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Answer the following medical question with one of the provided options:
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Q:A 50-year-old man presents to the emergency department with pain and swelling of his right leg for the past 2 days. Three days ago he collapsed on his leg after tripping on a rug. It was a hard fall and left him with bruising of his leg. Since then the pain and swelling of his leg have been gradually increasing. Past medical history is noncontributory. He lives a rather sedentary life and smokes two packs of cigarettes per day. The vital signs include heart rate 98/min, respiratory rate 15/min, temperature 37.8°C (100.1°F), and blood pressure 100/60 mm Hg. On physical examination, his right leg is visibly swollen up to the mid-calf with pitting edema and moderate erythema. Peripheral pulses in the right leg are weak and the leg is tender. Manipulation of the right leg is negative for Homan’s sign. What is the next best step in the management of this patient?? {'A': 'Make a diagnosis of deep vein thrombosis based on history and physical', 'B': 'Perform a venous ultrasound', 'C': 'Start intravenous heparin therapy immediately', 'D': 'Send the patient to surgery for an emergency fasciotomy', 'E': 'Perform intravenous venography within 24 hours'},
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B: Perform a venous ultrasound
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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 comes to the clinic complaining of a persistent cough for the last few months. His cough started gradually about a year ago, and it became more severe and persistent despite all his attempts to alleviate it. During the past year, he also noticed some weight loss and a decrease in his appetite. He also complains of progressive shortness of breath. He has a 40-pack-year smoking history but is a nonalcoholic. Physical examination findings are within normal limits. His chest X-ray shows a mass in the right lung. A chest CT shows a 5 cm mass with irregular borders near the lung hilum. A CT guided biopsy is planned. During the procedure, just after insertion of the needle, the patient starts to feel pain in his right shoulder. Which of the following nerves is responsible for his shoulder pain?? {'A': 'Intercostal nerves', 'B': 'Vagus nerve', 'C': 'Phrenic nerve', 'D': 'Pulmonary plexus', 'E': 'Thoracic spinal nerves'},
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C: Phrenic nerve
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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 comes to the emergency department one hour after the sudden onset of diffuse abdominal pain and nausea. She has no history of serious illness. Menses occur at regular 27-day intervals and last 4 to 6 days with moderate flow. Her last menstrual period was 6 weeks ago. She is sexually active with two sexual partners and uses oral contraceptive pills inconsistently. She appears pale and diaphoretic. Her temperature is 37.7°C (99.9°F), pulse is 120/min, respirations are 20/min, and blood pressure is 85/70 mm Hg. Abdominal examination shows diffuse abdominal tenderness. Pelvic examination shows a normal appearing vagina, cervix, and uterus, with right adnexal tenderness. Her hemoglobin concentration is 13 g/dL, leukocyte count is 10,000/mm3, and platelet count is 350,000/mm3. Results of a pregnancy test are pending. Which of the following is the most appropriate next step in management?? {'A': 'Perform exploratory laparoscopy', 'B': 'Administer intravenous normal saline fluids', 'C': 'Perform CT scan of the abdomen and pelvis with contrast', 'D': 'Transfuse O negative packed red blood cells', 'E': 'Perform pelvic ultrasound'},
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B: Administer intravenous normal saline fluids
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Answer the following medical question with one of the provided options:
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Q:An otherwise healthy 15-year-old girl is brought to the physician for evaluation of severe acne that involves her face, chest, and back. It has not improved with her current combination therapy of oral cephalexin and topical benzoyl peroxide. She is sexually active with one male partner, and they use condoms consistently. Facial scarring and numerous comedones are present, with sebaceous skin lesions on her face, chest, and back. Which of the following is indicated prior to initiating the appropriate treatment in this patient?? {'A': 'Perform quantitative beta-hCG assay', 'B': 'Switch cephalexin to doxycycline', 'C': 'Evaluate color vision', 'D': 'Administer oral contraceptives', 'E': 'Measure serum DHEA-S and testosterone levels'},
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A: Perform quantitative beta-hCG assay
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Answer the following medical question with one of the provided options:
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Q:A 76-year-old female is brought to the emergency department after being found unresponsive in her room at her nursing facility. Past medical history is significant for Alzheimer's disease, hypertension, and diabetes. Surgical history is notable for an open cholecystectomy at age 38 and multiple cesarean sections. On arrival, she is non-responsive but breathing by herself, and her vital signs are T 102.9 F, HR 123 bpm, BP 95/64, RR 26/min, and SaO2 97% on 6L nasal cannula. On physical exam the patient has marked abdominal distension and is tympanic to percussion. Laboratory studies are notable for a lactic acidosis. An upright abdominal radiograph and CT abdomen/pelvis with contrast are shown in Figures A and B respectively. She is started on IV fluids and a nasogastric tube is placed to suction which returns green bilious fluid. Repeat vitals 1 hour later are T 101F, HR 140 bpm, BP 75/44, RR 30/min, and SaO2 is 100% on the ventilator after she is intubated for airway concerns. What is the next best step in management?? {'A': 'Therapy with levofloxacin and metronidazole', 'B': 'Immediate laparotomy and surgical management', 'C': 'Continue IV fluid hydration, nasogastric suction, NPO', 'D': 'Pneumatic enema', 'E': 'Sigmoidoscopy, attempted derotation and rectal tube placement'},
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B: Immediate laparotomy and surgical management
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Answer the following medical question with one of the provided options:
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Q:A 34-year-old woman, gravida 4, para 3, comes to the physician because of left ankle swelling for 2 months. She notes that the swelling is present throughout the day and decreases when she goes to sleep. One year ago, she has had an episode of deep venous thrombosis after the delivery of her third child. Her prepregnancy BMI was 34 kg/m2. Examination shows distended, tortuous veins in the legs bilaterally and pitting edema of the left ankle. There are erythematous scaling patches on the medial side of the left ankle. Duplex ultrasonography is performed. Which of the following directions of blood flow would most likely confirm the diagnosis?? {'A': 'Anterior tibial vein to popliteal vein', 'B': 'Popliteal vein to small saphenous vein', 'C': 'Femoral vein to external iliac vein', 'D': 'Great saphenous vein to femoral vein', 'E': 'Dorsal venous arch to great saphenous vein'},
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B: Popliteal vein to small saphenous vein
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman is brought to the physician by her daughter because of progressive memory loss and weakness over the past 6 months. She is now unable to perform activities of daily living and has had several falls in her apartment. She has diarrhea but has not had nausea or vomiting. She was treated for tuberculosis 10 years ago. She smoked half a pack of cigarettes daily for 25 years but stopped 8 years ago. She drinks a pint of vodka daily. Vital signs are within normal limits. Examination shows glossitis and a hyperpigmented rash on her face and arms. There are multiple bruises over both arms. On mental status examination, she is oriented to place and person only. Short-term memory is impaired; she can recall 0 out of 5 objects after 10 minutes. Which of the following deficiencies is most likely present in this patient?? {'A': 'Vitamin B5 (panthothenic acid)', 'B': 'Vitamin B7 (biotin)', 'C': 'Vitamin B2 (riboflavin)', 'D': 'Vitamin B6 (pyridoxine)', 'E': 'Vitamin B3 (niacin)'},
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E: Vitamin B3 (niacin)
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Answer the following medical question with one of the provided options:
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Q:A 6-month old child is brought to the ER by parents for one day of fever, decreased feeding, and lethargy. They report that neither she nor her siblings are immunized due to their concerns about vaccinations. On exam, the infant is toxic-appearing. Antibiotics are started and lumbar puncture reveals bacterial meningitis caused by a gram-negative, encapsulated organism that requires chocolate agar and the two factors shown in Image A for growth. Which organism does this best describe?? {'A': 'Group B Streptococcus', 'B': 'Moraxella catarrhalis', 'C': 'Streptococcus pneumoniae', 'D': 'Haemophilus influenza', 'E': 'Listeria monocytogenes'},
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D: Haemophilus influenza
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Answer the following medical question with one of the provided options:
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Q:Two days after hospital admission, a 32-year-old woman with breast cancer is visited by the attending physician in the presence of medical students. She has limited English proficiency. The attending physician describes the situation to the patient in English, and the patient nods understandably. Subsequently, the attending physician pulls down the patient’s hospital gown and exposes her breasts. The patient is clearly shocked and upset. Her unease grows as the attending physician starts to palpate her breasts and she pulls up her gown in disbelief. Which of the following actions is most likely to improve similar miscommunications in the future?? {'A': 'Asking a family member who knows English to interpret physician requests', 'B': 'Employing medical staff with above-average familiarity with a language other than English', 'C': 'Hiring a qualified medical interpreter in patients’ native languages', 'D': 'Limiting encounters with such patients to noneducational visits', 'E': 'Providing written forms in different languages to bridge communication gaps'},
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C: Hiring a qualified medical interpreter in patients’ native languages
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Answer the following medical question with one of the provided options:
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Q:A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she actively smokes cigarettes. Her prenatal workup is unremarkable. Her previous pregnancies were remarkable for one episode of chorioamnionitis that resolved with antibiotics. Her temperature is 98.6°F (37°C), blood pressure is 90/60 mmHg, pulse is 130/min, and respirations are 20/min. The fetal pulse is 110/min. Her uterus is tender and firm. The remainder of her physical exam is unremarkable. What is the most likely diagnosis?? {'A': 'Preeclampsia', 'B': 'Preterm labor', 'C': 'Vasa previa', 'D': 'Placental abruption', 'E': 'Eclampsia'},
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D: Placental abruption
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Answer the following medical question with one of the provided options:
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Q:A potassium hydroxide preparation is conducted on a skin scraping of the hypopigmented area. Microscopy of the preparation shows long hyphae among clusters of yeast cells. Based on these findings, which of the following is the most appropriate pharmacotherapy?? {'A': 'Oral fluconazole', 'B': 'Topical corticosteroid', 'C': 'Oral ketoconazole', 'D': 'Topical selenium sulfide', 'E': 'Topical nystatin\n"'},
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D: Topical selenium sulfide
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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 her physician at the 3rd week postpartum with a fever and a swollen breast with redness and tenderness. She has been breastfeeding her infant since birth. The symptoms of the patient started 4 days ago. She has not taken any antibiotics for the past 12 months. She does not have any concurrent diseases. The vital signs include: blood pressure 110/80 mm Hg, heart rate 91/min, respiratory rate 15/min, and temperature 38.8℃ (101.8℉). Physical examination reveals redness and enlargement of the right breast. The breast is warm and is painful at palpation. There is purulent discharge from the nipple. No fluctuation is noted. Which of the following is a correct management strategy for this patient?? {'A': 'Prescribe dicloxacillin and encourage continuing breastfeeding', 'B': 'Prescribe dicloxacillin and bromocriptine for halting lactation', 'C': 'Manage with trimethoprim-sulfamethoxazole and encourage continuing breastfeeding', 'D': 'Prescribe trimethoprim-sulfamethoxazole and recommend emptying affected breast without feeding', 'E': 'Manage with clindamycin and recommend to interrupt breastfeeding until the resolution'},
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A: Prescribe dicloxacillin and encourage continuing breastfeeding
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Answer the following medical question with one of the provided options:
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Q:A 6-month-old boy is brought to the emergency department by his mother, who informs the doctor that her alcoholic husband hit the boy hard on his back. The blow was followed by excessive crying for several minutes and the development of redness in the area. On physical examination, the boy is dehydrated, dirty, and irritable and when the vital signs are checked, they reveal tachycardia. He cries immediately upon the physician touching the area around his left scapula. The doctor strongly suspects a fracture of the 6th, 7th, or 8th retroscapular posterior ribs. Evaluation of his skeletal survey is normal. The clinician is concerned about child abuse in this case. Which of the following is the most preferred imaging technique as the next step in the diagnostic evaluation of the infant?? {'A': 'Babygram', 'B': 'Bedside ultrasonography', 'C': 'Chest computed tomography scan', 'D': 'Magnetic resonance imaging', 'E': 'Skeletal survey in 2 weeks'},
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E: Skeletal survey in 2 weeks
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Answer the following medical question with one of the provided options:
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Q:A 21-year-old man presents to the emergency department with a 1-week history of increasing knee pain. Specifically, he says that the pain is severe enough that he is no longer able to bend his knee. His past medical history is not significant, but he says that he is sexually active with multiple partners. On physical exam, his right knee is found to be swollen, erythematous, and tender to palpation. Laboratory testing demonstrates an elevated erythrocyte sedimentation rate and C-reactive protein. Which of the following properties describes the organism that is most likely responsible for this patient's symptoms?? {'A': 'Gram-negative diplococci', 'B': 'Gram-negative rod', 'C': 'Gram-positive cocci in chains', 'D': 'Gram-positive cocci in clusters', 'E': 'Tick born gram-variable'},
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A: Gram-negative diplococci
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old man presents with fever, malaise, and severe pain in his right wrist and left knee for the last 2 days. He describes the pain as 8/10 in intensity, sharp in character, and extending from his right wrist to his fingers. He denies any recent inciting trauma or similar symptoms in the past. His past medical history is unremarkable. He is sexually active with multiple partners and uses condoms inconsistently. The vital signs include blood pressure 120/70 mm Hg, pulse 100/min, and temperature 38.3°C (101.0°F). On physical examination, the right wrist and left knee joints are erythematous, warm, and extremely tender to palpation. Both joints have a significantly restricted range of motion. A petechial rash is noted on the right forearm. An arthrocentesis is performed on the left knee joint. Which of the following would be the most likely finding in this patient?? {'A': 'Arthrocentesis aspirate showing gram-positive cocci in clusters', 'B': 'Arthrocentesis aspirate showing minimal, purulent joint effusion with negative culture', 'C': 'Positive serum ASO titer', 'D': 'Radiographs of right wrist and left knee showing osteopenia and joint space narrowing', 'E': 'Arthrocentesis aspirate showing negatively birefringent crystals under polarised light'},
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B: Arthrocentesis aspirate showing minimal, purulent joint effusion with negative culture
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man presents with 2 months of diarrhea, abdominal pain, and fatigue. He reports a weight loss of 4 kg (8 lb). He also says his joints have been hurting recently, as well. Past medical history is unremarkable. Review of systems is significant for problems with concentration and memory. Physical examination is unremarkable. A GI endoscopy is performed with a biopsy of the small bowel. Which of the following histologic finding would most likely be seen in this patient?? {'A': 'PAS positive macrophages', 'B': 'Blunting of the villi', 'C': 'Non-caseating granulomas in the small intestine', 'D': 'Absence of nerves in the myenteric plexus', 'E': 'Presence of C. trachomatis in urine specimen'},
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A: PAS positive macrophages
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old man who recently immigrated to the United States with his family is diagnosed with an autosomal dominant disorder that causes anemia by extravascular hemolysis. The doctor explains that his red blood cells (RBCs) are spherical, which decreases their lifespan and explains that a splenectomy may be required in the future. Which of the following is most likely to be defective in this patient?? {'A': 'Iron absorption', 'B': 'Glucose-6-phosphatase dehydrogenase', 'C': 'Decay accelerating factor', 'D': 'Spectrin', 'E': 'Glycosylphosphatidylinositol'},
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D: Spectrin
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old African-American woman presents to her primary care physician for a general checkup appointment. She works as a middle school teacher and has a 25 pack-year smoking history. She has a body mass index (BMI) of 22 kg/m^2 and is a vegetarian. Her last menstrual period was 1 week ago. Her current medications include oral contraceptive pills. Which of the following is a risk factor for osteoporosis in this patient?? {'A': 'Age', 'B': 'Body mass index', 'C': 'Estrogen therapy', 'D': 'Race', 'E': 'Smoking history'},
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E: Smoking history
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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 comes to the physician for the evaluation of painful swallowing and retrosternal pain over the past 2 days. He was recently diagnosed with HIV infection, for which he now takes tenofovir, emtricitabine, and raltegravir. There is no family history of serious illness. He has smoked one pack of cigarettes daily for the past 20 years. He drinks 2–3 beers per day. He does not use illicit drugs. Vital signs are within normal limits. Physical examination of the oral cavity shows no abnormalities. The patient's CD4+ T-lymphocyte count is 80/mm3 (normal ≥ 500). Empiric treatment is started. Two weeks later, he reports no improvement in his symptoms. Esophagogastroduodenoscopy is performed and shows multiple well-circumscribed, round, superficial ulcers in the upper esophagus. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Infection with herpes simplex virus', 'B': 'Transient lower esophageal sphincter relaxation', 'C': 'Allergic inflammation of the esophagus', 'D': 'Degeneration of inhibitory neurons within the myenteric plexuses', 'E': 'Infection with cytomegalovirus'},
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A: Infection with herpes simplex virus
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old male presents to the cardiologist after passing out during a basketball practice. An echocardiogram confirmed the diagnosis of hypertrophic cardiomyopathy. The cardiologist advises that a pacemaker must be implanted to prevent any further complications and states the player cannot play basketball anymore. Unfortunately, the coach objects to sidelining the player since a big game against their rivals is next week. The coach asks if the pacemaker can be implanted after the game, which of the following steps should the physician take?? {'A': 'Allow the patient to play and schedule a follow up after the game', 'B': 'Postpone the procedure so the patient can play', 'C': "Perform the procedure immediately so that both the physician and coach's wishes may be fulfilled", 'D': 'Recommend to the legal guardian that the player stop playing and have the procedure performed', 'E': 'Allow the patient to make the decision regarding his health'},
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D: Recommend to the legal guardian that the player stop playing and have the procedure performed
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Answer the following medical question with one of the provided options:
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Q:A 17-year-old girl comes to the physician because of a sore throat, fevers, and fatigue for the past 3 weeks. Her temperature is 37.8°C (100°F), pulse is 97/min, and blood pressure is 90/60 mm Hg. Examination of the head and neck shows cervical lymphadenopathy, pharyngeal erythema, enlarged tonsils with exudates, and palatal petechiae. The spleen is palpated 2 cm below the left costal margin. Her leukocyte count is 14,100/mm3 with 54% lymphocytes (12% atypical lymphocytes). Results of a heterophile agglutination test are positive. This patient is at increased risk for which of the following conditions?? {'A': 'Rheumatic fever', 'B': 'Kaposi sarcoma', 'C': 'Hepatocellular carcinoma', 'D': 'Hodgkin lymphoma', 'E': 'Mycotic aneurysm'},
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D: Hodgkin lymphoma
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Answer the following medical question with one of the provided options:
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Q:A 27-year-old soldier stationed in Libya sustains a shrapnel injury during an attack, causing a traumatic above-elbow amputation. The resulting arterial bleed is managed with a tourniquet prior to transport to the military treatment facility. On arrival, he is alert and oriented to person, place, and time. His armor and clothing are removed. His pulse is 145/min, respirations are 28/min, and blood pressure is 95/52 mm Hg. Pulmonary examination shows symmetric chest rise. The lungs are clear to auscultation. Abdominal examination shows no abnormalities. There are multiple shrapnel wounds over the upper and lower extremities. A tourniquet is in place around the right upper extremity; the right proximal forearm has been amputated. One large-bore intravenous catheter is placed in the left antecubital fossa. Despite multiple attempts, medical staff is unable to establish additional intravenous access. Which of the following is the most appropriate next step in management?? {'A': 'Irrigate the shrapnel wounds', 'B': 'Establish central venous access', 'C': 'Replace the tourniquet with a pressure dressing', 'D': 'Establish intraosseous access', 'E': 'Perform endotracheal intubation'},
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D: Establish intraosseous access
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Answer the following medical question with one of the provided options:
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Q:A 50-year-old female presents to her physician with vesicles and tense blisters across her chest, arms, and the back of her shoulders. Physical examination reveals that blistering is not present in her oral mucosa, and the epidermis does not separate upon light stroking of the skin. The patient most likely suffers from a hypersensitivity reaction located:? {'A': 'Linearly along the epidermal basement membrane', 'B': 'In net-like patterns around epidermal cells', 'C': 'In granular deposits at the tips of dermal papillae', 'D': 'In fat cells beneath the skin', 'E': 'In nuclei within epidermal cells'},
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A: Linearly along the epidermal basement membrane
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Answer the following medical question with one of the provided options:
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Q:In 2006, three researchers from North Carolina wanted to examine the benefits of treating the risk of suicidality in children and adolescents by looking at randomized, multicenter, controlled trials of sertraline usage compared to placebo. Their analysis found clinically significant benefits of the drug and a positive benefit-to-risk ratio for sertraline in adolescents with major depressive disorder. They also found that 64 depressed children and adolescents need to receive the drug for 1 extra patient to experience suicidality as an adverse outcome. In other words, if 64 treated individuals received sertraline, some would experience suicidality due to their illness, some would not experience suicidality, and 1 individual would become suicidal due to the unique contribution of sertraline. Which of the following statements is true for this measure (defined as the inverse of the attributable risk), which aims to describe adverse outcomes this way?? {'A': 'Input values must be probabilities of the events of interest.', 'B': 'The final metric represents proportions in percentage terms.', 'C': 'The measure can include multiple events at one time.', 'D': 'Multiple risks can be contained and described within one result.', 'E': 'Higher measures indicate greater risk.'},
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A: Input values must be probabilities of the events of interest.
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old Caucasian man presents to the clinic for evaluation of a mole on his back that he finds concerning. He states that his wife noticed the lesion and believes that it has been getting larger. On inspection, the lesion is 10 mm in diameter with irregular borders. A biopsy is performed. Pathology reveals abnormal melanocytes forming nests at the dermo-epidermal junction and discohesive cell growth into the epidermis. What is the most likely diagnosis?? {'A': 'Nodular melanoma', 'B': 'Superficial spreading melanoma', 'C': 'Lentigo melanoma', 'D': 'Desmoplastic melanoma', 'E': 'Acral lentiginous melanoma'},
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B: Superficial spreading melanoma
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old woman presents with complaints of fever, chills, and rigor. On physical exam, she also has left sided costovertebral tenderness. Vitals include a temperature of 39.4°C (103.0°F), blood pressure of 125/84 mm Hg, and pulse of 84/min. She has type 2 diabetes and is currently taking metformin daily. Urine dipstick analysis is positive for leukocytes, nitrites, and blood. The most likely cause for the present condition is?? {'A': 'Acute cystitis', 'B': 'Acute glomerulonephritis', 'C': 'Acute tubular necrosis', 'D': 'Acute interstitial nephritis', 'E': 'Acute papillary necrosis'},
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E: Acute papillary necrosis
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Answer the following medical question with one of the provided options:
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Q:A 70-year-old man comes to the emergency department because of severe lower back pain for 3 weeks. The pain was initially exacerbated by activity but now presents also at rest. The patient has not had a headache or a cough. He reports no changes in bowel movements or urination. He has type 2 diabetes mellitus and hypertension. He does not smoke or drink alcohol. His current medications include metformin and lisinopril. His temperature is 37.8°C (100°F), pulse is 86/min, and blood pressure is 134/92 mm Hg. Examination shows tenderness over the spinous processes of the second and third lumbar vertebrae with significant paraspinal spasm. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 10,800 /mm3 Erythrocyte sedimentation rate 75 mm/h CRP 82 mg/L (N = 0–10 mg/L) Serum Ca2+ 9.6 mg/dL Urea nitrogen 22 mg/dL Glucose 216 mg/dL Creatinine 1.1 mg/dL Albumin 3.7 g/dL Alkaline phosphatase 55 U/L An x-ray of the lumbar spine shows bone destruction, sequestrum formation, and periosteal reactions along the second and third lumbar vertebrae. An MRI of the lumbar spine shows increased T2 signals within the second and third lumbar vertebrae without signs of epidural abscess. A blood culture is taken and he is started on appropriate analgesia. Which of the following is the most appropriate next step in the management of this patient?"? {'A': 'Skeletal scintigraphy', 'B': 'CT-guided biopsy', 'C': 'Surgical debridement', 'D': 'Prostate-specific antigen assay', 'E': 'Isoniazid, rifampin, pyrazinamide, ethambutol\n"'},
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B: CT-guided biopsy
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Answer the following medical question with one of the provided options:
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Q:A 32-year-old woman comes to the physician because of a 1-week history of left flank pain and dysuria. She has had 2 episodes of urinary tract infection over the past 2 years. Her temperature is 37°C (98.6°F) and pulse is 82/min. An ultrasound of the kidneys shows left-sided hydronephrosis and echogenic foci with acoustic shadowing. A photomicrograph of the urine is shown. The crystals observed are most likely composed of which of the following?? {'A': 'Uric acid', 'B': 'Cystine', 'C': 'Calcium oxalate', 'D': 'Calcium phosphate', 'E': 'Magnesium ammonium phosphate\n"'},
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E: Magnesium ammonium phosphate "
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old woman comes to the physician because of a 2-year history of progressively worsening pain in her knees and fingers. The knee pain is worse when she walks for longer than 30 minutes. When she wakes up in the morning, her fingers and knees are stiff for about 15 minutes. She cannot recall any trauma to the joints. She was treated with amoxicillin following a tick bite 2 years ago. She is otherwise healthy and only takes a multivitamin and occasionally acetaminophen for the pain. She drinks 1–2 glasses of wine daily. She is 160 cm (5 ft 3 in) tall and weighs 79 kg (174 lb); BMI is 31 kg/m2. Her temperature is 36.9°C (98.4°F), pulse is 70/min, and blood pressure is 133/78 mm Hg. Examination of the lower extremities reveals mild genu varum. Range of motion of both knees is limited; there is palpable crepitus. Complete flexion and extension elicit pain. Tender nodules are present on the proximal and distal interphalangeal joints of the index, ring, and little fingers bilaterally. Which of the following is the most likely diagnosis?? {'A': 'Gout', 'B': 'Lyme arthritis', 'C': 'Osteoarthritis', 'D': 'Septic arthritis', 'E': 'Pseudogout'},
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C: Osteoarthritis
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Answer the following medical question with one of the provided options:
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Q:A 23-year-old woman on prednisone for lupus presents to her primary care physician because she experiences a burning sensation with urination. She has also been urinating more frequently than normal. The patient denies fever, chills, nausea/vomiting, abdominal or back pain, or other changes with urination. Her vital signs and physical exam are unremarkable, and her urine analysis is positive for leukocyte esterase and nitrites. The patient receives a diagnosis and is then prescribed an antimicrobial that acts by inhibiting DNA gyrase. Which adverse effect should the patient be counseled about?? {'A': 'Rhabdomyolysis', 'B': 'Leukopenia', 'C': 'Facial redness/flushing', 'D': 'Hemolytic anemia', 'E': 'Tendon rupture'},
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E: Tendon rupture
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Answer the following medical question with one of the provided options:
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Q:A 16-year-old boy is brought to the physician because of a cough and clear nasal secretions over the past 2 days. He is not coughing up any sputum. He says that he is the quarterback of his high school's football team and wants to get back to training as soon as possible. The patient's father had a myocardial infarction at the age of 45 years and underwent cardiac catheterization and stenting. The patient has no history of serious illness and takes no medications. His temperature is 37.8°C (100°F), pulse is 82/min, and blood pressure is 118/66 mm Hg. The lungs are clear to auscultation. Cardiac examination is shown. Which of the following is the most appropriate next step in management?? {'A': 'Echocardiography', 'B': 'Cardiac stress testing', 'C': 'Creatine kinase and troponin T', 'D': '24-hour ambulatory ECG monitoring', 'E': 'Reassurance'},
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E: Reassurance
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Answer the following medical question with one of the provided options:
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Q:You are called to evaluate a newborn. The patient was born yesterday to a 39-year-old mother. You observe the findings illustrated in Figures A-C. What is the most likely mechanism responsible for these findings?? {'A': 'Hypothyroidism', 'B': 'Microdeletion on chromosome 22', 'C': 'Maternal alcohol consumption during pregnancy', 'D': 'Trisomy 18', 'E': 'Trisomy 21'},
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E: Trisomy 21
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Answer the following medical question with one of the provided options:
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Q:A 29-year-old man presents to the emergency department with a sharp pain in the center of his chest. The pain is knife-like and constant. Sitting alleviates the pain and lying supine aggravates it. He denies the use of nicotine, alcohol or illicit drugs. Vital signs include: temperature 37.0°C (98.6°F), blood pressure 135/92 mm Hg, and pulse 97/min. On examination, a friction rub is heard at the left sternal border while the patient is leaning forward. His ECG is shown in the image. Which of the following can prevent recurrence of this patient’s condition?? {'A': 'Ibuprofen', 'B': 'Colchicine', 'C': 'Aspirin', 'D': 'Glucocorticoids', 'E': 'Systemic antibiotics'},
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B: Colchicine
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Answer the following medical question with one of the provided options:
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Q:A 42-year-old man is brought in to the emergency department by his daughter. She reports that her father drank heavily for the last 16 years, but he stopped 4 days ago after he decided to quit drinking on his birthday. She also reports that he has been talking about seeing cats running in his room since this morning, although there were no cats. There is no history of any known medical problems or any other substance use. On physical examination, his temperature is 38.4ºC (101.2ºF), heart rate is 116/min, blood pressure is 160/94 mm Hg, and respiratory rate is 22/min. He is severely agitated and is not oriented to his name, time, or place. On physical examination, profuse perspiration and tremors are present. Which of the following best describes the pathophysiologic mechanism underlying his condition?? {'A': 'Functional increase in GABA', 'B': 'Increased activity of NMDA receptors', 'C': 'Increased influx of chloride ions', 'D': 'Increased inhibition of norepinephrine', 'E': 'Increased inhibition of glutamate'},
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B: Increased activity of NMDA receptors
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Answer the following medical question with one of the provided options:
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Q:A 13-year-old boy is brought by his mother to the emergency department because he has had fever, chills, and severe coughing for the last two days. While they originally tried to manage his condition at home, he has become increasingly fatigued and hard to arouse. He has a history of recurrent lung infections and occasionally has multiple foul smelling stools. On presentation, his temperature is 102.2 °F (39 °C), blood pressure is 106/71 mmHg, pulse is 112/min, and respirations are 20/min. Physical exam reveals scattered rhonchi over both lung fields, rales at the base of the right lung base and corresponding dullness to percussion. The most likely organism responsible for this patient's symptoms has which of the following characteristics?? {'A': 'Coagulase-positive, gram-positive cocci', 'B': 'Green gram-negative rod', 'C': 'Lancet-shaped diplococci', 'D': 'Mixed anaerobic rods', 'E': 'Mucoid lactose-fermenting rod'},
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B: Green gram-negative rod
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Answer the following medical question with one of the provided options:
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Q:An investigator is developing a drug that selectively inhibits the retrograde axonal transport of rabies virus towards the central nervous system. To achieve this effect, this drug must target which of the following?? {'A': 'Tubulin', 'B': 'Kinesin', 'C': 'Dynein', 'D': 'Nidogen', 'E': 'Acetylcholine'},
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C: Dynein
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Answer the following medical question with one of the provided options:
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Q:A previously healthy 21-year-old man comes to the physician for the evaluation of lethargy, headache, and nausea for 2 months. His headache is holocephalic and most severe upon waking up. He is concerned about losing his spot on next season's college track team, given a recent decline in his performance during winter training. He recently moved into a new house with friends, where he lives in the basement. He does not smoke or drink alcohol. His current medications include ibuprofen and a multivitamin. His mother has systemic lupus erythematosus and his father has hypertension. His temperature is 37°C (98.6°F), pulse is 80/min, respirations are 18/min, and blood pressure is 122/75 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 98%. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 19.6 g/dL Hematocrit 59.8% Leukocyte count 9,000/mm3 Platelet count 380,000/mm3 Which of the following is the most likely cause of this patient's symptoms?"? {'A': 'Chronic cerebral hypoxia', 'B': 'Increased intracranial pressure', 'C': 'Exogenous erythropoietin', 'D': 'Inherited JAK2 kinase mutation', 'E': 'Overuse of NSAIDs'},
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A: Chronic cerebral hypoxia
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Q:A 15-year-old boy is brought to the physician for a well-child visit. His parents are concerned that he has not had his growth spurt yet. As a child, he was consistently in the 60th percentile for height; now he is in the 25th percentile. His classmates make fun of his height and high-pitched voice. His parents are also concerned that he does not maintain good hygiene. He frequently forgets to shower and does not seem aware of his body odor. As an infant, he had bilateral orchidopexy for cryptorchidism and a cleft palate repair. He is otherwise healthy. Vital signs are within normal limits. On physical exam, axillary and pubic hair is sparse. Genitals are Tanner stage 1 and the testicles are 2 mL bilaterally. Which of the following is the most likely diagnosis?? {'A': 'Hyperprolactinemia', 'B': 'Hypothyroidism', 'C': 'Primary hypogonadism', 'D': 'Kallmann syndrome', 'E': 'Constitutional delay of puberty\n"'},
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D: Kallmann syndrome
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Answer the following medical question with one of the provided options:
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Q:An investigator is studying the genetic profile of an isolated pathogen that proliferates within macrophages. The pathogen contains sulfatide on the surface of its cell wall to prevent fusion of the phagosome and lysosome. She finds that some of the organisms under investigation have mutations in a gene that encodes the enzyme required for synthesis of RNA from a DNA template. The mutations are most likely to reduce the therapeutic effect of which of the following drugs?? {'A': 'Streptomycin', 'B': 'Rifampin', 'C': 'Ethambutol', 'D': 'Pyrazinamide', 'E': 'Levofloxacin'},
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B: Rifampin
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Answer the following medical question with one of the provided options:
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Q:A 40-year-old woman comes to the physician because of a 2-week history of anal pain that occurs during defecation and lasts for several hours. She reports that she often strains during defecation and sees bright red blood on toilet paper after wiping. She typically has 3 bowel movements per week. Physical examination shows a longitudinal, perianal tear. This patient's symptoms are most likely caused by tissue injury in which of the following locations?? {'A': 'Posterior midline of the anal canal, distal to the pectinate line', 'B': 'Anterior midline of the anal canal, proximal to the pectinate line', 'C': 'Anterior midline of the anal canal, distal to the pectinate line', 'D': 'Posterior midline of the anal canal, proximal to the pectinate line', 'E': 'Lateral aspect of the anal canal, distal to the pectinate line'},
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A: Posterior midline of the anal canal, distal to the pectinate line
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Q:A 72-year-old man comes to the physician because of a 2-month history of intermittent retrosternal chest pain and tightness on exertion. He has type 2 diabetes mellitus, osteoarthritis of the right hip, and hypertension. Current medications include insulin, ibuprofen, enalapril, and hydrochlorothiazide. Vital signs are within normal limits. His troponin level is within the reference range. An ECG at rest shows a right bundle branch block and infrequent premature ventricular contractions. The patient's symptoms are reproduced during adenosine stress testing. Repeat ECG during stress testing shows new ST depression of > 1 mm in leads V2, V3, and V4. Which of the following is the most important underlying mechanism of this patient's ECG changes?? {'A': 'Ruptured cholesterol plaque within a coronary vessel', 'B': 'Diversion of blood flow from stenotic coronary arteries', 'C': 'Transient atrioventricular nodal blockade', 'D': 'Reduced left ventricular preload', 'E': 'Increased myocardial oxygen demand'},
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B: Diversion of blood flow from stenotic coronary arteries
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Q:A 14-year-old boy is brought to the physician by his parents for a follow-up examination. Since early childhood, he has had recurrent respiratory infections that cause him to miss several weeks of school each year. Last month, he had received treatment for his seventh episode of sinusitis this year. He has always had bulky, foul-smelling, oily stools that are now increasing in frequency. His parents are concerned that he is too thin and not gaining weight appropriately. He has a good appetite and eats a variety of foods. He is in the 10th percentile for height and the 5th percentile for weight. Examination of the nasal cavity shows multiple nasal polyps. The lung fields are clear upon auscultation. Further evaluation is most likely to show which of the following?? {'A': 'Hypersensitivity to aspirin', 'B': 'Absent vas deferens', 'C': 'Selective IgA deficiency', 'D': 'Positive methacholine challenge test', 'E': 'Anti-tissue transglutaminase antibodies\n"'},
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B: Absent vas deferens
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Q:A 25-year-old woman presents to her primary care provider for fatigue. She states that she has felt fatigued for the past 6 months and has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin, folate, B12, iron, fish oil, whey protein, baby aspirin, copper, and krill oil. Her temperature is 98.8°F (37.1°C), blood pressure is 107/58 mmHg, pulse is 90/min, respirations are 13/min, and oxygen saturation is 98% on room air. Laboratory values are as seen below. Hemoglobin: 8 g/dL Hematocrit: 24% Leukocyte count: 6,500/mm^3 with normal differential Platelet count: 147,000/mm^3 Physical exam is notable for decreased proprioception in the lower extremities and 4/5 strength in the patient's upper and lower extremities. Which of the following is the best next step in management to confirm the diagnosis?? {'A': 'Anti-intrinsic factor antibodies', 'B': 'Bone marrow biopsy', 'C': 'Homocysteine level', 'D': 'Iron level', 'E': 'Transferrin level'},
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A: Anti-intrinsic factor antibodies
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Answer the following medical question with one of the provided options:
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Q:A 4-month-old boy is brought to the emergency department by his mother because of lethargy and vomiting since he woke up 1 hour ago. The mother says that he last breastfed the previous evening and slept through the night for the first time. His family recently immigrated from Bolivia. His temperature is 38.7°C (101.2°F). Physical examination shows dry mucous membranes and enlarged, reddened tonsils. Serum studies show: Glucose 42 mg/dL Ketones 0.2 mg/dL N = < 1 mg/dL AST 40 U/L ALT 60 U/L Ammonia 80 μ/dL (N=15–45) Which of the following enzymes is most likely deficient in this patient?"? {'A': 'Medium-chain acyl-CoA dehydrogenase', 'B': 'Alpha-L-iduronidase', 'C': 'Galactose-1-phosphate uridyltransferase', 'D': 'Propionyl-CoA carboxylase', 'E': 'Lysosomal acid α-1,4- glucosidase'},
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A: Medium-chain acyl-CoA dehydrogenase
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Answer the following medical question with one of the provided options:
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Q:A 9-year-old boy is brought to a pediatric psychologist by his mother because of poor academic performance. The patient’s mother mentions that his academic performance was excellent in kindergarten and first grade, but his second and third-grade teachers complain that he is extremely talkative, does not complete schoolwork, and frequently makes careless mistakes. They also complain that he frequently looks at other students or outside the window during the class and is often lost during the lessons. At home, he is very talkative and disorganized. When the pediatrician asks the boy his name, he replies promptly. He was born at full term by spontaneous vaginal delivery. He is up-to-date on all vaccinations and has met all developmental milestones on time. A recent IQ test scored him at 95. His physical examination is completely normal. When he is asked to read from an age-appropriate children’s book, he reads it fluently and correctly. Which of the following is the most likely diagnosis in this patient?? {'A': 'Attention-deficit/hyperactivity disorder', 'B': 'Dyslexia', 'C': 'Persistent depressive disorder', 'D': 'Intellectual disability', 'E': 'Autism spectrum disorder'},
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A: Attention-deficit/hyperactivity disorder
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Answer the following medical question with one of the provided options:
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Q:A 39-year-old man presents to a primary care clinic for a routine physical exam. He denies any complaints. He has a long beard and hair, wears several copper bracelets, and a crystal amulet. When asked about his diet, he discloses eating mostly canned foods, which he has stockpiled in his cabin in case there is a natural disaster or "apocalypse" (though he admits that this is highly unlikely). He has a few close friends, but feels awkward when meeting new people. He seems happy overall and has many long-standing interests, including hiking and astrology. He has been steadily employed as a data scientist and a paranormal investigator. He has never been diagnosed with a mental illness, though he has a family history of schizophrenia. Review of systems is negative for depressed mood, anxiety, or hallucinations. Thought process is linear and reality testing is intact. Which of the following is the most likely diagnosis for this patient?? {'A': 'Brief psychotic disorder', 'B': 'Schizoid personality disorder', 'C': 'Schizophrenia', 'D': 'Schizophreniform disorder', 'E': 'Schizotypal personality disorder'},
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E: Schizotypal personality disorder
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman visits her physician to seek preconception advice. She is recently married and plans to have a child soon. Menses occur at regular 28-day intervals and last 5 days. She has sexual intercourse only with her husband and, at this time, they consistently use condoms for birth control. The patient consumes a well-balanced diet with moderate intake of meat and dairy products. She has no history of serious illness and takes no medications currently. She does not smoke or drink alcohol. The patient’s history reveals no birth defects or severe genetic abnormalities in the family. Physical examination shows no abnormalities. Pelvic examination indicates a normal vagina, cervix, uterus, and adnexa. To decrease the likelihood of fetal neural-tube defects in her future pregnancy, which of the following is the most appropriate recommendation for initiation of folic acid supplementation?? {'A': 'As soon as her pregnancy is confirmed', 'B': 'As soon as possible', 'C': 'In the second half of pregnancy', 'D': 'When off contraception', 'E': 'No folic acid supplement is required as nutritional sources are adequate'},
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B: As soon as possible
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Answer the following medical question with one of the provided options:
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Q:A 28-year-old woman is brought to the emergency department 30 minutes after being involved in a high-speed motor vehicle collision in which she was the unrestrained driver. On arrival, she is semiconscious and incoherent. She has shortness of breath and is cyanotic. Her pulse is 112/min, respirations are 59/min, and blood pressure is 128/89 mm Hg. Examination shows a 3-cm (1.2-in) laceration on the forehead and multiple abrasions over the thorax and abdomen. There is crepitation on palpation of the thorax on the right. Auscultation of the lung shows decreased breath sounds on the right side. A crunching sound synchronous with the heartbeat is heard best over the precordium. There is dullness on percussion of the right hemithorax. The lips and tongue have a bluish discoloration. There is an open femur fracture on the left. The remainder of the examination shows no abnormalities. Arterial blood gas analysis on room air shows: pH 7.31 PCO2 55 mm Hg PO2 42 mm Hg HCO3- 22 mEq/L O2 saturation 76% The patient is intubated and mechanically ventilated. Infusion of 0.9% saline is begun. Which of the following is the most likely diagnosis?"? {'A': 'Bronchial rupture', 'B': 'Flail chest', 'C': 'Tension pneumothorax', 'D': 'Myocardial rupture', 'E': 'Pulmonary embolism'},
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A: Bronchial rupture
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Q:You are a resident on a pediatric service entering orders late at night. Upon arrival the next morning, you note that you had mistakenly ordered that low molecular weight heparin be administered to a 17-year-old patient who does not need anti-coagulation. When you talk to her, she complains about the "shot" she had to get this morning but is otherwise well. How should you handle the situation?? {'A': 'You cannot disclose the error as a resident due to hospital policy', 'B': 'Tell the patient, but ask her not to tell her parents', 'C': 'Speak to risk management before deciding whether or not to disclose the error', 'D': 'Tell the patient and her parents about the error', 'E': 'Since there was no lasting harm to the patient, it is not necessary to disclose the error'},
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D: Tell the patient and her parents about the error
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Q:A 4-year-old boy presents with a history of recurrent bacterial infections, including several episodes of pneumococcal sepsis. His family history is significant for 2 maternal uncles who died from similar symptoms. Laboratory tests reveal undetectable serum levels of all isotypes of immunoglobulins and reduced levels of B cells. Which of the following is the most likely diagnosis in this patient?? {'A': 'Bruton agammaglobulinemia', 'B': 'Common variable immunodeficiency', 'C': 'DiGeorge syndrome', 'D': 'Hereditary angioedema', 'E': 'Chediak-Higashi syndrome'},
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A: Bruton agammaglobulinemia
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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 emergency room because of severe breathlessness for the past few hours. Over the course of a few years, he has been treated for asthma by several physicians, but his symptoms have continued to progress. He doesn’t smoke and never did. Both his father who died at the age of 40 years and his uncle (father’s brother), died with chronic obstructive pulmonary disorder. He has never smoked in his life. His respiratory rate is 19/min and temperature is 37.0°C (98.6°F). On physical examination, the patient has significantly longer exhalation than inhalation. His expiratory time is longer than 6 seconds. Clubbing is present. Chest auscultation reveals bilateral crackles. Mild hepatomegaly is present. What is the most likely diagnosis?? {'A': 'Pulmonary edema', 'B': 'Lung cancer', 'C': 'α1-antitrypsin-deficiency', 'D': 'Asthma', 'E': 'Pneumonia'},
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C: α1-antitrypsin-deficiency
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old woman presents to her primary care doctor with diarrhea. She has had 3-10 malodorous and loose bowel movements daily for the last 6 months, though she recalls that her bowel movements started increasing in frequency nearly 2 years ago. She was otherwise healthy until 2 years ago, when she had multiple elevated fasting blood glucose levels and was diagnosed with type 2 diabetes mellitus. She was also hospitalized once 6 months ago for epigastric pain that was determined to be due to cholelithiasis. She is an avid runner and runs 3-4 marathons per year. She is a vegetarian and takes all appropriate supplements. Her body mass index is 19 kg/m^2. She has lost 10 pounds since her last visit 18 months ago. On exam, she has dry mucous membranes and decreased skin turgor. A high-resolution spiral computerized tomography scan demonstrates a 5-cm enhancing lesion in the head of the pancreas. Additional similar lesions are found in the liver. Further laboratory workup confirms the diagnosis. The patient is offered surgery but refuses as she reportedly had a severe complication from anesthesia as a child. This patient should be treated with a combination of octreotide, 5-fluorouracil, and which other medication?? {'A': 'Streptozotocin', 'B': 'Insulin', 'C': 'Paclitaxel', 'D': 'Glucagon', 'E': 'Methotrexate'},
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A: Streptozotocin
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Answer the following medical question with one of the provided options:
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Q:A 31-year-old woman presents with difficulty walking and climbing stairs for the last 3 weeks. She has no history of trauma. The physical examination reveals a waddling gait with the trunk swaying from side-to-side towards the weight-bearing limb. When she stands on her right leg, the pelvis on the left side falls, but when she stands on the left leg, the pelvis on the right side rises. Which of the following nerves is most likely injured in this patient?? {'A': 'Right superior gluteal nerve', 'B': 'Right femoral nerve', 'C': 'Right inferior gluteal nerve', 'D': 'Right obturator nerve', 'E': 'Left femoral nerve'},
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A: Right superior gluteal nerve
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Answer the following medical question with one of the provided options:
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Q:A 25-year-old man presents to the emergency department with pain in his leg. He states that the pain was sudden and that his leg feels very tender. This has happened before, but symptoms resolved a few days later with acetaminophen. His temperature is 98.5°F (36.9°C), blood pressure is 129/88 mmHg, pulse is 90/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam reveals clear breath sounds bilaterally and a normal S1 and S2. The patient’s right leg is red, inflamed, and tender to palpation inferior to the popliteal fossa. Which of the following is the best treatment for this patient?? {'A': 'Aspirin', 'B': 'Clindamycin', 'C': 'Heparin', 'D': 'Ibuprofen and rest', 'E': 'Warfarin'},
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C: Heparin
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Answer the following medical question with one of the provided options:
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Q:A 51-year-old man presents to his physician with decreased libido and inability to achieve an erection. He also reports poor sleep, loss of pleasure to do his job, and depressed mood. His symptoms started a year ago, soon after his wife got into the car accident. She survived and recovered with the minimal deficit, but the patient still feels guilty due to this case. The patient was diagnosed with diabetes 6 months ago, but he does not take any medications for it. He denies any other conditions. His weight is 105 kg (231.5 lb), his height is 172 cm (5 ft 7 in), and his waist circumference is 106 cm. The blood pressure is 150/90 mm Hg, and the heart rate is 73/min. The physical examination only shows increased adiposity. Which of the following tests is specifically intended to distinguish between the organic and psychogenic cause of the patient’s condition?? {'A': 'Penile tumescence testing', 'B': 'Duplex ultrasound of the penis', 'C': 'Biothesiometry', 'D': 'Injection of prostaglandin E1', 'E': 'Angiography'},
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A: Penile tumescence testing
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Answer the following medical question with one of the provided options:
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Q:A 24-year-old woman, otherwise healthy, presents with a non-productive cough, sore throat, and myalgia. The patient reports that her symptoms started gradually 2 weeks ago and have not improved. She has no significant past medical history and no current medications. She is a college student and denies any recent overseas travel. The patient received the flu vaccine this year, and her 2-part PPD required for school was negative. She does not smoke, drink, or use recreational drugs. The patient denies being sexually active. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 110/75 mm Hg, pulse 98/min, respirations 20/min, and oxygen saturation 99% on room air. On physical exam, the patient is alert and cooperative. The cardiac exam is normal. There are rales present bilaterally over both lung fields. The skin and conjunctiva are pale. The laboratory tests are pending. The chest X-ray is shown in the image. Which of the following laboratory findings would also commonly be found in this patient?? {'A': 'Low serum levels of complement', 'B': 'Low serum ferritin and serum iron', 'C': 'Bite cells on peripheral smear', 'D': 'Schistocytes on peripheral smear', 'E': 'Heinz bodies on peripheral smear'},
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A: Low serum levels of complement
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Answer the following medical question with one of the provided options:
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Q:A 37-year-old woman, gravida 3, para 3, comes to the physician for very painful menses that have caused her to miss at least 3 days of work during each menstrual cycle for the past 6 months. Menses occur with heavy bleeding at regular 28-day intervals. She also has constant dull pain in the pelvic region between cycles. She is otherwise healthy. She weighs 53 kg (117 lb) and is 160 cm tall; BMI is 20.7 kg/m2. Pelvic examination shows no abnormalities. Pelvic ultrasonography shows a uniformly enlarged uterus and asymmetric thickening of the myometrial wall with a poorly defined endomyometrial border. Which of the following is the most likely cause of these findings?? {'A': 'Endometrial tissue within the uterine wall', 'B': 'Endometrial tissue in the fallopian tubes', 'C': 'Cystic enlargement of the ovaries', 'D': 'Benign smooth muscle tumors of the uterus', 'E': 'Infection of ovaries, fallopian tubes, and uterus'},
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A: Endometrial tissue within the uterine wall
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Answer the following medical question with one of the provided options:
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Q:A 52-year-old man is brought to the emergency department with severe epigastric discomfort and left-sided chest pain radiating to the back that began after waking up. He has also vomited several times since the pain began. He underwent an esophagogastroduodenoscopy the previous day for evaluation of epigastric pain. He has ischemic heart disease and underwent a coronary angioplasty 3 years ago. His mother died of pancreatic cancer when she was 60 years old. His current medications include aspirin, clopidogrel, metoprolol, ramipril, and rosuvastatin. He is pale, anxious, and diaphoretic. His temperature is 37.9°C (100.2°F), pulse is 140/min, respirations are 20/min, and blood pressure is 100/60 mm Hg in his upper extremities and 108/68 mm Hg in his lower extremities. Pulse oximetry on room air shows oxygen saturation at 98%. An S4 is audible over the precordium, in addition to crepitus over the chest. Abdominal examination shows tenderness to palpation in the epigastric area. Serum studies show an initial Troponin I level of 0.031 ng/mL (N < 0.1 ng/mL) and 0.026 ng/mL 6 hours later. A 12-lead ECG shows sinus tachycardia with nonspecific ST-T changes. Which of the following is the most likely diagnosis?? {'A': 'Pneumothorax', 'B': 'Acute pancreatitis', 'C': 'Esophageal perforation', 'D': 'Aortic dissection', 'E': 'Acute myocardial infarction'},
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C: Esophageal perforation
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old male with a history of difficult-to-treat bipolar disorder with psychotic features is under going a medication adjustment under the guidance of his psychiatrist. The patient was previously treated with lithium and is transitioning to clozapine. Which of the following tests will the patient need routinely?? {'A': 'Basic metabolic panel, weekly', 'B': 'Complete blood count, weekly', 'C': 'Thyroid-stimulating hormone, prior to introducing the medication', 'D': 'Hemoglobin A1c, weekly', 'E': 'Dexamethasone suppression test, monthly'},
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B: Complete blood count, weekly
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Answer the following medical question with one of the provided options:
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Q:A 47-year-old man comes to the emergency department because of urinary and fecal incontinence for 6 hours. Earlier in the day, he suffered a fall at a construction site and sustained injuries to his back and thighs but did not seek medical attention. He took ibuprofen for lower back pain. His temperature is 36.9°C (98.4°F), pulse is 80/min, and blood pressure is 132/84 mm Hg. Examination shows tenderness over the lumbar spine, bilateral lower extremity weakness, absent ankle jerk reflexes, and preserved patellar reflexes. There is decreased rectal tone. An ultrasound of the bladder shows a full bladder. Which of the following is the most likely diagnosis?? {'A': 'Spinal epidural abscess', 'B': 'Cerebellar stroke', 'C': 'Conus medullaris syndrome', 'D': 'Anterior spinal cord syndrome', 'E': 'Brown-Sequard syndrome\n"'},
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C: Conus medullaris syndrome
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Answer the following medical question with one of the provided options:
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Q:A 20-year-old female presents to the college health clinic concerned about a rash that has recently developed along her back and flank. Aside from a history of chronic diarrhea and flatulence, she reports being otherwise healthy. She is concerned that this rash could be either from bed bugs or possible be sexually transmitted, as she has engaged in unprotected sex multiple times over the past two years. The physician orders several lab tests and finds that the patient does indeed have chlamydia and elevated tissue transglutaminase (tTG) levels. What is the most likely cause of her rash?? {'A': 'Disseminiated chlamydial infection', 'B': 'Streptococcal meningitis infection', 'C': 'Immunologic response to gluten', 'D': 'Immunologic response to dairy', 'E': 'Bed bug infestation'},
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C: Immunologic response to gluten
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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 the physician with tiredness, lethargy, bone pain, and colicky right abdominal pain for 1 month. He has no comorbidities. He does not have any significant past medical history. His height is 176 cm (5 ft 7 in), weight is 88 kg (194 lb), and his BMI is 28.47 kg/m2. The physical examination is normal, except for mild right lumbar region tenderness. Laboratory studies show: Hemoglobin 13.5 g/dL Serum TSH 2.2 mU/L Serum calcium 12.3 mg/dL Serum phosphorus 1.1 mg/dL Serum sodium 136 mEq/L Serum potassium 3.5 mEq/L Serum creatinine 1.1 mg/dL Urine calcium Elevated An ultrasound of the abdomen reveals a single stone in the right ureter without hydroureteronephrosis. Clinically, no evidence of malignancy was observed. An X-ray of the long bones reveals diffuse osteopenia with subperiosteal bone resorption. The serum parathyroid hormone level is tested and it is grossly elevated. What is the most appropriate next step in his management?? {'A': '99mTc sestamibi scan with ultrasound of the neck', 'B': 'CT scan of the neck', 'C': 'Bone scan (DEXA)', 'D': 'Ultrasound of the neck only', 'E': 'Sestamibi scan only'},
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A: 99mTc sestamibi scan with ultrasound of the neck
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Answer the following medical question with one of the provided options:
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Q:A 22-year-old woman with type 1 diabetes mellitus and mild asthma comes to the physician for a follow-up examination. She has had several episodes of sweating, dizziness, and nausea in the past 2 months that occur during the day and always resolve after she drinks orange juice. She is compliant with her diet and insulin regimen. The physician recommends lowering her insulin dose in certain situations. This recommendation is most important in which of the following situations?? {'A': 'During a viral infection', 'B': 'After large meals', 'C': 'Before exercise', 'D': 'After a stressful exam', 'E': 'During pregnancy'},
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C: Before exercise
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Answer the following medical question with one of the provided options:
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Q:A 38-year-old woman seeks evaluation at the emergency room for sudden onset of pain and swelling of her left leg since last night. Her family history is significant for maternal breast cancer (diagnosed at 52 years of age) and a grandfather with bronchioloalveolar carcinoma of the lungs at 45 years of age. When the patient was 13 years old, she was diagnosed with osteosarcoma of the right distal femur that was successfully treated with surgery. The physical examination shows unilateral left leg edema and erythema that was tender to touch and warm. Homan's sign is positive. During the abdominal examination, you also notice a large mass in the left lower quadrant that is firm and fixed with irregular borders. Proximal leg ultrasonography reveals a non-compressible femoral vein and the presence of a thrombus after color flow Doppler evaluation. Concerned about the association between the palpable mass and a thrombotic event in this patient, you order an abdominal CT scan with contrast that reports a large left abdominopelvic cystic mass with thick septae consistent with ovarian cancer, multiple lymph node involvement, and ascites. Which of the following genes is most likely mutated in this patient?? {'A': 'BRCA1', 'B': 'TP53', 'C': 'BRCA2', 'D': 'MLH1', 'E': 'STK11'},
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B: TP53
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old man presents with fever and cough productive of rust-colored sputum and is diagnosed with community acquired pneumonia. The causative organism is isolated, and a Gram stain is shown in Figure 1. Which of the following most correctly describes additional features of the most likely causative organism?? {'A': 'Catalase positive, alpha hemolytic, optochin sensitive', 'B': 'Catalase positive, beta hemolytic, optochin sensitive', 'C': 'Catalase negative, alpha hemolytic, optochin sensitive', 'D': 'Catalase negative, beta hemolytic, optochin sensitive', 'E': 'Catalase negative, alpha hemolytic, optochin resistant'},
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C: Catalase negative, alpha hemolytic, optochin sensitive
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Q:A 30-year-old man is brought to the emergency room by ambulance after being found unconscious in his car parked in his garage with the engine running. His wife arrives and reveals that his past medical history is significant for severe depression treated with fluoxetine. He is now disoriented to person, place, and time. His temperature is 37.8 deg C (100.0 deg F), blood pressure is 100/50 mmHg, heart rate is 100/min, respiratory rate is 10/min, and SaO2 is 100%. On physical exam, there is no evidence of burn wounds. He has moist mucous membranes and no abnormalities on cardiac and pulmonary auscultation. His respirations are slow but spontaneous. His capillary refill time is 4 seconds. He is started on 100% supplemental oxygen by non-rebreather mask. His preliminary laboratory results are as follows: Arterial blood pH 7.20, PaO2 102 mm Hg, PaCO2 23 mm Hg, HCO3 10 mm Hg, WBC count 9.2/µL, Hb 14 mg/dL, platelets 200,000/µL, sodium 137 mEq/L, potassium 5.0 mEq/L, chloride 96 mEq/L, BUN 28 mg/dL, creatinine 1.0 mg/dL, and glucose 120 mg/dL. Which of the following is the cause of this patient's acid-base abnormality?? {'A': 'Increased anions from toxic ingestion', 'B': 'Decreased minute ventilation', 'C': 'Decreased oxygen delivery to tissues', 'D': 'Increased metabolic rate', 'E': 'Decreased ability for the tissues to use oxygen'},
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C: Decreased oxygen delivery to tissues
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Q:A 4-day-old boy is brought to the physician by his mother because of vomiting, irritability, and poor feeding. Pregnancy and delivery were uncomplicated. Physical examination shows increased muscle tone in all extremities. He appears lethargic. His diapers emit a caramel-like odor. Urine studies are positive for ketone bodies. Supplementation of which of the following is most likely to improve this patient's condition?? {'A': 'Thiamine', 'B': 'Cysteine', 'C': 'Leucine', 'D': 'Tyrosine', 'E': 'Tetrahydrobiopterin'},
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A: Thiamine
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Q:A 27-year-old woman presents to her primary care physician for foot pain. The patient states that she has pain in her foot and toes whenever she exerts herself or is at work. The patient is an executive at a medical device company and works 60 hours/week. She is currently training for a marathon. She has a past medical history of anxiety, constipation, and irritable bowel syndrome. Her current medications include clonazepam, sodium docusate, and hyoscyamine. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 50/min, respirations are 10/min, and oxygen saturation is 99% on room air. Cardiac and pulmonary exams are within normal limits. Examination of the lower extremity reveals 5/5 strength with 2+ reflexes. Palpation of the interdigital space between the third and fourth toes elicits pain and a clicking sound. Which of the following is the most likely diagnosis?? {'A': 'Inflammation and damage to the plantar fascia', 'B': 'Compression of the tibial nerve', 'C': 'Intermetatarsal plantar nerve neuroma', 'D': 'Damage to the trabeculae of the calcaneus', 'E': 'Anterior talofibular ligament strain'},
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C: Intermetatarsal plantar nerve neuroma
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Q:A 2-year-old boy is brought to the physician by his parents several weeks after the family immigrated from Russia. The parents are worried because the child appears to have trouble seeing and has not started walking. The child was born at home and has never been evaluated by a physician. During the pregnancy, the mother had a week of fever, myalgia, diffuse rash, and bilateral nontender cervical adenopathy after the family adopted a new cat. An MRI of the head is shown. Which of the following additional findings is most likely in this patient?? {'A': 'Continuous machinery murmur', 'B': 'Pupils do not react to light but constrict with accommodation', 'C': 'Spasticity of bilateral lower extremities', 'D': 'Tuft of hair over the lumbosacral area', 'E': 'Loss of pain sensation in shawl distribution'},
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C: Spasticity of bilateral lower extremities
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Q:A 10-year-old boy who recently immigrated to the United States from Africa with his family is brought to the emergency department by his mother for a progressively worsening ulcerative lesion on his jaw. His mother reports that her son’s right jaw has rapidly enlarged over the past few months. He says that it is very tender though he doesn’t recall any trauma to the site. In addition, the mother says her son hasn’t been himself the past few months with intermittent fever, weakness, and fatigue. Physical exam reveals a large, ulcerating right jaw mass that is draining serous fluid and painless cervical and axillary lymphadenopathy. Laboratory results are notable for an elevated serum lactate dehydrogenase. A biopsy of the right jaw mass is shown in the photograph. Which of the following chromosomal translocations is most likely to be found in this patient’s lesion?? {'A': 't(8;14)', 'B': 't(9;22)', 'C': 't(11;14)', 'D': 't(14;18)', 'E': 't(15;17)'},
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A: t(8;14)
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Q:An investigator is studying the teratogenicity of cigarette smoking during pregnancy. He reviews several databases containing data about birth defects and prenatal drug exposures and finds that infants exposed to cigarette smoke in utero are approximately 2 times as likely to have a particular birth defect than unexposed infants. This defect results from abnormal development during the 6th week of gestation, when the maxillary prominences grow medially and fuse first with the lateral and then the medial nasal prominence. The defect is most likely which of the following?? {'A': 'Cleft palate', 'B': 'Cleft lip', 'C': 'Choanal atresia', 'D': 'Macrognathia', 'E': 'Torus palatinus\n"'},
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B: Cleft lip
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Q:A 79-year-old woman who lives alone is brought to the emergency department by her neighbor because of worsening confusion over the last 2 days. Due to her level of confusion, she is unable to answer questions appropriately. She has had type 2 diabetes mellitus for 29 years for which she takes metformin. Vital signs include: blood pressure 111/72 mm Hg, temperature 38.5°C (101.3°F), and pulse 100/min. Her fingerstick blood glucose is 210 mg/dL. On physical examination, she is not oriented to time or place and mistakes the nursing assistant for her cousin. Laboratory results are shown: Hemoglobin 13 g/dL Leukocyte count 16,000/mm3 Segmented neutrophils 70% Eosinophils 1% Basophils 0.3% Lymphocytes 25% Monocytes 4% Which of the following is the most likely diagnosis?? {'A': "Alzheimer's dementia", 'B': 'Depression', 'C': 'Brief psychotic disorder', 'D': 'Delirium', 'E': 'Delusional disorder'},
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D: Delirium
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Q:A 35-year-old woman presents to the clinic with a 2-week history of headaches. She was in her usual state of health until 2 weeks ago, when she started having headaches. The headaches are throughout her whole head and rated as a 7/10. They are worse in the mornings and when she bends over. She has some mild nausea, but no vomiting. The headaches are not throbbing and are not associated with photophobia or phonophobia. On further questioning, she has noticed that she has noticed more hair than usual on her pillow in the morning and coming out in her hands when she washes her hair. The past medical history is unremarkable; she takes no prescription medications, but for the past year she has been taking an oral ‘health supplement’ recommended by her sister, which she orders over the internet. She cannot recall the supplement's name and does not know its contents. The physical exam is notable for some mild hepatomegaly but is otherwise unremarkable. This patient's presentation is most likely related to which of the following micronutrients?? {'A': 'Vitamin A', 'B': 'Vitamin B12', 'C': 'Vitamin C', 'D': 'Vitamin D', 'E': 'Vitamin K'},
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A: Vitamin A
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Q:A 68-year-old man presents for a screening ultrasound scan. He has been feeling well and is in his usual state of good health. His medical history is notable for mild hypertension and a 100-pack-year tobacco history. He has a blood pressure of 128/86 and heart rate of 62/min. Physical examination is clear lung sounds and regular heart sounds. On ultrasound, an infrarenal aortic aneurysm of 4 cm in diameter is identified. Which of the following is the best initial step for this patient?? {'A': 'Beta-blockers', 'B': 'Surveillance', 'C': 'Urgent repair', 'D': 'Elective repair', 'E': 'Reassurance'},
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B: Surveillance
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Q:A 42-year-old woman is brought to the emergency department because of two episodes of hemoptysis over the past 24 hours. The patient has a 6-month history of severe sinusitis and bloody nasal discharge. Her vital parameters are as follows: blood pressure, 155/75 mm Hg; pulse, 75/min; respiratory rate, 14/min; and temperature, 37.9°C (100.2°F). Examination reveals red conjunctiva, and an ulcer on the nasal septum. Pulmonary auscultation indicates diffuse rhonchi. Cardiac and abdominal examinations reveal no abnormalities. Laboratory studies show: Urine Blood 3+ Protein 2+ RBC 10-15/hpf with dysmorphic features RBC cast numerous Based on these findings, this patient is most likely to carry which of the following antibodies?? {'A': 'Anticyclic citrullinated peptide antibody', 'B': 'Antideoxyribonuclease antibody', 'C': 'Antiglomerular basement membrane antibody', 'D': 'Antimyeloperoxidase antibody', 'E': 'Antiproteinase 3 antineutrophil cytoplasmic antibody'},
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E: Antiproteinase 3 antineutrophil cytoplasmic antibody
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Q:A 66-year-old man is brought to the emergency department 1 hour after the abrupt onset of painless loss of vision in his left eye. Over the last several years, he has noticed increased blurring of vision; he says the blurring has made it difficult to read, but he can read better if he holds the book below or above eye level. He has smoked 1 pack of cigarettes daily for 40 years. Fundoscopic examination shows subretinal fluid and small hemorrhage with grayish-green discoloration in the macular area in the left eye, and multiple drusen in the right eye with retinal pigment epithelial changes. Which of the following is the most appropriate pharmacotherapy for this patient's eye condition?? {'A': 'Ustekinumab', 'B': 'Ruxolitinib', 'C': 'Cetuximab', 'D': 'Etanercept', 'E': 'Ranibizumab\n"'},
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E: Ranibizumab "
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Q:A 40-year-old woman comes to the emergency department due to severe right flank pain, fever, chills, and decreased urine output. The vital signs include a temperature of 39.0°C (102.2°F), heart rate of 120/min, a regular breathing pattern, and blood pressure of 128/70 mm Hg. Cardiopulmonary auscultation is normal. In addition, tenderness is elicited by right lumbar percussion. After initiating intravenous antibiotics empirically, the condition of the patient improves significantly. However, a low urine output persists. The results of the ordered laboratory tests are as follows: Urine culture Proteus mirabilis, > 150,000 CFU/mL (normal range: < 100,000 CFU/mL to no bacterial growth in asymptomatic patients) Density 1.030; Leukocyte esterase (+); Nitrites (+) pH 7.8 (normal range: 4.5–8.0) C-reactive protein 60 mg/dL (normal range: 0–10 mg/dL) Serum creatinine 1.8 mg/dL (normal range: 0.6–1.2 mg/dL) BUN 40 mg/dL (normal range: 7–20 mg/dL) Plain abdominal film Complex renal calculus in the right kidney Which of the following is the most likely type of stone the patient has?? {'A': 'Xanthine', 'B': 'Uric acid', 'C': 'Cystine', 'D': 'Struvite', 'E': 'Calcium oxalate'},
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D: Struvite
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Q:A 7-year-old boy is brought to the pediatrician by his parents for a routine checkup. The parents note that the patient recently joined a baseball team and has had trouble keeping up with his teammates and gets short of breath with exertion. The patient has otherwise been healthy and has no known history of asthma or allergic reaction. Today, the patient’s temperature is 98.2°F (36.8°C), blood pressure is 112/72 mmHg, pulse is 70/min, and respirations are 12/min. The physical exam is notable for a heart murmur that decreases when the patient bears down. Additionally, the hand grip and rapid squatting maneuvers increase the severity of the murmur. Which of the following is likely heard on auscultation?? {'A': 'Continuous murmur inferior to the left clavicle', 'B': 'Crescendo-decrescendo systolic murmur radiating to carotids', 'C': 'Holosystolic murmur at the apex radiating to the axilla', 'D': 'Holosystolic murmur at the lower left sternal border', 'E': 'Late systolic murmur with a midsystolic click'},
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D: Holosystolic murmur at the lower left sternal border
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Q:A 21-year-old woman comes to the physician because she had a positive pregnancy test at home. For the past 3 weeks, she has had nausea and increased urinary frequency. She also had three episodes of non-bloody vomiting. She attends college and is on the varsity soccer team. She runs 45 minutes daily and lifts weights for strength training for 1 hour three times per week. She also reports that she wants to renew her ski pass for the upcoming winter season. Her vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following is the most appropriate recommendation?? {'A': 'Continue playing soccer, continue strength training, and do not buy a ski pass', 'B': 'Stop playing soccer, stop strength training, and do not buy a ski pass', 'C': 'Continue playing soccer, stop strength training, and do not buy a ski pass', 'D': 'Stop playing soccer, continue strength training, and buy a ski pass', 'E': 'Stop playing soccer, continue strength training, and do not buy a ski pass'},
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E: Stop playing soccer, continue strength training, and do not buy a ski pass
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Q:A 32-year-old man is brought to the emergency department because of a 2-day history of confusion and rapidly progressive dyspnea. He has had a fever and chills for the past five days. Five years ago, he was diagnosed with hepatitis C. He has smoked two packs of cigarettes daily for 15 years and drinks one to two beers daily. He has a history of past intravenous heroin use. He appears pale, anxious, and in severe distress. His temperature is 39.3°C (102.7°F), respirations are 30/min, pulse is 59/min, and blood pressure is 80/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 75%. Examination shows multiple linear hemorrhages underneath the nails. There are nontender maculae on both palms and soles. Fine rales are heard bilaterally on auscultation of the chest. Cardiac examination shows an S3; a grade 3/6 high-pitched decrescendo early diastolic murmur is heard along the left sternal border and right second intercostal space. An x-ray of the chest shows a normal sized heart and pulmonary edema. An ECG shows P waves and QRS complexes that occur at regular intervals, but independently of each other. A transesophageal echocardiography (TEE) is most likely to show which of the following?? {'A': 'A highly echogenic, thin, linear structure in the right atrium', 'B': 'Anechoic space between pericardium and epicardium', 'C': 'Perivalvular thickening with an echolucent cavity', 'D': 'Oscillating mobile mass on the tricuspid valve', 'E': 'Eccentric hypertrophy of the left ventricle'},
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C: Perivalvular thickening with an echolucent cavity
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Q:A 10-year-old girl is admitted to the medical floor for a respiratory infection. The patient lives in a foster home and has been admitted many times. Since birth, the patient has had repeated episodes of pain/pressure over her frontal sinuses and a chronic cough that produces mucus. She was recently treated with amoxicillin for an infection. The patient is in the 25th percentile for height and weight which has been constant since birth. Her guardians state that the patient has normal bowel movements and has been gaining weight appropriately. The patient has a history of tricuspid stenosis. She also recently had magnetic resonance imaging (MRI) of her chest which demonstrated dilation of her airways. Her temperature is 99.5°F (37.5°C), blood pressure is 90/58 mmHg, pulse is 120/min, respirations are 18/min, and oxygen saturation is 94% on room air. Physical exam is notable for bruises along the patient's shins which the guardians state are from playing soccer. The rest of the exam is deferred because the patient starts crying. Which of the following findings is associated with this patient's most likely underlying diagnosis?? {'A': 'Diastolic murmur best heard along the right lower sternal border', 'B': 'Hypocalcemia', 'C': "Increased chloride in the patient's sweat", 'D': 'Repeat sinus infections secondary to seasonal allergies', 'E': 'Social withdrawal and avoidance of eye contact'},
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A: Diastolic murmur best heard along the right lower sternal border
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Q:A 34-year-old man comes to the physician for a follow-up examination. He has a 3-month history of a nonproductive cough. He has been treated with diphenhydramine since his last visit 2 weeks ago, but his symptoms have persisted. He does not smoke. He drinks 3 beers on the weekends. He is 177 cm (5 ft 10 in) tall and weighs 100 kg (220.46 lbs); BMI is 35.1 kg/m2. His temperature is 37.1°C (98.8°F), pulse is 78/min, respirations are 14/min, and blood pressure is 130/80 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 97%. Physical examination and an x-ray of the chest show no abnormalities. Which of the following is the most appropriate next step in management?? {'A': 'Azithromycin therapy', 'B': 'Pulmonary function testing', 'C': 'Omeprazole therapy', 'D': 'Oral corticosteroid therapy', 'E': 'CT scan of the chest'},
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B: Pulmonary function testing
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Q:A 70-year-old man with a recent above-the-knee amputation of the left lower extremity, due to wet gangrene secondary to refractory peripheral artery disease, presents with weakness and dizziness. He says that the symptoms began acutely 24 hours after surgery and have not improved. The amputation was complicated by substantial blood loss. He was placed on empiric antibiotic therapy with ciprofloxacin and clindamycin before the procedure, and blood and wound culture results are still pending. The medical history is significant for type 2 diabetes mellitus and hypertension. Current medications are metformin and lisinopril. The family history is significant for type 2 diabetes mellitus in both parents. Review of symptoms is significant for palpitations and a mild headache for the past 24 hours. His temperature is 38.2°C (100.8°F); blood pressure, 120/70 mm Hg (supine); pulse, 102/min; respiratory rate, 16/min; and oxygen saturation, 99% on room air. When standing, the blood pressure is 90/65 mm Hg and the pulse is 115/min. On physical examination, the patient appears pale and listless. The surgical amputation site does not show any signs of ongoing blood loss or infection. Laboratory tests and an ECG are pending. Which of the following is the next best step in management?? {'A': 'Administer IV fluids and withhold lisinopril', 'B': 'Administer oral midodrine', 'C': 'Administer oral fludrocortisone', 'D': 'Administer IV norepinephrine', 'E': 'Administer IV fluids'},
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A: Administer IV fluids and withhold lisinopril
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Q:A 31-year-old African American woman presents to her primary care provider complaining of stiff, painful fingers. She reports that her symptoms started 2 years ago and have gradually worsened. Her pain is not relieved by ibuprofen or acetaminophen. She is most concerned about having occasional episodes in which her fingers become extremely painful and turn white then pale blue. Her past medical history is notable for hypertension but she has previously refused to take any medication. She works as a postal worker and spends most of her time outside. Physical examination reveals induration of her digits with loss of skin fold wrinkles. She has limited finger range of motion. She would like to know if she can do anything to address her intermittent finger pain as it is affecting her ability to work outside in the cold. Which of the following medications is most appropriate to address this patient’s concerns?? {'A': 'Ambrisentan', 'B': 'Diltiazem', 'C': 'Enalapril', 'D': 'Methotrexate', 'E': 'Nifedipine'},
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E: Nifedipine
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Q:A 47-year-old woman comes to the physician because of easy bruising and fatigue. She appears pale. Her temperature is 38°C (100.4°F). Examination shows a palm-sized hematoma on her left leg. Abdominal examination shows an enlarged liver and spleen. Her hemoglobin concentration is 9.5 g/dL, leukocyte count is 12,300/mm3, platelet count is 55,000/mm3, and fibrinogen concentration is 120 mg/dL (N = 150–400). Cytogenetic analysis of leukocytes shows a reciprocal translocation of chromosomes 15 and 17. Which of the following is the most appropriate treatment for this patient at this time?? {'A': 'Platelet transfusion', 'B': 'Rituximab', 'C': 'All-trans retinoic acid', 'D': 'Imatinib', 'E': 'Cyclophosphamide'},
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C: All-trans retinoic acid
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Q:A 38-year-old woman presents to her primary care physician for evaluation of 3 months of increasing fatigue. She states that she feels normal in the morning, but that her fatigue gets worse throughout the day. Specifically, she says that her head drops when trying to perform overhead tasks. She also says that she experiences double vision when watching television or reading a book. On physical exam, there is right-sided ptosis after sustaining upward gaze for a 2 minutes. Which of the following treatments may be effective in treating this patient's diagnosis?? {'A': 'Antitoxin', 'B': 'Chemotherapy', 'C': 'Riluzole', 'D': 'Thymectomy', 'E': 'Vaccination'},
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D: Thymectomy
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Q:A 20-year-old male is brought to a psychiatrist by his parents for bizarre behavior. His parents report that over the past two semesters in school, his personality and behavior have changed noticeably. He refuses to leave his room because he believes people are spying on him. He hears voices that are persecutory and is convinced that people at school have chips implanted in their brains to spy on him. Screenings for depression and mania are negative. His past medical history is unremarkable. His family history is notable for a maternal uncle with bipolar disorder. He does not drink alcohol or smoke. His temperature is 98.8°F (37.1°C), blood pressure is 115/70 mmHg, pulse is 85/min, and respirations are 18/min. On examination, he appears to be responding to internal stimuli. Which of the following pathways is primarily responsible for these symptoms?? {'A': 'Mesolimbic pathway', 'B': 'Mesocortical pathway', 'C': 'Nigrostriatal pathway', 'D': 'Tuberoinfundibular pathway', 'E': 'Papez circuit'},
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A: Mesolimbic pathway
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Q:A 51-year-old man comes to the physician because of a 3-month history of diffuse perineal and scrotal pain. On a 10-point scale, he rates the pain as a 5 to 6. He reports that during this time he also has pain during ejaculation and dysuria. He did not have fever. The pain is persistent despite taking over-the-counter analgesics. He has smoked one pack of cigarettes daily for 20 years. He appears healthy and well nourished. Vital signs are within normal limits. Abdominal and scrotal examination shows no abnormalities. Rectal examination shows a mildly tender prostate without asymmetry or induration. Laboratory studies show: Hemoglobin 13.2 g/dL Leukocyte count 5000/mm3 Platelet count 320,000/mm3 Urine RBC none WBC 4-5/hpf A urine culture is negative. Analysis of expressed prostatic secretions shows 6 WBCs/hpf (N <10). Scrotal ultrasonography shows no abnormalities. Which of the following is the most likely diagnosis?"? {'A': 'Prostatic abscess', 'B': 'Benign prostatic hyperplasia', 'C': 'Chronic pelvic pain syndrome', 'D': 'Chronic epididymitis', 'E': 'Bladder neck cancer'},
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C: Chronic pelvic pain syndrome
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Answer the following medical question with one of the provided options:
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Q:A 57-year-old man presents to the emergency department for evaluation of slurred speech and left arm and leg weakness over the last 3 hours. History reveals hypertension that is being treated with hydrochlorothiazide. Vital signs include: blood pressure of 110/70 mm Hg, heart rate 104/min, respiratory rate 18/min, and temperature 36.6°C (98.0°F). Physical examination reveals 2/5 strength in both left upper and lower extremities. After 2 hours, the patient’s symptoms suddenly disappear. An electrocardiogram (ECG) is obtained (see image). Which of the following medications could prevent ischemic attacks in this patient in the future?? {'A': 'Acetylsalicylic acid', 'B': 'Clopidogrel', 'C': 'Enoxaparin', 'D': 'Heparin', 'E': 'Warfarin'},
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E: Warfarin
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Q:A 36-year-old man was sent to the Emergency Department after a stray baseball hit him in the left eye during a game. Paramedics on sight could not perform the necessary testing and encouraged the patient to visit an ED for further testing and imaging. At the Emergency Department, the patient complains of slight pain in the orbital region and minimal diplopia that mildly increases with upward gaze. The patient’s blood pressure is 110/60 mm Hg, heart rate is 53/min, respiratory rate is 13/min, and temperature 36.6℃ (97.9℉). On physical examination, the patient is alert and responsive. There is an ecchymosis involving the lower lid and infraorbital area on the left side, with a slight downward deviation of the left globe, and conjunctival injection of the left eye. An upward gaze is limited on the left side. The visual acuity is 5/20 bilaterally. A head and neck CT shows a small (0.4 cm), nondisplaced, linear fracture of the left orbital floor. Which of the following statements about the condition the patient presents with is the most accurate?? {'A': 'The patient’s condition warrants emergency surgery.', 'B': 'MRI is the best method to evaluate the patient’s condition.', 'C': 'There is a low chance of spontaneous improvement of the ocular motility.', 'D': 'The patient can be initially managed conservatively with corticosteroids and observation.', 'E': 'Surgical intervention within 3 days would allow to prevent enophthalmos in this patient.'},
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D: The patient can be initially managed conservatively with corticosteroids and observation.
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Q:A 37-year-old primigravid woman at 36 weeks' gestation is admitted to the hospital 30 minutes after the onset of labor. On arrival, contractions occur every 8–10 minutes. During the last 2 days she has noted decreased fetal movements. The pregnancy had been complicated by gestational hypertension. Current medications include labetalol and a pregnancy multivitamin. Her temperature is 36.8°C (98.2°F), pulse is 94/min, and blood pressure is 154/96 mm Hg. On pelvic examination, the cervix is 40% effaced and 2 cm dilated; the vertex is at -2 station. The uterus is consistent in size with a 30-week gestation. Ultrasonography shows the fetus in vertex position and a decreased amount of amniotic fluid. A fetal heart tracing is shown. Which of the following is the most likely diagnosis?? {'A': 'Umbilical cord prolapse', 'B': 'Umbilical cord compression', 'C': 'Physiologic fetal heart rate pattern', 'D': 'Placental insufficiency', 'E': 'Chorioamnionitis'},
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D: Placental insufficiency
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Q:A 2-year-old male presents to the pediatrician for abdominal pain. The patient’s parents report that he has been experiencing intermittent abdominal pain for two days. Each episode lasts several minutes, and the patient seems to be entirely well between the episodes. The pain seems to improve when the patient squats on the ground with his knees to his chest. The patient’s parents also endorse decreased appetite for two days and report that his last bowel movement was yesterday. Three days ago, the patient had two episodes of blood-streaked stools, which then seemed to resolve. His parents were not concerned at the time because the patient did not seem to be in any pain. They deny any other recent upper respiratory or gastrointestinal symptoms. The patient’s past medical history is otherwise unremarkable. His temperature is 98.2°F (36.8°C), blood pressure is 71/53 mmHg, pulse is 129/min, and respirations are 18/min. The patient is happily playing in his mother’s lap. His abdomen is soft and non-distended, and he is diffusely tender to palpation over the entire right side. A 2x4 cm cylindrical mass can be palpated in the right upper quadrant. Which of the following is most likely to be found in this patient?? {'A': 'Henoch-Schonlein purpura', 'B': 'Hypertrophy of Peyer’s patches', 'C': 'Positive stool culture', 'D': 'Positive technetium-99m scan', 'E': 'Resolution with dietary modification'},
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D: Positive technetium-99m scan
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Q:A 41-year-old female complains of frequent diarrhea and abdominal pain between meals. Endoscopy reveals a duodenal ulcer distal to the duodenal bulb. CT scan of the abdomen demonstrates a pancreatic mass, and subsequent tissue biopsy of the pancreas reveals a malignant islet cell tumor. Which of the following hormones is likely to be markedly elevated in this patient:? {'A': 'Gastrin', 'B': 'Cholecystokinin', 'C': 'Secretin', 'D': 'Vasoactive intestinal peptide', 'E': 'Motilin'},
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A: Gastrin
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Q:A 9-year-old boy is brought to the physician by his father, who is concerned because his son has been less interested in playing soccer with him recently. The father and son used to play every weekend, but the son now tires easily and complains of pain in his lower legs while running around on the soccer field. The patient has no personal or family history of serious illness. Cardiac examination reveals a systolic ejection murmur best heard over the left sternal border that radiates to the left paravertebral region. A chest X-ray shows erosions on the posterior aspects of the 6th to 8th ribs. If left untreated, this patient is at the greatest risk for which of the following?? {'A': 'Abdominal aortic aneurysm', 'B': 'Central cyanosis', 'C': 'Intracranial hemorrhage', 'D': 'Paradoxical embolism', 'E': 'Right heart failure'},
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C: Intracranial hemorrhage
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Answer the following medical question with one of the provided options:
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Q:A 58-year-old woman presents to the physician with a cough that began 6 years ago, as well as intermittent difficulty in breathing for the last year. There is no significant sputum production. There is no history of rhinorrhea, sneezing or nose congestion. She has been a chronic smoker from early adulthood. Her temperature is 36.9°C (98.4°F), the heart rate is 80/min, the blood pressure is 128/84 mm Hg, and the respiratory rate is 22/min. A physical examination reveals diffuse end-expiratory wheezing with prolonged expiration on chest auscultation; breath sounds and heart sounds are diminished. There is no cyanosis, clubbing or lymphadenopathy. Her chest radiogram shows hyperinflated lungs bilaterally and a computed tomography scan of her chest is shown in the picture. Which of the following best describes the pathogenesis of the condition of this patient?? {'A': 'Infiltration of the lower airway mucosa by activated eosinophils and T lymphocytes', 'B': 'Increased release of matrix metalloproteinase 12 (MMP-12) by neutrophils', 'C': 'Structural cell death mediated by Rtp801', 'D': 'Depletion of the periciliary fluid layer in airway cells', 'E': 'Activation of histone deacetylase-2'},
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C: Structural cell death mediated by Rtp801
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Answer the following medical question with one of the provided options:
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Q:An 82-year-old man presents to the emergency department complaining of vision loss in his left eye. He states that it suddenly appeared as if a curtain was coming down over his left eye. It resolved after five minutes, and his vision has returned to normal. He has a history of coronary artery disease and type 2 diabetes. What is the most likely cause of this patient's presentation?? {'A': 'Sclerosis and narrowing of retinal vessels', 'B': 'Deposition of retinal metabolism byproducts', 'C': 'Increased intraocular pressure due to a defect in the drainage of aqueous humor', 'D': 'lnflammation of the optic nerve', 'E': 'Cholesterol plaque embolization'},
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E: Cholesterol plaque embolization
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Answer the following medical question with one of the provided options:
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Q:A 55-year-old woman presents with symptoms of rectal bleeding and pruritus in the perianal region. She works as a real estate agent and has a history of gastroesophageal reflux disease (GERD). On physical examination, her spleen and liver are enlarged. A blood smear reveals teardrop red blood cells (RBCs), and a leucoerythroblastic picture with the presence of nucleated RBC precursors and immature myeloid cells. A complete blood count shows a normocytic anemia. The physician explains that her condition is due to a JAK2 mutation in one of her chromosomes. What is a characteristic bone marrow aspirate of this condition?? {'A': 'Hypercellular with numerous abnormal megakaryocytes', 'B': 'Hypercellular bone marrow with fibrosis in later stages', 'C': 'Ringed sideroblasts and < 20% of myeloblasts', 'D': 'Fibrous tissue with sclerotic spicules observed in early stages', 'E': 'Hypocellular bone marrow'},
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D: Fibrous tissue with sclerotic spicules observed in early stages
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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 is being evaluated due to complaint of fatigue and voiding pink urine. The laboratory results are as follows: Hb 6.7 Red blood cell count 3.0 x 1012/L Leukocyte count 5,000/mm3 Platelets 170 x 109/L Reticulocyte count 6% Hematocrit 32% The physician thinks that the patient is suffering from an acquired mutation in hematopoietic stem cells, which is confirmed by flow cytometry analysis that revealed these cells are CD 55 and CD 59 negative. However, the physician is interested in knowing the corrected reticulocyte count before starting the patient on eculizumab. What value does the physician find after calculating the corrected reticulocyte count?? {'A': '0.4%', 'B': '0.6%', 'C': '3.1%', 'D': '4.6%', 'E': '0.1%'},
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D: 4.6%
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Answer the following medical question with one of the provided options:
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Q:A 30-year-old woman presents to the clinic for a 3-month history of painful hair loss. She was in her usual state of health until about 3 months ago when she started to develop some painfully itchy spots across her scalp. Since that time these spots have lost hair and scarred, with new spots continuing to form. On further questioning, she shares that, for the last couple of years, she has generally felt poorly, specifically noting intermittent fevers, muscle and joint pains, and fatigue. On physical exam, she has several erythematous and scaly plaques across her scalp. These areas have no hair growth, but some do demonstrate hyperpigmentation. Which of the following is the most likely diagnosis?? {'A': 'Alopecia areata', 'B': 'Discoid lupus erythematosus (DLE)', 'C': 'Secondary syphilis', 'D': 'Tinea capitis', 'E': 'Trichotillomania'},
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B: Discoid lupus erythematosus (DLE)
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Answer the following medical question with one of the provided options:
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Q:A 60-year-old woman presents to the physician because of shortness of breath and easy fatigability over the past 3 months. Her symptoms become worse with physical activity. She notes no chest pain, cough, or wheezing. Her last menstrual period was 10 years ago. She currently takes calcium and vitamin D supplements as well as a vaginal estrogen cream. For several years, her diet has been poor, as she often does not feel like eating. The patient’s medical history is otherwise unremarkable. She works as a piano teacher at the local community center. She does not use tobacco or illicit drugs and enjoys an occasional glass of red wine with dinner. Her vital signs include: pulse 100/min, respiratory rate 16/min, and blood pressure 140/84 mm Hg. Physical examination reveals impaired vibratory sensation in the legs. Pallor is evident on her hands. Which of the following laboratory tests is expected to be abnormal in this patient?? {'A': 'Erythrocyte glutathione reductase activity', 'B': 'Erythrocyte pyruvate kinase activity', 'C': 'Serum folate level', 'D': 'Serum methylmalonic acid level', 'E': 'Serum protoporphyrin level'},
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D: Serum methylmalonic acid level
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