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Answer the following medical question with one of the provided options:
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Q:A 32-year-old man presents to the physician for a check-up as part of his immigration application. On auscultation, there is a mild rumble heard at the cardiac apex preceded by an opening snap. His blood pressure is 132/76 and heart rate is 78/min. The patient suffers from occasional asthma attacks but has noticed that he cannot hold his breath on exertion over the past 2 years. He is otherwise healthy. He does not recall if he had any serious infections during childhood, and there is no family history of congenital diseases. Which of the following could have been used to prevent the development of this condition?? {'A': 'Penicillin', 'B': 'Alprostadil', 'C': 'Sulfasalazine', 'D': 'Indomethacin', 'E': 'PGE1 infusion'},
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A: Penicillin
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Answer the following medical question with one of the provided options:
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Q:A 82-year-old woman is brought to the physician by her son because he is concerned about her forgetfulness for the past 2 years. She occasionally walks into a room and forgets why she went there and often forgets where she left her keys. She is sometimes unable to recall a familiar individual's name. She reports that she has become slower at completing sudoku puzzles. She has been living independently since the death of her husband 3 years ago. She goes shopping, cooks her own meals, and plays bridge with her friends every weekend. She is not anxious about her memory lapses. She has no trouble sleeping but has been getting up earlier than she used to. She has hypertension that is managed with hydrochlorothiazide. She appears healthy. Vital signs are within normal limits. She is oriented to person, place, and time. Examination shows a normal gait. She describes her mood as “good” and her speech is normal. Her thought process is organized and her judgement is intact. She makes one error when performing serial sevens. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Aging', 'B': "Alzheimer's disease", 'C': 'Lewy-body dementia', 'D': 'Vascular Dementia', 'E': 'Normal pressure hydrocephalus\n"'},
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A: Aging
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man comes to the physician because of fatigue, increased sweating, and itching in his legs for the past 2 years. He has chronic bronchitis. He has smoked two packs of cigarettes daily for 24 years and drinks one to two beers every night. His only medication is a tiotropium bromide inhaler. His vital signs are within normal limits. He is 175 cm (5 ft 9 in) tall and weighs 116 kg (256 lb); BMI is 38 kg/m2. Physical examination shows facial flushing and bluish discoloration of the lips. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Abdominal examination shows no abnormalities. Laboratory studies show: Erythrocyte count 6.9 million/mm3 Hemoglobin 20 g/dL Mean corpuscular volume 91 μm3 Leukocyte count 13,000/mm3 Platelet count 540,000/mm3 Serum Ferritin 8 ng/mL Iron 48 μg/dL Iron binding capacity 402 μg/dL (N: 251 - 406 μg/dL) Which of the following is the most appropriate next step in treatment?"? {'A': 'Weight loss', 'B': 'Allogeneic stem cell transplantation', 'C': 'Hydroxyurea', 'D': 'Inhaled budesonide', 'E': 'Phlebotomy'},
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E: Phlebotomy
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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 clinic complaining of headache and sinus drainage for the past 13 days. She reports cold-like symptoms 2 weeks ago that progressively got worse. The patient endorses subjective fever, congestion, sinus headache, cough, and chills. She claims that this is her 5th episode within the past year and is concerned if “there’s something else going on.” Her medical history is significant for asthma that is adequately controlled with her albuterol inhaler. Her laboratory findings are shown below: Serum: Hemoglobin: 16.2 g/dL Hematocrit: 39 % Leukocyte count: 7,890/mm^3 with normal differential Platelet count: 200,000/mm^3 IgA: 54 mg/dL (Normal: 76-390 mg/dL) IgE: 0 IU/mL (Normal: 0-380 IU/mL) IgG: 470 mg/dL (Normal: 650-1500 mg/dL) IgM: 29 mg/dL (Normal: 40-345 mg/dL) What is the most likely diagnosis?? {'A': 'Ataxia-telangiectasia', 'B': 'Common variable immunodeficiency', 'C': 'Selective IgA deficiency', 'D': 'Wiskott-Aldrich syndrome', 'E': 'X-linked agammaglobinemia'},
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B: Common variable immunodeficiency
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents to his primary care physician for a routine check-up. During the appointment, he remarks that he has started noticing some thinning and hair loss without other symptoms. The physician reassures him that he is likely experiencing male-pattern baldness and explains that the condition is largely inherited. Specifically he notes that there are multiple genes that are responsible for the condition so it is difficult to predict the timing and development of hair loss. What genetic principle is being illustrated by this scenario?? {'A': 'Pleiotropy', 'B': 'Anticipation', 'C': 'Polygenic inheritance', 'D': 'Uniparental disomy', 'E': 'Heteroplasmy'},
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C: Polygenic inheritance
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Answer the following medical question with one of the provided options:
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Q:A 67-year-old man comes to the physician because of a 3-month history of difficulty initiating urination. He wakes up at least 3–4 times at night to urinate. Digital rectal examination shows a symmetrically enlarged, nontender prostate with a rubbery consistency. Laboratory studies show a prostate-specific antigen level of 2.1 ng/mL (N < 4). Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Hyperplasia of lateral prostatic lobe tissue', 'B': 'Infiltrating neoplasia of bladder urothelium', 'C': 'Hypertrophy of middle prostatic lobe tissue', 'D': 'Lymphocytic infiltration of anterior prostatic lobe stroma', 'E': 'Infiltrating dysplasia of posterior prostatic lobe epithelium'},
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A: Hyperplasia of lateral prostatic lobe tissue
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Answer the following medical question with one of the provided options:
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Q:A 2860-g (6-lb 3-oz) male newborn is born at term to a primigravid woman via spontaneous vaginal delivery. The mother has had no routine prenatal care. She reports that there is no family history of serious illness. The initial examination of the newborn shows bowing of the legs and respiratory distress upon palpation of the chest. The skin and joints are hyperextensible. X-rays of the chest and skull show multiple rib fractures and small, irregular bones along the cranial sutures. The patient is at increased risk of which of the following complications?? {'A': 'Costochondral junction enlargement', 'B': 'Intestinal rupture', 'C': 'Intellectual disability', 'D': 'Spinal canal stenosis', 'E': 'Hearing loss'},
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E: Hearing loss
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Answer the following medical question with one of the provided options:
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Q:A 56-year-old man presents to his primary care provider because of a lack of flexibility in his right hand. He has noticed that his hand has become less flexible and more fixed over the past year and he now has trouble shaking other people’s hands comfortably. He has a history of chronic alcohol abuse, hepatitis C, and cirrhosis. His family history is insignificant. He has a 40 pack-year smoking history. At the physician’s office, his blood pressure is 118/67 mm Hg, the respirations are 18/min, the pulse is 77/min, and the temperature is 36.7°C (98.0°F). On physical examination, the 4th and 5th digits are mildly flexed with dense, rope-like cords extending down his palm. Additionally, small ulcerations are identified on his palm. Which of the following is considered the first-line therapy for this condition?? {'A': 'Surgery', 'B': 'Colchicine', 'C': 'Anti-TNF drugs', 'D': 'Steroid injections', 'E': 'Collagenase injections'},
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E: Collagenase injections
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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 presents to the physician with concerns that a “bad flu” he has had for the past 10 days is getting worse and causing sleeplessness. On presentation today, his sore throat has improved; however, fever and chest and body aches persist despite the use of ibuprofen. He reports sharp, intermittent chest pain that worsens with exertion. He has not traveled outside the United States recently and does not have a history of substance abuse or alcohol use. Physical examination shows the temperature is 38.3°C (100.9°F), the heart rate is 110/min, the blood pressure is 120/60 mm Hg, and the oxygen saturation is 98% on room air. There is bilateral pedal edema at the level of the ankle. Auscultation reveals normal S1 and S2 and a third early diastolic heart sound. Jugular vein distention is observed. An ECG shows sinus tachycardia and diffuse ST-segment elevation throughout the precordial leads with 1.0-mm PR-segment depression in leads I and II. Laboratory results WBC 14,000/mm3 Lymphocyte count 70% Hematocrit 45% CRP 56 mg/dL Troponin T 1.15 ng/mL Troponin I 0.2 ng/mL Ck-MB 22 ng/mL Coxsackie type b viral antibody positive A chest x-ray shows clear lung fields bilaterally and a mildly enlarged cardiac silhouette. Transthoracic ultrasound reveals a left ventricular ejection fraction of 30%. Which of the following is the cause of difficulty sleeping for this patient?? {'A': 'Progressive cardiac ischemia caused by a plaque event', 'B': 'Impaired gaseous exchange caused by pulmonary edema', 'C': 'Lobar consolidation due to Staphylococcus aureus', 'D': 'Decreased cardiac contractility due to cardiac myocyte injury', 'E': 'Diffuse alveolar damage and hyaline membrane formation'},
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D: Decreased cardiac contractility due to cardiac myocyte injury
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man presents to the emergency department with shortness of breath, cough, and fever. He states that his symptoms started a few days ago and have been progressively worsening. The patient recently returned from international travel. He works from home and manages a chicken coop as a hobby. He has a past medical history of an ST-elevation myocardial infarction and recently has had multiple sick contacts. His temperature is 102°F (38.9°C), blood pressure is 187/108 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 93% on room air. A radiograph of the chest reveals bilateral pleural effusions. Pleurocentesis demonstrates the findings below: Protein ratio (pleural/serum): 0.8 Lactate dehydrogenase ratio (pleural/serum): 0.75 Glucose: 25 mg/dL Further analysis reveals a lymphocytic leukocytosis of the pleural fluid. Which of the following is the next best step in management?? {'A': 'Azithromycin and ceftriaxone', 'B': 'Azithromycin and vancomycin', 'C': 'Furosemide', 'D': 'Rifampin, isoniazid, pyrazinamide, and ethambutol', 'E': 'Supportive therapy'},
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D: Rifampin, isoniazid, pyrazinamide, and ethambutol
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old sexually active male presents to an internal medicine physician for a routine health check up after having several unprotected sexual encounters. After appropriate testing the physician discusses with the patient that he is HIV+ and must be started on anti-retroviral treatment. Which of the following medications prescribed acts on the gp41 subunit of the HIV envelope glycoprotein?? {'A': 'Amantadine', 'B': 'Rimantadine', 'C': 'Zidovudine', 'D': 'Saquinavir', 'E': 'Enfuvirtide'},
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E: Enfuvirtide
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old primigravid woman who recently immigrated to the United States presents to her gynecologist for the first time during the 28th week of her pregnancy. She hasn’t received any prenatal care or folic acid supplementation. The patient’s history reveals that she has received blood transfusions in the past due to “severe anemia.” Which of the following blood type situations would put the fetus at risk for hemolytic disease of the newborn?? {'A': 'Mother is B positive, father is O negative', 'B': 'Mother is O positive, father is B negative', 'C': 'Mother is A negative, father is B positive', 'D': 'Mother is AB negative, father is O negative', 'E': 'Mother is O positive, father is AB negative'},
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C: Mother is A negative, father is B positive
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old male engineer who complains of shortness of breath when walking a few blocks undergoes a cardiac stress test because of concern for coronary artery disease. During the test he asks his cardiologist about what variables are usually used to quantify the functioning of the heart. He learns that one of these variables is stroke volume. Which of the following scenarios would be most likely to lead to a decrease in stroke volume?? {'A': 'Anxiety', 'B': 'Exercise', 'C': 'Pregnancy', 'D': 'Heart failure', 'E': 'Digitalis'},
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D: Heart failure
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old woman presents to the clinic with an abnormal sensation on the left side of her body that has been present for the past several months. At first, the area seemed numb and she recalls touching a hot stove and accidentally burning herself but not feeling the heat. Now she is suffering from a constant, uncomfortable burning pain on her left side for the past week. The pain gets worse when someone even lightly touches that side. She has recently immigrated and her past medical records are unavailable. Last month she had a stroke but she cannot recall any details from the event. She confirms a history of hypertension, type II diabetes mellitus, and bilateral knee pain. She also had cardiac surgery 20 years ago. She denies fever, mood changes, weight changes, and trauma to the head, neck, or limbs. Her blood pressure is 162/90 mm Hg, the heart rate is 82/min, and the respiratory rate is 15/min. Multiple old burn marks are visible on the left hand and forearm. Muscle strength is mildly reduced in the left upper and lower limbs. Hyperesthesia is noted in the left upper and lower limbs. Laboratory results are significant for: Hemoglobin 13.9 g/dL MCV 92 fL White blood cells 7,500/mm3 Platelets 278,000/mm3 Creatinine 1.3 U/L BUN 38 mg/dL TSH 2.5 uU/L Hemoglobin A1c 7.9% Vitamin B12 526 ng/L What is the most likely diagnosis?? {'A': 'Complex regional pain syndrome', 'B': 'Conversion disorder', 'C': 'Dejerine-Roussy syndrome', 'D': 'Medial medullary syndrome', 'E': 'Subacute combined degeneration of spinal cord'},
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C: Dejerine-Roussy syndrome
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Answer the following medical question with one of the provided options:
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Q:A young researcher is responsible for graphing laboratory data involving pulmonary blood flow and ventilation pattern obtained from a healthy volunteer who was standing in an upright position. After plotting the following graph, the researcher realizes he forgot to label the curves and the x-axis (which represents the position in the lung). Which of the following is the appropriate label for each point on the graph?? {'A': 'A: Blood flow B: Ventilation C: Base of the lung D: Apex of the lung', 'B': 'A: Ventilation B: Blood flow C: Base of the lung D: Apex of the lung', 'C': 'A: Blood flow B: Ventilation C: Apex of the lung D: Base of the lung', 'D': 'A: Ventilation B: Blood flow C: Apex of the lung D: Base of the lung', 'E': 'A: Ventilation B: Blood flow C: Mid-portion of the lung D: Apex of the lung'},
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B: A: Ventilation B: Blood flow C: Base of the lung D: Apex of the lung
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man is brought to the emergency department by his wife because of lethargy, confusion, and nausea for the past 2 days. He has previously been healthy and has no past medical history. His only medications are a daily multivitamin and acetaminophen, which he takes daily for hip pain. Vital signs are within normal limits. He is disoriented to place and time but recognizes his wife. The remainder of his physical examination shows no abnormalities. Laboratory studies show a hemoglobin concentration of 9.1 g/dL, a serum calcium concentration of 14.7 mg/dL, and a serum creatinine of 2.2 mg/dL (previously 0.9 mg/dL). Which of the following is the most likely underlying mechanism of this patient's condition?? {'A': 'Excessive consumption of calcium', 'B': 'Ectopic PTHrP release', 'C': 'Increased serum levels of 1,25-hydroxyvitamin D', 'D': 'Excess PTH secretion from parathyroid glands', 'E': 'Overproliferation of plasma cells\n"'},
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E: Overproliferation of plasma cells "
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Answer the following medical question with one of the provided options:
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Q:A 3-day-old female infant presents with poor feeding, lethargy, vomiting after feeding, and seizures. Labs revealed ketoacidosis and elevated hydroxypropionic acid levels. Upon administration of parenteral glucose and protein devoid of valine, leucine, methionine, and threonine, and carnitine, the infant began to recover. Which of the following enzymes is most likely deficient in this infant?? {'A': 'Branched-chain ketoacid dehydrogenase', 'B': 'Phenylalanine hydroxylase', 'C': 'Propionyl-CoA carboxylase', 'D': 'Cystathionine synthase', 'E': 'Homogentisate oxidase'},
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C: Propionyl-CoA carboxylase
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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 with recurrent panic attacks that have been worsening over the past 5 weeks. She also says she has been seeing things that are not present in reality and is significantly bothered by a short attention span which has badly affected her job in the past 6 months. No significant past medical history. No current medications. The patient is afebrile and vital signs are within normal limits. Her BMI is 34 kg/m2. Physical examination is unremarkable. The patient has prescribed antipsychotic medication. She expresses concerns about any effects of the new medication on her weight. Which of the following medications would be the best course of treatment in this patient?? {'A': 'Ziprasidone', 'B': 'Olanzapine', 'C': 'Clozapine', 'D': 'Clonazepam', 'E': 'Chlorpromazine'},
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A: Ziprasidone
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the relationship between fetal blood oxygen saturation and intrauterine growth restriction using MRI studies. The magnetic resonance transverse relaxation time (T2) is inversely related to the concentration of deoxyhemoglobin so that high concentrations of deoxyhemoglobin produce a low signal intensity on T2-weighted MRI. In a normal fetus, the T2 signal is most likely to be the highest in which of the following vessels?? {'A': 'Pulmonary veins', 'B': 'Ductus venosus', 'C': 'Superior vena cava', 'D': 'Descending aorta', 'E': 'Right atrium\n"'},
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B: Ductus venosus
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old woman presents to her primary care physician because she has been experiencing episodes of intense fear. Specifically, she says that roughly once per week she will feel an intense fear of dying accompanied by chest pain, lightheadedness, sweating, and palpitations. In addition, she will feel as if she is choking which leads her to hyperventilate. She cannot recall any trigger for these episodes and is afraid that they will occur while she is driving or working. In order to avoid this possibility, she has been getting rides from a friend and has been avoiding interactions with her coworkers. These changes have not stopped the episodes so she came in for evaluation. This patient's disorder is most likely genetically associated with a personality disorder with which of the following features?? {'A': 'Criminality and disregard for rights of others', 'B': 'Eccentric appearance and magical thinking', 'C': 'Grandiosity, entitlement, and need for admiration', 'D': 'Social withdrawal and limited emotional expression', 'E': 'Submissive, clingy, and low self-confidence'},
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E: Submissive, clingy, and low self-confidence
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Answer the following medical question with one of the provided options:
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Q:A 72-year-old man who was involved in a traffic collision is brought to the emergency room by the ambulance service. He was in shock and comatose at the time of presentation. On examination, the heart rate is 60/min, and the blood pressure is 70/40 mm Hg. The patient dies, despite resuscitative efforts. Autopsy reveals multiple internal hemorrhages and other evidence of ischemic damage affecting the lungs, kidneys, and brain. The patient’s heart shows evidence of gross anomaly similar to the picture. While acute hypovolemia is the likely cause of the ischemic changes seen in the lungs, kidneys, and brain, which of the following best explains the gross anomaly of his heart?? {'A': 'Aortic valve regurgitation', 'B': 'Mitral valve stenosis', 'C': 'Senile calcific aortic stenosis', 'D': 'Accumulation of amyloid in the myocardium', 'E': 'Genetic mutation'},
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C: Senile calcific aortic stenosis
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Answer the following medical question with one of the provided options:
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Q:A 75-year-old woman with metastatic colon cancer comes to the physician requesting assistance in ending her life. She states: “I just can't take it anymore; the pain is unbearable. Please help me die.” Current medications include 10 mg oral hydrocodone every 12 hours. Her cancer has progressed despite chemotherapy and she is very frail. She lives alone and has no close family. Which of the following is the most appropriate initial action by the physician?? {'A': 'Submit a referral to psychiatry', 'B': 'Submit a referral to hospice care', 'C': 'Consult with the local ethics committee', 'D': 'Increase her pain medication dose', 'E': 'Initiate authorization of physician-assisted suicide'},
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D: Increase her pain medication dose
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old man presents with a swollen left big toe that started this morning. The patient states that he attended a party last night and drank 4 glasses of whiskey. He denies any trauma to the foot. The patient has a history of similar episodes in the past that were related to alcohol use. His symptoms were previously relieved with ibuprofen. However, the pain persisted despite treatment with the medication. Physical examination reveals a tender and erythematous, swollen left 1st metatarsophalangeal joint. Which of the following events most likely contributed to his condition?? {'A': 'Vasoconstriction', 'B': 'Downregulation of integrins in the neutrophils', 'C': 'Upregulation of cellular adhesion molecules to promote neutrophil migration', 'D': 'Decreased expression of selectin in the endothelium', 'E': 'Activation of cytosolic caspases'},
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C: Upregulation of cellular adhesion molecules to promote neutrophil migration
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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 a pre-operative evaluation clinic prior to an elective cholecystectomy. She has a 5 pack-year smoking history. The anesthesiologist highly recommends to discontinue smoking for at least 8 weeks prior to the procedure for which she is compliant. What is the most likely histology of her upper respiratory tract's epithelial lining at the time of her surgery?? {'A': 'Simple squamous', 'B': 'Stratified squamous', 'C': 'Stratified columnar', 'D': 'Pseudostratified columnar', 'E': 'Simple columnar'},
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D: Pseudostratified columnar
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old man is brought to the emergency department by his wife for a 1-hour history of sudden behavior changes. They were having lunch together when, at 1:07 PM, he suddenly dropped his sandwich on the floor. Since then, he has been unable to use his right arm. She also reports that he is slurring his speech and dragging his right foot when he walks. Nothing like this has ever happened before. The vital signs include: pulse 95/min, blood pressure 160/90 mm Hg, and respiratory rate 14/min. The physical exam is notable for an irregularly irregular rhythm on cardiac auscultation. On neurological exam, he has a facial droop on the right half of his face but is able to elevate his eyebrows symmetrically. He has 0/5 strength in his right arm, 2/5 strength in his right leg, and reports numbness throughout the right side of his body. Angiography of the brain will most likely show a lesion in which of the following vessels?? {'A': 'Internal carotid artery', 'B': 'Anterior cerebral artery', 'C': 'Middle cerebral artery', 'D': 'Posterior cerebral artery', 'E': 'Basilar artery'},
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C: Middle cerebral artery
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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 comes to the physician because of a 6-month history of worsening involuntary movement of the left hand. Her symptoms are worse when she feels stressed at work. She has no history of serious illness and takes no medications. Neurological examination shows difficulty initiating movement and a tremor in the left hand at rest. The tremor decreases when the patient is asked to draw a circle. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Clonazepam', 'B': 'Methimazole', 'C': 'Trihexyphenidyl', 'D': 'Donepezil', 'E': 'Pramipexole'},
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E: Pramipexole
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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 presents to the clinic complaining of fatigue and difficulty breathing for the past month. He reports that it is particularly worse when he exercises as he becomes out of breath at 1 mile when he used to routinely run 3 miles. He is frustrated as he was recently diagnosed with diabetes despite a good diet and regular exercise. He denies any weight changes, chest pain, or gastrointestinal symptoms. When asked about other concerns, his wife complains that he is getting darker despite regular sunscreen application. A physical examination demonstrates a tanned man with an extra heart sound just before S1, mild bilateral pitting edema, and mild bibasilar rales bilaterally. An echocardiogram is ordered and shows a left ventricular ejection fraction (LVEF) of 65% with reduced filling. What is the most likely explanation for this patient’s condition?? {'A': 'Decreased copper excretion into bile', 'B': 'Increased intestinal absorption of iron', 'C': 'Infection with coxsackie B virus', 'D': 'Persistently elevated blood pressure', 'E': 'Systemic inflammatory state caused by type 2 diabetes'},
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B: Increased intestinal absorption of iron
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old soldier is rescued from a helicopter crash in the Arctic Circle and brought back to a treatment facility at a nearby military base. On arrival, the soldier’s wet clothes are removed. He appears pale and is not shivering. The patient is unresponsive to verbal or painful stimuli. His temperature is 27.4°C (81.3°F), the pulse is 30/min and irregular, the respiratory rate is 7/min, and the blood pressure is 83/52 mm Hg. Examination shows fixed, dilated pupils, and diffuse rigidity. The fingers and toes are white in color and hard to touch. An ECG shows atrial fibrillation. In addition to emergent intubation, which of the following is the most appropriate next step in patient management?? {'A': 'Application of heating pads to the extremities', 'B': 'Emergent electrical cardioversion', 'C': 'Increasing the room temperature', 'D': 'Intravenous administration of tissue plasminogen activator', 'E': 'Intravenous administration of warmed normal saline'},
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E: Intravenous administration of warmed normal saline
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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 presents to the emergency department with abdominal pain that started while she was at the gym. The patient competes as a power lifter and states that her pain started after one of her heavier lifts. The patient has no significant past medical history and is currently taking a multivitamin and oral contraceptive pills. She smokes cigarettes and drinks alcohol regularly and is currently sexually active with multiple partners. Her temperature is 99°F (37.2°C), blood pressure is 85/55 mmHg, pulse is 125/min, respirations are 18/min, and oxygen saturation is 99% on room air. Physical exam is notable for right upper quadrant abdominal tenderness, acne, and muscle hypertrophy. Right upper quadrant ultrasound demonstrates a solitary heterogeneous mass. Which of the following other findings is most likely to be found in this patient?? {'A': 'Elevated alpha fetoprotein', 'B': 'Elevated viral core antigen', 'C': 'Increased pigmentation in flexural areas', 'D': 'Increased LDL and decreased HDL', 'E': 'Prolonged PT and PTT'},
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D: Increased LDL and decreased HDL
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Answer the following medical question with one of the provided options:
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Q:A male newborn is delivered at term to a 26-year-old woman, gravida 2, para 3. The mother has no medical insurance and did not receive prenatal care. Physical examination shows microcephaly and ocular hypotelorism. There is a single nostril, cleft lip, and a solitary central maxillary incisor. An MRI of the head shows a single large ventricle and fused thalami. This patient's condition is most likely caused by abnormal expression of which of the following protein families?? {'A': 'Hedgehog', 'B': 'Transforming growth factor', 'C': 'Homeobox', 'D': 'Fibroblast growth factor', 'E': 'Wnt'},
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A: Hedgehog
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Answer the following medical question with one of the provided options:
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Q:A 62-year-old woman presents to the emergency department for evaluation of a spreading skin infection that began from an ulcer on her foot. The patient has type 2 diabetes mellitus that is poorly controlled. On examination, there is redness and erythema to the lower limb with skin breakdown along an extensive portion of the leg. The patient’s tissues separate readily from the fascial plane, prompting a diagnosis of necrotizing fasciitis. What is the exotoxin most likely associated with this patient’s presentation?? {'A': 'Diphtheria toxin', 'B': 'Streptococcal pyogenic exotoxin A', 'C': 'Exfoliative toxin', 'D': 'Streptococcal pyogenic exotoxin B', 'E': 'TSST-1'},
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D: Streptococcal pyogenic exotoxin B
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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 presents an urgent care clinic because he coughed up blood this morning. Although he had a persistent cough for the past 3 weeks, he had never coughed up blood until now. His voice is hoarse and admits that it has been like that for the past few months. Both his past medical history and family history are insignificant. He has smoked a pack of cigarettes a day since the age of 20 and drinks wine every night before bed. His vitals are: heart rate of 78/min, respiratory rate of 14/min, temperature of 36.5°C (97.8°F), blood pressure of 140/88 mm Hg. An indirect laryngoscopy reveals a rough vegetating lesion on the free border of the right vocal cord. Which of the following is the most likely diagnosis?? {'A': 'Acute laryngitis', 'B': 'Leukoplakia', 'C': 'Polypoid corditis', 'D': 'Vocal cord nodule', 'E': 'Laryngeal carcinoma'},
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E: Laryngeal carcinoma
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Q:A 23-year-old male is brought into the emergency department by his girlfriend following an argument. The patient’s girlfriend claims that she threatened to break up with him. He then called her saying he was going to kill himself. When she arrived at the patient’s home, she found him lying on the couch with empty alcohol bottles and multiple pill containers. The patient reports he does not remember everything he took, but says he ingested many pills about four hours ago. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/68 mmHg, pulse is 88/min, and respirations are 25/min with an oxygen saturation of 98% O2 on room air. An arterial blood gas (ABG) is obtained, with results shown below: pH: 7.47 pO2: 94 mmHg pCO2: 24 mmHg HCO3-: 22 mEq/L You check on him a couple hours later, and the patient appears agitated. His girlfriend says he keeps grabbing his head, yelling about non-stop ringing in his ears. Labs and a repeat ABG shows: pH: 7.30 pO2: 90 mmHg pCO2: 22 mmHg HCO3-: 9 mEq/L Na+: 144 mEq/L Cl-: 98 mEq/L K+: 3.6 mEq/L BUN: 18 mg/dL Glucose: 100 mg/dL Creatinine: 1.4 mg/dL Which of the following is the best next step in management?? {'A': 'Acetazolamide', 'B': 'Activated charcoal', 'C': 'N-acetylcysteine', 'D': 'IV haloperidol', 'E': 'IV sodium bicarbonate'},
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E: IV sodium bicarbonate
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Q:An 82-year-old woman is brought to the physician by her nephew, who lives with her because she has a pessimistic attitude and has displayed overall distrust of her nephew for 1 year. She frequently argues with her nephew and embarrasses him in front of his friends. She had a Colles’ fracture 2 months ago and has had hypertension for 18 years. Her medications include hydrochlorothiazide and nortriptyline. She has a quantity of each leftover since her previous visit 2 months ago and has not requested new prescriptions, which she would need if she were taking them as prescribed. She appears untidy. Her blood pressure is 155/98 mm Hg. She mumbles in response to questions, and her nephew insists on being at her side during the entire visit because she cannot express herself clearly. She has a sore on her ischial tuberosity and bruises around her ankles. Which of the following is the most appropriate action in patient care?? {'A': 'Discussing advance directives', 'B': 'Emphasizing compliance with medication and follow-up in 1 month', 'C': 'Referral for hospice care', 'D': 'Referral to a psychiatrist', 'E': 'Reporting possible elder abuse by phone'},
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E: Reporting possible elder abuse by phone
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Q:A 63-year-old man comes to the physician because of a 3-month history of fatigue and constipation. He reports having dull pain in the left portion of the midback for 2 weeks that has persisted despite taking ibuprofen. His father died of prostate cancer at 70 years of age. The patient has smoked one pack of cigarettes daily for 45 years. Vital signs are within normal limits. Physical examination shows a left-sided varicocele both in supine and in standing position. Rectal examination shows a symmetrically enlarged prostate with no masses. Laboratory studies show: Hemoglobin 11.2 g/dL Serum Creatinine 1.0 mg/dL Calcium 11.8 mg/dL Urine Protein 1+ Blood 2+ Which of the following is the most appropriate next step in management?"? {'A': 'CT scan of the abdomen', 'B': 'Urine cytology', 'C': 'Chest x-ray', 'D': 'Prostate biopsy', 'E': 'Serum protein electrophoresis\n"'},
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A: CT scan of the abdomen
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Q:A 23-year-old woman with Ehlers-Danlos syndrome is brought to the emergency department with right knee pain and swelling after she twisted it while dancing. She had two similar episodes last year that were treated conservatively. She was treated for a fracture of her humerus 2 years ago. She has gastroesophageal reflux disease. Her sister has allergic rhinitis. Her only medication is omeprazole. She appears tense and uncomfortable. Her temperature is 37.1°C (99.3°F), pulse is 97/min, and blood pressure is 110/70 mm Hg. Examination shows mild scoliosis. The lungs are clear to auscultation. Cardiac examination shows a mid-systolic click. The right knee shows a large, tender effusion and the patella is displaced laterally. Lachman's test, the posterior drawer test, and Apley's test are negative. A complete blood count and serum concentrations of electrolytes, urea nitrogen, and creatinine are within the reference range. Toxicology screening is negative. X-ray of the knee joint shows an osteochondral fragment within the knee joint. What is the most appropriate next step in management?? {'A': 'Arthroscopy', 'B': 'Above knee cast', 'C': 'Closed reduction', 'D': 'Total knee replacement', 'E': 'Physiotherapy only'},
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A: Arthroscopy
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Q:A 64-year-old woman presents for the scheduled annual physical examination for management of her hypertension. The patient is asymptomatic and her blood pressure is within normal limits throughout the year. She has a past medical history of polyarthrosis, and she is a carrier of hepatitis B antibodies. She does not smoke or drink alcohol. She is currently taking the following medications: enalapril, ranitidine, and lorazepam. The vital signs include: pulse rate 72/min, respiratory rate 14/min, blood pressure 138/76 mm Hg, and temperature 37.0°C (98.6°F). The physical examination shows no abnormalities. The laboratory test results are shown below: Hemoglobin 11.6 g/dL Hematocrit 34.8% MCV 91.4 fL MCH 31.4 pg Platelets 388,000/mm3 Leukocytes 7,300/mm3 ESR 59 mm/h On account of these laboratory test results, the patient was once again questioned for symptoms that would explain the abnormality detected in her laboratory test results. The patient insists that she is asymptomatic. Therefore, further laboratory studies were requested. The additional laboratory test results are shown below: PCR 5.3 mg/dL Serum protein electrophoresis Total proteins 7.4 g/dL Albumin 5.8 g/dL Alpha-1 3.5 g/dL Alpha-2 1 g/dL Beta 0.9 g/dL Gamma 1.7 g/dL The gamma protein was later confirmed as an immunoglobulin G (IgG) kappa paraprotein (1,040 mg/dL). Due to these results a computed tomography (CT) scan was conducted, and it showed moderate osteopathy without any other lesions. A bone marrow biopsy was done that showed 5–10% plasma cells. Which of the following is most likely associated with the diagnosis of this patient?? {'A': 'Acanthosis nigricans', 'B': 'Myeloblasts with azurophilic granules', 'C': 'Osteoporosis', 'D': 'Richter’s transformation', 'E': 'Teardrop cells in blood smear'},
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C: Osteoporosis
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Q:A 17-year-old girl is brought to the physician for a physical examination prior to participating in sports. She has no history of serious illness. She is on the school's cheerleading team and is preparing for an upcoming competition. Menarche was at 13 years of age, and her last menstrual period was 4 months ago. She is 167 cm (5 ft 6 in) tall and weighs 45 kg (99 lb); BMI is 16.1 kg/m2. Examination shows pale skin with thin, soft body hair. The patient is at increased risk for which of the following complications?? {'A': 'Hyperkalemia', 'B': 'Hyperphosphatemia', 'C': 'Fractures', 'D': 'Shortened QT interval', 'E': 'Hyperthyroidism'},
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C: Fractures
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Q:A 63-year-old male is admitted to the Emergency Department after 3 days difficulty breathing, orthopnea, and shortness of breath with effort. His personal medical history is positive for a myocardial infarction 6 years ago and a cholecystectomy 10 years ago. Medications include metoprolol, lisinopril, atorvastatin, and as needed furosemide. At the hospital his blood pressure is 108/60 mm Hg, pulse is 88/min, respiratory rate is 20/min, and temperature is 36.4°C (97.5°F). On physical examination, he presents with fine rales in both lungs, his abdomen is non-distended non-tender, and there is 2+ lower limb pitting edema up to his knees. Initial laboratory testing is shown below Na+ 138 mEq/L K+ 4 mEq/L Cl- 102 mEq/L Serum creatinine (Cr) 1.8 mg/dL Blood urea nitrogen (BUN) 52 mg/dL Which of the following therapies is the most appropriate for this patient?? {'A': 'Furosemide', 'B': 'Normal saline', 'C': 'Hyperoncotic starch', 'D': 'Terlipressin', 'E': 'Norepinephrine'},
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A: Furosemide
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Q:A 42-year-old man presents to his primary care physician for a wellness checkup. The patient has a past medical history of obesity, constipation, and depression. His current medications include metformin, lactulose, and fluoxetine. His temperature is 99.5°F (37.5°C), blood pressure is 157/102 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 5,500/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 105 mEq/L K+: 3.5 mEq/L HCO3-: 21 mEq/L BUN: 20 mg/dL Glucose: 129 mg/dL Creatinine: 1.1 mg/dL AST: 12 U/L ALT: 10 U/L Urine: Appearance: Yellow Bacteria: Absent Red blood cells: 0/hpf pH: 2.7 Nitrite: Absent Which of the following is the next best step in management?? {'A': 'Administer ammonium chloride and repeat lab studies', 'B': 'Administer bicarbonate and repeat lab studies', 'C': 'Administer high dose bicarbonate', 'D': 'Administer hydrochlorothiazide', 'E': 'Obtain urine sodium level'},
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B: Administer bicarbonate and repeat lab studies
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Q:A 35-year-old male presents to his physician with the complaint of fatigue and weakness for six months. His physician orders a CBC which demonstrates anemia and thrombocytopenia. During the subsequent work up, a bone marrow biopsy is performed which ultimately leads to the diagnosis of acute promyelocytic leukemia. Which of the following translocations and fusion genes would be present in this patient?? {'A': 't(8;14) - BCR/Abl1', 'B': 't(9;22) - BCR/Abl1', 'C': 't(15;17) - PML/RARalpha', 'D': 't(14;18) - PML/RARalpha', 'E': 't(9;22) - PML/RARalpha'},
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C: t(15;17) - PML/RARalpha
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Q:A 25-year-old man comes to the physician because of diarrhea, bloating, nausea, and vomiting for the past 3 days. He describes his stool as soft, frothy, and greasy. He denies seeing blood in stool. The patient went on a hiking trip last week and drank fresh water from the stream. Three months ago, he was on vacation with his family for 2 weeks in Brazil, where he tried many traditional dishes. He also had watery diarrhea and stomach cramping for 3 days during his visit there. He has no history of serious illness. He takes no medications. The patient appears dehydrated. His temperature is 37°C (98.6°F), blood pressure is 100/60 mm Hg, pulse is 80/min, and respirations are 12/min. Examination shows dry mucous membranes and diffuse abdominal tenderness. Microscopy of the stool reveals cysts. Which of the following is the most appropriate next step in management?? {'A': 'Ciprofloxacin therapy', 'B': 'Octreotide therapy', 'C': 'Metronidazole therapy', 'D': 'Trimethoprim-sulfamethoxazole therapy', 'E': 'Supportive treatment only'},
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C: Metronidazole therapy
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Q:A 17-year-old man presents to his primary care physician with bilateral tremor of the hands. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months in that he has frequent episodes of depression, separated by episodes of bizarre behavior, including excessive alcohol drinking and shoplifting. His parents have started to suspect that he is using street drugs, which he denies. His handwriting has become very sloppy. His parents have noted slight slurring of his speech. Family history is irrelevant. Physical examination reveals upper extremity tremors, mild dystonia of the upper extremities, and mild incoordination involving his hands. The patient’s eye is shown. Which of the following is the best initial management of this patient’s condition?? {'A': 'Liver transplantation', 'B': 'Penicillamine', 'C': 'Oral zinc', 'D': 'Oral deferasirox', 'E': 'Watchful waiting'},
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C: Oral zinc
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Q:A 28-year-old man comes to the physician because of a 2-week history of testicular swelling and dull lower abdominal discomfort. Physical examination shows a firm, nontender left testicular nodule. Ultrasonography of the scrotum shows a well-defined hypoechoic lesion of the left testicle. Serum studies show an elevated β-hCG concentration and a normal α-fetoprotein concentration. The patient undergoes a radical inguinal orchiectomy. Histopathologic examination of the surgical specimen shows a mixed germ cell tumor with invasion of adjacent lymphatic vessels. Further evaluation is most likely to show malignant cells in which of the following lymph node regions?? {'A': 'External iliac', 'B': 'Internal iliac', 'C': 'Mediastinal', 'D': 'Para-aortic', 'E': 'Deep inguinal'},
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D: Para-aortic
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Q:A 4-year-old child is brought to a pediatric clinic with complaints of a foul-smelling, recurrent, persistent vaginal discharge that started a few days ago. The child shows increased irritability with a slightly elevated temperature. The mother says that the child plays in the house and has no contact with other children. What is the most common cause of this patient’s symptom?? {'A': 'Congenital rectovaginal fistula', 'B': 'Sarcoma botyroides', 'C': 'Foreign body in the vagina', 'D': 'Clear cell carcinoma of the cervix', 'E': 'Sexual abuse'},
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C: Foreign body in the vagina
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Q:A 32-year-old man presents to his primary care physician complaining of pain accompanied by a feeling of heaviness in his scrotum. He is otherwise healthy except for a broken arm he obtained while skiing several years ago. Physical exam reveals an enlarged “bag of worms” upon palpation of the painful scrotal region. Shining a light over this area shows that the scrotum does not transilluminate. Which of the following statements is true about the most likely cause of this patient's symptoms?? {'A': 'Equally common on both sides', 'B': 'More common on left due to drainage into inferior vena cava', 'C': 'More common on left due to drainage into renal vein', 'D': 'More common on right due to drainage into inferior vena cava', 'E': 'More common on right due to drainage into renal vein'},
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C: More common on left due to drainage into renal vein
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Q:A 25-year-old primigravid woman at 34-weeks' gestation comes to the physician because of an 8-day history of generalized pruritus. She has no history of rash. She has had standard prenatal care. Three weeks ago she was diagnosed with iron deficiency anemia. She traveled to Mexico for a vacation 3 months ago. She takes her multivitamin supplements inconsistently. Her blood pressure is 110/80 mm Hg. Examination shows pallor and mild scleral icterus. The uterus is soft, nontender, and consistent in size with a 34-week gestation. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11 g/dL Leukocyte count 8,000/mm3 Platelet 250,000/mm3 Prothrombin time 11 seconds Serum Total bilirubin 4 mg/dL Direct bilirubin 3.2 mg/dL Bile acid 15 μmol/L (N = 0.3–10) AST 45 U/L ALT 50 U/L A peripheral blood smear is normal. There are no abnormalities on abdominopelvic ultrasonography. Which of the following is the most likely diagnosis?"? {'A': 'Cholestasis of pregnancy', 'B': 'Viral hepatitis A', 'C': 'Gilbert syndrome', 'D': 'Acute fatty liver of pregnancy', 'E': 'HELLP syndrome'},
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A: Cholestasis of pregnancy
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Q:A 21-year-old woman comes to the physician because of a 1-week history of white discoloration of the tongue. She has had similar, recurrent episodes over the past 5 years. Examination shows white plaques on the tongue that easily scrape off and thick, cracked fingernails with white discoloration. KOH preparation of a tongue scraping shows budding yeasts with pseudohyphae. This patient's condition is most likely caused by decreased activity of which of the following?? {'A': 'B cells', 'B': 'Complement C5–9', 'C': 'T cells', 'D': 'Complement C1–4', 'E': 'Neutrophils'},
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C: T cells
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Q:A 62-year-old man returns to his physician for a follow-up examination. During his last visit 1 month ago splenomegaly was detected. He has had night sweats for the past several months and has lost 5 kg (11 lb) unintentionally during this period. He has no history of a serious illness and takes no medications. The vital signs are within normal limits. The physical examination shows no abnormalities other than splenomegaly. The laboratory studies show the following: Hemoglobin 9 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 12,000/mm3 Platelet count 260,000/mm3 Ultrasound shows a spleen size of 15 cm (5.9 in) and mild hepatomegaly. The peripheral blood smear shows teardrop-shaped and nucleated red blood cells (RBCs) and immature myeloid cells. The marrow is very difficult to aspirate but reveals hyperplasia of all 3 lineages. The tartrate-resistant acid phosphatase (TRAP) test is negative. Clonal marrow plasma cells are not seen. JAK-2 is positive. The cytogenetic analysis is negative for translocation between chromosomes 9 and 22. Which of the following is the most appropriate curative management in this patient?? {'A': 'Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD)', 'B': 'Allogeneic bone marrow transplantation', 'C': 'Imatinib mesylate', 'D': 'Splenectomy', 'E': 'Splenic irradiation'},
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B: Allogeneic bone marrow transplantation
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Q:A 24-year-old previously healthy man comes to his physician because of dyspnea and hemoptysis for the past week. Examination shows inspiratory crackles at both lung bases. The remainder of the examination shows no abnormalities. His hemoglobin concentration is 14.2 g/dL, leukocyte count is 10,300/mm3, and platelet count is 205,000/mm3. Urine dipstick shows 2+ proteins. Urinalysis shows 80 RBC/hpf and 1–2 WBC/hpf. An x-ray of the chest shows pulmonary infiltrates. Further evaluation is most likely to show increased serum titers of which of the following?? {'A': 'Immunoglobulin A', 'B': 'Anti-GBM antibody', 'C': 'Anti-dsDNA antibody', 'D': 'Anti-PLA2R antibody', 'E': 'P-ANCA'},
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B: Anti-GBM antibody
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Q:A 42-year-old man presents to the clinic for a second evaluation of worsening blackened ulcers on the tips of his toes. His past medical history includes diabetes mellitus for which he takes metformin and his most recent HgA1c was 6.0, done 3 months ago. He also has hypertension for which he’s prescribed amlodipine and chronic obstructive pulmonary disease (COPD) for which he uses an albuterol-ipratropium combination inhaler. He is also a chronic tobacco user with a 27-pack-year smoking history. He first noticed symptoms of a deep aching pain in his toes. Several months ago, he occasionally felt pain in his fingertips both at rest and with activity. Now he reports blackened skin at the tips of his fingers and toes. Evaluation shows: pulse of 82/min, blood pressure of 138/85 mm Hg, oral temperature 37.0°C (98.6°F). He is thin. Physical examination of his feet demonstrates the presence of 3, 0.5–0.8 cm, eschars over the tips of his bilateral second toes and right third toe. There is no surrounding erythema or exudate. Proprioception, vibratory sense, and monofilament examination are normal on both ventral aspects of his feet, but he lacks sensation over the eschars. Dorsal pedal pulses are diminished in both feet; the skin is shiny and hairless. Initial lab results include a C-reactive protein (CRP) level of 3.5 mg/dL, leukocytes of 6,000/mm3, erythrocyte sedimentation rate (ESR) of 34 mm/hr, and negative antinuclear antibodies. Which part of the patient's history is most directly associated with his current problem?? {'A': 'Diabetes mellitus', 'B': 'Tobacco smoking', 'C': 'Autoimmune disorder', 'D': 'Hypertension', 'E': 'Chronic obstructive pulmonary disease'},
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B: Tobacco smoking
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Q:A 32-year-old man is brought to the emergency department 10 minutes after he sustained a stab wound to the left chest just below the clavicle. On arrival, he is hypotensive with rapid and shallow breathing and appears anxious and agitated. He is intubated and mechanically ventilated. Infusion of 0.9% saline is begun. Five minutes later, his pulse is 137/min and blood pressure is 84/47 mm Hg. Examination shows a 3-cm single stab wound to the left chest at the 4th intercostal space at the midclavicular line without active external bleeding. Cardiovascular examination shows muffled heart sounds and jugular venous distention. Breath sounds are normal bilaterally. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'A 15 mm Hg decrease in systolic blood pressure during inspiration', 'B': 'Cough productive of frank blood', 'C': 'Lateral shift of the trachea toward the right side', 'D': 'Subcutaneous crepitus on palpation of the chest wall', 'E': 'Inward collapse of part of the chest with inspiration'},
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A: A 15 mm Hg decrease in systolic blood pressure during inspiration
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Q:A 48-year-old woman comes to the physician for a follow-up examination. At her visit 1 month ago, her glomerular filtration rate (GFR) was 100 mL/min/1.73 m2 and her renal plasma flow (RPF) was 588 mL/min. Today, her RPF is 540 mL/min and her filtration fraction (FF) is 0.2. After her previous appointment, this patient was most likely started on a drug that has which of the following effects?? {'A': 'Relaxation of urinary smooth muscle', 'B': 'Inhibition of the renal Na-K-Cl cotransporter', 'C': 'Inhibition of vasopressin', 'D': 'Constriction of the afferent arteriole', 'E': 'Constriction of the efferent arteriole'},
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E: Constriction of the efferent arteriole
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Q:A 72-year-old man with coronary artery disease comes to the emergency department because of chest pain and shortness of breath for the past 3 hours. Troponin levels are elevated and an ECG shows ST-elevations in the precordial leads. Revascularization with percutaneous coronary intervention is performed, and a stent is successfully placed in the left anterior descending artery. Two days later, he complains of worsening shortness of breath. Pulse oximetry on 3L of nasal cannula shows an oxygen saturation of 89%. An x-ray of the chest shows distended pulmonary veins, small horizontal lines at the lung bases, and blunting of the costophrenic angles bilaterally. Which of the following findings would be most likely on a ventilation-perfusion scan of this patient?? {'A': 'Increased apical ventilation with normal perfusion bilaterally', 'B': 'Normal ventilation with multiple, bilateral perfusion defects', 'C': 'Matched ventilation and perfusion bilaterally', 'D': 'Normal perfusion with bilateral ventilation defects', 'E': 'Normal perfusion with decreased ventilation at the right base'},
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D: Normal perfusion with bilateral ventilation defects
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Q:A 48-year-old woman presented to the hospital with a headache, intermittent fevers and chills, generalized arthralgias, excessive thirst, increased fluid intake, and a progressive rash that developed on her back. Three days before seeking evaluation at the hospital, she noticed a small, slightly raised lesion appearing like a spider or insect bite on her back, which she considered to be a scab covering the affected region. The patient's fever reached 39.4°C (102.9°F) 2 days before coming to the hospital, with an intensifying burning sensation on the affected site. When a family member examined the bite, it was noticed that the bump had transformed into a circular rash. The patient took over-the-counter ibuprofen for intense pain so she could sleep through the night. The day before her hospital visit, the patient felt exhausted but managed to complete a normal workday. On the day of the hospital visit, she awoke feeling very ill, with shooting joint pains, high fevers, and excessive thirst, which led to her to seek medical attention. On physical examination, her temperature was 40.1°C (104.2°F), and there was a large circular red rash with a bulls-eye appearance (17 × 19 cm in diameter) on her back. The rest of the physical examination was unremarkable. Her past medical and surgical histories were not significant apart from a history of anaphylaxis when taking a tetracycline. She recalled a walk in the woods 3 weeks before this exam but denied finding a tick or any other ectoparasite on her body. She denied any nutritional or inhalational allergies, although she emphasized that she is allergic to tetracyclines. Based on her symptoms, medical history, and physical examination findings, the attending physician decides to institute antimicrobial therapy immediately. Which antimicrobial drug did the physician prescribe?? {'A': 'Cephalexin', 'B': 'Amoxicillin', 'C': 'Azithromycin', 'D': 'Erythromycin', 'E': 'Doxycycline'},
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B: Amoxicillin
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Q:A 3-year-old boy is brought to the emergency department by his mother because of a cough and mild shortness of breath for the past 12 hours. He has not had fever. He has been to the emergency department 4 times during the past 6 months for treatment of asthma exacerbations. His 9-month-old sister was treated for bronchiolitis a week ago. His father has allergic rhinitis. Current medications include an albuterol inhaler and a formoterol-fluticasone inhaler. He appears in mild distress. His temperature is 37.5°C (99.5°F), pulse is 101/min, respirations are 28/min, and blood pressure is 86/60 mm Hg. Examination shows mild intercostal and subcostal retractions. Pulmonary examination shows decreased breath sounds and mild expiratory wheezing throughout the right lung field. Cardiac examination shows no abnormalities. An x-ray of the chest shows hyperlucency of the right lung field with decreased pulmonary markings. Which of the following is the next best step in management?? {'A': 'Bronchoscopy', 'B': 'Albuterol nebulization', 'C': 'Racemic epinephrine', 'D': 'CT of the lung', 'E': 'Azithromycin therapy'},
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A: Bronchoscopy
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Q:A 37-year-old man presents to the emergency department after he cut his hand while working on his car. The patient has a past medical history of antisocial personality disorder and has been incarcerated multiple times. His vitals are within normal limits. Physical exam is notable for a man covered in tattoos with many bruises over his face and torso. Inspection of the patient's right hand reveals 2 deep lacerations on the dorsal aspects of the second and third metacarpophalangeal (MCP) joints. The patient is given a tetanus vaccination, and the wound is irrigated. Which of the following is appropriate management for this patient?? {'A': 'Ciprofloxacin and topical erythromycin', 'B': 'Clindamycin and topical erythromycin', 'C': 'Closure of the wound with sutures', 'D': 'No further management necessary', 'E': 'Surgical irrigation, debridement, and amoxicillin-clavulanic acid'},
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E: Surgical irrigation, debridement, and amoxicillin-clavulanic acid
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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 progressive pain and swelling of her wrists and hands for the past 2 months. Her hands are stiff in the morning; the stiffness decreases as she starts her chores. She also reports early-morning neck pain at rest for the past 3 weeks. She has no history of serious illness and takes no medications. Her sister has systemic lupus erythematosus. Vital signs are within normal limits. Examination shows bilateral swelling and tenderness of the wrists, second, third, and fourth metacarpophalangeal joints; range of motion is limited by pain. There is no vertebral tenderness. Cardiopulmonary examination shows no abnormalities. Neurologic examination shows no focal findings. Laboratory studies show: Hemoglobin 12.8 g/dL Leukocyte count 9,800/mm3 Erythrocyte sedimentation rate 44 mm/h Serum Glucose 77 mg/dL Creatinine 1.1 mg/dL Total bilirubin 0.7 mg/dL Alkaline phosphatase 33 U/L AST 14 U/L ALT 13 U/L Rheumatoid factor positive Which of the following is the most appropriate next step in management?"? {'A': 'Adalimumab', 'B': 'X-ray of the cervical spine', 'C': 'Measurement of anti-Smith antibodies', 'D': 'CT scan of the chest', 'E': 'Tuberculin skin test'},
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B: X-ray of the cervical spine
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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 comes to the physician because of a cough with blood-tinged sputum for 1 week. He also reports fever and a 5-kg (11 lb) weight loss during the past 2 months. Over the past year, he has had 4 episodes of sinusitis. Physical examination shows palpable nonblanching skin lesions over the hands and feet. Examination of the nasal cavity shows ulceration of the nasopharyngeal mucosa and a depressed nasal bridge. Oral examination shows a painful erythematous gingival enlargement that bleeds easily on contact. Which of the following is the most likely cause of the patient's symptoms?? {'A': 'Metalloprotease enzyme deficiency', 'B': 'Neutrophil-mediated damage', 'C': 'Arteriovenous malformation', 'D': 'Immune complex deposition', 'E': 'Malignant myeloid cell proliferation'},
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B: Neutrophil-mediated damage
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old pregnant woman in the 28th week of gestation presents to the emergency department for evaluation of bilateral edema of her legs. It seems to worsen at the end of the day and has lasted for the past 3 weeks. History reveals that this is her 3rd pregnancy. Vital signs include: blood pressure 120/80 mm Hg, heart rate 74/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F). Body mass index is 36 kg/m2. Physical examination reveals bilateral leg edema with engorged surface veins. A photograph of the patient’s legs is shown. Which of the following is the best initial management of the patient?? {'A': 'Compression stockings', 'B': 'Enoxaparin', 'C': 'Endovenous laser treatment', 'D': 'Foam sclerotherapy', 'E': 'Warfarin'},
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A: Compression stockings
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Q:A 9-year-old boy presents with abdominal pain that started nearly 6 hours ago. The pain is located in the periumbilical area and radiates to the right lower quadrant. There was no vomiting or passage of stool since the onset of pain. The patient reports that he passed stools with blood several times during the past month. The vital signs include: blood pressure 110/70 mm Hg, heart rate 81/min, respiratory rate 16/min, and temperature 37.5℃ (99.5℉). The physical examination reveals abdominal tenderness and guarding in the periumbilical area. An abdominal ultrasound does not reveal an appendiceal abnormality. The patient underwent an exploratory laparoscopy. At the time of laparoscopy, a 2-cm wide inflamed diverticulum is found 40 cm proximal to the ileocecal valve. The diverticulum is resected and sent for histologic evaluation. The result is shown in the exhibit. Which of the following statements is true?? {'A': 'It resulted from traction by embryonic peritoneal adhesions.', 'B': 'The most probable cause of this diverticulum is increased intraluminal pressure.', 'C': 'It is an unobliterated embryonic bile duct.', 'D': 'It is a remnant of the embryonic omphalomesenteric duct.', 'E': 'It is a false diverticulum.'},
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D: It is a remnant of the embryonic omphalomesenteric duct.
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Q:A 55-year-old man comes to the physician for a routine health visit. He feels well except for occasional left-sided abdominal discomfort and left shoulder pain. He has smoked 1 pack of cigarettes daily for 20 years. He does not drink alcohol. His pulse is 85/min and his blood pressure is 130/70 mmHg. Examination shows a soft, nontender abdomen. The spleen is palpated 5 cm below the costal margin. There is no lymphadenopathy present. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12.2 g/dL Hematocrit 36 % Leukocyte count 34,000/mm3 Platelet count 450,000/mm3 Cytogenetic testing of his blood cells is pending. Further evaluation of this patient is most likely to show which of the following findings?"? {'A': 'Low leukocyte alkaline phosphatase score', 'B': 'Elevated serum calcium', 'C': 'Decreased basophil count', 'D': 'Autoimmune hemolytic anemia', 'E': 'Elevated serum β2 microglobulin'},
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A: Low leukocyte alkaline phosphatase score
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Q:A 17-year-old boy comes to the physician for a follow-up examination. Two months ago, he suffered a spinal fracture after a fall from the roof. He feels well. His father has multiple endocrine neoplasia type 1. Vital signs are within normal limits. Examination shows no abnormalities. Laboratory studies show: Hemoglobin 13.7 g/dL Serum Creatinine 0.7 mg/dL Proteins Total 7.0 g/dL Albumin 4.1 g/dL Calcium 11.4 mg/dL Phosphorus 5.3 mg/dL Alkaline phosphatase 100 U/L Which of the following is the most likely cause of these findings?"? {'A': 'Sarcoidosis', 'B': 'Immobilization', 'C': 'Parathyroid adenoma', 'D': 'Pseudohypercalcemia', 'E': 'Paraneoplastic syndrome'},
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B: Immobilization
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Q:A 25-year-old woman presents to the ED with nausea, vomiting, diarrhea, abdominal pain, and hematemesis after ingesting large quantities of a drug. Which of the following pairs a drug overdose with the correct antidote for this scenario?? {'A': 'Iron; deferoxamine', 'B': 'Aspirin; N-acetylcysteine', 'C': 'Atropine; fomepizole', 'D': 'Organophosphate; physostigmine', 'E': 'Acetaminophen; naloxone'},
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A: Iron; deferoxamine
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Q:A 27-year-old soldier is brought to the emergency department of a military hospital 20 minutes after being involved in a motor vehicle accident during a training exercise. He was an unrestrained passenger. On arrival, he has shortness of breath and chest pain. He appears pale and anxious. His temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 100/65 mm Hg. He is alert and oriented to person, place, and time. Examination shows pale conjunctivae and mucous membranes. There is bruising on the chest, extremities, and abdomen. The lungs are clear to auscultation. He has normal heart sounds and flat neck veins. The abdomen is flat, soft, and mildly tender. The remainder of the physical examination shows no abnormalities. High-flow oxygen is applied, and intravenous fluid resuscitation is begun. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?? {'A': 'Pericardiocentesis', 'B': 'CT scan of the chest with contrast', 'C': 'Abdominal ultrasonography', 'D': 'Placement of a chest tube', 'E': 'Intubation with positive pressure ventilation\n"'},
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B: CT scan of the chest with contrast
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Q:An investigator is studying the effects of influenza virus on human lung tissue. Biopsy specimens of lung parenchyma are obtained from patients recovering from influenza pneumonia and healthy control subjects. Compared to the lung tissue from the healthy control subjects, the lung tissue from the affected patients is most likely to show which of the following findings on histopathologic examination?? {'A': 'Decreased alveolar macrophages', 'B': 'Decreased interstitial fibroblasts', 'C': 'Increased type II pneumocytes', 'D': 'Increased alveolar squamous epithelial cells', 'E': 'Increased goblet cells'},
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C: Increased type II pneumocytes
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Q:A 24-year-old male with cystic fibrosis is brought to the emergency room by his mother after he had difficulty breathing. He previously received a lung transplant 6 months ago and was able to recover quickly from the operation. He is compliant with all of his medications and had been doing well with no major complaints until 2 weeks ago when he began to experience shortness of breath. Exam reveals a decreased FEV1/FVC ratio and biopsy reveals lymphocytic infiltration. Which of the following components is present in the airway zone characteristically affected by the most likely cause of this patient's symptoms?? {'A': 'Cartilage', 'B': 'Goblet cells', 'C': 'Pseudostratified columnar cells', 'D': 'Simple cuboidal cells', 'E': 'Stratified cuboidal cells'},
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D: Simple cuboidal cells
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Q:A 19-year-old G1P0 presents to the emergency department with severe abdominal pain. She states that the pain has been recurring every 3 to 5 minutes for the past 5 hours. She denies having regular prenatal care but recalls that her last menstrual period was about 9 months ago. She denies taking or using any substances. Her temperature is 98°F (37°C), blood pressure is 120/60 mmHg, pulse is 120/min, and respirations are 8/min. Tenderness is elicited in the lower abdominal quadrants. Clear fluid is seen in her vaginal vault with a fetal crown seen at 10 cm cervical dilation and +1 station. The patient is emergently taken into the labor and delivery suite, where she delivers a male infant with APGAR scores of 9 and 9 at 5 and 10 minutes, respectively. Several hours after delivery, the nurse notes that the infant is very irritable and crying in high pitches. The infant appears very diaphoretic with a runny nose and flailing limbs. What is the necessary pharmacological treatment for this patient?? {'A': 'Acetaminophen', 'B': 'Diazepam', 'C': 'Naloxone', 'D': 'Phenobarbital', 'E': 'Morphine'},
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E: Morphine
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Q:A 55-year-old man with a history of myocardial infarction 3 months ago presents with feelings of depression. He says that he has become detached from his friends and family and has daily feelings of hopelessness. He says he has started to avoid strenuous activities and is no longer going to his favorite bar where he used to spend a lot of time drinking with his buddies. The patient says these symptoms have been ongoing for the past 6 weeks, and his wife is starting to worry about his behavior. He notes that he continues to have nightmares that he is having another heart attack. He says he is even more jumpy than he used to be, and he startles very easily. Which of the following is the most likely diagnosis in this patient?? {'A': 'Post-traumatic stress disorder', 'B': 'Acute stress disorder', 'C': 'Major depression disorder', 'D': 'Alcohol withdrawal', 'E': 'Midlife crisis'},
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A: Post-traumatic stress disorder
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Q:A 20-year-old man presents to the emergency department with complaints of severe malaise, fevers, and sore throat for the past 7 days. He also has had episodes of nausea and vomiting during this period. He does not smoke or drink alcohol. There is no family history of liver disease. His blood pressure is 130/80 mm Hg, temperature is 38.3℃ (100.9℉), pulse is 102/min, and respiratory rate is 20/min. On physical examination, he appears ill with bilateral cervical lymphadenopathy. His tonsils are erythematous and enlarged. There is no jaundice and he is mildly dehydrated. Abdominal examination demonstrates splenomegaly. The laboratory findings are shown below: Hemoglobin 15 g/dL Platelet count 95,000/mm³ Leukocytes 13,500/mm³ Neutrophils 50% Atypical lymphocytes 34% AST 232 U/L ALT 312 U/L ALP 120 U/L GGT 35 U/L Total bilirubin 1.2 mg/dL Direct bilirubin 0.2 mg/dL PT 12 seconds The serologic test for hepatitis A, B, and C, CMV, and leptospirosis are negative. Serology for both serum IgM and IgG antibodies for EBV capsid antigen are positive, but the heterophile antibody test is negative. What is the most likely reason for the negative heterophile test?? {'A': 'Low specificity', 'B': 'Age of the patient', 'C': 'False negative', 'D': 'Concurrent viral hepatitis A infection', 'E': 'CMV infection'},
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C: False negative
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Q:A 57-year-old otherwise healthy male presents to his primary care physician for a check-up. He has no complaints. His blood pressure at the previous visit was 160/95. The patient did not wish to be on any medications and at the time attempted to manage his blood pressure with diet and exercise. On repeat measurement of blood pressure today, the reading is 163/92. His physician decides to prescribe a medication which the patient agrees to take. The patient calls his physician 6 days later complaining of a persistent cough, but otherwise states that his BP was measured as 145/85 at a local pharmacy. Which of the following is a contraindication to this medication?? {'A': 'Chronic obstructive pulmonary disease', 'B': 'Gout', 'C': 'Bilateral renal artery stenosis', 'D': 'Congestive heart failure', 'E': 'Black race'},
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C: Bilateral renal artery stenosis
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Q:A 61-year-old man comes to the physician because of progressively worsening swelling of his ankles. He says he has felt exhausted lately. Over the past 3 months, he has gained 5 kg. He has smoked one pack of cigarettes daily for 30 years. His pulse is 75/min and his blood pressure is 140/90 mmHg. Examination shows 2+ pitting edema in the lower extremities. Neurologic exam shows diminished two-point discrimination in the fingers and toes. A urine sample is noted to be foamy. Laboratory studies show a hemoglobin A1c of 7.9% and creatinine of 1.9 mg/dL. A biopsy specimen of the kidney is most likely to show which of the following?? {'A': 'Interstitial inflammation', 'B': 'Wire looping of capillaries', 'C': 'Nodular glomerulosclerosis', 'D': 'Immune complex deposition', 'E': 'Split glomerular basement membrane'},
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C: Nodular glomerulosclerosis
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Q:A 21-year-old man presents to the office for a follow-up visit. He was recently diagnosed with type 1 diabetes mellitus after being hospitalized for diabetic ketoacidosis following a respiratory infection. He is here today to discuss treatment options available for his condition. The doctor mentions a recent study in which researchers have developed a new version of the insulin pump that appears efficacious in type 1 diabetics. They are currently comparing it to insulin injection therapy. This new pump is not yet available, but it looks very promising. At what stage of clinical trials is this current treatment most likely at?? {'A': 'Phase 1', 'B': 'Phase 4', 'C': 'Phase 3', 'D': 'Phase 0', 'E': 'Phase 2'},
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C: Phase 3
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Q:A 64-year-old man presents to his physician for a scheduled follow-up visit. He has chronic left-sided heart failure with systolic dysfunction. His current regular medications include captopril and digoxin, which were started after his last episode of symptomatic heart failure approximately 3 months ago. His last episode of heart failure was accompanied by atrial fibrillation, which followed an alcohol binge over a weekend. Since then he stopped drinking. He reports that he has no current symptoms at rest and is able to perform regular physical exercise without limitation. On physical examination, mild bipedal edema is noted. The physician suggested to him that he should discontinue digoxin and continue captopril and scheduled him for the next follow-up visit. Which of the following statements best justifies the suggestion made by the physician?? {'A': 'Digoxin is useful to treat atrial fibrillation, but does not benefit patients with systolic dysfunction who are in sinus rhythm.', 'B': 'Digoxin does not benefit patients with left-sided heart failure in the absence of atrial fibrillation.', 'C': 'Captopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin.', 'D': 'Both captopril and digoxin are likely to improve the long-term survival of the patient with heart failure, but digoxin has more severe side effects.', 'E': 'Long-term digoxin therapy produces significant survival benefits in patients with heart failure, but at the cost of increased heart failure-related admissions.'},
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C: Captopril is likely to improve the long-term survival of the patient with heart failure, unlike digoxin.
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Q:A 26-year-old male professional soccer player is brought to the emergency department due to an episode of syncope during a game. He has felt increasing shortness of breath during the past 3 months. During the past week, he has been feeling chest pain upon exertion. He also tells the doctor that his brother had a sudden death a couple of years ago. His heart rate is 98/min, respiratory rate is 18/min, temperature is 36.5°C (97.7°F), and blood pressure is 110/72 mm Hg. On physical examination, there is a harsh crescendo-decrescendo systolic murmur immediately after S1; it is best heard on the apex, and it radiates to the axilla. There is also an early diastolic murmur heard in early diastole, which is best heard with the bell of the stethoscope. When the Valsalva maneuver is performed, the murmur becomes louder. An ECG and an echocardiogram are performed, which confirm the diagnosis. What is the most likely cause of this patient’s condition?? {'A': 'Aortic stenosis', 'B': 'Cardiac tamponade', 'C': 'First-degree heart block', 'D': 'Hypertrophic cardiomyopathy', 'E': 'Third-degree heart block'},
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D: Hypertrophic cardiomyopathy
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Q:A 61-year-old man presents to the emergency department because he has developed blisters at multiple locations on his body. He says that the blisters appeared several days ago after a day of hiking in the mountains with his colleagues. When asked about potential triggering events, he says that he recently had an infection and was treated with antibiotics but he cannot recall the name of the drug that he took. In addition, he accidentally confused his medication with one of his wife's blood thinner pills several days before the blisters appeared. On examination, the blisters are flesh-colored, raised, and widespread on his skin but do not involve his mucosal surfaces. The blisters are tense to palpation and do not separate with rubbing. Pathology of the vesicles show that they continue under the level of the epidermis. Which of the following is the most likely cause of this patient's blistering?? {'A': 'Antibodies to proteins connecting intermediate filaments to type IV collagen', 'B': 'Antibodies to proteins connecting two sets of intermediate filaments', 'C': 'Depletion of protein C and protein S levels', 'D': 'Infection with a enveloped dsDNA virus', 'E': 'Necrosis of skin in reaction to a drug'},
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A: Antibodies to proteins connecting intermediate filaments to type IV collagen
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Q:A 31-year-old woman presents to her gynecologist for a routine well-visit. She is sexually active with multiple male partners and uses an intrauterine device for contraception. Her last menstrual period was two weeks ago. She denies abnormal vaginal discharge or sensations of burning or itching. Pelvic exam is normal. Routine Pap smear shows the following (see Image A). Which organism is most likely responsible for her abnormal Pap smear?? {'A': 'Treponema pallidum', 'B': 'Chlamydia trachomatis', 'C': 'Herpes simplex virus 1', 'D': 'Human papillomavirus', 'E': 'Trichomonas vaginalis'},
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D: Human papillomavirus
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Q:A 27-year-old woman presents to the emergency room with a rash over her shins for the last 3 months. She also has a swell in her knee and wrist joints on both sides for a few days. The rash is painful and erythematous. She had an episode of uveitis 6 months ago that was treated with topical therapy. She is not on any medication currently. In addition, she stated that 3 weeks ago she went hiking with her family and found a tick attached to her left thigh. Her vital signs include a blood pressure of 135/85 mm Hg, a pulse of 85/min, and a respiratory rate of 12/min. Physical examination shows swelling of the ankles, knees, and wrists bilaterally, and well-demarcated papules over the anterior aspect of both legs. A chest X-ray is performed and demonstrates bilateral hilar lymphadenopathy. Which of the following is the pathophysiologic mechanism behind this patient’s condition?? {'A': 'Loss of protection against proteases', 'B': 'Formation of caseating granulomas', 'C': 'Release of toxins by spirochete', 'D': 'Activation of T lymphocytes', 'E': 'Activation of Langerhans cells'},
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D: Activation of T lymphocytes
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Q:A 24-year-old woman comes to the physician because of a 2-month history of increased urination. She has also had dry mouth and excessive thirst despite drinking several gallons of water daily. She has a history of obsessive-compulsive disorder treated with citalopram. She drinks 1–2 cans of beer daily. Physical examination shows no abnormalities. Serum studies show a Na+ concentration of 130 mEq/L, a glucose concentration of 185 mg/dL, and an osmolality of 265 mOsmol/kg. Urine osmolality is 230 mOsmol/kg. The patient is asked to stop drinking water for 3 hours. Following water restriction, repeated laboratory studies show a serum osmolality of 280 mOsmol/kg and a urine osmolality of 650 mOsmol/kg. Which of the following is the most likely diagnosis?? {'A': 'Primary hyperparathyroidism', 'B': 'Syndrome of inappropriate ADH secretion', 'C': 'Nephrogenic diabetes insipidus', 'D': 'Primary polydipsia', 'E': 'Beer potomania'},
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D: Primary polydipsia
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Answer the following medical question with one of the provided options:
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Q:A 64-year-old man presents with unilateral severe chest pain which started a day ago. He describes the chest pain as sharp in nature and localized mainly to his right side. He also complains of mild shortness of breath but says that it is tolerable. He denies any recent history of fever, sweating, dizziness, or similar episodes in the past. Past medical history is significant for chronic lymphocytic leukemia a few months ago for which he was started on chemotherapy. He has currently completed 3 cycles with the last one being few days ago. His temperature is 36.5°C (97.7°F), blood pressure is 118/75 mm Hg, pulse is 95/min, and respirations are 20/min. Lung are clear to auscultation bilaterally. There is severe tenderness to palpation over the right chest and a painful stripe of vesicular lesions, but no evidence of lesions, bruising or trauma. An electrocardiogram is normal and a chest radiograph is unremarkable. Cardiac enzymes are pending. Laboratory studies show: Laboratory test BUN 40 mg/dL Serum creatinine 3.0 mg/dL Urinalysis Protein + Glucose absent RBC absent WBC 3/HPF Nitrite absent Leukocyte esterase negative Sediments negative Which of the following is the best course of treatment for this patient?? {'A': 'Cardiac catheterization', 'B': 'Ganciclovir', 'C': 'Acyclovir', 'D': 'Rest and NSAIDs', 'E': 'Famciclovir'},
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E: Famciclovir
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old Caucasian woman presents to her gynecologist's office with a chief complaint of irregular periods. In the past 2 years, she has often gone > 3 months without menstruating. Menarche was at 13 years old, and prior to the past 2 years, she had regular periods every 28 days lasting 5 days with normal flow and no pain. She denies other symptoms of headache, vision changes, excessive fatigue or sweating, feelings of a racing heart, or hair loss. Since starting college, she has been bothered by weight gain and acne that she attributes to her habit of late night pizza and french fries. On exam she is well appearing with severe acne, and her temperature is 98.6°F (37°C), blood pressure is 120/80 mmHg, pulse is 60/min, and BMI is 30 kg/m^2. Lab work confirms the most likely diagnosis and includes a Hemoglobin A1c of 5.4. If she is not interested in child bearing at this time, what is the best initial medication to treat this disease?? {'A': 'Ethinyl estradiol - norgestimate', 'B': 'Leuprolide', 'C': 'Metformin', 'D': 'Spironolactone', 'E': 'Simvastatin'},
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A: Ethinyl estradiol - norgestimate
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Q:A 41-year-old man presents at an office for a regular health check-up. He has no complaints. He has no history of significant illnesses. He currently takes omeprazole for gastroesophageal reflux disease. He occasionally smokes cigarettes and drinks alcohol. The family history is unremarkable. The vital signs include: blood pressure 133/67 mm Hg, pulse 67/min, respiratory rate 15/min, and temperature 36.7°C (98.0°F). The physical examination was within normal limits. A complete blood count reveals normal values. A urinalysis was ordered which shows the following: pH 6.7 Color light yellow RBC none WBC none Protein absent Cast hyaline casts Glucose absent Crystal none Ketone absent Nitrite absent Which of the following is the likely etiology for hyaline casts in this patient?? {'A': 'Post-streptococcal glomerulonephritis', 'B': 'Non-specific; can be a normal finding', 'C': 'Acute interstitial nephritis', 'D': 'Nephrotic syndrome', 'E': 'End-stage renal disease/chronic kidney disease (CKD)'},
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B: Non-specific; can be a normal finding
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Q:A 47-year-old woman presents with blurry vision for the past 2 weeks. She says that symptoms onset gradually and have progressively worsened. She works as a secretary in a law firm, and now her vision is hampering her work. Past medical history is significant for psoriasis, diagnosed 7 years ago, managed with topical corticosteroids. Her blood pressure is 120/60 mm Hg, respiratory rate is 17/min, and pulse is 70/min. Her BMI is 28 kg/m2. Physical examination is unremarkable. Laboratory findings are significant for the following: RBC count 4.4 x 1012/L WBC count 5.0 x 109/L Hematocrit 44% Fasting plasma glucose 250 mg/dL Hemoglobin A1C 7.8% Which of the following would be the most likely cause of death in this patient?? {'A': 'Renal failure', 'B': 'Rhinocerebral mucormycosis', 'C': 'Peripheral neuropathy', 'D': 'Myocardial infarction', 'E': 'Coma'},
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D: Myocardial infarction
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Q:A 46-year-old man who recently immigrated from Mexico comes to the physician for a pre-employment wellness examination. A tuberculin skin test is administered and he develops a raised, erythematous 12 mm lesion on his forearm within 48 hours. An x-ray of the chest shows no abnormalities. He is started on the recommended antibiotic treatment for latent tuberculosis. Four weeks later, he returns for a follow-up examination. Laboratory studies show a hemoglobin concentration of 9.3 g/dL, serum alanine aminotransferase activity of 86 U/L, and serum aspartate aminotransferase activity of 66 U/L. A photomicrograph of a Prussian blue-stained bone marrow smear is shown. Which of the following is the mechanism of action of the drug responsible for this patient's findings?? {'A': 'Inhibition of dihydropteroate synthase', 'B': 'Binding to 50S ribosomal subunit', 'C': 'Inhibition of bacterial RNA polymerase', 'D': 'Inhibition of mycolic acid synthesis', 'E': 'Inhibition of arabinosyltransferase'},
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D: Inhibition of mycolic acid synthesis
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Answer the following medical question with one of the provided options:
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Q:In your peripheral tissues and lungs, carbonic anhydrase works to control the equilibrium between carbon dioxide and carbonic acid in order to maintain proper blood pH. Through which mechanism does carbonic anhydrase exert its influence on reaction kinetics?? {'A': 'Lowers the activation energy', 'B': 'Changes the delta G of the reaction', 'C': 'Raises the activation energy', 'D': 'Lowers the free energy of products', 'E': 'Lowers the free energy of reactants'},
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A: Lowers the activation energy
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 10-year-old boy is brought to the emergency department for the evaluation of one episode of vomiting and severe headache since this morning. His mother says he also had difficulty getting dressed on his own. He has not had any trauma. The patient appears nervous. His temperature is 37°C (98.6°F), pulse is 100/min, and blood pressure is 185/125 mm Hg. He is confused and oriented only to person. Ophthalmic examination shows bilateral optic disc swelling. There is an abdominal bruit that is best heard at the right costovertebral angle. A complete blood count is within normal limits. Which of the following is most likely to confirm the diagnosis?? {'A': 'Echocardiography', 'B': 'Oral sodium loading test', 'C': 'CT angiography', 'D': 'Serum IGF-I level', 'E': 'High-dose dexamethasone suppression test'},
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C: CT angiography
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Q:A 26-year-old man is brought to the emergency room by his roommate after he was found attempting to commit suicide. His roommate says that he stopped him before he was about to jump off the balcony. He has been receiving treatment for depression for about a year. 6 months ago, he had come to the hospital reporting decreased interest in his daily activities and inability to concentrate on his work. He had stopped going out or accepting invitations for any social events. He spent several nights tossing and turning in bed. He also expressed guilt for being unable to live up to his parents’ expectations. His psychiatrist started him on fluoxetine. He says that none of the medications have helped even though the dose of his medication was increased on several occasions, and he was also switched to other medications over the course of the past year. He has mentioned having suicidal thoughts due to his inability to cope with daily activities, but this is the first time he has ever attempted it. Which of the following would this patient be a suitable candidate for?? {'A': 'Cognitive behavioral theory', 'B': 'Electroconvulsive therapy', 'C': 'Exposure therapy', 'D': 'Amitriptyline', 'E': 'Olanzapine'},
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B: Electroconvulsive therapy
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Q:A 12-year-old male presents to the emergency department following several days of facial edema. A urinalysis confirms proteinuria and hematuria. Once admitted, a kidney biopsy is viewed under an electron microscope to confirm the diagnosis of minimal change disease. In the following electron micrograph, what process occurs in the structure marked with an arrow?? {'A': 'Proteins are synthesized for extracellular secretion', 'B': 'Translation occurs', 'C': 'rRNA is produced', 'D': 'Assembly of the 80S ribosome', 'E': 'Initiation factors bind RNA'},
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C: rRNA is produced
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Q:A 28-year-old man who works as a resident in general surgery presents feeling "burned out" for the last 2 months. He says he has been working extremely long hours under stressful conditions, which makes him irritable, edgy, unfocused, and forgetful. He says he also has severe anxiety about how these symptoms are affecting his performance at work, making it difficult for him to sleep even when he has time off. The patient is referred for counseling and is prescribed some mild sleep aids. At follow-up a few months later, he says he is feeling much improved due to improved staffing at the hospital and a more manageable workload. Which of the following is the most likely diagnosis in this patient?? {'A': 'Adjustment disorder', 'B': 'Generalized anxiety disorder', 'C': 'Anxiety disorder', 'D': 'Panic disorder', 'E': 'Normal human behavior'},
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A: Adjustment disorder
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Q:A 60-year-old woman presents with changes in her left breast that started 1 month ago. The patient states that she noticed that an area of her left breast felt thicker than before, and has not improved. She came to get it checked out because her best friend was just diagnosed with invasive ductal carcinoma. The past medical history is significant for Hashimoto’s thyroiditis, well-managed medically with levothyroxine. The patient has a 30-pack-year smoking history, but she quit over 15 years ago. The menarche occurred at age 11, and the menopause was at age 53. She does not have any children and has never been sexually active. Her last screening mammogram 10 months ago was normal. The family history is significant for her mother dying from a myocardial infarction (MI) at age 68, her sister dying from metastatic breast cancer at age 55, and for colon cancer in her paternal grandfather. The review of systems is notable for unintentional weight loss of 3.6 kg (8 lb) in the past month. The vital signs include: temperature 37.0℃ (98.6℉), blood pressure 110/70 mm Hg, pulse 72/min, respiratory rate 15/min, and oxygen saturation 98% on room air. The physical examination is significant only for a minimally palpable mass with irregular, poorly defined margins in the upper outer quadrant of the left breast. The mass is rubbery and movable. There is no axillary lymphadenopathy noted. Which of the following characteristics is associated with this patient’s most likely type of breast cancer in comparison to her friend’s diagnosis?? {'A': 'Worse prognosis', 'B': 'Can present bilaterally', 'C': 'Higher prevalence', 'D': 'Mammogram is more likely to demonstrate a discrete spiculated mass', 'E': 'Fibrosis is a distinguishing feature on biopsy'},
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B: Can present bilaterally
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Q:A 6-year-old boy is brought to the emergency department due to a severe infection. Laboratory work shows leukocytosis of 60 × 109/L with marked left shift, but no blast cells. The patient is febrile and dehydrated. The physician believes that this is a severe reaction to the infection and orders a leukocyte alkaline phosphatase (LAP) stain on a peripheral smear. The LAP score is elevated. Which of the following statements best describes an additional characteristic of the condition this child is suffering from?? {'A': 'This condition can lead to chronic myelocytic leukemia.', 'B': 'Myeloblasts and promyelocytes are expected to be found.', 'C': 'A blood count will contain band forms, metamyelocytes, and myelocytes.', 'D': 'Chemotherapy is the treatment of choice.', 'E': 'The patient may develop anemia secondary to infection.'},
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C: A blood count will contain band forms, metamyelocytes, and myelocytes.
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Q:A 25-year-old male visits his physician because of fertility issues with his wife. Physical exam reveals bilateral gynecomastia, elongated limbs, and shrunken testicles. Levels of plasma gonadotropins are elevated. Which of the following is also likely to be increased in this patient:? {'A': 'Testosterone', 'B': 'Inhibin', 'C': 'Aromatase', 'D': 'Ejaculatory sperm', 'E': 'Sertoli cells'},
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C: Aromatase
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Answer the following medical question with one of the provided options:
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Q:A 7-year-old boy is brought to the physician by his parents because of a 4.5-kg (10-lb) weight loss during the last 3 months. During this period, he has complained of abdominal pain and fullness, and his parents feel that he has been eating less. His parents also report that his urine has appeared pink for several weeks. He has been performing poorly in school lately, with reports from teachers that he has not been paying attention in class and has been distracting to other students. He was born at term and has been healthy except for a history of several infantile seizures. His vital signs are within normal limits. He is at the 60th percentile for height and 20th percentile for weight. Physical examination shows a palpable abdominal mass, abdominal tenderness in the left upper quadrant, and left costovertebral angle tenderness. There are several ellipsoid, hypopigmented macules on the back and legs and a 4-cm raised plaque of rough, dimpled skin on the right lower back that is the same color as the surrounding skin. Which of the following is the most likely diagnosis?? {'A': 'Von Hippel‑Lindau disease', 'B': 'Neurofibromatosis type 1', 'C': 'Sturge-Weber syndrome', 'D': 'Tuberous sclerosis', 'E': 'Neurofibromatosis type 2'},
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D: Tuberous sclerosis
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Answer the following medical question with one of the provided options:
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Q:A 9-month-old boy is brought to the pediatrician because he can not sit on his own without support and has involuntary movements. He was born vaginally with no complications at full term. There is no history of consanguinity among parents. On physical examination, it was noticed that he is a stunted infant with generalized hypotonia and severe generalized dystonic movements. The mother says that she has noticed the presence of orange sand in his diapers many times. Laboratory evaluation revealed elevated uric acid levels in both blood and urine. Hypoxanthine-guanine phosphoribosyltransferase is found to be deficient in his blood samples. He was prescribed an appropriate medication and sent home. The most likely mechanism of this drug is the inhibition of which of the following enzymes in addition to xanthine oxidase?? {'A': 'Purine nucleoside phosphorylase', 'B': 'Orotate phosphoribosyltransferase', 'C': 'Ribonucleotide reductase', 'D': 'Inosine monophosphate dehydrogenase', 'E': 'Dihydrofolate reductase'},
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A: Purine nucleoside phosphorylase
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Answer the following medical question with one of the provided options:
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Q:A 49-year-old man presents to the emergency department with acute onset of pain and redness of the skin of his lower leg for the past 3 days. He has had type 2 diabetes mellitus for the past 12 years, but he is not compliant with his medications. He has smoked 10–15 cigarettes per day for the past 20 years. His temperature is 38°C (100.4°F), pulse is 95/min, and blood pressure is 110/70 mm Hg. On physical examination, the pretibial area is erythematous, edematous, and tender. He is diagnosed with acute cellulitis, and intravenous ceftazidime sodium is started. On the 5th day of antibiotic therapy, the patient complains of severe watery diarrhea, fever, and abdominal tenderness without rigidity. Complete blood count is ordered for the patient and shows 14,000 white blood cells/mm3. Which of the following is the best initial therapy for this patient?? {'A': 'Intravenous vancomycin', 'B': 'Oral vancomycin', 'C': 'Oral metronidazole', 'D': 'Oral ciprofloxacin', 'E': 'Fecal microbiota transplantation'},
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B: Oral vancomycin
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Answer the following medical question with one of the provided options:
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Q:At postpartum physical examination, a newborn is found to have male external genitalia. Scrotal examination shows a single palpable testicle in the right hemiscrotum. Ultrasound of the abdomen and pelvis shows an undescended left testis, seminal vesicles, uterus, and fallopian tubes. Chromosomal analysis shows a 46, XY karyotype. Which of the following sets of changes is most likely to be found in this newborn? $$$ SRY-gene activity %%% Müllerian inhibitory factor (MIF) %%% Testosterone %%% Dihydrotestosterone (DHT) $$$? {'A': '↓ ↓ ↓ ↓', 'B': 'Normal normal ↑ ↑', 'C': '↓ ↓ normal normal', 'D': 'Normal ↓ normal normal', 'E': 'Normal normal normal ↓'},
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D: Normal ↓ normal normal
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Answer the following medical question with one of the provided options:
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Q:A 3080-g (6-lb 13-oz) male newborn is delivered at term to a 27-year-old woman, gravida 2, para 1. Pregnancy was uncomplicated. He appears pale. His temperature is 36.8°C (98.2°F), pulse is 167/min, and respirations are 56/min. Examination shows jaundice of the skin and conjunctivae. The liver is palpated 2–3 cm below the right costal margin, and the spleen is palpated 1–2 cm below the left costal margin. The lungs are clear to auscultation. No murmurs are heard. His hemoglobin concentration is 10.6 g/dL and mean corpuscular volume is 73 μm3. Hemoglobin DNA testing shows 3 missing alleles. Which of the following laboratory findings is most likely present in this patient?? {'A': 'Low reticulocyte count', 'B': 'Elevated HbF', 'C': 'Low serum ferritin', 'D': 'Increased hemoglobin Barts concentration', 'E': 'Elevated HbA2\n"'},
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D: Increased hemoglobin Barts concentration
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman presents with dysuria and pain in the lower abdomen. It is the first time she has experienced such symptoms. She denies a history of any genitourinary or gynecologic diseases. The blood pressure is 120/80 mm Hg, heart rate is 78/min, respiratory rate is 13/min, and temperature is 37.0°C (98.6°F). The physical examination is within normal limits. A urine culture grew the pathogens pictured. The presence of which of the following factors specifically allows this pathogen to cause urinary tract infections?? {'A': 'P-fimbriae', 'B': 'K-capsule', 'C': 'Heat-labile toxin', 'D': 'Heat-stable toxin', 'E': 'Hemolysin'},
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A: P-fimbriae
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Answer the following medical question with one of the provided options:
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Q:A 44-year-old woman presents to the outpatient clinic for the evaluation of amenorrhea which she noted roughly 4 months ago. Her monthly cycles up to that point were normal. Initially, she thought that it was related to early menopause; however, she has also noticed that she has a small amount of milk coming from her breasts as well. She denies any nausea, vomiting, or weight gain but has noticed that she has lost sight in the lateral fields of vision to the left and right. Her vital signs are unremarkable. Physical examination confirms bitemporal hemianopsia. What test is likely to reveal her diagnosis?? {'A': 'Urine pregnancy test', 'B': 'MRI brain', 'C': 'Serum estrogen and progesterone levels', 'D': 'Mammogram', 'E': 'Serum TSH and free T4'},
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B: MRI brain
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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 rushed to the emergency department by his wife after complaining of sudden onset, an excruciating headache that started about an hour ago. On further questioning, the patient’s wife gives a prior history of flank pain, hematuria, and hypertension in the patient, and she recalls that similar symptoms were present in his uncle. On examination, his GCS is 12/15, and when his hip joint and knee are flexed, he resists the subsequent extension of the knee. When the neck is flexed there is severe neck stiffness and it causes a patient’s hips and knees to flex. During the examination, he lapses into unconsciousness. Which of the following mechanisms best explains what led to this patient's presentation? ? {'A': 'Embolic occlusion of a cerebral vessel', 'B': 'Increased wall tension within an aneurysm', 'C': 'Intracerebral hemorrhage due to vascular malformations', 'D': 'Meningeal irritation from a space occupying lesion', 'E': 'Uremic encephalopathy from chronic renal disease'},
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B: Increased wall tension within an aneurysm
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