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Answer the following medical question with one of the provided options: | Q:An 80-year-old woman seeks evaluation at an outpatient clinic for a firm nodular lump on the left side of her labia. The medical history is notable for hypertension, coronary artery disease status post CABG, and lichen sclerosus of the vagina that was treated with an over-the-counter steroid cream as needed. She first noticed the lump about 5 months ago. On physical examination, the temperature is 37°C (98.6°F), the blood pressure is 135/89 mm Hg, the pulse is 95/min, and the respiratory rate is 17/min. Examination of the genital area reveals a small nodular lump on the left labium majus with visible excoriations, but no white plaque-like lesions. What is the next best step in management?? {'A': 'HPV DNA testing', 'B': 'Estrogen level measurement', 'C': 'Pap smear', 'D': 'Vulvar punch biopsy', 'E': 'Potassium hydroxide test after scraping of the lesion'}, | D: Vulvar punch biopsy |
Answer the following medical question with one of the provided options: | Q:A 75-year-old male is hospitalized for bloody diarrhea and abdominal pain after meals. Endoscopic work-up and CT scan lead the attending physician to diagnose ischemic colitis at the splenic flexure. Which of the following would most likely predispose this patient to ischemic colitis:? {'A': 'Increased splanchnic blood flow following a large meal', 'B': 'Essential hypertension', 'C': 'Obstruction of the abdominal aorta following surgery', 'D': 'Hyperreninemic hyperaldosteronism secondary to type II diabetes mellitus', 'E': 'Juxtaglomerular cell tumor'}, | C: Obstruction of the abdominal aorta following surgery |
Answer the following medical question with one of the provided options: | Q:Two days following the home birth of her son, a mother brings the infant to the pediatric emergency room because of bilious vomiting. He is unable to pass meconium and his abdomen is distended. Endoscopic biopsy of the proximal colon demonstrates an absence of Meissner’s and Auerbach’s plexi in the bowel wall. Which of the following is the most likely diagnosis?? {'A': 'Hirschsprung’s disease', 'B': 'Ileocecal intussusception', 'C': 'Meckel’s diverticulum', 'D': 'Juvenile polyposis syndrome', 'E': 'Volvulus of the sigmoid colon'}, | A: Hirschsprung’s disease |
Answer the following medical question with one of the provided options: | Q:A 49-year-old man comes to the physician because of a 6-month history of increasing fatigue and reduced libido. He also complains of joint pain in both of his hands. His vital signs are within normal limits. Physical examination shows tanned skin and small testes. The second and third metacarpophalangeal joints of both hands are tender to palpation and range of motion is limited. The liver is palpated 2 to 3 cm below the right costal margin. Histopathologic examination of a liver biopsy specimen shows intracellular material that stains with Prussian blue. This patient is at greatest risk for developing which of the following complications?? {'A': 'Colorectal carcinoma', 'B': 'Restrictive cardiomyopathy', 'C': 'Rheumatoid arthritis', 'D': 'Pancreatic adenocarcinoma', 'E': 'Non-Hodgkin lymphoma'}, | B: Restrictive cardiomyopathy |
Answer the following medical question with one of the provided options: | Q:A general surgery intern is paged to the bedside of a 59-year-old male who underwent a successful sigmoidectomy for treatment of recurrent diverticulitis. The patient's nurse just recorded a temperature of 38.7 C, and relates that the patient is complaining of chills. The surgery was completed 8 hours ago and was complicated by extensive bleeding, with an estimated blood loss of 1,700 mL. Post-operative anemia was diagnosed after a hemoglobin of 5.9 g/dL was found; 2 units of packed red blood cells were ordered, and the transfusion was initiated 90 minutes ago. The patient's vital signs are as follows: T 38.7 C, HR 88, BP 138/77, RR 18, SpO2 98%. Physical examination does not show any abnormalities. After immediately stopping the transfusion, which of the following is the best management of this patient's condition?? {'A': 'Hydrate with 1 L bolus of normal saline followed by maintenance fluids at 125 cc/hr', 'B': 'Monitor patient and administer acetaminophen', 'C': 'Prescribe diphenhydramine', 'D': 'Start supplemental oxygen by nasal cannula', 'E': 'Initiate broad spectrum antibiotics'}, | B: Monitor patient and administer acetaminophen |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man presents to the emergency department with anxiety. The patient states that he is very anxious and has not been able to take his home anxiety medications. He is requesting to have his home medications administered. The patient has a past medical history of anxiety and depression. His current medications include clonazepam, amitriptyline, and lorazepam. Notably, the patient has multiple psychiatric providers who currently care for him. His temperature is 99.2°F (37.3°C), blood pressure is 130/85 mmHg, pulse is 112/min, respirations are 22/min, and oxygen saturation is 100% on room air. Physical exam is notable for an anxious, sweating, and tremulous young man who becomes more confused during his stay in the emergency department. Which of the following should be given to this patient?? {'A': 'Diazepam', 'B': 'Flumazenil', 'C': 'Midazolam', 'D': 'Sodium bicarbonate', 'E': 'Supportive therapy and monitoring'}, | A: Diazepam |
Answer the following medical question with one of the provided options: | Q:An 18-year-old female returning from a trip to a developing country presents with diarrhea and pain in the abdominal region. Microscopic evaluation of the stool reveals the presence of RBC's and WBC's. The patient reports poor sewage sanitation in the region she visited. The physician suspects a bacterial infection and culture reveals Gram-negative rods that are non-lactose fermenting. The A subunit of the bacteria's toxin acts to:? {'A': 'Inhibit the 60S ribosome', 'B': 'Lyse red blood cells', 'C': 'Prevent phagocytosis', 'D': 'Inhibit exocytosis of ACh from synaptic terminals', 'E': 'ADP-ribosylate the Gs protein'}, | A: Inhibit the 60S ribosome |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man with a recent diagnosis of peptic ulcer disease currently treated with an oral proton pump inhibitor twice daily presents to the urgent care center complaining of acute abdominal pain which began suddenly less than 2 hours ago. On physical exam, you find his abdomen to be mildly distended, diffusely tender to palpation, and positive for rebound tenderness. Given the following options, what is the next best step in patient management?? {'A': 'Abdominal radiographs', 'B': 'Urgent CT abdomen and pelvis', 'C': 'Upper endoscopy', 'D': 'H. pylori testing', 'E': 'Serum gastrin level'}, | B: Urgent CT abdomen and pelvis |
Answer the following medical question with one of the provided options: | Q:A 31-year-old male presents to the emergency room following an altercation with patrons at a local grocery store. He is acting aggressively toward hospital staff and appears to be speaking to non-existent individuals. On examination he is tachycardic and diaphoretic. Horizontal and vertical nystagmus is noted. The patient eventually admits to taking an illegal substance earlier in the evening. Which of the following mechanisms of action is most consistent with the substance this patient took?? {'A': 'Adenosine antagonist', 'B': 'Biogenic amine reuptake inhibitor', 'C': 'Mu receptor agonist', 'D': 'GABA agonist', 'E': 'NMDA receptor antagonist'}, | E: NMDA receptor antagonist |
Answer the following medical question with one of the provided options: | Q:A 29-year-old female presents to her primary care provider complaining of pain and stiffness in her hands and knees. She reports that the stiffness is worse in the morning and appears to get better throughout the day. She is otherwise healthy and denies any recent illness. She does not play sports. On examination, her metacarpal-phalangeal (MCP) and proximal interphalangeal (PIP) joints are swollen and erythematous. Her distal interphalangeal (DIP) joints appear normal. She exhibits pain with both passive and active range of motion in her knees bilaterally. Serological analysis reveals high titers of anti-cyclic citrullinated peptide antibodies. Which of the following processes underlies this patient’s condition?? {'A': 'Precipitation of monosodium urate crystals in the intra-articular space', 'B': 'Post-infectious inflammation of the articular surfaces', 'C': 'Aseptic necrosis of articular cartilage and subchondral bone', 'D': 'Degenerative deterioration of articular cartilage', 'E': 'Synovial hypertrophy and pannus formation'}, | E: Synovial hypertrophy and pannus formation |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man presents for severe abdominal pain and is diagnosed with appendicitis. He is taken for emergent appendectomy. During the procedure, the patient has massive and persistent bleeding requiring a blood transfusion. The preoperative laboratory studies showed a normal bleeding time, normal prothrombin time (PT), an INR of 1.0, and a normal platelet count. Postoperatively, when the patient is told about the complications during the surgery, he recalls that he forgot to mention that he has a family history of an unknown bleeding disorder. The postoperative laboratory tests reveal a prolonged partial thromboplastin time (PTT). Which of the following is the most likely diagnosis in this patient?? {'A': 'Hemophilia A', 'B': 'Bernard-Soulier syndrome', 'C': 'Glanzman syndrome', 'D': 'Thrombotic thrombocytopenic purpura', 'E': 'von Willebrand disease'}, | A: Hemophilia A |
Answer the following medical question with one of the provided options: | Q:An 11-year-old girl is brought to the emergency department because of high-grade fever, headache, and nausea for 3 days. She avoids looking at any light source because this aggravates her headache. She has acute lymphoblastic leukemia and her last chemotherapy cycle was 2 weeks ago. She appears lethargic. Her temperature is 40.1°C (104.2°F), pulse is 131/min and blood pressure is 100/60 mm Hg. Examination shows a stiff neck. The pupils are equal and reactive to light. Neck flexion results in flexion of the knee and hip. Muscle strength is decreased in the right upper extremity. Deep tendon reflexes are 2+ bilaterally. Sensation is intact. Extraocular movements are normal. Two sets of blood cultures are obtained. Which of the following is the most appropriate next step in management?? {'A': 'CT scan of the head', 'B': 'MRI of the brain', 'C': 'Antibiotic therapy', 'D': 'Lumbar puncture', 'E': 'Acyclovir therapy\n"'}, | C: Antibiotic therapy |
Answer the following medical question with one of the provided options: | Q:A 49-year-old man presents to a new primary care provider complaining of fatigue and occasional fever over the last month. These symptoms are starting to affect his job and he would like treatment. The physician runs a standard metabolic panel that shows elevated AST and ALT. The patient is then tested for hepatitis viruses. He is hepatitis C positive. The patient and his doctor discuss treatment options and agree upon pegylated interferon and oral ribavirin. Which side-effect is most likely while taking the ribavirin?? {'A': 'Hemolytic anemia', 'B': 'Drug-associated lupus', 'C': 'Leukopenia', 'D': 'Hyperthyroidism', 'E': 'Rash'}, | A: Hemolytic anemia |
Answer the following medical question with one of the provided options: | Q:A 45-year-old immigrant presents with unintentional weight loss, sleep hyperhidrosis, and a persistent cough. He says these symptoms have been present for quite some time. Upon imaging, many granulomas in the upper lobes are present. It is noted that these apical granulomas have centers of necrosis that appear cheese-like in appearance. Encircling the area of necrosis are large cells with cytoplasms pale in color. Of the following surface markers, which one is specific for these cells?? {'A': 'CD8', 'B': 'CD4', 'C': 'CD3', 'D': 'CD14', 'E': 'CD20'}, | D: CD14 |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman comes to the emergency room because of fever and severe left knee pain for the past week. She has not sustained any trauma or injury to the area, nor has she traveled or taken part in outdoor activities in the recent past. She is sexually active with one male partner, and they use condoms inconsistently. She appears ill. Her temperature is 38°C (100.4°F), pulse is 98/min, respirations are 17/min, and blood pressure is 106/72 mm Hg. Physical examination shows multiple painless pustular lesions on her ankles and the dorsum and soles of her feet bilaterally, as well as a swollen, erythematous, exquisitely tender left knee. Her wrists are also mildly edematous and tender, with pain on extension. X-ray of the knees shows tissue swelling. Arthrocentesis of the knee shows yellow purulent fluid. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 58,000/mm3 with 93% neutrophils and no crystals. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Oral penicillin V', 'B': 'Oral hydroxychloroquine', 'C': 'Intramuscular ceftriaxone and oral azithromycin', 'D': 'Oral doxycycline', 'E': 'Intramuscular ceftriaxone'}, | C: Intramuscular ceftriaxone and oral azithromycin |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man presents with restlessness and an inability to sit or lie down for the past 2 days. Past medical history is significant for schizophrenia, diagnosed 3 weeks ago and managed medically. Vital signs are a blood pressure of 140/90 mm Hg and a pulse of 96/min. On physical examination, the patient is fidgety and anxious but well-oriented. Which of the following is the most likely diagnosis in this patient?? {'A': 'Psychotic agitation', 'B': 'Essential tremor', 'C': 'Acute muscular dystonia', 'D': 'Drug-induced parkinsonism', 'E': 'Akathisia'}, | E: Akathisia |
Answer the following medical question with one of the provided options: | Q:In a previous experiment infecting hepatocytes, it was shown that viable HDV virions were only produced in the presence of a co-infection with HBV. To better understand which HBV particle was necessary for the production of viable HDV virions, the scientist encoded in separate plasmids the various antigens/proteins of HBV and co-infected the hepatocytes with HDV. In which of the experiments would viable HDV virions be produced in conjunction with the appropriate HBV antigen/protein?? {'A': 'HBsAg', 'B': 'HBV DNA polymerase', 'C': 'HBcAg', 'D': 'HBV RNA polymerase', 'E': 'HBeAg'}, | A: HBsAg |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman presents to her primary care physician for a routine check-up. Physical examination demonstrates asymmetric peripheral neuropathy in her feet. The patient has no previous relevant history and denies any symptoms of diabetes. Routine blood work shows normal results, and she is referred to a hematologist. Subsequent serum protein electrophoresis demonstrates a slightly elevated gamma globulin level, and monoclonal gammopathy of undetermined significance is diagnosed. Which of the following diseases is most likely to develop over the course of this patient’s condition?? {'A': 'Waldenström macroglobulinemia', 'B': 'Multiple myeloma', 'C': 'Acute myelocytic leukemia', 'D': 'Chronic lymphocytic leukemia', 'E': 'Chronic myelocytic leukemia'}, | B: Multiple myeloma |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man presents to his primary care physician because he is increasingly troubled by a tremor in his hands. He says that the tremor is worse when he is resting and gets better when he reaches for objects. His wife reports that he has been slowing in his movements and also has difficulty starting to walk. His steps have been short and unsteady even when he is able to initiate movement. Physical exam reveals rigidity in his muscles when tested for active range of motion. Histology in this patient would most likely reveal which of the following findings?? {'A': 'Alpha-synuclein', 'B': 'Intracellular hyperphosphorylated tau', 'C': 'Hyperphosphorylated tau inclusion bodies', 'D': 'Large intracellular vacuoles', 'E': 'Perivascular inflammation'}, | A: Alpha-synuclein |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man is brought to the emergency department while on vacation with a history of sudden onset vertigo and difficulty walking. He was in normal health since starting his vacation a week ago, but today he is suffering from a loss of balance, mild headache, and has had 5–6 episodes of vomiting over the last few hours. He denies fever, neck pain, head trauma, weakness, and diplopia. Past medical history is significant for hypertension and dyslipidemia. His medications include valsartan and atorvastatin, but he missed several doses since leaving for this trip. Blood pressure is 198/112 mm Hg, the heart rate is 76/min, the respiratory rate is 16/min, and the temperature is 37.0°C (98.6°F). The patient is awake and oriented to time, place, and person. Extraocular movements are within normal limits. Muscle strength is normal in all 4 extremities. An urgent head CT is ordered and shown in the picture. What additional clinical features be expected in this patient?? {'A': 'Inability to comprehend commands', 'B': 'Inability to perform repetitive alternating movements', 'C': 'Inability to speak fluently', 'D': 'Right-sided neglect', 'E': 'Right-sided visual field loss'}, | B: Inability to perform repetitive alternating movements |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man presents with painless swelling of the neck over the past week. He also has noted severe night sweats, which require a change of clothes and bed linens the next day. His medical history is significant for long-standing hypertension. He received a kidney transplant 6 years ago. His current medications include amlodipine, metoprolol, furosemide, aspirin, tacrolimus, and mycophenolate. His family history is significant for his sister, who died last year from lymphoma. A review of systems is positive for a 6-kg (13.2-lb) unintentional weight loss over the past 2 months. His vital signs include: temperature 37.8℃ (100.0℉) and blood pressure 120/75 mm Hg. On physical examination, there are multiple painless lymph nodes, averaging 2 cm in diameter, palpable in the anterior and posterior triangles of the neck bilaterally. Axillary and inguinal lymphadenopathy is palpated on the right side. Abdominal examination is significant for a spleen of 16 cm below the cost margin on percussion. Laboratory studies are significant for the following: Hemoglobin 9 g/dL Mean corpuscular volume 88 μm3 Leukocyte count 12,000/mm3 Platelet count 130,000/mm3 Creatinine 1.1 mg/dL Lactate dehydrogenase (LDH) 1 000 U/L A peripheral blood smear is unremarkable. Which of the following is the most likely diagnosis in this patient?? {'A': 'Chronic lymphocytic leukemia (CLL)', 'B': 'Drug-induced lymphadenopathy', 'C': 'Cytomegalovirus infection', 'D': 'Multiple myeloma', 'E': 'Non-Hodgkin’s lymphoma (NHL)'}, | E: Non-Hodgkin’s lymphoma (NHL) |
Answer the following medical question with one of the provided options: | Q:A 56-year-old man is brought to the emergency department by his neighbor 2 hours after ingesting an unknown substance in a suicide attempt. He is confused and unable to provide further history. His temperature is 39.1°C (102.3°F), pulse is 124/min, respiratory rate is 12/min, and blood pressure is 150/92 mm Hg. His skin is dry. Pupils are 12 mm and minimally reactive. An ECG shows no abnormalities. Which of the following is the most appropriate treatment for this patient's condition?? {'A': 'Sodium bicarbonate', 'B': 'Physostigmine', 'C': 'N-acetylcysteine', 'D': 'Glucagon', 'E': 'Flumazenil'}, | B: Physostigmine |
Answer the following medical question with one of the provided options: | Q:An 81-year-old man presents to his primary care physician for his yearly exam. His past medical history is significant for osteopenia, nephrolithiasis, and hypertension. His family history is significant for relatives who had early onset kidney failure. He takes occasional acetaminophen and supplemental calcium/vitamin D. He is physically active with a normal body mass index (BMI) and has no current concerns. Review of his laboratory results today were compared with those from 15 years ago with the following findings: Results today: Serum creatinine concentration: 1.1 mg/dL Urine creatinine concentration: 100 mg/dL Urine volume: 1000 mL/day Results 15 years ago: Serum creatinine concentration: 1.1 mg/dL Urine creatinine concentration: 120 mg/dL Urine volume: 1000 mL/day Which is the most likely cause of these changes in his creatinine clearance?? {'A': 'Benign prostatic hyperplasia', 'B': 'Nephrolithiasis', 'C': 'Normal aging', 'D': 'Polycystic kidney disease', 'E': 'Renovascular disease'}, | C: Normal aging |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care provider complaining of fatigue, mild headache, and discomfort with chewing for roughly 1 week. Before this, he felt well overall, but now is he is quite bothered by these symptoms. His medical history is notable for hypertension and hyperlipidemia, both controlled. On examination, he is uncomfortable but nontoxic-appearing. There is mild tenderness to palpation over his right temporal artery, but otherwise the exam is not revealing. Prompt recognition and treatment can prevent which of the following feared complications:? {'A': 'Renal failure', 'B': 'Blindness', 'C': 'Pericarditis', 'D': 'Pulmonary fibrosis', 'E': 'Cognitive impairment'}, | B: Blindness |
Answer the following medical question with one of the provided options: | Q:A 14-month-old boy is brought to the clinic for evaluation of a rash. The rash started on the face and spread to the trunk. He also had a fever and cough for the past 2 days. His mother says that they recently immigrated from Asia and cannot provide vaccination records. The physical examination reveals a maculopapular rash on the face, trunk, and proximal limbs with no lymphadenopathy. Blue-white spots are noted on the oral mucosa and there is bilateral mild conjunctival injection. The causative agent of this condition belongs to which of the following virus families?? {'A': 'ssDNA enveloped viruses', 'B': 'dsRNA enveloped viruses', 'C': 'ssRNA naked viruses', 'D': 'dsRNA naked viruses', 'E': 'ssRNA enveloped viruses'}, | E: ssRNA enveloped viruses |
Answer the following medical question with one of the provided options: | Q:A 31-year-old G1P0 woman at 26 weeks gestation presents to the clinic for evaluation of an abnormal glucose tolerance test. She denies any symptoms, but states that she was given 50 g of oral glucose 1 week earlier and demonstrated a subsequent venous plasma glucose level of 156 mg/dL 1 hour later. The vital signs are: blood pressure, 112/78 mm Hg; pulse, 81/min; and respiratory rate, 16/min. Physical examination is within normal limits. Which of the following is the most appropriate next step in management?? {'A': 'Repeat the 50 g oral glucose challenge', 'B': 'Administer an oral, 3-hour 100 g glucose dose', 'C': 'Advise the patient to follow an American Diabetic Association diet plan', 'D': 'Begin insulin treatment', 'E': 'Order a fetal ultrasound examination'}, | B: Administer an oral, 3-hour 100 g glucose dose |
Answer the following medical question with one of the provided options: | Q:A newborn of a mother with poor antenatal care is found to have a larger than normal head circumference with bulging fontanelles. Physical examination reveals a predominant downward gaze with marked eyelid retraction and convergence-retraction nystagmus. Ultrasound examination showed dilated lateral ventricles and a dilated third ventricle. Further imaging studies reveal a solid mass in the pineal region. Which of the following is the most likely finding for this patient?? {'A': 'Normal lumbar puncture opening pressure', 'B': 'Stenotic intraventricular foramina', 'C': 'Dilated cisterna magna', 'D': 'Compression of periaqueductal grey matter', 'E': 'Hypertrophic arachnoid granulations'}, | D: Compression of periaqueductal grey matter |
Answer the following medical question with one of the provided options: | Q:A 22-year-old man comes to the physician because of a progressive swelling and pain in his right ring finger for the past 2 days. The pain began while playing football, when his finger got caught in the jersey of another player who forcefully pulled away. Examination shows that the right ring finger is extended. There is pain and swelling at the distal interphalangeal joint. When the patient is asked to make a fist, his right ring finger does not flex at the distal interphalangeal joint. There is no joint laxity. Which of the following is the most likely diagnosis?? {'A': 'Rupture of the flexor digitorum profundus tendon at its point of insertion', 'B': 'Closed fracture of the distal phalanx', 'C': 'Rupture of the extensor digitorum tendon at its point of insertion', 'D': 'Inflammation of the flexor digitorum profundus tendon sheath', 'E': 'Slipping of the central band of the extensor digitorum tendon'}, | A: Rupture of the flexor digitorum profundus tendon at its point of insertion |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man comes to the physician for a routine checkup. He has had a progressively increasing swelling on the nape of his neck for 2 months. He does not have a fever or any discharge from the swelling. He underwent a colectomy for colon cancer at the age of 43 years. He has type 2 diabetes mellitus, hypertension, and osteoarthritis of the left knee. Current medications include insulin glargine, metformin, enalapril, and naproxen. He has worked as a traffic warden for the past 6 years and frequently plays golf. He appears healthy. His temperature is 37.3°C (99.1°F), pulse is 88/min, and blood pressure is 130/86 mm Hg. Examination of the neck shows a 2.5-cm (1-in) firm, mobile, and painless nodule. The skin over the nodule cannot be pinched. The lungs are clear to auscultation. The remainder of the examination shows no abnormalities. A photograph of the lesion is shown. Which of the following is the most likely diagnosis?? {'A': 'Actinic keratosis', 'B': 'Epidermoid cyst', 'C': 'Dermatofibroma', 'D': 'Lipoma', 'E': 'Squamous cell carcinoma\n"'}, | B: Epidermoid cyst |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the physician because of a 3-day history of fever, chills, headache, and fatigue. He appears ill. His temperature is 39°C (102.2°F). Analysis of nasal secretions shows infection with an enveloped, single-stranded segmented RNA virus. In response to infection with this pathogen, certain cells present antigens from the pathogen to CD8+ T-lymphocytes. Which of the following statements about the molecules used for the presentation of these antigens is most accurate?? {'A': 'The antigens are loaded onto the molecule within lysosomes', 'B': 'The molecule consists of a heavy chain associated with β2 microglobulin', 'C': 'The molecule is made up of 2 chains of equal length', 'D': 'The molecule is selectively expressed by antigen-presenting cells', 'E': 'The molecule is a product of the HLA-DP, HLA-DQ, and -DR genes'}, | B: The molecule consists of a heavy chain associated with β2 microglobulin |
Answer the following medical question with one of the provided options: | Q:A 58-year-old female, being treated on the medical floor for community-acquired pneumonia with levofloxacin, develops watery diarrhea. She reports at least 9 episodes of diarrhea within the last two days, with lower abdominal discomfort and cramping. Her temperature is 98.6° F (37° C), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her physical examination is unremarkable. Laboratory testing shows: Hb% 13 gm/dL Total count (WBC): 13,400/mm3 Differential count: Neutrophils: 80% Lymphocytes: 15% Monocytes: 5% ESR: 33 mm/hr What is the most likely diagnosis?? {'A': 'Ulcerative colitis', 'B': 'C. difficile colitis', 'C': 'Irritable bowel syndrome', 'D': 'Osmotic diarrhea', 'E': 'Giardiasis'}, | B: C. difficile colitis |
Answer the following medical question with one of the provided options: | Q:A 7-year-old girl presents to her primary care physician for a routine check-up. The physician allows the medical student to perform a physical examination. The medical student notes hearing impairment as well as the findings show in Figures A and B. Radiographs show indications of multiple old fractures of the humerus that have healed. After questioning the girl’s parents, the medical student learns that in addition, the patient is extremely picky with her food and eats a diet consisting mainly of cereal and pasta. What is the most likely etiology of the patient’s disease?? {'A': 'Decreased bone mineral density', 'B': 'Defective mineralization of cartilage', 'C': 'Deficiency of type 1 collagen', 'D': 'Dietary deficiency of ascorbic acid', 'E': 'Non-accidental trauma'}, | C: Deficiency of type 1 collagen |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man comes to the physician because of abdominal pain and foul-smelling, watery diarrhea for several days. He has not had nausea, vomiting, or blood in the stool. He has a history of alcohol use disorder and recently completed a 7-day course of clindamycin for pneumonia. He has not traveled out of the United States. Which of the following toxins is most likely to be involved in the pathogenesis of this patient's symptoms?? {'A': 'Shiga toxin', 'B': 'Cholera toxin', 'C': 'Cereulide toxin', 'D': 'Clostridioides difficile cytotoxin', 'E': 'Alpha toxin'}, | D: Clostridioides difficile cytotoxin |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy presents to the clinic because of monosymptomatic enuresis for the past month. Urinalysis, detailed patient history, and fluid intake, stool, and voiding diary from a previous visit all show no abnormalities. The parent and child are referred for education and behavioral therapy. Enuresis decreases but persists. Both the patient and his mother express concern and want this issue to resolve as soon as possible. Which of the following is the most appropriate next step in management?? {'A': 'Behavioral therapy', 'B': 'DDAVP', 'C': 'Enuresis alarm', 'D': 'Oxybutynin', 'E': 'Reassurance'}, | C: Enuresis alarm |
Answer the following medical question with one of the provided options: | Q:A 32-year-old homeless woman is brought to the emergency department by ambulance 30 minutes after the police found her on the sidewalk. On arrival, she is unresponsive. Her pulse is 76/min, respirations are 6/min, and blood pressure is 110/78 mm Hg. Examination shows cool, dry skin. The pupils are pinpoint and react sluggishly to light. Intravenous administration of a drug is initiated. Two minutes after treatment is started, the patient regains consciousness and her respirations increase to 12/min. The drug that was administered has the strongest effect on which of the following receptors?? {'A': 'M1 receptor', 'B': 'Ryanodine receptor', 'C': 'μ-receptor', 'D': 'GABAA receptor', 'E': '5-HT2A receptor'}, | C: μ-receptor |
Answer the following medical question with one of the provided options: | Q:An infectious disease investigator is evaluating the diagnostic accuracy of a new interferon-gamma-based assay for diagnosing tuberculosis in patients who have previously received a Bacillus Calmette-Guérin (BCG) vaccine. Consenting participants with a history of BCG vaccination received an interferon-gamma assay and were subsequently evaluated for tuberculosis by sputum culture. Results of the study are summarized in the table below. Tuberculosis, confirmed by culture No tuberculosis Total Positive interferon-gamma assay 90 6 96 Negative interferon-gamma assay 10 194 204 Total 100 200 300 Based on these results, what is the sensitivity of the interferon-gamma-based assay for the diagnosis of tuberculosis in this study?"? {'A': '194/200', 'B': '90/100', 'C': '90/96', 'D': '100/300', 'E': '194/204'}, | B: 90/100 |
Answer the following medical question with one of the provided options: | Q:Several patients at a local US hospital present with chronic secretory diarrhea. Although there are multiple potential causes of diarrhea present in these patients, which of the following is most likely the common cause of their chronic secretory diarrhea?? {'A': 'Lymphocytic colitis', 'B': 'Medications', 'C': 'Lactose intolerance', 'D': 'Carcinoid tumor', 'E': 'Crohn’s disease with ileitis'}, | B: Medications |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman with sickle cell disease and at 39-weeks' gestation is brought to the emergency department in active labor. She has had multiple episodes of acute chest syndrome and has required several transfusions in the past. She has a prolonged vaginal delivery complicated by postpartum bleeding, and she receives a transfusion of 1 unit of packed red blood cells. One hour later, the patient experiences acute flank pain. Her temperature is 38.7°C (101.6°F), pulse is 115/min, respirations are 24/min, and blood pressure is 95/55 mm Hg. Foley catheter shows dark brown urine. Further evaluation of this patient is most likely to show which of the following?? {'A': 'Bilateral pulmonary infiltrates on chest x-ray', 'B': 'Serum antibodies against class I HLA antigens', 'C': 'Positive direct Coombs test', 'D': 'Positive blood cultures', 'E': 'Low levels of serum IgA immunoglobulins'}, | C: Positive direct Coombs test |
Answer the following medical question with one of the provided options: | Q:A 17-year-old man is brought by his mother to his pediatrician in order to complete medical clearance forms prior to attending college. During the visit, his mother asks about what health risks he should be aware of in college. Specifically, she recently saw on the news that some college students were killed by a fatal car crash. She therefore asks about causes of death in this population. Which of the following is true about the causes of death in college age individuals?? {'A': 'More of them die from suicide than injuries', 'B': 'More of them die from homicide than injuries', 'C': 'More of them die from homicide than suicide', 'D': 'More of them die from cancer than suicide', 'E': 'More of them die from homicide than cancer'}, | E: More of them die from homicide than cancer |
Answer the following medical question with one of the provided options: | Q:A 7-month old boy, born to immigrant parents from Greece, presents to the hospital with pallor and abdominal distention. His parents note that they recently moved into an old apartment building and have been concerned about their son's exposure to chipped paint from the walls. On physical exam, the patient is found to have hepatosplenomegaly and frontal skull bossing. Hemoglobin electrophoresis reveals markedly increased HbF and HbA2 levels. What would be the most likely findings on a peripheral blood smear?? {'A': 'Basophilic stippling of erythrocytes', 'B': 'Macrocytosis of erythrocytes with hypersegmented neutrophils', 'C': 'Microcytosis and hypochromasia of erythrocytes', 'D': 'Schistocytes and normocytic erythrocytes', 'E': 'Sickling of erythrocytes'}, | C: Microcytosis and hypochromasia of erythrocytes |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman comes to the physician because of progressively worsening lower back pain. The pain radiates down the right leg to the lateral side of the foot. She has had no trauma, urinary incontinence, or fever. An MRI of the lumbar spine shows disc degeneration and herniation at the level of L5–S1. Which of the following is the most likely finding on physical examination?? {'A': 'Difficulty walking on heels', 'B': 'Exaggerated patellar tendon reflex', 'C': 'Diminished sensation of the anus and genitalia', 'D': 'Weak achilles tendon reflex', 'E': 'Diminished sensation of the anterior lateral thigh\n"'}, | D: Weak achilles tendon reflex |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman comes to the physician because of a 4-month history of progressive pain and stiffness of the fingers of her right hand that is worse at the end of the day. She works as a hair dresser and has to take frequent breaks to rest her hand. She has hypertension, for which she takes hydrochlorothiazide. Two weeks ago, she completed a course of oral antibiotics for a urinary tract infection. Her sister has systemic lupus erythematosus. She drinks one to two beers daily and occasionally more on weekends. Over the past 2 weeks, she has been taking ibuprofen as needed for the joint pain. Her vital signs are within normal limits. Physical examination shows swelling, joint-line tenderness, and decreased range of motion of the right first metacarpophalangeal joint as well as the 2nd and 4th distal interphalangeal joints of the right hand. Discrete, hard, mildly tender swellings are palpated over the 2nd and 4th distal interphalangeal joints of the right hand. Which of the following is the most likely underlying mechanism for these findings?? {'A': 'Monosodium urate crystal precipitation in the joints', 'B': 'Bacterial infection of the joint space', 'C': 'Autoimmune-mediated cartilage erosion', 'D': 'Degenerative disease of the joints', 'E': 'Calcium pyrophosphate dihydrate crystal precipitation in the joints'}, | D: Degenerative disease of the joints |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man presents to his dermatologist because of severe stomatitis and superficial skin erosions over his trunk. His condition started 2 months ago and was unresponsive to oral antibiotics and antiherpetic medications. He has no history of a similar rash. His medical history is remarkable for type 2 diabetes mellitus and essential hypertension. The physical examination reveals numerous flaccid blisters and bullae which rupture easily. Nikolsky's sign is positive. Which of the following best represents the etiology of this patient’s condition?? {'A': 'Anti-hemidesmosome antibodies', 'B': 'Increased mitotic activity of basal and suprabasal cells', 'C': 'Cutaneous T cell lymphoma', 'D': 'Anti-desmoglein-3 antibodies', 'E': 'Dermatophyte infection'}, | D: Anti-desmoglein-3 antibodies |
Answer the following medical question with one of the provided options: | Q:A 50-year-old male presents to his primary care physician for a routine check-up. He reports that he is doing well overall without any bothersome symptoms. His past medical history is significant only for hypertension, which has been well controlled with losartan. Vital signs are as follows: T 37.0 C, HR 80, BP 128/76, RR 14, SpO2 99%. Physical examination does not reveal any concerning abnormalities. The physician recommends a fecal occult blood test at this visit to screen for the presence of any blood in the patient's stool that might be suggestive of an underlying colorectal cancer. Which of the following best describes this method of disease prevention?? {'A': 'Primordial prevention', 'B': 'Primary prevention', 'C': 'Secondary prevention', 'D': 'Tertiary prevention', 'E': 'Quaternary prevention'}, | C: Secondary prevention |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents to the emergency department because of pain in the center of his chest that is radiating down his left arm and up the left side of his neck. The pain started suddenly 30 minutes ago while the patient was at work. The patient describes the pain as squeezing in nature, 10/10 in intensity, and is associated with nausea and difficulty breathing. He has had type 2 diabetes mellitus for 15 years, hypertension for 10 years, and dyslipidemia, but he denies any history of a cardiac problem. He has a 40-pack-year history of smoking but does not drink alcohol. Vital signs include: blood pressure 80/40 mm Hg, regular pulse 90/min, and temperature 37.2°C (98.9°F). Chest auscultation reveals diffuse bilateral rales with no murmurs. ECG reveals convex ST-segment elevation in leads V1 to V6 and echocardiogram shows anterolateral hypokinesis, retrograde blood flow into the left atrium, and an ejection fraction of 45%. Which of the following best describe the mechanism of this patient’s illness?? {'A': 'Occlusion of the right coronary artery, with infarction of the conduction system', 'B': 'Occlusion of the left anterior descending artery with rupture of a papillary muscle', 'C': 'Occlusion of the left anterior descending artery with interventricular septal rupture', 'D': 'Ventricular free wall rupture', 'E': 'Mitral leaflet thickening and fibrosis'}, | B: Occlusion of the left anterior descending artery with rupture of a papillary muscle |
Answer the following medical question with one of the provided options: | Q:A 29-year-old African American female presents to your office with extreme fatigue and bilateral joint pain. Serologies demonstrate the presence of rheumatoid factor along with anti-Smith and anti-dsDNA antibodies. A VDRL syphilis test is positive. You order a coagulation profile, which reveals normal bleeding time, normal PT, and prolonged PTT as well as normal platelet count. Further evaluation is most likely to reveal which of the following?? {'A': 'Palmar rash', 'B': 'HLA-B27 positivity', 'C': 'Factor VIII deficiency', 'D': 'History of multiple spontaneous abortions', 'E': 'Immune thrombocytopenia'}, | D: History of multiple spontaneous abortions |
Answer the following medical question with one of the provided options: | Q:A 31-year-old man comes to the physician because of a 5-day history of fever, chills, and dyspnea. His temperature is 38.9°C (102°F) and pulse is 90/min. Cardiac examination shows a murmur. In addition to other measures, cardiac catheterization is performed. A graph showing the results of the catheterization is shown. This patient most likely has which of the following valvular heart defects?? {'A': 'Mitral stenosis', 'B': 'Mitral regurgitation', 'C': 'Pulmonary regurgitation', 'D': 'Aortic regurgitation', 'E': 'Aortic stenosis\n"'}, | D: Aortic regurgitation |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman comes to the physician because of a painful skin lesion on her right leg for 1 month. It initially started out as a small red spot but has rapidly increased in size during this period. She remembers an ant bite on her leg prior to the lesion occurring. She was treated for anterior uveitis 8 months ago with corticosteroids. She has Crohn's disease, type 2 diabetes mellitus, and hypertension. Current medications include insulin, mesalamine, enalapril, and aspirin. She returned from Wisconsin after visiting her son 2 months ago. Her temperature is 37.6°C (98°F), pulse is 98/min, and blood pressure is 126/88 mm Hg. Examination shows pitting pedal edema of the lower extremities. There is a 4-cm tender ulcerative lesion on the anterior right leg with a central necrotic base and purplish irregular borders. There are dilated tortuous veins in both lower legs. Femoral and pedal pulses are palpated bilaterally. Which of the following is the most likely diagnosis?? {'A': 'Ecthyma gangrenosum', 'B': 'Pyoderma gangrenosum', 'C': 'Blastomycosis', 'D': 'Squamous cell carcinoma', 'E': 'Basal cell carcinoma\n"'}, | B: Pyoderma gangrenosum |
Answer the following medical question with one of the provided options: | Q:A primary care physician is recently receiving more negative online reviews from his patients. He is increasingly feeling tired and has written 2 wrong prescriptions over the past month alone. Currently, on his panel, he has a list of 1,051 patients, half of whom are geriatric patients. He spends approx. 51 hours per week visiting about 20 patients a day. He has no history of a serious illness and takes no medications. An evaluation by a psychiatrist shows no primary psychiatric disorders. According to recent national surveys, which of the following do physicians more frequently recognize as a contributor to this physician’s current condition?? {'A': 'The number of patients on his panel', 'B': 'Excessive bureaucratic tasks', 'C': 'Working too many hours', 'D': 'Concern over online reputation', 'E': 'The number of geriatric patients on his panel'}, | B: Excessive bureaucratic tasks |
Answer the following medical question with one of the provided options: | Q:A 42-year-old Caucasian woman is enrolled in a randomized controlled trial to study cardiac function in the setting of several different drugs. She is started on verapamil and instructed to exercise at 50% of her VO2 max while several cardiac parameters are being measured. During this experiment, which of the following represents the relative conduction speed through the heart from fastest to slowest?? {'A': 'Atria > Purkinje fibers > ventricles > AV node', 'B': 'AV node > ventricles > atria > Purkinje fibers', 'C': 'Purkinje fibers > ventricles > atria > AV node', 'D': 'Purkinje fibers > atria > ventricles > AV node', 'E': 'Purkinje fibers > AV node > ventricles > atria'}, | D: Purkinje fibers > atria > ventricles > AV node |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy comes to the physician because of a generalized rash for 3 days. Over the past 5 days, he has also had a high fever and a sore throat. His 16-year-old sister was treated for infectious mononucleosis 2 weeks ago. He returned from a summer camp a week ago. His immunizations are up-to-date. Three years ago, he required intubation after an allergic reaction to dicloxacillin. The patient appears ill. His temperature is 38.2°C (100.8°F). Examination shows circumferential oral pallor. Cervical lymphadenopathy is present. There is tonsillar erythema and exudate. A confluent, blanching, punctate erythematous rash with a rough texture is spread over his trunk and extremities. His hemoglobin concentration is 13.3 g/dL, leukocyte count is 12,000/mm3, and erythrocyte sedimentation rate is 43 mm/h. Which of the following is the most appropriate next step in management?? {'A': 'Acyclovir therapy', 'B': 'Doxycycline therapy', 'C': 'Amoxicillin therapy', 'D': 'Azithromycin therapy', 'E': 'Cephalexin therapy'}, | D: Azithromycin therapy |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman comes to the physician because of a swelling on her neck for 5 months. It has gradually enlarged in size and is mildly painful. She has also had intermittent episodes of throbbing headache, sweating, and palpitations over the past 3 months. Menses occur at regular 28-day intervals and last for 4–5 days. She does not smoke, occasionally consumes alcohol on weekends. She appears thin and pale. Her temperature is 38.7°C (101.7°F), pulse is 112/min, and blood pressure is 140/90 mm Hg. Examination shows a firm, 3-cm swelling on the neck that moves with swallowing; there is no lymphadenopathy. Cardiopulmonary examination shows no abnormalities. Laboratory studies show: Hemoglobin 13 g/dL Leukocyte count 9500/mm3 Platelet count 230,000/mm3 Serum Na+ 136 mEq/L K+ 3.5 mEq/L Cl- 104 mEq/L TSH 2.3 μU/mL Calcitonin 300 ng/dL (Normal < 5 ng/dL) An electrocardiogram shows sinus tachycardia. Which of the following laboratory abnormalities is most likely to be seen?"? {'A': 'Increased serum gastrin', 'B': 'Increased serum cortisol', 'C': 'Increased urinary 5-HIAA', 'D': 'Increased serum T3 levels', 'E': 'Increased plasma metanephrines'}, | E: Increased plasma metanephrines |
Answer the following medical question with one of the provided options: | Q:A 31-year-old G3P1 woman who is at 37 weeks of gestation is brought into the emergency department by her husband after repeated twitching. According to the husband, they were watching TV when she suddenly became unresponsive and her hands and legs started shaking. The episode lasted about 5 minutes and she “seemed to be sleeping afterwards.” Her past medical history is significant for pregnancy induced hypertension. The patient is tired but responsive and denies urinary incontinence, paresthesia, fever, upper respiratory signs, or new medication changes. She denies a history of seizures. Her temperature is 99°F (37°C), blood pressure is 186/97 mmHg, pulse is 96/min, and respirations are 12/min. Physical examination demonstrates a lethargic patient with moderate right upper quadrant tenderness. What is the most appropriate next step for this patient?? {'A': 'Emergency cesarean section', 'B': 'Expectant management', 'C': 'Intravenous ampicillin and gentamicin', 'D': 'Intravenous infusion of oxytocin', 'E': 'Intravenous magnesium sulfate'}, | E: Intravenous magnesium sulfate |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man was picked up by the security personnel for voiding urine and defecating at an inappropriate place in the community. On questioning, he was making offensive remarks and behaving inappropriately. On physical examination, the physician observed an ataxic gait and amnesia. Initial urine drug screen is negative for any drugs of abuse. Which is the most likely pathological finding present in this patient?? {'A': 'Drug abuse', 'B': 'PrPSC Sheets', 'C': 'Lewy bodies', 'D': 'Pick bodies', 'E': 'Amyloid plaques'}, | D: Pick bodies |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man undergoes an exercise stress test for a 1-week history of squeezing substernal chest pain that is aggravated by exercise and relieved by rest. During the test, there is a substantial increase in the breakdown of glycogen in the muscle cells. Which of the following changes best explains this intracellular finding?? {'A': 'Decrease in protein kinase A', 'B': 'Activation of phosphorylase kinase', 'C': 'Increase in glucose-6-phosphate', 'D': 'Activation of protein phosphatase', 'E': 'Inactivation of glycogen synthase kinase'}, | B: Activation of phosphorylase kinase |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man presents to the general practitioner with a skin rash that has been present for 2 days. The rash appeared suddenly and has progressively gotten worse. It started off as an erythematous lesion on the back of his hands and also over his nose. The lesions over his hands have become bullous and tense. He has never experienced similar symptoms before. He just got back from a canoeing trip during a very hot and sunny weekend. Physical exam is significant for erythematous, vesicular lesions over the nape of the neck and bridge of the nose as well as tense bullae over the dorsum of both hands. The attending physician suspects a defect in the synthesis of heme and orders some blood tests. Which of the following precursors will most likely be elevated in this patient?? {'A': 'Uroporphyrinogen III', 'B': 'Hydroxymethylbilane', 'C': 'Porphobilinogen', 'D': 'δ-Aminolevulinic acid', 'E': 'Protoporphyrin IX'}, | A: Uroporphyrinogen III |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman, gravida 2, para 1, at 38 weeks' gestation comes to the emergency department because of vaginal bleeding for the past hour. The patient reports that she felt contractions prior to the onset of the bleeding, but the contractions stopped after the bleeding started. She also has severe abdominal pain. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her pulse is 110/min, respirations are 17/min, and blood pressure is 90/60 mm Hg. Examination shows diffuse abdominal tenderness with no rebound or guarding; no contractions are felt. The fetal heart rate shows recurrent variable decelerations. Which of the following is the most likely diagnosis?? {'A': 'Abruptio placentae', 'B': 'Vasa previa', 'C': 'Uterine rupture', 'D': 'Uterine inertia', 'E': 'Amniotic fluid embolism'}, | C: Uterine rupture |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the emergency department by his parents for difficulty breathing. He was playing outside in the snow and had progressive onset of wheezing and gasping. His history is notable for eczema and nut allergies. The patient has respirations of 22/min and is leaning forward with his hands on his legs as he is seated on the table. Physical examination is notable for inspiratory and expiratory wheezes on exam. A nebulized medication is started and begins to relieve his breathing difficulties. Which of the following is increased in this patient as a result of this medication?? {'A': 'Diacylglycerol', 'B': 'Cyclic GMP', 'C': 'Cyclic AMP', 'D': 'Protein kinase C', 'E': 'ATP'}, | C: Cyclic AMP |
Answer the following medical question with one of the provided options: | Q:A 78-year-old male with history of coronary artery disease, status post coronary stent placement currently on aspirin and clopidogrel was found down in his bathroom by his wife. His GCS score was 3 and an accurate physical exam is limited. A stat non-contrast CT scan of his brain demonstrated a large right parietal intracranial hemorrhage with surrounding edema. He was promptly transferred to the intensive care unit (ICU) for monitoring. Over the next day, his mental status continues to worsen but repeat CT scan shows no new bleeding. In addition, the patient’s urinary output has been >200 cc/hr over the last several hours and increasing. His temperature is 99.0 deg F (37.2 deg C), blood pressure is 125/72 mmHg, pulse is 87/min, and respirations are 13/min. Which of the following values would most likely correspond to the patient’s urine specific gravity, urine osmolality, plasma osmolality, and serum sodium?? {'A': 'High, High, Low, Low', 'B': 'Low, High, High, High', 'C': 'Low, Low, High, Low', 'D': 'Low, Low, High, High', 'E': 'High, Low, Low, High'}, | D: Low, Low, High, High |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman comes to the physician for a follow-up examination. One month ago, she was diagnosed with carcinoma of the left breast. She underwent a lumpectomy for a 2.1-cm mass and sentinel lymph node biopsy 2 weeks ago. The biopsy of the breast mass showed margin-free invasive ductal carcinoma; immunohistochemistry showed the carcinoma is estrogen-receptor and progesterone-receptor negative, and HER2-receptor positive. The lymph node biopsy was negative for metastases. Examination shows a healing surgical incision over the left breast. There is no palpable axillary lymphadenopathy. Her physician decides to initiate treatment with appropriate pharmacotherapy. Which of the following is the most appropriate next step in management?? {'A': 'Echocardiography', 'B': 'Fundoscopy', 'C': 'Dual energy x-ray absorptiometry scan', 'D': 'X-ray of the chest', 'E': 'Endometrial biopsy'}, | A: Echocardiography |
Answer the following medical question with one of the provided options: | Q:Three weeks after birth, an infant girl develops episodes of apnea. She has become increasingly lethargic over the past two days, and experienced two episodes of apnea lasting 10 seconds each within the last day. She was born at 31 weeks of gestation and weighed 1600-g (3-lb 8-oz). Apgar scores were 4 and 7 at 1 and 5 minutes, respectively. She takes no medications. Her temperature is 36.7°C (98.0°F), pulse is 185/min, respirations are 60/min and irregular, and blood pressure is 70/35 mm Hg. She appears pale. Physical examination shows no abnormalities. Laboratory studies show a hemoglobin of 6.5 g/dL, a reticulocyte count of 0.5%, and a mean corpuscular volume of 92 μm3. Leukocyte count, platelet count, total bilirubin and indirect bilirubin are all within reference range. Which of the following is the most likely underlying mechanism of this patient's anemia?? {'A': 'Defective δ-aminolevulinic acid synthase', 'B': 'Bone marrow suppression', 'C': 'Glucose-6-phosphate dehydrogenase deficiency', 'D': 'Iron deficiency', 'E': 'Impaired erythropoietin production'}, | E: Impaired erythropoietin production |
Answer the following medical question with one of the provided options: | Q:A 45-year-old woman presents to the physician with a 6-month history of progressive shortness of breath. She now has to stop to rest three or four times whenever she climbs the stairs to her apartment on the third floor. She reports chronic, nonproductive cough and wheezing, for which she uses ipratropium inhalers. She has a 25 pack-year smoking history. On examination, the blood pressure is 130/80 mm Hg, the pulse rate is 95/min, the temperature is 36.6°C (97.8°F), and the respiratory rate is 26/min. Chest auscultation reveals bilateral crepitations. Cardiac auscultation reveals normal S1 and S2 without murmurs or added sounds. Arterial blood gas analysis shows: pH 7.36 (reference: 7.35–7.45) HCO3- 32 mEq/L (reference 22–28 mEq/L) Pco2 48 mm Hg (reference: 33–45 mm Hg) Po2 63 mm Hg (reference: 75–105 mm Hg) O2 saturation 91% (reference: 94–99%) Which of the following would you expect to find in this patient?? {'A': 'Decreased lung residual volume', 'B': 'Decreased diffusing capacity of the lungs for carbon monoxide (DLCO)', 'C': 'Increased FEV1/FVC ratio', 'D': 'Shift of the flow volume loop to the right', 'E': 'Decreased lung compliance'}, | B: Decreased diffusing capacity of the lungs for carbon monoxide (DLCO) |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?? {'A': 'Antisocial', 'B': 'Dependent', 'C': 'Histrionic', 'D': 'Paranoid', 'E': 'Schizotypal'}, | B: Dependent |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman presents with sudden-onset pain in her lower back. She says she was exercising in the gym several hours ago when she felt a sharp pain. The pain is radiating down the side of her leg and into her foot. On physical exam, her vital signs are as follows: HR 95, BP 120/70, T 37.2 degrees C. She has extreme pain shooting down her leg with a straight leg raise. Her sensation to light touch and pin-prick is intact throughout. Which of the following is the most likely diagnosis?? {'A': 'Disc herniation', 'B': 'Osteomyelitis', 'C': 'Cauda equina syndrome', 'D': 'Spinal stenosis', 'E': 'Ankylosing spondylitis'}, | A: Disc herniation |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man with AIDS comes to the physician because of a 2-day history of decreasing vision and seeing black spots in his right eye. He has no pain and the left eye is asymptomatic. He was treated for fungal esophagitis 6 months ago with fluconazole. He was diagnosed with Kaposi's sarcoma 2 years ago. Current medications include efavirenz, tenofovir, emtricitabine, azithromycin, trimethoprim-sulfamethoxazole, multivitamins, and a nutritional supplement. He is 170 cm (5 ft 7 in) tall and weighs 45 kg (99 lbs);BMI is 15.6 kg/m2. His temperature is 37°C (98.6°F), pulse is 89/min, and blood pressure is 110/70 mm Hg. Examination shows cervical lymphadenopathy. There are multiple violaceous plaques seen over his trunk and extremities. Fundoscopic examination shows granular yellow-white opacities around the retinal vessels and multiple areas of dot-blot hemorrhages. His CD4+ T-lymphocyte count is 36/mm3. Which of the following is the most likely diagnosis?? {'A': 'Cytomegalovirus retinitis', 'B': 'Herpes simplex keratitis', 'C': 'Toxoplasma retinitis', 'D': 'HIV retinopathy', 'E': 'Varicella zoster retinitis'}, | A: Cytomegalovirus retinitis |
Answer the following medical question with one of the provided options: | Q:A 45-year old man comes to the physician because of a painless neck lump and a 2-month history of difficulty swallowing. He has a history of recurrent nephrolithiasis and episodic hypertension. Physical examination shows a 3 × 3-cm, nontender nodule at the level of the thyroid cartilage. A photomicrograph of a section of tissue obtained by core needle biopsy of the nodule is shown. Which of the following is the most likely diagnosis?? {'A': 'Follicular carcinoma', 'B': 'Anaplastic carcinoma', 'C': 'Non-Hodgkin lymphoma', 'D': 'Papillary carcinoma', 'E': 'Medullary carcinoma'}, | E: Medullary carcinoma |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy is brought to the physician because of increasing pain and swelling of his right knee for 12 days. He has had episodes of pain with urination for 3 weeks. He had a painful, swollen left ankle joint that resolved without treatment one week ago. His mother has rheumatoid arthritis. He is sexually active with 2 female partners and uses condoms inconsistently. He appears anxious. His temperature is 38°C (100.4°F), pulse is 68/min, and blood pressure is 100/80 mm Hg. Examination shows bilateral inflammation of the conjunctiva. The right knee is tender, erythematous, and swollen; range of motion is limited by pain. There is tenderness at the left Achilles tendon insertion site. Genital examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.5 g/dL Leukocyte count 12,300/mm3 Platelet count 310,000/mm3 Erythrocyte sedimentation rate 38 mm/h Serum Urea nitrogen 18 mg/dL Glucose 89 mg/dL Creatinine 1.0 mg/dL Urine Protein negative Blood negative WBC 12–16/hpf RBC 1–2/hpf An ELISA test for HIV is negative. Arthrocentesis is done. The synovial fluid is cloudy and a Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 26,000/mm3 and 75% neutrophils. Which of the following is the most likely diagnosis?"? {'A': 'Septic arthritis', 'B': 'Rheumatoid arthritis', 'C': 'Lyme arthritis', 'D': 'Reactive arthritis', 'E': 'Syphilitic arthritis\n"'}, | D: Reactive arthritis |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care provider to discuss the frequency with which he wakes up at night to urinate. He avoids drinking liquids at night, but the symptoms have progressively worsened. The medical history is significant for hypertension and hyperlipidemia. He takes lisinopril, atorvastatin, and a multivitamin every day. Today, the vital signs include: blood pressure 120/80 mm Hg, heart rate 90/min, respiratory rate 17/min, and temperature 37.0°C (98.6°F). On physical examination, he appears tired. The heart has a regular rate and rhythm and the lungs are clear to auscultation bilaterally. A bedside bladder ultrasound reveals a full bladder. A digital rectal exam reveals an enlarged and symmetric prostate free of nodules, that is consistent with benign prostatic enlargement. He also has a history of symptomatic hypotension with several episodes of syncope in the past. The patient declines a prostate biopsy that would provide a definitive diagnosis and requests less invasive treatment. Which of the following is recommended to treat this patient’s enlarged prostate?? {'A': 'Tamsulosin', 'B': 'Finasteride', 'C': 'Prazosin', 'D': 'Tadalafil', 'E': 'Leuprolide'}, | B: Finasteride |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man comes to the physician for the evaluation of a skin lesion on his chest. He first noticed the lesion 2 months ago and thinks that it has increased in size since then. The lesion is not painful or pruritic. He has type 2 diabetes mellitus, hypercholesterolemia, and glaucoma. The patient has smoked 1 pack of cigarettes daily for the last 40 years and drinks two to three beers on the weekend. Current medications include metformin, atorvastatin, topical timolol, and a multivitamin. Vital signs are within normal limits. The lesion is partly elevated on palpation and does not change its form on pinching. A photograph of the lesion is shown. Which of the following is the most likely diagnosis?? {'A': 'Malignant melanoma', 'B': 'Keratoacanthoma', 'C': 'Lentigo maligna', 'D': 'Seborrheic keratosis', 'E': 'Basal cell carcinoma'}, | A: Malignant melanoma |
Answer the following medical question with one of the provided options: | Q:A case-control study looking to study the relationship between infection with the bacterium Chlamydia trachomatis and having multiple sexual partners was conducted in the United States. A total of 100 women with newly diagnosed chlamydial infection visiting an outpatient clinic for sexually transmitted diseases (STDs) were compared with 100 women from the same clinic who were found to be free of chlamydia and other STDs. The women diagnosed with this infection were informed that the potential serious consequences of the disease could be prevented only by locating and treating their sexual partners. Both groups of women were queried about the number of sexual partners they had had during the preceding 3 months. The group of women with chlamydia reported an average of 4 times as many sexual partners compared with the group of women without chlamydia; the researchers, therefore, concluded that women with chlamydia visiting the clinic had significantly more sexual partners compared with women who visited the same clinic but were not diagnosed with chlamydia. What type of systematic error could have influenced the results of this study?? {'A': 'Ascertainment bias', 'B': 'Lost-to-follow-up bias', 'C': 'Response bias', 'D': 'Detection bias', 'E': 'Reporting bias'}, | E: Reporting bias |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man is brought to the emergency department 3 hours after being bitten by a rattlesnake. He was hiking in the Arizona desert when he accidentally stepped on the snake and it bit his right leg. His pulse is 135/min and blood pressure is 104/81 mm Hg. Examination shows right lower leg swelling, ecchymosis, and blistering. Right ankle dorsiflexion elicits severe pain. A manometer inserted in the lateral compartment of the lower leg shows an intracompartmental pressure of 67 mm Hg. In addition to administration of the antivenom, the patient undergoes fasciotomy. Two weeks later, he reports difficulty in walking. Neurologic examination shows a loss of sensation over the lower part of the lateral side of the right leg and the dorsum of the right foot. Right foot eversion is 1/5. There is no weakness in dorsiflexion. Which of the following nerves is most likely injured in this patient?? {'A': 'Tibial nerve', 'B': 'Sural nerve', 'C': 'Deep peroneal nerve', 'D': 'Superficial peroneal nerve', 'E': 'Saphenous nerve'}, | D: Superficial peroneal nerve |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman visits the clinic with chronic diarrhea on most days for the past four months. She also complains of lower abdominal discomfort and cramping, which is relieved by episodes of diarrhea. She denies any recent change in her weight. Bowel movements are preceded by a sensation of urgency, associated with mucus discharge, and followed by a feeling of incomplete evacuation. The patient went camping several months earlier, and another member of her camping party fell ill recently. Her temperature is 37° C (98.6° F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Her physical examination is unremarkable. A routine stool examination is within normal limits and blood test results show: Hb% 13 gm/dL Total count (WBC): 11,000/mm3 Differential count: Neutrophils: 70% Lymphocytes: 25% Monocytes: 5% ESR: 10 mm/hr What is the most likely diagnosis?? {'A': 'Irritable bowel syndrome', 'B': 'Crohn’s disease', 'C': 'Ulcerative colitis', 'D': 'Giardiasis', 'E': 'Laxative abuse'}, | A: Irritable bowel syndrome |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man presents to his primary care physician for a persistent and low grade headache as well as trouble focusing. The patient was seen in the emergency department 3 days ago after hitting his head on a branch while biking under the influence of alcohol. His head CT at the time was normal, and the patient was sent home with follow up instructions. Since the event, he has experienced trouble focusing on his school work and feels confused at times while listening to lectures. He states that he can’t remember the lectures and also says he has experienced a sensation of vertigo at times. On review of systems, he states that he has felt depressed lately and has had trouble sleeping, though he denies any suicidal or homicidal ideation. His temperature is 98.2°F (36.8°C), blood pressure is 122/65 mmHg, pulse is 70/min, respirations are 12/min, and oxygen saturation is 98% on room air. The patient’s neurological and cardiopulmonary exam are within normal limits. Which of the following is the best next step in management?? {'A': 'Cognitive behavioral therapy', 'B': 'CT scan of the head without contrast', 'C': 'Fluoxetine', 'D': 'Rest and primary care follow up', 'E': 'Thiamine'}, | D: Rest and primary care follow up |
Answer the following medical question with one of the provided options: | Q:While playing the catcher position in baseball, a 27-year-old male sustained a blow to his left testes which required surgical removal. Upon awakening from anesthesia, he jokes to his wife that he is now half the man that she once knew. Which of the following scenarios is a similar ego defense as the one above?? {'A': 'A religious woman with homosexual desires speaks out against gay marriage', 'B': 'A husband angry at his wife takes out his anger on his employees', 'C': 'A short-tempered male lifts weights to deal with his anger', 'D': 'A cheating husband accuses his wife of doing the same', 'E': 'A recently divorced man states he will finally be able to watch a football game without nagging'}, | E: A recently divorced man states he will finally be able to watch a football game without nagging |
Answer the following medical question with one of the provided options: | Q:A 31-year-old man comes to the physician because of severe muscle pain and fever for 4 days. He likes to go hunting and consumed bear meat 1 month ago. Examination shows periorbital edema and generalized muscle tenderness. His leukocyte count is 12,000/mm3 with 19% eosinophils. The release of major basic protein in response to this patient’s infection is most likely a result of which of the following?? {'A': 'Immune complex-dependent complement activation', 'B': 'Interaction between Th1 cells and macrophages', 'C': 'Increased expression of MHC class I molecules', 'D': 'Increased expression of MHC class II molecules', 'E': 'Antibody-dependent cell-mediated cytotoxicity'}, | E: Antibody-dependent cell-mediated cytotoxicity |
Answer the following medical question with one of the provided options: | Q:A 65-year-old patient with a history of COPD and open-angle glaucoma in the left eye has had uncontrolled intraocular pressure (IOP) for the last few months. She is currently using latanoprost eye drops. Her ophthalmologist adds another eye drop to her regimen to further decrease her IOP. A week later, the patient returns because of persistent dim vision. On exam, she has a small fixed pupil in her left eye as well as a visual acuity of 20/40 in her left eye compared to 20/20 in her right eye. Which of the following is the mechanism of action of the medication most likely prescribed in this case?? {'A': 'Inhibiting the production of aqueous humor by the ciliary epithelium', 'B': 'Closing the trabecular mesh by relaxing the ciliary muscles', 'C': 'Opening the canal of Schlemm by contracting the ciliary muscle', 'D': 'Increasing reabsorption of aqueous humor by the ciliary epithelium', 'E': 'Increasing the permeability of sclera to aqueous humor'}, | C: Opening the canal of Schlemm by contracting the ciliary muscle |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man presents to the clinic with a 10-day history of a sore throat and fever. He has a past medical history significant for ulcerative colitis and chronic lower back pain. He smokes at least 1 pack of cigarettes daily for 10 years. The father of the patient died of colon cancer at the age of 50. He takes sulfasalazine and naproxen. The temperature is 38.9°C (102.0°F), the blood pressure is 131/87 mm Hg, the pulse is 74/min, and the respiratory rate is 16/min. On physical examination, the patient appears tired and ill. His pharynx is erythematous with exudate along the tonsillar crypts. The strep test comes back positive. In addition to treating the bacterial infection, what else would you recommend for the patient at this time?? {'A': 'Fecal occult blood testing', 'B': 'Flexible sigmoidoscopy', 'C': 'Low-dose CT', 'D': 'Colonoscopy', 'E': 'PSA and digital rectal exam'}, | D: Colonoscopy |
Answer the following medical question with one of the provided options: | Q:A patient with HCC and a long history of alcohol dependence and chronic hepatitis C has been using the mTOR inhibitor Metalimus 100 mg for cancer treatment. Her cancer has shown a partial response. She also has a history of hypertension and poorly controlled type 2 diabetes mellitus complicated by diabetic retinopathy. Current medications include enalapril and insulin. She asks her oncologist and hepatologist if she could try Noxbinle (tumorolimus) for its purported survival benefit in treating HCC. Based on the data provided in the drug advertisement, which of the following statements is most accurate?? {'A': 'The patient is not a good candidate for Noxbinle due to her history of hypertension', 'B': 'The patient is not a good candidate for Noxbinle due to her history of diabetes', 'C': 'The patient should start Noxbinle 50 mg because of the survival benefit relative to Metalimus 100 mg', 'D': 'The patient should start Noxbinle 100 mg because of the survival benefit relative to Metalimus 100 mg', 'E': 'The patient should start Noxbinle 50 mg because of her history of alcohol use disorder and hepatitis C'}, | B: The patient is not a good candidate for Noxbinle due to her history of diabetes |
Answer the following medical question with one of the provided options: | Q:A 22-year-old G4P2 at 35 weeks gestation presents to the hospital after she noticed that "her water broke." Her prenatal course is unremarkable, but her obstetric history includes postpartum hemorrhage after her third pregnancy, attributed to a retained placenta. The patient undergoes augmentation of labor with oxytocin and within four hours delivers a male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Three minutes later, the placenta passes the vagina, but a smooth mass attached to the placenta continues to follow. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 90/min, and respirations are 20/min. What is the most likely complication in the absence of intervention?? {'A': 'Heart failure', 'B': 'Hemorrhagic shock', 'C': 'Hypertension', 'D': 'Hyperthermia', 'E': 'Tachypnea'}, | B: Hemorrhagic shock |
Answer the following medical question with one of the provided options: | Q:A 40-year-old nulliparous woman with no significant medical history presents to your office with shortness of breath and increased abdominal girth over the past month. The initial assessment demonstrates that the patient has a right-sided hydrothorax, ascites, and a large ovarian mass. Surgery is performed to remove the ovarian mass, and the patient's ascites and pleural effusion resolve promptly. What is the most likely diagnosis?? {'A': 'Metastatic colon cancer', 'B': 'Metastatic lung cancer', 'C': 'Metastatic ovarian cancer', 'D': 'Meigs syndrome', 'E': 'Nephrotic syndrome'}, | D: Meigs syndrome |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man comes to the physician for a follow-up examination. He has a 2-month history of increasing generalized fatigue and severe pruritus. He has hypertension and ulcerative colitis which was diagnosed via colonoscopy 5 years ago. Current medications include lisinopril and rectal mesalamine. He is sexually active with 2 female partners and uses condoms inconsistently. His temperature is 37.3°C (99.1°F), pulse is 86/min, and blood pressure is 130/84 mm Hg. Examination shows scleral icterus and multiple scratch marks on the trunk and extremities. The lungs are clear to auscultation. The abdomen is soft and nontender. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 11.5 g/dL Leukocyte count 7500/mm3 Platelet count 280,000/mm3 Serum Na+ 138 mEq/L Cl- 101 mEq/L K+ 4.7 mEq/L Urea nitrogen 18 mg/dL Glucose 91 mg/dL Creatinine 0.8 mg/dL Bilirubin Total 1.5 mg/dL Direct 0.9 mg/dL Alkaline phosphatase 460 U/L AST 75 U/L ALT 78 U/L Anti-nuclear antibody negative Antimitochondrial antibodies negative Abdominal ultrasound shows thickening of the bile ducts and focal bile duct dilatation. Which of the following is the most likely diagnosis?"? {'A': 'Autoimmune hepatitis', 'B': 'Primary sclerosing cholangitis', 'C': 'Primary biliary cholangitis', 'D': 'Hepatitis B infection', 'E': 'IgG4-associated cholangitis'}, | B: Primary sclerosing cholangitis |
Answer the following medical question with one of the provided options: | Q:An 82-year-old woman is brought to the emergency department after losing consciousness at her nursing home. She had been watching TV for several hours and while getting up to use the bathroom, she fell and was unconscious for several seconds. She felt dizzy shortly before the fall. She does not have a headache or any other pain. She has a history of hypertension, intermittent atrial fibrillation, and stable angina pectoris. Current medications include warfarin, aspirin, hydrochlorothiazide, and a nitroglycerin spray as needed. Her temperature is 36.7°C (98.1°F), pulse is 100/min and regular, and blood pressure is 102/56 mm Hg. Physical exam shows a dry tongue. A fold of skin that is pinched on the back of her hand unfolds after 2 seconds. Cardiopulmonary examination shows no abnormalities. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Elevated serum concentration of cardiac enzymes', 'B': 'Absent P waves on ECG', 'C': 'Elevated blood urea nitrogen concentration', 'D': 'Hypodense lesions on CT scan of the head', 'E': 'Elevated serum creatine kinase concentration'}, | C: Elevated blood urea nitrogen concentration |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman comes to the physician because of a 10-month history of nonbloody diarrhea and recurrent episodes of flushing and wheezing. She does not take any medications. Physical examination shows a hyperpigmented rash around the base of her neck. Cardiac examination shows a grade 4/6, holosystolic murmur in the 5th intercostal space at the left midclavicular line. Echocardiography shows left-sided endocardial and valvular fibrosis with moderate mitral regurgitation; there are no septal defects or right-sided valvular defects. Urinalysis shows increased 5-hydroxyindoleacetic acid concentration. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Tumor in the pancreas without metastasis', 'B': 'Tumor in the lung without metastasis', 'C': 'Tumor in the left atrium with hepatic metastasis', 'D': 'Tumor in the appendix without metastasis', 'E': 'Tumor in the descending colon with hepatic metastasis'}, | B: Tumor in the lung without metastasis |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the clinic by his mother with fever and a rash. The patient’s mother says his symptoms started 1 week ago with the acute onset of fever and a runny nose, which resolved over the next 3 days. Then, 4 days later, she noted a rash on his face, which, after a day, spread to his neck, torso, and extremities. The patient denies any pruritus or pain associated with the rash. No recent history of sore throat, chills, or upper respiratory infection. The patient has no significant past medical history and takes no medications. The vital signs include: temperature 37.2°C (99.9°F) and pulse 88/min. On physical examination, there is a maculopapular rash on his face, torso, and extremities, which spares the palms and soles. The appearance of the rash is shown in the exhibit (see image below). Which of the following would most likely confirm the diagnosis in this patient?? {'A': 'Throat culture', 'B': 'Assay for IgM and IgG against measles virus', 'C': 'Serology for human herpesvirus-6 IgM antibodies', 'D': 'ELISA for IgG antibodies against Rubella virus', 'E': 'ELISA for parvovirus B-19 IgM and IgG antibodies'}, | E: ELISA for parvovirus B-19 IgM and IgG antibodies |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman presents to her physician’s office complaining of a worsening cough with large volumes of mucoid sputum in her phlegm every morning and thickened foul smell sputum almost every time she coughs. She says that this cough started about one month ago and has been increasing in intensity. Over the counter medications are ineffective. Past medical history is significant for cystic fibrosis diagnosed at the age of 6 years old, and pneumonia twice in the past 2 years. Other than a cough, she has no fever or any other concerns. A sputum samples grows aerobic, non-lactose fermenting, oxidase-positive, gram-negative bacillus. Which of the following treatment regimens is the most beneficial for her at this time?? {'A': 'Amoxicillin and clavulanic acid', 'B': 'Postural drainage of the chest', 'C': 'Surgical therapy', 'D': 'Trimethoprim and sulfamethoxazole', 'E': 'Intravenous ciprofloxacin'}, | E: Intravenous ciprofloxacin |
Answer the following medical question with one of the provided options: | Q:A 7-month-old boy is brought to the pediatrician for a change in his behavior. The patient has been breastfeeding up until this point and has been meeting his developmental milestones. He is in the 90th percentile for weight and 89th percentile for height. This past week, the patient has been lethargic, vomiting, and has been refusing to eat. The patient's parents state that he had an episode this morning where he was not responsive and was moving his extremities abnormally followed by a period of somnolence. The patient's past medical history is notable for shoulder dystocia and poorly managed maternal diabetes during the pregnancy. His temperature is 99.5°F (37.5°C), blood pressure is 60/30 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a lethargic infant with a sweet smell to his breath. Which of the following is most likely deficient in this patient?? {'A': 'Aldolase B', 'B': 'Galactose-1-phosphate uridyltransferase', 'C': 'Glucose', 'D': 'Branched chain alpha-ketoacid dehydrogenase', 'E': 'Ornithine transcarbamolase'}, | A: Aldolase B |
Answer the following medical question with one of the provided options: | Q:A 21-year-old woman is admitted to the hospital for severe malnutrition with a BMI of 15 kg/m2. Past medical history is significant for chronic anorexia nervosa. During the course of her stay, she is treated with parenteral fluids and nutrition management. On the 4th day, her status changes. Her blood pressure is 110/75 mm Hg, heart rate is 120/min, respiratory rate is 25/min, and temperature is 37.0°C (98.6°F). On physical exam, her heart is tachycardic with a regular rhythm and her lungs are clear to auscultation bilaterally. She appears confused, disoriented, and agitated. Strength in her lower extremities is 4/5. What is the next step in management?? {'A': 'MRI of the brain', 'B': 'Arrange for outpatient counseling', 'C': 'Measure electrolytes', 'D': 'Administer insulin', 'E': 'Doppler ultrasound on lower extremities'}, | C: Measure electrolytes |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man comes to the physician because of a 5-day history of fatigue, fever, and chills. For the past 9 months, he has had hand pain and stiffness that has progressively worsened. He started a new medication for these symptoms 3 months ago. Medications used prior to that included ibuprofen, prednisone, and hydroxychloroquine. He does not smoke or drink alcohol. Examination shows a subcutaneous nodule at his left elbow, old joint destruction with boutonniere deformity, and no active joint warmth or tenderness. The remainder of the physical examination shows no abnormalities. His hemoglobin concentration is 10.5 g/dL, leukocyte count is 3500/mm3, and platelet count is 100,000/mm3. Which of the following is most likely to have prevented this patient's laboratory abnormalities?? {'A': 'Cobalamin', 'B': 'Amifostine', 'C': 'Pyridoxine', 'D': 'Leucovorin', 'E': 'Mesna\n"'}, | D: Leucovorin |
Answer the following medical question with one of the provided options: | Q:Please refer to the summary above to answer this question An ECG is most likely to show which of the following findings in this patient?" "Patient Information Age: 64 years Gender: F, self-identified Ethnicity: unspecified Site of Care: emergency department History Reason for Visit/Chief Concern: “My chest hurts, especially when I take a deep breath.” History of Present Illness: 2-hour history of chest pain pain described as “sharp” pain rated 6/10 at rest and 10/10 when taking a deep breath Past Medical History: rheumatoid arthritis major depressive disorder Medications: methotrexate, folic acid, fluoxetine Allergies: penicillin Psychosocial History: does not smoke drinks one glass of bourbon every night Physical Examination Temp Pulse Resp BP O2 Sat Ht Wt BMI 36.7°C (98°F) 75/min 17/min 124/75 mm Hg – 163 cm (5 ft 4 in) 54 kg (120 lb) 20 kg/m2 Appearance: sitting forward at the edge of a hospital bed, uncomfortable Neck: no jugular venous distension Pulmonary: clear to auscultation Cardiac: regular rate and rhythm; normal S1 and S2; no murmurs; a scratching sound is best heard over the left sternal border; pain is not reproducible on palpation; pain is worse when the patient is lying back and improved by leaning forward Abdominal: no tenderness, guarding, masses, bruits, or hepatosplenomegaly Extremities: tenderness to palpation, stiffness, and swelling of the metacarpophalangeal and proximal interphalangeal joints of the fingers; swan neck deformities and ulnar deviation of several fingers; firm, nontender nodules on the extensor aspects of the left forearm; no edema Neurologic: alert and oriented; cranial nerves grossly intact; no focal neurologic deficits"? {'A': 'S waves in lead I, Q waves in lead III, and inverted T waves in lead III', 'B': 'Diffuse, concave ST-segment elevations', 'C': 'Sawtooth-appearance of P waves', 'D': 'Peaked T waves and ST-segment elevations in leads V1-V6', 'E': 'Alternating high and low amplitude QRS complexes'}, | B: Diffuse, concave ST-segment elevations |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy is brought to the physician for a follow-up appointment. He has a seizure disorder treated with valproic acid. He has always had difficulties with his schoolwork. He was able to walk independently at the age of 2 years and was able to use a fork and spoon at the age of 3 years. Ophthalmic examination shows hyperpigmented iris nodules bilaterally. A photograph of his skin examination findings is shown. This patient is at increased risk for which of the following conditions?? {'A': 'Vestibular schwannoma', 'B': 'Hemangioblastoma', 'C': 'Pheochromocytoma', 'D': 'Leptomeningeal angioma', 'E': 'Cardiac rhabdomyoma'}, | C: Pheochromocytoma |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman presents to her primary care physician with a chief complaint of diarrhea. She states that it has been going on for the past month and started after she ate a burger cooked over a campfire. She endorses having lost 10 pounds during this time. The patient has no other complaints other than hoarseness which has persisted during this time. The patient has a past medical history of obesity, hypothyroidism, diabetes, and anxiety. Her current medications include insulin, metformin, levothyroxine, and fluoxetine. She currently drinks 4 to 5 alcoholic beverages per day. Her temperature is 99.5°F (37.5°C), blood pressure is 157/98 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. On physical exam, you note a healthy obese woman. Cardiopulmonary exam is within normal limits. HEENT exam is notable for a mass on the thyroid. Abdominal exam is notable for a candida infection underneath the patient's pannus. Pelvic exam is notable for a white, fish-odored discharge. Laboratory values are as follows: Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 4,500 cells/mm^3 with normal differential Platelet count: 190,000/mm^3 Serum: Na+: 141 mEq/L Cl-: 102 mEq/L K+: 5.5 mEq/L HCO3-: 24 mEq/L Glucose: 122 mg/dL Ca2+: 7.1 mg/dL Which of the following could also be found in this patient?? {'A': 'Acute renal failure', 'B': 'Acute liver failure', 'C': 'Episodic hypertension and headaches', 'D': 'Bitemporal hemianopsia', 'E': 'Schistocytes'}, | C: Episodic hypertension and headaches |
Answer the following medical question with one of the provided options: | Q:A 27-year-old female presents to her OB/GYN for a check-up. During her visit, a pelvic exam and Pap smear are performed. The patient does not have any past medical issues and has had routine gynecologic care with normal pap smears every 3 years since age 21. The results of the Pap smear demonstrate atypical squamous cells of undetermined significance (ASCUS). Which of the following is the next best step in the management of this patient?? {'A': 'Repeat Pap smear in 1 year', 'B': 'Repeat Pap smear in 3 years', 'C': 'Perform an HPV DNA test', 'D': 'Perform colposcopy', 'E': 'Perform a Loop Electrosurgical Excision Procedure (LEEP)'}, | C: Perform an HPV DNA test |
Answer the following medical question with one of the provided options: | Q:A 19-year-old man comes to the physician for the evaluation of progressive difficulty climbing stairs over the last 2 years. During this period, he has also had problems with running, occasional falls, and standing from a chair. He has not had any vision problems or muscle cramping. There is no personal or family history of serious illness. Neurological examination shows deep tendon reflexes are 2+ bilaterally and sensation to pinprick and light touch is normal. Musculoskeletal examination shows enlarged calf muscles bilaterally. He has a waddling gait. Laboratory studies show a creatine kinase level of 1700 U/L. Which of the following is the most appropriate next step to confirm the diagnosis?? {'A': 'Tensilon test', 'B': 'Anti-Jo-1 antibodies measurement', 'C': 'CT scan of the chest', 'D': 'Electromyography', 'E': 'Genetic analysis'}, | E: Genetic analysis |
Answer the following medical question with one of the provided options: | Q:An 11-year-old man presents with fever and joint pain for the last 3 days. His mother says that he had a sore throat 3 weeks ago but did not seek medical care at that time. The family immigrated from the Middle East 3 years ago. The patient has no past medical history. The current illness started with a fever and a swollen right knee that was very painful. The following day, his knee improved but his left elbow became swollen and painful. While in the waiting room, his left knee is also becoming swollen and painful. Vital signs include: temperature 38.7°C (101.6°F), and blood pressure 110/80 mm Hg. On physical examination, the affected joints are swollen and very tender to touch, and there are circular areas of redness on his back and left forearm (as shown in the image). Which of the following is needed to establish a diagnosis of acute rheumatic fever in this patient?? {'A': 'Elevated erythrocyte sedimentation rate (ESR)', 'B': 'Elevated leukocyte count', 'C': 'No other criterion is needed to establish the diagnosis of acute rheumatic fever', 'D': 'Prolonged PR interval', 'E': 'Positive anti-streptococcal serology'}, | E: Positive anti-streptococcal serology |
Answer the following medical question with one of the provided options: | Q:A 41-year-old woman is referred by her radiation oncologist to the medical genetics clinic. She was recently diagnosed with an infiltrating ductal carcinoma of the breast. She has a previous history of colonic polyps for which she undergoes bi-annual colonoscopy. The maternal and paternal family history is unremarkable for polyps and malignant or benign tumors. However, the patient reports that her 10-year-old son has dark brown pigmentation on his lips, and she also had similar pigmentation as a child. Histology of colonic polyps in this patient will most likely reveal which of the following?? {'A': 'Hyperplastic polyps', 'B': 'Adenomatous polyps', 'C': 'Inflammatory polyps', 'D': 'Retention polyps', 'E': 'Hamartomatous polyp'}, | E: Hamartomatous polyp |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman presents to her primary care physician with a 5-month history of worsening bladder discomfort. Her discomfort is relieved by voiding. She voids 10–15 times per day and wakes up 2–3 times per night to void. She has not had any involuntary loss of urine. She has tried cutting down on fluids and taking NSAIDs to reduce the discomfort with minimal relief. Her past medical history is significant for bipolar disorder. She is sexually active with her husband but reports that intercourse has recently become painful. Current medications include lithium. Her temperature is 37°C (98.6°F), pulse is 65/min, and blood pressure is 110/80 mm Hg. Examination shows tenderness to palpation of her suprapubic region. Urinalysis shows: Color clear pH 6.7 Specific gravity 1.010 Protein 1+ Glucose negative Ketones negative Blood negative Nitrite negative Leukocyte esterase negative WBC 0/hpf Squamous epithelial cells 2/hpf Bacteria None A pelvic ultrasound shows a postvoid residual urine is 25 mL. A cystoscopy shows a normal urethra and normal bladder mucosa. Which of the following is the most likely diagnosis?"? {'A': 'Urinary tract infection', 'B': 'Overactive bladder', 'C': 'Interstitial cystitis', 'D': 'Urinary retention', 'E': 'Diabetes insipidus'}, | C: Interstitial cystitis |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman presents to her primary care provider with a 2-month history of insidious onset of left shoulder pain. It only occurs at the extremes of her range of motion and has made it difficult to sleep on the affected side. She has noticed increasing difficulty with activities of daily living, including brushing her hair and putting on or taking off her blouse and bra. She denies a history of shoulder trauma, neck pain, arm/hand weakness, numbness, or paresthesias. Her medical history is remarkable for type 2 diabetes mellitus, for which she takes metformin and glipizide. Her physical examination reveals a marked decrease in both active and passive range of motion of the left shoulder, with forwarding flexion to 75°, abduction to 75°, external rotation to 45°, and internal rotation to 15° with significant pain. Rotator cuff strength is normal. AP, scapular Y, and axillary plain film radiographs are reported as normal. Which of the following is the most likely diagnosis?? {'A': 'Degenerative cervical spine disease', 'B': 'Adhesive capsulitis', 'C': 'Rotator cuff injury', 'D': 'Subacromial impingement syndrome', 'E': 'Glenohumeral arthritis'}, | B: Adhesive capsulitis |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man comes to the physician because of right-sided back pain, red urine, and weight loss for the last 4 months. He has smoked one pack of cigarettes daily for 40 years. A CT scan of the abdomen shows a large right-sided renal mass. Biopsy of the mass shows polygonal clear cells filled with lipids. Which of the following features is necessary to determine the tumor grade in this patient?? {'A': 'Size of malignant proliferation', 'B': 'Invasion of surrounding structures', 'C': 'Degree of mitotic activity', 'D': 'Response to chemotherapy', 'E': 'Involvement of regional lymph nodes\n"'}, | C: Degree of mitotic activity |
Answer the following medical question with one of the provided options: | Q:A previously healthy 46-year-old woman comes to her physician because of an itchy rash on her legs. She denies any recent trauma, insect bites, or travel. Her vital signs are within normal limits. Examination of the oral cavity shows white lace-like lines on the buccal mucosa. A photograph of the rash is shown. A biopsy specimen of the skin lesion is most likely to show which of the following?? {'A': 'Decreased thickness of the stratum granulosum', 'B': 'Inflammation of subcutaneous adipose tissue', 'C': 'Lymphocytes at the dermoepidermal junction', 'D': 'Proliferation of vascular endothelium', 'E': 'Deposition of antibodies around epidermal cells'}, | C: Lymphocytes at the dermoepidermal junction |
Answer the following medical question with one of the provided options: | Q:A 48-year-old female presents to the emergency room with mental status changes. Laboratory analysis of the patient's serum shows: Na 122 mEq/L K 3.9 mEq/L HCO3 24 mEq/L BUN 21 mg/dL Cr 0.9 mg/dL Ca 8.5 mg/dL Glu 105 mg/dL Urinalysis shows: Osmolality 334 mOsm/kg Na 45 mEq/L Glu 0 mg/dL Which of the following is the most likely diagnosis?? {'A': 'Aspirin overdose', 'B': 'Diarrhea', 'C': 'Diabetes insipidus', 'D': 'Primary polydipsia', 'E': 'Lung cancer'}, | E: Lung cancer |
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