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Answer the following medical question with one of the provided options: | Q:On the 4th day of hospital admission due to pneumonia, a 69-year-old woman develops non-bloody diarrhea and abdominal pain. She is currently treated with ceftriaxone. Despite the resolution of fever after the first 2 days of admission, her temperature is now 38.5°C (101.3°F). On physical examination, she has mild generalized abdominal tenderness without abdominal guarding or rebound tenderness. Laboratory studies show re-elevation of leukocyte counts. Ceftriaxone is discontinued. Given the most likely diagnosis in this patient, which of the following is the most sensitive test? ? {'A': 'Endoscopy ', 'B': 'Enzyme immunoassay glutamate dehydrogenase ', 'C': 'Gram stain of stool sample ', 'D': 'Nucleic acid amplification test', 'E': 'Stool culture for bacterial isolation and toxin presence'}, | E: Stool culture for bacterial isolation and toxin presence |
Answer the following medical question with one of the provided options: | Q:A 2-year-old boy is brought to the physician for a well-child examination. Since infancy, he has frequently had large-volume stools that are loose and greasy. He was treated for otitis media twice in the past year. He has a history of recurrent respiratory tract infections since birth. He is at the 5th percentile for height and 3rd percentile for weight. Vital signs are within normal limits. Examination shows softening of the occipital and parietal bones. Scattered expiratory wheezing and rhonchi are heard throughout both lung fields. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Deficient α1 antitrypsin', 'B': 'Gliadin autoantibodies', 'C': 'CFTR gene mutation', 'D': 'Absent T cells', 'E': 'Impaired ciliary function'}, | C: CFTR gene mutation |
Answer the following medical question with one of the provided options: | Q:A 77-year-old woman is brought to her primary care provider by her daughter with behavioral changes and an abnormally bad memory for the past few months. The patient’s daughter says she sometimes gets angry and aggressive while at other times she seems lost and stares at her surroundings. Her daughter also reports that she has seen her mother talking to empty chairs. The patient says she sleeps well during the night but still feels sleepy throughout the day. She has no problems getting dressed and maintaining her one bedroom apartment. Past medical history is significant for mild depression and mild osteoporosis. Current medications include escitalopram, alendronic acid, and a multivitamin. The patient is afebrile, and her vital signs are within normal limits. On physical examination, the patient is alert and oriented and sitting comfortably in her chair. A mild left-hand tremor is noted. Muscle strength is 5 out of 5 in the upper and lower extremities bilaterally, but muscle tone is slightly increased. She can perform repetitive alternating movements albeit slowly. She walks with a narrow gait and has mild difficulty turning. Which of the following is the most likely diagnosis in this patient?? {'A': "Alzheimer's disease", 'B': 'Delirium', 'C': 'Frontotemporal dementia', 'D': 'Lewy body dementia', 'E': 'Serotonin syndrome'}, | D: Lewy body dementia |
Answer the following medical question with one of the provided options: | Q:A 49-year-old man comes to the physician because of severe, shooting pain in his lower back for the past 2 weeks. The pain radiates down the back of both legs and started after he lifted a concrete manhole cover from the ground. Physical examination shows decreased sensation to light touch bilaterally over the lateral thigh area and lateral calf bilaterally. Patellar reflex is decreased on both sides. The passive raising of either the right or left leg beyond 30 degrees triggers a shooting pain down the leg past the knee. Which of the following is the most likely underlying cause of this patient's current condition?? {'A': 'Involuntary contraction of the paraspinal muscles', 'B': 'Inflammatory degeneration of the spine', 'C': 'Compromised integrity of the vertebral body', 'D': 'Herniation of nucleus pulposus into vertebral canal', 'E': 'Inflammatory reaction in the epidural space'}, | D: Herniation of nucleus pulposus into vertebral canal |
Answer the following medical question with one of the provided options: | Q:A 23-year-old patient with a past medical history of anxiety and appropriately treated schizophrenia presents to the emergency department for a first time seizure. The patient was at home eating dinner when he began moving abnormally and did not respond to his mother, prompting her to bring him in. His symptoms persisted in the emergency department and were successfully treated with diazepam. The patient is discharged and scheduled for a follow up appointment with neurology the next day for treatment. The patient returns to his neurologist 1 month later for a checkup. Physical exam is notable for carpopedal spasm when his blood pressure is being taken. Cranial nerves II-XII are grossly intact and his gait is stable. Which of the following is the most likely explanation of this patient's current presentation?? {'A': 'Acute renal failure', 'B': 'Elevated blood levels of a medication', 'C': 'Increased water consumption', 'D': 'P450 induction', 'E': 'Sub-therapeutic dose'}, | D: P450 induction |
Answer the following medical question with one of the provided options: | Q:A 16-year-old boy comes to the physician because of a 1-week history of difficulty swallowing, a foreign body sensation at the back of his throat, and trouble breathing at night. He has just recovered from an upper respiratory tract infection that began 5 days ago. On questioning, he reports that he has had similar symptoms in the past each time he has had an upper respiratory tract infection. Physical examination shows a 3 x 2-cm, nontender, rubbery midline mass at the base of the tongue. His skin is dry and cool. An image of his technetium-99m pertechnetate scan is shown. Which of the following is the most likely underlying cause of this patient’s condition?? {'A': 'Ductal obstruction of the sublingual salivary glands', 'B': 'Chronic infection of the palatine and lingual tonsils', 'C': 'Arrested endodermal migration from pharyngeal floor', 'D': 'Persistent epithelial tract between the foramen cecum and thyroid isthmus', 'E': 'Failure of obliteration of the second branchial cleft'}, | C: Arrested endodermal migration from pharyngeal floor |
Answer the following medical question with one of the provided options: | Q:A previously healthy 44-year-old man is brought by his coworkers to the emergency department 45 minutes after he became light-headed and collapsed while working in the boiler room of a factory. He did not lose consciousness. His coworkers report that 30 minutes prior to collapsing, he told them he was nauseous and had a headache. The patient appears sweaty and lethargic. He is not oriented to time, place, or person. The patient’s vital signs are as follows: temperature 41°C (105.8°F); heart rate 133/min; respiratory rate 22/min; and blood pressure 90/52 mm Hg. Examination shows equal and reactive pupils. Deep tendon reflexes are 2+ bilaterally. His neck is supple. A 0.9% saline infusion is administered. A urinary catheter is inserted and dark brown urine is collected. The patient’s laboratory test results are as follows: Laboratory test Blood Hemoglobin 15 g/dL Leukocyte count 18,000/mm3 Platelet count 51,000/mm3 Serum Na+ 149 mEq/L K+ 5.0 mEq/L Cl- 98 mEq/L Urea nitrogen 42 mg/dL Glucose 88 mg/dL Creatinine 1.8 mg/dL Aspartate aminotransferase (AST, GOT) 210 Alanine aminotransferase (ALT, GPT) 250 Creatine kinase 86,000 U/mL Which of the following is the most appropriate next step in patient management?? {'A': 'Acetaminophen therapy', 'B': 'Dantrolene', 'C': 'Evaporative cooling', 'D': 'Ice water immersion', 'E': 'Hemodialysis'}, | D: Ice water immersion |
Answer the following medical question with one of the provided options: | Q:A 35-year-old male anesthesiologist presents to the occupational health clinic after a needlestick exposure while obtaining an arterial line in a patient with cirrhosis. In addition to a standard bloodborne pathogen laboratory panel sent for all needlestick exposures at his hospital, additional hepatitis panels are ordered upon the patient's request. The patient's results are shown below: HIV 4th generation Ag/Ab: Negative/Negative Hepatitis B surface antigen (HBsAg): Negative Hepatitis C antibody: Negative Anti-hepatitis B surface antibody (HBsAb): Positive Anti-hepatitis B core IgM antibody (HBc IgM): Negative Anti-hepatitis B core IgG antibody (HBc IgG): Positive What is the most likely explanation of the results above?? {'A': 'Acute infection', 'B': 'Chronic infection', 'C': 'Immune due to infection', 'D': 'Immune due to vaccination', 'E': 'Window period'}, | C: Immune due to infection |
Answer the following medical question with one of the provided options: | Q:A 75-year-old woman presents to her physician with a cough and shortness of breath. She says that cough gets worse at night and her shortness of breath occurs with moderate exertion or when lying flat. She says these symptoms have been getting worse over the last 6 months. She mentions that she has to use 3 pillows while sleeping in order to relieve her symptoms. She denies any chest pain, chest tightness, or palpitations. Past medical history is significant for hypertension and diabetes mellitus type 2. Her medications are amiloride, glyburide, and metformin. Family history is significant for her father who also suffered diabetes mellitus type 2 before his death at 90 years old. The patient says she drinks alcohol occasionally but denies any smoking history. Her blood pressure is 130/95 mm Hg, temperature is 36.5°C (97.7°F), and heart rate is 100/min. On physical examination, she has a sustained apical impulse, a normal S1 and S2, and a loud S4 without murmurs. There are bilateral crackles present bilaterally. A chest radiograph shows a mildly enlarged cardiac silhouette. A transesophageal echocardiogram is performed and shows a normal left ventricular ejection fraction. Which of the following myocardial changes is most likely present in this patient?? {'A': 'Ventricular hypertrophy with sarcomeres duplicated in series', 'B': 'Macrophages with hemosiderin', 'C': 'Ventricular hypertrophy with sarcomeres duplicated in parallel', 'D': 'Asymmetric hypertrophy of the interventricular septum', 'E': 'Granuloma consisting of lymphocytes, plasma cells and macrophages surrounding necrotic'}, | C: Ventricular hypertrophy with sarcomeres duplicated in parallel |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman presents to the emergency department with a 2-hour history of sharp chest pain. She says that the pain is worse when she inhales and is relieved by sitting up and leaning forward. Her past medical history is significant for rheumatoid arthritis, myocardial infarction status post coronary artery bypass graft, and radiation for breast cancer 20 years ago. Physical exam reveals a rubbing sound upon cardiac auscultation as well as increased jugular venous distention on inspiration. Pericardiocentesis is performed revealing grossly bloody fluid. Which of the following is most specifically associated with this patient's presentation?? {'A': 'Malignancy', 'B': 'Myocardial infarction', 'C': 'Rheumatoid arthritis', 'D': 'Uremia', 'E': 'Viral illness'}, | A: Malignancy |
Answer the following medical question with one of the provided options: | Q:Four days after admission to the hospital for anorexia nervosa, a 20-year-old woman has new-onset palpitations and paresthesias in all four limbs. Prior to admission, she was found unconscious by her parents on the floor of a residential treatment center. The patient was started on a trial of nutritional rehabilitation upon arrival to the hospital. Her temperature is 36°C (96.8°F), pulse is 47/min, and blood pressure is 90/60 mmHg. She is 160 cm tall and weighs 35 kg; BMI is 14 kg/m2. The patient appears emaciated. Examination shows lower leg edema. A 2/6 holosystolic murmur is heard over the 5th intercostal space at the midclavicular line. AN ECG shows intermittent supraventricular tachycardia and QTc prolongation. Serum studies show: Day 2 Day 4 Potassium (mEq/L) 3.5 2.7 Calcium (mg/dL) 8.5 7.8 Magnesium (mEq/L) 1.2 0.5 Phosphorus (mg/dL) 3.6 1.5 Which of the following is the most likely underlying cause of this patient's condition?"? {'A': 'Thiamine deficiency', 'B': 'Rapid gastric emptying', 'C': 'Uncompensated metabolic alkalosis', 'D': 'Increased insulin release', 'E': 'Euthyroid sick syndrome'}, | D: Increased insulin release |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy comes to the emergency department because of a 3-day history of pain in his left wrist. That morning the pain increased and he started to have chills and malaise. Last week he had self-resolving left knee pain. He is otherwise healthy and has not had any trauma to the wrist. He recently returned from a camping trip to Minnesota. He is sexually active with one female partner, who uses a diaphragm for contraception. His temperature is 37.7°C (99.9°F). Examination shows several painless violaceous vesiculopustular lesions on the dorsum of both wrists and hands; two lesions are present on the left palm. There is swelling and erythema of the left wrist with severe tenderness to palpation and passive movement. Which of the following is the most likely diagnosis?? {'A': 'Lyme arthritis', 'B': 'Acute rheumatic fever', 'C': 'Systemic lupus erythematosus', 'D': 'Disseminated gonococcal infection', 'E': 'Reactive arthritis\n"'}, | D: Disseminated gonococcal infection |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man with obesity and heart disease presents to your outpatient clinic with complaints of orthopnea, significant dyspnea on minimal exertion, nausea, vomiting, and diarrhea. He says that his old doctor gave him "some pills" that he takes in varying amounts every morning. Physical exam is significant for a severely displaced point of maximal impulse, bilateral rales in the lower lung fields, an S3 gallop, and hepatomegaly. You decide to perform an EKG (shown in figure A). Suddenly, his rhythm changes to ventricular tachycardia followed by ventricular fibrillation, and he syncopizes and expires despite resuscitative efforts. High levels of which medication are most likely responsible?? {'A': 'Digoxin', 'B': 'Propranolol', 'C': 'Verapamil', 'D': 'Amiodarone', 'E': 'Lidocaine'}, | A: Digoxin |
Answer the following medical question with one of the provided options: | Q:A 7-year-old African-American boy presents to his physician with fatigue, bone and abdominal pain, and mild jaundice. The pain is dull and remitting, and the patient complains it sometimes migrates from one extremity to another. His mother reports that his jaundice and pain have occurred periodically for the past 5 years. At the time of presentation, his vital signs are as follows: the blood pressure is 80/50 mm Hg, the heart rate is 87/min, the respiratory rate is 17/min, and the temperature is 36.5°C (97.7°F). On physical examination, the patient appears to be pale with mildly icteric sclera and mucous membranes. On auscultation, there is a soft systolic ejection murmur, and palpation reveals hepatosplenomegaly. His musculoskeletal examination shows no abnormalities. Laboratory investigations show the following results: Complete blood count Erythrocytes 3.7 x 106/mm3 Hgb 11 g/dL Total leukocyte count Neutrophils Lymphocytes Eosinophils Monocytes Basophils 7,300/mm3 51% 40% 2% 7% 0 Platelet count 151,000/mm3 Chemistry Total bilirubin 3.1 mg/dL (53 µmol/L) Direct bilirubin 0.5 mg/dL (8.55 µmol/L) A peripheral blood smear shows numerous sickle-shaped red blood cells. Among other questions, the patient’s mother asks you how his condition would influence his vaccination schedule. Which of the following statements is true regarding vaccination in this patient?? {'A': 'The patient should not receive meningococcal, pneumococcal, or Haemophilus influenzae vaccines, because they are likely to cause complications or elicit disease in his case.', 'B': 'The patient should receive serogroup B meningococcal vaccination at the age of 10 years.', 'C': 'The patient should receive serogroup D meningococcal vaccination as soon as possible, because he is at higher risk of getting serogroup B meningococcal infection than other children.', 'D': 'The patient should receive the pneumococcal polysaccharide vaccine as soon as possible, because he is at higher risk of getting pneumococcal infection than other children.', 'E': 'The patient’s condition does not affect his chances to get any infection; thus, additional vaccinations are not advised.'}, | B: The patient should receive serogroup B meningococcal vaccination at the age of 10 years. |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man presents to his primary care physician for generalized pain. The patient states that he feels like his muscles and bones are in constant pain. This has persisted for the past several weeks, and his symptoms have not improved with use of ibuprofen or acetaminophen. The patient has a past medical history of alcohol abuse, repeat episodes of pancreatitis, constipation, and anxiety. He has a 22 pack-year smoking history. His temperature is 99.5°F (37.5°C), blood pressure is 140/95 mmHg, pulse is 70/min, respirations are 15/min, and oxygen saturation is 99% on room air. On physical exam, you note generalized tenderness/pain of the patient's extremities. Abdominal exam reveals normoactive bowel sounds and is non-tender. Dermatologic exam is unremarkable. Laboratory values are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 147,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 100 mEq/L K+: 4.2 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 99 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL Alkaline phosphatase: 252 U/L Lipase: 30 U/L AST: 12 U/L ALT: 10 U/L Which of the following is associated with this patient's condition?? {'A': 'Hearing loss', 'B': 'Bence Jones proteins', 'C': 'Hypercalcemia', 'D': 'Adenocarcinoma of the gallbladder', 'E': 'Obstructive jaundice'}, | A: Hearing loss |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman comes to the physician because of a 3-day history of redness, foreign body sensation, and discharge of both eyes. She reports that her eyes feel “stuck together” with yellow crusts every morning. She has a 3-year history of nasal allergies; her sister has allergic rhinitis. She is sexually active with 2 male partners and uses an oral contraceptive; they do not use condoms. Vital signs are within normal limits. Visual acuity is 20/20 in both eyes. Ophthalmic examination shows edema of both eyelids, bilateral conjunctival injection, and a thin purulent discharge. Examination of the cornea, anterior chamber, and fundus is unremarkable. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Topical natamycin', 'B': 'Topical prednisolone acetate', 'C': 'Topical erythromycin', 'D': 'Artificial tears', 'E': 'Oral erythromycin'}, | C: Topical erythromycin |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man is brought to the emergency department by paramedics following a high-speed motor vehicle collision. The patient complains of excruciating chest pain, which he describes as tearing. Further history reveals that the patient is healthy, taking no medications, and is not under the influence of drugs or alcohol. On physical examination, his heart rate is 97/min. His blood pressure is 95/40 mm Hg in the right arm and 60/30 mm Hg in the left arm. Pulses are absent in the right leg and diminished in the left. A neurological examination is normal. A chest X-ray reveals a widened mediastinum. Which of the following is the most likely etiology of this patient's condition?? {'A': 'Rib fracture', 'B': 'Traumatic aortic dissection', 'C': 'Myocardial rupture', 'D': 'Pulmonary contusion', 'E': 'Diaphragmatic rupture'}, | B: Traumatic aortic dissection |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man presents to the emergency department with shortness of breath. The patient was at a lunch hosted by his employer. He started to feel his symptoms begin when he started playing football outside with a few of the other employees. The patient has a past medical history of atopic dermatitis and asthma. His temperature is 98.3°F (36.8°C), blood pressure is 87/58 mmHg, pulse is 150/min, respirations are 22/min, and oxygen saturation is 85% on room air. Which of the following is the best next step in management?? {'A': 'Albuterol and norepinephrine', 'B': 'Albuterol and prednisone', 'C': 'IM epinephrine', 'D': 'IV epinephrine', 'E': 'IV fluids and 100% oxygen'}, | C: IM epinephrine |
Answer the following medical question with one of the provided options: | Q:A 32-year-old G1P0 woman presents to her obstetrician for a prenatal visit. She is 30 weeks pregnant. She reports some fatigue and complains of urinary urgency. Prior to this pregnancy, she had no significant medical history. She takes a prenatal vitamin and folate supplements daily. Her mother has diabetes, and her brother has coronary artery disease. On physical examination, the fundal height is 25 centimeters. A fetal ultrasound shows a proportional reduction in head circumference, trunk size, and limb length. Which of the following is the most likely cause of the patient’s presentation?? {'A': 'Antiphospholipid syndrome', 'B': 'Cigarette smoking', 'C': 'Gestational diabetes', 'D': 'Pre-eclampsia', 'E': 'Rubella infection'}, | E: Rubella infection |
Answer the following medical question with one of the provided options: | Q:A 71-year-old male presents to the emergency department after having a generalized tonic-clonic seizure. His son reports that he does not have a history of seizures but has had increasing confusion and weakness over the last several weeks. An electrolyte panel reveals a sodium level of 120 mEq/L and a serum osmolality of 248 mOsm/kg. His urine is found to have a high urine osmolality. His temperature is 37° C (98.6° F), respirations are 15/min, pulse is 67/min, and blood pressure is 122/88 mm Hg. On examination he is disoriented, his pupils are round and reactive to light and accommodation and his mucous membranes are moist. His heart has a regular rhythm without murmurs, his lungs are clear to auscultation bilaterally, the abdomen is soft, and his extremities have no edema but his muscular strength is 3/5 bilaterally. There is hyporeflexia of all four extremities. What is the most likely cause of his symptoms?? {'A': 'Syndrome of Inappropriate Antidiuretic Hormone (SIADH)', 'B': 'Sheehan’s syndrome', 'C': 'Lithium use', 'D': 'Diabetic ketoacidosis', 'E': 'Hereditary diabetes insipidus'}, | A: Syndrome of Inappropriate Antidiuretic Hormone (SIADH) |
Answer the following medical question with one of the provided options: | Q:A 69-year-old woman presents with pain in her hip and groin. She states that the pain is present in the morning, and by the end of the day it is nearly unbearable. Her past medical history is notable for a treated episode of acute renal failure, diabetes mellitus, obesity, and hypertension. Her current medications include losartan, metformin, insulin, and ibuprofen. The patient recently started taking high doses of vitamin D as she believes that it could help her symptoms. She also states that she recently fell off the treadmill while exercising at the gym. On physical exam you note an obese woman. There is pain, decreased range of motion, and crepitus on physical exam of her right hip. The patient points to the areas that cause her pain stating that it is mostly over the groin. The patient's skin turgor reveals tenting. Radiography is ordered. Which of the following is most likely to be found on radiography?? {'A': 'Loss of joint space and osteophytes', 'B': 'Hyperdense foci in the ureters', 'C': 'Femoral neck fracture', 'D': 'Posterior displacement of the femoral head', 'E': 'Normal radiography'}, | A: Loss of joint space and osteophytes |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman presents to a physician’s office for a follow-up visit. She recently underwent a complete physical examination with routine laboratory tests. She also had a Pap smear and testing for sexually transmitted diseases. Since her divorce 2 years ago, she had sexual encounters with random men at bars or social events and frequently did not use any form of contraception during sexual intercourse. She was shown to be positive for the human immunodeficiency virus (HIV). Combination anti-retroviral treatment is initiated including zidovudine, didanosine, and efavirenz. One week later, she is rushed to the hospital where she is diagnosed with acute pancreatitis. Which of the following precautions will be required after pancreatitis resolves with treatment?? {'A': 'Frequent monitoring of CD4+ cell count', 'B': 'Add ritonavir to the HIV treatment regimen', 'C': 'Replace efavirenz with nevirapine', 'D': 'Check hemoglobin levels', 'E': 'Replace didanosine with lamivudine'}, | E: Replace didanosine with lamivudine |
Answer the following medical question with one of the provided options: | Q:A primigravida at 10+5 weeks gestation registers in an obstetric clinic for prenatal care. She has noted a rash that is rough with red-brown spots on her palms. The rapid plasma reagin (RPR) test is positive. The diagnosis is confirmed by darkfield microscopy. What is the fetus at risk for secondary to the mother’s condition?? {'A': 'Seizures', 'B': 'Vision loss', 'C': 'Saddle nose', 'D': 'Chorioretinitis', 'E': 'Muscle atrophy'}, | C: Saddle nose |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman that has recently immigrated from Southeast Asia is brought to the emergency department due to a 3-week history of fatigue, night sweats, and enlarged lymph nodes and persistent fever. These symptoms have been getting worse during the past week. She has no history of any cardiac or pulmonary disease. A chest X-ray reveals ipsilateral hilar enlargement and a rounded calcified focus near the right hilum. A Mantoux test is positive. Sputum samples are analyzed and acid-fast bacilli are identified on Ziehl-Neelsen staining. The patient is started on a 4 drug regimen. She returns after 6 months to the emergency department with complaints of joint pain, a skin rash that gets worse with sunlight and malaise. The antinuclear antibody (ANA) and anti-histone antibodies are positive. Which of the following drugs prescribed to this patient is the cause of her symptoms?? {'A': 'Rifampicin', 'B': 'Isoniazid', 'C': 'Pyrazinamide', 'D': 'Ethambutol', 'E': 'Streptomycin'}, | B: Isoniazid |
Answer the following medical question with one of the provided options: | Q:A 71-year-old African American man is brought to the emergency department with sudden onset lower limb paralysis and back pain. He has had generalized bone pain for 2 months. He has no history of severe illnesses. He takes ibuprofen for pain. On examination, he is pale. The vital signs include: temperature 37.1°C (98.8°F), pulse 68/min, respiratory rate 16/min, and blood pressure 155/90 mm Hg. The neurologic examination shows paraparesis. The 8th thoracic vertebra is tender to palpation. X-ray of the thoracic vertebrae confirms a compression fracture at the same level. The laboratory studies show the following: Laboratory test Hemoglobin 9 g/dL Mean corpuscular volume 95 μm3 Leukocyte count 5,000/mm3 Platelet count 240,000/mm3 ESR 85 mm/hr Serum Na+ 135 mEq/L K+ 4.2 mEq/L Cl− 113 mEq/L HCO3− 20 mEq/L Ca+ 11.8 mg/dL Albumin 4 g/dL Urea nitrogen 38 mg/dL Creatinine 2.2 mg/dL Which of the following is the most likely mechanism underlying this patient’s vertebral fracture?? {'A': 'Acidosis-induced bone lysis', 'B': 'Bone demineralization', 'C': 'Increased mechanical pressure', 'D': 'Increased osteoblastic activity', 'E': 'Proliferation of tumor cells'}, | E: Proliferation of tumor cells |
Answer the following medical question with one of the provided options: | Q:A 24-year-old male was in a motor vehicle accident that caused him to fracture his femur and pelvis. After 2 days in the hospital, the patient became delirious, tachypneic, and a petechial rash was found in his upper extremities. Which of the following is most likely responsible for this patient’s symptoms?? {'A': 'Thrombotic clot in the pulmonary artery', 'B': 'Fat microglobules in the microvasculature', 'C': 'Type I and type II pneumocyte damage due to neutrophils', 'D': 'Aspiration of oropharyngeal contents', 'E': 'Alveolar foamy exudates with disc shaped cysts seen with methenamine silver stain'}, | B: Fat microglobules in the microvasculature |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man with a 30-pack-year history comes to the physician for a follow-up examination 6 months after a chest CT showed a solitary 5-mm solid nodule in the upper lobe of the right lung. The follow-up CT shows that the size of the nodule has increased to 2 cm. Ipsilateral mediastinal lymph node involvement is noted. A biopsy of the pulmonary nodule shows small, dark blue tumor cells with hyperchromatic nuclei and scarce cytoplasm. Cranial MRI and skeletal scintigraphy show no evidence of other metastases. Which of the following is the most appropriate next step in management?? {'A': 'Wedge resection', 'B': 'Radiation therapy', 'C': 'Cisplatin-etoposide therapy and radiotherapy', 'D': 'Right lobectomy', 'E': 'Gefitinib therapy'}, | C: Cisplatin-etoposide therapy and radiotherapy |
Answer the following medical question with one of the provided options: | Q:A newborn born at 33 weeks of gestation has a respiratory rate of 70/min and a heart rate of 148/min 2 hours after birth. He is grunting and has intercostal and subcostal retractions. He has peripheral cyanosis as well. An immediate chest radiograph is taken which shows a fine reticular granulation with ground glass appearance on both lungs. Which of the following is the most likely diagnosis?? {'A': 'Pneumothorax', 'B': 'Transient tachypnea of the newborn', 'C': 'Respiratory distress syndrome', 'D': 'Cyanotic congenital heart disease', 'E': 'Bacterial pneumonia'}, | C: Respiratory distress syndrome |
Answer the following medical question with one of the provided options: | Q:A hospitalized 70-year-old woman, who recently underwent orthopedic surgery, develops severe thrombocytopenia of 40,000/mm3 during her 7th day of hospitalization. She has no other symptoms and has no relevant medical history. All of the appropriate post-surgery prophylactic measures had been taken. Her labs from the 7th day of hospitalization are shown here: The complete blood count results are as follows: Hemoglobin 13 g/dL Hematocrit 38% Leukocyte count 8,000/mm3 Neutrophils 54% Bands 3% Eosinophils 1% Basophils 0% Lymphocytes 33% Monocytes 7% Platelet count 40,000/mm3 The coagulation tests are as follows: Partial thromboplastin time (activated) 85 seconds Prothrombin time 63 seconds Reticulocyte count 1.2% Thrombin time < 2 seconds deviation from control The lab results from previous days were within normal limits. What is the most likely cause of the thrombocytopenia?? {'A': 'DIC', 'B': 'Thrombotic microangiopathy', 'C': 'Immune thrombocytopenia', 'D': 'Myelodysplasia', 'E': 'Heparin-induced thrombocytopenia'}, | E: Heparin-induced thrombocytopenia |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man presents to his physician with dyspnea on exertion and rapid heartbeat. He denies any pain during these episodes. He works as a machine operator at a solar panels manufacturer. He has a 21-pack-year history of smoking. The medical history is significant for a perforated ulcer, in which he had to undergo gastric resection and bypass. He also has a history of depression, and he is currently taking escitalopram. The family history is unremarkable. The patient weighs 69 kg (152 lb). His height is 169 cm (5 ft 7 in). The vital signs include: blood pressure 140/90 mm Hg, heart rate 95/min, respiratory rate 12/min, and temperature 36.6℃ (97.9℉). Lung auscultation reveals widespread wheezes. Cardiac auscultation shows decreased S1 and grade 1/6 midsystolic murmur best heard at the apex. Abdominal and neurological examinations show no abnormalities. A subsequent echocardiogram shows increased left ventricular mass and an ejection fraction of 50%. Which of the options is a risk factor for the condition detected in the patient?? {'A': 'The patient’s body mass', 'B': 'History of gastric bypass surgery', 'C': 'Exposure to heavy metals', 'D': 'Smoking', 'E': 'Escitalopram intake'}, | D: Smoking |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man presents to the emergency department with bilateral eye pain. The patient states it has slowly been worsening over the past 48 hours. He admits to going out this past weekend and drinking large amounts of alcohol and having unprotected sex but cannot recall a predisposing event. The patient's vitals are within normal limits. Physical exam is notable for bilateral painful and red eyes with opacification and ulceration of each cornea. The patient's contact lenses are removed and a slit lamp exam is performed and shows bilateral corneal ulceration. Which of the following is the best treatment for this patient?? {'A': 'Acyclovir', 'B': 'Erythromycin ointment', 'C': 'Gatifloxacin eye drops', 'D': 'Intravitreal vancomycin and ceftazidime', 'E': 'Topical dexamethasone and refrain from wearing contacts'}, | C: Gatifloxacin eye drops |
Answer the following medical question with one of the provided options: | Q:A 73-year-old man is brought in by his wife with a history of progressive personality changes. The patient’s wife says that, over the past 3 years, he has become increasingly aggressive and easily agitated, which is extremely out of character for him. His wife also says that he has had several episodes of urinary incontinence in the past month. He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. The patient is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. The patient takes the mini-mental status examination (MMSE) and scores 28/30. A T2 magnetic resonance image (MRI) of the head is performed and the results are shown in the exhibit (see image). Which of the following is the next best diagnostic step in the management of this patient?? {'A': 'Noncontrast CT of the head', 'B': 'Contrast MRI of the head', 'C': 'Lumbar puncture', 'D': 'Brain biopsy', 'E': 'Serum ceruloplasmin level'}, | C: Lumbar puncture |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman presents to the emergency department with palpitations, sweating, and blurry vision after playing volleyball on the beach. She denies chest pain and shortness of breath. She states that these episodes occur often, but resolve after eating a meal or drinking a sugary soda. Past medical history is unremarkable, and she takes no medications. Temperature is 37°C (98.6°F), blood pressure is 135/80 mm Hg, pulse is 102/min, and respirations are 18/min. Fingerstick blood glucose level is 42 g/dL. ECG reveals sinus tachycardia. Urinalysis and toxicology are noncontributory. Appropriate medical therapy is administered and she is discharged with an appointment for a fasting blood draw within the week. Laboratory results are as follows: Blood glucose 45 mg/dL Serum insulin 20 microU/L (N: < 6 microU/L) Serum proinsulin 10 microU/L (N: < 20% of total insulin) C-peptide level 0.8 nmol/L (N: < 0.2 nmol/L) Sulfonylurea Negative IGF-2 Negative What is the most likely cause of this patient’s hypoglycemia?? {'A': 'Heat stroke', 'B': 'Delta cell tumor of the pancreas', 'C': 'Exogenous insulin', 'D': 'Beta cell tumor of the pancreas', 'E': 'Alpha cell tumor of the pancreas'}, | D: Beta cell tumor of the pancreas |
Answer the following medical question with one of the provided options: | Q:A 12-month-old boy is brought in by his mother who is worried about pallor. She says that the patient has always been fair-skinned, but over the past month relatives have commented that he appears more pale. The mother says that the patient seems to tire easy, but plays well with his older brother and has even started to walk. She denies bloody or black stools, easy bruising, or excess bleeding. She states that he is a picky eater, but he loves crackers and whole milk. On physical examination, pallor of the conjunctiva is noted. There is a grade II systolic ejection murmur best heard over the lower left sternal border that increases when the patient is supine. Labs are drawn as shown below: Leukocyte count: 6,500/mm^3 with normal differential Hemoglobin: 6.4 g/dL Platelet count: 300,000/mm^3 Mean corpuscular volume (MCV): 71 µm^3 Reticulocyte count: 2.0% Serum iron: 34 mcg/dL Serum ferritin: 6 ng/mL (normal range 7 to 140 ng/mL) Total iron binding capacity (TIBC): 565 mcg/dL (normal range 240 to 450 mcg/dL) On peripheral blood smear, there is microcytosis, hypochromia, and mild anisocytosis without basophilic stippling. Which of the following is the next best step in management for the patient’s diagnosis?? {'A': 'Administer deferoxamine', 'B': 'Echocardiogram', 'C': 'Limit milk intake', 'D': 'Measure folate level', 'E': 'Measure lead level'}, | C: Limit milk intake |
Answer the following medical question with one of the provided options: | Q:A 58-year-old man presents to the emergency department with a chief complaint of ringing in his ears that started several hours previously that has progressed to confusion. The patient denies any history of medical problems except for bilateral knee arthritis. He was recently seen by an orthopedic surgeon to evaluate his bilateral knee arthritis but has opted to not undergo knee replacement and prefers medical management. His wife noted that prior to them going on a hike today, he seemed confused and not himself. They decided to stay home, and roughly 14 hours later, he was no longer making any sense. Physical exam is notable for a confused man. The patient's vitals are being performed and his labs are being drawn. Which of the following is most likely to be seen on blood gas analysis?? {'A': 'pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L', 'B': 'pH: 7.31, PaCO2: 31 mmHg, HCO3-: 15 mEq/L', 'C': 'pH: 7.37, PaCO2: 41 mmHg, HCO3-: 12 mEq/L', 'D': 'pH: 7.41, PaCO2: 65 mmHg, HCO3-: 34 mEq/L', 'E': 'pH: 7.47, PaCO2: 11 mmHg, HCO3-: 24 mEq/L'}, | A: pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L |
Answer the following medical question with one of the provided options: | Q:A 56-year-old woman is referred to your office with mammography results showing a dense, spiculated mass with clustered microcalcifications. The family history is negative for breast, endometrial, and ovarian cancers. She was formerly a flight attendant and since retirement, she has started a strict Mediterranean diet because she was "trying to compensate for her lack of physical activity". She is the mother of two. She breastfed each infant for 18 months, as recommended by her previous physician. Her only two surgical procedures have been a breast augmentation with implants and tubal ligation. The physical examination is unremarkable. There are no palpable masses and no nipple or breast skin abnormalities. The patient lacks a family history of breast cancer. Which of the following is the most significant risk factor for the development of breast cancer in this patient?? {'A': 'Sedentarism', 'B': 'Breastfeeding', 'C': 'Mediterranean diet', 'D': 'Breast implants', 'E': 'Occupation'}, | E: Occupation |
Answer the following medical question with one of the provided options: | Q:A 29-year-old woman is brought to the emergency department after an episode of syncope. For the past 10 days, she has had dyspnea and palpitations occurring with mild exertion. The patient returned from a hiking trip in Upstate New York 5 weeks ago. Except for an episode of flu with fever and chills a month ago, she has no history of serious illness. Her temperature is 37.3°C (99.1°F), pulse is 45/min, respirations are 21/min, and blood pressure is 148/72 mm Hg. A resting ECG is shown. Two-step serological testing confirms the diagnosis. Which of the following is the most appropriate treatment?? {'A': 'Intravenous ceftriaxone', 'B': 'Beta blocker', 'C': 'Oral doxycycline', 'D': 'Atropine', 'E': 'Permanent pacemaker implantation'}, | A: Intravenous ceftriaxone |
Answer the following medical question with one of the provided options: | Q:A 64-year-old male presents to his primary care physician. Laboratory work-up and physical examination are suggestive of a diagnosis of prostatic adenocarcinoma. A tissue biopsy is obtained, which confirms the diagnosis. Which of the following is indicative of metastatic disease?? {'A': 'Decreased serum alkaline phosphatase', 'B': 'Elevated prostatic acid phosphatase (PAP)', 'C': 'Involvement of the periurethral zone', 'D': 'New-onset lower back pain', 'E': 'Palpation of a hard nodule on digital rectal examination'}, | D: New-onset lower back pain |
Answer the following medical question with one of the provided options: | Q:A patient with a known spinal cord ependymoma presents to his neurologist for a check up. He complains that he has had difficulty walking, which he attributes to left leg weakness. On exam, he is noted to have 1/5 strength in his left lower extremity, as well as decreased vibration and position sensation in the left lower extremity and decreased pain and temperature sensation in the right lower extremity. Which of the following spinal cord lesions is most consistent with his presentation?? {'A': 'Left-sided Brown-Sequard (hemisection)', 'B': 'Right-sided Brown-Sequard (hemisection)', 'C': 'Anterior cord syndrome', 'D': 'Posterior cord syndrome', 'E': 'Syringomelia'}, | A: Left-sided Brown-Sequard (hemisection) |
Answer the following medical question with one of the provided options: | Q:A 2500-g (5-lb 8-oz) female newborn delivered at 37 weeks' gestation develops rapid breathing, grunting, and subcostal retractions shortly after birth. Despite appropriate lifesaving measures, the newborn dies 2 hours later. Autopsy shows bilateral renal agenesis. Which of the following is the most likely underlying cause of this newborn's respiratory distress?? {'A': 'Decreased amniotic fluid ingestion', 'B': 'Injury to the diaphragmatic innervation', 'C': 'Displacement of intestines into the pleural cavity', 'D': 'Collapse of the supraglottic airway', 'E': 'Surfactant inactivation and epithelial inflammation'}, | A: Decreased amniotic fluid ingestion |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man comes to the physician for recurring fever and night sweats for the past 6 months. The fevers persist for 7 to 10 days and then subside completely for about a week before returning again. During this period, he has also noticed two painless lumps on his neck that have gradually increased in size. Over the past year, he has had an 8.2-kg (18.1 lbs) weight loss. Two years ago, he had a severe sore throat and fever, which was diagnosed as infectious mononucleosis. He has smoked a pack of cigarettes daily for the past 10 years. He does not drink alcohol. His job involves monthly international travel to Asia and Africa. He takes no medications. His temperature is 39°C (102.2°F), pulse is 90/min, respirations are 22/min, and blood pressure is 105/60 mm Hg. Physical examination shows 2 enlarged, nontender, fixed cervical lymph nodes on each side of the neck. Microscopic examination of a specimen obtained on biopsy of a cervical lymph node is shown. Which of the following additional findings is most likely present in this patient?? {'A': 'Anti-viral capsid antigen IgG and IgM positive', 'B': 'CD15/30 positive cells', 'C': 'Auer rods on peripheral smear', 'D': 'Leukocyte count > 500,000/μL', 'E': 'Acid fast bacilli in the sputum'}, | B: CD15/30 positive cells |
Answer the following medical question with one of the provided options: | Q:A 17-year-old male presents with altered mental status. He was recently admitted to the hospital due to a tibial fracture suffered while playing soccer. His nurse states that he is difficult to arouse. His temperature is 98.6 deg F (37 deg C), blood pressure is 130/80 mm Hg, pulse is 60/min, and respirations are 6/min. Exam is notable for pinpoint pupils and significant lethargy. Which of the following describes the mechanism of action of the drug likely causing this patient's altered mental status?? {'A': 'Neuronal hyperpolarization due to potassium efflux', 'B': 'Neuronal depolarization due to potassium influx', 'C': 'Neuronal hyperpolarization due to sodium influx', 'D': 'Neuronal depolarization due to sodium efflux', 'E': 'Neuronal hyperpolarization due to chloride influx'}, | A: Neuronal hyperpolarization due to potassium efflux |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy is brought to the emergency department because of sudden-onset abdominal pain that began 1 hour ago. Three days ago, he was diagnosed with a urinary tract infection and was treated with nitrofurantoin. There is no personal history of serious illness. His parents emigrated from Kenya before he was born. Examination shows diffuse abdominal tenderness, mild splenomegaly, and scleral icterus. Laboratory studies show: Hemoglobin 9.8 g/dL Mean corpuscular volume 88 μm3 Reticulocyte count 3.1% Serum Bilirubin Total 3.8 mg/dL Direct 0.6 mg/dL Haptoglobin 16 mg/dL (N=41–165 mg/dL) Lactate dehydrogenase 179 U/L Which of the following is the most likely underlying cause of this patient's symptoms?"? {'A': 'Enzyme deficiency in red blood cells', 'B': 'Defective red blood cell membrane proteins', 'C': 'Defect in orotic acid metabolism', 'D': 'Lead poisoning', 'E': 'Absent hemoglobin beta chain'}, | A: Enzyme deficiency in red blood cells |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man comes to the physician with chills, nausea, and diffuse muscle aches for 3 days. His niece had similar symptoms 2 weeks ago and H1N1 influenza strain was isolated from her respiratory secretions. He received his influenza vaccination 2 months ago. His temperature is 38°C (100.4°F). A rapid influenza test is positive. Which of the following mechanisms best explains this patient's infection despite vaccination?? {'A': 'Random point mutations within viral genome', 'B': 'Complementing with functional viral proteins', 'C': 'Exchange of viral genes between chromosomes', 'D': 'Reassortment of viral genome segments', 'E': 'Acquisition of viral surface proteins'}, | A: Random point mutations within viral genome |
Answer the following medical question with one of the provided options: | Q:A 34-year-old G1P0 woman gives birth to a male infant at 35 weeks gestation. The child demonstrates a strong cry and moves all his arms and legs upon birth. Respirations are slow and irregular. His temperature is 99.1°F (37.3°C), blood pressure is 100/55 mmHg, pulse is 115/min, and respirations are 18/min. At a follow up appointment, the physician notices that the infant’s torso and upper extremities are pink while his lower extremities have a bluish hue. Which of the following will most likely be heard on auscultation of the patient’s chest?? {'A': 'Rumbling noise in late diastole', 'B': 'Early diastolic decrescendo murmur at the left sternal border', 'C': 'Holosystolic murmur radiating to the right sternal border', 'D': 'Holosystolic murmur radiating to the axilla', 'E': 'Continuous systolic and diastolic murmur at left upper sternal border'}, | E: Continuous systolic and diastolic murmur at left upper sternal border |
Answer the following medical question with one of the provided options: | Q:Blood cultures are sent to the laboratory. Intravenous antibiotic therapy is started. Transesophageal echocardiography shows a large, oscillating vegetation attached to the tricuspid valve. There are multiple small vegetations attached to tips of the tricuspid valve leaflets. There is moderate tricuspid regurgitation. The left side of the heart and the ejection fraction are normal. Which of the following is the most likely causal organism of this patient's conditions?? {'A': 'Streptococcus sanguinis', 'B': 'Enterococcus faecalis', 'C': 'Staphylococcus epidermidis', 'D': 'Neisseria gonorrhoeae', 'E': 'Staphylococcus aureus'}, | E: Staphylococcus aureus |
Answer the following medical question with one of the provided options: | Q:A 59-year-old male presents to the emergency room complaining of substernal chest pain. He reports a three-hour history of dull substernal chest pain that radiates into his left arm and jaw. He has experienced similar chest pain before that was brought on with exertion, but this pain is more severe and occurred with rest. His past medical history includes gout, hypertension, diabetes mellitus, and hyperlipidemia. An EKG demonstrates ST segment depression. Serum troponin is elevated. In addition to aspirin, oxygen, and morphine, he is started on a sublingual medication. What is the main physiologic effect of this medication?? {'A': 'Decrease preload', 'B': 'Increase preload', 'C': 'Decrease afterload', 'D': 'Increase contractility', 'E': 'Decrease heart rate'}, | A: Decrease preload |
Answer the following medical question with one of the provided options: | Q:A 6-day-old male newborn is brought to the physician by his mother for the evaluation of yellowing of his skin and eyes for one day. The mother reports that she is breastfeeding her son about 7 times per day. She also states that her son had two wet diapers and two bowel movements yesterday. He was born at 38 weeks' gestation and weighed 3500 g (7.7 lb); he currently weighs 3000 g (6.6 lb). His newborn screening was normal. His temperature is 37°C (98.6°F), pulse is 180/min, and blood pressure is 75/45 mm Hg. Physical examination shows scleral icterus, widespread jaundice, and dry mucous membranes. The remainder of the examination shows no abnormalities. Serum studies show: Bilirubin Total 9 mg/dL Direct 0.7 mg/dL AST 15 U/L ALT 15 U/L Which of the following is the most appropriate next step in the management of this patient?"? {'A': 'Intravenous immunoglobulin', 'B': 'Phenobarbital', 'C': 'Increasing frequency of breastfeeding', 'D': 'Abdominal sonography', 'E': 'Phototherapy\n"'}, | C: Increasing frequency of breastfeeding |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman is rushed to the emergency department after she was found unconscious in a house fire. She has no previous medical history available. At the hospital, the vital signs include: blood pressure 110/70 mm Hg, temperature 36.0°C (97.0°F), and heart rate 76/min with oxygen saturation 99% on room air. On physical exam she is unconscious. There are superficial burns on her hands and parts of her face. Her face and clothes are blackened with soot. What is the 1st best step while treating this patient?? {'A': 'Penicillamine', 'B': 'Sodium nitrite', 'C': 'Administer 100% oxygen', 'D': 'Pyridoxine (vitamin B6)', 'E': 'N-acetylcysteine'}, | C: Administer 100% oxygen |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman is brought to the emergency department in a semi-unconscious state by her neighbor who saw her lose consciousness. There was no apparent injury on the primary survey. She is not currently taking any medications. She has had loose stools for the past 3 days and a decreased frequency of urination. No further history could be obtained. The vital signs include: blood pressure 94/62 mm Hg, temperature 36.7°C (98.0°F), pulse 105/min, and respiratory rate 10/min. The skin appears dry. Routine basic metabolic panel, urine analysis, urine osmolality, and urine electrolytes are pending. Which of the following lab abnormalities would be expected in this patient?? {'A': 'Urine osmolality < 350 mOsm/kg', 'B': 'Urine Na+ > 40 mEq/L', 'C': 'Fractional excretion of sodium (FENa) > 2%', 'D': 'Serum blood urea nitrogen/creatinine (BUN/Cr) > 20', 'E': 'Serum creatinine < 1 mg/dL'}, | D: Serum blood urea nitrogen/creatinine (BUN/Cr) > 20 |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man is brought to the emergency department following a house fire. Following initial stabilization, the patient is transferred to the ICU for management of his third-degree burn injuries. On the second day of hospitalization, a routine laboratory panel is obtained, and the results are demonstrated below. Per the nurse, he remains stable compared to the day prior. His temperature is 99°F (37°C), blood pressure is 92/64 mmHg, pulse is 98/min, respirations are 14/min, and SpO2 is 98%. A physical examination demonstrates an unresponsive patient with extensive burn injuries throughout his torso and lower extremities. Hemoglobin: 13 g/dL Hematocrit: 36% Leukocyte count: 10,670/mm^3 with normal differential Platelet count: 180,000/mm^3 Serum: Na+: 135 mEq/L Cl-: 98 mEq/L K+: 4.7 mEq/L HCO3-: 25 mEq/L BUN: 10 mg/dL Glucose: 123 mg/dL Creatinine: 1.8 mg/dL Thyroid-stimulating hormone: 4.3 µU/mL Triiodothyronine: 48 ng/dL Thyroxine: 10 ug/dL Ca2+: 8.7 mg/dL AST: 89 U/L ALT: 135 U/L What is the best course of management for this patient?? {'A': 'Continued management of his burn wounds', 'B': 'Immediate administration of propanolol', 'C': 'Increase opioid dosage', 'D': 'Regular levothyroxine sodium injections', 'E': 'Start patient on intravenous ceftriaxone and vancomycin'}, | A: Continued management of his burn wounds |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy comes to the physician because of fever, fatigue, and a sore throat for 12 days. He was prescribed amoxicillin at another clinic and now has a diffuse rash all over his body. He was treated for gonorrhea one year ago. He has multiple sexual partners and uses condoms inconsistently. He appears lethargic and thin. His BMI is 19.0 kg/m2. His temperature is 38.4°C (101.1°F), pulse 94/min, blood pressure 106/72 mm Hg. Examination shows a morbilliform rash over his extremities. Oropharyngeal examination shows tonsillar enlargement and erythema with exudates. Tender cervical and inguinal lymphadenopathy is present. Abdominal examination shows mild splenomegaly. Laboratory studies show: Hemoglobin 14 g/dL Leukocyte count 13,200/mm3 Platelet count 160,000/mm3 Which of the following is the next best step in management?"? {'A': 'Throat swab culture', 'B': 'Anti-CMV IgM', 'C': 'ELISA for HIV', 'D': 'Heterophile agglutination test', 'E': 'Flow cytometry'}, | D: Heterophile agglutination test |
Answer the following medical question with one of the provided options: | Q:A 71-year-old man presents to the primary care clinic with non-specific complaints of fatigue and malaise. His past medical history is significant for diabetes mellitus type II, hypertension, non-seminomatous testicular cancer, and hypercholesterolemia. He currently smokes 1 pack of cigarettes per day, drinks a glass of wine per day, and he currently denies any illicit drug use. His vital signs include: temperature, 36.7°C (98.0°F); blood pressure, 126/74 mm Hg; heart rate, 87/min; and respiratory rate, 17/min. On examination, his physician notices cervical and inguinal lymphadenopathy bilaterally, as well as splenomegaly. The patient comments that he has lost 18.1 kg (40 lb) over the past 6 months without a change in diet or exercise, which he was initially not concerned about. The physician orders a complete blood count and adds on flow cytometry. Based on his age and overall epidemiology, which of the following is the most likely diagnosis?? {'A': 'Acute lymphocytic leukemia', 'B': 'Acute myelogenous leukemia', 'C': 'Chronic lymphocytic leukemia', 'D': 'Chronic myelogenous leukemia', 'E': 'Hairy cell leukemia'}, | C: Chronic lymphocytic leukemia |
Answer the following medical question with one of the provided options: | Q:A 69-year-old man comes to his cardiologist for a follow-up visit. He is being considered for a new drug therapy that works by modulating certain proteins released from the heart in patients with heart failure. A drug called candoxatril is being investigated for its ability to inhibit the action of an endopeptidase that breaks down a vasodilatory mediator released from the heart, as well as, endothelin and bradykinin. This mediator is known to promote the excretion of sodium from the body and improve the ejection fraction. One of its side effects is its ability to increase angiotensin II levels which causes harm to patients with heart failure. Therefore, to improve efficacy and reduce its adverse effects, candoxatril has to be used in conjunction with angiotensin receptor blockers. Which of the following is most likely to increase as a result of this drug regimen?? {'A': 'Thromboxane', 'B': 'Nitric oxide', 'C': 'Leukotrienes', 'D': 'Acetylcholine', 'E': 'Natriuretic peptides'}, | E: Natriuretic peptides |
Answer the following medical question with one of the provided options: | Q:Seventy-two hours after admission for an acute myocardial infarction, a 48-year-old man develops dyspnea and a productive cough with frothy sputum. Physical examination shows coarse crackles in both lungs and a blowing, holosystolic murmur heard best at the apex. ECG shows Q waves in the anteroseptal leads. Pulmonary capillary wedge pressure is 23 mm Hg. Which of the following is the most likely cause of this patient’s current condition?? {'A': 'Postmyocardial infarction syndrome', 'B': 'Aortic root dilation', 'C': 'Rupture of the chordae tendinae', 'D': 'Rupture of the ventricular free wall', 'E': 'Rupture of the interventricular septum'}, | C: Rupture of the chordae tendinae |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man comes to the physician because of a productive cough and dyspnea. He has smoked one pack of cigarettes daily for 15 years. His temperature is 38.8°C (102°F). Physical examination shows decreased breath sounds and dullness on percussion above the right lower lobe. An x-ray of the chest shows a right lower lobe density and a small amount of fluid in the right pleural space. The patient's symptoms improve with antibiotic treatment, but he develops right-sided chest pain one week later. Pulmonary examination shows new scratchy, high-pitched breath sounds on auscultation of the right lobe. Histologic examination of a pleural biopsy specimen is most likely to show which of the following findings?? {'A': 'Cholesterol-rich infiltrate', 'B': 'Fibrin-rich infiltrate', 'C': 'Dense bacterial infiltrate', 'D': 'Epithelioid infiltrate with central necrosis', 'E': 'Red blood cell infiltrate'}, | B: Fibrin-rich infiltrate |
Answer the following medical question with one of the provided options: | Q:A 50-year-old obese woman presents for a follow-up appointment regarding microcalcifications found in her left breast on a recent screening mammogram. The patient denies any recent associated symptoms. The past medical history is significant for polycystic ovarian syndrome (PCOS), for which she takes metformin. Her menarche occurred at age 11, and the patient still has regular menstrual cycles. The family history is significant for breast cancer in her mother at the age of 72. The review of systems is notable for a 6.8 kg (15 lb) weight loss in the past 2 months. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 130/70 mm Hg, pulse 82/min, respiratory rate 17/min, and oxygen saturation 98% on room air. On physical examination, the patient is alert and cooperative. The breast examination reveals no palpable masses, lymphadenopathy, or evidence of skin retraction. An excisional biopsy of the left breast is performed, and histologic examination demonstrates evidence of non-invasive malignancy. Which of the following is the most appropriate course of treatment for this patient?? {'A': 'Observation with bilateral mammograms every 6 months', 'B': 'Tamoxifen', 'C': 'Radiotherapy', 'D': 'Lumpectomy', 'E': 'Bilateral mastectomy'}, | D: Lumpectomy |
Answer the following medical question with one of the provided options: | Q:An 18-month-old boy presents to the clinic with his mother for evaluation of a rash around the eyes and mouth. His mother states that the rash appeared 2 weeks ago and seems to be very itchy because the boy scratches his eyes often. The patient is up to date on all of his vaccinations and is meeting all developmental milestones. He has a history of asthma that was recently diagnosed. On examination, the patient is playful and alert. He has scaly, erythematous skin surrounding both eyes and his mouth. Bilateral pupils are equal and reactive to light and accommodation, and conjunctiva is clear, with no evidence of jaundice or exudates. The pharynx and oral mucosa are within normal limits, and no lesions are present. Expiratory wheezes can be heard in the lower lung fields bilaterally. What is this most likely diagnosis in this patient?? {'A': 'Viral conjunctivitis', 'B': 'Bronchiolitis', 'C': 'Impetigo', 'D': 'Atopic dermatitis', 'E': 'Scalded skin syndrome'}, | D: Atopic dermatitis |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man presents to the emergency department with periorbital swelling. He states that he was gardening, came inside, looked in the mirror, and then noticed his eyelids were swollen. He denies pain, pruritus, or visual disturbances. He states that he was drinking “a lot of water" to prevent dehydration, because it was hot outside this morning. His medical history is significant for rheumatoid arthritis. He takes methotrexate and acetaminophen as needed. The patient’s temperature is 98°F (36.7°C), blood pressure is 168/108 mmHg, and pulse is 75/min. Physical examination is notable for periorbital edema, hepatomegaly, and bilateral 1+ pitting lower extremity edema. Labs and a urinalysis are obtained, as shown below: Leukocyte count: 11,000/mm^3 Hemoglobin: 14 g/dL Serum: Na: 138 mEq/L K+: 4.3 mEq/L Cl-: 104 mEq/L HCO3-: 25 mEq/L Urea nitrogen: 26 mg/dL Creatinine: 1.4 mg/dL Glucose: 85 mg/dL Aspartate aminotransferase (AST, GOT): 15 U/L Alanine aminotransferase (ALT, GPT): 19 U/L Albumin: 2.0 g/dL Urine: Protein: 150 mg/dL Creatinine: 35 mg/dL An abdominal ultrasound reveals an enlarged liver with heterogeneous echogenicity and enlarged kidneys with increased echogenicity in the renal parenchyma. A biopsy of the kidney is obtained. Which of the following biopsy findings is associated with the patient’s most likely diagnosis?? {'A': 'Apple green birefringence with Congo red staining', 'B': 'Glomerular basement membrane splitting', 'C': 'Kimmelstiel-Wilson nodules', 'D': 'Subepithelial dense deposits', 'E': 'Tubulointerstitial fibrosis'}, | A: Apple green birefringence with Congo red staining |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman presents to her primary care physician for a regular check-up. She complains of swelling of her legs and face, which is worse in the morning and decreases during the day. She was diagnosed with type 2 diabetes mellitus a year ago and prescribed metformin, but she has not been compliant with it preferring ‘natural remedies’ over the medications. She does not have a history of cardiovascular disease or malignancy. Her vital signs are as follows: blood pressure measured on the right hand is 130/85 mm Hg, on the left hand, is 110/80 mm Hg, heart rate is 79/min, respiratory rate is 16/min, and the temperature is 36.6℃ (97.9°F). Physical examination reveals S1 accentuation best heard in the second intercostal space at the right sternal border. Facial and lower limbs edema are evident. The results of the laboratory tests are shown in the table below. Fasting plasma glucose 164 mg/dL HbA1c 10.4% Total cholesterol 243.2 mg/dL Triglycerides 194.7 mg/dL Creatinine 1.8 mg/dL Urea nitrogen 22.4 mg/dL Ca2+ 9.6 mg/dL PO42- 38.4 mg/dL Which of the following statements best describes this patient’s condition?? {'A': 'If measured in this patient, there would be an increased PTH level.', 'B': 'The calcitriol level is unlikely to be affected in this patient.', 'C': 'Hypoparathyroidism is most likely the cause of the patient’s altered laboratory results.', 'D': 'Increase in 1α, 25(OH)2D3 production is likely to contribute to alteration of the patient’s laboratory values.', 'E': 'There is an error in Ca2+ measurement because the level of serum calcium is always decreased in the patient’s condition.'}, | A: If measured in this patient, there would be an increased PTH level. |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 27-year-old man presents to the Emergency Department with dark urine and left flank pain. He has had a fever, sore throat, and malaise for the last 2 days. Vital signs reveal a temperature of 38.1°C (100.5°F), blood pressure of 120/82 mm Hg, and a pulse of 95/min. His family history is noncontributory. Physical examination reveals enlarged tonsils with tender anterior cervical lymphadenopathy. Urinalysis shows pink urine with 20–25 red cells/high power field and 2+ protein. This patient’s condition is most likely due to which of the following?? {'A': 'Inherited abnormalities in type IV collagen', 'B': 'Autoantibodies against alpha-3 chain of type IV collagen', 'C': 'C3 nephritic factor', 'D': 'Immune complex deposition', 'E': 'Diffuse mesangial IgA deposition'}, | E: Diffuse mesangial IgA deposition |
Answer the following medical question with one of the provided options: | Q:A 70-year-old man is brought to the emergency department with complaints of chest pain for the last 2 hours. He had been discharged from the hospital 10 days ago when he was admitted for acute myocardial infarction. It was successfully treated with percutaneous coronary intervention. During the physical exam, the patient prefers to hunch forwards as this decreases his chest pain. He says the pain is in the middle of the chest and radiates to his back. Despite feeling unwell, the patient denies any palpitations or shortness of breath. Vitals signs include: pulse 90/min, respiratory rate 20/min, blood pressure 134/82 mm Hg, and temperature 36.8°C (98.2°F). The patient is visibly distressed and is taking shallow breaths because deeper breaths worsen his chest pain. An ECG shows diffuse ST elevations. Which of the following should be administered to this patient?? {'A': 'Ibuprofen', 'B': 'Heparin', 'C': 'Levofloxacin', 'D': 'Propranolol', 'E': 'Warfarin'}, | A: Ibuprofen |
Answer the following medical question with one of the provided options: | Q:A 55-year-old female presents to her primary care physician complaining of a mass in her mid-thigh. The mass has grown slowly over the past six months and is not painful. The patient’s past medical history is notable for hypertension and hyperlipidemia. She takes lisinopril and rosuvastatin. On examination, there is a firm, immobile mass on the medial aspect of the distal thigh. She has full range of motion and strength in her lower extremities and patellar reflexes are 2+ bilaterally. A biopsy of the mass reveals multiple pleomorphic smooth muscle cells with nuclear atypia. The patient subsequently initiates radiation therapy with plans to undergo surgical resection. This tumor will most strongly stain for which of the following?? {'A': 'Chromogranin', 'B': 'Desmin', 'C': 'Cytokeratin', 'D': 'Glial fibrillary acidic protein', 'E': 'Neurofilament'}, | B: Desmin |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman presents to the emergency department for fever and generalized malaise. Her symptoms began approximately 3 days ago, when she noticed pain with urination and mild blood in her urine. Earlier this morning she experienced chills, flank pain, and mild nausea. Approximately 1 month ago she had the "flu" that was rhinovirus positive and was treated with supportive management. She has a past medical history of asthma. She is currently sexually active and uses contraception inconsistently. She occasionally drinks alcohol and denies illicit drug use. Family history is significant for her mother having systemic lupus erythematosus. Her temperature is 101°F (38.3°C), blood pressure is 125/87 mmHg, pulse is 101/min, and respirations are 18/min. On physical examination, she appears uncomfortable. There is left-sided flank, suprapubic, and costovertebral angle tenderness. Urine studies are obtained and a urinalysis is demonstrated below: Color: Amber pH: 6.8 Leukocyte: Positive Protein: Trace Glucose: Negative Ketones: Negative Blood: Positive Nitrite: Positive Leukocyte esterase: Positive Specific gravity: 1.015 If a renal biopsy is performed in this patient, which of the following would most likely be found on pathology?? {'A': 'Diffuse capillary and glomerular basement membrane thickening', 'B': 'Focal and segmental sclerosis of the glomeruli and mesangium', 'C': 'Mesangial proliferation', 'D': 'Normal appearing glomeruli', 'E': 'Suppurative inflammation with interstitial neutrophilic infiltration'}, | E: Suppurative inflammation with interstitial neutrophilic infiltration |
Answer the following medical question with one of the provided options: | Q:A 20-year-old man, who was previously healthy, is taken to the emergency department due to agitation during the past 24 hours. During the past week, his family members noticed a yellowish coloring of his skin and eyes. He occasionally uses cocaine and ecstasy, and he drinks alcohol (about 20 g) on weekends. The patient also admits to high-risk sexual behavior and does not use appropriate protection. Physical examination shows heart rate of 94/min, respiratory rate of 13/min, temperature of 37.0°C (98.6°F), and blood pressure of 110/60 mm Hg. The patient shows psychomotor agitation, and he is not oriented to time and space. Other findings include asterixis, jaundice on the skin and mucous membranes, and epistaxis. The rest of the physical examination is normal. The laboratory tests show: Hemoglobin 16.3 g/dL Hematocrit 47% Leukocyte count 9,750/mm3 Neutrophils 58% Bands 2% Eosinophils 1% Basophils 0% Lymphocytes 24% Monocytes 2% Platelet count 365,000/mm3 Bilirubin 25 mg/dL AST 600 IU/L ALT 650 IU/L TP activity < 40% INR 1,5 What is the most likely diagnosis?? {'A': 'Hemolytic uremic syndrome', 'B': 'Alcoholic hepatitis', 'C': 'Fulminant hepatic failure', 'D': 'Ecstasy intoxication', 'E': 'Cocaine-abstinence syndrome'}, | C: Fulminant hepatic failure |
Answer the following medical question with one of the provided options: | Q:A 31-year-old woman is brought to the physician because of increasing restlessness over the past 2 weeks. She reports that she continuously paces around the house and is unable to sit still for more than 10 minutes at a time. During this period, she has had multiple episodes of anxiety with chest tightness and shortness of breath. She was diagnosed with a psychotic illness 2 months ago. Her current medications include haloperidol and a multivitamin. She appears agitated. Vital signs are within normal limits. Physical examination shows no abnormalities. The examination was interrupted multiple times when she became restless and began to walk around the room. To reduce the likelihood of the patient developing her current symptoms, a drug with which of the following mechanisms of action should have been prescribed instead of her current medication?? {'A': 'H2 receptor antagonism', 'B': 'NMDA receptor antagonism', 'C': 'GABA receptor antagonism', 'D': '5-HT2Areceptor antagonism', 'E': 'α2 receptor antagonism'}, | D: 5-HT2Areceptor antagonism |
Answer the following medical question with one of the provided options: | Q:A 62-year-old man presents to the emergency department with shortness of breath on exertion and fatigue. He says that his symptoms onset gradually 5 days ago and have progressively worsened. Past medical history is significant for chronic alcoholism. His vital signs are blood pressure 100/60 mm Hg, temperature 36.9°C (98.4°F), respiratory rate 18/min, and pulse 98/min. On physical examination, there is bilateral pedal edema and decreased sensation in both feet. Basal crackles and rhonchi are heard on pulmonary auscultation bilaterally. Cardiac exam is unremarkable. A chest radiograph shows a maximal horizontal cardiac diameter to a maximal horizontal thoracic ratio of 0.7. A deficiency of which of the following vitamins is most likely responsible for this patient’s condition? ? {'A': 'Thiamine', 'B': 'Riboflavin', 'C': 'Vitamin C', 'D': 'Niacin', 'E': 'Folic acid'}, | A: Thiamine |
Answer the following medical question with one of the provided options: | Q:A 60-year-old woman sought evaluation at an urgent care clinic after developing breathlessness 30 minutes earlier. She also developed swelling of the tongue and lips. She has heart failure and was recently diagnosed with hypertension. She was started on a medication, the first dose of which she took this afternoon before her symptoms started. Her blood pressure is 167/88 mm Hg, the respiratory rate is 17/min, and the pulse is 78/min. The physical examination reveals a skin rash on the back and abdomen. There is a mild swelling of the lips and tongue. Chest auscultation does not reveal any abnormal breath sounds. Which of the following medications most likely led to her current symptoms?? {'A': 'Captopril', 'B': 'Amlodipine', 'C': 'Clonidine', 'D': 'Hydrochlorothiazide (HCTZ)', 'E': 'Propranolol'}, | A: Captopril |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman presents for pregnancy counseling. She says she has a 8 week history of chronic diarrhea. She is also found to be intolerant to heat and has been significantly losing her hair. She denies any recent changes to her diet. The patient is afebrile and her vital signs are within normal limits. Her weight today is 45.0 kg (99.2 lb) which is 4.5 kg (10 lb) less than her weight during her last visit 2 months back. On physical examination, the patient is anxious and has a non-intention tremor. Significant exophthalmos is present. Laboratory findings are significant for a low TSH, elevated free T4 and free T3, and a positive thyroid stimulating immunoglobulin assay. She still wants to conceive a baby and asks for an appropriate treatment that is safe in pregnancy. Which of the following best describes the therapy she will most likely receive during her pregnancy for her thyroid disorder?? {'A': 'Thyroidectomy and thyroid replacement', 'B': 'Beta-blockers', 'C': 'Radiation', 'D': 'Thyroid peroxidase inhibitors', 'E': 'Plasmapheresis'}, | D: Thyroid peroxidase inhibitors |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man was shown to have a blood pressure of 142/90 mm Hg at a health fair. Despite modifying his lifestyle, his blood pressure remained elevated on 2 separate subsequent occasions. He was prescribed an anti-hypertensive medication. After 3 weeks, the swelling of the lips shown in the accompanying photograph was observed. What is the most likely cause of this finding?? {'A': 'Verapamil', 'B': 'Amlodipine', 'C': 'Lisinopril', 'D': 'Hydrochlorothiazide', 'E': 'Furosemide'}, | C: Lisinopril |
Answer the following medical question with one of the provided options: | Q:A 13-year-old girl is brought to the physician because of worsening fever, headache, photophobia, and nausea for 2 days. One week ago, she returned from summer camp. She has received all age-appropriate immunizations. Her temperature is 39.1°C (102.3°F). She is oriented to person, place, and time. Physical examination shows a maculopapular rash. There is rigidity of the neck; forced flexion of the neck results in involuntary flexion of the knees and hips. Cerebrospinal fluid studies show: Opening pressure 120 mm H2O Appearance Clear Protein 47 mg/dL Glucose 68 mg/dL White cell count 280/mm3 Segmented neutrophils 15% Lymphocytes 85% Which of the following is the most likely causal organism?"? {'A': 'Echovirus', 'B': 'Listeria monocytogenes', 'C': 'Herpes simplex virus', 'D': 'Streptococcus pneumoniae', 'E': 'Neisseria meningitidis'}, | A: Echovirus |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy presents to his pediatrician for a well-child visit. His mother reports him to be doing well and has no concerns. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. On physical exam, he is noted to have a right upper extremity blood pressure of 150/80 mm Hg. 2+ radial pulses and trace femoral pulses are felt. Cardiac auscultation reveals a regular rate and rhythm with a normal S1 and S2. A 2/6 long systolic murmur with systolic ejection click is heard over left sternal border and back. The point of maximal impact is normal Which of the following is the most likely diagnosis?? {'A': 'Takayasu arteritis', 'B': 'Interrupted aortic arch', 'C': 'Pheochromocytoma', 'D': 'Coarctation of the aorta', 'E': 'Essential hypertension'}, | D: Coarctation of the aorta |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman comes to the physician for a follow-up examination. Two months ago, she underwent left renal transplantation for recurrent glomerulonephritis. At the time of discharge, her creatinine was 0.9 mg/dL. She feels well. Current medications include tacrolimus and azathioprine. Her pulse is 85/min and blood pressure is 135/75 mmHg. Physical examination shows a well-healed surgical scar on her left lower abdomen. The remainder of the examination shows no abnormalities. The patient should be monitored for which of the following adverse effects of her medications?? {'A': 'Teeth discoloration', 'B': 'Gingival hyperplasia', 'C': 'Hepatic necrosis', 'D': 'Kidney injury', 'E': 'Polycythemia'}, | D: Kidney injury |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the physician because of a 12 month history of progressive fatigue and shortness of breath with exertion. Five years ago, she emigrated from Eastern Europe. She has smoked one pack of cigarettes daily for 20 years. She has a history of using methamphetamines and cocaine but quit 5 years ago. Vital signs are within normal limits. Physical examination shows jugular venous pulsations 9 cm above the sternal angle. The lungs are clear to auscultation. There is a normal S1 and a loud, split S2. An impulse can be felt with the fingers left of the sternum. The abdomen is soft and nontender. The fingertips are enlarged and the nails are curved. There is pitting edema around the ankles bilaterally. An x-ray of the chest shows pronounced central pulmonary arteries and a prominent right heart border. Which of the following is most likely to confirm the diagnosis?? {'A': 'CT angiography', 'B': 'Doppler echocardiography', 'C': 'High-resolution CT of the lung', 'D': 'Right-heart catheterization', 'E': 'Serologic testing'}, | D: Right-heart catheterization |
Answer the following medical question with one of the provided options: | Q:A 29-year-old man is admitted to the emergency department following a motorcycle accident. The patient is severely injured and requires life support after splenectomy and evacuation of a subdural hematoma. Past medical history is unremarkable. The patient’s family members, including wife, parents, siblings, and grandparents, are informed about the patient’s condition. The patient has no living will and there is no durable power of attorney. The patient must be put in an induced coma for an undetermined period of time. Which of the following is responsible for making medical decisions for the incapacitated patient?? {'A': 'An older sibling', 'B': 'The parents', 'C': 'Physician', 'D': 'Legal guardian', 'E': 'The spouse'}, | E: The spouse |
Answer the following medical question with one of the provided options: | Q:An 11-year-old girl is brought to the physician by her parents because of a mildly pruritic rash on her trunk and extremities for 2 days. One week ago, she developed a low-grade fever, rhinorrhea, and headache, followed by a facial rash 4 days later. The facial rash did not involve the perioral skin. Her temperature is 37.4°C (99.3°F). A photograph of the rash on her lower arms is shown. Which of the following is the most likely diagnosis?? {'A': 'Rubella', 'B': 'Erythema infectiosum', 'C': 'Hand, foot, and mouth disease', 'D': 'Exanthem subitum', 'E': 'Scarlet fever'}, | B: Erythema infectiosum |
Answer the following medical question with one of the provided options: | Q:An 11-year-old boy is brought to the emergency department by his parents with a 2-day history of fever, malaise, and productive cough. On presentation, he is found to be very weak and is having difficulty breathing. His past medical history is significant for multiple prior infections requiring hospitalization including otitis media, upper respiratory infections, pneumonia, and sinusitis. His family history is also significant for a maternal uncle who died of an infection as a child. Lab findings include decreased levels of IgG, IgM, IgA, and plasma cells with normal levels of CD4 positive cells. The protein that is most likely defective in this patient has which of the following functions?? {'A': 'Actin polymerization', 'B': 'Autoimmune regulation', 'C': 'Lysosomal trafficking', 'D': 'Nucleotide salvage', 'E': 'Protein phosphorylation'}, | E: Protein phosphorylation |
Answer the following medical question with one of the provided options: | Q:A two-month-old female presents to the emergency department for difficulty feeding. The patient was born at 38 weeks gestation to a 29-year-old primigravid via vaginal delivery. The newborn period has thus far been uncomplicated. The patient has been exclusively breastfed since birth. Her parents report that feeding had previously seemed to be going well, and the patient has been gaining weight appropriately. Over the past several days, the patient’s mother has noticed that the patient seems to tire out before the end of the feeding. She has also noticed that the patient begins to appear short of breath and has a bluish discoloration of her lips. The patient’s height and weight were in the 20th and 10th percentile at birth, respectively. Her current height and weight are in the 20th and 15th percentiles, respectively. Her temperature is 98.0°F (36.7°C), blood pressure is 60/48 mmHg, pulse is 143/min, and respirations are 40/min. On physical exam, the patient is in no acute distress and appears well developed. A systolic crescendo-decrescendo murmur can be heard at the left upper sternal border. Her abdomen is soft, non-tender, and non-distended. During the abdominal exam, the patient begins crying and develops cyanosis of the perioral region. Which of the following is the best initial test to diagnose this patient’s condition?? {'A': 'Chest radiograph', 'B': 'CT angiography', 'C': 'Electrocardiogram', 'D': 'Echocardiogram', 'E': 'Genetic testing'}, | D: Echocardiogram |
Answer the following medical question with one of the provided options: | Q:A 4-year-old male is evaluated for frequent epistaxis and mucous membrane bleeding. Physical examination shows diffuse petechiae on the patient’s distal extremities. Peripheral blood smear shows an absence of platelet clumping. An ELISA binding assay reveals that platelet surfaces are deficient in GIIb/IIIa receptors. Serum platelet count is normal. Which of the following is the most likely diagnosis?? {'A': 'Hemophilia A', 'B': 'Thrombotic thrombocytopenic purpura', 'C': 'Bernard-Soulier disease', 'D': 'Idiopathic thrombocytopenic purpura', 'E': 'Glanzmann’s thrombasthenia'}, | E: Glanzmann’s thrombasthenia |
Answer the following medical question with one of the provided options: | Q:A 45-year-old man was a driver in a motor vehicle collsion. The patient is not able to offer a medical history during initial presentation. His temperature is 97.6°F (36.4°C), blood pressure is 104/74 mmHg, pulse is 150/min, respirations are 12/min, and oxygen saturation is 98% on room air. On exam, he does not open his eyes, he withdraws to pain, and he makes incomprehensible sounds. He has obvious signs of trauma to the chest and abdomen. His abdomen is distended and markedly tender to palpation. He also has an obvious open deformity of the left femur. What is the best initial step in management?? {'A': '100% oxygen', 'B': 'Emergency open fracture repair', 'C': 'Exploratory laparoscopy', 'D': 'Intubation', 'E': 'Packed red blood cells'}, | D: Intubation |
Answer the following medical question with one of the provided options: | Q:An 81-year-old woman comes to the emergency department due to a left-sided paralysis for the past 2 hours. Her husband says her symptoms began suddenly, and she is also unable to speak. Her pulse is 90/min, respirations are 18/min, temperature is 36.8°C (98.2°F), and blood pressure is 150/98 mm Hg. An ECG is obtained and is shown below. Which of the following is the most probable cause of the patient's paralysis?? {'A': 'Cardioembolic stroke', 'B': 'Cocaine toxicity', 'C': 'Conversion disorder', 'D': 'Hemorrhagic disorder', 'E': 'Rupture of berry aneurysm'}, | A: Cardioembolic stroke |
Answer the following medical question with one of the provided options: | Q:A 52-year-old female with a history of poorly-controlled diabetes presents to her primary care physician because of pain and tingling in her hands. These symptoms began several months ago and have been getting worse such that they interfere with her work as a secretary. She says that the pain is worse in the morning and she has been woken up at night by the pain. The tingling sensations have been located primarily in the thumb, index and middle fingers. On physical exam atrophy of the thenar eminence is observed and the pain is reproduced when the wrist is maximally flexed. The most likely cause of this patient's symptoms affects which of the nerves shown in the image provided?? {'A': 'A', 'B': 'B', 'C': 'C', 'D': 'D', 'E': 'E'}, | D: D |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man is brought to the emergency department because of a 2-day history of fever and right upper quadrant abdominal pain. Examination shows jaundice. Ultrasonography of the abdomen shows cholelithiasis and marked dilation of the biliary duct. An ERCP is performed and reveals pus with multiple brown concrements draining from the common bile duct. Which of the following is the most likely underlying cause of the patient's findings?? {'A': 'Increased alanine aminotransferase activity', 'B': 'Decreased heme oxygenase activity', 'C': 'Decreased HMG-coenzyme A reductase activity', 'D': 'Increased cholesterol 7-α hydroxylase activity', 'E': 'Increased β-glucuronidase activity'}, | E: Increased β-glucuronidase activity |
Answer the following medical question with one of the provided options: | Q:A 9-year-old boy presents for incision and drainage of a small abscess on his left thigh. No significant past medical history. No current medications. Before the procedure, the patient is allowed to inhale colorless, sweet-smelling gas. After the procedure, the patient receives 3–4 minutes of high flow oxygen through a nasal mask. The pulse oximetry shows an oxygen saturation of 94%. This patient was oxygenated at the end of the procedure to prevent which of the following complications?? {'A': 'Malignant hyperthermia', 'B': 'Cardiac arrhythmias', 'C': 'Raised intracranial pressure', 'D': 'Hepatotoxicity', 'E': 'Diffusion hypoxia'}, | E: Diffusion hypoxia |
Answer the following medical question with one of the provided options: | Q:A 50-year-old man presents to his primary care physician with a chief complaint of chest pain that is squeezing in nature. He used to have similar symptoms in the past while playing tennis with his friends. Yesterday, while moving furniture in his new home, he experienced this pain that lasted for 20 minutes and radiated towards his jaw and shoulder. He has been diagnosed with diabetes mellitus and hypertension for over 10 years and regularly takes his medications. The pain is not associated with nausea, vomiting, food intake, sweating, or cough. On physical examination, the patient is not in acute distress. His blood pressure is 135/85 mm Hg, heart rate is 80/min, respiratory rate is 16/min, temperature is 36.9°C (98.5°F), and BMI is 30 kg/m2. On physical examination, bilateral vesicular breath sounds are heard with absent chest tenderness. Cardiovascular examination reveals normal S1 and S2 without any abnormal sounds or murmur. Abdominal examination is within normal limit. What is the most likely cause of this patient’s condition?? {'A': 'GERD', 'B': 'Musculoskeletal pain', 'C': 'Rib fracture', 'D': 'Anxiety', 'E': 'Myocardial ischemia'}, | E: Myocardial ischemia |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man presents to his physician with a complaint of recurrent episodes of palpitations over the past 2 weeks. He also mentions that he tends to tire easily. He denies chest pain, breathlessness, dizziness, or syncope, but has a history of ischemic heart disease. He smokes 1 pack of cigarettes every day and drinks alcohol occasionally. The physical examination revealed a temperature of 36.9°C (98.4°F), a pulse of 124/min (irregular), a blood pressure of 142/86 mm Hg, and a respiratory rate of 16/min. Auscultation of his chest is normal with an absence of rales overall lung fields. An ECG was significant for fibrillatory waves and an irregular RR interval. Thus, the physician concludes that the symptoms are due to atrial fibrillation. The patient is prescribed oral diltiazem. Which of the following side effects should the physician warn the patient about?? {'A': 'Hypoglycemia', 'B': 'Bilateral pedal edema', 'C': 'Bloody diarrhea', 'D': 'Stevens-Johnson syndrome', 'E': 'Multifocal atrial tachycardia'}, | B: Bilateral pedal edema |
Answer the following medical question with one of the provided options: | Q:A 51-year-old female presents to her primary care physician complaining of body aches and constipation. She reports that her “bones hurt” and that she has experienced worsening constipation over the past few months. Her medical history is notable for three kidney stones within the past year that both passed spontaneously. Her vital signs are stable. Physical examination reveals a small nodule near the right inferior pole of the thyroid. Which of the following sets of serum findings is most likely in this patient?? {'A': 'Increased calcium, decreased phosphate, increased parathyroid hormone', 'B': 'Decreased calcium, increased phosphate, increased parathyroid hormone', 'C': 'Increased calcium, decreased phosphate, decreased parathyroid hormone', 'D': 'Decreased calcium, increased phosphate, decreased parathyroid hormone', 'E': 'Normal calcium, normal phosphate, normal parathyroid hormone'}, | A: Increased calcium, decreased phosphate, increased parathyroid hormone |
Answer the following medical question with one of the provided options: | Q:A 12-hour old male infant is seen in the newborn nursery. He was born full term by vaginal delivery to a 40-year-old G4P3-->4 mother. Her pregnancy and delivery were uncomplicated, notable only for declining genetic testing. On exam, her son has a flat face, a fold in the upper eyelid, palpebral fissures that appear to slant upwards, and small ears. The diagnostic test for her son’s most likely condition should be conducted during which of the following phases of the cell cycle?? {'A': 'Prophase', 'B': 'Metaphase', 'C': 'Anaphase', 'D': 'Telophase', 'E': 'S-phase'}, | B: Metaphase |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman with a past medical history significant for pernicious anemia and vitiligo presents to the physician with the chief complaints of heat intolerance and frequent palpitations. The patient does not take birth control and her urine pregnancy test is negative today. Physical exam reveals a patient that is hyper-reflexive with a non-tender symmetrically enlarged thyroid gland. You order thyroid function tests for workup. What thyroid function values are most expected?? {'A': 'T4 elevated, free T4 normal, T3 elevated, thyroid stimulating hormone (TSH) normal', 'B': 'T4 elevated, free T4 elevated, T3 elevated, TSH elevated', 'C': 'T4 elevated, free T4 elevated, T3 elevated, TSH decreased', 'D': 'T4 decreased, free T4 decreased, T3 decreased, TSH decreased', 'E': 'T4 normal, free T4 normal, T3 normal, TSH elevated'}, | C: T4 elevated, free T4 elevated, T3 elevated, TSH decreased |
Answer the following medical question with one of the provided options: | Q:A 75-year-old woman presents to her primary care physician with her son because she is convinced that people are stealing from her. Her son claims she has been misplacing her medications and money throughout the house. She recently lost her husband to old age and has become reclusive and no longer wants people to visit. Physical examination is unremarkable and the patient is oriented to person, time, and place. A mini-mental status examination (MMSE) is performed and she has difficulty recalling words after 5 minutes and also has problems with serial subtraction. Which of the following is the most likely diagnosis in this patient?? {'A': 'Delirium', 'B': 'Dementia', 'C': 'Histrionic personality disorder', 'D': 'Schizoid personality disorder', 'E': 'Schizophrenia'}, | B: Dementia |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the office due to pain in the lower part of his calves on his afternoon walk to get the mail. The pain is relieved by rest. It started slowly about 6 months ago and has become more painful over time. He has a history of hypertension, hyperlipidemia, diabetes mellitus, and smoking. Medications include hydrochlorothiazide, atorvastatin, metformin, and a multivitamin that he takes daily. The patient does not smoke and only drinks socially. Today, his blood pressure is 145/90 mm Hg, pulse is 75/min, respiratory rate is 17/min, and temperature is 37.6°C (99.6°F). On physical exam, he appears mildly obese and healthy. His heart has a regular rate and rhythm, and his lungs are clear to auscultation bilaterally. Examination of the legs shows atrophic changes and diminished pedal pulses. A measure of his ankle brachial index (ABI) is 0.89. Which of the following is the most appropriate initial treatment?? {'A': 'Enoxaparin', 'B': 'Metoprolol', 'C': 'A recommendation to perform pedal pumping exercises', 'D': 'A recommendation to walk more', 'E': 'A referral to a supervised exercise program'}, | E: A referral to a supervised exercise program |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man presents to his primary care physician with worsening cough and asthma. The patient reports that he was in his usual state of health until 1 month ago, when he developed a cold. Since then his cold has improved, but he continues to have a cough and worsening asthma symptoms. He says that he has been using his rescue inhaler 3 times a day with little improvement. He is studying for an accounting exam and states that his asthma is keeping him up at night and making it hard for him to focus during the day. The patient admits to smoking tobacco. His smoking has increased from a half pack per day since he was 17 years old to 1 pack per day during the past month to cope with the stress of his exam. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/74 mmHg, pulse is 75/min, and respirations are 15/min with an oxygen saturation of 97% on room air. Physically examination is notable for mild expiratory wheezes bilaterally. Labs are obtained, as shown below: Serum: Na+: 144 mEq/L Cl-: 95 mEq/L K+: 4.3 mEq/L HCO3-: 23 mEq/L Urea nitrogen: 24 mg/dL Glucose: 100 mg/dL Creatinine: 1.6 mg/dL Leukocyte count and differential: Leukocyte count: 13,000/mm^3 Segmented neutrophils: 63% Eosinophils: 15% Basophils: < 1% Lymphocytes: 20% Monocytes: 1.3% Hemoglobin: 13.5 g/dL Hematocrit: 50% Platelets: 200,000/mm^3 Urinalysis reveals proteinuria and microscopic hematuria. Which of the following is associated with the patient’s most likely diagnosis?? {'A': 'c-ANCA levels', 'B': 'Hepatitis B surface antigen', 'C': 'IgA deposits', 'D': 'p-ANCA levels', 'E': 'Smoking'}, | D: p-ANCA levels |
Answer the following medical question with one of the provided options: | Q:A 25-year-old man is brought to the physician because of fatigue, lethargy, and lower leg swelling for 2 weeks. He also noticed that his urine appeared darker than usual and for the last 2 days he has passed only small amounts of urine. His temperature is 37.5°C (98.6°F), pulse is 88/min, respirations are 15/min, and blood pressure is 154/98 mm Hg. Examination shows 2+ pretibial edema bilaterally. Laboratory studies show: Hemoglobin 10.9 g/dL Leukocyte count 8200/mm3 Platelet count 220,000/mm3 Serum Na+ 137 mEq/L Cl- 102 mEq/L K+ 4.8 mEq/L HCO3- 22 mEq/L Glucose 85 mg/dL Urea nitrogen 34 mg/dL Creatinine 1.4 mg/dL Urine Blood 2+ Protein 3+ Glucose negative RBC 10–12/HPF with dysmorphic features RBC casts numerous Renal biopsy specimen shows a crescent formation in the glomeruli with extracapillary cell proliferation. Which of the following is the most appropriate next step in management?"? {'A': 'Administer rituximab', 'B': 'Administer lisinopril', 'C': 'Perform hemodialysis', 'D': 'Administer methylprednisolone', 'E': 'Administer cyclosporine A'}, | D: Administer methylprednisolone |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man comes to the physician because of a painful mass in his left thigh for 3 days. He underwent a left lower limb angiography for femoral artery stenosis and had a stent placed 2 weeks ago. He has peripheral artery disease, coronary artery disease, hypercholesterolemia and type 2 diabetes mellitus. He has smoked one pack of cigarettes daily for 34 years. Current medications include enalapril, aspirin, simvastatin, metformin, and sitagliptin. His temperature is 36.7°C (98°F), pulse is 88/min, and blood pressure is 116/72 mm Hg. Examination shows a 3-cm (1.2-in) tender, pulsatile mass in the left groin. The skin over the area of the mass shows no erythema and is cool to the touch. A loud bruit is heard on auscultation over this area. The remainder of the examination shows no abnormalities. Results of a complete blood count and serum electrolyte concentrations show no abnormalities. Duplex ultrasonography shows an echolucent sac connected to the common femoral artery, with pulsatile and turbulent blood flow between the artery and the sac. Which of the following is the most appropriate next best step in management?? {'A': 'Ultrasound-guided thrombin injection', 'B': 'Coil embolization', 'C': 'Ultrasound-guided compression', 'D': 'Schedule surgical repair', 'E': 'Covered stent implantation\n"'}, | A: Ultrasound-guided thrombin injection |
Answer the following medical question with one of the provided options: | Q:A 57-year-old woman presents to the emergency department with acute onset vomiting, vertigo, throbbing headache, and weakness. She says that the symptoms started when she went to dinner with friends and had a drink of alcohol. Her past medical history is significant for type 2 diabetes, and she was recently started on a new medication for this disease. She says that she was warned that she might experiences these symptoms as a side effect of a new medication, but she did not realize how severe they would be. Which of the following describes the mechanism of action for the most likely diabetes drug that this patient started taking?? {'A': 'Binding to peroxisome proliferator-activating receptors', 'B': 'Closing potassium channels', 'C': 'Decreasing hepatic gluconeogenesis', 'D': 'Inhibiting alpha-glucosidase', 'E': 'Inhibiting dipeptidyl peptidase'}, | B: Closing potassium channels |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman is brought to the emergency department for shortness of breath and chest pain. Pulmonary angiography shows a large saddle embolus in the pulmonary arteries. Emergency drug therapy is administered and she is admitted to the hospital for observation. A follow-up CT scan of the chest shortly after admission shows that the thrombus has disappeared. Five hours later, the patient is found to be lethargic with slurred speech. Physical examination shows decreased consciousness, dysarthria, and optic disc swelling bilaterally. Which of the following is the most likely cause of her neurological symptoms?? {'A': 'Acute metabolic encephalopathy', 'B': 'Idiopathic intracranial hypertension', 'C': 'Drug-induced hypotension', 'D': 'Embolic cerebrovascular accident', 'E': 'Intracerebral hemorrhage\n"'}, | E: Intracerebral hemorrhage " |
Answer the following medical question with one of the provided options: | Q:A 6-day-old infant who was born via uncomplicated vaginal delivery at 39 weeks of gestation is brought to the family physician for poor feeding. The mother received adequate prenatal care throughout the pregnancy, and has no medical conditions. On physical exam, the infant's temperature is 36.5°C (97.7°F), blood pressure is 70/45 mmHg, pulse is 170/min, and respirations are 40/min. The infant has dry mucous membranes, capillary refill of 4 seconds, and a depressed anterior fontanelle. No abdominal masses are noted. Genital exam shows enlargement of the clitoris with fusion of the labioscrotal folds. Serum chemistry is remarkable for hyponatremia and hyperkalemia. The infant's karyotype is 46,XX. Which of the following findings are most likely to be discovered upon further workup?? {'A': 'Increased aldosterone, decreased cortisol', 'B': 'Decreased aldosterone, increased 11-deoxycorticosterone', 'C': 'Increased sex hormones, increased 17-hydroxyprogesterone', 'D': 'Increased sex hormones, decreased renin activity', 'E': 'Decreased cortisol, decreased sex hormones'}, | C: Increased sex hormones, increased 17-hydroxyprogesterone |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man is brought to the physician because of increasing pain and swelling of the left knee for 2 months. The pain has awoken him from his sleep on multiple occasions. He tried ibuprofen but has had no relief of his symptoms. There is no family or personal history of serious illness. Vital signs are within normal limits. On examination, the left knee is mildly swollen and tender; range of motion is limited by pain. An x-ray of the left knee is shown. Which of the following is the most likely diagnosis?? {'A': 'Chondrosarcoma', 'B': 'Fibrous dysplasia', 'C': 'Aneurysmal bone cyst', 'D': 'Osteoclastoma', 'E': 'Ewing sarcoma'}, | D: Osteoclastoma |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought in by his parents as they are concerned about his behavior. He is constantly arguing with his parents and blatantly defying their every request. In school, he is known for being intentionally tardy and for defying his teachers. Upon further questioning of the patient you learn about some of his recent behaviors such as beginning smoking to bother his parents. You also notice that he is disrespectful towards you. You then learn that he has also gotten into weekly fights with his peers at school with no apparent cause. In addition, last week he was seen hitting one of the local neighborhood cats with a baseball bat trying to kill it. The patient lives at home with his two parents in a pre-World War II house that was recently renovated. Physical exam is unremarkable. Laboratory values are as follows: Na: 140 mmol/L K: 4.5 mmol/L Cl: 100 mmol/L Glucose: 80 mg/dL Ca: 10 mmol/L Mg: 3 mEq/L Cr: 0.8 mg/dL BUN: 10 mg/dL Serum lead: < .01 µg/dL Hb: 15 g/dL Hct: 45% MCV: 95 Urine toxicology: negative As the patient leaves the office you notice him stealing all of the candy from the office candy bowl. The patient seems unconcerned about his behavior overall. Which of the following statements is most likely to be true in this patient?? {'A': 'This patient will likely function normally despite continuing to defy authority figures', 'B': 'This patient is suffering from antisocial personality disorder and will likely be incarcerated in adulthood', 'C': "Environmental exposures are likely causing this patient's behavior", 'D': "The patient's symptoms could progress to antisocial personality disorder", 'E': 'Strong D2 antagonists are first-line pharmacotherapy'}, | D: The patient's symptoms could progress to antisocial personality disorder |
Answer the following medical question with one of the provided options: | Q:A 24-hour-old girl is found to be cyanotic in the newborn nursery. She was born via spontaneous vaginal delivery at 38 weeks gestation to a gravida 1, para 0 healthy mother who received routine prenatal care. The patient is small for her gestational age. She manifests lower-extremity cyanosis along with a mesh-like mass on the back of her neck. Her vital signs are: pulse, 150/min; respirations, 48/min; and blood pressure, 120/80 mm Hg in the right arm, 124/82 mm Hg in the left arm, 80/40 mm Hg in the right leg, and 85/45 mm Hg in the left leg. Femoral pulses are 1+ and delayed. Cardiac examination shows a continuous murmur in the interscapular area. Auscultation of the lung reveals faint crackles at the base of the lung fields bilaterally. Which of the following is the most appropriate next step in management?? {'A': 'Administration of alprostadil', 'B': 'Arteriogram', 'C': 'Echocardiography', 'D': 'Indomethacin', 'E': 'Lower extremity Doppler'}, | A: Administration of alprostadil |
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