instruction
stringclasses 5
values | input
stringlengths 10
4.2k
| output
stringlengths 1
7.16k
|
|---|---|---|
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman comes to the physician because of progressive weakness. She has noticed increasing difficulty performing household chores and walking her dog over the past month. Sometimes she feels too fatigued to cook dinner. She has noticed that she feels better after sleeping. She does not have chest pain, shortness of breath, or a history of recent illness. She has no personal history of serious illness and takes no medications. She has smoked two packs of cigarettes daily for 25 years. She appears fatigued. Her temperature is 37°C (98.8°F), pulse is 88/min, and blood pressure is 148/80 mm Hg. Pulse oximetry shows an oxygen saturation of 98% in room air. Bilateral expiratory wheezes are heard at both lung bases. Examination shows drooping of the upper eyelids. There is diminished motor strength in her upper extremities. Her sensation and reflexes are intact. A treatment with which of the following mechanisms of action is most likely to be effective?? {'A': 'Inhibition of acetylcholinesterase', 'B': 'Stimulation of B2 adrenergic receptors', 'C': 'Removing autoantibodies, immune complexes, and cytotoxic constituents from serum', 'D': 'Reactivation of acetylcholinesterase', 'E': 'Competitive blocking of the muscarinic receptor'}, | A: Inhibition of acetylcholinesterase |
Answer the following medical question with one of the provided options: | Q:An investigator is studying cardiomyocytes in both normal and genetically modified mice. Both the normal and genetically modified mice are observed after aerobic exercise and their heart rates are recorded and compared. After a 10-minute session on a treadmill, the average pulse measured in the normal mice is 680/min, whereas in the genetically modified mice it is only 160/min. Which of the following is most likely to account for the increased heart rate seen in the normal mice?? {'A': 'Greater cardiomyocyte size', 'B': 'Lower threshold potential for Ca2+ channel opening', 'C': 'Greater ratio of heart to body weight', 'D': 'Lower number of gap junctions', 'E': 'Greater T-tubule density'}, | E: Greater T-tubule density |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man presents to his primary care physician with a 2-month-history of diarrhea. He says that he feels the urge to defecate 3-4 times per day and that his stools have changed in character since the diarrhea began. Specifically, they now float, stick to the side of the toilet bowl, and smell extremely foul. His past medical history is significant for several episodes of acute pancreatitis secondary to excessive alcohol consumption. His symptoms are found to be due to a deficiency in an enzyme that is resistant to bile salts. Which of the following enzymes is most likely deficient in this patient?? {'A': 'Amylase', 'B': 'Chymotrypsin', 'C': 'Colipase', 'D': 'Enterokinase', 'E': 'Lipase'}, | C: Colipase |
Answer the following medical question with one of the provided options: | Q:A 50-year-old woman comes to the physician because of worsening pain and swelling of her left knee. For the past year, she has had pain in her knees and hands bilaterally, but never this severe. During this period, she has also had difficulties moving around for about an hour in the mornings and has been sweating more than usual, especially at night. She has been sexually active with a new partner for the past 4 weeks, and they use condoms inconsistently. She occasionally drinks alcohol. The day before she drank 6 beers because she was celebrating a friend's birthday. Her temperature is 38.5°C (101.3°F), blood pressure is 110/70 mm Hg, and pulse is 92/min. The left knee is erythematous, swollen, and tender; movement is restricted due to pain. There is swelling of the metacarpophalangeal joints and proximal interphalangeal joints bilaterally. Arthrocentesis of the knee with synovial fluid analysis shows a greenish, turbid fluid, a cell count of 68,000 WBC/μL and Gram-negative diplococci. An x-ray of the affected knee is most likely to show which of the following findings?? {'A': 'Calcifications and osteolysis with moth-eaten appearance', 'B': 'Osteophytes and subchondral cysts', 'C': 'Irregularity or fragmentation of the tubercle', 'D': 'Calcification of the meniscal and hyaline cartilage', 'E': 'Joint space narrowing and bone erosions'}, | E: Joint space narrowing and bone erosions |
Answer the following medical question with one of the provided options: | Q:A 35-year-old woman, gravida 2, para 1, at 16 weeks' gestation comes to the office for a prenatal visit. She reports increased urinary frequency but otherwise feels well. Pregnancy and delivery of her first child were uncomplicated. Her vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 16-week gestation. Urinalysis shows mild glucosuria. Laboratory studies show a non-fasting serum glucose concentration of 110 mg/dL. Which of the following is the most likely explanation for this patient's glucosuria?? {'A': 'Decreased insulin production', 'B': 'Decreased SGLT2 expression', 'C': 'Increased glomerular filtration barrier permeability', 'D': 'Decreased insulin sensitivity', 'E': 'Increased glomerular filtration rate'}, | E: Increased glomerular filtration rate |
Answer the following medical question with one of the provided options: | Q:A 10-month-old boy is referred to the hospital because of suspected severe pneumonia. During the first month of his life, he had developed upper airway infections, bronchitis, and diarrhea. He has received all the immunizations according to his age. He failed to thrive since the age of 3 months. A month ago, he had a severe lung infection with cough, dyspnea, and diarrhea, and was unresponsive to an empiric oral macrolide. Upon admission to his local hospital, the patient has mild respiratory distress and crackles on auscultation. The temperature is 39.5°C (103.1°F), and the oxygen saturation is 95% on room air. The quantitative immunoglobulin tests show increased IgG, IgM, and IgA. The peripheral blood smear shows leukocytosis and normochromic normocytic anemia. The chloride sweat test and tuberculin test are negative. The chest X-ray reveals bilateral pneumonia. The bronchoalveolar lavage and gram stain report gram-negative bacteria with a growth of Burkholderia cepacia on culture. The laboratory results on admission are as follows: Leukocytes 36,600/mm3 Neutrophils 80% Lymphocytes 16% Eosinophils 1% Monocytes 2% Hemoglobin 7.6 g/dL Creatinine 0.8 mg/dL BUN 15 mg/dL Which of the following defects of neutrophil function is most likely responsible?? {'A': 'Absent respiratory burst', 'B': 'Leukocyte adhesion molecule deficiency', 'C': 'X-linked agammaglobulinemia', 'D': 'Phagocytosis defect', 'E': 'Lysosomal trafficking defect'}, | A: Absent respiratory burst |
Answer the following medical question with one of the provided options: | Q:A 74-year-old man presents to the physician with a painful lesion over his right lower limb which began 2 days ago. He says that the lesion began with pain and severe tenderness in the area. The next day, the size of the lesion increased and it became erythematous. He also mentions that a similar lesion had appeared over his left lower limb 3 weeks earlier, but it disappeared after a few days of taking over the counter analgesics. There is no history of trauma, and the man does not have any known medical conditions. On physical examination, the physician notes a cordlike tender area with erythema and edema. There are no signs suggestive of deep vein thrombosis or varicose veins. Which of the following malignancies is most commonly associated with the lesion described in the patient?? {'A': 'Basal cell carcinoma', 'B': 'Multiple myeloma', 'C': 'Malignant melanoma', 'D': 'Squamous cell carcinoma of head and neck', 'E': 'Adenocarcinoma of pancreas'}, | E: Adenocarcinoma of pancreas |
Answer the following medical question with one of the provided options: | Q:A 53-year-old man is being evaluated for a 3-week history of fatigue, difficulty to concentrate, dyspnea with exertion, dizziness, and digital pain that improves with cold. He has smoked half a pack of cigarettes a day since he was 20. His current medical history involves hypertension. He takes enalapril daily. The vital signs include a blood pressure of 131/82 mm Hg, a heart rate of 95/min, and a temperature of 36.9°C (98.4°F). On physical examination, splenomegaly is found. A complete blood count reveals thrombocytosis of 700,000 cells/m3. Lab work further shows decreased serum iron, iron saturation, and serum ferritin and increased total iron binding capacity. A blood smear reveals an increased number of abnormal platelets, and a bone marrow aspirate confirmed the presence of dysplastic megakaryocytes. A mutation on his chromosome 9 confirms the physician’s suspicion of a certain clonal myeloproliferative disease. The patient is started on hydroxyurea. What is the most likely diagnosis?? {'A': 'Myelofibrosis with myeloid metaplasia', 'B': 'Essential thrombocythemia', 'C': 'Chronic myelogenous leukemia', 'D': 'Polycythemia vera', 'E': 'Aplastic anemia'}, | B: Essential thrombocythemia |
Answer the following medical question with one of the provided options: | Q:A 50-year-old Caucasian man presents for a routine checkup. He does not have any current complaint. He is healthy and takes no medications. He has smoked 10–15 cigarettes per day for the past 10 years. His family history is negative for gastrointestinal disorders. Which of the following screening tests is recommended for this patient according to the United States Preventive Services Task Force (USPSTF)?? {'A': 'Prostate-specific antigen for prostate cancer', 'B': 'Carcinoembryonic antigen for colorectal cancer ', 'C': 'Abdominal ultrasonography for abdominal aortic aneurysm', 'D': 'Low-dose computerized tomography for lung cancer', 'E': 'Colonoscopy for colorectal cancer'}, | E: Colonoscopy for colorectal cancer |
Answer the following medical question with one of the provided options: | Q:A 76-year-old man comes to the physician for a follow-up examination. One week ago, he was prescribed azithromycin for acute bacterial sinusitis. He has a history of atrial fibrillation treated with warfarin and metoprolol. Physical examination shows no abnormalities. Compared to one month ago, laboratory studies show a mild increase in INR. Which of the following best explains this patient's laboratory finding?? {'A': 'Depletion of intestinal flora', 'B': 'Inhibition of cytochrome p450', 'C': 'Increased non-protein bound warfarin fraction', 'D': 'Drug-induced hepatotoxicity', 'E': 'Increased gastrointestinal absorption of warfarin'}, | A: Depletion of intestinal flora |
Answer the following medical question with one of the provided options: | Q:A 2-week-old male newborn is brought to the physician because his mother has noticed her son has occasional bouts of ""turning blue in the face"" while crying. He also tires easily and sweats while feeding. He weighed 2150 g (4 lb 11 oz) at birth and has gained 200 g (7 oz). The baby appears mildly cyanotic. Examination shows a 3/6 systolic ejection murmur heard over the left upper sternal border. A single S2 is present. An echocardiography confirms the diagnosis. Which of the following factors is the main determinant of the severity of this patient's cyanosis?"? {'A': 'Right ventricular outflow obstruction', 'B': 'Left ventricular outflow obstruction', 'C': 'Right ventricular hypertrophy', 'D': 'Ventricular septal defect', 'E': 'Atrial septal defect'}, | A: Right ventricular outflow obstruction |
Answer the following medical question with one of the provided options: | Q:A 19-year-old man presents to an orthopedic surgeon to discuss repair of his torn anterior cruciate ligament. He suffered the injury during a college basketball game 1 week ago and has been using a knee immobilizer since the accident. His past medical history is significant for an emergency appendectomy when he was 12 years of age. At that time, he said that he never wanted to have surgery again. At this visit, the physician explains the procedure to him in detail including potential risks and complications. The patient acknowledges and communicates his understanding of both the diagnosis as well as the surgery and decides to proceed with the surgery in 3 weeks. Afterward, he signs a form giving consent for the operation. Which of the following statements is true about this patient?? {'A': 'He cannot provide consent because he lacks capacity', 'B': 'He did not need to provide consent for this procedure since it is obviously beneficial', 'C': 'He has the right to revoke his consent at any time', 'D': 'His consent is invalid because his decision is not stable over time', 'E': 'His parents also need to give consent to this operation'}, | C: He has the right to revoke his consent at any time |
Answer the following medical question with one of the provided options: | Q:A 55-year-old male presents with complaints of intermittent facial flushing. He also reports feeling itchy after showering. On review of systems, the patient says he has been having new onset headaches recently. On physical exam, his vital signs, including O2 saturation, are normal. He has an abnormal abdominal mass palpable in the left upper quadrant. A complete blood count reveals: WBCs 6500/microliter; Hgb 18.2 g/dL; Platelets 385,000/microliter. Which of the following is most likely responsible for his presentation?? {'A': 'Elevated serum erythropoietin levels', 'B': 'Fibrosis of bone marrow', 'C': 'Tyrosine kinase mutation', 'D': 'BCR-ABL fusion', 'E': 'Chronic hypoxemia'}, | C: Tyrosine kinase mutation |
Answer the following medical question with one of the provided options: | Q:A 42-year-old Caucasian male presents to your office with hematuria and right flank pain. He has no history of renal dialysis but has a history of recurrent urinary tract infections. You order an intravenous pyelogram, which reveals multiple cysts of the collecting ducts in the medulla. What is the most likely diagnosis?? {'A': 'Simple retention cysts', 'B': 'Acquired polycystic kidney disease', 'C': 'Autosomal dominant polycystic kidney disease', 'D': 'Medullary sponge kidney', 'E': 'Chronic renal failure'}, | D: Medullary sponge kidney |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman presents with severe vertigo. She also reports multiple episodes of vomiting and difficulty walking. The vertigo is continuous, not related to the position, and not associated with tinnitus or hearing disturbances. She has a past history of acute vision loss in her right eye that resolved spontaneously several years ago. She also experienced left-sided body numbness 3 years ago that also resolved rapidly. She only recently purchased health insurance and could not fully evaluate the cause of her previous symptoms at the time they presented. The patient is afebrile and her vital signs are within normal limits. On physical examination, she is alert and oriented. An ophthalmic exam reveals horizontal strabismus. There is no facial asymmetry and her tongue is central on the protrusion. Gag and cough reflexes are intact. Muscle strength is 5/5 bilaterally. She has difficulty maintaining her balance while walking and is unable to perform repetitive alternating movements with her hands. Which of the following is the best course of treatment for this patient’s condition?? {'A': 'Acyclovir', 'B': 'Azathioprine', 'C': 'High doses of glucose', 'D': 'High-doses of corticosteroids', 'E': 'Plasma exchange'}, | D: High-doses of corticosteroids |
Answer the following medical question with one of the provided options: | Q:A 19-year-old man is brought to the emergency department by the resident assistant of his dormitory for strange behavior. He was found locked out of his room, where the patient admitted to attending a fraternity party before becoming paranoid that the resident assistant would report him to the police. The patient appears anxious. His pulse is 105/min, and blood pressure is 142/85 mm Hg. Examination shows dry mucous membranes and bilateral conjunctival injection. Further evaluation is most likely to show which of the following?? {'A': 'Tactile hallucinations', 'B': 'Pupillary constriction', 'C': 'Synesthesia', 'D': 'Sense of closeness to others', 'E': 'Impaired reaction time'}, | E: Impaired reaction time |
Answer the following medical question with one of the provided options: | Q:A 23-year-old primigravid woman comes to the physician at 36 weeks' gestation for her first prenatal visit. She confirmed the pregnancy with a home urine pregnancy kit a few months ago but has not yet followed up with a physician. She takes no medications. Vital signs are within normal limits. Pelvic examination shows a uterus consistent in size with a 36-week gestation. Laboratory studies show: Hemoglobin 10.6 g/dL Serum Glucose 88 mg/dL Hepatitis B surface antigen negative Hepatitis C antibody negative HIV antibody positive HIV load 11,000 copies/mL (N < 1000 copies/mL) Ultrasonography shows an intrauterine fetus consistent in size with a 36-week gestation. Which of the following is the most appropriate next step in management of this patient?"? {'A': 'Intrapartum zidovudine and vaginal delivery when labor occurs', 'B': "Start cART and schedule cesarean delivery at 38 weeks' gestation", 'C': "Start cART and prepare for vaginal delivery at 38 weeks' gestation", 'D': "Intrapartum zidovudine and cesarean delivery at 38 weeks' gestation", 'E': 'Conduct cesarean delivery immediately'}, | B: Start cART and schedule cesarean delivery at 38 weeks' gestation |
Answer the following medical question with one of the provided options: | Q:A 54-year-old woman comes to the emergency department because of drooping on the left side of her face since that morning. She also reports difficulty closing her eyes and chewing. During the neurologic examination, the physician asks the patient to open her jaw against resistance. Which of the following muscles is most likely activated in this movement?? {'A': 'Lateral pterygoid', 'B': 'Masseter', 'C': 'Orbicularis oris', 'D': 'Hyoglossus', 'E': 'Buccinator'}, | A: Lateral pterygoid |
Answer the following medical question with one of the provided options: | Q:A 45-year-old female with a history of gastroesophageal reflux disease presents to her family physician with symptoms of epigastric pain right after a meal. The physician performs a urea breath test which is positive and the patient is started on appropriate medical therapy. Three days later at a restaurant, she experienced severe flushing, tachycardia, hypotension, and vomiting after her first glass of wine. Which of the following is the mechanism of action of the medication causing this side effect?? {'A': 'Blocks the synthesis of the peptidoglycan layer', 'B': 'Blocks protein synthesis by binding to the 50S ribosomal subunit inhibiting protein translocation', 'C': 'Binds to the 30S ribosomal subunit preventing attachment of the aminoacyl-tRNA', 'D': 'Forms toxic metabolites that damage bacterial DNA', 'E': 'Inhibits the H+/K+ ATPase'}, | D: Forms toxic metabolites that damage bacterial DNA |
Answer the following medical question with one of the provided options: | Q:A 53-year-old woman presents to your office with several months of fatigue and abdominal pain. The pain is dull in character and unrelated to meals. She has a history of type 2 diabetes mellitus and rheumatic arthritis for which she is taking ibuprofen, methotrexate, and metformin. She has 2-3 drinks on the weekends and does not use tobacco products. On physical examination, there is mild tenderness to palpation in the right upper quadrant. The liver span is 15 cm at the midclavicular line. Laboratory results are as follows: Serum: Na+: 135 mEq/L Cl-: 100 mEq/L K+: 3.7 mEq/L HCO3-: 24 mEq/L BUN: 13 mg/dL Creatinine: 1.0 mg/dL Alkaline phosphatase: 100 U/L AST: 70 U/L ALT: 120 U/L Bilirubin (total): 0.5 mg/dL Bilirubin (conjugated): 0.1 mg/dL Amylase: 76 U/L What is the most likely cause of her clinical presentation?? {'A': 'Copper accumulation in hepatocytes', 'B': 'Fatty infiltration of hepatocytes', 'C': 'Autoimmune destruction of the intralobular bile ducts', 'D': 'Alcohol-induced destruction of hepatocytes', 'E': 'Drug-induced liver damage'}, | B: Fatty infiltration of hepatocytes |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man presents with low-grade fever and shortness of breath for the last 3 weeks. Past medical history is significant for severe mitral regurgitation status post mitral valve replacement five years ago. His temperature is 38.3°C (101.0°F) and respiratory rate is 18/min. Physical examination reveals vertical hemorrhages under his nails, multiple painless erythematous lesions on his palms, and two tender, raised nodules on his fingers. Cardiac auscultation reveals a new-onset 2/6 holosystolic murmur loudest at the apex with the patient in the left lateral decubitus position. A transesophageal echocardiogram reveals vegetations on the prosthetic valve. Blood cultures reveal catalase-positive, gram-positive cocci. Which of the following characteristics is associated with the organism most likely responsible for this patient’s condition?? {'A': 'Hemolysis', 'B': 'Optochin sensitive', 'C': 'Coagulase positive', 'D': 'DNAse positive', 'E': 'Novobiocin sensitive'}, | E: Novobiocin sensitive |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman with asthma is brought to the emergency department because of shortness of breath and wheezing for 20 minutes. She is unable to speak more than a few words at a time. Her pulse is 116/min and respirations are 28/min. Pulse oximetry on room air shows an oxygen saturation of 92%. Examination of the lungs shows decreased breath sounds and scattered end-expiratory wheezing over all lung fields. Treatment with high-dose continuous inhaled albuterol is begun. This patient is at increased risk for which of the following adverse effects?? {'A': 'Miosis', 'B': 'Hypoglycemia', 'C': 'Hypokalemia', 'D': 'Sedation', 'E': 'Urinary frequency'}, | C: Hypokalemia |
Answer the following medical question with one of the provided options: | Q:A 59-year-old man comes to the physician because of a 4-month history of a pruritic rash. His symptoms have not improved despite treatment with over-the-counter creams. During this period, he has also had a 6-kg (13.5-lb) weight loss. Examination shows a scaly rash over his chest, back, and thighs. A photograph of the rash on his thighs is shown. A biopsy of the skin lesions shows clusters of neoplastic cells with cerebriform nuclei within the epidermis. This patient's condition is most likely caused by the abnormal proliferation of which of the following cell types?? {'A': 'T cells', 'B': 'Keratinocytes', 'C': 'Mast cells', 'D': 'Melanocytes', 'E': 'B cells'}, | A: T cells |
Answer the following medical question with one of the provided options: | Q:A 6-year-old boy is brought in by his mother to his pediatrician for headache and nausea. His headaches began approximately 3 weeks ago and occur in the morning. Throughout the 3 weeks, his nausea has progressively worsened, and he had 2 episodes of emesis 1 day ago. On physical exam, cranial nerves are grossly intact, and his visual field is intact. The patient has a broad-based gait and difficulty with heel-to-toe walking, as well as head titubation. Fundoscopy demonstrates papilledema. A T1 and T2 MRI of the brain is demonstrated in Figures A and B, respectively. Which of the following is most likely the diagnosis?? {'A': 'Craniopharyngioma', 'B': 'Ependymoma', 'C': 'Medulloblastoma', 'D': 'Pilocytic astrocytoma', 'E': 'Pinealoma'}, | C: Medulloblastoma |
Answer the following medical question with one of the provided options: | Q:A simple experiment is performed to measure the breakdown of sucrose into glucose and fructose by a gut enzyme that catalyzes this reaction. A glucose meter is used to follow the breakdown of sucrose into glucose. When no enzyme is added to the sucrose solution, the glucose meter will have a reading of 0 mg/dL; but when the enzyme is added, the glucose meter will start to show readings indicative of glucose being formed. Which of the following diabetic pharmacological agents, when added before the addition of the gut enzyme to the sucrose solution, will maintain a reading of 0 mg/dL?? {'A': 'Insulin', 'B': 'Glyburide', 'C': 'Metformin', 'D': 'Acarbose', 'E': 'Exenatide'}, | D: Acarbose |
Answer the following medical question with one of the provided options: | Q:Three days into hospitalization for a fractured distal femur, a 33-year-old man develops dyspnea and confusion. He has no history of a serious illness. He is unable to answer any questions or follow any commands. His blood pressure is 145/90 mm Hg, the pulse is 120/min, the respiratory rate is 36/min, and the temperature is 36.7°C (98.1°F). His oxygen saturation is 90% on 80% FiO2. On examination, purpura is noted on the anterior chest, head, and neck. Inspiratory crackles are heard in both lung fields. Arterial blood gas analysis on 80% FiO2 shows: pH 7.54 PCO2 17 mm Hg PO2 60 mm Hg HCO3− 22 mEq/L A chest X-ray is shown. Which of the following best explains the cause of these findings?? {'A': 'Acute respiratory distress syndrome', 'B': 'Fat embolism', 'C': 'Hospital-acquired pneumonia', 'D': 'Pulmonary contusion', 'E': 'Pulmonary thromboembolism'}, | B: Fat embolism |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the emergency department for a 2-week history of right upper quadrant abdominal pain. She has also been feeling tired and nauseous for the past 5 weeks. She has a history of depression and suicidal ideation. She is a social worker for an international charity foundation. She used intravenous illicit drugs in the past but quit 4 months ago. Her only medication is sertraline. Her temperature is 37.8°C (100.0°F), pulse is 100/min, and blood pressure is 128/76 mm Hg. She is alert and oriented. Scleral icterus is present. Abdominal examination shows tenderness to palpation in the right upper quadrant. The liver edge is palpated 3 cm below the right costal margin. There is no rebound tenderness or guarding. The abdomen is non-distended and the fluid wave test is negative. She is able to extend her arms with wrists in full extension and hold them steady without flapping. Laboratory studies show: Hemoglobin 13.8 g/dL Leukocytes 13,700/mm3 Platelets 165,000/mm3 Prothrombin time 14 seconds Partial thromboplastin time 35 seconds Serum: Total bilirubin 4.8 mg/dL Direct bilirubin 1.3 mg/dL Aspartate aminotransferase 1852 U/L Alanine aminotransferase 2497 U/L Urea nitrogen 21 mg/dL Creatinine 1.2 mg/dL Hepatitis A IgM antibody Negative Hepatitis B surface antigen Negative Hepatitis B surface antibody Negative Hepatitis B core IgM antibody Positive Hepatitis C antibody Positive Hepatitis C RNA Negative Urine beta-hCG Negative Which of the following is the most appropriate next step in management?"? {'A': 'Pegylated interferon-alpha', 'B': 'Supportive therapy', 'C': 'Tenofovir', 'D': 'Ribavirin and interferon', 'E': 'Vaccination against Hepatitis B'}, | B: Supportive therapy |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man comes to the physician because of sudden-onset fever, malaise, and pain and swelling of his wrists and ankles that began a week ago. One month ago, he was started on hydralazine for adjunctive treatment of hypertension. His temperature is 37.8°C (100°F). Examination shows swelling, tenderness, warmth, and erythema of both wrists and ankles; range of motion is limited. Further evaluation is most likely to show an increased level of which of the following autoantibodies?? {'A': 'Anti-dsDNA', 'B': 'Anti-Smith', 'C': 'Anti-β2-glycoprotein', 'D': 'Anti-histone', 'E': 'Anti-Jo-1'}, | D: Anti-histone |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man who recently immigrated to the United States from Haiti comes to the physician because of a 3-week history of progressively worsening exertional dyspnea and fatigue. For the past few days, he has also had difficulty lying flat due to trouble breathing. Over the past year, he has had intermittent fever, night sweats, and cough but he has not been seen by a physician for evaluation of these symptoms. His temperature is 37.8°C (100°F). An x-ray of the chest is shown. Further evaluation of this patient is most likely to show which of the following findings?? {'A': 'Elimination of S2 heart sound splitting with inspiration', 'B': 'Head bobbing in synchrony with heart beat', 'C': '"Prominent ""a"" wave on jugular venous pressure tracing"', 'D': 'Jugular venous distention on inspiration', 'E': 'Crescendo-decrescendo systolic ejection murmur'}, | D: Jugular venous distention on inspiration |
Answer the following medical question with one of the provided options: | Q:A 55-year-old man with a past medical history of obesity and hyperlipidemia suddenly develops left-sided chest pain and shortness of breath while at work. He relays to coworkers that the pain is intense and has spread to his upper left arm over the past 10 minutes. He reports it feels a lot like the “heart attack” he had a year ago. He suddenly collapses and is unresponsive. Coworkers perform cardiopulmonary resuscitation for 18 minutes until emergency medical services arrives. Paramedics pronounce him dead at the scene. Which of the following is the most likely cause of death in this man?? {'A': 'Aortic dissection', 'B': 'Atrial fibrillation', 'C': 'Free wall rupture', 'D': 'Pericarditis', 'E': 'Ventricular tachycardia'}, | E: Ventricular tachycardia |
Answer the following medical question with one of the provided options: | Q:A previously healthy 13-year-old girl is brought to the physician for evaluation of a 2-month history of fatigue. She reports recurrent episodes of pain in her right wrist and left knee. During this period, she has had a 4-kg (8.8-lb) weight loss. Her mother has rheumatoid arthritis. Her temperature is 38°C (100.4°F). Examination shows diffuse lymphadenopathy. Oral examination shows several painless oral ulcers. The right wrist and the left knee are swollen and tender. Laboratory studies show a hemoglobin concentration of 9.8 g/dL, a leukocyte count of 2,000/mm3, and a platelet count of 75,000/mm3. Urinalysis shows excessive protein. This patient's condition is associated with which of the following laboratory findings?? {'A': 'Leukocytoclastic vasculitis with IgA and C3 immune complex deposition', 'B': 'Anti-dsDNA antibodies', 'C': 'Anti-citrullinated peptide antibodies', 'D': 'Excessive lymphoblasts', 'E': 'Positive HLA-B27 test'}, | B: Anti-dsDNA antibodies |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man comes to the emergency department because of palpitations, dizziness, and substernal chest pain for three hours. The day prior, he was at a friend’s wedding, where he consumed seven glasses of wine. The patient appears diaphoretic. His pulse is 220/min and blood pressure is 120/84 mm Hg. Based on the patient's findings on electrocardiography, the physician diagnoses atrial fibrillation with rapid ventricular response and administers verapamil for rate control. Ten minutes later, the patient is unresponsive and loses consciousness. Despite resuscitative efforts, the patient dies. Histopathologic examination of the heart at autopsy shows an accessory atrioventricular conduction pathway. Electrocardiography prior to the onset of this patient's symptoms would most likely have shown which of the following findings?? {'A': 'Slurred upstroke of the QRS complex', 'B': 'Cyclic alteration of the QRS axis', 'C': 'Epsilon wave following the QRS complex', 'D': 'Prolongation of the QT interval', 'E': 'Positive Sokolow-Lyon index'}, | A: Slurred upstroke of the QRS complex |
Answer the following medical question with one of the provided options: | Q:A typically healthy 27-year-old woman presents to the physician because of a 3-week history of fatigue, headache, and dry cough. She does not smoke or use illicit drugs. Her temperature is 37.8°C (100.0°F). Chest examination shows mild inspiratory crackles in both lung fields. An X-ray of the chest shows diffuse interstitial infiltrates bilaterally. A Gram stain of saline-induced sputum shows no organisms. Inoculation of the induced sputum on a cell-free medium that is enriched with yeast extract, horse serum, cholesterol, and penicillin G grows colonies that resemble fried eggs. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous ceftriaxone', 'B': 'Intravenous ceftriaxone and oral azithromycin', 'C': 'Intravenous clindamycin', 'D': 'Oral amoxicillin', 'E': 'Oral azithromycin'}, | E: Oral azithromycin |
Answer the following medical question with one of the provided options: | Q:A 59-year-old Caucasian man with a history of hypertension and emphysema is brought to the hospital because of progressive lethargy and confusion. The patient has been experiencing poor appetite for the past 3 months and has unintentionally lost 9 kg (19.8 lb). He was a smoker for 35 years and smoked 1 pack daily, but he quit 5 years ago. He takes lisinopril and bisoprolol for hypertension and has no allergies. On examination, the patient appears cachectic. He responds to stimulation but is lethargic and unable to provide any significant history. His blood pressure is 138/90 mm Hg, heart rate is 100/min, and his oxygen saturation on room air is 90%. His mucous membranes are moist, heart rate is regular without murmurs or an S3/S4 gallop, and his extremities are without any edema. His pulmonary examination shows mildly diminished breath sounds in the right lower lobe with bilateral wheezing. His laboratory values are shown: Sodium 110 mEq/L Potassium 4.1 mEq/L Chloride 102 mEq/L CO2 41 mm Hg BUN 18 Creatinine 1.3 mg/dL Glucose 93 mg/dL Urine osmolality 600 mOsm/kg H2O Plasma osmolality 229 mEq/L WBC 8,200 cells/mL Hgb 15.5 g/dL Arterial blood gas pH 7.36/pCO2 60/pO2 285 Chest X-ray demonstrates a mass in the right upper lobe. What is the most appropriate treatment to address the patient’s hyponatremia?? {'A': 'Dextrose with 20 mEq/L KCl at 250 mL/h', 'B': '0.9% saline at 125 mL/h', 'C': '0.45% saline at 100 mL/h', 'D': '3% saline at 35 mL/h', 'E': '0.45% saline with 30 mEq/L KCl at 100 mL/h'}, | D: 3% saline at 35 mL/h |
Answer the following medical question with one of the provided options: | Q:A 30-year-old male presents with a testicular mass of unknown duration. The patient states he first noticed something unusual with his right testicle two weeks ago, but states he did not think it was urgent because it was not painful and believed it would resolve on its own. It has not changed since he first noticed the mass, and the patient still denies pain. On exam, the patient’s right testicle is non-tender, and a firm mass is felt. There is a negative transillumination test, and the mass is non-reducible. Which of the following is the best next step in management?? {'A': 'Needle biopsy', 'B': 'Testicular ultrasound', 'C': 'MRI abdomen and pelvis', 'D': 'CT abdomen and pelvis', 'E': 'Send labs'}, | B: Testicular ultrasound |
Answer the following medical question with one of the provided options: | Q:A 1-year-old boy is brought to the emergency department after his mother witnessed him swallow a nickel-sized battery a few hours ago. She denies any episodes of vomiting or hematemesis. The vital signs include: temperature 37.0°C (98.6°F), blood pressure 95/45 mm Hg, pulse 140/min, respiratory rate 15/min, and oxygen saturation 99% on room air. On physical examination, the patient is alert and responsive. The oropharynx is clear. The cardiac exam is significant for a grade 2/6 holosystolic murmur loudest at the left lower sternal border. The lungs are clear to auscultation. The abdomen is soft and nontender with no hepatosplenomegaly. Bowel sounds are present. What is the most appropriate next step in the management of this patient?? {'A': 'Induce emesis to expel the battery', 'B': 'Induce gastrointestinal motility with metoclopramide to expel the battery', 'C': 'Reassurance and observation for the next 24 hours', 'D': 'Computed tomography (CT) scan to confirm the diagnosis ', 'E': 'Immediate endoscopic removal'}, | E: Immediate endoscopic removal |
Answer the following medical question with one of the provided options: | Q:A 28-year-old soldier is brought back to a military treatment facility 45 minutes after sustaining injuries in a building fire from a mortar attack. He was trapped inside the building for around 20 minutes. On arrival, he is confused and appears uncomfortable. He has a Glasgow Coma Score of 13. His pulse is 113/min, respirations are 18/min, and blood pressure is 108/70 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Examination shows multiple second-degree burns over the chest and bilateral upper extremities and third-degree burns over the face. There are black sediments seen within the nose and mouth. The lungs are clear to auscultation. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. Intravenous fluid resuscitation is begun. Which of the following is the most appropriate next step in management?? {'A': 'Insertion of nasogastric tube and enteral nutrition', 'B': 'Intravenous antibiotic therapy', 'C': 'Intubation and mechanical ventilation', 'D': 'Intravenous corticosteroid therapy', 'E': 'Immediate bronchoscopy'}, | C: Intubation and mechanical ventilation |
Answer the following medical question with one of the provided options: | Q:A 49-year-old woman presents to her primary care physician for a routine health maintenance examination. She says that she is currently feeling well and has not noticed any acute changes in her health. She exercises 3 times a week and has tried to increase the amount of fruits and vegetables in her diet. She has smoked approximately 1 pack of cigarettes every 2 days for the last 20 years. Her last pap smear was performed 2 years ago, which was unremarkable. Her past medical history includes hypertension and type II diabetes. Her mother was diagnosed with breast cancer at 62 years of age. The patient is 5 ft 5 in (165.1 cm), weighs 185 lbs (84 kg), and has a BMI of 30.8 kg/m^2. Her blood pressure is 155/98 mmHg, pulse is 90/min, and respirations are 18/min. Physical examination is unremarkable. Lipid studies demonstrate an LDL cholesterol of 130 mg/dL and an HDL cholesterol of 42 mg/dL. Which of the following is the best next step in management?? {'A': 'Chest radiography', 'B': 'Colonoscopy', 'C': 'Mammogram', 'D': 'Pap smear', 'E': 'Statin therapy'}, | E: Statin therapy |
Answer the following medical question with one of the provided options: | Q:A 24-year-old woman with a past medical history of anorexia nervosa presents to the clinic due to heavy menses, bleeding gums, and easy bruisability. She says she is trying to lose weight by restricting her food intake. She has taken multiple courses of antibiotics for recurrent sinusitis over the past month. No other past medical history or current medications. She is not sexually active. Her vital signs are as follows: temperature 37.0°C (98.6°F), blood pressure 90/60 mm Hg, heart rate 100/min, respiratory rate 16/min. Her BMI is 16 kg/m2. Her physical examination is significant for ecchymosis on the extremities, dry mucous membranes, and bleeding gums. A gynecological exam is non-contributory. Laboratory tests show a prolonged PT, normal PTT, and normal bleeding time. CBC shows microcytic anemia, normal platelets, and normal WBC. Her urine pregnancy test is negative. Which of the following is the most likely cause of her condition?? {'A': 'Vitamin K deficiency', 'B': 'Acute myelogenous leukemia', 'C': 'Missed miscarriage', 'D': 'Immune thrombocytopenic purpura', 'E': 'Physical abuse'}, | A: Vitamin K deficiency |
Answer the following medical question with one of the provided options: | Q:A 65-year-old obese female presents to the emergency room complaining of severe abdominal pain. She reports pain localized to the epigastrium that radiates to the right scapula. The pain occurred suddenly after a fast food meal with her grandchildren. Her temperature is 100.9°F (38.2°C), blood pressure is 140/85 mmHg, pulse is 108/min, and respirations are 20/min. On examination, she demonstrates tenderness to palpation in the epigastrium. She experiences inspiratory arrest during deep palpation of the right upper quadrant but this exam finding is not present on the left upper quadrant. A blockage at which of the following locations is most likely causing this patient’s symptoms?? {'A': 'Common hepatic duct', 'B': 'Ampulla of Vater', 'C': 'Cystic duct', 'D': 'Pancreatic duct of Wirsung', 'E': 'Common bile duct'}, | C: Cystic duct |
Answer the following medical question with one of the provided options: | Q:A 27-year-old Asian woman presents to her primary care physician with joint pain and a headache. She has had intermittent joint and muscle pain for the past several months in the setting of a chronic headache. She states that the pain seems to migrate from joint to joint, and her muscles typically ache making it hard for her to sleep. The patient's past medical history is non-contributory, and she is currently taking ibuprofen for joint pain. Physical exam is notable for an asymmetrical pulse in the upper extremities. The patient has lost 10 pounds since her previous visit 2 months ago. Laboratory values are notable for an elevated C-reactive protein and erythrocyte sedimentation rate. Which of the following is the best next step in management?? {'A': 'Anti-dsDNA level', 'B': 'Methotrexate', 'C': 'Prednisone', 'D': "Recommend exercise and optimize the patient's sleep regimen", 'E': 'Temporal artery biopsy'}, | C: Prednisone |
Answer the following medical question with one of the provided options: | Q:Your colleague has been reading the literature on beta-carotene supplementation and the risk of heart disease. She thinks they may share a clinically relevant association and would like to submit an editorial to a top journal. Upon final literature review, she discovers a newly published study that refutes any association between beta-carotene and heart disease. Your colleague is upset; you suggest that she, instead, mathematically pool the results from all of the studies on this topic and publish the findings. What type of study design are you recommending to your colleague?? {'A': 'Randomized control trial', 'B': 'Systematic review', 'C': 'Case-cohort study', 'D': 'Meta-analysis', 'E': 'Cross-sectional study'}, | D: Meta-analysis |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl comes to the physician with her father for evaluation of short stature. She feels well overall but is concerned because all of her friends are taller than her. Her birth weight was normal. Menarche has not yet occurred. Her father says he also had short stature and late puberty. The girl is at the 5th percentile for height and 35th percentile for weight. Breast development is Tanner stage 2. Pubic and axillary hair is absent. An x-ray of the left hand and wrist shows a bone age of 12 years. Further evaluation of this patient is most likely to show which of the following sets of laboratory findings? $$$ FSH %%% LH %%% Estrogen %%% GnRH $$$? {'A': '↓ ↓ ↓ ↓', 'B': '↓ ↓ ↑ ↓', 'C': 'Normal normal normal normal', 'D': '↑ ↑ ↓ ↑', 'E': 'Normal normal ↓ normal'}, | C: Normal normal normal normal |
Answer the following medical question with one of the provided options: | Q:In which of the following pathological states would the oxygen content of the trachea resemble the oxygen content in the affected alveoli?? {'A': 'Emphysema', 'B': 'Pulmonary fibrosis', 'C': 'Pulmonary embolism', 'D': 'Foreign body obstruction distal to the trachea', 'E': 'Exercise'}, | C: Pulmonary embolism |
Answer the following medical question with one of the provided options: | Q:A previously healthy 32-year-old man comes to the physician because of a 1-week history of upper back pain, dyspnea, and a sensation of pressure in his chest. He has had no shortness of breath, palpitations, fevers, or chills. He emigrated from Ecuador when he was 5 years old. He does not smoke or drink alcohol. He takes no medications. He is 194 cm (6 ft 4 in) tall and weighs 70.3 kg (155 lb); BMI is 19 kg/m2. His temperature is 37.2°C (99.0°F), pulse is 73/min, respirations are 15/min, and blood pressure is 152/86 mm Hg in the right arm and 130/72 mg Hg in the left arm. Pulmonary examination shows faint inspiratory wheezing bilaterally. A CT scan of the chest with contrast is shown. Which of the following is the most likely underlying cause of this patient's condition?? {'A': 'Infection with Trypanosoma cruzi', 'B': 'Cystic medial necrosis', 'C': 'Large-vessel vasculitis', 'D': 'Atherosclerotic plaque formation', 'E': 'Congenital narrowing of the aortic arch'}, | B: Cystic medial necrosis |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman presents to the emergency department with fever, chills, lower quadrant abdominal pain, and urinary frequency for the past week. Her vital signs include temperature 38.9°C (102.0°F), pulse 110/min, respirations 16/min, and blood pressure 122/78 mm Hg. Physical examination is unremarkable. Urinalysis reveals polymorphonuclear leukocytes (PMNs) > 10 cells/HPF and the presence of bacteria (> 105 CFU/mL). Which of the following is correct concerning the most likely microorganism responsible for this patient’s condition?? {'A': 'Nonmotile, pleomorphic rod-shaped, gram-negative bacilli ', 'B': 'Pear-shaped motile protozoa', 'C': 'Gram-negative rod-shaped bacilli', 'D': 'Gram-positive cocci that grow in clusters', 'E': 'Gram-positive cocci that grow in chains'}, | C: Gram-negative rod-shaped bacilli |
Answer the following medical question with one of the provided options: | Q:A 30-year-old man comes to the emergency department because of the sudden onset of back pain beginning 2 hours ago. Beginning yesterday, he noticed that his eyes started appearing yellowish and his urine was darker than normal. Two months ago, he returned from a trip to Greece, where he lived before immigrating to the US 10 years ago. Three days ago, he was diagnosed with latent tuberculosis and started on isoniazid. He has worked as a plumber the last 5 years. His temperature is 37.4°C (99.3°F), pulse is 80/min, and blood pressure is 110/70 mm Hg. Examination shows back tenderness and scleral icterus. Laboratory studies show: Hematocrit 29% Leukocyte count 8000/mm3 Platelet count 280,000/mm3 Serum Bilirubin Total 4 mg/dL Direct 0.7 mg/dL Haptoglobin 15 mg/dL (N=41–165 mg/dL) Lactate dehydrogenase 180 U/L Urine Blood 3+ Protein 1+ RBC 2–3/hpf WBC 2–3/hpf Which of the following is the most likely underlying cause of this patient's anemia?"? {'A': 'Crescent-shaped erythrocytes', 'B': 'Absence of reduced glutathione', 'C': 'Inhibition of aminolevulinate dehydratase', 'D': "Absence of uridine 5'-monophosphate", 'E': 'Defective ankyrin in the RBC membrane'}, | B: Absence of reduced glutathione |
Answer the following medical question with one of the provided options: | Q:A 69-year-old Caucasian man presents for a routine health maintenance examination. He feels well. He has no significant past medical history. He takes aspirin for the occasional headaches that he has had for over several years. He exercises every day and does not smoke. His father was diagnosed with a hematologic malignancy at 79 years old. The patient’s vital signs are within normal limits. Physical examination shows no abnormalities. The laboratory test results are as follows: Hemoglobin 14.5 g/dL Leukocyte count 62,000/mm3 Platelet count 350,000/mm3 A peripheral blood smear is obtained (shown on the image). Which of the following best explains these findings?? {'A': 'Acute lymphoid leukemia', 'B': 'Acute myeloid leukemia', 'C': 'Adult T cell leukemia', 'D': 'Chronic lymphocytic leukemia', 'E': 'Hairy cell leukemia'}, | D: Chronic lymphocytic leukemia |
Answer the following medical question with one of the provided options: | Q:A 62-year-old woman is referred to a tertiary care hospital with a history of diplopia and fatigue for the past 3 months. She has also noticed difficulty in climbing the stairs and combing her hair. She confirms a history of 2.3 kg (5.0 lb) weight loss in the past 6 weeks and constipation. Past medical history is significant for type 2 diabetes mellitus. She has a 50-pack-year cigarette smoking history. Physical examination reveals a blood pressure of 135/78 mm Hg supine and 112/65 while standing, a heart rate of 82/min supine and 81/min while standing, and a temperature of 37.0°C (98.6°F). She is oriented to time and space. Her right upper eyelid is slightly drooped. She has difficulty in abducting the right eye. Pupils are bilaterally equal and reactive to light with accommodation. The corneal reflex is intact. Muscle strength is reduced in the proximal muscles of all 4 limbs, and the lower limbs are affected more when compared to the upper limbs. Deep tendon reflexes are bilaterally absent. After 10 minutes of cycling, the reflexes become positive. Sensory examination is normal. Diffuse wheezes are heard on chest auscultation. Which of the following findings is expected?? {'A': 'Antibodies against muscle-specific kinase', 'B': 'Elevated serum creatine kinase', 'C': 'Incremental pattern on repetitive nerve conduction studies', 'D': 'Periventricular plaques on MRI of the brain', 'E': 'Thymoma on CT scan of the chest'}, | C: Incremental pattern on repetitive nerve conduction studies |
Answer the following medical question with one of the provided options: | Q:A 60-year-old man is brought to the emergency department by police officers because he was acting strangely in public. The patient was found talking nonsensically to characters on cereal boxes in the store. Past medical history is significant for multiple hospitalizations for alcohol-related injuries and seizures. The patient’s vital signs are within normal limits. Physical examination shows a disheveled male who is oriented to person, but not time or place. Neurologic examination shows nystagmus and severe gait ataxia. A T1/T2 MRI is performed and demonstrates evidence of damage to the mammillary bodies. The patient is given the appropriate treatment for recovering most of his cognitive functions. However, significant short-term memory deficits persist. The patient remembers events from his past such as the school and college he attended, his current job, and the names of family members quite well. Which of the following is the most likely diagnosis in this patient?? {'A': 'Delirium', 'B': 'Delirium tremens', 'C': "Korsakoff's syndrome", 'D': 'Schizophrenia', 'E': 'Wernicke encephalopathy'}, | C: Korsakoff's syndrome |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman presents to her primary care physician for a general wellness appointment. The patient states that sometimes she has headaches and is ashamed of her body habitus. Otherwise, the patient has no complaints. The patient's 90-year-old mother recently died of breast cancer. The patient smokes 1 pack of cigarettes per day. She drinks 2-3 glasses of red wine per day with dinner. She has been considering having a child as she has just been promoted to a position that gives her more time off and a greater income. The patient's current medications include lisinopril, metformin, and a progesterone intrauterine device (IUD). On physical exam, you note a normal S1 and S2 heart sound. Pulmonary exam is clear to auscultation bilaterally. The patient's abdominal, musculoskeletal, and neurological exams are within normal limits. The patient is concerned about her risk for breast cancer and asks what she can do to reduce her chance of getting this disease. Which of the following is the best recommendation for this patient?? {'A': 'Switch to oral contraceptive pills for contraception', 'B': 'Begin breastfeeding', 'C': 'Test for BRCA1 and 2', 'D': 'Recommend monthly self breast exams', 'E': 'Exercise and reduce alcohol intake'}, | E: Exercise and reduce alcohol intake |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy is brought to his pediatrician with a high fever. He was feeling fatigued yesterday and then developed a high fever overnight that was accompanied by chills and malaise. This morning he also started complaining of headaches and myalgias. He has otherwise been healthy and does not take any medications. He says that his friends came down with the same symptoms last week. He is given oseltamivir and given instructions to rest and stay hydrated. He is also told that this year the disease is particularly infectious and is currently causing a global pandemic. He asks the physician why the same virus can infect people who have already had the disease and is told about a particular property of this virus. Which of the following properties is required for the viral genetic change that permits global pandemics of this virus?? {'A': 'Concurrent infection with 2 viruses', 'B': 'Crossing over of homologous regions', 'C': 'Point mutations in the viral genetic code', 'D': 'One virus that produces a non-functional protein', 'E': 'Segmented genomic material'}, | E: Segmented genomic material |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman presents to the clinic with complaints of intermittent chest pain for 3 days. The pain is retrosternal, 3/10, and positional (laying down seems to make it worse). She describes it as “squeezing and burning” in quality, is worse after food intake and emotional stress, and improves with antacids. The patient recently traveled for 4 hours in a car. Past medical history is significant for osteoarthritis, hypertension and type 2 diabetes mellitus, both of which are moderately controlled. Medications include ibuprofen, lisinopril, and hydrochlorothiazide. She denies palpitations, dyspnea, shortness of breath, weight loss, fever, melena, or hematochezia. What is the most likely explanation for this patient’s symptoms?? {'A': 'Blood clot within the lungs', 'B': 'Decreased gastric mucosal protection', 'C': 'Incompetence of the lower esophageal sphincter', 'D': 'Insufficient blood supply to the myocardium', 'E': 'Temporary blockage of the bile duct'}, | C: Incompetence of the lower esophageal sphincter |
Answer the following medical question with one of the provided options: | Q:A 24-year-old man presents to the emergency department for severe abdominal pain for the past day. The patient states he has had profuse, watery diarrhea and abdominal pain that is keeping him up at night. The patient also claims that he sees blood on the toilet paper when he wipes and endorses having lost 5 pounds recently. The patient's past medical history is notable for IV drug abuse and a recent hospitalization for sepsis. His temperature is 99.5°F (37.5°C), blood pressure is 120/68 mmHg, pulse is 100/min, respirations are 14/min, and oxygen saturation is 98% on room air. On physical exam, you note a young man clutching his abdomen in pain. Abdominal exam demonstrates hyperactive bowel sounds and diffuse abdominal tenderness. Cardiopulmonary exam is within normal limits. Which of the following is the next best step in management?? {'A': 'Metronidazole', 'B': 'Vancomycin', 'C': 'Clindamycin', 'D': 'Mesalamine enema', 'E': 'Supportive therapy and ciprofloxacin if symptoms persist'}, | B: Vancomycin |
Answer the following medical question with one of the provided options: | Q:A 57-year-old man is brought to the emergency department for worsening pain and swelling of his left ankle for the past 2 hours. The pain is severe and awakened him from sleep. He has hypertension and hyperlipidemia. Current medications include hydrochlorothiazide and pravastatin. His temperature is 37.8°C (100.1°F), pulse is 105/min, and blood pressure is 148/96 mm Hg. Examination shows exquisite tenderness, erythema, and edema of the left ankle; active and passive range of motion is limited by pain. Arthrocentesis of the ankle joint yields cloudy fluid with a leukocyte count of 19,500/mm3 (80% segmented neutrophils). Gram stain is negative. A photomicrograph of the joint fluid aspirate under polarized light is shown. Which of the following is the most appropriate pharmacotherapy?? {'A': 'Probenecid', 'B': 'Colchicine and allopurinol', 'C': 'Triamcinolone and probenecid', 'D': 'Colchicine', 'E': 'Ketorolac and aspirin'}, | D: Colchicine |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man presents to the physician because of dysphagia and regurgitation for the past 5 years. In recent weeks, it has become very difficult for him to ingest solid or liquid food. He has lost 3 kg (6 lb) during this time. He was admitted to the hospital last year because of pneumonia. Three years ago, he had an endoscopic procedure which partially improved his dysphagia. He takes amlodipine and nitroglycerine before meals. His vital signs are within normal limits. BMI is 19 kg/m2. Physical examination shows no abnormalities. A barium swallow X-ray is shown. Which of the following patterns of esophageal involvement is the most likely cause of this patient’s condition?? {'A': 'Abnormal esophageal contraction with deglutition lower esophageal sphincter relaxation', 'B': 'Absent peristalsis and impaired lower esophageal sphincter relaxation', 'C': 'Poor pharyngeal propulsion and upper esophageal sphincter obstruction', 'D': 'Sequenced inhibition followed by contraction of the musculature along the esophagus', 'E': 'Severely weak peristalsis and patulous lower esophageal sphincter'}, | B: Absent peristalsis and impaired lower esophageal sphincter relaxation |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman is seen by her primary care physician. The patient has a several year history of excessive daytime sleepiness. She also reports episodes where she suddenly falls to the floor after her knees become weak, often during a laughing spell. She has no other significant past medical history. Her primary care physician refers her for a sleep study, which confirms the suspected diagnosis. Which of the following laboratory findings would also be expected in this patient?? {'A': 'Increased serum methoxyhemoglobin', 'B': 'Reduced serum hemoglobin', 'C': 'Undetectable CSF hypocretin-1', 'D': 'Increased CSF oligoclonal bands', 'E': 'Increased serum ESR'}, | C: Undetectable CSF hypocretin-1 |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman comes to the physician with her husband because they have been trying to conceive for 15 months with no success. They have been sexually active at least twice a week. The husband sometimes has difficulties maintaining erection during sexual activity. During attempted vaginal penetration, the patient has discomfort and her pelvic floor muscles tighten up. Three years ago, the patient was diagnosed with body dysmorphic disorder. There is no family history of serious illness. She does not smoke or drink alcohol. She takes no medications. Vital signs are within normal limits. Pelvic examination shows normal appearing vulva without redness; there is no vaginal discharge. An initial attempt at speculum examination is aborted after the patient's pelvic floor muscles tense up and she experiences discomfort. Which of the following is the most likely diagnosis?? {'A': 'Vulvodynia', 'B': 'Vulvovaginitis', 'C': 'Painful bladder syndrome', 'D': 'Genitopelvic pain disorder', 'E': 'Endometriosis'}, | D: Genitopelvic pain disorder |
Answer the following medical question with one of the provided options: | Q:An otherwise healthy 76-year-old man is brought to the physician because of poor sleep for the past several years. Every night he has been sleeping less and taking longer to fall asleep. During the day, he feels tired and has low energy and difficulty concentrating. Sleep hygiene and relaxation techniques have failed to improve his sleep. He would like to start a short-term pharmacological therapy trial but does not want a drug that makes him drowsy during the day. Which of the following is the most appropriate pharmacotherapy for this patient?? {'A': 'Temazepam', 'B': 'Diphenhydramine', 'C': 'Suvorexant', 'D': 'Zaleplon', 'E': 'Flurazepam'}, | D: Zaleplon |
Answer the following medical question with one of the provided options: | Q:A 23-year-old man is brought to the emergency department by ambulance following a motor vehicle accident. He was pinned between 2 cars for several hours. The patient has a history of asthma. He uses an albuterol inhaler intermittently. The patient was not the driver, and admits to having a few beers at a party prior to the accident. His vitals in the ambulance are stable. Upon presentation to the emergency department, the patient is immediately brought to the operating room for evaluation and surgical intervention. It is determined that the patient’s right leg has a Gustilo IIIC injury in the mid-shaft of the tibia with a severely comminuted fracture. The patient’s left leg suffered a similar injury but with damage to the peroneal nerve. The anesthesiologist begins to induce anesthesia. Which of the following agents would be contraindicated in this patient?? {'A': 'Etomidate', 'B': 'Halothane', 'C': 'Neostigmine', 'D': 'Propofol', 'E': 'Succinylcholine'}, | E: Succinylcholine |
Answer the following medical question with one of the provided options: | Q:A 3-year-old girl is brought to the physician for a well-child visit. Her father is concerned about the color and strength of her teeth. He says that most of her teeth have had stains since the time that they erupted. She also has a limp when she walks. Examination shows brownish-gray discoloration of the teeth. She has lower limb length discrepancy; her left knee-to-ankle length is 4 cm shorter than the right. Which of the following drugs is most likely to have been taken by this child's mother when she was pregnant?? {'A': 'Trimethoprim', 'B': 'Ciprofloxacin', 'C': 'Gentamicin', 'D': 'Chloramphenicol', 'E': 'Tetracycline'}, | E: Tetracycline |
Answer the following medical question with one of the provided options: | Q:A 2300-g (5.07-lb) male newborn is delivered at term to a 39-year-old woman. Examination shows a sloping forehead, a flat nasal bridge, increased interocular distance, low-set ears, a protruding tongue, a single palmar crease and an increased gap between the first and second toe. There are small white and brown spots in the periphery of both irises. The abdomen is distended. An x-ray of the abdomen shows two large air-filled spaces in the upper quadrant. This patient's condition is most likely associated with which of the following cardiac anomalies?? {'A': 'Patent ductus arteriosus', 'B': 'Atrial septal defects', 'C': 'Atrioventricular septal defect', 'D': 'Tetralogy of Fallot', 'E': 'Ventricular septal defect'}, | C: Atrioventricular septal defect |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman comes to the physician because of a 3-week history of generalized fatigue, mild fever, abdominal pain, and nausea. She attended the state fair over a month ago, where she tried a number of regional foods, and wonders if it might have been caused by something she ate. She has also noticed darkening of her urine, which she attributes to not drinking enough water recently. She has type 2 diabetes mellitus. She drinks 1–2 beers daily. She works as nursing assistant in a rehabilitation facility. Current medications include glyburide, sitagliptin, and a multivitamin. She appears tired. Her temperature is 38.1°C (100.6°F), pulse is 99/min, and blood pressure is 110/74 mm Hg. Examination shows mild scleral icterus. The liver is palpated 2–3 cm below the right costal margin and is tender. Laboratory studies show: Hemoglobin 10.6 g/dL Leukocyte count 11600/mm3 Platelet count 221,000/mm3 Serum Urea nitrogen 26 mg/dL Glucose 122 mg/dL Creatinine 1.3 mg/dL Bilirubin 3.6 mg/dL Total 3.6 mg/dL Direct 2.4 mg/dL Alkaline phosphatase 72 U/L AST 488 U/L ALT 798 U/L Hepatitis A IgG antibody (HAV-IgG) positive Hepatitis B surface antigen (HBsAg) positive Hepatitis B core IgG antibody (anti-HBc) positive Hepatitis B envelope antigen (HBeAg) positive Hepatitis C antibody (anti-HCV) negative Which of the following is the most likely diagnosis?"? {'A': 'Inactive chronic hepatitis B infection', 'B': 'Acute hepatitis B infection', 'C': 'Active chronic hepatitis B infection', 'D': 'Resolved acute hepatitis B infection', 'E': 'Alcoholic hepatitis'}, | C: Active chronic hepatitis B infection |
Answer the following medical question with one of the provided options: | Q:A 5-year-old boy is brought to the emergency department for evaluation of a progressive rash that started 2 days ago. The rash began on the face and progressed to the trunk and extremities. Over the past week, he has had a runny nose, a cough, and red, crusty eyes. He immigrated with his family from Turkey 3 months ago. His father and his older brother have Behcet disease. Immunization records are unavailable. The patient appears irritable and cries during the examination. His temperature is 40.0°C (104°F). Examination shows general lymphadenopathy and dry mucous membranes. Skin turgor is decreased. There is a blanching, partially confluent erythematous maculopapular exanthema. Examination of the oral cavity shows two 5-mm aphthous ulcers at the base of the tongue. His hemoglobin concentration is 11.5 g/dL, leukocyte count is 6,000/mm3, and platelet count is 215,000/mm3. Serology confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Intravenous immunoglobulin (IVIG)', 'B': 'Oral acyclovir', 'C': 'Vitamin A supplementation', 'D': 'Reassurance and follow-up in 3 days', 'E': 'Oral penicillin V'}, | C: Vitamin A supplementation |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy presents to the ER with progressive dysphagia over the course of 3 months and a new onset fever for the past 24 hours. The temperature in the ER was 39.5°C (103.1°F). There are white exudates present on enlarged tonsils (Grade 2). Routine blood work reveals a WBC count of 89,000/mm3, with the automatic differential yielding a high (> 90%) percentage of lymphocytes. A peripheral blood smear is ordered, demonstrating the findings in the accompanying image. The peripheral smear is submitted to pathology for review. After initial assessment, the following results are found on cytologic assessment of the cells: TdT: positive CALLA (CD 10): positive Which of the following cell markers are most likely to be positive as well? ? {'A': 'CD 8', 'B': 'CD 2', 'C': 'CD 7', 'D': 'CD 19', 'E': 'CD 5'}, | D: CD 19 |
Answer the following medical question with one of the provided options: | Q:A 74-year-old man presents to the emergency department with sudden onset of abdominal pain that is most felt around the umbilicus. The pain began 16 hours ago and has no association with meals. He has not been vomiting, but he has had several episodes of bloody loose bowel movements. He was hospitalized 1 week ago for an acute myocardial infarction. He has had diabetes mellitus for 35 years and hypertension for 20 years. He has smoked 15–20 cigarettes per day for the past 40 years. His temperature is 36.9°C (98.4°F), blood pressure is 95/65 mm Hg, and pulse is 95/min. On physical examination, the patient is in severe pain, there is a mild periumbilical tenderness, and a bruit is heard over the epigastric area. Which of the following is the most likely diagnosis?? {'A': 'Chronic mesenteric ischemia', 'B': 'Colonic ischemia', 'C': 'Acute mesenteric ischemia', 'D': 'Peptic ulcer disease', 'E': 'Irritable bowel syndrome'}, | C: Acute mesenteric ischemia |
Answer the following medical question with one of the provided options: | Q:A 33-year-old woman, gravida 2, para 1, at 26 weeks' gestation comes to the emergency department because of frequent contractions. The contractions are 40 seconds each, occurring every 2 minutes, and increasing in intensity. Her first child was delivered by lower segment transverse cesarean section because of a nonreassuring fetal heart rate. Her current medications include folic acid and a multivitamin. Her temperature is 36.9°C (98.4°F), heart rate is 88/min, and blood pressure is 126/76 mm Hg. Contractions are felt on the abdomen. There is clear fluid in the vulva and the introitus. The cervix is dilated to 5 cm, 70% effaced, and station of the head is -2. A fetal ultrasound shows polyhydramnios, a median cleft lip, and fused thalami. The corpus callosum, 3rd ventricle, and lateral ventricles are absent. The spine shows no abnormalities and there is a four chamber heart. Which of the following is the most appropriate next step in management?? {'A': 'Perform cesarean delivery', 'B': 'Allow vaginal delivery', 'C': 'Initiate misoprostol therapy', 'D': 'Perform dilation and evacuation', 'E': 'Initiate nifedipine therapy'}, | B: Allow vaginal delivery |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man comes to the physician for a 2-month history of an itchy rash on his forearm. He feels well otherwise and has not had any fever or chills. He returned from an archaeological expedition to Guatemala 4 months ago. Skin examination shows a solitary, round, pink-colored plaque with central ulceration on the right wrist. There is right axillary lymphadenopathy. A photomicrograph of a biopsy specimen from the lesion is shown. Which of the following is the most likely causal organism?? {'A': 'Treponema pallidum', 'B': 'Trypanosoma brucei', 'C': 'Ancylostoma duodenale', 'D': 'Borrelia burgdorferi', 'E': 'Leishmania braziliensis'}, | E: Leishmania braziliensis |
Answer the following medical question with one of the provided options: | Q:A 59-year-old woman comes to the physician because of a 1-month history of episodic cough and shortness of breath. The cough is nonproductive and worsens when she climbs stairs and during the night. She has not had chest pain or palpitations. Eight weeks ago, she had fever, sore throat, and nasal congestion. She has a 10-year history of hypertension. She has smoked half a pack of cigarettes daily for 16 years. Her only medication is enalapril. Her pulse is 78/min, respirations are 18/min, and blood pressure is 145/95 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 96%. Diffuse end-expiratory wheezes are heard on pulmonary auscultation. An x-ray of the chest shows no abnormalities. Spirometry shows an FEV1:FVC ratio of 65% and an FEV1 of 60%. Which of the following is the most likely diagnosis?? {'A': 'Pneumonia', 'B': 'Gastroesophageal reflux disease', 'C': 'Side effect of medication', 'D': 'Asthma', 'E': 'Chronic bronchitis'}, | D: Asthma |
Answer the following medical question with one of the provided options: | Q:A 2850-g (6-lb 5-oz) newborn is delivered at term to a 19-year-old primigravid woman via normal spontaneous vaginal delivery. The mother has had no prenatal care. Examination of the newborn in the delivery room shows a small, retracted jaw and hypoplasia of the zygomatic arch. This patient's condition is most likely caused by abnormal development of the structure that also gives rise to which of the following?? {'A': 'Facial nerve', 'B': 'Cricothyroid muscle', 'C': 'Incus', 'D': 'Greater horn of hyoid', 'E': 'Platysma'}, | C: Incus |
Answer the following medical question with one of the provided options: | Q:A 52-year-old woman comes to the emergency department because of epigastric abdominal pain that started after her last meal and has become progressively worse over the past 6 hours. She has had intermittent pain similar to this before, but it has never lasted this long. Her temperature is 39°C (102.2°F). Examination shows a soft abdomen with normal bowel sounds. The patient has sudden inspiratory arrest during right upper quadrant palpation. Her alkaline phosphatase, total bilirubin, amylase, and aspartate aminotransferase levels are within the reference ranges. Abdominal imaging is most likely to show which of the following findings?? {'A': 'Dilated common bile duct with intrahepatic biliary dilatation', 'B': 'Gallstone in the cystic duct', 'C': 'Fistula formation between the gallbladder and bowel', 'D': 'Decreased echogenicity of the liver', 'E': 'Enlargement of the pancreas with peripancreatic fluid'}, | B: Gallstone in the cystic duct |
Answer the following medical question with one of the provided options: | Q:A 15-year-old boy is brought to the physician by his father because he has been waking up frequently during the night to urinate. Apart from occasional headaches, he has no other complaints. His family recently emigrated from Tanzania and his medical history is unknown. His father was diagnosed with sickle cell disease at the age of 5. Physical examination shows no abnormalities. Laboratory studies show: Hemoglobin 14.5 g/dL Hematocrit 44% MCV 90 fL Reticulocytes 1.5% A hemoglobin electrophoresis shows: HbA 55% HbS 43% HbF 1% This patient is at greatest risk for which of the following conditions?"? {'A': 'Avascular osteonecrosis', 'B': 'Clear cell renal carcinoma', 'C': 'Renal papillary necrosis', 'D': 'Functional asplenia', 'E': 'Ischemic stroke\n"'}, | C: Renal papillary necrosis |
Answer the following medical question with one of the provided options: | Q:A 71-year-old woman comes to the physician because of an 8-month history of fatigue. Laboratory studies show a hemoglobin concentration of 13.3 g/dL, a serum creatinine concentration of 0.9 mg/dL, and a serum alkaline phosphatase concentration of 100 U/L. Laboratory evaluation of which of the following parameters would be most helpful in determining the cause of this patient's symptoms?? {'A': 'Cancer antigen 27-29', 'B': 'Lactate dehydrogenase', 'C': 'Ferritin', 'D': 'Gamma-glutamyl transpeptidase', 'E': 'Calcitriol'}, | D: Gamma-glutamyl transpeptidase |
Answer the following medical question with one of the provided options: | Q:A laboratory physician investigates the chromosomes of a fetus with a suspected chromosomal anomaly. She processes a cell culture obtained by amniocentesis. Prior to staining and microscopic examination of the fetal chromosomes, a drug that blocks cell division is added to the cell culture. In order to arrest chromosomes in metaphase, the physician most likely added a drug that is also used for the treatment of which of the following conditions?? {'A': 'Trichomonas vaginitis', 'B': 'Acute gouty arthritis', 'C': 'Herpes zoster', 'D': 'Testicular cancer', 'E': 'Polycythemia vera'}, | B: Acute gouty arthritis |
Answer the following medical question with one of the provided options: | Q:Following gastric surgery, a 45-year-old woman complains of severe nausea and vomiting on the 2nd postoperative day. On physical examination, her vitals are stable and examination of the abdomen reveals no significant abnormality. The patient is already receiving a maximum dosage of ondansetron. Metoclopramide is given, and she experiences significant relief from nausea and vomiting. Which of the following best explains the mechanism of action of this drug?? {'A': 'Inhibition of dopamine receptors in the area postrema', 'B': 'Inhibition of serotonin receptors on the nucleus tractus solitarius', 'C': 'Stimulation of motilin receptors in gastrointestinal smooth muscle', 'D': 'Enhancement of small intestinal and colonic motility by dopamine antagonism', 'E': 'Decreased esophageal peristaltic amplitude'}, | A: Inhibition of dopamine receptors in the area postrema |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman is found unconscious on the office floor just before lunch by her colleagues. She had previously instructed them on the location of an emergency kit in case this ever happened so they are able to successfully inject her with the substance inside. Her past medical history is significant for type 1 diabetes for which she takes long acting insulin as well as periprandial rapid acting insulin injections. She has previously been found unconscious once before when she forgot to eat breakfast. The substance inside the emergency kit most likely has which of the following properties.? {'A': 'Inhibits activity of pancreatic alpha and beta cells', 'B': 'Promotes gluconeogenesis in the liver', 'C': 'Promotes glucose release from skeletal muscles', 'D': 'Promotes glucose uptake in muscles', 'E': 'Promotes glycogen formation in the liver'}, | B: Promotes gluconeogenesis in the liver |
Answer the following medical question with one of the provided options: | Q:A 6-year-old girl is brought to the physician because of a generalized pruritic rash for 3 days. Her mother has noticed fluid oozing from some of the lesions. She was born at term and has been healthy except for an episode of bronchitis 4 months ago that was treated with azithromycin. There is no family history of serious illness. Her immunization records are unavailable. She attends elementary school but has missed the last 5 days. She appears healthy. Her temperature is 38°C (100.4°F). Examination shows a maculopapular rash with crusted lesions and vesicles over the entire integument, including the scalp. Her hemoglobin concentration is 13.1 g/dL, leukocyte count is 9800/mm3, and platelet count is 319,000/mm3. Which of the following is the most appropriate next best step?? {'A': 'Vitamin A therapy', 'B': 'Rapid strep test', 'C': 'Tzanck test', 'D': 'Measles IgM titer', 'E': 'Calamine lotion'}, | E: Calamine lotion |
Answer the following medical question with one of the provided options: | Q:A 3-month-old boy is brought to the emergency room by his mother for 2 days of difficulty breathing. He was born at 35 weeks gestation but has otherwise been healthy. She noticed a cough and some trouble breathing in the setting of a runny nose. His temperature is 100°F (37.8°C), blood pressure is 64/34 mmHg, pulse is 140/min, respirations are 39/min, and oxygen saturation is 93% on room air. Pulmonary exam is notable for expiratory wheezing and crackles throughout and intercostal retractions. Oral mucosa is noted to be dry. Which of the following is the most appropriate diagnostic test?? {'A': 'Chest radiograph', 'B': 'No further testing needed', 'C': 'Polymerase chain reaction', 'D': 'Sputum culture', 'E': 'Viral culture'}, | B: No further testing needed |
Answer the following medical question with one of the provided options: | Q:A 2200-g (4-lbs 13-oz) female newborn is delivered at term to a 37-year-old gravida 2, para 1 woman. The newborn is at the 10th percentile for length, 14th percentile for weight, and 3rd percentile for head circumference. Examination shows “punched-out“ skin lesions on the scalp, cleft lip, and a small chin. There is a convex-shaped deformity of the plantar surface of the feet. Auscultation shows a holosystolic murmur heard best at the left lower sternal border. Some of her intestines protrude through the umbilicus, covered by a thin membranous sac. An MRI of the brain shows a single ventricle and a fusion of the basal ganglia. Which of the following additional findings is most likely to be seen in this patient?? {'A': 'Polydactyly', 'B': 'Webbed neck', 'C': 'Single palmar crease', 'D': 'Overlapping fingers', 'E': 'Hypoplastic philtrum'}, | A: Polydactyly |
Answer the following medical question with one of the provided options: | Q:A 39-year-old woman presents to the emergency department with fever, cough, and shortness of breath. She reports developing flu-like symptoms 7 days ago but progressively worsened to the point where she experiences dyspnea on exertion. Her cough is accompanied by a mild amount of yellow sputum. Past medical history is notable for a previous admission to the hospital for pneumonia 4 months ago and an admission for bacteremia 6 weeks ago. She additionally has a history of IV heroin abuse, but her last use of heroin was 3 years ago. Temperature is 101.2°F (38.4°C), blood pressure is 104/70 mmHg, pulse is 102/min, and respirations are 20/min. Physical examination demonstrates coarse upper airway breath sounds over the right lower lung field. A faint 1/6 non-radiating systolic flow murmur is auscultated at the first right intercostal space. Abdominal examination is significant for moderate splenomegaly. Tenderness of the wrists and fingers is elicited on palpation, and range of motion is restricted. The patient comments that her range of motion and pain usually improve as the day goes on. Which of the following laboratory abnormalities is most likely to be found in this patient?? {'A': 'Decreased anion gap', 'B': 'Flow cytometry positive for CD11c and CD2', 'C': 'Leukocytosis with left-shift', 'D': 'Neutropenia', 'E': 'Positive HIV serology'}, | D: Neutropenia |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man presents to his primary care physician complaining of pain and bulging in his groin. He is otherwise healthy and has never had surgery. He is referred to a general surgeon, and is scheduled for an elective hernia repair the following week. On closer inspection in the operating room, the surgeon notes a hernia sac that protrudes through the external inguinal ring, bypassing the inguinal canal. Which of the following accurately describes this patient's condition?? {'A': 'Direct hiatal hernia', 'B': 'Indirect femoral hernia', 'C': 'Direct incisional hernia', 'D': 'Isolated rectus diastasis', 'E': 'Direct inguinal hernia'}, | E: Direct inguinal hernia |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to the physician for evaluation of a neck mass and weight loss. He first noticed the growing mass 2 months ago. The mass is not painful. He also has decreased appetite and intermittent abdominal pain. He has lost 10 kg (22 lb) of weight over the past 3 months. Sometimes, he wakes up in the morning drenched in sweat. He takes daily over-the-counter multivitamins. He appears pale. His pulse is 65/min, blood pressure is 110/70 mm Hg, and temperature is 38.1°C (100.6°F). Physical exam shows a painless, golf ball-sized mass in the anterior triangle of the neck. A biopsy shows large cells with a bilobed nucleus that are CD15- and CD30-positive. Laboratory analysis of serum shows a calcium level of 14.5 mg/dL and a parathyroid hormone level of 40 pg/mL. Which of the following is the most likely explanation of this patient's laboratory findings?? {'A': 'Osteoblastic metastasis', 'B': 'Ectopic vitamin D production', 'C': 'Ectopic PTH-related protein production', 'D': 'Multivitamin overdose', 'E': 'Osteolytic metastasis'}, | B: Ectopic vitamin D production |
Answer the following medical question with one of the provided options: | Q:A 29-year-old African American woman presents with incidentally noted bilateral hilar lymphadenopathy on a recent chest radiograph for the evaluation of pneumonia 1 month earlier. Upon questioning, she reports a cough, dyspnea, and angina. The report provided by a previous ophthalmologic consultation did not demonstrate any eye abnormalities. Clinical laboratory pathologic analysis reveals an elevated level of angiotensin-converting enzyme. Her physical examination reveals no obvious abnormalities. Her vital signs show a heart rate of 76/min, respiratory rate of 16/min, and blood pressure of 123/73 mm Hg. Of the following options, which is the mechanism of the reaction causing hilar adenopathy in this patient?? {'A': 'Type I–anaphylactic hypersensitivity reaction', 'B': 'Type II–cytotoxic hypersensitivity reaction', 'C': 'Type III–immune complex-mediated hypersensitivity reaction', 'D': 'Type IV–cell-mediated (delayed) hypersensitivity reaction', 'E': 'Type III and IV–mixed immune complex and cell-mediated hypersensitivity reactions'}, | D: Type IV–cell-mediated (delayed) hypersensitivity reaction |
Answer the following medical question with one of the provided options: | Q:Ten days after starting a new medication, a 60-year-old man is brought to the emergency department after a 3-minute episode of myoclonic jerking movements and urinary incontinence. After regaining consciousness, the patient had no recollection of what happened and seemed confused. He has bipolar disorder, which has been controlled with maintenance therapy for the past 15 years. Physical examination shows dry oral mucosa, muscle fasciculations, and bilateral hand tremors. His speech is slow, and he is disoriented. Which of the following drugs most likely precipitated this patient's current condition?? {'A': 'Valproic acid', 'B': 'Theophylline', 'C': 'Fluoxetine', 'D': 'Celecoxib', 'E': 'Metoprolol'}, | D: Celecoxib |
Answer the following medical question with one of the provided options: | Q:A previously healthy 2-year-old boy is brought to the emergency department because of a 2-day history of fever and pain in the left lower extremity. His mother says that he has refused to walk for the last two days and has had a poor appetite. He returned from a weekend camping trip about a month ago. His maternal cousin died of osteosarcoma at the age of 12. His immunizations are up-to-date. He is at the 80th percentile for height and 70th percentile for weight. He appears ill. His temperature is 39.3°C (102.7°F), pulse is 115/min, respirations are 19/min, and blood pressure is 95/50 mm Hg. Examination of the left hip shows tenderness; range of motion is limited. Minimal attempts to rotate the hip cause severe discomfort. The remainder of the examination shows no abnormalities. Laboratory studies show: Hemoglobin 12 g/dL Leukocyte count 19,800/mm3 Platelet count 254,000/mm3 Erythrocyte sedimentation rate 55 mm/h Serum Glucose 80 mg/dL CRP 15 mg/L X-rays of the pelvis shows a widened acetabular space on the left side. Which of the following is the most appropriate next step in management?"? {'A': 'Vancomycin therapy', 'B': 'Synovial fluid drainage plus cefazolin therapy', 'C': 'Trimethoprim/sulfamethoxazole therapy', 'D': 'Arthroscopic drainage of hip', 'E': 'Doxycycline therapy\n"'}, | B: Synovial fluid drainage plus cefazolin therapy |
Answer the following medical question with one of the provided options: | Q:A 51-year-old male presents to his primary care provider for a normal check-up. He reports that he “hasn’t felt like himself” recently. He describes feeling down for the past 8 months since his mother passed away. He has had trouble sleeping and has unintentionally lost 15 pounds. He feels guilty about his mother’s death but cannot articulate why. His performance at work has declined and he has stopped running, an activity he used to enjoy. He has not thought about hurting himself or others. Of note, he also complains of numbness in his feet and fingers and inability to maintain an erection. His past medical history is notable for diabetes. He is on metformin. His temperature is 98.6°F (37°C), blood pressure is 125/65 mmHg, pulse is 90/min, and respirations are 16/min. On exam, he is alert and oriented with intact memory and normal speech. He appears tired with a somewhat flattened affect. The best medication for this patient inhibits which of the following processes?? {'A': 'Serotonin reuptake only', 'B': 'Norepinephrine and serotonin reuptake', 'C': 'Amine degradation', 'D': 'Norepinephrine and dopamine reuptake', 'E': 'Dopamine receptor activation'}, | B: Norepinephrine and serotonin reuptake |
Answer the following medical question with one of the provided options: | Q:A 35-year-old man arrives at the emergency department within minutes after a head-on motor vehicle accident. He suffered from blunt abdominal trauma, several lacerations to his face as well as lacerations to his upper and lower extremities. The patient is afebrile, blood pressure is 45/25 mmHg and pulse is 160/minute. A CBC is obtained and is most likely to demonstrate which of the following?? {'A': 'Hb 5 g/dL, Hct 20%', 'B': 'Hb 5 g/dL, Hct 30%', 'C': 'Hb 15 g/dL, Hct 45%', 'D': 'Hb 20 g/dL, Hct 60%', 'E': 'Hb 17 g/dL, Hct 20%'}, | C: Hb 15 g/dL, Hct 45% |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man comes to the physician because of a 3-month history of pain in his left shoulder. He is physically active and plays baseball twice a week. The pain is reproduced when the shoulder is externally rotated against resistance. Injury of which of the following tendons is most likely in this patient?? {'A': 'Teres major', 'B': 'Pectoralis major', 'C': 'Infraspinatus', 'D': 'Supraspinatus', 'E': 'Subscapularis'}, | C: Infraspinatus |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman presents to the physician with a throbbing headache. She says she had it for the last year and it’s usually located in the right temporal area. There is localized tenderness over the scalp. During the last 2 weeks, she experienced 3 episodes of transient loss of vision on the right side, without ocular pain. On physical examination, her vital signs are normal. Palpation reveals that the pulsations of the superficial temporal artery on the right side are reduced in amplitude. Laboratory studies show: Blood hemoglobin 10.7 g/dL (6.64 mmol/L) Leukocyte count 8,000/mm3 (8.0 x 109/L) Platelet count 470,000/mm3 (470 x 109/L) Erythrocyte sedimentation rate 60 mm/h (60 mm/h) Which of the following conditions is most likely to co-exist with the presenting complaint in this woman?? {'A': 'Amyloidosis', 'B': 'Dermatomyositis', 'C': 'Fibromyalgia', 'D': 'Polymyalgia rheumatica', 'E': 'Sjogren’s syndrome'}, | D: Polymyalgia rheumatica |
Answer the following medical question with one of the provided options: | Q:A researcher is studying proteins that contribute to intestinal epithelial permeability. He has isolated intestinal tissue from several mice. After processing the tissue into its individual components, he uses a Western blot analysis to identify a protein that forms part of a multi-protein complex at the apical aspect of epithelial cells. The complex is known to provide a diffusion barrier between the apical and basolateral aspects of epithelial cells. Which of the following proteins is this researcher most likely investigating?? {'A': 'Integrin', 'B': 'Connexon', 'C': 'Desmoglein', 'D': 'E-cadherin', 'E': 'Claudin'}, | E: Claudin |
Answer the following medical question with one of the provided options: | Q:A 38-year-old woman is evaluated for a difficult-to-control hypertension. Her symptoms include sleep interruption because of frequent waking up for voiding and frequent headaches. She has smoked 10 cigarettes daily for the past 5 years. Family history is insignificant. Her vital signs include a blood pressure of 170/96 mm Hg, pulse of 90/min, and temperature of 36.7°C (98.0°F). Physical examination is unremarkable. Her lab results are shown: Serum sodium 146 mEq/L Serum potassium 4 mEq/L Serum bicarbonate 29 mEq/L Her plasma aldosterone concentration (PAC): plasma renin activity (PRA) ratio measured after following all precautions is found to be elevated. Oral salt loading testing reveals a lack of aldosterone suppression. A computerized tomography (CT) scan of the adrenal glands shows a 2 cm mass on the left side. Which of the following is the best next step for this patient?? {'A': 'Renal angiogram', 'B': 'Adrenal venous sampling', 'C': 'Measurement of 11-deoxycortisol', 'D': 'Left laparoscopic adrenalectomy', 'E': 'Treatment with eplerenone'}, | B: Adrenal venous sampling |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman comes to the office with a 3-day history of a rash. She's had a rash across her neck, shoulders, and the palms of her hands for the past five days. She's also had large-volume watery diarrhea for the same period of time. Past medical history is notable for acute myeloid leukemia, for which she received a stem cell transplant from a donor about two months prior. Physical exam reveals a faint red maculopapular rash across her neck, shoulders, and hands, as well as an enlarged liver and spleen. Labs are notable for a total bilirubin of 10. Which of the following is the mechanism of this patient's pathology?? {'A': 'Drug hypersensitivity reaction', 'B': 'Pre-existing host antibodies against graft antigens', 'C': 'Host antibodies that have developed against graft antigens', 'D': 'Host CD8+ T cells against graft antigens', 'E': 'Graft T cells against host antigens'}, | E: Graft T cells against host antigens |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man who recently emigrated as a refugee from Somalia presents with fever, weight loss, fatigue, and exertional chest pain. He says his symptoms began 3 weeks ago and that his appetite has decreased and he has lost 3 kg (6.6 lb) in the last 3 weeks. He denies any history of cardiac disease. His past medical history is unremarkable. The patient admits that he has always lived in poor hygienic conditions in overcrowded quarters and in close contact with cats. His vital signs include: blood pressure 120/60 mm Hg, pulse 90/min, and temperature 38.0°C (100.4°F). Physical examination reveals generalized pallor. A cardiac examination reveals an early diastolic murmur loudest at the left third intercostal space. Abdominal examination reveals a tender and mildly enlarged spleen. Prominent axillary lymphadenopathy is noted. Laboratory investigations reveal a WBC count of 14,500/μL with 5% bands and 93% polymorphonuclear cells. An echocardiogram reveals a 5-mm vegetation on the aortic valve with moderate regurgitation. Three sets of blood cultures are taken over 24 hours followed by empiric antibiotic therapy with gentamicin and vancomycin. The blood cultures show no growth after 5 days. Following a week of empiric therapy, the patient continues to deteriorate. Which of the following would most likely confirm the diagnosis in this patient?? {'A': 'Bartonella serology', 'B': 'Q fever serology', 'C': 'Peripheral blood smear', 'D': 'HIV polymerase chain reaction', 'E': 'Epstein-Barr virus heterophile antibody'}, | A: Bartonella serology |
Answer the following medical question with one of the provided options: | Q:Four days after having been admitted to the hospital for a pulmonary contusion and whiplash injury sustained in a motor vehicle collision, a 66-year-old woman complains of severe pain in her right flank and muscle spasms. She also has nausea with two episodes of vomiting and abdominal bloating. Her pain had previously been well controlled with acetaminophen every 6 hours. She underwent umbilical hernia repair surgery two years ago. She takes sertraline for depression. Her temperature is 36.5°C (97.7°F), pulse is 99/min, respirations are 17/min, and blood pressure is 102/72 mm Hg. After administration of 0.5 L of crystalloid fluids, blood pressure improves to 118/79 mm Hg. Multiple ecchymoses are present over the anterior abdominal wall in a pattern that follows the course of a seatbelt. There are ecchymoses of the flanks bilaterally. Bowel sounds are absent. There is tenderness to palpation in all four quadrants with voluntary guarding. Her hemoglobin is 7.9 g/dL, leukocyte count is 8,500/mm3, platelet count is 350,000/mm3, prothrombin time is 11 seconds, and activated partial thromboplastin time is 33 seconds. An x-ray of the abdomen shows obliteration of the right psoas shadow and uniform distribution of gas in the small bowel, colon, and rectum without air-fluid levels. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Small bowel perforation', 'B': 'Intraabdominal adhesions', 'C': 'Spinal cord injury', 'D': 'Retroperitoneal hemorrhage', 'E': 'Acute mesenteric ischemia\n"'}, | D: Retroperitoneal hemorrhage |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to the physician because of a 2-week history of chest pain that begins after walking at a brisk pace for 2 blocks. The pain does not radiate anywhere and is hard to localize. He has had similar episodes in the past 6 months and was prescribed sublingual nitroglycerin, which helps relieve the pain. The patient has hypertension and type 2 diabetes mellitus. He takes lisinopril and metformin daily. He appears well. His temperature is 37°C (98.6°F), pulse is 75/min, and blood pressure is 145/90 mm Hg. Examination shows a regular heart rhythm. S1 and S2 are normal. The lungs are clear to auscultation. There is no peripheral edema. Which of the following is the most likely explanation for the improvement of this patient's chest pain?? {'A': 'Delayed electrical conduction', 'B': 'Decreased venous pooling', 'C': 'Coronary arterial vasodilation', 'D': 'Increased atherosclerotic plaque stability', 'E': 'Decreased end-diastolic pressure\n"'}, | E: Decreased end-diastolic pressure " |
Answer the following medical question with one of the provided options: | Q:A 34-year-old woman presents with confusion, drowsiness, and headache. The patient’s husband says her symptoms began 2 days ago and have progressively worsened with an acute deterioration of her mental status 2 hours ago. The patient describes the headaches as severe, localized to the frontal and periorbital regions, and worse in the morning. Review of symptoms is significant for a mild, low-grade fever, fatigue, and nausea for the past week. Past medical history is significant for HIV infection for which she is not currently receiving therapy. Her CD4+ T cell count last month was 250/mm3. The blood pressure is 140/85 mm Hg, the pulse rate is 90/min, and the temperature is 37.7°C (100.0°F). On physical examination, the patient is conscious but drowsy. Papilledema is present. No pain is elicited with extension of the leg at the knee joint. The remainder of the physical examination is negative. Laboratory findings, including panculture, are ordered. A noncontrast CT scan of the head is negative and is followed by a lumbar puncture. CSF analysis is significant for: Opening pressure 250 mm H2O (70-180 mm H2O) Glucose 30 mg/dL (40-70 mg/dL) Protein 100 mg/dL (<40 mg/dL) Cell count 20/mm3 (0-5/mm3) Which of the following additional findings would most likely be found in this patient?? {'A': 'CSF shows a positive acid-fast bacillus stain', 'B': 'CSF shows gram negative diplococci', 'C': 'CSF India ink stain shows encapsulated yeast cells', 'D': 'Gram-positive diplococci are present on microscopy', 'E': 'Multiple ring-enhancing lesions are seen on a CT scan'}, | C: CSF India ink stain shows encapsulated yeast cells |
Answer the following medical question with one of the provided options: | Q:A 55-year-old male is started on nitrate therapy for treatment of stable angina. He experiences significant and immediate relief of his symptoms within minutes of starting therapy. Approximately 48 hours after initiating this new medication, he notes return of chest pain and pressure with exertion that no longer responds to continued nitrate use. Which of the following 24-hour dosing schedules would most likely explain this patient's response to nitrate treatment?? {'A': 'Transdermal nitroglycerin patch placed at 7AM then removed and replaced with another at 7PM', 'B': 'PO regular-release isosorbide dinitrate taken at 8AM, noon, and 5PM', 'C': 'Transdermal nitroglycerin patch placed at bedtime and removed at 7AM without replacement', 'D': 'Transdermal nitroglycerin patch placed upon awakening in the morning and removed at 7PM without replacement', 'E': 'PO extended release isosorbide-5-mononitrate once daily at 8AM'}, | A: Transdermal nitroglycerin patch placed at 7AM then removed and replaced with another at 7PM |
Answer the following medical question with one of the provided options: | Q:A 68-year-old woman comes to the physician for a follow-up visit for elevated blood pressure. Two weeks ago, her blood pressure was 154/78 mm Hg at a routine visit. Subsequent home blood pressure measurements at days 5, 10, and 14 have been: 156/76 mm Hg, 158/80 mm Hg, and 160/80 mm Hg. She has trouble falling asleep but otherwise feels well. She had a cold that resolved with over-the-counter medication 2 weeks ago. She has a history of primary hypothyroidism and a cyst in the right kidney, which was found incidentally 20 years ago. She takes levothyroxine. She is 178 cm (5 ft 10 in) tall and weighs 67 kg (148 lb); BMI is 21.3 kg/m2. Her pulse is 82/min, and blood pressure is 162/79 mm Hg. Examination shows no abnormalities. Laboratory studies, including thyroid function studies, serum electrolytes, and serum creatinine, are within normal limits. Which of the following is the most likely underlying cause of this patient's blood pressure findings?? {'A': 'Increase in kidney size', 'B': 'Decrease in arterial compliance', 'C': 'Medication-induced vasoconstriction', 'D': 'Decrease in baroreceptor sensitivity', 'E': 'Increase in aldosterone production'}, | B: Decrease in arterial compliance |
Answer the following medical question with one of the provided options: | Q:An 9-month-old infant is brought to the physician because of a generalized nonpruritic rash for 2 days. The rash began on her trunk and spread to her extremities. Five days ago, she was taken to the emergency department for fever of 40.5°C (104.9°F) and a 1-minute generalized tonic-clonic seizure. She was born at term and has no history of serious illness. Her immunizations are up-to-date. Current medications include acetaminophen. Her temperature is 37.2°C (99.0°F) and pulse is 120/min. Examination shows a maculopapular rash that blanches on pressure. A photograph of the rash is shown. Posterior auricular lymphadenopathy is present. Which of the following is the most likely diagnosis?? {'A': 'Kawasaki disease', 'B': 'Drug allergy', 'C': 'Impetigo', 'D': 'Roseola infantum', 'E': 'Rubella'}, | D: Roseola infantum |
Answer the following medical question with one of the provided options: | Q:An 11-month-old boy is brought to the physician by his adoptive mother for the evaluation of seizures and musty-smelling urine. His immunizations are up-to-date. His height and weight are both below the 10th percentile. He is pale and has blue eyes. He cannot pull himself up from a seated position to stand and does not crawl. Which of the following genetic principles best explains the variety of phenotypic traits seen in this patient?? {'A': 'Variable expressivity', 'B': 'Pleiotropy', 'C': 'Incomplete penetrance', 'D': 'Anticipation', 'E': 'Loss of heterozygosity'}, | B: Pleiotropy |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.