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Answer the following medical question with one of the provided options: | Q:A 24-year-old woman is in the intensive care unit for the management of a severe acute asthma exacerbation. She is currently intubated and sedated, and she is receiving intravenous steroids, continuous nebulized beta-agonists, and anticholinergic therapy via breathing treatments. On hospital day 2, she has a new fever to 38.9°C (102.0°F). Chest X-ray shows a right lower lobe consolidation. Blood cultures are collected, and she is started empirically on intravenous cefepime and daptomycin. On hospital day 4, she continues to be febrile; chest X-ray shows interval worsening of the right lower lobe opacity. Which of the following is the most likely reason for treatment failure in this patient?? {'A': 'Abnormally rapid clearance of the medicines by the kidney', 'B': 'Abnormally rapid metabolism of the medicines by the liver', 'C': 'Inactivation of the medicine in the target tissue', 'D': 'Low bioavailability of the medicines', 'E': 'Poor delivery of the medicines to the target tissue'}, | C: Inactivation of the medicine in the target tissue |
Answer the following medical question with one of the provided options: | Q:A 53-year-old Asian woman comes to the physician because of a 2-month history of severe pain in her right leg while walking. She used to be able to walk a half-mile (800-m) to the grocery store but has been unable to walk 200 meters without stopping because of the pain over the past month. She can continue to walk after a break of around 5 minutes. She has hypertension, atrial fibrillation, and type 2 diabetes mellitus. She has smoked one pack of cigarettes daily for the past 32 years. Current medications include metformin, enalapril, aspirin, and warfarin. Vital signs are within normal limits. Examination shows an irregularly irregular pulse. The right lower extremity is cooler than the left lower extremity. The skin over the right leg appears shiny and dry. Femoral pulses are palpated bilaterally; pedal pulses are diminished on the right side. Which of the following is the most appropriate next step in management?? {'A': 'MRI spine screening', 'B': 'Duplex ultrasonography', 'C': 'Nerve conduction studies', 'D': 'Ankle-brachial index', 'E': 'Biopsy of tibial artery'}, | D: Ankle-brachial index |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman develops progressive difficulty breathing after a long day of chores in a dusty house. These chores included brushing the family dog, vacuuming, dusting, and sweeping. She occasionally gets these episodes once or twice a year and has her medication on hand. Her symptoms are reversed by inhaling a β2-adrenergic receptor agonist. Which of the following chemical mediators is responsible for this patient’s breathing difficulties?? {'A': 'Bradykinin', 'B': 'Leukotrienes', 'C': 'Endorphins', 'D': 'Serotonin', 'E': 'Histamine'}, | B: Leukotrienes |
Answer the following medical question with one of the provided options: | Q:Nine healthy subjects participate in a study of gastric secretions. Subjects are asked to eat a meal at hour 0, at which time the pH of stomach contents and rate of stomach acid secretions are measured over the next 4 hours. Results of the study are shown. Which of the following mediators is most active at point A in the graph?? {'A': 'Prostaglandin', 'B': 'Secretin', 'C': 'Somatostatin', 'D': 'Glucose-dependent insulinotropic peptide', 'E': 'Acetylcholine'}, | E: Acetylcholine |
Answer the following medical question with one of the provided options: | Q:A 43-year-old Caucasian woman is admitted to the hospital with acute onset right upper quadrant (RUQ) pain. The pain started 6 hours ago after the patient had a large meal at a birthday party and has progressively worsened. She recalls having similar pain before but not so intense. No significant past medical history. Current medications are only oral contraceptive. Vitals are blood pressure 140/80 mm Hg, heart rate 79/min, respiratory rate 14/min, and temperature 37.6℃ (99.7℉). The patient’s BMI is 36.3 kg/m2. On exam, the patient appears slightly jaundiced. Her cardiac and respiratory examinations are within normal limits. Abdominal palpation reveals tenderness to palpation in the RUQ with no rebound or guarding, and there is an inspiratory arrest on deep palpation in this region. The remainder of the examination is within normal limits. Laboratory tests are significant for the following: RBC count 4.1 million/mm3 Hb 13.4 mg/dL Leukocyte count 11,200/mm3 ESR 22 mm/hr Platelet count 230,000/mm3 Total bilirubin 2 mg/dL Direct bilirubin 1.1 mg/dL ALT 20 IU/L AST 18 IU/L Amylase 33 IU/L Ultrasound of the abdomen shows the following result (see image): The common bile duct (CBD) (not shown in the image) is not dilated. Which of the following procedures is most appropriate for the treatment of this patient?? {'A': 'Open cholecystectomy', 'B': 'Endoscopic retrograde cholangiopancreatography', 'C': 'Laparoscopic cholecystectomy', 'D': 'Percutaneous cholecystostomy', 'E': 'Shock wave lithotripsy'}, | C: Laparoscopic cholecystectomy |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man comes to the physician because of severe muscle pain and swelling of his eyelids for 3 days. He has also had fever and chills during this period. For the last 2 days, he has had severe pain in his mouth while chewing. He had an episode of diarrhea a month ago for which he did not seek medical care. He has no history of serious illness. His sister has dermatomyositis. He returned from a hunting trip to eastern Europe 45 days ago. His temperature is 38.1°C (100.6°F), pulse is 80/min, and blood pressure is 130/70 mm Hg. Examination shows periorbital edema and severe generalized muscle tenderness. There are splinter hemorrhages on both hands. Laboratory studies show: Hemoglobin 14.2 g/dL Leukocyte count 12,500/mm3 Segmented neutrophils 60% Eosinophils 18% Lymphocytes 20% Monocytes 2% Serum Glucose 117 mg/dL Creatinine 1.1 mg/dL Alkaline phosphatase 72 U/L Creatine kinase 765 U/L Urinalysis is within normal limits. Which of the following is most likely to have prevented this patient's condition?"? {'A': 'Clean drinking water', 'B': 'Cooking meat to 71°C (160°F)', 'C': 'Influenza vaccine', 'D': 'Consume pasteurized dairy products', 'E': 'Metronidazole at the onset of diarrhea'}, | B: Cooking meat to 71°C (160°F) |
Answer the following medical question with one of the provided options: | Q:A 28-year-old man comes to the physician for a pre-employment examination. He has no history of serious illness and takes no medications. A screening blood test is performed in which peptides are added to the sample to stimulate in vitro production of interferon-gamma, which is then measured using an enzyme-linked immunosorbent assay. This test is most likely to be helpful in diagnosing infection with which of the following pathogens?? {'A': 'Human immunodeficiency virus', 'B': 'Staphylococcus aureus', 'C': 'Hepatitis B virus', 'D': 'Mycobacterium tuberculosis', 'E': 'Legionella pneumophila'}, | D: Mycobacterium tuberculosis |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman comes to the physician because of a 5-month history of a pruritic rash on the bilateral upper extremities. She has no history of serious illness and takes no medications. A skin biopsy of the rash shows intraepidermal accumulation of edematous fluid and widening of intercellular spaces between keratinocytes. Which of the following is the most likely diagnosis?? {'A': 'Psoriasis vulgaris', 'B': 'Lichen planus', 'C': 'Dermatitis herpetiformis', 'D': 'Acanthosis nigricans', 'E': 'Eczematous dermatitis'}, | E: Eczematous dermatitis |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man with a 20+ year history of smoking comes in today to talk about quitting. His wife has recently been trying to quit, and she wants him to quit with her. He has been resistant in the past, but he is now very willing to talk with you about it. Today, he seems like he really wants to make a change. What stage of change does this behavior correspond to?? {'A': 'Precontemplation', 'B': 'Contemplation', 'C': 'Preparation', 'D': 'Action', 'E': 'Maintenance'}, | C: Preparation |
Answer the following medical question with one of the provided options: | Q:A 28-year-old woman is brought into the clinic by her husband with concerns that she might be depressed. She delivered a healthy newborn a week and a half ago without any complications. Since then, she has been having trouble sleeping, eating poorly, and has stopped playing with the baby. The patient says she feels like she is drained all the time and feels guilty for not doing more for the baby. Which of the following is the best course of treatment for this patient?? {'A': 'Reassurance', 'B': 'Fluoxetine', 'C': 'Amitriptyline ', 'D': 'Risperidone', 'E': 'No treatment'}, | A: Reassurance |
Answer the following medical question with one of the provided options: | Q:A 51-year-old man presents to the emergency department with complaints of upper abdominal pain for the last several hours. He says that the pain travels to his back and is less severe when he leans forward. He is diagnosed with acute pancreatitis following enzyme analysis and CT scan of the abdomen and is subsequently managed in intensive care unit (ICU) with IV fluids, analgesics, nasogastric decompression, and supportive therapy. He recovers quickly and is discharged within a week. However, after 5 weeks, the patient develops projectile vomiting containing food but no bile. Physical examination shows visible peristalsis from left to right in the upper abdomen. A repeat CT scan is done. Which of the following is the next best step in the management of this patient?? {'A': 'Need no management as this will resolve spontaneously', 'B': 'Octreotide infusion to reduce all gastrointestinal secretions', 'C': 'External percutaneous drainage of the lesion', 'D': 'Endoscopic drainage', 'E': 'Intravenous fluids, analgesia, and antiemetics'}, | D: Endoscopic drainage |
Answer the following medical question with one of the provided options: | Q:A 13-year-old boy is brought to the physician because of a 5-day history of a rash on his chest and back. His mother initially noticed only a few lesions on his back, but since then the rash has spread to his chest. His family returned from a trip to the Caribbean 2 weeks ago. His mother started using a new laundry detergent 8 days ago. He has type 1 diabetes mellitus controlled with insulin. His mother has Hashimoto thyroiditis and his brother has severe facial acne. His temperature is 37.2°C (99°F), pulse is 81/min, and blood pressure is 115/74 mm Hg. Examination of the skin shows multiple, nontender, round, white macules on the chest and trunk. There is fine scaling when the lesions are scraped with a spatula. There are no excoriation marks. The remainder of the examination shows no abnormalities. Which of the following is the most likely underlying mechanism of this patient's symptoms?? {'A': 'Autoimmune destruction of melanocytes', 'B': 'Increased sebum production', 'C': 'Increased growth of Malassezia globosa', 'D': 'Exposure to human herpes virus 7', 'E': 'Antigen uptake by Langerhans cells'}, | C: Increased growth of Malassezia globosa |
Answer the following medical question with one of the provided options: | Q:A 72-year-old woman is brought to the emergency department because of increasing abdominal pain for 6 hours. The pain is dull and diffuse over her abdomen and radiates to her lower back bilaterally. Three weeks ago, she was diagnosed with atrial fibrillation and started on warfarin. Her only other medication is 1 g of acetaminophen daily for osteoarthritis of her knees. Her pulse is 87/min and blood pressure is 112/75 mm Hg. Physical examination shows abdominal tenderness to palpation at both lower quadrants. A CT scan of the abdomen shows a retroperitoneal mass and hazy margins of the surrounding structures. In addition to discontinuation of warfarin, the most appropriate next step in management is administration of which of the following?? {'A': 'Fresh frozen plasma and tranexamic acid', 'B': 'Aminocaproic acid and packed red blood cells', 'C': 'Factor VIII and von Willebrand factor', 'D': 'Phytonadione and prothrombin complex concentrate', 'E': 'Protamine sulfate and hydroxyethyl starch'}, | D: Phytonadione and prothrombin complex concentrate |
Answer the following medical question with one of the provided options: | Q:A 36-year-old man presents to a psychiatrist for management of nicotine dependence. He has been a heavy smoker for the past 20 years. He has unsuccessfully attempted to quit smoking many times. He has seen multiple physicians for nicotine dependence. They prescribed nicotine replacement therapy and varenicline. He has also taken two antidepressants and participated in talk therapy. He asks the psychiatrist whether there are other alternatives. The psychiatrist explains that nicotine replacement therapy, non-nicotine pharmacotherapy, and talk therapy are the best options for the management of nicotine dependence. He tells the patient he can take a second-line medication for non-nicotine pharmacotherapy because the first-line medication failed. Which of the following medications would the psychiatrist most likely use to manage this patient’s nicotine dependence?? {'A': 'Buprenorphine', 'B': 'Clonidine', 'C': 'Lorazepam', 'D': 'Methadone', 'E': 'Topiramate'}, | B: Clonidine |
Answer the following medical question with one of the provided options: | Q:A physician attempts to study cirrhosis in his state. Using a registry of admitted patients over the last 10 years at the local hospital, he isolates all patients who have been diagnosed with cirrhosis. Subsequently, he contacts this group of patients, asking them to complete a survey assessing their prior exposure to alcohol use, intravenous drug abuse, blood transfusions, personal history of cancer, and other medical comorbidities. An identical survey is given to an equal number of patients in the registry who do not carry a prior diagnosis of cirrhosis. Which of the following is the study design utilized by this physician?? {'A': 'Case-control study', 'B': 'Cohort study', 'C': 'Cross-sectional study', 'D': 'Meta-analysis', 'E': 'Randomized controlled trial'}, | A: Case-control study |
Answer the following medical question with one of the provided options: | Q:A 17-year-old male presents to your office complaining of polyuria, polydipsia, and unintentional weight loss of 12 pounds over the past 3 months. On physical examination, the patient is tachypneic with labored breathing. Which of the following electrolyte abnormalities would you most likely observe in this patient?? {'A': 'Alkalemia', 'B': 'Hyperkalemia', 'C': 'Hypoglycemia', 'D': 'Hypermagnesemia', 'E': 'Hyperphosphatemia'}, | B: Hyperkalemia |
Answer the following medical question with one of the provided options: | Q:A 54-year-old man comes to the physician because of generalized fatigue and numbness of his legs and toes for 5 months. He has hypertension and hypercholesterolemia. He underwent a partial gastrectomy for peptic ulcer disease 15 years ago. Current medications include amlodipine and atorvastatin. He is a painter. His temperature is 37°C (98.6°F), pulse is 101/min, respirations are 17/min, and blood pressure is 122/82 mm Hg. Examination shows conjunctival pallor and glossitis. Sensation to vibration and position is absent over the lower extremities. He has a broad-based gait. The patient sways when he stands with his feet together and closes his eyes. His hemoglobin concentration is 10.1 g/dL, leukocyte count is 4300/mm3, and platelet count is 110,000/mm3. Which of the following laboratory findings is most likely to be seen in this patient?? {'A': 'Decreased serum iron levels', 'B': 'Oligoclonal bands in cerebrospinal fluid', 'C': 'Elevated methylmalonic acid levels', 'D': 'Basophilic stippling on peripheral smear', 'E': 'Positive rapid plasma reagin test'}, | C: Elevated methylmalonic acid levels |
Answer the following medical question with one of the provided options: | Q:A 5-year-old male is brought to his pediatrician after recurrent, prolonged upper respiratory infections over a period of several months. Physical exam reveals petechiae on the patient’s legs and arms. Laboratory studies show hemoglobin: 10 g/L, platelet count: 35,000/mm^3, leukocyte count: 6,600/mm^3. A bone marrow aspiration shows an abundance of lymphoblasts indicative of acute lymphoblastic leukemia (ALL). Positive immunostaining for which of the following would support a diagnosis of precursor B-cell leukemia?? {'A': 'TdT, HER-2', 'B': 'CD2, CD8', 'C': 'CD19, CD10', 'D': 'CD30, CD15', 'E': 'CD4, CD5'}, | C: CD19, CD10 |
Answer the following medical question with one of the provided options: | Q:The objective of one case-control study was to assess whether a history of past trauma represents a risk factor for the development of spondyloarthritis. Cases of spondyloarthritis were compared with a random sample taken from the general population in regards to a history of prior trauma. This kind of history, which in turn increased the likelihood of being subjected to X-ray imaging investigations, led to a higher likelihood of diagnosing spondyloarthritis in these individuals compared with the general population. This resulted in a significantly higher proportion of spondyloarthritis in study participants with prior trauma, with the resulting overestimation of related odds ratio. In which case is the bias in this example more likely to occur?? {'A': 'If the outcome is ascertained through electronic health records', 'B': 'If the outcome is assessed systematically regardless of exposure', 'C': 'If the outcome is ascertained while the exposed status is masked', 'D': 'If the study participants are followed at the same time intervals', 'E': 'If the study participants are subjected to identical tests at each visit'}, | A: If the outcome is ascertained through electronic health records |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man presents to the emergency department with trouble urinating. The patient states that in general he has had difficulty urinating but recently, it has taken significant effort for him to initiate a urinary stream. He finds himself unable to completely void and states he has suprapubic tenderness as a result. These symptoms started suddenly 3 days ago. The patient has a history of benign prostatic hyperplasia, constipation, and diabetes mellitus. His current medications include finasteride, sodium docusate, and hydrochlorothiazide. He recently started taking phenylephrine for seasonal allergies. The patient’s last bowel movement was 2 days ago. His temperature is 99.0°F (37.2°C), blood pressure is 167/98 mmHg, pulse is 90/min, respirations are 14/min, and oxygen saturation is 100% on room air. Physical exam is notable for suprapubic tenderness, and an ultrasound reveals 750 mL of fluid in the bladder. Which of the following is the most likely etiology of this patient’s symptoms?? {'A': 'Constipation', 'B': 'Medication-induced symptoms', 'C': 'Prostatic adenocarcinoma', 'D': 'Urinary tract infection', 'E': 'Worsening benign prostatic hypertrophy'}, | B: Medication-induced symptoms |
Answer the following medical question with one of the provided options: | Q:A 26-year-old woman, gravida 2, para 1, at 26 weeks’ gestation, comes to the emergency department because of pain and swelling in her right calf. Physical examination shows an increased circumference of the right calf. The leg is warm and tender on palpation. Dorsiflexion of the right foot elicits calf pain. An ultrasound of the right leg shows a noncompressible popliteal vein. Which of the following is the most appropriate pharmacotherapy for this patient's condition?? {'A': 'Aspirin', 'B': 'Clopidogrel', 'C': 'Heparin', 'D': 'Rivaroxaban', 'E': 'Warfarin'}, | C: Heparin |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy is brought to the physician by his mother because of generalized weakness and difficulty walking for the past month. Laboratory studies show a hemoglobin concentration of 6.6 g/dL, mean corpuscular volume of 74 μm3, platelet count of 150,000/mm3, and serum total bilirubin of 2 mg/dl. An MRI of the spine shows low signal intensity in all vertebral bodies and a small epidural mass compressing the spinal canal at the level of L1. A CT scan of the head shows osteopenia with widening of the diploic spaces in the skull. A biopsy of the epidural mass shows erythroid colonies with an abundance of megakaryocytes and myeloid cells. Which of the following is the most likely diagnosis?? {'A': 'G6PD deficiency', 'B': 'Aplastic anemia', 'C': 'Lead poisoning', 'D': 'Multiple myeloma', 'E': 'Beta-thalassemia\n"'}, | E: Beta-thalassemia " |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman comes to the physician because of weight gain, generalized weakness, and irregular menstrual cycles for the past 16 months. She began having symptoms of insomnia and depression 10 months ago. More recently, she has been having difficulties rising from a chair. She has a 2-year history of hypertension. Current medications include citalopram and hydrochlorothiazide. She is 168 cm (5 ft 6 in) tall and weighs 100 kg (220 lb). BMI is 36 kg/m2. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. She appears tired and has a full, plethoric face and central obesity. Examination of the skin shows violaceous linear striations on her lower abdomen. Two midnight serum cortisol studies show measurements of 288 μg/L and 253 μg/L (N < 90); a 24-hour urinary cortisol measurement was 395 μg (N < 300). Upon follow-up laboratory examination, the patient's serum ACTH levels were also elevated at 136 pg/mL (N = 7–50). Which of the following is the most appropriate next step in evaluation?? {'A': 'MRI of the head with contrast', 'B': 'Measure ACTH levels in inferior petrosal sinuses', 'C': 'High-dose dexamethasone suppression test', 'D': 'CT scan of the abdomen with contrast', 'E': 'Bilateral adrenalectomy'}, | C: High-dose dexamethasone suppression test |
Answer the following medical question with one of the provided options: | Q:A 43-year-old woman is found in the hospital to have a plasma sodium concentration of 126 mg/dL. She was hospitalized after she expressed suicidal ideations and was started on a medication for major depressive disorder. Her past medical history is significant for diabetes for which she is currently taking metformin. Her blood pressure while in the hospital has been around 130/85 mmHg and she is not taking any other medications. Urinalysis shows a serum osmolality of 1085 mOsm/L. Which of the following best describes the cell bodies of the cells that are behaving abnormally in this patient?? {'A': 'Acidophils in the anterior pituitary', 'B': 'Basophils in the anterior pituitary', 'C': 'Chromophobes in the anterior pituitary', 'D': 'Located in the hypothalamus', 'E': 'Located in the posterior pituitary'}, | D: Located in the hypothalamus |
Answer the following medical question with one of the provided options: | Q:A 41-year-old nulliparous woman comes to the physician for an annual pelvic examination and Pap smear. Over the past year she has been feeling healthy. She is sexually active and uses an intrauterine device with copper for contraception. She has smoked one pack of cigarettes daily for 20 years. She is 160 cm (5 ft 3 in) tall and weighs 88 kg (194 lb); BMI is 34.4 kg/m2. Bimanual pelvic examination shows an irregularly enlarged uterus. A transvaginal ultrasound reveals a singular 4 cm, hypoechoic mass inside the myometrial wall. Which of the following is the most likely cause of this finding?? {'A': 'Leiomyoma', 'B': 'Endometrial cancer', 'C': 'Endometrial hyperplasia', 'D': 'Endometrial polyp', 'E': 'Uterine leiomyosarcoma'}, | A: Leiomyoma |
Answer the following medical question with one of the provided options: | Q:A 52-year-old man comes to the physician for a routine health maintenance examination. He feels well. His blood pressure is 125/70 mm Hg. His glomerular filtration rate is calculated to be 105 mL/min/1.73 m2 and glucose clearance is calculated to be 103 mL/min. This patient is most likely being treated with which of the following agents?? {'A': 'Metformin', 'B': 'Canagliflozin', 'C': 'Ifosfamide', 'D': 'Glipizide', 'E': 'Acarbose'}, | B: Canagliflozin |
Answer the following medical question with one of the provided options: | Q:An 18-month-old boy is brought in by his parents for a routine check-up. The parents state that the patient still has not had any language development, and they are concerned about developmental delay. Of note, they have also noticed that the patient’s facial features have changed significantly in the last year. The patient also seems to have trouble visually focusing on objects or on the television. On exam, the patient's temperature is 98.2°F (36.8°C), blood pressure is 108/72 mmHg, pulse is 86/min, and respirations are 14/min. Of interest, the patient has not increased much in length or weight in the past 3 months. He is now in the 25th percentile for weight but is in the 90th percentile for head circumference. The patient does not appear to have any gross or fine motor deficiencies. Of note, he has coarse facial features that were not previously noted, including a long face, prominent forehead, and protruding eyes. The patient has corneal clouding bilaterally. At rest, the patient keeps his mouth hanging open. After extensive workup, the patient is found to have 2 mutated copies of the IDUA gene, with no production of the protein iduronidase. Which of the following is the likely mutation found in this disease?? {'A': 'Chromosomal translocation', 'B': 'Interstitial deletion', 'C': 'Missense mutation', 'D': 'Nonsense mutation', 'E': 'Silent mutation'}, | D: Nonsense mutation |
Answer the following medical question with one of the provided options: | Q:A 29-year-old man is brought to the emergency department 20 minutes after being stabbed in the left thigh. His pulse is 110/min, respirations are 20/min, and blood pressure is 110/70 mm Hg. Examination shows a 2-cm wound overlying a pulsatile mass on the left anterior thigh, 4 cm below the inguinal crease. A thrill is palpated, and a bruit is heard over this area. Peripheral pulses are normal bilaterally. The patient is at greatest risk for which of the following?? {'A': 'Pudendal nerve compression', 'B': 'High-output cardiac failure', 'C': 'Iliac artery aneurysm', 'D': 'Femoral head necrosis', 'E': 'Erectile dysfunction'}, | B: High-output cardiac failure |
Answer the following medical question with one of the provided options: | Q:A 69-year-old man presents to his primary care physician for pain when he walks. He states that the pain is the worst in his left great toe but is also present in his hips and knees. He says that his symptoms are worse with activity and tend to improve with rest. His symptoms have progressively worsened over the past several years. He has a past medical history of obesity, type II diabetes mellitus, smoking, and hypertension. He drinks roughly ten beers per day. His current medications include metformin, insulin, lisinopril, and hydrochlorothiazide. The patient has a recent travel history to Bangkok where he admits to having unprotected sex. On physical exam, examination of the lower extremity results in pain. There is crepitus of the patient's hip when his thigh is flexed and extended. Which of the following is the most likely diagnosis?? {'A': 'Osteoarthritis', 'B': 'Rheumatoid arthritis', 'C': 'Infectious arthritis', 'D': 'Gout', 'E': 'Pseudogout'}, | A: Osteoarthritis |
Answer the following medical question with one of the provided options: | Q:A 51-year-old woman presents to your office with 2 weeks of fatigue and generalized weakness. She has a past medical history of diabetes, hypertension, and hyperlipidemia. She was recently diagnosed with rheumatoid arthritis and started on disease-modifying therapy. She states she has felt less able to do things she enjoys and feels guilty she can't play sports with her children. Review of systems is notable for the patient occasionally seeing a small amount of bright red blood on the toilet paper. Laboratory studies are ordered as seen below. Hemoglobin: 12 g/dL Hematocrit: 36% Leukocyte count: 7,700/mm^3 with normal differential Platelet count: 207,000/mm^3 MCV: 110 fL Which of the following is the most likely etiology of this patient's fatigue?? {'A': 'Depression', 'B': 'Gastrointestinal bleed', 'C': 'Iron deficiency', 'D': 'Medication side effect', 'E': 'Vitamin B12 deficiency'}, | D: Medication side effect |
Answer the following medical question with one of the provided options: | Q:A 34-year-old man presents with acute-onset fever and weakness followed by shifting neurologic deficits (aphasia, motor deficits), which have lasted for a few days. His relatives add that his quantity of urine has reduced significantly over the last few days. He has never had any similar symptoms. Laboratory findings are significant for the following: Hb 8.6 g/dL WBC 6.5 × 1000/mm3 Platelets 43 × 1000/mm3 Cr 3.1 mg/dL BUN 25 mg/dL Na+ 136 mg/dL K+ 4.2 mg/dL Cl- 101 mg/dL HCO3- 24 mg/dL Glu 101 mg/dL Examination of the peripheral smear shows the presence of schistocytes, helmet cells, and spherocytes. Which of the following is true regarding this patient's condition?? {'A': 'The condition is caused by the deficiency of a sodium transporter.', 'B': 'A platelet transfusion should be given.', 'C': 'Bleeding time will be normal.', 'D': 'Splenectomy should be performed as early as possible.', 'E': 'Plasmapheresis is the treatment of choice.'}, | E: Plasmapheresis is the treatment of choice. |
Answer the following medical question with one of the provided options: | Q:A 38-year-old man comes to the physician because of a 1-month history of fever and a cough productive of a moderate amount of yellowish sputum. He has had a 6-kg (13-lb) weight loss during this period. He emigrated from the Middle East around 2 years ago. His father died of lung cancer at the age of 54 years. He has smoked one pack of cigarettes daily for 18 years. He appears malnourished. His temperature is 38.1°C (100.6°F), pulse is 101/min, and blood pressure is 118/72 mm Hg. Crackles are heard on auscultation of the chest. Cardiac examination shows no abnormalities. The abdomen is soft and nontender. Laboratory studies show: Hemoglobin 12.3 g/dL Leukocyte count 13,200/mm3 Platelet count 330,000/mm3 Erythrocyte sedimentation rate 66 mm/h Serum Urea nitrogen 16 mg/dL Glucose 122 mg/dL Creatinine 0.9 mg/dL Urinalysis is within normal limits. An x-ray of the chest is shown. Which of the following is the most appropriate next step in management?"? {'A': 'Perform a high-resolution CT scan of the chest', 'B': 'Start treatment with oral levofloxacin', 'C': 'Collect sputum specimens for acid-fast bacilli smear microscopy, culture, and nucleic acid amplification', 'D': 'Perform transbronchial lung biopsy of the suspected lesion', 'E': 'Perform an interferon-gamma release assay'}, | C: Collect sputum specimens for acid-fast bacilli smear microscopy, culture, and nucleic acid amplification |
Answer the following medical question with one of the provided options: | Q:A 5-year-old girl is brought to the physician by her mother for a 6-week history of fatigue, fever, and recurrent epistaxis. She has a history of duodenal atresia and an atrioventricular septal defect. She is at the 5th percentile for height and 30th percentile for weight. Physical examination shows painless cervical lymphadenopathy. Her hands are short and broad and there is a space between the first and second toes bilaterally. The spleen tip is palpated 3 cm below the left costal margin. Bone marrow aspirate shows leukocytosis with 50% lymphoblasts. Which of the following best explains this patient's condition?? {'A': 'Meiotic nondisjunction', 'B': 'Deletion of a chromosome segment', 'C': 'Uniparental disomy', 'D': 'Trinucleotide repeat expansion', 'E': 'Unbalanced Robertsonian translocation'}, | A: Meiotic nondisjunction |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman, gravida 2, para 1, at 37 weeks' gestation is admitted to the hospital in active labor. She has received routine prenatal care, but she has not been tested for group B streptococcal (GBS) colonization. Pregnancy and delivery of her first child were complicated by an infection with GBS that resulted in sepsis in the newborn. Current medications include folic acid and a multivitamin. Vital signs are within normal limits. The abdomen is nontender and contractions are felt every 4 minutes. There is clear amniotic fluid pooling in the vagina. The fetus is in a cephalic presentation. The fetal heart rate is 140/min. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance', 'B': 'Obtain vaginal-rectal swab for GBS culture', 'C': 'Administer intrapartum intravenous penicillin', 'D': 'Obtain vaginal-rectal swab for GBS culture and nucleic acid amplification testing', 'E': 'Obtain vaginal-rectal swab for nucleic acid amplification testing'}, | C: Administer intrapartum intravenous penicillin |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman presents with diarrhea and a rash. She reports having some painful reddish nodules on her legs that she noticed a week ago. She also has been having loose stools associated with cramping lower abdominal pain for the past month. This is associated with an urgency to defecate, and defecation helps relieve the abdominal pain. The stool is occasionally blood-tinged and has some mucus. She feels fatigued but denies fever, weight loss, exposure to any sick people, or history of travel recently. No significant past medical history. Her family history is significant for osteoporosis in her mother, aunt, and older sister. On physical examination, the patient has generalized pallor. There are multiple erythematous tender nodules over the extensor surface of the legs bilaterally below the level of the knee. Abdominal examination reveals mild tenderness to palpation in the left lower quadrant. A DEXA scan is performed and reveals a T-score of -1.5 at the hips and spine. Laboratory findings are significant for microcytic anemia and an elevated ESR. A colonoscopy is performed and reveals patchy inflammation of the colon with rectal sparing. The lesions are present in patches with intermittent normal colonic mucosa. The patient is started on sulfasalazine and shows a good response. However, 6 months later, she returns with a recurrence of her symptoms. A repeat colonoscopy reveals more extensive involvement of the colon and the small bowel. A second drug is added to her treatment regimen. Which of the following is the most common adverse effect associated with the use of this second drug?? {'A': 'Worsening of osteoporosis', 'B': 'Infection', 'C': 'Rash', 'D': 'Megaloblastic anemia', 'E': 'Hepatotoxicity'}, | B: Infection |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy presents to the emergency department with several days of high fever accompanied by runny nose, cough, and red itchy eyes. Upon further history, you learn that the family is undocumented and has not had access to primary health services. Upon physical examination you see a red, slightly bumpy rash extending from the head to the mid-chest level. If you had examined this child a prior to the development of the rash, which of the following signs may you have observed?? {'A': 'Parotid gland swelling', 'B': 'Posterior auricular lymphadenopathy', 'C': 'Blueberry muffin rash', 'D': 'Dermatomal vesicular rash', 'E': 'Koplik spots'}, | E: Koplik spots |
Answer the following medical question with one of the provided options: | Q:A 75-year-old female patient comes to the emergency department with altered mental status. She is brought in by her daughter with whom the patient lives. The patient’s daughter said they were watching TV when her mother became unresponsive. On exam the patient withdraws to pain but does not open her eyes or speak. An emergent head CT is done and shows an intracranial bleed. The patient is moved to the ICU and intubated. Further history is obtained from the daughter. The patient has a past medical history of diabetes and a previous stroke. Her medications are metformin and warfarin. The patient is compliant with all of her medications. The daughter says that the patient changed her diet about 1 month ago in response to a diet she saw on a talk show. Which of the following foods is most likely to cause the pathology seen in this patient?? {'A': 'St. John’s wort', 'B': 'Chili peppers', 'C': 'Grapefruit juice', 'D': 'Spinach', 'E': 'Green tea'}, | C: Grapefruit juice |
Answer the following medical question with one of the provided options: | Q:A 25-year-old gravida 1 para 0 woman visits an OB/GYN for her first prenatal visit and to establish care. She is concerned about the costs related to future prenatal visits, medications, procedures, and the delivery. She has no type of health insurance through her work and has previously been denied coverage by public health insurance based on her income. Since then she has been promoted and earns a higher salary. In addressing this patient, which of the following is the most appropriate counseling?? {'A': 'She may be eligible for Medicaid based on her higher salary', 'B': 'She may be eligible for Medicaid because she is pregnant', 'C': 'She may be eligible for Medicare based on her higher salary', 'D': 'She may be eligible for Medigap based on her higher salary', 'E': 'She may be eligible for Medigap because she is pregnant'}, | B: She may be eligible for Medicaid because she is pregnant |
Answer the following medical question with one of the provided options: | Q:A 19-year-old male with cystic fibrosis is evaluated in the clinic for regular health maintenance. He is compliant with his respiratory therapy, but states that he often "forgets" to take the medications before he eats. A panel of labs is drawn which reveals a moderate vitamin D deficiency. Which of the following electrolyte abnormalities might be seen as a consequence of vitamin D deficiency?? {'A': 'Increased calcium and increased phosphate', 'B': 'Increased calcium and decreased phosphate', 'C': 'Decreased calcium and increased phosphate', 'D': 'Decreased calcium and decreased phosphate', 'E': 'Normal calcium and decreased phosphate'}, | D: Decreased calcium and decreased phosphate |
Answer the following medical question with one of the provided options: | Q:A 57-year-old male presents with a primary complaint of erectile dysfunction. After proper evaluation, the patient is started on daily administration of sildenafil. This medication directly causes accumulation of which of the following intracellular mediators?? {'A': 'Ca2+', 'B': 'cGMP', 'C': 'AMP', 'D': 'NO', 'E': 'ANP'}, | B: cGMP |
Answer the following medical question with one of the provided options: | Q:A 32-year-old Caucasian female is admitted to the emergency department with a 48-hour history of severe and diffuse abdominal pain, nausea, vomiting, and constipation. Her personal history is unremarkable except for an ectopic pregnancy 5 years ago. Upon admission, she is found to have a blood pressure of 120/60 mm Hg, a pulse of 105/min, a respiratory rate 20/min, and a body temperature of 37°C (98.6°F). She has diffuse abdominal tenderness, hypoactive bowel sounds, and mild distention on examination of her abdomen. Rectal and pelvic examination findings are normal. An abdominal plain film of the patient is given. What is the most likely cause of this patient’s condition?? {'A': 'Malrotation', 'B': 'Hernia', 'C': 'Adhesions', 'D': 'Enlarged Peyer’s plaques', 'E': 'Gastrointestinal malignancy'}, | C: Adhesions |
Answer the following medical question with one of the provided options: | Q:A 32-year-old woman presents with three-days of vaginal burning, itching, and pain with intercourse. She is in a monogamous relationship with her husband and has an intrauterine device for contraception. Her past medical history is unremarkable, except for recently being treated with antibiotics for sinusitis. Pelvic exam is remarkable for vulvar excoriations, vaginal wall edema, and thick, white discharge in the vault. Wet mount with KOH staining reveals budding filaments with pseudohyphae and hyphae. Which of the following is the most appropriate treatment?? {'A': 'Fluconazole', 'B': 'Itraconazole', 'C': 'Metronidazole', 'D': 'Posaconazole', 'E': 'Voriconazole'}, | A: Fluconazole |
Answer the following medical question with one of the provided options: | Q:A 2-week-old female newborn is brought to the physician for the evaluation of red eyes with discharge for 2 days. She was born at 39 weeks' gestation to a 22-year-old woman. Pregnancy and delivery were uncomplicated. The mother received irregular prenatal care during the second half of the pregnancy. The newborn weighed 3700 g (8 lb 2.5 oz) at birth, and no congenital anomalies were noted. She currently weighs 4000 g (8 lb 13 oz). Examination of the newborn shows pink skin. The lungs are clear to auscultation. There is mucopurulent discharge in both eyes and mild eyelid swelling. Polymerase chain reaction assay of conjunctival scraping confirms the diagnosis. Which of the following is the most appropriate next step in management?? {'A': 'Reassurance and follow-up in 1 week', 'B': 'Intravenous acyclovir administration', 'C': 'Oral doxycycline administration', 'D': 'Oral erythromycin administration', 'E': 'Topical silver nitrate administration'}, | D: Oral erythromycin administration |
Answer the following medical question with one of the provided options: | Q:A 40-year-old woman was admitted to the surgical service after an uncomplicated appendectomy. She underwent surgery yesterday and had an uneventful postoperative course. However, she now complains that she is unable to completely void. She also complains of pain in the suprapubic area. You examine her and confirm the tenderness and fullness in the suprapubic region. You ask the nurse to perform a bladder scan, which reveals 450cc. What is the next appropriate step in management?? {'A': 'Oral bethanechol chloride', 'B': 'Neostigmine methylsulfate injection', 'C': 'Intravenous neostigmine methylsulfate', 'D': 'Intravenous furosemide', 'E': 'Catheterization'}, | E: Catheterization |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman presents to her family physician with a headache. The patient reports that the symptoms started about 2 hours ago when she woke up and have not improved. She states the pain is moderate, throbbing, tight in character, and is located in the occipital region bilaterally. The patient denies any visual and audio disturbances, nausea, and vomiting. She recalls 2 similar headaches in the past month. She has no other relevant medical history. Current medications are alendronate and a daily multivitamin. The patient works long hours as a corporate attorney. A review of systems is significant for mild photophobia. Her temperature is 37.0°C (98.6°F), the blood pressure is 110/70 mm Hg, the pulse is 70/min, the respiratory rate is 18/min, and the oxygen saturation is 98% on room air. On physical exam, the patient is alert and oriented. There is moderate tenderness to palpation diffusely over the upper posterior cervical muscles and occipital region of the scalp. The remainder of the physical exam is normal. Laboratory tests are normal. Urine pregnancy test is negative. What is the next best step in management?? {'A': 'Non-contrast CT of the head and neck', 'B': 'T1/T2 MRI of the head and neck', 'C': 'Temporal artery biopsy', 'D': 'Administer high-flow oxygen, ibuprofen 200 mg orally, and sumatriptan 6 mg subcutaneously', 'E': 'Recommend lifestyle changes, relaxation techniques, and massage therapy'}, | E: Recommend lifestyle changes, relaxation techniques, and massage therapy |
Answer the following medical question with one of the provided options: | Q:A 27-year-old man comes to the physician for a follow-up examination. Paroxetine therapy was initiated 6 weeks ago for a major depressive episode. He now feels much better and says he is delighted with his newfound energy. He gets around 8 hours of sleep nightly. His appetite has increased. Last year, he had two episodes of depressed mood, insomnia, and low energy during which he had interrupted his job training and stopped going to the gym. Now, he has been able to resume his job at a local bank. He also goes to the gym three times a week to work out and enjoys reading books again. His temperature is 36.5°C (97.7°F), pulse is 70/min, and blood pressure is 128/66 mm Hg. Physical and neurologic examinations show no abnormalities. On mental status examination, he describes his mood as ""good.” Which of the following is the most appropriate next step in management?"? {'A': 'Continue paroxetine therapy for 2 years', 'B': 'Switch from paroxetine to venlafaxine therapy', 'C': 'Discontinue paroxetine', 'D': 'Continue paroxetine therapy for 6 months', 'E': 'Switch from paroxetine to lithium therapy\n"'}, | A: Continue paroxetine therapy for 2 years |
Answer the following medical question with one of the provided options: | Q:A 15-year-old girl comes to the physician because of a 2-year history of irregular menstrual bleeding. Menses have occurred at irregular 45- to 60-day intervals since menarche at the age of 13 years. Her last menstrual period was 5 weeks ago and lasted for 7 days with heavy flow and no cramping. She is not sexually active. She is 171 cm (5 ft 7 in) tall and weighs 58 kg (128 lb); BMI is 20 kg/m2. Her temperature is 36.6°C (97.8°F), pulse is 80/min, and blood pressure is 110/60 mm Hg. Pelvic examination shows a normal-appearing vagina and cervix. Bimanual examination shows a normal-sized uterus and no palpable adnexal masses. The remainder of the physical examination shows no abnormalities. A urine pregnancy test is negative. Which of the following is the most likely explanation for this patient's symptoms?? {'A': 'Pituitary adenoma', 'B': 'Endometriosis', 'C': 'Polycystic ovary syndrome', 'D': 'Anovulation', 'E': 'Ovarian insufficiency\n"'}, | D: Anovulation |
Answer the following medical question with one of the provided options: | Q:A 7-year-old boy is brought by his parents to his pediatrician due to progressive fatigue and shortness of breath while playing sports. He is otherwise healthy with no known medical disorders and no other symptoms. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. On physical examination, his temperature is 36.9ºC (98.4ºF), pulse rate is 90/min, blood pressure is 100/70 mm Hg, and respiratory rate is 18/min. Pulses in all four extremities are equal and normally palpated; there is no radio-femoral delay. The pediatrician suspects a congenital heart disease after auscultation of the heart. Which of the following congenital heart diseases is most likely to present with the clinical features listed above?? {'A': 'Aortopulmonary window defect', 'B': 'Coarctation of the aorta', 'C': 'Complete atrioventricular septal defect', 'D': 'Atrial septal defect', 'E': 'Double-outlet right ventricle with subaortic ventricular septal defect'}, | D: Atrial septal defect |
Answer the following medical question with one of the provided options: | Q:A previously healthy 17-year-old boy is brought to the emergency department by his mother for further evaluation after elective removal of his wisdom teeth. During the procedure, the patient had persistent bleeding from the teeth's surrounding gums. Multiple gauze packs were applied with minimal effect. The patient has a history of easy bruising. The mother says her brother had similar problems when his wisdom teeth were removed, and that he also has a history of easy bruising and joint swelling. The patient takes no medications. His temperature is 37°C (98.6°F), pulse is 90/min, and blood pressure is 108/74 mm Hg. Laboratory studies show: Hematocrit 35% Leukocyte count 8,500/mm3 Platelet count 160,000/mm3 Prothrombin time 15 sec Partial thromboplastin time 60 sec Bleeding time 6 min Fibrin split products negative Serum Urea nitrogen 20 mg/dL Creatinine 1.0 mg/dL Bilirubin Total 1.0 mg/dL Direct 0.5 mg/dL Lactate dehydrogenase 90 U/L Peripheral blood smear shows normal-sized platelets. Which of the following is the most likely diagnosis?"? {'A': 'Von Willebrand disease', 'B': 'Glanzmann thrombasthenia', 'C': 'Immune thrombocytopenia', 'D': 'Hemophilia', 'E': 'Bernard-Soulier syndrome'}, | D: Hemophilia |
Answer the following medical question with one of the provided options: | Q:A 48-year-old man with a history of diabetes mellitus presents to his primary care physician with lethargy, joint pain, and impotence. Lab evaluation is notable for a ferritin of 1400 ug/L (nl <300 ug/L), increased total iron, increased transferrin saturation, and decreased total iron binding capacity. All of the following are true regarding this patient's condition EXCEPT:? {'A': 'It may lead to a decline in cardiac function', 'B': 'It may improve with serial phlebotomy', 'C': 'It may improve with calcium chelators', 'D': 'It is associated with an increased risk for hepatocellular carcinoma', 'E': 'It results in skin bronzing'}, | C: It may improve with calcium chelators |
Answer the following medical question with one of the provided options: | Q:A 68-year-old man is brought to the clinic by his daughter who has noticed behavioral changes and frequent headaches for the past 2 weeks. The patient’s daughter says he has been having memory and simple calculation issues, gets upset easily, and his grip strength has dramatically declined. The patient was completely normal prior to these recent changes and used to be able to perform his activities of daily living without a problem. He has a past medical history significant for hypertension, stable angina, and benign prostatic hypertrophy, as well as frequent falls with the last one occurring 1 month ago. Physical examination is remarkable for dyscalculia, short-term memory deficits, and decreased grip strength (4/5) in his right hand. A noncontrast CT of the head is performed and is shown in the image. Which of the following is the most likely etiology of this patient condition?? {'A': 'Arteriovenous malformation', 'B': 'Tearing of bridging veins', 'C': 'Tearing of the middle meningeal artery', 'D': 'Dural arteriovenous fistula', 'E': 'Charcot-Bouchard aneurysm'}, | B: Tearing of bridging veins |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman, gravida 1, para 0, at 40 weeks' gestation is admitted to the hospital in active labor. Pregnancy was complicated by iron deficiency anemia treated with iron supplements. At the beginning of the first stage of labor, there are coordinated, regular, rhythmic contractions of high intensity that occur approximately every 10 minutes. Four hours later, the cervix is 100% effaced and 10 cm dilated; the vertex is at -1 station. Over the next two hours, there is minimal change in in fetal descent; vertex is still at -1 station. Fetal birth weight is estimated at the 75th percentile. The fetal heart rate is 145/min and is reactive with no decelerations. Contractions occurs approximately every 2 minutes with adequate pressure. Epidural anesthesia was not given, as the patient is coping well with pain. Which of the following is the most appropriate next step in management?? {'A': 'Administration of terbutaline', 'B': 'Cesarean section', 'C': 'Vacuum-assisted delivery', 'D': 'Observation for another hour', 'E': 'Epidural anesthesia'}, | D: Observation for another hour |
Answer the following medical question with one of the provided options: | Q:A 23-year-old woman, gravida 2, para 1, at 26 weeks gestation comes to the physician for a routine prenatal visit. Physical examination shows a uterus consistent in size with a 26-week gestation. Fetal ultrasonography shows a male fetus with a thick band constricting the right lower arm; the limb distal to the constrictive band cannot be visualized. The most likely condition is an example of which of the following embryological abnormalities?? {'A': 'Deformation', 'B': 'Agenesis', 'C': 'Disruption', 'D': 'Malformation', 'E': 'Aplasia'}, | C: Disruption |
Answer the following medical question with one of the provided options: | Q:A 47-year-old man presents to the emergency department due to a rash. He states the rash started last night and is very concerning to him. The patient cannot remember being exposed to any environmental stimuli such as new detergents or poison ivy. The patient recently started following with a primary care provider who is helping him manage his arthritis and a new onset cough. His temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 125/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical exam is notable for the findings of coalescing erythematous macules, bullae, desquamation, and mucositis only on the upper half of his back. Cardiopulmonary exam and abdominal exam are within normal limits. Inspection of the patient’s oropharynx reveals ulcers and erythema. Which of the following is the most likely diagnosis?? {'A': 'Erythema multiforme', 'B': 'Herpes simplex virus', 'C': 'Herpes zoster', 'D': 'Steven-Johnson syndrome', 'E': 'Toxic epidermal necrolysis'}, | D: Steven-Johnson syndrome |
Answer the following medical question with one of the provided options: | Q:A 12-year-old boy presents to the pediatrician with complaints of chronic cough for the past two years. The cough is present during the day, especially after returning from school. His school teacher says he does not cough at school. The cough is absent while he is asleep, although it increases during examinations or when he experiences boredom. His mother reports that there was a one-month period where he did not cough, but during that month, he used to shrug his shoulders frequently, especially when he was stressed or fatigued. There is no history of sneezing, nasal discharge, nasal congestion, headache, ear symptoms, or breathing difficulty. Detailed history does not suggest the presence of a mood disorder, obsessive-compulsive symptoms, or attention-deficit/hyperactivity disorder. There is no past history of a known neurological disorder, and there is no history of substance abuse. On physical examination, his vital signs are stable. Examination of his respiratory and cardiovascular systems is normal. However, the pediatrician notes repeated eye blinking; upon asking about eye blinking, the mother reports that he has had this habit since he was almost eight years old. Further inquiry suggests that eye blinking, coughing, and grunting disappear for a few weeks without explanation, only to reappear again. Which of the following drugs is likely to be most effective to control this patient’s symptoms?? {'A': 'Atomoxetine', 'B': 'Clonidine', 'C': 'Fluoxetine', 'D': 'Haloperidol', 'E': 'Levetiracetam'}, | D: Haloperidol |
Answer the following medical question with one of the provided options: | Q:A 27-year-old woman consults an obstetrician as she is planning to become pregnant. She has been diagnosed with HIV (human immunodeficiency virus) infection recently and is currently taking antiretroviral therapy (HAART), as prescribed by her physician. The obstetrician emphasizes the importance of antenatal and peripartum antiretroviral therapy for reducing the risk of mother-to-child transmission of HIV. She also tells the patient that certain antiretroviral drugs, if taken during pregnancy, increase the risk of birth defects in the fetus. She gives a printed list of such drugs to the woman for educational and informational purposes. Which of the following drugs are most likely to be present on the list?? {'A': 'Abacavir and Didanosine', 'B': 'Efavirenz and Delavirdine', 'C': 'Lamivudine and Nevirapine', 'D': 'Lopinavir and Ritonavir', 'E': 'Nelfinavir and Saquinavir'}, | B: Efavirenz and Delavirdine |
Answer the following medical question with one of the provided options: | Q:A 1-month-old baby is brought to the emergency department because he had a coughing spell while feeding and turned blue. The mother says that the blue color went away when she picked the baby up and brought his knees to his chest. The physician orders a chest X-ray which shows a boot-shaped heart and he tells the mother that the baby has a condition that is caused by an anterosuperior displacement of the infundibular septum. What are the 4 features of the baby’s cardiac condition?? {'A': 'Pulmonary stenosis, left ventricular hypertrophy, ventricular septal defect, overriding aorta', 'B': 'Pulmonary regurgitation, left ventricular hypertrophy, ventricular septal defect, overriding aorta', 'C': 'Pulmonary regurgitation, right ventricular hypertrophy, atrial septal defect, overriding aorta', 'D': 'Pulmonary stenosis, right ventricular hypertrophy, atrial septal defect, overriding pulmonary artery', 'E': 'Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta'}, | E: Pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, overriding aorta |
Answer the following medical question with one of the provided options: | Q:A 16-year-old girl is brought to the physician by her mother because she has not had her menstrual period yet. At birth, she was found to have partial labial fusion and clitoromegaly. The mother reports that during the pregnancy she had noticed abnormal hair growth on her chin. The girl has severe acne. Three years ago, she broke her wrist after a minor trauma. Last year, she sustained a spinal compression fracture after lifting a box during a move. She currently takes oral isotretinoin and an oral contraceptive. The patient is at the 97th percentile for height and 50th percentile for weight. Physical examination shows numerous inflamed pustules on her face and upper back. Breast development is at Tanner stage I. The patient refuses to have a pelvic examination. A pelvic ultrasound shows ovaries with multiple cysts and a normal uterus. Which of the following is the most likely diagnosis?? {'A': 'Polycystic ovary syndrome', 'B': 'Congenital adrenal hyperplasia', 'C': 'Hyperprolactinemia', 'D': 'Turner syndrome', 'E': 'Aromatase deficiency'}, | E: Aromatase deficiency |
Answer the following medical question with one of the provided options: | Q:A 6-month-old infant is brought to the physician’s office by his parents due to a fever, cough, and shortness of breath. The cough is dry and has been progressively worsening for the past 48 hours along with the shortness of breath. His fever never exceeded 37.8°C (100.0°F) at home. The parents say that he has also had abundant nasal drainage and loss of appetite. He is irritable and vomited twice during this period. He has no relevant medical or family history. His vitals are the following: Pulse rate 165/min Respiratory rate 77/min Temperature 38.0°C (100.4°F) On physical examination, there is nasal congestion with thick secretions, accompanied by nasal flaring. On chest examination, intercostal retractions are seen and diffuse wheezing on both sides are heard on auscultation. What is the most likely cause?? {'A': 'Asthma', 'B': 'Sinusitis', 'C': 'Rhinopharyngitis', 'D': 'Bronchiolitis', 'E': 'Laryngotracheitis'}, | D: Bronchiolitis |
Answer the following medical question with one of the provided options: | Q:A 67-year-old woman comes to the physician because of fever, chills, myalgias, and joint pain 1 month after undergoing aortic prosthetic valve replacement due to high-grade aortic stenosis. She does not drink alcohol or use illicit drugs. Her temperature is 39.3°C (102.8°F). She appears weak and lethargic. Physical examination shows crackles at both lung bases and a grade 2/6, blowing diastolic murmur over the right sternal border. Laboratory studies show leukocytosis and an elevated erythrocyte sedimentation rate. The causal organism is most likely to have which of the following characteristics?? {'A': 'Alpha hemolytic, optochin-sensitive diplococci', 'B': 'Novobiocin-sensitive, coagulase-negative cocci', 'C': 'Catalase-negative cocci that grows in 6.5% saline', 'D': 'Beta hemolytic, bacitracin-sensitive cocci', 'E': 'Alpha hemolytic, optochin-resistant cocci'}, | B: Novobiocin-sensitive, coagulase-negative cocci |
Answer the following medical question with one of the provided options: | Q:A 42-year-old woman presents to her primary care provider with vision loss. She reports that twice over the last 2 weeks she has had sudden “black out” of the vision in her right eye. She notes that both episodes were painless and self-resolved over approximately a minute. The patient’s past medical history is significant for hypertension, diet-controlled diabetes mellitus, and hypothyroidism. Her family history is notable for coronary artery disease in the patient’s father and multiple sclerosis in her mother. Ophthalmologic and neurologic exam is unremarkable. Which of the following is the best next step in management?? {'A': 'Check serum inflammatory markers', 'B': 'Emergent referral to ophthalmology', 'C': 'Intravenous dexamethasone', 'D': 'MRI of the brain', 'E': 'Ultrasound of the carotid arteries'}, | E: Ultrasound of the carotid arteries |
Answer the following medical question with one of the provided options: | Q:A 37-year-old man presents to his primary care provider with dysphagia. He notes that his symptoms began several weeks ago and have worsened over time. He now has trouble swallowing solids and liquids. He denies any other symptoms. He has no significant past medical history. Travel history reveals a recent trip to South America but no other travel outside the United States. His temperature is 100°F (37.8°C), blood pressure is 120/81 mmHg, pulse is 99/min, respirations are 14/min, and oxygen saturation is 98% on room air. HEENT exam is unremarkable. He has no palpable masses in his abdomen. What is the most appropriate next step in management?? {'A': 'Barium swallow', 'B': 'Endoscopy', 'C': 'Manometry', 'D': 'Myotomy', 'E': 'Nifurtimox'}, | A: Barium swallow |
Answer the following medical question with one of the provided options: | Q:A 61-year-old woman presents for a routine health visit. She complains of generalized fatigue and lethargy on most days of the week for the past 4 months. She has no significant past medical history and is not taking any medications. She denies any history of smoking or recreational drug use but states that she drinks “socially” approx. 6 nights a week. She says she also enjoys a “nightcap,” which is 1–2 glasses of wine before bed every night. The patient is afebrile, and her vital signs are within normal limits. On physical examination, there is significant pallor of the mucous membranes. Laboratory findings are significant for a mean corpuscular volume (MCV) of 72 fL, leukocyte count of 4,800/mL, hemoglobin of 11.0 g/dL, and platelet count of 611,000/mL. She is started on oral ferrous sulfate supplements. On follow-up, her laboratory parameters show no interval change in her MCV or platelet level. Which of the following is the best next step in the management of this patient?? {'A': 'Transfuse the patient with whole blood', 'B': 'Continue oral ferrous sulfate and supplement with ascorbic acid', 'C': 'Continue oral ferrous sulfate and supplement with omeprazole', 'D': 'Administer folate', 'E': 'Administer iron intravenously'}, | B: Continue oral ferrous sulfate and supplement with ascorbic acid |
Answer the following medical question with one of the provided options: | Q:A 41-year-old man with HIV comes to the physician because of rectal bleeding and itching for 2 weeks. During this period, he has also had pain with defecation. Four months ago, he was diagnosed with anogenital warts that were treated with cryotherapy. Over the past year, he has been sexually active with 3 male partners. He uses condoms inconsistently. Current medications are zidovudine, emtricitabine, and efavirenz. Digital rectal examination and anoscopy show an exophytic mass on the anal margin that is protruding into the anal canal. The mass is tender to palpation and bleeds easily on contact. Laboratory studies show a leukocyte count of 7,600/mm3 and a CD4+ T-lymphocyte count of 410/mm3 (N ≥ 500). A biopsy specimen of the lesion shows a well-differentiated squamous cell carcinoma. Which of the following cellular processes was most likely involved in the pathogenesis of this patient's malignancy?? {'A': 'Activation of c-myc gene', 'B': 'Inactivation of VHL gene', 'C': 'Activation of TAX gene', 'D': 'Inactivation of WT1 gene', 'E': 'Inactivation of TP53 gene\n"'}, | E: Inactivation of TP53 gene " |
Answer the following medical question with one of the provided options: | Q:A 3-year-old child is brought to the emergency department by his parents. The child presents with significant rapid breathing and appears unwell. On examination, his liver size is 1.5 times larger than children of his age, and he has mild pitting edema in his legs. This child is also in the lower weight-age and height-age percentiles. On auscultation, mild rales were noted and a fixed split S2 was heard on inspiration. There is no family history of congenital disorders or metabolic syndromes. Which of the following is the likely diagnosis?? {'A': 'Liver failure', 'B': 'Atrial septal defect', 'C': 'Patent foramen ovale', 'D': 'Endocardial cushion syndrome', 'E': 'Transposition of the great vessels'}, | B: Atrial septal defect |
Answer the following medical question with one of the provided options: | Q:A neurophysiologist describes the mechanism of a specific type of synaptic transmission to his students. While illustrating this, he points out that when the action potential reaches the presynaptic terminal of a chemical synapse, the voltage-gated Ca2+ channels open. Ca2+ ions trigger the release of neurotransmitters from vesicles in the presynaptic terminal. In this type of synaptic transmission, increased cytosolic Ca2+ levels cause the release of a neurotransmitter from small vesicles with dense cores. Which of the following neurotransmitters is most likely to be the one that is released into the synaptic cleft in this type of synapse?? {'A': 'Follicle stimulating hormone', 'B': 'Epinephrine', 'C': 'Glycine', 'D': 'GABA (γ-amino butyric acid)', 'E': 'Glutamate'}, | B: Epinephrine |
Answer the following medical question with one of the provided options: | Q:A 32-year-old man with a history of major depressive disorder is brought to the emergency department by his wife because of a sudden onset of restlessness and disorientation that developed 3 hours ago. The patient’s wife says that he suddenly started sweating, having tremors, and mumbling to himself. Yesterday, the patient visited his psychiatrist with worsening depression who added phenelzine to his current treatment regimen. No other significant past medical history. His temperature is 39.7°C (103.5°F), blood pressure is 145/90 mm Hg, and pulse is 115/min. On physical examination, the skin is flushed. Mucous membranes are dry, and pupils are dilated. There is pronounced clonus in the extremities bilaterally. Babinski sign is present bilaterally. All the patient’s medications are discontinued, and intravenous fluids are started. Which of the following drugs most likely interacted with phenelzine to cause this patient’s condition?? {'A': 'Mirtazapine', 'B': 'Bupropion', 'C': 'Sertraline', 'D': 'Olanzapine', 'E': 'Lithium'}, | C: Sertraline |
Answer the following medical question with one of the provided options: | Q:A 55-year-old woman comes to your office because she noticed the growth of unwanted hair on her upper lip, chin, and chest. She has also noticed an increase in blackheads and pimples on her skin. Her female partner has also recently brought to her attention the deepening of her voice, weight gain, and changes in her external genitalia that generated some personal relationship issues. The patient is frustrated as these changes have appeared over the course of the last 8 months. She claims that she was feeling completely normal before all of these physical changes started. Physical examination shows dark coarse stubbles distributed along her upper lip, chin, chest, back, oily skin, and moderately inflamed acne. Pelvic examination reveals a clitoris measuring 12 mm long, a normal sized mobile retroverted uterus, and a firm, enlarged left ovary. What is the most likely diagnosis of this patient?? {'A': 'Thecoma', 'B': 'Sertoli-Leydig cell tumour', 'C': 'Adrenocortical carcinoma', 'D': 'Granulosa cell tumour', 'E': 'Polycystic ovarian syndrome (PCOS)'}, | B: Sertoli-Leydig cell tumour |
Answer the following medical question with one of the provided options: | Q:A 44-year-old female presents to her primary care physician with complaints of headache, fatigue, muscle weakness, and frequent urination. These issues have developed and worsened over the past month. She has no significant prior medical or surgical history other than cholecystitis managed with cholecystectomy 5 years ago. Her vital signs at today's visit are as follows: T 37.1 C, HR 77, BP 158/98, RR 12, and SpO2 99%. Physical examination is significant for tetany, mild abdominal distension, reduced bowel sounds, and hypertensive retinal changes on fundoscopic exam. The physician orders a laboratory and imaging work-up based on his suspected diagnosis. An abdominal CT scan shows an 8 cm unilateral left adrenal mass suggestive of an adrenal adenoma. Which of the following sets of laboratory findings would be most likely in this patient?? {'A': 'Metabolic acidosis, hypernatremia, hyperkalemia', 'B': 'Metabolic acidosis, hyponatremia, hyperkalemia', 'C': 'Metabolic acidosis, hypernatremia, hypokalemia', 'D': 'Metabolic alkalosis, hypernatremia, hyperkalemia', 'E': 'Metabolic alkalosis, hypernatremia, hypokalemia'}, | E: Metabolic alkalosis, hypernatremia, hypokalemia |
Answer the following medical question with one of the provided options: | Q:A 58-year-old woman comes to the physician because of a 6-month history of difficulty walking, clumsiness of her arms and legs, and slurred speech. Physical examination shows masked facies and a slow, shuffling gait. When her ankles are passively flexed, there is involuntary, jerky resistance. Treatment is initiated with a combination of levodopa and carbidopa. The addition of carbidopa is most likely to decrease the risk of which of the following potential adverse drug effects?? {'A': 'Resting tremor', 'B': 'Orthostatic hypotension', 'C': 'Urinary retention', 'D': 'Visual hallucinations', 'E': 'Dyskinesia'}, | B: Orthostatic hypotension |
Answer the following medical question with one of the provided options: | Q:A 12-month-old boy is brought to the pediatrician for a routine examination. Past medical history is significant for a pyloric myomectomy at 2 months of age after a few episodes of projectile vomiting. He has reached all appropriate developmental milestones. He currently lives with his parents and pet cat in a house built in the 1990s. He was weaned off of breast milk at 6 months of age. He is a very picky eater, but drinks 5–6 glasses of whole milk a day. The patient's height and weight are in the 50th percentile for his age and sex. The vital signs are within normal limits except for the presence of slight tachycardia. Physical examination reveals an alert infant with a slight pallor. Abdomen is soft and nondistended. A grade 2/6 systolic ejection murmur is noted in the left upper sternal border. Which of the following will most likely be expected in this patient's laboratory results?? {'A': 'Decreased vitamin B12 levels', 'B': 'Increased lead levels', 'C': 'Increased Hb S levels', 'D': 'Decreased hemoglobin', 'E': 'Metabolic alkalosis'}, | D: Decreased hemoglobin |
Answer the following medical question with one of the provided options: | Q:A 47-year-old woman presents to a local medical shelter while on a mission trip with her church to help rebuild homes after a hurricane. She has been experiencing severe nausea, vomiting, and diarrhea for the last 2 days and was feeling too fatigued to walk this morning. On presentation, her temperature is 99.2°F (37.3°C), blood pressure is 95/62 mmHg, pulse is 121/min, and respirations are 17/min. Physical exam reveals decreased skin turgor, and a stool sample reveals off-white watery stools. Gram stain reveals a gram-negative, comma-shaped organism that produces a toxin. Which of the following is consistent with the action of the toxin most likely involved in the development of this patient's symptoms?? {'A': 'Activation of receptor tyrosine kinase', 'B': 'Cleavage of junctional proteins', 'C': 'Decreased ribosomal activity', 'D': 'Increased adenylyl cyclase activity', 'E': 'Increased membrane permeability'}, | D: Increased adenylyl cyclase activity |
Answer the following medical question with one of the provided options: | Q:A 48-year-old woman with alpha-1-antitrypsin deficiency undergoes a lung transplant. She tolerates the surgery well, but 3 years later develops inflammation and fibrosis in her terminal bronchioles. Which of the following best describes the pathophysiology of this patient's deterioration?? {'A': 'Staphylocuccus aureus pneumonia', 'B': 'Cytotoxic T lymphocytes reacting against foreign MHCs', 'C': 'Lymphocytic inflammation of the bronchiolar wall', 'D': 'T-cell mediated vascular damage', 'E': 'Proliferation of grafted immunocompetent T cells'}, | C: Lymphocytic inflammation of the bronchiolar wall |
Answer the following medical question with one of the provided options: | Q:A 8-month-old girl is brought to her pediatrician because her mom is concerned that she may have a "lazy eye". She was born prematurely at 33 weeks and was 3 pounds at birth. Her mother also says that there is a history of visual problems that run in the family, which is why she wanted to make sure that her daughter was evaluated early. On presentation, she is found to have eyes that are misaligned both horizontally and vertically. Physical examination and labs reveal no underlying disorders, and the patient is discharged with occlusion therapy to help correct the misalignment. Which of the following would most likely have also been seen on physical exam?? {'A': 'Asymmetric corneal light reflex', 'B': 'Bitemporal hemianopsia', 'C': 'Increased intraocular pressure', 'D': 'Fundus neovascularization', 'E': 'Nystagmus'}, | A: Asymmetric corneal light reflex |
Answer the following medical question with one of the provided options: | Q:A 13-year-old teenage girl was brought to the emergency department by her mom after she collapsed. Her mom reports that she was at a birthday party when all of a sudden she fell. She reported left foot weakness and has been limping ever since. The patient has been healthy and had an uncomplicated birth history, though her mom reports that she just recovered from a cold. She currently lives with her younger sister and mother as her parents recently divorced. She does well in school and has a handful of good friends. Her physical exam demonstrated normal bulk and tone, 5/5 strength in all motions, 2+ and symmetric reflexes at biceps, triceps and knees. She had 1+ ankle reflex on left. What is the most likely explanation for her symptoms?? {'A': 'Cerebral vascular accident', 'B': 'Conversion disorder', 'C': 'Guillain-Barre syndrome', 'D': 'Multiple sclerosis', 'E': 'Myasthenia gravis'}, | B: Conversion disorder |
Answer the following medical question with one of the provided options: | Q:A 30-year-old woman presents to her family doctor requesting sleeping pills. She is a graduate student and confesses that she is a “worry-a-holic,” which has been getting worse for the last 6 months as the due date for her final paper is approaching. During this time, she feels more on edge, irritable, and is having difficulty sleeping. She has already tried employing good sleep hygiene practices, including a switch to non-caffeinated coffee. Her past medical history is significant for depression in the past that was managed medically. No current medications. The patient’s family history is significant for her mother who has a panic disorder. Her vital signs are within normal limits. Physical examination reveals a mildly anxious patient but is otherwise normal. Which of the following is the most effective treatment for this patient’s condition?? {'A': 'Buspirone', 'B': 'Bupropion', 'C': 'Desensitization therapy', 'D': 'Relaxation training', 'E': 'Diazepam'}, | A: Buspirone |
Answer the following medical question with one of the provided options: | Q:A 25-year-old woman presents to the emergency department with nausea and vomiting. She denies any recent illnesses, sick contacts, or consumption of foods outside of her usual diet. She reports smoking marijuana at least three times a day. Her temperature is 97.7°F (36.5°C), blood pressure is 90/74 mmHg, pulse is 100/min, respirations are 10/min, and SpO2 is 94% on room air. Her conjunctiva are injected. Her basic metabolic panel is obtained below. Serum: Na+: 132 mEq/L Cl-: 89 mEq/L K+: 2.9 mEq/L HCO3-: 30 mEq/L BUN: 35 mg/dL Glucose: 80 mg/dL Creatinine: 1.5 mg/dL Magnesium: 2.0 mEq/L She continues to have multiple bouts of emesis and dry retching. What is the next best step in management?? {'A': 'Obtain an urine toxin screen', 'B': 'Administer ondansetron per oral and provide oral rehydration solution', 'C': 'Administer ondansetron and isotonic saline with potassium', 'D': 'Administer metoclopramide and 1/2 normal saline with potassium', 'E': 'Administer ondansetron and 1/2 normal saline with dextrose'}, | C: Administer ondansetron and isotonic saline with potassium |
Answer the following medical question with one of the provided options: | Q:A 34-year-old male is brought to the emergency department by fire and rescue following a motor vehicle accident in which the patient was an unrestrained driver. The paramedics report that the patient was struck from behind by a drunk driver. He was mentating well at the scene but complained of pain in his abdomen. The patient has no known past medical history. In the trauma bay, his temperature is 98.9°F (37.2°C), blood pressure is 86/51 mmHg, pulse is 138/min, and respirations are 18/min. The patient is somnolent but arousable to voice and pain. His lungs are clear to auscultation bilaterally. He is diffusely tender to palpation on abdominal exam with bruising over the left upper abdomen. His distal pulses are thready, and capillary refill is delayed bilaterally. Two large-bore peripheral intravenous lines are placed to bolus him with intravenous 0.9% saline. Chest radiograph shows multiple left lower rib fractures. Which of the following parameters is most likely to be seen in this patient?? {'A': 'Decreased systemic vascular resistance', 'B': 'Decreased pulmonary capillary wedge pressure', 'C': 'Increased mixed venous oxygen saturation', 'D': 'Increased cardiac output', 'E': 'Increased right atrial pressure'}, | B: Decreased pulmonary capillary wedge pressure |
Answer the following medical question with one of the provided options: | Q:A 26-year-old Caucasian G1 presents at 35 weeks gestation with mild vaginal bleeding. She reports no abdominal pain or uterine contractions. She received no prenatal care after 20 weeks gestation because she was traveling. Prior to the current pregnancy, she used oral contraception. At 22 years of age she underwent a cervical polypectomy. She has a 5 pack-year smoking history. The blood pressure is 115/70 mmHg, the heart rate is 88/min, the respiratory rate is 14/min, and the temperature is 36.7℃ (98℉). Abdominal palpation reveals no uterine tenderness or contractions. The fundus is palpable between the umbilicus and the xiphoid process. An ultrasound exam shows placental extension over the internal cervical os. Which of the following factors present in this patient is the risk factor for her condition?? {'A': 'Intake of oral contraceptives', 'B': 'History of cervical polyp', 'C': 'Nulliparity', 'D': 'Smoking', 'E': 'White race'}, | D: Smoking |
Answer the following medical question with one of the provided options: | Q:A 7-year-old girl is brought to the physician by her father because of a dry cough, nasal congestion, and intermittent wheezing during the past 2 months. Since birth, she has had four upper respiratory tract infections that resolved without treatment and one episode of acute otitis media treated with antibiotics. She has a history of eczema. Her temperature is 37.1°C (98.7°F), and respirations are 28/min. Physical examination shows a shallow breathing pattern and scattered expiratory wheezing throughout both lung fields. Which of the following is the most appropriate next step in diagnosing this patient’s condition?? {'A': 'Methacholine challenge test', 'B': 'Arterial blood gas analysis', 'C': 'Chest x-ray', 'D': 'Serum IgE levels', 'E': 'Spirometry'}, | E: Spirometry |
Answer the following medical question with one of the provided options: | Q:A 42-year-old man comes to the physician for 1 month of worsening right knee pain. He has not had any trauma other than stubbing his toe 3 days ago at the garage where he works as a mechanic. Examination of the right knee shows swelling and erythema with fluctuance over the inferior patella. There is tenderness on palpation of the patella but no joint line tenderness or warmth. The range of flexion is limited because of the pain. Which of the following is the most likely underlying cause of this patient's symptoms?? {'A': 'Inflammation of the patellar tendon', 'B': 'Noninflammatory degeneration of the joint', 'C': 'Infection of the joint', 'D': 'Deposition of crystals in the joint', 'E': 'Inflammation of periarticular fluid-filled sac'}, | E: Inflammation of periarticular fluid-filled sac |
Answer the following medical question with one of the provided options: | Q:A 17-year-old man presents to his primary care physician with a bilateral tremor of the hands. He is a senior in high school and during the year, his grades have plummeted to the point that he is failing. He says his memory is now poor, and he has trouble focusing on tasks. His behavior has changed in the past 6 months, in that he has frequent episodes of depression, separated by episodes of bizarre behavior, including excessive alcohol drinking and shoplifting. His parents have started to suspect that he is using street drugs, which he denies. His handwriting has become very sloppy. His parents have noted slight slurring of his speech. Family history is irrelevant. Physical examination reveals upper extremity tremors, mild dystonia of the upper extremities, and mild incoordination involving his hands. The patient’s eye is shown. Which of the following best represents the etiology of this patient illness?? {'A': 'Mineral accumulation in the basal ganglia', 'B': 'Central nervous system demyelination', 'C': 'Loss of dopaminergic neurons in the nigrostriatal pathway', 'D': 'Autosomal dominant, trinucleotide repeat disorder', 'E': 'Autoimmune process following infection with group A streptococci'}, | A: Mineral accumulation in the basal ganglia |
Answer the following medical question with one of the provided options: | Q:A 4-year-old boy presents to the emergency department with a 1 hour history of severe knee pain after he bumped his knee against a door. He has no past medical history though his parents say that he seems to bruise fairly easily. His parents say that they are afraid he may have accidentally taken his grandfather's warfarin medication. On presentation, he is found to have an erythematous, warm, swollen knee. Based on this presentation, a panel of laboratory tests are ordered with the following results: Bleeding time: 3 minutes Prothrombin time (PT): 12 seconds Partial thromboplastin time (PTT): 56 seconds Mixing studies show no change in the above lab values Which of the following is most likely the cause of this patient's symptoms?? {'A': 'Deficiency in a coagulation factor', 'B': 'Deficiency of von Willebrand factor', 'C': 'Platelet defect', 'D': 'Production of an autoantibody', 'E': 'Warfarin toxicity'}, | D: Production of an autoantibody |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man comes to the physician for a follow-up examination. He feels well. He has no urinary urgency, increased frequency, dysuria, or gross hematuria. He has a history of recurrent urinary tract infections. His last urinary tract infection was 3 months ago and was treated with ciprofloxacin. Current medications include a multivitamin. He has smoked one pack of cigarettes daily for 18 years. Vital signs are within normal limits. The abdomen is soft and nontender. There is no costovertebral angle tenderness. Laboratory studies show: Hemoglobin 11.2 g/dL Leukocyte count 9,500/mm3 Platelet count 170,000/mm3 Serum Na+ 135 mEq/L K+ 4.9 mEq/L Cl- 101 mEq/L Urea nitrogen 18 mg/dL Creatinine 0.6 mg/dL Urine Blood 2+ Protein negative RBC 5–7/hpf, normal shape and size RBC casts negative WBC 0–2/hpf Bacteria negative Urine cultures are negative. Urine analysis is repeated and shows similar results. A cystoscopy shows no abnormalities. Which of the following is the most appropriate next step in management?"? {'A': 'Annual urinalysis', 'B': 'Transrectal ultrasound', 'C': 'Voided urine cytology', 'D': 'Reassurance', 'E': 'CT urography\n"'}, | E: CT urography " |
Answer the following medical question with one of the provided options: | Q:A 40-year-old man presents with severe fatigue, dyspnea on exertion, and weight loss. He reports a weight loss of 15 kg (33.0 lb) over the past 3 months and feels full almost immediately after starting to eat, often feeling nauseous and occasionally vomiting. Past medical history is not significant. However, the patient reports a 10-pack-year smoking history. His temperature is 37.0°C (98.6°F), respiratory rate is 15/min, pulse is 67/min, and blood pressure is 122/98 mm Hg. Physical examination reveals paleness and conjunctival pallor. Abdominal examination reveals an ill-defined nontender mass in the epigastric region along with significant hepatomegaly. Routine laboratory studies show a hemoglobin level of 7.2 g/dL. A contrast CT scan of the abdomen is presented below. Which of the following structures is most helpful in the anatomical classification of gastrointestinal bleeding in this patient?? {'A': 'Ligament of Treitz', 'B': 'Hepatoduodenal ligament', 'C': 'Ampulla of Vater', 'D': 'Sphincter of Oddi', 'E': 'Portal vein'}, | A: Ligament of Treitz |
Answer the following medical question with one of the provided options: | Q:A 33-year-old man with a history of alcohol abuse and cirrhosis presents to the emergency department with profuse vomiting. The patient is aggressive, combative, emotionally labile, and has to be chemically restrained. The patient continues to vomit and blood is noted in the vomitus. His temperature is 99.2°F (37.3°C), blood pressure is 139/88 mmHg, pulse is 106/min, respirations are 17/min, and oxygen saturation is 100% on room air. The patient complains of sudden onset chest pain during his physical exam. A crunching and rasping sound is heard while auscultating the heart. Which of the following is the pathophysiology of the most likely diagnosis?? {'A': 'Dilated and tortuous veins', 'B': 'Inflammation of the pericardium', 'C': 'Mucosal tear', 'D': 'Pericardial fluid accumulation', 'E': 'Transmural tear'}, | E: Transmural tear |
Answer the following medical question with one of the provided options: | Q:A 74-year-old male is brought to the emergency department 1 hour after he fell from the top of the staircase at home. He reports pain in his neck as well as weakness of his upper extremities. He is alert and immobilized in a cervical collar. He has hypertension treated with hydrochlorthiazide. His pulse is 90/min and regular, respirations are 18/min, and blood pressure is 140/70 mmHg. Examination shows bruising and midline cervical tenderness. Neurologic examination shows diminished strength and sensation to pain and temperature in the upper extremities, particularly in the hands. Upper extremity deep tendon reflexes are absent. Strength, sensation, and reflexes in the lower extremities are intact. Anal sensation and tone are present. Babinski's sign is absent bilaterally. Which of the following is most likely to confirm the cause of this patient's neurologic examination findings?? {'A': 'CT angiography of the neck', 'B': 'CT of the cervical spine with contrast', 'C': 'Cervical myelography', 'D': 'X-ray of the cervical spine', 'E': 'MRI of the cervical spine without contrast'}, | E: MRI of the cervical spine without contrast |
Answer the following medical question with one of the provided options: | Q:A 36-year old pregnant woman (gravida 4, para 1) presents at week 11 of pregnancy. Currently, she has no complaints. She had an uncomplicated 1st pregnancy that ended in an uncomplicated vaginal delivery at the age of 28 years. Her male child was born healthy, with normal physical and psychological development over the years. Two of her previous pregnancies were spontaneously terminated in the 1st trimester. Her elder sister has a child born with Down syndrome. The patient denies smoking and alcohol consumption. Her blood analysis reveals the following findings: Measured values Beta human chorionic gonadotropin (beta-hCG) High Pregnancy-associated plasma protein-A (PAPP-A) Low Which of the following is the most appropriate next step in the management of this patient?? {'A': 'Offer a blood test for rubella virus, cytomegalovirus, and toxoplasma IgG', 'B': 'Perform an ultrasound examination with nuchal translucency and crown-rump length measurement', 'C': 'Recommend chorionic villus sampling with subsequent cell culturing and karyotyping', 'D': 'Recommend amniocentesis with subsequent cell culturing and karyotyping', 'E': 'Schedule a quadruple test at the 15th week of pregnancy'}, | C: Recommend chorionic villus sampling with subsequent cell culturing and karyotyping |
Answer the following medical question with one of the provided options: | Q:A 63-year-old man is brought to the emergency department by the police after he was found in the streets lying unconscious on the ground. Both of his pupils are normal in size and reactive to light. There are no obvious signs of head trauma. The finger prick test shows a blood glucose level of 20 mg/dL. He has been brought to the emergency department due to acute alcohol intoxication several times. The vital signs include: blood pressure 100/70 mm Hg, heart rate 110/min, respiratory rate 22/min, and temperature 35℃ (95℉). On general examination, he is pale looking and disheveled with an odor of EtOH. On physical examination, the abdomen is soft and non-tender with no hepatosplenomegaly. After giving a bolus of intravenous dextrose, thiamine, and naloxone, he spontaneously opens his eyes. Blood and urine samples are drawn for toxicology screening. The blood alcohol level comes out to be 300 mg/dL. What will be the most likely laboratory findings in this patient?? {'A': 'Schistocytes', 'B': 'Hypersegmented neutrophils', 'C': 'Sickle cells', 'D': 'Macrocytosis MCV > 100fL', 'E': 'Howell-Jolly bodies'}, | D: Macrocytosis MCV > 100fL |
Answer the following medical question with one of the provided options: | Q:A 65-year-old man comes to his primary care physician with a 6-month history of bilateral calf pain. The pain usually occurs after walking his dog a few blocks and is more severe on the right side. He has coronary artery disease, essential hypertension, and type 2 diabetes mellitus. He has smoked two packs of cigarettes daily for 43 years and drinks two alcoholic beverages a day. Current medications include metformin, lisinopril, and aspirin. He is 183 cm (5 ft 11 in) tall and weighs 113 kg (250 lb); BMI is 34.9 kg/m2. His temperature is 37°C (98.6°F), pulse is 84/min, and blood pressure is 129/72 mm Hg. Cardiac examination shows a gallop without murmurs. The legs have shiny skin with reduced hair below the knee. Femoral and popliteal pulses are palpable bilaterally. Dorsal pedal pulses are 1+ on the left and absent on the right. Ankle-brachial index (ABI) is performed in the office. ABI is 0.5 in the right leg, and 0.6 in the left leg. Which of the following is the most appropriate initial step in management?? {'A': 'Graded exercise therapy', 'B': 'Propranolol therapy', 'C': 'Spinal cord stimulation', 'D': 'Vascular bypass surgery', 'E': 'Percutaneous transluminal angioplasty with stenting'}, | A: Graded exercise therapy |
Answer the following medical question with one of the provided options: | Q:A previously healthy 25-year-old man comes to the physician because of a 1-week history of fever and fluid release from painful lumps in his right groin. He had an atraumatic ulceration of his penis about 1 month ago that was not painful and resolved on its own within 1 week. He works at an animal shelter for abandoned pets. He is sexually active with multiple male partners and does not use condoms. His temperature is 38.5°C (101.3°F). Examination of the groin shows numerous tender nodules with purulent discharge. The remainder of the examination shows no abnormalities. Which of the following is the most likely causal pathogen?? {'A': 'Bartonella henselae', 'B': 'Treponema pallidum', 'C': 'Chlamydia trachomatis', 'D': 'Haemophilus ducreyi', 'E': 'Klebsiella granulomatis'}, | C: Chlamydia trachomatis |
Answer the following medical question with one of the provided options: | Q:A 67-year-old man comes to the physician because of numbness and burning sensation of his legs for the past week. He also complains that his stools have been larger and rougher than usual. He has non-Hodgkin lymphoma and is currently receiving chemotherapy with prednisone, vincristine, rituximab, cyclophosphamide, and doxorubicin. He has received 4 cycles of chemotherapy, and his last chemotherapy cycle was 2 weeks ago. His temperature is 37.1°C (98.8°F), pulse is 89/min, and blood pressure is 122/80 mm Hg. Examination shows decreased muscle strength in the distal muscles of the lower extremities. Ankle jerk is 1+ bilaterally and knee reflex is 2+ bilaterally. Sensation to pain, vibration, and position is decreased over the lower extremities. Serum concentrations of glucose, creatinine, electrolytes, and calcium are within the reference range. Which of the following is the most likely cause of this patient's symptoms?? {'A': 'Adverse effect of vincristine', 'B': 'Spinal cord compression', 'C': 'Paraneoplastic autoantibodies', 'D': 'Guillain-Barré syndrome', 'E': 'Charcot–Marie–Tooth disease'}, | A: Adverse effect of vincristine |
Answer the following medical question with one of the provided options: | Q:A 76-year-old Japanese man is admitted to the hospital because of a 3-month history of loose stools and worsening peripheral edema. He also reports fatigue, a 10-pound weight loss over the past 6 weeks, and a tingling sensation in his hands and feet over the same time period. Aside from the family dog, he has not had contact with animals for over 1 year and has not traveled outside the country. He has hypertension and benign prostatic hyperplasia. Five years ago, he underwent a partial gastrectomy with jejunal anastomosis for gastric cancer. Current medications include hydrochlorothiazide and tamsulosin. His temperature is 36.8°C (98.2°F), pulse is 103/min, and blood pressure is 132/83 mm Hg. Examination shows a soft and nontender abdomen. There is a well-healed scar on the upper abdomen. Cardiopulmonary examination shows no abnormalities. The conjunctivae appear pale. Sensation to vibration and position is absent over the lower extremities. His hemoglobin concentration is 9.9 g/dL, MCV is 108 μm3, total protein 3.9 g/dL, and albumin 1.9 g/dL. Which of the following is the most likely cause of this patient's condition?? {'A': 'Neoplastic growth', 'B': 'Increased intestinal motility', 'C': 'Bacterial overgrowth', 'D': 'Bypass of the pyloric sphincter', 'E': 'Anastomotic stricture'}, | C: Bacterial overgrowth |
Answer the following medical question with one of the provided options: | Q:A 7-week-old male presents to the pediatrician for vomiting. His parents report that three weeks ago the patient began vomiting after meals. They say that the vomitus appears to be normal stomach contents without streaks of red or green. His parents have already tried repositioning him during mealtimes and switching his formula to eliminate cow’s milk and soy. Despite these adjustments, the vomiting has become more frequent and forceful. The patient’s mother reports that he is voiding about four times per day and that his urine looks dark yellow. The patient has fallen one standard deviation off his growth curve. The patient's mother reports that the pregnancy was uncomplicated other than an episode of sinusitis in the third trimester, for which she was treated with azithromycin. In the office, the patient's temperature is 98.7°F (37.1°C), blood pressure is 58/41 mmHg, pulse is 166/min, and respirations are 16/min. On physical exam, the patient looks small for his age. His abdomen is soft, non-tender, and non-distended. Which of the following is the best next step in management?? {'A': 'Abdominal ultrasound', 'B': 'Intravenous hydration', 'C': 'MRI of the head', 'D': 'Pyloromyotomy', 'E': 'Thickening feeds'}, | B: Intravenous hydration |
Answer the following medical question with one of the provided options: | Q:An investigator is studying nutritional deficiencies in humans. A group of healthy volunteers are started on a diet deficient in pantothenic acid. After 4 weeks, several of the volunteers develop irritability, abdominal cramps, and burning paresthesias of their feet. These symptoms are fully reversed after reintroduction of pantothenic acid to their diet. The function of which of the following enzymes was most likely impaired in the volunteers during the study?? {'A': 'Gamma-glutamyl carboxylase', 'B': 'Methionine synthase', 'C': 'Dopamine beta-hydroxylase', 'D': 'Glutathione reductase', 'E': 'Alpha-ketoglutarate dehydrogenase'}, | E: Alpha-ketoglutarate dehydrogenase |
Answer the following medical question with one of the provided options: | Q:A 64-year-old man presents to his primary care physician's office for a routine check-up. His past medical history is significant for type 2 diabetes mellitus, hypertension, chronic atrial fibrillation, and ischemic cardiomyopathy. On his last visit three months ago, he was found to have hyperkalemia, at which time lisinopril and spironolactone were removed from his medication regimen. Currently, his medications include coumadin, aspirin, metformin, glyburide, metoprolol, furosemide, and amlodipine. His T is 37 C (98.6 F), BP 154/92 mm Hg, HR 80/min, and RR 16/min. His physical exam is notable for elevated jugular venous pressure, an S3 heart sound, and 1+ pitting pedal edema. His repeat lab work at the current visit is as follows: Sodium: 138 mEq/L, potassium: 5.7 mEq/L, chloride 112 mEq/L, bicarbonate 18 mEq/L, BUN 29 mg/dL, and creatinine 2.1 mg/dL. Which of the following is the most likely cause of this patient's acid-base and electrolyte abnormalities?? {'A': 'Furosemide', 'B': 'Chronic renal failure', 'C': 'Glyburide', 'D': 'Renal tubular acidosis', 'E': 'Amlodipine'}, | D: Renal tubular acidosis |
Answer the following medical question with one of the provided options: | Q:A 17-year-old boy comes to the physician because of a 3-month history of pain in his right shoulder. He reports that he has stopped playing for his high school football team because of persistent difficulty lifting his right arm. Physical examination shows impaired active abduction of the right arm from 0 to 15 degrees. After passive abduction of the right arm to 15 degrees, the patient is able to raise his arm above his head. The dysfunctional muscle in this patient is most likely to be innervated by which of the following nerves?? {'A': 'Suprascapular nerve', 'B': 'Long thoracic nerve', 'C': 'Axillary nerve', 'D': 'Upper subscapular nerve', 'E': 'Accessory nerve'}, | A: Suprascapular nerve |
Answer the following medical question with one of the provided options: | Q:A 72-year-old man is brought to the physician by his son because of gradually progressive yellow discoloration of his skin and generalized pruritus for the past 2 weeks. During this period, his appetite has decreased and he has had a 6.3-kg (14-lb) weight loss. He reports that his stool appears pale and his urine is very dark. Three years ago, he had an episode of acute upper abdominal pain that was treated with IV fluids, NSAIDs, and dietary modification. He has stopped drinking alcohol since then; he used to drink 1–2 beers daily for 40 years. He has smoked a pack of cigarettes daily for the past 50 years. His vital signs are within normal limits. Physical examination shows yellowing of the conjunctivae and skin. The abdomen is soft and nontender; a soft, cystic mass is palpated in the right upper quadrant. Serum studies show: Bilirubin, total 5.6 mg/dL Direct 4.8 mg/dL Alkaline phosphatase 192 U/L AST 32 U/L ALT 34 U/L Abdominal ultrasonography shows an anechoic cystic mass in the subhepatic region and dilation of the intrahepatic and extrahepatic bile ducts. Which of the following is the most likely diagnosis?"? {'A': 'Pancreatic adenocarcinoma', 'B': 'Choledocholithiasis', 'C': 'Alcoholic hepatitis', 'D': 'Cholecystitis', 'E': 'Budd-Chiari syndrome'}, | A: Pancreatic adenocarcinoma |
Answer the following medical question with one of the provided options: | Q:A 2-day-old infant dies of severe respiratory distress following a gestation complicated by persistent oligohydramnios. Upon examination at autopsy, the left kidney is noted to selectively lack cortical and medullary collecting ducts. From which of the following embryological structures do the cortical and medullary collecting ducts arise?? {'A': 'Pronephros', 'B': 'Mesonephros', 'C': 'Paramesonephric duct', 'D': 'Metanephric mesenchyme', 'E': 'Ureteric bud'}, | E: Ureteric bud |
Answer the following medical question with one of the provided options: | Q:A 2-year-old child is brought to the emergency department with rapid breathing and a severe cyanotic appearance of his lips, fingers, and toes. He is known to have occasional episodes of mild cyanosis, especially when he is extremely agitated. This is the worst episode of this child’s life, according to his parents. He was born with an APGAR score of 8 via a normal vaginal delivery. His development is considered delayed compared to children of his age. History is significant for frequent squatting after strenuous activity. On auscultation, there is evidence of a systolic ejection murmur at the left sternal border. On examination, his oxygen saturation is 71%, blood pressure is 81/64 mm Hg, respirations are 42/min, pulse is 129/min, and temperature is 36.7°C (98.0°F). Which of the following will most likely be seen on chest x-ray (CXR)?? {'A': 'Egg on a string', 'B': 'Boot-shaped heart', 'C': 'Displaced tricuspid valve', 'D': 'Pre-ductal coarctation of the aorta', 'E': 'Atrial septal defect'}, | B: Boot-shaped heart |
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