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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician because of a 6-month history of worsening shortness of breath and fatigue. Her paternal uncle had similar symptoms and died of respiratory failure at 45 years of age. The lungs are clear to auscultation. Pulmonary function testing shows an FVC of 84%, an FEV1/FVC ratio of 92%, and a normal diffusion capacity. An ECG shows a QRS axis greater than +90 degrees. Genetic analysis shows an inactivating mutation in the bone morphogenetic protein receptor type II (BMPR2) gene. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Chronic intravascular hemolysis', 'B': 'Elevated left atrial pressure', 'C': 'Fibrosis of the pulmonary parenchyma', 'D': 'Thickening of the interventricular septum', 'E': 'Elevated pulmonary arterial pressure'},
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E: Elevated pulmonary arterial pressure
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Answer the following medical question with one of the provided options:
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Q:A 6-year-old girl is referred to the pediatrician after a primary care practitioner found her to be anemic, in addition to presenting with decreased bowel movements, intermittent abdominal pain, and hearing loss. The child has also shown poor performance at school and has lost interest in continuing her classes of glazed pottery that she has taken twice a week for the past year. During the examination, the pediatrician identifies gingival lines, generalized pallor, and moderate abdominal pain. Laboratory tests show elevated iron and ferritin concentration, and a blood smear shows small and hypochromic erythrocytes, basophilic stippling, and the presence of nucleated erythroblasts with granules visualized with Prussian blue. Which of the following molecules cannot be produced in the erythrocytes of this patient?? {'A': 'Coproporphyrinogen', 'B': 'Aminolevulinic acid', 'C': 'Hydroxymethylbilane', 'D': 'Porphobilinogen', 'E': 'Protoporphyrin'},
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D: Porphobilinogen
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Answer the following medical question with one of the provided options:
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Q:A 10-year-old boy presents to the emergency department with sudden shortness of breath. He was playing in the school garden and suddenly started to complain of abdominal pain. He then vomited a few times. An hour later in the hospital, he slowly developed a rash on his chest, arms, and legs. His breathing became faster with audible wheezing. On physical examination, his vital signs are as follows: the temperature is 37.0°C (98.6°F), the blood pressure is 100/60 mm Hg, the pulse is 130/min, and the respiratory rate is 25/min. A rash is on his right arm, as shown in the image. After being administered appropriate treatment, the boy improves significantly, and he is able to breathe comfortably. Which of the following is the best marker that could be measured in the serum of this boy to help establish a definitive diagnosis?? {'A': 'Prostaglandin D2', 'B': 'Serotonin', 'C': 'Histamine', 'D': 'Tryptase', 'E': 'Leukotrienes'},
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D: Tryptase
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old African American woman comes to the physician because of fatigue and muscle weakness for the past 5 weeks. During this period, she has had recurrent headaches and palpitations. She has hypertension and major depressive disorder. She works as a nurse at a local hospital. She has smoked about 6–8 cigarettes daily for the past 10 years and drinks 1–2 glasses of wine on weekends. Current medications include enalapril, metoprolol, and fluoxetine. She is 160 cm (5 ft 6 in) tall and weighs 60 kg (132 lb); BMI is 21.3 kg/m2. Her temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 155/85 mm Hg. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender; bowel sounds are normal. Her skin is dry and there is no edema in the lower extremities. Laboratory studies show: Hemoglobin 13.3 g/dL Serum Na+ 146 mEq/L Cl- 105 mEq/L K+ 3.0 mEq/L HCO3- 30 mEq/L Urea nitrogen 10 mg/dL Glucose 95 mg/dL Creatinine 0.8 mg/dL Urine Blood negative Glucose negative Protein negative RBC 0–1/hpf WBC none Which of the following is the most likely diagnosis in this patient?"? {'A': 'Laxative abuse', 'B': 'Aldosteronoma', 'C': 'Renal artery stenosis', 'D': 'Pheochromocytoma', 'E': 'Cushing syndrome'},
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B: Aldosteronoma
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Answer the following medical question with one of the provided options:
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Q:A 31 year-old-man presents to an urgent care clinic with symptoms of lower abdominal pain, bloating, bloody diarrhea, and fullness, all of which have become more frequent over the last 3 months. His vital signs are as follows: blood pressure is 121/81 mm Hg, heart rate is 87/min, and respiratory rate is 15/min. Rectal examination reveals a small amount of bright red blood. Lower endoscopy is performed, showing extensive mucosal erythema, induration, and pseudopolyps extending from the rectum to the splenic flexure. Given the following options, what is the definitive treatment for this patient’s underlying disease?? {'A': 'Sulfasalazine', 'B': 'Mesalamine', 'C': 'Systemic corticosteroids', 'D': 'Azathioprine', 'E': 'Total proctocolectomy'},
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E: Total proctocolectomy
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Answer the following medical question with one of the provided options:
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Q:A woman presents to the emergency department due to abdominal pain that began 1 hour ago. She is in the 35th week of her pregnancy when the pain came on during dinner. She also noted a clear rush of fluid that came from her vagina. The patient has a past medical history of depression which is treated with cognitive behavioral therapy. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a healthy young woman who complains of painful abdominal contractions that occur every few minutes. Laboratory studies are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 197,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 4.3 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.1 mg/dL Ca2+: 10.2 mg/dL Lecithin/Sphingomyelin: 1.5 AST: 12 U/L ALT: 10 U/L Which of the following is the best next step in management?? {'A': 'Betamethasone', 'B': 'Terbutaline', 'C': 'Oxytocin', 'D': 'RhoGAM', 'E': 'Expectant management'},
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A: Betamethasone
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Answer the following medical question with one of the provided options:
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Q:Five days after undergoing a pancreaticoduodenectomy for pancreatic cancer, a 46-year-old woman has 2 episodes of non-bilious vomiting and mild epigastric pain. She has a patient-controlled analgesia pump. She has a history of hypertension. She has smoked one pack of cigarettes daily for 25 years. She drinks 3–4 beers daily. Prior to admission to the hospital, her only medications were amlodipine and hydrochlorothiazide. Her temperature is 37.8°C (100°F), pulse is 98/min, and blood pressure is 116/82 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows a midline surgical incision over the abdomen with minimal serous discharge and no erythema. The abdomen is soft with mild tenderness to palpation in the epigastrium. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.6 g/dL Leukocyte count 16,000/mm3 Serum Na+ 133 mEq/L K+ 3.4 mEq/L Cl- 115 mEq/L Glucose 77 mg/dL Creatinine 1.2 mg/dL Arterial blood gas on room air shows: pH 7.20 pCO2 23 mm Hg pO2 91 mm Hg HCO3- 10 mEq/L Which of the following is the most likely cause of this patient's acid-base status?"? {'A': 'Adrenal insufficiency', 'B': 'Excessive alcohol intake', 'C': 'Rhabdomyolysis', 'D': 'Adverse effect of medication', 'E': 'Fistula'},
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E: Fistula
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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 emergency department with jaundice and diffuse abdominal pain. She denies any previous medical problems and says she does not take any medications, drugs, or supplements. Her temperature is 97.6°F (36.4°C), blood pressure is 133/87 mmHg, pulse is 86/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for sclera which are icteric and there is tenderness to palpation over the right upper quadrant. Laboratory studies are ordered as seen below. Hepatitis B surface antigen: Positive Hepatitis B surface IgG: Negative Hepatitis B core antigen: Positive Hepatitis B core IgG: Positive Hepatitis B E antigen: Positive Hepatitis B E IgG: Positive Which of the following is the most likely diagnosis?? {'A': 'Acute hepatitis B infection', 'B': 'Chronic hepatitis B infection', 'C': 'Hepatitis B vaccination', 'D': 'No hepatitis B vaccination or infection', 'E': 'Resolved hepatitis B infection'},
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B: Chronic hepatitis B infection
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old woman presents to the emergency department complaining of a left-sided headache and right-sided blurry vision. She states that 2 weeks ago she developed dark urine and abdominal pain. She thought it was a urinary tract infection so she took trimethoprim-sulfamethoxazole that she had left over. She planned on going to her primary care physician today but then she developed headache and blurry vision so she came to the emergency department. The patient states she is otherwise healthy. Her family history is significant for a brother with sickle cell trait. On physical examination, there is mild abdominal tenderness, and the liver edge is felt 4 cm below the right costal margin. Labs are drawn as below: Hemoglobin: 7.0 g/dL Platelets: 149,000/mm^3 Reticulocyte count: 5.4% Lactate dehydrogenase: 3128 U/L Total bilirubin: 2.1 mg/dL Indirect bilirubin: 1.4 mg/dL Aspartate aminotransferase: 78 U/L Alanine aminotransferase: 64 U/L A peripheral smear shows polychromasia. A Doppler ultrasound of the liver shows decreased flow in the right hepatic vein. Magnetic resonance imaging of the brain is pending. Which of the following tests, if performed, would most likely identify the patient’s diagnosis?? {'A': 'Anti-histone antibodies', 'B': 'Bone marrow biopsy', 'C': 'Flow cytometry', 'D': 'Glucose-6-phosphate-dehydrogenase levels', 'E': 'Hemoglobin electrophoresis'},
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C: Flow cytometry
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old woman presents to her primary care physician with 3 weeks of palpitations and shortness of breath while exercising. She says that these symptoms have been limiting her ability to play recreational sports with her friends. Her past medical history is significant for pharyngitis treated with antibiotics and her family history reveals a grandfather who needed aortic valve replacements early due to an anatomic abnormality. She admits to illicit drug use in college, but says that she stopped using drugs 4 years ago. Physical exam reveals a clicking sound best heard in the left 6th intercostal space. This sound occurs between S1 and S2 and is followed by a flow murmur. Which of the following is most likely associated with the cause of this patient's disorder?? {'A': 'Bicuspid aortic valve', 'B': 'Increased valvular dermatan sulfate', 'C': 'Infection with Streptococcus pyogenes', 'D': 'Intravenous drug abuse', 'E': 'Mutation in cardiac contractile proteins'},
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B: Increased valvular dermatan sulfate
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman comes to the physician because of a 3-day history of dry cough and low-grade fever. Four months ago, she was diagnosed with major depressive disorder and started treatment with fluoxetine. Physical examination shows no abnormalities. A diagnosis of upper respiratory infection is made and a medication is prescribed to relieve her symptoms. A drug with which of the following mechanisms of action should be avoided in this patient?? {'A': 'Disruption of mucoid disulfide bonds', 'B': 'Inhibition of H1 receptors', 'C': 'Reduction in secretion viscosity', 'D': 'Inhibition of NMDA glutamate receptors', 'E': 'Stimulation of α-adrenergic receptors'},
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D: Inhibition of NMDA glutamate receptors
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man is brought to the emergency department by his wife after falling down. About 90 minutes ago, they were standing in their kitchen making lunch and chatting when he suddenly complained that he could not see as well, felt weak, and was getting dizzy. He began to lean to 1 side, and he eventually fell to the ground. He did not hit his head. In the emergency department, he is swaying while seated, generally leaning to the right. The general physical exam is unremarkable. The neurologic exam is notable for horizontal nystagmus, 3/5 strength in the right arm, ataxia of the right arm, and absent pinprick sensation in the left arm and left leg. The computed tomography (CT) scan of the head is unremarkable. Which of the following is the most likely single location of this patient's central nervous system lesion?? {'A': 'Anterior spinal cord', 'B': 'Lateral medulla', 'C': 'Primary motor cortex', 'D': 'Primary somatosensory cortex', 'E': 'Thalamus'},
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B: Lateral medulla
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Answer the following medical question with one of the provided options:
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Q:A 77-year-old Caucasian woman presents to her primary care provider for a general checkup. The patient is with her daughter who brought her to this appointment. The patient states that she is doing well and has some minor joint pain in both hips. She states that sometimes she is sad because her husband recently died. She lives alone and follows a vegan diet. The patient's daughter states that she has noticed her mother struggling with day to day life. It started 2 years ago with her forgetting simple instructions or having difficulty running errands. Now the patient has gotten to the point where she can no longer pay her bills. Sometimes the patient forgets how to get home. The patient has a past medical history of obesity, hypertension, gastroesophageal reflux disease (GERD) controlled with pantoprazole, and diabetes mellitus. Her temperature is 99.5°F (37.5°C), blood pressure is 158/108 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Which of the following will most likely help with this patient's presentation?? {'A': 'Donepezil', 'B': 'Fluoxetine and cognitive behavioral therapy', 'C': 'Lisinopril and metoprolol', 'D': 'Vitamin B12 and discontinue pantoprazole', 'E': 'No intervention needed'},
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A: Donepezil
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Answer the following medical question with one of the provided options:
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Q:A 33-year-old woman presents to her primary care physician for non-bloody nipple discharge. She states that it has been going on for the past month and that it sometimes soils her shirt. The patient drinks 2 to 3 alcoholic beverages per day and smokes 1 pack of cigarettes per day. She is currently seeking mental health treatment with an outpatient psychiatrist after a recent hospitalization for auditory hallucinations. Her psychiatrist prescribed her a medication that she can not recall. Otherwise, she complains of headaches that occur frequently. Her temperature is 98.6°F (37.0°C), blood pressure is 137/68 mmHg, pulse is 70/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for bilateral galactorrhea that can be expressed with palpation. Which of the following is the best next step in management?? {'A': 'CT scan of the head', 'B': 'Discontinuation of current psychiatric medications', 'C': 'Mammography', 'D': 'TSH level', 'E': 'Ultrasound and biopsy'},
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D: TSH level
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the physician by his wife for the evaluation of abnormal sleep patterns that began 10 days ago. She reports that he has only been sleeping 2–3 hours nightly during this time and has been jogging for long periods of the night on the treadmill. The patient has also been excessively talkative and has missed work on several occasions to write emails to his friends and relatives to convince them to invest in a new business idea that he has had. He has chronic kidney disease requiring hemodialysis, but he has refused to take his medications because he believes that he is cured. Eight months ago, he had a 3-week long period of persistent sadness and was diagnosed with major depressive disorder. Mental status examination shows psychomotor agitation and pressured speech. Treatment of this patient's condition should include which of the following drugs?? {'A': 'Buproprion', 'B': 'Triazolam', 'C': 'Valproate', 'D': 'Mirtazapine', 'E': 'Fluoxetine'},
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C: Valproate
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old high school student is brought to the emergency department because of irritability and rapid breathing. He appears agitated and is diaphoretic. His temperature is 38.3°C (101°F), pulse is 129/min, respirations are 28/min, and blood pressure is 158/95 mmHg. His pupils are dilated. An ECG shows sinus tachycardia. Which of the following substances is used to make the drug this patient has most likely taken?? {'A': 'Ergotamine', 'B': 'Pseudoephedrine', 'C': 'Homatropine', 'D': 'Sodium oxybate', 'E': 'Codeine'},
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B: Pseudoephedrine
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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 is brought to the emergency department because of a 30-minute history of dizziness and shortness of breath. After establishing the diagnosis, treatment with a drug is administered. Shortly after administration, the patient develops severe left eye pain and decreased vision of the left eye, along with nausea and vomiting. Ophthalmologic examination shows a fixed, mid-dilated pupil and a narrowed anterior chamber of the left eye. The patient was most likely treated for which of the following conditions?? {'A': 'Atrioventricular block', 'B': 'Hypertensive crisis', 'C': 'Mitral regurgitation', 'D': 'Pulmonary embolism', 'E': 'Viral pleuritis'},
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A: Atrioventricular block
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Answer the following medical question with one of the provided options:
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Q:A 4-year-old girl is brought to the pediatrician by her parents after her mother recently noticed that other girls of similar age talk much more than her daughter. Her mother reports that her language development has been abnormal and she was able to use only 5–6 words at the age of 2 years. Detailed history reveals that she has never used her index finger to indicate her interest in something. She does not enjoy going to birthday parties and does not play with other children in her neighborhood. The mother reports that her favorite “game” is to repetitively flex and extend the neck of a doll, which she always keeps with her. She is sensitive to loud sounds and starts screaming excessively when exposed to them. There is no history of delayed motor development, seizures, or any other major illness; perinatal history is normal. When she enters the doctor’s office, the doctor observes that she does not look at him. When he gently calls her by her name, she does not respond to him and continues to look at her doll. When the doctor asks her to look at a toy on his table by pointing a finger at the toy, she looks at neither his finger nor the toy. The doctor also notes that she keeps rocking her body while in the office. Which of the following is an epidemiological characteristic of the condition the girl is suffering from?? {'A': 'This condition is 4 times more common in boys than girls.', 'B': 'There is an increased incidence if the mother gives birth before 25 years of age.', 'C': 'There has been a steady decline in prevalence in the United States over the last decade.', 'D': 'There is an increased risk if the mother smoked during pregnancy.', 'E': 'There is an increased risk with low prenatal maternal serum vitamin D level.'},
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A: This condition is 4 times more common in boys than girls.
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Answer the following medical question with one of the provided options:
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Q:An 85-year-old man with hypertension and type 2 diabetes mellitus is brought to the emergency department because of a 2-day history of shortness of breath. He has smoked one pack of cigarettes daily for 30 years. His temperature is 36.9°C (98.4°F), pulse is 100/min, respirations are 30/min, and blood pressure is 138/75 mm Hg. Pulmonary function testing shows decreased tidal volume and normal lung compliance. Which of the following is the most likely underlying etiology of this patient's tachypnea?? {'A': 'Emphysema exacerbation', 'B': 'Tension pneumothorax', 'C': 'Diabetic ketoacidosis', 'D': 'Rib fracture', 'E': 'Pulmonary edema'},
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D: Rib fracture
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Answer the following medical question with one of the provided options:
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Q:A 2-year-old boy is brought to the emergency department because of fever, fatigue, and productive cough for the past 2 days. He had similar symptoms 6 months ago when he was diagnosed with pneumonia. Three weeks ago, he was diagnosed with otitis media for the 6th time since birth and was treated with amoxicillin. His temperature is 38.7°C (101.7°F), the pulse is 130/min, the respirations are 36/min, and the blood pressure is 84/40 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 93%. Examination shows purulent discharge in the left ear canal and hypoplastic tonsils without exudate. Coarse crackles are heard over the right lung field on auscultation. An X-ray of the chest shows a right-middle lobe consolidation. Flow cytometry shows absent B cells and normal T cells. Which of the following is the most appropriate next step in management?? {'A': 'Combined antiretroviral therapy', 'B': 'Intravenous immunoglobulins', 'C': 'Recombinant human granulocyte-colony stimulating factor administration', 'D': 'Stem cell transplantation', 'E': 'Thymus transplantation'},
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B: Intravenous immunoglobulins
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old man comes to the physician for recurrent heartburn for 12 years. He has also developed a cough for a year, which is worse at night. He has smoked a pack of cigarettes daily for 30 years. His only medication is an over-the-counter antacid. He has not seen a physician for 8 years. He is 175 cm (5 ft 9 in) tall and weighs 95 kg (209 lb); BMI is 31 kg/m2. Vital signs are within normal limits. There is no lymphadenopathy. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. A complete blood count is within the reference range. An upper endoscopy shows columnar epithelium 2 cm from the gastroesophageal junction. Biopsies from the columnar epithelium show low-grade dysplasia and intestinal metaplasia. Which of the following is the most appropriate next step in management?? {'A': 'Repeat endoscopy in 18 months', 'B': 'Endoscopic therapy', 'C': 'Omeprazole, clarithromycin, and metronidazole therapy', 'D': 'External beam radiotherapy', 'E': 'Nissen fundoplication'},
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B: Endoscopic therapy
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man of Mediterranean descent makes an appointment with his physician because his skin and sclera have become yellow. He complains of fatigue and fever that started at the same time icterus appeared. On examination, he is tachycardic and tachypneic. The oxygen (O2) saturation is < 90%. He has increased unconjugated bilirubin, hemoglobinemia, and an increased number of reticulocytes in the peripheral blood. What is the most likely diagnosis?? {'A': 'Hemolytic anemia caused by glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)', 'B': 'Anemia caused by renal failure', 'C': 'Autoimmune hemolytic anemia (AIHA)', 'D': 'Microcytic anemia caused by iron deficiency', 'E': 'Aplastic anemia'},
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A: Hemolytic anemia caused by glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)
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Answer the following medical question with one of the provided options:
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Q:A 65-year-old man comes to a follow-up appointment with his surgeon 2 months after undergoing hip replacement surgery. His major concern at this visit is that he is still limping since the surgery even after the post-operative pain has subsided. Specifically, when he stands on his right leg, he feels that he has to lean further to the right in order to maintain balance. When standing on his left leg, he feels that he is able to step normally. Damage to which of the following nerves would most likely present with this patient's symptoms?? {'A': 'Common peroneal nerve', 'B': 'Femoral nerve', 'C': 'Inferior gluteal nerve', 'D': 'Superior gluteal nerve', 'E': 'Tibial nerve'},
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D: Superior gluteal nerve
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old man presents to his primary care physician for diarrhea. He states that he has experienced roughly 10 episodes of non-bloody and watery diarrhea every day for the past 3 days. The patient has a past medical history of IV drug abuse and recently completed treatment for an abscess with cellulitis. His vitals are notable for a pulse of 105/min. Physical exam reveals diffuse abdominal discomfort with palpation but no focal tenderness. A rectal exam is within normal limits and is Guaiac negative. Which of the following is the best initial treatment for this patient?? {'A': 'Clindamycin', 'B': 'Fidaxomicin', 'C': 'Metronidazole', 'D': 'Oral rehydration and discharge', 'E': 'Vancomycin'},
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E: Vancomycin
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old Caucasian female presents with severe right lower quadrant pain, malaise, and diarrhea. The physician performs an endoscopy and finds disease involvement in the terminal ileum, noting that that the disease process is patchy with normal intervening mucosa. The entire wall of the region is thickened and inflamed, which may directly lead to formation of:? {'A': 'Fistulas', 'B': 'Toxic megacolon', 'C': 'Widening of the intestinal lumen', 'D': 'Plummer-Vinson syndrome', 'E': 'Paneth cell metaplasia'},
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A: Fistulas
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old man is brought to the emergency department by his friends because of a 1-hour history of shortness of breath and squeezing chest pain. They were at a party where cocaine was consumed. A diagnosis of acute myocardial infarction is made. The physician stabilizes the patient and transfers him to the inpatient unit. Six hours later, his wife arrives at the emergency department and requests information about her husband's condition. Which of the following is the most appropriate action by the physician?? {'A': 'Obtain authorization from the patient to release information', 'B': "Inform the wife about her husband's condition", 'C': 'Consult the hospital ethics committee', 'D': "Request the patient's durable power of attorney document", 'E': 'Ask the wife for a marriage certificate'},
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A: Obtain authorization from the patient to release information
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Answer the following medical question with one of the provided options:
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Q:A 71-year-old, hospitalized man develops abnormal laboratory studies 4 days after starting treatment for exacerbation of congestive heart failure. He also has a history of osteoarthritis and benign prostatic hyperplasia. He recently completed a course of amikacin for bacterial prostatitis. Before hospitalization, his medications included simvastatin and ibuprofen. Blood pressure is 111/76 mm Hg. Serum studies show a creatinine of 2.3 mg/dL (previously normal) and a BUN of 48 mg/dL. Urinalysis shows a urine osmolality of 600 mOsm/kg and urine sodium of 10 mEq/L. Which of the following is the most likely explanation for this patient's renal insufficiency?? {'A': 'Volume depletion', 'B': 'Urinary tract infection', 'C': 'Bladder outlet obstruction', 'D': 'Glomerulonephritis', 'E': 'Antibiotic use'},
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A: Volume depletion
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old woman comes to the physician because of a 1-day history of right leg pain. The pain is worse while walking and improves when resting. Eight months ago, she was diagnosed with a pulmonary embolism and was started on warfarin. Anticoagulant therapy was discontinued two months ago. Her mother had systemic lupus erythematosus. On examination, her right calf is diffusely erythematous, swollen, and tender. Cardiopulmonary examination shows no abnormalities. On duplex ultrasonography, the right popliteal vein is not compressible. Laboratory studies show an elevated serum level of D-dimer and insensitivity to activated protein C. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Protein S deficiency', 'B': 'Elevated coagulation factor VIII levels', 'C': 'Mutation of prothrombin', 'D': 'Mutation of coagulation factor V', 'E': 'Deficiency of protein C\n"'},
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D: Mutation of coagulation factor V
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Answer the following medical question with one of the provided options:
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Q:A 68-year-old man is brought to the emergency department because of right-sided weakness for 2 hours. He has hypertension, dyslipidemia, and type 2 diabetes. Current medications include hydrochlorothiazide, metoprolol, amlodipine, pravastatin, and metformin. His pulse is 87/min and blood pressure is 164/98 mm Hg. Neurological examination shows right-sided weakness, facial droop, and hyperreflexia. Sensation is intact. Which of the following is the most likely cause of these findings?? {'A': 'Rupture of an intracranial aneurysm', 'B': 'Lipohyalinosis of penetrating vessels', 'C': 'Dissection of the vertebral artery', 'D': 'Stenosis of the internal carotid artery', 'E': 'Embolism from the left atrium'},
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B: Lipohyalinosis of penetrating vessels
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Answer the following medical question with one of the provided options:
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Q:A 59-year-old woman comes to the physician for a 3-month history of progressively worsening shortness of breath on exertion and swelling of her legs. She has a history of breast cancer, which was treated with surgery followed by therapy with doxorubicin and trastuzumab 4 years ago. Cardiac examination shows an S3 gallop; there are no murmurs or rubs. Examination of the lower extremities shows pitting edema below the knees. Echocardiography is most likely to show which of the following sets of changes in this patient? $$$ Ventricular wall thickness %%% Ventricular cavity size %%% Diastolic function %%% Aorto-ventricular pressure gradient $$$? {'A': 'Normal normal ↓ normal', 'B': '↑ ↑ normal normal', 'C': '↑ ↓ ↓ normal', 'D': '↑ ↓ ↓ ↑', 'E': '↓ ↑ normal normal'},
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E: ↓ ↑ normal normal
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old female volunteers for an invasive study to measure her cardiac function. She has no previous cardiovascular history and takes no medications. With the test subject at rest, the following data is collected using blood tests, intravascular probes, and a closed rebreathing circuit: Blood hemoglobin concentration 14 g/dL Arterial oxygen content 0.22 mL O2/mL Arterial oxygen saturation 98% Venous oxygen content 0.17 mL O2/mL Venous oxygen saturation 78% Oxygen consumption 250 mL/min The patient's pulse is 75/min, respiratory rate is 14/ min, and blood pressure is 125/70 mm Hg. What is the cardiac output of this volunteer?? {'A': '250 mL/min', 'B': '5.0 L/min', 'C': '50 L/min', 'D': 'Stroke volume is required to calculate cardiac output.', 'E': 'Body surface area is required to calculate cardiac output.'},
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B: 5.0 L/min
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Answer the following medical question with one of the provided options:
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Q:A 48-year-old man, with a history of gluten intolerance, presents to the emergency department with persistent vomiting and diarrhea, and no fever. He recently returned from a vacation in Central America. He describes his diarrhea as profuse and almost clear. On physical examination, his skin turgor is decreased and his blood pressure is 90/60 mm Hg. He is administered a saline solution and admitted for further examination and observation. What shifts are expected to be seen in this patient’s Darrow-Yannet diagram before the administration of saline?? {'A': 'Decreased extracellular volume and osmolality with an increased intracellular volume', 'B': 'Increased extracellular volume, increased osmolarity, and decreased intracellular volume', 'C': 'Decreased extracellular volume with no change in osmolarity', 'D': 'Increased extracellular volume with no change in osmolarity or intracellular volume', 'E': 'Decreased extracellular volume and intracellular volume with a rise in osmolality'},
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C: Decreased extracellular volume with no change in osmolarity
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Q:A 42-year-old woman comes to the physician because of 2 episodes of loss of consciousness over the past week. She recovered immediately and was not confused following the episodes. During the past 5 months, she has also had increased shortness of breath and palpitations. She has been unable to carry out her daily activities. She also reports some chest tightness that resolves with rest. She has no history of serious illness and takes no medications. She immigrated with her family from India 10 years ago. Her temperature is 37.3°C (99.1°F), pulse is 115/min and irregular, and blood pressure is 108/70 mm Hg. Examination shows jugular venous distention and pitting edema below the knees. Bilateral crackles are heard at the lung bases. Cardiac examination shows an accentuated and split S2. There is an opening snap followed by a low-pitched diastolic murmur in the fifth left intercostal space at the midclavicular line. An ECG shows atrial fibrillation and right axis deviation. Which of the following is the most likely underlying mechanism of these findings?? {'A': 'Increased left ventricular end diastolic pressure', 'B': 'Increased left to right shunting', 'C': 'Decreased left ventricular contractility', 'D': 'Increased systemic arterial resistance', 'E': 'Increased left atrial pressure'},
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E: Increased left atrial pressure
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Q:A 62-year-old man with small cell lung cancer undergoes radiation therapy. His oncologist explains that radiation causes DNA damage and double strand breaks and this damage stops the cancer cells from growing because they can no longer replicate their DNA. One key mediator of this process is a cell cycle regulator called P53, which is upregulated after DNA damage and helps to trigger cell cycle arrest and apoptosis. One mechanism by which P53 activity is increased is a certain chromatin modification that loosens DNA coiling allowing for greater transcription of the proteins within that region of DNA. Which of the following enyzmes most likely causes the chromatin modification described in this case?? {'A': 'DNA methyltransferase', 'B': 'Histone acetyltransferase', 'C': 'Histone deacetylase', 'D': 'Histone methyltransferase', 'E': 'Xist'},
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B: Histone acetyltransferase
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Q:A 5-year-old girl is brought to the physician because her mother has found her to be inattentive at home and has received multiple complaints from her teachers at school. She does not complete her assignments and does not listen to her teachers' instructions. She refuses to talk to her parents or peers. Her mother says, “She ignores everything I say to her!” She prefers playing alone, and her mother reports that she likes playing with 5 red toy cars, repeatedly arranging them in a straight line. She avoids eye contact with her mother and the physician throughout the visit. Physical and neurological examination shows no abnormalities. Which of the following is the most likely diagnosis?? {'A': 'Attention deficit hyperactivity disorder', 'B': 'Oppositional defiant disorder', 'C': 'Autism spectrum disorder', 'D': 'Conduct disorder', 'E': 'Rett syndrome'},
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C: Autism spectrum disorder
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Q:A 38-year-old man comes to the physician because of a 2-year-history of cough and progressively worsening breathlessness. He has smoked 1 pack of cigarettes daily for the past 10 years. Physical examination shows contraction of the anterior scalene and sternocleidomastoid muscles during inspiration. An x-ray of the chest shows flattening of the diaphragm and increased radiolucency in the lower lung fields. Further analysis shows increased activity of an isoform of elastase that is normally inhibited by alpha-1-antitrypsin. The cells that produce this isoform of elastase were most likely stimulated to enter the site of inflammation by which of the following substances?? {'A': 'High-molecular-weight kininogen', 'B': 'Lactoferrin', 'C': 'Interferon gamma', 'D': 'Leukotriene B4', 'E': 'Thromboxane A2'},
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D: Leukotriene B4
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Q:A 40-year-old woman is brought to the emergency department by a paramedic team from the scene of a motor vehicle accident where she was the driver. The patient was restrained by a seat belt and was unconscious at the scene. On physical examination, the patient appears to have multiple injuries involving the trunk and extremities. There are no penetrating injuries to the chest. As part of her trauma workup, a CT scan of the chest is ordered. At what vertebral level of the thorax is this image from?? {'A': 'T4', 'B': 'T1', 'C': 'T5', 'D': 'T6', 'E': 'T8'},
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E: T8
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Q:A 28-year-old woman presents with continuous feelings of sadness and rejection. She says that over the past couple of weeks, she has been unable to concentrate on her job and has missed several days of work. She also has no interest in any activity and typically rejects invitations to go out with friends. She has no interest in food or playing with her dog. Her husband is concerned about this change in behavior. A few months ago, she was very outgoing and made many plans with her friends. She remembers being easily distracted and also had several ‘brilliant ideas’ on what she should be doing with her life. She did not sleep much during that week, but now all she wants to do is lie in bed all day. She denies any suicidal or homicidal ideations. She has no past medical history and has never been hospitalized. Laboratory tests were normal. Which of the following is the most likely diagnosis in this patient?? {'A': 'Dysthymia', 'B': 'Major depressive disorder', 'C': 'Schizoaffective disorder', 'D': 'Bipolar disorder, type II', 'E': 'Bipolar disorder, type I'},
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D: Bipolar disorder, type II
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Q:A 7-year-old boy with asthma is brought to the physician because of a 1-month history of worsening shortness of breath and cough. The mother reports that the shortness of breath usually occurs when he is exercising with his older brother. His only medication is an albuterol inhaler that is taken as needed. The physician considers adding zafirlukast to his drug regimen. Which of the following is the most likely mechanism of action of this drug?? {'A': 'Antagonism at leukotriene receptors', 'B': 'Inhibition of phosphodiesterase', 'C': 'Antagonism at muscarinic receptors', 'D': 'Inhibition of mast cell degranulation', 'E': 'Blockade of 5-lipoxygenase pathway'},
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A: Antagonism at leukotriene receptors
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Q:A 24-year-old woman comes to the physician because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly book club and continues to plan her annual family reunion. She stopped going to the gym, eats more, and has gained 4 kg (8.8 lb) over the past 4 weeks. Three weeks ago, she also started to smoke marijuana a few times a week. She drinks one glass of wine daily and does not smoke cigarettes. She is currently unemployed; she lost her job as a physical therapist 3 months ago. Her vital signs are within normal limits. On mental status examination, she is calm, alert, and oriented to person, place, and time. Her mood is depressed; her speech is organized, logical, and coherent. She denies suicidal thoughts. Which of the following is the most likely diagnosis?? {'A': 'Adjustment disorder', 'B': 'Dysthymic disorder', 'C': 'Substance use disorder', 'D': 'Bipolar disorder', 'E': 'Major depressive disorder'},
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A: Adjustment disorder
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Q:A 63-old man is brought in by ambulance after a bar fight. Witnesses report that he is a bar regular and often drinks several shots of hard liquor throughout the night. The emergency department recognize him as a local homeless man with a long history of alcohol abuse. During the initial workup in the ED, he has a prolonged seizure and dies. An autopsy is performed that shows an enlarged heart with severe calcified atherosclerotic coronary arteries. Evaluation of his brain shows atrophic mammillary bodies with brown-tan discoloration. Which of the following tests would have most likely produced an abnormal result in vivo with respect to his nervous system findings on autopsy?? {'A': 'CSF IgG protein', 'B': 'Rapid fluorescent spot test', 'C': 'Serum methylmalonic acid', 'D': 'Erythrocyte transketolase activity', 'E': 'Aldolase B activity'},
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D: Erythrocyte transketolase activity
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Q:A 56-year-old woman presents to her primary care physician complaining of heartburn, belching, and epigastic pain that is aggravated by coffee and fatty foods. She states that she has recently been having difficulty swallowing in addition to her usual symptoms. What is the most appropriate next step in management of this patient?? {'A': 'Trial of a proton pump inhibitor', 'B': 'Nissen fundoplication', 'C': "Lifestyle changes - don't lie down after eating; avoid spicy foods; eat small servings", 'D': 'Trial of an H2 receptor antagonist', 'E': 'Upper endoscopy'},
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E: Upper endoscopy
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Q:A 17-year-old boy is brought to the emergency department by his parents 6 hours after he suddenly began to experience dyspnea and pleuritic chest pain at home. He has a remote history of asthma in childhood but has not required any treatment since the age of four. His temperature is 98.4°F (36.9°C), blood pressure is 100/76 mmHg, pulse is 125/min, respirations are 24/min. On exam, he has decreased lung sounds and hyperresonance in the left upper lung field. A chest radiograph shows a slight tracheal shift to the right. What is the best next step in management?? {'A': 'Chest tube placement', 'B': 'CT scan for apical blebs', 'C': 'Needle decompression', 'D': 'Observe for another six hours for resolution', 'E': 'Pleurodesis'},
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C: Needle decompression
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Q:A 4-month-old male infant is brought in because he rejects food and is losing weight. He had several upper respiratory tract infections during the last 2 months. Upon examination, hepatosplenomegaly is noted, as well as mild hypotonia. During the next few weeks, hepatosplenomegaly progresses, the boy fails to thrive, and he continues to reject food. He has a blood pressure of 100/70 mm Hg and heart rate of 84/min. Blood tests show pancytopenia and elevated levels of transaminases. Slit lamp examination shows bilateral cherry-red spots on the macula. Chest X-ray shows a reticulonodular pattern and calcified nodules. Biopsy of the liver shows foamy histiocytes. What is the most likely diagnosis?? {'A': 'Crigler-Najjar syndrome type I', 'B': 'Niemann-Pick disease type A', 'C': 'Gaucher disease', 'D': 'Primary biliary cirrhosis', 'E': 'Gilbert syndrome'},
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B: Niemann-Pick disease type A
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Q:A 51-year-old man with a history of severe persistent asthma is seen today with the complaint of white patches on his tongue and inside his mouth. He says this all started a couple of weeks ago when he recently started a new medication for his asthma. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 74/min, and respiratory rate 14/min. His physical examination is significant for mild bilateral wheezes, and attempts at scraping off the lesions in the mouth are successful but leave erythema underlying where they were removed. Which of the following medications is responsible for his presentation?? {'A': 'Over-use of the albuterol inhaler', 'B': 'Theophylline', 'C': 'Salmeterol inhaler', 'D': 'Beclomethasone inhaler', 'E': 'Omalizumab'},
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D: Beclomethasone inhaler
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Q:A 29-year-old male is brought to the emergency department 20 minutes after sustaining a stab wound to the right chest. First-responders found the patient sitting on the curb smoking a cigarette, complaining of pain where he had been stabbed. On arrival, he is alert. His temperature is 36.8°C (98.2°F), pulse is 110/min, respirations are 16/min, and blood pressure is 112/70 mmHg. Pulse oximetry on room air shows an oxygen saturation of 97%. Examination shows several 1–2 cm lacerations and ecchymoses over the face and trunk. There is no neck crepitus. There is a pocket knife in the right fourth intercostal space at the anterior axillary line and blood oozing out of the wound. There is no bubbling of the blood at the wound. The lungs are clear to auscultation with equal breath sounds. The remainder of the examination shows no abnormalities. A chest x-ray shows the knife in situ extending into the right thorax. Which of the following is the most appropriate next step in management?? {'A': 'Right needle thoracostomy', 'B': 'Right tube thoracostomy', 'C': 'Endotracheal intubation', 'D': 'Cricothyroiditomy', 'E': 'CT scan of the chest'},
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C: Endotracheal intubation
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Answer the following medical question with one of the provided options:
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Q:A 26-year-old woman presents to the clinic complaining of a headache, runny nose, and malaise. A few minutes into the interview, she mentions that she recently started her job and is glad to work long hours despite the toll on her health. However, she admits that she is finding it difficult to keep up with the workload. She has numerous pending papers to correct. When advised to seek help from other teachers, she exclaims that it needs to be done in a particular way, and only she can do it the right way. This is causing her to perform poorly at work, and she is at risk of being asked to quit her very first job. Which of the following is the most likely diagnosis in this patient?? {'A': 'Ego-syntonic obsessive-compulsive personality disorder', 'B': 'Ego-dystonic obsessive-compulsive personality disorder', 'C': 'Ego-syntonic obsessive-compulsive disorder', 'D': 'Ego-dystonic obsessive-compulsive disorder', 'E': 'Personality disorder not otherwise specified'},
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A: Ego-syntonic obsessive-compulsive personality disorder
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Q:A 28-year-old woman comes to the emergency department for a 1-week history of jaundice and nausea. She recalls eating some seafood last weekend at a cookout. She lives at home with her 2-year-old son who attends a daycare center. The child's immunizations are up-to-date. The woman's temperature is 37.5°C (99.5°F), pulse is 82/min, and blood pressure is 134/84 mm Hg. Examination shows scleral icterus. The liver is palpated 2-cm below the right costal margin and is tender. Her serum studies show: Total bilirubin 3.4 mg/dL Alkaline phosphatase 89 U/L AST 185 U/L ALT 723 U/L Hepatitis A IgM antibody positive Hepatitis B surface antibody positive Hepatitis B surface antigen negative Hepatitis B core IgM antibody negative Hepatitis C antibody negative Which of the following health maintenance recommendations is most appropriate for the child at this time?"? {'A': 'Administer hepatitis B immunoglobulin and hepatitis B vaccine', 'B': 'Isolate the child', 'C': 'No additional steps are needed', 'D': 'Administer hepatitis B immunoglobulin only', 'E': 'Administer hepatitis A vaccine and hepatitis A immunoglobulin'},
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C: No additional steps are needed
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Answer the following medical question with one of the provided options:
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Q:A 45-year-old male immigrant with rheumatoid arthritis comes to the physician because of severe pain and swelling in both his knees. He also reports an unintentional weight loss of around 10 kg over 3 months and episodic abdominal pain, varying in intensity and location. He has been having loose stools with no blood, 2–3 times a day for 1 month. He denies fever, night sweats, cough, or shortness of breath. Current medications include methotrexate, naproxen, and folic acid. His weight is 68 kg (150 lbs), temperature is 37.4°C (99.3°F), pulse is 90/min, and blood pressure is 130/80 mm Hg. Examination shows pale conjunctivae, cheilitis, and hyperpigmentation of the skin around his neck. Generalized lymphadenopathy is present. Examination of the knee joints shows bilateral warmth, erythema, swelling, tenderness, and limited range of motion. A grade 2/6 early diastolic murmur is heard over the right second intercostal space and an S3 is heard. Abdominal examination shows no abnormalities. Laboratory studies show: Hemoglobin 9.1 g/dL Leukocyte count 3800/mm3 Platelet count 140,000/mm3 Mean corpuscular volume 67 μm3 Erythrocyte sedimentation rate 62 mm/h Serum Glucose 100 mg/dL Creatinine 0.7 mg/dL TIBC 500 mcg/dL Ferritin 10 mcg/dL Rheumatoid factor negative Anti -CCP negative An esophagogastroduodenoscopy is ordered. A biopsy specimen of the duodenum is likely to show which of the following?"? {'A': 'Poorly differentiated cells', 'B': 'Granuloma with caseating necrosis', 'C': 'Villous atrophy and crypt hyperplasia', 'D': 'Noncaseating granulomas', 'E': 'PAS-positive macrophages'},
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E: PAS-positive macrophages
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Q:A 65-year-old man presents to the emergency department for shortness of breath. He was at home working on his car when he suddenly felt very short of breath, which failed to improve with rest. He states he was working with various chemicals and inhalants while trying to replace a broken piece in the engine. The patient was brought in by paramedics and is currently on 100% O2 via nasal cannula. The patient has a 52 pack-year smoking history and drinks 2 to 3 alcoholic drinks every night. He has a past medical history of asthma but admits to not having seen a physician since high school. His temperature is 98.2°F (36.8°C), blood pressure is 157/108 mmHg, pulse is 120/min, respirations are 29/min, and oxygen saturation is 77%. Physical exam demonstrates tachycardia with a systolic murmur heard best along the right upper sternal border. Breath sounds are diminished over the right upper lobe. Bilateral lower extremity pitting edema is noted. Which of the following best describes the most likely diagnosis?? {'A': 'Fe3+ hemoglobin in circulating red blood cells', 'B': 'Ischemia of the myocardium', 'C': 'Pulmonary edema secondary to decreased cardiac output', 'D': 'Rupture of an emphysematous bleb', 'E': 'Severe bronchoconstriction'},
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D: Rupture of an emphysematous bleb
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Q:A 38-year-old man presents to the emergency department due to severe alcohol intoxication. The patient is agitated and refuses to answer any questions in regards to his medical history. The vital signs are within normal limits. The complete blood count results demonstrate hemoglobin of 11.5 g/dL, hematocrit of 39%, and mean corpuscular volume of 77 μm3. Using a special dye, the histology demonstrates blue-colored rings in the peripheral smear. What are the most likely findings on the ferritin, total iron-binding capacity, and serum iron levels?? {'A': 'Ferritin: ↓, total iron-binding capacity: ↓, serum iron: ↓', 'B': 'Ferritin: normal, total iron binding capacity: normal, serum iron: normal', 'C': 'Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↑', 'D': 'Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↓', 'E': 'Ferritin: ↓, total iron-binding capacity: ↑, serum iron: ↓'},
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C: Ferritin: ↑, total iron-binding capacity: ↓, serum iron: ↑
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Q:A 5-year-old boy is brought to see his pediatrician because of painless swelling in both legs and around his eyes. His mother reports that it is worse in the morning and these symptoms have started 4 days ago. The child has just recovered from a severe upper respiratory tract infection 8 days ago. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Today, his blood pressure is 110/65 mm Hg, the heart rate is 90/min, the respiratory rate is 22/min, and the temperature is 36.8°C (98.2°F). On physical examination, his face is edematous and there is a 2+ pitting edema over both legs up to his hips. Laboratory results are shown. Serum albumin 2.4 g/dL Serum triglycerides 250 mg/dL Serum cholesterol 300 mg/dL Urine dipstick 4+ protein Which of the following is the best initial therapy for this patient’s condition?? {'A': 'Albumin infusion', 'B': 'Oral antibiotic', 'C': 'Enalapril', 'D': 'Prednisolone and cyclophosphamide', 'E': 'Prednisolone'},
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E: Prednisolone
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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 is brought to the Emergency Department with intense chest pain that radiates to his left arm and jaw. He also complains of feeling lightheaded. Upon arrival, his blood pressure is 104/60 mm Hg, pulse is 102/min, respiratory rate is 25/min, body temperature is 36.5°C (97.7°F), and oxygen saturation is 94% on room air. An electrocardiogram shows an ST-segment elevation in I, aVL, and V5-6. The patient is transferred to the cardiac interventional suite for a percutaneous coronary intervention. The patient is admitted to the hospital after successful revascularization. During his first night on the ICU floor his urinary output is 0.15 mL/kg/h. Urinalysis shows muddy brown casts. Which of the following outcomes specific to the patient’s condition would you expect to find?? {'A': 'Urinary osmolality 900 mOsmol/kg (normal: 500–800 mOsmol/kg)', 'B': 'Urinary osmolality 550 mOsmol/kg (normal: 500–800 mOsmol/kg)', 'C': 'Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) > 20:1', 'D': 'Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1', 'E': 'FENa+ < 1%'},
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D: Blood urea nitrogen (BUN):Serum creatinine ratio (Cr) < 15:1
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Q:A previously-healthy 24-year-old male is admitted to the intensive care unit following a motorcycle crash. He sustained head trauma requiring an emergency craniotomy, has burns over 30% of his body, and a fractured humerus. His pain is managed with a continuous fentanyl infusion. Two days after admission to the ICU he develops severe hematemesis. What is the mechanism underlying the development of his hematemesis?? {'A': 'Gastric mucosal disruption', 'B': 'Increased gastric acid production', 'C': 'Helicobacter pylori infection', 'D': 'Answers 1 and 2', 'E': 'Fentanyl overuse'},
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D: Answers 1 and 2
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Answer the following medical question with one of the provided options:
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Q:An 18-year-old man presents with a sudden loss of consciousness while playing college football. There was no history of a concussion. Echocardiography shows left ventricular hypertrophy and increased thickness of the interventricular septum. Which is the most likely pathology underlying the present condition?? {'A': 'Streptococcal infection', 'B': 'Mutation in the myosin heavy chain', 'C': 'Drug abuse', 'D': 'Viral infection', 'E': 'Autoimmunity of myocardial fibers'},
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B: Mutation in the myosin heavy chain
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Q:A 69-year-old man is brought to the emergency department because of severe abdominal pain radiating to his left flank for 30 minutes. He is weak and has been unable to stand since the onset of the pain. He vomited twice on the way to the hospital. He has not passed stools for 3 days. He has hypertension, coronary heart disease, and peptic ulcer disease. He has smoked half a pack of cigarettes daily for 46 years. Current medications include enalapril, metoprolol, aspirin, simvastatin, and pantoprazole. He appears ill. His temperature is 37°C (98.6°F), pulse is 131/min, respirations are 31/min, and blood pressure is 82/56 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. Examination shows a painful pulsatile abdominal mass. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?? {'A': 'Supine and erect x-rays of the abdomen', 'B': 'CT scan of the abdomen and pelvis with contrast', 'C': 'Open emergency surgery', 'D': 'Transfusion of packed red blood cells', 'E': 'Colonoscopy'},
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C: Open emergency surgery
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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 comes to the emergency department with fever, chills, dyspnea, and a productive cough. His symptoms began suddenly 2 days ago. He was diagnosed with HIV 4 years ago and has been on triple antiretroviral therapy since then. He smokes one pack of cigarettes daily. He is 181 cm (5 ft 11 in) tall and weighs 70 kg (154 lb); BMI is 21.4 kg/m2. He lives in Illinois and works as a carpenter. His temperature is 38.8°C (101.8°F), pulse is 110/min, respirations are 24/min, and blood pressure is 105/74 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. Examinations reveals crackles over the right lower lung base. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.5 g/dL Leukocyte count 12,800/mm3 Segmented neutrophils 80% Eosinophils 1% Lymphocytes 17% Monocytes 2% CD4+ T-lymphocytes 520/mm3(N ≥ 500) Platelet count 258,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 5.0 mEq/L HCO3- 22 mEq/L Glucose 92 mg/dL An x-ray of the chest shows a right lower-lobe infiltrate of the lung. Which of the following is the most likely causal organism?"? {'A': 'Staphylococcus aureus', 'B': 'Cryptococcus neoformans', 'C': 'Legionella pneumophila', 'D': 'Streptococcus pneumoniae', 'E': 'Pneumocystis jirovecii'},
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D: Streptococcus pneumoniae
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Answer the following medical question with one of the provided options:
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Q:A 5-month-old boy is brought to his pediatrician because his parents have noticed that he has very restricted joint movement. He was born at home without prenatal care, but they say that he appeared healthy at birth. Since then, they say that he doesn't seem to move very much and is hard to arouse. Physical exam reveals coarse facial structures and hepatosplenomegaly. Radiography reveals skeletal malformations, and serum tests show high plasma levels of lysosomal enzymes. The production of which of the following substances will most likely be disrupted in this patient?? {'A': 'Ceramide', 'B': 'Glucocerebroside', 'C': 'GM3', 'D': 'Heparin sulfate', 'E': 'Mannose-6-phosphate'},
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E: Mannose-6-phosphate
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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 comes to the physician for a 1-month history of fever, chest pain with deep breathing, and a 4-kg (9 lb) weight loss. His temperature is 38°C (100.4°F). An x-ray of the chest shows a subpleural nodule in the right lower lobe with right hilar lymphadenopathy. Histological examination of a right hilar lymph node biopsy specimen shows several granulomas with acellular cores. Which of the following is the most likely diagnosis?? {'A': 'Hodgkin lymphoma', 'B': 'Primary tuberculosis', 'C': 'Chronic berylliosis', 'D': 'Miliary tuberculosis', 'E': 'Pulmonary sarcoidosis'},
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B: Primary tuberculosis
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Q:A 56-year-old man presents with breathlessness and altered mental status. The patient’s daughter says that he has been having high fever and cough for the last 3 days. Past medical history is significant for a recent hospitalization 5 days ago, following a successful coronary artery bypass grafting (CABG). In the post-operative period, he was in an intensive care unit (ICU) for 6 days, including 12 hours on mechanical ventilation. Current medications are aspirin and rosuvastatin. The patient’s daughter mentions that he has had anaphylactic reactions to penicillin in the past. His temperature is 39.4°C (103°F), pulse rate is 110/min, blood pressure is 104/78 mm Hg, and respiratory rate is 30/min. On physical examination, the patient is confused and disoriented and shows signs of respiratory distress and cyanosis. On chest auscultation, there is crepitus in the right lung. The patient is immediately started on oxygen therapy, intravenous fluids, and supportive care. After the collection of appropriate samples for bacteriological culture, treatment with empirical intravenous antibiotics are started. After 24 hours of treatment, the microbiology results indicate Pseudomonas aeruginosa infection. Antibiotic therapy is changed to a combination of aztreonam and tobramycin. Which of the following best describes the rationale for choosing this antibiotic combination?? {'A': 'Broad-spectrum coverage against gram-positive cocci by adding tobramycin to aztreonam', 'B': 'Effective combination of a bactericidal and a bacteriostatic antimicrobial against Pseudomonas aeruginosa', 'C': 'Reduction of the side-effects of both aztreonam and tobramycin', 'D': 'Synergism of aztreonam with tobramycin', 'E': 'Broad-spectrum coverage against anaerobes by adding tobramycin to aztreonam'},
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D: Synergism of aztreonam with tobramycin
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old girl is brought to the emergency department with a headache and double vision 1 hour after being hit on the head while playing with a friend. Her friend's elbow struck her head, just above her left ear. She did not lose consciousness, but her mother reports that she was confused for 20 minutes after the incident and did not recall being hit. She appears healthy. She is alert and oriented to person, place, and time. Her temperature is 37.2°C (99°F), pulse is 86/min, respirations are 15/min, and blood pressure is 118/78 mmHg. Examination shows the head tilted toward the right shoulder. A photograph of the eyes at primary gaze is shown. There is mild tenderness to palpation over the left temporal bone. Visual acuity is 20/20 in both eyes when tested independently. The patient's left eye hypertropia worsens with right gaze and when the patient tilts her head toward her left shoulder. The pupils are equal and reactive to light. Muscle strength and sensation are intact bilaterally. Deep tendon reflexes are 2+ bilaterally. Plantar reflex shows a flexor response. Which of the following is the most likely cause of this patient's ocular symptoms?? {'A': 'Oculomotor nerve damage', 'B': 'Retrobulbar hemorrhage', 'C': 'Trochlear nerve damage', 'D': 'Medial longitudinal fasciculus damage', 'E': 'Dorsal midbrain damage'},
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C: Trochlear nerve damage
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Q:An 8-year-old girl is brought to the emergency department by her parents with severe difficulty in breathing for an hour. She is struggling to breathe. She was playing outside with her friends, when she suddenly fell to the ground, out of breath. She was diagnosed with asthma one year before and has since been on treatment for it. At present, she is sitting leaning forward with severe retractions of the intercostal muscles. She is unable to lie down. Her parents mentioned that she has already taken several puffs of her inhaler since this episode began but without response. On physical examination, her lungs are hyperresonant to percussion and there is decreased air entry in both of her lungs. Her vital signs show: blood pressure 110/60 mm Hg, pulse 110/min, respirations 22/min, and a peak exploratory flow rate (PEFR) of 50%. She is having difficulty in communicating with the physician. Her blood is sent for evaluation and a chest X-ray is ordered. Her arterial blood gas reports are as follows: PaO2 50 mm Hg pH 7.38 PaCO2 47 mm Hg HCO3 27 mEq/L Which of the following is the most appropriate next step in management?? {'A': 'Methacholine challenge test', 'B': 'Inhaled β-agonist', 'C': 'Inhaled corticosteroid', 'D': 'Intravenous corticosteroid', 'E': 'Mechanical ventilation'},
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E: Mechanical ventilation
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Q:A 12-hour-old newborn is found to have difficulty breathing and bluish skin appearance by the shift nurse. The birth was unremarkable and the mother is known to be diabetic. The child is examined by the on-call physician, who detects a single loud S2. The chest X-ray shows an 'egg-shaped' heart. Which medication below would possibly prevent further progression of the patient’s symptoms?? {'A': 'Indomethacin', 'B': 'Low-dose aspirin', 'C': 'Prostaglandins E2', 'D': 'Erythromycin ointment', 'E': 'Vitamin K'},
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C: Prostaglandins E2
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Q:A 68-year-old woman was recently diagnosed with pancreatic cancer. At what point should her physician initiate a discussion with her regarding advance directive planning?? {'A': 'Now that she is ill, speaking about advanced directives is no longer an option', 'B': 'At this visit', 'C': 'Only if her curative surgical and medical treatment fails', 'D': 'Once she enters hospice', 'E': 'Only if she initiates the conversation'},
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B: At this visit
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Q:A 38-year-old woman comes to the physician for a follow-up visit. She has a 2-year history of depressed mood and fatigue accompanied by early morning awakening. One week ago, she started feeling a decrease in her need for sleep and now feels rested after about 5 hours of sleep per night. She had two similar episodes that occurred 6 months ago and a year ago, respectively. She reports increased energy and libido. She has a 4-kg (8.8-lb) weight loss over the past month. She does not feel the need to eat and says she derives her energy ""from the universe"". She enjoys her work as a librarian. She started taking fluoxetine 3 months ago. On mental exam, she is alert and oriented to time and place; she is irritable. She does not have auditory or visual hallucinations. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?"? {'A': 'Medication-induced bipolar disorder', 'B': 'Bipolar disorder with rapid cycling', 'C': 'Delusional disorder', 'D': 'Schizoaffective disorder', 'E': 'Cyclothymic disorder\n"'},
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E: Cyclothymic disorder "
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Q:A 33-year-old man presents to his primary care physician with shoulder pain. He states that he can't remember a specific instance when the injury occurred. He is a weight lifter and competes in martial arts. The patient has no past medical history and is currently taking a multivitamin. Physical exam demonstrates pain with abduction of the patient's right shoulder and with external rotation of the right arm. There is subacromial tenderness with palpation. His left arm demonstrates 10/10 strength with abduction as compared to 4/10 strength with abduction of the right arm. Which of the following best confirms the underlying diagnosis?? {'A': 'CT', 'B': 'MRI', 'C': 'Physical exam and history', 'D': 'Radiography', 'E': 'Ultrasound'},
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B: MRI
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Q:A 10-year-old boy comes to the physician because of a 4-month history of intermittent red urine. During the past 2 years, he has had recurrent episodes of swelling of his face and feet. Five years ago, he was diagnosed with mild bilateral sensorineural hearing loss. His uncle died of kidney disease in his twenties. His blood pressure is 145/85 mm Hg. Laboratory studies show a hemoglobin concentration of 12.5 g/dL, urea nitrogen concentration of 40 mg/dL, and creatinine concentration of 2.4 mg/dL. Urinalysis shows 5–7 RBC/hpf. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Defective type IV collagen', 'B': 'Autosomal-recessive gene defect in fibrocystin', 'C': 'Phospholipase A2 receptor antibody', 'D': 'Prior streptococcal infection', 'E': 'Vascular IgA deposits'},
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A: Defective type IV collagen
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Q:A 45-year-old man with a history of epilepsy comes to the physician for a follow-up examination. He has had trouble moving the right side of his body for 2 weeks. Three weeks ago he was admitted to the hospital for a generalized convulsive seizure. He was treated with intravenous lorazepam and phenytoin; the seizure activity resolved after 50 minutes on EEG monitoring. He was discharged 2 days later after no further epileptic activity occurred. Physical examination at discharge showed no abnormalities. He has had multiple hospitalizations for similar episodes over the past year. His only medication is lamotrigine, though he says that he sometimes forgets to take it. His temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 130/80 mm Hg. Physical examination shows right-sided hemiparesis, right homonymous hemianopsia, and receptive aphasia. Which of the following is the most likely underlying cause of this patient's current symptoms?? {'A': 'Lacunar stroke', 'B': 'Brain abscess', 'C': 'Cortical laminar necrosis', 'D': 'Intraventricular hemorrhage', 'E': 'Ruptured intracranial aneurysm'},
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C: Cortical laminar necrosis
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Q:A 28-year-old patient presents to the hospital complaining of progressively worsening dyspnea and a dry cough. Radiographic imaging is shown below. Pulmonary function testing (PFT's) reveals a decreased FEV1 and FEV1/FVC, but an increase TLC. The patient states that he does not smoke. Which of the following conditions is most consistent with the patients symptoms?? {'A': 'Chronic bronchitis', 'B': 'Alpha1-antitrypsin deficiency', 'C': 'Pneumothorax', 'D': 'Asthma', 'E': 'Hypersensitivity pneumonitis'},
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B: Alpha1-antitrypsin deficiency
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Q:A 25-year-old man presents to the clinic with a complaint of lightheadedness when standing up from his bed in the morning and then from his chair at work. He has had similar complaints for many months, and the symptoms have not improved despite drinking lots of fluids, eating regular meals, and taking daily multivitamin. His daily routine is disturbed as he finds himself getting up very slowly to avoid the problem. This has created some awkward situations at his workplace and in social settings. His blood pressure while seated is 120/80 mm Hg, and upon standing it falls to 100/68 mm Hg. The physical examination is unremarkable except for a strong odor suggestive of marijuana use. The patient denies drug use and insists the odor is due to his roommate who smokes marijuana for medical purposes. No pallor or signs of dehydration are seen. The lab results are as follows: Serum Glucose 90 mg/dL Sodium 140 mEq/L Potassium 4.1 mEq/L Chloride 100 mEq/L Serum Creatinine 0.8 mg/dL Blood Urea Nitrogen 9 mg/dL Hemoglobin (Hb) Concentration 15.3 g/dL Mean Corpuscular Volume (MCV) 83 fl Reticulocyte count 0.5% Erythrocyte count 5.3 million/mm3 Platelet count 200,000/mm3 The ECG shows no abnormal finding. Which of the following could alleviate this patient’s symptoms?? {'A': 'Alpha 1 receptor activation', 'B': 'Carotid massage', 'C': 'Increased parasympathetic stimulation', 'D': 'Inhibition of the baroreceptor response', 'E': 'Sodium chloride infusion'},
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A: Alpha 1 receptor activation
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Q:A 6-year-old girl is brought to the clinic for evaluation of malaise and low-grade fever over the past 3 days. In the last 24 hours, she developed sores and pain in her mouth. She also had vesicles on her hands and feet. Her past medical history was benign and the immunization history was up-to-date. The oral temperature was 36.1°C (97.0°F). The physical examination revealed several erythematous macules in the oropharynx and small oval vesicles with an erythematous base on the palms. What is the next best step in the management of this patient?? {'A': 'Ribavirin', 'B': 'Supportive care', 'C': 'Aspirin', 'D': 'Corticosteroids', 'E': 'Penicillin'},
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B: Supportive care
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Q:A 37-year-old woman presents with a 3-day history of fever. Past medical history is significant for chronic schizophrenia, managed with an antipsychotic medication. The patient has a low-grade fever and is slightly tachycardic. Physical examination is significant for the presence of tonsillar exudates. A CBC shows a markedly decreased WBC count. The patient’s antipsychotic medication is immediately discontinued. Which of the following is the antipsychotic medication that could have caused this problem?? {'A': 'Quetiapine', 'B': 'Olanzapine', 'C': 'Risperidone', 'D': 'Clozapine', 'E': 'Haloperidol'},
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D: Clozapine
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Q:A 61-year-old man is brought to the emergency department because of increasing weakness of his right arm and leg that began when he woke up that morning. He did not notice any weakness when he went to bed the night before. He has hypertension and hypercholesterolemia. Current medications include hydrochlorothiazide and atorvastatin. He is alert and oriented to person, time, place. His temperature is 36.7°C (98°F), pulse is 91/min, and blood pressure is 132/84 mm Hg. Examination shows drooping of the right side of the face. Muscle strength is decreased in the right upper and lower extremities. Deep tendon reflexes are 4+ on the right side. Sensation is intact. His speech is normal in rate and rhythm. The remainder of the examination shows no abnormalities. An infarction of which of the following sites is the most likely cause of this patient's symptoms?? {'A': 'Posterior limb of the left internal capsule', 'B': 'Base of the left pons', 'C': 'Left posterolateral thalamus', 'D': 'Left lateral medulla', 'E': 'Left cerebellar vermis\n"'},
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A: Posterior limb of the left internal capsule
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Q:A 65-year-old woman comes to the physician because of a 1-month history of persistent epigastric abdominal pain. She reports dull, aching pain that is worse after meals and wakes her up at night. She is afraid to eat, as it worsens the pain, and has had a 2-kg (4.4-lb) weight loss during this time. She has smoked a pack of cigarettes daily for the past 40 years. Her only medication is a calcium supplement. Her vital signs are within normal limits. She appears thin. Examination shows yellow discoloration of the sclera. The remainder of the examination shows no abnormalities. Laboratory studies show a total bilirubin of 9.8 mg/dL, direct bilirubin of 8.6 mg/dL, and an alkaline phosphatase of 120 IU/L. Abdominal ultrasonography shows dilation of the biliary and pancreatic ducts but no pancreatic or extrahepatic biliary lesions. Which of the following is the most appropriate next step in management?? {'A': 'Colonoscopy', 'B': 'Plain abdominal CT', 'C': 'Contrast-enhanced abdominal CT', 'D': 'Endoscopic ultrasonography', 'E': 'Endoscopic retrograde cholangiopancreatography'},
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C: Contrast-enhanced abdominal CT
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Q:A 73-year-old male presents to the ED with several days of fevers, cough productive of mucopurulent sputum, and pleuritic chest pain. He has not been to a doctor in 30 years because he “has never been sick”. His vital signs are: T 101F, HR 98, BP 100/55, RR 31. On physical exam he is confused and has decreased breath sounds and crackles on the lower left lobe. Gram positive diplococci are seen in the sputum. Which of the following is the most appropriate management for his pneumonia?? {'A': 'Oral Penicillin V and outpatient follow-up', 'B': 'IV Penicillin G and inpatient admission', 'C': 'Azithromycin and outpatient follow-up', 'D': 'Linezolid and inpatient admission', 'E': 'Levofloxacin and outpatient follow-up'},
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B: IV Penicillin G and inpatient admission
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Q:A 48-year-old male accountant presents to the family practice clinic for his first health check-up in years. He has no complaints, and as far as he is concerned, he is well. He does not have any known medical conditions. With respect to the family history, the patient reports that his wife's brother died of a heart attack at 35 years of age. His blood pressure is 140/89 mm Hg and his heart rate is 89/min. Physical examination is otherwise unremarkable. What is the single best initial management for this patient?? {'A': 'Return to the clinic for a repeat blood pressure reading and counseling on the importance of aerobic exercise.', 'B': 'Try angiotensin-converting enzyme inhibitor.', 'C': 'Start trial of calcium channel blockers.', 'D': 'Treat the patient with beta-blockers.', 'E': 'The patient does not require any treatment.'},
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A: Return to the clinic for a repeat blood pressure reading and counseling on the importance of aerobic exercise.
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Q:A 24-year-old man, an information technology professional, gets himself tested for serum immunoglobulin M (IgM) levels because he wants to know more about his immunity. He knows that IgM levels reflect the status of his immunity, based on the internet. Although the laboratory report is normal, he consults a physician. The physician discusses human immunity and its important components. He also tells him that most circulating IgM antibodies in the blood of normal persons are produced by a specific type of B cell, which is present mostly in the peritoneal cavity and in mucosal tissues. He also mentions that these cells are components of innate immunity. Which of the following types of B cells is the physician referring to?? {'A': 'B-1 B cells', 'B': 'Follicular B cells', 'C': 'Marginal zone B cells', 'D': 'Memory B cells', 'E': 'Naïve B cells'},
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A: B-1 B cells
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Q:A 37-year-old man presents to his gastroenterologist due to a transaminitis found by his primary care physician (PCP). He reports currently feeling well and has no acute concerns. Medical history is significant for ulcerative colitis treated with 5-aminosalicylate. He recently went on a trip to Mexico and experienced an episode of mild diarrhea. The patient is 5 ft 4 in and weighs 220 lbs (99.8 kg). His temperature is 98°F (36.7°C), blood pressure is 138/88 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination is unremarkable. Laboratory testing demonstrates: Leukocyte count: 7,200 /mm^3 Alkaline phosphatase: 205 U/L Aspartate aminotransferase (AST): 120 U/L Alanine aminotransferase (ALT): 115 U/L Perinuclear antineutrophil cytoplasmic antibody (pANCA): Positive Antimitochondrial antibody: Negative Which of the following is most likely the diagnosis?? {'A': 'Acute cholecystitis', 'B': 'Acute viral hepatitis', 'C': 'Choledocholithiasis', 'D': 'Primary biliary cirrhosis', 'E': 'Primary sclerosing cholangitis'},
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E: Primary sclerosing cholangitis
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Q:A 33-year-old man comes to the emergency department because of a pounding headache for the past 3 hours. The pain is 8 out of 10 in intensity, does not radiate, and is not relieved by ibuprofen. He also has associated dizziness, blurring of vision, and palpitations. He has had similar episodes over the last 6 months but none this severe. He has not had fever, weight change, or loss of appetite. He underwent an appendectomy at the age of 18. His father died of renal cancer. He is diaphoretic. His temperature is 36.8°C (98.4°F), pulse is 112/min, and blood pressure is 220/130 mm Hg. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.8 g/dL Leukocyte count 9600/mm3 Platelet count 345,000/mm3 Serum Glucose 112 mg/dL Na+ 137 mEq/L K+ 4.2 mEq/L Cl- 105 mEq/L Creatinine 1.0 mg/dL Urine dipstick shows no abnormalities. Which of the following findings on imaging is the most likely explanation for this patient's symptoms?"? {'A': 'Paravertebral mass', 'B': 'Meningeal mass', 'C': 'Adrenal medullary mass', 'D': 'Renal cortical mass', 'E': 'Intracranial hemorrhage'},
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C: Adrenal medullary mass
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Q:A 65-year-old male with multiple comorbidities presents to your office complaining of difficulty falling asleep. Specifically, he says he has been having trouble breathing while lying flat very shortly after going to bed. He notes it only gets better when he adds several pillows, but that sitting up straight is an uncomfortable position for him in which to fall asleep. What is the most likely etiology of this man's sleeping troubles?? {'A': 'Obstructive sleep apnea', 'B': 'Amyotrophic lateral sclerosis (ALS)', 'C': 'Myasthenia gravis', 'D': 'Right-sided heart failure', 'E': 'Left-sided heart failure'},
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E: Left-sided heart failure
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 2-month-old girl is brought to the emergency department because her lips turned blue while passing stools 30 minutes ago. She is at the 40th percentile for length and below the 35th percentile for weight. Pulse oximetry on room air shows an oxygen saturation of 65%, which increases to 76% on administration of 100% oxygen. Physical examination shows perioral cyanosis and retractions of the lower ribs with respiration. Cardiac examination shows a harsh grade 2/6 systolic crescendo-decrescendo murmur heard best at the left upper sternal border. Which of the following is most likely to improve this patient's symptoms?? {'A': 'Cooling of the face', 'B': 'Elevation of the lower extremities', 'C': 'Administration of indomethacin', 'D': 'Hyperextension of the neck', 'E': 'Knee to chest positioning'},
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E: Knee to chest positioning
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Q:A newborn male is evaluated in the hospital nursery two hours after birth. The patient was born at 39 weeks of gestation to a 30-year-old primigravid via vaginal delivery. The patient’s mother received routine prenatal care, and the pregnancy was uncomplicated. The patient’s anatomy ultrasound at 20 weeks of gestation was unremarkable. The patient’s mother denies any family history of genetic diseases. The patient’s Apgar scores were notable for poor muscle tone at both one and five minutes of life. The patient’s birth weight is 2.6 kg (5 lb 11 oz), which is at the 5th percentile. His height and head circumference are in the 15th and 3rd percentile, respectively. On physical exam, the patient has a wide nasal bridge, downslanting palpebral fissures, and widely spaced eyes. He has good respiratory effort with a high-pitched cry. This patient is most likely to have experienced a deletion on which of the following chromosomes?? {'A': '4p', 'B': '5p', 'C': '5q', 'D': '7q', 'E': '15q'},
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B: 5p
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Q:A 44-year-old male presents to his primary care physician with complaints of fatigue, muscle weakness, cramps, and increased urination over the past several weeks. His past medical history is significant only for hypertension, for which he was started on hydrochlorothiazide (HCTZ) 4 weeks ago. Vital signs at today's visit are as follows: T 37.2, HR 88, BP 129/80, RR 14, and SpO2 99%. Physical examination does not reveal any abnormal findings. Serologic studies are significant for a serum potassium level of 2.1 mEq/L (normal range 3.5-5.0 mEq/L). Lab-work from his last visit showed a basic metabolic panel and complete blood count results to all be within normal limits. Which of the following underlying diseases most likely contributed to the development of this patient's presenting condition?? {'A': 'Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)', 'B': 'Pituitary adenoma', 'C': 'Adrenal insufficiency', 'D': 'Hyperaldosteronism', 'E': "Cushing's disease"},
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D: Hyperaldosteronism
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Q:A 50-year-old man presents the emergency department for intense chest pain, profuse sweating, and shortness of breath. The onset of these symptoms was 3 hours ago. The chest pain began after a heated discussion with a colleague at the community college where he is employed. Upon arrival, he is found conscious and responsive; the vital signs include a blood pressure of 130/80 mm Hg, a heart rate at 90/min, a respiratory rate at 20/min, and a body temperature of 36.4°C (97.5°F). His medical history is significant for hypertension diagnosed 7 years ago, which is well-controlled with a calcium channel blocker. The initial electrocardiogram (ECG) shows ST-segment depression in multiple consecutive leads, an elevated cardiac troponin T level, and normal kidney function. Which of the following would you expect to find in this patient?? {'A': 'Ventricular pseudoaneurysm', 'B': 'Transmural necrosis', 'C': 'Subendocardial necrosis', 'D': 'Incomplete occlusion of a coronary artery', 'E': 'Coronary artery spasm'},
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C: Subendocardial necrosis
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Q:The patient is admitted to the hospital. A stereotactic brain biopsy of the suspicious lesion is performed that shows many large lymphocytes with irregular nuclei. Which of the following is the most appropriate treatment?? {'A': 'Intrathecal glucocorticoids', 'B': 'Temozolomide', 'C': 'Pyrimethamine and sulfadiazine', 'D': 'Methotrexate', 'E': 'Surgical resection'},
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D: Methotrexate
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Q:You are counseling a mother whose newborn has just screened positive for a deficit of phenylalanine hydroxylase enzyme. You inform her that her child will require dietary supplementation of which of the following?? {'A': 'Leucine', 'B': 'Aspartame', 'C': 'Tyrosine', 'D': 'Niacin', 'E': 'Homogentisic Acid'},
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C: Tyrosine
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Q:A 35-year-old male is brought to the physician by his wife who is concerned because he has begun to demonstrate odd behavior which has worsened over the past several months. She states that he has become very aggressive and at times will have sudden, jerky movements which he is unable to control. The patient states that his father had the same problem which he died of at age 69. The patient had a recent, "cold," with fevers, chills and, "throat pain," which resolved on its own, "some time ago." Which of the following is true of this disease?? {'A': 'A mutation in ATP7B on chromosome 13 is responsible', 'B': 'Erythema marginatum is a complication associated with this disease', 'C': 'Overactivity of dopamine in the mesolimbic pathway is the underlying pathology', 'D': 'Underactivity of dopamine in the nigrostriatal cortex is the underlying pathology', 'E': 'It demonstrates anticipation'},
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E: It demonstrates anticipation
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Q:A 20-year-old male with no significant medical history comes to you with a urine positive for fructose. He does not have diabetes mellitus. Which enzyme is most likely to be deficient in this patient?? {'A': 'Aldolase B', 'B': 'Galactokinase', 'C': 'Fructokinase', 'D': 'Pyruvate kinase', 'E': 'Lactase'},
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C: Fructokinase
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Q:A 21-year-old male presents after several days of flatulence and greasy, foul-smelling diarrhea. The patient reports symptoms of nausea and abdominal cramps followed by sudden diarrhea. He says that his symptoms started after he came back from a camping trip. When asked about his camping activities, he reports that his friend collected water from a stream, but he did not boil or chemically treat the water. His temperature is 98.6°F (37°C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Stool is sent for microscopy which returns positive for motile protozoans. Which of the following antibiotics should be started in this patient?? {'A': 'Erythromycin', 'B': 'Ciprofloxacin', 'C': 'Metronidazole', 'D': 'Vancomycin', 'E': 'Cephalexin'},
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C: Metronidazole
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Q:A 72-year-old man comes to the physician for a 5-month history of hoarseness, exertional dyspnea, and fatigue. He does not smoke or drink alcohol. His pulse is 98/min and irregular. His voice is coarse in quality. Physical examination shows a liver span of 16 cm and a soft diastolic murmur heard best at the apex. Which of the following is the most likely cause of this patient's hoarseness?? {'A': 'Carcinoma arising from the mucosa of the larynx', 'B': 'Extrinsic impingement of the recurrent laryngeal nerve', 'C': 'Bacterial infection of the vocal folds', 'D': 'Laryngeal inflammation due to chemical irritant', 'E': 'Circulating acetylcholine receptor antibodies\n"'},
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B: Extrinsic impingement of the recurrent laryngeal nerve
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Q:A 2-year-old girl is brought to the physician by her mother for a well-child examination. Cardiac auscultation is shown. When she clenches her fist forcefully for a sustained time, the intensity of the murmur increases. Which of the following is the most likely cause of this patient's auscultation findings?? {'A': 'Prolapse of the mitral valve', 'B': 'Fusion of the right and left coronary leaflets', 'C': 'Defect in the atrial septum', 'D': 'Defect in the ventricular septum', 'E': 'Failure of the ductus arteriosus to close'},
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D: Defect in the ventricular septum
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Answer the following medical question with one of the provided options:
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Q:A 36-year-old woman comes to the physician because she has not had her menstrual period for the past 4 months. During this period, she has had frequent headaches, difficulty sleeping, and increased sweating. She has not had any weight changes. Over the past year, menses occurred at irregular 30- to 45-day intervals with light flow. The patient underwent two successful cesarean sections at the ages of 28 and 32. She has two healthy children. She is sexually active with her husband and does not use condoms. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies show: Estradiol 8 pg/mL (mid-follicular phase: N=27–123 pg/mL) Follicle-stimulating hormone 200 mIU/mL Luteinizing hormone 180 mIU/mL Prolactin 16 ng/mL Which of the following is the most likely diagnosis?"? {'A': 'Primary hypothyroidism', 'B': 'Pregnancy', 'C': 'Premature ovarian failure', 'D': 'Polycystic ovary syndrome', 'E': 'Major depressive disorder'},
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C: Premature ovarian failure
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Q:A 63-year-old man comes to the physician for blurry vision and increased difficulty walking over the past month. He feels very fatigued after watering his garden but feels better after taking a nap. He has not had any recent illness. He has smoked one pack of cigarettes daily for 35 years. Examination shows drooping of the upper eyelids bilaterally and diminished motor strength in the upper extremities. Sensation to light touch and deep tendon reflexes are intact. An x-ray of the chest shows low lung volumes bilaterally. A drug with which of the following mechanisms of action is most appropriate for this patient?? {'A': 'Inhibition of muscarinic ACh receptor', 'B': 'Regeneration of acetylcholinesterase', 'C': 'Stimulation of D2 receptors', 'D': 'Stimulation of β2 adrenergic receptors', 'E': 'Inhibition of acetylcholinesterase'},
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E: Inhibition of acetylcholinesterase
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Q:An 82-year-old woman is brought to the physician by her daughter because of a 3-day history of a runny nose, headache, and cough. The patient's grandson recently had similar symptoms. Her vital signs are within normal limits. Pulse oximetry on room air shows an oxygen saturation of 99%. Lungs are clear to auscultation. Testing of nasal secretions is performed to identify the viral strain. Electron microscopy shows a non-enveloped RNA virus with an icosahedral capsid. Binding to which of the following is responsible for the virulence of this virus?? {'A': 'P antigen', 'B': 'CD21', 'C': 'ICAM-1', 'D': 'Sialic acid residues', 'E': 'Integrin'},
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C: ICAM-1
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Q:A 31-year-old man presents to the Emergency Department with severe left leg pain and paresthesias 4 hours after his leg got trapped by the closing door of a bus. Initially, he had a mild pain which gradually increased to unbearable levels. Past medical history is noncontributory. In the Emergency Department, his blood pressure is 130/80 mm Hg, heart rate is 87/min, respiratory rate is 14/min, and temperature is 36.8℃ (98.2℉). On physical exam, his left calf is firm and severely tender on palpation. The patient cannot actively dorsiflex his left foot, and passive dorsiflexion is limited. Posterior tibial and dorsalis pedis pulses are 2+ in the right leg and 1+ in the left leg. Axial load does not increase the pain. Which of the following is the best next step in the management of this patient?? {'A': 'Lower limb CT scan', 'B': 'Lower limb X-ray in two projections', 'C': 'Lower limb ultrasound', 'D': 'Splinting and limb rest', 'E': 'Fasciotomy'},
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E: Fasciotomy
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old G2P0A2 woman comes to the office complaining of light vaginal spotting. She received a suction curettage 2 weeks ago for an empty gestational sac. Pathology reports showed hyperplastic and hydropic trophoblastic villi, but no fetal tissue. The patient denies fever, abdominal pain, dysuria, dyspareunia, or abnormal vaginal discharge. She has no chronic medical conditions. Her periods are normally regular and last 3-4 days. One year ago, she had an ectopic pregnancy that was treated with methotrexate. She has a history of chlamydia and gonorrhea that was treated 5 years ago with azithromycin and ceftriaxone. Her temperature is 98°F (36.7°C), blood pressure is 125/71 mmHg, and pulse is 82/min. On examination, hair is present on the upper lip, chin, and forearms. A pelvic examination reveals a non-tender, 6-week-sized uterus and bilateral adnexal masses. There is scant dark blood in the vaginal vault on speculum exam. A quantitative beta-hCG is 101,005 mIU/mL. Two weeks ago, her beta-hCG was 63,200 mIU/mL. A pelvic ultrasound shows bilaterally enlarged ovaries with multiple thin-walled cysts between 2-3 cm in size. Which of the following is the most likely cause of the patient’s adnexal masses?? {'A': 'Corpus luteal cysts', 'B': 'Dermoid cysts', 'C': 'Ectopic pregnancy', 'D': 'Endometrioma', 'E': 'Theca lutein cysts'},
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E: Theca lutein cysts
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Answer the following medical question with one of the provided options:
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Q:A 78-year-old man is brought to the emergency department because of difficulty speaking. The symptoms began abruptly one hour ago while he was having breakfast with his wife. He has hypertension, type 2 diabetes mellitus, and coronary artery disease. Current medications include pravastatin, lisinopril, metformin, and aspirin. His temperature is 37°C (98.6°F), pulse is 76/min, and blood pressure is 165/90 mm Hg. He is right-handed. The patient speaks in short, simple sentences, and has difficulty repeating sequences of words. He can follow simple instructions. Right facial droop is present. Muscle strength is 4/5 on the right side and 5/5 on the left, and there is a mild right-sided pronator drift. Which of the following is the most likely cause of the patient's symptoms?? {'A': 'Occlusion of the right penetrating arteries', 'B': 'Occlusion of the right middle cerebral artery', 'C': 'Occlusion of the left middle cerebral artery', 'D': 'Occlusion of the right posterior inferior cerebellar artery', 'E': 'Rupture of left posterior cerebral artery malformation'},
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C: Occlusion of the left middle cerebral artery
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old man presents for an annual check-up. He is a bodybuilder and tells you he is on a protein-rich diet that only allows for minimal carbohydrate intake. His friend suggests he try exogenous glucagon to help him lose some excess weight before an upcoming competition. Which of the following effects of glucagon is he attempting to exploit?? {'A': 'Increased hepatic gluconeogenesis', 'B': 'Increased hepatic glycogenolysis', 'C': 'Increased glucose utilization by tissues', 'D': 'Decreased blood cholesterol level', 'E': 'Increased lipolysis in adipose tissues'},
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E: Increased lipolysis in adipose tissues
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Answer the following medical question with one of the provided options:
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Q:An 18-month-old boy presents to the emergency department for malaise. The boy’s parents report worsening fatigue for 3 days with associated irritability and anorexia. The patient’s newborn screening revealed a point mutation in the beta-globin gene but the patient has otherwise been healthy since birth. On physical exam, his temperature is 102.4°F (39.1°C), blood pressure is 78/42 mmHg, pulse is 124/min, and respirations are 32/min. The child is tired-appearing and difficult to soothe. Laboratory testing is performed and reveals the following: Serum: Na+: 137 mEq/L Cl-: 100 mEq/L K+: 4.4 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 16 mg/dL Creatinine: 0.9 mg/dL Glucose: 96 mg/dL Leukocyte count: 19,300/mm^3 with normal differential Hemoglobin: 7.8 g/dL Hematocrit: 21% Mean corpuscular volume: 82 um^3 Platelet count: 324,000/mm^3 Reticulocyte index: 3.6% Which of the following is the most likely causative organism for this patient's presentation?? {'A': 'Haemophilus influenzae', 'B': 'Listeria monocytogenes', 'C': 'Neisseria meningitidis', 'D': 'Salmonella', 'E': 'Streptococcus pneumoniae'},
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E: Streptococcus pneumoniae
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Answer the following medical question with one of the provided options:
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Q:A 2-day-old newborn boy has failed to pass meconium after 48 hours. There is an absence of stool in the rectal vault. Family history is significant for MEN2A syndrome. Which of the following confirms the diagnosis?? {'A': 'Absence of ganglion cells demonstrated by rectal suction biopsy', 'B': 'Atrophic nerve fibers and decreased acetylcholinesterase activity', 'C': 'Barium enema demonstrating absence of a transition zone', 'D': 'Rectal manometry demonstrating relaxation of the internal anal sphincter with distension of the rectum', 'E': 'Genetic testing confirming mutation in the RET oncogene'},
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A: Absence of ganglion cells demonstrated by rectal suction biopsy
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