short of breath, and complaining of chest pain. Her symptoms usually resolve within 30 minutes, but she is left with a lingering fear for the next attack. She does not know of any triggers for these episodes. After medical causes are ruled out, the patient is referred to outpatient psychiatry to confirm her most likely diagnosis. Which one of the following is correct regarding this patient’s most likely condition?? {'A': 'The patient must have symptoms of elevated autonomic activity.', 'B': 'Attacks occur at regular intervals.', 'C': 'There is a fixed number of attacks needed for diagnosis.', 'D': 'The patients must have symptoms for at least 3 months.', 'E': 'The patient must have a fear of not being able to escape.'},
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A: The patient must have symptoms of elevated autonomic activity.
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Q:An 18-month-old toddler is brought to a pediatric hematologist by his father. The boy was referred to this office for prolonged neutropenia. He has had several blood tests with an isolated low neutrophil count while hemoglobin, hematocrit, and platelet count is normal. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today his complete blood count (CBC) with differential shows: Hemoglobin: 15.5 g/dL Platelets: 300,000 mm3 Neutrophils: 20% Bands: 2% Lymphocytes: 40% Monocytes: 15% Today, he has a heart rate of 90/min, respiratory rate of 22/min, blood pressure of 110/65 mm Hg, and temperature of 37.0°C (98.6°F). On physical exam, the child appears healthy and is within expected growth parameters for his age and sex. A bone marrow biopsy shows normal bone marrow with 95% cellularity and trilineage maturation. Flow cytometry is normal with no abnormal markers noted. Which of the following is the most probable diagnosis in the present case?? {'A': 'Chronic benign neutropenia', 'B': 'Chronic lymphoblastic leukemia', 'C': 'Sepsis', 'D': 'Aplastic anemia', 'E': 'Acute lymphoblastic leukemia'},
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A: Chronic benign neutropenia
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old girl is brought to the physician for a routine checkup. She was recently adopted and has never seen a doctor before. The patient's parents state she was very emaciated when they adopted her and noticed she has trouble seeing in the evening. They also noted that she was experiencing profuse foul-smelling diarrhea as well, which is currently being worked up by a gastroenterologist. Her temperature is 97.8°F (36.6°C), blood pressure is 104/54 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. The girl appears very thin. She has dry skin noted on physical exam. Laboratory studies are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 4,500/mm^3 with normal differential Platelet count: 191,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 3.8 mEq/L HCO3-: 28 mEq/L BUN: 20 mg/dL Glucose: 88 mg/dL Creatinine: 0.7 mg/dL Ca2+: 9.0 mg/dL Which of the following findings is also likely to be seen in this patient?? {'A': 'Ataxia', 'B': 'Cheilosis', 'C': 'Diarrhea', 'D': 'Perifollicular hemorrhages', 'E': 'Xerophthalmia'},
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E: Xerophthalmia
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Q:A 32-year-old man presents to the emergency department with vomiting, diarrhea, and abdominal pain 2 hours after eating seafood in a restaurant. He also mentions that immediately after ingestion of the food, he experienced tingling and numbness over the lips and face. On physical examination, his vital signs are stable. On neurological examination, he has reduced strength in the lower extremities, but deep tendon reflexes are present and normal. Laboratory evaluation of the seafood from the restaurant confirms the presence of a toxin which is known to block voltage-gated fast sodium channels. Which of the following toxins is the most likely cause of the patient’s symptoms?? {'A': 'Latrotoxin', 'B': 'Domoic acid', 'C': 'Okadaic acid', 'D': 'Scombrotoxin', 'E': 'Tetrodotoxin'},
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E: Tetrodotoxin
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Q:A 24-year-old woman presents with a 3-month history of bloody diarrhea and intermittent abdominal pain. She says that after she has a bowel movement, she still feels as though she needs to go more. She also reports a 10-pound weight loss, significant fatigue, and frequent cravings to chew ice. Her past medical history is significant only for chronic iron deficiency anemia since high school. She currently takes a women’s multivitamin and ferrous sulfate 65 mg orally once daily. She is on the college track team but now is too tired to participate in practice. Her family history is significant for colon cancer and her grandmother died from breast cancer in her 70’s. Her vital signs include: temperature 37.0°C (98.6°F), pulse 102/min, respiratory rate 16/min, blood pressure 100/75 mm Hg. Physical examination is significant for conjunctival pallor, koilonychia, and the cutaneous findings shown in the exhibit. Laboratory tests show elevated ESR and C-reactive protein and findings consistent with iron deficiency anemia. A barium enema demonstrates a lead pipe appearance and a loss of haustra. Which of the following are the recommended screening guidelines for colorectal cancer for this patient?? {'A': 'Colonoscopy by age 32 and repeated every 1–2 years thereafter', 'B': 'Colonoscopy by age 50 and repeated every 10 years thereafter', 'C': 'Colonoscopy by age 32 and repeated every 3 years thereafter', 'D': 'Colonoscopy by age 45 and repeated every 10 years thereafter', 'E': 'Flexible sigmoidoscopy by age 32 and repeated every 1–2 years thereafter'},
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A: Colonoscopy by age 32 and repeated every 1–2 years thereafter
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Q:A 24-year-old woman presents to the emergency department with severe abdominal and lower back pain. She describes it as intense cramping and states that she experienced severe pain roughly 1 month ago that was similar. The patient's past medical history is non-contributory, and she states that her menses cause her to soak through 1 pad in a day. She is currently sexually active and does not use any contraception. Her vitals are within normal limits. The patient's abdominal exam is non-focal, and her pelvic exam reveals no adnexal masses or tenderness and no cervical motion tenderness. Which of the following is the most likely diagnosis?? {'A': 'Adenomyosis', 'B': 'Appendicitis', 'C': 'Ectopic pregnancy', 'D': 'Leiomyoma', 'E': 'Primary dysmenorrhea'},
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E: Primary dysmenorrhea
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Q:Which of the following factors gives the elastin molecule the ability to stretch and recoil?? {'A': 'Hydroxylation of proline and lysine rich regions', 'B': 'Cross-links between lysine residues', 'C': 'Elastase activity', 'D': 'Triple helix formation', 'E': 'Cleavage of disulfide rich terminal regions'},
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B: Cross-links between lysine residues
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Q:A 68-year-old woman, otherwise healthy, is admitted to the coronary care unit due to acute ischemic cardiomyopathy. No other significant past medical history. Her vital signs include: pulse 116/min, respiratory rate 21/min, temperature 37.4°C (99.3°F), and blood pressure 160/100 mm Hg. On physical examination, the patient is in distress. Cardiopulmonary exam is positive for bilateral pulmonary crackles at the lung bases, tachycardia, and jugular venous distension. Her laboratory findings are significant for a hemoglobin of 7.8 g/dL. She is initially treated with oxygen, antiplatelet therapy, nitroglycerin, and beta-blockers. In spite of these treatments, her angina does not subside. The patient is not a candidate for percutaneous coronary intervention, so she is being prepared for a coronary artery bypass graft. Which of the following would be the next, best step in management of this patient?? {'A': 'Administer intravenous iron', 'B': 'Transfuse packed red blood cells', 'C': 'Transfuse whole blood', 'D': 'Treat with erythropoietin', 'E': 'Observation and supportive care'},
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B: Transfuse packed red blood cells
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Q:A goalkeeper of a famous soccer team gives an interview with a health agency regarding his childhood. He describes how when he was a child, he would constantly clear his throat in class and the teachers would write a note to his mother with advice to go see an ENT doctor. He complained of being restless, fidgety, and sometimes hyperactive in class, disrupting the environment and causing him many social problems. He would blurt out the answer at times and keep repeating it without any control, leading to some embarrassing timeouts. But he was always nice to his teachers, so he calls it a “benign frustration” rather than aggressively causing distress. He also talked about how his symptoms were dramatically improved with medication. Which of the following is an FDA approved drug for this patient’s most likely condition?? {'A': 'Clonazepam', 'B': 'Clonidine', 'C': 'Guanfacine', 'D': 'Haloperidol', 'E': 'Lithium'},
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D: Haloperidol
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Q:A 36-year-old healthy man presents to his physician to discuss his concerns about developing heart disease. His father, grandfather, and older brother had heart problems, and he has become increasingly worried he might be at risk. He takes no medications and his past medical history is only significant for an appendectomy at 20 years ago. He is married happily with 2 young children and works as a hotel manager and exercises occasionally in the hotel gym. He drinks 3–5 alcoholic beverages per week but denies smoking and illicit drug use. Today his blood pressure is 146/96 mm Hg, pulse rate is 80/min, and respiratory rate is 16/min. He has a body mass index of 26.8 kg/m2. His physical examination is otherwise unremarkable. Laboratory tests show: Laboratory test Serum glucose (fasting) 88 mg/dL Serum electrolytes Sodium 142 mEq/L Potassium 3.9 mEq/L Chloride 101 mEq/L Serum creatinine 0.8 mg/dl Blood urea nitrogen 10 mg/dl Cholesterol, total 350 mg/dL HDL-cholesterol 40 mg/dL LDL-cholesterol 280 mg/dL Triglycerides 130 mg/dL Besides appropriate medications for his cholesterol and a follow-up for his hypertension, which of the following supplements is thought to provide a protective cardiovascular effect?? {'A': 'Folic acid', 'B': 'Thiamine', 'C': 'Vitamin B12', 'D': 'Vitamin E', 'E': 'Vitamin K'},
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D: Vitamin E
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Q:A 22-year-old man comes to the emergency department for pain and swelling of his left knee one day after injuring it while playing soccer. While sprinting on the field, he slipped as he attempted to kick the ball and landed on the anterior aspect of his knee. He underwent an appendectomy at the age of 16 years. His vitals signs are within normal limits. Examination shows a swollen and tender left knee; range of motion is limited by pain. The tibial tuberosity shows tenderness to palpation. The left tibia is displaced posteriorly when force is applied to the proximal tibia after flexing the knee. The remainder of the examination shows no abnormalities. An x-ray of the left knee joint shows an avulsion fracture of the tibial condyle. Which of the following is the most likely diagnosis?? {'A': 'Anterior cruciate ligament injury', 'B': 'Lateral meniscus injury', 'C': 'Posterior cruciate ligament injury', 'D': 'Medial meniscus injury', 'E': 'Medial collateral ligament injury'},
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C: Posterior cruciate ligament injury
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Q:A 49-year-old woman comes to the physician with a 2-month history of mild abdominal pain, nausea, and several episodes of vomiting. She often feels full after eating only a small amount of food. Abdominal examination shows mild right upper quadrant tenderness and a liver span of 16 cm. Ultrasonography shows a 5 x 4 cm hyperechoic mass in the left lobe of the liver. The mass is surgically excised. A photomicrograph of the resected specimen is shown. Which of the following is the most likely diagnosis?? {'A': 'Hepatocellular adenoma', 'B': 'Alveolar echinococcosis', 'C': 'Cavernous hemangioma', 'D': 'Focal nodular hyperplasia', 'E': 'Angiosarcoma'},
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C: Cavernous hemangioma
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Q:A pharmaceutical company has created an experimental medication, Drug Z, for patients with relapsing-remitting multiple sclerosis. Drug Z has been deemed to be safe in rats and is nearly ready for human trials. Before initiating a Phase I clinical trial, the company would like to study the medication’s pharmacokinetic properties in humans. The drug was found to have a half-life of 2.5 hours and is eliminated by first-order kinetics. The volume of distribution of the drug is determined to be 0.5 L/kg. The drug is administered intravenously and sublingually and plasma drug concentration vs. time plots are obtained. Intravenous administration of 10 mg of Drug Z yields an area under the curve (AUC) of 15 mg hr/L. Sublingual administration of 25 mg of Drug Z yields an area under the curve of 20 mg hr/L. What is the absolute bioavailability of this medication?? {'A': '48%', 'B': '53%', 'C': '59%', 'D': '67%', 'E': '71%'},
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B: 53%
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Q:A 42-year-old homeless male presents with fever and cough. He was found unconscious on the side of the road and was brought to the emergency room. He is noticeably drunk and is unable to answer any questions. On physical exam his temperature is 103°F (40°C), blood pressure is 130/85 mmHg, pulse is 110/min, respirations are 23/min, and pulse oximetry is 96% on room air. You note decreased breath sounds in the right lower lobe. The pathogen most likely responsible for this patient's symptoms has which of the following features?? {'A': 'Organism that forms black colonies on cysteine-tellurite agar', 'B': 'Disc-shaped yeast seen on methenamine silver stain', 'C': 'Gram-positive, catalase-positive organism that forms cocci in clusters', 'D': 'Negative-sense, single-stranded RNA virus', 'E': 'Gram-negative organism that produces mucoid colonies on MacConkey agar'},
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E: Gram-negative organism that produces mucoid colonies on MacConkey agar
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Q:A 45-year-old Caucasian male presents complaining of inability to open his mouth. Patient history reveals that he recently injured his foot from an exposed floor nail in his house. This patient's symptoms are likely the result of:? {'A': 'Impaired motor neuron release of ACh', 'B': 'Impaired motor neuron release of GABA', 'C': 'Increased production of gas in his soft tissues', 'D': 'Cross-reactivity of bacterial antigens', 'E': 'Bacterial infiltration of the central nervous system'},
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B: Impaired motor neuron release of GABA
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Q:An 18-year-old college student presents to the ED straight from chemistry lab where he ingested an unknown compound. He complains of a headache, and is flushed, tachypneic and tachycardic. Suspecting cyanide poisoning, you administer amyl nitrite which causes which of the following?? {'A': 'Oxidation of ferrous iron in hemoglobin to ferric iron', 'B': 'A decrease in serum methemoglobin levels', 'C': 'Formation of thiocyanate', 'D': 'Chelation of the residue', 'E': 'Increase in intracellular NADH/NAD+ ratio'},
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A: Oxidation of ferrous iron in hemoglobin to ferric iron
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Q:A 76-year-old man presents to his physician with his daughter for evaluation of memory loss and disorientation that has become progressively worse over the last few years. The patient’s daughter states that the memory loss started with her father forgetting things ''here and there'' and the memory loss has progressed to the patient forgetting the names of loved ones and getting lost in familiar places. The medical history is non-contributory. On examination, the patient is awake and alert but only oriented to self (not time or place). The cardiopulmonary and neurologic exams are within normal limits. Routine lab work is performed to rule out infection and is found to be within normal limits. Four years later the patient passes away and an autopsy is performed to confirm the presumptive diagnosis. Brain biopsy slides are shown. What histologic features confirm this patient’s diagnosis?? {'A': 'Lewy bodies', 'B': 'Aβ amyloid neuritic plaques', 'C': 'Ubiquitinated TDP-43', 'D': 'Beta-pleated sheet proteins resistant to proteases', 'E': 'Viral inclusions within oligodendrocytes'},
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B: Aβ amyloid neuritic plaques
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Q:A 19-year-old female student presents to her physician for overall fatigue. She is having a hard time concentrating while studying and feeling tired most of the time. She also has had constipation for more than 3 weeks and rectal bleeding on occasions. She notices she is getting colder and often needs to wear warmer clothes than usual for the same weather. On examination, a small nodule around the size of 1cm is palpated in the left thyroid lobule; the gland is nontender. There is no lymphadenopathy. Her vital signs are: blood pressure is 118/75 mm Hg, respirations are 17/min, pulse is 87/min, and temperature is 36.1°C (97.0°F). Which of the following is the best next step in the management of this patient?? {'A': 'Serum T3 levels', 'B': 'Thyroid ultrasound', 'C': 'Serum calcitonin levels', 'D': 'Radionuclide thyroid scan', 'E': 'Combination T4 and T3 therapy'},
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B: Thyroid ultrasound
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Q:A 43-year-old man is brought to the emergency department because of severe back pain for 2 hours. He describes it as a stabbing pain between his scapulae that is 9 out of 10 in intensity. He has vomited once during this period. He has hypertension and type 2 diabetes mellitus. He has not seen a physician in 18 months. Current medications include metformin and enalapril. He is diaphoretic. His temperature is 37.3°C (99.1°F), pulse is 100/min, respirations are 20/min, and blood pressure is 210/130 mm Hg. He is not oriented to person, place, or time. The lungs are clear to auscultation. Cardiac examination shows no murmurs, rubs, or gallops. Abdominal examination shows mild epigastric tenderness with no rebound or guarding. The radial pulse is decreased on the left side. Laboratory studies show: Hemoglobin 13.1 g/dL Leukocyte count 10,000/mm3 Platelet count 230,000/mm3 Serum Na+ 139 mEq/L K+ 4.1 mEq/L Cl- 103 mEq/L Glucose 230 mg/dL Creatinine 3.9 mg/dL Alkaline phosphatase 55 U/L Urine toxicology screening is positive for opiates and cocaine. An ECG shows sinus tachycardia with no evidence of ischemia. An x-ray of the chest shows a widened mediastinum. Which of the following is the most appropriate next step in management?"? {'A': 'Transthoracic echocardiography', 'B': 'Gadolinium-enhanced MRA', 'C': 'Contrast-enhanced CT angiography', 'D': 'Transesophageal echocardiography', 'E': 'Aortography\n"'},
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D: Transesophageal echocardiography
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Q:A 67-year-old man presents to his primary care provider for routine follow-up. He complains of mild fatigue and occasional tingling in both feet. He reports that this numbness and tingling has led to him having 3 falls over the last month. He has had type 2 diabetes mellitus for 23 years and hypertension for 15 years, for which he takes metformin and enalapril. He denies tobacco or alcohol use. His blood pressure is 126/82 mm Hg, the heart rate is 78/min, and the respiratory rate is 15/min. Significant laboratory results are shown: Hemoglobin 10 g/dL Hematocrit 30% Mean corpuscular volume (MCV) 110 fL Serum B12 level 210 picograms/mL Which of the following is the best next step in the management of this patient’s condition?? {'A': 'Intrinsic factor antibody', 'B': 'Schilling test', 'C': 'Folic acid supplementation', 'D': 'Pregabalin or gabapentin', 'E': 'Methylmalonic acid level'},
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E: Methylmalonic acid level
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Q:A previously healthy 31-year-old man comes to the emergency department because of acute onset of left flank pain radiating to his inner groin and scrotum for 3 hours. He also had nausea and one episode of hematuria. His only medication is a multivitamin. He appears uncomfortable. His temperature is 37°C (98.6°F), pulse is 104/min, respirations are 19/min, and blood pressure is 132/85 mm Hg. Physical examination shows marked tenderness in the left costovertebral area. He has normal skin turgor, a capillary refill time of < 1 second, and has been urinating normally. Laboratory studies show: Serum Calcium 9.5 mg/dL Phosphorus 4.3 mg/dL Creatinine 0.8 mg/dL Urea nitrogen 15 mg/dL Urine pH 6.5 RBCs 50–60/hpf A CT scan of the abdomen shows a 4-mm stone in the left distal ureter. Intravenous fluid resuscitation is begun and treatment with tamsulosin and ketorolac is initiated. Five hours later, he passes the stone. Metabolic analysis of the stone is most likely going to show which of the following?"? {'A': 'Uric acid', 'B': 'Magnesium ammonium phosphate', 'C': 'Cystine', 'D': 'Xanthine', 'E': 'Calcium oxalate'},
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E: Calcium oxalate
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Q:A 50-year-old female teacher presents to the clinic with complaints of discoloration of the skin around the right ankle accompanied by itching. She began noticing it a month ago and the pruritus worsened over time. She also has some pain and swelling of the region every night, especially on days when she teaches late into the evening. Her past medical history is significant for diabetes mellitus type 2, for which she takes metformin. She lives with her husband and takes oral contraceptive pills. On examination, the physician observes hyperpigmentation of the medial aspect of her right ankle. The skin is dry, scaly, and edematous along with some superficial varicosities. Dorsiflexion of the foot is extremely painful. Peripheral pulses are equally palpable on both lower limbs. There is a small 2 cm ulcer noted near the medial malleolus with thickened neighboring skin and indurated edges. Laboratory studies show D-dimer of 1,000 µg/L and HbA1c of 9%. Doppler ultrasound of the lower extremity reveals an intramural thrombus in the popliteal vein. Which of the following is the most likely diagnosis in this patient?? {'A': 'Basal cell carcinoma', 'B': 'Stasis dermatitis', 'C': 'Diabetic foot', 'D': 'Atopic dermatitis', 'E': 'Cellulitis'},
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B: Stasis dermatitis
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Q:A 22-year-old man comes to the physician because of a 2-month history of episodes of shortness of breath, lightheadedness, and palpitations. During the examination, he reports the onset of one such episode. His pulse is 170/min and regular, respirations are 22/min, and blood pressure is 100/65 mm Hg. An ECG shows a regular narrow complex tachycardia; no P waves are visible. A common clinical maneuver to diagnose and/or relieve the patient's symptoms involves stimulation of which of the following nerves?? {'A': 'Trigeminal', 'B': 'Recurrent laryngeal', 'C': 'Facial', 'D': 'Phrenic', 'E': 'Glossopharyngeal'},
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E: Glossopharyngeal
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Q:A 20-year-old man comes to the physician because he believes he has low testosterone. He states that he is embarrassed at his lack of musculature, despite lifting weights twice daily. Every day, he drinks a gallon of milk and several protein shakes in addition to 3 large meals. He is convinced that his female classmates at the community college he attends are secretly laughing at his scrawny appearance. Over the course of the semester, he has attended fewer and fewer classes out of embarrassment and shame. He is also concerned that his hair is thinning and applies topical minoxidil to his scalp 3 times daily. He spends 2 hours daily anxiously examining himself in the mirror. Today, he is wearing a long-sleeved shirt and a hat. His BMI is 26 kg/m2. Physical examination shows no abnormalities. On mental status examination, he has an anxious mood and a full range of affect. Serum studies show a normal testosterone concentration. Which of the following is the most likely diagnosis?? {'A': 'Avoidant personality disorder', 'B': 'Body dysmorphic disorder', 'C': 'Obsessive compulsive disorder', 'D': 'Binge eating disorder', 'E': 'Generalized anxiety disorder'},
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B: Body dysmorphic disorder
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Q:Clinical study looks at the effect of childhood exposure of 2nd-hand smoking on the incidence of bronchogenic adenocarcinoma (BA). Study of 100 subjects (50 exposed to childhood 2nd-hand smoking and 50 healthy controls with no childhood exposure) involves monitoring the lifetime incidence of BA data from the study are shown in the table below: Group\BA Dx Yes No Exposed 18 32 Controls 7 43 Which of the following statements is correct regarding the number needed to harm (NNH) based on this study?? {'A': 'If the incidence of BA increases in the control group, the NNH will decrease.', 'B': 'If the incidence of BA increases in the experimental group, the NNH will increase.', 'C': 'The NNH is 11.', 'D': 'The NNH is inversely correlated with the relative risk increase.', 'E': 'If the absolute risk in the exposed group increases, the NNH increases.'},
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D: The NNH is inversely correlated with the relative risk increase.
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Q:Two patients are vaccinated for poliomyelitis. Patient A receives the Sabin oral vaccine, and Patient B receives the Salk intramuscular vaccine. Six weeks after their initial vaccinations, which of the following would be the greatest difference regarding these two patients?? {'A': 'Patient A has a higher level of duodenal IgA antibodies', 'B': 'Patient B has a higher level of duodenal IgA antibodies', 'C': 'Patient A has a lower level of serum IgA antibodies', 'D': 'Patient B has a lower level of serum IgM antibodies', 'E': 'Patient A has a higher level of serum IgG antibodies'},
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A: Patient A has a higher level of duodenal IgA antibodies
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Q:A 71-year-old woman comes to the physician because of dizziness and intermittent episodes of heart palpitations for 5 days. During this time, she has also had one episode of syncope. An ECG shows absence of P waves and irregular RR intervals. Treatment with an antiarrhythmic drug is initiated. The effect of the drug on the cardiac action potential is shown. Which of the following cardiac ion channels is most likely targeted by this drug?? {'A': 'Voltage-gated nonselective cation channels', 'B': 'Voltage-gated sodium channels', 'C': 'Voltage-gated potassium channels', 'D': 'Voltage-gated calcium channels', 'E': 'Voltage-gated chloride channels'},
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C: Voltage-gated potassium channels
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Q:A 53-year-old woman presents to her primary care physician in order to discuss the results of a biopsy. Two weeks ago, her mammogram revealed the presence of suspicious calcifications in her right breast, and she subsequently underwent biopsy of these lesions. Histology of the lesions revealed poorly cohesive cells growing in sheets with a nuclear to cytoplasmic ratio of 1:1. Furthermore, these cells were found to undergo invasion into the surrounding tissues. Given these findings, the patient is referred to an oncologist for further evaluation. Upon further imaging, the patient is found to have no lymph node adenopathy and no distant site metastases. Which of the following would most properly describe the lesions found in this patient?? {'A': 'High grade and high stage', 'B': 'High grade and no stage', 'C': 'High grade and low stage', 'D': 'Low grade and high stage', 'E': 'Low grade and low stage'},
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C: High grade and low stage
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Answer the following medical question with one of the provided options:
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Q:A graduate student is developing the research design for a current project on the detection of ovarian tumor markers in mice. The main method requires the use of chromogenic substrates, in which a reaction may be interpreted according to an enzyme-mediated color change. The detection of which of the substances below is routinely used in clinical practice and applies the above-described method?? {'A': 'ABO blood types', 'B': 'Anti-D antibodies', 'C': 'P24 antigen', 'D': 'Epstein-Barr virus infection', 'E': 'Antibodies in autoimmune hemolytic anemia'},
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C: P24 antigen
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Q:A 12-year-old boy is brought to the physician because of a 6-day history of gradually worsening left knee pain. The pain is exacerbated by movement and kneeling. There is no pain at rest and no history of trauma to the knee. He is concerned because his soccer tryouts are in a few days. Vital signs are within normal limits. Examination shows mild swelling and tenderness to palpation of the left anterior, superior tibia. Extension of the left knee against resistance reproduces the knee pain; flexion is limited by pain. There is no local erythema or effusion of the left knee. A lateral view of an x-ray of his left knee is shown. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Impingement of the infrapatellar fat pad', 'B': 'Inflammation of the infrapatellar bursa', 'C': 'Chondromalacia patella', 'D': 'Traction apophysitis of the tibial tubercle', 'E': 'Osteochondritis dissecans of the knee'},
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D: Traction apophysitis of the tibial tubercle
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Q:A 17-year-old teenager presents to the clinic with her parents complaining of headaches and loss of vision which began insidiously 3 months ago. She describes her headaches as throbbing, mostly on her forehead, and severe enough to affect her daily activities. She has not experienced menarche. Past medical history is noncontributory. She takes no medication. Both of her parents are alive and well. Today, her blood pressure is 110/70 mm Hg, the heart rate is 90/min, the respiratory rate is 17/min, and the temperature is 37.0°C (98.6°F). Breasts and pubic hair development are in Tanner stage I. Blood work is collected and an MRI is performed (the result is shown). Inhibition of which of the following hormones is the most likely explanation for the patient's signs and symptoms?? {'A': 'Antidiuretic hormone', 'B': 'Thyroid-stimulating hormone', 'C': 'Gonadotropins', 'D': 'Adrenocorticotropic hormone', 'E': 'Prolactin'},
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C: Gonadotropins
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Answer the following medical question with one of the provided options:
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Q:A healthy 31-year-old woman comes to the physician because she is trying to conceive. She is currently timing the frequency of intercourse with at-home ovulation test kits. An increase in the levels of which of the following is the best indicator that ovulation has occurred?? {'A': 'Estrogen', 'B': 'Gonadotropin-releasing hormone', 'C': 'Follicle stimulating hormone', 'D': 'Progesterone', 'E': 'Luteinizing hormone\n"'},
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D: Progesterone
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Q:A 32-year-old man presents with a 2-month history of increasing lethargy, frequent upper respiratory tract infections, and easy bruising. Past medical history is unremarkable. The patient reports a 14-pack-year smoking history and says he drinks alcohol socially. No significant family history. His vital signs include: temperature 36.8°C (98.2°F), blood pressure 132/91 mm Hg and pulse 95/min. Physical examination reveals conjunctival pallor and scattered ecchymoses on the lower extremities. Laboratory results are significant for the following: Hemoglobin 8.2 g/dL Leukocyte count 2,200/mm3 Platelet count 88,000/mm3 Reticulocyte count 0.5% A bone marrow biopsy is performed, which demonstrates hypocellularity with no abnormal cell population. Which of the following is the most likely diagnosis in this patient? ? {'A': 'Aplastic anemia', 'B': 'Myelodysplastic syndrome', 'C': 'Infectious mononucleosis', 'D': 'Acute lymphocytic leukemia', 'E': 'Drug-induced immune pancytopenia'},
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A: Aplastic anemia
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Q:A 2-year-old boy is brought to the physician for evaluation of delayed onset of speech. Over the past year, he has also had recurrent dizziness and three episodes of syncope. Examination of the ears shows clear auditory canals and intact tympanic membranes with normal light reflexes. Visual reinforcement audiometry shows bilateral sensorineural deafness. Genetic analysis reveals a mutation in the KCNQ1 gene causing a defect in slow voltage-gated potassium channels. An electrocardiogram of this patient is most likely to show which of the following?? {'A': 'Pseudo-right bundle branch block', 'B': 'Slurred upstroke of the QRS complex', 'C': 'Epsilon wave following the QRS complex', 'D': 'Absence of P waves', 'E': 'Prolongation of the QT interval'},
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E: Prolongation of the QT interval
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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 is brought to the emergency department 20 minutes after losing control over his bicycle and colliding with a parked car. The handlebar of the bicycle hit his lower abdomen. On arrival, he is alert and oriented. His pulse is 90/min, respirations are 17/min and blood pressure is 110/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. The pupils are equal and reactive to light. There are multiple bruises over his chest and lower extremities. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. There is no pelvic instability. Rectal examination is unremarkable. A complete blood count, prothrombin time, and serum concentrations of glucose, creatinine, and electrolytes are within the reference range. Urine dipstick is mildly positive for blood. Microscopic examination of the urine shows 20 RBCs/hpf. Which of the following is the most appropriate next step in management?? {'A': 'Suprapubic catheterization', 'B': 'Intravenous pyelography', 'C': 'Laparotomy', 'D': 'Observation and follow-up', 'E': 'CT scan of the abdomen and pelvis'},
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D: Observation and follow-up
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Answer the following medical question with one of the provided options:
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Q:Four days after admission to the hospital for acute pancreatitis, a 41-year-old man develops hypotension and fever. His temperature is 39.1°C (102.3°F), pulse is 115/min, and blood pressure is 80/60 mm Hg. Physical examination shows warm extremities, asymmetric calf size, and blood oozing around his IV sites. There are numerous small, red, non-blanching macules and patches covering the extremities, as well as several large ecchymoses. His hemoglobin concentration is 9.0 g/dL. A peripheral blood smear shows schistocytes and decreased platelets. Which of the following sets of serum findings are most likely in this patient? $$$ Prothrombin time %%% Partial thromboplastin time %%% Fibrinogen %%% D-dimer $$$? {'A': '↑ ↑ ↓ normal', 'B': 'Normal normal normal normal', 'C': '↑ ↑ ↓ ↑', 'D': 'Normal ↑ normal normal', 'E': 'Normal normal normal ↑'},
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C: ↑ ↑ ↓ ↑
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old man with a history of hypertension presents to his primary care physician for a headache and abdominal pain. His symptoms began approximately 1 week ago and have progressively worsened. He describes his headache as pressure-like and is mildly responsive to ibuprofen. His abdominal pain is located in the bilateral flank area. His hypertension is poorly managed with lifestyle modification and chlorthalidone. He had 1 urinary tract infection that was treated with ciprofloxacin approximately 6 months ago. He has a home blood pressure monitor, where his average readings are 155/95 mmHg. Family history is significant for his father expiring secondary to a myocardial infarction and his history was complicated by refractory hypertension and end-stage renal disease. His vital signs are significant for a blood pressure of 158/100 mmHg. Physical examination is notable for bilateral flank masses. Laboratory testing is significant for a creatinine of 3.1 mg/dL. Urinalysis is remarkable for hematuria and proteinuria. Which of the following will this patient most likely be at risk for developing?? {'A': 'Epilepsy', 'B': 'Lymphangioleiomyomatosis', 'C': 'Migraine headache', 'D': 'Mitral valve prolapse', 'E': 'Neuroendocrine pancreatic tumor'},
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D: Mitral valve prolapse
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